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The use of administrative data to assess quality of care for bipolar disorder in a large staff model HMO

GENERAL HOSPITAL PSYCHIATRY 2000年第1期22卷 1-10页

作者： Unützer, J Simon, G Pabiniak, C Bond, K Katon, W Univ Calif Los Angeles Inst Neuropsychiat Ctr Hlth Serv Res Los Angeles CA 90024 USA Grp Hlth Cooperat Puget Sound Ctr Hlth Studies Seattle WA 98121 USA Univ Washington Dept Psychiat & Behav Sci Seattle WA 98195 USA

We examined patterns of care for 1246 adults treated for bipolar disorder in a large health maintenance organization. Computerized pharmacy and visit data were used to identify patients treated for bipolar disorder. Automated medical records for the following year were used to assess continuity and nosing of treatment with mood stabilizers, laboratory monitoring for adverse effects and therapeutic serum levels, and frequency of follow-up visits. Of our 1246 subjects 83% filled a mood stabilizer prescription during the 1-year study period, and doses were within recommended ranges 80% of the rime. Over 75% of the patients on mood stabilizers had at least one apparent interruption in medication use. Approximately half of the long-term users of mood stabilizers had at least one 7-month period without a recorded blood level and approximately half had a similar period without monitoring for adverse medication effects. Of the 116 subjects discharged from a psychiatric hospitalization 58% had a visit with a psychiatrist or a psychiatric nurse practitioner within 30 days. Of those discontinuing mood stabilizer treatment 68% made a mental health visit within 90 days. Our findings demonstrate the feasibility of using administrative data systems for population-based qualify of care assessment and suggest opportunities for improving the care of bipolar patients. (C) 2000 Elsevier Science Inc.

关键词：抗躁狂药/副作用抗躁狂药/药代动力学抗躁狂药/治疗应用双相情感障碍/血液双相情感障碍/药物疗法数据收集/统计学和数值数据药物监测/统计学和数值数据可行性研究健康维护组织/组织和管理病案系统计算机化/统计学和数值数据病人医疗小组/统计学和数值数据质量保证卫生保健/统计学和数值数据华盛顿青少年成年人老年人老年人 80以上女(雌)性人类男(雄)性中年人

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An armed forces epidemiological board evaluation of injuries in the military

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AMERICAN JOURNAL OF PREVENTIVE MEDICINE 2000年第3期18卷 14-25页

作者： Jones, BH Hansen, BC USA Ctr Hlth Promot & Prevent Med Aberdeen Proving Ground MD USA Univ Maryland Sch Med Baltimore MD 21201 USA

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Prevalence of problem drinking in a Venezuelan Native American population

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ALCOHOL AND ALCOHOLISM 2002年第2期37卷 198-204页

作者： Seale, JP Seale, JD Alvarado, M Vogel, RL Terry, NE Mercer Univ Sch Med Dept Family Med Macon GA 31207 USA

This is the first study of alcohol-related problems among a Latin American indigenous population using the Alcohol Use Disorders Identification Test (AUDIT). A randomly selected community sample consisting of 3% of the adult population of the tribe completed oral interviews (n = 105 adults, completion rate 86%). The majority of both men (98%) and women (53%) had drunk alcohol at some time in their lives, with 94 and 26% respectively having consumed alcohol within the past 12 months. Using a cut-off score of 8 for the AUDIT, 86.5% of all men and 7.5% of all women were found to be problem drinkers. Focus group discussions revealed that traditional patterns of binge drinking of corn liquor had gradually been replaced by consumption of commercial beer and rum at more frequent intervals and with more negative social consequences. This male population demonstrates one of the highest prevalence rates for problem drinking reported in the world literature. Both the magnitude of problems detected and participants' concerns about them suggest that broad-scale interventions are warranted at the community level.

关键词：饮酒/流行病学饮酒/人种学慢性酒精中毒/流行病学慢性酒精中毒/人种学卡方分布数据收集/统计学和数值数据印第安人南美洲/统计学和数值数据患病率前瞻性研究性别因素禁酒/统计学和数值数据委内瑞拉/流行病学委内瑞拉/人种学成年人女(雌)性人类男(雄)性

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Multiple imputation of missing blood pressure covariates in survival analysis

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STATISTICS IN MEDICINE 1999年第6期18卷 681-694页

作者： Van Buuren, S Boshuizen, HC Knook, DL TNO Prevent & Hlth Dept Stat NL-2301 CE Leiden Netherlands Leiden Univ Hosp Dept Internal Med Sect Gerontol NL-2300 RC Leiden Netherlands

This paper studies a non-response problem in survival analysis where the occurrence of missing data in the risk factor is related to mortality. In a study to determine the influence of blood pressure on survival in the very old (85+ years), blood pressure measurements are missing in about 12.5 per cent of the sample. The available data suggest that the process that created the missing data depends jointly on survival and the unknown blood pressure, thereby distorting the relation of interest. Multiple imputation is used to impute missing blood pressure and then analyse the data under a variety of non-response models. One special modelling problem is treated in detail;the construction of a predictive model for drawing imputations if the number of variables is large. Risk estimates for these data appear robust to even large departures from the simplest non-response model, and are similar to those derived under deletion of the incomplete records. Copyright (C) 1999 John Wiley & Sons, Ltd.

