Female veterans' and nonveterans' use of health care services.
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Female↗
Biomedical subjects
J C Romeis
Publications and source records attributed to J C Romeis.
The effects of residency training programs on the financial performance of Veterans Affairs medical centers.
This study examines financial performance and physician productivity in Veterans Affairs teaching hospitals following the elimination of a separate payment for the indirect costs of medical education. Financial performance of teaching hospitals in the VA system was no worse than nonteaching peers even without a teaching subsidy. Residents were found to provide patient care but this contribution to output was offset by indirect teaching costs of resident training. Physicians were less productive in teaching hospitals, possibly reflecting the time spent in training and supervising residents, while nurses were more productive. Finally, as staff size increases, the indirect costs of medical education decrease. Future downsizing of residency programs would financially benefit smaller-staffed VAMCs; larger-staffed facilities would lose.
Costs and Cost Analysis↗
Correlates of a measure of coping in older veterans: a preliminary report.
Sense of Coherence (SOC) is a specific measure of perception of coping ability which is examined here in relation to demographic characteristics and measures of physical and mental health status of older veterans (N = 240). Results suggest that the SOC is strongly correlated with measures of subjective health status. It does not uniquely contribute to that dimension but does exhibit appropriate psychometric properties to encourage its use in further research.
Activities of Daily Living↗
Observer reliability in CT and MRI of the abdomen/pelvis.
The purpose of this research was to evaluate two sources of error in the performance of computerized tomography (CT) and magnetic resonance imaging (MRI) of the abdomen/pelvis. The sources of error assessed were inter- and intra-observer reliability. Thirty abdomen/pelvis CT scans were randomly selected from each of three hospitals (university, VA, military) with different CT scanners. Two radiologists were recruited from each site to be CT observers. Forty-five abdomen/pelvis MRI scans were randomly selected from two institutions with different MRI scanners. Four observers were recruited to read the MRI scans. All scans were read blind without clinical information or patient identification. Overall inter-observer and intra-observer diagnostic agreement was significantly higher for MRI compared to CT. Inter-observer diagnostic agreement rates were also significantly higher for MRI when the etiologies of neoplastic vascular and metabolic/toxic were assigned. Observer experience in CT (range: 5-9 yr) or MRI (range: 2-4 yr) was not statistically associated with improved diagnostic agreement. This research addresses many of the criticisms of the MRI literature and compares MRI favorably to CT.
Abdomen↗
Progress in the development of a nutritional risk index.
The development of a 16-item nutritional risk index (NRI) is chronicled from its inception through its application in three studies designed to assess its reliability and validity. Study I involved a survey of 401 community-dwelling elderly in St. Louis, Missouri who were interviewed at baseline, 4-5 mo later, and 1 yr later. Study II involved a cross-sectional survey of 377 male outpatients attending two clinics at the St. Louis Veterans Administration Medical Center. Study III involved a cross-sectional survey of 424 community-dwelling elderly in Houston, Texas. Internal consistency reliability coefficients ranged between 0.47 and 0.60, and test-retest reliability coefficients ranged between 0.65 and 0.71. Validity was established by using the NRI to predict the use of health services, as well as by correlating it with a variety of anthropometric, laboratory, and clinical markers of nutritional status. The utility of the NRI for future applications is discussed.
Aged↗
The effects of monitoring and feedback on compliance.
A two-group randomized experimental design was employed to assess the effects of monitoring and feedback on the compliance of 93 psychiatric outpatients treated with lithium. Compliance in both groups was measured using self-report, lithium level, appointment-keeping, and medication refill frequency. The experimental group was also monitored using a unique electronic device that records the time and day pills are removed. At the midpoint of the study, the experimental group received feedback about serum lithium levels and patterns of removing medications from the monitoring device while the control group received feedback about serum lithium levels only. The study demonstrated no sustained effect of the monitoring and feedback interventions on compliance.
Adult↗
Clinical validation of a nutritional risk index.
This research assessed the clinical validity of a nutritional risk index (NRI). Subjects were 377 male veterans, aged 55+, attending general medicine and geriatric outpatient clinics. Data were collected by personal interviews, anthropometric measurements, laboratory assay of nutritional parameters, three-day food records, and medical record reviews. Although the results showed that the NRI correlated significantly with only two nutritional measures (body mass index, total energy intake), critical values or threshold levels of NRI were identified that significantly discriminated low risk from high risk patients on four nutritional parameters (body mass index, total energy intake, laboratory risk, and medications risk). It was concluded that the NRI is a valid measure of health status and contains a nutritional dimension.
Aged↗
Practice pattern variation between two medical schools.
This study examined physician test-ordering behavior at a large urban Veterans Administration Medical Center staffed by two medical schools. Patients are assigned randomly to the two schools' wards, which operate independently of each other. The medical records of 119 patients, admitted during a 5-month period, were abstracted for data on the process and outcomes of medical care. Only one statistically significant difference in diagnostic testing practices was revealed by the observation that 12% of patients on one service received another abdominal film, while no patients on the other service did. The implications of studies such as this for small-area analysis are discussed. If variation in the utilization of health services is observed in a geographic region, then a study of physician behavior at a single facility may help to identify the reason for the variation.
Diagnosis-Related Groups↗
Female veterans' use of health care services.
The number of female veterans has more than doubled in the last 15 years, and this growth is expected to continue. This study examines the current utilization of both overall and Veterans Administration (VA) health care services by female veterans. Current utilization is studied as a set of contact decisions: whether or not to utilize any inpatient, VA inpatient, any outpatient, and VA outpatient services. Probit regression is used to estimate these dichotomous choices. Results indicate that health status and some demographic variables are significantly related to the use of all four types of care. In addition, use of other VA benefits, the absence of private insurance coverage, and low income are predictors of use of the VA.
Aged↗
Older veterans' future use of VA health care services.
This study is a secondary analysis of the Harris Survey of Aging Veterans (SAV) and is designed to identify variables that may be associated with older veterans' future use of the Veterans Administration (VA) health care system. Using regression and discriminant analysis techniques, the study identifies variables that may predispose older veterans to use the VA health care system in the next 10 years. The results indicate that older veterans may elect to use their health care benefits on objective criteria consistent with their health and financial resources, e.g., past use of veterans benefits, expected health status, and private insurance coverage. These variables suggest that the VA's recently enacted means test and the removal of automatic age eligibility will disenfranchise few older veterans.
Aged↗
Extending the extenders. Compromise for the geriatric specialization-manpower debate.
This pilot study reports on issues germane to the geriatric specialization-manpower debate. The study found that a large amount of the functional responsibility required by older adults in an urban clinic setting could be delegated to physician extenders. Other findings included shorter hospitalizations, increased feelings of well-being, and high patient satisfaction with physician extended care. The implications are that rather than develop a new physician specialty, more geriatric manpower needs could be met by delegating responsibility to appropriately trained and supervised physician extenders.
Aged↗