Biomedical subjects

Michael J Long

Publications and source records attributed to Michael J Long.

8 recordsLinked to original sources

PubMed2005

Using self-assessed health to predict patient outcomes after total knee replacement.

Self-assessed health status has been shown to be a powerful predictor of mortality, service use, and total cost of medical care treatment. We investigated the potential for self-assessed health to further serve as a predictor of improvement in health status after a clinical intervention. Using the five-category measure of self-assessed health (excellent, very good, good, fair, or poor), we examined patients' improvements in health status after total knee arthroplasty in each of the WOMAC-defined categories for health status in patients. The results indicate that the greater patients rated their preoperative health, the greater their postoperative improvement. The results suggest that a simple process of asking patients to rate their own health in a presurgery clinic could be a powerful tool in predicting patient outcome. This also suggests that by stratifying preoperative self-assessed health, potential improvements in health status will be more fully captured.

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PubMed2005

Selecting a subjective health status measure for optimum utility in everyday orthopaedic practice.

BACKGROUND: The time required to complete patient outcome questionnaires such as the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the Short Form General Health Survey (SF-36) and the Musculoskeletal Function Assessment (MFA) can sometimes threaten elderly, compromised patients sufficiently to compromise compliance with follow-up clinics. Incomplete questionnaires can also present problems of data bias. A little used (in the USA), patient-friendly questionnaire, the Nottingham Health Profile (NHP) has the potential to reduce the statistical and practical problems associated with the more generally used instruments. We hypothesized that NHP will produce similar results to WOMAC and SF-36 and is more sensitive to small changes in patient outcomes than SF-36 and MFA. METHOD: Twenty-three patients blindly completed WOMAC, SF-36 and NHP questionnaires. Spearman's Rank Order Correlation was used to compare the component scores of each instrument. Simulation of the before and after results of 10 fictitious patient comparing MFA and NHP was conducted using the related sample t-test. RESULTS: Seven of nine correlation coefficients were statistically significant and ranged from 0.711 to 0.901. The significance of the before and after difference on the five-point scale response was P = 0.05 when the NHP was used and P = 0.07 when MFA was used. The before and after difference on 'yes-no' response questions was P < 0.001 when NHP was used but showed no difference when the MFA was used. CONCLUSIONS: Our hypothesis was supported and we suggest that NHP can be used with confidence as an alternative to other patient outcome instruments.

Arthroplasty, Replacement, Knee↗

PubMed2005

Capturing the full measure of patient outcome improvement using a self-assessed health adjustment.

RATIONALE: Self-assessed health (SAH) status is a very simple four-, or five-category self-reported measure of health status that has been shown to be a powerful predictor of mortality, service use and total cost of medical care treatment. It is therefore reasonable to suggest that pre-intervention SAH may influence the extent to which patient outcomes improve following surgery. METHODS: Using the four-category measure of SAH of Excellent; Good; Fair; Poor, we developed an adjustment factor based on the mean improvement of the SAH category relative to the mean improvement of the overall sample. RESULTS: The results clearly indicate that the higher patients rated their pre-operative health, the greater their pre-post-operative improvement. Adjusting the outcome improvement by this SAH factor provides for the adjustment of the overall sample results by extent to which each category of SAH contributes to the overall mean. CONCLUSION: The results indicate that by adjusting patient outcome improvement measures by a factor based on pre-intervention SAH, overall sample patient outcome improvement increased 5.8%. The results also indicate that failure to adjust for pre-intervention SAH will result in an understatement of patient outcome improvement following surgery.

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PubMed2004

Ultrasonic deposition of cells on a surface.

Bacteria in water have been driven to a glass surface by an ultrasonic standing wave. On an antibody coated surface capture of Bacillus subtilis var niger (BG) spores (6.6 x 10(6) ml(-1)) was increased more than 200-fold over above the efficiency in the absence of ultrasound. In microfluidic (non-turbulent) systems detection of particles by sensors operating at a surface is diffusion limited. This results in very low detection abilities particularly for particles with diameters greater than 1 microm. Ultrasound is used here to drive bacterial spores to a wall and overcome this limitation. The results confirm: (1) pressure nodes can be formed close to the water-glass interface when the glass thickness is near half the ultrasonic wavelength; (2) the antibody used was able to capture spores in the presence of an ultrasonic standing wave.

