PubMed Health⌕ Search

Biomedical subjects

M S Donaldson

Publications and source records attributed to M S Donaldson.

At least 19 recordsLinked to original sources
PubMed2001

Fibromyalgia syndrome improved using a mostly raw vegetarian diet: an observational study.

BACKGROUND: Fibromyalgia engulfs patients in a downward, reinforcing cycle of unrestorative sleep, chronic pain, fatigue, inactivity, and depression. In this study we tested whether a mostly raw vegetarian diet would significantly improve fibromyalgia symptoms. METHODS: Thirty people participated in a dietary intervention using a mostly raw, pure vegetarian diet. The diet consisted of raw fruits, salads, carrot juice, tubers, grain products, nuts, seeds, and a dehydrated barley grass juice product. Outcomes measured were dietary intake, the fibromyalgia impact questionnaire (FIQ), SF-36 health survey, a quality of life survey (QOLS), and physical performance measurements. RESULTS: Twenty-six subjects returned dietary surveys at 2 months; 20 subjects returned surveys at the beginning, end, and at either 2 or 4 months of intervention; 3 subjects were lost to follow-up. The mean FIQ score (n = 20) was reduced 46% from 51 to 28. Seven of the 8 SF-36 subscales, bodily pain being the exception, showed significant improvement (n = 20, all P for trend < 0.01). The QOLS, scaled from 0 to 7, rose from 3.9 initially to 4.9 at 7 months (n = 20, P for trend 0.000001). Significant improvements (n = 18, P < 0.03, paired t-test) were seen in shoulder pain at rest and after motion, abduction range of motion of shoulder, flexibility, chair test, and 6-minute walk. 19 of 30 subjects were classified as responders, with significant improvement on all measured outcomes, compared to no improvement among non-responders. At 7 months responders' SF-36 scores for all scales except bodily pain were no longer statistically different from norms for women ages 45-54. CONCLUSION: This dietary intervention shows that many fibromyalgia subjects can be helped by a mostly raw vegetarian diet.

Adult↗
PubMed2001

Continuity of care: a reconceptualization.

Although continuity of care is considered an essential feature of good health care, researchers have used and measured continuity in many different ways, and no clear conceptual framework links continuity to outcomes. This article of offers a reconceptualization and definition of continuity based on agency theory. It posits that the value of continuity is to reduce agency loss by decreasing information asymmetry and increasing goal alignment. Three decades of empirical literature on continuity were examined to assess whether this model would provide greater clarity about continuity. Some authors measured improved information transfer, but more appeared to assume that continuity would lead to better information. Most authors appeared to have assumed that goal alignment was present and did not measure it. The model of continuity based on agency theory appears to provide a useful conceptual tool for health services research and policy.

Continuity of Patient Care↗
PubMed2000

Metabolic vitamin B12 status on a mostly raw vegan diet with follow-up using tablets, nutritional yeast, or probiotic supplements.

BACKGROUND: Pure vegetarian diets might cause cobalamin deficiency due to lack of dietary intake. It was hypothesized that a population following a vegan diet consuming mostly raw fruits and vegetables, carrot juice, and dehydrated barley grass juice would be able to avoid vitamin B12 deficiency naturally. METHODS: Subjects were recruited at a health ministers' reunion based on adherence to the Hallelujah diet for at least 2 years. Serum cobalamin and urinary methylmalonic acid (MMA) assays were performed. Follow-up with sublingual tablets, nutritional yeast, or probiotic supplements was carried out on subjects with abnormal MMA results. RESULTS: 49 subjects were tested. Most subjects (10th to 90th percentile) had followed this diet 23-49 months. 6 subjects had serum B12 concentrations <147 pmol/l (200 pg/ml). 37 subjects (76%) had serum B12 concentrations <221 pmol/l (300 pg/ml). 23 subjects (47%) had abnormal urinary MMA concentrations above or equal to 4.0 microg/mg creatinine. Sublingual cyanocobalamin and nutritional yeast, but not probiotic supplements, significantly reduced group mean MMA concentrations (tablet p < 0.01; yeast p < 0.05, probiotic > 0.20). CONCLUSIONS: The urinary MMA assay is effective for identifying early metabolic cobalamin deficiency. People following the Hallelujah diet and other raw-food vegetarian diets should regularly monitor their urinary MMA levels, consume a sublingual cobalamin supplement, or consume cobalamin in their food.

Administration, Sublingual↗
PubMed1998

Measuring quality of care at the end of life.

Caring for patients at the end of life presents a series of quality-of-care problems to the health care system. In the past, concern has focused on overaggressive treatment of dying patients. Given rapid changes in the financing and delivery of care, it is time to focus on a range of quality problems and address ways to improve care and achieve outcomes desired by patients and their families. We provide a framework for conceptualizing such a task. This article addresses the purposes of measurement, definition of the patient population, timing of measurement, use of surrogates in measurement, scope of services to be evaluated, and the choice of measures. It emphasizes the necessary links between quality measurement and quality improvement.

Continuity of Patient Care↗
PubMed1998

Accountability for quality in managed care.

