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Objectives: Rapid muscle wasting occurs during acute respiratory failure, resulting in muscle weakness and functional impairments. This study examines survivors' body composition in the year after acute respiratory distress syndrome and tests associations of patient characteristics, hospital exposures, and survivors' strength and physical functioning with whole body percent lean mass.Design: Prospective cohort study with 6- and 12-month follow-up.Setting: National study enrolling patients from five study centers.Patients: Acute respiratory distress syndrome survivors (n = 120).Interventions: None.Measurements and Main Results: Lean and fat mass from dual energy x-ray absorptiometry. On average, survivors gained whole body total mass (+1.4 kg; 0.1-2.7) and fat mass (+1.2 kg; 0.2-2.2) and maintained lean mass (+0.2 kg; -0.4 to 0.8) between 6 and 12 months. Proportionally, percent fat mass increased and percent lean mass decreased for the whole body, trunk, and legs (p < 0.05). Greater whole body percent lean mass was associated with younger age, male sex, and lower baseline body mass index, but not other patient characteristics or ICU/hospital exposures. Greater percent lean mass was also significantly associated with gait speed and 6-minute walk distance, but not volitional strength or self-reported functional status.Conclusions: In the first year after acute respiratory distress syndrome, patients gained fat mass and maintained lean mass. We found no association of whole body percent lean mass with commonly hypothesized hospital risk factors. Direct measurement of body composition and performance-based functional measures may be helpful for understanding functional recovery in ICU survivors. [ABSTRACT FROM AUTHOR]

Neighborhood characteristics have been associated with obesity, but less is known whether relationships vary by race/ethnicity. This study examined the relationship between soda consumption - a behavior strongly associated with obesity - and weight status with neighborhood sociodemographic, social, and built environments by race/ethnicity. We merged data on adults from the 2011-2013 California Health Interview Survey, U.S. Census data, and InfoUSA (n=62,396). Dependent variables were soda consumption and weight status outcomes (body mass index and obesity status). Main independent variables were measures of three neighborhood environments: social (social cohesion and safety), sociodemographic (neighborhood socioeconomic status, educational attainment, percent Asian, percent Hispanic, and percent black), and built environments (number of grocery stores, convenience stores, fast food restaurants, and gyms in neighborhood). We fit multi-level linear and logistic regression models, stratified by individual race/ethnicity (NH (non-Hispanic) Whites, NH African Americans, Hispanics, and NH Asians) controlling for individual-level characteristics, to estimate neighborhood contextual effects on study outcomes. Lower neighborhood educational attainment was associated with higher odds of obesity and soda consumption in all racial/ethnic groups. We found fewer associations between study outcomes and the neighborhood, especially the built environment, among NH African Americans and NH Asians. While improvements to neighborhood environment may be promising to reduce obesity, null associations among minority subgroups suggest that changes, particularly to the built environment, may alone be insufficient to address obesity in these groups. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to develop and assess a composite measure of physical capacity using self-report and physical performance items. Method: Item response theory (IRT) is used to evaluate measurement properties of self-report and performance items and to develop a composite measure for 7,609 participants in the National Health and Aging Trends Study. Results: Self-reports distinguish differences at the lower end of physical capacity but not at mid-to-high levels. Performance-based measures discriminate across a fuller spectrum. An IRT-based composite score, drawing on both, provides increased measurement precision across the physical capacity spectrum and detects age group differences if either self-report or performance does so—suggesting it is better suited for studying age-related changes than either measure alone. Discussion: Self-report and performance measures have different strengths on the physical capacity spectrum. IRT provides a means of combining these different measurement approaches for analyses of physical capacity across a broad range of functioning in later life. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the internal consistency, validity, responsiveness, and minimal important difference of the Functional Status Score for the ICU, a physical function measure designed for the ICU.Design: Clinimetric analysis.Settings: Five international datasets from the United States, Australia, and Brazil.Patients: Eight hundred nineteen ICU patients.Intervention: None.Measurements and Main Results: Clinimetric analyses were initially conducted separately for each data source and time point to examine generalizability of findings, with pooled analyses performed thereafter to increase power of analyses. The Functional Status Score for the ICU demonstrated good to excellent internal consistency. There was good convergent and discriminant validity, with significant and positive correlations (r = 0.30-0.95) between Functional Status Score for the ICU and other physical function measures, and generally weaker correlations with nonphysical measures (|r| = 0.01-0.70). Known group validity was demonstrated by significantly higher Functional Status Score for the ICU scores among patients without ICU-acquired weakness (Medical Research Council sum score, ≥ 48 vs < 48) and with hospital discharge to home (vs healthcare facility). Functional Status Score for the ICU at ICU discharge predicted post-ICU hospital length of stay and discharge location. Responsiveness was supported via increased Functional Status Score for the ICU scores with improvements in muscle strength. Distribution-based methods indicated a minimal important difference of 2.0-5.0.Conclusions: The Functional Status Score for the ICU has good internal consistency and is a valid and responsive measure of physical function for ICU patients. The estimated minimal important difference can be used in sample size calculations and in interpreting studies comparing the physical function of groups of ICU patients. [ABSTRACT FROM AUTHOR]

Importance: Process quality measure performance has improved significantly with public reporting, requiring reevaluation of process-outcome relationships and the emerging role of patient perspectives on care.Objective: To evaluate associations between heart failure patient perspectives of care and publicly reported processes and outcomes.Design: Cross-sectional study, July 2008-June 2011.Setting: US hospitals in the Press Ganey database.Participants: Heart failure inpatients.Measures: Outcomes were Hospital Compare hospital-level risk-adjusted 30-day heart failure mortality and readmissions. Predictors included Hospital Compare heart failure processes of care, a weighted process composite and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) domains for heart failure. Hospital characteristics included volume of heart failure patients and race, health status and education.Results: Among 895 included hospitals, performance on process measures was high (median by hospital for composite, 95.6%); the median HCAHPS overall rating was 86.9. Median mortality was 11.3% and readmissions was 24.8%. No process measures were statistically significantly associated with lower mortality or readmissions in adjusted analyses. Higher ratings on HCAHPS patient perspectives of care were significantly correlated with lower readmissions in adjusted analyses, particularly those publicly reported domains conceptually related to readmissions. The magnitude was small (1.8 points higher on a 100-point scale between the highest and lowest quartiles of hospital readmissions).Conclusions: Publicly reported process quality measures were no longer associated with outcomes, but higher patient perspectives of care were associated with lower heart failure readmissions. These associations support continued reevaluation of these measures and increased emphasis on patient experience and outcomes, as planned for Value-Based Purchasing. [ABSTRACT FROM AUTHOR]

