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Purpose The purpose of this qualitative study was to explore diabetes medication experiences of patients with type 2 diabetes. Methods Study participants were recruited through newspaper advertisements and letters from [...]

Background. When considered individually, self-reported functional status and performance-based functional stares predict functional status decline and mortality. However, what additional prognostic information is gained by combining these approaches remains unknown. Methods. The authors used three waves of three sites (5138 participants) of the Established Populations for Epidemiologic Studies of the Elderly to determine the prognostic value of individual and combined approaches. Baseline self-reported (mobility and activities of daily living [ADL] items) and performance-based (Physical Performance Score) functional status information was classified into three and four hierarchical categories, respectively. Results. Based on self-reported information alone, at 1 year, 73% participants bad not changed, 15% declined, 6% improved, and 6% died. At 4 years, 53% had not changed, 24% declined, 2% improved, and 22% died. Based on performance-based assessment alone, at 4 years. 33% of the sample remained stable, 37% declined, 6% improved, and 24% died. In the top two self-reported categories, functioning on the performance-based assessment varied widely. Among those who were independent in all self-reported functioning, approximately 40% scored in each of the top two performance-based categories. Among persons in the top two self-reported categories, poorer performance was associated with progressively higher 1-year and 4-year mortality rates. Among persons with impaired mobility and at least 1 ADL dependency, the mortality rate was high and was not influenced by performance-based score. Conclusions. Combining self-reported and performance-based measurements can reline prognostic information, particularly among older persons with high self-reported functioning. However, if ADL dependency is present, performance-based measures do not add prognostic value regarding mortality.

Purpose: We determined the prognostic value of self-reported and performance-based measurement of function, including functional transitions and combining different measurement approaches, on utilization. Design and Methods: Our cohort study used the 6th, 7th, and 10th waves of three sites of the Established Populations for Epidemiologic Studies of the Elderly, linked to 1- and 4-year Medicare Part A hospital costs. We examined mean hospital expenditures based on (a) 1- and 4-year transitions in self-reported functional status; (b) 4-year transitions in performance-based functional status; (c) combined baseline self-reported and performance-based functional status; and (d) poorest self-reported and performance-based functional status during a 4-year period. Results: Even modest declines in self-reported or performance-based functional status were associated with increased expenditures. When baseline self-reported and performance-based assessments were combined, mean 1- and 4-year adjusted costs were higher with progressively worse performance-based scores, even among those who were independent in self-reported function. When the poorest 4-year self-reported and performance-based functions were examined, self-reported functioning was the most important determinant of hospital costs, but within each self-reported functional level, poorer performance-based function was associated with progressively higher costs. Implications: The costs associated with even modest functional decline are high. Combining self-reported and performance-based measurements can provide more precise estimates of future hospital costs. Key Words: Health care costs, Disability, Medicare

Byline: David W. Baker, Risa P. Hayes, Barry M. Massie, Carissa A. Craig Abstract: Background: Improved understanding of the reasons for underuse of diagnostic tests and treatments for congestive heart failure (CHF) may be helpful for designing future interventions to improve quality of care. Methods: To determine differences between family physicians' and cardiologists' practice styles for diagnosis and treatment of CHF, a random sample of family physicians and cardiologists were surveyed with standardized case scenarios. Results: Survey respondents were 182 family physicians and 163 cardiologists. Family physicians were less likely than cardiologists to rate measurement of left ventricular ejection fraction as 'very important' for patients with new CHF, less likely to order an echocardiogram or test for ischemia, and much less likely to identify diastolic dysfunction as a cause of CHF. Family physicians were more likely to prescribe digoxin when it was not indicated (diastolic dysfunction) and less likely to prescribe digoxin and an angiotensin-converting enzyme (ACE) inhibitor when they were indicated (moderately to severely reduced left ventricular ejection fraction). Family physicians expressed more concern over the risks of ACE inhibitors in patients with blood pressure of 100/70 mm Hg or serum creatinine of 2.0 mg/dL and were less likely to prescribe an ACE inhibitor in these settings. Family physicians overestimated the risks of warfarin use for atrial fibrillation and were therefore less likely to prescribe warfarin. Conclusions: Family physicians appear to have less understanding of CHF pathophysiology (ie, systolic versus diastolic dysfunction) and how treatment differs according to the underlying disease process. Overestimation of the risk of ACE inhibitor and warfarin use may result in underprescribing these medications. (Am Heart J 1999;138:826-34.) Author Affiliation: Cleveland, Ohio; Atlanta and Decatur, Ga; and San Francisco, Calif From the.sup.aDepartments of Medicine and Epidemiology/Biostatistics, MetroHealth Medical Center and Case Western Reserve University, Cleveland..sup.bEmory University Center for Clinical Evaluation Sciences, Atlanta, and the Kerr L. White Institute for Health Services Research, Decatur..sup.cGrady Memorial Hospital Center for Clinical Effectiveness, Atlanta; and the.sup.dDepartment of Medicine, University of California San Francisco, and the Section of Cardiology of the Department of Veterans Affairs Medical Center, San Francisco Article History: Received 19 November 1998; Accepted 4 March 1999 Article Note: (footnote) [star] Reprint requests: Risa P. Hayes, PhD, 101 W Ponce de Leon Ave, Suite 610, Decatur, GA 30030-2542. E-mail: rhayes@klwi.org , [star][star] 0002-8703/99/$8.00 + 0 4/1/98464