Background CareOregon is a Medicaid provider of healthcare services in Oregon, USA, serving mainly low-income households without employment-based healthcare insurance. CareOregon has developed tools to identify proactively members at risk... more
Background CareOregon is a Medicaid provider of healthcare services in Oregon, USA, serving mainly low-income households without employment-based healthcare insurance. CareOregon has developed tools to identify proactively members at risk for decline in health status and increases in the utilization of healthcare services, the CareOregon Complex Case Management (CCCM) program. Results from previous studies at CareOregon indicate that enrolment in
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By H Nguyen-Dinh and David Feeny; Socio-economic Environment, Parental Characteristics, and Child Survival: The Case of Vietnam.
Research Interests: Psychology and Geography
Both noncemented fixation and improved cemented fixation of total hip replacements emerged to counteract the clinical and radiographic failures of early cemented procedures. A randomized clinical trial comparing a second-generation... more
Both noncemented fixation and improved cemented fixation of total hip replacements emerged to counteract the clinical and radiographic failures of early cemented procedures. A randomized clinical trial comparing a second-generation cemented with a second-generation noncemented total hip replacement demonstrated that in the medium term both implants allow excellent, disease-specific, global and functional capacity outcome measures. No significant differences existed between the cemented and noncemented implants in terms of these parameters or revision rate. Cost-to-utility analyses of both types of replacements revealed that total hip replacement is one of the most cost-effective medical interventions. Noncemented total hip replacements seem as efficacious as cemented devices in patients younger than 70 years.
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... A Reconsideration David Feeny and Darrell Joan Tomkins ... Layard R (ed): “Cost-Benefit Analysis: Selected Readings.” Baltimore: Penguin Books, Inc., 1972. Layde PM, von Allmen SD, Oakley GP: Maternal serum alphafetoprotein screening:... more
... A Reconsideration David Feeny and Darrell Joan Tomkins ... Layard R (ed): “Cost-Benefit Analysis: Selected Readings.” Baltimore: Penguin Books, Inc., 1972. Layde PM, von Allmen SD, Oakley GP: Maternal serum alphafetoprotein screening: A cost-benefit ...
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There is increasing recognition that major new medical therapies should be rigorously evaluated before they are put into general clinical use. Randomized controlled trials provide the most unbiased assessment of the risks and benefits of... more
There is increasing recognition that major new medical therapies should be rigorously evaluated before they are put into general clinical use. Randomized controlled trials provide the most unbiased assessment of the risks and benefits of such therapies. In this article, the most important aspects of the design and execution of a randomized clinical trial in orthopaedics are discussed. These include the reasons for and mechanisms of randomization, appropriate selection of patients and therapy, reasons for the blinding of therapy, types of measures of outcome that can be used, aspects of sample-size calculation and analysis of data, and ethics of randomized controlled trials.
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Research Interests: Palliative Care, Cancer, Medicine, Multivariate Analysis, Lung Cancer, and 15 moreHumans, Internal Medicine, Cancer Therapy, Health related Quality of Life, Female, Male, Functional Assessment, Aged, Middle Aged, Adult, Prognosis, Cancer Registry, Predictive value of tests, liver metastases, and lung neoplasms
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Research Interests: Anxiety Disorders, Medicine, Anxiety, Humans, Generalized Anxiety Disorder, and 15 moreHealth related Quality of Life, Female, Male, Patients, Health Status, Middle Aged, Health Care Delivery, Adult, Clinical Assessment, ANXIETY, Depressive Symptoms, Indexation, Health Survey, Patient Health Questionnaire, and functional outcome
The objective of this study was to assess the independent effect of income on health-related quality of life (HRQL) among older adults in Canada and the United States. Data were obtained from the 2002-2003 Joint Canada/United States... more
The objective of this study was to assess the independent effect of income on health-related quality of life (HRQL) among older adults in Canada and the United States. Data were obtained from the 2002-2003 Joint Canada/United States Survey of Health. The sample consisted of 755 Canadians and 1,151 Americans aged 65 years or older. HRQL was measured with the multidimensional Health Utilities Index Mark 3 (HUI3). The results indicated that in the elderly population, HRQL was significantly associated with household income in the United States but not in Canada, controlling for sociodemographic and health indicators. Various explanations for the positive linear relationship between HRQL and income in the elderly population are discussed, including the roles of access to health care and socioeconomic inequalities in the United States and Canada.
