bluuebunny/crossref_metadata_2025_split huggingface dataset:
Reading errors made by children with low vision*
Authors: Douglas Graeme , Grimley Mick , McLinden Mike , Watson Linda 
Published: July 2004

AbstractPrevious research has shown that, on average, children with low vision lag their sighted peers in general reading development (in terms of speed, accuracy and comprehension). This study sought to examine this apparent lag by comparing the reading profiles of 25 normally sighted readers (mean age 8 years 8 months) with 25 low vision readers. The children were tested using a reading test (the Neale Analysis of Reading Ability, NARA) and were matched on the reading accuracy score produced by the test. Therefore in terms of the reading accuracy scores (and reading ages) derived from the NARA both groups were the same. The low vision readers were on average older than the normally sighted children (mean = 10 years, 5 months). When the reading profile (i.e. accuracy, comprehension and speed) was examined in the same analysis no significant effect was revealed [d.f. = 1, 48; F = 0.05; p > 0.1], but a general lag for these children is suggested (in keeping with previous research). However, a closer analysis of the reading error profile revealed the most common reading errors made by all readers in the analysis were either mispronunciations or substitutions. The low vision readers were more prone to making substitution errors than mispronunciations and the reverse was true for normally sighted readers [d.f. = 1, 48; F = 7.1; p < 0.05]. This indicates that the reading strategies adopted by low vision readers may differ from those of normally sighted readers of the same apparent reading ability.
Predicting prescribed magnification*
Authors: Wolffsohn James S. , Eperjesi Frank 
Published: July 2004

AbstractAim:  To determine the best method of estimating the optimum magnification needed by visually impaired patients.Methods:  The magnification of low vision aids prescribed to 187 presbyopic visually impaired patients for reading newspapers or books was compared with logMAR distance and near acuity (at 25 cm) and magnification predicted by +4 D step near additions.Results:  Distance letter (r = 0.58) and near word visual acuity (r = 0.67) were strongly correlated to the prescribed magnification as were predictive formulae based on these measures. Prediction using the effect of proximal magnification resulted in a similar correlation (r = 0.67) and prediction was poorer in those who did not benefit from proximal magnification. The difference between prescribed and predicted magnification was found to be unrelated to the condition causing visual impairment (F = 2.57, p = 0.08), the central visual field status (F = 0.57, p = 0.57) and patient psychology (F = 0.44, p = 0.51), but was higher in those prescribed stand magnifiers than high near additions (F = 5.99, p < 0.01).Conclusions:  The magnification necessary to perform normal visual tasks can be predicted in the majority of cases using visual acuity measures, although measuring the effect of proximal magnification demonstrates the effect of stronger glasses and identifies those in whom prescribed magnification is more difficult to predict.
An ideal ocular nutritional supplement?*
Authors: Bartlett Hannah , Eperjesi Frank 
Published: July 2004

AbstractThe role of nutritional supplementation in prevention of onset or progression of ocular disease is of interest to health care professionals and patients. The aim of this review is to identify those antioxidants most appropriate for inclusion in an ideal ocular nutritional supplement, suitable for those with a family history of glaucoma, cataract, or age‐related macular disease, or lifestyle factors predisposing onset of these conditions, such as smoking, poor nutritional status, or high levels of sunlight exposure. It would also be suitable for those with early stages of age‐related ocular disease. Literature searches were carried out on Web of Science and PubMed for articles relating to the use of nutrients in ocular disease. Those highlighted for possible inclusion were vitamins A, B, C and E, carotenoids beta‐carotene, lutein, and zeaxanthin, minerals selenium and zinc, and the herb, Ginkgo biloba. Conflicting evidence is presented for vitamins A and E in prevention of ocular disease; these vitamins have roles in the production of rhodopsin and prevention of lipid peroxidation respectively. B vitamins have been linked with a reduced risk of cataract and studies have provided evidence supporting a protective role of vitamin C in cataract prevention. Beta‐carotene is active in the prevention of free radical formation, but has been linked with an increased risk of lung cancer in smokers. Improvements in visual function in patients with age‐related macular disease have been noted with lutein and zeaxanthin supplementation. Selenium has been linked with a reduced risk of cataract and activates the antioxidant enzyme glutathione peroxidase, protecting cell membranes from oxidative damage while zinc, although an essential component of antioxidant enzymes, has been highlighted for risk of adverse effects. As well as reducing platelet aggregation and increasing vasodilation, Gingko biloba has been linked with improvements in pre‐existing field damage in some patients with normal tension glaucoma. We advocate that vitamins C and E, and lutein/zeaxanthin should be included in our theoretically ideal ocular nutritional supplement.
Low vision service delivery: an audit of newly developed outreach clinics in Northern Ireland*
Authors: Lindsay J. , Bickerstaff D. , McGlade A. , Toner A. , Jackson A. J. 
Published: July 2004

