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Biomedical subjects

M Chapko

Publications and source records attributed to M Chapko.

16 recordsLinked to original sources
PubMed1999

Physician participation in research surveys. A randomized study of inducements to return mailed research questionnaires.

The authors randomly selected 400 physicians from a population of 1,545 practicing physicians providing follow-up care to patients who received bone marrow or blood stem cell transplants at the Fred Hutchinson Cancer Research Center to determine interest in receiving Internet-based transplant information. In a two-factor completely randomized factorial design, the 400 physicians were assigned to receive mailed surveys with either no compensation or a $5 check and either no follow-up call or a follow-up call 3 weeks after mailing. Overall, 51.5% of the physicians returned the mailed surveys. Comparison of logit models showed that inclusion of a $5 check in the mailer significantly (p = .016) increased the probability of returning the surveys (57.5% vs. 45.5%). In contrast, the telephone follow-up had no overall effect. The authors concluded a modest financial reward can significantly improve physician response rates to research surveys but a telephone follow-up may be inefficient and even ineffective.

Adult↗
PubMed1998

The need for a thoughtful deployment strategy: evaluating clinicians' perceptions of critical deployment issues.

This paper presents data collected from 899 clinicians across three Department of Veterans Affairs (VA) medical centers where existing terminal-based architecture was being replaced with client-server architecture. Surveys were conducted with physicians (n = 184), nurses (n = 355) and other clinicians (n = 360) gathering user characteristics and their perceptions of five deployment issues (e.g. adequacy of technical and institutional support and perceptions of the soon-to-be-implemented clinical workstation). Mean scores for the five deployment issues for all clinicians indicates perceptions are somewhat neutral. However, when data is analyzed according to job classification, significant (p = 0.05) differences in perceptions were noted among groups of clinicians (e.g., physicians and registered nurses). Results of analyzing data grouped by VA site (n = 3) indicates significant (p = 0.05) differences exist among sites in clinicians' perceptions of the deployment issues. A thoughtful deployment strategy including an in-depth assessment of clinician users by job classification and by location may produce important information, critical to the successful deployment of new technologies, in very large health management institutions.

Attitude to Computers↗
PubMed1998

CARE-PARTNER: a computerized knowledge-support system for stem-cell post-transplant long-term follow-up on the World-Wide-Web.

Evidence-based practice in medicine promotes the performance of medicine based upon proven and validated practice. The CARE-PARTNER system presented here is a computerized knowledge-support system for stem-cell post-transplant long-term follow-up (LTFU) care on the WWW, which means that it monitors the quality of the knowledge both of its own knowledge-base and of its users. Its aim is to support the evidence-based practice of the LTFU clinicians and of the home-town physicians who actually care for the transplanted patients. Currently, three fundamental characteristics of CARE-PARTNER are accountable for its knowledge-support function: the quality of its knowledge-base, its availability on the WWW, and its learning from experience capability. As a matter of fact, the integration of a case-based reasoner in the reasoning framework enables the system to introspectively study its results, and to learn from its successes and failures, thus confronting the quality of the guidelines and pathways it reuses to the reality and complexity of the clinical cases.

Artificial Intelligence↗
PubMed1996

Willingness to pay for child survival: results of a national survey in Central African Republic.

