Patient satisfaction and organizational impact: a hierarchical linear modeling approach.

This article presents the rationale for using multilevel analysis to address the broad environmental contexts in patient satisfaction research. This study utilized patient satisfaction data and the American Hospital Association Hospital Guide Book (2004). This study found significant contributions of individual patient attribute reactions (nursing care, physician care, etc.), and also clearly demonstrated hospital-level effects and cross-level interactions on patient satisfaction. Thus, it is clear that patient satisfaction is not solely explained by patients' attribute reactions and their demographic variables, but is also explained by patients' hospital levels. This approach would offer additional understanding in patient satisfaction research.

Association of induction of labor and uterine rupture in women attempting vaginal birth after cesarean: a survival analysis.

OBJECTIVE: We sought to estimate the risk of uterine rupture associated with labor induction in women attempting trial of labor after cesarean (TOLAC) accounting for length of labor. STUDY DESIGN: This was a nested case-control study of women attempting TOLAC within a multicenter retrospective cohort study of women with a prior cesarean. Time-to-event analyses were performed with time zero defined as the first cervical exam of 4 cm. Subjects experienced the event (uterine rupture) or were censored (delivered). RESULTS: In all, 111 cases of uterine rupture were compared to 607 controls. When accounting for length of labor, the risk of uterine rupture in induced labor was similar to the risk in spontaneous-onset labor (hazard ratio, 1.52; 95% confidence interval, 0.97-2.36). An initial unfavorable cervical exam was associated with an increased risk of uterine rupture compared to spontaneous (hazard ratio, 4.09; 95% confidence interval, 1.82-9.17). CONCLUSION: After accounting for labor duration, induction is not associated with an increased risk of uterine rupture in women undergoing TOLAC.

Inpatients' willingness to recommend: a multilevel analysis.

BACKGROUND: Satisfaction with health care is one of the most widely assessed measures of hospital care quality, yet studies that account for clustering effects are uncommon. We constructed a multilevel model to identify predictors of willingness to recommend while controlling for clustering effects due to hospital and care unit. We also examined differences in predictors by care unit. PURPOSE: The aim of this study was to identify factors that both influence patient perceptions of care and are potentially modifiable by the hospital delivering care. METHODOLOGY: Our sample includes Hospital Consumer Assessment of Healthcare Providers and Systems survey data collected between July 1, 2007, and June 30, 2008, for 131 hospitals and 33,445 patients. The primary outcome was willingness to recommend the hospital to family and friends. Variables were collected at three levels: patient (Hospital Consumer Assessment of Healthcare Providers and Systems survey item responses and demographics), care unit, and hospital. Data were analyzed using multilevel modeling. We also ran a series of two-level models to explore differences in predictors by care type. FINDINGS: The strongest predictors of willingness to recommend, controlling for clustering effects, were items that generally reflected interpersonal aspects of care such as nursing and physician behaviors. In the two-level models, predictors of willingness to recommend overlapped across care units, but important differences were noted. PRACTICE IMPLICATIONS: Our results suggest that hospitals that wish to improve their performance would benefit most from focusing on interpersonal aspects of care. Hospitals that focus resources on improving in these areas, that assess care units separately, and that investigate the meaning and context of survey responses will be most likely to see improvements in satisfaction scores.

How patient reactions to hospital care attributes affect the evaluation of overall quality of care, willingness to recommend, and willingness to return.

