Betsy L. Thompson

Handwashing and glove use in a long-term-care facility.

OBJECTIVES To determine glove use and handwashing practices, the factors associated with infection control practices, and the frequency of potential microbial transmission in a long-term-care facility (LTCF). DESIGN Observational study of 230 staff-resident interactions in an LTCF. We recorded resident characteristics, type of activity, staff credentials, and movements of the staff members hands, then used the LTCFs guidelines to judge appropriateness of glove use and handwashing. SETTING 255-bed, university-based LTCF in Baltimore, Maryland. PARTICIPANTS A systematic sample of staff-resident interactions. RESULTS Gloves were worn in 139 (82%) of 170 interactions when indicated, but changed appropriately in only 1 (16%) of 132. Hands were washed when needed before an interaction in 27%, during an interaction in 0%, and after an interaction in 63%. Gloves were less likely to be used when caring for residents with gastrostomy tubes compared with other residents (relative risk, 0.85; 95% confidence interval, 0.73-0.98). Guidelines were followed more frequently during wound care than during other activities. Microbial transmission potentially could have occurred in 158 (82%) of 193 evaluable interactions. CONCLUSIONS We documented marked deficiencies in glove and handwashing, demonstrated the possible impact of these deficiencies, and identified factors associated with inadequate handwashing and glove use. This information can be used in future educational and research efforts to improve infection control practices.

Tracking clinical preventive service use: a comparison of the health plan employer data and information set with the behavioral risk factor surveillance system.

BACKGROUND There is a need for meaningful and accurate ways of tracking preventive service delivery among different sectors of the US population. OBJECTIVES To compare methodologies of and clinical preventive service use estimates obtained from 2 data sets: the Health Plan Employer Data and Information Set (HEDIS 3.0) and the Behavioral Risk Factor Surveillance System (BRFSS). METHODS HEDIS used a combination of mailed-survey, administrative, and medical-record data to measure preventive service use among commercial enrollees of 320 HMOs in 42 states during 1996. BRFSS data are from insured respondents (excluding those reporting Medicare or Medicaid coverage) to a random-digit-dialed telephone survey conducted in the same 42 states during 1996. RESULTS The median state-specific mammography, Papanicolaou smear, and retinal examination rates reported by HEDIS were consistently and substantially lower than those reported by BRFSS. For mammography, the median HEDIS rate was 72.4%, compared with 81.1% for BRFSS. For Papanicolaou smear and retinal examinations, HEDIS rates were 72.7% and 40.8%, respectively, compared with 91.2% and 61.6% for BRFSS. The median state rates of advice to quit smoking reported by HEDIS were similar to those for BRFSS: 62.1% versus 62.2%, respectively. For each measure, the absolute difference between HEDIS and BRFSS rates varied substantially both within a state and between states. CONCLUSIONS It does not appear that the BRFSS and HEDIS data can be compared directly to accurately track progress toward national preventive health objectives. This study highlights some of the problems with comparing these data and possible means for addressing the discrepancies.

Assessment of Health Risk Behaviors A Tool to Inform Consumers, Providers, Health Care Organizations, and Purchasers

INTRODUCTION Tobacco use, diet and physical activity patterns, and alcohol use are the leading causes of death in the United States. To make major improvements in the health status of the population, behavioral risk factors for disease must be addressed. METHODS We propose a brief survey of behavioral risk factors for enrollees of health care organizations, employer groups, or other adult populations that can be used to profile the health risk behaviors of a population, assess performance of prevention and risk reduction programs, or make comparisons with other populations. The survey contains questions about tobacco, diet, physical activity, alcohol, firearms, motor vehicle safety, sexual behavior, and drugs. RESULTS Recommendations for survey items, implementation, and calculation of performance measures are given. CONCLUSIONS Widespread adoption of this type of survey would be a major step forward in acknowledging the impact that behavior has on health and in furthering individual and organizational accountability for improving health risk behaviors.