AbstractRecent publications recommend that low vision services are multi‐professional; easily accessible; freely available to all those with visual impairment; monitored by professional and patient groups, and responsive to user feedback. These standards were applied when developing low vision outreach services in Northern Ireland in 1999/2000. Results are reported of the complete clinical audit cycle, coupled with a patient satisfaction telephone questionnaire, which was used to evaluate the service. Of the 48 patients randomly selected from the list of clinic attendees, 28 (58%) were female, 27 (56%) over 80 years of age and 38 (78%) had a primary ocular diagnosis of age related macular degeneration (AMD). Of the 46 low vision aids issued at patients’ first appointments, 30 (67%) were illuminated stand magnifiers and 29 (63%) had magnification levels of ×5 or less. A total of 46 (96%) patients reported that they had benefited from low vision services.
Quality of Care for Patients with Type 2 Diabetes Mellitus in the Netherlands and the United States: A Comparison of Two Quality Improvement Programs
Authors: Valk Gerlof D. , Renders Carry M. , Kriegsman Didi M. W. , Newton Katherine M. , Twisk Jos W. R. , van Eijk Jacques Th. M. , van der Wal Gerrit , Wagner Edward H. 
Published: July 2004

Objective. To assess differences in diabetes care and patient outcomes by comparing two multifaceted quality improvement programs in two different countries, and to increase knowledge of effective elements of such programs.Study Setting. Primary care in the ExtraMural Clinic (EMC) of the Department of General Practice of the Vrije Universiteit in Amsterdam, the Netherlands, and the Group Health Cooperative (GHC), a group‐model health maintenance organization (HMO) in western Washington State in the United States. Data were collected from 1992 to 1997.Study Design. In this observational study two diabetes cohorts in which a quality improvement program was implemented were compared. Both programs included a medical record system, clinical practice guidelines, physician educational meetings, audit, and feedback. Only the Dutch program (EMC) included guidelines on the structure of diabetes care and a recall system. Only the GHC program included educational outreach visits, formation of multidisciplinary teams, and patient self‐management support.Data Collection. Included were 379 EMC patients, and 2,119 GHC patients with type 2 diabetes mellitus. Main process outcomes were: annual number of diabetes visits, and number of HbA1c and blood lipid measurements. Main patient outcomes were HbA1c and blood lipid levels. Multilevel analysis was used to adjust for dependency between repeated observations within one patient and for clustering of patients within general practices.Principal Findings. In the EMC process outcomes and glycemic control improved more than at GHC, however, GHC had better baseline measures. There were no differences between programs on blood lipid control. During follow‐up, intensification of pharmacotherapy was noted at both sites. Differences noted between programs were in line with differences in diabetes guidelines.Conclusions. Following implementation of guidelines and organizational improvement efforts, change occurred primarily in the process outcomes, rather than in the patient outcomes. Although much effort was put into improving process and patient outcomes, both complex programs still showed only moderate effects.
Patient Satisfaction, Treatment Experience, and Disability Outcomes in a Population‐Based Cohort of Injured Workers in Washington State: Implications for Quality Improvement
Authors: Wickizer Thomas M. , Franklin Gary , Fulton‐Kehoe Deborah , Turner Judith A. , Mootz Robert , Smith‐Weller Terri 
Published: July 2004

