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Goodness-of-fit for GEE: An example with mental health service utilization

STATISTICS IN MEDICINE 1999年第2期18卷 213-222页

作者： Horton, NJ Bebchuk, JD Jones, CL Lipsitz, SR Catalano, PJ Zahner, GEP Fitzmaurice, GM Harvard Univ Sch Publ Hlth Dept Biostat Boston MA 02115 USA Dana Farber Canc Inst Boston MA 02115 USA Harvard Univ Sch Med Dept Psychiat Boston MA 02115 USA

Suppose we use generalized estimating equations to estimate a marginal regression model for repeated binary observations. There are no established summary statistics available for assessing the adequacy of the fitted model. In this paper we propose a goodness-of-fit test statistic which has an approximate chi-squared distribution when we have specified the model correctly. The proposed statistic can be viewed as an extension of the Hosmer and Lemeshow goodness-of-fit statistic for ordinary logistic regression to marginal regression models for repeated binary responses. We illustrate the methods using data from a study of mental health service utilization by children. The repeated responses are a set of binary measures of service use. We fit a marginal logistic regression model to the data using generalized estimating equations, and we apply the proposed goodness-of-fit statistic to assess the adequacy of the fitted model. Copyright (C) 1999 John Wiley & Sons, Ltd.

关键词：年龄因素卡方分布儿童保健服务/统计学和数值数据康涅狄格精神卫生服务/统计学和数值数据模型统计学回归分析性别因素美国儿童女(雌)性人类男(雄)性

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Extension of academic pediatric radiology to the community setting: experience in two sites

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PEDIATRIC RADIOLOGY 2000年第1期30卷 3-6页

作者： Ecklund, K Share, JC Childrens Hosp Dept Radiol Boston MA 02115 USA Harvard Univ Sch Med Boston MA 02115 USA

Background. Children are better served by radiologists and technical personnel trained in the care of pediatric patients. However, a variety of obstacles may limit the access of children to dedicated pediatric imaging facilities. Objective. We designed and implemented two models for providing community-based imaging by academic pediatric radiologists. Materials and methods. The first site was an outpatient clinic staffed by physicians from the university-affiliated children's hospital. Imaging services included radiography, fluoroscopy, and ultrasound. The second site was a full-service community hospital radiology department staffed by a group practice, with pediatric imaging covered by the children's hospital radiologists. Facility, equipment, and protocol modifications were required to maintain quality standards. Success of these models was determined by volume statistics, referring physician/patient satisfaction surveys, and quality-assurance (QA) programs. Results. The outpatient satellite had a 48 % increase in total examinations from the first year to the second year and 87 % the third year. Pediatric examinations in the community hospital increased over 1000 % the first 7 months. Referring physicians reported increased diagnostic information and patient satisfaction compared to previous service. QA efforts revealed improved image quality when pediatric radiologists were present, but some continuing difficulties off-hours. Conclusion. We successfully implemented pediatric imaging programs in previously underserved communities. This resulted in increased pediatric radiologist supervision and interpretation of examinations performed on children and improved referring physician and patient satisfaction.

关键词：儿童保健服务/统计学和数值数据医院社区门诊部医院儿科学/统计学和数值数据放射学/统计学和数值数据放射科医院专业医学儿童人类

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LOT QUALITY ASSURANCE SAMPLING FOR MONITORING IMMUNIZATION PROGRAMS - COST-EFFICIENT OR QUICK AND DIRTY

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HEALTH POLICY AND PLANNING 1993年第3期8卷 217-223页

作者： SANDIFORD, P UNIV LIVERPOOL LIVERPOOL SCH TROP MED DIV INT HLTH PEMBROKE PL LIVERPOOL L3 5QA ENGLAND

In recent years Lot quality assurance sampling (LQAS), a method derived from production-line industry, has been advocated as an efficient means to evaluate the coverage rates achieved by child immunization programmes. This paper examines the assumptions on which LQAS is based and the effect that these assumptions have on its utility as a management tool. It shows that the attractively low sample sizes used in LQAS are achieved at the expense of specificity unless unrealistic assumptions are made about the distribution of coverage rates amongst the immunization programmes to which the method is applied. Although it is a very sensitive test and its negative predictive value is probably high in most settings, its specificity and positive predictive value are likely to be low. The implications of these strengths and weaknesses with regard to management decision-making are discussed.

