Steven K. Broste

University of Wisconsin - Milwaukee, Milwaukee, Wisconsin, United States

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Publications (39)273.79 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: We had the rare opportunity to conduct a cluster-randomized controlled trial to observe the long-term (16-year) effects of a well-designed hearing conservation intervention for rural high school students. This trial assessed whether the intervention resulted in (1) reduced prevalence of noise-induced hearing loss (NIHL) assessed clinically and/or (2) sustained use of hearing protection devices. In 1992-1996, 34 rural Wisconsin schools were recruited and 17 were assigned randomly to receive a comprehensive, 3-year, hearing conservation intervention. In 2009-2010, extensive efforts were made to find and contact all students who completed the original trial. Participants in the 16-year follow-up study completed an exposure history questionnaire and a clinical audiometric examination. Rates of NIHL and use of hearing protection were compared. We recruited 392 participants from the original trial, 200 (53%) from the intervention group and 192 (51%) from the control group. Among participants with exposure to agricultural noise, the intervention group reported significantly greater use of hearing protection compared with the control group (25.9% vs 19.6%; P = .015). The intervention group also reported significantly greater use of hearing protection for shooting guns (56.2% vs 41.6%; P = .029), but the groups reported similar uses of protection in other contexts. There was no significant difference between groups with respect to objective measures of NIHL. This novel trial provides objective evidence that a comprehensive educational intervention by itself may be of limited effectiveness in preventing NIHL in a young rural population.
    PEDIATRICS 11/2011; 128(5):e1139-46. DOI:10.1542/peds.2011-0770 · 5.30 Impact Factor
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    ABSTRACT: Agriculture has among the highest recorded exposures to dangerous levels of noise. Studies have demonstrated an increased prevalence of noise-induced hearing loss (NIHL) among youth actively involved in farm work. Since most agricultural worksites are exempt from safety and health regulations, alternative strategies to promote hearing conservation among farm youth must be identified. We are evaluating the long-term effectiveness of a three-year hearing conservation program for farm youth conducted between 1992 and 1996 in Wisconsin, USA. Thirty-four rural schools had been recruited and randomized to intervention or control. The intervention included classroom instruction, distribution of hearing protection devices, direct mailings, noise level assessments, and yearly audiometric testing. The control group received the audiometric testing. In total, 690 high school farm youth completed the study. Students exposed to the hearing conservation program reported increased use of hearing protection devices (OR 7.73; 95% CI: 4.98 to 11.99), but there was no evidence of reduced levels of NIHL where odds ratios varied between 0.88 (95% CI: 0.58 to 1.34) at 3000 HZ to 1.55 (0.89 to 2.69) at 4000 HZ. Since NIHL is cumulative, a three-year study was likely not long enough to evaluate the efficacy of this intervention. A 16-year follow-up study of this hearing conservation program cohort is currently underway. To date, 356 former students have been recruited and enrolled. The results of this long-term follow-up will be available by November, 2010 and will demonstrate the role of early intervention in sustaining hearing protection behaviors and preventing NIHL in young workers.
    138st APHA Annual Meeting and Exposition 2010; 11/2010
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    ABSTRACT: (1) To conduct a contemporary analysis of historical data on short-term efficacy of a 3-year hearing conservation program conducted from 1992 to 1996 in Wisconsin, USA, with 753 high school students actively involved in farm work; (2) to establish procedures for assessment of hearing loss for use in a recently funded follow-up of this same hearing conservation program cohort. We analyzed a pragmatic cluster-randomized controlled trial, with schools as the unit of randomization. Thirty-four rural schools were recruited and randomized to intervention or control. The intervention included classroom instruction, distribution of hearing protection devices, direct mailings, noise level assessments, and yearly audiometric testing. The control group received the audiometric testing. Students exposed to the hearing conservation program reported more frequent use of hearing protection devices, but there was no evidence of reduced levels of noise-induced hearing loss (NIHL). Our analysis suggests that, since NIHL is cumulative, a 3-year study was likely not long enough to evaluate the efficacy of this intervention. While improvements in reported use of hearing protection devices were noted, the lasting impact of these behaviors is unknown and the finding merits corroboration by longer term objective hearing tests. A follow-up study of the cohort has recently been started.