关键词：血压队列研究数据收集/方法数据收集/统计学和数值数据人口统计学 Meta分析(主题) 存活率分析老年人老年人 80以上女(雌)性人类男(雄)性

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Patterns of alcohol drinking in a population of young social drinkers: A comparison of questionnaire and diary measures

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ALCOHOL AND ALCOHOLISM 2002年第2期37卷 187-192页

作者： Townshend, JM Duka, T Univ Sussex Expt Psychol Lab Brighton BN1 9QG E Sussex England

Studies of alcohol use often depend on self-reported alcohol intake measured by quantity/frequency questionnaires. Previous research has shown that alcohol consumption may be underestimated by this type of retrospective questionnaire. The primary aim of this study was to compare the accuracy of an Alcohol Use Questionnaire (AUQ) with a 4-week diary account, A further aim was to explore patterns of drinking in young social drinkers, with particular attention to binge drinking, which has been suggested as a factor in increasing the risk of alcohol dependency. University students completed the AUQ in the laboratory. They were then asked to keep a record of their alcohol, nicotine and caffeine consumption. over a 4-week period (diary). The questionnaire and the diaries were compared on factors of alcohol intake (units per week) and patterns of drinking behaviour (speed of drinking, number of times being drunk and percentage of times getting drunk when drinking). The two measures (AUQ and diary) were highly correlated on alcohol consumption and the other questions relating to drinking behaviour. However, differences were found between the two measures on alcohol intake, speed of drinking (drinks per hour) and number of times being drunk. Alcohol consumption was underestimated by similar to12% on the questionnaire, and, when the accuracy of estimation of drinking habits was examined, it was found that high drinkers tended to underestimate their drinking behaviour, whereas lower drinkers tended to overestimate. The results suggest that the AUQ can be used with a reasonable degree of confidence, bearing in mind the tendency for high drinkers to underestimate consumption and drinking behaviour. Relationships between 'binge scores', beverage specificity and alcohol consumption support the idea that the criteria for binge drinkers should be based on patterns of drinking rather than alcohol consumption.

关键词：饮酒/流行病学饮酒/心理学急性酒精中毒/流行病学急性酒精中毒/心理学中枢神经系统抑制药/副作用数据收集/统计学和数值数据乙醇/副作用病案回顾性研究自我揭露社会行为统计学非参数青少年成年人女(雌)性人类男(雄)性

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The use of existing military administrative and health databases for injury surveillance and research

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AMERICAN JOURNAL OF PREVENTIVE MEDICINE 2000年第3期18卷 8-13页

作者： Lincoln, AE Smith, GS Baker, SP Johns Hopkins Univ Sch Publ Hlth Dept Hlth Policy & Management Ctr Injury Res & Policy Baltimore MD 21205 USA

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Sample allocation for overlapping domains in a physician survey with a limited population

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STATISTICS IN MEDICINE 1999年第8期18卷 935-946页

作者： Zaslavsky, AM Williams, TV Cleary, PD Harvard Univ Sch Med Dept Hlth Care Policy Boston MA 02115 USA US Dept Def Tricare Management Act Falls Church VA 22041 USA

We consider an analytic survey in which each survey unit can respond with respect to one or more domains to which it belongs. In this situation, the optimal sample allocation is constrained by the number of available units in each stratum defined by a set of domains. We present optimal sample allocation rules for this situation, and other rules that apply when there are additional constraints on sample sizes or variances by domain. We apply these rules to our motivating example, the design of a survey of physicians on their experiences with health plans, in which each physician can only be asked about her experience with one plan regardless of her number of affiliations. Copyright (C) 1999 John Wiley & Sons, Ltd.

关键词：算法数据收集/方法数据收集/统计学和数值数据管理医疗规划马萨诸塞医师家庭/统计学和数值数据样本大小抽样研究人类

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Using large-scale databases to measure outcomes in critical care

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CRITICAL CARE CLINICS 1999年第3期15卷 615-+页

作者： Pronovost, P Angus, DC Univ Pittsburgh Dept Crit Care Med Pittsburgh PA 15213 USA

The major intent of this article is to describe the availability and potential use of large-scale databases;however, it is first essential to know and understand the basic principles involved in the conduct and interpretation of observational outcomes studies. In this article, the authors briefly overview the design of observational outcomes studies as applied to critical care medicine. Then, criteria for evaluating data sources and for in-depth reviewing of the available data sources from which these observational studies can be conducted are discussed.

