Browsing by Subject "Outcome Assessment (Health Care)"
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Item Ability of the Pain Disability Questionnaire in Predicting Healthcare Utilization(2014-09-01) Rankin, McKenna Blair; Gatchel, Robert J.; Noe, Carl; Robinson, Richard C.BACKGROUND: Chronic pain is one of the most expensive and prevalent healthcare problems in the United States. It affects not only the individual but also society as a whole. The Biopsychosocial Model of chronic pain is the standard model for understanding and treating the pain experience. As such, it is important to have accurate ways of predicting healthcare outcomes for the chronic pain population. Prior research has evaluated the predictive abilities of health outcome measures and healthcare utilization. However, only one study to our knowledge has evaluated the Pain Disability Questionnaire’s (PDQ) ability to predict healthcare utilization. SUBJECTS: The current study consisted of 50 [Mage = 54.76 (12.41) years] adult patients diagnosed with chronic pain who completed an interdisciplinary treatment program at the Eugene McDermott Center for Pain Management. METHOD: The PDQ was administered at baseline and total health care cost was obtained at three-month follow-up. Participants were placed in either the high or low health care cost group depending on how they compared to a national average estimate for chronic pain patients. Logistic and linear regression modeling, as well as receiver operator characteristic analyses were used to evaluate the predictive ability of the PDQ in determining healthcare utilization cost at a three-month follow-up time point. RESULTS: The logistic regression analysis indicated the PDQ accurately placed participants in the respective high or low healthcare cost group [X2 (1) = 10.67, p < .001]. Receiver operator characteristic analysis yielded an area under the curve of .76. A PDQ cutoff score of 96 produced the optimal sensitivity (.70) and specificity (.67) for determining whether patients fall in the high or low healthcare cost group. The linear regression established that PDQ scores at baseline statistically significantly predicted total healthcare utilization at three months following the end of their treatment program, where higher PDQ scores were related to higher healthcare cost [F (1, 48) = 11.41, p = .001]. DISCUSSION: These findings offer support for the use of the PDQ in predicting healthcare cost. Use of the PDQ in this context may help clinicians, caregivers, and patients in planning the cost of the chronic pain sufferers’ treatment. Knowing what to expect financially could help increase the patient’s quality of life.Item Association Between Health-Related Perceptions and Treatment Outcomes in an Interdisciplinary Pain Management Program(2014-12-22) Mader, Megan Denise; Gatchel, Robert J.; Robinson, Richard C.; Noe, CarlBACKGROUND: Adherence to treatment recommendations, specifically chronic pain treatment, is a particular area of importance in the elderly. It has been suggested that patient beliefs/perceptions play a role in treatment outcome, and the current study seeks to further explore this relationship in order to determine the extent to which health-related beliefs and perceptions effect treatment outcome. SUBJECTS: The study consisted of a total of 103 patients, ages 20-82, who were treated at the Eugene McDermott Center for Pain Management at University of Texas Southwestern Medical Center over the past two years. METHOD: Initial and discharge responses to Computerized Adaptive Testing (CAT) items were collected. Select measures, such as the PMQ (Pain Medication Questionnaire), BIPQ (Brief Illness Perception Questionnaire), PROMIS Global Health, Composite Pain Rating, and other PROMIS measures were analyzed via SPSS. RESULTS: Strong correlations were found between Global Health and outcomes, specifically initial Global Health and initial outcome responses. Strong correlations were also found between initial BIPQ and initial outcome measure scores. DISCUSSION: The results supported the hypotheses and showed that as health-related perceptions change, outcome measures can also change accordingly with the progression of treatment.Item Attachment Style, Depression, and Health Outcomes among Antepartum Patients(2015-07-14) Enander, Richard Anthony; Robinson, Richard C.; Evans, Harry M.; Frank, Blake; Bernstein, Ira; Stringer, Claude A.Clear evidence of the impact of psychosocial factors on healthcare utilization continues to grow. An individual's attachment style is hypothesized to be one such important psychosocial factor related to healthcare utilization. Women with high-risk pregnancies treated in antepartum units have been shown to experience higher levels of stress than the