scholarly journals Development of a Simple Index to Measure Overuse of Diagnostic Testing at the Hospital Level Using Administrative Data

2021 ◽  
Vol 16 (2) ◽  
pp. 77-83 ◽  
Author(s):  
Michael I Ellenbogen ◽  
Laura Prichett ◽  
Pamela T Johnson ◽  
Daniel J Brotman
Keyword(s):  
Administrative Data ◽  
Internal Consistency ◽  
Odds Ratio ◽  
Diagnostic Testing ◽  
Temporal Stability ◽  
County Level ◽  
Hospital Level ◽  
Physician Reimbursement ◽  
Simple Index ◽  
Cost Metrics

OBJECTIVE: We developed a diagnostic overuse index that identifies hospitals with high levels of diagnostic intensity by comparing negative diagnostic testing rates for common diagnoses. METHODS: We prospectively identified candidate overuse metrics, each defined by the percentage of patients with a particular diagnosis who underwent a potentially unnecessary diagnostic test. We used data from seven states participating in the State Inpatient Databases. Candidate metrics were tested for temporal stability and internal consistency. Using mixed-effects ordinal regression and adjusting for regional and hospital characteristics, we compared results of our index with three Dartmouth health service area-level utilization metrics and three Medicare county-level cost metrics. RESULTS: The index was comprised of five metrics with good temporal stability and internal consistency. It correlated with five of the six prespecified overuse measures. Among the Dartmouth metrics, our index correlated most closely with physician reimbursement, with an odds ratio of 2.02 (95% CI, 1.11-3.66) of being in a higher tertile of the overuse index when comparing tertiles 3 and 1 of this Dartmouth metric. Among the Medicare county-level metrics, our index correlated most closely with standardized costs of procedures per capita, with an odds ratio of 2.03 (95% CI, 1.21-3.39) of being in a higher overuse index tertile when comparing tertiles 3 and 1 of this metric. CONCLUSIONS: We developed a novel overuse index that is preliminary in nature. This index is derived from readily available administrative data and shows some promise for measuring overuse of diagnostic testing at the hospital level.

Internal Structure of the Spanish Adaptation of the Eating Disorder Inventory-3

2012 ◽  
Vol 28 (1) ◽  
pp. 25-31 ◽  
Author(s):  
Paula Elosua ◽  
Alicia López-Jáuregui
Keyword(s):  
Eating Disorders ◽  
Eating Disorder ◽  
Internal Structure ◽  
Internal Consistency ◽  
Clinical Sample ◽  
Temporal Stability ◽  
Second Order ◽  
Order Structure ◽  
Eating Disorder Inventory ◽  
High Internal Consistency

In this study the Eating Disorder Inventory-3 was adapted to Spanish and analyzed the internal psychometric properties of the test in a clinical sample of females with eating disorders. The results showed a high internal consistency of the scores as well as high temporal stability. The factor structure of the scale composites was analyzed using confirmatory factor analysis. The results supported the existence of a second-order structure beyond the psychological composites. The second-order factor showed high correlation with the factor related to eating disorders. Overall, the Spanish version of the EDI-3 showed good psychometric qualities in terms of internal consistency, temporal stability and internal structure.

scholarly journals Deterioration of housing environment and mental health of asylum seekers – a multi-level analysis

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
A Mohsenpour ◽  
L Biddle ◽  
K Bozorgmehr
Keyword(s):  
Mental Health ◽  
Internal Consistency ◽  
Odds Ratio ◽  
Asylum Seekers ◽  
Rapid Assessment ◽  
Living Environment ◽  
Generalized Anxiety ◽  
Rater Reliability ◽  
General Anxiety ◽  
Housing Environment