BACKGROUND: It is often difficult to understand where responsibility lies for monitoring and improving quality in managed care. From 1996 through 1998 a group of individuals convened by the Institute of Medicine's (Washington, DC) National Roundtable on Health Care Quality developed a model of accountability for the quality of care provided by managed care organizations (MCOs). Each of three overarching forms of accountability (professional, market, and regulatory) has a set of tools for imposing accountability and-because accountability relationships are not self-enforcing-sanctions for failures of accountability. PROFESSIONAL ACCOUNTABILITY: Fiduciary relationships in medicine are an essential part of any quality accountability mechanism, and it will be important to maintain the strength of the professional model in the changing health care system. Yet it is not easy to preserve the strength of the professional model in an MCO environment in which professionals are not dominant, and there is likely to be increasing pressure to weaken their autonomy. MARKET ACCOUNTABILITY: The primary assumption of market accountability is that consumers will select options based on perceived value to them and will make new choices based on their information and experience. Market accountability requires choice among competing providers and information to inform choice. In health care, however, individuals rarely have the information they need and often do not have choice. Accountability for quality generally has not been a major feature in contracts. REGULATORY ACCOUNTABILITY: There is a widespread perception of defects in a market-based health care system. Many believe there is a need for a regulatory structure to correct market failures. The use of regulation to impose accountability for quality requires that a regulatory framework, penalties for violations, and effective enforcement mechanisms are all established. PUBLIC GOODS: The model of accountability for quality in managed care does not promote public goods such as education, research, public health, or care for the uninsured. Indeed, the locus of responsibility to the community when markets fail to supply these public goods is controversial. Nevertheless, such responsibility should be considered by MCOs and policy makers. COLLABORATION TO IMPROVE QUALITY OF CARE: Given market-driven models of health care financing and delivery, it might be feasible and desirable to encourage collaboration among MCOs to improve quality, whether at the national or local market level. The health professions in general, and the medical profession in particular, are and must be accountable to society for providing leadership in the development of knowledge about effective medical care, in defining high-quality care, and in advocating for and improving the quality of care. CONCLUSION: Establishing effective accountability for quality involves multiple entities and many different kinds of accountability relationships. The three forms of accountability interact, and all operate at once.

Accreditation↗
PubMed1998

The importance of measuring quality of care at the end of life.

Although designed to respond to acute illness, the current health care system must increasingly provide care for people living longer with chronic diseases. Evaluation of the quality of this care must utilize appropriate measurements, study populations, and outcomes. Current quality measures and major studies of quality of care are highlighted. A framework for measuring quality of care is outlined.

Accreditation↗
PubMed1997

Measuring the quality of health care: state of the art.

BACKGROUND: September 12-13, 1996, in Washington, DC, the Institute of Medicine, as part of its Special Initiative on Health Care Quality, held an invitational conference to illustrate exemplary quality measurement and to discuss the results. Patient reports, innovative uses of outcome measures for quality improvement, risk adjustment, assessment in integrated health plans and health care settings, clinical guidelines, and projects on disseminating information on quality measurement techniques and tools were among the topics represented. IMPROVING MEDICATION USE: Brent James described studies undertaken to reduce adverse drug events (ADEs). When implementing any measurement system where error is a possible factor, it is important to emphasize identifying problems for the purpose of learning, not judgment. Lucian Leape agreed that staff involved must feel that the purpose of the study is to examine system problems, not individuals' mistakes. David Classen described a nonproprietary computerized disease-management program designed to reduce ADEs in infectious diseases. "A QUALITY VISION": Robert Brook said that the relationship between cost or resources devoted to care and quality is not well understood and is certainly not simple. He also said that although investments in measurement strategies are needed to make them better, that doesn't mean we shouldn't attempt to use the measurements we have now. CLOSING ADDRESS: Mark Chassin said that the presentations at the conference provided evidence that should allow us to conclude beyond a reasonable doubt that quality can be measured-with a degree of scientific precision equal to that of most of the measures used to take care of patients every day.

Health Services Research↗
PubMed1994

Gearing up for health data in the information age.

This workshop summary focuses on public disclosure--the publication of provider-specific (but non-person-identified) information to improve health care and the delivery of health services. It also summarizes participant discussions about quality-of-care research in health database organizations, as well as issues related more broadly to the creation of a health data infrastructure.

Computer Security↗
PubMed1992

Medicare: a strategy for quality assurance, V: Quality of care in a changing health care environment.

This article, the fifth and final in a series, provides a retrospective wrap-up of an Institute of Medicine (IOM) study to develop a strategy for quality review and assurance in Medicare. Portions of that report were adapted for four articles in QRB in January, March, August, and October 1991. This final article reflects on selected developments in the period since the IOM report first appeared, particularly those involving other IOM activities, in the context of certain of the findings, conclusions, and recommendations of the IOM study committee on Medicare quality assurance.

Health Services Research↗
PubMed1991

Medicare: a strategy for quality assurance, II: Site visits.

The second of a series of articles on the Institute of Medicine study on a quality review and assurance program for Medicare, this article recapitulates the findings of site visits conducted between October 1988 and May 1989. The issues and concerns raised by site visit hosts, as listed in the IOM report, are discussed in detail. For example, concerns about QA methods include those regarding the duplication of quality review and assurance efforts, the value of education and feedback of quality-of-care information, disclosure, dealing with the very poor practitioner, and improving average practice. Most problems of quality and QA identified by the organizations visited are those of "systems" rather than individual providers, which itself is an important finding.

Attitude of Health Personnel↗
PubMed1991

Medicare: a strategy for quality assurance, III: Beneficiary and physician focus groups.

The third of a series on the Institute of Medicine study on a quality review and assurance program for Medicare, this article describes findings on two separate series of focus groups held with Medicare beneficiaries and with physicians in private practice. The respondents' perceptions of quality of care, understanding of the Medicare program and QA activities, and recommendations for improvement are reported directly and examined for implications for designing a coherent QA strategy. A surprising finding is that both beneficiaries and physicians define quality of care in terms of the "art of care" as well as in technical and clinical terms.

Attitude of Health Personnel↗