Objective This study will estimate distribution-based minimal important difference (MID) for the Hospital Anxiety and Depression Scale anxiety (HADS-A) and depression (HADS-D) subscales, and the Impact of Event Scale-Revised (IES-R) in survivors of acute respiratory failure (ARF). Methods Secondary analyses of data from two US and three UK studies of ARF survivors (total N =1223). HADS-D and HADS-A were used to assess depression and anxiety symptoms. IES-R assessed post-traumatic stress disorder symptoms. Standard error of measurement, minimal detectable change 90 , 0.5 standard deviation (S.D.), and 0.2 S.D. were used to estimate MID for the combined sample, by studies, 6- and 12-month follow-ups, country and mental health condition. Results Overall, MID estimates converged to 2.0–2.5 for the HADS-A, 1.9–2.3 for the HADS-D and 0.17–0.18 for the IES-R. MID estimates were comparable across studies, follow-up, country and mental health condition. Conclusion Among ARF survivors, 2.0–2.5 is a reasonable range for the MID for both HADS subscales, and 0.2 is reasonable for IES-R. Until anchor-based MIDs for these instruments are available, these distribution-based estimates can help researchers plan future studies and interpret the clinical importance of findings in ARF patient populations. [ABSTRACT FROM AUTHOR]

Objective: To examine the reliability, validity, responsiveness, and minimal important difference of the 4-m gait speed test in acute respiratory distress syndrome survivors.Design: Secondary analyses of data from two longitudinal follow-up studies of acute respiratory distress syndrome survivors. Test-retest and inter-rater reliability, construct validity (convergent, discriminant, and known group), predictive validity, and responsiveness were examined. The minimal important difference was estimated using anchor- and distribution-based approaches.Setting: A national multicenter prospective study (ARDSNet Long-Term Outcome Study) and a multisite prospective study in Baltimore, MD (Improving Care of Acute Lung Injury Patients).Patients: Acute respiratory distress syndrome survivors with 4-m gait speed assessment up to 60 months after acute respiratory distress syndrome (ARDSNet Long-Term Outcome Study, n = 184; Improving Care of Acute Lung Injury Patients, n = 122).Interventions: Not applicable.Measurements and Main Results: Four-meter gait speed was assessed at 6- and 12-month follow-up (ARDSNet Long-Term Outcome Study) and 36-, 48-, and 60-month follow-up (Improving Care of Acute Lung Injury Patients). Excellent test-retest (intraclass correlation, 0.89-0.99 across studies and follow-up) and inter-rater (intraclass correlation, 0.97) reliability were found. Convergent validity was supported by moderate-to-strong correlations (69% of 32 > 0.40) with other physical function measures. Discriminant validity was supported by weak correlations (86% of 28 < 0.30) with mental health measures. Survivors with impaired versus nonimpaired measures of muscle strength and pulmonary function had significantly slower 4-m gait speed (all but one p < 0.05). Furthermore, 4-m gait speed significantly predicted future hospitalization and health-related quality of life. Gait speed changes were consistent with reported changes in function, supporting responsiveness. The estimated 4-m gait speed minimal important difference was 0.03-0.06 m/s.Conclusions: The 4-m gait speed is a reliable, valid, and responsive measure of physical function in acute respiratory distress syndrome survivors. The estimated minimal important difference will facilitate sample size calculations for clinical studies evaluating the 4-m gait speed test in acute respiratory distress syndrome survivors. [ABSTRACT FROM AUTHOR]

Objective: To harmonize measures of cognitive performance using item response theory (IRT) across two international aging studies. Method: Data for persons ≥65 years from the Health and Retirement Study (HRS, N = 9,471) and the English Longitudinal Study of Aging (ELSA, N = 5,444). Cognitive performance measures varied (HRS fielded 25, ELSA 13); 9 were in common. Measurement precision was examined for IRT scores based on (a) common items, (b) common items adjusted for differential item functioning (DIF), and (c) DIF-adjusted all items. Results: Three common items (day of date, immediate word recall, and delayed word recall) demonstrated DIF by survey. Adding survey-specific items improved precision but mainly for HRS respondents at lower cognitive levels. Discussion: IRT offers a feasible strategy for harmonizing cognitive performance measures across other surveys and for other multi-item constructs of interest in studies of aging. Practical implications depend on sample distribution and the difficulty mix of in-common and survey-specific items. [ABSTRACT FROM AUTHOR]

The article discusses a study which aims to evaluate the construct validity and minimal important difference (MID) of the 6-min walk distance (6MWD) on survivors of acute respiratory failure (ARF) or acute respiratory distress syndrome (ARDS). Topics include the guidelines set by the American Thoracic Society as basis of the study, the predictive validity of 6MWD on aspects as mortality and alive-at-home status, and responsiveness of patients with positive SF-36 PF domain changes.

