How Tailoring Led to Variation in Care Issues, Dosage, and Outcomes: Part 1: Secondary Analysis of the PREP Trial for Frail Older Adults and Family Caregivers.

In family caregiving interventions for adults with health problems, tailoring has become the norm. Studies that evaluate tailored interventions, however, have rarely included intentional variation in dosage or explored the dosage-outcome association. In this Part 1 secondary analysis, we examine dosage and outcomes in intervention families ( = 116) who participated in the Oregon Health & Science University/Kaiser Permanente Northwest Region Family Care Study.

Predicting patient follow-through on telephone nursing advice.

Although use of telephone advice nursing services continues to grow, little research has addressed factors that affect crucial call outcomes like follow-through on the advice given. This article describes aspects of the advice call process and examines predictors of caller follow-through, using a conceptual model derived from the literature and the authors' preliminary work. Calls to call centers and medical offices of a large health maintenance organization were taped, then content was coded and matched with caller questionnaire (CQ) data.

Predictors of patient satisfaction with telephone nursing services.

Patient satisfaction has been shown to be a factor in clinical outcomes, health care quality, and patient follow-through. Thus, a high level of satisfaction is a desired outcome of patient care. This article examines predictors of patient satisfaction with telephone nursing services among a sample of 1,939 respondents, using a conceptual model derived from the literature and preliminary work.

Improving services for sex partners of chlamydia-infected patients in an HMO.

Objective: To improve services for sex partners of chlamydia-infected patients (ie, chlamydia partner services [CPS]) at an HMO.

Study Design: Assessment of current CPS policy, practices, and opinions in Kaiser Permanente Northwest Region (KPNW) and in local health departments, and design, implementation, and evaluation of 4 CPS interventions.

Methods: We reviewed KPNW policy documents, conducted focus groups with KPNW clinicians, and did phone interviews with KPNW chlamydia-infected patients and health department disease intervention specialists.

The Beta-Carotene and Retinol Efficacy Trial: incidence of lung cancer and cardiovascular disease mortality during 6-year follow-up after stopping beta-carotene and retinol supplements.

Background: The Beta-Carotene and Retinol Efficacy Trial (CARET) tested the effect of daily beta-carotene (30 mg) and retinyl palmitate (25,000 IU) on the incidence of lung cancer, other cancers, and death in 18,314 participants who were at high risk for lung cancer because of a history of smoking or asbestos exposure. CARET was stopped ahead of schedule in January 1996 because participants who were randomly assigned to receive the active intervention were found to have a 28% increase in incidence of lung cancer, a 17% increase in incidence of death and a higher rate of cardiovascular disease mortality compared with participants in the placebo group.

Methods: After the intervention ended, CARET participants returned the study vitamins to their study center and provided a final blood sample.

Cost-effectiveness of a tailored intervention to increase screening in HMO women overdue for Pap test and mammography services.

Background: Research has established the societal cost-effectiveness of providing breast and cervical cancer screening to women. Less is known about the cost of motivating women significantly overdue for services to receive screening.

Methods: In this intent-to-treat study, a total of 254 women, aged 52-69, who were overdue for both Pap test and mammography, were randomized to two groups, a tailored, motivational outreach or usual care.

Telephone advice nursing services in a US health maintenance organization.

We studied telephone advice nursing (TAN) in the US. We recorded 4269 TAN calls in four regions served by Kaiser Permanente, a health maintenance organization. A call description form was used to record information regarding both calls and callers.

Integrating prenatal-postnatal smoking interventions into usual care in a health maintenance organization.

Consistent with the increasing national emphasis on providing health promotion in clinical care settings, Stop Smoking for OuR Kids (STORK), a research-derived, prenatal-postnatal smoking cessation intervention, was implemented throughout prenatal clinics, inpatient postpartum services, and pediatric clinics of Kaiser Permanente Northwest. Process data collected during the project rollout and maintenance to monitor the clinical practices of clinicians and staff members, patient responses to the intervention, and penetration of the intervention into the health maintenance organization priority population of prenatal smokers high-lighted barriers to intervention delivery. These barriers fell into three categories related to the smoking intervention design, clinicians and staff members, and the organization.

Consumer knowledge and opinions of genetic testing for breast cancer risk.

Although clinical evidence shows the value of genetic testing for breast cancer risk, consumer opinion about the test-and its outcomes-may differ. We conducted focus groups with white and black women to assess consumer opinions about genetic testing for breast cancer risk. We conducted 5 focus groups with women between the ages of 30 and 79.

Screening rarely screened women: time-to-service and 24-month outcomes of tailored interventions.

Background: Managed care organizations and others reaching out to underscreened women seek strategies to encourage mammogram and Pap screening.

Methods: Female HMO members aged 50-69 years and overdue for a mammogram and a Pap test (n = 501) were followed for 24 months after interventions began. An Outreach intervention (tailored letters and motivational telephone interviews), an Inreach intervention (motivational interview delivered in clinics), and a Combined Inreach/Outreach intervention were compared to Usual Care at 24 months.

Tool development for measuring caller satisfaction and outcome with telephone advice nursing.

Caller descriptions and evaluations of their experiences with telephone advice services provide unique information that correlates highly with objective measures of quality and can help interpret data from other sources. An author-developed questionnaire assessed caller outcomes of telephone nursing advice in Phase I an iterative, purposive sample of 40 callers was interviewed by phone. An emergent design was used to develop questions, analyze constructs of interest, and test questions for a draft caller questionnaire, which was tested in Phase II.

Making it work: organization and processes of telephone nursing advice services.

