Biomedical subjects

Peter J Veazie

Publications and source records attributed to Peter J Veazie.

9 recordsLinked to original sources

PubMed2006

A connection between medication adherence, patient sense of uniqueness, and the personalization of information.

Adherence to treatment regimens is important to achieve optimal disease management. However, nonadherence is evident across numerous clinical contexts, which leads to a higher disease burden on society. Among the various factors associated with patient adherence behavior, patient beliefs are the most influential set of factors. Several cognitive-social models and constructs that incorporate patient belief have been developed to explain patient health behaviors, such as the Health Belief Model, Self-Efficacy Model, Theory of Planned Behavior and so on. However, these models do not explain the formulation of health beliefs. The underlying mechanism accounting for patient variation in information processing that generates beliefs needs to be investigated, which will inform the development of interventions. We propose that patient's sense of uniqueness moderates the self-attribution of statistically-based information. Self-attribution is defined as a person's perceived probability that a statement applies to herself, and is influenced by experience and sense of uniqueness. Sense of uniqueness is a person's general belief regarding how unique she is. Statistically-based information is defined as information derived from or regarding aggregated effects or influences. Basically, the proposed hypothesis is that patients who have a stronger belief that they are unique are less likely to attribute to themselves statistically-based propositions regarding the majority of their group and are more likely to attribute to themselves statistically-based propositions regarding the minority. We further model the relationship between sense of uniqueness and self-attribution of information in terms of an idealized inexperienced person, and then extend the model to include the effect of personal experience. The estimation of hypothesis-specific effect parameters can be achieved by maximum likelihood. In conclusion, the sense of uniqueness hypothesis is general to the formulation of personal beliefs and consequently has implications for deliberate health behavior and indeed personal behavior in general.

Humans↗

PubMed2006

An individual-based framework for the study of medical error.

BACKGROUND: In the late 1990s, medical error came into focus as a problem to be explicitly acknowledged and addressed. Research on this topic is amassing in the epidemiology of medical error and the system and human factors that contribute to error. In addition, however, an understanding of medical errors in terms of the underlying decision process is needed. OBJECTIVE: To present an individual-based framework for the study of medical errors in the context of the decision maker. RESULTS: A framework is developed in terms of four state spaces: the decision environment, problem, goal, and action spaces. The role of information uncertainty is discussed. The framework is purposefully simple to provide flexibility and options for research-specific extensions, but sufficient structure is imposed to guide understanding and investigation. CONCLUSION: Understanding medical error in terms of the proposed framework can guide research and subsequent interventions by illuminating where in the decision process such errors are generated.

Decision Making↗

PubMed2006

When to combine hypotheses and adjust for multiple tests.

OBJECTIVE: To provide guidelines for identifying composite hypotheses and addressing the probability of false rejection for multiple hypotheses. DATA SOURCES AND STUDY SETTING: Examples from the literature in health services research are used to motivate the discussion of composite hypothesis tests and multiple hypotheses. METHODS: This article is a didactic presentation. PRINCIPAL FINDINGS: It is not rare to find mistaken inferences in health services research because of inattention to appropriate hypothesis generation and multiple hypotheses testing. Guidelines are presented to help researchers identify composite hypotheses and set significance levels to account for multiple tests. CONCLUSIONS: It is important for the quality of scholarship that inferences are valid: properly identifying composite hypotheses and accounting for multiple tests provides some assurance in this regard.

Bias↗

PubMed2006

Primary care physician office visits for depression by older Americans.

BACKGROUND: Older patients mostly receive depression care from primary care physicians, but it is not known whether depression treatment is primarily received from family/general practice physicians or internal medicine physicians and whether the type of depression treatment offered varies between these types of primary care physicians. OBJECTIVE: To assess what proportion of visits for depression are to family/general practice physicians or to internal medicine physicians and whether the type of depression treatment offered varies by primary care physician specialty. DESIGN: Data from the 2000 and 2001 National Ambulatory Medical Care Surveys, a nationally representative survey of visits to office-based practices using clustered sampling, were used. PARTICIPANTS: Office-based physician practices in the United States. RESULTS: There were an estimated 9.8 million visits made to office-based providers by older patients for depression in 2001 to 2002, of which 64% were to primary care physicians. Visits to primary care providers were evenly split between Internists and family/general practice physicians. There was no significant difference in the rate of antidepressant prescribing between visits to Internists versus family/general practice (55.9% vs 48.0%; P = .42). Mental health counseling or psychotherapy was offered more often during visits to family/general practice physicians than to Internists (39.4% vs 14.0%; P = .07). CONCLUSIONS: Visits for depression by elderly patients continue to take place in primary care settings to both family/general practice physicians and Internists. Interventions aimed at improving depression care in primary care should focus on both types of primary care physicians and emphasize improving rates of diagnosis and referral for counseling or psychotherapy as a viable treatment option.

Aged↗

PubMed2006

Projection, stereotyping, and the perception of chronic medical conditions.

