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ABSTRACT: Vitamin D is necessary for bone health and calcium metabolism. Vitamin D deficiency may play a role in coronary artery disease, some cancers, autoimmune disease, and glucose tolerance. Vitamin D deficiency may be prevalent even among affluent US adults.
We conducted a retrospective chart review study of 287 adult patients who underwent executive physical examinations between April 2009 and May 2010 in Chicago, Illinois. Data collected included age, sex, body mass index, vitamin D levels, supplement use, fish consumption, milk consumption, hours spent outdoors, and sunscreen use. Vitamin D insufficiency was defined as <30 ng/mL.
The mean vitamin D level was 40.0 ng/mL (standard deviation 16.6), which varied by month. The mean vitamin D level ranged from 32.9 ng/mL in January to 55.4 ng/mL in September. Insufficient levels of vitamin D were observed in 30.3% of patients. Younger age (younger than 40 years); no milk or fish consumption; no use of multivitamins, vitamin D supplements, or calcium supplements; no sun exposure; and routine use of sunscreens were positively associated with vitamin D insufficiency.
Vitamin D insufficiency in almost one-third of patients presenting for executive physicals may be indicative of a widespread nutritional deficiency in the US population.
Southern medical journal 02/2012; 105(2):78-81. · 0.92 Impact Factor
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ABSTRACT: To determine whether overweight and obese inpatients are receptive to weight-loss interventions while hospitalized and whether interest in weight-loss intervention correlates with accurate self-perception of weight.
We conducted a cross-sectional survey of overweight and obese patients admitted to the general medicine service at a large urban academic medical center from September 17, 2007 through October 16, 2007. Subjects were identified based on body mass index (BMI) on admission ≥25 and surveyed using a 14-question instrument. The main outcome measure was patient willingness to consider weight-loss intervention.
Of 67 eligible patients, 64 (95.5%) agreed to be interviewed. BMI ranged from 25 to 50. Overall, 52.6% (10 of 19) of overweight patients did not believe they were overweight and 46.7% (21 of 45) of those with a BMI over 30 were unaware that they met criteria for obesity. Among all patients surveyed, 56.3% stated they would be interested in weight-loss intervention while hospitalized. In obese patients specifically, 68.9% expressed interest. Interest correlated with BMI (Pearson correlation coefficient (r) = 0.261, P = 0.04), accurate self-perception of weight (P = 0.03), diagnostic delays related to weight (P = 0.01) and a history of past weight-loss attempts (P = 0.04). None of the patients we interviewed received weight-loss intervention of any kind while hospitalized.
Inpatients who recognize that they are overweight or obese are interested in pursuing weight-loss initiatives. Despite their interest, most do not receive weight-loss interventions while hospitalized.
Southern medical journal 06/2011; 104(6):397-400. · 0.92 Impact Factor
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ABSTRACT: Organ scarcity has resulted in increased utilization of donation after cardiac death (DCD) donors. Prior analysis of patient survival following DCD liver transplantation has been restricted to single institution cohorts and a limited national experience. We compared the current national experience with DCD and DBD livers to better understand survival after transplantation.
We compared 1113 DCD and 42,254 DBD recipients from the Scientific Registry of Transplant Recipients database between 1996 and 2007. Patient survival was analyzed using the Kaplan-Meier methodology and Cox regression.
DCD recipients experienced worse patient survival compared to DBD recipients (p<0.001). One and 3 year survival was 82% and 71% for DCD compared to 86% and 77% for DBD recipients. Moreover, DCD recipients required re-transplantation more frequently (DCD 14.7% vs. DBD 6.8%, p<0.001), and re-transplantation survival was markedly inferior to survival after primary transplant irrespective of graft type. Amplification of mortality risk was observed when DCD was combined with cold ischemia time >12h (HR = 1.81), shared organs (HR = 1.69), recipient hepatocellular carcinoma (HR=1.80), recipient age >60 years (HR = 1.92), and recipient renal insufficiency (HR = 1.82).
DCD recipients experience significantly worse patient survival after transplantation. This increased risk of mortality is comparable in magnitude to, but often exacerbated by other well-established risk predictors. Utilization decisions should carefully consider DCD graft risks in combination with these other factors.
