Kurt C Stange
Datos Biográficos
| ID | 374648 |
|---|---|
| NOMBRE | Kurt C Stange |
| NOMBRES | Kurt C |
| APELLIDO | Stange |
| FIRMA | STANGE K C |
| AFILIACIONES | Case Western Reserve University |
| ORCID | 0000-0002-2189-0191 |
| VERIFICADO | Sí |
| TOTAL DE OBRAS | 34 |
| TOTAL DE CITAS | 51 |
| TOTAL COMO AUTOR | 34 |
| TOTAL COMO EDITOR | 0 |
| PRIMER AÑO DE PUBLICACIÓN | 1996 |
| AÑO MÁS RECIENTE DE PUBLICACIÓN | 2025 |
| ÍNDICE H | 3 |
Video versus audio telehealth in safety net clinic patients
BACKGROUND: Understanding the mix of video versus audio telehealth modality is critical to informing care for low-income safety net clinic patients. Our study examined whether telehealth modality and continued use of telehealth varied by rurality and whether that changed over time. METHODS: Encounters from adults in the OCHIN national network of primary care safety net clinics were identified by encounter type (in-person vs telehealth) and telehe…
The Impact of a Bidirectional Clinic to Community Social Care Referral Program
BACKGROUND: Practical knowledge of how to address patients' social needs could have a large health impact. OBJECTIVE: Describe a scalable electronic health record (EHR)-facilitated, clinic-to-community linkage (CCL) program that addresses social needs at 6 clinics in 4 health systems. RESEARCH DESIGN: Primary care teams referred eligible patients to United Way 211 (UW 211) via a point-of-care EHR referral between 2018 and 2023. Patients were elig…
When a Patient Leaves Your Care, How Do You Want Them to Feel
Peacefulness is a potentially healing inner state that can be fostered by skilled interpersonal interactions. Skilled interactions in health care are those in which clinicians focus on making patients feel seen and heard and that their needs are important and can be met. But data collected in health care encounters tend to place value on consumerism and commodification, both of which undermine clinicians' capacities to skillfully interact with pa…
Association of School Instructional Mode with Community Covid-19 Incidence during August–December 2020 in Cuyahoga County, Ohio
Remote and hybrid modes of instruction were employed as alternatives to in-person instruction as part of early mitigation efforts in response to the COVID-19 pandemic. We investigated the impact of a public school district's instructional mode on cumulative incidence and transmission in the surrounding community by employing a generalized estimating equations approach to estimate the association with weekly COVID-19 case counts by zip code in Cuy…
Back to the Basics
BACKGROUND: A school district in Northern Ohio implemented a COVID-19 surveillance program from January 4 to May 21, 2021, as in-person school and extracurricular activities resumed. METHODS: Among 560 staff members and >6300 students, random weekly testing was performed on 563 students and weekly for 204 students participating in extracurricular activities, and 553 staff. RESULTS: Cases of COVID-19 were identified among 26 staff members and 23 s…
How Should Clinicians Ally With Patients Whose Health Is Unlikely to Be Improved by Even Numerous Clinical Encounters
Patients experiencing homelessness and mental illness face conditions and circumstances that deserve focused ethical and clinical attention. The first commentary on the case applies insights from qualitative research about social determinants of health to these patients' care and dignity. The second commentary describes 3 kinds of power wielded by physicians#x2014;charismatic, social, and Aesculapian#x2014;each of which is considered in terms of …
Commentary
Validating the New Primary Care Measure in the Medical Expenditure Panel Survey
BACKGROUND: The advancement of primary care research requires reliable and validated measures that capture primary care processes embedded within nationally representative datasets. OBJECTIVE: The objective of this study was to assess the validity of a newly developed measure of primary care processes [Medical Expenditure Panel Survey (MEPS)-PC] with preliminary evidence of moderate to excellent reliability. STUDY DESIGN: A retrospective cohort s…
Developing a New Measure of Primary Care Using the Medical Expenditure Panel Survey
OBJECTIVE: To develop and assess the reliability of a measure of primary care using items from the Medical Expenditure Panel Survey (MEPS), a US representative survey of community-dwelling persons. METHODS: On the basis of the domains from the literature on primary care characteristics, we identified relevant items within the 2013-2014 MEPS family of surveys. In a sample of primary survey respondents with at least 1 office-based physician visit i…
An Innovative Three-Step Method for Identifying Exemplars
Purpose: To improve practices in rapidly changing environments, it is helpful to learn from relevant innovators. This article describes a well-defined and adaptable method for discovering innovative cases that inform best practices or positive/negative deviant research. Methods: As part of a national study of innovation in primary care settings, we developed a three-step method for identifying exemplar practices and applied that method to finding…
Personal strengths reported by people with chronic illness
