Biomedical subjects

Todd Rockwood

Publications and source records attributed to Todd Rockwood.

11 recordsLinked to original sources

PubMed2005

Visual Analog Scale pain reporting was standardized.

BACKGROUND AND OBJECTIVE: Whereas pain is frequently measured using a visual analog scale (VAS) that can examine change over short time intervals in the same subject, such ratings are not useful in analyzing differences across subjects. We created a method for normalizing VAS pain reporting to control for the variation between different populations due to the differences in subjective perception or objective evaluation of pain. METHODS: A list of 226 pains was gathered from a convenience sample of persons on the street and patients waiting at medical and orthopedic clinics. These pains were ranked according to severity by health professionals and 19 pains with the most stable rankings were selected. These 19 pains were then rated by a sample of community-dwelling persons and a method of VAS standardization was developed, based on six selected pains. RESULTS: Individual variations in pain ratings were found to be independent of respondent age and gender, but were correlated with experience of the event or behavior and with self-reported health status. A new scoring method that takes into account these correlations is proposed. CONCLUSION: It is possible to standardize VAS pain ratings to compare pain between different populations.

Age Factors↗

PubMed2005

Rating the importance of nursing home residents' quality of life.

OBJECTIVES: To assess how various stakeholders involved with nursing home care rate the importance of various quality-of-life (QoL) items for hypothetical residents with varying types of impairment. DESIGN: A community-based exploratory description of a convenience sample. SETTING: Eleven nursing homes in Florida, New Jersey, and Minnesota. PARTICIPANTS: Samples of registered and licensed nurses (RNs and LPNs), certified nursing assistants (CNAs), activities personnel, social workers, physicians, residents, and family members. MEASUREMENTS: Using a magnitude estimation approach, 17 QoL items were rated in order of importance on each of three hypothetical types of nursing home residents. RESULTS: Overall, there was little variation in the ratings for individual items. Ratings for persons with cognitive impairment were consistently lower. RNs'/LPNs' and CNAs' ratings were generally higher than the others, and physicians' ratings were generally lower. Residents' and families' ratings were generally lower than nurses' ratings. CONCLUSION: All stakeholders considered QoL to be important and felt that it deserves more attention in practice and regulation. A summary QoL score need not be weighted. Respondents (who were not cognitively impaired) considered QoL less important for residents with cognitive impairment. Value differences between those involved in nursing home care deserve more exploration.

Aged↗

PubMed2003

State variation in SCHIP allocations: how much is there, what are its sources, and can it be reduced?

Allocations for the State Children's Health Insurance Program (SCHIP) varied 22% per state between 1999 and 2002. The funding fluctuations present significant problems for states as they develop budget priorities under difficult fiscal conditions. We examine sources of the variation in state allocations during the first four years of SCHIP, focusing on the Current Population Survey's "child component" of the allocation formula. We consider the trade-offs in using alternative estimates from the American Community Survey and model-based estimation. Obtaining reliable estimates of need for SCHIP allocations is critical for states dependent on federal support for insurance programs.

Budgets↗

PubMed2003

Evaluating health plan quality 1: a conceptual model.

OBJECTIVE: To develop a theoretical foundation for measuring health plan quality from a physician's perspective. STUDY DESIGN: Literature review and theory development. METHODS: We defined health plan quality as the degree to which health plan management practices increase the likelihood of high-quality care for individuals and populations and addressed the ways in which health plan quality is similar to, and different from, other commonly used quality measures. Based on an assessment of the literature, we proposed a conceptual model that organizes health plan care management practices into a coherent structure for measuring health plan quality. RESULTS: A conceptual model of health plan operation that organizes managerial practices into a structure for measuring health plan quality from a physician's perspective was developed. CONCLUSION: Health plan quality is distinct from quality of care, and physicians can provide unique, timely, and reliable information about aspects of health plan quality.

Attitude of Health Personnel↗

PubMed2003

Evaluating health plan quality 2: survey design principles for measuring health plan quality.

OBJECTIVE: To develop principles for measuring the quality of specific health plans from a physician's perspective. STUDY DESIGN: Literature review, expert review, cognitive interviews. METHODS: We did a literature review on the use of physician surveys about managed care to determine the contributions and weaknesses of those surveys. Then, an expert review of prior survey efforts to measure health plan quality from the physician's perspective was performed. RESULTS: A survey instrument based on a conceptual model of health plan quality was developed. Its purpose was to measure health plan quality from the physician's perspective. Principles for surveying physicians guided the structure of the survey. CONCLUSION: Survey instruments can be designed to take into account a physician's unique perspective on health plan quality and can include measures that control for potential biases such as anti-managed care bias.

Attitude of Health Personnel↗

PubMed2003

Evaluating health plan quality 3: survey measurement properties.