general population, which has been hypothesized to activate adaptive and maladaptive patterns of interpersonal relationships. Therefore, the present study investigated the relationship among attachment style, stress, depression, and healthcare utilization in a sample of women with high-risk pregnancies. Stress and depressive symptoms were hypothesized to serve as moderating variables between patients' attachment styles and their healthcare utilization. To the author's knowledge, this was the first study to examine the role of stress in this manner. One hundred seventeen participants from the antepartum unit of Baylor University Medical Center were enrolled. Participants were administered a demographic questionnaire, the Edinburgh Postpartum Depression Scale, the Experiences in Close Relationships Scale - Short Form, the Attachment Style Questionnaire, the Crowne-Marlowe Social Desirability Scale, and the Perceived Stress Scale. Healthcare utilization data was then collected from participants' electronic medical records. Regression analyses determined that while an insecure attachment style was associated with increased depressive symptoms, the strongest association with depressive symptomatology was subjective stress levels (b = .813, t = 11.54, p < .001). Thus, while the moderator analysis was significant overall, stress was most closely associated with depressive symptoms. With regard to healthcare utilization, a MANOVA revealed no association between attachment style and healthcare utilization, although it did reveal that stress scores were significantly associated with emergency room visits in the past twelve months (F(1, 103) = 11.48, p < .001, partial η2 = .093) as well as with pain scores (F(1, 103) = 5.19, p = .025, partial η2 = .044). Thus, although attachment style is related to depression, stress was found to be more strongly associated with depression and several healthcare variables. Further research is warranted to examine the role that attachment style may play in depressive symptoms and healthcare utilization.Item Embracing electronic tools to improve patient outcomes(2017-08-18) Beg, MuhammadItem Neurosurgery in Resource-Poor Settings: Improving Access to Surgical Education and Outcomes Analysis of Spine Surgery in a Training Hospital in Cambodia(2019-03-26) Still, Megan Elizabeth Hermann; Bagley, Carlos; Patel, Toral; Lega, Bradley C.BACKGROUND: Access to basic surgical care, and neurosurgery in particular, has historically been a neglected topic in the global health sphere. However, up to 30% of the global burden of disease is surgical in nature and great strides have been made in the past few years to spotlight and begin to rectify the huge gap in access to safe, timely, and affordable surgical care around the globe. Spine pathology is a common reason for admission to neurosurgical units in low- and middle- income countries (LMICs) and can have high morbidity rates from lack of specialized institutes. However, good surgical outcomes and quality of life scores have been reported in LMICs. OBJECTIVE: This study details the complication rates and predictive factors from spine surgery at a large hospital in Cambodia, aiming to identify high-risk patients to improve surgeon understanding of these complications for improved pre-operative planning and patient counseling. METHODS: This is a retrospective review of patients admitted for spine conditions to Preah Kossamak Hospital, in Phnom Penh (2013-2017). Univariate analysis was conducted on potential predictive factors; variables with p<0.1 were entered into multivariate logistic regression models. RESULTS: 773 patients were included. 46 patients had complications including wrong level surgery, hardware failure, and infection. On multivariate analysis, patients from the provinces of Kratie (p=0.009) or Sihanoukville (p=0.036), and delay to evaluation of over one year (p=0.027) were significant predictive factors of postoperative complications and ASIA A injury (p=0.020) was a predictive factor of poor outcome. CONCLUSION: Many factors play a role in spine surgery complications in LMICs, including limited access to intra-operative technology, low follow-up rates, and minimal physiotherapy and rehabilitation capabilities. Patients with long delays in presentation, ASIA A injuries, and lumbar-level surgery may be especially susceptible to complications and post-operative morbidity. Despite this, institutions have reported encouraging spine trauma outcomes, and spine surgeries are becoming more accepted and safe operations in many LMICs. Additionally, various groups are working towards equality and training in neurosurgery around the globe using different approaches towards education.Item Opioid Treatment for Chronic Pain and Interdisciplinary