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Robert O Morgan

Publications and source records attributed to Robert O Morgan.

15 recordsLinked to original sources
PubMed2006

Using a Spanish surname match to improve identification of Hispanic women in Medicare administrative data.

OBJECTIVE: To assess the effectiveness of a Spanish surname match for improving the identification of Hispanic women in Medicare administrative data in which Hispanics are historically underrepresented. DATA SOURCES: We collected self-identified race/ethnicity data (N=2,997) from a mailed survey sent to elderly Medicare beneficiaries who resided in 11 geographic areas consisting of eight metropolitan counties and three nonmetropolitan areas (171 counties) in the fall of 2004. The 1990 Census Spanish Surname list was used to identify Hispanics in the Medicare data. In addition, we used data published on the U.S. Census Bureau website to obtain estimates of elderly Hispanics. STUDY DESIGN: We used self-identified race/ethnicity as the gold standard to examine the agreement with Medicare race code alone, and with Medicare race code+Spanish surname match. Additionally, we estimated the proportions of Hispanic women and men, in each of the 11 geographic areas in our survey, using the Medicare race code alone and the Medicare race code+Spanish surname match, and compared those estimates with estimates derived from U.S. Census 2000 data. PRINCIPAL FINDINGS: The Spanish surname match dramatically increased the accuracy of the Medicare race code for identifying both Hispanic and white women, producing improvements comparable with those seen for men. CONCLUSIONS: We recommend the addition of a proxy race code in the Medicare data using the Spanish surname match to improve the accuracy of racial/ethnic representation.To assess the effectiveness of a Spanish surname match for improving the identification of Hispanic women in Medicare administrative data in which Hispanics are historically underrepresented. We collected self-identified race/ethnicity data (N=2,997) from a mailed survey sent to elderly Medicare beneficiaries who resided in 11 geographic areas consisting of eight metropolitan counties and three nonmetropolitan areas (171 counties) in the fall of 2004. The 1990 Census Spanish Surname list was used to identify Hispanics in the Medicare data. In addition, we used data published on the U.S. Census Bureau website to obtain estimates of elderly Hispanics. We used self-identified race/ethnicity as the gold standard to examine the agreement with Medicare race code alone, and with Medicare race code+Spanish surname match. Additionally, we estimated the proportions of Hispanic women and men, in each of the 11 geographic areas in our survey, using the Medicare race code alone and the Medicare race code+Spanish surname match, and compared those estimates with estimates derived from U.S. Census 2000 data. The Spanish surname match dramatically increased the accuracy of the Medicare race code for identifying both Hispanic and white women, producing improvements comparable with those seen for men. We recommend the addition of a proxy race code in the Medicare data using the Spanish surname match to improve the accuracy of racial/ethnic representation.

Data Collection↗
PubMed2006

Is there a race-based disparity in the survival of veterans with HIV?

BACKGROUND: Disparities in survival for black patients with HIV in the United States have been reported. The VA is an equal access health care system. OBJECTIVE: To determine whether such disparities are present in the VA health care system. DESIGN: Retrospective cohort study using national VA administrative databases. PATIENTS: Two thousand three hundred and four white and 3,641 black HIV-infected patients first hospitalized for HIV between October 1, 1996 and September 30, 2000. MEASUREMENTS: Thirty-day mortality after first hospitalization with HIV, and subsequent long-term survival. Follow-up ended at death or September 30, 2002. Data were adjusted for age, sex, HIV disease severity, non-HIV-related comorbidities, primary discharge diagnosis, hepatitis C status, and facility effects. RESULTS: The mean follow-up was 3.2 years. Overall survival was similar for black patients compared with white patients (adjusted hazard ratio 1.09, P=.09). Hospital mortality was 7.0% for black and 6.4% for white patients (P=.35). Adjusted hospital mortality for black patients was similar to that of white patients (odds ratio 1.20, P=.10). Long-term survival after hospitalization did not significantly differ by race (adjusted hazard ratio 1.07, P=.21, for black patients compared with white patients). CONCLUSIONS: Survival during and after first hospitalization with HIV in the VA did not significantly differ for white and black patients, possibly indicating similar effectiveness of care for HIV. Further research is needed to understand the reasons for the lack of disparities for VA patients with HIV and whether the VA's results could be replicated.

