Health outcomes research in medicine最新文献

{"title":"Antidepressant Utilization, Adherence, and Health Care Spending in the United States: The Case of MDD Patients 2000-2007","authors":"Hsien-Chang Lin PhD ,&nbsp;Steven R. Erickson PharmD ,&nbsp;Rajesh Balkrishnan PhD","doi":"10.1016/j.ehrm.2011.06.003","DOIUrl":"10.1016/j.ehrm.2011.06.003","url":null,"abstract":"<div><h3>Objective</h3><p>Selective serotonin reuptake inhibitors<span><span> have been widely adopted in the US as the first-line treatment for </span>major depressive disorder<span> (MDD). This study attempted to understand how patient factors and antidepressant choice influenced medication adherence and associated health care expenditures.</span></span></p></div><div><h3>Study Design</h3><p>A retrospective multiple-year cross-sectional study was conducted. This study used the 2004-2007 Medical Expenditure Panel Survey database; MDD patients who filled one or more prescriptions of antidepressants were extracted. Data were analyzed using weighted ordinary least squares regressions to examine MDD patient antidepressant adherence (measured by proportional days covered) and impacts of patient factors on associated health care expenditures.</p></div><div><h3>Results</h3><p>Sociological factors such as patient ethnicity and health insurance status were associated with differential levels of antidepressant adherence and associated health expenditures. Hispanic ethnicity was associated with the lowest antidepressant adherence among all. Patients covered by insurance were associated with better proportional days covered and spent more on MDD-specific drugs compared with uninsured patients. Use of newer antidepressants such as selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors was associated with an increase in MDD-specific drug expenditure.</p></div><div><h3>Conclusions</h3><p>Differences in antidepressant adherence and health care spending across patient factors could have important policy implications for health disparity; certain patient populations may be at higher risk for inadequate health care.</p></div>","PeriodicalId":88882,"journal":{"name":"Health outcomes research in medicine","volume":"2 2","pages":"Pages e79-e89"},"PeriodicalIF":0.0,"publicationDate":"2011-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.ehrm.2011.06.003","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"54246069","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing Coping with Stress Self-Efficacy: English Validation of the CSSES","authors":"Débora Godoy-Izquierdo PhD ,&nbsp;Helena Colodro Sola Lyc ,&nbsp;Juan F. Godoy García PhD","doi":"10.1016/j.ehrm.2011.06.001","DOIUrl":"10.1016/j.ehrm.2011.06.001","url":null,"abstract":"<div><h3>Background</h3><p>Specific self-efficacy for coping with stress refers to the judgments regarding the personal resources aimed at effectively facing taxing conditions. Coping self-efficacy is essential in stress-related issues as well as for increasing coping skills.</p></div><div><h3>Objective</h3><p>To cross-validate the psychometric properties of the Coping with Stress Self-Efficacy Scale (CSSES) among English speakers in order to complement previous findings with the original Spanish version.</p></div><div><h3>Methods</h3><p>A convenience, population-based sample of adult women and men from the UK answered the CSSES and another questionnaire assessing self-efficacy beliefs for the use of specific strategies for coping with stress.</p></div><div><h3>Results</h3><p>The CSSES showed adequate reliability and factorial and concurrent validity. Confirmatory factor analysis corroborates those results. A few weaknesses were detected and some solutions are proposed.</p></div><div><h3>Conclusions</h3><p>Given that the CSSES is brief and easy to use as well as adequate psychometrically, it seems to be an appropriate instrument for evaluating coping with stress self-efficacy in both research and clinical contexts.</p></div>","PeriodicalId":88882,"journal":{"name":"Health outcomes research in medicine","volume":"2 2","pages":"Pages e105-e118"},"PeriodicalIF":0.0,"publicationDate":"2011-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.ehrm.2011.06.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"54246055","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Psychometric Evaluation of Brief Patient-reported Outcome Measures of Overactive Bladder: The ICIQ-SF, SAC, SATS, SATT, and TBS","authors":"Karin S. Coyne PhD, MPH ,&nbsp;Mary Kay Margolis MPH, MHA ,&nbsp;Vasudha Vats MPH ,&nbsp;Heather Gelhorn PhD ,&nbsp;Victor Nitti MD","doi":"10.1016/j.ehrm.2011.07.001","DOIUrl":"10.1016/j.ehrm.2011.07.001","url":null,"abstract":"<div><h3>Objective</h3><p>Overactive bladder (OAB), a bothersome condition that affects many, is best measured using patient-reported outcomes (PROs). This study was conducted to examine the psychometric properties of 5 brief OAB measures: International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), Subject's Assessment of Condition (SAC), Subject's Assessment of Treatment Satisfaction (SATS), Subject's Assessment of Treatment Tolerance (SATT), and Treatment Benefit Scale (TBS).