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Biomedical subjects

David W Baker

Publications and source records attributed to David W Baker.

At least 37 records · Page 2Linked to original sources
PubMed2005

A telephone survey to measure communication, education, self-management, and health status for patients with heart failure: the Improving Chronic Illness Care Evaluation (ICICE).

BACKGROUND: Many aspects of quality of care for heart failure cannot be reliably obtained by chart review. METHODS AND RESULTS: We created and tested a telephone survey to measure provider-patient communication; satisfaction; patient education, knowledge, and self-management; and health status for the Improving Chronic Illness Care Evaluation. A total of 781 patients participated in the survey; 62% were age 65 or older, 66% had a history of coronary artery disease, and 59% were cared for by a cardiologist. The measures of communication, satisfaction, patient education, knowledge, and self-management performed very well with low rates of missing values and good psychometric properties. The self-efficacy scale had acceptable reliability (Cronbach's alpha 0.69); however, it was weakly correlated with objective measures of knowledge about self-management. The Heart Failure Symptom Scale (HFSS) showed high reliability (Cronbach's alpha 0.88) and good correlation with the SF-12 Physical Health Summary Scale (r=0.63); the HFSS was also moderately correlated with measures of mental health. CONCLUSIONS: Reliable information about processes of care and health outcomes that cannot be reliably assessed by chart can be obtained by telephone. This tool should be useful for measuring quality of care for large patient populations and determining the effectiveness of quality improvement activities.

Aged↗
PubMed2005

Differences in education, knowledge, self-management activities, and health outcomes for patients with heart failure cared for under the chronic disease model: the improving chronic illness care evaluation.

BACKGROUND: The objective of this study was to determine whether participation in a quality improvement (QI) collaborative for heart failure (HF) was associated with better interpersonal aspects of care and health outcomes. METHODS AND RESULTS: We conducted a cross-sectional telephone survey of patients in 6 organizations who participated in a QI collaborative for HF (participants, n = 387) and 6 comparable control organizations (controls, n = 414) and measured provider-patient communication, education received, knowledge of HF, self-management behaviors, satisfaction, and quality of life. The participant group patients were more likely to report their doctor and nurse discussed treatment options and reviewed self-management (P < .01 for both). A total of 88% of participants were told to weigh themselves daily and record their weight compared with 34% of controls (P < .01). Participants were more likely to know how often to check their weight (P < .01), recognize symptoms of worsening HF (P < or = .01 for all), have a scale (P = .002), and monitor their weight daily (P < .001). Participants had similar quality of life but fewer emergency department visits and hospitalizations. CONCLUSION: Participation in a QI collaborative for HF was associated with better communication, education, and knowledge, and lower health care use. Collaboratives may be a useful method for disseminating quality improvement strategies.

Adolescent↗
PubMed2005

Does the collaborative model improve care for chronic heart failure?

BACKGROUND: Organizationally based, disease-targeted collaborative quality improvement efforts are widely applied but have not been subject to rigorous evaluation. We evaluated the effects of the Institute of Healthcare Improvement's Breakthrough Series (IHI BTS) on quality of care for chronic heart failure (CHF). RESEARCH DESIGN: We conducted a quasi-experiment in 4 organizations participating in the IHI BTS for CHF in 1999-2000 and 4 comparable control organizations. We reviewed a total of 489 medical records obtained from the sites and used a computerized data collection tool to measure performance on 23 predefined quality indicators. We then compared differences in indicator performance between the baseline and post-intervention periods for participating and non-participating organizations. RESULTS: Participating and control patients did not differ significantly with regard to measured clinical factors at baseline. After adjusting for age, gender, number of chronic conditions, and clustering by site, participating sites showed greater improvement than control sites for 11 of the 21 indicators, including use of lipid-lowering and angiotensin converting enzyme inhibition therapy. When all indicators were combined into a single overall process score, participating sites improved more than controls (17% versus 1%, P < 0.0001). The improvement was greatest for measures of education and counseling (24% versus -1%, P < 0.0001). CONCLUSIONS: Organizational participation in a common disease-targeted collaborative provider interaction improved a wide range of processes of care for CHF, including both medical therapeutics and education and counseling. Our data support the use of programs like the IHI BTS in improving the processes of care for patients with chronic diseases.

Chi-Square Distribution↗
PubMed2005

Patients' attitudes toward health care providers collecting information about their race and ethnicity.

