Nelda P Wray
Datos Biográficos
| ID | 3926871 |
|---|---|
| NOMBRE | Nelda P Wray |
| NOMBRES | Nelda P |
| APELLIDO | Wray |
| FIRMA | WRAY N P |
| AFILIACIONES | Baylor College of Medicine |
| VERIFICADO | No |
| TOTAL DE OBRAS | 25 |
| TOTAL DE CITAS | 46 |
| TOTAL COMO AUTOR | 25 |
| TOTAL COMO EDITOR | 0 |
| PRIMER AÑO DE PUBLICACIÓN | 1987 |
| AÑO MÁS RECIENTE DE PUBLICACIÓN | 2016 |
| ÍNDICE H | 4 |
Outcomes and Resource Use of Sepsis-associated Stays by Presence on Admission, Severity, and Hospital Type
Greater emphasis is needed on public awareness of sepsis and the detection of sepsis in the prehospitalization and early hospitalization period. Hospital characteristics and case mix should be accounted for in cross-hospital comparisons of sepsis outcomes and costs
Mortality After Cardiac Bypass Surgery
BACKGROUND: Risk-adjusted outcome rates frequently are used to make inferences about hospital quality of care. We calculated risk-adjusted mortality rates in veterans undergoing isolated coronary artery bypass surgery (CABS) from administrative data and from chart-based clinical data and compared the assessment of hospital high and low outlier status for mortality that results from these 2 data sources. STUDY POPULATION: We studied veterans who u…
Mortality After Noncardiac Surgery
BACKGROUND: Hospital profiles are increasingly constructed using risk-adjusted clinical data abstracted from patient records. OBJECTIVE: We sought to compare hospital profiles based on risk adjusted death within 30 days of surgery from administrative versus clinical data in a national cohort of surgical patients. DESIGN: This was a cohort study that included 78,546 major noncardiac operations performed between October 1, 1991 and December 31, 199…
Physician-patient communication following invasive procedures
Predicting Healthcare Costs in a Population of Veterans Affairs Beneficiaries Using Diagnosis-Based Risk Adjustment and Self-Reported Health Status
BACKGROUND: Many healthcare organizations use diagnosis-based risk adjustment systems for predicting costs. Health self-report may add information not contained in a diagnosis-based system but is subject to incomplete response. OBJECTIVE: The objective of this study was to evaluate the added predictive power of health self-report in combination with a diagnosis-based risk adjustment system in concurrent and prospective models of healthcare cost. …
Racial and ethnic disparities in the use of health services
Effect of Definition of Mortality on Hospital Profiles
BACKGROUND: Hospitals are ranked based on risk-adjusted measures of postoperative mortality, but definitions differ about which deaths following surgery should be included. OBJECTIVE: To determine whether varying the case definition of deaths following surgery that are included in coronary artery bypass surgery quality assessment affects the identification of outlier hospitals. RESEARCH DESIGN: The study used a prospective cohort design. SUBJECTS…
A psychometric analysis of the measurement level of the rating scale, time trade-off, and standard gamble
A Trial for Comparing Methods for Eliciting Treatment Preferences From Men With Advanced Prostate Cancer
OBJECTIVE: The objective of this study was to evaluate the convergent validity of 3 types of utility measures: standard gamble, time tradeoff, and rating scale. RESEARCH DESIGN: A prospective cohort of 120 men with advanced prostate cancer were first asked to rank order 8 health states, and then utility values were obtained from each participant for each of the 8 health states through 2 of the 3 techniques evaluated (standard gamble, time tradeof…
Veterans Affairs Quality Enhancement Research Initiative in Chronic Heart Failure
Chronic heart failure (CHF) is a highly prevalent condition associated with serious morbidity, intense levels of health services use, and shortened survival. It is also a condition for which ameliorative therapies exist. The evidence indicates that there is substantial need to change clinical practice and health care delivery for people with CHF and thereby improve their outcomes. The goal of the Veterans Affairs (VA) Quality Enhancement Research…
Assessing the Performance of Utility Techniques in the Absence of a Gold Standard
BACKGROUND: Utility techniques are the most commonly used means to assess patient preferences for health outcomes. However, whether utility techniques produce valid measures of preference has been difficult to determine in the absence of a gold standard. OBJECTIVE: To introduce and demonstrate two methods that can be used to evaluate how well utility techniques measure patients' preferences. SUBJECTS AND DESIGN: Patients treated for advanced pros…
How Good Are US Studies of HIV Costs of Care
BACKGROUND: Valid, timely estimates of the costs of HIV care are needed by health planners and policy makers. OBJECTIVE: To perform a methodologic critique of published estimates of resource utilization and costs of HIV care. DATA SOURCES: MEDLINE database for 1990-1998. DATA SELECTION: Included articles focused on adults with a spectrum of HIV disease in which the authors developed their own resource use and cost data. Thirty one articles met th…