</p></div><div><h3>Study Design</h3><p>These secondary analyses of 2 12-week studies of fesoterodine in OAB patients utilized PRO data from Baseline and Week 12. The concurrent and discriminant validity and responsiveness of each measure were evaluated using Spearman's correlations and general linear models.</p></div><div><h3>Results</h3><p>There were 798 US patients (Study 1) and 1097 international patients (Study 2) analyzed. Mean age was 58.9 and 56.7 years, with the majority women (75.9% and 80.6%), respectively, in Study 1 and Study 2. The ICIQ-SF and SAC were moderately correlated with most King's Health Questionnaire (KHQ) subscales; the SATT and SATS had weak correlations with the KHQ. Urinary urgency incontinence episodes were highly correlated with the ICIQ-SF, but weak correlations were present with all other PROs and bladder diary variables. The ICIQ-SF significantly discriminated between wet and dry OAB patients. The SAC, SATS, and TBS significantly discriminated between patients who had improved versus not improved in micturition frequency and urinary urgency incontinence episodes. The SATT significantly discriminated among patients reporting adverse events versus no adverse events.</p></div><div><h3>Conclusions</h3><p>The ICIQ-SF, SAC, TBS, SATT, and SATS are brief, useful measures that can be used in research settings and by health care providers in clinical settings who wish to quickly evaluate patients' treatment.</p></div>","PeriodicalId":88882,"journal":{"name":"Health outcomes research in medicine","volume":"2 2","pages":"Pages e61-e69"},"PeriodicalIF":0.0,"publicationDate":"2011-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.ehrm.2011.07.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"54246077","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative Performance of Comorbidity Indices in Discriminating Health-related Behaviors and Outcomes","authors":"Huang-Tz Ou PhD ,&nbsp;Bhramar Mukherjee PhD ,&nbsp;Steven R. Erickson PharmD ,&nbsp;John D. Piette PhD ,&nbsp;Richard P. Bagozzi PhD ,&nbsp;Rajesh Balkrishnan PhD","doi":"10.1016/j.ehrm.2011.06.002","DOIUrl":"10.1016/j.ehrm.2011.06.002","url":null,"abstract":"<div><h3>Background and Objective</h3><p><span><span>Although the predictive ability of the Charlson Index, </span>Elixhauser Index<span> (EI), Chronic Disease Score (CDS), and Health-related </span></span>Quality of Life<span> Comorbidity Index (HRQL-CI) for health care outcomes<span> has been assessed individually, little research has compared the discriminative performance of these indices directly in a single study. The current study compared these indices in discriminating among type 2 diabetes patients varying in demographics and health care outcomes characteristics.</span></span></p></div><div><h3>Study Design</h3><p><span>There were 9832 Medicaid patients with type 2 diabetes from 8 states evaluated. Endpoints included demographics (age, race), health care behaviors (physician's diabetes care standard adherence, patient's medication adherence), and health care utilization and expenditures. Discriminative power of comorbidity indices was determined by c-statistics from </span>logistic regression, the shape of receiver operator characteristic curve, and area under the curve.</p></div><div><h3>Results</h3><p>The CDS demonstrated the best ability in discriminating between age subgroups (c<!--> <!-->=<!--> <!-->0.61) and patients who were or were not adherent to their medication (c<!--> <!-->=<!--> <!-->0.56). The CDS and HRQL-CI mental index performed similarly in discriminating based on diabetes care standard adherence (c<!--> <!-->=<!--> <!-->0.60). The EI had the best discrimination for health care utilization and costs, while HRQL-CI physical index performed similarly to EI in predicting hospitalization admission (c<!--> <!-->=<!--> <!-->0.62), and the HRQL-CI mental index performed similarly to the EI in predicting outpatient visits (c<!--> <!-->=<!--> <!-->0.74).</p></div><div><h3>Conclusions</h3><p>The CDS was found to be the best metric for differentiating among patients varying in demographics, physician's diabetes care standard adherence, and patient's medication adherence, while the EI should be the first choice to identify patients at risk of high medical resource use.