Paula Diehr
Biographic Data
| ID | 354546 |
|---|---|
| NAME | Paula Diehr |
| GIVEN NAMES | Paula |
| FAMILY NAME | Diehr |
| SIGNATURE | DIEHR P |
| AFFILIATIONS | University of Washington |
| VERIFIED | No |
| TOTAL WORKS | 49 |
| TOTAL CITATIONS | 77 |
| AUTHOR COUNT | 49 |
| EDITOR COUNT | 0 |
| FIRST PUBLICATION YEAR | 1975 |
| LATEST PUBLICATION YEAR | 2010 |
| H-INDEX | 5 |
Comparison of 7-day and repeated 24-h recall of type 2 diabetes
Chiropractic Use by Urban and Rural Residents With Insurance Coverage
Purpose: To describe the use of chiropractic care by urban and rural residents in Washington state with musculoskeletal diagnoses, all of whom have insurance coverage for this care. The analyses investigate whether restricting the analyses to insured individuals attenuates previously reported differences in the prevalence of chiropractic use between urban and rural residents as well as whether differences in provider availability or patient cost‐…
The effect of different public health interventions on longevity, morbidity, and years of healthy life
Interventions that promote health and prevent disease performed well, but other types of intervention were sometimes better. The value to society of interventions that increase longevity but also increase morbidity needs further research. More comprehensive screening and treatment of new Medicare enrollees might improve their health and longevity without increasing future medical expenditures
Maternal Work and Birth Outcome Disparities
The Effect of Complementary and Alternative Medicine Claims on Risk Adjustment
OBJECTIVE: We sought to assess how the inclusion of claims from complementary and alternative medicine (CAM) providers affects measures of morbidity burden and expectations of health care resource use for insured patients. METHODS: Claims data from Washington State were used to create 2 versions of a case-mix index. One version included claims from all provider types; the second version omitted claims from CAM providers who are covered under comm…
A prospective study of household smoking bans and subsequent cessation related behaviour
Objective: To assess the degree to which smokers living with a full household ban on smoking change their cessation related behaviour. Design, setting, and participants: Prospective cohort study; follow up of a population based cohort of 1133 smokers, identified from a 1997 telephone survey of adult Oregonians. After a median of 21 months, 565 were located and reinterviewed. Main outcome measures: Quit attempts, time until relapse, and smoking ce…
Accounting for Deaths in Longitudinal Studies Using the SF-36
BACKGROUND: Commonly used measures such as the Physical Component Scale of the Short Form 36-item health survey (PCS) are undefined at death, limiting longitudinal analyses to survivors, a healthier cohort that cannot be identified prospectively, and that might have had little change in health. One proposed approach is to transform the PCS into the Physical Component Transformed, with Deaths included (PCTD), which is the probability of being heal…
The Importance of the Normality Assumption in Large Public Health Data Sets
It is widely but incorrectly believed that the t-test and linear regression are valid only for Normally distributed outcomes. The t-test and linear regression compare the mean of an outcome variable for different subjects. While these are valid even in very small samples if the outcome variable is Normally distributed, their major usefulness comes from the fact that in large samples they are valid for any distribution. We demonstrate this validit…
Common Methodological Terms in Health Services Research and Their Symptoms
OBJECTIVE: Health services researchers use methods and terminology from a variety of disciplines to understand individual and organizational behavior related to health, health care, and health insurance. Although this diversity benefits the process of research, the resulting differences in terminology can occasionally lead to confusion among even the most experienced researchers. The purpose of this paper is to clarify different methodological te…
Probabilities of transition among health states for older adults
Transforming Self-Rated Health and the SF-36 Scales to Include Death and Improve Interpretability
BACKGROUND: Most measures of health-related quality of life are undefined for people who die. Longitudinal analyses are often limited to a healthier cohort (survivors) that cannot be identified prospectively, and that may have had little change in health. OBJECTIVE: To develop and evaluate methods to transform a single self-rated health item (excellent to poor; EVGGFP) and the physical component score of the SF-36 (PCS) to new variables that incl…
Methods for Analyzing Health Care Utilization and Costs