Is naturopathy as effective as conventional therapy for treatment of menopausal symptoms

BACKGROUND Although the use of alternative medicine in the United States is increasing, no published studies have documented the effectiveness of naturopathy for treatment of menopausal symptoms compared to women receiving conventional therapy in the clinical setting. OBJECTIVE To compare naturopathic therapy with conventional medical therapy for treatment of selected menopausal symptoms. DESIGN A retrospective cohort study, using abstracted data from medical charts. SETTING One natural medicine and six conventional medical clinics at Community Health Centers of King County, Washington, from November 1, 1996, through July 31, 1998. PATIENTS Women aged 40 years of age or more with a diagnosis of menopausal symptoms documented by a naturopathic or conventional physician. MAIN OUTCOME MEASURES Improvement in selected menopausal symptoms. RESULTS In univariate analyses, patients treated with naturopathy for menopausal symptoms reported higher monthly incomes (

Performance measures: are we measuring what matters?

1848.00 versus

Congenital syphilis in Maryland, 1989-1991: the effect of changing the case definition and opportunities for prevention.

853.60), were less likely to be smokers (11.4% versus 41.9%), exercised more frequently, and reported higher frequencies of decreased energy (41.8% versus 24.4%), insomnia (57.0% versus 33.1%), and hot flashes (69.6% versus 55.6%) at baseline than those who received conventional treatment. In multivariate analyses, patients treated with naturopathy were approximately seven times more likely than conventionally treated patients to report improvement for insomnia (odds ratio [OR], 6.77; 95% confidence interval [CI], 1.71, 26.63) and decreased energy (OR, 6.55; 95% CI, 0.96, 44.74). Naturopathy patients reported improvement for anxiety (OR, 1.27; 95% CI, 0.63, 2.56), hot flashes (OR, 1.40; 95% CI, 0.68, 2.88), menstrual changes (OR, 0.98; 95% CI, 0.43, 2.24), and vaginal dryness (OR, 0.91; 95% CI, 0.21, 3.96) about as frequently as patients who were treated conventionally. CONCLUSIONS Naturopathy appears to be an effective alternative for relief of specific menopausal symptoms compared to conventional therapy.

Cost-Benefit Analysis of a New HEDIS Performance Measure for Pneumococcal Vaccination

BACKGROUND The ultimate intent of healthcare performance measures is to improve health status by stimulating improvements to healthcare quality. This report evaluates how well current performance measurement sets address the leading causes of illness and death in the United States, using the Health Plan Employer Data and Information Set (HEDIS) as an example. METHODS We assessed whether HEDIS measures exist for the leading causes of illness and death according to five commonly used indices: physiologic cause of death, underlying cause of death, disability-adjusted life years, healthcare expenditures, and missed work days. RESULTS Fewer than one half of the leading causes of morbidity and mortality are addressed by current measures. CONCLUSIONS The opportunities for using accurate and meaningful measurement for disease prevention and health promotion are substantial, yet this potential remains only partly realized and depends on further expansion of performance measurement efforts.

Cost as a Barrier to Medical Care in Relation to Unemployment Rates

Background The reported incidence of congenital syphilis in the United States rose dramatically during the 1980s. Although lack of prenatal care has been associated with congenital syphilis, little has been published regarding missed opportunities for prenatal intervention. Goal of this Study To determine whether congenital syphilis increases in Maryland between 1989 and 1991 resulted from a true increase in congenital syphilis incidence or a change in the surveillance case definition, and to describe missed opportunities for prenatal intervention. Study Design This was a retrospective cohort study. Results When the revised case definition was used, a 473% increase in the number of cases was seen. Among infants who met the revised definition, 45% of mothers had received no prenatal care. Among those whose mothers had received prenatal care, opportunities to intervene were missed for 53%. Conclusions Although a true increase in congenital syphilis incidence occurred before 1990, the increase reported in Maryland between 1989 and 1991 was primarily due to the change in case definition. Many cases of congenital syphilis could have been prevented with early and adequate prenatal care.

Association between health insurance coverage of office visit and cancer screening among women.

Objectives Measurement of the quality of care provided by managed care organizations (MCOs) has achieved national prominence, though there is controversy regarding its value. This article assesses the economic implications of a new Health Plan Employer Data and Information Set (HEDIS®) measure for pneumococcal vaccination. Methods A Markov decision model, with Monte Carlo simulations, was utilized to conduct a cost-benefit analysis of annual HEDIS-associated interventions, which were repeated for 5 consecutive years, in an average Medicare MCO, using a societal perspective and a 3% annual discount rate. Results Compared with the status quo, the HEDIS intervention will be cost saving 99.8% of the time, with an average net savings of

Monitoring System Change: a New Need for an Old Tool

3.80 per enrollee (95% probability interval: