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Dive into the research topics where Rita Mangione-Smith is active.

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Featured researches published by Rita Mangione-Smith.


Medical Care | 2005

The PedsQL: reliability and validity of the short-form generic core scales and Asthma Module.

Kitty S. Chan; Rita Mangione-Smith; Tasha M. Burwinkle; Mayde Rosen; James W. Varni

Objective:We sought to assess the reliability and validity of the PedsQL™ 4.0 SF15, a shortened version of the 23-item PedsQL™ 4.0 Generic Core Scales, which is a pediatric health-related quality of life (HRQoL) instrument, and the PedsQL™ 3.0 SF22 Asthma Module, a short-form of the PedsQL™ 3.0 Asthma Module. Methods:The PedsQL™ 4.0 SF15 and the PedsQL™ 3.0 SF22 Asthma Module were administered by telephone to 125 adolescents (aged 12–18) and 338 parents of children with asthma (aged 2–11). Healthy (n = 451) and chronically ill (n = 422) children, matched by age, respondent status, and ethnicity to the asthma sample, provided data for selected validity tests. Results:The Total Score from the PedsQL™ 4.0 SF15 and the Asthma Symptoms scale and Treatment Problems scale from the PedsQL™ 3.0 SF22 Asthma Module were sufficiently reliable for group comparisons (alpha ≥ 0.70 across all age groups) in the asthma sample. The PedsQL™ 4.0 SF15 and the PedsQL™ 3.0 SF22 Asthma Module were able to distinguish between children of different clinical status and correlated as expected with measures of productivity and family functioning in the asthma sample. The psychometric properties of the PedsQL™ 4.0 SF15 were generally comparable to those of the original instrument. Conclusion:The Total Score of the PedsQL™ 4.0 SF15 and the Asthma Symptoms scale of the PedsQL™ 3.0 SF22 Asthma Module demonstrated the best reliability and validity and should be suitable for group-level comparisons of generic and asthma-specific HRQoL in clinical research studies of children with asthma.


Pediatrics | 2013

The Architecture of Provider-Parent Vaccine Discussions at Health Supervision Visits

Douglas J. Opel; James A. Taylor; Rita Mangione-Smith; Halle Showalter Salas; Victoria DeVere; Chuan Zhou; Jeffrey D. Robinson

OBJECTIVE: To characterize provider-parent vaccine communication and determine the influence of specific provider communication practices on parent resistance to vaccine recommendations. METHODS: We conducted a cross-sectional observational study in which we videotaped provider-parent vaccine discussions during health supervision visits. Parents of children aged 1 to 19 months old were screened by using the Parent Attitudes about Childhood Vaccines survey. We oversampled vaccine-hesitant parents (VHPs), defined as a score ≥50. We developed a coding scheme of 15 communication practices and applied it to all visits. We used multivariate logistic regression to explore the association between provider communication practices and parent resistance to vaccines, controlling for parental hesitancy status and demographic and visit characteristics. RESULTS: We analyzed 111 vaccine discussions involving 16 providers from 9 practices; 50% included VHPs. Most providers (74%) initiated vaccine recommendations with presumptive (eg, “Well, we have to do some shots”) rather than participatory (eg, “What do you want to do about shots?”) formats. Among parents who voiced resistance to provider initiation (41%), significantly more were VHPs than non-VHPs. Parents had significantly higher odds of resisting vaccine recommendations if the provider used a participatory rather than a presumptive initiation format (adjusted odds ratio: 17.5; 95% confidence interval: 1.2–253.5). When parents resisted, 50% of providers pursued their original recommendations (eg, “He really needs these shots”), and 47% of initially resistant parents subsequently accepted recommendations when they did. CONCLUSIONS: How providers initiate and pursue vaccine recommendations is associated with parental vaccine acceptance.


The Journal of Allergy and Clinical Immunology | 2012

Asthma outcomes: composite scores of asthma control.