关键词：儿童保健服务/标准儿童保健服务/统计学和数值数据费用效益分析数据收集决策组织英格兰免疫法/标准免疫法/利用麻疹/免疫学模型统计学方案评价/方法质量保证卫生保健/方法抽样研究儿童人类婴儿

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A preschool immunization project to enhance immunization levels, the public-private relationship, and continuity of care

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JOURNAL OF COMMUNITY HEALTH 1999年第5期24卷 347-358页

作者： Smith, SW Connery, P Knudsen, K Scott, KL Frintner, MP Outlaw, G Weingart, S Cook Cty Dept Publ Hlth Immunizat Program Oak Pk IL 60301 USA Univ Illinois Maternal & Child Community Hlth Sci Consortium Chicago IL 60680 USA

This study was conducted to determine whether implementing a program aimed at providing a variety of incentives to physicians who provide immunizations to preschool-aged children would help to improve immunization rates and reduce fragmented care for patients. Twenty physicians from 14 private practices that provide care to preschool-aged children from low income families in suburban Cook County, Illinois participated in the project. A randomly selected subset of patient case records from the physicians' offices were audited after the implementation of the project to determine the immunization status of children in the practices and the nature of services provided. These 310 records of children under three years of age who were treated between 1991-1994 (the intervention sample) were compared to 310 charts from a 1988-1990 cohort of records (baseline sample). The groups did not differ on race or gender;however, significantly more families in the 1988 through 1990 cohort of children under 3 years of age were insured privately when compared to the 1991 through 1994 cohort Seventy percent (218) of the records in the intervention sample were up to date for age on immunizations compared to 45% (141) of the baseline records, reflecting a statistically significant difference (p<.00001). The intervention sample showed significantly more well child visits where immunizations were given and follow up visits where immunizations were given when compared to the baseline sample. Physicians completed surveys before and after implementation of the project. They were questioned about their knowledge and practices regarding immunizations as well as their opinion of specific project components. All of the physicians viewed the project as an effective means to improve immunization services to low income children. The project demonstrates a potential means of enhancing immunization levels and continuity of care among preschool-aged children. It also highlights the workable nature of the

关键词：儿童保健服务/统计学和数值数据病人医护连续性白喉-破伤风-百日咳菌苗伊利诺伊免疫接种规划/统计学和数值数据保险健康机构间关系麻疹疫苗麻疹-腮腺炎-风疹疫苗腮腺炎疫苗医师的作用贫困随机分配风疹疫苗郊区人口疫苗联合儿童学龄前女(雌)性人类婴儿男(雄)性

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Expanded school mental health services: Assessing needs related to school level and geography

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COMMUNITY MENTAL HEALTH JOURNAL 2000年第3期36卷 259-273页

作者： Weist, MD Myers, CP Danforth, J McNeil, D Ollendick, TH Hawkins, R Univ Maryland Sch Med Baltimore MD 21201 USA Eastern Connecticut State Univ Willimantic CT 06226 USA W Virginia Univ Morgantown WV 26506 USA Virginia Tech Blacksburg VA 24061 USA

We surveyed 62 school administrators from three midatlantic (MD, VA, WV) and one northeastern (CT) state on factors relevant to developing school-based mental health programs. Administrators were from schools that varied on education level (elementary, middle, and high) and geographic location turban, suburban, and rural, with equivalent numbers in each subgroup. Administrators provided ratings to questions grouped in five categories: (a) Stressful Conditions, (b) Internalizing Behavioral Problems, (c) Externalizing Behavioral Problems, (d) Substance Abuse, and (e) Barriers to Mental Health Care, and provided open-ended comments on needs of youth and mental health programs for them. They rated behavioral and substance abuse problems as progressively more serious as students advanced in school level. Urban youth were reported to encounter higher stress and present more severe internalizing problems than suburban or rural youth. Suburban and rural schools provided more health and mental health services than urban schools. Across geographic locales, physical health services far outnumbered mental health services. Findings related to barriers to mental health care, and the viability of schools as delivery sites for comprehensive mental health services, are discussed.

关键词：儿童保健服务/统计学和数值数据地理学卫生服务易得程度卫生服务需求精神卫生服务/统计学和数值数据农村人口中小学生卫生保健服务/统计学和数值数据院校/分类应激心理学市区人口青少年成年人儿童女(雌)性人类男(雄)性

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Access to primary care among young African-American children in Chicago

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Journal of Health and Social Policy 1993年第2期5卷 35-48页

作者： Kelley, M.A. Perloff, J.D. Morris, N.M. Liu, W. Community Health Sciences School of Public Health The University of Illinois Chicago United States

No abstract available for this article.

关键词：非洲裔美国人/统计学和数值数据芝加哥儿童保健服务/统计学和数值数据儿童保健服务/利用数据收集卫生服务易得程度/统计学和数值数据健康状况产妇卫生保健服务/利用贫困区初级卫生保健/统计学和数值数据初级卫生保健/利用社会经济因素城市卫生/标准城市卫生/统计学和数值数据青少年成年人儿童学龄前女(雌)性人类婴儿婴儿新生

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Childhood mortality in sub-Saharan Africa

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LANCET 1999年第9153期353卷 673-673页

作者： Müller, O Garenne, M Univ Heidelberg Dept Trop Hyg & Publ Hlth D-69120 Heidelberg Germany CEPED Paris France

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