Catherine H MacLean

University of California, Los Angeles, Los Angeles, California, United States

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Publications (73)641.95 Total impact

  • David S Zingmond · Debra Saliba · Kathleen H Wilber · Catherine H MacLean · Neil S Wenger ·
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    ABSTRACT: To adapt the Assessing Care of Vulnerable Elders project nursing home (NH) specific quality indicators (QIs), for use with routinely collected data, and to evaluate which clinical conditions and types of care were inadequately measured using these data sources. Retrospective cohort study. Nursing homes. NH residents 66 years of age and older dually enrolled in Medicare and Medicaid in 19 California counties between 1999 and 2000. Identification of care inaccessible to measurement by Medicare and Medicaid claims linked to the Minimum Data Set (MDS). Assessment of care provided for measurable QIs by condition (eg, heart failure) and by intervention type (eg, medication use). Only 50 of 283 QIs were captured using linked claims data. The 21,657 patients triggered 152,376 QIs (7.0 QIs/person). The overall QI pass rate (receipt of recommended care) for eligible participants was 76%. In this sample, QIs with the highest pass rates measured avoidance of adverse medications and appropriate medication use. Fewer than half of the QIs were passed for ischemic heart disease, stroke, and osteoporosis. The MDS permitted assessment of 8 QIs that focus on geriatric care. No measured QIs assessed history taking or nursing care. The use of claims data linked to MDS to measure the quality of care process measures is feasible for NH populations, but would be more valuable if additional data elements focused on geriatric and residential care. QIs that could be applied to patients in this study suggested areas of care needing improvement.
    Medical care 05/2009; 47(5):536-44. DOI:10.1097/MLR.0b013e318190cd8b · 3.23 Impact Factor
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    ABSTRACT: To systematically develop a quality indicator (QI) set for systemic lupus erythematosus (SLE). We used a validated process that combined available scientific evidence and expert consensus to develop a QI set for SLE. We extracted 20 candidate indicators from a systematic literature review of clinical practice guidelines pertaining to SLE. An advisory panel revised and augmented these candidate indicators and, through 2 rounds of voting, arrived at 25 QIs. These QIs advanced to the next phase of the project, in which we employed a modification of the RAND/UCLA Appropriateness Method. A systematic review of the literature was performed for each QI, linking the proposed process of care to potential improved health outcomes. After reviewing this scientific evidence, a second interdisciplinary expert panel convened to discuss the evidence and provide final ratings on the validity and feasibility of each QI. The final expert panel rated 20 QIs as both valid and feasible. Areas covered included diagnosis, general preventive strategies (e.g., vaccinations, sun avoidance counseling, and screening for cardiovascular disease), osteoporosis prevention and treatment, drug toxicity monitoring, renal disease, and reproductive health. We employed a rigorous multistep approach with systematic literature reviews and 2 expert panels to develop QIs for SLE. This new set of indicators provides an opportunity to assess health care quality in patients with SLE and represents an initial step toward the important goal of improving care in this patient population.
    Arthritis & Rheumatology 03/2009; 61(3):370-7. DOI:10.1002/art.24356 · 7.76 Impact Factor
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    ABSTRACT: To determine whether a practice-based intervention can improve care for falls, urinary incontinence, and cognitive impairment. Controlled trial. Two community medical groups. Community-dwelling patients (357 at intervention sites and 287 at control sites) aged 75 and older identified as having difficulty with falls, incontinence, or cognitive impairment. Intervention and control practices received condition case-finding, but only intervention practices received a multicomponent practice-change intervention. Percentage of quality indicators satisfied measured using a 13-month medical record abstraction. Before the intervention, the quality of care was the same in intervention and control groups. Screening tripled the number of patients identified as needing care for falls, incontinence, or cognitive impairment. During the intervention, overall care for the three conditions was better in the intervention than the control group (41%, 95% confidence interval (CI)=35-46% vs 25%, 95% CI=20-30%, P<.001). Intervention group patients received better care for falls (44% vs 23%, P<.001) and incontinence (37% vs 22%, P<.001) but not for cognitive impairment (44% vs 41%, P=.67) than control group patients. The intervention was more effective for conditions identified by screening than for conditions identified through usual care. A practice-based intervention integrated into usual clinical care can improve primary care for falls and urinary incontinence, although even with the intervention, less than half of the recommended care for these conditions was provided. More-intensive interventions, such as embedding intervention components into an electronic medical record, will be needed to adequately improve care for falls and incontinence.
    Journal of the American Geriatrics Society 02/2009; 57(3):547-55. DOI:10.1111/j.1532-5415.2008.02128.x · 4.57 Impact Factor
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    ABSTRACT: Guidelines and recommendations developed and/or endorsed by the American College of Rheumatology (ACR) are intended to provide guidance for particular patterns of practice and not to dictate the care of a particular patient. The ACR considers adherence to these guidelines and recommendations to be voluntary, with the ultimate determination regarding their application to be made by the physician in light of each patient's individual circumstances. Guidelines and recommendations are intended to promote beneficial or desirable outcomes but cannot guarantee any specific outcome. Guidelines and recommendations developed or endorsed by the ACR are subject to periodic revision as warranted by the evolution of medical knowledge, technology, and practice.
    Arthritis & Rheumatology 06/2008; 59(6):762-84. DOI:10.1002/art.23721 · 7.76 Impact Factor

