The EQ-5D is a brief, multi-attribute, preference-based health status measure. This dissertation describes the development of a statistical model for estimating U.S. population-based preference weights for the EQ-5D health states. A multistage probability sample was selected from the adult U.S. population. Using the time trade-off (TTO) method, each respondent valued 13 of the 243 health states described by the EQ-5D. The valuations were linearly transformed to lie on the interval [-1, 1]. Numerous model specifications were investigated, and a modified split-sample approach was used to evaluate the predictive accuracy of the models. All statistical analyses took into account the clustering and disproportionate selection probabilities inherent in our sampling design. The best model proved to be one based on a conceptual notion of the effect of movements away from perfect health. This model, which we have named D1, included ordinal terms to capture the effect of departures from perfect health as well as interaction effects due to increasing health problems. Relative to other models tested, a random effects specification of the D1 model provided a good fit for the observed TTO data. This model yielded an overall R² of 0.38, a mean absolute error of 0.02, and a correlation between mean observed and predicted valuations of 0.99. We also examined differences in health state valuations among the three major racial/ethnic groups in the U.S., i.e., Hispanics, non-Hispanic blacks, and others. In general, non-Hispanic blacks valued health states more highly than Hispanics or non-Hispanic non-blacks. Non-Hispanic blacks appeared to perceive extreme health problems to be associated with less disutility than did members of the other racial/ethnic groups. Differences in valuations did not appear to be related to differences between groups in education, income, or self-reported chronic conditions. The D1 model predicts the values for observed health states with a high degree of accuracy. This model's predictions provide a set of EQ-5D preference weights specifically developed for use in the U.S. population. Within the U.S. population, there exist differences among the major racial/ethnic groups in the perceived desirability of the EQ-5D health states. These differences cannot be readily explained by socioeconomic disparities.

A self-administered, mail questionnaire was used to assess the current state of hospital drug-use evaluation (DUE) programs within short-term, general U.S. hospitals. During February-March 1992, two mailings were sent to pharmacy directors at 491 randomly selected institutions. A net response rate of 66.6% (327/491) was achieved. The level of pharmacist participation in DUE program activities was found to be very high and to have a significant, positive correlation with the rated effectiveness of current DUE programs and the rated importance of pharmacist participation in DUE program activities. Pharmacists were members on 97.9% of responders' DUE (sub)committees, while 65.5% of pharmacist members held voting privileges. Pharmacists devoted an average of 11.27 hours per week to DUE-related tasks. Wide variation was demonstrated in rationale used to select DUE study drugs, interventions employed, use of DUE study results, and methods selected to evaluate DUE program effectiveness.

In a descriptive study, Lutzen's Moral Sensitivity Questionnaire (MSQ) was used to describe nurse case managers' perception of ethical decision making. Both community-based and hospital-based case managers responded. Research questions addressed (a) relationship between respondent's age and patient autonomy and between length of experience as case manager and benevolence; and (b) difference in conflict in ethical decision-making by level of education and difference in rules in ethical decision-making by type of setting. No significant correlations were found between the respondent age and patient autonomy nor between the respondents' length of experience as case manager and benevolence. There was a statistically significant difference in perception of conflict by educational level. Difference in rules in ethical decision making by type of setting approached statistical significance.

The purpose of this study was to determine the perceptions of residents, family members, and nursing staff regarding quality of care and the physical environment in the nursing home. Relationships among quality of care, the physical environment, and selected organizational characteristics were then described. The Quality of Care Scale (QoCS) and the Environment Description Scale (EDS) were given to a convenience sample of 100 subjects. A significant difference in perceptions of quality of care was found between the nurse assistants and residents. Significant relationships were obtained between perceptions of quality of care and the physical environment for Registered Nurses, Licensed Practical Nurses, and families. Defining quality of care and determining the significance of the physical environment from the consumer perspective may contribute to both quality of life and quality of care in the nursing home.

