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Biomedical subjects

Ron D Hays

Publications and source records attributed to Ron D Hays.

At least 37 records · Page 2Linked to original sources
PubMed2006

Comparison of data quality for reports and ratings of ambulatory care by African American and White Medicare managed care enrollees.

OBJECTIVE: Compare missing data and reliability of health care evaluations between African Americans and Whites in Medicare managed care health plans. METHOD: Consumer Assessment of Healthcare Providers and Systems (CAHPS) 3.0 health plan survey data collected from 109,980 Medicare managed care enrollees (101,189 Whites, 8,791 African Americans) in 321 plans. Participants self-administered the survey and four single-item global ratings of care. RESULTS: Missing data rates were significantly higher for African Americans than Whites on all CAHPS items (p < .0001). Internal consistency reliability estimates for the CAHPS scales did not differ significantly between African Americans and Whites, but plan-level reliability estimates for the scales and global rating items were significantly lower for African Americans than Whites. DISCUSSION: Higher missing data rates and lower plan-level reliability estimates for African American Medicare managed care enrollees suggest caution in making race/ethnicity comparisons. Future efforts are needed to enhance the quality of data collected from older African Americans.

Adult↗
PubMed2006

The impact of interpreters on parents' experiences with ambulatory care for their children.

Health plan members who did not need an interpreter in the past 6 months were compared with those who needed one and always, usually, sometimes, or never got one. In multivariate analyses, Hispanic and Asian/Pacific Islanders (API) members who needed interpreters and usually, sometimes, or never used one reported significantly worse (p < .05) provider and office staff communication, access to care, and health plan customer service compared with members who did not need interpreters. Hispanic and API members who needed and always used an interpreter reported similar or significantly better (p < .05) provider and office staff communication, access to care, and health plan customer service than members that did not need interpreters. Use of interpreters reduced White-Hispanic disparities in reports of care by up to 28 percent and White-API disparities by as much as 21 percent. Increasing use of interpreters could reduce racial/ethnic disparities and improve health plan performance.

Adult↗
PubMed2006

Health-related quality of life and patient reports about care outcomes in a multidisciplinary hospital intervention.

BACKGROUND: Patient perceptions of care and health-related quality of life (HRQOL) are important outcomes for hospitalized patients. PURPOSE: This study examined patient experiences with hospital care and HRQOL in individuals hospitalized at a west coast teaching hospital. METHODS: We assessed patient experiences with care and HRQOL using interviews with 1,207 hospitalized, general medicine patients participating in a multidisciplinary provider team intervention at a large academic medical center. Patient outcome variables included the Picker dimensions of hospital care (Continuity and Transition, Coordination of Care, Emotional Support, Information and Education, Involvement of Family and Friends, Physical Comfort, Respect for Patient Preferences, Overall Impression), the Health Utilities Index Mark 3 (HUI-3), and the SF-12 physical (PCS-12) and mental health (MCS-12) summary scores. RESULTS: Patients randomized to a multidisciplinary intervention reported higher emotional support (b = 3.32), t(903) = 2.01, p =.044, and physical comfort (b = 3.49), t(863) = 2.25, p = .025, from health care providers than did the control group, but these effects became nonsignificant after adjusting for multiple comparisons. The HUI-3, PCS-12, and MCS-12 summary scores improved significantly from baseline to the 30-day, ts(943, 919, 860) = 4.94, 2.20, and 5.31, ps < .0001, = .03, and < .0001, respectively, and the 4-month follow-ups, ts(871, 919, 943) = 7.25, 8.68, and 8.08, ps < .001, < .001, and < .0001, respectively, but change on these measures did not differ between intervention and control patients. Baseline health was significantly associated with patient evaluations of hospital care, but patient evaluations did not predict future health. CONCLUSIONS: There were no differences in reports and ratings of hospital care or HRQOL between the control and the intervention groups. Hence, the behavioral changes in hospital staff in the intervention group had no effect on patient-reported outcomes. Mental health at baseline was predictive of patient evaluations of the hospitalization, but evaluations of care were not associated with subsequent HRQOL. Thus, it may be important to adjust patient evaluations of hospital care for case-mix differences in health.

Adolescent↗
PubMed2006

Psychometric characteristics of a patient satisfaction instrument tailored to the concerns of African Americans.

