Health and Economic Impact of Surgical Site Infections Diagnosed after Hospital Discharge

Although surgical site infections (SSIs) are known to cause substantial illness and costs during the index hospitalization, little information exists about the impact of infections diagnosed after discharge, which constitute the majority of SSIs. In this study, using patient questionnaire and administrative databases, we assessed the clinical outcomes and resource utilization in the 8-week postoperative period associated with SSIs recognized after discharge. SSI recognized after discharge was confirmed in 89 (1.9%) of 4,571 procedures from May 1997 to October 1998. Patients with SSI, but not controls, had a significant decline in SF-12 (Medical Outcomes Study 12-Item Short-Form Health Survey) mental health component scores after surgery (p=0.004). Patients required significantly more outpatient visits, emergency room visits, radiology services, readmissions, and home health aide services than did controls. Average total costs during the 8 weeks after discharge were US$5,155 for patients with SSI and$1,773 for controls (p<0.001)

Patient participation in decision-making

We review the research both for and against patient participation in decision-making and conclude that (a) patients want to be informed of treatment alternatives, (b) they, in general, want to be involved in treatment decisions when more than one treatment alternative exists, and (c) the benefits of participation have not yet been clearly demonstrated in research studies. However, studies that have addressed the latter issue suffer from methodological problems such as small sample sizes and lack of control for potential confounding variables. We conclude that patient participation in decision-making is justified on humane grounds alone and that physicians should endeavor to engage patients in decision-making, albeit at varying degrees, when more than one effective treatment option exists. We propose that methods be developed to evaluate a patient's level of "readiness" to participate in decision-making and that interventions that match the patient's level of readiness be applied to increase participation.patient participation decision-making outcomes research

Reducing Racial/Ethnic Disparities in Female Breast Cancer: Screening Rates and Stage at Diagnosis

Objectives. We assessed whether population rates of mammography screening, and their changes over time, were associated with improvements in breast cancer stage at diagnosis and whether the strength of this association varied by race/ethnicity. Methods. We analyzed state cancer registry data linked to socioeconomic characteristics of patients’ areas of residence for 1990–1998 time trends in the likelihood of early stage diagnosis. We appended each cancer registry record with matching subgroup estimates of self-reported mammography screening. Results. Trends in screening and stage at diagnosis were consistent within groups, but African American women had a significantly lower proportion of early stage cancers despite an advantage in screening. Population screening rates were significantly associated with early diagnosis, with a weaker association in African American women than White women (odds ratio [OR] = 1.70; P<.0001 vs OR=2.02; P<.0001, respectively). Conclusions. Improvements in screening rates during the 1990s across racial/ethnic groups appear to have contributed significantly to earlier diagnosis within each group, but a smaller effect in African American women should raise concerns. A key health policy challenge is to ensure that screening effectively translates into earlier diagnosis

Construct validity for the Activity Vector Analysis utilizing the Sixteen Personality Factor Questionnaire

This study utilized a canonical correlation procedure to investigate the construct validity of the Activity Vector Analysis (AVA, Form E) by comparing it to the Sixteen Personality Factors Questionnaire (16PF, Forms A and B). All subjects (N = 114; 57 males and 57 females) were from the greater Kansas City area and included students in continuing education classes at the University of Kansas, working spouses of graduate students in psychology, and employees from two large manufacturing companies. Examination of the descriptions of the dimensions defined by the obtained structure vectors associated with each instrument based on the canonical correlation linear composites suggests that construct validity for the Activity Vector Analysis relative to the Sixteen Personality Factors Questionnaire exists. Given the support for the construct validity of the Activity Vector Analysis and the fact that the AVA is an instrument that takes little time to administer, it is suggested that the AVA be employed more frequently in the assessment of personality

Factor structure of the Profile of Mood States (POMS): Two partial replications

Examined the factor structure of the Profile of Mood States (POMS) in samples of psychiatric outpatients (N= 165) and adult smokers (N = 298). Principal component analyses (oblique rotation) yielded seven interpretable components in both cases, which accounted for 66% and 64% of the total variance, respectively. Coefficients of congruence indicated that the two component structures were quite similar. Three of the six POMS scales (Anger‐Hostility, Vigor‐Activity, Fatigue‐Inertia) were replicated successfully in both samples. The remaining three scales were factorally complex and tended to merge, partially attributable to social desirability, to high scale intercorrelations, and to the inherent confluence of psychopathology. The POMS appears to be an internally consistent, multidimensional instrument with a relatively stable factor structure. Caution is recommended in the separate scoring and interpretation of several POMS scales. Copyright © 1984 Wiley Periodicals, Inc., A Wiley Compan

The Effect of Managed Care Market Share on Appropriate Use of Coronary Angiography among Traditional Medicare Beneficiaries

Evidence suggests that when managed care market share increases in a geographic area, expenditures in Medicare's fee-for-service sector decrease. But it is unclear how expenditure reductions relate to the quality of medical care for traditional Medicare beneficiaries. We estimated how managed care market share varied with the proportion of fee-for-service Medicare beneficiaries who were admitted for acute myocardial infarction (AMI) and underwent angiography. We classified patients as appropriate, discretionary, and inappropriate, according to guidelines of the American College of Cardiology and the American Heart Association (ACC-AHA). Within all ACC-AHA classes, coronary angiography fell slightly as managed care market share increased

The impact of cardiac comorbidity after carotid endarterectomy

AbstractPurpose: Myocardial infarction and other comorbidities contribute to complications after carotid endarterectomy (CEA). However, because the combined stroke and death rate after CEA is less than 5%, even relatively large series have small numbers of adverse events that preclude a detailed analysis of the association between the outcome and the patient factors, such as comorbidity and age. We sought to overcome this limitation by studying patients who underwent CEA in a large random sample of Medicare beneficiaries. Methods: We used a database that contained a 20% random sample of all Medicare beneficiaries to identify patients who underwent CEA between the years 1988 to 1990 (n = 22,165), and we followed these cases until 1992. With multivariate logistic regression and Cox proportional hazards regression models, we examined the impact of age, race, gender, geographic location, hospital characteristics, and comorbidity, including acute myocardial infarction (AMI) and congestive heart failure (CHF), on the risk of stroke and death after CEA. Results: AMI and CHF had the greatest negative impact on the long-term survival rates (adjusted hazard ratio [HR]: 2.40, P < .0001, and 2.85, P < .0001, respectively). Other variables with a significant impact on the long-term survival rates were an age of >80 years (HR, 2.16; P < .0001), an acute stroke (HR, 1.51; P < .0001), diabetes mellitus (DM; HR, 1.52; P < .0001), and male sex (HR, 1.32; P < .0001). In addition, AMI, CHF, DM, and advanced age were associated with an increased risk of perioperative stroke and death. Conclusion: Patients with AMI, CHF, DM, and an age of >80 years have diminished perioperative and long-term survival rates after CEA. These results may alter the risk/benefit analysis for such patients, especially those with asymptomatic disease. (J Vasc Surg 1998;28:577-84.