  • Jinoos Yazdany · Catherine H MacLean ·
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    ABSTRACT: To review the recent literature examining quality of care for several prevalent rheumatic conditions, including rheumatoid arthritis, osteoarthritis, gout and osteoporosis, and to summarize quality measurement and improvement initiatives relevant to rheumatology in the USA. In recent years, research has identified a significant gap between ideal and actual clinical practice in the USA. Consistent with trends seen in the US healthcare system as a whole, research suggests deficits in healthcare quality for populations with rheumatic conditions. We review the growing literature on quality of care for rheumatoid arthritis, osteoarthritis, gout and glucocorticoid-induced osteoporosis. Existing evidence suggests suboptimal healthcare quality for four common rheumatic conditions, a finding that parallels trends in the healthcare system as a whole.
    Current Opinion in Rheumatology 04/2008; 20(2):159-66. DOI:10.1097/BOR.0b013e3282f50ec4 · 4.89 Impact Factor
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    ABSTRACT: Although several agents are available to treat osteoporosis, the relative efficacy and toxicity of these agents when used to prevent fractures has not been well described. To compare the benefits in fracture reduction and the harms from adverse events of various therapies for osteoporosis. MEDLINE (1966 to November 2007) and other selected databases were searched for English-language studies. For the efficacy analysis, investigators selected studies that reported the rate of or risk for fractures. For the adverse event analysis, they selected studies that reported the relationship between an agent and cardiovascular, thromboembolic, or upper gastrointestinal events; malignant conditions; and osteonecrosis. Using a standardized protocol, investigators abstracted data on fractures and adverse events, agents and comparators, study design, and variables of methodological quality. Good evidence suggests that alendronate, etidronate, ibandronate, risedronate, zoledronic acid, estrogen, parathyroid hormone (1-34), and raloxifene prevent vertebral fractures more than placebo; the evidence for calcitonin was fair. Good evidence suggests that alendronate, risedronate, and estrogen prevent hip fractures more than placebo; the evidence for zoledronic acid was fair. The effects of vitamin D varied with dose, analogue, and study population for both vertebral and hip fractures. Raloxifene, estrogen, and estrogen-progestin increased the risk for thromboembolic events, and etidronate increased the risk for esophageal ulcerations and gastrointestinal perforations, ulcerations, and bleeding. Few studies have directly compared different agents or classes of agents used to treat osteoporosis. Although good evidence suggests that many agents are effective in preventing osteoporotic fractures, the data are insufficient to determine the relative efficacy or safety of these agents.
    Annals of internal medicine 03/2008; 148(3):197-213. · 17.81 Impact Factor
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    ABSTRACT: Rigorous guideline development methods are designed to produce recommendations that are relevant to common clinical situations and consistent with evidence and expert understanding, thereby promoting guidelines' acceptability to providers. No studies have examined whether this technical quality consistently leads to acceptability. To examine the clinical acceptability of guidelines having excellent technical quality. We selected guidelines covering several musculoskeletal disorders and meeting 5 basic technical quality criteria, then used the widely accepted AGREE Instrument to evaluate technical quality. Adapting an established modified Delphi method, we assembled a multidisciplinary panel of providers recommended by their specialty societies as leaders in the field. Panelists rated acceptability, including "perceived comprehensiveness" (perceived relevance to common clinical situations) and "perceived validity" (consistency with their understanding of existing evidence and opinions), for ten common condition/therapy pairs pertaining to Surgery, physical therapy, and chiropractic manipulation for lumbar spine, shoulder, and carpal tunnel disorders. Five guidelines met selection criteria. Their AGREE scores were generally high indicating excellent technical quality. However, panelists found 4 guidelines to be only moderately comprehensive and valid, and a fifth guideline to be invalid overall. Of the topics covered by each guideline, panelists rated 50% to 69% as "comprehensive" and 6% to 50% as "valid". Despite very rigorous development methods compared with guidelines assessed in prior studies, experts felt that these guidelines omitted common clinical situations and contained much content of uncertain validity. Guideline acceptability should be independently and formally evaluated before dissemination.
    Journal of General Internal Medicine 02/2008; 23(1):37-44. DOI:10.1007/s11606-007-0440-9 · 3.42 Impact Factor
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    Jennifer Grossman · Catherine H MacLean ·

