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Biomedical subjects

Matthias Schonlau

Publications and source records attributed to Matthias Schonlau.

11 recordsLinked to original sources
PubMed2006

Variations in reconstruction after radical cystectomy.

BACKGROUND: Most urologists specializing in the management of patients with bladder cancer consider continent urinary diversion the reconstructive technique that affords the best quality of life after radical cystectomy. The authors sought to evaluate factors that predict reconstructive technique after radical cystectomy. METHODS: Using linked data from Medicare and the National Cancer Institute's (NCI) Surveillance, Epidemiology, and End Results (SEER) program, 3611 subjects were identified who underwent radical cystectomy for bladder cancer between 1992 and 2000. Multivariate logistic regression was used to identify factors independently associated with utilization of continent reconstruction after radical cystectomy, incorporating patient and provider variables. RESULTS: In multivariate analysis, the likelihood of continent diversion was inversely associated with older age (odds ratio [OR] < or = 0.68, P <.002), African American race (OR 0.43, P = .003), and higher comorbidity index (OR 0.71, P = .03), and directly associated with male sex (OR 1.45, P = .002), higher education level (OR 1.54, P = .03), and year of surgery (OR > or = 1.56, P < .001 for all year categories vs. 1992-1994). Treatment at academic (OR 1.43, P = .003) and NCI-designated cancer centers (OR 5.50, P <.001) and by high-volume providers (OR 1.49, P <.001) was independently associated with continent reconstruction. CONCLUSIONS: Disparities in the utilization of continent urinary diversion after radical cystectomy suggest that demographic, socioeconomic, provider-based, and clinical variables predict the likelihood that those undergoing radical cystectomy will receive continent reconstruction. Regionalization of bladder cancer care may ameliorate many of the disparities noted but must be balanced against the risk imposed by a delay in care.

Aged↗
PubMed2006

Patterns of care for men with prostate cancer after failure of primary treatment.

BACKGROUND: This study sought to determine trends in patterns of care after failure of primary prostate cancer treatment and to determine whether nonclinical factors influenced the receipt of secondary treatment. METHODS: The authors identified individuals treated for nonmetastatic prostate cancer in the years 1991-1999 from the linked databases of Medicare and the National Cancer Institute's Surveillance, Epidemiology, and End Results registry. The outcome of interest was receipt of secondary therapy. They performed Cox proportional hazard analyses to investigate the link between demographic and clinical characteristics and the likelihood of receiving secondary treatment after either surgery or radiation. RESULTS: Of 65,716 subjects who met our inclusion criteria, 10,200 (15%) received some form of secondary therapy. For men undergoing initial surgical or radiation therapy, tumor grade, year of diagnosis, and geographic region were associated with secondary therapy. No socioeconomic factors such as education, ethnicity, or income level were associated with secondary therapy. CONCLUSIONS: Patterns of care after primary prostate cancer therapy continue to vary regionally. Standardized clinical algorithms and utilization of prostate-specific antigen testing appear to have influenced secondary therapy rates.

Aged↗
PubMed2006

The impact of realized access to care on health-related quality of life: a two-year prospective cohort study of children in the California State Children's Health Insurance Program.

OBJECTIVE: To examine the effect of realized access to care (problems getting care, access to needed care) on health-related quality of life (HRQOL) in the California State Children's Health Insurance Program. STUDY DESIGN: This was a prospective cohort study (n = 4,925; 70.5% [3438] had complete data). Surveys were taken at enrollment and after 1 and 2 years in the program. Parents and children reported HRQOL (PedsQL 4.0 Generic Core Scales). Repeated-measures analysis accounted for within-person correlation and adjusted for baseline PedsQL, baseline realized access, race/ethnicity, language, chronic health condition, and having a regular physician. RESULTS: Realized access to care during the prior year was related to HRQOL for each subsequent year. Foregone care and problems getting care were associated with decrements of 3.5 (P < .001) and 4.5 (P < .001) points for parent proxy-report PedsQL and with decrements of 3.2 (P < .001) and 4.4 (P < .001) points for child self-report PedsQL. Improved realized access resulted in higher PedsQL scores, continued realized access resulted in sustained PedsQL scores, and foregone care resulted in cumulative declines in PedsQL scores. CONCLUSIONS: Realized access to care is associated with statistically significant and clinically meaningful changes in HRQOL in children enrolled in the California State Children's Health Insurance Program.