Journal of Hepatology 02/2011; 55(4):808-13. · 9.26 Impact Factor
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ABSTRACT: Nights and weekends represent a potentially high-risk time for hospitalized patients. Data regarding night or weekend admission and its impact on outcomes is limited. We studied the association between night or weekend admission and outcomes.
We reviewed 857 admissions to the general medicine services from the emergency department (ED) at our tertiary care hospital for demographic information, time and day of admission, and hospitalization-relevant outcomes (length of stay [LOS], hospital charges, intensive care unit [ICU] transfer during hospitalization, repeat ED visit within 30 days, readmission within 30 days, and poor outcome [ICU transfer, cardiac arrest, or death] within the first 24 hours of admission). Outcomes were compared between groups using univariate and multivariate modeling.
Complete data for analysis were available for 824 patients. A total of 58% of patients were admitted at night and 22% were admitted during the weekend. Patients admitted at night as compared to those admitted during the day had similar a LOS (4.1 vs. 4.3, P = 0.38), hospital charges (25,200 vs. 27,500, P = 0.17), ICU transfer during hospitalization (3% vs. 6%, P = 0.06), 30 day repeat ED visit (22% vs. 20%, P = 0.42), 30 day readmission (20% vs. 17%, P = 0.23), and poor outcomes within 24 hours of admission (1% vs. 2%, P = 0.15). Patients admitted during the weekend as compared to those admitted during the week had lower hospital charges and lower likelihood of an ICU transfer but were otherwise similar.
Night or weekend admission was not associated with worse hospitalization-relevant outcomes at our tertiary care hospital.
Journal of Hospital Medicine 01/2011; 6(1):10-4. · 1.40 Impact Factor
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ABSTRACT: To present pilot data from an ongoing electronic health record (EHR) quality improvement study to improve medication management using patient previsit review of the EHR medication list and a plain-language new medication information sheet to provide with every new EHR prescription.
Postvisit survey of 191 patients at an academic general internal medicine clinic.
Patients were asked about discrepancies and problems, concerns, and questions (PCQs) in their EHR summary for up to 10 current medications and about knowledge of new prescriptions. Findings describe the extent of medication discrepancies, perceived PCQs about current medications, and patient knowledge about new medications.
Overall, 78.0% of patients had at least 1 discrepancy, more than half had a drug listed that they were not taking or dose or frequency discrepancies, and 8.9% reported an omission; 41.9% indicated at least 1 PCQ about their current medications. Among patients who received a new prescription, most knew what the new medication was for and how to take it. However, 66.0% indicated uncertainty about potential adverse effects that they should telephone the physician about.
Discrepancies can be efficiently categorized by previsit review of EHR medication lists. Prereview offers physicians the opportunity to better address important medication PCQs. Testing the value of EHR-generated plain-language medication information sheets requires follow-up interviews after medications are filled. Patients may not understand the actual benefits of new medications.
The American journal of managed care 12/2010; 16(12):919-22. · 2.46 Impact Factor
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ABSTRACT: In the setting of acute ST-segment elevation myocardial infarction (STEMI), reperfusion therapy with emergent primary percutaneous coronary intervention (PCI) significantly reduces mortality. It is unknown whether a hospital's performance on the Centers for Medicare & Medicaid Services (CMS) quality metric for time from patient arrival to angioplasty is associated with its overall hospital acute myocardial infarction (AMI) mortality rate.
The objective of this study was to evaluate if hospitals with higher performance on the time-to-PCI quality measure are more likely to achieve lower mortality for patients admitted for any type of AMI.
Using merged 2006 data from the Nationwide Inpatient Sample (NIS), the American Hospital Association (AHA) annual survey, and CMS Hospital Compare quality indicator data, we examined 69,101 admissions with an International Classification of Diseases, Ninth Revision (ICD-9)-coded principal diagnosis of AMI in the 116 hospitals that reported more than 24 emergent primary PCI admissions in that year. Hospitals were categorized into quartiles according to percentage of admissions in 2006 that achieved the primary PCI timeliness threshold (time-to-PCI quality measure). Using a random effects logistic regression model of inpatient mortality, we examined the significance of the hospital time-to-PCI quality measure after adjustment for other hospital and individual patient sociodemographic and clinical characteristics.
