Research Interests: Social Work, Mental Health, Long Term Care, Logistic Regression, Parameter estimation, and 22 moreActivities of Daily Living, Humans, African American, Nursing Homes, United States, Female, Male, Risk factors, Home Ownership, Health Status, Nursing Home, Aged, Cognitive impairment, Sex Factors, Age Factors, Geriatric Assessment, Risk Factors, Proportional Hazards Models, Logistic Models, Homes for the Aged, Instrumental Activities of Daily Living, and Socioeconomic Factors(Activities of Daily Living, Humans, African American, Nursing Homes, United States, Female, Male, Risk factors, Home Ownership, Health Status, Nursing Home, Aged, Cognitive impairment, Sex Factors, Age Factors, Geriatric Assessment, Risk Factors, Proportional Hazards Models, Logistic Models, Homes for the Aged, Instrumental Activities of Daily Living, and Socioeconomic Factors)
(Activities of Daily Living, Humans, African American, Nursing Homes, United States, Female, Male, Risk factors, Home Ownership, Health Status, Nursing Home, Aged, Cognitive impairment, Sex Factors, Age Factors, Geriatric Assessment, Risk Factors, Proportional Hazards Models, Logistic Models, Homes for the Aged, Instrumental Activities of Daily Living, and Socioeconomic Factors)
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ncreasingly, the explosion in scien- tific knowledge is overwhelming both researchers and practitioners in the health professions. The man- aged care pharmacist today needs a con - stant and current sense of the basic phar- maceutical... more
ncreasingly, the explosion in scien- tific knowledge is overwhelming both researchers and practitioners in the health professions. The man- aged care pharmacist today needs a con - stant and current sense of the basic phar- maceutical sciences, clinical pharmacy, pharmacy management systems, health policy and ethics, new drug introductions, pharmacoeconomics, and pharmacoepi- demiology. Monitoring the ever-changing pharmaceutical industry is now
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Older Americans receive healthcare benefits through the federal Medicare program. The Centers for Medicare & Medicaid Services provides comprehensive information to Medicare beneficiaries regarding benefits, plan options, and enrollment... more
Older Americans receive healthcare benefits through the federal Medicare program. The Centers for Medicare & Medicaid Services provides comprehensive information to Medicare beneficiaries regarding benefits, plan options, and enrollment policies primarily through the annual Medicare & You handbook and the Medicare website. Few studies have assessed the overall readability and, therefore, the usefulness of this handbook for adequately educating beneficiaries. Healthcare communications written at higher levels than the readers' comprehension levels cannot be well understood. To measure the readability of the 2008 Medicare & You handbook provided to all Medicare beneficiaries. For our analysis, the 2008 version of the Medicare & You handbook was downloaded from the Centers for Medicare & Medicaid Services website. Passages of ≥250 words were saved individually in Windows Notepad as text files. Shorter passages (ie, <250 words) were combined with the next continuing passage. Each...
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Corporate attention to problems in health care delivery has grown over the last decade. As this focus by the "purchasers" of medical care increases business and industry influence on health policy decisions, significant changes... more
Corporate attention to problems in health care delivery has grown over the last decade. As this focus by the "purchasers" of medical care increases business and industry influence on health policy decisions, significant changes may come about in the delivery system, and eventually in medical education. Whether the evolving corporate design for health care best serves consumer interests is less clear than how the medical profession and medical educators will fare in the next twenty years.
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Medicare Part D, the senior prescription drug benefit plan, was introduced through the Medicare Modernization Act of 2003. Medicare beneficiaries receive information about plan options through multiple sources, and it is often assumed by... more
Medicare Part D, the senior prescription drug benefit plan, was introduced through the Medicare Modernization Act of 2003. Medicare beneficiaries receive information about plan options through multiple sources, and it is often assumed by consumer health plans and healthcare providers that beneficiaries can understand and compare plan information. Medicare beneficiaries are older, may have cognitive problems, and may not have a true understanding of managed care. They are more likely than younger persons to have inadequate health literacy, thereby demonstrating significant gaps in knowledge and information about healthcare. To develop a Medicare Beneficiary Comprehension Test (MBCT) to evaluate Medicare beneficiaries' understanding of Part D plan concepts, as presented in the 2008 Medicare & You handbook. A 10-question MBCT was developed using a case-vignette approach that required beneficiaries to read portions of the Medicare & You handbook and answer Part D-related questions a...
Disease Management (DM) programs have advanced to address costly chronic disease patterns in populations. This is in part due to the programs' significant clinical and economical value, coupled with interest by pharmaceutical... more
Disease Management (DM) programs have advanced to address costly chronic disease patterns in populations. This is in part due to the programs' significant clinical and economical value, coupled with interest by pharmaceutical manufacturers, managed care organizations, and pharmacy benefit management firms. While cost containment realizations for many such interventions have been less than anticipated, this article explores potentials in marrying Medication Error Risk Reduction into DM programs within managed care environments. Medication errors are an emergent serious problem now gaining attention in US health policy. They represent a failure within population-based health programs because they remain significant cost drivers. Therefore, medication errors should be addressed in an organized fashion, with DM being a worthy candidate for piggybacking such programs to achieve the best synergistic effects.
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To investigate the impact of urinary incontinence (UI) on health-related quality of life (QOL), as measured by the Medical Outcomes Study Short Form-36 (SF-36) and to compare UI and non-UI elderly Medicare beneficiaries enrolled in... more
To investigate the impact of urinary incontinence (UI) on health-related quality of life (QOL), as measured by the Medical Outcomes Study Short Form-36 (SF-36) and to compare UI and non-UI elderly Medicare beneficiaries enrolled in managed care plans on the prevalence of depression and self-rated health. After excluding beneficiaries younger than 65 years old, a total of 141 815 completed surveys were used for analysis. The survey included 1 question on difficulty in controlling urination, 3 questions on depression, 3 questions on health, a series of questions regarding comorbid medical conditions, and the SF-36. Self-rated health, prevalence of depression, and scores in each domain of QOL were compared between UI and non-UI groups. Overall, the prevalence of UI was 24.7% (20.9% in men, 27.5% in women). The UI group was about twice as likely to feel depressed as the non-UI group. The UI group also rated their health more negatively. Compared with continent respondents, those who wer...
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This paper reviews the various organizations in the United States that perform accreditation and establish standards for healthcare delivery. These agencies include the Joint Commission on Accreditation of Healthcare Organizations... more
This paper reviews the various organizations in the United States that perform accreditation and establish standards for healthcare delivery. These agencies include the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), the National Committee for Quality Assurance (NCQA), the American Medical Accreditation Program (AMAP), the American Accreditation HealthCare Commission/Utilization Review Accreditation Commission (AAHC/URAC), and the Accreditation Association for Ambulatory HealthCare (AAAHC). In addition, the Foundation for Accountability (FACCT) and the Agency for Healthcare Research and Quality (AHRQ) play important roles in ensuring the quality of healthcare. Each of the accrediting bodies is unique in terms of their mission, activities, compositions of their boards, and organizational histories, and each develops their own accreditation process and programs and sets their own accreditation standards. For this reason, certain accrediting organizations are bet...
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A forthright rebellion against the philosophical and clinical orientations of scientific medicine has occurred in the United States during the 1970s. This rebellion includes a growing number of people engaged in self-care practices in... more
A forthright rebellion against the philosophical and clinical orientations of scientific medicine has occurred in the United States during the 1970s. This rebellion includes a growing number of people engaged in self-care practices in attempts to alter their health status through "lifestyle" adjustments, as well as a diverse amalgamation of practitioners (both medical and otherwise), who offer a wide range of therapies outside the mainstream of modern medical practice. Holistic health care has lately become the rubric under which these therapies are grouped. Scientific medicine is the term commonly used to refer to procedures officially sanctioned by the organized medical profession. In the late 19th century, scientific medicine emerged as an advance beyond allopathic medicine after germ theory provided an explanation and, later treatment for infectious diseases. Financial support by private philantropic foundations came in the wake of the Flexner Report on medical educati...
