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Biomedical subjects

Sarah Hudson Scholle

Publications and source records attributed to Sarah Hudson Scholle.

At least 19 recordsLinked to original sources
PubMed2007

Efforts to reduce racial disparities in Medicare managed care must consider the disproportionate effects of geography.

OBJECTIVE: To examine the impact of geographic variation on racial differences in 7 of 15 Health Plan Employer Data and Information Set (HEDIS) measures that assess the quality of the Medicare managed care program (also known as Medicare+Choice). STUDY DESIGN: Cross-sectional analysis using the 2004 individual-level HEDIS for Medicare managed care plans and 2003 Medicare enrollment and demographic (ie, denominator) data for more than 5.1 million Medicare+Choice enrollees. METHODS: Individual-level HEDIS data were linked with Medicare enrollment data. Hierarchical generalized linear models were used to assess statistical significance of region and race. Direct standardization was used to estimate the rate of meeting each HEDIS standard while controlling for differences in age and sex. RESULTS: Quality of care for white Medicare+Choice enrollees was strongly correlated with the racial composition of the geographic area. Except for cholesterol management after an acute cardiac event, between-region racial variation was consistently greater than within-region racial variation. CONCLUSION: Removing within-region racial variation while ignoring geographic differences will not equalize the experiences of black and white elders. Rather, both racial and geographic components of healthcare quality must be addressed if the Medicare managed care program is to provide care of equal quality to all elders regardless of race.

Black or African American↗
PubMed2006

Understanding behavior change for women experiencing intimate partner violence: mapping the ups and downs using the stages of change.

OBJECTIVE: For women who are experiencing intimate partner violence (IPV), making changes toward safety is often a gradual process. When providing counseling and support, health care providers may benefit from better understanding of where women are in their readiness to change. Our objective was to apply the transtheoretical model's stages of change to the experiences of women who experienced IPV and map their experiences of change as they moved toward increased safety. METHODS: A multi-disciplinary team designed a qualitative interview process with 20 women who had current or past histories of IPV in order to explore their experiences. RESULTS: The women in our study (1) moved through stages of readiness generally in a nonlinear fashion, with varying rates of progression between safe and nonsafe situations, (2) were able to identify a "turning-point" in their situations, (3) attempted multiple "action" steps and (4) were influenced by internal and external factors. CONCLUSIONS: Our study suggests that focusing on the transtheoretical model to develop stage-based interventions for IPV may not be the most appropriate given the nonsequential movement between stages and influence of external factors. PRACTICE IMPLICATIONS: The "change mapping" technique can be used as an educational and counseling tool with patients, as well as a training tool for health care providers.

Adaptation, Psychological↗
PubMed2006

Brief report: lack of a race effect in primary care ratings among women veterans.

OBJECTIVE: To explore the effect of race on primary care quality and satisfaction among women in the Department of Veterans Affairs (VA). METHODS: We used a mail survey to measure primary care quality and satisfaction. We focused on 4 primary care domains: patient preference for provider, interpersonal communication, accumulated knowledge, and coordination. We performed univariate analyses to compare variables by race and multiple logistic regression analysis to examine the effect of race on the probability of reporting a perfect score on each domain, while adjusting for patient characteristics and site. RESULTS: Black women were younger, unmarried, educated, of higher income, and reported female providers and gynecological care in VA more often. In regression analysis, race was not significantly associated with any primary care domain or satisfaction. Gynecological care from VA provider was associated with perfect ratings on patient preference for provider (odds ratio [OR] 2.0, 95% confidence intervals [CI] 1.3, 3.1), and satisfaction (OR 1.6, 95% CI 1.2, 2.3), while female provider was associated with interpersonal communication (OR 1.9, 95% CI 1.4, 2.6). CONCLUSIONS: While demographics and health experiences vary by race among veterans, race had no effect on primary care ratings. Future studies need to determine whether this racial equity persists in health outcomes among women veterans.

Adolescent↗
PubMed2005

Variations among Institutional Review Board reviews in a multisite health services research study.

OBJECTIVE: To document the Institutional Review Board (IRB) review process and to explore the impact of different patient notification procedures. DATA SOURCES/STUDY SETTING: Review of IRB application and correspondence records prospectively collected during a multisite study of health care quality involving telephone interviews of 3,000 participants across 15 primary care sites. STUDY DESIGN: Records were reviewed to ascertain: (1) the type of IRB review conducted, (2) the number of days from submission to approval of the IRB application, (3) whether the IRB required patient notification and/or consent prior to the release of names, and (4) patient participation rates. DATA COLLECTION/EXTRACTION METHODS: The study coordinating center prepared a common study protocol for IRB submission and assisted sites with submission. The application, correspondence with the IRB, consent script, and patient letters were collected, reviewed, coded, and analyzed. PRINCIPAL FINDINGS: IRBs at the 15 sites and survey center varied in the type of IRB required and the number of days from submission to approval (range of 5-172 days). Four sites required patient notification in advance of the study; 2-11 percent of patients refused in opt-out sites and 37 percent in the single opt-in site. Participation among contacted patients did not appear to be related to patient notification procedures. CONCLUSIONS: Variations in IRB requirements can affect response rates and sample generalizability.

