14 results on '"Fiscella K"'
Search Results
2. Health characteristics associated with gaining and losing private and public health insurance: a national study.
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Jerant A, Fiscella K, and Franks P
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- 2012
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3. Patient-centered communication during primary care visits for depressive symptoms: what is the role of physician personality?
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Chapman BP, Duberstein PR, Epstein RM, Fiscella K, Kravitz RL, Chapman, Benjamin P, Duberstein, Paul R, Epstein, Ronald M, Fiscella, Kevin, and Kravitz, Richard L
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- 2008
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4. Connoisseurs of care? Unannounced standardized patients' ratings of physicians.
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Srinivasan M, Franks P, Meredith LS, Fiscella K, Epstein RM, Kravitz RL, Srinivasan, Malathi, Franks, Peter, Meredith, Lisa S, Fiscella, Kevin, Epstein, Ronald M, and Kravitz, Richard L
- Abstract
Background: Patient satisfaction surveys can be informative, but bias and poor response rates may limit their utility as stable measures of physician performance. Using unannounced standardized patients (SPs) may overcome some of these limitations because their experience and training make them able judges of physician behavior.Objectives: We sought to understand the reliability of unannounced SPs in rating primary care physicians when covertly presenting as real patients.Study Design: Data from 2 studies (Patient Centered Communication [PCC]; Social Influences in Practice [SIP]) were included. For the PCC study, 5 SPs made 192 visits to 96 physicians; for the SIP study, 18 SPs made 292 visits to 146 physicians. SPs visits to physicians were randomized, thus avoiding mutual selection bias. Each SP rated 16 to 38 physicians on interpersonal skills (autonomy support: PCC, SIP), technical skills (information gathering: SIP-only), and overall satisfaction (SIP-only). We evaluated SP evaluation consistency (physician vs. total variance rho), and SPs' overall satisfaction with specific dimensions of physician performance.Results: Scale reliability varied from 0.71 to 0.92. Physician rhos (95% confidence intervals) for autonomy support were 0.40 (0.22-0.58; PCC) and 0.30 (0.14-0.45; SIP); information gathering rho was 0.46 (0.33-0.59; SIP). Overall SP satisfaction rho was 0.47 (0.34-0.60; SIP). SPs varied significantly in adjusted overall satisfaction levels, but not other dimensions.Conclusions: These analyses provide some evidence that medical connoisseurship can be learned. When adequately sampled by trained SPs, some physician skills can be reliably measured in community practice settings. [ABSTRACT FROM AUTHOR]- Published
- 2006
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5. Mammography self-report and mammography claims: racial, ethnic, and socioeconomic discrepancies among elderly women.
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Holt K, Franks P, Meldrum S, and Fiscella K
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BACKGROUND: National self-report surveys show minimal racial disparity in mammography, whereas analyses of administrative data show large disparity. METHODS: Using the 1998-2002 Medicare Current Beneficiary Surveys, which contain participants' self-report and claims data, we developed multivariable adjusted models examining factors associated with self-reported mammography and self-reported mammography verified by billing records. RESULTS: No racial/ethnic disparities were found in self-reported mammography. Verified mammography, however, revealed significant disparities for race, education, income, insurance, and health status. CONCLUSIONS: Race, education, income, insurance, and health status are associated with a lower likelihood of self-reported mammography verified by the existence of claims data. These data caution against exclusive reliance on self-report survey data to assess disparity in mammography. [ABSTRACT FROM AUTHOR]
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- 2006
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6. Effects of patient and physician practice socioeconomic status on the health care of privately insured managed care patients.