BACKGROUND: Self-management of chronic illness can be highly demanding and people need to mobilize their personal strengths to live well with their condition. More knowledge is needed about how people with chronic illness perceive and use their personal strengths as a basis for better integrating empowering person-centred approaches into health care. OBJECTIVE: To explore what people with chronic illness describe as their strengths relevant to th…
The Influence of Multimorbidity on Leading Causes of Death in Older Adults With Cognitive Impairment
Objective: The aim of this study is to evaluate the relationship of leading causes of death with gradients of cognitive impairment and multimorbidity. Method: This is a population-based study using data from the linked 1992-2010 Health and Retirement Study and National Death Index ( n = 9,691). Multimorbidity is defined as a combination of chronic conditions, functional limitations, and geriatric syndromes. Regression trees and Random Forest iden…
Changes in Case-Mix and Health Outcomes of Medicare Fee-for-Service Beneficiaries and Managed Care Enrollees During the Years 1992–2011
BACKGROUND: Recent studies suggest that managed care enrollees (MCEs) and fee-for-service beneficiaries (FFSBs) have become similar in case-mix over time; but comparisons of health outcomes have yielded mixed results. OBJECTIVE: To examine changes in differentials between MCEs and FFSBs both in case-mix and health outcomes over time. DESIGN: Temporal study of the linked Health and Retirement Study (HRS) and Medicare data, comparing case-mix and h…
Identifying Specific Combinations of Multimorbidity that Contribute to Health Care Resource Utilization
BACKGROUND: Multimorbidity affects the majority of elderly adults and is associated with higher health costs and utilization, but how specific patterns of morbidity influence resource use is less understood. OBJECTIVE: The objective was to identify specific combinations of chronic conditions, functional limitations, and geriatric syndromes associated with direct medical costs and inpatient utilization. DESIGN: Retrospective cohort study using the…
The dynamic sustainability framework
BACKGROUND: Despite growth in implementation research, limited scientific attention has focused on understanding and improving sustainability of health interventions. Models of sustainability have been evolving to reflect challenges in the fit between intervention and context. DISCUSSION: We examine the development of concepts of sustainability, and respond to two frequent assumptions -'voltage drop,' whereby interventions are expected to yield l…
Prevalence of metabolic syndrome among urban community residents in China
The MetS is highly prevalent and has reached epidemic proportion in Chinese urban adult community residents
A Reemerging Political Space for Linking Person and Community Through Primary Health Care
Objectives. We sought to understand how national policy key informants perceive the value and changing role of primary care in the context of emerging political opportunities. Methods. We conducted 13 semistructured interviews in May 2011 with leaders of federal agencies, think tanks, nonprofits, and quality standard–defining organizations with influence over health care reform policies and implementation. We recorded the interviews and used an e…
Primary Care Practice Transformation is Hard Work
BACKGROUND: Serious shortcomings remain in clinical care in the United States despite widespread use of improvement strategies for enhancing clinical performance based on knowledge transfer approaches. Recent calls to transform primary care practice to a patient-centered medical home present even greater challenges and require more effective approaches. METHODS: Our research team conducted a series of National Institutes of Health funded descript…
Childbearing, Stress and Obesity Disparities in Women
Why The Nation Needs A Policy Push On Patient-Centered Health Care
The phrase "patient-centered care" is in vogue, but its meaning is poorly understood. This article describes patient-centered care, why it matters, and how policy makers can advance it in practice. Ultimately, patient-centered care is determined by the quality of interactions between patients and clinicians. The evidence shows that patient-centered care improves disease outcomes and quality of life, and that it is critical to addressing racial, e…
Racial, Ethnic, and Socioeconomic Differences in the Incidence of Obesity Related to Childbirth
Objectives. We investigated the relationship between childbirth and 5-year incidence of obesity. Methods. We performed a prospective analysis of data on 2923 nonobese, nonpregnant women aged 14 to 22 years from the 1979 National Longitudinal Survey of Youth Cohort, which was followed from 1980 to 1990. We used multivariable logistic regression analyses to determine the adjusted relative risk of obesity for mothers 5 years after childbirth compare…
Recruiting Minority Primary Care Practices Into Practice-Based Research
BACKGROUND: A potentially fruitful strategy for increasing enrollment of minority patients in research is to engage minority clinicians. However, little attention has been paid to unique challenges and effective strategies for engaging practices with minority physicians. OBJECTIVE: The objective of this study was to provide a model for recruiting community-based primary care practices with minority physicians into research studies. RESEARCH DESIG…
A Comparison of the National Ambulatory Medical Care Survey (NAMCS) Measurement Approach With Direct Observation of Outpatient Visits