    Preventive Medicine 10/2009; 49(6):546-52. DOI:10.1016/j.ypmed.2009.09.020 · 2.93 Impact Factor
  • Mary Jo Knobloch · Steven K. Broste
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    ABSTRACT: Adolescents working in agricultural settings may be exposed to noise levels that result in hearing loss. The article describes the design, implementation, and results of a four-year, hearing conservation program (HCP) conducted at school. Thirty-four schools (753 students) were randomly assigned to either an intervention or control group. The intervention included multicomponent educational strategies and employed features of an industrial HCP. Final compliance surveys indicated 87.5% of intervention students reported using hearing protection devices (HPD) at least some of the time, compared to 45% of control students. The HCP components with the greatest reported influence were distribution of HPDs for use on the farm and yearly hearing tests. Eighty percent of intervention students reported intention to use HPDs in the future. It is feasible to conduct a hearing conservation program with junior high school and senior high school students, and it appears possible to persuade teen-agers to protect themselves from exposure to loud noise while working on a farm.
    Journal of School Health 11/1998; 68(8):313-8. DOI:10.1111/j.1746-1561.1998.tb00591.x · 1.66 Impact Factor
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    ABSTRACT: We sought to describe the resuscitation preferences of patients hospitalized with an exacerbation of severe congestive heart failure, perceptions of those preferences by their physicians, and the stability of the preferences. Of 936 patients in this study, 215 (23%) explicitly stated that they did not want to be resuscitated. Significant correlates of not wanting to be resuscitated included older age, perception of a worse prognosis, poorer functional status, and higher income. The physician's perception of the patient's preference disagreed with the patient's actual preference in 24% of the cases overall. Only 25% of the patients reported discussing resuscitation preferences with their physician, but discussion of preferences was not significantly associated with higher agreement between the patient and physician. Of the 600 patients who responded to the resuscitation question again 2 months later, 19% had changed their preferences, including 14% of those who initially wanted resuscitation (69 of 480) and 40% of those who initially did not (48 of 120). The physician's perception of the patient's hospital resuscitation preference was correct for 84% of patients who had a stable preference and 68% of those who did not. Almost one quarter of patients hospitalized with severe heart failure expressed a preference not to be resuscitated. The physician's perception of the patient's preference was not accurate in about one quarter of the cases. but communication was not associated with greater agreement between the patient and the physician. A substantial proportion of patients who did not want to be resuscitated changed their minds within 2 months of discharge.
    Circulation 09/1998; 98(7):648-55. · 14.95 Impact Factor
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    ABSTRACT: Background—We sought to describe the resuscitation preferences of patients hospitalized with an exacerbation of severe congestive heart failure, perceptions of those preferences by their physicians, and the stability of the preferences. Methods and Results—Of 936 patients in this study, 215 (23%) explicitly stated that they did not want to be resuscitated. Significant correlates of not wanting to be resuscitated included older age, perception of a worse prognosis, poorer functional status, and higher income. The physician's perception of the patient's preference disagreed with the patient's actual preference in 24% of the cases overall. Only 25% of the patients reported discussing resuscitation preferences with their physician, but discussion of preferences was not significantly associated with higher agreement between the patient and physician. Of the 600 patients who responded to the resuscitation question again 2 months later, 19% had changed their preferences, including 14% of those who initially wanted resuscitation (69 of 480) and 40% of those who initially did not (48 of 120). The physician's perception of the patient's hospital resuscitation preference was correct for 84% of patients who had a stable preference and 68% of those who did not. Conclusions—Almost one quarter of patients hospitalized with severe heart failure expressed a preference not to be resuscitated. The physician's perception of the patient's preference was not accurate in about one quarter of the cases, but communication was not associated with greater agreement between the patient and the physician. A substantial proportion of patients who did not want to be resuscitated changed their minds within 2 months of discharge. (Circulation. 1998;98:648-655.)
    Circulation 08/1998; 98(7). DOI:10.1161/01.CIR.98.7.648 · 14.95 Impact Factor
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    ABSTRACT: The purpose of this study was to describe stimulant use and abuse as reported by school administrators and children diagnosed with attention deficit/hyperactivity disorder or attention deficit disorder inattentive. Five years after being identified as Ritalin responders, 161 children were surveyed regarding stimulant use and abuse. School principals in central Wisconsin were also surveyed regarding stimulant use and policies. No child believed stimulants as prescribed could lead to abuse. Sixteen percent of the children had been approached to sell, give, or trade their medication. During school hours, 44% of children and 37% of schools reported stimulants were stored unlocked. Not all schools had written policies regarding prescription drugs, and 10% permitted students to carry their own medication. Monitoring prescription usage, periodic reassessment of efficacy, and continuing education of family and teaching staff should be part of the multimodal treatment for this disorder. School policies should be developmentally sensitive.