Adolescent↗
PubMed2005

How do ethnicity and primary language spoken at home affect management practices and outcomes in children and adolescents with asthma?

BACKGROUND: Lower rates of preventive medication use and higher rates of hospitalization and emergency department use have been documented among Latino children and adolescents with asthma. However, little is known about how language barriers influence asthma management practices and outcomes. OBJECTIVE: To examine the effects of language on asthma management practices and asthma-related outcomes. DESIGN: Cross-sectional survey of asthma management practices, perceived efficacy, asthma knowledge, family functioning, and health-related quality of life in 405 white non-Latino, African American non-Latino, and Latino children and adolescents from English- and Spanish-speaking homes. RESULTS: Latino children and adolescents from Spanish-speaking homes had lower rates of goal setting and peak flow monitoring, poorer asthma knowledge, and greater negative family impact than white children and adolescents (P < .05 for all). Although Latino children and adolescents from English-speaking homes did worse than their non-Latino white peers, the decrements were modest and not statistically significant (P>.16 for all). Management practices and outcomes for non-Latino African American children and adolescents closely approximated those of white children and adolescents. CONCLUSIONS: Language barriers seem to contribute to poorer asthma management practices and knowledge among Latino children and adolescents. Efforts to increase knowledge in this group may enhance asthma self-care and limit the morbidity associated with asthma.

Adolescent↗
PubMed2005

Developmental considerations for substance use interventions from middle school through college.

This article summarizes a symposium organized by Dr. Elizabeth D'Amico and presented at the 2004 Annual Meeting of the Research Society on Alcoholism in Vancouver, Canada. The four presentations illustrate the importance of creating substance use interventions that are developmentally appropriate for youth. They represent innovative approaches to working with preteens, teenagers, and young adults. Dr. D'Amico's paper describes her research on the development of a voluntary brief intervention targeting alcohol use among middle school students. Findings indicated that by using school and community input, she was able to obtain a diverse a sample of youth across grades, sex, ethnicity, and substance use status. Dr. Ellickson's paper describes her research on Project ALERT, a school-based prevention program for middle school youth. Her findings indicate that Project ALERT worked for students at all levels of risk (low, moderate, and high) and for all students combined. Dr. Wagner's Teen Intervention Project was a randomized clinical trial to test the efficacy of a standardized Student Assistance Program for treating middle and high school students with alcohol and other drug problems. The study provided a unique opportunity to begin to examine how development may impact response to an alcohol or other drug intervention. Dr. Turrisi's paper examined processes underlying the nature of the effects of a parent intervention on college student drinking tendencies. Findings suggested that the parent intervention seems to have its impact on student drinking by reducing the influence of negative communications and decreasing the susceptibility of influences from closest friends. Dr. Kim Fromme provided concluding remarks.

Adolescent↗
PubMed2005

Does the collaborative model improve care for chronic heart failure?