Patient satisfaction is a critical part of the quality outcomes of healthcare. Every industry is interested in customer satisfaction because satisfied customers are loyal customers. Healthcare is no exception. Many research studies assume that satisfied patients are more likely to recommend their providers to their friends and to return when they need care again. Although this assumption sounds logical, we argue that three dependent variables-the Evaluation of Overall Quality of Care, Willingness to Recommend, and Willingness to Return-are unique constructs. Thus, we examine how patient reactions (experiences) to different hospital care attributes (factors or dimensions) influence these dependent variables. Our study analyzed a comprehensive patient satisfaction data set collected by BJC HealthCare. We used a multiple linear regression model with a scatter term to analyze 14,432 cases. In Evaluation of Overall Quality of Care model, we found that the nursing care attribute showed the strongest influence, followed by staff care. In assessing the other two models-Willingness to Recommend and Willingness to Return-we found that staff care showed the strongest influence, followed by nursing care. Patients put a different emphasis or a different priority on their reactions to hospital care attributes, depending on which outcome they arrive at. In addition, we found that patients are disproportionately influenced by a weak or poor attribute reaction, which is a conjunctive strategy (risk averse). In general, nursing care and staff care should be the first priority for improvement. This may be good news because these areas are under the control of hospital managers.

Risk factors for extremely long length-of-stay among pediatric emergency patients.

OBJECTIVE: Over time, we observed more visits in our pediatric emergency department with length-of-stay (LOS) of more than 10 hours, whereas our mean LOS was approximately 3 hours. We sought to characterize factors associated with this extremely long LOS. METHODS: Eighty-one visits with LOS more than 10 hours were identified from January 1, 2001, to June 30, 2003. In this retrospective study, we compared these cases with 405 randomly selected age-matched controls with LOS less than 10 hours (5 controls per case). RESULTS: The groups were similar for sex, visit month, arrival mode, and level of training of the supervising physician. Cases more frequently arrived during night shifts (30% vs 13%) and had laboratory tests (93% vs 32%), radiological studies (83% vs 34%), procedures (28% vs 15%), sedations (24% vs 4%), subspecialty consultations (84% vs 20%), chief complaints of abdominal pain (42% vs 6%) and diagnoses of appendicitis (10% vs 1%), and had a greater hospitalization rate (67 vs 19%). Although more cases involved white patients (57% vs 31%), race was not associated with LOS more than 10 hours in adjusted analysis. In multivariable analysis, longer waiting time (odds ratio [OR], 1.013; 95% confidence interval [CI], 1.007-1.019), night shift arrival (OR, 5.0; 95% CI, 1.9-12.8), higher triage acuity (lowest acuity: OR, 0.003; 95% CI, 0.0-0.286), radiology study other than radiographs (OR, 18.0; 95% CI, 7.5-43.1), and subspecialty consultation (OR, 7.6; 95% CI, 3.2-18.3) were associated with LOS more than 10 hours. CONCLUSIONS: In our pediatric emergency department, risk factors for LOS more than 10 hours included longer waiting time, night shift arrivals, high triage acuity, radiology studies, and subspecialty consultations. These factors may also be important considerations for quality improvement initiatives at other institutions.

Patient satisfaction: focusing on "excellent".

In an emerging competitive market such as healthcare, managers should focus on achieving excellent ratings to distinguish their organization from others. When it comes to customer loyalty, "excellent" has a different meaning. Customers who are merely satisfied often do not come back. The purpose of this study was to find out what influences adult patients to rate their overall experience as "excellent." The study used patient satisfaction data collected from one major academic hospital and four community hospitals. After conducting a multiple logistic regression analysis, certain attributes were shown to be more likely than others to influence patients to rate their experiences as excellent. The study revealed that staff care is the most influential attribute, followed by nursing care. These two attributes are distinctively stronger drivers of overall satisfaction than are the other attributes studied (i.e., physician care, admission process, room, and food). Staff care and nursing care are under the control of healthcare managers. If improvements are needed, they can be accomplished through training programs such as total quality management or continuous quality improvement, through which staff employees and nurses learn to be sensitive to patients' needs. Satisfying patients' needs is the first step toward having loyal patients, so hospitals that strive to ensure their patients are completely satisfied are more likely to prosper.

Predictors of pediatric emergency patients discharged against medical advice.