    Journal of the American Geriatrics Society 11/2007; 55 Suppl 2:S392-402. DOI:10.1111/j.1532-5415.2007.01347.x · 4.57 Impact Factor
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    Susannah Rowe · Catherine H MacLean ·

    Journal of the American Geriatrics Society 11/2007; 55 Suppl 2(s2):S450-6. DOI:10.1111/j.1532-5415.2007.01355.x · 4.57 Impact Factor
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    David S Zingmond · Kathleen H Wilber · Catherine H Maclean · Neil S Wenger ·
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    ABSTRACT: Small studies suggest that the quality of healthcare provided to older patients needs improvement. However, measuring the quality of care for larger groups of older adults is difficult. To measure the quality of care in a community-dwelling vulnerable geriatric population using administrative data to apply quality indicators (QIs) from the Assessing Care of Vulnerable Elders project. Cohort study of community-dwelling dual enrollees in Medicare and Medicaid, age 75 years and older, living in 19 California counties in 1999 and 2000. Measurement of care provided for 43 QIs by condition (eg, heart failure) and by intervention type (eg, medication use), and identification of care inaccessible to measurement by linked Medicare and Medicaid claims. A total of 43 out of 230 QIs were captured using linked claims data. The 100,528 patients triggered 930,753 QIs (9.3 QIs/person). The overall QI pass rate (ie, successful receipt of care) was 65%. QIs with the highest pass rates measured avoidance of adverse medications and appropriate medication use. Fewer than half of the QIs were passed for ischemic heart disease, stroke, and osteoporosis. Few QIs aimed at geriatric care could be measured and none assessed counseling, history taking, or information continuity. The use of claims data-derived quality-of-care process measures is feasible for the vulnerable older population, but requires development of data elements focused on geriatric care. QIs that could be applied to the older patients included in this study identified several areas of care that need improvement.
    Medical Care 11/2007; 45(10):931-8. DOI:10.1097/MLR.0b013e318127143e · 3.23 Impact Factor
  • Barbara M Bates-Jensen · Catherine H MacLean ·

    Journal of the American Geriatrics Society 11/2007; 55 Suppl 2(s2):S409-16. DOI:10.1111/j.1532-5415.2007.01349.x · 4.57 Impact Factor
  • Arash Naeim · Rishi Sawhney · Catherine H MacLean · Homayoon Sanati ·

    Journal of the American Geriatrics Society 11/2007; 55 Suppl 2:S258-69. DOI:10.1111/j.1532-5415.2007.01331.x · 4.57 Impact Factor
  • Catherine H MacLean · James N Pencharz · Kenneth G Saag ·

    Journal of the American Geriatrics Society 11/2007; 55 Suppl 2:S383-91. DOI:10.1111/j.1532-5415.2007.01346.x · 4.57 Impact Factor
  • Shiri Etzioni · Joshua Chodosh · Bruce A Ferrell · Catherine H MacLean ·