</p></div>","PeriodicalId":88882,"journal":{"name":"Health outcomes research in medicine","volume":"2 2","pages":"Pages e91-e104"},"PeriodicalIF":0.0,"publicationDate":"2011-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.ehrm.2011.06.002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"54246061","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors of Duloxetine Treatment Persistence for Patients with Major Depressive Disorder","authors":"Steve Gelwicks MS ,&nbsp;Douglas E. Faries PhD ,&nbsp;Xianchen Liu MD, PhD","doi":"10.1016/j.ehrm.2010.12.002","DOIUrl":"10.1016/j.ehrm.2010.12.002","url":null,"abstract":"<div><h3>Objectives</h3><p><span><span><span>Early discontinuation of antidepressant therapy is associated with relapse and increased costs. This exploratory study examined demographical and pretreatment clinical predictors of </span>duloxetine (Eli Lilly and Company, Indianapolis, IN) </span>treatment persistence </span>in patients treated in real-world clinical settings.</p></div><div><h3>Study Design</h3><p><span>Using a large US managed-care claims database (PharMetrics Integrated Outcomes Database; PharMetrics Inc., Watertown, MA), study subjects were individuals aged 18 to 64 years who initiated duloxetine treatment between April 2005 and March 2006, had ≥1 claim associated with major depressive disorder diagnosis, and had continuous insurance coverage 6 months before and 12 months after initiation of duloxetine therapy. Treatment persistence was defined as continuous duloxetine treatment without a 30-day gap for ≥3 months. Chi-squared tests and </span>logistic regression analysis were used to examine predictors of persistence.</p></div><div><h3>Results</h3><p>Among 9148 patients (74.1% female; mean age 45.6 years) who initiated duloxetine treatment, 63.5% stayed on the medication for ≥3 months. Logistic regression analysis showed that an initial dose ≥60<!--> <span><span>mg (odds ratio [OR] 1.43), older age groups (OR ≥1.49), and venlafaxine XR<span> (OR 1.85) or selective serotonin reuptake inhibitor (OR 1.59) use in the prior 6 months were significantly associated with increased odds of treatment persistence, whereas prior </span></span>benzodiazepine<span> use (OR 0.86), comorbid alcohol dependence (OR 0.75), drug dependence (OR 0.76), and Parkinson disease (OR 0.36) were associated with decreased odds of treatment persistence. Findings were essentially unchanged with classification and regression tree analysis.</span></span></p></div><div><h3>Conclusion</h3><p>The results suggest that multiple demographic and clinical variables are associated with treatment persistence of duloxetine therapy. The findings may have important implications for clinicians to take actions to prevent early therapy discontinuation.</p></div>","PeriodicalId":88882,"journal":{"name":"Health outcomes research in medicine","volume":"2 1","pages":"Pages e3-e13"},"PeriodicalIF":0.0,"publicationDate":"2011-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.ehrm.2010.12.002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"54245408","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Validation and Modification of the Graphical Appraisal Tool for Epidemiology (GATE) for Appraising Systematic Reviews in Evidence-based Guideline Development","authors":"Anita Fitzgerald MPH,&nbsp;Catherine Coop MPH","doi":"10.1016/j.ehrm.2010.11.001","DOIUrl":"10.1016/j.ehrm.2010.11.001","url":null,"abstract":"<div><h3>Background</h3><p>There are many checklists and validity scales available to assess the quality of systematic reviews<span> and their content; New Zealand Guidelines Group is a not-for-profit organization that uses the Graphical Appraisal Tool for Epidemiology (GATE), a critical appraisal tool developed by the Effective Practice, Informatics and Quality Improvement collaboration in New Zealand, in guideline development. The objectives of this study were to test the interobserver reliability of individual items on the GATE systematic review checklist and to document reviewers’ experiences of using GATE in order to modify the checklist.</span></p></div><div><h3>Methods</h3><p>Two reviewers independently completed a GATE systematic review checklist for each study from a sample of 10 systematic reviews included in clinical practice guidelines. Agreement between reviewers was calculated for each item on the GATE checklist using percentage agreement; kappa, prevalence-adjusted bias-adjusted kappa (PABAK), and reviewers’ experiences of using the tool were documented. The GATE tool was modified based on reviewers’ agreement.</p></div><div><h3>Results</h3><p>Crude agreement between reviewers on individual GATE items ranged from 55% to 100%, with a median score of 73%. Interrater reliability was variable across individual items, ranging from a PABAK score of 0.09 (poor) to 1 (perfect), with a median score of 0.455 (moderate). Agreement and reliability were both highest for interpretation of subgroup analyses and summary scores of internal validity. Lowest scores related to individual items assessing reproducibility, publication bias, precision of results, and applicability. Agreement on the overall summary score was rated “good,” with 82% agreement and a PABAK score of 0.636. Following the appraisals, 7 question items on the GATE framework were amended and one question was deleted. In the accompanying notes, 12 changes were made.