Functional status outcomes in rehabilitation. Implications for prospective payment

Previous studies have demonstrated that functional status is a significant predictor of resource utilization for rehabilitation patients. Before implementing a prospective payment system (PPS) for rehabilitation, it is important to first: 1) develop an underlying conceptual framework of rehabilitation resource use; and 2) understand how the role of functional status may vary by rehabilitation condition. In this study, a theoretical model of rehabilitation is presented that proposes relationships between patient and provider characteristics, rehabilitation treatment, costs, and clinical outcomes of rehabilitation. Also presented are regression analyses based on this model for a key outcome of rehabilitation, change in functional status, for nine rehabilitation conditions using variables that minimize adverse incentives by providers in selecting patients for admission to rehabilitation. The change-in-functional-status model explained the most variance for back injury, cardiopulmonary, and arthritis, and less variance for stroke, spinal cord injury, and neurologic impairment. The significant predictors of change in functional status varied by condition. Results support the use of functional status measurements in a PPS for rehabilitation services, the need to refine the measurement of functional status, and the use of condition-specific activities of daily living (ADL) items to include in summary indices.     

Implications of payment of fees for psychotherapy.

Considers the question of how the payment of fees by clients for psychotherapy and related psychological services influences therapeutic outcomes. Psychoanalytic theory and cognitive dissonance theory suggest that clients who pay for psychotherapy will benefit more than those who pay nothing. This question and related issues are discussed with reference to observations and experimental studies that have explored how fees influence psychotherapy. Presently, sufficient evidence does not exist either to support or refute most of the hypotheses that have been generated, including the one that clients who pay a fee benefit more than those who pay nothing. Explanations for this void in the research literature and suggestions for expanding the understanding of this domain are provided. (29 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Rising verbal intelligence scores: Implications for research and clinical practice.

Evidence suggests that scores on various intelligence tests have been rising at a fast rate. To find out whether performance on the Wechsler Adult Intelligence Scale (WAIS) Vocabulary subtest has also been rising, the authors searched major psychology journals for investigations involving healthy younger and older adult participants and collected the reported WAIS Vocabulary scores. The meta-analysis shows that WAIS Vocabulary scores have been rising at the rate of 0.117/year (corresponding to 1.52 IQ points/decade) for younger adults and 0.367/year (corresponding to 4.79 IQ points/decade) for older adults. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Transference in everyday experience: Implications of experimental research for relevant clinical phenomena.

Experimental research examining the clinical concept of transference (S. Freud 1912/1958; H. S. Sullivan, 1953) using a social–cognitive model has demonstrated that mental representations of significant others are stored in memory and can be activated and applied in new social encounters, with consequences for cognition, evaluation, affect, motivation, expectancies, and self-evaluations (S. M. Andersen and N. S. Glassman, 1996; S. M. Andersen, I. Reznik, and S. Chen, 1997). These findings constitute empirical demonstration of transference in everyday social relations and suggest that transference is a normal, nonpathological process, occurring both inside and outside psychotherapy, following basic rules of social information processing. In this article clinical implications of this research are discussed, including how the content versus process of transference may contribute to maladaptive transference responses and the potential value of identifying triggering cues in transference in real life and in therapy to promote more adaptive responding. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Implications of test revisions for research.

Test revisions are increasingly common in psychology and neuropsychology in particular. However, such revisions may alter in complex ways the kind of information obtained, and they may assess traits, abilities, and conditions in ways different from earlier versions. This article outlines some of the problems associated with the revision of tests facing clinicians and researchers. Three broad classes of revision are considered. Part I considers the aging of tests, part 2 concerns the aging of participants, and part 3 considers changes in test format. Although the article focuses largely on measures of intelligence and personality, the issues addressed in the article apply to other tests and assessment domains as well. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Causal attributions in posttraumatic stress disorder: Implications for clinical research and practice.

