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Biomedical subjects

D C Cherkin

Publications and source records attributed to D C Cherkin.

At least 55 records · Page 3Linked to original sources
PubMed1992

Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases.

Administrative databases are increasingly used for studying outcomes of medical care. Valid inferences from such data require the ability to account for disease severity and comorbid conditions. We adapted a clinical comorbidity index, designed for use with medical records, for research relying on International Classification of Diseases (ICD-9-CM) diagnosis and procedure codes. The association of this adapted index with health outcomes and resource use was then examined with a sample of Medicare beneficiaries who underwent lumbar spine surgery in 1985 (n = 27,111). The index was associated in the expected direction with postoperative complications, mortality, blood transfusion, discharge to nursing home, length of hospital stay, and hospital charges. These associations were observed whether the index incorporated data from multiple hospitalizations over a year's time, or just from the index surgical admission. They also persisted after controlling for patient age. We conclude that the adapted comorbidity index will be useful in studies of disease outcome and resource use employing administrative databases.

Aged↗
PubMed1992

Use of the International Classification of Diseases (ICD-9-CM) to identify hospitalizations for mechanical low back problems in administrative databases.

Large administrative databases are increasingly valuable tools for health care research. Although increased access to these databases provides valuable opportunities to study health care utilization, costs and outcomes and valid and comparable results require explicit and consistent analytic methods. Algorithms for identifying surgical and nonsurgical hospitalizations for "mechanical" low back problems in automated databases are described. Sixty-six ICD-9-CM diagnosis and 15 procedure codes that could be applied to patients with mechanical low back problems were identified. Twenty-seven diagnosis and two procedure codes identify hospitalizations for problems definitely in the lumbar or lumbosacral region. Exclusion criteria were developed to eliminate nonmechanical causes of low back pain, such as malignancies, infections, and major trauma. The use of the algorithms is illustrated using national hospital discharge data.

Algorithms↗
PubMed1992

Morbidity and mortality in association with operations on the lumbar spine. The influence of age, diagnosis, and procedure.

We examined the rates of postoperative complications and mortality, as recorded in a hospital discharge registry for the State of Washington for the years 1986 through 1988, for patients who had had an operation on the lumbar spine. When patients who had had a malignant lesion, infection, or fracture are excluded, there were 18,122 hospitalizations for procedures on the lumbar spine, 84 per cent of which involved a herniated disc or spinal stenosis. The rates of morbidity and mortality during hospitalization, as well as the hospital charges, increased with the ages of the patients. The rate of complications was 18 per cent for patients who were seventy-five years or older. Nearly 7 per cent of patients who were seventy-five years old or more were discharged to nursing homes. Complications were most frequent among patients who had spinal stenosis, but multivariate analysis suggested that the complications associated with procedures for this condition were primarily related to the patient's age and the type of procedure. Complications, length of hospitalization, and charges were higher for patients who had had a spinal arthrodesis than for those who had not. Over-all, operations for conditions other than a herniated disc were associated with more complications and greater use of resources, particularly when arthrodesis was performed, than were operations for removal of a herniated disc. No data on symptoms or functional results were available.

Adolescent↗
PubMed1990

The effect of office visit copayments on preventive care services in an HMO.

We examined the impact of a $5 office visit copayment on use of preventive care services by Washington State enrollees in a health maintenance organization. Utilization data were compared for 30,415 State enrollees and 21,633 enrollees without copayments who were enrolled 12 months before and after the start of copayments. Copayments resulted in a 14% decrease in physical examinations but did not significantly affect immunization rates for young children, cancer screening tests received by women, or medication use by persons with cardiovascular disease. For employed populations small copayments appear to have little impact on the most valuable types of preventive care services.

Adolescent↗
PubMed1989

The effect of office visit copayments on utilization in a health maintenance organization.

This study estimated the impact of a $5 copayment on office visit rates in a health maintenance organization. A quasi-experimental design was used to compare the observed changes in visit rates by state government enrollees between the year before copayments and their first year of copayments with changes between the same time periods for a control group of enrollees without copayments. Visit data for 30,415 state enrollees and 21,633 federal enrollees who were enrolled continuously for at least 12 months before and after the start of copayments were obtained from automated data systems. The introduction of a $5 copayment for office visits resulted in an estimated 10.9% decrease in primary care visits (95% confidence interval (CI): -13.4% to -8.4%) and a 3.3% drop in specialty care visits (95% CI: -15.6% to +9.0%). The effect of copayments on primary care visits by enrollees under 40 years of age was twice as large for females as for males. Copayments also had a significantly greater impact on enrollees who were high users (greater than ten primary care visits) during the year before copayments. The copayment effect was immediate and did not diminish over the 12-month study period.

