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The American Journal of Managed Care Jun 2017To compare the performance of methods to retrospectively attribute patients to provider systems by comparing the fraction attributed and the stability of assignment over... (Comparative Study)
Comparative Study
OBJECTIVES
To compare the performance of methods to retrospectively attribute patients to provider systems by comparing the fraction attributed and the stability of assignment over time.
STUDY DESIGN
Retrospective cross-sectional study.
METHODS
Descriptive statistics are used to measure the fraction of patients attributed and stability of attribution from year to year. This study uses a panel of administrative claims data (2010-2011). Attribution rules were defined by unit of measure (count of physician visits, dollars paid), type of providers (primary care physicians [PCPs], all physicians), type of encounters (all visits, evaluation and management visits only), and level of concentration of care (majority, plurality). We created 32 retrospective attribution rules, spanning PCP-only rules, all-physician rules, hierarchical rules based on PCPs then all physicians, and lookback rules based on current-year PCP visits then prior-year experience.
RESULTS
All methods exhibit a tradeoff between stability of attribution and fraction of the population attributed. This tradeoff is minimized when PCP-based rules are supplemented by a 1-year lookback when the current-year experience does not result in attribution.
CONCLUSIONS
We recommend using this lookback method when multiple years of data are available. In absence of multiple years of data, PCP-based rules maximize stability; hierarchical rules result in a greater fraction attributed with less loss of stability than simple all-provider rules.
Topics: Adolescent; Adult; Cross-Sectional Studies; Delivery of Health Care; Health Status; Humans; Insurance, Health; Middle Aged; Physicians, Primary Care; Retrospective Studies; Young Adult
PubMed: 28817293
DOI: No ID Found -
PloS One 2012Campylobacteriosis contributes strongly to the disease burden of food-borne pathogens. Case-control studies are limited in attributing human infections to the different...
BACKGROUND
Campylobacteriosis contributes strongly to the disease burden of food-borne pathogens. Case-control studies are limited in attributing human infections to the different reservoirs because they can only trace back to the points of exposure, which may not point to the original reservoirs because of cross-contamination. Human Campylobacter infections can be attributed to specific reservoirs by estimating the extent of subtype sharing between strains from humans and reservoirs using multilocus sequence typing (MLST).
METHODOLOGY/PRINCIPAL FINDINGS
We investigated risk factors for human campylobacteriosis caused by Campylobacter strains attributed to different reservoirs. Sequence types (STs) were determined for 696 C. jejuni and 41 C. coli strains from endemic human cases included in a case-control study. The asymmetric island model, a population genetics approach for modeling Campylobacter evolution and transmission, attributed these cases to four putative animal reservoirs (chicken, cattle, sheep, pig) and to the environment (water, sand, wild birds) considered as a proxy for other unidentified reservoirs. Most cases were attributed to chicken (66%) and cattle (21%), identified as the main reservoirs in The Netherlands. Consuming chicken was a risk factor for campylobacteriosis caused by chicken-associated STs, whereas consuming beef and pork were protective. Risk factors for campylobacteriosis caused by ruminant-associated STs were contact with animals, barbecuing in non-urban areas, consumption of tripe, and never/seldom chicken consumption. Consuming game and swimming in a domestic swimming pool during springtime were risk factors for campylobacteriosis caused by environment-associated STs. Infections with chicken- and ruminant-associated STs were only partially explained by food-borne transmission; direct contact and environmental pathways were also important.
CONCLUSION/SIGNIFICANCE
This is the first case-control study in which risk factors for campylobacteriosis are investigated in relation to the attributed reservoirs based on MLST profiles. Combining epidemiological and source attribution data improved campylobacteriosis risk factor identification and characterization, generated hypotheses, and showed that genotype-based source attribution is epidemiologically sensible.
Topics: Animals; Campylobacter; Campylobacter Infections; Case-Control Studies; Cattle; Chickens; Confidence Intervals; Disease Reservoirs; Environmental Microbiology; Humans; Multilocus Sequence Typing; Multivariate Analysis; Netherlands; Odds Ratio; Risk Factors; Ruminants
PubMed: 22880049
DOI: 10.1371/journal.pone.0042599 -
BMC Public Health Aug 2011Up to this date, prevalence rates of obesity are still rising. Aside from co-morbid diseases, perceived discrimination and stigmatization leads to worsen outcomes in... (Review)
Review
BACKGROUND
Up to this date, prevalence rates of obesity are still rising. Aside from co-morbid diseases, perceived discrimination and stigmatization leads to worsen outcomes in obese individuals. Higher stigmatizing attitudes towards obese individuals may also result in less support of preventive and interventive measures. In light of the immense burden of obesity on health care systems and also on the individuals' quality of life, accepted and subsidized preventive measures are needed. Policy support might be determined by views of the lay public on causes of obesity and resulting weight stigma. This study seeks to answer how representative samples of the lay public perceive people with obesity or overweight status (stigmatizing attitudes); what these samples attribute obesity to (causal attribution) and what types of interventions are supported by the lay public and which factors determine that support (prevention support).