Efforts of health plans to balance service quality with cost control have spurred rapid growth in telephone nursing advice services. Service system design can affect costs, patient outcomes, and staff retention. Research has not addressed how the organization of nursing services affects practice outcomes in telephone advice settings.

Effects of estrogen plus progestin on health-related quality of life.

Background: The Women's Health Initiative (WHI) and other clinical trials indicate that significant health risks are associated with combination hormone use. Less is known about the effect of hormone therapy on health-related quality of life.

Methods: The WHI randomly assigned 16,608 postmenopausal women 50 to 79 years of age (mean, 63) with an intact uterus at base line to estrogen plus progestin (0.

A model for examining predictors of outcomes of telephone nursing advice.

Although telephone advice nursing is the fastest-growing nursing specialty, useful information to guide managers' decisions about how best to structure and support advice services to achieve desired outcomes is unavailable. We identified issues and variables relevant to outcomes of telephone advice from the perspectives of callers, nurses, and the system. Subsequently, we derived a model for studying factors affecting nursing advice outcomes that will help managers identify modifiable factors to improve outcomes of care.

Screening HMO women overdue for both mammograms and pap tests.

Background: Regular screening has the potential to reduce breast and cervical cancer mortality, but despite health plan programs to encourage screening, many women remain unscreened. Tailored communications have been identified as a promising approach to promote mammography and Pap test screening.

Methods: The study used a four-group randomized design to compare with Usual Care the separate and combined effects of two tailored, motivational interventions to increase screening-a clinical office In-reach intervention and a sequential letter/telephone Outreach intervention.

Promoting smoking abstinence in pregnant and postpartum patients: a comparison of 2 approaches.

Objective: To compare the implementation, delivery, and implications for dissemination of 2 different maternal smoking-cessation/relapse-prevention interventions in managed care environments.

Study Design: Healthy Options for Pregnancy and Parenting (HOPP) was a randomized, controlled efficacy trial of an intervention that bypassed the clinical setting. Stop Tobacco for OuR Kids (STORK) was a quasi-experimental effectiveness study of a point-of-service intervention.

Maternal smoking cessation and relapse prevention during health care visits.

Background: Although effects of maternal smoking during pregnancy could be alleviated if women quit early in pregnancy, most do not. Relapse rates among quitters are high.

Objective: To test the effects of a low-intensity, smoking-cessation/relapse-prevention intervention delivered by clinic staff and providers and based on stages-of-change constructs of the transtheoretical model and brief motivational interviewing techniques.

Barriers to mammography and Pap smear screening among women who recently had neither, one or both types of screening.

There is legitimate concern about whether cancer screening programs and other types of prevention and early detection programs are designed to reach those most in need of services. Previous research on barriers to screening has generally addressed screening for specific cancers. The purpose of this study was to evaluate and compare the types and strengths of barriers to both mammography and Pap smear screening experienced by three groups of women.

Sexual orientation and health: comparisons in the women's health initiative sample.

Context: Little is known about older lesbian and bisexual women. Existing research rarely compares characteristics of these women with comparable heterosexual women.

Objective: To compare heterosexual and nonheterosexual women 50 to 79 years on specific demographic characteristics, psychosocial risk factors, screening practices, and other health-related behaviors associated with increased risk for developing particular diseases or disease outcomes.

Professional nursing practice in an HMO: the future is now.

Managed care forms of service delivery now dominate the nursing practice environment. Nursing is potentially a key resource for helping the system to meet the increased and evolving demands, maintaining quality while decreasing costs. However, nurses need additional competencies to function effectively in this environment.

Effects of incentive items on participation in a randomized chemoprevention trial.

Behavioral research has an important role in increasing and maintaining participation in disease prevention trials, both in interventions and in follow-up visits. We conducted a randomized experiment among participants in the lung cancer chemoprevention trial, CARET (Carotene and Retinol Efficacy Trial) to test the effects of providing two incentives on retention. The items used for this study were a Certificate of Appreciation and one of two lapel pins, provided in a 2 2 design.

Occupational exposure to antineoplastic agents: self-reported miscarriages and stillbirths among nurses and pharmacists.

Insult to the germ cells of an ovum or sperm prior to pregnancy as well as exposures to a fetus during pregnancy can affect the outcome of a pregnancy. Antineoplastic agents are mutagenic and teratogenic, so the potential effects of exposure on reproduction are of concern to the workers who handle them. This study investigates pregnancy loss associated with occupational exposures to antineoplastic drugs by comparing rates of spontaneous abortion and stillbirths for pregnancies without antineoplastic exposure and exposed pregnancies in which the pregnant woman or the father handled antineoplastic agents either before or during the pregnancy.

Strategies for recruitment to a population-based lung cancer prevention trial: the CARET experience with heavy smokers. Beta-Carotene and Retinol Efficacy Trial.

The Beta-Carotene and Retinol Efficacy Trial tested the effect of the combination of beta-carotene (30 mg) and retinyl palmitate (25,000 units) daily on the incidence of lung cancer in high-risk individuals. In study centers located in Seattle, WA; Portland, OR; and Irvine, CA, we recruited current and recent ex-cigarette smokers, aged 50-69 years. Our primary method of recruitment was by mailing study information and eligibility questionnaires to age-selected health insurance subscribers.

Nurses' and pharmacists' exposure to antineoplastic drugs: findings from industrial hygiene scans and urine mutagenicity tests.

Data from 83 nurses and pharmacists handling antineoplastic drugs and 35 nurse/pharmacist controls who participated in a national study of antineoplastic drug-handling risks were examined to investigate antineoplastic drug exposure. Measures of external exposure included self-completion drug logs and industrial hygiene scans conducted in clinical settings. Internal exposure was measured by urine mutagenicity tests on end-of-week 24-hour urine specimens.