Objectives. We examined variations in having a usual source of care (USC) among non-Hispanic White and Asian American adults in California. Methods. Data were from the 2005 and 2009 California Health Interview Survey. Using a modified Anderson model, we used multiple logistic regression to compare odds of having a USC between non-Hispanic White (n = 38 554) and Asian American adults (n = 7566) and to examine associations with acculturation factors (English proficiency, length of residence, residence in a racially concordant neighborhood) and key enabling (employment, income, insurance) and predisposing (education) factors. Results. Race-related disparities between Asian Americans and non-Hispanic Whites in having a USC were no longer significant after accounting for acculturation factors. Limited English proficiency and short time in the United States (< 5 years) were significantly associated with not having a USC for both races. Increasing levels of education and insurance were not associated with better access among Asian Americans. Conclusions. Key differences exist in how Asian American and non- Hispanic White adults access care. Acculturation factors are key drivers of disparities and should be included in access-to-care models with Asians. Insurance and education are differentially significant for Asian Americans and non-Hispanic Whites. [ABSTRACT FROM AUTHOR]

Objectives. We compared the strength of association between average 5-year county-level mortality rates and area-level measures, including air quality, sociodemographic characteristics, violence, and economic distress. Methods. We obtained mortality data from the National Vital Statistics System and linked it to socioeconomic and demographic data from the Census Bureau, air quality data, violent crime statistics, and loan delinquency data. We modeled 5-year average mortality rates (1998-2002) for all-cause, cancer, heart disease, stroke, and respiratory diseases as a function of county-level characteristics using ordinary least squares regression models. We limited analyses to counties with population of 100000 or greater (n =458). Results. Demographic and socioeconomic characteristics, particularly the percentage older than 65 years and near poor, were top predictors of all-cause and condition-specific mortality, as were a high concentration of construction and service workers. We found weaker associations for air quality, mortgage delinquencies, and violent crimes. Protective characteristics included the percentage of Hispanics, Asians, and married residents. Conclusions. Multiple factors influence county-level mortality. Although county demographic and socioeconomic characteristics are important, there are independent, although weaker, associations of other environmental characteristics. Future studies should investigate these factors to better understand community mortality risk. [ABSTRACT FROM AUTHOR]

Health care overuse contributes to unnecessary expenditures and patient exposure to harm. Understanding and addressing this problem requires a comprehensive set of valid metrics. This article describes and critiques the current state of overuse measurement through a review of the published and gray literature, measures clearinghouses and ongoing work by major measure developers. Our review identified 37 fully specified measures and 123 measurement development opportunities. Many services were considered overuse due to the extension of diagnostic or screening services to low-risk populations. There were more diagnostic or therapeutic overuse measures than for screening or monitoring/surveillance. Imaging services is a major focus of current measures, but opportunities exist to expand overuse measurement in medication, laboratory services. Future development of overuse measures would benefit from new empirical research and clinical guidelines focused on identifying indications or populations for which there is likely to be no or low benefit. [ABSTRACT FROM AUTHOR]

Objective. To examine the measurement equivalence of items on disability across three international surveys of aging. Method. Data for persons aged 65 and older were drawn from the Health and Retirement Survey (HRS, n = 10,905), English Longitudinal Study of Aging (ELSA, n = 5,437), and Survey of Health, Ageing and Retirement in Europe (SHARE, n = 13,408). Differential item functioning (DIF) was assessed using item response theory (IRT) methods for activities of daily living (ADL) and instrumental activities of daily living (IADL) items. Results. HRS and SHARE exhibited measurement equivalence, but 6 of 11 items in ELSA demonstrated meaningful DIF. At the scale level, this item-level DIF affected scores reflecting greater disability. IRT methods also spread out score distributions and shifted scores higher (toward greater disability). Results for mean disability differences by demographic characteristics, using original and DIF-adjusted scores, were the same overall but differed for some subgroup comparisons involving ELSA. Discussion. Testing and adjusting for DIF is one means of minimizing measurement error in cross-national survey comparisons. IRT methods were used to evaluate potential measurement bias in disability comparisons across three international surveys of aging. The analysis also suggested DIF was mitigated for scales including both ADL and IADL and that summary indexes (counts of limitations) likely underestimate mean disability in these international populations. [ABSTRACT FROM PUBLISHER]

Previous reviews of research on electronic health record (EHR) data quality have not focused on the needs of quality measurement. The authors reviewed empirical studies of EHR data quality, published from January 2004, with an emphasis on data attributes relevant to quality measurement. Many of the 35 studies reviewed examined multiple aspects of data quality. Sixty-six percent evaluated data accuracy, 57% data completeness, and 23% data comparability. The diversity in data element, study setting, population, health condition, and EHR system studied within this body of literature made drawing specific conclusions regarding EHR data quality challenging. Future research should focus on the quality of data from specific EHR components and important data attributes for quality measurement such as granularity, timeliness, and comparability. Finally, factors associated with poor or variability in data quality need to be better understood and effective interventions developed. [ABSTRACT FROM AUTHOR]

To develop and validate a composite score based on clinically meaningful events (CMEs) for the opioid-related symptom distress scale (OR-SDS) that would be appropriate for use in postoperative clinical trials. Secondary analysis of data from 2 multi-site Phase III randomized clinical safety trials: a general surgery trial ( N = 1,050) and a coronary artery bypass graft surgery trial ( N = 1,636). Validating measures include daily opioid consumption and physician and patient global evaluations of study medication. We empirically defined CMEs for each symptom, using factor analysis and an area under the receiver-operating characteristic analysis of the severity and frequency items of the OR-SDS. Construct validity was examined by testing hypotheses of relationships between composite CME scores and opioid consumption and physician and patient evaluations of study medication. Hypotheses supporting the construct validity of the CME-based composite score were confirmed. Significant associations were found between higher numbers of CMEs with greater opioid consumption and lower likelihood of a positive evaluation of the study medication. The OR-SDS CME-based composite score demonstrates evidence of construct validity and appears appropriate for use in evaluating patients’ opioid-related side effect burden in future postoperative clinical trials. [ABSTRACT FROM AUTHOR]

The relationship between prisoner client characteristics and Therapeutic Community treatment process was examined in a male program (N = 164) and a female program (N = 195). Analyses were based on client reports on a multidimensional measure of treatment process and administrative data. Prisoner clients who are older or are poly-substance users had better Community Environment scores. Clients with children and fewer lifetime arrests had better scores on Personal Development and Change. Treatment process scores were comparable for clients in the female program and the male program. However, the association of treatment process with client characteristics appears stronger in the male program. [ABSTRACT FROM AUTHOR]