The national initiative to eliminate health disparities by 2010 makes clear the need for culturally appropriate patient-reported outcome measures. The objective of the study was to refine and augment an existing comprehensive patient satisfaction instrument, the Group Health Association of America (GHAA) survey, to capture the health care concerns of African Americans from diverse socioeconomic backgrounds. Modifications of GHAA items included splitting, rewording, substituting, and adding items. The result was a 21-domain instrument. Three new domains included respect, health education, and discrimination/stereotyping. A cross sectional survey of 600 African Americans and Whites yielded 237 usable surveys with 214 self-identified as African American (n=100) or White (n=114). Item-scale correlations were examined to evaluate the extent to which items correlated more highly with the scale they were intended to represent than they did with other scales. Support was found for 15 of 19 hypothesized multi-item scales. This study yields a survey that can be used to evaluate care delivered to African Americans and Whites. The survey needs to be evaluated in other samples to determine if it adequately reflects cultural issues from other ethnic minorities.

Black or African American↗
PubMed2006

Physician communication about the cost and acquisition of newly prescribed medications.

OBJECTIVE: To describe the frequency and content of physician discussions about the cost and acquisition of new medications. STUDY DESIGN: Qualitative and quantitative study combining patient and physician surveys with transcribed audiotaped office visits from 185 outpatient encounters with 15 family physicians, 18 internists, and 11 cardiologists in 2 Sacramento healthcare systems between January and November 1999, in which 243 new medications were prescribed. METHODS: Transcripts were qualitatively analyzed to describe conversations concerning the cost and acquisition of new medication prescriptions, frequencies of discussions were described, and multivariate logistic regression was used to examine the predictors of cost discussions. RESULTS: For one third of newly prescribed medications, physicians discussed an aspect of acquisition, including cost and insurance coverage for 12%, logistics of obtaining medications for 18%, and medication supply for 9%. Patients initiated cost or insurance concerns for fewer than 2% of the new medications prescribed. There were 5 discussions about patient out-of-pocket costs and 7 discussions offering tips for cost savings. In multivariate analysis, cost discussions were more likely to occur with patients earning less than 20,000 dollars per year compared with those earning more than 60,000 dollars per year, were less likely to occur with medications prescribed by family physicians or internists compared with cardiologists, and were less likely with medications prescribed to older patients. CONCLUSIONS: Physician-patient discussions about new medication cost and other acquisition issues, especially medication affordability, occur infrequently. Because physicians may not recognize patients' financial impediments to acquiring medications, this issue should be raised when prescribing new medications.

Adult↗
PubMed2005

Do proxies reflect patients' health concerns about urinary incontinence and gait problems?

BACKGROUND: While falls and urinary incontinence are prevalent among older patients, who sometimes rely on proxies to provide their health information, the validity of proxy reports of concern about falls and urinary incontinence remains unknown. METHODS: Telephone interviews with 43 consecutive patients with falls or fear of falling and/or bothersome urinary incontinence and their proxies chosen by patients as most knowledgeable about their health. The questionnaire included items derived from the Medical Outcomes Study Short Form 12 (SF-12), a scale assessing concerns about urinary incontinence (UI), and a measure of fear of falling, the Falls Efficacy Scale (FES). Scores were estimated using items asking the proxy perspective (6 items from the SF-12, 10 items from a UI scale, and all 10 FES items). Proxy and patient scores were compared using intraclass correlation coefficients (ICC, one-way model). Variables associated with absolute agreement between patients and proxies were explored. RESULTS: Patients had a mean age of 81 years (range 75-93) and 67% were female while proxies had a mean age of 70 (range 42-87) and 49% were female. ICCs were 0.63 for the SF-12, 0.52 for the UI scale, and 0.29 for the FES. Proxies tended to understate patients' general health and incontinence concern, but overstate patients' concern about falling. Proxies who lived with patients and those who more often see patients more closely reflected patient FES scores compared to those who lived apart or those who saw patients less often. Internal consistency reliability of proxy responses was 0.62 for the SF-12, 0.86 for the I-QOL, and 0.93 for the FES. In addition, construct validity of the proxy FES scale was supported by greater proxy-perceived fear of falling for patients who received medical care after a fall during the past 12 months (p < .05). CONCLUSION: Caution should be exercised when using proxies as a source of information about older patients' health perceptions. Questions asking about proxies' views yield suboptimal agreement with patient responses. However, proxy scales of UI and fall concern are internally consistent and may provide valid independent information.