Care(2015-08-31) Warrington, Lacy Kay; Robinson, Richard C.; Noe, Carl; Gatchel, Robert J.BACKGROUND: The amount of individuals suffering from chronic pain (3 months or more) is growing. Along with this growth, the amount of money spent on medical treatment of chronic pain with or without relief is growing. A major issue that stems from this is the misuse and abuse of prescription opioid medication. This brings a massive loss of productivity and quality of life. SUBJECTS: Patients included in the current study suffer from chronic pain, are at least 18 years of age, and are capable of providing informed consent, and reading and speaking English. EMCPM provides an interdisciplinary program including; cognitive-behavioral therapy, group cognitive-behavioral therapy focusing on psychoeducation, and physical therapy. Patients receive 8 sessions of individual CBT, group CBT, and physical therapy throughout the program. Patients receive these sessions twice a week throughout the 4 week program. METHOD: This study used outcomes that measure ratings of pain; pain, pain interference, depression, anxiety, sleep disturbance, sleep related impairment, satisfaction with participation in discretionary social activities, satisfaction with social roles and activities, and global health. Opioid status was determined as “no,” “decreased,” or “same” for each patient after oral morphine equivalents were calculated at baseline and monitored throughout the 4-week program. One-way within-subjects ANOVAs were conducted for each opioid status as the factor and the outcome measure T scores as the dependent variable. If significant, polynomial contrasts were used to determine linear effects. One-way within-subjects ANCOVAs were then conducted for each opioid status as the factor, outcome measure T scores as the dependent variable and pre-program outcome measure T scores as the covariate to control for pre-morbid dysfunction. If significant, polynomial contrasts were used to determine linear effects. Finally, three Pearson correlations were run between percent change of outcome measure T scores and pre-, post-, and percent change in morphine equivalents. RESULTS: Overall, individuals with chronic pain who participated in a four-week interdisciplinary pain program maximized their results by maintaining no or low opioid dosage, or by decreasing moderate-high opioid doses throughout the program, as expected. Individuals who entered the interdisciplinary pain program with no opioid use showed significantly more improvement (p<.01) than those with initial opioid use over the course of the program on several outcome measures; pain (composite pain rating and pain interference), depression, anxiety, social satisfaction (satisfaction with participation in discretionary social activities and satisfaction with social roles and activities), and global health. Significant (p<.01) linear effects were also found on all previously mentioned outcome measures. Anxiety levels showed significantly more improvement (p<.01) over the course of the pain program only when a control for pre-morbid anxiety was added. A significant (p<.01) linear effect was also found. Individuals who entered the interdisciplinary pain program using opioid medication and decreased the dosage of opioid medication over the course of the program reported significantly more improvement (p<.01) in pain (both composite pain rating and pain interference) and social satisfaction (satisfaction with participation in discretionary social activities only when controlled for pre-morbid social satisfaction with participation in discretionary social activities) when compared with participants who maintained initial opioid dosage. Significant (p<.01) linear effects were found on all three outcome measures. Individuals who maintained a low opioid dosage over the course of the interdisciplinary pain program reported significantly more improvement (p<.01) on; pain (composite pain rating and pain interference), anxiety, sleep (sleep-related impairment only), social satisfaction (satisfaction with participation in discretionary social activities and satisfaction with social roles and activities), and global health. Significant (p<.01) linear effects were found on all of the above measures except pain related impairment. Weak Pearson correlations (r=22) between pre-morphine equivalent and percent change in sleep-related impairment was found. This was again found between post-morphine equivalent and percent change in sleep-related impairment (r=29), as well as a weak negative correlation with pain interference (r=-.28). More research is indicated to determine the relationship between these correlations. Pearson correlations between percent change in morphine equivalent and percent change in outcome measure T scores did not yield any significant (r>.29) correlations.Item Outcomes of an Interdisciplinary Pain Management Program: Does Participants' Opioid Status Predict Improvement?