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Bost, J.E., Thompson, J.W., Shih, S., et al. (2002). "Differences in health care quality for children and adults under managed care: Justification for separate quality assessments?" (AHRQ grant HS09205). Ambulatory Pediatrics 2(3), pp. 224-229.

These researchers assessed reported results of health care quality for children and adults in managed systems of care to determine whether variations exist between reported quality results for the two groups within the same plan. They used Consumer Assessment of Health Plans Study (CAHPS®) survey results reported from 424 managed care plans to the National Committee for Quality Assurance in 1999. Responses from nearly 220,000 adults and more than 55,000 parents of children 0-12 years of age were available. The researchers restricted their analyses to the 178 plans that reported both adult and child results. They found marked variation between the care provided by specialists and primary care physicians to adults and children within the same plan, including rating of doctor and rating of specialist. However, assessments of activities related directly to health plan activities showed little variation, including rating of health plans and claims processing. The researchers conclude that having health plan quality information about adult care does not serve as a proxy for information on children.

Darby, C. (2002, July). "Patient/parent assessment of the quality of care." Ambulatory Pediatrics 2(4), pp. 345-348.

Assessing the interpersonal aspects of care has traditionally been referred to as the measurement of patient satisfaction. However, the varying expectations of patients and the presence of a ceiling effect on the measures often confound the use of patient satisfaction measures for evaluating the quality of care. The research team involved in the Consumer Assessments of Health Plans Study (CAHPS®) recently developed a set of domains that specifically focus on patient interaction with the health care delivery system: communication with providers, courtesy of staff, getting needed care, and getting care quickly. A review of the few existing studies on the assessment of the interpersonal aspects of pediatric health care in emergency departments suggests some ways to improve interpersonal interaction with children and their parents in the ED. These include providing them with a clearer picture of how long they will have to wait, taking a caring approach with children and their parents, and explaining clearly to parents what care they need to provide for their child after discharge.

Reprints (AHRQ Publication No. 02-R088) are available from the AHRQ Publications Clearinghouse.

Flores, G. (2002, July). "Mad scientists, compassionate healers, and greedy egotists: The portrayal of physicians in the movies." (AHRQ grant K02 HS11305). Journal of the National Medical Association 94(7), pp. 635-658.

On average, Americans see about six films per year in cinemas and spend an average of 54 hours per year watching home videos. Movies are a potent force in popular culture because they are accessible, aggressively marketed, heavily financed, and hugely popular. According to this author, half of all films made in the 1990s with physicians as major characters portray physicians negatively, often as egotistical, materialistic, uncaring, or unethical. Such negative portrayals of physicians could create expectations of similar behaviors, attitudes, and values when patients visit their real-life doctors. The author recently reviewed 131 20th-century films released on videotape in which physicians were the main characters. He examined data on physician characteristics, diagnoses, medical accuracy, and dialogue. Movie doctors were most commonly surgeons (33 percent), psychiatrists (26 percent), or family practitioners (18 percent). Physicians were portrayed negatively in 44 percent of movies and as compassionate healers in only 56 percent. From the 1920s to the 1950s, film doctors usually were portrayed in a positive light, with compassion and idealism common, except during the 1930s in the heyday of horror films. Movies from the past two decades have explored critical issues surrounding medical ethics and managed care. Over one-fourth of films (27 percent) included medical inaccuracies, such as scientifically unsubstantiated treatments.

Kneipp, S.M., and Yarandi, H.N. (2002). "Complex sampling designs and statistical issues in secondary analysis." (AHRQ grant HS10727). Western Journal of Nursing Research 24(5), pp. 552-566.

Secondary analysis using large national survey databases has gained recognition as a legitimate way to conduct research within the nursing scientific community. However, the incorporation of complex sampling designs challenges researchers who wish to apply secondary analysis to large data sets. This article presents sampling design issues inherent in many large national surveys and explains the rationale for applying sample and variance estimation weights when conducting statistical analyses. It also describes the rationale for using statistical software packages capable of analyzing data derived from complex sampling designs. The authors provide examples of differences in statistical outcomes with and without weights. They use two different classes of statistical software packages with data from AHRQ's Medical Expenditure Panel Survey (MEPS) and discuss the implications for the statistical outcome differences.

Greenberg, W., and Goldberg, L. (2002). "The determinants of hospital and HMO vertically integrated delivery systems in a competitive health care sector." International Journal of Health Care Finance and Economics 51-68.

Increased competition in the U.S. health care system has led to a number of structural changes such as hospital closings, horizontal mergers (for example, multihospital systems and health networks), and vertical integration of hospitals with physicians. These authors use logistic regression and ordinary least squares models to attempt to understand why short-term, non-Federal hospitals created vertically integrated systems with HMOs in urban and rural markets during the 1993-1997 period, when 1,917 integrated systems were formed and 1,466 dissolved. The results indicate that the relative buying power of hospitals is a significant determinant of why hospitals would create vertically integrated systems with HMOs. At the hospital level, occupancy, number of hospitals in the geographic area, number of HMOs in the geographic area, the physician-to-population ratio, the hospital's for-profit status, whether it is a teaching hospital, and its location in a metropolitan statistical area all have a significant impact on whether a hospital affiliates with an HMO.

Parzen, M., Lipsitz, S., Ibrahim, J., and Lipshultz, S. (2002). "A weighted estimating equation for linear regression with missing covariate data." (AHRQ grant HS10871). Statistics in Medicine 21, pp. 2421-2436.

Missing covariate data is a common occurrence in linear regression analysis, one of the most popular statistical techniques. A recent approach to analyze covariate data is a weighted estimating equation. With this type of equation, the contribution to the estimating equation from a complete observation is weighted by the inverse probability of being observed. These authors propose a weighted estimating equation in which they wrongly assume that the missing covariates are multivariate normal but still produce consistent estimates as long as the probability of being observed is correctly modeled. In simulations, these weighted estimating equations appear to be much more efficient, but less computationally intensive, than other weighted estimating equations. They compare the weighted estimating equations they propose to the efficient weighted estimating equations via an example and a simulation study.

Siderowf, A., Ravina, B., and Glick, H. (2002). "Preference-based quality-of-life in patients with Parkinson's disease." (AHRQ grant K08 HS11285). Neurology 59, pp. 103-108.

Preference-based measures of health-related quality of life are designed to measure the relative value of health by rating a given health state compared with an alternative. This study assessed quality of life using preference-based scales in a group of patients with Parkinson's disease (PD) and compared these scores with measures of clinical severity and traditional quality of life. They rated each patient using the Disability and Distress Index (DDI), the Euroqol System (EQ-5D), and the Health Utilities Index Mark II (HUI). They measured clinical severity using the Unified PD Rating Scale (UPDRS) and PD Questionnaire-39 (PDQ-39) quality-of-life instrument. They compared the results of the preference-based instruments with each other and with clinical measures of disease severity for 97 PD patients. The DDI, EQ-5D and HUI correlated well with measures of disease severity and quality of life. However, they gave strikingly different values. When applied in cost-effectiveness analysis, these discrepancies could result in substantially different cost-effectiveness ratios for PD-related interventions.

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Current as of October 2002
AHRQ Publication No. 03-0003

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