The unadjusted inpatient AMI mortality rate at the 27 top quartile hospitals was 4.3%, compared to 5.1% at the 32 bottom quartile (worst performing) hospitals. The risk-adjusted odds ratio (OR) of inpatient death was 0.83 (95% confidence interval [CI] = 0.72 to 0.95), or 17% lower odds of inpatient death, among patients admitted to hospitals in the top quartile for the time-to-PCI quality measure compared to the case if the hospitals were in the bottom 25th percentile.
Hospitals with the highest and second highest quartiles of time-to-PCI quality measure had a significantly lower overall AMI mortality rate than the lowest quartile hospitals. Despite the fact that a minority of all patients with AMI get an emergent primary PCI, hospitals that perform this more efficiently also had a significantly lower mortality rate for all their patients admitted with AMI. The time-to-PCI quality measure in 2006 was a potentially important proxy measure for overall AMI quality of care.
Academic Emergency Medicine 08/2010; 17(8):793-800. · 1.86 Impact Factor
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ABSTRACT: Residency programs strive to accurately assess applicants' qualifications and predict future performance. However, there is little evidence-based guidance on how to do this. The aim of this study was to design an algorithm for ranking applicants to an internal medicine residency program.
Ratings of overall performance in residency were compared to application characteristics of 230 graduating residents from 2000-2005. We analyzed 5 characteristics of the application: medical school, overall medical school performance, performance in junior medicine clerkship, United States Medical Licensing Examination (USMLE) Step 1 score, and interview ratings. Using bivariate correlations and multiple regression analysis, we calculated the association of each characteristic with mean performance ratings during residency.
In multiple regression analysis, the most significant application factors (r(2) = 0.22) were the quality of the medical school and the applicant's overall performance in medical school (P < .001).
This data has allowed the creation of a weighted algorithm to rank applicants that uses 4 application factors-school quality, overall medical school performance, medicine performance, and USMLE Step 1 score.
Journal of graduate medical education. 03/2010; 2(1):129-32.
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ABSTRACT: This study was designed to determine risk factors and potential harm associated with medication errors at hospital admission.
Study pharmacist and hospital-physician medication histories were compared with medication orders to identify unexplained history and order discrepancies in 651 adult medicine service inpatients with 5,701 prescription medications. Discrepancies resulting in order changes were considered errors. Logistic regression was used to analyze the association of patient demographic and clinical characteristics including patients' number of pre-admission prescription medications, pharmacies, prescribing physicians and medication changes; and presentation of medication bottles or lists. These factors were tested after controlling for patient demographics, admitting service and severity of illness.
Over one-third of study patients (35.9%) experienced 309 order errors; 85% of patients had errors originate in medication histories, and almost half were omissions. Cardiovascular agents were commonly in error (29.1%). If undetected, 52.4% of order errors were rated as potentially requiring increased monitoring or intervention to preclude harm; 11.7% were rated as potentially harmful. In logistic regression analysis, patient's age > or = 65 [odds ratio (OR), 2.17; 95% confidence interval (CI), 1.09-4.30] and number of prescription medications (OR, 1.21; 95% CI, 1.14-1.29) were significantly associated with errors potentially requiring monitoring or causing harm. Presenting a medication list (OR, 0.35; 95% CI, 0.19-0.63) or bottles (OR, 0.55; 95% CI, 0.27-1.10) at admission was beneficial.
Over one-third of the patients in our study had a medication error at admission, and of these patients, 85% had errors originate in their medication histories. Attempts to improve the accuracy of medication histories should focus on older patients with a large number of medications. Primary care physicians and other clinicians should help patients utilize and maintain complete, accurate and understandable medication lists.
Journal of General Internal Medicine 02/2010; 25(5):441-7. · 2.83 Impact Factor
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ABSTRACT: Studies have demonstrated significant associations between limited literacy and health outcomes. Yet differences in literacy measurement and the cutoffs used for analysis have made it difficult to fully understand the relationship between literacy and health across the entire spectrum of literacy (i.e., whether the relationship is continuous and graded or whether a threshold exists below which literacy is independently associated with health). To analyze this question, we re-examined the relationship between literacy, baseline physical functioning and mental health, and all-cause mortality for a cohort of 3260 US community-dwelling elderly who were interviewed in 1997 to determine demographics, socioeconomic status, chronic conditions, self-reported physical and mental health (SF-36 subscales), health behaviors, and literacy based upon the Short Test of Functional Health Literacy in Adults (S-TOFHLA). All-cause mortality was determined using data from the US National Death Index through 2003. Seven categories of S-TOFHLA literacy scores were created and used in this analysis instead of the existing three categories identified with the measure. In multivariate analyses, a continuous, graded relationship between literacy and baseline physical functioning was identified. However, participants scoring below the third literacy category had significantly worse mental health compared to the highest literacy category, displaying a notable threshold. Finally, all six literacy categories were significantly associated with greater all-cause mortality risk compared to the highest literacy category, but again there was a marked threshold below the third category at which the adjusted mortality rate significantly increased compared to all other categories. We conclude that the nature of the relationship between literacy and health may vary depending upon the outcome under examination.