The Association of Quality of Care and Occurrence of In-Hospital, Treatment-Related Complications
BACKGROUND: Little data exist supporting the association of quality of care and nonfatal adverse outcomes in hospitalized patients, yet those outcomes are routinely scrutinized in quality assessment efforts. OBJECTIVE: To determine whether measurable differences in quality of care are associated with the occurrence of non-fatal, in-hospital, and treatment-related complications. DESIGN: Retrospective cohort study. SUBJECTS: A total of 2,268 patien…
An Empirical Assessment of the Validity of Explicit and Implicit Process-of-Care Criteria for Quality Assessment
OBJECTIVE: To evaluate the validity of three criteria-based methods of quality assessment: unit weighted explicit process-of-care criteria; differentially weighted explicit process-of-care criteria; and structured implicit process-of-care criteria. METHODS: The three methods were applied to records of index hospitalizations in a study of unplanned readmission involving roughly 2,500 patients with one of three diagnoses treated at 12 Veterans Affa…
The Veterans Affairs Medical Care System
OBJECTIVES: The authors describe the role the Veterans Affairs (VA) medical system plays as a provider of clinic and hospital services by examining utilization levels and users' characteristics. METHODS: The Veterans Affairs hospital discharge database, the Veterans Affairs outpatient clinic files, and the veteran population files were used to estimate the number of persons using the Veterans Affairs medical care system in 1994 and the intensity …
A conceptual framework for the study of early readmission as an indicator of quality of care
Selecting Disease-Outcome Pairs for Monitoring the Quality of Hospital Care
Health care payors and providers are increasingly monitoring hospital discharge data bases for adverse events as markers for quality of care. The principal criticisms of these analyses have focused on the impediments to risk adjustment posed by the incompleteness and inaccuracy of the data bases. However, efforts to address the inadequacies of the data bases will not correct deficiencies of the analytic process. These deficiencies arise from the …
Outpatient Surgical Utilization in Veterans Affairs Hospitals, 1981-1989
In the 1980s, there was a large increase in the percentage of surgical operations performed in the United States without an overnight hospital admission. This shift may have been related to changes in reimbursement for outpatient surgery; studies of this relationship have had conflicting results. The Department of Veterans Affairs (VA) has a budgeting strategy significantly different from reimbursement strategies used by nonfederal hospitals. The…
Using administrative databases to evaluate the quality of medical care
A Method of Developing and Weighting Explicit Process of Care Criteria for Quality Assessment
The use of explicit criteria to evaluate how well processes of care conform to accepted standards is a key method of quality assessment. Synthesizing four decades of literature, we devised an inexpensive, 6-step method of developing reliable, content-valid, explicit process criteria. This paper describes the method using a set of congestive heart failure criteria. In step 1 of the Criteria Development Method, criteria are derived from state-of-th…
Changes in VA Hospital Use 1980-1990
During the 1980s several changes occurred within and outside the Veterans Affairs medical system which may have affected levels of Veterans Affairs (VA) hospital use. We performed a secondary analysis of the 1980-1990 national VA hospital discharge database and Veteran Population Files to examine trends in VA hospital use and to assess effects of the aging of the veteran population. Between 1980 and 1990 discharges increased by 7% despite a 6% dr…
Misclassification of Patients Can Affect Group Quality of Care Scores
Ashton, Carol M. MD, MPH; Kuykendall, David H. PHD; Wray, Nelda P. MD, MPH Author Information
Variation in hemodialysis patient compliance according to demographic characteristics
Characteristics of the Recurrently Hospitalized Adult
Hospital use in the US is concentrated in the approximately 2% of the population that is repeatedly hospitalized. Using the research integration technique of information synthesis, empirical studies of readmission were assembled and analyzed to determine the demographic and clinical characteristics of the repeatedly hospitalized adult. The authors' synthesis of articles that met preset criteria of relevance and validity indicated that clinical va…
Predicting Readmission in Veterans With Chronic Disease
Ashton, Carol M. MD; Wray, Nelda P. MD; Dunn, J Kay PhD; Scheurich, James W. MD; DeBehnke, Richard D. MD; Friedland, Joan A. MD Author Information
A conceptual framework for the study of early readmission as an indicator of quality of care
Using administrative databases to evaluate the quality of medical care