METHODS
A systematic literature search was conducted. All studies of representative samples reporting results on (a) stigmatizing attitudes towards overweight and obese individuals, (b) causal beliefs and (c) prevention support were included.
RESULTS
Only 7 articles were found. One study reported prevalence rates of stigmatizing attitudes. About a quarter of the population in Germany displayed definite stigmatizing attitudes. Other studies reported causal attributions. While external influences on weight are considered as well, it seems that internal factors are rated to be of higher importance. Across the studies found, regulative prevention is supported by about half of the population, while childhood prevention has highest approval rates. Results on sociodemographic determinants differ substantially.
CONCLUSIONS
Further research on public attitudes toward and perception of overweight and obesity is urgently needed to depict the prevailing degree of stigmatization. Introducing a multidimensional concept of the etiology of obesity to the lay public might be a starting point in stigma reduction.
Topics: Germany; Humans; Obesity; Public Health; Social Stigma; Stereotyping
PubMed: 21859493
DOI: 10.1186/1471-2458-11-661 -
Schizophrenia Bulletin Jul 2014In schizophrenia, social cognition is strongly linked to functional outcome and is increasingly seen as a viable treatment target. The goal of the Social Cognition...
BACKGROUND
In schizophrenia, social cognition is strongly linked to functional outcome and is increasingly seen as a viable treatment target. The goal of the Social Cognition Psychometric Evaluation (SCOPE) study is to identify and improve the best existing measures of social cognition so they can be suitably applied in large-scale treatment studies. Initial phases of this project sought to (1) develop consensus on critical domains of social cognition and (2) identify the best existing measures of social cognition for use in treatment studies.
METHODS
Experts in social cognition were invited to nominate key domains of social cognition and the best measures of those domains. Nominations for measures were reduced according to set criteria, and all available psychometric information about these measures was summarized and provided to RAND panelists. Panelists rated the quality of each measure on multiple criteria, and diverging ratings were discussed at the in-person meeting to obtain consensus.
RESULTS
Expert surveys identified 4 core domains of social cognition-emotion processing, social perception, theory of mind/mental state attribution, and attributional style/bias. Using RAND panel consensus ratings, the following measures were selected for further evaluation: Ambiguous Intentions Hostility Questionnaire, Bell Lysaker Emotion Recognition Task, Penn Emotion Recognition Test, Relationships Across Domains, Reading the Mind in the Eyes Test, The Awareness of Social Inferences Test, Hinting Task, and Trustworthiness Task.
DISCUSSION
While it was possible to establish consensus, only a limited amount of psychometric information is currently available for the candidate measures, which underscores the need for well-validated and standardized measures in this area.
Topics: Cognition Disorders; Humans; Psychometrics; Schizophrenia; Schizophrenic Psychology; Social Behavior; Social Perception; Surveys and Questionnaires; Theory of Mind
PubMed: 23728248
DOI: 10.1093/schbul/sbt081 -
PloS One 2014Several case-control studies have investigated risk factors for human salmonellosis while others have used Salmonella subtyping to attribute human infections to...
Several case-control studies have investigated risk factors for human salmonellosis while others have used Salmonella subtyping to attribute human infections to different food and animal reservoirs. This study combined case-control and source attribution data into a single analysis to explore risk factors at the point of exposure for human salmonellosis originating from four putative food-producing animal reservoirs (pigs, cattle, broilers and layers/eggs) in the Netherlands. We confirmed that most human cases (∼ 90%) were attributable to layers/eggs and pigs. Layers/eggs and broilers were the most likely reservoirs of salmonellosis in adults, in urban areas, and in spring/summer, whereas pigs and cattle were the most likely reservoirs of salmonellosis in children, in rural areas, and in autumn/winter. Several reservoir-specific risk factors were identified. Not using a chopping board for raw meat only and consuming raw/undercooked meat were risk factors for infection with salmonellas originating from pigs, cattle and broilers. Consuming raw/undercooked eggs and by-products were risk factors for layer/egg-associated salmonellosis. Using antibiotics was a risk factor for pig- and cattle-associated salmonellosis and using proton-pump inhibitors for salmonellosis attributable to any reservoir. Pig- and cattle-associated infections were also linked to direct contact with animals and environmental exposure (e.g. playing in sandboxes). Eating fish, meat in pastry, and several non-meat foods (fruit, vegetables and pasteurized dairy products) were protective factors. Consuming pork and occupational exposure to animals and/or raw meats were protective against layer/egg-associated salmonellosis. We concluded that individuals acquiring salmonellosis from different reservoirs have different associated risk factors, suggesting that salmonellas may infect humans through various transmission pathways depending on their original reservoirs. The outcome of classical case-control studies can be enhanced by incorporating source attribution data and vice versa.