</p></div><div><h3>Conclusions</h3><p>The amended GATE checklist demonstrates clearer and easier-to-follow notes for appraising systematic reviews. This study demonstrates how the usability of critical appraisal checklists can be adapted through a formal evaluation process that could be undertaken alongside critiquing evidence.</p></div>","PeriodicalId":88882,"journal":{"name":"Health outcomes research in medicine","volume":"2 1","pages":"Pages e51-e59"},"PeriodicalIF":0.0,"publicationDate":"2011-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.ehrm.2010.11.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"54245375","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of Blood Loss on Physical Function in Arthritis Patients: A Pooled Analysis","authors":"Vibeke Strand MD ,&nbsp;Byron Cryer MD ,&nbsp;Xuemei Luo PhD ,&nbsp;Andrew G. Bushmakin MS ,&nbsp;Joseph C. Cappelleri PhD ,&nbsp;Brian Cuffel PhD ,&nbsp;George Sands MD ,&nbsp;Annlouise R. Assaf PhD","doi":"10.1016/j.ehrm.2010.12.001","DOIUrl":"10.1016/j.ehrm.2010.12.001","url":null,"abstract":"<div><h3>Background and Objectives</h3><p><span><span>The clinical consequences of lower gastrointestinal bleeding resulting from nonselective nonsteroidal anti-inflammatory drug (NSAID) use are less well documented than </span>upper gastrointestinal bleeding<span>. The aim of this study was to assess the effect of clinically significant gastrointestinal blood loss on health-related </span></span>quality of life (HRQoL) using the SF-36 in a large arthritis population.</p></div><div><h3>Study Design</h3><p>To compare treatment-associated changes in HRQoL, data from 14 multinational randomized controlled trials<span> (2–52 weeks’ duration) involving 14,173 subjects with osteoarthritis/rheumatoid arthritis, treated with celecoxib versus placebo or active comparator NSAIDs or both, were pooled. Clinically significant blood loss was defined as hemoglobin decreases ≥2 g/dL from baseline versus no change (from −1 to +1 g/dL).</span></p></div><div><h3>Results</h3><p>Subjects with no change in hemoglobin reported statistically significant and clinically meaningful improvements in all SF-36 domains. In those with clinically significant blood loss, improvements were reported in bodily pain (both females and males), and role physical and vitality domains (females) only. Change scores in SF-36 between subjects with significant blood loss and those with no changes in hemoglobin demonstrated statistically significant and clinically meaningful differences in physical function (both females and males) and role physical (males) domains—more pronounced in women and men with baseline hemoglobin values ≤14 and ≤15 g/dL, respectively.</p></div><div><h3>Conclusions</h3><p>Treatment-associated improvements in physical function reported by subjects with no blood loss were not evident in those with significant blood loss. Differences between groups were statistically and clinically meaningful, and more pronounced when baseline hemoglobin levels were ≤14 g/dL for females and ≤15 g/dL for males. Use of medications with lower incidence of significant blood loss should be warranted in patients with arthritis.</p></div>","PeriodicalId":88882,"journal":{"name":"Health outcomes research in medicine","volume":"2 1","pages":"Pages e27-e38"},"PeriodicalIF":0.0,"publicationDate":"2011-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.ehrm.2010.12.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"54245384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Basal Supported Oral Therapy with Insulin Glargine Results in Longer Persistence and Lower Costs Compared with Insulin Detemir in Type 2 Diabetics in Germany","authors":"Martin Pfohl MD ,&nbsp;Franz-Werner Dippel MSc ,&nbsp;Karel Kostev MA ,&nbsp;Sabine Fuchs MD, MPH ,&nbsp;Wioletta Kotowa MD","doi":"10.1016/j.ehrm.2011.02.001","DOIUrl":"10.1016/j.ehrm.2011.02.001","url":null,"abstract":"<div><h3>Objective</h3><p>To investigate the persistence of basal supported oral therapy (BOT) with either insulin glargine<span> (GLA) or insulin detemir<span> (DET) in type 2 diabetics and to assess long-term costs associated with the initiation of respective treatment regimens.