Accidental Falls↗
PubMed2005

Impact of hepatitis C on health related quality of life: a systematic review and quantitative assessment.

Hepatitis C virus (HCV) diminishes health related quality of life (HRQOL), and it is now common to measure HRQOL in clinical trials. We sought to summarize the HRQOL data in HCV, and to establish the minimally clinically important difference (MCID) in HRQOL scores in HCV. We performed a systematic review to identify relevant studies, and converted HRQOL data from each study into clinically interpretable statistics. An expert panel used a modified Delphi technique to estimate the MCID in HCV. We found that patients with HCV scored lower than controls across all scales of the SF-36. Patients achieving sustained virological response (SVR) scored higher across all scales versus patients without SVR, especially in the physical health domains. HRQOL differences did not correspond with differences in liver histology or ALT levels. Based upon the published data, the expert panel concluded that the SF-36 vitality scale was most relevant in patients with HCV, and generated a mean MCID of 4.2 points on this scale. In conclusion, patients with HCV have a clinically significant decrement in HRQOL versus controls, and physical HRQOL improves in patients achieving SVR but not in those without SVR. The data further suggest that traditional outcomes fail to capture the full spectrum of illness related to chronic HCV. A difference of 4.2 points on the SF-36 vitality scale can be used as an estimate of the MCID in HCV, and this value may be used as the basis for power calculations in clinical trials evaluating HRQOL. Supplementary material for this article can be found on the HEPATOLOGY website (http://www.interscience.wiley.com/jpages/0270-9139/suppmat/index.html).

Case-Control Studies↗
PubMed2005

Estimating clinically significant differences in quality of life outcomes.

OBJECTIVE: This report extracts important considerations for determining and applying clinically significant differences in quality of life (QOL) measures from six published articles written by 30 international experts, in the field of QOL assessment and evaluation. The original six articles were presented at the Symposium on Clinical Significance of Quality of Life Measures in Cancer Patients at the Mayo Clinic in April 2002 and subsequently were published in Mayo Clinic Proceedings. PRINCIPAL FINDINGS: Specific examples and formulas are given for anchor-based methods, as well as distribution-based methods that correspond to known or relevant anchors to determine important differences in QOL measures. Important prerequisites for clinical significance associated with instrument selection, responsiveness, and the reporting of QOL trial results are provided. We also discuss estimating the number needed to treat (NNT) relative to clinically significant thresholds. Finally, we provide a rationale for applying group-derived standards to individual assessments. CONCLUSIONS: While no single method for determining clinical significance is unilaterally endorsed, the investigation and full reporting of multiple methods for establishing clinically significant change levels for a QOL measure, and greater direct involvement of clinicians in clinical significance studies are strongly encouraged.

Cross-Sectional Studies↗
PubMed2005

Approaches and recommendations for estimating minimally important differences for health-related quality of life measures.

We describe currently available approaches for estimating the minimally important difference (MID) and their associated strengths and weaknesses. Specifically, we show that anchor-based methods should be the primary method of estimating the MID because of the limitations of distribution-based methods. In addition, we provide recommendations for estimating the MID in future research.

Data Interpretation, Statistical↗
PubMed2005

Development of the 12-item Expectations Regarding Aging Survey.

PURPOSE: This study describes the development of a short version of the Expectations Regarding Aging Survey (ERA-38), a 38-item survey measuring expectations regarding aging. DESIGN AND METHODS: In 1999, surveys containing the ERA-38 were mailed to 588 adults aged > or = 65 years who were recruited through physicians; 429 individuals (73%) returned completed surveys. The mean age of participants was 77 years; 76% were White. In 2001, we surveyed 643 adults aged > or = 65 years recruited at 14 senior centers. The mean age of participants was 78 years; 37% were Latino and 16% were African American. With the 1999 data, we selected items for the shorter version of the ERA-38 by using qualitative criteria and by evaluating the items' factor structure, internal consistency reliability of scales, and correlations with age and self-reported measures of health. Then, using the 2001 data, we evaluated the selected items with confirmatory factor analysis, and we reevaluated the internal consistency reliability and associations of the scales with age and self-reported measures of health. RESULTS: The factor analyses of the ERA-12 on both samples provided support for three 4-item scales (expectations regarding physical health, expectations regarding mental health, and expectations regarding cognitive function), and one global expectations regarding aging scale combining all 12 items. In both samples, internal consistency reliability estimates for all scales exceeded 0.74, and the 12 items together explained over 88% of the variance in the ERA-38 total score. We found comparable associations of the ERA-12 scales with age and self-reported health measures in both samples. IMPLICATIONS: The ERA-12 demonstrated acceptable reliability and validity to estimate expectations regarding aging.