Adult↗
PubMed2005

NCQA behavioral health measurement efforts.

OBJECTIVE: To review the role of the National Committee for Quality Assurance (NCQA) in ensuring the quality of care in the managed care setting and identify novel strategies to improve performance rates for Health Plan Employer Data and Information Set (HEDIS) measures, particularly in the area of depression. SUMMARY: NCQA, by regulating HEDIS measures, sets the standards by which managed care organizations evaluate their performance in providing care for their enrollees. The medication management measure for depression evaluates practitioner contacts and acute and continuation phase treatments for persons treated with an antidepressant. Despite increased detection and management of patients with depression, there is still room for improvement in HEDIS performance rates for this chronic disease. CONCLUSION: NCQA hopes to improve collaboration among managed care organizations and managed behavioral health organizations In addition, NCQA regularly reevaluates the HEDIS measures using input from panels of experts. Incentive p r o grams for providers who deliver quality care may also help to improve HEDIS performance rates for depression. Research is under way to evaluate the feasibility and re t u rn on investment for pay-for-performance programs in depression.

Antidepressive Agents↗
PubMed2005

The relationship between quality and utilization in managed care.

OBJECTIVE: To examine correlations of commercial health plan performance on Health Plan Employer Data and Information Set (HEDIS) effectiveness-of-care measures with utilization rates, as a proxy for cost. STUDY DESIGN: Cross-sectional study of 254 commercial health plans. METHODS: This report used data reported by commercial managed care plans in the 2003 HEDIS dataset. Utilization measures included access to care (the proportion of adults with at least 1 primary care or preventive visit), outpatient use (the number of outpatient visits per 1000 members per year), inpatient discharges (the number of inpatient discharges for medical conditions per 1000 members per year), and inpatient days (inpatient hospital days for medical conditions per 1000 members per year). A composite quality score was calculated from HEDIS indicators. Estimates of health plan membership demographics were identified from Consumer Assessment of Health Plans (CAHPS) survey data. Of 316 reporting plans, 254 reported sufficient data to be included in this analysis. Bivariate correlations and multivariate regressions (controlling for health plan and membership characteristics) were conducted. RESULTS: Quality was positively correlated with access to outpatient care (r = 0.46, P < .001), negatively associated with inpatient days (r = -0.30, P < .001), and not associated with total outpatient visits (r = 0.04, not significant). Regression results controlling for selected plan and member characteristics demonstrated similar findings. CONCLUSIONS: Although the mechanism of this cross-sectional association is unclear, these data provide important starting points for further research on the interrelationships of quality and resource use.

Adult↗
PubMed2005

Practice systems for chronic care: frequency and dependence on an electronic medical record.

OBJECTIVES: To document the presence and functioning of different practice systems in a small sample of medical groups in Minnesota and to examine the relationship between the presence of practice systems and prior adoption of an electronic medical record (EMR). STUDY DESIGN: Descriptive study of the frequency of practice systems in 11 medical groups. METHODS: We recruited 11 medical groups for the study. Four groups had an EMR; the other groups used paper medical records, often supplemented by electronic ordering or data systems. Using an on-site audit team, we validated the presence of practice systems organized under 8 categories. RESULTS: All of the medical groups had implemented a substantial number of practice systems for care management of patients with chronic conditions. Although the medical groups with an EMR tended to have more comprehensive practice systems in place, the medical groups without an EMR also had most of the practice systems. CONCLUSIONS: Although required in some functions, an EMR may not be necessary in facilitating practice systems that support consistent management of patients with chronic illness. Approaches are needed that will encourage the implementation of practice systems in medical groups with and without an EMR.

Ambulatory Care Information Systems↗
PubMed2004

Characteristics of patients seen and services provided in primary care visits in obstetrics/gynecology: data from NAMCS and NHAMCS.