BACKGROUND: Organizationally based, disease-targeted collaborative quality improvement efforts are widely applied but have not been subject to rigorous evaluation. We evaluated the effects of the Institute of Healthcare Improvement's Breakthrough Series (IHI BTS) on quality of care for chronic heart failure (CHF). RESEARCH DESIGN: We conducted a quasi-experiment in 4 organizations participating in the IHI BTS for CHF in 1999-2000 and 4 comparable control organizations. We reviewed a total of 489 medical records obtained from the sites and used a computerized data collection tool to measure performance on 23 predefined quality indicators. We then compared differences in indicator performance between the baseline and post-intervention periods for participating and non-participating organizations. RESULTS: Participating and control patients did not differ significantly with regard to measured clinical factors at baseline. After adjusting for age, gender, number of chronic conditions, and clustering by site, participating sites showed greater improvement than control sites for 11 of the 21 indicators, including use of lipid-lowering and angiotensin converting enzyme inhibition therapy. When all indicators were combined into a single overall process score, participating sites improved more than controls (17% versus 1%, P < 0.0001). The improvement was greatest for measures of education and counseling (24% versus -1%, P < 0.0001). CONCLUSIONS: Organizational participation in a common disease-targeted collaborative provider interaction improved a wide range of processes of care for CHF, including both medical therapeutics and education and counseling. Our data support the use of programs like the IHI BTS in improving the processes of care for patients with chronic diseases.

Chi-Square Distribution↗
PubMed2003

Incremental treatment costs in national cancer institute-sponsored clinical trials.

CONTEXT: Concern about additional costs for direct patient care impedes efforts to enroll patients in clinical trials. But generalizable evidence substantiating these concerns is lacking. OBJECTIVE: To assess the additional cost of treating cancer patients in the National Cancer Institute (NCI)-sponsored clinical trials in the United States across a range of trial phases, treatment modalities, and patient care settings. DESIGN: Retrospective cost study using a multistage, stratified, random sample of patients enrolled in 1 of 35 active phase 3 trials or phase 1 or any phase 2 trials between October 1, 1998, and December 31, 1999. Unadjusted and adjusted costs were compared and related to trial phase, institution type, and vital status. SETTING AND PARTICIPANTS: A representative sample of 932 cancer patients enrolled in nonpediatric, NCI-sponsored clinical trials and 696 nonparticipants with a similar stage of disease not enrolled in a research protocol from 83 cancer clinical research institutions across the United States. MAIN OUTCOME MEASURES: Direct treatment costs as measured using a combination of medical records, telephone survey, and Medicare claims data. Administrative and other research costs were excluded. RESULTS: The incremental costs of direct care in trials were modest. Over approximately a 2.5-year period, adjusted costs were 6.5% higher for trial participants than nonparticipants (35,418 dollars vs 33,248 dollars; P =.11). Cost differences for phase 3 studies were 3.5% (P =.22), lower than for phase 1 or 2 trials (12.8%; P =.20). Trial participants who died had higher costs than nonparticipants who died (17.9%; 39,420 dollars vs 33,432 dollars, respectively; P =.15). CONCLUSIONS: Treatment costs for nonpediatric clinical trial participants are on average 6.5% higher than what they would be if patients did not enroll. This implies total incremental treatment costs for NCI-sponsored trials of 16 million dollars in 1999. Incremental costs were higher for patients who died and who were in early phase studies although these findings deserve further scrutiny. Overall, the additional treatment costs of an open reimbursement policy for government-sponsored cancer clinical trials appear minimal.

Adult↗
PubMed2002

Compliance among pharmacies in California with a prescription-drug discount program for Medicare beneficiaries.