Important questions about health care are often addressed by studying health care utilization. Utilization data have several characteristics that make them a challenge to analyze. In this paper we discuss sources of information, the statistical properties of utilization data, common analytic methods including the two-part model, and some newly available statistical methods including the generalized linear model. We also address issues of study de…
Body mass index and mortality in nonsmoking older adults
OBJECTIVES: This study assesses the relationship of body mass index to 5-year mortality in a cohort of 4317 nonsmoking men and women aged 65 to 100 years. METHODS: Logistic regression analyses were conducted to predict mortality as a function of baseline body mass index, adjusting for demographic, clinical, and laboratory covariates. RESULTS: There was an inverse relationship between body mass index and mortality; death rates were higher for thos…
Will uninsured people volunteer for voluntary health insurance? Experience from Washington State
OBJECTIVES: In national and local discussions of health care reform, there is disagreement about whether a national health insurance plan should be mandatory or voluntary. This study describes characteristics of low- income people who were more likely or less likely to be covered by a voluntary plan. METHODS: Survey data were available from an evaluation of Washington State's Basic Health Plan, which offered subsidized health insurance to low-inc…
A Survey of Current Problems in Meta-Analysis
The United States Agency for Health Care Policy and Research brought together representatives from each of the Patient Outcomes Research Teams (PORTs) as the Inter-PORT Meta-Analysis Work Group. The purpose of the meeting was to discuss a wide range of problems the panel had encountered in the area of meta-analysis. Several actual problems were presented, and tentative solutions to those problems were given. The PORTs had to consider issues such …
The validity of self-reported smoking
OBJECTIVES. The purpose of this study was to identify circumstances in which biochemical assessments of smoking produce systematically higher or lower estimates of smoking than self-reports. A secondary aim was to evaluate different statistical approaches to analyzing variation in validity estimates. METHODS. Literature searches and personal inquiries identified 26 published reports containing 51 comparisons between self-reported behavior and bio…
Small Area Variation Analysis
In small-area variation analysis, the variation of health care utilization rates, e.g., admission rates, among small areas is calculated. Frequently, the variation of one diagnosis, diagnosis-related group (DRG), or procedure is compared with the variation of another. Unfortunately, the methods generally used to make these comparisons are not consistent. They differ on whether they 1) adjust for the prevalence of the DRGs, 2) distinguish between …
Who Enrolled in a State Program for the Uninsured
Managed care plans may hesitate to participate in programs for uninsured persons because they fear adverse selection, whereby only the sickest people or highest users would choose to join the program. We studied this issue in Washington State's Basic Health Plan, a demonstration program that provides subsidized health insurance for families earning less than 200% of the poverty level. We interviewed people in three counties who enrolled in the pr…
Self-Efficacy and Health Behavior Among Older Adults
Self-efficacy has a well-established, beneficial effect on health behavior and health status in young and middle-aged adults, but little is known about these relationships in older populations. We examined this issue as part of a randomized trial to determine the cost savings and changes in health-related quality of life associated with the provision and reimbursement of a preventive services package to 2,524 Medicare beneficiaries enrolled in Gr…
Restricted activity days among older adults
OBJECTIVES. The number of restricted activity days experienced by an individual in the course of a year is an important measure of functional well-being, particularly for older adults. We sought to determine multivariate associations between restricted activity days and various health conditions. METHODS. We used data from the 1984 Supplement on Aging of the National Health Interview Survey to estimate the relationship between restricted activity…
Can Small-Area Analysis Detect Variation in Surgery Rates
A variety of statistical methods can be used in small-area analysis to test whether there is more variation than would be expected by chance alone. However, the power of these methods to detect existing variation has never been studied. The authors used data regarding back surgery in Washington State to suggest several types of variation that might exist (alternative hypotheses), and then used computer simulation to determine the power, or the pr…