    Journal of Developmental & Behavioral Pediatrics 07/1998; 19(3):187-92. DOI:10.1097/00004703-199806000-00006 · 2.12 Impact Factor
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    ABSTRACT: Nonthoracotomy ICDs are believed to be the best therapeutic modality for treatment of life-threatening ventricular arrhythmias. Little is known about the risk of infection with initial implantation of these devices. We studied the incidence, clinical characteristics, and risk factors associated with infections in 1,831 patients with nonthoracotomy ICD from the Endotak-C nonthoracotomy lead registry of Cardiac Pacemakers, Inc. A transvenous lead was implanted in 950 patients (51.9%) and a combination transvenous plus subcutaneous patch was used in 881 patients (48.1%). Nine preselected data variables were studied, and all investigators identified as having patients with infections were personally contacted. Infections occurred in 22 (1.2%) of 1,831 patients receiving this nonthoracotomy ICD system. The mean time to infection was 5.7 +/- 6.5 months (range 1-25 months). Staphylococci were isolated in 58% of patients with reported infection. The presence of a subcutaneous defibrillator patch system was associated with the development of infection. Six of 950 patients (0.63%) with a totally transvenous lead system developed infection versus 16 of 838 (1.9%) patients with a transvenous lead plus subcutaneous patch system configuration (P = 0.015, Chi-square test), with an unadjusted estimated odds ratio of 3.06 (CI 1.19-7.86). The risk of infection encountered with the nonthoracotomy ICD is low, estimated from our data to be 1.2%. Placement of a subcutaneous defibrillator patch appears to be an independent risk factor for development of infection.
    Pacing and Clinical Electrophysiology 02/1998; 21(1 Pt 1):42-55. · 1.25 Impact Factor
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    ABSTRACT: Nonthoracotomy ICDs are believed to be the best therapeutic modality for treatment of life-threatening ventricular arrhythmias. Little is known about the risk of infection with initial implantation of these devices. We studied the incidence, clinical characteristics, and risk factors associated with infections in 1,831 patients with nonthoracotomy ICD from the Endotak-C nonthoracotomy lead registry of Cardiac Pacemakers, Inc. A transvenous lead was implanted in 950 patients (51.9%) and a combination transvenous plus subcutaneous patch was used in 881 patients (48.1%). Nine preselected data variables were studied, and all investigators identified as having patients with infections were personally contacted. Infections occurred in 22 (1.2%) of 1,831 patients receiving this nonthoracotomy ICD system. The mean time to infection was 5.7 ± 6.5 months (range 1–25 months). Staphylococci were isolated in 58% of patients with reported infection. The presence of a subcutaneous defibrillator patch system was associated with the development of infection. Six of 950 patients (0.63%) with a totally transvenous lead system developed infection versus 16 of 838 (1.9%) patients with a transvenous lead plus subcutaneous patch system configuration (P = 0.015, Chi-square test), with an unadjusted estimated odds ratio of 3.06 (CI 1.19–7.86). The risk of infection encountered with the nonthoracotomy ICD is low, estimated from our data to be 1.2%. Placement of a subcutaneous defibrillator patch appears to be an independent risk factor for development of infection.
    Pacing and Clinical Electrophysiology 01/1998; 21(1):42-55. DOI:10.1111/j.1540-8159.1998.tb01060.x · 1.25 Impact Factor
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    Tom Faciszewski · Steven K. Broste · David Fardon
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    ABSTRACT: The purpose of the present study was to evaluate the accuracy of data regarding diagnoses of spinal disorders in administrative databases at eight different institutions. The records of 189 patients who had been managed for a disorder of the lumbar spine were independently reviewed by a physician who assigned the appropriate diagnostic codes according to the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). The age range of the 189 patients was seventeen to eighty-four years. The six major diagnostic categories studied were herniation of a lumbar disc, a previous operation on the lumbar spine, spinal stenosis, cauda equina syndrome, acquired spondylolisthesis, and congenital spondylolisthesis. The diagnostic codes assigned by the physician were compared with the codes that had been assigned during the ordinary course of events by personnel in the medical records department of each of the eight hospitals. The accuracy of coding was also compared among the eight hospitals, and it was found to vary depending on the diagnosis. Although there were both false-negative and false-positive codes at each institution, most errors were related to the low sensitivity of coding for previous spinal operations: only seventeen (28 per cent) of sixty-one such diagnoses were coded correctly. Other errors in coding were less frequent, but their implications for conclusions drawn from the information in administrative databases depend on the frequency of a diagnosis and its importance in an analysis. This study demonstrated that the accuracy of a diagnosis of a spinal disorder recorded in an administrative database varies according to the specific condition being evaluated. It is necessary to document the relative accuracy of specific ICD-9-CM diagnostic codes in order to improve the ability to validate the conclusions derived from investigations based on administrative databases.