Many policy-makers and health economists are interested in designing and implementing user fee/quality improvement programs in public facilities in Sub-Saharan Africa on a national scale. This research addresses two design issues for a national program: (1) to what extent would user fees finance the costs of quality improvements, and (2) whether a uniform program could be implemented throughout the country or the user fees should differ between urban and rural areas or across health regions. A national survey was conducted to determine the population's willingness and ability to pay for seven quality improvements: (1) facility maintenance, (2) supervision of personnel, and drugs to treat (3) diarrheal diseases, (4) acute respiratory infections (ARI), (5) malaria, (6) intestinal parasites, and (7) sexually transmitted diseases (STDs). Willingness to pay for quality improvements was measured by contingent valuation techniques in which subjects were asked about expenditures for care at government facilities under a hypothetical user fee/quality improvement program. Ability to pay was measured by monthly expenditures for health care as a percentage of monthly household consumption. The majority of the population was willing to pay the cost of the quality improvements, which ranged from U.S. $0.40 to U.S. $4.00. Estimates of the percentage of the population that was willing to pay the cost of the quality improvements ranged from 81% for facility maintenance (an improvement with the lowest cost) to 64% for drugs to treat ARI (the improvement with the highest cost). The median willingness to pay ranged from U.S. $7.98 for drugs to treat malaria to U.S. $16.61 for drugs to treat diarrheal diseases. Willingness to pay was greater in rural areas than in urban areas. It was also greater in Health Region I than in Health Regions IV and V. The population was able to pay the estimated cost of all seven quality improvements. Median monthly health care expenditures per episode of illness was 2.6% of median monthly household consumption. In comparison, the estimated cost of the quality improvements ranged from 0.2 to 2.4% median monthly household consumption. The national user fee/quality improvement program has good prospects for financing the quality improvements because the majority of the population is willing to pay the estimated costs of the quality improvements and more than half of the population is willing to pay substantially more than the costs. It also appears that the user fees should differ between urban and rural areas and across some health regions.

Adult↗
PubMed1993

Implications of the Adult Day Health Care Evaluation Study for program revision and research.

With no additional effort to revise adult day health care (ADHC) services or the types of patients who receive them, it would appear that adding an ADHC program to a VA Medical Center would not achieve the desired objectives. The authors discuss here the advantages, disadvantages, and feasibility of 2 options for program revision. The first is to target ADHC to those types of patients who may be most likely to benefit. A targeting scheme should use the most objective criteria possible and may need to be implemented as part of a case-managed package of community-based services. The second option for program revision is to reduce the costs of ADHC services. A cost model developed as a part of the study demonstrated the effect of possible revisions, including increasing enrollment, reducing staffing costs, decreasing length of stay in ADHC, and increasing substitution of ADHC for other services. These changes differ in the level of administrative support and clinician behavior change needed for their implementation. This report then concludes with a discussion of the implications of the results for implementation of VA-ADHC versus contract ADHC, and a discussion of possible directions for future research.

Adult↗
PubMed1993

Data collection in the Adult Day Health Care Evaluation Study.

This report presents data collection measures and methods for the evaluation of Adult Day Health Care (ADHC) in the Department of Veterans Affairs (VA). Measures of patient health were survival, the Sickness Impact Profile, self-rated health, the Mini-Mental State Exam, Psychological Distress Scale, Social Support Scale, and Problem Behaviors Scale. Measures of health for the care giver were: Activities of Daily Living, Instrumental Activities of Daily Living, health perceptions, Psychological Distress Scale, life satisfaction, Social Support Scale, and Caregiver Burden Scale. We also assessed patient and care giver satisfaction with the care received by the patient. Measures of health status and outcomes were assessed primarily through patient and care giver interview at study enrollment, 6 months, and 12 months. Utilization and cost both within and outside VA were assessed for hospital, ambulatory care, nursing home, ADHC, home care, pharmacy, laboratory, and other forms of health care. Sources of utilization data included VA's computerized patient database, VA medical records, patient questionnaires, care giver questionnaires, and health care providers outside VA. Costs were obtained from VA's cost accounting system, VA Central Office, VA's contracts with outside providers, and directly from outside providers. Utilization and cost were assessed for each patient for a period of 1 year after entry into the study.

Activities of Daily Living↗
PubMed1993

Overview and patient recruitment in the Adult Day Health Care Evaluation Study.