In this paper we seek to illuminate connections among basic research findings in cognition and causal inference, clinical research on the treatment of Posttraumatic Stress Disorder (PTSD), and the practices of clinicians who work with trauma survivors. We examine one particular (and, we believe, important) aspect of PTSD: The creation and maintenance of causal attributions about trauma. We suggest that elements of two principal theories of causal induction (the connectionist model and the "Power PC" causal power model) clarify the role of causal attributions in creating and sustaining the symptoms of PTSD. By exploring the role of causal attributions in creating and sustaining posttraumatic symptoms, we hope to understand better the subjective experience of trauma and its sequelae. We then suggest new directions for clinical research on cognitive restructuring in PTSD patients as well as ideas for optimizing attribution-based therapies for trauma survivors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Impact of clinical information systems on nursing practice. Nurses' perspectives

This article adds to the literature on the impact of computerized clinical information systems by asking nurses important questions about their nursing practices. A research tool was developed from collaborative work with clinicians who have used computers in their daily practice for more than two decades. A statewide study then was conducted on how nurses believed computer technology impacted their practice. This study also examined the different views that computer users and nonusers held. Questions were posed relating to resource consumption, nursing work practices, and professional and patient outcomes. It was found that nurses, whether computer naive or knowledgeable, clearly do not expect the technology to have negative impact on practice. The two groups differed mostly in the strength of their beliefs. One startling outcome, that slow computer response time delayed care, was identified within the computer-user group and direct action was taken as a result.     

The need for an outcomes research agenda for clinical laboratory testing

Aural papillomatosis has been infrequently reported in the English literature. It is a condition which can be very difficult to treat. We present the first reported case of aural papillomatosis successfully treated with the CO2 laser.     

The research readership and information source reliance of clinical psychologists.

Conducted a mail survey of 95 clinical psychologists employed in VA hospitals, medical schools, state mental hospitals, and federally funded community mental health centers to determine the extent to which clinicians read research articles and/or rely on other sources of information for their professional work activities. Results indicate that academic clinicians and medical school psychologists read slightly more than 4 research articles each month, while the other psychologists read slightly more than 2 articles each month. Furthermore, the groups of psychologists differentially relied on such information sources as nonresearch articles and workshops. Findings are discussed in the context of mental health research utilization and mental health innovation diffusion. (12 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comparison of computer-based versus counselor-based occupational information systems with disadvantaged vocational students.

Based on the rationale that occupational information is an educational essential, 72 Ss, who were occupational work experience 10th-12th graders, were randomly assigned to individual guidance from either a computerized occupational information system or a counselor-based information system or assigned to a control group. Ss were posttested on the Assessment of Career Development to determine which group learned the most information. Results demonstrate a hierarchical learning effect: The computer group learned more than the counseled group, which learned more than the control group. Only the treatment effects were significantly different between the groups, since there was no interaction of IQ and treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The clinical management of client dynamics and fees for psychotherapy: Implications for research and practice.

Research indicates that there is no clear relationship between fees and therapy effectiveness, although fees do impact the therapeutic process. By integrating E. Fromm's (1947) personality theory with a typology of client dynamics in response to fees, it is suggested that therapists are aided in the conceptualization of client dynamics and are able to develop proactive treatment interventions. For example, receptive clients may use fees to get attention, to foster helplessness, or to maintain ties with the therapist in the therapeutic relationship. Dynamics of exploitative, hoarding, and marketing clients are also outlined. A major benefit of the typology is that therapists can assess, evaluate, and interpret clients' dynamics in terms of goals, needs, feelings, and behavioral expressions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Depression and coronary heart disease in women: Implications for clinical practice and research.

Practicing psychologists who treat depression in women need to consider their depressed clients at heightened risk for heart disease. In this article, the authors review evidence supporting the link between depression in women and their subsequent increased risk for illness and death from coronary heart disease (CHD). Although further research is needed, the evidence to date suggests that women in treatment for depression should, at the very least, be educated about their increased risk for CHD, and, ideally, psychotherapy for depressed women should incorporate interventions designed either to reduce risk factors for CHD, such as obesity, smoking, and alcohol abuse, or to enhance health-maintenance behaviors, such as exercise and adherence to a low-fat diet, which are associated with cardiovascular health. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Casemix adjustment of managed care claims data using the clinical classification for health policy research method

OBJECTIVES: The objective of this study was to explore the use of the Clinical Classification for Health Policy Research (CCHPR) as a casemix adjustment method for examining physician practice patterns. METHODS: The data source was 2 years of administrative claims from an 86,000 member health maintenance organization in southeastern Michigan. The CCHPR version 2 algorithm, which is in the public domain, was used to assign each claim to one of 260 clinical categories. CCHPR and age-sex categories were used as explanatory variables in multiple linear regression models with approved claims payments in dollars as the outcome variable. Regressions were performed retrospectively for 1994 and 1995, and with 1994 claims' history to predict 1995 utilization. Similar regressions were performed with age-sex categories alone, and also with the ambulatory diagnostic groups. RESULTS: The adjusted R2 value of the retrospective regression models for total approved dollars was 0.42 for both study years when CCHPR categories were used. In contrast, age-sex explanatory variables alone achieved an R2 of 0.02. CONCLUSIONS: The CCHPR method appears to be a promising tool to understand variability in physician resource utilization in managed care.     

