Karen J. Connell

A survey of exercise beliefs and exercise habits among people with arthritis

OBJECTIVEnTo explore a possible explanation for the problem of why few people exercise despite the positive health advantages, by examining the relationship between exercise beliefs and participation in exercise activities.nnnMETHODSnEighty-one respondents aged 27-80 were recruited from 3 Chicago-area health care facilities to complete the study survey; 68 (84%) did so. Participants were asked about their participation in 6 types of exercise activities; they also reported their beliefs concerning their ability to exercise (self-efficacy for exercise), barriers to exercise, benefits of exercise, and the impact of exercise on their arthritis.nnnRESULTSnStudy results indicate that belief in the benefits of exercise and self-efficacy for exercise are associated with participation in exercise activities. Also, severity of disease differentiated exercisers from non-exercisers.nnnCONCLUSIONSnResults suggest the importance of finding ways to strengthen belief in the benefits of exercise and self-efficacy for exercise in people with arthritis, particularly people with moderate to severe disease-related limitations.

Patient-Centered Care for Muslim Women: Provider and Patient Perspectives

OBJECTIVEnThe purpose of this study was twofold: (1) to address the gap in existing literature regarding provider perspectives about provision of high-quality, culturally appropriate, patient-centered care to Muslim women in the United States and (2) to explore congruence between provider and patient perceptions regarding barriers to and recommendations for providing such care.nnnMETHODSnUsing a cross-sectional study design, a written survey was administered to a convenience sample of healthcare providers (nu2009=u200980) and Muslim women (nu2009=u200927).nnnRESULTSnThere was considerable congruence among patients and providers regarding healthcare needs of Muslim women. A majority (83.3%) of responding providers reported encountering challenges while providing care to Muslim women. A majority (93.8%) of responding patients reported that their healthcare provider did not understand their religious or cultural needs. Providers and patients outlined similar barriers/challenges and recommendations. Key challenges included lack of providers understanding of patients religious and cultural beliefs; language-related patient-provider communication barriers; patients modesty needs; patients lack of understanding of disease processes and the healthcare system; patients lack of trust and suspicion about the healthcare system, including providers; and system-related barriers. Key recommendations included provider education about basic religious and cultural beliefs of Muslim patients, provider training regarding facilitation of a collaborative patient-provider relationship, addressing language-related communication barriers, and patient education about disease processes and preventive healthcare.nnnCONCLUSIONSnBoth providers and patients identify significant barriers to the provision of culturally appropriate care to Muslim women. Improving care would require a flexible and collaborative care model that respects and accommodates the needs of patients, provides opportunities for training providers and educating patients, and makes necessary adjustments in the healthcare system. The findings of this study can guide future research aimed at ensuring high-quality, culturally appropriate, patient-centered healthcare for Muslim women in the United States and other western countries.

Toward meaningful evaluation of clinical competence: the role of direct observation in clerkship ratings.

Problem Statement and Purpose. The lack of direct observation by faculty may affect meaningful judgments of clinical competence. The purpose of this study was to explore the influence of direct observation on reliability and validity evidence for family medicine clerkship ratings of clinical performance. Method. Preceptors rating family medicine clerks (n = 172) on a 16-item evaluation instrument noted the data-source for each rating: note review, case discussion, and/or direct observation. Mean data-source scores were computed and categorized as low, medium or high, with the high-score group including the most direct observation. Analyses examined the influence of data-source on interrater agreement and associations between clerkship clinical scores (CCS) and scores from the National Board of Medical Examiners (NBME®) subject examination as well as a fourth-year standardized patient-based clinical competence examination (M4CCE). Results. Interrater reliability increased as a function of data-source; for the low, medium, and high groups, intraclass correlation coefficients were .29, .50, and .74, respectively. For the high-score group, there were significant positive correlations between CCS and NBME score (r = .311, p = .054); and between CCS and M4CCE (r = .423, p = .009). Conclusion. Reliability and validity evidence for clinical competence is enhanced when more direct observation is included as a basis for clerkship ratings.

History-taking Behaviors Associated with Diagnostic Competence of Clerks: An Exploratory Study

The devel-opment of standardized patients (SPs) as an assessment tool hascompensated greatly for the lack of direct faculty observation andevaluation of student histories and physicals. However, a majorshortcoming of SP-based assessment is its propensity to reward datagathering, a skill that is not necessarily associated with good datainterpretation.

Healthy Steps for Young Children Program in Pediatric Residency Training: Impact on Primary Care Outcomes

OBJECTIVE. Incorporating Healthy Steps for Young Children into pediatric practice has been shown to have positive effects for children and families. Although this model of care has also been integrated into several pediatric and family medicine training programs, published reports to date have focused only on residents’ perceptions of their interactions with the model of care. In this study, we report the impact on primary care outcomes after integrating Healthy Steps for Young Children into residency training. METHODS. Continuity of care, longitudinal care in the practice, quality of primary care services, and rates of behavioral, developmental, and psychosocial diagnoses were measured for 3 cohorts: (1) Healthy Steps–enrolled children, (2) non–Healthy Steps–enrolled children who were followed at the same site of care, and (3) non–Healthy Steps–enrolled children who were receiving primary care at a similar residency training site within the same training program. All data were extracted from patient charts at the 2 practice sites. RESULTS. Continuity of care was significantly better for Healthy Steps–enrolled children compared with non–Healthy Steps–enrolled children at the Healthy Steps site for both total visits and health maintenance visits. Longitudinal care and quality of primary care services did not differ within or between sites. The rates of documentation of behavioral, developmental, or psychosocial diagnoses did not differ between Healthy Steps–enrolled and non–Healthy Steps–enrolled children at the Healthy Steps for Young Children site but were significantly different between the Healthy Steps and the non–Healthy Steps for Young Children sites; the effect was driven wholly by differences in psychosocial diagnoses. CONCLUSIONS. Multiple indices that measure health service outcomes suggest benefits of incorporating Healthy Steps for Young Children into pediatric residency training. Most important, continuity of care in residents’ practices significantly improved, as did the residents’ documentation of psychosocial issues in children.

A Method for Measuring Interrater Agreement on Checklists

A method for measuring interrater agreement on checklists is presented. This technique does not assign individual scores to raters, but computes a single agreement score from the concordance of their check mark configurations. An overall coefficient of agreement, called phi, is derived. The agreement coefficient that is expected by chance and the statistical significance of phi are determined by statistical simulation. Despite the dichotomous nature of the checklist agreement (raters either agree or disagree on items), we show that the binomial distribution does not provide a means for testing the statistical significance of phi. A medical education study is used to illustrate the phi methodology.