Although Adult Day Health Care (ADHC) is increasingly prominent in the continuum of long-term care services, the results from previous studies of the effects of ADHC are mixed. The objectives of the ADHC Evaluation Study were to determine the effect of ADHC on health status, utilization, and cost of care. The first phase was a randomized controlled trial evaluating ADHC provided directly by the VA. Patients at four medical centers (n = 826) were randomly assigned to receive either ADHC or customary care, and outcomes were compared for the two groups. The second phase was a prospective cohort study evaluating ADHC provided under contract to community agencies in which patients at four additional medical centers (n = 163) were assigned to contract ADHC programs. Outcomes were compared with those of similar patients in the randomized trial. Patients and care givers were assessed at intake and 6 and 12 months after intake. To be admitted to the study, patients must have met one of the following criteria: residence in a nursing home; dependence in ambulation, dressing, or toileting; bowel incontinence; or significant cognitive impairment. Patients at intake demonstrated major impairment in function and high levels of prior use of health care services.

Adult↗
PubMed1993

Cost of VA adult day health care programs and their effect on utilization and cost of care.

The VA-ADHC Evaluation included a detailed assessment of the cost of the VA-ADHC programs and an evaluation of their effect on patients' utilization and costs of other health care services. Although each VA-ADHC program had little variation in its program costs over the 3 years of the study, there were large variations between the programs in total costs, their costs per patient day, and in some cost components. The 3 most important factors in determining the level of program costs were: the way patients were transported to and from ADHC, the availability of space to house the program, and the staff-to-patient ratio. The total cost of health care for patients randomly assigned to VA-ADHC was significantly (15.5%) higher than those assigned to customary care. Although ADHC care did substitute for certain other forms of care (i.e., home care and clinic visits), there was not enough of a substitution effect to offset the additional costs of ADHC services.

Adult↗
PubMed1993

Effects of adult day health care on utilization and cost of care for subgroups of patients.

An important goal of the Adult Day Health Care (ADHC) Evaluation Study was to identify subgroups of patients assigned to ADHC for whom the health care costs were less than, or not higher than, the costs of similar patients assigned to customary care. Patients eligible for VA services because of a severe disability that occurred during military service had significantly lower costs when assigned to ADHC compared with customary care. For several types of patients, total health care costs were not significantly higher for those assigned to ADHC compared with those assigned to customary care: patients who at study intake 1) were at highest risk of going to a nursing home, 2) had high levels of physical dysfunction as measured by the Sickness Impact Profile, 3) had multiple behavior problems, and 4) were eligible for VA services because of a less severe service-connected disability but admitted to the ADHC for treatment of that disability. Two types of patients were found to have particularly high costs when assigned to ADHC compared with customary care: patients with low levels of physical dysfunction and patients with few behavior problems. Significant differences in the relative costs of ADHC versus customary care also were found between the 4 study sites.

Activities of Daily Living↗
PubMed1993

Comparison of utilization and cost among contract adult day health care, VA adult day health care, and customary care.

The contract ADHC evaluation compared the utilization and costs of patients assigned to contract ADHC with patients assigned to VA-ADHC care or customary care in the VA-ADHC evaluation. The ADHC costs per patient day were lower on average in the contract sites than in the VA-ADHC sites, although they were similar to the costs at 2 of the 4 VA-ADHCs. The contract site patients received significantly more days of ADHC care, offsetting their lower cost per day. Contract site patients had significantly fewer VA clinic visits and VA nursing home admissions than did patients in the VA-ADHC or customary care groups. Patients at the contract sites also had significantly fewer days of nursing home care than did the customary care group patients. Propensity scores based on intake characteristics were used to adjust for initial differences between the patients in the 2 evaluations. After adjustments, the total cost of care for contract ADHC patients was found to be significantly higher than the cost for customary care patients, but no significant difference was found between contract ADHC patients and VA-ADHC patients.

Adult↗
PubMed1993

Summary and discussion of methods and results of the Adult Day Health Care Evaluation Study.