    Journal of the American Geriatrics Society 11/2007; 55 Suppl 2(s2):S403-8. DOI:10.1111/j.1532-5415.2007.01348.x · 4.57 Impact Factor
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    ABSTRACT: Older patients with multiple chronic conditions may be at higher risk of receiving poorer overall quality of care compared with those with single or no chronic conditions. Possible reasons include competing guidelines for individual conditions, burden of numerous recommendations, and difficulty implementing treatments for multiple conditions. We sought to determine whether coexisting combinations of 8 common chronic conditions (hypertension, coronary artery disease, chronic obstructive pulmonary disease, osteoarthritis, diabetes mellitus, depression, osteoporosis, and having atrial fibrillation or congestive heart failure) are associated with overall quality of care among vulnerable older patients. Using an observational cohort study, we enrolled 372 community-dwelling persons 65 years of age or older who were at increased risk for death or functional decline within 2 years. We included (1) a comprehensive measure (% of quality indicators satisfied) of quality of medical and geriatric care that accounted for patient preference and appropriateness in light of limited life expectancy and advanced dementia, and (2) a measure of multimorbidity, either as a simple count of conditions or as a combination of specific conditions. : Multimorbidity was associated with greater overall quality scores: mean proportion of quality indicators satisfied increased from 47% for elders with none of the prespecified conditions to 59% for those with 5 or 6 conditions (P < 0.0001), after controlling for number of office visits. Patients with greater multimorbidity also received care that was better than would be expected based on the specific set of quality indicators they triggered. Among older persons at increased risk of death or functional decline, multimorbidity results in better, rather than worse, quality of care.
    Medical Care 07/2007; 45(6):480-8. DOI:10.1097/MLR.0b013e318030fff9 · 3.23 Impact Factor
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    ABSTRACT: Evidence-based systematic reviews evaluating dietary intake and nutritional interventions are becoming common but are relatively few compared with other applications. Concerns remain that systematic reviews of nutrition topics pose several unique challenges. We present a successful collaboration to systematically review the health effects of a common nutrient, n-3 (or omega-3) fatty acids, across a wide range of clinical conditions. More generally, we discuss the challenges faced and the lessons learned during the review, the benefits of systematic review of nutritional topics, and recommendations for conducting and reviewing nutrition-related studies. Through a structured but flexible process, 3 Evidence-based Practice Centers in the Agency for Healthcare Research and Quality program produced 11 reports on a wide range of n-3 fatty acid-related topics. An important resource has been created, through which nutrition and dietetics researchers, clinical dietitians and nutritionists, clinicians, and the general public can understand the state of the science. The process identified challenges and problems in evaluating the health effects of n-3 fatty acid consumption, highlighted challenges to reviewing the human nutrition literature, and yielded recommendations for future research. The goals of these systematic reviews, the processes that were used, the benefits and limitations of the collaboration, and the conclusions of the reviews, including recommendations for future research, are summarized here.
    American Journal of Clinical Nutrition 07/2007; 85(6):1448-56. · 6.77 Impact Factor
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    ABSTRACT: To evaluate the American College of Rheumatology (ACR) starter set of quality measures for rheumatoid arthritis (RA) in an actual patient cohort that preceded publication of the quality measures. We retrospectively applied the 2006 ACR quality criteria to a prospectively studied cohort of 568 patients with RA treated by 1,932 unique physicians including 255 different rheumatologists between the years 1999 and 2003. Data on performance were obtained from self-report surveys and medical record review within 12 months. At least 1 joint examination was performed in 98% of patients. Patient and physician global assessments were reported for 79% and 74% of patients, respectively. A total of 85% of patients received disease-modifying antirheumatic drugs (DMARDs). DMARD adjustments were made for 50% of patients in whom increasing disease activity was noted at least once and for 64% of patients in whom increasing disease activity was noted during 2 (of 4) 3-month periods within the year. Compared with self-report surveys, medical records substantially underreported performance on quality measures. The ACR-endorsed quality measures for RA can be assessed using available data sources. When both self-report and medical record data are used, adherence rates, designed to serve as minimum standards of care, were moderate or high for most measures. Prior to using indicators to compare quality across groups, specific strategies for operationalizing measures and for using accurate data sources to assess adherence to the measures should be defined.