    The Journal of Bone and Joint Surgery 11/1997; 79(10):1481-8. · 4.31 Impact Factor
  • Lung Cancer 08/1997; 18:28-28. DOI:10.1016/S0169-5002(97)89377-4 · 3.74 Impact Factor
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    ABSTRACT: Objectives: To evaluate the pain experience of seriously ill hospitalized patients and their satisfaction with control of pain during hospitalization. To understand the relationship of level of pain and dissatisfaction with pain control to demographic, psychological, and illness-related variables. Design: Prospective, cohort study. Setting: Five teaching hospitals. Patients: Patients for whom interviews were available about pain (n = 5,176) from a total of 9,105 patients in the Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments (SUPPORT). Interventions: None. Measurements and Main Results: Patients were interviewed after study enrollment about their experiences with pain. When patients could not be interviewed due to illness, we used surrogate (usually a family member) responses calibrated to patient responses (from the subset of interviews with both patient and surrogate responses). Ordinal logistic regression was used to study the association of variables with level of pain and satisfaction with its control. Nearly 50% of patients reported pain.Nearly 15% reported extremely severe pain or moderately severe pain occurring at least half of the time, and nearly 15% of those patients with pain were dissatisfied with its control. After adjustment for confounding variables, older and sicker patients reported less pain, while patients with more dependencies in activities of daily living, more comorbid conditions, more depression, more anxiety, and poor quality of life reported more pain. Patients with colon cancer reported more pain than patients in other disease categories. Levels of reported pain varied among the five hospitals and also by physician specialty. After adjustment for confounding variables, dissatisfaction with pain control was more likely among patients with more severe pain, greater anxiety, depression, and alteration of mental status, and lower reported income; dissatisfaction with pain control also varied among study hospitals and by physician specialty. Conclusions: Pain is common among severely ill hospitalized patients. The most important variables associated with pain and satisfaction with pain control were patient demographics and those variables that reflected the acute illness. Pain and satisfaction with pain control varied significantly among study sites, even after adjustment for many potential confounders. Better pain management strategies are needed for patients with the serious and common illnesses studied in SUPPORT. (Crit Care Med 1996; 24:1953-1961)
    Critical Care Medicine 11/1996; 24(12):1953-1961. DOI:10.1097/00003246-199612000-00005 · 6.15 Impact Factor
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    ABSTRACT: The Marshfield Epidemiologic Study Area (MESA), a geographically defined population registry at one of the participating sites in SUPPORT (a multicenter study of the care of seriously ill hospitalized patients) permitted assessment of generalizability in that study. On the basis of age- and sex-specific rates of enrollment of SUPPORT patients in MESA, we estimate that about 400,000 patients per year would fulfill SUPPORT eligibility criteria in the United States. However, an estimated 925,000 patients, particularly the elderly and those with impairments in their activities of daily living (ADLs), have SUPPORT-like illnesses annually, but do not receive the aggressive care required for study enrollment. The absence of patients not interested in aggressive care in tertiary care-based studies is compounded by the overrepresentation of patients referred from distant areas to the tertiary care center. Such patients tended to be older and to have different diseases than patients in MESA. Care should be taken in generalizing results from clinical and epidemiologic studies conducted at tertiary care centers.