Aged↗
PubMed2005

Do Medicaid and commercial CAHPS scores correlate within plans?: a New Jersey case study.

BACKGROUND: The Consumer Assessment of Health Plans Study (CAHPS) health plan survey is currently administered to large independent samples of Medicaid beneficiaries and commercial enrollees for managed care organizations that serve both populations. There is interest in reducing survey administration costs and sample size requirements by sampling these 2 groups together for health plan comparisons. Plan managers may also be interested in understanding variability within plans. OBJECTIVE: The objective of this study was to assess whether the within plan correlation of CAHPS scores for the 2 populations are sufficiently large to warrant inferences about one from the other, reducing the total sample sizes needed. RESEARCH DESIGN: This study consisted of an observational cross-sectional study. SUBJECTS: Subjects were 3939 Medicaid beneficiaries and 3027 commercial enrollees in 6 New Jersey managed care plans serving both populations. MEASURES: Outcomes are 4 global ratings and 6 report composites from the CAHPS 1.0 survey. RESULTS: Medicaid beneficiaries reported poorer care than commercial beneficiaries for 6 composites, but none of the 4 global ratings. Controlling for these main effects, variability between commercial enrollees and Medicaid beneficiaries within plans exceeded variability by plans for commercial enrollees for 4 of the 10 measures (2 composites, 2 global ratings). CONCLUSIONS: Within-plan variability in evaluations of care by Medicaid and commercial health plan member evaluations is too great to permit meaningful inference about plan performance for one population from the other for many important outcomes; separate surveys should still be fielded.

Consumer Behavior↗
PubMed2005

Imputation of SF-12 health scores for respondents with partially missing data.

OBJECTIVE: To create an efficient imputation algorithm for imputing the SF-12 physical component summary (PCS) and mental component summary (MCS) scores when patients have one to eleven SF-12 items missing. STUDY SETTING: Primary data collection was performed between 1996 and 1998. STUDY DESIGN: Multi-pattern regression was conducted to impute the scores using only available SF-12 items (simple model), and then supplemented by demographics, smoking status and comorbidity (enhanced model) to increase the accuracy. A cut point of missing SF-12 items was determined for using the simple or the enhanced model. The algorithm was validated through simulation. DATA COLLECTION: Thirty-thousand-three-hundred and eight patients from 63 physician groups were surveyed for a quality of care study in 1996, which collected the SF-12 and other information. The patients were classified as "chronic" patients if they reported that they had diabetes, heart disease, asthma/chronic obstructive pulmonary disease, or low back pain. A follow-up survey was conducted in 1998. PRINCIPAL FINDINGS: Thirty-one percent of the patients missed at least one SF-12 item. Means of variance of prediction and standard errors of the mean imputed scores increased with the number of missing SF-12 items. Correlations between the observed and the imputed scores derived from the enhanced models were consistently higher than those derived from the simple model and the increments were significant for patients with > or =6 missing SF-12 items (p<.03). CONCLUSION: Missing SF-12 items are prevalent and lead to reduced analytical power. Regression-based multi-pattern imputation using the available SF-12 items is efficient and can produce good estimates of the scores. The enhancement from the additional patient information can significantly improve the accuracy of the imputed scores for patients with > or =6 items missing, leading to estimated scores that are as accurate as that of patients with <6 missing items.

Adult↗
PubMed2005

Patients' preferences for technical versus interpersonal quality when selecting a primary care physician.