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Franks P, Fiscella K, Beckett L, Zwanziger J, Mooney C, Gorthy S, Franks, Peter, Fiscella, Kevin, Beckett, Laurel, Zwanziger, Jack, Mooney, Cathy, and Gorthy, ShihFangHuang
- Abstract
Background: Previous research shows that patient socioeconomic status (SES) affects health care, but little is known about the relative effects of patient and physician practice SES among privately insured patients.Objective: To examine the effects of patient and physician practice SES on prevention, disease management, utilization, and cost expenditures.Design: Cross-sectional analyses of claims data.Subjects: Primary care physicians (568) and their adult managed care organization patients (437,743) in the Rochester, New York, area.Measures: Pap smears, mammograms, glycohemoglobins, and eye examinations for diabetics, physician visits, referrals, hospitalizations, costs standardized expenditures (diagnostic testing, office visits, and total), patient zip code-based SES, and physician practice SES (mean SES of patients in practice).Results: After adjustment, lower SES patients had lower compliance with Pap smears, mammograms, and diabetic eye exams, and were less likely to have a referral or make any office visit, but were more likely to be hospitalized, and generated higher testing standardized expenditures. Lower physician practice SES was associated with lower adjusted Pap, mammogram, and glycohemoglobin compliance, lower office visit standardized expenditures, but higher diagnostic testing and total standardized expenditures. Patient SES effects were stronger for mammography, whereas physician practice SES effects were stronger for diagnostic testing costs. For the utilization indicators, the SES effects on utilization exhibited a linear gradient, whereas there was a threshold effect for costs.Conclusions: Patient and practice SES are independently associated with care among privately insured patients. These effects are not confined to the poorest patients but span the entire socioeconomic spectrum. Interventions to address these disparities need to be broad-based, but should also address the needs of practices with predominantly lower SES patients. [ABSTRACT FROM AUTHOR]- Published
- 2003
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7. Impact of patient socioeconomic status on physician profiles: a comparison of census-derived and individual measures.
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Fiscella, K and Franks, P
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- 2001
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8. Skepticism toward medical care and health care utilization.
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Fiscella, Kevin, Franks, Peter, Clancy, Carolyn M., Fiscella, K, Franks, P, and Clancy, C M
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- 1998
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9. Mortality Risk Prediction: Can Comorbidity Indices Be Improved With Psychosocial Data?
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Chapman BP, Weiss A, Fiscella K, Muennig P, Kawachi I, and Duberstein P
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- Health Status, Humans, Prognosis, Quality of Life, ROC Curve, Risk Assessment methods, Social Behavior, Attitude to Health, Comorbidity trends, Health Status Indicators, Mortality trends
- Abstract
Background: Predicting risk of premature death is one of the most basic tasks in medicine and public health, but has proven to be difficult over the long term even with the best prognostic models. One popular strategy has been to improve prognostic models with candidate genes and other novel biomarkers. However, the gains in predictive power have been modest and the costs have been high, leading to a demand for cost-effective alternatives. We conducted a proof-of-principle investigation to examine whether simple, cheap, and noninvasive paper-and-pencil measures of social class and personality phenotype could improve the performance of one of the most widely used prediction models for all-cause mortality, the Charlson Comorbidity Index (CCI)., Methods: We used data from baseline and 25-year mortality follow-up of the UK Health and Lifestyle Study cohort. In a subset of the cohort, we first identified 5 psychosocial factors highly predictive of mortality: income, education, type A personality, communalism (preference for the company of others), and "lie" scale (a measure of denial, putatively associated with ill health). We then examined the predictive performance of the CCI with and without these measures in a validation subsample., Results: Across 5-, 10-, 15-, 20-, and 25-year time horizons, the psychosocially augmented CCI showed substantially better discrimination [area under the receiver-operating curves (95% confidence interval) from 0.83 (0.81-0.85) to 0.84 (0.83-0.86)] than the CCI [area under the receiver-operating curves from 0.74 (0.71-0.76) to 0.77 (0.76-0.79)]. These translated into net reclassification improvements from 27% (23%-31%) to 35% (32%-38%) of survivors and from 23% (17%-30%) to 34% (17%-30%) of decedents; and 23%-42% reductions in the Number Needed to Screen. Calibration improved at all time horizons except 25 years, where it was decreased., Conclusion: Widespread attempts to improve prognostic models might consider not only novel biomarkers, but also psychosocial questionnaire measures.
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- 2015
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10. Psychometric evaluation of the patient satisfaction with logistical aspects of navigation (PSN-L) scale using item response theory.