(2014-09-01) Harding, Megan Rose; Gatchel, Robert J.; Robinson, Richard C.; Noe, CarlBACKGROUND: Chronic pain is a prevalent and costly illness that affects 1 in 5 Americans. Interdisciplinary pain management programs have demonstrated cost-effectiveness and significant benefits for a variety of chronic pain conditions. Interdisciplinary programs combined with opioid cessation have also demonstrated effectiveness for patients with chronic pain despite tapering opioid dosage. SUBJECTS: 41 participants who completed a 4-week interdisciplinary pain management program were included in this study. METHOD: Participants completed measures of pain rating, pain interference, and anxiety at admission and discharge. Oral morphine equivalents were calculated based on a chart review of program completers. Participants were divided into three groups based on opioid status throughout the program (no opioid, decreased opioid, and same opioid). RESULTS: Participants with a no opioid status significantly improved on pain rating and pain interference scores from admission to discharge (p < .01). Participants with a decreased opioid status significantly improved on pain rating scores (p < .05) but not on pain interference scores from admission to discharge. Participants with a same opioid status did not significantly improve on either pain rating or pain interference scores from admission to discharge. Additionally, a participant status of “same opioid” was a significant predictor of post-pain interference scores where participants in this group could expect to have 5.46 T-score points higher at discharge. Additionally, younger participants were predicted to have higher post-pain interference scores. DISCUSSION: Participants who had a no opioid or decreased opioid status throughout the program fared better than those who chose to remain on the same opioid dose. These findings indicate that prescription pain relievers may not have the desired effect for patients with chronic pain seeking interdisciplinary treatment. Future research on the impact of prescription pain relievers on potential benefits of an interdisciplinary pain management program is needed.Item Outcomes research: an investigator's journey(1998-10-22) Coyle, Yvonne M.Item Performance anxiety: the impact of performance measures in medicine(2004-12-16) Kazi, SalahuddinItem Predicting Potential Risk Factors of Prescription Pain Medication Misuse in a Chronic Pain Population Through PROMIS Global Health Score(2014-09-01) Altamirano, Gerardo; Gatchel, Robert J.; Noe, Carl; Robinson, Richard C.BACKGROUND: Chronic pain patients who are treated through an interdisciplinary treatment program have shown to report less symptoms of pain by a substantial degree. (Gatchel & Okifuji, 2006) Aspects of the Biopsychosocial Model such as physical and mental health, as well as appropriate medication adherence, must be considered for treatment. This study attempts to reinforce the clinical utility of the Biopsychosocial model by illustrating differences in self-perceived physical and mental health status. Subsequently, we hope to identify the influence of mental vs. physical health on pain-behaviors. Overall we hope to find a correlation between a patient’s self-reported health, using the Global Health Status PROMIS, and predicting their likelihood to abuse prescription pain medication, as measured through the PMQ (Pain Medication Questionnaire). Successively, clinicians can target the endorsement of poor mental health and/or poor physical health as a distinct concern in reducing pain behaviors such as prescription misuse. SUBJECTS: The final sample included data from males and females evaluated for the Interdisciplinary Pain Program at the McDermott Pain Clinic at UT Southwestern Medical center. Participants who were not chosen to participate in the IPP were still included in the data set. As the McDermott Pain Clinic does not typically provide care for children and adolescents (<18 years), children and adolescents were excluded from the present study. The test groups will consist of participants between 18 and 90 years of age as referred to the program by psychologists, Dr. Travis Whitfill and Dr. Richard Robinson of UT Southwestern and capable of providing informed consent, able to read and speak English, experiencing non-malignant pain-related problems, and willing to allow access to their electronic medical records. METHOD: Participants were administered a battery of assessments including the Pain Medication Questionnaire, Global Health Status PROMIS and other established measures of health and