Adolescent↗
PubMed1989

Patient evaluations of low back pain care from family physicians and chiropractors.

We compare health maintenance organization enrollees' evaluations of the care they received from family physicians and chiropractors for low back pain. Patients of chiropractors were three times as likely as patients of family physicians to report that they were very satisfied with the care they received for low back pain (66% versus 22%, respectively). Compared with patients of family physicians, patients of chiropractors were much more likely to have been satisfied with the amount of information they were given, to have perceived that their provider was concerned about them, and to have felt that their provider was comfortable and confident dealing with their problem. Although the more positive evaluations of chiropractors may be related to differences in the patient populations served by the two providers or to benefits of spinal manipulation, it is suggested that a potentially more potent force--the therapeutic effect of the patient and provider interaction itself--may explain the observed differences.

Adolescent↗
PubMed1988

Managing low back pain--a comparison of the beliefs and behaviors of family physicians and chiropractors.

Random samples of 605 family physicians and 299 chiropractors in Washington were surveyed to determine their beliefs about back pain and how they would respond to three hypothetic patients with back pain. With 79% of the family physicians and 70% of the chiropractors responding, family physicians and chiropractors differed greatly not only in their technical approaches to back pain--such as drug therapy versus spinal manipulation--but also in their underlying beliefs and attitudes. Family physicians think that most back pain is caused by muscle strain, that lumbosacral radiographs are rarely useful, that appropriate therapy does not depend on a precise diagnosis, and that back pain will usually resolve within a few weeks without professional help. Family physicians were more likely than chiropractors to feel frustrated by patients with back pain, less likely to think they can help patients prevent future episodes of back pain, and less confident that their patients are satisfied with their care. Studies are needed to determine whether the different perspectives of family physicians and chiropractors are associated with differences in the costs and outcomes of care.

Adult↗
PubMed1988

How patients and physicians address each other in the office.

Six hundred four patients in three primary care office settings were asked whether they preferred to be addressed by their physician by their first or last name and whether they preferred to address their physician by first or last name. Actual use of first vs last name by the physician addressing the patient and the patient addressing the physician was also recorded. Of the patients expressing a preference, 96 percent preferred that their physician address them by first name while 87 percent noted that this gesture actually occurred. Forty percent of the patients preferred to address the physician by first name while 14 percent actually did so. These findings suggest that physicians can feel comfortable addressing almost all of their patients by first name and that many of their patients may desire to address them by their first name. It is suggested that the physician at the time of the patient's first visit clarify the manner in which each addresses the other.

Adolescent↗
PubMed1988

Patient satisfaction with family physicians and general internists: is there a difference?

Although general internists and family physicians see similar types of patients, they have been found to have different styles of practice. It is not known whether these differences in practice style are associated with differences in outcomes of care such as patient satisfaction. This study examined whether patients of family physicians and general internists have different perceptions of the care they receive. National samples of recently trained family physicians and general internists were asked to complete questionnaires about their practices and to record information on all patient encounters during a three-day period. Three patients were randomly sampled from among those seen by each physician during the study period and were sent questionnaires that included questions about their satisfaction with the medical care they were receiving from the physician. Two hundred thirteen adult patients who saw 124 family physicians and 218 adult patients who saw 98 general internists participated in this study. Patients of general internists and of family physicians reported similar levels of satisfaction on all four dimensions measured (access, humaneness, quality, and general satisfaction) even after controlling for the effects of a variety of patient, practice, physician, and encounter characteristics. It is concluded that the fundamental differences in practice style that have been reported between family physicians and general internists do not seem to be associated with differences in patient satisfaction.

Consumer Behavior↗
PubMed1987

The use of medical resources by residency-trained family physicians and general internists. Is there a difference?