Research Interests: Psychology, Anthropology, Health Behavior, Gerontology, Medicine, and 15 moreCanada, Humans, Health related Quality of Life, Elderly People, Female, Male, International Comparison, Income, Access to Health Care, Aged, Indexation, Older Adult, Health Indicator, Household Income, and Health Services Accessibility
Background: Utility scores are an important tool for evaluating health-related quality of life. Utility score norms have been published for Canadian adults, but no nationally representative utility score norms are available for children... more
Background: Utility scores are an important tool for evaluating health-related quality of life. Utility score norms have been published for Canadian adults, but no nationally representative utility score norms are available for children and youth. Data and methods: Health Utilities Index Mark 3 (HUI3) data from two recent cycles of the Canadian Health Measures Survey (i.e., 2016 and 2017, and 2018 and 2019) were used to provide utility score norms for children aged 6 to 11 years and adolescents aged 12 to 17 years. Children younger than 14 years answered the HUI3 under the supervision of an adult, while older children answered without supervision. Utility scores were reported as a weighted average (95% confidence intervals [CIs]) and median values (interquartile range). Utility scores were stratified by sociodemographic and medical characteristics of the child or adolescent. Regression analyses were used to identify predictors of utility scores. All results were weighted using sampling weights provided by Statistics Canada. Results: Among the 2,297,136 children aged 6 to 11 years and the 2,329,185 adolescents aged 12 to 17 years in the weighted sample, the average utility scores were 0.95 (95% CI: 0.94 to 0.95) and 0.89 (95% CI: 0.87 to 0.90), respectively. Approximately 60% of the children and 34% of the adolescents had a utility score of 1.00. Analyses identified several factors associated with utility scores (e.g., age, chronic condition and income levels), although differences were observed between children and adolescents. Interpretation: This study provides utility score estimates based on a nationally representative sample of Canadian children and youth. Further research examining the determinants of utility scores of children and adolescents is warranted.
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To compare the impact of ankylosing spondylitis (AS) on health-related quality of life (HRQL) and of adalimumab on initial and sustained improvement in HRQL for patients with active AS versus the general US population. Data from the... more
To compare the impact of ankylosing spondylitis (AS) on health-related quality of life (HRQL) and of adalimumab on initial and sustained improvement in HRQL for patients with active AS versus the general US population. Data from the 5-year ATLAS trial were analysed. HRQL burden of AS and treatment impact on HRQL were assessed by comparing health status and utility scores from ATLAS (Short Form 36 Health Survey [SF-36] and Health Utilities Index Mark 3 [HUI3]) with population norms. Baseline scores for all measures were comparable between adalimumab and placebo. All scores for both groups were significantly worse than general population norms (all p<0.0001). Within- and between-group improvements in SF-36 Physical Component Summary and SF-6D scores from baseline to Weeks 12 and 24 were clinically relevant for patients receiving adalimumab. For patients initially randomised to adalimumab, HRQL scores improved from Weeks 25 to 52 and remained relatively stable through 3 years but remained lower than for the general US population at all time points. Findings demonstrate a significant burden of AS on HRQL. Treatment with adalimumab significantly improved physical functioning and other measures of HRQL compared with placebo. Clinically relevant improvements in HRQL outcomes over 3 years represent a significant benefit of adalimumab. Because of the advanced AS disease, patient health status remained below that of the general population. Treatment earlier in the course of AS may be needed to restore HRQL to the level of the general population.