BACKGROUND: The National Ambulatory Medical Care Survey (NAMCS) informs a wide range of important policy and clinical decisions by providing nationally representative data about outpatient practice. However, the validity of the NAMCS methods has not been compared with a reference standard. METHODS: Office visits of 549 patients visiting 30 family physicians in Northeastern Ohio were observed by trained research nurses. Visit content measured by d…
Long-Term Impact of Preventive Proactivity on Quality of Life of the Old-Old
OBJECTIVE: This research explored the long-term benefits of engaging in proactive health promotion efforts among old-old residents of Sunbelt retirement communities to empirically test components of the Preventive and Corrective Proactivity (PCP) Model of Successful Aging. Specifically, we examined the contributions of exercise, tobacco use, moderate alcohol use, and annual medical checkups to multidimensional quality of life indicators of physic…
Race and Preventive Services Delivery Among Black Patients and White Patients Seen in Primary Care
BACKGROUND: Numerous studies have documented racial disparities in delivery of health care treatment services, but there is little information to determine whether similar disparities exist in the delivery of preventive services. OBJECTIVE: To determine if disparities exist in preventive service delivery to non-Hispanic white patients and black patients in primary care. RESEARCH DESIGN: Multimethod study using direct observation of patient encoun…
Why The Nation Needs A Policy Push On Patient-Centered Health Care
The phrase "patient-centered care" is in vogue, but its meaning is poorly understood. This article describes patient-centered care, why it matters, and how policy makers can advance it in practice. Ultimately, patient-centered care is determined by the quality of interactions between patients and clinicians. The evidence shows that patient-centered care improves disease outcomes and quality of life, and that it is critical to addressing racial, e…
Racial, Ethnic, and Socioeconomic Differences in the Incidence of Obesity Related to Childbirth
Objectives. We investigated the relationship between childbirth and 5-year incidence of obesity. Methods. We performed a prospective analysis of data on 2923 nonobese, nonpregnant women aged 14 to 22 years from the 1979 National Longitudinal Survey of Youth Cohort, which was followed from 1980 to 1990. We used multivariable logistic regression analyses to determine the adjusted relative risk of obesity for mothers 5 years after childbirth compare…
Sustained Personal Autonomy
The results are consistent with previous studies of successful aging and show that attitudes expressed at baseline favoring personal independence are associated with sustained autonomy during a period of at least 2 years
A Reemerging Political Space for Linking Person and Community Through Primary Health Care
Objectives. We sought to understand how national policy key informants perceive the value and changing role of primary care in the context of emerging political opportunities. Methods. We conducted 13 semistructured interviews in May 2011 with leaders of federal agencies, think tanks, nonprofits, and quality standard–defining organizations with influence over health care reform policies and implementation. We recorded the interviews and used an e…
Forced Disruption in Continuity of Primary Care
This investigation examines patients' experiences when policy changes of a managed care system require them to change health care providers. Continuity of care has been recognized as a major cornerstone of the ideal physician I patient relationship, particularly as it applies to primary care (Ware and Snyder 1975; Gonnella and Herman 1980; Weiss, Ramsey and McWhinney 1982; Weiss and Ramsey 1989; Hjortdahl and Laerum 1992; Emanuel and Dubler 1995)…
A Comparison of US and Canadian Family Physician Attitudes Toward Their Respective Health-Care Systems
OBJECTIVES: To examine how family physicians in the United States and Canada evaluate their respective health-care systems. METHODS: The study design was a cross-sectional survey of 300 randomly selected US family physicians and 300 Canadian family physicians. Outcome measures included: attitudes about professional satisfaction and views on health-care delivery and government involvement in health care. RESULTS: Sixty-one percent of the US sample…
Forced Disruption in Continuity of Primary Care
This investigation examines patients' experiences when policy changes of a managed care system require them to change health care providers. Continuity of care has been recognized as a major cornerstone of the ideal physician I patient relationship, particularly as it applies to primary care (Ware and Snyder 1975; Gonnella and Herman 1980; Weiss, Ramsey and McWhinney 1982; Weiss and Ramsey 1989; Hjortdahl and Laerum 1992; Emanuel and Dubler 1995)…
The Association of Attributes of Primary Care With the Delivery of Clinical Preventive Services
OBJECTIVES: Evidence is building that primary care is associated with quality of care and cost effectiveness. Still, little is known of the contribution of specific attributes of primary care to important health outcomes, such as the delivery of preventive services. This study tests the association of specific attributes of primary care with a comprehensive measure of the delivery of preventive services. METHODS: A cross-sectional multimethod stu…
