Functional status as measured by dependencies in the Activities of Daily Living (ADLs) is an important indicator of overall health for older adults. Methodologies for outcomes-based medical-decision-making for public policy, such as decision modeling and cost-effectiveness analysis, require utilities for outcome health states. Utilities have been reported for many disease states, but have not been indexed by functional status, which is a strong predictor of outcome in geriatrics. We describe here a utility elicitation program developed specifically for use with computer-inexperienced older adults: Functional Limitation And Independence Rating (FLAIR1). FLAIR1 design features address common physical problems of the aged and computer attitudes of inexperienced users that could impede computer acceptance. We interviewed 400 adults ages 65 years and older with FLAIR1. In exit interviews with 154 respondents, 118 (76%) found FLAIR1 easy to use. Design features in FLAIR1 can be applied to other software for older adults.

Objectives. Concerns have mounted about the complexities of the health care system potentially causing significant unintended adverse effects. With a major national interest in addressing patient safety issues, a wide spectrum of individuals and organizations are working toward developing methods and systems to detect, characterize, and report potentially preventable adverse events. One approach is to develop screening measures based on routinely collected administrative data, such as the patient safety indicators (PSIs) reported here. The purpose of the PSI project is to report 1) literature-based evidence on potential PSIs, 2) clinician panel review results of potential indicators, 3) empirical analyses on a subset of indicators, and 4) recommendations regarding potential PSIs.

Methods. A four-pronged strategy to collect validation data and descriptive information was used: 1) background literature review, 2) structured clinical panel reviews of candidate PSIs, 3) expert review of ICD-9-CM codes in candidate PSIs, and 4) empirical analyses of the potential candidate PSIs. Evidence from these four sources was used to modify and select the most promising indicators for use as a screening tool to provide an accessible and low-cost approach to identifying potential problems in the quality of care related to patient safety.

Main results. A review of previously reported measures in the literature, and of medical coding manuals, resulted in identification of over 200 ICD-9-CM codes representing potential patient safety problems. Most of these codes were grouped into clinically meaningful indicators either based on previous indicator definitions or on clinical and coding expertise. Based on literature review of the published evidence related to their validity, several potential PSIs were eliminated. Because of the limited validation literature available on PSIs and complications indicators from which many PSIs were derived, the research team conducted a clinical panel review process to assess the face validity and to guide refinements to the initial definitions of the 34 most promising PSIs. Response to a questionnaire by clinicians (i.e., physicians from a number of specialties, nurses, and pharmacists) for each indicator, augmented by coding review and initial empirical testing, provided the basis for selecting the indicators expected to be most useful for screening for potentially preventable adverse events. Twenty hospital level PSIs are recommended for implementation as the initial AHRQ PSI set (designated Accepted indicators).

Conclusions and future research. Future validation work should focus on the sensitivity and specificity of these indicators in detecting the occurrence of a complication; the extent to which failures in processes of care at the system or individual level are detected using these indicators; the relationship of these indicators with other measures of quality, such as mortality; and further explorations of bias and risk adjustment. Enhancements to administrative data are worth exploring in the context of further validation studies that utilize data from other sources. The current development and evaluation effort will best be augmented by a continuous communication loop between users of these measures, researchers interested in improving these measures, and policy makers with influence over the resources aimed at data collection and patient safety measurement.

The Nation's capacity to respond to bioterrorism depends in part on the ability of clinicians and public health officials to detect, manage, and communicate during a bioterrorism event. Information technologies and decision support systems (IT/DSSs) have the potential to aid clinicians (e.g., physicians, nurses, nurse practitioners, and respiratory therapists) and public health officials to respond effectively to a bioterrorist attack.

The Evidence Report from which this summary was taken details the methodology, results, and conclusions of a systematic and extensive search for published materials on the use of IT/DSSs to serve the information needs of clinicians and public health officials in the event of a bioterrorist attack. The information is intended to assist clinicians, public health officials, and policymakers to improve preparedness for a bioterrorism event.

After setting out a conceptual framework that focuses on how personal and social resources aid adolescents in managing acute and chronic stressors, I describe methods by which to assess adolescents' family environments and specific life stressors and social resources, and the approach and avoidance coping responses adolescents use to manage life stressors. I then review some research that employs these concepts and methods to focus on the families and life contexts, and coping skills, of youth with chronic medical disorders, including juvenile rheumatic disease (JRD). I close by drawing implications for assessment and intervention and describing some fruitful areas for future research, such as examining the reciprocal linkages between parental and youth behavior, how adolescents' personal characteristics shape their life context, and how life crises and transitions enhance adolescents' development and maturation.

BACKGROUND: Electronically available data, both administrative, such as outpatient encounter diagnostic data, and clinical, such as problem lists, are being used increasingly for outcome and quality assessment, risk adjustment, and clinical reminder systems. OBJECTIVE: To determine the accuracy of outpatient primary care diagnostic information recorded in administrative and clinical files in a Veterans Affairs VISTA (Veterans Health Information Systems and Technology Architecture) database compared with medical chart notes. STUDY DESIGN: Cross-sectional medical chart review of 148 patients attending a general medicine clinic at a university-affiliated Veterans Affairs hospital for 9 diagnoses relevant to the choice of drug therapy for hypertension. PATIENTS AND METHODS: An administrative file of encounter diagnoses, for a 2-year period, and a clinical file of the problem list maintained by the clinician were the sources of electronic diagnoses. We compared these sources with diagnoses abstracted by medical chart review. We estimated the sensitivity and specificity of each electronic data source for detecting medical chart note diagnoses. RESULTS: The sensitivity for 8 of the 9 study diagnoses was greater than 80% in the administrative file and 49% in the clinical problem list. The specificity was good for the administrative file (91% to 100%) and even better for the clinical file (98% to 100%). CONCLUSIONS: Outpatient encounter diagnoses relevant to hypertension recorded as electronic data had high specificity, and some codes had high sensitivity when collected over multiple visits. The administrative file was more sensitive but less specific than the clinical file. Administrative vs clinical files can be selected to minimize either the false-negative or the false-positive designations, respectively, as dictated by the needs of the quality assessment review.

Objective: Identifying parental behaviors that influence childhood obesity is critical for the development of effective prevention and treatment programs. Findings from a prior laboratory study suggest that parents who impose control over their children's eating may interfere with their children's ability to regulate intake, potentially resulting in overweight. These findings have been widely endorsed; however, the direct relationship between parental control of children's intake and their children's degree of overweight has not been shown in a generalized sample.

Research Methods and Procedures: This study surveyed 792 third-grade children with diverse ethnic and socioeconomic backgrounds from 13 public elementary schools. Parental control over children's intake was assessed through telephone interviews using a state-of-the-art instrument, and children were measured for height, weight, and triceps skinfold thickness.

Results: Counter to the hypothesis, parental control over children's intake was inversely associated with overweight in girls, as measured by body mass index, r = -0.12, p 0.05, and triceps skinfolds, r = -0.11, p 0.05. This weak relationship became only marginally significant when controlling for parents' perceptions of their own weight, level of household education, and children's age. No relationship between parental control of children's intake and their children's degree of overweight was found in boys.

Discussion: Previous observations of the influence of parental control over children's intake in middle-class white families did not generalize to 8- to 9-year-olds in families with diverse socioeconomic and ethnic backgrounds. The present findings reveal a more complex relationship between parental behaviors and children's weight status.