BACKGROUND: Experts recommend that health care providers (HCPs) collect patients' race/ethnicity, but HCPs worry that this may alienate patients. OBJECTIVE: To determine patients' attitudes toward HCPs collecting race/ethnicity data. DESIGN: Cross-sectional survey. PARTICIPANTS: General Internal Medicine patients (n=220). MEASUREMENTS: Perceived importance of having HCPs collect race/ethnicity data, their concerns about this, comfort level providing this information, and reactions to 4 statements explaining the rationale for collecting this. RESULTS: Approximately 80% somewhat or strongly agreed that HCPs should collect information on patients' race/ethnicity. However, 28% had significant discomfort (score 5 or less on 10-point scale) reporting their own race/ethnicity to a clerk, and 58% were somewhat or very concerned that this information could be used to discriminate against patients. Compared with whites, blacks, and Hispanics felt less strongly that HCPs should collect race/ethnicity data from patients (P=.04 for both pairwise comparisons), and blacks were less comfortable reporting their own race/ethnicity than whites (P=.03). Telling patients that this information would be used for monitoring quality of care improved comfort more than telling patients that the data collected (a) was mandated by others, (b) would be used to guide staff hiring and training, and (c) would be used to ensure the patient got the best care possible. CONCLUSIONS: Most patients think HCPs should collect information about race/ethnicity, but many feel uncomfortable giving this information, especially among minorities. Health care providers can increase patients' comfort levels by telling them this will be used to monitor quality of care.

Attitude to Health↗
PubMed2005

Differences in leisure-time, household, and work-related physical activity by race, ethnicity, and education.

BACKGROUND: Racial and ethnic minority groups have lower levels of leisure-time physical activity (LTPA) than whites, but it is unclear how much of this is explained by differences in socioeconomic status and health. OBJECTIVE: To examine differences in LTPA, work-related physical activity (WRPA; heavy household chores and strenuous job activities), and total physical activity (TPA) by race, ethnicity, and education. DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional analyses of data from the 1992 Health and Retirement Study for a nationally representative cohort of 9,621 community-dwelling adults aged 51-61 years. MEASUREMENTS: Physical activity scores for LTPA, WRPA, and TPA based upon self-reported frequency of light or vigorous recreational activities, heavy household chores, and strenuous job-related physical activities. MAIN RESULTS: LTPA was lower for blacks and Hispanics compared to whites, and LTPA steadily declined with lower levels of education. WRPA showed the reverse pattern, being lowest for whites and persons with greater education. Education was far more important than race/ethnicity as a determinant of LTPA and WRPA in multivariate analyses. After adjusting for differences in overall health and physical functioning, mean TPA scores were similar across racial/ethnic and education categories; blacks (beta=1.0; 95% confidence interval [CI], 0.5 to 1.5) and Spanish-speaking Hispanics (beta=1.1; 95% CI, 0.3 to 1.9) had slightly higher levels of TPA than whites (P<.01 and P=.01, respectively). CONCLUSIONS: Differences in educational attainment and health status accounted for virtually all of the racial and ethnic differences in LTPA. After accounting for WRPA, TPA was similar across race, ethnicity, and education subgroups.

Black or African American↗
PubMed2004

Trends in postdischarge mortality and readmissions: has length of stay declined too far?

BACKGROUND: Length of hospital stay continues to decline, but the effect on postdischarge outcomes is unclear. METHODS: We determined trends in risk-adjusted mortality rates and readmission rates for 83,445 Medicare patients discharged alive after hospitalization for myocardial infarction, heart failure, gastrointestinal hemorrhage, chronic obstructive pulmonary disease, pneumonia, or stroke. Patients were stratified into deciles of observed/expected length of stay to determine whether patients whose length of stay was much shorter than expected had higher risk-adjusted mortality and readmission rates. Analyses were stratified by whether a do-not-resuscitate (DNR) order was written within 2 days of admission (early) or later. RESULTS: From 1991 through 1997, risk-adjusted postdischarge mortality generally remained stable for patients without a DNR order. Postdischarge mortality increased by 21% to 72% for patients with early DNR orders and increased for 2 of 6 diagnoses for patients with late DNR orders. Markedly shorter than expected length of stay was associated with higher than expected risk-adjusted mortality for patients with early DNR orders but not for others (no DNR and late DNR). Risk-adjusted readmission rates remained stable from 1991 through 1997, except for a 15% (95% confidence interval, 3%-30%) increase for patients with congestive heart failure. Short observed/expected length of stay was not associated with higher readmission rates. CONCLUSIONS: The dramatic decline in length of stay from 1991 through 1997 was not associated with worse postdischarge outcomes for patients without DNR orders. However, postdischarge mortality increased among patients with early DNR orders, and some of this trend may be due to patients being discharged more rapidly than previously.