How Valid Are Medical Records and Patient Questionnaires for Physician Profiling and Health Services Research
OBJECTIVES: This study was designed to determine the optimal nonobservational method of measuring the delivery of outpatient medical services. METHODS: As part of a multimethod study of the content of primary care practice, research nurses directly observed consecutive patient visits to 138 practicing family physicians. Data on services delivered were collected using a direct observation checklist, medical record review, and patient exit question…
The Utility of Medicare Claims Data for Measuring Cancer Stage
BACKGROUND: The validity of using claims data for measuring tumor stage, one of the most important determinants of choice of therapy and long-term survival, is unknown. OBJECTIVES: To determine the relative accuracy of both inpatient and hospital Outpatient Medicare claims for measuring the stage of disease of six commonly diagnosed cancers. RESEARCH DESIGN: Analysis of a database linking Surveillance, Epidemiology, and End Results (SEER) registr…
The Sensitivity of Medicare Claims Data for Case Ascertainment of Six Common Cancers
BACKGROUND: Although Medicare claims data have been used to identify cases of cancer in older Americans, there are few data about their relative sensitivity. OBJECTIVES: To investigate the sensitivity of diagnostic and procedural coding for case ascertainment of breast, colorectal, endometrial, lung, pancreatic, and prostate cancer. SUBJECTS: Three hundred and eighty nine thousand and two hundred and thirty-six patients diagnosed with cancer betw…
Sustained Personal Autonomy
The results are consistent with previous studies of successful aging and show that attitudes expressed at baseline favoring personal independence are associated with sustained autonomy during a period of at least 2 years
Facilitating Participatory Decision-Making
BACKGROUND: Participatory decision-making (PDM), a widely held ideal, depends on physician facilitation of patient participation. However, little is known about how PDM facilitation is actualized in outpatient primary care. OBJECTIVES: The objective of this study was to describe the prevalence of physician facilitation of PDM in community family practices and associated physician, patient, and visit characteristics. RESEARCH DESIGN: This was a cr…
Agreement of Medicare Claims and Tumor Registry Data for Assessment of Cancer-Related Treatment
BACKGROUND: Although health claims data are increasingly used in evaluating variations in patterns of cancer care and outcomes, little is known about the comparability of these data with tumor registry information. OBJECTIVES: To evaluate the agreement between Medicare claims and tumor registry data in measuring patterns of diagnostic and therapeutic procedures for older cancer patients. RESEARCH DESIGN: Analysis of a database linking Surveillanc…
Race and Preventive Services Delivery Among Black Patients and White Patients Seen in Primary Care
BACKGROUND: Numerous studies have documented racial disparities in delivery of health care treatment services, but there is little information to determine whether similar disparities exist in the delivery of preventive services. OBJECTIVE: To determine if disparities exist in preventive service delivery to non-Hispanic white patients and black patients in primary care. RESEARCH DESIGN: Multimethod study using direct observation of patient encoun…
Long-Term Impact of Preventive Proactivity on Quality of Life of the Old-Old
OBJECTIVE: This research explored the long-term benefits of engaging in proactive health promotion efforts among old-old residents of Sunbelt retirement communities to empirically test components of the Preventive and Corrective Proactivity (PCP) Model of Successful Aging. Specifically, we examined the contributions of exercise, tobacco use, moderate alcohol use, and annual medical checkups to multidimensional quality of life indicators of physic…
A Comparison of the National Ambulatory Medical Care Survey (NAMCS) Measurement Approach With Direct Observation of Outpatient Visits
BACKGROUND: The National Ambulatory Medical Care Survey (NAMCS) informs a wide range of important policy and clinical decisions by providing nationally representative data about outpatient practice. However, the validity of the NAMCS methods has not been compared with a reference standard. METHODS: Office visits of 549 patients visiting 30 family physicians in Northeastern Ohio were observed by trained research nurses. Visit content measured by d…
Recruiting Minority Primary Care Practices Into Practice-Based Research
BACKGROUND: A potentially fruitful strategy for increasing enrollment of minority patients in research is to engage minority clinicians. However, little attention has been paid to unique challenges and effective strategies for engaging practices with minority physicians. OBJECTIVE: The objective of this study was to provide a model for recruiting community-based primary care practices with minority physicians into research studies. RESEARCH DESIG…
Racial, Ethnic, and Socioeconomic Differences in the Incidence of Obesity Related to Childbirth
Objectives. We investigated the relationship between childbirth and 5-year incidence of obesity. Methods. We performed a prospective analysis of data on 2923 nonobese, nonpregnant women aged 14 to 22 years from the 1979 National Longitudinal Survey of Youth Cohort, which was followed from 1980 to 1990. We used multivariable logistic regression analyses to determine the adjusted relative risk of obesity for mothers 5 years after childbirth compare…