pain-related outcomes (e.g., SF-36, PROMIS pain-related measures) at baseline RESULTS: The results in the current study suggest that the PROMIS mental health score is a significant predictor in examining the likelihood for prescription pain medication misuse. Although the predictor variables of PROMIS physical health, age and gender improved the overall variance of the model when examined as single predictors they were shown not to be significant. The first hypothesis was not supported as shown by the weak linearity in the scatter plots of PROMIS physical and PROMIS mental health scores. Surprisingly, the strength of the relationship of physical and mental health scores was not significantly correlated despite support in the literature; however, this may be due to sampling limitations. The second hypothesis was supported through findings that suggest PROMIS mental health score is a strong predictor of participants’ PMQ score. Although PROMIS physical, age and gender improved the overall fit of the model their p values were not found to be significant when examined within the model. The latter part of hypothesis two that suggested age and gender would not be significant predictors of PMQ was supported, as their p-values found were .862 for age and .058 for gender, respectively. DISCUSSION: The current study achieved its stated goals of evaluating the predictive utility of the Global Health Status PROMIS in comparison with the PMQ. The current study offers an important contribution to understanding and evaluating chronic pain and the multifaceted nature of Biopsychosocial outcomes. It is anticipated that future clinical research will continue to expand upon the implications from this study and contribute to more effective evaluation and treatment for individuals suffering from chronic pain and lend attention to risk factors of prescription pain medication misuse. Through targeting psychological elements in addition to physiological pain reduction clinicians can help reduce risk factors of detrimental pain behaviors.Item Presurgical Behavioral Medicine Evaluation for Implantable Devices for Pain Management: Clinical Effectiveness for Predicting Outcomes(2005-08-11) Schocket, Kimberly Gardner; Stowell, Anna W.The current study attempts to apply a presurgical psychological screening algorithm to a subset of patients being considered to receive implantable pain management devices, specifically spinal cord stimulators and intrathecal drug delivery systems. The Presurgical Behavioral Medicine Evaluation (PBME) algorithm was designed to evaluate patients prior to spine surgery. The algorithm showed strong outcome predictability in previous studies (Block et al., 2003). A PBME was administered to 60 patients being evaluated for implantable devices at a major pain center that provides interdisciplinary pain management to patients. Patients were classified into one of five prognostic categories including Green, Yellow-I, Yellow-II, Red-I, and Red-II. This study sought to elucidate the characteristics of patients falling into the separate prognostic categories. Analyses revealed that males were more likely than females to fall in the Green and Yellow-I groups and patients receiving disability were more commonly found in the Red and Yellow-II groups. The biopsychosocial profiles of each category were examined using various physical/functional and psychosocial measures. As hypothesized, the Green group, with the lowest mean scores for each measure, yielded the most positive biopsychosocial profile at initial evaluation. The Green group reported low levels of depression and little impairment in physical functioning. The Red group obtained the highest mean scores, indicating decreased biopsychosocial functioning at initial evaluation. More specifically, the Red group experienced more depressive symptomatology and decreased physical functioning at the time of the initial evaluation. Additionally, the Red group had a greater number of medical risk factors and the presence of adverse clinical features at onset, and was more likely to use catastrophizing as a coping strategy. The patients were also compared at follow-up showing improvements on most physical/functional and psychosocial measures. Lastly, regression analyses were conducted to elucidate those factors most predictive of prognostic assignments. Thus, the algorithm was able to correctly classify those patients who were and were not appropriate candidates for surgery by collecting and analyzing data with regard to the overall biopsychosocial functioning of patients.Item Rethinking diabetes screening and case finding strategies in clinical practice: who's really at risk?(2016-08-26) Bowen, MichaelItem Transitions of care: the missing links(2016-01-08) Thomas, Abey K.