Aged↗
PubMed2004

Changes in weight among a nationally representative cohort of adults aged 51 to 61, 1992 to 2000.

BACKGROUND: Few studies have examined patterns and predictors of changes in body weight among adults in late middle age. METHODS: Prospective cohort study of 7391 community-dwelling U.S. adults aged 51 to 61 years at baseline (1992), using publicly available data files from the 1992, 1994, 1996, 1998, and 2000 Health and Retirement Survey interviews. Changes in weight and body mass index (BMI) were examined for different racial/ethnic groups of men and women. The predictors of changes in body weight and BMI were determined using gender-specific linear regression. RESULTS: Mean body weight and BMI increased in both genders and all ethnic groups. The mean weight gain was higher for women (1.67 kg, 95% confidence interval [CI]=1.34-1.99) than for men (1.43 kg, 95% CI=1.17-1.68). White men and women had the lowest baseline BMI but tended to gain more weight than other racial/ethnic groups. In multivariate analyses, individuals who were older or had higher baseline weight showed less weight gain. Men were less likely to gain weight if their self-reported overall health at baseline was poor compared to those in excellent health. Regular light or vigorous recreational activities and work-related activities were not associated with less weight gain. Race, education, and income were not associated with weight gain in multivariate analyses. CONCLUSIONS: All population subgroups are at risk for weight gain. Public health messages should target diverse populations. The current levels of physical activity attained by this population do not appear to protect against weight gain.

Body Mass Index↗
PubMed2004

Variability in emergency physician decision making about prescribing opioid analgesics.

STUDY OBJECTIVE: The purpose of this study is to determine what factors influence emergency physicians' decisions to prescribe an opioid analgesic for 3 common, painful conditions. METHODS: We developed items thought to influence the decision to prescribe an opioid analgesic through a review of the literature, expert consultation, and interviews with practicing emergency physicians. We developed a baseline vignette and items expected to influence the decision for each of the 3 conditions: migraine, back pain, and ankle fracture. We surveyed 650 physicians randomly selected from the American College of Emergency Physicians. The influence of individual items was explored through a univariate analysis of the response distribution. Patterns were assessed by analytically creating scales. RESULTS: We received responses from 398 (63%) of the 634 eligible physicians. Physicians' likelihoods of prescribing an opioid showed marked variability, with at least 10% of physicians saying they were unlikely and 10% of physicians saying they were likely to prescribe for each condition. Physician responses to individual pieces of clinical information, such as the patient requesting "something strong" for the pain, were also highly variable, with at least 10% of physicians saying they would be negatively influenced by this request and at least 10% saying they would be positively influenced by it. CONCLUSION: Even when faced with identical case scenarios, physicians' decisions to prescribe opioid analgesics are highly variable. Moreover, the same clinical information, such as a patient requesting a strong analgesic, changes the likelihood of prescribing opioids in opposite directions for different physicians.

Analgesics, Opioid↗
PubMed2004

Health literacy and use of outpatient physician services by Medicare managed care enrollees.

OBJECTIVE: To determine whether inadequate functional health literacy adversely affects use of physician outpatient services. DESIGN: Cohort study. SETTING: Community. PARTICIPANTS: New Medicare managed care enrollees age 65 or older in 4 U.S. cities (N = 3,260). MEASUREMENTS AND MAIN RESULTS: We measured functional health literacy using the Short Test of Functional Health Literacy in Adults. Administrative data were used to determine the time to first physician visit and the total number of visits during the 12 months after enrollment. The time until first visit, the proportion without any visit, and adjusted mean visits during the year after enrollment were unrelated to health literacy in crude and multivariate analyses. Participants with inadequate and marginal health literacy were more likely to have an emergency department (ED) visit than those with adequate health literacy (30.4%, 27.6%, and 21.8%, respectively; P =.01 and P <.001, respectively). In multivariate analysis, the adjusted relative risk of having 2 or more ED visits was 1.44 (95% confidence interval, 1.01 to 2.02) for enrollees with marginal health literacy and 1.34 (1.00 to 1.79) for those with inadequate health literacy compared to participants with adequate health literacy. CONCLUSIONS: Inadequate health literacy was not independently associated with the mean number of visits or the time to a first visit. This suggests that inadequate literacy is not a major barrier to accessing outpatient health care. Nevertheless, the higher rates of ED use by persons with low literacy may be caused by real or perceived barriers to using their usual source of outpatient care.