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Bystander CPR rates remain low. One reason may be that the thought of responding to an emergency is so stressful that it decreases the willingness of laypersons to respond. The purpose of this study was to quantify the amount of stress... more
Bystander CPR rates remain low. One reason may be that the thought of responding to an emergency is so stressful that it decreases the willingness of laypersons to respond. The purpose of this study was to quantify the amount of stress experienced by lay responders to a medical emergency and to identify barriers that may have impeded their response to the event. Responses from 1243 laypersons responding to an emergency during the Public Access Defibrillation Trial were analyzed in a mixed methods study. Stress related to the event was recorded using a 0 (none) to 5 (severe) scale. Qualitative responses to the question of "What was most difficult?" about the event were analyzed using content analysis. Reported stress levels were low overall (mean 1.2, median 1.0). Laypersons responding to an emergency presumed to be a cardiac arrest had higher stress than those involved in other events (median 2.0 versus 1.0). Stress levels were higher in residential than in public settings (mean 1.41, median 1.0 versus mean 1.13, median 1.0). Those who fit a certain profile (females, non-native English speakers) reported statistically higher stress levels than others. A total of 614 qualitative responses were studied and aggregated into four major categories of difficulty: practical issues; characteristics of the victim; interpersonal issues; thoughts and feelings of the lay responder. Most difficulties were in the category of practical issues. Among these study volunteer lay responders, low levels of stress were reported. Incorporating descriptions of the difficulties experienced by lay responders in CPR/AED training curricula may make courses more realistic and useful.
Research Interests: Medicine, Automated External defibrillator, Cardiac arrest, Prospective studies, Humans, and 13 moreFemale, Resuscitation, Male, Feeling, Clinical Sciences, Cardiopulmonary Resuscitation, Middle Aged, Adult, Public health systems and services research, Volunteers, Psychological Stress, First Responder, and Heart arrest
Health‐related quality of life (HRQL) is an amalgam of three elements – the opportunities that a person's health status affords, the constraints that it places upon the person and the value that a person places on his/her health... more
Health‐related quality of life (HRQL) is an amalgam of three elements – the opportunities that a person's health status affords, the constraints that it places upon the person and the value that a person places on his/her health status. HRQL measures are specific, for example for a disease, or generic with broad applicability. The latter include preference‐based measures that can be used to generate quality‐adjusted life years and so contribute to economic evaluation. Measures of HRQL in adolescents and young adults (AYAs) with cancer may fail to capture some important dimensions, for example sexual health. However, the use of HRQL measures in this population has identified burdens of morbidity according to disease, treatment status and duration of follow‐up. There are few economic evaluations of the treatment of cancer in AYAs but preliminary evidence suggests that this is a cost‐effective undertaking. Opportunities abound to include measurement of HRQL in routine clinical care.
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Research Interests: English language, Clinical Trial, Quality of life, Medicine, Humans, and 15 moreStandard Deviation, Health related Quality of Life, Chronic Disease, Sample Size, Questionnaires, Quality adjusted life years, Neoplasms, Quality of Life Research, English Language, Quality Life, Overall Survival, GuideLine, Progression Free Survival, Clinical Trials as Topic, and Outcome Assessment Health Care
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This history of moral hazard in health insurance shows that this concept is different from how moral hazard is understood in economics outside of health. Health economists are divided on their understanding and conceptualization of moral... more
This history of moral hazard in health insurance shows that this concept is different from how moral hazard is understood in economics outside of health. Health economists are divided on their understanding and conceptualization of moral hazard in health insurance and we show that these divisions can be organized along two main questions: one on the nature of demand for health care and one on the nature of demand for health insurance. The former revolves around the ability of consumers to make informed choices and, as a consequence, how we value the health care services that are consumed. The latter revolves around the idea that utility of consumption is significantly affected by changes in health status, and that health insurance might work, as a result, as an income transfer across states of the world rather than as protection against financial risk.