Objective. To determine what aspects of patient satisfaction are most important in explaining the variance in patients' overall treatment experience and to evaluate the relationship between treatment experience and subsequent outcomes.Data Sources and Setting. Data from a population‐based survey of 804 randomly selected injured workers in Washington State filing a workers' compensation claim between November 1999 and February 2000 were combined with insurance claims data indicating whether survey respondents were receiving disability compensation payments for being out of work at 6 or 12 months after claim filing.Study Design. We conducted a two‐step analysis. In the first step, we tested a multiple linear regression model to assess the relationship of satisfaction measures to patients' overall treatment experience. In the second step, we used logistic regression to assess the relationship of treatment experience to subsequent outcomes.Principal Findings. Among injured workers who had ongoing follow‐up care after their initial treatment (n=681), satisfaction with interpersonal and technical aspects of care and with care coordination was strongly and positively associated with overall treatment experience (p<0.001). As a group, the satisfaction measures explained 38 percent of the variance in treatment experience after controlling for demographics, satisfaction with medical care prior to injury, job satisfaction, type of injury, and provider type. Injured workers who reported less‐favorable treatment experience were 3.54 times as likely (95 percent confidence interval, 1.20–10.95, p=.021) to be receiving time‐loss compensation for inability to work due to injury 6 or 12 months after filing a claim, compared to patients whose treatment experience was more positive.
Trust in Insurers and Access to Physicians: Associated Enrollee Behaviors and Changes over Time
Authors: Balkrishnan Rajesh , Hall Mark A. , Blackwelder Stephen , Bradley Donald 
Published: July 2004

Objective. Most studies of trust in the medical arena have focused on trust in physicians rather than trust in health insurers, and have been cross‐sectional rather than longitudinal studies. This study examined associations among trust in a managed care insurer, trust in one's primary physician, and subsequent enrollee behaviors relating to source of care. The study also documents changes in trust in the study population following the disclosure of physician incentives.Study Setting. A medium‐sized (300,000 member) HMO, located in the southeastern United States.Data Collection. One to two years after baseline, we randomly resurveyed a quarter (n=558) of the initial study population of a large intervention study designed to measure the impact of disclosing HMO financial incentives on patient trust. This follow‐up study was also designed to measure the effects of trust on source of care.Analyses. Multivariate regression analyses of survey data examined associations between baseline levels of trust and subsequent enrollee behaviors such as using a non‐PCP physician without a PCP referral, as well as changes in trust since baseline.Results. High baseline insurer trust was associated with a lower probability of a patient seeking care from a non‐PCP physician (OR=0.55, 95 percent CI: 0.33, 0.91). No long‐term effects of prior disclosure of financial incentives were observed. Overall, there was a slight increase in overall trust in the insurer (1.8 percent, p<.05) but no change in trust in one's primary physician. The increase in insurer trust was primarily restricted to 23 percent of the enrollees who had changed their PCPs following the baseline survey (6.6 percent, p<.01). In multivariate analyses, changing physicians was the most significant predictor of increased insurer trust (OR=2.17, 95 percent CI: 1.37, 3.43).Conclusions. Trust in one's insurer seems to change over time more than trust in one's primary physician, and is predictive of enrollee behaviors such as seeking care from other physicians. The ability to change physicians seems to increase trust in the insurer.
Context or Composition: What Explains Variation in SCHIP Disenrollment?
Authors: Phillips Julie A. , Miller Jane E. , Cantor Joel C. , Gaboda Dorothy 
Published: July 2004

