bluuebunny/crossref_metadata_2025_split huggingface dataset:
Electrical Remodeling and Atrial Dilation During Atrial Tachycardia are Influenced by Ventricular Rate: Role of Developing Tachycardiomyopathy
Authors: SCHOONDERWOERD BAS A. , VAN GELDER ISABELLE C. , VAN VELDHUISEN DIRK J. , TIELEMAN ROBERT G. , GRANDJEAN JAN G. , BEL KLAAS J. , ALLESSIE MAURITS A. , CRIJNS HARRY J.G.M. 
Published: August 2003

Atrial Remodeling in Tachycardiomyopathy.
Introduction: Atrial fibrillation (AF) and congestive heart failure (CHF) are two clinical entities that often coincide. Our aim was to establish the influence of concomitant high ventricular rate and consequent development of CHF on electrical remodeling and dilation during atrial tachycardia. Methods and Results: A total of 14 goats was studied. Five goats were subjected to 3:1 AV pacing (A‐paced group, atrial rate 240 beats/min, ventricular rate 80 beats/min). Nine goats were subjected to rapid 1:1 AV pacing (AV‐paced group, atrial and ventricular rates 240 beats/min). During 4 weeks, right atrial (RA) and left ventricular (LV) diameters were measured during sinus rhythm. Atrial effective refractory periods (AERP) and inducibility of AF were assessed at three basic cycle lengths (BCL). After 4 weeks of rapid AV pacing, RA and LV diameters had increased to 151% and 113% of baseline, whereas after rapid atrial pacing alone, these parameters were unchanged. Right AERP (157 ± 10 msec vs 144 ± 16 msec at baseline with BCL of 400 msec in the A‐paced and AV‐paced group, respectively) initially decreased in both groups, reaching minimum values within 1 week. Subsequently, AERP partially recovered in AV‐paced goats, whereas AERP remained short in A‐paced goats (79 ± 7 msec vs 102 ± 12 msec after 4 weeks; P < 0.05). Left AERP demonstrated a similar time course. Inducibility of AF increased in both groups and reached a maximum during the first week in both groups, being 20% and 48% in the A‐paced and AV‐paced group, respectively. Conclusion: Nature and time course of atrial electrical remodeling and dilation during atrial tachycardia are influenced by concurrent high ventricular rate and consequent development of CHF.
A Modest Notion of Coherence in Legal Reasoning. A Model for the European Court of Justice
Authors: Soriano Leonor Moral 
Published: August 2003

Abstract. The aim of this article is to propose a theoretical theme to explain coherence in legal reasoning. The main argument that this paper wants to put forward is that theories of coherence in the legal system should be differentiated from theories of coherence in legal reasoning. These focus on arguments, and on how the given arguments are connected. In particular, the notion of coherence in legal reasoning proposed here is a modest one. The article applies this theme to the case‐law of the European Court of Justice in environmental matters. This provides an example of how to deal with conflicts between incommensurable goods, and how to promote coherence by justifying decisions.
Simple folk have an advantage over the learned, who often get lost in the search for general laws. They often have the intuition of the individual. But this intuition by itself is insufficient. (Eco, The Name of the Rose)
Global networks and local developments: agendas for development geography
Authors: Bebbington Anthony 
Published: August 2003

AbstractIt can be argued that development geography has left few traces either on the broader canvas of development theory or on the thought and practices of social actors engaging with material processes of change typically framed within the language of development. This paper argues that this is because the sub‐field has been somewhat too case study oriented, and because its prac‐titioners have, with some exceptions, kept themselves – or at least their identities – at the margins of debates within and among development actors. Yet development geography has much to con‐tribute to on‐going reflections on the nature of development. The paper explores themes that might be at the centre of an empirically grounded but theoretically oriented development geography that might speak to contemporary processes of globalisation and local change. It suggests that comparative case study work exploring the ways in which the development of capitalism and processes of intervention are both linked and vary across space still offers fruitful terrain for theory.
Parents' Perceptions of Pediatric Primary Care Quality: Effects of Race/Ethnicity, Language, and Access
Authors: Seid Michael , Stevens Gregory D. , Varni James W. 
Published: August 2003