Purpose: We sought to determine whether patient–provider gender concordance influences the detection and care of depression and comorbid anxiety and substance use in patients with major depression Methods: Cross-sectional analyses of baseline patient survey data linked with provider data were performed. Data based on routine primary care visits in clinics from a variety of health systems serving diverse patient populations across the United States. Participants all had major depression. Depression care was examined in the Quality Improvement for Depression (QID) Collaboration sample (n patients = 1,428, n providers = 389). In a subanalysis of data solely from 714 patients and 157 providers from Partners-In-Care, one of the projects participating in QID, we also examined detection of anxiety disorder and alcohol or drug problems. Main Findings: Rates of detection and care of mental health problems in primary care were low even among patients with major depression. Except for anxiety counseling in female patients, patient–provider gender concordance did not improve care as hypothesized. However, female providers were more likely to counsel on anxiety and less likely to counsel on alcohol or drug use than male providers. Female patients were less likely to be counseled on alcohol or drug use compared with male patients. Conclusion: Detection and care of mental health and substance use problems for patients with major depression is not influenced by patient–provider gender concordance. However, depressed female patients may have greater unmet needs for alcohol and drug use counseling than their male counterparts. [Copyright &y& Elsevier]

Abstract: Aims: To predict DUI recidivism using personality, attitudinal, and behavioral factors. Design: We conducted cross-sectional analyses of survey data. Covariance structure modeling was used to identify unique predictors of driving after drinking (DAD), alcohol consumption, and high-risk driving. Participants: Two hundred and eighty individuals with multiple DUI convictions, predominately male and Hispanic. Participants were surveyed in the Rio Hondo Courthouse, Los Angeles County, California. Measurements: The survey included measures of past year frequency of DAD, socially desirable response bias, sensation seeking, trait hostility, high-risk driving style, alcohol expectancies, and alcohol consumption. Findings: DAD was positively related with frequency of drinking and with positive alcohol expectancies. It was negatively associated with socially desirable response bias. Measures of high-risk driving and the personality variables were highly negatively associated with socially desirable response bias. Conclusions: Individuals who believe that they are affected positively by alcohol intoxication are not responding to the standard penalties for DUI and persist in driving after drinking. These beliefs may serve as an important point of intervention for programs designed to reduce drunk driving. The current research also suggests that self-report measures of DAD, as well as many hypothesized risk factors, are highly correlated with socially desirable response biases. Failure to control for such biases may be a significant threat to the validity of research in this field. [Copyright &y& Elsevier]

Prior research has demonstrated that therapeutic communities (TCs) are effective at improving posttreatment outcomes for substance abusers. However, little is known about the in-treatment experience for clients with different backgrounds, experiences, and needs. The aim of this study is to examine the in-treatment experience for different clients by exploring the relationships between treatment process and client characteristics. A comprehensive measure of treatment process, operationalized as Community Environment and Personal Change and Development and change was administered to 447 adults and 148 adolescents receiving treatment at community-based TC programs in New York, California, and Texas. Data on demographic characteristics, substance use and treatment history, and client risk factors were extracted from intake interviews and analyzed separately for adolescent and adult residents. Multivariate general linear models were used to examine the effect of client variables on treatment process, after controlling for treatment duration and program effects. Within adult programs, clients who were 25 years or older, female, and had a prior drug treatment experience had higher Community Environment scores. Adolescents with one or more arrests within the past 2 years had lower scores on both process dimensions of Community Environment and Personal Development and Change. Our results indicate the need to understand why adult clients who are younger, male, and have no prior treatment history and adolescent clients with recent arrests reported lower ratings of treatment process. Future research should also examine the role of modifiable mediators so that appropriate strategies to enhance therapeutic engagement may be developed as necessary. [ABSTRACT FROM AUTHOR]

The juvenile justice system relies heavily on residential treatment services for adolescents. Because treatment dropout limits the likely effectiveness of these services, in this study we examine the client and program characteristics associated with program retention among a sample of adolescent probationers referred to residential rehabilitation by the Juvenile Court in Los Angeles. Participants in the present study (n = 291) are a subset of those in the Adolescent Outcomes Project, conducted within RAND's Drug Policy Research Center, to examine the outcomes of youths entering treatment at seven residential treatment programs. Three months after a preadmission interview, youths were asked about their perceptions of counselors at the program, other residents, and their feelings of safety in the program. In addition, they were asked whether they needed and had received various services (e.g., job training, legal advice, family counseling). Results of a multivariate survival analysis revealed that pretreatment characteristics including motivation and substance use severity, as well as treatment program factors including safety, and perceived over- and underprovision of services, contribute significantly to the prediction of retention. Pretreatment environmental risk factors and ratings of program counselor and resident support were marginally significant. These results imply that changes in adolescent residential program delivery may serve to increase retention rates, thus improving long-term outcomes. [ABSTRACT FROM AUTHOR]

Reports on a study conducted by researchers in the U.S., which assesses whether mental health improvements observed in a nationally representative sample of HIV persons receiving care in the U.S. during the dissemination of combination antiretroviral therapy is a result of global optimism or directly related to treatment. Relationship between changes in mental health and physical health and antiretroviral therapy use.

We examined associations of different levels of same-ethnicity neighborhood concordance with health care access and utilization among all Asian American, Chinese, Filipino, and Vietnamese adults (aged 18–64 years) using the 2005, 2007, and 2009 California Health Interview Survey and the 2010 US Census. Although associations varied by subgroup, Asian Americans in highly concordant neighborhoods were more likely to lack a usual source of care but did not lack doctor visits or experience delays in medical care and prescriptions. [ABSTRACT FROM AUTHOR]

Presents information on a study that evaluates the relationship between laboratory markers of HIV, AIDS-defining events, study discontinuation, and summary scores from the Medical Outcomes Study-HIV Health Survey. Background of the study; Methods used; Results and discussion.

Background: Team-based interventions are effective for improving safety and quality of healthcare. However, contextual factors, such as team functioning, leadership, and organizational support, can vary significantly across teams and affect the level of implementation success. Yet, the science for measuring context is immature. The goal of this study is to validate measures from a short instrument tailored to track dynamic context and progress for a team-based quality improvement (QI) intervention.Methods: Design: Secondary cross-sectional and longitudinal analysis of data from a clustered randomized controlled trial (RCT) of a team-based quality improvement intervention to reduce central line-associated bloodstream infection (CLABSI) rates in intensive care units (ICUs).Setting: Forty-six ICUs located within 35 faith-based, not-for-profit community hospitals across 12 states in the U.S.Population: Team members participating in an ICU-based QI intervention.Measures: The primary measure is the Team Check-up Tool (TCT), an original instrument that assesses context and progress of a team-based QI intervention. The TCT is administered monthly. Validation measures include CLABSI rate, Team Functioning Survey (TFS) and Practice Environment Scale (PES) from the Nursing Work Index.Analysis: Temporal stability, responsiveness and validity of the TCT.Results: We found evidence supporting the temporal stability, construct validity, and responsiveness of TCT measures of intervention activities, perceived group-level behaviors, and barriers to team progress.Conclusions: The TCT demonstrates good measurement reliability, validity, and responsiveness. By having more validated measures on implementation context, researchers can more readily conduct rigorous studies to identify contextual variables linked to key intervention and patient outcomes and strengthen the evidence base on successful spread of efficacious team-based interventions. QI teams participating in an intervention should also find data from a validated tool useful for identifying opportunities to improve their own implementation. [ABSTRACT FROM AUTHOR]

An abstract of the article "Implementing Electronic Health Record-Based Quality Measures for Developmental Screening," by Roxanne E. Jensen and colleagues is presented.

Hoyer EH, Brotman DJ, Chan KS, Needham DM: Barriers to early mobility of hospitalized general medicine patients: survey development and results. Am J Phys Med Rehabil 201 5 ;94 :3 0 4 -3 1 2. Objective: Functional status decline commonly accompanies hospitalization making patients vulnerable to complications. Such decline can be mitigated through hospital-based early mobility programs. Success in implementing patient mobility quality improvement processes requires evaluating providers' knowledge, attitudes, and behaviors. Design: A cross-sectional, self-administered survey in two different hospital settings was completed by 1 20 nurses and physical and occupational therapists (rehabilitation therapists, 38; nurses, 82) from six general medicine units. The survey was developed using published guidelines, literature review, and provider meetings and refined through pilot testing. Psychometric properties were assessed, and regression analyses were conducted to examine barriers to early mobility by hospital site, provider discipline, and years of experience. Results: Internal consistency reliability, item consistency, and discriminant validity psychometric characteristics were acceptable. In multivariable regression analysis, overall perceived barriers were similar between the two hospitals (P = 0.25) and significantly higher for staff with less experience (P = 0.02) and for nurses vs. rehabilitation therapists (P < 0.001 ).The survey identified specific barriers common to both nurses and rehabilitation therapists and other barriers that were discipline specific. Conclusions: This novel survey identified important barriers to mobilizing medical inpatients that were similar across two hospital settings. These results can assist with the implementation of quality improvement projects for increasing early hospital-based patient mobility. [ABSTRACT FROM AUTHOR]

Abstract: Residential characteristics influence opportunities, life chances and access to health services in the United States but what role does residential segregation play in differential access and mental health service utilization? We explore this issue using secondary data from the 2006 Medical Expenditure Panel Survey, 2006 American Medical Association Area Research File and the 2000 Census. Our sample included 9737 whites, 3362 African Americans and 5053 Latinos living in Metropolitan Statistical Areas. Using logistic regression techniques, results show respondents high on Latino isolation and Latino centralization resided in psychiatrist shortage areas whereas respondents high on African American concentration had access to psychiatrists in their neighborhoods. Predominant race of neighborhood was associated with the type of mental health professional used where respondents in majority African American neighborhoods were treated by non-psychiatrists and general doctors whereas respondents in majority Latino neighborhoods saw general doctors. Respondents high on Latino Isolation and Latino Centralization were more likely to utilize non-psychiatrists. These findings suggest that living in segregated neighborhoods influence access and utilization of mental health services differently for race/ethnic groups which contradicts findings that suggest living in ethnic enclaves is beneficial to health. [Copyright &y& Elsevier]

Objective To examine the association between residential segregation and geographic access to primary care physicians ( PCPs) in metropolitan statistical areas ( MSAs). Data Sources We combined zip code level data on primary care physicians from the 2006 American Medical Association master file with demographic, socioeconomic, and segregation measures from the 2000 U.S. Census. Our sample consisted of 15,465 zip codes located completely or partially in an MSA. Methods We defined PCP shortage areas as those zip codes with no PCP or a population to PCP ratio of >3,500. Using logistic regressions, we estimated the association between a zip code's odds of being a PCP shortage area and its minority composition and degree of segregation in its MSA. Principal Findings We found that odds of being a PCP shortage area were 67 percent higher for majority African American zip codes but 27 percent lower for majority Hispanic zip codes. The association varied with the degree of segregation. As the degree of segregation increased, the odds of being a PCP shortage area increased for majority African American zip codes; however, the converse was true for majority Hispanic and Asian zip codes. Conclusions Efforts to address PCP shortages should target African American communities especially in segregated MSAs. [ABSTRACT FROM AUTHOR]

Measures of provider success are the centerpiece of quality improvement and pay-for-performance programs around the globe. In most nations, these measures are derived from administrative records, paper charts and consumer surveys; increasingly, electronic patient record systems are also being used. We use the term ‘e-QMs’ to describe quality measures that are based on data found within electronic health records and other related health information technology (HIT). We offer a framework or typology for e-QMs and describe opportunities and impediments associated with the transition from old to new data sources. If public and private systems of care are to effectively use HIT to support and evaluate health-care system quality and safety, the quality measurement field must embrace new paradigms and strategically address a series of technical, conceptual and practical challenges. [ABSTRACT FROM AUTHOR]