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Research Interests: Social Work, Mental Health, Long Term Care, Logistic Regression, Parameter estimation, and 22 moreActivities of Daily Living, Humans, African American, Nursing Homes, United States, Female, Male, Risk factors, Home Ownership, Health Status, Nursing Home, Aged, Cognitive impairment, Sex Factors, Age Factors, Geriatric Assessment, Risk Factors, Proportional Hazards Models, Logistic Models, Homes for the Aged, Instrumental Activities of Daily Living, and Socioeconomic Factors(Activities of Daily Living, Humans, African American, Nursing Homes, United States, Female, Male, Risk factors, Home Ownership, Health Status, Nursing Home, Aged, Cognitive impairment, Sex Factors, Age Factors, Geriatric Assessment, Risk Factors, Proportional Hazards Models, Logistic Models, Homes for the Aged, Instrumental Activities of Daily Living, and Socioeconomic Factors)
(Activities of Daily Living, Humans, African American, Nursing Homes, United States, Female, Male, Risk factors, Home Ownership, Health Status, Nursing Home, Aged, Cognitive impairment, Sex Factors, Age Factors, Geriatric Assessment, Risk Factors, Proportional Hazards Models, Logistic Models, Homes for the Aged, Instrumental Activities of Daily Living, and Socioeconomic Factors)
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The area configuration of healthcare resources, such as the number of hospitals per hundred thousand population, has often been used in healthcare planning and policy making to estimate the global access (potential access) of health... more
The area configuration of healthcare resources, such as the number of hospitals per hundred thousand population, has often been used in healthcare planning and policy making to estimate the global access (potential access) of health services to a local population. However, the actual utilization of the &amp;amp;amp;amp;amp;amp;quot;available&amp;amp;amp;amp;amp;amp;quot; healthcare resources (revealed access) is usually much more limited. The objectives of this study were to examine the availability of healthcare resources by measuring the potential access and the revealed access for outpatients who need to access pharmacies to fill prescriptions of Schedule II (CII) opioids for pain management, and to explore the difference between rural and urban residents in these two types of access. About 191,700 prescriptions for CII opioids dispensed in 1997 in the state of Michigan, USA were analyzed. Revealed accessibility was measured by the distance between the paired zip codes of the pharmacy and the patient listed on each prescription. Potential accessibility was measured by the distance from a patient&amp;amp;amp;amp;amp;amp;#39;s zip code to that of the nearest community pharmacy that could dispense the opioid prescriptions. The analyses on revealed access showed that 50% of the CII prescriptions were dispensed by pharmacies located within a 5-mile radius of patients&amp;amp;amp;amp;amp;amp;#39; residences, 75% of prescriptions were dispensed within about a 10-mile radius, and 90% were within 20 miles. If patients were free to access the nearest pharmacy for dispensing (a hypothetical situation under potential access), the median, 75th percentile, and 90th percentile distances could reduce to 2, 3, and 5 miles, respectively. Similar differences between revealed and potential access were observed in both rural and urban areas and for every major opioid drug group. We conclude that policymakers should recognize the discrepancy between potential and revealed accessibility and move beyond only considering area configuration of healthcare resources to evaluating and improving access to care.
Research Interests: Sociology, Anthropology, Pain, Pain Management, Social Science & Medicine, and 11 morePolicy making, Humans, Needs Assessment, Health Services, Public health systems and services research, Urban Population, Access to Care, Geographic Information System, Geographic Information Systems, Pharmacies, and Urban Area
Research Interests: Respiratory Medicine, Palliative Care, Medication Adherence, Humans, End of life, and 12 moreUnited States, Female, Male, Patient Compliance, Clinical Sciences, Aged, Middle Aged, Retrospective Studies, Chronic obstructive pulmonary disease, Combination drug therapy, Department of Veterans Affairs, and Cohort Studies
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Current conditions surrounding the house of medicine-including corporate and government cost-containment strategies, increasing market-penetration schemes in health care, along with clinical scrutiny and the administrative control imposed... more
Current conditions surrounding the house of medicine-including corporate and government cost-containment strategies, increasing market-penetration schemes in health care, along with clinical scrutiny and the administrative control imposed under privatization by managed care firms, insurance companies, and governments-have spurred an upsurge in physician unionization, which requires a revisiting of the issue of physician strikes. Strikes by physicians have been relatively rare events in medical history. When they have occurred, they have aroused intense debate over their ethical justification among professionals and the public alike, notwithstanding what caused the strikes. As physicians and other health care providers increasingly find employment within organizations as wage-contract employees and their work becomes more highly rationalized, more physicians will join labor organizations to protect both their economic and their professional interests. As a result, these physicians will have to come to terms with the use of the strike weapon. On the surface, many health care strikes may not ever seem justifiable, but in certain defined situations a strike would be not only permissible but an ethical imperative. With an exacerbation of labor strife in the health sector in many nations, it is crucial to explore the question of what constitutes an ethical physician strike.