    Journal of Clinical Epidemiology 09/1996; 49(8):835-41. DOI:10.1016/0895-4356(96)00006-6 · 5.48 Impact Factor
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    ABSTRACT: To examine the association between patient race and hospital resource use. Prospective cohort study. Five geographically diverse teaching hospitals. Patients were 9,105 hospitalized adults with one of nine illnesses associated with an average 6-month mortality of 50%. Measures of resource use included: a modified version of the Therapeutic Intervention Scoring System (TISS); performance of any of five procedures (operation, dialysis, pulmonary artery catheterization, endoscopy, and bronchoscopy); and hospital charges, adjusted by the Medicare cost-to-charge ratio per cost center at each participating hospital. The median patient age was 65; 79% were white, 16% African-American, 3% Hispanic, and 2% other races; 47% died within 6 months. After adjusting for other sociodemographic factors, severity of illness, functional status, and study site, African-Americans were less likely to receive any of five procedures on study day 1 and 3 (adjusted odds ratio [OR] 0.70; 95% confidence interval [CI] 0.60, 0.81). In addition, African-Americans had lower TISS scores on study day 1 and 3 (OR -1.8; 95% CI-1.3, -2.4) and lower estimated costs of hospitalization (OR (-)$2,805; 95% CI (-)$1,672, (-)$3,883). Results were similar after adjustment for patients' preferences and physicians' prognostic estimates. Differences in resource use were less marked after adjusting for the specialty of the attending physician but remained significant. In a subset analysis, cardiologists were less likely to care for African-Americans with congestive heart failure (p < .001), and cardiologists used more resources (p < .001). After adjustment for other sociodemographic factors, severity of illness, functional status, and study site, survival was slightly better for African-American patients (hazard ratio 0.91; 95% CI 0.84, 0.98) than for white or other race patients. Seriously ill African-Americans received less resource-intensive care than other patients after adjustment for other sociodemographic factors and for severity of illness. Some of these differences may be due to differential use of subspecialists. The observed differences in resource use were not associated with a survival advantage for white or other race patients.
    Journal of General Internal Medicine 07/1996; 11(7):387-96. · 3.42 Impact Factor
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    ABSTRACT: To capitalize on Marshfield Clinic's advantages for population-based health research, we developed the Marshfield Epidemiologic Study Area (MESA). Marshfield Clinic is an integrated system consisting of a large multispecialty clinic and 23 affiliated clinics. Clinic physicians provide virtually all of the medical care, both inpatient and outpatient, for residents of the area. MESA consists of 14 ZIP codes in which over 95% of the 50,000 residents and most significant health events are captured in Marshfield Clinic databases, including all deaths, 94% of hospital discharges, and 92% of medical outpatient visits. MESA exemplifies the research potential of integrated medical care systems and the efforts required to realize that potential. Because it is representative of a defined population and provides an unselected sample of patients, MESA is well suited for epidemiologic research and research elucidating the clinical spectrum and natural history of diseases and the effectiveness of treatment.
    Journal of Clinical Epidemiology 07/1996; 49(6):643-52. DOI:10.1016/0895-4356(96)00008-X · 5.48 Impact Factor
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    ABSTRACT: OBJECTIVE: To examine the association between patient race and hospital resource use. DESIGN: Prospective cohort study. SETTING: Five geographically diverse teaching hospitals. PATIENTS: Patients were 9,105 hospitalized adults with one of nine illnesses associated with an average 6-month mortality of 50%. MEASUREMENTS AND MAIN RESULTS: Measures of resource use included: a modified version of the Therapeutic Intervention Scoring System (TISS); performance of any of any of five procedures (operation, dialysis, pulmonary artery catheterization, endoscopy, and bronchoscopy); and hospital charges, adjusted by the Medicare cost-to-charge ratio per cost center at each participating hospital. The median patient age was 65; 79% were white, 16% African-American, 3% Hispanic, and 2% other races; 47% died within 6 months. After adjusting for other sociodemographic factors, severity of illness, functional status, and study site, African-Americans were less likely to receive any of five procedures on study day 1 and 3 (adjusted odds ratio [OR] 0.70; 95% confidence interval [CI] 0.60, 0.81). In addition, African-Americans had lower TISS scores on study day 1 and 3 (OR −1.8; 95% CI −1.3, −2.4) and lower estimated costs of hospitalization (OR −$2,805; 95% CI −$2,805; 95% CI −1,672, −$3,883). Results were similar after adjustment for patients’ preferences and physicians’ prognostic estimates. Differences in resource use were less marked after adjusting for the specialty of the attending physician but remained significant. In a subset analysis, cardiologists were less likely to care for African-Americans with congestive heart failure (p<.001), and cardiologists used more resources (p<.001). After adjustment for other sociodemographic factors, severity of illness, functional status, and study site, survival was slightly better for African-American patients (hazard ratio 0.91; 95% CI 0.84, 0.98) than for white or other race patients. CONCLUSIONS: Seriously ill African-Americans received less resource-intensive care than other patients after adjustment for other sociodemographic factors and for severity of illness. Some of these differences may be due to differential use of subspecialists. The observed differences in resource use were not associated with a survival advantage for white or other race patients.
