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D S Shepard

Publications and source records attributed to D S Shepard.

47 records · Page 3Linked to original sources
PubMed1977

A pitfall in sampling medical visits.

Samples of outpatient visits often must be used to identify users of a health facility with a given chronic condition. Such samples can lead to biases, however, because patients with more frequent visits are overrepresented. These biases can be avoided by a weighting procedure in which each sampled visit is weighted inversely to the number of clinic visits made by that patient during the sample period. This procedure proved critical in estimating the number and characteristics of hypertensive patients seen in the medical clinic of a teaching hospital. The unweighted estimate of the number of hypertensives was 7,373 patients, more than three times the weighted estimate of 2,250. Similarly,, the number of visits per year by these patients would be overestimated by almost 50 per cent without weighting. The estimated proportion of hypertensives still under treatment after 18 months was 68 per cent without weighting, compared to 51 per cent with weighting. Thus biases from failure to weight may be substantial. Analogous biases and solutions apply to other sampling problems in health services research.

Humans↗
PubMed1976

Mailed versus telephoned appointment reminders to reduce broken appointments in a hospital outpatient department.

This study compared mail, telephone, and control strategies to reduce the rate of broken appointments in a pediatric outpatient department. Based on 1,039 randomly assigned appointments, the mail strategy had a broken appointment rate of 29.1 per cent, the telephone strategy of 25.3 per cent, and the control of 44.2 per cent. Both strategies were significantly effective, but the difference between them was not significant. Patients without telephones had a higher rate of broken appointments than patients with telephones. Mailed reminders are the more cost-effective intervention.

Appointments and Schedules↗
PubMedDate not supplied

The impact of substance abuse treatment modality on birth weight and health care expenditures.

During the 1990s, substance abuse treatment programs were developed for pregnant women to help improve infant birth outcomes, reduce maternal drug dependency and promote positive lifestyle changes. This study compared the relative impact of five treatment modalities--residential, outpatient, residential/outpatient, methadone and detoxification-only--on infant birth weight and perinatal health care expenditures for a sample of 445 Medicaid-eligible pregnant women who received treatment in Massachusetts between 1992 and 1997. Costs and outcomes were measured using the Addiction Severity Index and data from birth certificates, substance abuse treatment records and Medicaid claims. Multiple regression was used to control for intake differences between the groups. Results showed a near linear relationship between birth weight and amount of treatment received. Women who received the most treatment (the residential/outpatient group) delivered infants who were 190 grams heavier than those who received the least treatment (the detoxification-only group) for an additional cost of $17,211. Outpatient programs were the most cost-effective option, increasing birth weight by 139 grams over detoxification-only for an investment of only $1,788 in additional health care and treatment costs. A second regression using five intermediate treatment outcomes--prenatal care, weight gain, relapse, tobacco use and infection--suggested that increases in birth weight were due primarily to improved nutrition and reduced drug use, behaviors which are perhaps more easily influenced in residential settings.

Adult↗
PubMedDate not supplied

Small-area variations in rates of hospitalization and surgery within Rhode Island.

We analyzed variations in the usage rates and costs of 13 surgical procedures among 37 cities and towns in the state of Rhode Island. To compare different operations and years, we defined the deviation index, a percentage indicator similar to the coefficient of variation, but with chance variation removed. Tonsillectomy and disc excision were the procedures for which rates varied most around the state average; their deviation indexes for 1981 were 40.5 percent and 38.9 percent, respectively. In 14 areas, rates for one of these two procedures (standardized for age and sex) were significantly (p less than .01) above or below the state average; such outlying observations would have been expected for only one area if rates had been uniform statewide. To indicate the relative amount of surgery in an area combining rates for all 13 procedures, we computed the area's surgical index. This index, the average of the ratios of observed to expected cases (based on standardized statewide rates), doubled from the lowest- to the highest-rate areas. Overall, surgical hospital days, nonsurgical days, total hospital days, and hospital costs (all per 1,000 population) doubled from lowest- to highest-rate areas. If the rates of these 13 surgical procedures could be lowered in high-rate areas to not more than 20 percent above the state average, usage could drop by 4 percent. We conclude that even within the small state of Rhode Island, surgical practice varies considerably across communities. Identifying and studying areas with extremely high or low rates should enable more explicit consideration of the indications for surgery and perhaps lead to lower costs for medical care.

Adolescent↗