This research study was conducted to examine changes in cost and service utilization of nurse case managed clients. A secondary analysis was conducted using a pre-test/post-test design. Data for this analysis were collected by Papenhausen (1995) for a study to measure the effect of nurse case management intervention on client outcomes. Cost data for 53 subjects for the periods six months before and six months after nurse case management intervention was initiated were compared. Statistically significant decreases were found in the frequencies of inpatient admissions and emergency visits, as well as in inpatient length of stay and the total cost of services. This cost, including that of nurse case management service, as determined by Huggins (1996), represented a 61% decrease from the total cost before nurse case management was started.

<p> The infusion of information and communication technology (ICT) as the electronic health record (EHR) requires a significant increase in the knowledge and skills of the current Canadian health information management (HIM) workforce (Prism Economics and Analysis [Prism], 2009). However, there exists a shortfall in the capacity of the Canadian Health Information Management Association (CHIMA) to provide the required training and development to the organization&rsquo;s membership (Prism, 2009). This study is an exploratory qualitative case study to examine the reasons for the CHIMA&rsquo;s capacity shortfall and whether or not the use of a virtual community of practice (vCoP) might be effective to address the need. Three one-hour teleconference interviews were conducted with the CHIMA leadership. Data were analyzed using the work of Senge (1990a), Rogers (2003), and Wenger (1998) as a theoretical lens, which implies that leadership has a responsibility to provide a strategy and communication channels for organizational learning and development. The study findings provide implications for the CHIMA, its membership, and related educational stakeholder organizations to make firm determinations of their role in continuing professional education (CPE) for Canadian HIM professionals. The study is significant in its contribution to understanding the CPE challenges and opportunities resultant from the EHR implementation. Future research areas include (a) engagement of the CHIMA membership in the association, (b) awareness of Canadian HIM professionals of the changing profession (c) visibility of the Canadian HIM profession, and (d) the role of vCoPs in the Canadian HIM setting.</p>

<p> American Heart Association officials and other expert cardiologists recommend omega-3 (n-3) dietary supplementation for the secondary prevention of cardiovascular disease, a prevalent health problem in the United States. Physicians' lack of understanding of possible n-3 preventive health benefits results in underprescribing n-3 dietary supplements and lower n-3 dietary supplement product sales. N-3 dietary supplement marketers do not understand physician n-3 prescribing decision criteria enough to optimize high-impact communication to physicians to increase n-3 dietary supplement product use. The purpose of this phenomenological research study was to improve n-3 marketers' understanding of how physicians reach decisions to prescribe or recommend products including n-3 dietary supplements. Argyris' ladder of inference theory provided the study framework to facilitate understanding physicians' decision criteria. Rich data collected and analyzed from 20 primary care physician interviews in Kentucky, Indiana, and Tennessee revealed physicians use similar decision criteria for drugs and n-3s. Three essential influencers of physician decisions included clinical evidence, personal experience, and cost. Other influencers were opinions of peers, pharmaceutical representatives, samples, direct-to-consumer advertising, and knowledge of dietary supplements. Study outcomes may inform pharmaceutical marketers regarding presentation of clinical evidence, cost emphasis, and pharmaceutical representative skills and may facilitate competitive advantage for n-3 marketers. The social benefit of this study is improved physician understanding of n-3s may result in more accurate and appropriate prescribing to augment positive health outcomes. </p>

The Transition cost accounting system integrates clinical, resource utilization, and financial information and is currently being used by several hospitals in Canada and the United States (U.S.) to calculate the costs of patient care. The potential use of the Transition system for estimating in-hospital costs in health services research, however, depends on the accuracy of the system's measurements. Thus, the objectives of this thesis were (1) to assess the use of hospital-based cost accounting systems to measure costs of treatment, (2) to identify potential sources of measurement error inherent to the Transition system methodology, (3) to collect audit documentation in order to evaluate the accuracy of the Transition system's information, and to collect cost of treatment data from Canadian and U.S. hospitals in order to illustrate the system's use in health services research, and (4) to discuss the potential use of the Transition system in health services research in Canada and the U.S. (Abstract shortened by UMI.)