Adult↗
PubMed2005

A self-assessment tool was reliable in identifying hazards in the homes of elders.

BACKGROUND AND OBJECTIVES: Falls are a leading cause of fatal and nonfatal injuries, particularly among the elderly. A reliable instrument for self-assessment of home falls hazards would facilitate screening for falls risk. This study examined the reliability of self-assessment of home falls hazards by elderly women. METHODS AND SETTING: Participants were 52 elderly women, aged 67 to 97. All evaluations were performed in the participants' homes. Home falls hazards were evaluated independently by study participants and by trained observers. RESULTS: Kappa statistics indicated good to excellent agreement for most of the environmental factors. However, observers were significantly more likely than the study participants to report certain tripping hazards, particularly objects in walkways. CONCLUSION: This home checklist is an important step towards a reliable self-report instrument for measuring home falls hazards. Self-assessment appears to be a reliable method for assessing many putative hazards of falling in the home. However, our findings raise questions regarding the reliable assessment of tripping hazards.

Accidental Falls↗
PubMed2005

Prevalence of dementia among Veterans Affairs medical care system users.

OBJECTIVES: In an aging population, the number of veterans diagnosed with dementia is likely to increase. Knowledge of existing dementia prevalence will be beneficial in planning for future patient care needs. Our objectives were to assess the prevalence of the dementia diagnosis among those treated at Veterans Affairs (VA) medical centers and determine how it varies across race and Veterans Integrated Service Network (VISN). MATERIALS AND METHODS: Data were collected on all veterans seen within the VA medical system from 1997 through the first half of 2001. Only veterans aged 65 and over were included in the study. Veterans were included if they had one of the following dementia ICD-9 codes: 290.XX, 291.2, 294.XX, 331.XX, 046.1, or 046.3. RESULTS: The overall prevalence of dementia was 7.3%. The prevalence of dementia was similar among white patients and patients of other races, except African-American patients, in whom it was 50% higher. Across VISNs, the prevalence of dementia ranged from 5.8 to 9.4%. Alzheimer's disease was the most frequently diagnosed type of dementia within the VA, and inpatient service utilization and outpatient psychiatry visits by individuals with dementia were high relative to other VA patients. DISCUSSION: The overall prevalence identified is consistent with that reported in the literature, as is the elevated prevalence in African-Americans versus whites. The data on prevalence by VISN may identify regional variation in either the types of dementia present or the diagnostic criteria used. The dementia diagnosis is clearly associated with substantial service use.

Age Factors↗
PubMed2005

Strategic opportunities in the oversight of the U.S. hospital accreditation system.

Hospital accreditation and state certification are the means that the Centers for Medicare & Medicaid Services (CMS) employs to meet quality of care requirements for medical care reimbursement. Hospitals can choose to use either a national accrediting agency or a state certification inspection in order to receive Medicare payments. Approximately, 80% of hospitals choose the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). The purpose of this paper is to analyze and discuss improvements on the structure of the accreditation process in a Principal-Agent-Supervisor framework with a special emphasis on the oversight by the principal (CMS) of the supervisor (JCAHO).

Accreditation↗
PubMed2005

Proxies and other external raters: methodological considerations.

OBJECTIVE: The purpose of this paper is to introduce researchers to the measurement and subsequent analysis considerations involved when using externally rated data. We will define and describe two categories of externally rated data, recommend methodological approaches for analyzing and interpreting data in these two categories, and explore factors affecting agreement between self-rated and externally rated reports. We conclude with a discussion of needs for future research. DATA SOURCES/STUDY SETTING: Data sources for this paper are previous published studies and reviews comparing self-rated with externally rated data. STUDY DESIGN/DATA COLLECTION/EXTRACTION METHODS: This is a psychometric conceptual paper. PRINCIPAL FINDINGS: We define two types of externally rated data: proxy data and other-rated data. Proxy data refer to those collected from someone who speaks for a patient who cannot, will not, or is unavailable to speak for him or herself, whereas we use the term other-rater data to refer to situations in which the researcher collects ratings from a person other than the patient to gain multiple perspectives on the assessed construct. These two types of data differ in the way the measurement model is defined, the definition of the gold standard against which the measurements are validated, the analysis strategies appropriately used, and how the analyses are interpreted. There are many factors affecting the discrepancies between self- and external ratings, including characteristics of the patient, the proxy, and of the rated construct. Several psychological theories can be helpful in predicting such discrepancies. CONCLUSIONS: Externally rated data have an important place in health services research, but use of such data requires careful consideration of the nature of the data and how it will be analyzed and interpreted.