OBJECTIVE: To assess patients' use of and preferences for information about technical and interpersonal quality when using simulated, computerized health care report cards to select a primary care provider (PCP). DATA SOURCES/STUDY SETTING: Primary data collected from 304 adult consumers living in Los Angeles County in January and February 2003. STUDY DESIGN/DATA COLLECTION: We constructed computerized report cards for seven pairs of hypothetical individual PCPs (two internal validity check pairs included). Participants selected the physician that they preferred. A questionnaire collected demographic information and assessed participant attitudes towards different sources of report card information. The relationship between patient characteristics and number of times the participant selected the physician who excelled in technical quality are estimated using an ordered logit model. PRINCIPAL FINDINGS: Ninety percent of the sample selected the dominant physician for both validity checks, indicating a level of attention to task comparable with prior studies. When presented with pairs of physicians who varied in technical and interpersonal quality, two-thirds of the sample (95 percent CI: 62, 72 percent) chose the physician who was higher in technical quality at least three out of five times (one-sample binomial test of proportion). Age, gender, and ethnicity were not significant predictors of choosing the physician who was higher in technical quality. CONCLUSIONS: These participants showed a strong preference for physicians of high technical quality when forced to make tradeoffs, but a substantial proportion of the sample preferred physicians of high interpersonal quality. Individual physician report cards should contain ample information in both domains to be most useful to patients.

Adult↗
PubMed2005

A Self-Report Measure of Clinicians' Orientation toward Integrative Medicine.

OBJECTIVE: Patients in the U.S. often turn to complementary and alternative medicine (CAM) and may use it concurrently with conventional medicine to treat illness and promote wellness. However, clinicians vary in their openness to the merging of treatment paradigms. Because integration of CAM with conventional medicine can have important implications for health care, we developed a survey instrument to assess clinicians' orientation toward integrative medicine. STUDY SETTING: A convenience sample of 294 acupuncturists, chiropractors, primary care physicians, and physician acupuncturists in academic and community settings in California. DATA COLLECTION METHODS: We used a qualitative analysis of structured interviews to develop a conceptual model of integrative medicine at the provider level. Based on this conceptual model, we developed a 30-item survey (IM-30) to assess five domains of clinicians' orientation toward integrative medicine: openness, readiness to refer, learning from alternate paradigms, patient-centered care, and safety of integration. PRINCIPAL FINDINGS: Two hundred and two clinicians (69 percent response rate) returned the survey. The internal consistency reliability for the 30-item total scale and the five subscales ranged from 0.71 to 0.90. Item-scale correlations for the five subscales were higher for the hypothesized subscale than other subscales 75 percent or more of the time. Construct validity was supported by the association of the IM-30 total scale score (0-100 possible range, with a higher score indicative of greater orientation toward integrative medicine) with hypothesized constructs: physician acupuncturists scored higher than physicians (71 versus 50, p<.001), dual-trained practitioners scored higher than single-trained practitioners (71 versus 62, p<.001), and practitioners' self-perceived "integrativeness" was significantly correlated (r=0.60, p<.001) with the IM-30 total score. CONCLUSION: This study provides support for the reliability and validity of the IM-30 as a measure of clinicians' orientation toward integrative medicine. The IM-30 survey, which we estimate as requiring 5 minutes to complete, can be administered to both conventional and CAM clinicians.

Adult↗
PubMed2005

Assessment of the equivalence of the Spanish and English versions of the CAHPS Hospital Survey on the quality of inpatient care.

