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Researchers from the Michigan Health Care Education and Research Foundation, a research affiliate of Blue Cross and Blue Shield of Michigan, compared three focused utilization review (UR) strategies to determine which method most effectively and efficiently identifies nonacute inpatient hospital admissions. Intensity, Severity, Discharge-Appropriateness (ISD-A) criteria were used to identify nonacute admissions in 8,973 cases in 73 Michigan hospitals. Significant proportions of nonacute admissions were found in medical, psychiatric, and substance abuse cases; surgical admissions had the lowest rates. Strategies involving the concentration ratio were most effective at indicating potential efficiency gains. Focused UR on Diagnosis-Related Groups (DRGs) with nonacute rates greater than 15% captured 41% of admissions and accounted for 85% of nonacute admissions, 85% of nonacute days, and 80% of potential dollar savings. This suggests that UR efforts focused primarily on DRGs with high nonacute rates would significantly improve the efficiency and effectiveness of the overall UR process.

It is argued that the number of plausible causes effect is a product of the total valence of the causes rather than the number of causes. Orthogonal manipulations of the number of causes and total valence for a chosen (experiment 1) and foregone (experiment 2) action show no effect for the number of causes variable. Attribution to a given cause is a function of its proportion of the total valence. This conception of valence relegates the number of plausible causes concept to the role of an epiphenomenon whose influence can only be understood and predicted by knowledge of changes in valence.

A study was conducted to determine which Major Diagnostic Categories (MDCs) accounted for most of the nonessential hospital admissions in 73 Michigan hospitals in 1986. The Intensity, Severity, Discharge- Appropriateness (ISD-A) criteria set was used to identify nonessential admissions. Large concentra tions of nonessential admissions were found in medi cal, psychiatric, and substance abuse cases; surgical admissions had low rates of nonessential hospitaliza tion. Focusing utilization review on MDCs with non essential rates exceeding 15% results in an examina tion of 44% of admissions, while capturing 77% of nonessential admissions and 73% of potential dollar savings. Implications for UR activities are discussed.

Recent revisions of cognitive dissonance theory no longer encompass some of the important examples, data, and hypotheses that were part of Festinger's original statement. Further, the psychological character of the motivation for cognitive change can be interpreted, in recent statements of the theory, as a need to preserve self-esteem rather than a need to maintain logic-like consistency among cognitions. These changes are so substantial as to prompt the observation that the evolved theory might be identified as a different theory-in fact, as one that predates cognitive dissonance theory. A final, disturbing thought: What if the original dissonance theory, which has now surrendered its name to somewhat different ideas, was correct?

Female college students filled out a questionnaire about breast self-examination (BSE) including (a) past and intended frequency of BSE, (b) attitude toward BSE, (c) beliefs about the benefits and costs of BSE, (d) knowledge about BSE, (e) confidence in ability to perform BSE, (f) social influences to perform BSE, (g) personal experiences related to breast cancer, and (h) perceptions of susceptibility to and severity of breast cancer. Results were consistent with a model in which (a) attitude and confidence are the direct causes of BSE, (b) beliefs about the benefits and costs of BSE are the direct causes of attitude, and (c) social influences (e.g., being taught how) and knowledge are the direct causes of confidence.

A survey of 619 Detroit-area women was conducted in order to understand why women do or do not perform breast self-examination and obtain or not obtain professional breast examinations. The survey assessed these behaviors and women's beliefs about (a) their susceptibility to breast cancer, (b) the seventy or seriousness of breast cancer, (c) the benefits of breast examinations and (d) the costs or disadvantages of the examinations. Separate sets of questions measured seventy of breast cancer when it is treated (a) late (seventy-late) and (b) promptly (seventy-early). Predictions were derived by combining the health belief model with the theory of subjective expected utility. Path analysis supported most predictions of the combined theory. As predicted, high severity-late increased perceived benefit, high seventy-early decreased benefit, and perceived benefit mediated the effects of seventy on behavior. Implications for understanding health decisions, measuring health beliefs, and modifying health...

The purpose of this report is to make available two sets of persuasive messages one for fictitious brands of 12 types of consumer products and the other for 20 sociopolitical issues. These communications were developed as part of a research program directed at obtaining reliable persuasion effects.

