Biomedical subjects

Mark P Becker

Publications and source records attributed to Mark P Becker.

3 recordsLinked to original sources

PubMed2006

Prognostic value of a novel classification scheme for heart failure: the Minnesota Heart Failure Criteria.

The authors present the Minnesota Heart Failure Criteria (MHFC), derived using latent class analysis from widely available items in the Framingham Criteria. The authors used 1995 and 2000 data on hospitalized Minnesota Heart Survey subjects discharged after myocardial infarction or heart failure (N = 7,379). Selected Framingham Criteria variables (dyspnea, pulmonary rales, cardiomegaly, interstitial or pulmonary edema on chest radiograph, S(3) heart sound, tachycardia) plus left ventricular ejection fraction were used. The discriminatory power of the MHFC was evaluated using age- and sex-adjusted 2-year mortality. A five-class latent class analysis model was collapsed into cases and noncases. Mortality estimates discriminated noncases (18%) from cases (43%) (p < 0.001). The MHFC performed better than previous truncated criteria (Framingham Criteria: 26% noncases, 43% cases; Duke Criteria: 29%, 40%; Killip Score: 31%, 44%; Boston Score: 28%, 45%). In a subset of patients admitted for heart failure (n = 5,128), the MHFC identified all but 2% (116/4,746) of cases found with a nearly full version of the Framingham Criteria. In terms of prognostic value, the MHFC are as precise as or more precise than several previous sets of truncated criteria. They closely approximate a nearly full version of the Framingham Criteria but require many fewer variables and can facilitate epidemiologic case-finding for heart failure.

Adult↗

PubMed2006

The role of organizational infrastructure in implementation of hospitals' quality improvement.

Quality improvement (QI) is an organized approach to planning and implementing continuous improvement in performance. Although QI holds promise for improving quality of care and patient safety, hospitals that adopt QI often struggle with its implementation. This article examines the role of organizational infrastructure in implementation of quality improvement practices and structures in hospitals. The authors focus specifically on four elements of hospital support and infrastructure for QI-integrated data systems, financial support for QI, clinical integration, and information system capability. These macrolevel factors provide consistent, ongoing support for the QI efforts of clinical teams engaging in direct patient care, thus promoting institutionalization of QI. Results from the multivariate analysis of 1997 survey data on 2350 hospitals provide strong support for the hypotheses. Results signal that organizations intent upon improving quality must attend to the context in which QI efforts are practiced, and that such efforts are unlikely to be effective unless appropriate support systems are in place to ensure full implementation.

Data Collection↗

PubMed2002

Assessing rater agreement using marginal association models.

New models that are useful in the assessment of rater agreement, particularly when the rating scale is ordered or partially ordered, are presented. The models are parameterized to address two important aspects of rater agreement: (i) agreement in terms of the overall frequency in which raters assign categories; and (ii) the extent to which raters agree on the category assigned to individual subjects or items. We present methodology for the simultaneous modelling of univariate marginal responses and bivariate marginal associations in the K-way contingency table representing the joint distribution of K rater responses. The univariate marginal responses provide information for evaluating agreement in terms of the overall frequency of responses, and the bivariate marginal associations provide information on category-wise agreement among pairs of raters. In addition, estimated scores within a generalized log non-linear model for bivariate associations facilitate the assessment of category distinguishability.

Carcinoma in Situ↗