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Carle AC, Jean-Pierre P, Winters P, Valverde P, Wells K, Simon M, Raich P, Patierno S, Katz M, Freund KM, Dudley D, and Fiscella K
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- Delivery of Health Care methods, Delivery of Health Care standards, Female, Humans, Male, Neoplasms diagnosis, Neoplasms therapy, Psychometrics, Reproducibility of Results, Surveys and Questionnaires, Health Services Accessibility standards, Patient Satisfaction statistics & numerical data
- Abstract
Background: Patient navigation--the provision of logistical, educational, and emotional support needed to help patients "navigate around" barriers to high-quality cancer treatment offers promise. No patient-reported outcome measures currently exist that assess patient navigation from the patient's perspective. We use a partial independence item response theory model to report on the psychometric properties of the Patient Satisfaction with Navigation, Logistical measure developed for this purpose., Methods: We used data from an ethnically diverse sample (n = 1873) from the National Cancer Institute Patient Navigation Research Program. We included individuals with the presence of an abnormal breast, cervical, colorectal, or prostate cancer finding., Results: The partial independence item response theory model fit well. Results indicated that scores derived from responses provide extremely precise and reliable measurement between -2.5 SD below and 2 SD above the mean and acceptably precise and reliable measurement across nearly the entire range., Conclusions: Our findings provide evidence in support of the Patient Satisfaction with Navigation, Logistical. Scale users should utilize 1 of the 2 described methods to create scores.
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- 2014
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11. Patient trust: is it related to patient-centered behavior of primary care physicians?
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Fiscella K, Meldrum S, Franks P, Shields CG, Duberstein P, McDaniel SH, and Epstein RM
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- Adult, Age Distribution, Female, Health Status, Humans, Male, Mental Health statistics & numerical data, Middle Aged, Multivariate Analysis, New York, Primary Health Care methods, Racial Groups statistics & numerical data, Sex Distribution, Attitude of Health Personnel, Patient-Centered Care statistics & numerical data, Physician-Patient Relations, Primary Health Care statistics & numerical data, Trust
- Abstract
Background: Patients' trust in their health care providers may affect their satisfaction and health outcomes. Despite the potential importance of trust, there are few studies of its correlates using objective measures of physician behavior during encounters with patients., Methods: We assessed physician behavior and length of visit using audio tapes of encounters of 2 unannounced standardized patients (SPs) with 100 community-based primary care physicians participating in a large managed care organization. Physician behavior was assessed via 3 components of the Measure of Patient-Centered Communication (MPCC) scale. The Primary Care Assessment Survey (PCAS) trust subscale was administered to 50 patients from each physician's practice and to SPs. We used multilevel modeling to examine the associations between physicians' Patient-Centered Communication during the SP visits and ratings of trust by both patients and SPs., Results: Component 1 of the MPCC, which explored the patient's experience of the disease and illness, was independently associated with patient's rating of trust in their physician. A I SD increase in this score was associated with 0.08 SD increase in trust (95% confidence interval 0.02-0.14). Each additional minute spent in SP visits was also independently associated with 0.01 SD increase in patient trust. (95% confidence interval 0.0001-0.02). Component 1 and visit length were also positively associated with SP trust ratings., Conclusions: Physician verbal behavior during an SP encounter is associated with trust reported by SPs and patients. Research is needed to determine whether interventions designed to enhance physicians' exploration patients' experiences of disease and illness improves trust. Key Words: physician-patient relationship, patient-centered care, trust, physician behavior
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- 2004
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12. Socioeconomic status disparities in healthcare outcomes: selection bias or biased treatment?
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Fiscella K
- Subjects
- APACHE, Adult, Bias, Black People, Education, Elective Surgical Procedures, Female, Humans, Insurance, Health, Intensive Care Units, Life Expectancy trends, Male, Mortality trends, Stereotyping, United Kingdom, United States, White People, Black or African American, Prejudice, Quality of Health Care, Selection Bias, Socioeconomic Factors, Treatment Outcome
- Published
- 2004
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13. Effect of patient socioeconomic status on physician profiles for prevention, disease management, and diagnostic testing costs.