</span></span></p></div><div><h3>Study Design</h3><p>A cost comparison was conducted from the perspective of the German statutory health insurance, applying a Markov model. Two base case scenarios were conducted. Transition probabilities from BOT to intensified conventional therapy (ICT) for scenario 1 were obtained from 5-year persistence data on BOT of the IMS Disease Analyzer (IMS Health Inc. Frankfurt am Main, Germany). Transition probabilities applied for scenario 2 were based on a regression equation of extrapolated persistence data for 10 years. A BOT initiation using GLA and DET at a ratio of 1:1 was assumed. Treatment costs of BOT and ICT with GLA and DET were derived from published sources. Estimation of type 2 diabetics starting a BOT was based on epidemiologic data from the literature. The model was operated over 5 and 10 years for scenarios 1 and 2, respectively. Costs were discounted by 5% per annum in the base case analyses, and varied to 0% and 10%. Multiple one-way sensitivity analyses were conducted varying input cost data.</p></div><div><h3>Results</h3><p>Based on the persistence data, the cumulative 5-year costs for a cohort of 44,366 type 2 diabetics were 134 million € (GLA) versus 179 million € (DET), resulting in savings of 45 million € in favor of insulin glargine. Total 10-year treatment costs based on the regression equation were 272 million € (GLA) versus 338 million € (DET), resulting in savings of 66 million € in favor of insulin glargine. In sensitivity analyses, cost savings over 10 years for GLA versus DET ranged from € 53 to € 97 million.</p></div><div><h3>Conclusions</h3><p>Starting an insulin therapy with GLA- rather than DET-based BOT results in a later initiation of ICT in type 2 diabetics. Because treatment costs of an ICT are roughly twice that of a BOT, the longer persistence using GLA shows potential cost savings of € 67 million for the German statutory health insurance within 10 years compared with DET.</p></div>","PeriodicalId":88882,"journal":{"name":"Health outcomes research in medicine","volume":"2 1","pages":"Pages e39-e50"},"PeriodicalIF":0.0,"publicationDate":"2011-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.ehrm.2011.02.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"54245956","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"New and More Facile Endpoints in Oncology","authors":"John M. Kirkwood","doi":"10.1016/j.ehrm.2011.03.001","DOIUrl":"10.1016/j.ehrm.2011.03.001","url":null,"abstract":"","PeriodicalId":88882,"journal":{"name":"Health outcomes research in medicine","volume":"2 1","pages":"Pages e1-e2"},"PeriodicalIF":0.0,"publicationDate":"2011-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.ehrm.2011.03.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"54245973","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Comparison of Patient and Clinician Assessments of Functional Ability in Predicting Number of Hospitalizations for Older Patients with Left Ventricular Dysfunction","authors":"Donald E. Stull PhD ,&nbsp;Karl Kosloski PhD ,&nbsp;Kyle Kercher PhD","doi":"10.1016/j.ehrm.2011.03.002","DOIUrl":"10.1016/j.ehrm.2011.03.002","url":null,"abstract":"<div><h3>Objective</h3><p>To compare the relative ability of patient self-assessments and clinician assessments of functional limitations for predicting hospitalizations for older adults with left ventricular dysfunction.</p></div><div><h3>Study Design</h3><p>Latent growth model analyses used secondary data from a clinical drug study, the Studies of Left Ventricular Dysfunction. Self-report and clinician-report data of patients' functional limitations were collected at baseline, and 6 weeks, 12 months, and 24 months postbaseline to assess the effects of an angiotensin-converting enzyme inhibitor versus placebo. Latent growth model analyses were used to assess the relative effect of baseline ratings and changes in these 2 ratings of patient functional limitations over the initial 2 years of the study (ie, the drug study component) as potential predictors of the number of hospitalizations occurring over 3 subsequent years.</p></div><div><h3>Results</h3><p>Data from 1099 patients aged 65+ years were analyzed. Both baseline patient assessments and changes in patient assessments of functional limitations were significant predictors of the number of subsequent hospitalizations (β = 0.119 and 0.273, respectively). This was not the case for clinician assessments. Moreover, baseline patient and clinician assessments of the patient's functional limitations were correlated at 0.42, indicating only a modest relationship between the 2 assessments.</p></div><div><h3>Conclusions</h3><p>These results demonstrate the greater utility of patient self-report measures for predicting hospitalizations. Incorporating patient-reported outcomes into clinical practice will expand understanding of the effect of diseases. Assessing changes in patient reports yields important insights into those patients more likely to have multiple admissions for heart failure.</p></div>","PeriodicalId":88882,"journal":{"name":"Health outcomes research in medicine","volume":"2 1","pages":"Pages e15-e25"},"PeriodicalIF":0.0,"publicationDate":"2011-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.ehrm.2011.03.002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"54245980","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}