OBJECTIVE: To describe translation and cultural adaptation procedures, and examine the degree of equivalence between the Spanish and English versions of the Agency for Healthcare Research and Quality's (AHRQ) Consumer Assessments of Healthcare Providers and Systems (CAHPS) Hospital Survey (H-CAHPS) of patient experiences with care. DATA SOURCES: Cognitive interviews on survey comprehension with 12 Spanish-speaking and 31 English-speaking subjects. Psychometric analyses of 586 responses to the Spanish version and 19,134 responses to the English version of the H-CAHPS survey tested in Arizona, Maryland, and New York in 2003. STUDY DESIGN: A forward/backward translation procedure followed by committee review and cognitive testing was used to ensure a translation that was both culturally and linguistically appropriate. Responses to the two language versions were compared to evaluate equivalence and assess the reliability and validity of both versions. DATA COLLECTION/EXTRACTION METHODS: Comparative analyses were carried out on the 32 items of the shortened survey version, focusing on 16 items that comprise seven composites representing different aspects of hospital care quality (communication with nurses, communication with doctors, communication about medicines, nursing services, discharge information, pain control, and physical environment); three items that rate the quality of the nursing staff, physician staff, and the hospital overall; one item on intention to recommend the hospital. The other 12 items used in the analyses addressed mainly respondent characteristics. Analyses included item descriptives, correlations, internal consistency reliability of composites, factor analysis, and regression analysis to examine construct validity. PRINCIPAL FINDINGS: Responses to both language versions exhibit similar patterns with respect to item-scale correlations, factor structure, content validity, and the association between each of the seven qualities of care composites with both the hospital rating and intention to recommend the hospital. Internal consistency reliability was slightly, yet significantly lower for the Spanish-language respondents for five of the seven composites, but overall the composites were generally equivalent across language versions. CONCLUSIONS: The results provide preliminary evidence of the equivalence between the Spanish and English versions of H-CAHPS. The translated Spanish version can be used to assess hospital quality of care for Spanish speakers, and compare results across these two language groups.

Adult↗
PubMed2005

Exploratory factor analyses of the CAHPS Hospital Pilot Survey responses across and within medical, surgical, and obstetric services.

OBJECTIVES: To estimate the associations among hospital-level scores from the Consumer Assessments of Healthcare Providers and Systems (CAHPS) Hospital pilot survey within and across different services (surgery, obstetrics, medical), and to evaluate differences between hospital- and patient-level analyses. DATA SOURCE: CAHPS Hospital pilot survey data provided by the Centers for Medicare and Medicaid Services. STUDY DESIGN: Responses to 33 questionnaire items were analyzed using patient- and hospital-level exploratory factor analytic (EFA) methods to identify both a patient-level and hospital-level composite structures for the CAHPS Hospital survey. The latter EFA was corrected for patient-level sampling variability using a hierarchical model. We compared results of these analyses with each other and to separate EFAs conducted at the service level. To quantify the similarity of assessments across services, we compared correlations of different composites within the same service with those of the same composite across different services. DATA COLLECTION: Cross-sectional data were collected during the summer of 2003 via mail and telephone from 19,720 patients discharged from November 2002 through January 2003 from 132 hospitals in three states. PRINCIPAL FINDINGS: Six factors provided the best description of inter-item covariation at the patient level. Analyses that assessed variability across both services and hospitals suggested that three dimensions provide a parsimonious summary of inter-item covariation at the hospital level. Hospital-level factor structures also differed across services; as much variation in quality reports was explained by service as by composite. CONCLUSIONS: Variability of CAHPS scores across hospitals can be reported parsimoniously using a limited number of composites. There is at least as much distinct information in composite scores from different services as in different composite scores within each service. Because items cluster slightly differently in the different services, service-specific composites may be more informative when comparing patients in a given service across hospitals. When studying individual-level variability, a more differentiated structure is probably more appropriate.

Attitude of Health Personnel↗
PubMed2005

Review of the literature on survey instruments used to collect data on hospital patients' perceptions of care.

OBJECTIVE: To review the existing literature (1980-2003) on survey instruments used to collect data on patients' perceptions of hospital care. STUDY DESIGN: Eight literature databases were searched (PubMED, MEDLINE Pro, MEDSCAPE, MEDLINEplus, MDX Health, CINAHL, ERIC, and JSTOR). We undertook 51 searches with each of the eight databases, for a total of 408 searches. The abstracts for each of the identified publications were examined to determine their applicability for review. METHODS OF ANALYSIS: For each instrument used to collect information on patient perceptions of hospital care we provide descriptive information, instrument content, implementation characteristics, and psychometric performance characteristics. PRINCIPAL FINDINGS: The number of institutional settings and patients used in evaluating patient perceptions of hospital care varied greatly. The majority of survey instruments were administered by mail. Response rates varied widely from very low to relatively high. Most studies provided limited information on the psychometric properties of the instruments. CONCLUSIONS: Our review reveals a diversity of survey instruments used in assessing patient perceptions of hospital care. We conclude that it would be beneficial to use a standardized survey instrument, along with standardization of the sampling, administration protocol, and mode of administration.

Health Care Surveys↗