Michelle M. Cloutier; Michael Schatz; Mario Castro; Noreen M. Clark; H. William Kelly; Rita Mangione-Smith; James R. Sheller; Christine A. Sorkness; Stuart W. Stoloff; Peter J. Gergen

BACKGROUND Current asthma guidelines recommend assessing the level of a patients asthma control. Consequently, there is increasing use of asthma control as an outcome measure in clinical research studies. Several composite assessment instruments have been developed to measure asthma control. OBJECTIVE National Institutes of Health institutes and federal agencies convened an expert group to propose the most appropriate standardized composite score of asthma control instruments to be used in future asthma studies. METHODS We conducted a comprehensive search of PubMed using both the National Library of Medicines Medical Subject Headings and key terms to identify studies that attempted to develop and/or test composite score instruments for asthma control. We classified instruments as core (required in future studies), supplemental (used according to study aims and standardized), or emerging (requiring validation and standardization). This work was discussed at a National Institutes of Health-organized workshop convened in March 2010 and finalized in September 2011. RESULTS We identified 17 composite score instruments with published validation information; all had comparable content. Eight instruments demonstrated responsiveness over time; 3 demonstrated responsiveness to treatment. A minimal clinically important difference has been established for 3 instruments. The instruments have demographic limitations; some are proprietary, and their use could be limited by cost. CONCLUSION Two asthma composite score instruments are sufficiently validated for use in adult populations, but additional research is necessary to validate their use in nonwhite populations. Gaps also exist in validating instruments for pediatric populations.


Pediatrics | 2014

Pediatric Medical Complexity Algorithm: A New Method to Stratify Children by Medical Complexity

Tamara D. Simon; Mary Lawrence Cawthon; Susan Stanford; Jean Popalisky; Dorothy Lyons; Peter Woodcox; Margaret Hood; Alex Y. Chen; Rita Mangione-Smith

OBJECTIVES: The goal of this study was to develop an algorithm based on International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM), codes for classifying children with chronic disease (CD) according to level of medical complexity and to assess the algorithm’s sensitivity and specificity. METHODS: A retrospective observational study was conducted among 700 children insured by Washington State Medicaid with ≥1 Seattle Children’s Hospital emergency department and/or inpatient encounter in 2010. The gold standard population included 350 children with complex chronic disease (C-CD), 100 with noncomplex chronic disease (NC-CD), and 250 without CD. An existing ICD-9-CM–based algorithm called the Chronic Disability Payment System was modified to develop a new algorithm called the Pediatric Medical Complexity Algorithm (PMCA). The sensitivity and specificity of PMCA were assessed. RESULTS: Using hospital discharge data, PMCA’s sensitivity for correctly classifying children was 84% for C-CD, 41% for NC-CD, and 96% for those without CD. Using Medicaid claims data, PMCA’s sensitivity was 89% for C-CD, 45% for NC-CD, and 80% for those without CD. Specificity was 90% to 92% in hospital discharge data and 85% to 91% in Medicaid claims data for all 3 groups. CONCLUSIONS: PMCA identified children with C-CD (who have accessed tertiary hospital care) with good sensitivity and good to excellent specificity when applied to hospital discharge or Medicaid claims data. PMCA may be useful for targeting resources such as care coordination to children with C-CD.


Academic Pediatrics | 2009

Off-Label Prescribing to Children in the United States Outpatient Setting

Alicia Bazzano; Rita Mangione-Smith; Matthias Schonlau; Marika J Suttorp; Robert H. Brook

OBJECTIVE The aim of this study was to determine the frequency of off-label prescribing to children at United States outpatient visits and to determine how drug class, patient age, and physician specialty relate to off-label prescribing. METHODS Data from the 2001 through 2004 National Ambulatory Medical Care Surveys (NAMCS) consisted of a sample of 7901 outpatient visits by children aged 0 through 17 years in which prescriptions were given, representative of an estimated 312 million visits. We compared FDA-approved age and indication to the childs age and diagnoses. We used multivariate logistic regression to determine adjusted differences in probabilities of off-label prescribing. RESULTS Sixty-two percent of outpatient pediatric visits included off-label prescribing. Approximately 96% of cardiovascular-renal, 86% of pain, 80% of gastrointestinal, and 67% of pulmonary and dermatologic medication prescriptions were off label. Visits by children aged <6 years had a higher probability of off-label prescribing (P < .01), especially visits by children aged <1 year (74% adjusted probability). Visits to specialists also involved a significantly increased probability (68% vs 59% for general pediatricians, P < .01) of off-label prescribing. CONCLUSIONS Despite recent studies and labeling changes of pediatric medications, the majority of pediatric outpatient visits involve off-label prescribing across all medication categories. Off-label prescribing is more frequent for younger children and those receiving care from specialist pediatricians. Increased dissemination of pediatric studies and label information may be helpful to guide clinical practice. Further research should be prioritized for the medications most commonly prescribed off label and to determine outcomes, causes, and appropriateness of off-label prescribing to children.