Health Status and Use of Services Among Families With and Without Health Insurance
Patrick, Donald L. PhD, MSPH; Madden, Carolyn W. PhD; Diehr, Paula PhD; Martin, Diane P. PhD; Cheadle, Allen PhD; Skillman, Susan M. MS Author Information
Community-level comparisons between the grocery store environment and individual dietary practices
Reproducibility and responsiveness of health status measures statistics and strategies for evaluation
A small area simulation approach to determining excess variation in dental procedure rates
All small area analyses need to compare the observed variability in rates to that expected by chance alone, but the expected variability is usually not known. This paper uses patient-level data for five dental procedures to simulate the distributions of the summary statistics that are usually generated in such studies. These statistics are found to vary greatly even under the "null hypothesis" that all dentists are using procedures at the same ra…
Self-Efficacy and Health Behavior Among Older Adults
Self-efficacy has a well-established, beneficial effect on health behavior and health status in young and middle-aged adults, but little is known about these relationships in older populations. We examined this issue as part of a randomized trial to determine the cost savings and changes in health-related quality of life associated with the provision and reimbursement of a preventive services package to 2,524 Medicare beneficiaries enrolled in Gr…
The Relationships Among Dimensions of Health Services in Two Provider Systems
Stephen M. Shortell, William C. Richardson, James P. LoGerfo, Paula Diehr, Barbara Weaver, The Relationships Among Dimensions of Health Services in Two Provider Systems: A Causal Model Approach, Journal of Health and Social Behavior, Vol. 18, No. 2 (Jun., 1977), pp. 139-159
Body mass index and mortality in nonsmoking older adults
OBJECTIVES: This study assesses the relationship of body mass index to 5-year mortality in a cohort of 4317 nonsmoking men and women aged 65 to 100 years. METHODS: Logistic regression analyses were conducted to predict mortality as a function of baseline body mass index, adjusting for demographic, clinical, and laboratory covariates. RESULTS: There was an inverse relationship between body mass index and mortality; death rates were higher for thos…
Effect of a gatekeeper plan on health services use and charges
A randomized trial was conducted to determine the effectiveness of a health care plan which uses physicians as gatekeepers to control health services use and charges. New enrollees in United Healthcare (UHC), an independent practice association, were randomly assigned to the standard UHC plan requiring a gatekeeper, or to an alternate plan with equal benefits but without a gatekeeper. Individuals in both plans were similar in demographic characte…
Restricted activity days among older adults
OBJECTIVES. The number of restricted activity days experienced by an individual in the course of a year is an important measure of functional well-being, particularly for older adults. We sought to determine multivariate associations between restricted activity days and various health conditions. METHODS. We used data from the 1984 Supplement on Aging of the National Health Interview Survey to estimate the relationship between restricted activity…
Studying patterns of cancer care
Records of hospital inpatients were abstracted for 5,000 newly diagnosed cancer patients admitted in 1982-83 to 17 Comprehensive Cancer Centers and 17 Community Hospital Oncology Programs. Generally available data items (silent record rate less than 5 per cent for the typical institution) included: age, race, sex, dates of hospitalization, zip code of residence, pathological stage, dates of biopsy and surgery, numbers of nodes examined and positi…
Will uninsured people volunteer for voluntary health insurance? Experience from Washington State
OBJECTIVES: In national and local discussions of health care reform, there is disagreement about whether a national health insurance plan should be mandatory or voluntary. This study describes characteristics of low- income people who were more likely or less likely to be covered by a voluntary plan. METHODS: Survey data were available from an evaluation of Washington State's Basic Health Plan, which offered subsidized health insurance to low-inc…
A small area simulation approach to determining excess variation in dental procedure rates