This article summarizes the study results and presents an evaluative summary of the implementation of study methods designed to provide guidance in the degree of confidence with which the results may be accepted and generalized to other situations. Patients who were offered VA-ADHC services in the first phase of this study had significantly higher VA health care costs on average than patients assigned to customary care, with no apparent incremental health benefit to themselves or their care givers. One can have a high level of confidence in these results. The ADHC clinical services were implemented as planned, the randomized controlled trial was implemented successfully, and such threats to validity as insufficient numbers of patients and differential attrition were not present. Certain subgroups of patients assigned to VA-ADHC had VA costs of care that were not significantly higher than those assigned to customary care, although these results must be interpreted with caution. The findings of the second phase of the study evaluating contract ADHC provide no support for choosing to provide either contract ADHC or VA-ADHC over the other. The nonrandomized design and smaller sample size suggest that inferences from the contract ADHC evaluation should be drawn with more caution than those from the VA-ADHC evaluation.

Activities of Daily Living↗
PubMed1991

Adult day health care evaluation study: methodology and implementation. Adult Day Health Care Evaluation Development Group.

The Adult Day Health Care Evaluation Study was developed in response to a congressional mandate to study the medical efficacy and cost effectiveness of the Adult Day Health Care (ADHC) effort in the Department of Veterans Affairs (VA). Four sites providing ADHC in VA facilities are participating in an ongoing randomized controlled trial. Three years of developmental work prior to the study addressed methodological issues that were problematic in previous studies. This developmental work resulted in the methodological approaches described here: (1) a patient recruitment process that actively recruits and screens all potential candidates using empirically developed admission criteria based on predictors of nursing home placement in VA; (2) the selection and development of measures of medical efficacy that assess a wide range of patient and caregiver outcomes with sufficient sensitivity to detect small but clinically important changes; and (3) methods for detailed, accurate, and efficient measurement of utilization and costs of health care within and outside VA. These approaches may be helpful to other researchers and may advance the methodological sophistication of long-term care program evaluation.

Aged↗
PubMed1990

Effects of albuterol and procaterol on exercise-induced asthma.

Procaterol and albuterol, beta agonists, were studied using a placebo-controlled, repeated exercise challenge design in order to assess their duration of effectiveness in both bronchodilation and in modifying exercise-induced asthma (EIA). Fifty-three subjects aged 12 to 50 years who had at least a 20% drop in FEV1 during a screening exercise tolerance test were entered. Subjects took two inhalations of procaterol (10 micrograms/inhalation), albuterol (90 micrograms/inhalation), or placebo. Thirty minutes later they exercised on a treadmill at a workload sufficient to induce greater than or equal to 80% aerobic O2 consumption for six minutes. Pulmonary function was measured before and serially for 30 minutes after exercise. The same exercise challenge was repeated three, six, and nine hours after drug administration. Both procaterol and albuterol bronchodilated and modified EIA at 30 minutes and three hours, mean drops in FEV1 being 8.2 and 9.7% respectively at 30 minutes and 16.8 and 16.3% at three hours. This was compared with placebo falls of 30% and 26%. At six hours the subjects' response was similar after both procaterol and albuterol, and fewer subjects had a 20% fall in FEV1 than with placebo, although protection afforded by both beta agonists was substantially less than at three hours. Both drugs were tolerated well.

Adolescent↗
PubMed1985

Quality assurance and the role of self-evaluation and continuing education.

Optimal practice competency requires planned change. Self-evaluation, goal-setting, planning and implementing change, and continual evaluation are required to keep a practice at its best. In this article, the authors recommend steps toward regular self-assessment and new sources of information and advice.

Clinical Competence↗
PubMed1984

Facial characteristics of children who breathe through the mouth.

There are many claims that abnormal breathing patterns alter facial growth; however, there are limited controlled data to confirm these claims. Thirty children with allergy, aged 6 to 12 years, who had moderate-to-severe nasal mucosal edema on physical examination and who appeared to breathe predominantly through the mouth and 15 children without allergy who had normal findings from nasal examination and who appeared to breathe predominantly through the nose were evaluated. All subjects received an intraoral clinical examination and cephalometric radiograph analysis. In comparison with children who breathed through the nose, children who breathed through the mouth had longer faces with narrower maxillae and retruded jaws. This supports the hypothesis that children with nasal obstruction and who appear to breathe through the mouth have distinctive facial characteristics.

Cephalometry↗