It has been suggested that use of interactive statistical models would greatly increase the proportion of variance accounted for by studies of physician utilization. The purpose of this paper is to evaluate and describe the benefits and pitfalls of using interactive statistical models of physician utilization. The paper presents Monte Carlo simulation data and real world data to determine how much more of the variance in physician utilization can be accounted for by interactive regression models. Results indicate that adding interaction terms is unlikely to produce large increases in variance accounted for. The usefulness of interactive models is particularly low when there is substantial measurement error in the predictor variables. Other advantages and disadvantages of interactive models are discussed, including 1) improved understanding, 2) inflation of alpha, 3) sensitivity to transformations and scale of measurement, and 4) confounding of interaction effects with nonlinear effects.

Background Skin cancer are increasing and some types of skin cancer are among the most lethal cancers yet are easily preventable. However, sun protection interventions are rarely implemented among outdoor workers. Our prior work shows that Michigan Operating Engineers (heavy equipment operators) spend an average of 4–5 hours in the sun, about one-third reported getting sun burned at least once a summer, and over half burned more than once a summer. About three-quarters of the sample never or only sometimes used sun block. Methods/design Using the Health Belief Model as a guide, this randomized controlled trial (RCT) will test the efficacy of four sun protection interventions targeting Operating Engineers: a) education only; b) education and mailed sunscreen; c) education and text message reminders; and, d) education, mailed sunscreen, and text message reminders. Participations in the study will be offered during regularly scheduled safety trainings at the Local 324 Training Center. Pre- and post-intervention surveys will be collected to determine changes in sunscreen use and sun burning, the primary dependent variables. The analyses will include: a) paired t-tests to determine changes over time (from pre-intervention to post–intervention) in outcome variables (sunscreen use and burning) separately in the 4 intervention groups, b) Repeated Measures Analysis of Variance (RM-ANOVA) to compare the changes in outcomes across the 4 groups, and c) t-tests on change scores as follow-ups to the RM-ANOVA to determine exactly which groups differ from each other. Discussion Based on the outcome of this study, we will develop a RO1 for wider scale testing and dissemination in conjunction with the International Training Center which services North America (including the US, Mexico, and Canada). Wide scale dissemination of an efficacious sun protection intervention has the potential to substantially impact skin cancer rates among this population. The ultimate goal is for high reach, high efficacy, and low cost. Trial registration NCT01804595

Background Fall prevention programs for hospitalized patients have had limited success, and the effect of programs on decreasing total falls and fall-related injuries is still inconclusive. This exploratory multi-hospital study examined the unique contribution of call light response time to predicting total fall rates and injurious fall rates in inpatient acute care settings. The conceptual model was based on Donabedian's framework of structure, process, and health-care outcomes. The covariates included the hospital, unit type, total nursing hours per patient-day (HPPDs), percentage of the total nursing HPPDs supplied by registered nurses, percentage of patients aged 65 years or older, average case mix index, percentage of patients with altered mental status, percentage of patients with hearing problems, and call light use rate per patient-day. Methods We analyzed data from 28 units from 4 Michigan hospitals, using archived data and chart reviews from January 2004 to May 2009. The patient care unit-month, defined as data aggregated by month for each patient care unit, was the unit of analysis (N = 1063). Hierarchical multiple regression analyses were used. Results Faster call light response time was associated with lower total fall and injurious fall rates. Units with a higher call light use rate had lower total fall and injurious fall rates. A higher percentage of productive nursing hours provided by registered nurses was associated with lower total fall and injurious fall rates. A higher percentage of patients with altered mental status was associated with a higher total fall rate but not a higher injurious fall rate. Units with a higher percentage of patients aged 65 years or older had lower injurious fall rates. Conclusions Faster call light response time appeared to contribute to lower total fall and injurious fall rates, after controlling for the covariates. For practical relevance, hospital and nursing executives should consider strategizing fall and injurious fall prevention efforts by aiming for a decrease in staff response time to call lights. Monitoring call light response time on a regular basis is recommended and could be incorporated into evidence-based practice guidelines for fall prevention.