Topics: Adolescent; Adult; Aged; Animals; Case-Control Studies; Cattle; Chickens; Child; Child, Preschool; Disease Reservoirs; Female; Food Microbiology; Humans; Infant; Infant, Newborn; Male; Middle Aged; Netherlands; Risk Factors; Salmonella Food Poisoning; Salmonella Infections; Seasons; Swine; Young Adult
PubMed: 24503703
DOI: 10.1371/journal.pone.0087933 -
Mental Illness Jan 2010A few months from the time of this survey, the nearly completed inpatient psychiatric facility within the Aminu Kano Teaching Hospital's complex would be ready for... (Review)
Review
A few months from the time of this survey, the nearly completed inpatient psychiatric facility within the Aminu Kano Teaching Hospital's complex would be ready for admissions. Understanding the health workers' level of experience of mental illness and their likely behavioural responses towards people with psychiatric illness, therefore, should be a good baseline to understanding their likely reactions towards admitting such patients within a general hospital setting. The study, which used a pre-tested and adapted attribution questionnaire, was prospective and cross-sectional. Randomly selected health workers in Aminu Kano Teaching Hospital had their level of familiarity and attributions towards psychiatric patients assessed. The respondents showed a high level of experience with mental illness, with more than 3 in 5 of them having watched movies on mental illness before. More than half of them held positive (favorable) attributions towards persons with mental illness on nine of the ten assessed attribution factors. Almost all held negative (unfavourable) opinion towards intimate relationships with such persons. Attribution factors, "Responsibility, "Anger", "Dangerousness", "Fear" and "Segregation" were significantly related to the respondents' level of education (P<0.05). Marital status of the respondents related significantly to "Pity" and "Avoidance" factors (P<0.05). Having watched movies on mental illness significantly related to "Responsibility" and "Fear" factors (P<0.05). Programs designed to improve the health workers mental health literacy, and increased positive professional contacts with mentally ill persons on treatment, would further enhance their perceived positive attributions towards them.
PubMed: 25478083
DOI: 10.4081/mi.2010.e1 -
Schizophrenia (Heidelberg, Germany) Feb 2024We examined the association between causal attributions and self-reported motivational negative symptoms (amotivation) in a German online community sample (n = 251)....
We examined the association between causal attributions and self-reported motivational negative symptoms (amotivation) in a German online community sample (n = 251). Bivariate correlations revealed significant associations between amotivation and attribution of success to external, variable, and specific causes. No associations between amotivation and failure attributions were found. Our data suggest that demotivational causal attributions of success could be a feature of amotivation and a promising target for research and intervention.
PubMed: 38347003
DOI: 10.1038/s41537-024-00441-9 -
EGEMS (Washington, DC) 2016There has been significant research on provider attribution for quality and cost. Low-value care is an area of heightened focus, with little of the focus being on...
OBJECTIVES
There has been significant research on provider attribution for quality and cost. Low-value care is an area of heightened focus, with little of the focus being on measurement; a key methodological decision is how to attribute delivered services and procedures. We illustrate the difference in relative and absolute physician- and panel-attributed services and procedures using overuse in cervical cancer screening.
STUDY DESIGN
A retrospective, cross-sectional study in an integrated health care system.
METHODS
We used 2013 physician-level data from Group Health Cooperative to calculate two utilization attributions: (1) panel attribution with the procedure assigned to the physician's predetermined panel, regardless of who performed the procedure; and (2) physician attribution with the procedure assigned to the performing physician. We calculated the percentage of low-value cervical cancer screening tests and ranked physicians within the clinic using the two utilization attribution methods.