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Franks P and Fiscella K
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- Adult, Benchmarking, Cross-Sectional Studies, Diagnostic Tests, Routine economics, Female, Health Services Accessibility, Health Services Research, Humans, Male, Managed Care Programs statistics & numerical data, Middle Aged, New York, Preventive Health Services organization & administration, Quality Indicators, Health Care, Diagnostic Tests, Routine statistics & numerical data, Disease Management, Managed Care Programs standards, Practice Patterns, Physicians' statistics & numerical data, Preventive Health Services statistics & numerical data, Social Class
- Abstract
Background: Previous research shows patient socioeconomic status (SES) affects physician profiles for health status and satisfaction, but effects on other aspects of care are not known., Objective: To examine the effect of patient SES on physician profiles for preventive care, disease management, and diagnostic testing costs., Research Design: Cross-sectional analysis of a managed care claims data., Subjects: Five hundred sixty-eight physicians and 600,618 patients., Measures: Patient age, gender, case-mix, and SES based on zip code, likelihood of having a Papanicolaou smear, mammogram, for diabetics having had a glycosylated hemoglobin, diabetic eye exam, and diagnostic testing costs., Results: For each performance indicator, except glycosylated hemoglobin, there was a statistically significant effect of adjusting for patient SES. For diabetic eye checks, mammograms and Papanicolaou tests respectively, 5%, 16%, and 21% of physicians who were outliers (in the top or bottom 5% of rankings) were no longer outliers after socioeconomic adjustment. For all performance measures the change in physician ranking was strongly correlated with the mean practice SES., Conclusions: Patient SES, as measured by zip code, appreciably affects physician profiles for preventive care and diabetes management. Monitoring patient SES using patient zip codes could be used to target resources to improve outcomes for higher risk patients.
- Published
- 2002
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14. Disparities in health care by race, ethnicity, and language among the insured: findings from a national sample.
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Fiscella K, Franks P, Doescher MP, and Saver BG
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- Adult, Cross-Sectional Studies, Female, Health Care Surveys, Health Services Accessibility economics, Health Services Needs and Demand statistics & numerical data, Humans, Logistic Models, Male, Medicaid, Middle Aged, Patient Acceptance of Health Care statistics & numerical data, Socioeconomic Factors, Black or African American statistics & numerical data, Health Services statistics & numerical data, Health Services Accessibility statistics & numerical data, Hispanic or Latino statistics & numerical data, Insurance, Health statistics & numerical data, Language, Patient Acceptance of Health Care ethnology, White People statistics & numerical data
- Abstract
Background: Racial and ethnic disparities in health care have been well documented, but poorly explained., Objective: To examine the effect of access barriers, including English fluency, on racial and ethnic disparities in health care., Research Design: Cross-sectional analysis of the Community Tracking Survey (1996-1997)., Subjects: Adults 18 to 64 years with private or Medicaid health insurance., Measures: Independent variables included race, ethnicity, and English fluency. Dependent variables included having had a physician or mental health visit, influenza vaccination, or mammogram during the past year., Results: The health care use pattern for English-speaking Hispanic patients was not significantly different than for non-Hispanic white patients in the crude or multivariate models. In contrast, Spanish-speaking Hispanic patients were significantly less likely than non-Hispanic white patients to have had a physician visit (RR, 0.77; 95% CI, 0.72-0.83), mental health visit (RR, 0.50; 95% CI, 0.32-0.76), or influenza vaccination (RR, 0.30; 95% CI, 0.15-0.52). After adjustment for predisposing, need, and enabling factors, Spanish-speaking Hispanic patients showed significantly lower use than non-Hispanic white patients across all four measures. Black patients had a significantly lower crude relative risk of having received an influenza vaccination (RR, 0.73; 95% CI, 0.58-0.87). Adjustment for additional factors had little impact on this effect, but resulted in black patients being significantly less likely than non-Hispanic white patients to have had a visit with a mental health professional (RR, 0.46; 95% CI, 0.37-0.55)., Conclusions: Among insured nonelderly adults, there are appreciable disparities in health-care use by race and Hispanic ethnicity. Ethnic disparities in care are largely explained by differences in English fluency, but racial disparities in care are not explained by commonly used access factors.
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- 2002
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