Objective. To investigate (1) the relative contributions of family and contextual characteristics to observed variation in disenrollment rates from the State Children's Health Insurance Program (SCHIP), and (2) whether context explains observed family‐level patterns.Data Sources. We use secondary data on 24,628 families enrolled in New Jersey's SCHIP program (NJ KidCare), and county‐level data from the Area Resource File, the Census, and the NJ FamilyCare provider roster.Study Design. Information on family characteristics, SCHIP plan, and dates of enrollment and disenrollment are taken from NJ KidCare administrative records, which provided surveillance data from January 1998 through April 2000.Data Collection/Analysis. We estimate a multilevel discrete‐time‐hazards model of SCHIP disenrollment.Findings. Families enrolled in plans involving cost‐sharing, blacks, and those with only one enrolled child have higher than average rates of disenrollment. Disenrollment rates for blacks are lower in counties with a high share of black physicians. These characteristics account for part of the intercounty variation in disenrollment rates; remaining intercounty variation is largely explained by physician density or population density.Policy Implications. It may be worthwhile to pay special attention to black families and counties with high disenrollment rates to address the reasons for their lower retention. Addressing cultural differences between physician and client and the geographic distribution of medical providers might reduce disenrollment.
Variations in Nurse Practitioner Use in Veterans Affairs Primary Care Practices
Authors: Huang Patty Y. , Yano Elizabeth M. , Lee Martin L. , Chang Betty L. , Rubenstein Lisa V. 
Published: July 2004

Background. Increasingly, primary care practices include nurse practitioners (NPs) in their staffing mix to contain costs and expand primary care. To achieve these aims in U.S. Department of Veterans Affairs medical centers (VAMCs), national policy endorsed involvement of NPs as primary care (PC) providers.Objectives. To evaluate the degree to which VAMCs incorporated NPs into PC practices between 1996 and 1999, and to identify the internal and external practice environment features associated with NP use.Study Design. We surveyed 131 PC directors of all VAMCs in 1996 and 1999 to ascertain the staffing and characteristics of the PC practice and parent organization (e.g., academic affiliation, level of physician staffing, use of managed care arrangements), and drew on previously published studies and HRSA State Health Workforce Profiles to characterize each practice's regional health care environment (e.g., geographic region, state NP practice laws, state managed care penetration). Using multivariate linear regression, we evaluate the contribution of these environmental and organizational factors on the number of NPs/10,000 PC patients in 1999, controlling for the rate of NP use in 1996.Principal Findings. From 1996–1999, NP use increased from 75 percent to 90 percent in VA PC practices. The mean number of NPs per practice increased by about 60 percent (2.0 versus 3.2; p<.001), while the rate of NPs/10,000 PC patients trended upward (2.2 versus 2.7; p=.09). Staffing of other primary care clinicians (e.g., physicians and physician assistants per practice) remained stable, while the NP‐per‐physician rate increased (0.2 versus 0.4; p<.001). After multivariate adjustment, greater reliance on managed‐care‐oriented provider education programs (p=.02), the presence of NP training programs (p=.05), and more specialty‐trained physicians/10,000 PC patients (p=.09) were associated with greater NP involvement in primary care.Conclusions. Staffing models in VA PC practices have, in fact, changed, with NPs having a greater presence. However, we found substantial practice‐based variations in their use, suggesting that more research is needed to better understand how they have been integrated into practice and what impact their involvement has had on the VA's ability to achieve its restructuring goals.
Antiretroviral Therapy and Health Care Utilization: A Study of Privately Insured Men and Women with HIV Disease
Authors: Hellinger Fred J. , Encinosa William E. 
Published: July 2004