All small area analyses need to compare the observed variability in rates to that expected by chance alone, but the expected variability is usually not known. This paper uses patient-level data for five dental procedures to simulate the distributions of the summary statistics that are usually generated in such studies. These statistics are found to vary greatly even under the "null hypothesis" that all dentists are using procedures at the same ra…
Use of ambulatory care services in three provider plans
A previous study of low-income enrollees in a closed-panel health maintenance organization (HMO) and a Blue Cross/Blue Shield (BC/BS) plan showed that the effect on the use of health services of the age, sex, health status, previous health care use, race, and family size of the enrollees was different in the two plans. We have replicated this study using the same two provider plans but studying a different group of white collar, middle class enro…
The Seattle evaluation of computerized drug profiles
Since 1979, all outpatient pharmacy transactions at the US Public Health Service Hospital in Seattle have been captured in a computer system which generates a profile of each patient's active and previously used drugs. We conducted a controlled trial in which patients were allocated to profile or no-profile groups while the computer continued to collect data on everyone. In all, 41,572 clinic visits made by 6,186 patients were studied. The incide…
Phased trial of a proven algorithm at a new primary care clinic
A previous study showed that a clinical algorithm for respiratory illnesses, consisting of a checklist, a set of instructions (logic), and computer audit/feedback, could reduce costs significantly while maintaining a high quality of care. The results of this study show that the algorithm system, developed and validated at one primary care clinic, can be successfully imported to another primary care clinic. In the present study, the algorithm syst…
Evaluating community-based nutrition programs
A pilot test of a survey of grocery store product displays was conducted to measure the amount of health-education information provided and the proportion of the display devoted to "healthier" products. Inter-rater reliability ranged between 0.73 and 0.78 for the healthiness indices and between 0.30 and 0.67 for the health education measures. Test-retest reliability ranged from 0.44 to 1.0
Factors related to the use of ambulatory mental health services in three providers plans
Access to Medical Care
Paula Diehr, Kathleen O. Jackson, M. Vickie Boscha, Access to Medical Care: The Impact of Outreach Services on Enrollees of a Prepaid Health Insurance Program, Journal of Health and Social Behavior, Vol. 16, No. 3 (Sep., 1975), pp. 326-340
The Relationships Among Dimensions of Health Services in Two Provider Systems
Stephen M. Shortell, William C. Richardson, James P. LoGerfo, Paula Diehr, Barbara Weaver, The Relationships Among Dimensions of Health Services in Two Provider Systems: A Causal Model Approach, Journal of Health and Social Behavior, Vol. 18, No. 2 (Jun., 1977), pp. 139-159
Tonsillectomies, Adenoidectomies, Audits
In the Seattle Prepaid Health Care Project, we studied medical records and claims information for all 97 children undergoing tonsillectomy and/or adenoidectomy in an independent practice plan from February 1971, through January 1975. Overall only 32 per cent of the procedures met commonly promulgated indications of surgery. Of 77 persons having one of these procedures performed because of recurrent pharyngeal or ear infections, 86 per cent did no…
Mental Health Services
Mental health services were included in a comprehensive package of benefits available to low income enrollees in a prepaid group practice plan (PGP) and in an independent practice plan (IPP) under the Seattle Prepaid Health Care Project. There were no out-of-pocket costs for enrollees. Utilization of services was studied for four years under conditions that might simulate universal entitlement. The analyses indicated that females used substantial…
Reproducibility of Clinical Data and Decisions in the Management of Upper Respiratory Illnesses
The ability of non-physician providers to collect the data required by an algorithm for upper respiratory illness management, and the appropriateness of resulting key management decisions, were studied by comparing non-physician data and management decisions on 426 patients with those of internists. The internists, blinded to Amosists' findings and plans, evaluated the same patients and indicated management without using the algorithm (AM-MD) stu…
Increased Access to Medical Care
Many federally financed programs have been launched to improve the access of the poor to medical care, under the assumption that this will improve their health. The effectiveness of these programs, however, has generally been measured by increased utilization rather than by improved health. The few studies which have considered health status have shown small or negative effects. Here, data are presented from a project which provided fully prepaid…
