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Biomedical subjects

John W Rowe

Publications and source records attributed to John W Rowe.

8 recordsLinked to original sources
PubMed2006

The emerging context for advances in comparative effectiveness assessment.

The call for an entity for independent assessment and guidance on alternative medical interventions is timely. The emergence of four developments underscores the importance and sets the stage for progress: an improving evidence base; growing recognition of the importance of variation in the effectiveness of treatments across patients; recent emphasis on transparency; and growing adoption of pay-for-performance initiatives. To advance progress on these issues, the Institute of Medicine (IOM) has convened a Roundtable on Evidence-based Medicine. The roundtable is exploring ways to improve the development of evidence, the thoroughness with which it is applied, and the mechanisms for increasing national capacity for the work.

Cost-Benefit Analysis↗
PubMed2006

Pay-for-performance and accountability: related themes in improving health care.

Value-based purchasing, or pay-for-performance, is a major emerging theme in U.S. health care. Forces enhancing adoption of pay-for-performance programs include continued increases in medical costs beyond overall economic growth, a body of evidence that the quality of health care provided to patients is not directly related to the volume of services received, increasing evidence to serve as a basis for the development of standards against which to measure clinical performance, and increasing acceptance by physician organizations and individual practitioners of the rationale underlying these efforts. In this context, employers, government payers, and health plans are establishing a wide variety of pay-for-performance programs. This article reviews the critical design features of such efforts, describes the current types of programs on offer, and comments on the implications of this emerging movement for the future of health care in the United States.

Health Care Costs↗
PubMed2005

Homocysteine versus the vitamins folate, B6, and B12 as predictors of cognitive function and decline in older high-functioning adults: MacArthur Studies of Successful Aging.

BACKGROUND: Elevated plasma total homocysteine concentration may be a risk factor for cognitive decline and Alzheimer disease, but data from prospective studies are limited. Further, high homocysteine levels are associated with low vitamin status, and it is unknown whether it is homocysteine toxicity or vitamin insufficiency that is responsible for the observed cognitive dysfunction. METHODS: We performed cross-sectional and longitudinal analyses of a cohort of 499 high-functioning community-dwelling persons aged 70 to 79 years to determine the effect of homocysteine and related vitamin plasma concentrations on cognitive function and cognitive decline. Nonfasting plasma concentrations of homocysteine, folate, vitamin B(6), and vitamin B(12) were measured at baseline. Summary measures of cognitive function were created from tests of multiple cognitive domains administered at baseline and again after 7 years. RESULTS: In cross-sectional analyses investigating each variable separately, subjects with elevated homocysteine levels, or low levels of folate or vitamin B(6), demonstrated worse baseline cognitive function. In longitudinal analyses, after adjusting for multiple covariates, including homocysteine, those in the bottom quartile of folate had a 1.6-fold increased risk (95% confidence interval: 1.01 to 2.31; P =0.04) of being in the worst quartile of 7-year cognitive decline. Low folate levels largely accounted for a trend towards greater cognitive decline with elevated homocysteine level. CONCLUSION: In high-functioning older adults, low folate levels appear to be a risk factor for cognitive decline. The risk of developing cognitive decline might be reduced through dietary folate intake.

Aged↗
PubMed2002

Homocysteine levels and decline in physical function: MacArthur Studies of Successful Aging.

PURPOSE: To test whether elevated homocysteine levels are associated with an increased risk of decline in physical function in older persons. METHODS: We performed a prospective cohort study of 499 highly functioning men and women aged 70 to 79 years who were enrolled in the MacArthur Studies of Successful Aging. We measured total homocysteine levels and performance-based physical function at baseline; physical function measures were repeated an average of 28 months later. A summary measure of physical performance from tests of balance, gait, lower body strength and coordination, and manual dexterity was developed, and a change score was calculated as the difference in scores from 1988 to 1991. RESULTS: The mean (+/-SD) homocysteine level was 11.6 +/- 4.3 micromol/L. With each SD increase in homocysteine, there was an increased risk of being in the worst quartile of decline in physical function (odds ratio = 1.5; 95% confidence interval: 1.2 to 1.9) in analyses that adjusted for age, sex, baseline physical performance, smoking status, vitamin B(12) levels, and incident stroke. Similar results were seen when change in physical performance was treated as a continuous variable. CONCLUSION: Older persons with elevated plasma homocysteine levels are at an increased risk of decline in physical function.

Aged↗
PubMed2002

Allostatic load as a predictor of functional decline. MacArthur studies of successful aging.

Allostatic load has been proposed as a cumulative measure of dysregulation across multiple physiological systems, and has been postulated to impact health risks. In the allostatic load model, increased risk is hypothesized to result not only from large and clinically significant dysregulation in individual systems, but also from more modest dysregulation, if present in multiple systems. Our objective was to construct an allostatic load score by optimally combining several physiologic measurements, and to examine its association with future functional decline. We analyzed data from a 7-year longitudinal study of a community-based cohort, whose age at baseline was between 70 and 79 years. Canonical correlation analysis was used to study the association of 10 biological measurements representing allostatic load with declines in scores on five tests each of physical and cognitive function over two follow-up periods: 1998-1991 and 1991-1995. We used bootstrapping to evaluate the stability of the canonical correlation and canonical weights. The canonical correlation between allostatic load and the 20 decline scores was 0.43 (P =.03) and the [25th, 75th] percentile interval of its distribution over 200 bootstrapped subsamples of the cohort was [0.48, 0.53]. These findings were not substantially affected by adjusting for covariates and cardiovascular disease. We conclude that a summary measure of physiologic dysregulation, such as allostatic load, is an independent predictor of functional decline in elderly men and women.

Adaptation, Physiological↗
PubMed2002

Peripheral blood markers of inflammation predict mortality and functional decline in high-functioning community-dwelling older persons.

OBJECTIVES: Several peripheral blood markers of inflammation have demonstrated prognostic ability, but the value of combining multiple markers as a measure of inflammatory burden remains unknown. The objective of this study was to determine the prognostic value of combining four peripheral blood measures of inflammation in healthy older persons. DESIGN: Inception cohort study with 7 years of follow-up. SETTING: Three communities. PARTICIPANTS: Eight hundred seventy high-functioning subjects aged 70 to 79 who had serum albumin, cholesterol, interleukin (IL)-6, and C-reactive protein (CRP) levels measured at baseline. MEASUREMENTS: Three- and 7-year mortality and Rosow- Breslau functional decline. RESULTS: A summary score was created that assigned one point each for the following blood levels: albumin <3.8 g/dL, cholesterol <170 mg/dL (bottom decile), IL-6>3.8 pg/mL (top tertile), and CRP>2.65 mg/L (top tertile). By 3 years, 6% of subjects had died, and, by 7 years, 23% had died. In subjects with three or four markers of inflammation, the adjusted odds ratios (AORs) for 3- and 7-year mortality were 6.6 and 3.2, respectively, compared with those who had no abnormal markers. Subjects with one or two markers were at more moderate and statistically insignificant increased risk of 3- and 7-year mortality with AORs of 1.5 and 1.3, respectively. The risks for functional decline at 3- and 7-years were generally small (AOR = 1.1-1.9) and not statistically significant. CONCLUSIONS: In high-functioning older persons, a measure of inflammation can identify those at a much higher risk of mortality and a possibly higher risk of functional decline. Whether therapies directed at reducing inflammation can attenuate such risk remains to be determined.

Aged↗