Social Science [?] Medicine 02/2010; 70(9):1335-41. · 2.70 Impact Factor
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ABSTRACT: With the growth of hospitalist services and the reduction in residency work hours, medical education has changed dramatically. The objective of this study was to examine changes in junior medical student-patient encounters after initiation of residency work hours and implementation of a large hospitalist practice at our academic medical center.
Medicine clerkship students from 2002-2007 recorded the number of hospital patients and their principal diagnoses cared for during a 6-week block rotation. Comparisons were made between clerkship experiences among students in 2002-2004 and 2005-2007 for number of patients and diversity of patient diagnoses seen. Data from the 2004-2005 transition period, when teams fluctuated during implementation of the hospitalist service, were excluded.
A total of 4,697 patients were seen by students during the two periods, and patient logs for 154 students (3,253 patients in 2002-2004) and 120 students (1,444 patients in 2005-2007) were compared. The mean number of patients directly cared for by students on their junior medicine clerkship dropped from 21 patients (2002-2004) to 12 patients (2005-2007) per student (p < 0.001). Compared to 2002-2004, fewer students from 2005-2007 helped manage patients with chest pain (85.7% vs. 74.2%, p = 0.016), pancreatitis (66.9% vs. 23.3%, p < 0.001), pneumonia (69.5% vs. 54.2%, p = 0.009), gastroenteritis (45.5% vs. 20.8%, p < 0.001), or cellulitis (46.8% vs. 19.2%, p < 0.001). Alternatively, students from 2005-2007 saw more patients with abdominal pain (64.9% vs. 79.2%, p = 0.010), anemia (44.8% vs. 70.8%, p < 0.001), mental status changes (32.5% vs. 51.7%, p = 0.001), failure to thrive (16.2% vs. 53.3%, p < 0.001), and endocrine disorders (including diabetes, thyroid disorders, Addison's, 51.3% vs. 74.2%, p < 0.001).
With institutional and residency changes, junior medicine clerkship students had fewer opportunities for direct care of patients and encountered a different mix of patient diagnoses. Increasingly during their junior medicine clerkship, students may not have exposure to basic medical conditions, which may affect their ability to care for future patients.
Journal of General Internal Medicine 12/2009; 25(3):207-10. · 2.83 Impact Factor
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ABSTRACT: Deficits in information transfer between inpatient and outpatient physicians are common and potentially dangerous.
To evaluate the effect of a newly-created electronic discharge summary.
Pre-post evaluation of discharge summaries using a survey of outpatient physicians and a medical records review.
Outpatient physicians' ratings of satisfaction with discharge summaries before and after implementation of an electronic discharge summary using a 5-point Likert scale (1 = very dissatisfied; 5 = very satisfied). Additionally, 196 randomly selected discharge summaries before and after implementation were rated for timeliness and presence of 16 key content areas by 3 internists.
Two hundred and twenty-six of 416 (54%) and 256 of 397 (64%) outpatient physicians completed the baseline and postimplementation surveys. Satisfaction with quality and timeliness of discharge summaries improved with the use of the electronic discharge summary (mean quality rating 3.04 versus 3.64; P < 0.001, mean timeliness rating 2.59 versus 3.34; P < 0.001). A higher percentage of electronic discharge summaries were completed within 3 days of discharge as compared with dictated discharge summaries (44.8% versus 74.1%; P < 0.001). Several elements of the discharge summary were present more often with the electronic discharge summary, including discussion of follow-up issues (52.0% versus 75.8%; P = 0.001), pending test results (13.9% versus 46.3%; P < 0.001), and information provided to the patient and/or family (85.1% versus 95.8%; P = 0.01).