Objective. To compare the use of antiretroviral therapy and other health care resources by women and men with HIV disease who are privately insured.Data Sources. Data were obtained from the MarketScan Commercial Claims and Encounter Database produced by the Medstat Group, Inc., of Ann Arbor, Michigan. This database includes eligibility files as well as claims data for inpatient care, outpatient care, physician services, and prescription drugs for enrollees in employer‐sponsored benefit plans for 24 large employers around the nation.Study Design. Examine utilization by 2,026 privately insured persons (1,494 men and 532 women) with HIV disease in calendar year 2000 under the age of 65.Principal Findings. Using a simple comparison, we found that 71 percent of men (68.7 to 73.3 percent is 95 percent confidence interval) and 39 percent of women (35.1 to 43.5 percent is 95 percent confidence interval) with HIV disease received antiretroviral therapy. We also found that the average annual drug cost was $9,037 for a man ($8,372 to $9,702 is 95 percent confidence interval) and $3,893 for a woman ($3,476 to $4,490 is 95 percent confidence interval). Furthermore, we found that the out‐of‐pocket expenses comprised 10 percent of total expenses for men ($1,617 out of $16,405) and 4 percent for women ($405 out of $10,397).Conclusion.There are major differences in the utilization and cost of health care between privately insured men and women with HIV disease.
Economic Profiling of Primary Care Physicians: Consistency among Risk‐Adjusted Measures
Authors: Thomas J. William , Grazier Kyle L. , Ward Kathleen 
Published: July 2004

Objective. To investigate whether different risk‐adjustment methodologies and economic profiling or “practice efficiency” metrics produce differences in practice efficiency rankings for a set of primary care physicians (PCPs).Data Source. Twelve months of claims records (inpatient, outpatient, professional, and pharmacy) for an independent practice association HMO.Study Design. Patient risk scores obtained with six profiling risk‐adjustment methodologies were used in conjunction with claims cost tabulations to measure practice efficiency of all primary care physicians who managed 25 or more members of an HMO.Data Collection. For each of the risk‐adjustment methodologies, two measures of “efficiency” were constructed: the standardized cost difference between total observed (standardized actual) and total expected costs for patients managed by each PCP, and the ratio of the PCP's total observed to total expected costs (O/E ratio). Primary care physicians were ranked from most to least efficient according to each risk‐adjusted measure, and level of agreement among measures was tested using weighted kappa. Separate rankings were constructed for pediatricians and for other primary care physicians.Findings. Moderate to high levels of agreement were observed among the six risk‐adjusted measures of practice efficiency. Agreement was greater among pediatrician rankings than among adult primary care physician rankings, and, with the standardized difference measure, greater for identifying the least efficient than the most efficient physicians. The O/E ratio was shown to be a biased measure of physician practice efficiency, disproportionately targeting smaller sized panels as outliers.Conclusions. Although we observed moderate consistency among different risk‐adjusted PCP rankings, consistency of measures does not prove that practice efficiency rankings are valid, and health plans should be careful in how they use practice efficiency information. Indicators of practice efficiency should be based on the standardized cost difference, which controls for number of patients in a panel, instead of O/E ratio, which does not.
Coding Response to a Case‐Mix Measurement System Based on Multiple Diagnoses
Authors: Preyra Colin 
Published: July 2004

Objective. To examine the hospital coding response to a payment model using a case‐mix measurement system based on multiple diagnoses and the resulting impact on a hospital cost model.Data Sources. Financial, clinical, and supplementary data for all Ontario short stay hospitals from years 1997 to 2002.Study Design. Disaggregated trends in hospital case‐mix growth are examined for five years following the adoption of an inpatient classification system making extensive use of combinations of secondary diagnoses. Hospital case mix is decomposed into base and complexity components. The longitudinal effects of coding variation on a standard hospital payment model are examined in terms of payment accuracy and impact on adjustment factors.Principal Findings. Introduction of the refined case‐mix system provided incentives for hospitals to increase reporting of secondary diagnoses and resulted in growth in highest complexity cases that were not matched by increased resource use over time. Despite a pronounced coding response on the part of hospitals, the increase in measured complexity and case mix did not reduce the unexplained variation in hospital unit cost nor did it reduce the reliance on the teaching adjustment factor, a potential proxy for case mix. The main implication was changes in the size and distribution of predicted hospital operating costs.Conclusions. Jurisdictions introducing extensive refinements to standard diagnostic related group (DRG)‐type payment systems should consider the effects of induced changes to hospital coding practices. Assessing model performance should include analysis of the robustness of classification systems to hospital‐level variation in coding practices. Unanticipated coding effects imply that case‐mix models hypothesized to perform well ex ante may not meet expectations ex post.