Physician-patient communication following invasive procedures
Variation in hemodialysis patient compliance according to demographic characteristics
A psychometric analysis of the measurement level of the rating scale, time trade-off, and standard gamble
Predicting Readmission in Veterans With Chronic Disease
Ashton, Carol M. MD; Wray, Nelda P. MD; Dunn, J Kay PhD; Scheurich, James W. MD; DeBehnke, Richard D. MD; Friedland, Joan A. MD Author Information
Characteristics of the Recurrently Hospitalized Adult
Hospital use in the US is concentrated in the approximately 2% of the population that is repeatedly hospitalized. Using the research integration technique of information synthesis, empirical studies of readmission were assembled and analyzed to determine the demographic and clinical characteristics of the repeatedly hospitalized adult. The authors' synthesis of articles that met preset criteria of relevance and validity indicated that clinical va…
Variation in hemodialysis patient compliance according to demographic characteristics
A Method of Developing and Weighting Explicit Process of Care Criteria for Quality Assessment
The use of explicit criteria to evaluate how well processes of care conform to accepted standards is a key method of quality assessment. Synthesizing four decades of literature, we devised an inexpensive, 6-step method of developing reliable, content-valid, explicit process criteria. This paper describes the method using a set of congestive heart failure criteria. In step 1 of the Criteria Development Method, criteria are derived from state-of-th…
Changes in VA Hospital Use 1980-1990
During the 1980s several changes occurred within and outside the Veterans Affairs medical system which may have affected levels of Veterans Affairs (VA) hospital use. We performed a secondary analysis of the 1980-1990 national VA hospital discharge database and Veteran Population Files to examine trends in VA hospital use and to assess effects of the aging of the veteran population. Between 1980 and 1990 discharges increased by 7% despite a 6% dr…
Misclassification of Patients Can Affect Group Quality of Care Scores
Ashton, Carol M. MD, MPH; Kuykendall, David H. PHD; Wray, Nelda P. MD, MPH Author Information
Selecting Disease-Outcome Pairs for Monitoring the Quality of Hospital Care
Health care payors and providers are increasingly monitoring hospital discharge data bases for adverse events as markers for quality of care. The principal criticisms of these analyses have focused on the impediments to risk adjustment posed by the incompleteness and inaccuracy of the data bases. However, efforts to address the inadequacies of the data bases will not correct deficiencies of the analytic process. These deficiencies arise from the …
Outpatient Surgical Utilization in Veterans Affairs Hospitals, 1981-1989
In the 1980s, there was a large increase in the percentage of surgical operations performed in the United States without an overnight hospital admission. This shift may have been related to changes in reimbursement for outpatient surgery; studies of this relationship have had conflicting results. The Department of Veterans Affairs (VA) has a budgeting strategy significantly different from reimbursement strategies used by nonfederal hospitals. The…
Using administrative databases to evaluate the quality of medical care
A conceptual framework for the study of early readmission as an indicator of quality of care
The Veterans Affairs Medical Care System
OBJECTIVES: The authors describe the role the Veterans Affairs (VA) medical system plays as a provider of clinic and hospital services by examining utilization levels and users' characteristics. METHODS: The Veterans Affairs hospital discharge database, the Veterans Affairs outpatient clinic files, and the veteran population files were used to estimate the number of persons using the Veterans Affairs medical care system in 1994 and the intensity …
Assessing the Performance of Utility Techniques in the Absence of a Gold Standard
BACKGROUND: Utility techniques are the most commonly used means to assess patient preferences for health outcomes. However, whether utility techniques produce valid measures of preference has been difficult to determine in the absence of a gold standard. OBJECTIVE: To introduce and demonstrate two methods that can be used to evaluate how well utility techniques measure patients' preferences. SUBJECTS AND DESIGN: Patients treated for advanced pros…
How Good Are US Studies of HIV Costs of Care
BACKGROUND: Valid, timely estimates of the costs of HIV care are needed by health planners and policy makers. OBJECTIVE: To perform a methodologic critique of published estimates of resource utilization and costs of HIV care. DATA SOURCES: MEDLINE database for 1990-1998. DATA SELECTION: Included articles focused on adults with a spectrum of HIV disease in which the authors developed their own resource use and cost data. Thirty one articles met th…
The Association of Quality of Care and Occurrence of In-Hospital, Treatment-Related Complications