The use of an electronic discharge summary significantly improved the quality and timeliness of discharge summaries.
Journal of Hospital Medicine 03/2009; 4(4):219-25. · 1.40 Impact Factor
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ABSTRACT: Low health literacy and low cognitive abilities both predict mortality, but no study has jointly examined these relationships.
We conducted a prospective cohort study of 3,260 community-dwelling adults age 65 and older. Participants were interviewed in 1997 and administered the Short Test of Functional Health Literacy in Adults and the Mini Mental Status Examination. Mortality was determined using the National Death Index through 2003.
In multivariate models with only literacy (not cognition), the adjusted hazard ratio was 1.50 (95% confidence of interval [CI] 1.24-1.81) for inadequate versus adequate literacy. In multivariate models without literacy, delayed recall of 3 items and the ability to serial subtract numbers were associated with higher mortality (e.g., adjusted hazard ratios [AHR] 1.74 [95% CI 1.30-2.34] for recall of zero versus 3 items, and 1.32 [95% CI 1.09-1.60] for 0-2 vs 5 correct subtractions). In multivariate analysis with both literacy and cognition, the AHRs for the cognition items were similar, but the AHR for inadequate literacy decreased to 1.27 (95% CI 1.03 - 1.57).
Both health literacy and cognitive abilities independently predict mortality. Interventions to improve patient knowledge and self-management skills should consider both the reading level and cognitive demands of the materials.
Journal of General Internal Medicine 07/2008; 23(6):723-6. · 2.83 Impact Factor
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ABSTRACT: The present study sought to examine whether racial/ethnic differences exist in stigmatizing attitudes towards people with mental illness among community college students. Multiple regression models were used to investigate racial/ethnic differences in students' perceived dangerousness and desire for segregation from persons with mental illness both before and after participation in an antistigma intervention. At baseline, African Americans and Asians perceived people with mental illness as more dangerous and wanted more segregation than Caucasians, and Latinos perceived people with mental illness as less dangerous and wanted less segregation than Caucasians. Similar patterns emerged postintervention, except that Asians' perceptions changed significantly such that they tended to perceive people with mental illness as least dangerous of all the racial/ethnic groups. These findings suggest that racial/ethnic background may help to shape mental illness stigma, and that targeting antistigma interventions to racial/ethnic background of participants may be helpful.
The Journal of nervous and mental disease 01/2008; 195(12):1020-3. · 1.77 Impact Factor
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ABSTRACT: Individuals with low levels of health literacy have less health knowledge, worse self-management of chronic disease, lower use of preventive services, and worse health in cross-sectional studies. We sought to determine whether low health literacy levels independently predict overall and cause-specific mortality.
We designed a prospective cohort study of 3260 Medicare managed-care enrollees in 4 US metropolitan areas who were interviewed in 1997 to determine their demographic characteristics, chronic conditions, self-reported physical and mental health, and health behaviors. Participants also completed the shortened version of the Test of Functional Health Literacy in Adults. Main outcome measures included all-cause and cause-specific (cardiovascular, cancer, and other) mortality using data from the National Death Index through 2003.
The crude mortality rates for participants with adequate (n = 2094), marginal (n = 366), and inadequate (n = 800) health literacy were 18.9%, 28.7%, and 39.4%, respectively (P < .001). After adjusting for demographics, socioeconomic status, and baseline health, the hazard ratios for all-cause mortality were 1.52 (95% confidence interval, 1.26-1.83) and 1.13 (95% confidence interval, 0.90-1.41) for participants with inadequate and marginal health literacy, respectively, compared with participants with adequate health literacy. In contrast, years of school completed was only weakly associated with mortality in bivariate analyses and was not significant in multivariate models. Participants with inadequate health literacy had higher risk-adjusted rates of cardiovascular death but not of death due to cancer.
Inadequate health literacy, as measured by reading fluency, independently predicts all-cause mortality and cardiovascular death among community-dwelling elderly persons. Reading fluency is a more powerful variable than education for examining the association between socioeconomic status and health.
Archives of Internal Medicine 08/2007; 167(14):1503-9. · 11.46 Impact Factor
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ABSTRACT: Uninsured adults in late middle age are more likely to have a health decline than individuals with private insurance.
To determine how health and the risk of future adverse health outcomes changes after the uninsured gain Medicare.
Prospective cohort study.