Bacillus subtilis↗

PubMed2002

An explanatory model of medical practice variation: a physician resource demand perspective.

Practice style variation, or variation in the manner in which physicians treat patients with a similar disease condition, has been the focus of attention for many years. The research agenda is further intensified by the unrealistic assumption that by reducing variation, quality will be improved, costs will be reduced, or both. There is a wealth of literature that identifies differences in health care use of many kinds, in apparently similar communities. Attempts have been made by many scholars to identify the determinants of variation in terms of differences in the population characteristics (e.g. age, sex, insurance, etc.) and geographical characteristics (e.g. distance to provider, number of physicians, number of hospital beds, etc.). When significant differences in use rates prevail after controlling for differences in population characteristics, it is often attributed to 'uncertainty', or the fact that there is no consensus on what constitutes the optimum treatment process. It is suggested by this literature that the greatest variation can be found in the circumstances where there is the most 'uncertainty'. In this work, a physician resource demand model is proposed in which it is suggested that, during the diagnosis and treatment process, physicians demand resources consistent with the clinical needs of the patients, modified by the intervening forces under which they practice. These intervening forces, or constraints, are categorized as patient agency constraints, organizational constraints and environmental constraints, which are characterized as 'induced variation'. It is suggested that when all of the variables that constitute these constraints are identified, the remaining variance represents 'innate variance', or practice style differences. It is further suggested that the more completely this model is specified, the more likely area differences will be attenuated and the smaller will be the residual variance.

Decision Making↗

PubMed2002

Case management model or case manager type? That is the question.

Case management models have been categorized many different ways, but classification into two generic models is proposed here: an interrogative model that relies on intense oversight with expected cost reduction and a patient advocacy model that relies on a brokering arrangement for services in the best interest of the patient. A randomized trial in an elderly, functionally impaired population resulted in the implementation of a patient advocacy model and suggests that this model results in increased service use and costs, but that increased survival rates may justify the additional cost.

Aged↗

PubMedDate not supplied

Marital status and health care expenditures among the elderly in a managed care organization.

The purpose of this study was to determine the relationship of marital status in and health care expenditures among the elderly in a managed care organization. The study population consisted of 277 functionally impaired elderly people who were 75 years and older enrolled in a managed care organization. In separate analyses, the relationship between marital status and total expenditure per enrollee, the number of outpatient visits, hospital admissions, and emergency department (ED) visits during the two-year study period was examined. The results indicate that married individuals had significantly higher health care expenditures than the unmarried. However, there were no significant differences in number of hospital admissions, number of outpatient visits, and number of ED visits. It would behoove health care administrators and policy makers to take into consideration marital status when planning, designing, and implementing health care policies for the elderly.

Aged↗

PubMedDate not supplied

Does age influence the intensity of care in a managed care organization?

The primary objective of this study was to determine whether an inverse relationship between age and the intensity of care prevailed in an elderly, functionally impaired population enrolled in a managed care organization. The secondary objective was to determine whether those who died during the study were treated more intensively than the survivors. A total of 278 enrollees in a managed care organization who were 75 years and over, had a severe functional disability, excessive hospital or Emergency Department use, volunteered to take part in a 2-year study. Seventy-seven clients died during the study. We calculated indices of outpatient care intensity and hospital care intensity for the study period. With minor exceptions, the results clearly show that, for this group of clients, the intensity of outpatient care was clearly, inversely related to age. The intensity of hospital care was also inversely related to age, thereby ruling out the hypothesis that it was being substituted for outpatient care. The results also clearly show that, for this population, those who died during the study period were treated more intensively than the survivors. We found strong support for our hypotheses. An investigation of the reasons for these findings was beyond the scope of our data.

Activities of Daily Living↗