Using data from the 2006 Medical Expenditure Panel Survey and the 2000 Census, the authors explored whether race/ethnic disparities in health care use were associated with residential segregation. They used five measures of health care use: office-based physician visits, outpatient department physician visits, visits to nurses and physician’s assistants, visits to other health professionals, and having a usual source of care. For each individual, the authors controlled for age, gender, marital status, insurance status, income, educational attainment, employment status, region, and health status. The authors used the racial–ethnic composition of the zip code to control for residential segregation. The findings suggest that disparities in health care utilization are related to both individuals’ racial and ethnic identity and the racial and ethnic composition of their communities. Therefore, efforts to improve access to health care services and to eliminate health care disparities for African Americans and Hispanics should not only focus on individual-level factors but also include community-level factors. [ABSTRACT FROM AUTHOR]

The article presents a study of a breakthrough series (BTS) collaborative for asthma. Its purpose is to evaluate whether the BTS Collaborative improved processes and outcomes of care for adult patients receiving asthma care at sites participating in the collaborative. The BTS Collaborative for asthma began on February 1, 2000, and ended on March 1, 2001. Twenty-six health care organizations volunteered to participate in the collaborative and paid a fee to attend. All asthma organizations were invited to participate in the evaluation before the start of the collaborative.

Purpose: Early mobilization in the intensive care unit (ICU) can improve patient outcomes but has perceived barriers to implementation. As part of an ongoing structured quality improvement project to increase mobilization of medical ICU patients by nurses and clinical technicians, we adapted the existing, validated Patient Mobilization Attitudes & Beliefs Survey (PMABS) for the ICU setting and evaluated its performance characteristics and results. Materials and Methods: The 26-item PMABS adapted for the ICU (PMABS-ICU) was administered as an online survey to 163 nurses, clinical technicians, respiratory therapists, attending and fellow physicians, nurse practitioners, and physician assistants in one medical ICU. We evaluated the overall and subscale (knowledge, attitude, and behavior) scores and compared these scores by respondent characteristics (clinical role and years of work experience). Results: The survey response rate was 96% (155/163). The survey demonstrated acceptable discriminant validity and acceptable internal consistency for the overall scale (Cronbach a: 0.82, 95% confidence interval: 0.76-0.85), with weaker internal consistency for all subscales (Cronbach a: 0.62-0.69). Across all respondent groups, the overall barrier score (range: 1-100) was relatively low, with attending physicians perceiving the lowest barriers (median [interquartile range]: 30 [28-34]) and nurses perceiving the highest (37 [31-40]). Within the first 10 years of work experience, greater experience was associated with a lower overall barrier score (-0.8 for each additional year; P = 0.02). Conclusions: In our medical ICU, across 6 different clinical roles, there were relatively low perceived barriers to patient mobility, with greater work experience over the first 10 years being associated with lower perceived barriers. As part of a structured quality improvement project, the PMABSICU may be valuable in assisting to identify specific perceived barriers for consideration in designing mobility interventions for the ICU setting. [ABSTRACT FROM AUTHOR]

Background: The complexity of retroperitoneal soft tissue sarcoma (RPS) surgery has prompted international recommendations to regionalize it to high-volume hospitals (HVHs). A minimum procedural volume threshold for RPS is not yet defined, hampering effective referral and regionalization in the US. This multihospital study sought to establish an HVH threshold informed by national data and international expert opinion.Study Design: The 2004-2015 National Cancer Database identified 8,721 surgically treated RPS patients. Multivariable models, using linear splines, identified annual volume thresholds predictive of overall and 90-day mortality. Transatlantic Australasian Retroperitoneal Soft Tissue Sarcoma Working Group members (n = 48) completed a 15-item survey regarding these data.Results: Overall mortality risk was reduced by 4% per additional case (hazard ratio [HR] 0.96, 95% CI 0.95 to 0.98) up to a threshold of 13 cases/year; no further reduction was observed over 13 (HR 0.99, 95% CI 0.97 to 1.01). After revealing the results from our statistical analysis, 71.4% of respondents who initially chose >30 cases/year as a cutoff shifted their response to a lower value. More than 56% cited 11 to 20 procedures/year as the cutoff for an HVH. Median survival in hospitals with <13 vs >13 cases/year was 94 vs 139 months, respectively (p < 0.001). Forty percent of respondents cited 1% to 2% as an acceptable 90-day mortality. This was achieved with a minimum of 13 cases/year based on risk-adjusted survival analysis.Conclusions: This is the first multicenter analysis to merge data-driven RPS surgery volume thresholds to clinically meaningful sarcoma expert opinions. These findings will help inform national/international consensus recommendations, a practical volume threshold, trial design, and motivate evidence-based hospital referral. [ABSTRACT FROM AUTHOR]

Minimally invasive surgery (MIS) for colorectal cancer (CRC) is increasingly common; however, uptake has differed by hospital type. It is unknown how these trends have evolved for laparoscopic or robotic approaches in different types of hospitals. This study assesses temporal trends for MIS utilization and examines differences in surgical outcomes by hospital type. The National Cancer Database was queried for patients who underwent CRC surgery between 2010 and 2015. Time-trend analysis of MIS utilization was performed for both approaches by hospital type (community, comprehensive community, integrated network, academic). Multivariate logistic regression models were used to examine MIS utilization, differences in case severity, and surgical outcomes by hospital type, after controlling for patient characteristics. Across all hospital types, community hospitals had the lowest rate of laparoscopic (36.8%) and robotic (3.3%) procedures for CRC (P < 0.001). Community hospitals also exhibited a significant lag in adoption rate of robotic surgery (colon = 0.84% versus 1.41%/y; rectum = 2.14% versus 3.88 %/y). Community hospitals performing MIS had worse outcomes, including the most frequent conversions to open (colon = 15.2%; rectal = 17.1%) and highest 90-day mortality (colon = 6%; rectal = 3.2%) (P < 0.001). Finally, compared with laparoscopic colon surgery at academic centers, community centers treated lower grade tumors (OR 0.938, P < 0.05) with higher 30-day (OR 1.332, P < 0.05) and 90-day mortality (OR 1.210, P < 0.05). MIS for CRC lags at the community level and experiences worse postoperative outcomes. Future initiatives must focus on understanding and correcting this trend to ensure uniform access to high-quality surgical care. [ABSTRACT FROM AUTHOR]