Debate continues on the role of obstetricians/gynecologists in women's primary care and there is conflicting data on what these physicians actually do. Using data from nationally representative surveys, we found that obstetricians/gynecologists identify themselves as primary care providers for 21.7% of private physician office visits and 22.2% of hospital-based outpatient clinic visits. Primary care visits more often involved pregnancy care and less often included referred patients. Other demographic characteristics had different effects in community office practices versus hospital outpatient clinic visits. In general, preventive services and counseling were more likely to be provided in general/gynecologic examinations not designated as primary care provider visits. However, the more frequent provision of mental health counseling and lower rates of mammography services in primary care visits suggest that these obstetricians/gynecologists may serve a more longitudinal role in care for their patients. Overall, there continues to be strong variation in the role of obstetricians/gynecologists in women's primary care.

Adolescent↗
PubMed2004

Comprehensive care for women veterans: indicators of dual use of VA and non-VA providers.

OBJECTIVE: To compare women who use Department of Veterans Affairs (VA) health care providers only with women who use VA and non-VA providers (dual users). METHODS: An anonymous survey was mailed to women veterans randomly sampled from 10 VA medical centers in 3 states. We measured reports of dual use of VA and non-VA providers according to the VA provider's gender, provision of routine gynecological care by VA provider, use of VA women's clinic, and overall satisfaction with VA care. Multiple logistic regression analyses were performed with adjustment for patient demographics, health status, VA service connection status, and clustering by site to determine what factors influenced dual use of providers. RESULTS: In the fully adjusted logistic regression model, provision of routine gynecological care by VA providers (odds ratios [OR] 0.37; 95% confidence intervals [CI] 0.22, 0.60) and use of VA women's clinics (OR 0.56; CI 0.35, 0.90) were strongly associated with a lower likelihood of dual use. Dissatisfaction with care (OR 1.88; CI 1.04,3.41) and higher income (OR 1.89; CI 1.32, 2.71) were also associated with an increased likelihood of dual use. Having a female VA provider was not associated with dual use. CONCLUSIONS: Women veterans' use of VA and non-VA providers is influenced by the scope of clinical services and dissatisfaction with those services. VA clinics should either promote routine gynecological care within primary care clinic settings or pair traditional primary care with VA women's clinics to enhance coordination and comprehensiveness and, thus, reduce fragmentation of care for veteran women.

Adult↗
PubMed2003

Preferences for depression advice among low-income women.

OBJECTIVES: Because patient reluctance to discuss depression may influence the success of depression interventions, we assessed preferences for the source of depression advice among high-risk women and factors associated with those preferences. METHODS: The sample included 147 consecutive patients at a hospital-based obstetrics and gynecology clinic. All were age 18-44, on Medicaid and able to complete a previsit survey and postvisit interview. Women were asked "Where would you prefer to get advice on how you are feeling, whether you are sad or worried?" Responses were grouped as the ob/gyn clinic, general medical provider, mental health/substance abuse provider or no professional advice desired. RESULTS: Many women did not want professional advice on depression: 33% said they preferred to get advice from informal sources and 5% preferred no information. A total of 23% of women preferred to discuss depression with the ob/gyn provider, 14% with a general medical provider, and 25% with a mental health or substance abuse provider. Women were more likely to want advice from a health provider (of any type) if they had previously use mental health care (OR = 3.6, p = 0.005) or had at least one chronic health condition (OR = 3.1, p = 0.013). Women were more likely to want advice from the ob/gyn clinic if it was their primary care provider (OR = 41.8, p = 0.002) or if they had high depressive symptoms (OR = 4.8, p = 0.048). CONCLUSIONS: Many women do not want to discuss depression with a health professional, but familiarity with the mental health care system, health status, and relationship with a provider influence women's openness to depression advice.

Adolescent↗
PubMed2003

Patient satisfaction in women's clinics versus traditional primary care clinics in the Veterans Administration.

OBJECTIVE: To compare patient satisfaction in women's clinics (WCs) versus traditional primary care clinics (TCs). DESIGN: Anonymous, cross-sectional mailed survey. SETTING: Eight Department of Veterans Affairs (VA) medical centers in 3 states. PATIENTS: A random sample of women stratified by site and enrollment in WC versus TC (total response rate = 61%). MEASURES: Overall satisfaction and gender-specific satisfaction as measured by the Primary Care Satisfaction Survey for Women (PCSSW). ANALYSIS: We dichotomized the satisfaction scores (excellent versus all other), and compared excellent satisfaction in WCs versus TCs using logistic regression, controlling for demographics, health status, health care use, and location. RESULTS: Women enrolled in WCs were more likely than those in TCs to report excellent overall satisfaction (odds ratio, 1.42; 95% confidence interval, 1.00 to 2.02; P = .05). Multivariate models demonstrated that receipt of care in WCs was a significant positive predictor for all 5 satisfaction domains (i.e., getting care, privacy and comfort, communication, complete care, and follow-up care) with the gender-specific satisfaction instrument (PCSSW). CONCLUSIONS: This study is the first to consistently show higher satisfaction in WCs versus TCs despite age and race differences and comparable health status. Since these WCs show better quality in terms of satisfaction, other quality indicators should be evaluated. If WCs reduce fragmentation and improve health care delivery, the model will be applicable in VA and non-VA outpatient settings.