Participants (N=3,419) in the Health and Retirement Study who transitioned from private insurance or being uninsured to having Medicare coverage at the 1996, 1998, 2000, or 2002 interview.
We analyzed risk-adjusted changes in self-reported overall health and physical functioning during the transition period to Medicare (t(-2) to t(0)) and the following 2 years (t(0) to t(2)).
Between the interview before age 65 (t(-2)) and the first interview after reaching age 65 (t(0)), previously uninsured individuals were more likely than those who had private insurance to have a major decline in overall health (adjusted relative risk [ARR] 1.46; 95% confidence interval [CI] 1.03 to 2.04) and to develop a new physical difficulty affecting mobility (ARR 1.24; 95% CI 0.96 to 1.56) or agility (ARR 1.33; 95% CI 1.12 to 1.54). Rates of improvement were similar between the 2 groups. During the next 2 years (t(0) to t(2)), adjusted rates of declines in overall health and physical functioning were similar for individuals who were uninsured and those who had private insurance before gaining Medicare.
Gaining Medicare does not lead to immediate health benefits for individuals who were uninsured before age 65. However, after 2 or more years of continuous coverage, the uninsured no longer have a higher risk of adverse health outcomes.
Journal of General Internal Medicine 12/2006; 21(11):1144-9. · 2.83 Impact Factor
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ABSTRACT: Deficits in information transfer between inpatient and outpatient physicians are common and potentially dangerous.
To evaluate satisfaction with current discharge summaries, perceptions of preventable adverse events related to suboptimal information transfer, and the perceived need for the electronic discharge summary we plan to design.
: Survey of Department of Medicine physicians with an outpatient practice.
Satisfaction with timeliness and quality of discharge summaries was assessed using a 5-point Likert scale. Respondents estimated the number of patients with preventable adverse events related to suboptimal information transfer at discharge.
Of the 416 eligible respondents, 226 completed the survey (54%). Only 19% of the participants were satisfied or very satisfied with timeliness, and only 32% were satisfied or very satisfied with the quality of discharge summaries. Overall, 41% believed that at least 1 of their patients hospitalized in the previous 6 months had experienced a preventable adverse event related to poor transfer of information at discharge.
Physicians were not satisfied with the timeliness or quality of discharge summaries. Physicians indicated that suboptimal transfer of information at hospital discharge contributed to preventable adverse events.
Journal of Hospital Medicine 10/2006; 1(5):317-20. · 1.40 Impact Factor
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ABSTRACT: Although individuals' health insurance coverage changes frequently, previous analyses have not accounted for changes in insurance coverage over time.
We sought to determine the independent association between lack of insurance and the risk of a decline in self-reported overall health and death from 1992 to 2002, accounting for changes in self-reported overall health and insurance coverage.
We analyzed data from the Health and Retirement study, a prospective cohort study of a national sample of community-dwelling adults age 51-61 years old at baseline. Major decline in self-reported overall health and mortality was determined at 2-year intervals.
People who were uninsured at baseline had a 35% (95% confidence interval [CI] 12-62%) higher risk-adjusted mortality from 1992 to 2002 compared with those with private insurance. However, when we analyzed outcomes over 2-year intervals, individuals who were uninsured at the start of each interval were more likely to have a major decline in their overall health (pooled adjusted relative risk 1.43, 95% CI 1.28-1.63), but they were equally likely to die (pooled adjusted relative risk 0.96, 95% CI 0.73-1.27). Of the 1512 people who were uninsured at baseline, 220 (14.6%) died; of those who died, only 70 (31.8%) were still uninsured at the HRS interview prior to death.
Death does not appear to be a short-term consequence of being uninsured. Instead, higher long-term mortality among the uninsured results from erosion in this population's health status over time and the attendant higher mortality associated with this. Most deaths among the uninsured occur after individuals have gained either public or private health insurance.
Medical Care 04/2006; 44(3):277-82. · 3.41 Impact Factor
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ABSTRACT: We assessed the feasibility of collecting race/ethnicity data from patients using their own preferred racial/ethnic terms.
The 424 patients described their race/ethnicity using their own categories, and we compared their descriptions with their responses to the questions (1) "Do you consider yourself Latino or Hispanic?" and (2) "Which category best describes your race?" (7 response options in our computer interview). We also determined patients' preferences between the 2 approaches.