Background: Adequate lymphadenectomy (AL) of 15+ lymph nodes comprises an important component of gastric cancer surgical therapy. Despite endorsement by the National Comprehensive Cancer Network and the Committee on Cancer, initial adoption of this paradigm has been relatively slow. The current analysis sought to perform an adjusted time-trend evaluation of the factors associated with AL and its dissemination.Methods: Utilizing the 2004-2015 National Cancer Database, 28,985 patients were identified who underwent gastrectomy for adenocarcinoma. An adjusted time-trend analysis was performed to estimate the adoption of AL overall. Multivariable logistic regression was utilized to assess factors associated with these observed trends. Interactions and stratified models determined disparate effects in vulnerable populations (older adults, ethnic minorities, low socioeconomic status).Results: The adjusted time-trend analysis demonstrated an overall 30% increase (28.8 to 58.7%) in receipt of AL (OR 1.10 increase/year; 95%CI 1.09-1.10) from 2004 to 2015. This trend persisted even after stratifying the models by age, race/ethnicity, and income (OR 1.07-1.12; p < 0.05). Slowest rates of adoption were seen amongst hospitals in the Midwest census region (OR 1.08, CI 1.06-1.90) and comprehensive community hospitals (OR 1.08, CI 1.06-1.91) and with African-American patients (OR 1.09, CI 1.06-1.11) (all p < 0.05).Conclusion: This multi-center evaluation demonstrates increased adoption of AL during gastric cancer surgery in the USA overall and amongst vulnerable populations, although regional and racial disparities were observed. Future studies are needed to investigate reasons underlying racial and regional differences in receipt of AL. [ABSTRACT FROM AUTHOR]

This paper reports the development and baseline data of a vignettes-based measure of gender equality. Methods: Vignettes were developed through 3-day long focus groups. After piloting in 13 sites and repiloting a revised version in 6 countries, responses were categorized by the construct tapped and a scoring system developed. Finalized vignettes were then tested in DR Congo, Ecuador and China. Results: Young adolescents can successfully respond to vignettes; and can differentiate self from hypothetical protagonists of same and opposite sex. Response differences by sex of respondent and protagonist were statistically significant across a range of scenarios and settings. Conclusion: This is the first vignettes-based measure for young adolescents assessing young adolescent perceptions of relationships differentiated by sex of the protagonist. [ABSTRACT FROM AUTHOR]

PURPOSE: Surgery continues to be the dominant therapy for the management of retroperitoneal soft-tissue sarcoma (RPS). Many groups advocate performing these resections at high-volume hospitals (HVHs), given their complexity. We therefore sought to explore whether RPS surgery has indeed begun to regionalize to HVHs in the same manner as pancreatic cancer (PC) surgery during the last decade. METHODS: We identified 70,763 patients who underwent surgical resection for RPS or PC using the National Cancer Database (2004 to 2015). Patients were stratified by hospital surgical volume. We performed an adjusted time trend analysis to compare trends in performance of surgery at HVHs for RPS versus PC. Multivariable logistic analyses were then performed, controlling for covariables, to elucidate relationships between patient-, hospital-, and treatment-related variables that may contribute to these observed trends. RESULTS: Only 9.6% of patients underwent RPS surgery at HVHs. During this time period, the odds ratio of undergoing RPS compared with pancreatectomy at HVHs was 0.65 (P <.05). Time trend analysis estimated that whereas both procedures are regionalizing, the rate of RPS regionalization grew at 30.5% of the rate of PC (1.017 v 1.056; P <.001) and remained consistent after using several hospital volume thresholds and hospital volume as a continuous variable. CONCLUSION: Results from this retrospective multi-institutional analysis uncovered a lag in the regionalization of surgery for RPS compared with PC surgery. These findings reinforce the call to regionalize surgery for RPS to HVHs in a manner that is similar to that of other procedures in complex cancer surgery. [ABSTRACT FROM AUTHOR]

Objectives: To develop a valid, reliable measure that reflected the environment of respectfulness within the ICU setting.Design: We developed a preliminary survey instrument based on conceptual domains of respect identified through prior qualitative analyses of ICU patient, family member, and clinician perspectives. The initial instrument consisted of 21 items. After five cognitive interviews and 16 pilot surveys, we revised the instrument to include 23 items. We used standard psychometric methods to analyze the instrument.Settings: Eight ICUs serving adult patients affiliated with a large university health system.Subjects: ICU clinicians.Interventions: None.Measurements and Main Results: Based on 249 responses, we identified three factors and created subscales: General Respect, Respectful Behaviors, and Disrespectful Behaviors. The General Respect subscale had seven items (α = 0.932) and reflected how often patients in the ICU are treated with respect, in a dignified manner, as an individual, equally to all other patients, on the "same level" as the ICU team, as a person, and as you yourself would want to be treated. The Respectful Behaviors subscale had 10 items (α = 0.926) and reflected how often the ICU team responds to patient and/or family anxiety, makes an effort to get to know the patient and family as people, listens carefully, explains things thoroughly, gives the opportunity to provide input into care, protects patient modesty, greets when entering room, and talks to sedated patients. The subscale measuring disrespect has four items (α = 0.702) and reflects how often the ICU team dismisses family concerns, talks down to patients and families, speaks disrespectfully behind their backs, and gets frustrated with patients and families.Conclusions: We created a reliable set of scales to measure the climate of respectfulness in intensive care settings. These measures can be used for ongoing quality improvement that aim to enhance the experience of ICU patients and their families. [ABSTRACT FROM AUTHOR]