Data Collection↗
PubMed2005

Measurement in Veterans Affairs Health Services Research: veterans as a special population.

OBJECTIVE: To introduce this supplemental issue on measurement within health services research by using the population of U.S. veterans as an illustrative example of population and system influences on measurement quality. PRINCIPAL FINDINGS: Measurement quality may be affected by differences in demographic characteristics, illness burden, psychological health, cultural identity, or health care setting. The U.S. veteran population and the VA health system represent a microcosm in which a broad range of measurement issues can be assessed. CONCLUSIONS: Measurement is the foundation on which health decisions are made. Poor measurement quality can affect both the quality of health care decisions and decisions about health care policy. The accompanying articles in this issue highlight a subset of measurement issues that have applicability to the broad community of health services research. It is our hope that they stimulate a broad discussion of the measurement challenges posed by conducting "state-of-the-art" health services research.

Data Collection↗
PubMed2004

A controlled trial of active versus passive learning strategies in a large group setting.

OBJECTIVE: To compare the effects of active and didactic teaching strategies on learning- and process-oriented outcomes. DESIGN: Controlled trial. SETTING: After-hours residents' teaching session. PARTICIPANTS: Family and Community Medicine, Internal Medicine, and Pediatrics residents at two academic medical institutions. INTERVENTIONS: We randomly assigned residents to two groups. One group received a didactic lecture on effective use of diagnostic tests; during this session, the teacher spent a full hour delivering content. The other group received the same content in a session structured to foster resident-to-resident interactions. In the latter session, the teacher spent only 30 minutes directly delivering content to residents. MEASURES AND MAIN RESULTS: We measured residents' knowledge about and attitudes toward the session content before, immediately after, and one month after each session. We measured residents' perceptions of engagement and session value immediately after each session. We employed blinded observers who used a structured instrument to observe residents' activities during each session. Both teaching methods led to improvements in residents' scores on both knowledge and attitude assessments. The amount of improvement was not statistically different between groups. Residents in the active learning session perceived themselves, and were observed to be, more engaged with the session content and each other than residents in the didactic session. Residents in the didactic session perceived greater educational value from the session compared to residents in the active session. CONCLUSIONS: We reduced the amount of time spent in teacher-driven content delivery by 50 percent and covered the same amount of content with no detrimental effects on knowledge acquisition or attitude enhancement. Teaching strategies that foster learner-to-learner interactions will lead to more active engagement among learners, however, these learners may value the session less. Further research is needed to explore learner perceptions of the teaching process and other outcomes of active learning in medical education.

Adult↗
PubMed2004

Hepatitis C infection and the increasing incidence of hepatocellular carcinoma: a population-based study.

BACKGROUND AND AIMS: A significant increase in the incidence of hepatocellular carcinoma (HCC) has been reported in the United States. The risk factors underlying this increase remain unclear. METHODS: By using Surveillance, Epidemiology, and End-Results program (SEER)-Medicare-linked data, we conducted a population-based study to examine temporal changes in risk factors for patients 65 years and older diagnosed with HCC between 1993 and 1999. Only patients with continuous Medicare enrollment for 2 years before and up to 2 years after HCC diagnosis were examined. Univariate and multiple logistic regression analyses were used to evaluate changes in risk factors over time (January 1993-June 1996 and July 1996-December 1999). RESULTS: The age-adjusted incidence of HCC among persons 65 years of age and older significantly increased from 14.2 per 100,000 in 1993 to 18.1 per 100,000 in 1999. We identified 2584 patients with continuous Medicare enrollment 2 years before and up to 2 years after HCC diagnosis. The proportion of hepatitis C virus (HCV)-related HCC increased from 11% during January of 1993 to June of 1996 to 21% during July of 1996 to December of 1999, whereas hepatitis B virus (HBV)-related HCC increased from 6% to 11% ( P < .0001). In multiple logistic regression analyses that adjusted for age, sex, race, and geographic region, the risk for HCV-related HCC and HBV-related HCC increased by 226% and 67%, respectively. Idiopathic HCC decreased from 43% to 39%. This decrease did not fully account for the significant increases observed for HCV and HBV. No significant changes over time were observed for alcohol-induced liver disease, nonspecific cirrhosis, or nonspecific hepatitis. CONCLUSIONS: There has been a significant recent increase in HCV- and HBV-related HCC. Increasing rates of HCV-related HCC can explain a substantial proportion of the reported increase in HCC incidence during recent years.