BACKGROUND: Several states have developed prescription-drug discount programs for Medicare beneficiaries. In California, Senate Bill 393, enacted in 1999, requires pharmacies participating in the state Medicaid program (Medi-Cal) to charge customers who present a Medicare card amounts based on Medi-Cal rates. Because Medicare beneficiaries may not be accustomed to presenting their Medicare cards at pharmacies, we assessed the compliance of pharmacies with Senate Bill 393. METHODS: Fifteen Medicare beneficiaries who received special training and acted as "standardized patients" visited a random sample of pharmacies in the San Francisco Bay area and Los Angeles County in April and May 2001. According to a script, they asked for the prices of three commonly prescribed drugs: rofecoxib, sertraline, and atorvastatin. The script enabled us to determine whether and when, during their interactions with pharmacists or salespeople, the discounts specified in Senate Bill 393 were offered. Pharmacies at which the appropriate discounts were offered were considered compliant. RESULTS: The patients completed visits to 494 pharmacies. Seventy-five percent of the pharmacies complied with the prescription-drug discount program; at only 45 percent, however, was the discount offered before it was specifically requested. The discount was offered at 91 percent of pharmacies that were part of a chain, as compared with 58 percent of independent pharmacies (P<0.001). Compliance was higher in the San Francisco Bay area than in Los Angeles County (84 percent vs. 72 percent, P=0.004) and was higher in high-income than low-income neighborhoods (81 percent vs. 69 percent, P=0.002). A Medicare beneficiary taking all three drugs would have saved an average of $55.70 per month as compared with retail prices (a savings of 20 percent). CONCLUSIONS: Discounts required under California's prescription-drug discount program for Medicare beneficiaries offer substantial savings. Many patients, however, especially those who use independent pharmacies or who live in low-income neighborhoods, may not receive the discounts.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMedDate not supplied

Measuring the effectiveness of a collaborative for quality improvement in pediatric asthma care: does implementing the chronic care model improve processes and outcomes of care?

OBJECTIVE: To examine whether a collaborative to improve pediatric asthma care positively influenced processes and outcomes of that care. METHODS: Medical record abstractions and patient/parent interviews were used to make pre- and postintervention comparisons of patients at 9 sites that participated in the evaluation of a Breakthrough Series (BTS) collaborative for asthma care with patients at 4 matched control sites. SETTING: Thirteen primary care clinics. PATIENTS: Three hundred eighty-five asthmatic children who received care at an intervention clinic and 126 who received care at a control clinic (response rate = 76%). INTERVENTION: Three 2-day educational sessions for quality improvement teams from participating sites followed by 3 "action" periods over the course of a year. RESULTS: The overall process of asthma care improved significantly in the intervention group but remained unchanged in the control group (change in process score +13% vs 0%; P < .0001). Patients in the intervention group were more likely than patients in the control group to monitor their peak flows (70% vs 43%; P < .0001) and to have a written action plan (41% vs 22%; P = .001). Patients in the intervention group had better general health-related quality of life (scale score 80 vs 77; P = .05) and asthma-specific quality of life related to treatment problems (scale score 89 vs 85; P < .05). CONCLUSIONS: The intervention improved some important aspects of processes of care that have previously been linked to better outcomes. Patients who received care at intervention clinics also reported higher general and asthma-specific quality of life.

Adolescent↗
PubMedDate not supplied

Evaluation of a quality improvement collaborative in asthma care: does it improve processes and outcomes of care?

PURPOSE: We wanted to examine whether a collaborative to improve asthma care influences process and outcomes of care in asthmatic adults. METHOD: We undertook a preintervention-postintervention evaluation of 185 patients in 6 intervention clinics and 3 matched control sites that participated in the Institute for Healthcare Improvement Breakthrough Series (BTS) Collaborative for asthma care. The intervention consisted of 3, 2-day educational sessions for teams dispatched by participating sites, which were followed by 3 action periods during the course of a year. RESULTS: Overall process of asthma care improved significantly in the intervention compared with the control group (change of 10% vs 1%, P = .003). Patients in the intervention group were more likely to attend educational sessions (20% vs 5%, P = .03). Having a written action plan, setting goals, monitoring peak flow rates, and using long-term asthma medications increased between 2% and 19% (not significant), but asthma-related knowledge was unchanged for the 2 groups. Patients in the BTS Collaborative were significantly more likely to be satisfied with clinician and lay educator communication (62% vs 39%, P = .02). Health-related quality of life, asthma-specific quality of life, number of bed days caused by asthma-related illness, and acute care service use were not significantly different between the 2 groups. CONCLUSIONS: The intervention was associated with improved process-of-care measures that have been linked with better outcomes. Patients benefited through increased satisfaction with communication. Follow-up of patients who participated in the intervention may have been too brief to be able to detect significant improvement in health-related outcomes.

Adult↗