BACKGROUND: Little data exist supporting the association of quality of care and nonfatal adverse outcomes in hospitalized patients, yet those outcomes are routinely scrutinized in quality assessment efforts. OBJECTIVE: To determine whether measurable differences in quality of care are associated with the occurrence of non-fatal, in-hospital, and treatment-related complications. DESIGN: Retrospective cohort study. SUBJECTS: A total of 2,268 patien…
An Empirical Assessment of the Validity of Explicit and Implicit Process-of-Care Criteria for Quality Assessment
OBJECTIVE: To evaluate the validity of three criteria-based methods of quality assessment: unit weighted explicit process-of-care criteria; differentially weighted explicit process-of-care criteria; and structured implicit process-of-care criteria. METHODS: The three methods were applied to records of index hospitalizations in a study of unplanned readmission involving roughly 2,500 patients with one of three diagnoses treated at 12 Veterans Affa…
A Trial for Comparing Methods for Eliciting Treatment Preferences From Men With Advanced Prostate Cancer
OBJECTIVE: The objective of this study was to evaluate the convergent validity of 3 types of utility measures: standard gamble, time tradeoff, and rating scale. RESEARCH DESIGN: A prospective cohort of 120 men with advanced prostate cancer were first asked to rank order 8 health states, and then utility values were obtained from each participant for each of the 8 health states through 2 of the 3 techniques evaluated (standard gamble, time tradeof…
Veterans Affairs Quality Enhancement Research Initiative in Chronic Heart Failure
Chronic heart failure (CHF) is a highly prevalent condition associated with serious morbidity, intense levels of health services use, and shortened survival. It is also a condition for which ameliorative therapies exist. The evidence indicates that there is substantial need to change clinical practice and health care delivery for people with CHF and thereby improve their outcomes. The goal of the Veterans Affairs (VA) Quality Enhancement Research…
A psychometric analysis of the measurement level of the rating scale, time trade-off, and standard gamble
Effect of Definition of Mortality on Hospital Profiles
BACKGROUND: Hospitals are ranked based on risk-adjusted measures of postoperative mortality, but definitions differ about which deaths following surgery should be included. OBJECTIVE: To determine whether varying the case definition of deaths following surgery that are included in coronary artery bypass surgery quality assessment affects the identification of outlier hospitals. RESEARCH DESIGN: The study used a prospective cohort design. SUBJECTS…
Racial and ethnic disparities in the use of health services
Predicting Healthcare Costs in a Population of Veterans Affairs Beneficiaries Using Diagnosis-Based Risk Adjustment and Self-Reported Health Status
BACKGROUND: Many healthcare organizations use diagnosis-based risk adjustment systems for predicting costs. Health self-report may add information not contained in a diagnosis-based system but is subject to incomplete response. OBJECTIVE: The objective of this study was to evaluate the added predictive power of health self-report in combination with a diagnosis-based risk adjustment system in concurrent and prospective models of healthcare cost. …
Mortality After Cardiac Bypass Surgery
BACKGROUND: Risk-adjusted outcome rates frequently are used to make inferences about hospital quality of care. We calculated risk-adjusted mortality rates in veterans undergoing isolated coronary artery bypass surgery (CABS) from administrative data and from chart-based clinical data and compared the assessment of hospital high and low outlier status for mortality that results from these 2 data sources. STUDY POPULATION: We studied veterans who u…
Mortality After Noncardiac Surgery
BACKGROUND: Hospital profiles are increasingly constructed using risk-adjusted clinical data abstracted from patient records. OBJECTIVE: We sought to compare hospital profiles based on risk adjusted death within 30 days of surgery from administrative versus clinical data in a national cohort of surgical patients. DESIGN: This was a cohort study that included 78,546 major noncardiac operations performed between October 1, 1991 and December 31, 199…
Physician-patient communication following invasive procedures
Outcomes and Resource Use of Sepsis-associated Stays by Presence on Admission, Severity, and Hospital Type
Greater emphasis is needed on public awareness of sepsis and the detection of sepsis in the prehospitalization and early hospitalization period. Hospital characteristics and case mix should be accounted for in cross-hospital comparisons of sepsis outcomes and costs
Medicine (23 obras) · Internal Medicine (11 obras) · Healthcare Policy and Management (10 obras) · Health care (9 obras) · Internal Medicine (9 obras) · Veterans Affairs (9 obras) · Primary Care and Health Outcomes (8 obras) · Intensive care medicine (7 obras) · MEDLINE (7 obras) · Psychology (7 obras)