Rates of Surgical Care in Prepaid Group Practices and the Independent Setting What Are the Reasons for the Differences
The Seattle Prepaid Health Care Evaluation Project is a comparative study designed to assess the care received by persons enrolled in either a large prepaid group practice (PGP) or in a prepaid, independent practice setting in which physicians are reimbursed on a fee-for-service basis (IPP). As part of the study we assessed the patterns of surgical care for hysterectomy, cholecystectomy, appendectomy, and tonsillectomy/adenoidectomy. Overall, the…
The Relationship Between Utilization of Mental Health and Somatic Health Services Among Low Income Enrollees in Two Provider Plans
Mental health services were included in comprehensive benefits available with no out-of-pocket expenses to enrollees in the Seattle Prepaid Health Care Project. This study was designed to examine the characteristics of users as compared to nonusers of mental health services and to examine the possibility of lower use of somatic health services attributable to the availability of mental health services. Two enrollee groups were studied: one group …
Health Status as a Measure of Need for Medical Care
At the national level there has been a desire to assure that individuals have access to effective personal medical care services. Accordingly, there has been an interest in linking policies on access to care to the health needs of diverse population groups. This article critiques three measures of access linked to health status: the Use-Disability Ratio, the Symptoms-Response Ratio, and the Episode of Illness Analysis. Their utility in determinin…
Phased trial of a proven algorithm at a new primary care clinic
A previous study showed that a clinical algorithm for respiratory illnesses, consisting of a checklist, a set of instructions (logic), and computer audit/feedback, could reduce costs significantly while maintaining a high quality of care. The results of this study show that the algorithm system, developed and validated at one primary care clinic, can be successfully imported to another primary care clinic. In the present study, the algorithm syst…
The Seattle evaluation of computerized drug profiles
Since 1979, all outpatient pharmacy transactions at the US Public Health Service Hospital in Seattle have been captured in a computer system which generates a profile of each patient's active and previously used drugs. We conducted a controlled trial in which patients were allocated to profile or no-profile groups while the computer continued to collect data on everyone. In all, 41,572 clinic visits made by 6,186 patients were studied. The incide…
The Effect of Chest Radiographs on the Management and Clinical Course of Patients With Acute Cough
The authors studied 2018 consecutive patients with a cough of less than 1 month's duration, presenting for medical care with this problem for the first time. Chest films were taken of all of the last 1819 of these patients. After physicians had specified diagnoses and patient management plans for the last 1531 of these 1819 patients, 98 per cent of the 1531 were randomized either to a group whose chest films were then used in their care, or to a …
The Seattle Evaluation of Computerized Drug Profiles
We studied whether furnishing care providers with computer-generated summaries of patients' current and past medications would reduce the time they spent on various drug-related tasks during patient visits. An observer used time-sampling methods to measure the amount of provider time spent on each of 10 activities during 166 clinic visits, some with profiles and some without them. Additional data were taken from the medical record on factors that…
Use of ambulatory care services in three provider plans
A previous study of low-income enrollees in a closed-panel health maintenance organization (HMO) and a Blue Cross/Blue Shield (BC/BS) plan showed that the effect on the use of health services of the age, sex, health status, previous health care use, race, and family size of the enrollees was different in the two plans. We have replicated this study using the same two provider plans but studying a different group of white collar, middle class enro…
Ambulatory Mental Health Services Utilization in Three Provider Plans
This article examines the use of mental health services in three insurance plans: Blue Cross (BC), a health maintenance organization (HMO), and an independent practice association (IPA) in which the primary care physician was to manage all care for an individual. Approximately 7.3% of the enrollees in all three plans used some mental health care in the 18-month study period. The percent of enrollees with mental health utilization was lower in BC …