Objective: To examine the association between healthcare provider communication quality and child obesity status, and the role of parent obesity and child race/ethnicity regarding this association.Methods: We conducted a cross-sectional secondary data analysis with the 2011-2013 Medical Expenditures Panel Survey of parents with children ages 6-12 (n=5390). We used multivariable logistic regression to examine the association of parent-reported healthcare provider communication quality (explaining well, listening carefully, showing respect, and spending enough time) with child obesity status, and effect modification by parent obesity and child race/ethnicity.Results: Parents of obese children were more likely to report that their child's healthcare provider listened carefully (OR=1.41, p=0.002) and spent enough time (OR=1.33, p=0.022) than parents of non-obese children. Non-obese parents of obese children experienced better communication in the domains of listening carefully (p<0.001) and spending enough time (p=0.007). Parents of obese non-Hispanic Asian children and non-Hispanic Black children were more likely to report that providers explained things well (p=0.043) and listened carefully (p=0.012), respectively.Conclusion: Parents of obese children experienced better communication if parents were non-obese or children were non-Hispanic Black or Asian.Practice Implications: Healthcare providers should ensure effective communication with obese parents of obese children. [ABSTRACT FROM AUTHOR]

The present study extends the item-level psychometric information of the Leeds Dependence Questionnaire (LDQ; Raistrick et al., 1994) that has been purported to measure psychological dependence and the International Statistical Classification of Diseases and Related Health Problems-10th edition substance dependence criteria. Prior research on the LDQ has not established item-level properties or the degree of differential item functioning (DIF) by gender and substance type. Principal component and Mokken scale analyses were used to assess unidimensionality and monotonicity of the responses to the scale items, respectively. Graphical and statistical methods examined the model-data fit of the graded response model and two-parameter logistic model of LDQ responses (n = 1,681) obtained from 2 community treatment centers. DIF analysis was performed on gender (men = 1,313, women = 353) and substance (alcohol = 821, opiates = 528) groups. The 2PL achieved the best model-data fit. Three items provided little information about standing on the underlying construct, indicating that they are likely not good indicators of the "pure" psychological construct the LDQ aims to measure. Overall, the LDQ offers the greatest precision in quantifying psychological dependence in a clinical sample along the lower to mid ranges of this construct. Uniform DIF was present in Item 7 of the dichotomized responses by substance (alcohol vs. opiates). DIF by gender was not found in any of the LDQ items. Recommendations include revising the scaling and discussing the need to obtain LDQ data from different levels of care and primary identified substance. (PsycINFO Database Record [ABSTRACT FROM AUTHOR]

Objectives: To review the evidence supporting the validity of health literacy (HL) measures for ethnic minority populations.Methods: PubMed, CINAHL, and PsycINFO databases were searched for HL measures between 1965 and 2013.Results: A total of 109HL measures were identified; 37 were non-English HL measures and 72 were English language measures. Of the 72 English language measures, 17 did not specify the racial/ethnic characteristic of their sample. Of the remaining 55 measures, 10 (18%) did not include blacks, 30 (55%) did not include Hispanics, and 35 (64%) did not include Asians in their validation sample. When Hispanic and Asian Americans were included, they accounted for small percentages in the overall sample. Between 2005-2013, a growing number of REALM and TOFHLA translations were identified, and new HL measures for specific cultural/linguistic groups within and outside the United States were developed.Conclusions: While there are a growing number of new and translated HL measures for minority populations, many existing HL measures have not been properly validated for minority groups.Practice Implications: HL measures that have not been properly validated for a given population should be piloted before wider use. In addition, improving HL instrument development/validation methods are imperative to increase the validity of these measures for minority populations. [ABSTRACT FROM AUTHOR]

There are currently more than 100 health literacy instruments. The procedures used to develop and test the measures are primarily guided by classical test theory. However, a small and growing number (n = 13) of health literacy measures are guided by modern measurement theories such as item response theory. This article briefly describes (a) the benefits of using modern measurement approaches for the development of health literacy measures, (b) how these approaches have been used with existing health literacy measures, and (c) some considerations for how modern measurement theory can help strengthen future work in health literacy measurement. Ultimately, this article provides evidence to support an assertive shift toward the use of modern measurement approaches in health literacy instrument development. [ABSTRACT FROM PUBLISHER]

Background: While community capabilities are recognized as important factors in developing resilient health systems and communities, appropriate metrics for these have not yet been developed. Furthermore, the role of community capabilities on access to maternal health services has been underexplored. In this paper, we summarize the development of a community capability score based on the Future Health System (FHS) project's experience in Bangladesh, India, and Uganda, and, examine the role of community capabilities as determinants of institutional delivery in these three contexts.Methods: We developed a community capability score using a pooled dataset containing cross-sectional household survey data from Bangladesh, India, and Uganda. Our main outcome of interest was whether the woman delivered in an institution. Our predictor variables included the community capability score, as well as a series of previously identified determinants of maternal health. We calculate both population-averaged effects (using GEE logistic regression), as well as sub-national level effects (using a mixed effects model).Results: Our final sample for analysis included 2775 women, of which 1238 were from Bangladesh, 1199 from India, and 338 from Uganda. We found that individual-level determinants of institutional deliveries, such as maternal education, parity, and ante-natal care access were significant in our analysis and had a strong impact on a woman's odds of delivering in an institution. We also found that, in addition to individual-level determinants, greater community capability was significantly associated with higher odds of institutional delivery. For every additional capability, the odds of institutional delivery would increase by up to almost 6 %.Conclusion: Individual-level characteristics are strong determinants of whether a woman delivered in an institution. However, we found that community capability also plays an important role, and should be taken into account when designing programs and interventions to support institutional deliveries. Consideration of individual factors and the capabilities of the communities in which people live would contribute to the vision of supporting people-centered approaches to health. [ABSTRACT FROM AUTHOR]