Health plan decision making with new medicare information materials.

OBJECTIVE: To examine the effect of providing new Medicare information materials on consumers' attitudes and behavior about health plan choice. DATA SOURCE: New and experienced Medicare beneficiaries who resided in the Kansas City metropolitan statistical area during winter 1998-99 were surveyed. More than 2,000 computer-assisted telephone interviews were completed across the two beneficiary populations with a mean response rate of 60 percent. STUDY DESIGN: Medicare beneficiaries were randomly assigned to a control group or one of three treatment groups that received varying amounts and types of new Medicare information materials. One treatment group received the Health Care Financing Administrations's pilot Medicare & You 1999 handbook, a second group received the same version of the handbook and a Medicare version of the Consumer Assessment of Health Plans (CAHPS) report, and a third treatment group received the Medicare & You bulletin, an abbreviated version of the handbook. PRINCIPAL FINDINGS: Results of the study suggest that the federal government's new consumer information materials are having some influence on Medicare beneficiaries' attitudes and behaviors about health plan decision making. Experienced beneficiary treatment group members were significantly more confident with their current health plan choice than control group members, but new beneficiaries were significantly less likely to use the new materials to choose or change health plans than control group members. In general the effects on confidence and health plan switching did not vary across the different treatment materials. CONCLUSIONS: The 1999 version of the Medicare & You materials contained a message that it is not necessary to change health plans. This message appears to have decreased the likelihood of using the new materials to choose or change plans, whereas other materials to which beneficiaries are exposed may encourage plan switching. Because providing more information to beneficiaries did not result in commensurate increases in confidence levels or rate of health plan switching, factors other than the amount of information, such as how the information is presented, may be more critical than volume.

Primary versus secondary insomnia in older adults: subjective sleep and daytime functioning.

Most psychological research on insomnia has centered on primary insomnia (PI). Secondary insomnia (SI), though more common than PI, has received little attention because of its presumed unresponsiveness to treatment. The present study recruited older adults with PI, SI, and a comparison group of older adults with no insomnia (NI). Self-report assessments of sleep revealed no significant difference between the 2 insomnia groups. Daytime functioning measures found significant differences in impairment between the 3 groups with SI having the worst daytime functioning, followed by PI, which was worse than NI. Further analyses found substantial independence between sleep and daytime functioning. Implications of these findings for the clinical management of SI are discussed.

The use of schematic knowledge about sources in source monitoring.

Source monitoring refers to mental processes leading to attributions regarding the origin of information. We tested Johnson, Hashtroudi, and Lindsay's (1993) assumption that prior source-relevant knowledge is used in some source-monitoring tasks. In two experiments using different domains of schematic knowledge, two sources presented information that was expected for one source and somewhat unexpected for the other. In a later source-monitoring test, participants decided whether items had been presented by Source A, by Source B, or were new. The results of both experiments show that source identification is better for expected items than for somewhat unexpected items. Multinomial modeling analyses revealed that when participants do not remember the source of information, they guess that it was presented by the expected source. These results provide evidence for the claim that source monitoring can be based on prior knowledge and support a guessing hypothesis.

Age-related differences in the use of contextual information in recognition memory: a global matching approach.

Age differences in the processing of contextual information were investigated using the Item, associated Context, and Ensemble (ICE) model (K. Murnane, M. P. Phelps, & K. Malmberg, 1999), a general global matching model of recognition memory. In two experiments, young and older adults studied words in environmental contexts and were tested in both the same and different contexts. Patterns of context effects for hit rate, false alarm rate, and d' suggest that older adults process associated context, but have difficulties integrating items and context into an ensemble. Thus, older adults appear to have a specific, rather than a general, deficit in processing contextual information. A deficiency in ensemble processing may be responsible for the prevalent finding that older adults show poorer recognition memory performance than young adults.

Source monitoring deficits in patients with schizophrenia; a multinomial modelling analysis.

BACKGROUND: Schizophrenia patients, particularly those with symptoms such as thought insertion, passivity experiences and hallucinations, may share an underlying cognitive deficit in monitoring the generation of their own thoughts. This deficit, which has been referred to as 'autonoetic agnosia', may result in the conclusion that self-generated thoughts come from an external source. Previous work supports this notion, yet the statistical approaches that have been used have not enabled a distinction between specific deficits suggesting autonoetic agnosia and more general cognitive dysfunction. METHODS: Autonoetic agnosia was assessed using source-monitoring paradigms in 28 patients with schizophrenia and 19 control subjects. Multinomial model analyses, which allow the distinction between deficits in recognizing information, remembering its source, and response biases, were applied to the data. RESULTS: Schizophrenia patients were impaired in discriminating between words that came from two external sources, from two internal sources, and one internal and one external source. In a condition requiring subjects to distinguish between words they had heard from those they had imagined hearing, when schizophrenic patients did not remember the source of the information, they showed a stronger bias than controls to report that it had come from an external source. CONCLUSIONS: The application of multinomial models to source monitoring data suggests that schizophrenia patients have source monitoring deficits that are not limited to the distinction between internally-generated and externally-perceived information. However, when schizophrenia patients do not remember the source of information, they may be more likely than controls to report that it came from an external source.

Measuring memory for source: some theoretical assumptions and technical limitations.

Henkel and Franklin (1998) present a series of well-designed experiments in support of the conclusion that memory for the source of an item is affected by the similarity between the item and other information in memory. Their principle analyses use an empirical measure of source memory that is a variant of a measure evaluated by Murnane and Bayen (1996). We point out an important assumption that underlies the use of this measure and question additional arguments and analyses that Henkel and Franklin offer in support of their conclusions. The problems discussed illustrate the need for careful consideration of the technical characteristics of measures and the theoretical assumptions on which measures rest when one is conducting research on source memory.

An evaluation of empirical measures of source identification.

Source identification refers to memory for the origin of information. A consistent nomenclature is introduced for empirical measures of source identification which are then mathematically analyzed and evaluated. The ability of the measures to assess source identification independently of identification of an item as old or new depends on assumptions made about how inconsistencies between the item and source components of a source-monitoring task may be resolved. In most circumstances, the empirical measure that is used most often when source identification is measured by collapsing across pairs of sources (sometimes called "the identification-of-origin score") confounds item identification with source identification. Alternative empirical measures are identified that do not confound item and source identification in specified circumstances. None of the empirical measures examined provides a valid measure of source identification in all circumstances.

Aging and the use of perceptual and temporal information in source memory tasks.

A number of studies have reported age differences in memory for the source of information. S.A. Ferguson, S. Hashtroudi, and M.K. Johnson (1992) suggested that older adults do not efficiently use multiple distinctive characteristics of sources to distinguish between sources in source memory tasks. In the study reported here, participants heard information from 2 sources and later decided whether test items had been presented by Source A, by Source B, or were new. The distinctiveness of both perceptual and temporal characteristics of sources were independently manipulated. Older adults benefited more than young adults from multiple distinctive characteristics of sources. These results question the generality of S.A. Ferguson et al.'s hypothesis.