Age Distribution↗
PubMed2004

Low-intensity exercise and reduction of the risk for falls among at-risk elders.

BACKGROUND: Among elderly persons, falls account for 87% of all fractures and are contributing factors in many nursing home admissions. This study evaluated the effect of an easily implemented, low-intensity exercise program on the incidence of falls and the time to first fall among a clinically defined population of elderly men and women. METHODS: This community-based, randomized trial compared the exercise intervention with a no-intervention control. The participants were 294 men and women, aged 60 years or older, who had either a hospital admission or bed rest for 2 days or more within the previous month. Exercise participants were scheduled to attend exercise sessions lasting 45 minutes, including warm-up and cool-down, 3 times a week for 8 weeks (24 sessions). Assessments included gait and balance measures, self-reported physical function, the number of medications being taking at baseline, participant age, sex, and history of falling. Falls were tracked for 1 year after each participant's baseline assessment. RESULTS: 29% of the study participants reported a fall during the study period. The effect of exercise in preventing falls varied significantly by baseline physical function level (p < or =.002). The risk for falls decreased for exercise participants with low baseline physical functioning (hazard ratio,.51) but increased for exercise participants with high baseline physical functioning (hazard ratio, 3.51). CONCLUSIONS: This easily implemented, low-intensity exercise program appears to reduce the risk for falls among elderly men and women recovering from recent hospitalizations, bed rest, or both who have low levels of physical functioning.

Accidental Falls↗
PubMed2004

Improving identification of Hispanic males in Medicare: use of surname matching.

OBJECTIVES: Medicare administrative and claims files maintained by the Centers for Medicare and Medicaid Services (CMS) are frequently used to examine racial and ethnic disparities in healthcare use. However, identification of Hispanic ethnicity for beneficiaries in the Medicare claims files is problematic, greatly limiting the use of these administrative data for examining race/ethnicity differences. This article reports on 2 studies assessing the effectiveness of a Hispanic surname match for improving the accuracy of race/ethnicity codes for elderly males in the Medicare data sets. METHODS: Study 1 used survey data to compare a Medicare race code + Spanish surname composite indicator to self-identification as Hispanic. Study 2 used Medicare administrative files and U.S. Census 2000 data to identify how well the Medicare race code alone and the Medicare race code + Spanish surname composite indicator compared with estimates obtained from census data for 16 U.S. counties dispersed across 5 states. RESULTS: Using self-identification as the gold standard, including the Spanish surname match increased accuracy for Hispanics and whites compared with the Medicare race code alone. The Spanish surname match also dramatically improved the Medicare code's estimation of elderly Hispanic and white males compared with county-level census data. CONCLUSIONS: Augmenting the Medicare race code with a match to Spanish surnames yields substantial improvement in the identification of elderly Hispanic and white non-Hispanic male Medicare beneficiaries. Using surname information to supplement the Medicare race code could greatly enhance researchers' ability to examine healthcare equity.

Aged↗
PubMed2003

Validation of an observation instrument for measuring student engagement in health professions settings.

Documenting student engagement has received increased emphasis in medical schools, as teaching strategies are changing to include more student-to-student interactions. The purpose of this study was to develop and evaluate a measure of student engagement completed by independent observers that would not interfere with student learning time. Data from 3,182 observations completed by nine observers in 32 educational classroom settings with 23 different instructors were used to evaluate the interobserver reliability and gather validity evidence for our observational instrument, named the STROBE. Results indicated that interobserver agreement was good to excellent when observations were conducted simultaneously on randomly selected students in the same classroom (84% average agreement and 0.79 average kappa coefficient) and when observations were conducted on different randomly selected students (79% average agreement). Results also provided strong evidence for validity. Overall, findings indicate that the STROBE demonstrates promise for educational research and evaluation by documenting student engagement in medical education settings.