    Arthritis & Rheumatology 06/2007; 57(5):707-15. DOI:10.1002/art.22781 · 7.76 Impact Factor
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    ABSTRACT: Previous studies suggest that poorer knowledge and expectations about surgical outcomes may be responsible for low rates of total knee replacement (TKR) among African American males. The goal of this study was to pilot test the scope, acceptability, and efficacy of an educational videotape and tailored TKR decision aid designed to reduce disparities in TKR knowledge and expectations. African American and Caucasian male veteran volunteers ages 55-85 years with moderate to severe knee osteoarthritis (OA) were recruited. During group meetings, patients viewed a video about knee OA treatments and were provided a personalized arthritis report that presented predicted patient outcomes should they decide to undergo TKR. Patients completed baseline and postintervention questionnaires that included an adapted Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) instrument to measure post-TKR expectations (0-100 scale with higher scores reflecting poorer outcomes). A total of 102 patients (54 African American, 48 Caucasian) completed the baseline survey and 64 patients attended the intervention. There were no significant differences by race between patients completing and those dropping out of the study. At baseline (n = 102), African American patients expressed lower expectations about post-TKR outcomes than did Caucasian patients for both pain (WOMAC score 41 versus 34; P = 0.18) and physical function expectations (WOMAC score 38 versus 30; P = 0.13). Among African Americans who underwent the intervention, expected pain and physical function improved to 31 (P = 0.04 versus baseline) and 30 (P = 0.09 versus baseline), respectively. Caucasian patients' expectations changed little. Disparities in baseline knowledge and expectations about TKR may be improved with the combined educational video and tailored decision aid.
    Arthritis & Rheumatology 05/2007; 57(4):568-75. DOI:10.1002/art.22670 · 7.76 Impact Factor
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    ABSTRACT: Policymakers and clinicians are concerned that initiatives to improve the quality of care for some conditions may have unintended negative consequences for quality in other conditions. We sought to determine whether a practice redesign intervention that improved care for falls, incontinence, and cognitive impairment by an absolute 15% change also affected quality of care for masked conditions (conditions not targeted by the intervention). Controlled trial in 2 community medical groups, with 357 intervention and 287 control patients age 75 years or older who had difficulty with falls, incontinence, or cognitive impairment. Both intervention and control practices implemented case-finding for target conditions, but only intervention practices received a multicomponent practice-change intervention. Quality of care in the intervention practices improved for 2 of the target conditions (falls and incontinence). Percent of quality indicators satisfied for a set of 9 masked conditions measured by abstraction of medical records. Before the intervention, the overall percent of masked indicators satisfied was 69% in the intervention group and 67% in the control group. During the intervention period, these percentages did not change, and there was no difference between intervention and control groups for the change in quality between the 2 periods (P=0.86). The intervention minus control difference-in-change for the percent of masked indicators satisfied was 0.2% (bootstrapped 95% confidence interval, -2.7% to 2.9%). Subgroup analyses by clinical condition and by type of care process performed by the clinician did not show consistent results favoring either the intervention or the control group. A practice-based intervention that improved quality of care for targeted conditions by an absolute 15% change did not affect measurable aspects of care on a broad set of masked quality measures encompassing 9 other conditions.
    Medical Care 02/2007; 45(1):8-18. DOI:10.1097/01.mlr.0000241115.31531.15 · 3.23 Impact Factor

Publication Stats

5k Citations
641.95 Total Impact Points


  • 2000-2009
    • University of California, Los Angeles
      • • Division of General Internal Medicine and Health Services Research
      • • Department of Medicine
      • • Division of Rheumatology
      Los Angeles, California, United States
  • 2005-2006
    • VA Greater Los Angeles Healthcare System
      • Geriatric Research Education and Clinical Center
      Los Angeles, California, United States
  • 2000-2006
    • RAND Corporation
      Santa Monica, California, United States
  • 2003-2004
    • Brooks Rand
      Seattle, Washington, United States
    • University of Washington Seattle
      • Department of Health Services
      Seattle, Washington, United States
  • 2001-2002
    • Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center
      • Department of Medicine
      Torrance, California, United States
  • 1998
    • Harbor-UCLA Medical Center
      Torrance, California, United States