    Journal of General Internal Medicine 07/1996; 11(7):387-396. DOI:10.1007/BF02600183 · 3.42 Impact Factor
  • Journal of the American College of Cardiology 02/1996; 27(2):303-304. DOI:10.1016/S0735-1097(96)82111-5 · 15.34 Impact Factor
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    ABSTRACT: Objective. —To examine the association between the use of right heart catheterization (RHC) during the first 24 hours of care in the intensive care unit (ICU) and subsequent survival, length of stay, intensity of care, and cost of care.
    JAMA The Journal of the American Medical Association 01/1996; 276(11):889-897. DOI:10.1001/jama.1996.03540110043030 · 30.39 Impact Factor
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    ABSTRACT: Seriously or terminally ill patients are frequently incapacitated and unable to express their preferences regarding cardiopulmonary resuscitation (CPR). In this situation, family members or other surrogate decision makers are often asked whether they believe the patient would want to be resuscitated. We evaluated the concordance of patient CPR preferences and surrogate perceptions of the patient preferences in the Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments (SUPPORT), a large, multicenter study of seriously ill hospitalized patients. We compared patient preferences and surrogate perceptions in 1226 pairings in which both patient and surrogate responded to CPR decision questions. We also examined factors that might influence patient-surrogate concordance. Twenty-nine percent of patients with paired data did not want to be resuscitated; 26% of surrogates did not believe the patient they represented would want to be resuscitated. Within pairs, the overall exact agreement with respect to CPR decisions was 74%. For patients favoring CPR, only 16% of the surrogates misconstrued the patient's wishes. For patients who did not want to be resuscitated, however, 50% of the surrogates did not reflect the patient's wishes. If patients reported telling surrogates their CPR preference, concordance was significantly improved if the surrogate believed the patient did not want to be resuscitated and was significantly worsened if the surrogate believed the patient wanted CPR. This finding is likely an artifact of patients being more likely to report their preference to surrogates if that preference was not to be resuscitated. Surrogates' perceptions of patient CPR preferences are often inaccurate, particularly for those patients who do not want to be resuscitated. Methods to improve communication between patients and surrogates on CPR preferences should be developed and evaluated.
    Archives of Family Medicine 07/1995; 4(6):518-23. DOI:10.1001/archfami.4.6.518
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    ABSTRACT: To assess 1) the health values and health ratings of seriously ill hospitalized patients, their surrogate decision makers, and their physicians; 2) the determinants of health values; and 3) whether health values change over time. Prospective, longitudinal, multicenter study. 5 academic medical centers. 1438 seriously ill patients with at least one of nine diseases who had a projected overall 6-month mortality rate of 50%; their surrogates; and their physicians. Time-tradeoff utilities (reflecting preferences for a shorter but healthy life) and health ratings. At study day 3, patients had a mean time-tradeoff utility of 0.73 +/- 0.32 (median [25th, 75th percentile], 0.92 [0.63, 1.0]), indicating that they equated living 1 year in their current state of health with living 8.8 months in excellent health. However, scores varied widely; 34.8% of patients were unwilling to exchange any time in their current state of health for a shorter life in excellent health (utility, 1.0), and 9.0% were willing to live 2 weeks or less in excellent health rather than 1 year in their current state of health (utility, 0.04). Health rating scores averaged 57.8 +/- 24.0 (median [25th percentile, 75th percentile], 60 [50, 75]) on a scale of 0 (death) to 100 (perfect health). The patients' mean time-tradeoff score exceeded that of their paired surrogates (n = 1041) by 0.08 (P < 0.0001). Time-tradeoff scores were related to psychosocial well-being; health ratings; desire for resuscitation and extension of life rather than relief of pain and discomfort; degree of willingness to live with constant pain; and perceived prognosis for survival and independent functioning. Scores of surviving patients increased by an average of 0.06 after 2 months (P < 0.0001) and 0.08 after 6 months (P < 0.0001). Health values of seriously ill patients vary widely, are higher than patients' surrogates believe, are related to few other preference and health status measures, and increase over time.
    Annals of internal medicine 05/1995; 122(7):514-20. DOI:10.7326/0003-4819-122-7-199504010-00007 · 16.10 Impact Factor

Publication Stats

1k Citations
273.79 Total Impact Points

Institutions

  • 1996
    • University of Wisconsin - Milwaukee
      Milwaukee, Wisconsin, United States
  • 1990–1996
    • Marshfield Clinic
      • Division of Cardiology
      MFI, Wisconsin, United States
  • 1995
    • University of Cincinnati
      • Division of General Internal Medicine
      Cincinnati, Ohio, United States