Adult↗
PubMed2003

Assessing primary care performance in an obstetrics/gynecology clinic.

OBJECTIVES: Young, low-income women often use ob/gyns for routine care. Yet, little is known about the extent to which these settings achieve primary care goals. This study compared primary care performance among young low-income women using ob/gyns versus other settings as their primary care providers (PCP). METHODS: Anonymous interviews with 158 women on Medical Assistance age 18-44 seen at a university ob/gyn clinic. RESULTS: Sixty women (38.0%) used the ob/gyn setting for primary care, 83 (52.5%) use other places and 15 (9.5%) identified no primary care provider. Compared to women using other places for primary care, women who used the ob/gyn setting as their PCP were younger (OR 0.93, p = .04), had less education (OR 3.9, p = .02), and more frequently had small children (OR 2.8, p = .05) and reported illicit drug use (OR 3.1, p = .05). Performance on first contact care, ongoing care, coordination, and family and community issues did not vary by whether the PCP was an ob/gyn versus another provider, though women with an ob/gyn PCP rated their provider significantly higher on cultural competence. Access to advice on general medical prevention topics differed little by type of PCP; however, women who used the ob/gyn clinic as PCP received advice on more reproductive health, behavioral health, and injury prevention topics, with a mean number of preventive topics of 13.0 (SD 3.6) versus 6.3 (SD 4.1) (p < .01). DISCUSSION: Many young women who rely on hospital-based ob/gyn clinics for primary care may benefit from expanded health promotion efforts. The large portion of young, low-income women using ob/gyn settings for primary care may receive primary care of equal or better quality compared to women using other settings. More research is needed to see if these findings are generalizable.

Adult↗
PubMed2002

Child sex differences in primary care clinicians' mental health care of children and adolescents.

BACKGROUND: Sex differences in the medical and mental health care of adults are well established. OBJECTIVE: To study the effect of child patient's sex on whether primary care clinicians (PCCs), including pediatricians, family physicians, and nurse practitioners, found or treated mental health problems in primary care settings. DESIGN: The data were collected by clinicians and parents from 21 065 individual child visits (50.3% girls) in 204 primary care practices. METHODS: Each PCC enrolled a consecutive sample of approximately 55 children and adolescents aged 4 to 15 years. Parents filled out questionnaires, including the Pediatric Symptom Checklist, before seeing the clinician. Clinicians completed a survey after the visit about the psychosocial problems and recommended treatments, but they did not see the results of the Pediatric Symptom Checklist or any other data collected from the parents. RESULTS: Boys were more likely to be seen for a mental health-related visit and by a clinician who identified them as "my patient." Boys with parent-reported symptom profiles that were similar to those of girls were more likely to be identified as having attention-deficit/hyperactivity problems or behavior or conduct problems and less likely to be identified as having internalizing problems. Adjusting for parent-reported symptoms, PCCs were more likely to prescribe medications for boys. Child sex differences in referrals to mental health specialists and the provision of counseling to families were not statistically significant. CONCLUSION: There are substantial sex differences in the mental health care of children in the primary care system.

Adolescent↗
PubMedDate not supplied

The development and validation of the primary care satisfaction survey for women.

Assessing patient satisfaction with health care is becoming an integral component of quality monitoring in health care systems, but existing tools typically were developed to minimize differences related to gender. This paper reports the development and psychometric properties of a new survey instrument to measure women's satisfaction with their primary care. A multisite, cross-sectional validation survey of 1,202 women receiving care in primary care settings in Michigan, North Carolina, and Pennsylvania was conducted. Item response theory (IRT) and factor analysis methods were used to identify three scales in the Primary Care Satisfaction Survey for Women (PCSSW): Communication, Administration and Office Procedures, and Care Coordination and Comprehensiveness. Internal consistency reliability is reported, as well as convergent validity in relation to two generic measures (Medical Outcomes Study [MOS] Visit Satisfaction and Consumer Assessment of Health Plans Survey [CAHPS] overall quality rating); discriminant validity in relation to groups expected to have differing satisfaction levels based on previous literature; predictive validity in relation to behavioral intentions; and explanatory power in overall satisfaction ratings. The 24-item PCSSW may be self-administered or conducted by telephone and may be used in studies to evaluate or improve the quality of primary care for women.

Adult↗