<p> <i>Introduction:</i> The purpose of this study was to examine the association of social determinants of health with 30-day rehospitalization among elderly patients who were discharged from an acute care hospital with an initial discharge destination of home with home health care support and to explore the social determinants' ability to accurately predict the odds of rehospitalization. </p><p> <i>Methods:</i> A secondary data analysis was performed on data obtained from the home healthcare agency. A total of 4,717 unique patients found in the data set. Some patients were represented in the data more than once during the observation period. To examine the relationship between socioeconomic factors and 30-day rehospitalization while controlling for select clinical factors, bivariate and multivariable analyses were performed using generalized linear mixed models (Proc GLIMMIX) and Cox proportional hazard models (Proc PHReg). A backward variable selection procedure was used to determine the best predictive model and a stepwise forward procedure was used to develop the survival model. </p><p> <i>Results:</i> Bivariate analyses of the variables used for predictive modeling showed that race (<i>p</i> = 0.0019), overall prognosis (<i>p</i> &lt; .0001), overall status (<i>p</i> &lt; .0001), multiple hospitali-zations (<i>p</i> &lt; .0001), multiple medications (<i>p</i> = .0001), multiple falls (<i>p</i> = 0.0004), mental disorder (<i>p</i> &lt; .0001), no risk of hospitalization (<i>p</i> = 0.002), no high risk factors (<i>p</i> = 0.03), and clinical classification (<i>p</i> &lt; .0001) were significantly associated with 30-day rehospi-talization. </p><p> Bivariate analyses of the variables used for survival modeling showed that race (<i>p</i> = 0.0029), living arrangement (<i>p</i> = 0.037), overall prognosis (<i>p</i> &lt; .0001), overall status (<i>p</i> &lt; .0001), multiple hospitalizations (<i>p</i> &lt; .0001), multiple medications (<i>p</i> &lt; .0001), multiple falls (<i>p</i> &lt; .0001), mental disorder (<i>p</i> &lt; .0001), no risk of hospitalization (<i>p</i> = 0.0017), no high risk factors (<i>p</i> = 0.02), smoking (<i>p</i> = 0.04), and clinical classification (<i>p</i> &lt; .0001) were significantly associated with 30-day rehospitalization. The predictive model was developed on 80% of the data and a random sample of 20% was used for independent validation of the predictive algorithm, Model sensitivity was 47% and specificity was 78% with a <i>C</i> statistic of 0.6 in the validation data. </p><p> <i>Conclusion:</i> While the variables in the final predictive model were statistically significantly associated with rehospitalization, the observed effect sizes were small to moderate and the model lacked sensitivity and was not very useful in correctly predicting which patients were rehospitalized. </p>

The health care burden associated with childhood injury is huge. Surveillance--the collection, analysis, interpretation, and dissemination of data--is seen as an important step towards understanding and controlling the injury problem. The usefulness of surveillance data, however, depends on their quality. Quality may be defined as the collection of reliable and valid data along with an unbiased capture of events. (An important issue in paediatric injury surveillance is that proxy respondents are often used to provide data on behalf of the child.) Previous evaluations of paediatric injury surveillance data, however, have not directly estimated the reliability and validity of proxy respondent information nor assessed the relative importance of factors associated with system capture. / Given these gaps in knowledge, this thesis examines the reliability and validity of proxy respondent information on childhood injuries. In addition, the importance of precise definition of the surveillance population of interest is described, along with identification of factors associated with failure of injury capture by a national paediatric injury surveillance system. The sensitivity, specificity, and representativeness of injury capture by this system is estimated for three different, but not mutually exclusive, populations of childhood injury. / The results from the proxy respondent studies provide important information on the utility of proxy data on childhood injury, while the studies on injury capture highlight the influence of process and health services utilization on surveillance system function. The implications of these findings for researchers and policy makers are discussed, with examination of the cautions necessary when drawing inferences from surveillance data.