Customized clinical case management for chronically ill patients. Health system sees remarkable results with teams of case managers,physicians, patients

Securing excellent care and positive outcomes for seriously ill, high-risk patients requires extraordinary measures. A health system in Georgia is experiencing strong results by taking a team approach to health care with case managers, physicians and patients working together.     

The power of outcomes: FOTO Industrial Outcomes Tool -- Initial assessment

OBJECTIVE: To demonstrate how outcomes assessment can assist in describing clients receiving rehabilitation in occupational health rehabilitation clinics and to describe the preliminary assessment of internal consistency reliability and construct validity of the FOTO Industrial Outcomes Tool. METHODS: 266 adults referred for acute work rehabilitation (AWR), work conditioning/hardening (WC/WH) or a Functional Capacity Evaluation (FCE) comprised the data set. Clients were treated between July 1998 and January 1999 in 15 clinics from 6 states by 46 clinicians participating in the Focus on Therapeutic Outcomes (FOTO) national rehabilitation database beta test. For AWR and WC/WH, clients completed a health status questionnaire on intake and discharge, and health status was assessed prior to the FCE. Comprehensive demographic data were collected describing the clinics, clinicians, clients and work status collected 2 weeks following discharge. RESULTS: Internal consistency reliability coefficients for the health status scores ranged from 0.57 to 0.89. Construct validity was supported. CONCLUSION: Results demonstrate the power of collecting outcomes from a variety of constructs for clients receiving industrial rehabilitation services. Initial reliability and construct validity findings were adequate and support continuing data analyses.     

The Safeguarding Effect of Governance Mechanisms in Inter‐firm Exchange: The Decisive Role of Mutual Opportunism

This study empirically investigates the safeguarding effect of (1) administrative control, (2) a dominant power position and (3) relational norms, on opportunistic behaviour of suppliers, by means of a survey among 624 information and communication technology professionals in Dutch municipalities. The findings indicate that individual effectiveness of relational norms, particularly in terms of flexibility and solidarity, was most prominent. Administrative control and power did not show a significant impact on supplier opportunism in our sample. Research into the simultaneous use of several safeguards against opportunism generated the finding that different relational norms fortify each other's safeguarding effect. Furthermore, we demonstrate that supplier opportunism is only mitigated by a dominant power position when the buyer does not exploit its favourable position and the buyer does not behave opportunistically. Hence, power seems to have a safeguarding effect only when it is not used.     

Estimating Individual-Level Risk in Spatial Epidemiology Using Spatially Aggregated Information on the Population at Risk

We propose a novel alternative to case-control sampling for the estimation of individual-level risk in spatial epidemiology. Our approach uses weighted estimating equations to estimate regression parameters in the intensity function of an inhomogeneous spatial point process, when information on risk-factors is available at the individual level for cases, but only at a spatially aggregated level for the population at risk. We develop data-driven methods to select the weights used in the estimating equations and show through simulation that the choice of weights can have a major impact on efficiency of estimation. We develop a formal test to detect non-Poisson behavior in the underlying point process and assess the performance of the test using simulations of Poisson and Poisson cluster point processes. We apply our methods to data on the spatial distribution of childhood meningococcal disease cases in Merseyside, U.K. between 1981 and 2007.     

Network and Health Changes Among Older Dutch Adults

A negative effect of good health on the instrumental support received can be viewed as an effect of the mobilization of helpers. A positive effect of good health on the personal network size and the instrumental support given demonstrates that people in poor health have difficulty actively maintaining their relationships. Furthermore, the support received and given is positively related to the support given and received in the past. In four waves of a seven–year longitudinal study, personal interviews were conducted with 2,302 older Dutch adults (aged 60 to 85) who live on their own. The hypotheses have been confirmed. An implication is that investing in relationships by giving support might pay off in times of need.     