Vaccine | 2011

Validity and reliability of a survey to identify vaccine-hesitant parents.

Douglas J. Opel; James A. Taylor; Rita Mangione-Smith; Cam Solomon; Chuan Zhao; Sheryl L. Catz; Diane P. Martin

OBJECTIVE To assess the construct validity and reliability of the Parent Attitudes about Childhood Vaccines survey. STUDY DESIGN Cross-sectional survey of parents of 19-35 month old children in a closed model HMO. We used factor analysis to confirm survey sub-domains and Cronbachs α to determine the internal consistency reliability of sub-domain scales. Construct validity was assessed by linking parental responses to their childs immunization record. RESULTS Our response rate was 46% (N=230). Factor analysis identified 3 factors that explained 70% of the total variance for the 18 survey items. We deleted 3 items that failed to load highly (>.4) on an identified factor, correlated poorly with other items, or had a hesitant response that was not associated with increased under-immunization. Cronbachs α coefficients for the 3 sub-domain scales created by grouping the remaining 15 items were .74, .84, and .74, respectively. Children of parents with survey scores of 50-79 had 14% more days under-immunized from birth to 19 months (95% CI: 8.0, 20.5) than those with parents who scored <50. Scores of ≥ 80 were associated with 51% more days under-immunized (95% CI: 38.2, 63.4). CONCLUSION The revised survey is a valid and reliable instrument to identify vaccine-hesitant parents.


Human Vaccines | 2011

Development of a survey to identify vaccine-hesitant parents: the parent attitudes about childhood vaccines survey.

Douglas J. Opel; Rita Mangione-Smith; James A. Taylor; Carolyn Korfiatis; Cheryl Wiese; Sheryl L. Catz; Diane P. Martin

Objective: To develop a survey to accurately assess parental vaccine hesitancy. Results: The initial survey contained 17 items in four content domains: (1) immunization behavior; (2) beliefs about vaccine safety and efficacy; (3) attitudes about vaccine mandates and exemptions; and (4) trust. Focus group data yielded an additional 10 survey items. Expert review of the survey resulted in the deletion of nine of 27 items and revisions to 11 of the remaining 18 survey items. Parent pretesting resulted in the deletion of one item, the addition of one item, the revision of four items, and formatting changes to enhance usability. The final survey contains 18 items in the original four content domains. Methods: An iterative process was used to develop the survey. First, we reviewed previous studies and surveys on parental health beliefs regarding vaccination to develop content domains and draft initial survey items. Focus groups of parents and pediatricians generated additional themes and survey items. Six immunization experts reviewed the items in the resulting draft survey and ranked them on a 1–5 scale for significance in identifying vaccine-hesitant parents (5 indicative of a highly significant item). The lowest third of ranked items were dropped. The revised survey was pretested with 25 parents to assess face validity, usability and item understandability. Conclusions: The Parent Attitudes about Childhood Vaccines survey was constructed using qualitative methodology to identify vaccine-hesitant parents and has content and face validity. Further psychometric testing is needed.


Annals of Family Medicine | 2005

Evaluation of a Quality Improvement Collaborative in Asthma Care: Does it Improve Processes and Outcomes of Care?

Matthias Schonlau; Rita Mangione-Smith; Kitty S. Chan; Joan Keesey; Mayde Rosen; Thomas A. Louis; Shinyi Wu; Emmett B. Keeler