Objective.To examine the effects of race/ethnicity, language, and potential access on parents' reports of pediatric primary care experiences.Data Sources/Study Setting.Primary survey data were collected (67 percent response rate) from 3,406 parents of students in kindergarten through sixth grade in a large urban school district in California during the 1999–2000 school year.Data Collection.The data were collected by mail, telephone, and in person. Surveys were administered in English, Spanish, Vietnamese, and Tagalog.Study Design.Data were analyzed using multiple regression models. The dependent variable was parents' reports of primary care quality, assessed via the previously validated Parents' Perceptions of Primary Care measure (P3C). The independent variables were race/ethnicity, language, and potential access to care (insurance status, presence of a regular provider of care), controlling for child age, gender, and chronic health condition status, and mother's education.Principal Findings.Parents' reports of primary care quality varied according to race/ethnicity, with Asian and Latino parents reporting lower P3C scores than African Americans and whites. In multivariate analyses, both language and potential access exerted strong independent effects on primary care quality, reducing the effect of race/ethnicity such that the coefficient for Latinos was no longer significant, and the coefficient for Asians was much smaller, though still statistically significant.Conclusions.To reduce racial/ethnic disparities in primary care, attention should be paid both to policies aimed at improving potential access and to providing linguistically appropriate services.
The Contribution of Nurse Practitioners and Physician Assistants to Generalist Care in Washington State
Authors: Larson Eric H. , Palazzo Lorella , Berkowitz Bobbi , Pirani Michael J. , Hart L. Gary 
Published: August 2003

Objective. To quantify the total contribution to generalist care made by nurse practitioners (NPs) and physician assistants (PAs) in Washington State.Data Sources. State professional licensure renewal survey data from 1998–1999.Study Design. Cross‐sectional. Data on medical specialty, place of practice, and outpatient visits performed were used to estimate productivity of generalist physicians, NPs, and PAs. Provider head counts were adjusted for missing specialty and productivity data and converted into family physician full‐time equivalents (FTEs) to facilitate estimation of total contribution to generalist care made by each provider type.Principal Findings. Nurse practitioners and physician assistants make up 23.4 percent of the generalist provider population and provide 21.0 percent of the generalist outpatient visits in Washington State. The NP/PA contribution to generalist care is higher in rural areas (24.7 percent of total visits compared to 20.1 percent in urban areas). The PAs and NPs provide 50.3 percent of generalist visits provided by women in rural areas, 36.5 percent in urban areas. When productivity data were converted into family physician FTEs, the productivity adjustments were large. A total of 4,189 generalist physicians produced only 2,760 family physician FTEs (1 FTE=105 outpatient visits per week). The NP and PA productivity adjustments were also quite large.Conclusions. Accurate estimates of available generalist care must take into account the contributions of NPs and PAs. Additionally, simple head counts of licensed providers are likely to result in substantial overestimates of available care. Actual productivity data or empirically derived adjustment factors must be used for accurate estimation of provider shortages.
Economic Consequences of Underuse of Generic Drugs: Evidence from Medicaid and Implications for Prescription Drug Benefit Plans
Authors: Fischer Michael A. , Avorn Jerry 
Published: August 2003

Objective.To calculate the financial impact of underuse of generic medications in state Medicaid programs.Data Sources/Study Setting.State‐by‐state data on Medicaid drug spending for 48 states and the District of Columbia in calendar year 2000.Study Design.We compared the total amount paid by each state Medicaid program for brand name prescriptions with the amount that would have been paid for generic versions of the same agent, to estimate the level of unrealized savings from use of substitutable generic drugs. We also examined whether variation in prices between states represented a potential source of unrealized savings.Principal Findings.Analysis of state‐by‐state Medicaid prescription drug spending in 2000 identified potential savings of $229 million that could have been realized from greater use of generic drugs. If the best available prices from each state had been used nationally, savings would have increased to $450 million. The majority of the unrealized savings were concentrated in a small group of medications, including clozapine, alprazolam, and levothyroxine.Conclusions.Federal regulations on prescription drug reimbursement limit the excess spending on brand name drugs in the Medicaid program to a small percentage of total spending, although the absolute dollar amount is large. Further savings could be realized if lowest available prices were used nationwide. Concentrating on specific agents may be a productive way to address the unrealized savings.
Variations in Patterns of Care and Outcomes after Acute Myocardial Infarction for Medicare Beneficiaries in Fee‐for‐Service and HMO Settings
Authors: Luft Harold S. 
Published: August 2003