This study compared the use of medical resources by recently trained family physicians and general internists. Analyses are based on records of 3,737 adult office encounters with 132 family physicians and 2,250 adult office encounters with 102 general internists. General internists are twice as likely as family physicians to order blood tests, blood counts, chest x-rays, and electrocardiograms for their adult patients. Internists also spend more time with patients, and refer and hospitalize them at slightly higher rates. The different practice styles of general internists and family physicians were evident for adult patients of all ages and for patients with essential benign hypertension. The average per visit charge for diagnostic tests ordered during follow-up visits with hypertensive patients was estimated to be $11.97 for patients seen by general internists and $5.67 for patients seen by family physicians. These findings persisted after controlling for a variety of patient, practice, and physician characteristics.

Diagnostic Tests, Routine↗
PubMed1986

A comparison of the patients and practices of recent graduates of family practice and general internal medicine residency programs.

This study compares the characteristics of the practices and patients of recent graduates of family practice and general internal medicine residency programs. National samples of 104 family physicians and 134 general internists completed questionnaires and provided log-diary data for more than 7,500 office visits and 1,100 hospitalized patients. Family physicians and general internists were generally similar in demographic and practice characteristics, though family physicians were more likely to have entered office-based practice (90% versus 70%). Among office-based physicians, family physicians saw more patients per week in ambulatory settings (117.3 versus 74.6), whereas general internists had more patients in the hospital (6.45 versus 3.81) and provided more hospital consultations per week (2.74 versus 0.45). Family physicians practiced in smaller communities and were more likely to practice on Saturday mornings, to accept walk-in patients, and to schedule appointments for new patients within 1 week. Both specialties functioned as first-contact generalists for at least 95% of office encounters. Although pediatrics and obstetrics are practiced only by family physicians and general internists see proportionately more older patients, within specific age groups the patients of general internists and family physicians were similar in terms of their main health problems, functional status, and diagnoses.

Data Collection↗
PubMed1986

Diagnosis clusters adapted for ICD-9-CM and ICHPPC-2.

An ad hoc committee of the North American Primary Care Research Group (NAPCRG) was appointed to adapt the diagnosis clusters instrument for use with the International Classification of Diseases (ICD-9-CM) and the International Classification of Health Problems in Primary Care (ICHPPC-2). This article describes the development and testing of the final roster of 110 diagnosis clusters for family physicians. Almost 90 percent of all diagnoses recorded by family physicians in a variety of settings were included in the clusters. The diagnosis clusters can be used in the analysis of large databases and facilitate comparisons between different providers and practices.

Ambulatory Care↗
PubMed1984

The impact of residency training on the productivity of family physicians.

Because of a projected rapid increase in the proportion of family physicians who are residency graduates, it is important to understand the impact of residency training on practice patterns. In this study of the effect of family practice residency training on productivity, residency graduates were found to have seen 21.5% fewer patients per hour but to have spent commensurately more time per patient visit than did their counterparts without residency training. This relationship persisted even after controlling for a variety of physician and practice characteristics, including physician age, practice organization, and geographic region.

Adult↗
PubMed1984

A method for estimating the population at risk in primary care practices by applying correction factors to the active patient census.

Epidemiological research based in primary care practices has been hindered by the inability to estimate the number of persons served by individual practices. This study examines one method proposed as a means of estimating practice populations. The effectiveness of this "correction factor" method depends on uniformity in the proportion of persons visiting a physician in a two-year period across various sociodemographic subpopulations in the United States. The National Health Interview Survey data were examined for evidence of such uniformity. Within broad age-sex categories there was little variation by race, educational level, income, Spanish ancestry, or location of residence in the proportion reporting a physician visit within the previous two years. Although these results are encouraging, a number of problems remain before the "correction factor" method can be credibly used to estimate practice denominators.

Adolescent↗
PubMed1984

Inpatient diagnosis clusters: analyzing hospital care in family practice.

Hospital care is an important component of family practice in the United States, but the study of this area has been impeded by the lack of a simple and clinically meaningful method of categorizing the diagnostic problems that make up the inpatient workload. This paper extends the method of diagnosis clusters--first used in the analysis of ambulatory care--to the hospital setting. Using the University of Southern California Medical Activities and Manpower Study of office-based general and family physicians, 52 clinically discrete diagnosis clusters were developed that include 78 percent of all principal diagnoses recorded in the hospital during the study interval. Fifty percent of all hospital encounters can be incorporated in only 15 clusters. Data clustered using this technique demonstrate that clinical problems such as ischemic heart disease and malignant neoplasms represent a major part of the family physician's hospital workload, a fact that has important implications for training and practice. Diagnosis clustering should facilitate further study of the hospital activities of primary care physicians.

California↗