Based on a retrospective 5-year medical record review, this study characterizes factors associated with patients discharged against medical advice (AMA) from a tertiary pediatric emergency department (ED) and compares rates of return to the ED and admission to the hospital with those of patients routinely discharged. Data from 94 patients discharged AMA are compared with those of 188 control patients. Pediatric patients at risk for discharge AMA are older than 15 years (odds ratio [OR], 3.561; 95% confidence interval [CI], 1.695-7.482), self-register independent of a parent (OR, 3.100; 95% CI, 1.818-152.770), arrive by ambulance (OR, 2.761; 95% CI, 1.267-6.018), involve a consultant (OR, 2.592; 95% CI, 1.507-4.458), and have a chief complaint of abdominal pain (OR, 3.095; 95% CI, 1.154-8.303). Negative predictors include urgent triage (OR, 0.155; 95% CI, 0.039-0.618), a chief complaint of upper respiratory tract illness or otitis media (OR, 0.229; 95% CI, 0.075-0.702), and discharge diagnoses of infection (adjusted OR, 0.053; 95% CI, 0.004-0.767), disease of the nervous system and sense organs (adjusted OR, 0.066; 95% CI, 0.005-0.898), respiratory illness (adjusted OR, 0.072; 95% CI, 0.007-0.718), and gastrointestinal disease (adjusted OR, 0.050; 95% CI, 0.006-0.419). Certain key elements of discharge AMA are well documented, including consequences of discharge AMA (74.5%) and instructions for care (54.3%). Other elements such as alternative therapies (1.1%) are poorly documented. Patients discharged AMA have a significantly higher return rate (24.5%) within 15 days compared with patients who have routine discharge (6.4%) (chi2=18.85, P<.001). Ninety-six percent of patients who return to the ED have the same chief complaint at both visits if discharged AMA compared with 50% of patients who are discharged routinely (P=.003), with 25% admission rates at the time of second visit for both types of discharges. Adolescents who register themselves are at increased risk for discharge AMA. Patients who are triaged as urgent or nonurgent or who have minor illnesses are likely to be dispositioned routinely. Patients discharged AMA are more likely to return to the ED with the same complaint than patients who are routinely discharged.

Evidence for potential bias in the Health and Activity Limitation Index as a health preference measure for persons with disabilities.

BACKGROUND: The American public health plan Healthy People 2010 sets overall goals based on utility-linked information from the Health and Activity Limitation Index (HALex). However, little is known about how utilities measured by the HALex compare with those from established gold standard preference-based utility measures. In addition, distribution of HALex values from the general population underrepresents the experience of persons with disability, leading to uncertain interpretation of their utility values. Therefore, we sought to report the validity and interpretation of HALex scores compared to scores from a preference-based health-related quality of life measure, the Quality of Well-Being (QWB) scale. METHODS: A telephone survey with component measures was administered in random order. Participants consisted of 401 adults from a large Midwest metropolitan area: 302 were selected by random-digit-dial methodology and 99 were volunteers with mobility impairment extending the disability values of the sample. Multiple regression analysis predicted HALex scores from QWB scores and from demographic and self-reported health characteristics. RESULTS: QWB scores accounted for 41% of the variance in HALex scores. The addition of five demographic and health factors increased the variance explained to 63%. Scores on the QWB and HALex were similar on mid-range values and discrepant at the extremes; that is, persons with extreme HALex scores tended to have more moderate QWB scores. HALex scores were higher for white adults than predicted by their QWB scores and lower for people with chronic diseases and disabilities. CONCLUSIONS: Utilities as measured by the HALex and QWB can differ markedly, particularly if the person is classified at either end of the spectrum of function. Of similar concern is that fact that HALex scores show a systematic bias in relationship to QWB scores depending on a person's demographic and health-related characteristics.

Infectious, malignant, and autoimmune complications in pediatric heart transplant recipients.

