Richard T. Meenan

Surveying physicians: do components of the "Total Design Approach" to optimizing survey response rates apply to physicians?

Background. Surveys serve essential roles in clinical epidemiology and health services research. However, physician surveys frequently encounter problems achieving adequate response rates. Research on enhancing response rates to surveys of the general public has led to the development of Dillman’s “Total Design Approach“ to the design and conduct of surveys. The impact of this approach on response rates among physicians is uncertain. Objective. To determine the extent to which the components of the total design approach have been found to be effective in physician surveys. Design. A systematic review. Results. The effectiveness of prepaid financial incentives, special contacts, and personalization to enhance response rates in surveys of physicians have been confirmed by the existing research. There is suggestive evidence supporting the use of first class stamps on return envelopes and multiple contacts. The optimum amount for incentives and the number of contacts necessary have not been established. Details of questionnaire design and their impact on response rates have received almost no attention from researchers. Few studies have assessed the usefulness of combinations of components of the total design approach. Conclusions. Despite the number of surveys conducted among physicians, their cost, the level of interest in their findings, and in spite of inadequate response rates, there have been few randomized trials conducted on important aspects of enhancing response in this population. Until this gap has been filled, researchers conducting surveys of physicians should consider including all components of the total design approach whenever feasible.

Impact of direct-to-consumer advertising for hereditary breast cancer testing on genetic services at a managed care organization: a naturally-occurring experiment.

Purpose: To describe the impact of Myriad Genetics, Inc.s direct-to-consumer advertising (DTC-ad) campaign on cancer genetic services within two Managed Care Organizations, Kaiser Permanente Colorado (KPCO), Denver, Colorado, where the ad campaign occurred, and Henry Ford Health System (HFHS), Detroit, Michigan, where there were no advertisements.Methods: The main outcome measures were the changes in number and pretest mutation probability of referrals approved for cancer genetic services at KPCO and HFHS during the campaign versus the year prior, and mutation probability of those undergoing testing.Results: At KPCO, referrals increased 244% during the DTC-ad compared to the same time period a year earlier (P value < 0.001). The proportion of referrals at high pretest probability of a mutation (10% or greater) dropped from 69% the previous year to 48% during the campaign (P value < 0.001). There was no significant change in pretest mutation probability among women who underwent testing between the two time periods. HFHS reported no significant change between the two time periods for numbers or mutation probability of referrals, or for mutation probability of women tested.Conclusion: The DTC-ad caused significant increase in demand for cancer genetic services. In the face of potential future DTC-ad for inherited cancer risk, providers and payers need to consider the delivery of genetic services and genetic education for persons of all risk levels.

COST-EFFECTIVENESS OF A HOSPITAL-BASED SMOKING CESSATION INTERVENTION

OBJECTIVES This study evaluated the cost-effectiveness of a smoking cessation and relapse-prevention program for hospitalized adult smokers from the perspective of an implementing hospital. It is an economic analysis of a two-group, controlled clinical trial in two acute care hospitals owned by a large group-model health maintenance organization. The intervention included a 20-minute bedside counseling session with an experienced health counselor, a 12-minute video, self-help materials, and one or two follow-up calls. METHODS Outcome measures were incremental cost (above usual care) per quit attributable to the intervention and incremental cost per discounted life-year saved attributable to the intervention. RESULTS Cost of the research intervention was

Using risk-adjustment models to identify high-cost risks.

159 per smoker, and incremental cost per incremental quit was

Case-Control Study of Medical Comorbidities in Women With Interstitial Cystitis

3,697. Incremental cost per incremental discounted life-year saved ranged between

Cost-Effectiveness Analysis of Screening for KRAS and BRAF Mutations in Metastatic Colorectal Cancer

1,691 and

Prevalence and severity of undiagnosed urinary incontinence in women.

7,444, much less than most other routine medical procedures. Replication scenarios suggest that, with realistic implementation assumptions, total intervention costs would decline significantly and incremental cost per incremental discounted life-year saved would be reduced by more than 90%, to approximately

Work, Weight, and Wellness: the 3W Program: a worksite obesity prevention and intervention trial.

380. CONCLUSIONS Providing brief smoking cessation advice to hospitalized smokers is relatively inexpensive, cost-effective, and should become a part of the standard of inpatient care.

Costs of Interstitial Cystitis in a Managed Care Population

Background. We examine the ability of various publicly available risk models to identify high-cost individuals and enrollee groups using multi-HMO administrative data. Methods. Five risk-adjustment models (the Global Risk-Adjustment Model [GRAM], Diagnostic Cost Groups [DCGs], Adjusted Clinical Groups [ACGs], RxRisk, and Prior-expense) were estimated on a multi-HMO administrative data set of 1.5 million individual-level observations for 1995–1996. Models produced distributions of individual-level annual expense forecasts for comparison to actual values. Prespecified “high-cost” thresholds were set within each distribution. The area under the receiver operating characteristic curve (AUC) for “high-cost” prevalences of 1% and 0.5% was calculated, as was the proportion of “high-cost” dollars correctly identified. Results are based on a separate 106,000-observation validation dataset. Main Results. For “high-cost” prevalence targets of 1% and 0.5%, ACGs, DCGs, GRAM, and Prior-expense are very comparable in overall discrimination (AUCs, 0.83–0.86). Given a 0.5% prevalence target and a 0.5% prediction threshold, DCGs, GRAM, and Prior-expense captured

Systems of Support to Increase Colorectal Cancer Screening and Follow-up Rates (SOS): design, challenges, and baseline characteristics of trial participants

963,000 (approximately 3%) more “high-cost” sample dollars than other models. DCGs captured the most “high-cost” dollars among enrollees with asthma, diabetes, and depression; predictive performance among demographic groups (Medicaid members, members over 64, and children under 13) varied across models. Conclusions. Risk models can efficiently identify enrollees who are likely to generate future high costs and who could benefit from case management. The dollar value of improved prediction performance of the most accurate risk models should be meaningful to decision-makers and encourage their broader use for identifying high costs.