Abstract Background Asylum seekers arriving in Germany are assigned to a local district and an accommodation centre wherein. We developed and validated a six-item questionnaire for rapid assessment of housing deterioration and investigated its association with inhabitant mental health. Methods Using cross-sectional data from a state-wide survey in Germany, we applied a random-effects modelling approach to estimate the exposure effect of housing deterioration on depression and general anxiety among a random sample of asylum seekers, using validated instruments (GAD2/PHQ2) for outcome variables. Housing deterioration was assessed on six items (windows/glass, walls/roof, garbage, graffiti, outside spaces, overall living environment) resulting in a deterioration score as exposure of interest. Additionally, we assessed the instrument’s intra- and inter-rater reliability and internal consistency. Results Of the 412 asylum seekers living in 58 accommodation centres, 45.7% reported symptoms of depression and 45.0% suffered general anxiety. Most centres (76.7%) were based in urban municipalities and 45.7% of inhabitants were living in an accommodation centre hosting ≥51 inhabitants. Preliminary adjusted odds ratio for accommodation centres with highest deterioration (Q 4) was 2.07 (0.67-6.40) for generalized anxiety, compared to 1.17 (0.45-3.08) for centres with lowest deterioration (Q 1). For depression, preliminary odds ratio was 1.92 (0.87-4.27) compared to 1.26 (0.63-2.50). The validation study confirmed inter-/intra-rater reliability (Brennan-Prediger coefficient: 0.81 and 0.92, respectively) and internal consistency (Crohnbach’s α: 0.80). Conclusions There are higher odds ratios for generalized anxiety disorder and depression among asylum seekers based on higher deterioration of housing environment. A questionnaire for rapid deterioration assessment and identification of accommodations needing further evaluation has been developed and successfully validated. Key messages Deterioration of small-scale housing environment is associated with poorer mental health for asylum seekers living in accommodation centres. A highly reliable new tool has been developed for rapid assessment of deterioration status of accommodation centres and identification of those needing further evaluation.

scholarly journals Reliability and practical aspects of the disease impact measure on hypertensive patients

2013 ◽  
Vol 21 (6) ◽  
pp. 1258-1265 ◽  
Author(s):  
Renata Bigatti Bellizzotti Pavan ◽  
Kátia Melissa Padilha ◽  
Simey de Lima Lopes Rodrigues ◽  
Roberta Cunha Matheus Rodrigues ◽  
Maria Cecília Jayme Bueno Gallani
Keyword(s):  
Internal Consistency ◽  
Temporal Stability ◽  
Emotional Impact ◽  
Disease Symptoms ◽  
Hypertensive Patients ◽  
Social And Emotional ◽  
Disease Impact ◽  
Physical Impact ◽  
The Stability ◽  
The Impact

OBJECTIVE: to evaluate the feasibility, acceptability, the ceiling and floor effects and the reliability of the Instrument to Measure the Impact of Coronary Disease on Patient's Daily Life (IDCV) when applied to hypertensive patients. METHOD: one hundred and thirty seven hypertensive outpatients were interviewed, using questionnaires to collect sociodemographic and clinical data, followed by the IDCV. Reliability was assessed according to the temporal stability and internal consistency criteria. RESULTS: the IDCV was applied in 8.0 (±3.0) minutes with 100% of the items answered. A ceiling effect of 31.4% was observed in the domain Adjustment to the Disease. The stability measure was observed for the total score and for all domains. There was evidence of internal consistency of the total IDCV (α=0.83) and the domains Physical Impact of the Disease - Symptoms (α=0.78) and Social and Emotional Impact of the Disease (α=0.74). CONCLUSION: the IDCV is an instrument of easy use and its reliability among hypertensive patients is evidenced. The domain Adjustment to the Disease, however, should be reviewed in further studies.

scholarly journals CooC11 and CooC7: The Development and Validation of Age Appropriate Children’s Perceived Cooking Competence Measures

2020 ◽  
Author(s):  
Moira Dean ◽  
Johann Issartel ◽  
Tony Benson ◽  
Amanda McCloat ◽  
Elaine Mooney ◽  
...  
Keyword(s):  
Factor Analysis ◽  
Internal Consistency ◽  
Intraclass Correlation ◽  
Temporal Stability ◽  
School Nutrition ◽  
Face Validity ◽  
Childhood And Adolescence ◽  
Cooking Skills ◽  
Age Appropriate ◽  
Responsiveness To Change

Abstract Background Learning cooking skills during childhood and adolescence is associated with positive dietary outcomes in adulthood as well as being tracked from adolescence to adulthood. In addition studies have found that perceived competence to be a greater motivator to perform a behaviour than actual competence. However, a lack of validated tools that effectively measure behavioural and dietary changes and other related measures in children is a limitation. Therefore, this research aimed to develop and validate age-appropriate perceived cooking competence measures for younger and older primary school aged children. Methods Two measures of perceived Cooking Competence (CooC11 and CooC7) for older (8–12 years) and younger (6–7 years) children were developed from a critical evaluation of publically available recommendations and expert consultation. The cooking skills within the measures were illustrated by a graphic designer in consultation with a chef and reviewed in an iterative manner by the research team. The measures were piloted for clarity, ease of use and initial face validity. Multiple studies were used for both CooC11 and CooC7 to establish psychometric properties of the measures, temporal stability, internal consistency reliability, construct validity, as well as responsiveness to change for CooC11. Analysis included Exploratory Factor Analysis, Confirmatory Factor Analysis, Intraclass Correlation Coefficients, Pearson’s Correlations, ANOVAs and Cronbach’s Alphas. Results Both measures had high levels of face validity and received positive user feedback. Two factors were shown in both measures with the measures showing excellent temporal stability (ICC > 0.9) and good internal consistency (Cronbach’s Alphas > 0.7). Both measures showed initial discriminant validity, with significant differences (P < 0.001) between those who reported assisting their parents with dinner preparation and those who did not. Additionally, CooC11 was significantly correlated with an adult cooking measure and had a significant responsiveness to change (P < 0.01). Conclusions The CooC11 and CooC7 are the first validated age-appropriate measures for assessing children’s perceived Cooking Competence for ages 8–12 and 6–7 years respectively. They can be used to evaluate the efficacy of children’s cooking intervention studies or school nutrition education programmes.

scholarly journals Interfacility transfers for US ischemic stroke and TIA, 2006–2014

Neurology ◽  
2018 ◽  
Vol 90 (18) ◽  
pp. e1561-e1569 ◽  
Author(s):  
Benjamin P. George ◽  
Sara J. Doyle ◽  
George P. Albert ◽  
Ania Busza ◽  
Robert G. Holloway ◽  
...  
Keyword(s):  
Emergency Department ◽  
Ischemic Stroke ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Stroke Care ◽  
Hospital Level ◽  
Transfer Rates ◽  
The Us ◽  
Ed Visits ◽  
Low Volume

ObjectiveTo investigate changes in emergency department (ED) transfers for ischemic stroke (IS) and TIA.MethodsWe performed a retrospective observational study using the US Nationwide Emergency Department Sample to identify changes in interfacility ED transfers for IS and TIA from the perspective of the transferring ED (2006–2014). We calculated nationwide transfer rates and individual ED transfer rates for IS/TIA by diagnosis and hospital characteristics. Hospital-level fractional logistic regression examined changes in transfer rates over time.ResultsThe population-estimated number of transfers for IS/TIA increased from 22,576 patient visits in 2006 to 54,485 patient visits in 2014 (p trend < 0.001). The rate of IS/TIA transfer increased from 3.4 (95% confidence interval [CI] 3.0–3.8) in 2006 to 7.6 (95% CI 7.2–7.9) in 2014 per 100 ED visits. Among individual EDs, mean transfer rates for IS/TIA increased from 8.2 per 100 ED visits (median 2.0, interquartile range [IQR] 0–10.2) to 19.4 per 100 ED visits (median 8.1, IQR 1.1–33.3) (2006–2014) (p trend < 0.001). Transfers were more common among IS. Transfer rates were greatest among rural (adjusted odds ratio [AOR] 3.05, 95% CI 2.56–3.64) vs urban/teaching and low-volume EDs (AOR 7.49, 95% CI 6.58–8.53, 1st vs 4th quartile). The adjusted odds of transfer for IS/TIA increased threefold (2006–2014).ConclusionsInterfacility ED transfers for IS/TIA more than doubled from 2006 to 2014. Further work should determine the necessity of IS/TIA transfers and seek to optimize the US stroke care system.

The relation between head circumference and mid pelvic circumference: A simple index for cephalo-pelvic disproportion evaluation

2021 ◽  
Author(s):  
Gad Liberty ◽  
Ofer Gemer ◽  
Irena Siyanov ◽  
Eyal Y. Anteby ◽  
Alona Apter ◽  
...  
Keyword(s):  
Head Circumference ◽  
Odds Ratio ◽  
Proof Of Concept ◽  
Fetal Head ◽  
Simple Index ◽  
Bony Pelvis ◽  
Cesarean Deliveries ◽  
Simple Tool ◽  
Vaginal Deliveries ◽  
Concept Evaluation

Introduction: Cephalo-pelvic-disproportion (CPD) is one of the most common obstetric complications. Since CPD is the disproportion between the fetal head and maternal bony pelvis, evaluation of the head-circumference (HC) relative to maternal bony pelvis may be a useful adjunct to pre-labor CPD evaluation. The aim of the present study was a proof-of-concept evaluation of the ratio between HC to pelvic circumference (PC) as a predictor of CPD. Methods: Of 11,822 deliveries, 104 cases that underwent an abdomino-pelvic CT for any medical indication and who underwent normal vaginal deliveries (NVD) (n=84) or cesarean deliveries (CD) due to CPD (n=20) were included retrospectively. Maternal pelvis dimensions were reconstructed and neonatal HC, as a proxy for fetal HC, were measured. The correlation between cases of CPD and Cephalo-Pelvic Circumference Index (CPCI), which represents the ratio between the HC and PC in percent (HC/PC *100) was evaluated. Results: The mid-pelvis cephalo-pelvic circumference index (MP-CPCI) was larger in CD groups as compared to the NVD group: 103±11 vs. 97±8% respectively (p=0.0003). In logistic regression analysis, the MP-CPCI was found to be independently associated with CD due to CPD: each 1% increase in MP-CPCI increased the likelihood of CD for CPD by 11% (aOR 1.11, CI 95% 1.03-1.19, p=0.004). The adjusted odds ratio for CD due to CPD increased incrementally as the MP-CPCI increased, from 3.56 (95%CI, 1.01-12.6) at MP-CPCI of 100, to 5.6 (95%CI, 1.63-19.45) at 105, 21.44 (95%CI, 3.05-150.84) at 110, and 28.88 (95%CI, 2.3-362.27) at MP-CPCI of 115 Conclusions: The MP-CPCI, representing the relative dimensions of the fetal HC and maternal PC, is a simple tool that can potentially distinguish between parturients at lower and higher risk of CPD. Prospective randomized studies are required to evaluate the feasibility of prenatal pelvimetry and MP-CPCI to predict the risk of CPD during labor.

scholarly journals Validation and Adaptation of the Academic-Resilience Scale in the Spanish Context

2020 ◽  
Vol 17 (11) ◽  
pp. 3779 ◽  
Author(s):  
Rubén Trigueros ◽  
Ana M. Magaz-González ◽  
Marta García-Tascón ◽  
Antonio Alias ◽  
José M. Aguilar-Parra
Keyword(s):  
Standard Deviation ◽  
University Students ◽  
Psychometric Properties ◽  
Internal Consistency ◽  
Temporal Stability ◽  
Academic Resilience ◽  
Spanish Version ◽  
Factorial Structure ◽  
Resilience Scale

The aim of this study was to validate and adapt the academic-resilience scale in the Spanish context. The study involved 2967 university students aged 18–33 (Mean, M = 23.65; Standard Deviation, SD = 2.57) from several universities in Andalusia (Spain). Exploratory and confirmatory factorial analyses revealed adequate adjustment rates for the new version of the scale showing the factorial structure invariant with respect to that generated. Three factors that integrate the scale obtained high correlation, internal consistency, and temporal stability. The Spanish version of the academic-resilience scale was shown to have adequate psychometric properties to measure academic resilience in the Spanish university context.

The applicability of the cognitive abilities screening instrument–short (CASI-S) in primary care in Brazil

2015 ◽  
Vol 28 (1) ◽  
pp. 93-99 ◽  
Author(s):  
Glaucia Martins de Oliveira ◽  
Juliana Emy Yokomizo ◽  
Laís dos Santos Vinholi e Silva ◽  
Laura Ferreira Saran ◽  
Cássio M. C. Bottino ◽  
...  
Keyword(s):  
Primary Care ◽  
Internal Consistency ◽  
Cognitive Abilities ◽  
Temporal Stability ◽  
Screening Instrument ◽  
Eastern Region ◽  
Limited Information ◽  
Cognitive Screening ◽  
Dementia Patients ◽  
Normal Controls

ABSTRACTBackground:The Cognitive Abilities Screening Instrument – Short (CASI-S) is a brief cognitive screening test. However, there is limited information regarding its applicability in primary care.Objectives:To ascertain whether the CASI-S differentiates between dementia patients and normal controls in primary care; to examine its correlation with other cognitive instruments, to analyze its internal consistency, test-retest stability, and diagnostic accuracy.Methods:In a case-control study, carried out at two Primary Care Units (PCUs) in the eastern region of the city of São Paulo, 47 older adults were diagnosed with dementia according to DSM-IV criteria (mean age = 76.81 ± 7.03 years), and 55 were classified as normal controls (mean age = 72.78 ± 7.37 years), by a multidisciplinary panel which had access to results from a comprehensive cognitive battery and the patients’ health data. The present analyses included results from the Mini-Mental State Examination (MMSE). The CASI-S was not used to determine diagnostic status.Results:The CASI-S was easily applied in the primary care setting. There was a significant performance difference (p < 0.001) between dementia patients (15.57 ± 7.40) and normal controls (26.67 ± 3.52) on the CASI-S. CASI-S scores correlated with age (ρ = −0.410, p < 0.001), educational level (ρ = 0.373, p < 0.001), and MMSE score (ρ = 0.793, p < 0.001). The internal consistency of the CASI-S was high (α = 0.848) and the correlation between test and retest was 0.688, suggesting adequate temporal stability. In the ROC curve analyses, scores of 22/23 generated an area under the curve of 0.907, with sensitivity of 93% and specificity of 81%.Conclusions:The CASI-S can be useful for dementia screening in primary care in Brazil.

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