Objective. To assess revascularization and mortality after acute myocardial infarction (AMI) for all Medicare patients in fee‐for‐service (FFS) and health maintenance organization (HMO) settings in California.Data Sources/Study Setting. Hospital discharge abstract and death certificate data linked with Medicare enrollment files for patients aged 65 and over with Medicare coverage (69,040) discharged from a California‐licensed hospital in 1994–1996.Study Design. Risk‐adjusted results were assessed for HMOs and FFS, as well as for FFS beneficiaries from areas served by each plan.Data Collection/Extraction Methods. Risk models were based on all sampled patients. The HMO patients were aggregated into 17 pseudoplans: 5 individual plans, 4 large plans split geographically (10 observations), and 2 “pseudoplans” of small HMOs. Observed versus expected 30‐day mortality rates, lengths‐of‐stay (LOS) during the index hospitalization and any transfers, revascularization (coronary artery bypass graft [CABG] surgery and/or percutaneous transluminal coronary angioplasty [PTCA]) during the index hospitalization or 30 days after admission, were calculated for each pseudoplan.Principal Findings. Risk‐adjusted death rate was slightly higher in FFS than in HMO settings (p<.01 with one risk adjustment model, n.s. with another). Three pseudoplans had significantly (p<.01) better than expected mortality rates. One pseudoplan was significantly worse (p<.05) with one risk adjustment model but not the other. The LOS and revascularization rates varied widely, but were not associated with outcomes. Plans with among the best results had the lowest LOS and revascularization rates. These pseudoplans were less likely to have their patients initially admitted to a hospital with revascularization capability, but the hospitals they used had higher CABG volumes. Even if CABG facilities were available during the index admission, in these plans with better than expected mortality rates, revascularization was often postponed or carried out elsewhere.Conclusions. For Medicare patients having an AMI in the mid‐1990s in California, risk‐adjusted outcomes were no different, or slightly better on average, for those in HMOs than in FFS. Not all plans performed equally well, so understanding what leads to differences in quality is more important than simple comparisons of HMOs versus FFS.
Identifying Physician‐Recognized Depression from Administrative Data: Consequences for Quality Measurement
Authors: Spettell Claire M. , Wall Terry C. , Allison Jeroan , Calhoun Jaimee , Kobylinski Richard , Fargason Rachel , Kiefe Catarina I. 
Published: August 2003

Background. Multiple factors limit identification of patients with depression from administrative data. However, administrative data drives many quality measurement systems, including the Health Plan Employer Data and Information Set (HEDIS®).Methods. We investigated two algorithms for identification of physician‐recognized depression. The study sample was drawn from primary care physician member panels of a large managed care organization. All members were continuously enrolled between January 1 and December 31, 1997. Algorithm 1 required at least two criteria in any combination: (1) an outpatient diagnosis of depression or (2) a pharmacy claim for an antidepressant. Algorithm 2 included the same criteria as algorithm 1, but required a diagnosis of depression for all patients. With algorithm 1, we identified the medical records of a stratified, random subset of patients with and without depression (n=465). We also identified patients of primary care physicians with a minimum of 10 depressed members by algorithm 1 (n=32,819) and algorithm 2 (n=6,837).Results. The sensitivity, specificity, and positive predictive values were: Algorithm 1: 95 percent, 65 percent, 49 percent; Algorithm 2: 52 percent, 88 percent, 60 percent. Compared to algorithm 1, profiles from algorithm 2 revealed higher rates of follow‐up visits (43 percent, 55 percent) and appropriate antidepressant dosage acutely (82 percent, 90 percent) and chronically (83 percent, 91 percent) (p<0.05 for all).Conclusions. Both algorithms had high false positive rates. Denominator construction (algorithm 1 versus 2) contributed significantly to variability in measured quality. Our findings raise concern about interpreting depression quality reports based upon administrative data.
Improved Comorbidity Adjustment for Predicting Mortality in Medicare Populations
Authors: Schneeweiss Sebastian , Wang Philip S. , Avorn Jerry , Glynn Robert J. 
Published: August 2003