OBJECTIVE: To review clinical courses of pediatric heart transplant survivors after 5 years from transplantation for infections, lymphoproliferative, and autoimmune diseases. STUDY DESIGN: A total of 71 patients were examined in 2 groups, infant recipients (underwent transplant <1 year of age, n = 38) and older recipients (underwent transplant >1 year, n = 33). All patients received comparable immunosuppression. Calculated occurrence rates were reported as means per 10 years of follow-up with SEs. Differences were examined by using Poisson regression. RESULTS: Infant recipients had significantly higher (P < .001) occurrence rates of severe (mean, 2.04 +/- 0.5) and chronic infections (mean, 4.58 +/- 0.67) compared with older recipients (means, 0.37 +/- 0.19 and 1.87 +/- 0.70, respectively). Types of infections were similar to those in the general population with extremely rare opportunistic infections; however, they were more severe and resistant to treatment. Autoimmune disorders occurred at a frequency comparable with lymphoproliferative diseases and were observed in 7 of 38 infants (18%). Most common were autoimmune cytopenias. CONCLUSIONS: Infant heart transplant recipients who survive in the long term have higher occurrence rates of infections compared with older recipients. Autoimmune disorders are a previously unrecognized morbidity in pediatric heart transplantation.

Low daytime pulse oximetry reading is associated with nocturnal desaturation and obstructive sleep apnea in children with sickle cell anemia.

A retrospective medical record review was established to test the hypothesis that in children with sickle cell anemia (SCA), a daytime oxygen saturation (SpO(2))

Comparison of mortality risk adjustment using a clinical data algorithm (American College of Surgeons National Surgical Quality Improvement Program) and an administrative data algorithm (Solucient) at the case level within a single institution.

BACKGROUND: There is great interest in efficiently evaluating health care quality, but there is controversy over the use of administrative versus clinical data methods. We sought to compare actual mortality with risk-adjusted expected mortality in a sample population calculated by two different methods; one based on preexisting administrative records and one based on chart reviews. STUDY DESIGN: We examined a sample of patients (n = 1,234) undergoing surgical procedures at an academic teaching hospital during 1 year. The first risk-adjustment method was that used by the National Surgical Quality Improvement Program, which is based on dedicated medical record review. The second method was that used by Solucient, LLC, which is based on preexisting administrative records. RESULTS: The ratio of observed to expected mortality for this population set was higher using the National Surgical Quality Improvement Program algorithm (1.1; 95% CI, 0.8 to 1.5) than using the Solucient algorithm (0.9; 95% CI, 0.6 to 1.2) but neither estimate was notably different from 1.0. Similarly, when observed to expected mortality ratios were calculated separately for each quartile of mortality, there were no marked differences within quartiles, although minor differences with potential importance were noted. Fit was comparable by age categories, gender, and American Society of Anesthesiologists' categories. A number of actual deaths had higher predicted mortality scores using the Solucient algorithm. CONCLUSIONS: Risk-adjusted mortality estimates were comparable using administrative or clinical data. Minor performance differences might still have implications. Because of the potential lower cost of using administrative data, this type of algorithm can be an efficient alternative and should continue to be investigated.

A short interpregnancy interval is a risk factor for preterm birth and its recurrence.

OBJECTIVE: We tested the hypothesis that short interpregnancy intervals (IPIs) increase the risk for preterm birth (PTB), recurrence of PTB, and delivery at early extremes of gestational age. STUDY DESIGN: Using the Missouri Department of Health's birth certificate database, we performed a population-based cohort study of 156,330 women who had 2 births from 1989-1997. The association between IPI and subsequent pregnancy outcome was assessed. RESULTS: The shortest IPIs (<6 months) increased the risk of extreme PTB (adjusted odds ratio, 1.41; 95% CI, 1.13-1.76). IPIs of <6 months and 6-12 months increased the overall risk of PTB (adjusted odds ratios, 1.48 [95% CI, 1.37-1.61] and 1.14 [95% CI, 1.06-1.23], respectively) and PTB recurrence (adjusted odds ratios, 1.44 [95% CI, 1.19-1.75] and 1.24 [95% CI, 1.02-1.50], respectively). CONCLUSION: The risk of PTB and its recurrence increases with short IPIs, even after adjustment for coexisting risk factors. This highlights the importance of counseling women with either an initial term or preterm birth to wait at least 12 months between delivery and subsequent conception.