The proportions of patients who described themselves with 1, 2, 3, or 4 terms were 46%, 33%, 14%, and 6%, respectively; 2 said only "American" (1%,) and 1 refused to answer (0.5%). The average completion time was 37 +/- 17 seconds. Rates of missing values and categorization as "other" race were lower than with the closed questions. Agreement between racial/ethnic categorization with open-ended and closed responses was 93% (kappa =0.88). Latino/Hispanic and multiracial/multiethnic individuals were more likely to prefer using their own categories to describe their race/ethnicity.
Collecting race/ethnicity data using patients' own racial/ethnic categories is feasible with the use of computerized systems to capture verbatim responses and results in lower rates of missing and unusable data than do standard questions.
American Journal of Public Health 04/2006; 96(3):532-7. · 3.93 Impact Factor
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ABSTRACT: To explore barriers to medical care for osteoporosis following a minimal trauma fracture (MTF). MTFs occur from a fall while in a seated, recumbent or standing position; during normal walking, or from a height less than 4 feet.
Prospective study and focus groups of women with MTF performed in Chicago from June to December of 2003. Study protocol approved by Institutional Review Board (IRB) and all participants signed consent forms. Focus groups were audiotaped and transcribed, transcripts analyzed using Atlas.ti. Survey results analyzed with SPSS 11.5.
Twenty nine participants recruited with average age of 74+/-16 years. MTF occurred at the mean age of 61+/-8 years, with fifteen (15/29) reporting more that one prior MTF. The age distribution was 40-49 years 2 (2/29) participants, 50-59 years 2 (2/29), 60-69 years 6 (6/29), 70-79 years 10 (10/29), 80 and above 9 (9/29). Most participants (21/29, 70%) reported knowledge about osteoporosis obtained from written media. Osteoporotic fractures were rated on a single item Likert Scale (1=not important to 5=most important) as 2.5 (compared with breast cancer 2.3, and myocardial infarction 2.8). Half (16/29) had osteoporosis counseling with their PCP and 9 were receiving medications for bone loss. We observed a positive correlation between osteoporosis counseling and BMD testing (r=0.6, p<0.001), and a trend toward osteoporosis treatment (r=0.372, p=0.09). Half of the participants had reported the occurrence of MTF to their PCP (14/29), however this did not lead to counseling, BMD testing (r=0.07, p=0.78), or treatment (r=-0.14, p=0.53). None of the women believed that low BMD or osteoporosis had contributed to their fracture. Women studied believed that they were "too young" (12/29) to have osteoporosis.
Women are not receiving adequate information about osteoporosis; they remain unaware of the connection between MTFs and osteoporosis. Post-menopausal women with MTF do not identify osteoporosis as a cause for the fracture, may exhibit ageism and thereby fail to seek adequate medical care.
Maturitas 02/2006; 53(3):260-6. · 2.77 Impact Factor
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ABSTRACT: Experts recommend that health care providers (HCPs) collect patients' race/ethnicity, but HCPs worry that this may alienate patients.
To determine patients' attitudes toward HCPs collecting race/ethnicity data.
Cross-sectional survey.
General Internal Medicine patients (n=220).
Perceived importance of having HCPs collect race/ethnicity data, their concerns about this, comfort level providing this information, and reactions to 4 statements explaining the rationale for collecting this.
Approximately 80% somewhat or strongly agreed that HCPs should collect information on patients' race/ethnicity. However, 28% had significant discomfort (score 5 or less on 10-point scale) reporting their own race/ethnicity to a clerk, and 58% were somewhat or very concerned that this information could be used to discriminate against patients. Compared with whites, blacks, and Hispanics felt less strongly that HCPs should collect race/ethnicity data from patients (P=.04 for both pairwise comparisons), and blacks were less comfortable reporting their own race/ethnicity than whites (P=.03). Telling patients that this information would be used for monitoring quality of care improved comfort more than telling patients that the data collected (a) was mandated by others, (b) would be used to guide staff hiring and training, and (c) would be used to ensure the patient got the best care possible.
Most patients think HCPs should collect information about race/ethnicity, but many feel uncomfortable giving this information, especially among minorities. Health care providers can increase patients' comfort levels by telling them this will be used to monitor quality of care.
Journal of General Internal Medicine 11/2005; 20(10):895-900. · 2.83 Impact Factor