OBJECTIVES: To test the hypotheses that people with chronic medical conditions are more likely than those without chronic medical conditions to project personal characteristics onto the population with chronic medical conditions, and that people without chronic medical conditions are more likely to stereotype those with chronic medical conditions. METHODS: The study is a secondary analysis of the 2000 Chronic Illness and Caregiving survey conducted by Harris Interactive Inc. using linear and probit regressions. RESULTS: The hypothesis that persons with chronic medical conditions project their characteristics onto the population of those with chronic medical conditions is strongly supported. The hypothesis that persons without chronic medical conditions stereotype the population of those with chronic medical conditions is weakly supported. DISCUSSION: The findings imply that characterizations of persons with chronic medical conditions vary more among those with chronic medical conditions than among those without, and that those without chronic medical conditions have more homogeneous representations. This difference between those who have chronic medical conditions and those who do not implies a potential for greater variation in support for the particulars of policies addressing chronic medical conditions among those with chronic medical conditions.

Chronic Disease↗

PubMed2005

Another look at observational studies in rehabilitation research: going beyond the holy grail of the randomized controlled trial.

Horn SD, DeJong G, Ryser DK, Veazie PJ, Teraoka J. Another look at observational studies in rehabilitation research: going beyond the holy grail of the randomized controlled trial. This commentary compares randomized controlled trials (RCTs) and clinical practice improvement (CPI) approaches to study design, evaluates their relative advantages and disadvantages, and discusses their implications for rehabilitation research and evidence-based practice. Many argue that observational cohort studies are not sufficient as scientific evidence for practice change. We challenge this assertion by introducing the concept of a CPI study: a comprehensive observational paradigm structured to decrease biases generally associated with observational research. One strength of CPI studies is their attention to defining and characterizing the "black box" of clinical practice. CPI studies require demanding data collection, but by using bivariate and multivariate associations among patient characteristics, process steps, and outcomes, they can uncover best practices more quickly while achieving many of the presumed advantages of RCTs.

Clinical Trials as Topic↗

PubMed2005

Making improvements in the management of patients with type 2 diabetes: a possible role for the control of variation in glycated hemoglobin.

Glucose level varies over time due to a number of complex physiologic processes. Evidence suggests variation in glucose level contributes to risk of complications. The timescale associated with variation in glucose level is on the order of seconds to minutes, yet diabetes complications stem from years of cumulative effects. This difference between timescale suggests a slower timescale may better represent the influential component of variation. We hypothesize variation in glycated hemoglobin captures the component of variation associated with future complications. Moreover, we hypothesize that patient-management strategies influence variation in glycated hemoglobin level. From a systems control perspective, increasing variation may well reflect a policy of closed loop feedback control where changes in patient glycated hemoglobin are addressed after the fact. Such a strategy attends to problems as they arise. In contrast, decreasing variation may result from a clinical strategy that is anticipatory and proactive. A physician using a proactive strategy will base current moves on anticipation of future states, controlling variation in patient outcomes such as glycated hemoglobin. We motivate our discussion using observational data from a large multispecialty medical group in Minnesota: we characterize the within-patient trend and variation of glycated hemoglobin in adults with type 2 diabetes, describe patterns of variation, and identify factors associated with variation. Our hypotheses imply: (1) patterns of variation in glycated hemoglobin reflect physician treatment strategy; (2) variation provides an independent contribution to risk of diabetes complications; (3) the development of treatment strategies that control variation may be a beneficial goal in the management of type 2 diabetes.

Adult↗

PubMed2003

Improving risk adjustment for Medicare capitated reimbursement using nonlinear models.

OBJECTIVES: This article compares a linear risk-adjusted model of medical expenditures for Medicare patients with a model that explicitly account for skewness in distribution of expenditures. METHODS: A model of expenditures and a model of the square root of expenditures, each expressed as linear combinations of risk adjusters, are estimated using data from the 1992 through 1994 Medicare Current Beneficiary Surveys. Five sets of risk adjusters are considered. Each combination of model and set of risk adjusters is tested for linearity, heteroscedasticity, in-sample fit (R2), forecast performance (forecast bias and forecast mean squared error), and overfitting the data. We analyze forecast performance (1)based on forecasts in same year used for estimation, and (2)based on forecasts in the year following that used for estimation. RESULTS: In the first analysis, the model using a square root transformation of expenditures as the dependent variable and the more parsimonious specification of risk adjusters performs best in terms of forecast squared error and overfitting. The untransformed model performs best in terms of forecast bias in each group based on severity of disability, with the exception of the severely disabled for whom the square root model is best. In the second analysis, the square root model performs better than the untransformed model in terms of forecast squared error, but neither model is statistically distinguishable from zero in terms of bias. CONCLUSIONS: Accounting for skewness in expenditures tends to improve precision but not necessarily bias, except among the severely disabled. Adjusting for health status improves risk adjustment.

Activities of Daily Living↗

PubMed2002

Understanding variation in chronic disease outcomes.

We propose an explanation for variation in disease outcomes based on patient adaptation to the conditions of chronic disease. We develop a model of patient adaptation using the example of Type 2 diabetes mellitus and assumptions about the process entailed in transforming self-care behaviors of compliance with treatment, compliance with glucose monitoring, and patient's knowledge seeking behavior into health outcomes of glycemic control and patient satisfaction. Using data from 609 adults with diagnosed Type 2 diabetes we develop an efficiency (fitness) frontier in order to identify best practice (maximally adapted) patients and forms (archetypes) of patient inefficiency. Outcomes of frontier patients are partitioned by categories of returns to scale. Outcomes for off-frontier patients are associated with disease severity and patient archetype. The model implicates strategies for improved health outcomes based on fitness and self-care behaviors.

Adaptation, Psychological↗