Aged↗
PubMed2004

Comparison of responses to a US 2 dollar bill versus a chance to win 250 US dollars in a mail survey of emergency physicians.

OBJECTIVES: To evaluate whether small monetary incentives improve physicians' responses to surveys. To the best of the authors' knowledge, no one has evaluated emergency physicians' response rate and cost per participant of a small monetary incentive relative to a chance to win a more substantial sum. The authors compared emergency physicians' responses and per-participant costs between a US 2 dollar bill and a 250 US dollars lottery. METHODS: Two groups of 288 emergency physicians were randomly selected and mailed a survey. Within each group of 288, half received a US 2 dollar bill and the other half received an offer that respondents would be entered into a drawing to win 250 US dollars. Nonresponders received a reminder postcard one week later, and persistent nonresponders received a second mailing of the survey three weeks after the initial mailing. RESULTS: Of the 576 surveys that were mailed, nine (2%) subjects were ineligible or undeliverable, leaving 567 eligible subjects, of whom 301 (53%) participated in the survey. The US 2 dollar bill had a substantially higher response rate: 170 (56%) of those receiving a US 2 dollar bill participated versus 131 (44%) of those receiving a chance to win 250 US dollars (95% confidence interval = 5% to 22%; p < 0.001). The US 2 dollar bill offer was less expensive per participant than the 250 US dollars offer. The cost of postage and incentives was 997.33 US dollars for 170 participants, or 5.87 US dollars per participant, for the US 2 dollar bill and 979.29 US dollars for 131 participants, or 7.48 US dollars per participant, for the chance to win 250 US dollars. CONCLUSIONS: Mailing a US 2 dollar bill incentive produces a better response rate with lower cost per participant than offering a chance to win 250 US dollars.

Awards and Prizes↗
PubMed2004

Body mass index, physical activity, and the risk of decline in overall health and physical functioning in late middle age.

OBJECTIVES: We examined the relation between body mass index, exercise, overall health, and physical functioning. METHODS: We studied 7867 adults aged 51 to 61 years in 1992 to 1996. Adjusted relative risks for health decline and new physical difficulties were determined with logistic regression. RESULTS: Overweight and obesity were independently associated with health decline (adjusted relative risk [ARR] = 1.29 and 1.36) and development of a new physical difficulty (ARR = 1.27 and 1.45). Regular exercise significantly reduced the risk of health decline and development of a new physical difficulty, even among obese individuals. CONCLUSIONS: Maintaining ideal body weight is important in preventing decline in overall health and physical functioning. However, regular exercise can reduce the risk of health decline even among individuals who cannot achieve ideal weight.

Attitude to Health↗
PubMed2003

Mortality trends for 23,505 Medicare patients hospitalized with heart failure in Northeast Ohio, 1991 to 1997.

BACKGROUND: Clinical trials have identified major therapeutic advances for heart failure (HF), but the degree to which survival has improved among the general population of patients with HF is not known. This study analyzed mortality trends from 1991 to 1997 for 23,505 Medicare patients hospitalized with a first admission for HF at 29 Northeast Ohio hospitals. METHODS: We linked databases from the Cleveland Health Quality Choice (CHQC) program and Medicare to allow identification of first admissions for HF and death date. We adjusted for changes in admission illness severity using chart data from CHQC (eg, vital signs, do-not-resuscitate status, comorbid conditions, and laboratory results). Logistic regression was used to analyze trends in risk-adjusted mortality. RESULTS: At baseline (1991), crude inhospital, 30-day and 1-year mortality rates were 6.4%, 8.6% and 36.5%, respectively. Between 1991 and 1997, mean length of stay declined steeply from 9.2 days to 6.6 days (P <.001 for trend). Risk-adjusted inhospital mortality also declined markedly (absolute-decline -3.7%, 95% CI -4.3 to -3.0), a 52.8% relative decrease. However, the decline in 30-day mortality was only -1.4% (95% CI -2.5 to -0.1, P <.05), a 15.3% relative decrease. The 1-year mortality declined -5.3% (95% CI -3.2 to -7.4, P <.001), a 14.6% relative decrease. CONCLUSIONS: Long-term mortality for patients hospitalized with HF improved from 1991 to 1997, although mortality remains very high. The 30-day mortality declined far less than inhospital mortality, indicating that mortality shortly after discharge increased. This raises concerns that the marked reduction in length of stay is causing adverse consequences.