Inaccuracy of family health information: Implications for prevention.

Highlights the relevance of family health history information for secondary and possibly primary prevention and discusses the complications of interaction of multiple risk factors, such as the lack of knowledge of family health history for adoptees and inaccurate knowledge of family health history for nonadoptees. Conflicts between the rest of the family's right to medical confidentiality and the individual's need to know about health risks for which he or she may show increased susceptibility are noted. Implications of inaccurate information for self-directed and public health prevention are discussed, and confidentiality and other reasons for maintaining nondisclosure are considered. It is contended that research and progress in prevention will likely accelerate, continuing to alter the traditional view from one of the individual with a personal health history to one in which individuals share a familial (genetic?+?shared environment?+?similar behavior patterns) risk with others, who may also benefit from preventive programs. (32 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Implications of research for psychotherapeutic treatment of women.

Research data concerning psychotherapeutic treatment of women are limited to analog studies; thus, all conclusions necessarily are highly inferential. It is contended that although there are many well-publicized conclusions pointing to the existence of sexism in therapy, the data do not provide clear evidence in this regard. Although sex role stereotyping exists as a general phenomenon, it is less clear that it systematically influences individuals' judgments of single patients, and there is no indication that it is more common among male than female therapists. Evidence for a double standard of mental health, although widely cited, is based on questionable data. While sexism undoubtedly occurs in individual cases, further evidence is needed to define the generality of the phenomenon. (20 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Temperament and dyadic contributions to affect regulation: Implications from developmental research for clinical practice.

The temperamental trait of inhibition offers a setting to examine the characteristics of the interplay between intraindividual factors and contextual influences. This article drew from both the developmental psychoanalytic model on mutual regulation of affect and developmental research on temperament to portray the mechanisms and consequences of the dynamic processes of change, in which both the individual and the environment are constantly changing. The portrait presents a unique case of a very inhibited girl at age 3, who gradually shifts from a frozen, fearful stance into a spontaneous, active behavior. The examination uses the paradigm of coconstruction of play narratives, a paradigm that combines both projective techniques and developmental research perspectives. The function of the adults as stress buffers is explored. Possible implications for psychoanalysis, treatment processes and developmental psychopathology are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Implications of computerized axial tomography for clinical neuropsychology.

Suggests that the development of computerized axial tomography (CT scanning) will alter the role of the clinical neuropsychologist working in a medical setting. The CT technique is rapid, noninvasive, and more accurate than traditional neurodiagnostic and neuropsychological measures. It is likely that the ability to isolate the suspected location of brain lesions on the basis of psychological test data will become increasingly an obsolete skill, while the ability to specify precise, functional deficits for purposes of litigation and/or rehabilitation counseling will become increasingly important. Finally, CT scanning will prove invaluable as an aid in mapping the functional geography of the brain. (13 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Perceived control over caregiving outcomes: Implications for child abuse.

We predicted low perceived caregiver control over caregiving failure to be related to (a) coercive or abusive parenting and (b) affective reactions to "difficult" children. On the basis of a multidimensional scaling analysis of the Parent Attribution Test (Study 1), we constructed a scale (PCF) that assessed perceived balance of control over caregiving failure (attributed control to caregivers vs attributed control to children). In Study 2, we found low PCF to predict abusiveness and nonabusive coerciveness among mothers in counseling at a child abuse agency. Additionally, we found low PCF to predict experienced annoyance/irritation among unrelated mothers interacting with children at relatively high risk for abuse (compared with their lower-risk siblings). We interpreted results as demonstrating the potential importance of low perceived control as a moderator of negative affect in response to difficult children. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Implications of general systems theory for assessment and intervention.

Although concepts about people's behavior have traditionally emphasized the individual psyche, psychologists are becoming more aware of other systems that influence behavior; for example, biological (physical condition), family, peer group, and community. General systems theory provides a logical and effective means to inventory the systems influencing behavior. Because several malfunctioning systems can yield the same presenting problem, the first task in assessment is to identify the malfunctioning system(s). Intervention must be aimed at the system(s) implicated; depending on the problem, intervention must be chosen for its attention to input/output variables or internal process variables; and intervention must support changes in target system(s) with changes in neighboring systems. Six major implications of general systems theory are discussed (e.g., the need for a more intense dialog with community psychology). (20 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)