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Duncan Neuhauser

Publications and source records attributed to Duncan Neuhauser.

16 recordsLinked to original sources
PubMed2006

Functional status decline as a measure of adverse events in home health care: an observational study.

BACKGROUND: Research that examines the quality of home health care is complex because no gold standard exists for measuring adverse outcomes, and because the patient and clinician populations are highly heterogeneous. The objectives in this study are to develop models to predict functional decline for three indices of functional status as measures of adverse events in home health care and determine which index is most appropriate for risk-adjusting for future quality research. METHODS: Data come from the Outcomes and Assessment Information Set (OASIS) from a large urban home health care agency and other agency data. Prognostic data yields 49,437 episodes, while follow-up data yields 47,684 episodes. We tested three indices defined as substantial decline in three or more (gt3_ADLs), two or more (gt2_ADLs), and one or more (gt1_ADLs) ADLs. Multivariate logistic regression determines the performance of the models for each index as measured by the c-statistic and Hosmer-Lemeshow chi square (chi2). RESULTS: Frequencies for gt3_ADLs, gt2_ADLs, and gt1_ADLs are 212 (0.43%), 783 (1.58%), and 4,271 (8.64%) respectively. Follow-up results are comparable with frequencies of 218 (0.46%), 763 (1.60%), and 3,949 (8.28%) for each index. Gt3_ADLs does not produce valid models. The model for gt2_ADLs consistently yields a higher c-statistic compared to gt1_ADLs (0.754 vs. 0.679, respectively). Both indices' models yield non-significant Hosmer-Lemeshow chi square indicating reasonable model fit. Findings for gt2_ADLs and gt1_ADLs are consistent over time as indicated by follow-up data results. CONCLUSION: Gt2_ADLs yields the best models as indicated by a high c-statistic and a non-significant Hosmer-Lemeshow chi2, both of which exhibit exceptional consistency. We conclude that gt2_ADLs may be preferable in defining ADL adverse events in the context of home health care.

Activities of Daily Living↗
PubMed2006

A student-written, faculty-reviewed, free, on-line textbook of public health management and policy.

A student-written, faculty-reviewed, on-line textbook of public health management and policy has been created in conjunction with a course on this subject. Writing a chapter is a requirement for course credit. With each class, each year, this textbook is revised and in 2005 is in its sixth edition. This book is in the public domain and can be copied and used by others without permission and for free.

Curriculum↗
PubMed2004

Time-between control charts for monitoring asthma attacks.

BACKGROUND: The monitoring of peak expiratory flow rate (PEFR) is crucial for effective management of asthma. Daily PEFR monitoring is recommended, yet the data are rarely used by patients to help them understand their progress or by clinicians to modify treatment plans. Time-between control charts, which have been shown to be specially suited for monitoring rare events, can be used to monitor asthma attacks. METHODS: Each patient is asked to record his or her PEFR value once a day, and these data are used to construct the control chart. PEFR data for three previously reported cases are presented and used to illustrate the control chart methodology. If duration of consecutive attacks is plotted and the observed duration exceeds the upper control limit (UCL), the patient is getting worse. If length of consecutive symptom-free days is plotted and the observed duration exceeds the UCL, the patient is getting better. In both circumstances, the clinician and the patient explore what brought about the prolonged recovery or periods of deterioration. The object is to increase time until the next attack. DISCUSSION: Using time-between control charts in monitoring asthma attacks has the advantage of providing a visual display of data that, unlike eyeballing of trends, clarifies when patients should seek additional clinical advice. The control limit allows clinicians and patients to ignore random variations and focus on real changes in underlying patterns of asthma attacks.

Asthma↗
PubMed2004

The sensitivity of Medicare data for identifying incident cases of invasive melanoma (United States).

BACKGROUND: The completeness of Medicare claims for identifying patients with melanoma for purposes of conducting population-based studies of melanoma is unknown. METHODS: Using a linked Surveillance, Epidemiology, and End Result (SEER) tumor registry-Medicare database, the sensitivity of Medicare claims for identifying 5372 patients age > or =65 years diagnosed with invasive melanoma between 1992 and 1996 was determined. Sensitivity was calculated as the proportion of incident cases of melanoma reported by SEER that was also captured by Medicare claim diagnostic codes. RESULTS: The overall sensitivity of combined Part A and Part B Medicare for incident cases of melanoma was 90.1%. Part B Medicare and Part A Medicare alone had 89.5% and 16.5% sensitivity respectively. Sensitivity was lower for patients with unrecorded Breslow depth and for patients with unstaged or distant stage melanoma. CONCLUSIONS: Medicare Part B claims have a high sensitivity for detecting melanoma incidence; Medicare Part A has low sensitivity. This sharply contrasts with published studies of other cancers, for whom Part A rather than Part B Medicare captures the predominant portion of incident cases. Medicare Part B or combined Part A and Part B administrative data is a potentially valuable resource for population-based melanoma research in the elderly. Further research characterizing the specificity and predictive value of Medicare data is needed to assess the potential implications of false positive melanoma diagnostic codes.