Health Occupations↗
PubMed2002

Differential increases in average isokinetic power by specific muscle groups of older women due to variations in training and testing.

BACKGROUND: As a person ages, leg speed and power decrease. These changes are associated with increased falls and reduced gait speed. It has been shown that upper leg training in younger persons results in increased strength and power at the specific speed at which resistance training is applied, although there are only limited data concerning speed-specific training effects on lower leg activity. However, because both upper and lower leg speed and power influence gait and balance, it is important to determine the training speeds that selectively improve these variables in older persons. METHODS: No studies have examined selective speed-specific changes in performance for the upper and lower leg muscles in older individuals. Therefore, we compared shifts in the power-velocity relationship after high-speed (HS) and low-speed (LS) isokinetic training of knee extensors (KE) and flexors (KF), dorsiflexors (DF), and plantar flexors (PF) in community-dwelling women (ages 61 to 75). Subjects were randomly assigned to a HS training, LS training, or control (C) group. Training occurred three times a week for 12 weeks. HS training occurred at 4.73 rad.s(-1) (knee) and 3.14 rad.s(-1) (ankle); LS training for both joint actions was at 1.05 rad.s(-1). RESULTS: HS training improved KE power at intermediate (3.14 rad.s(-1); p =.0007) and high (5.24 rad.s(-1); p =.0004) testing speeds. Neither the HS nor LS group showed any change in KF as a result of the training. Both LS and HS training improved DF power at all testing speeds; however, PF power improved only with LS training and only at 1.05 rad.s(-1) (p =.0132) and 3.14 rad.s(-1) (p =.0310). CONCLUSIONS: Our results suggest that, in older women, lower leg training should occur at lower training speeds than upper leg training. Additionally, attention to differential speed-specific training of knee and ankle actions could improve power production, mobility, balance, and other functional measures in older persons.

Age Factors↗
PubMedDate not supplied

Physical performance effects of low-intensity exercise among clinically defined high-risk elders.

BACKGROUND: Falls are among the leading causes of injuries and deaths. Results from a number of studies have suggested that a community-based exercise program may be effective in improving lower body strength, although some have shown only limited improvements. However, the impact of these programs on gait and balance are equivocal. Further, studies that have specifically targeted deconditioned elderly individuals, rather than individuals drawn from the general community, either showed limited or no improvements in gait and balance. OBJECTIVE: This study examined the effectiveness of a community-based, short-term, low-intensity exercise intervention strategy on measures of mobility skills, gait and balance, and muscle strength for a clinically targeted group of elderly individuals at high risk of falls. METHODS: 245 men and women aged 60 years or older were randomized into either an intervention or control group and received a baseline (T1) assessment. Subjects in the intervention group received up to 24 sessions (45 min long) of low-intensity standard exercise modalities tailored to the individual patient over an 8- to 10-week period. At the conclusion of the program, the participants in the intervention group were instructed to continue performing the exercises at home until 1 year after T1. Measures of physical function and performance were collected for all subjects at three different points of study enrollment. RESULTS: Of the subjects assessed at baseline, 138 (56%) also had a postintervention assessment (T2), 128 (52%) had a 6-month follow-up assessment (T3), and 105 subjects had assessments at all time points. Primary analyses were based on the 105 subjects who had assessments at all time points. Intervention and control subjects did not differ in any of the physical function or performance measures at baseline. Between T1 and T2, the intervention subjects showed significantly greater improvement than the control subjects on all outcomes, with improvements plateauing for most measures between T2 and T3. Gait and balance scores continued to improve throughout the study period for both groups of subjects. CONCLUSIONS: This easily implemented, low-intensity exercise program may lead to improvements in physical functioning that are retained over the long term and effectively targets a clinically defined population of deconditioned elders at high risk of falling and sustaining serious injury.

Accidental Falls↗