Personality and organizational health: the role of conscientiousness

Organizational health research identifies processes through which the work environment and individual differences combine to influence both individual and organizational outcomes. This study investigated the contribution of conscientiousness to organizational health. Research in the areas of occupational stress, work performance, and organizational climate was used to develop a framework for integrating different elements of organizational health. Within this framework, the work environment was assessed by perceptions of workload and role clarity ; individual well-being was assessed by psychological distress and job satisfaction ; and behaviour important for organizational success was assessed by contextual performance. Conscientiousness was investigated within the framework using self-reports from a sample of 104 Australian employees. Conscientiousness directly influenced contextual performance but did not influence well-being or perceptions of the work environment. Conscientiousness also reduced the impact of role clarity on both psychological distress and job satisfaction. The role of conscientiousness in a comprehensive model of organizational health is discussed.     

Regulation of Jealousy Protest in the Context of Reunion Following Differential Treatment

Emotion regulation strategies and variation in their presentation were explored toward understanding infants' responses during reunion with mother (Re) following baseline mother–infant interaction (Bl) and differential treatment (DT) episodes. Correlation analyses revealed cohesion among distress and mother‐directed touch and proximity‐seeking during DT and Re, mother‐directed gaze during DT, and resistance during Re. The association between mother‐directed gaze during DT and distress during Re suggests that visual inattention during DT serves as a regulatory strategy. Overall, these linkages yield expanded understanding of jealousy protest as a constellation of responses that endures beyond the eliciting condition and includes regulatory behaviors. Cross‐context comparisons revealed that distress was lower during Re than during DT, but not as low as Bl, suggesting that DT poses challenge to interactive repair. Inquiry into individual variation revealed that distress during Re was augmented in laterborn males and with risk influences of dysregulated fear, and maternal insensitivity and hostility. Conversely, maternal depression was associated with less distress; later judgment as insecure, especially insecure‐avoidance, was associated with less mother‐directed behaviors. These findings suggest that dysregulation following DT is indicated by both resistance and passivity. In sum, the results highlight emotion regulation as a powerful framework for addressing recovery following DT.     

A case–control study relating railroad worker mortality to diesel exhaust exposure using a threshold regression model

A case–control study of lung cancer mortality in U.S. railroad workers in jobs with and without diesel exhaust exposure is reanalyzed using a new threshold regression methodology. The study included 1256 workers who died of lung cancer and 2385 controls who died primarily of circulatory system diseases. Diesel exhaust exposure was assessed using railroad job history from the US Railroad Retirement Board and an industrial hygiene survey. Smoking habits were available from next-of-kin and potential asbestos exposure was assessed by job history review. The new analysis reassesses lung cancer mortality and examines circulatory system disease mortality. Jobs with regular exposure to diesel exhaust had a survival pattern characterized by an initial delay in mortality, followed by a rapid deterioration of health prior to death. The pattern is seen in subjects dying of lung cancer, circulatory system diseases, and other causes. The unique pattern is illustrated using a new type of Kaplan–Meier survival plot in which the time scale represents a measure of disease progression rather than calendar time. The disease progression scale accounts for a healthy-worker effect when describing the effects of cumulative exposures on mortality.     

Testing the Significance of Categorical Predictor Variables in Nonparametric Regression Models

In this paper we propose a test for the significance of categorical predictors in nonparametric regression models. The test is fully data-driven and employs cross-validated smoothing parameter selection while the null distribution of the test is obtained via bootstrapping. The proposed approach allows applied researchers to test hypotheses concerning categorical variables in a fully nonparametric and robust framework, thereby deflecting potential criticism that a particular finding is driven by an arbitrary parametric specification. Simulations reveal that the test performs well, having significantly better power than a conventional frequency-based nonparametric test. The test is applied to determine whether OECD and non-OECD countries follow the same growth rate model or not. Our test suggests that OECD and non-OECD countries follow different growth rate models, while the tests based on a popular parametric specification and the conventional frequency-based nonparametric estimation method fail to detect any significant difference.