Aged↗
PubMed2003

Screening for left ventricular systolic dysfunction among patients with risk factors for heart failure.

BACKGROUND: The prevalence of left ventricular systolic dysfunction (LVSD) among individuals at risk for heart failure (HF) and the feasibility of screening have not been clearly defined. This study determined the prevalence of LVSD with the use of a limited screening echocardiogram among patients with risk factors for HF but no prior HF. METHODS: General medicine patients > or =60 years of age with hypertension, diabetes, coronary artery disease, or previous myocardial infarction (MI) but no history of HF or reduced left ventricular ejection fraction (LVEF) were eligible. Medical history and symptoms of breathlessness were determined by interview and chart review; consenting patients underwent electrocardiography and echocardiography. The outcome was LVEF < or =45%, based on visual estimation from the echocardiogram. RESULTS: Of the 482 patients who completed the study, only 1 patient could not have the LVEF visually estimated. A total of 7.9% of patients had LVEF < or =45%. The prevalence was 15.4% among those with a prior MI and 6.7% among those without prior MI. In multivariate analysis, prior MI (adjusted odds ratio, 2.75; 95% CI, 1.14 to 6.64) and probable or definite left ventricular hypertrophy by electrocardiography (adjusted odds ratio, 3.57; 95% CI, 1.22 to 10.48) were the strongest predictors of LVEF < or =45%. CONCLUSIONS: Screening for LVSD among high-risk patients is feasible and has substantial yield, even among patients without prior MI. In light of the low cost of screening and the available therapies to prevent progression of LVSD to overt HF, controlled clinical trials of screening high-risk subgroups appear to be justified.

Aged↗
PubMed2003

Health literacy and knowledge of chronic disease.

We sought to examine the relationship between health literacy and knowledge of disease among patients with a chronic disease. A total of 653 new Medicare enrollees aged 65 years or older who had at least one chronic disease (115 asthma, 266 diabetes, 166 congestive heart failure, 214 hypertension), completed both the in-person and telephone survey. Health literacy measured by the short test of functional health literacy in adults (S-TOFHLA) and demographic information were collected during the in-person survey. Knowledge of disease was assessed by questions based on key elements in educational materials during a telephone survey. Overall, 24% of patients had inadequate and 12% had marginal health literacy skills. Respondents with inadequate health literacy knew significantly less about their disease than those with adequate literacy. Multivariate analysis indicated that health literacy was independently related to disease knowledge. There are many opportunities to improve patients' knowledge of their chronic disease(s), and efforts need to consider their health literacy skills.

Aged↗
PubMed2003

Changes in the use of do-not-resuscitate orders after implementation of the Patient Self-Determination Act.

OBJECTIVE: To determine changes in the use of do-not-resuscitate (DNR) orders and mortality rates following a DNR order after the Patient Self-determination Act (PSDA) was implemented in December 1991. DESIGN: Time-series. SETTING: Twenty-nine hospitals in Northeast Ohio. PATIENTS/PARTICIPANTS: Medicare patients (N = 91,539) hospitalized with myocardial infarction, heart failure, gastrointestinal hemorrhage, chronic obstructive pulmonary disease, pneumonia, or stroke. MEASUREMENTS AND MAIN RESULTS: The use of "early" (first 2 hospital days) and "late" DNR orders was determined from chart abstractions. Deaths within 30 days after a DNR order were identified from Medicare Provider Analysis and Review files. Risk-adjusted rates of early DNR orders increased by 34% to 66% between 1991 and 1992 for 4 of the 6 conditions and then remained flat or declined slightly between 1992 and 1997. Use of late DNR orders declined by 29% to 53% for 4 of the 6 conditions between 1991 and 1997. Risk-adjusted mortality during the 30 days after a DNR order was written did not change between 1991 and 1997 for 5 conditions, but risk-adjusted mortality increased by 21% and 25% for stroke patients with early DNR and late DNR orders, respectively. CONCLUSIONS: Overall use of DNR orders changed relatively little after passage of the PSDA, because the increase in the use of early DNR orders between 1991 and 1992 was counteracted by decreasing use of late DNR orders. Risk-adjusted mortality rates after a DNR order generally remained stable, suggesting that there were no dramatic changes in quality of care or aggressiveness of care for patients with DNR orders. However, the increasing mortality for stroke patients warrants further examination.

Aged↗