Aged↗
PubMed2004

Geographic and patient variation in receipt of surveillance procedures after local excision of cutaneous melanoma.

Little is known about variation in surveillance practices following the diagnosis of invasive melanoma. The objective of this study was to characterize geographic, patient, and tumor variation in the use of follow-up surveillance testing in patients with local or regional stage melanoma. A cohort of Medicare beneficiaries > or =65 y diagnosed with invasive melanoma during 1992 to 1996 living in a Surveillance, Epidemiology, and End Results registry area was studied. Outpatient and inpatient Medicare claims 3 mo following diagnosis were examined for up to 2 y for surveillance procedures of interest. Use of chest X-ray, chest computed tomography scan, abdominal and/or pelvic computed tomography scan, abdominal ultrasound, head computed tomography scan, head magnetic resonance imaging, laboratory testing, and skin examinations were compared between patient groups and geographic regions. A total of 3389 patients were identified for the analysis. Surveillance testing was relatively common, ranging from 13% for abdominal ultrasound to 80% for laboratory testing. Follow-up skin examinations were performed in 70% to 90% of patients. The use of most surveillance procedures was associated (p<0.01) with younger age, male gender, regional stage tumors, and geographical area, with up to 2-fold differences observed. In contrast, there was much less variability in the receipt of skin examinations. Further studies are needed to determine the etiology and impact of such disparities, and the influence of surveillance procedures on morbidity and mortality.

Aged↗
PubMed2004

Electrical twitch-obtaining intramuscular stimulation in lower back pain: a pilot study.

OBJECTIVES: To determine if electrical twitch-obtaining intramuscular stimulation (ETOIMS) provides greater myofascial lower back pain relief than muscle stimulation or skin stimulation. DESIGN: In this single-blinded, crossover, pilot trial performed at a university-affiliated outpatient rehabilitation medicine department in Taiwan, 12 acupuncture-naive patients with lower back pain of 3-60 mos duration received one crossover treatment every 2 wks by monopolar needle electrode insertion at bilateral T10-S1 levels to: (1) paraspinal muscles, (2) overlying skin, and (3) paraspinal muscles with ETOIMS applied via the needle electrode at individual treatment sites. A total of 30 manual insertions per side per treatment were performed, with withdrawal after 2 secs. Beginning 1 wk before each trial and continuing until 2 wks after, patients completed a visual analog scale twice daily. In addition, on the day of treatment, patients received a physical examination and completed a visual analog scale both before and after treatment. RESULTS: Significant and immediate reduction in the visual analog scale levels was noted only with ETOIMS. Immediate improvement occurred in one of nine physical tests with muscle stimulation and ETOIMS only. In the 2 wks after treatment, absolute visual analog scale levels for ETOIMS were significantly lower than muscle stimulation and skin stimulation. ETOIMS resulted in a greater percentage of pain relief in the first week after treatment, although it was not statistically significant from muscle stimulation and skin stimulation. CONCLUSIONS: ETOIMS provided significantly greater immediate and sustained myofascial lower back pain relief than muscle stimulation and skin stimulation. Although a greater percentage of pain reduction occurred with ETOIMS, it was not statistically significant.

Acupuncture Therapy↗
PubMedDate not supplied

The coming third health care revolution: personal empowerment.

The financing and organization of health care in the United States has been rapidly evolving in the last 30 years. Managed care and capitation have largely replaced fee-for-service as a way to pay providers. Cost-control initiatives were developed by payers. These crude cost-control methods proved insufficient and new approaches were developed. These might be referred to as disease management that includes evidence-based medicine and outcomes measurement. It is proposed that a third revolution, patient empowerment, is just starting. The potential far-reaching consequences are described, discussed, and analyzed here, including their cost consequences.

Capitation Fee↗
PubMedDate not supplied

Measuring performance improvement: total organizational commitment or clinical specialization.

BACKGROUND: Resources for hospitals are limited when they are faced with multiple publicly reported performance measures as tools to assess quality. The leadership in these organizations may choose to focus on 1 or 2 of these outcomes. An alternative approach is that the leadership may commit resources or create conditions that result in improved quality over a broad range of measures. METHODS: We used aggregated data on mortality, length of stay, and obstetrical outcomes from Greater Cleveland Health Quality Choice data to test these theories. We used Pearson correlation analysis to determine of outcomes were correlated with one another. We used repeated-measures ANOVA to determine if an association existed between outcome and time and outcome and hospital. RESULTS: All of the outcomes across all hospitals demonstrate a trend of overall improvement. Both the Pearson and ANOVA result support the hypothesis for the organization-wide approach to quality improvement. CONCLUSIONS: Hospital that make improvements in one clinical area trend to make improvements in others. Hospitals that produce improvements in limited clinical or administrative areas may not have completely adopted CQI into their culture or may not have yet realized the benefits of their organizational commitments, but use some of the concepts to improve quality outcomes.

Humans↗