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E Oddone

Publications and source records attributed to E Oddone.

7 recordsLinked to original sources
PubMed1995

Measuring activities in clinical trials using random work sampling: implications for cost-effectiveness analysis and measurement of the intervention.

Determining research-related costs from intervention-related costs is important for both clinical and health services research. Often this task involves estimating what proportion of the workday personnel spend on a variety of activities. We used a portable random reminder beeper to measure the daily work activities and contacts of study nurses within the context of a multi-site randomized trial designed to assess the effectiveness of primary care. Nurses recorded 4920 work activities over 140 consecutive workdays. Research-related activities consumed the largest proportion of the workday, 42.5% (95% CI, 38.1-46.7) followed by patient care, 28.8% (24.1-33.2), personal time 16.4% (12.0-20.7), and time spent in transit 12.5% (9.1-15.9). Because this research-related time is spent performing tasks specific to the enrollment of patients and measurement of outcome variables, we will use an adjusted annual salary for these nurses (from $56,392-$32,425) when attributing costs of the intervention in cost-effectiveness analyses and for future management projections. Work sampling is a flexible, inexpensive method that was well accepted by the nurses in this study. Our results provide important insights into the costs analysis of complex interventions involving health professionals and may allow us to explore why the intervention worked or did not work at individual sites.

Clinical Trials as Topic↗
PubMed1994

Time analysis of a general medicine service: results from a random work sampling study.

OBJECTIVE: To describe a novel method of time analysis for health care settings by quantifying internal medicine housestaff's work activities and contacts. DESIGN: Observational work sampling study based on random sampling technique. SETTING: General medicine service in a university hospital. PARTICIPANTS: All housestaff (18 interns, 18 residents) rotating through the general medicine service during a 12-week period. MAIN OUTCOME MEASURES: Proportion of time spent doing 22 work activities and proportion of time spent with 13 work contacts, reported separately for interns and residents and for on-call days and off-call days. RESULTS: The authors sampled 6,599 unique time observations (3,533 from on-call days, 3,066 from off-call days) during 193 housestaff workdays. The housestaff spent a majority of their time engaged in direct patient care activities (81% of the interns' workdays, and 64.5% of the residents' workdays), primarily in patient evaluation and follow-up (48% of the interns' and 39% of the residents' workdays). Compared with the interns, the residents spent relatively more time in direct educational activities (conferences, reading, teaching): 27% of the residents' workdays versus 10% of the interns' workdays. Analysis of work contacts showed that the housestaff spent a large portion of the workday alone: 27% of the residents' and 34% of the interns' workdays. The housestaff also spent a large portion of the workday with attending physicians: 23% of the residents' and 11% of the interns' workdays. This translates into 21 hours/week of attending supervision for the residents and 10 hours/week for the interns. CONCLUSIONS: Using random work sampling, the authors found that the vast majority of the houseofficer's workday was spent in direct patient care. This method of time analysis may be used to describe housestaff training and supervision, as well as to evaluate administrative interventions designed to change housestaff work experience.

Hospitals, University↗
PubMed1994

Lack of association between patients' measured burden of disease and risk for hospital readmission.

Identifying patients at increased risk for hospital readmission is important for clinicians, health policy-makers, hospital administrators, and researchers. We used a retrospective case-control design to compare the clinimetric properties of five validated indices that measure a patient's disease burden. The study was conducted on a random sample of patients discharged from the general medicine service at the Durham Department of Veterans Affairs Medical Center. Trained observers (two research assistants, one nurse, and two physicians) blinded to readmission status abstracted the required data elements from the medical record for three indices (Charlson, Kaplan-Feinstein, Index of Coexistent Disease). The hospital's computer provided data elements for two indices (Smith, adapted Charlson). Indices varied in the time required to complete, the ability to capture individual heterogeneity, and inter-observer variability. However, none of the indices discriminated among patients who did and those who did not have 6-month hospital readmissions. Factors other than summary scores derived from these indices should be used to identify patients at high risk for readmission.

Aged↗
PubMed1993

Comparison of housestaff's estimates of their workday activities with results of a random work-sampling study.

BACKGROUND: Accurately quantifying housestaff's workday activities is acquiring increasing importance as resources become constrained and programs become more accountable for medical education. The authors compared a traditional method of time analysis based on housestaff's estimates of how they spent their workdays with the results of a formal time-analysis study based on random work sampling. METHOD: All housestaff (18 interns and 18 residents) rotating on a general medicine service at Duke University Medical Center between December 1991 and March 1992 participated in the study. Twenty-six of the housestaff first provided estimates of how they spent their workdays, and then all 36 wore random reminder beepers and recorded what they were doing (activity) and with whom (contact) at each beep. RESULTS: The housestaff overestimated the amounts of time spent in patient evaluation (e.g., the mean estimated proportion of time spent performing histories and physical examinations was 29%, whereas the mean actual proportion was 17%) and in educational activities (e.g., the mean estimated proportion of reading time was 8.4%, whereas the mean actual proportion was 2.7%). The housestaff underestimated the amount of supervision by attending physicians: the mean estimated proportion was 7.7%, whereas the mean actual proportion was 16.9%. CONCLUSION: The Housestaff's estimates of workday times differed from the observed times measured by random work sampling. These inaccuracies were manifest in several important areas, such as patient evaluation, educational activities, and attending physicians' supervision. These results suggest that program directors who seek to describe housestaff's work activities or wish to determine the effects of administrative interventions should use random work sampling as the measure.

Humans↗