关键词：危重病人医疗/统计学和数值数据数据收集/统计学和数值数据数据库事实型 Medicare/统计学和数值数据观察结果评价(卫生保健)/方法登记可重复性结果美国人类

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Estimation of the average correlation coefficient for stratified bivariate data

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STATISTICS IN MEDICINE 1999年第5期18卷 567-580页

作者： Rubenstein, LM Davis, CS Univ Iowa Dept Prevent Med Iowa City IA 52242 USA

If the relationship between two ordered categorical variables X and Y is influenced by a third categorical variable with K levels, the Cochran-Mantel-Haenszel (CMH) correlation statistic Q(C) is a useful stratum-adjusted summary statistic for testing the null hypothesis of no association between X and Y. Although motivated by and developed for the case of K I x J contingency tables, the correlation statistic Q(C) is also applicable when X and Y are continuous variables. In this paper we derive a corresponding estimator of the average correlation coefficient for K I x J tables. We also study two estimates of the variance of the average correlation coefficient. The first is a restricted variance based on the variances of the observed cell frequencies under the null hypothesis of no association. The second is an unrestricted variance based on an asymptotic variance derived by Brown and Benedetti. The estimator of the average correlation coefficient works well in tables with balanced and unbalanced margins, for equal and unequal stratum-specific sample sizes, when correlation coefficients are constant over strata, and when correlation coefficients vary across strata. When the correlation coefficients are zero, close to zero, or the cell frequencies are small, the confidence intervals based on the restricted variance are preferred. For larger correlations and larger cell frequencies, the unrestricted confidence intervals give superior performance. We also apply the CMH statistic and proposed estimators to continuous non-normal data sampled from bivariate gamma distributions. We compare our methods to statistics for data sampled from normal distributions. The size and power of the CMH and normal theory statistics are comparable. When the stratum-specific sample sizes are small and the distributions are skewed, the proposed estimator is superior to the normal theory estimator. When the correlation coefficient is zero or close to zero, the restricted confidence intervals pr

关键词：二项分布数据收集/方法数据收集/统计学和数值数据效应修正因子流行病学农村卫生样本大小统计学非参数老年人老年人 80以上人类男(雄)性

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Recall of depressive episode 25 years previously

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PSYCHOLOGICAL MEDICINE 1999年第4期29卷 787-791页

作者： Andrews, G Anstey, K Brodaty, H Issakidis, C Luscombe, G Univ New S Wales St Vincents Hosp Sch Psychiat Clin Res Unit Anxiety Disorders Sydney NSW Australia Prince Wales Hosp Acad Dept Psychogeriatr Sydney NSW Australia Prince Henry Hosp Acad Dept Psychogeriatr Sydney NSW Australia Flinders Univ S Australia Adelaide SA 5001 Australia

Background. Lifetime rates of depression reported in epidemiological surveys are generally only twice the 12 month rates. Either people forget the symptoms of depression or many people who have a depressive episode remain depressed for many years. Both may be true. There is a need to examine the long-term clinical validity of interviews that are used to make lifetime diagnoses. Methods. Forty-five patients who were part of a long-term follow-up study of depression were interviewed 25 years after the index episode. The diagnoses from the original, fully structured interviews were compared with the responses people made for that period when interviewed using the CIDI 25 years later. Results. Twenty-seven patients met CIDI DSM-III-R criteria for depression at index episode. At the 25 year follow-up, 19 of the 27 reported the essential symptoms of 'depression or loss of interest' being present at the index time, and in 14 of the 27 the depressive symptoms recalled met criteria for DSM-III-R major depressive episode at that time. Conclusions. Seventy per cent of people who were hospitalized for a major depressive episode can recall being depressed but only half can recall sufficient detail to satisfy the diagnostic criteria when interviewed 25 years later. As depressive episodes, especially those severe enough to warrant admission, are recalled better than many other diagnoses, one must be cautious about the lifetime rates for mental disorders reported in retrospective epidemiological surveys.

关键词：队列研究横断面研究数据收集/统计学和数值数据抑郁症更年期/诊断抑郁症更年期/流行病学抑郁症更年期/心理学随访研究交谈心理学回忆新南威尔士/流行病学病人入院精神病状态评定量表结果可重复性成年人老年人老年人 80以上女(雌)性人类男(雄)性中年人

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