Factors related to the use of ambulatory mental health services in three providers plans
Relationship Between Patient Race and the Intensity of Hospital Services
This study reviews evidence on whether services in United States hospitals vary by racial groupings of patients. The focus is on both equity and quality of hospital services. Patients with the diagnosis of pneumonia were studied at 16 randomly selected hospitals. The services and outcomes studied include five measures of the intensity of diagnostic and therapeutic services received by patients, and death rates during hospitalization. Multiple reg…
Use of Ambulatory Health Care Services in a Preferred Provider Organization
The organization of the delivery of health care can have significant cost-saving implications, but few of the available studies have made adequate comparisons of costs across plans. Furthermore, new organizational types such as independent practice associations and preferred provider organizations have not yet been studied in detail. This paper examines ambulatory utilization in a preferred provider organization (PPO) for Uniformed Services benef…
Studying patterns of cancer care
Records of hospital inpatients were abstracted for 5,000 newly diagnosed cancer patients admitted in 1982-83 to 17 Comprehensive Cancer Centers and 17 Community Hospital Oncology Programs. Generally available data items (silent record rate less than 5 per cent for the typical institution) included: age, race, sex, dates of hospitalization, zip code of residence, pathological stage, dates of biopsy and surgery, numbers of nodes examined and positi…
Relationship Between Patient Source of Payment and the Intensity of Hospital Services
Yergan, John MD, MPH; Flood, Ann Barry PhD; Diehr, Paula PhD; LoGerfo, James P. MD, MPH Author Information
Effect of a gatekeeper plan on health services use and charges
A randomized trial was conducted to determine the effectiveness of a health care plan which uses physicians as gatekeepers to control health services use and charges. New enrollees in United Healthcare (UHC), an independent practice association, were randomly assigned to the standard UHC plan requiring a gatekeeper, or to an alternate plan with equal benefits but without a gatekeeper. Individuals in both plans were similar in demographic characte…
Treatment Modality and Quality Differences for Black and White Breast-Cancer Patients Treated in Community Hospitals
This study assessed the relationship of race and patterns of care, defined by an expert NCI-appointed committee, for 7,781 patients with breast cancer treated in 107 hospitals in 45 communities between 1982 and 1985. After control for age and stage of disease, black patients had significantly different care from white patients for four of the ten patterns examined. They were less likely to have a progesterone receptor assay or to be referred for …
A small area simulation approach to determining excess variation in dental procedure rates
All small area analyses need to compare the observed variability in rates to that expected by chance alone, but the expected variability is usually not known. This paper uses patient-level data for five dental procedures to simulate the distributions of the summary statistics that are usually generated in such studies. These statistics are found to vary greatly even under the "null hypothesis" that all dentists are using procedures at the same ra…
Evaluating community-based nutrition programs
A pilot test of a survey of grocery store product displays was conducted to measure the amount of health-education information provided and the proportion of the display devoted to "healthier" products. Inter-rater reliability ranged between 0.73 and 0.78 for the healthiness indices and between 0.30 and 0.67 for the health education measures. Test-retest reliability ranged from 0.44 to 1.0
Use of a Preferred Provider Plan by Employees of the City of Seattle
Little is known about the use of services in a preferred provider organization (PPO). We studied a preferred provider arrangement between Pacific Medical Center and employees of the City of Seattle. In the second 12 months of this program 8,529 subjects submitted at least one claim; of these, only 420 (4.9%) ever used the preferred provider. Those who used the PPO at least once differed significantly from those who never used it on age, sex, empl…
Medicine (47 works) · Health care (22 works) · Family medicine (20 works) · Healthcare Policy and Management (19 works) · Environmental health (18 works) · Gerontology (16 works) · Gerontology (13 works) · Demography (12 works) · Business (11 works) · Computer Science (11 works)