Mortality and morbidity in pre-sensitized pediatric heart transplant recipients with a positive donor crossmatch utilizing peri-operative plasmapheresis and cytolytic therapy.

BACKGROUND: The difficulty in obtaining a prospective negative donor/recipient crossmatch limits the ability to successfully transplant pediatric heart transplant candidates who show evidence of antibodies to multiple human leukocyte antigens (pre-sensitized patients). METHODS: We utilized a protocol that included peri-operative plasmapheresis, thymoglobulin and cyclophosphamide in 17 pre-sensitized (panel-reactive antibodies [PRA] >10%) pediatric patients to accept donors for these patients without a prospective crossmatch between 1995 and 2005. A retrospective review of survival, rejection and infection was performed, comparing the frequency of rejection and infection in our patients who were transplanted with a complement-dependent cytotoxic (CDC)-positive donor/recipient crossmatch to those patients transplanted with a negative crossmatch. RESULTS: Thirteen of 17 patients were found to have a CDC-positive crossmatch. Actuarial survival after transplantation was 85% at 1 year and 73% at 3 years. Twelve of 13 (92%) of these patients experienced rejection, and 5 of 13 (38%) had recurrent rejection, generally in the first 2 months after transplantation. Rejection was associated with hemodynamic compromise in 58% of first rejection episodes and 67% of episodes of recurrent rejection. The frequency of rejection in these patients was significantly greater than the frequency in patients with a negative crossmatch in the first 6 months after transplantation, but not afterward. The frequency of infection episodes was not significantly different between the groups. CONCLUSIONS: Heart transplantation in pre-sensitized pediatric recipients with a CDC-positive donor/recipient crossmatch may result in reasonable short-term survival, but with a high frequency of early rejection, often with hemodynamic compromise.

Maternal positive skin prick test results and asthma prediction after early childhood wheezing.

BACKGROUND: Previous studies have used parental history of asthma or allergy but not positive skin prick test results to predict the evolution of asthma in wheezing infants. OBJECTIVE: To determine whether positive parental skin prick test results serve as a predictive factor for the subsequent development of asthma in a child with a history of wheezing before the age of 3 years. METHODS: In a retrospective cohort study we investigated 91 individuals from 71 families. Enrollment criteria were age 6 to 40 years, history of wheezing before the age of 3 years, and no chronic lung disease other than asthma. Each participant was asked about current asthma-related symptoms, underwent pulmonary function testing, and underwent skin prick testing. Participants' parents underwent skin prick testing and measurement of total serum IgE levels. RESULTS: Asthma was diagnosed in 56 participants (61%). Although maternal positive skin prick test results conferred a 3.4-fold risk of asthma (P = .02), neither the mother's nor the father's self-reported allergy or asthma was predictive of later development of asthma. CONCLUSION: The presence of parental, and especially maternal, positive skin prick test results is a significant predictive factor for the subsequent development of asthma in early childhood wheezing.

A prospective assessment of food and nutrient intake in a population of Malawian children at risk for kwashiorkor.