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Objectives:There is relatively little evidence on the test–retest reliability of utility scores derived from multiattribute measures. The objective was to estimate test–retest reliability for Health Utilities Index Mark 2 (HUI2) and Mark... more
Objectives:There is relatively little evidence on the test–retest reliability of utility scores derived from multiattribute measures. The objective was to estimate test–retest reliability for Health Utilities Index Mark 2 (HUI2) and Mark 3 (HUI3) utility scores in patients recovering from hip fracture.Methods:We enrolled an inception cohort of hip fracture patients within 3 to 5 days of surgery. Baseline assessments included the Functional Independence Measure (FIM™), Folstein Mini-Mental State Examinations, and the HUI2 and HUI3 questionnaire. Follow-up assessments at 1, 3, and 6 months also included a global change question. Test–retest reliability was assessed as agreement between 3- and 6-month scores using the intraclass correlation coefficient (ICC). Two approaches were used to classify patients as stable; a third approach based on the generalizability theory was also used. Patients were classified as stable if their FIM™ overall scores changed by 10 points or fewer and if they classified themselves as having experienced no or only a little change according to their global change question.Results:Complete data at both the 3- and 6-month assessments based on self-report were available for 196 patients; 141 patients with complete data were classified as stable. The ICCs for HUI2 and HUI3 for stable patients were 0.71 and 0.72; the ICCs derived from the generalizability theory were 0.76 and 0.77.Conclusions:Test–retest reliability for HUI in this cohort was similar to reliability estimates for other preference-based multiattribute and generic health-profile measures—in the acceptable range for making valid group-level comparisons.
Research Interests: Psychometrics, Medicine, Applied Economics, Humans, Female, and 11 moreMale, Follow-up studies, Generalizability Theory, Hip Fractures, Aged, Intraclass Correlation Coefficient, Public health systems and services research, Hip fracture, Sensitivity and Specificity, Cohort Studies, and health status indicators
There is a great need for the accurate assessment of health-related quality of life (HRQOL) in clinical practice, research, health interventions and health planning. The menopause transition and special issues influencing the health of... more
There is a great need for the accurate assessment of health-related quality of life (HRQOL) in clinical practice, research, health interventions and health planning. The menopause transition and special issues influencing the health of women as they age can affect quality of life. The assessment of these effects requires a variety of validated instruments to capture their influence in a variety of populations and for a variety of outcomes. This review identifies the important measurement properties of HRQOL instruments, determinants of health status and the currently available measures of HRQOL. Specifically, the reliability, validity and applicability of HRQOL instruments designed for use at the climacteric are individually discussed. It is important to choose validated and appropriate instruments depending on the individual or population being assessed and the relevant HRQOL issues.
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By H Nguyen-Dinh and David Feeny; Socio-economic Environment, Parental Characteristics, and Child Survival: The Case of Vietnam.
Research Interests: Psychology and Geography
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... EconPapers has moved to http://EconPapers.repec.org! Please update your bookmarks. A Multi-attribute Approach to Population Health Status. David Feeny (), G Torrance, C Goldsmith, W Furlong and M Boyle. No 1994-05, Centre ...
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Objectives Health status (HS)/ health-related quality of life measures, completed by self or proxy, are important outcome indicators. Most HS literature on children born preterm includes adolescents and adults with limited data at... more
Objectives Health status (HS)/ health-related quality of life measures, completed by self or proxy, are important outcome indicators. Most HS literature on children born preterm includes adolescents and adults with limited data at preschool age. This study aimed to describe parent-reported HS in a large national cohort of extreme preterm children at preschool age and to identify clinical and sociodemographic variables associated with HS. Methods Infants born before 29 weeks’ gestation between 2009 and 2011 were enrolled in a prospective longitudinal national cohort study through the Canadian Neonatal Network (CNN) and the Canadian Neonatal Follow-Up Network (CNFUN). HS, at 36 months’ corrected age (CA), was measured with the Health Status Classification System for Pre-School Children tool completed by parents. Information about HS predictors was extracted from the CNN and CNFUN databases. Results Of 811 children included, there were 79, 309 and 423 participants in 23–24, 25–26 and 27–28 weeks’ gestational age groups, respectively. At 36 months’ CA, 78% had a parent-reported health concern, mild in >50% and severe in 7%. Most affected HS attributes were speech (52.1%) and self-care (41.4%). Independent predictors of HS included substance use during pregnancy, infant male sex, Score for Neonatal Acute Physiology-II, bronchopulmonary dysplasia, severe retinopathy of prematurity, caregiver employment and single caregiver. Conclusion Most parents expressed no or mild health concerns for their children at 36 months’ CA. Factors associated with health concerns included initial severity of illness, complications of prematurity and social factors.