Objective. To define and improve the performance of existing comorbidity scores in predicting mortality in Medicare enrollees.Data Sources. Study participants were two Medicare populations who had complete drug coverage either through Medicaid or a statewide pharmacy assistance program: New Jersey Medicare enrollees (NNJ=235,881) and Pennsylvania Medicare enrollees (NPA=230,913).Study Design. Frequently used comorbidity scores were computed for all subjects during the baseline year (January 1, 1994, to December 31, 1994, and one year later in Pennsylvania). The study outcome was one‐year mortality during the following year. Performance of scores was measured with the c‐statistic derived from multivariate logistic regression models. Empirical weights were derived in the New Jersey population and the performance of scores with new weights was validated in the Pennsylvania population.Principal Findings. A score based on ICD‐9‐diagnoses (Romano) performed 60 percent better than one based on patterns of medication use (Chronic Disease Score, or CDS‐1) (c=0.771 vs. c=0.703). The performance of the Romano score was further improved slightly by inclusion of the number of different prescription drugs used during the past year. Modeling the 17 conditions included in the Romano score as separate binary indicators increased its performance by 8 percent (c=0.781). We derived elderly‐specific weights for these scores in the New Jersey sample, including negative weights for the use of some drugs, for example, lipid lowering drugs. Applying these weights, the performance of Romano and CDS‐1 scores improved in an independent validation sample of Pennsylvania Medicare enrollees by 8.3 percent and 43 percent compared to the scores with the original weights. When we added an indicator of nursing home residency, age, and gender, the Romano score reached a performance of c=0.80.Conclusions. We conclude that in epidemiologic studies of the elderly, a modified diagnosis‐based score using empirically derived weights provides improved adjustment for comorbidity and enhances the validity of findings.
Do Commercial Managed Care Members Rate Their Health Plans Differently than Medicaid Managed Care Members?
Authors: Roohan Patrick J. , Franko Scott J. , Anarella Joseph P. , Dellehunt Laura K. , Gesten Foster C. 
Published: August 2003

Objective. To determine if members of commercial managed care and Medicaid managed care rate the experience with their health plans differently.Data Sources. Data from both commercial and Medicaid Consumer Assessment of Health Plan Surveys (CAHPS) in New York State.Study Design. Regression models were used to determine the effect of population (commercial or Medicaid) on a member's rating of their health plan, controlling for health status, age, gender, education, race/ethnicity, number of office visits, and place of residence.Data Collection. Managed care plans are required to submit to the New York State Department of Health (NYSDOH) results of the annual commercial CAHPS survey. The NYSDOH conducted a survey of Medicaid enrollees using Medicaid CAHPS.Principal Findings. Medicaid managed care members in excellent or very good health rate their health plan higher than commercial members in excellent or very good health. There is no difference in health plan rating for commercial and Medicaid members in good, fair, or poor health. Older, less educated, black, and Hispanic members who live outside New York City are more likely to rate their managed care plan higher.Conclusions. Medicaid members rating of their health care equals or exceeds ratings by commercial members.
Practice Characteristics and HMO Enrollee Satisfaction with Specialty Care: An Analysis of Patients with Glaucoma and Diabetic Retinopathy
Authors: Escarce José J. , Kapur Kanika , Solomon Matthew D. , Mangione Carol M. , Lee Paul P. , Adams John L. , Wickstrom Steven L. , Quiter Elaine S. 
Published: August 2003