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The psychometric properties of the 12-Item Short-Form Health Survey (SF-12), a subset of the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), have been tested in the general population and certain disease states. The... more
The psychometric properties of the 12-Item Short-Form Health Survey (SF-12), a subset of the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), have been tested in the general population and certain disease states. The purpose of this study was to evaluate the psychometric properties of the SF-12 as a generic measure of health-related quality of life (HRQoL) in osteoarthritis (OA) and rheumatoid arthritis (RA) patient populations in clinical trials. Data were aggregated from 5 clinical trials evaluating the efficacy of non-steroidal anti-inflammatory drugs in OA (n = 651) and RA (n = 693) patients. Patient assessments in these trials were made using the SF-36 and commonly used clinical measures of OA and RA at baseline and after up to 6 weeks of treatment. For the items of the SF-36 contained in the SF-12, the item missing rate, computability of scores, floor and ceiling effects, factor structure, and item-component correlations were evaluated. Clinical variables and correlations of physical component summary (PCS-12) and mental component summary (MCS-12) scores of the SF-12 with the corresponding SF-36 component summary scores (PCS-36 and MCS-36) were also examined. Analyses were conducted separately for OA and RA patients. A low individual SF-12 item missing rate (0.29% to 2.30%) and a high percentage score computability (90.9%-94.3%) were observed at baseline. No floor or ceiling effects at baseline were observed. The scree plot confirmed the 2-factor structure of the SF-12 items. Items belonging to the physical component correlated more strongly with the PCS-12 than with the MCS-12; similarly, items belonging to the mental component correlated more strongly with the MCS-12 than with the PCS-12. The correlations between the PCS-12 and PCS-36 and between the MCS-12 and MCS-36 ranged from 0.92 to 0.96 (P &lt; 0.001) at baseline and at week 2, 4, or 6. Significant correlations ranging from -0.09 to -0.58 (P &lt; 0.05) were observed between the SF-12 scores and clinical variables. The SF-12 appears to be a psychometrically sound tool for the assessment of HRQoL in OA and RA patients.
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To explain rural-urban differences in mammography screening by supply of health care services. Logistic regression models were used to assess whether variation in the supply of health care services related to mammography screening... more
To explain rural-urban differences in mammography screening by supply of health care services. Logistic regression models were used to assess whether variation in the supply of health care services related to mammography screening explained rural-urban differences in mammography screening rates. Women living in small (thinly populated) rural areas not adjacent to a metro area were less likely to obtain a mammogram (OR = 0.682, CI: 0.62-0.75) compared to women in large metro counties. This difference was reduced after adjusting for predisposing and enabling factors (OR = 0.843, CI: 0.76-0.93). Contextual-level enabling factors mediated the rural-urban difference in mammography screening.
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Research Interests: Sociology, Anthropology, Decision Making, Theory of Planned Behavior, Family Practice, and 20 moreSocial Science & Medicine, Humans, Internal Medicine, Behavior Modeling, Sample Size, Multiple Regression, Management System, Questionnaires, Anti-Bacterial Agents, Perceived Behavioral Control, Health Care System, Cross Section, Public health systems and services research, Managed care, Theory of Reasoned Action, Social Norm, Decision Maker, Observational Study, Drug Utilization, and Ambulatory Care(Social Science & Medicine, Humans, Internal Medicine, Behavior Modeling, Sample Size, Multiple Regression, Management System, Questionnaires, Anti-Bacterial Agents, Perceived Behavioral Control, Health Care System, Cross Section, Public health systems and services research, Managed care, Theory of Reasoned Action, Social Norm, Decision Maker, Observational Study, Drug Utilization, and Ambulatory Care)
(Social Science & Medicine, Humans, Internal Medicine, Behavior Modeling, Sample Size, Multiple Regression, Management System, Questionnaires, Anti-Bacterial Agents, Perceived Behavioral Control, Health Care System, Cross Section, Public health systems and services research, Managed care, Theory of Reasoned Action, Social Norm, Decision Maker, Observational Study, Drug Utilization, and Ambulatory Care)