PURPOSE We wanted to examine whether a collaborative to improve asthma care influences process and outcomes of care in asthmatic adults. METHOD We undertook a preintervention-postintervention evaluation of 185 patients in 6 intervention clinics and 3 matched control sites that participated in the Institute for Healthcare Improvement Breakthrough Series (BTS) Collaborative for asthma care. The intervention consisted of 3, 2-day educational sessions for teams dispatched by participating sites, which were followed by 3 action periods during the course of a year. RESULTS Overall process of asthma care improved significantly in the intervention compared with the control group (change of 10% vs 1%, P = .003). Patients in the intervention group were more likely to attend educational sessions (20% vs 5%, P = .03). Having a written action plan, setting goals, monitoring peak flow rates, and using long-term asthma medications increased between 2% and 19% (not significant), but asthma-related knowledge was unchanged for the 2 groups. Patients in the BTS Collaborative were significantly more likely to be satisfied with clinician and lay educator communication (62% vs 39%, P = .02). Health-related quality of life, asthma-specific quality of life, number of bed days caused by asthma-related illness, and acute care service use were not significantly different between the 2 groups. CONCLUSIONS The intervention was associated with improved process-of-care measures that have been linked with better outcomes. Patients benefited through increased satisfaction with communication. Follow-up of patients who participated in the intervention may have been too brief to be able to detect significant improvement in health-related outcomes.


Sexually Transmitted Diseases | 1999

Health and cost-benefits of chlamydia screening in young women.

Rita Mangione-Smith; June O'Leary; Elizabeth A. McGlynn

BACKGROUND The Health Plan Employer Data and Information Set (HEDIS) is a set of performance measures used to assess the quality of care delivered in managed care plans. New measures that address unevaluated areas of care are continuously being developed. Chlamydia screening among young women is one new measure that was recently adopted by the National Committee for Quality Assurance (NCQA) for inclusion in HEDIS. An essential criterion for new measures is that the clinical intervention is beneficial to health and cost-effective. GOAL To assess the health benefits and cost-effectiveness of chlamydia screening among young women. STUDY DESIGN A focused review of the literature was performed using Medline. Articles addressing the epidemiology of chlamydia infection, its health consequences, and the benefits, problems, and cost-effectiveness associated with chlamydia screening are reviewed. RESULTS The literature reviewed shows scientific and cost-effectiveness data that support the adoption of the HEDIS measure for chlamydia screening among young women. CONCLUSION The National Committee for Quality Assurances recent adoption of the measure for chlamydia screening among young women into the formal HEDIS measurement set is justifiable from a health benefit standpoint and from a cost-effectiveness standpoint.


JAMA Pediatrics | 2013

The Relationship Between Parent Attitudes About Childhood Vaccines Survey Scores and Future Child Immunization Status: A Validation Study

Douglas J. Opel; James A. Taylor; Chuan Zhou; Sheryl L. Catz; Mon Myaing; Rita Mangione-Smith

IMPORTANCE Acceptance of childhood vaccinations is waning, amplifying interest in developing and testing interventions that address parental barriers to immunization acceptance. OBJECTIVE To determine the predictive validity and test-retest reliability of the Parent Attitudes About Childhood Vaccines survey (PACV), a recently developed measure of vaccine hesitancy. DESIGN, SETTING, AND PARTICIPANTS Prospective cohort of English-speaking parents of children aged 2 months and born from July 10 through December 10, 2010, who belonged to an integrated health care delivery system based in Seattle and who returned a completed baseline PACV. Parents who completed a follow-up survey 8 weeks later were included in the reliability analysis. Parents who remained continuous members in the delivery system until their child was 19 months old were included in the validity analysis. EXPOSURE The PACV, scored on a scale of 0 to 100 (100 indicates high vaccine hesitancy). MAIN OUTCOMES AND MEASURES Childs immunization status as measured by the percentage of days underimmunized from birth to 19 months of age. RESULTS Four hundred thirty-seven parents completed the baseline PACV (response rate, 50.5%), and 220 (66.5%) completed the follow-up survey. Of the 437 parents who completed a baseline survey, 310 (70.9%) maintained continuous enrollment. Compared with parents who scored less than 50, parents who scored 50 to 69 on the survey had children who were underimmunized for 8.3% (95% CI, 3.6%-12.8%) more days from birth to 19 months of age; those who scored 70 to 100, 46.8% (40.3%-53.3%) more days. Baseline and 8-week follow-up PACV scores were highly concordant (ρ = 0.844). CONCLUSIONS AND RELEVANCE Scores on the PACV predict childhood immunization status and have high reliability. Our results should be validated in different geographic and demographic samples of parents.

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Chuan Zhou

University of Washington

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Arti D. Desai

University of Washington

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K. Casey Lion

University of Washington

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Maria T. Britto

Cincinnati Children's Hospital Medical Center

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Cam Solomon

Boston Children's Hospital

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