OBJECTIVE: To determine what foods, nutrients, and dietary patterns are associated with development of kwashiorkor in populations of vulnerable 1- to 3-year-old Malawian children. PATIENTS AND METHODS: This was a prospective observational study conducted in 8 rural villages. Upon enrollment, demographic, anthropometric, and dietary intake data were collected. Children were studied every 2 weeks for 10 weeks to determine whether they developed kwashiorkor. Dietary intake was assessed on enrollment using a food frequency questionnaire, which included all possible foods in the child's diet. Food frequency data were used to estimate energy, protein, vitamins C and A, niacin, thiamin, zinc, and iron intake using food composition and serving size data. Dietary diversity was assessed with a 7-point score. Regression modeling was used to determine whether the consumption of any food or nutrient was associated with the development of kwashiorkor. RESULTS: A total of 43 (2.6%) of the 1651 healthy children ages 1 to 3 years enrolled developed kwashiorkor. Children who developed kwashiorkor were younger and had more nutritional wasting than those who did not. Thirty children (70%) who developed kwashiorkor were breast-fed. In the combined regression model no foods or nutrients were found to be associated with the development of kwashiorkor. There were no differences in the dietary diversity between children who developed kwashiorkor and those who did not. CONCLUSIONS: No association between the development of kwashiorkor and the consumption of any food or nutrient was found.

Risk for postterm delivery after previous postterm delivery.

OBJECTIVE: We examined the hypothesis that the risk for subsequent postterm birth is increased in women with an initial postterm birth. STUDY DESIGN: We performed a population-based cohort study of Missouri births (1989-1997) to assess the recurrence of postterm birth using the Missouri Department of Health's maternally linked database. RESULTS: A total of 368,633 births were evaluated, of which 7.6% were postterm (>42 weeks of gestation). Black mothers had a lower risk for all (adjusted odds ratio [OR], 0.70; 95% CI, 0.67-0.73) or recurrent (adjusted OR, 0.73; 95% CI, 0.67-0.79) postterm birth. Maternal education of <12 years (adjusted OR, 1.51; 95% CI, 1.41-1.62), indices of low socioeconomic status, and maternal body mass index >35 kg/m2 (adjusted OR, 1.23; 95% CI, 1.11-1.37) were associated with increased risk for recurrent postterm birth. Mothers with an initial postterm birth were at increased risk for postterm birth (OR, 1.88; 95% CI, 1.79-1.97) in subsequent pregnancies, independent of race. CONCLUSION: Among mothers who deliver postterm, there is a significant risk for subsequent postterm births. This increased risk suggests that common factors (genetic or other) influence the likelihood of abnormal parturition timing.

Racial disparity in the frequency of recurrence of preterm birth.

OBJECTIVE: We examined the hypothesis that black race independent of other factors increases the risk for extreme preterm birth and its frequency of recurrence at a similar gestational age. STUDY DESIGN: We conducted a population-based cohort study using the Missouri Department of Health's maternally linked database of all births in Missouri between 1989 and 1997 for factors associated with recurrent preterm delivery. RESULTS: Recurrent black preterm births occurred at increased frequency (adjusted odds ratio 4.11 [95% confidence interval 3.78 to 4.4.47]) and earlier gestations (31 versus 33 weeks' median age) than white births. Black siblingships also had higher multiplicity of prematurity (odds ratio 2.14 [95% confidence interval 1.49 to 3.07] and 5.09 [95% confidence interval 1.26 to 20.51] for 3 and 4 preterm births). Additionally, 47% of women delivered recurrent preterm infants within 2 weeks of the gestational age of their initial preterm infant. CONCLUSION: Overrepresentation of preterm births in blacks occurs independently of maternal medical and socioeconomic factors. Furthermore, the grouping of timing for preterm birth in different pregnancies of the same mother implicates important genetic contributors to the timing of birth.

Cathepsin-G interferes with clearance of Pseudomonas aeruginosa from mouse lungs.