Background. The specialist's role in caring for managed care patients is likely to grow. Thus, assessing the correlates of patient satisfaction with specialty care is essential.Objective. To examine the association between characteristics of eye care practices and satisfaction with eye care among working age patients with open‐angle glaucoma (OAG) or diabetic retinopathy (DR).Subjects/Study Setting. A total of 913 working age patients with OAG or DR enrolled in six commercial managed care health plans. The patients were treated in 144 different eye care practices.Study Design. We used a patient survey to obtain information on patient characteristics and satisfaction with eye care, measured by scores on satisfaction subscales of the 18‐item Patient Satisfaction Questionnaire. We used a survey of eye care practices to obtain information on practice characteristics, including provider specialties, practice organization, financial features, and utilization and quality management systems. We estimated logistic regression models to assess the association of patient and practice characteristics with high levels of patient satisfaction.Principal Findings. Treatment in a practice with a glaucoma specialist (for OAG patients) or a retina specialist (for DR patients) was associated with higher satisfaction, whereas treatment in a practice that obtained a high proportion of its revenues from capitation payments or in a group practice where providers obtained a high proportion of their incomes from bonuses was associated with lower satisfaction.Conclusions. Many eye care patients prefer to be treated by specialists with expertise in their conditions. Financial arrangement features of eye care practices also are associated with patient satisfaction with care. The most likely mechanisms underlying these associations are effects on provider behavior and satisfaction, which in turn influence patient satisfaction. Managed care plans and provider groups should aim to minimize the negative impact of managed care features on patient satisfaction.
Measuring Continuity of Care for Clients of Public Mental Health Systems
Authors: Fortney John , Sullivan Greer , Williams Keith , Jackson Catherine , Morton Sally C. , Koegel Paul 
Published: August 2003

Objectives. The aims of this research were to generate a set of time‐variant measures of continuity of outpatient care using administrative data, and to evaluate the validity of these measures for persons in the community with serious mental illness (SMI) who use public mental health services.Data Sources. Individuals with SMI were identified using multistage random sampling from shelters, streets, and public mental health clinics in Houston, Texas.Study Design. The study design was observational, cross‐sectional, and retrospective. Based on a review of the literature, five distinct conceptual dimensions of continuity of care were defined: timeliness, intensity, comprehensiveness, stability, and coordination. Repeated measures of continuity were generated for each day of the year. Construct validity was assessed by comparing continuity for housed persons and homeless persons based on the assumption that homelessness is a risk factor for low continuity of outpatient care.Data Collection. Subjects were interviewed to collect sociodemographic and clinical information. Service use was retrospectively tracked through the administrative records of multiple public sector agencies.Principal Findings. All five continuity measures demonstrated good construct validity by the fact that homelessness was significantly (p<0.001) and substantially associated with lower continuity of care.Discussion. The five continuity‐of‐care measures are relatively easy and inexpensive to generate using administrative data. The five continuity‐of‐care measures may be useful for identifying individuals at risk for poor outcomes and for evaluating the ability of public service systems to keep clients engaged in care over time.
Variations in Hospitalization Rates among Nursing Home Residents: The Role of Discretionary Hospitalizations
Authors: Carter Mary W. 
Published: August 2003

Objective. To examine variations in hospitalization rates among nursing home residents associated with discretionary hospitalization practices.Data Sources. Quarterly Medicaid case‐mix reimbursement data from the state of Massachusetts served as the core data source for this study, which was linked with data from the Medicare Provider Analysis and Review file (MEDPAR) to specify hospitalization status, nursing facility attribute data from the state of Massachusetts to specify facility‐level organizational and structural attributes, and data from the Area Resource File (ARF) to specify area market‐level attributes. Data spans three years (1991–1993) to produce a longitudinal analytical file containing 72,319 person‐quarter‐level observations.Study Design. Two‐step, multivariate logistic regression models were estimated for highly discretionary hospitalizations versus those containing less discretion, and low discretionary hospitalizations versus those containing greater amounts of physician discretion.Principal Findings. Findings indicate that facility case‐mix levels and area hospital bed supply levels contribute to variations in hospitalization rates among nursing home residents. Highly discretionary hospitalizations appear to be most sensitive to patient diagnoses best described as chronic, ambulatory care sensitive conditions.Conclusions. Findings suggest that defining hospitalizations simply in terms of whether an event occurs versus otherwise may obscure valuable information regarding the contribution of various risk factors to highly discretionary versus low discretionary hospitalization rates.