RESULTS
The percentage of low-value cervical cancer screening varied substantially between physician and panel attributions. Across the whole delivery system, median panel- and physician-attributed percentages were 15 percent and 10 percent, respectively. Among sampled clinics, panel-attributed percentages ranged between 10 percent and 17 percent, and physician-attributed percentages ranged between 9 percent and 13 percent. Within a clinic, median panel-attributed screening percentage was 17 percent (range 0 percent-27 percent) and physician-attributed percentage was 11 percent (range 0 percent-24 percent); physician rank varied by attribution method.
CONCLUSIONS
The attribution method is an important methodological decision when developing low-value care measures since measures may ultimately have an impact on national benchmarking and quality scores. Cross-organizational dialogue and transparency in low-value care measurement will become increasingly important for all stakeholders.
PubMed: 28203612
DOI: 10.13063/2327-9214.1276 -
Chinese Journal of Cancer Research =... Aug 2019Precise prevention is more desired for cervical cancer due to the huge population, high prevalence of human papillomavirus (HPV) infection in China and the vision of...
OBJECTIVE
Precise prevention is more desired for cervical cancer due to the huge population, high prevalence of human papillomavirus (HPV) infection in China and the vision of screen-and-treat strategies in low- and middle-income countries (LMICs). Considerations of combining type-specific prevalence and attribution proportion to high-grade cervical intraepithelial neoplasia are informative to more precise and effective region-specific cervical cancer prevention and control programs. The aim of the current study was to determine the genotype distribution of HPV and attribution to cervical precancerous lesions among women from rural areas in North China.
METHODS
A total of 9,526 women participated in the cervical cancer screening project in rural China. The samples of women who tested positive for HPV were retested with a polymerase chain reaction (PCR)-based HPV genotyping test. The attribution proportion of specific high-risk human papillomavirus (HR-HPV) types for different grades of cervical lesions was calculated by using the type contribution weighting method.
RESULTS
A total of 22.2% (2,112/9,526) of women were HR-HPV positive and HPV52 (21.7%) was the most common HR-HPV genotype, followed by HPV58 (18.2%), HPV53 (18.2%) and HPV16 (16.2%). The top three genotypes detected in HR-HPV-positive cervical intraepithelial neoplasia (CIN)1 were HPV16 (36.7%), HPV58 (20.4%), HPV56 (15.3%). Among CIN2+, the most frequent genotypes were HPV16 (75.6%), HPV52 (17.8%), HPV58 (16.7%). HPV16, 56, 58, 53, 52, 59, 68, and 18 combined were attributed to 84.17% of all CIN1 lesions, and HPV16, 58, and 52 combined were attributed to 86.98% of all CIN2+ lesions.
CONCLUSIONS
The prevalence of HR-HPV infection among women from rural areas in North China was high and HPV16, HPV58, HPV52 had paramount attributable fraction in CIN2+. Type-specific HPV prevalence and attribution proportion to cervical precancerous lesions should be taken into consideration in the development of vaccines and strategy for screening in this population.
PubMed: 31564809
DOI: 10.21147/j.issn.1000-9604.2019.04.10 -
Stigma and Health Nov 2016Even though our knowledge of the cause of disease and disability has grown, stigma still exists. Weiner, Perry, and Magnusson's seminal study on attributions of stigma...
Even though our knowledge of the cause of disease and disability has grown, stigma still exists. Weiner, Perry, and Magnusson's seminal study on attributions of stigma has been cited over 500 times since its publication in 1988. The current research sought to replicate and expand this literature in two studies. We used the 10 stigmas from the original study and we added six more (representing common psychological and physical stigmas). In the first study, we examined the classification of stigmas using cluster analysis. We found that instead of dichotomizing stigmas into either psychological or physical, attributions of controllability and stability together resulted in four distinct clusters. Although these were mostly consistent with past literature, the fourth cluster included both psychological and physical stigmas and was rated as moderately controllable and moderately stable. In the second study, we examined how information about responsibility shifts causal attributions, emotional responses, and helping behaviors. Information that an individual was responsible for their stigma led to greater attributions of controllability, less positive emotions, and less help compared to information that an individual was not responsible. More interestingly, the no-information control condition was similar to the responsibility information condition for stigmas that fell into the controllable clusters whereas the control condition was similar to the not responsible information condition for stigmas that fell into the uncontrollable clusters. While parsimony is valued, the psychological/physical dichotomy is not nuanced enough to fully capture the variation in stigmas, which in turn has implications for future research on stigma reduction.
PubMed: 28083562
DOI: 10.1037/sah0000031