Shu-Pi C. Chen

Reliability of three lumbar sagittal motion measurement methods: surface inclinometers.

Three surface methods for measuring lumbar sagittal motion (LSM) were tested for reliability. The three methods used were the Pleurimeter V double inclinometer, the carpenter double inclinometer, and the computerized single sensor inclinometer. In this study, 30 volunteers were examined independently by three occupational health professionals. Each volunteer rotated twice through three stations at which LSM was measured by each of the three methods. The intra- and interexaminer reliabilities in identifying the skin levels of T12 and S1 were acceptable, having intraclass correlation coefficients (ICC) greater than or equal to 0.75. With a single exception, all ICC values for the intraexaminer reliability of LSM measurements fell below 0.90 (a clinically desirable level). The interexaminer reliability was poor, with all ICC values below 0.75. The largest source of measurement error was attributable to the examiner and its associated factors. We concluded that the intra- and interexaminer reliabilities varied greatly, limiting the clinical usefulness of the three surface methods.

Health Problems Encountered by Nurse Practitioners and Physicians

The effects of specialty, setting, and provider group on the distributions of health problems managed by nurse practitioners and physicians in obstetric-gynecology, adult medicine, pediatrics, and family practice specialties are studied. Proportional samples by clinic were drawn from a total of 39,243 patient visits made to 16 ambulatory care clinics during an 18-week period. A Patient Encounter Form was used as the instrument and the ICD-9-CM was used as the coding system. Distributions of health problems differed between nurse practitioners and physicians in each clinic. Specialty affected the distributions of health problems managed by both provider groups. Setting affected the distributions of health problems for all specialties except the distributions of health problems not related to diseases or injuries (V codes) in family practice. Provider group effects were inconclusive. Community-based settings seem especially appropriate for nurse practitioner practice.

Health Problems Encountered by Pediatric Nurse Practitioners and Pediatricians in Ambulatory Care Clinics

This study documents the health problems managed by pediatric nurse practitioners (PNPs) and pediatricians and examines the effects of setting and provider group on the distribution of health problems. Proportional samples by clinic were selected from a total of 11,968 patient visits to five ambulatory care clinics during an 18-week period in 1978. A patient encounter form was devised and the ICD-9-CM was used as the coding system. Results indicated 1) distributions of health problems differed significantly between the PNPs and the pediatricians in each clinic; 2) setting significantly effected the distributions of both types of health problems; and 3) provider group significantly affected the distribution of health problems with V codes but not frequently reported problems given a setting. The PNPs caseloads differ from pediatrician caseloads in diagnostic categories and wellness emphases. Community-based settings seem to be especially appropriate for nurse practitioner practice.

Reliability of Graduate Nursing Students in Coding Health Problems By Use of ICDA

Coding is a means for handling a large data set for planning and evaluation of health programs (Last & White 1969). Although some codings are done by automated machines, people are involved in establishing systems forthe automated coding. High school graduates, medical record personnel, nurses, physicians, and others serve as coders. The International Classification of Diseases (ICD; WHO 1977) or the International Classification of Diseases Adapted for Use in the United States (ICDA; U.S. D.H.E.W. 1972) have been used as coding systems. The reliability of the various coders is largely unknown. Since the ICD and ICDA systems are evolved from studies in disease classification, some knowledge of the disease classification is necessary to use the systems accurately. Graduate nursing students are believed to possess the knowledge of disease classification. Determining the reliability of graduate nursing students in coding health problems will provide information for using various categories of coders. The appropriate use of coders will, in turn, increase the quality of a large data set. The purpose of this study was to determine the interand intra-coder reliability of graduate nursing students by use of ICDA.

Health problems encountered by nurse-practitioners and physicians in obstetric-gynecologic ambulatory care clinics☆

This study documents the distribution of health problems managed by obstetric-gynecologic nurse-practitioners (OB-GYN NPs) and obstetrician-gynecologists in community-based ambulatory care settings, and examines the effects of provider group on the distribution of health problems. A proportional sampling technique was used in selecting a sample of 3,873 visits for analysis from a total of 5,889 patient visits made to three community-based clinics during an 18-week period from February to June, 1978. A Patient Encounter Form was devised to record basic encounter data and the health problems managed by providers. The International Classification of Diseases, 9th revision (ICD-9-CM) was used as the coding system. Results indicated: (1) in each clinic, the distribution of health problems based on the three-digit headings of ICD-9-CM differed significantly between the OB-GYN NPs and the obstetrician-gynecologists; (2) the distributions of frequently reported health problems were clinically similar for OB-GYN NPs and obstetrician-gynecologists; and (3) the distributions of health problems with V codes were clinically similar for the two provider groups. Data indicate the OB-GYN NP caseloads are similar to those of obstetrician-gynecologists in frequently managed health problems and in wellness emphases. Nurse-practitioners are appropriate collaborators with obstetrician-gynecologists in the provision of primary health care for women.