OBJECTIVE: To assess the measurement and scaling properties of survey items designed to measure health plan quality from a physician's perspective. STUDY DESIGN: Prospective survey design with multivariate regression analysis. METHODS: Data were from 3798 physicians representing 23 health plans in 5 regions: Florida, New York, Colorado, Pennsylvania, and Washington. Scale reliability was assessed by using the Cronbach alpha. Generalist and specialist scales were compared with structural equation modeling. Multivariate analysis was used to examine internal validity by testing theoretically based hypotheses. RESULTS: Scales constructed from the data were reliable, were stable across both generalist and specialist physicians, and demonstrated construct validity. Hypotheses about the relationship between physician experiences with a health plan and physician recommendations of the plan were confirmed, supporting construct validity. CONCLUSION: The items on the survey instrument can be used with confidence to measure health plan quality from a physician perspective.

Attitude of Health Personnel↗

PubMed2002

Efforts to standardize the reporting of pain.

In an effort to develop a method for standardizing patients' reports of pain intensity, we tested seven different approaches to employing patients' ratings of four consistent types of pain as a means of correcting their reports (the average of the four standard pain measures, the average of the greater pains--finger in a door and tooth drilling, the average of the lesser pains--blister and leg cramp, the predicted back pain VAS from a regression of the standard pains, a conversion to the same scale based on population mean, the difference between individual mean and population mean of the four standard pain measures, and the difference between individual range and population range of the four standard pain measures). None of the adjustments proved to be a substantial improvement over the unstandardized approach. The best adjuster was the approach that used the average of the greater pain scores.

Analysis of Variance↗

PubMedDate not supplied

Nursing home staff's perceived ability to influence quality of life.

Nurses, certified nursing assistants, activity personnel, social workers, and physicians in 5 cities rated their ability to affect each of 17 quality of life (QoL) items for 2 hypothetical cases. Those closest to the residents feel the most empowered to make a difference. Overall, certified nursing assistants were consistently the most optimistic about their ability to influence QoL. Perceptions of ability to influence QoL were correlated with attitudes about nursing homes. These perceptions may be helpful in retaining such staff.

Adult↗

PubMedDate not supplied

Measuring the culture of medical group practices.

OBJECTIVE: To develop an instrument that can be used to assess the organizational culture of medical group practices. DATA SOURCES AND STUDY SETTING: Study participants were primary care physicians in 267 medical group practices. The iterative process began in Minnesota and then expanded to practices in 21 other states. DATA COLLECTION METHODS: Practice culture statements were collected using questionnaires distributed at a national medical group practice meeting and mailed questionnaires sent to a broader set of participants identified by the Medical Group Management Association. STUDY DESIGN: Using a framework developed earlier, physicians in medical groups were asked to react to statements that described the basic assumptions and patterns of behavior characteristic of their practices. An iterative process involving over 500 physicians in 267 practices was used to identify and refine statements. Factor analysis was used to group the statements into cohesive cultural dimensions. PRINCIPAL FINDINGS: Thirty-nine statements correlated with nine cultural dimensions were identified and a test of this instrument found that it successfully identified differences in the cultures of medical groups. CONCLUSIONS: Although there is increasing agreement that the culture of medical group practices is one of the most important factors influencing the cost and quality of care, efforts to understand and manage these cultures have been hampered by the lack of a measurement instrument. This article presents an instrument that has broad face validity in the group practice field and successfully differentiates the cultures of different types of practices.

Attitude of Health Personnel↗

PubMedDate not supplied

Cognitive impairment and quality-of-life: views of providers of long-term care services.

Quality-of-life (QoL) is now recognized as a principal outcome marker for long-term care. However, QoL is difficult to define and measure, especially in residents with dementia. Providers of long-term care services (n = 182) were asked to rate the importance of 19 psychosocial quality-of-life elements for hypothetical residents with physical impairment and for residents with cognitive impairment. Respondents also were asked to rate their ability to influence these elements for each type of resident. Respondents rated the importance of 18 of the 19 elements and their ability to influence 17 of 19 elements lower for residents with cognitive impairment. Of the five types of respondents, certified nursing assistants (CNAs) rated their ability to influence these QoL elements the highest for both types of residents; physicians' ratings were the lowest. Pain management was given high ratings for both importance and ability to influence for both resident types; the lowest ratings were given for elements that pertained to residents' understanding. A strong correlation between ratings for importance and ability to influence was observed. Additional research is needed on the psychosocial aspects of long-term care residents' QoL, especially those with cognitive impairment.

Adult↗

PubMedDate not supplied

Resolving the tug-of-war between Medicare's national and local coverage.

Medicare's decentralized local coverage policy process leads to policy variation, raising serious equity and quality issues. The policy debate resembles a tug-of-war, with advocates favoring nationalization of all local policies or arguing for the status quo. We extensively analyzed thousands of local policies and surveyed Medicare's contractors. We found that all local policies are not the same. We classified them based on where they fall on the diffusion curve. The classification by type allows for reallocation to the national or local process to improve the decisions and satisfy Medicare's equity and quality goals.

Health Care Reform↗