Childbearing, Stress and Obesity Disparities in Women
Why The Nation Needs A Policy Push On Patient-Centered Health Care
The phrase "patient-centered care" is in vogue, but its meaning is poorly understood. This article describes patient-centered care, why it matters, and how policy makers can advance it in practice. Ultimately, patient-centered care is determined by the quality of interactions between patients and clinicians. The evidence shows that patient-centered care improves disease outcomes and quality of life, and that it is critical to addressing racial, e…
Primary Care Practice Transformation is Hard Work
BACKGROUND: Serious shortcomings remain in clinical care in the United States despite widespread use of improvement strategies for enhancing clinical performance based on knowledge transfer approaches. Recent calls to transform primary care practice to a patient-centered medical home present even greater challenges and require more effective approaches. METHODS: Our research team conducted a series of National Institutes of Health funded descript…
A Reemerging Political Space for Linking Person and Community Through Primary Health Care
Objectives. We sought to understand how national policy key informants perceive the value and changing role of primary care in the context of emerging political opportunities. Methods. We conducted 13 semistructured interviews in May 2011 with leaders of federal agencies, think tanks, nonprofits, and quality standard–defining organizations with influence over health care reform policies and implementation. We recorded the interviews and used an e…
The dynamic sustainability framework
BACKGROUND: Despite growth in implementation research, limited scientific attention has focused on understanding and improving sustainability of health interventions. Models of sustainability have been evolving to reflect challenges in the fit between intervention and context. DISCUSSION: We examine the development of concepts of sustainability, and respond to two frequent assumptions -'voltage drop,' whereby interventions are expected to yield l…
Prevalence of metabolic syndrome among urban community residents in China
The MetS is highly prevalent and has reached epidemic proportion in Chinese urban adult community residents
Identifying Specific Combinations of Multimorbidity that Contribute to Health Care Resource Utilization
BACKGROUND: Multimorbidity affects the majority of elderly adults and is associated with higher health costs and utilization, but how specific patterns of morbidity influence resource use is less understood. OBJECTIVE: The objective was to identify specific combinations of chronic conditions, functional limitations, and geriatric syndromes associated with direct medical costs and inpatient utilization. DESIGN: Retrospective cohort study using the…
Personal strengths reported by people with chronic illness
BACKGROUND: Self-management of chronic illness can be highly demanding and people need to mobilize their personal strengths to live well with their condition. More knowledge is needed about how people with chronic illness perceive and use their personal strengths as a basis for better integrating empowering person-centred approaches into health care. OBJECTIVE: To explore what people with chronic illness describe as their strengths relevant to th…
The Influence of Multimorbidity on Leading Causes of Death in Older Adults With Cognitive Impairment
Objective: The aim of this study is to evaluate the relationship of leading causes of death with gradients of cognitive impairment and multimorbidity. Method: This is a population-based study using data from the linked 1992-2010 Health and Retirement Study and National Death Index ( n = 9,691). Multimorbidity is defined as a combination of chronic conditions, functional limitations, and geriatric syndromes. Regression trees and Random Forest iden…
Changes in Case-Mix and Health Outcomes of Medicare Fee-for-Service Beneficiaries and Managed Care Enrollees During the Years 1992–2011
BACKGROUND: Recent studies suggest that managed care enrollees (MCEs) and fee-for-service beneficiaries (FFSBs) have become similar in case-mix over time; but comparisons of health outcomes have yielded mixed results. OBJECTIVE: To examine changes in differentials between MCEs and FFSBs both in case-mix and health outcomes over time. DESIGN: Temporal study of the linked Health and Retirement Study (HRS) and Medicare data, comparing case-mix and h…
Developing a New Measure of Primary Care Using the Medical Expenditure Panel Survey
OBJECTIVE: To develop and assess the reliability of a measure of primary care using items from the Medical Expenditure Panel Survey (MEPS), a US representative survey of community-dwelling persons. METHODS: On the basis of the domains from the literature on primary care characteristics, we identified relevant items within the 2013-2014 MEPS family of surveys. In a sample of primary survey respondents with at least 1 office-based physician visit i…
Medicine (31 obras) · Health care (15 obras) · Family medicine (13 obras) · Psychology (13 obras) · Nursing (12 obras) · Primary Care and Health Outcomes (12 obras) · Political science (10 obras) · Environmental health (9 obras) · Gerontology (9 obras) · Chronic Disease Management Strategies (8 obras)