The cystic fibrosis airway is susceptible to Pseudomonas aeruginosa infection, which stimulates an intense inflammatory response leading to airway obstruction and bronchiectasis. Neutrophils migrate into the airway, and once there, release high concentrations of neutral serine proteases during phagocytosis and in death. In particular, neutrophil elastase is central to progression of bronchiectasis by interfering with bacterial clearance and directly perpetuating the inflammatory response in the airway. Using a murine model of endobronchial inflammation, we found that a different neutrophil-derived serine protease, cathepsin G, inhibited the host's ability to clear Pseudomonas from the lung, based on a 1-log reduction in bacteria recovered from cathepsin G-deficient mice. Higher antibody concentrations were found in respiratory epithelial lining fluid from mice lacking cathepsin G, but there was no difference in other opsonins, such as surfactant proteins A and D. Chemokine levels measured in the lung correlated with bacterial burden and not the animal's genotype, indicating that airway inflammation was not affected by the presence (or absence) of specific serine proteases. These findings suggest that cathepsin G interferes with airway defenses, showing that proteases other than neutrophil elastase have roles in the pathogenesis of suppurative airway diseases.

Pre-transplant mechanical ventilation increases short-term morbidity and mortality in pediatric patients with cystic fibrosis.

BACKGROUND: Patients with cystic fibrosis (CF) who are listed for lung transplantation may require mechanical ventilatory support before transplant. Although CF is a risk factor for poor outcomes in adults, no data currently exist pertaining to pre-transplant ventilatory support in children with CF. METHODS: In a retrospective cohort study, we reviewed the medical records of 18 consecutive CF patients transplanted at St. Louis Children's Hospital (SLCH) who required mechanical ventilation before lung transplantation. Controls included patients transplanted at SLCH who were not mechanically ventilated before transplant and were matched for underlying diagnosis, gender, age, type of transplant (cadaveric vs living donor) and year of transplant. RESULTS: Ventilated and non-ventilated patients were similar in their pre-transplant characteristics (weight, height and body mass index) and ischemic and bypass times. However, patients ventilated before transplantation had significantly worse immediate post-transplant outcomes, including early graft dysfunction (p = 0.012), prolonged mechanical ventilation (34.1 vs 5 days, p = 0.009), prolonged stay in the pediatric intensive care unit (35.4 vs 8.1 days, p = 0.01), longer time to hospital discharge (38.4 vs 21.3 days, p = 0.033), and worse 1-year mortality after transplant (221.6 vs 335.2 days, p = 0.021). Among ventilated patients, length of pre-transplant ventilation did not affect post-transplant outcomes (length of ventilation, p = 0.92; length of stay in the pediatric intensive care unit, p = 0.68; time to hospital discharge, p = 0.46; and 1-year mortality rate, p = 0.25). CONCLUSIONS: This is the first report in pediatric patients with CF demonstrating that mechanical ventilation before lung transplant is a predictor of poor short-term outcomes, including 1-year-survival, after transplant. Length of pre-transplant ventilatory support does not appear to impact outcomes.

Correlates of physical activity for adults with disability.

INTRODUCTION: This study was designed to determine factors that influence the physical activity level of adults with disability as identified in a large representative sample of U.S. adults. METHODS: Data were taken from the District of Columbia and the 12 states that administered the Quality of Life and Caregiving Module of the 2001 Behavioral Risk Factor Surveillance System. Adults with disability (n = 4038) were defined as those who required special equipment because of a health problem or who required the assistance of another person either for their personal care or routine needs. Adequate physical activity was defined as meeting the Centers for Disease Control and Prevention and American College of Sports Medicine recommendation of at least 30 minutes of moderate activity per day at least 5 days per week. Unadjusted and adjusted odds ratios were computed for demographic, health status, health care access, and health behavior variables. RESULTS: Only one fourth of the study population met the recommendation for moderate activity level. African American race, age of 50 years or older, annual income of $50,000 or higher, and being in good, fair, or poor health were all significantly related to activity level; sex, education level, health care access, and years of disability were not. CONCLUSION: Adults with disability are not meeting basic recommendations for physical activity. Some correlates of physical activity found in general populations are also related to activity level for people with disability (age, general health, race), whereas others (sex, education level) are not. These factors should be considered when planning physical activity interventions for people with disability.