On the Use of Summary Comorbidity Measures for Prognosis and Survival Treatment Effect Estimation.

Prognostic scores have been proposed as outcome based confounder adjustment scores akin to propensity scores. However, prognostic scores have not been widely used in the substantive literature. Instead, comorbidity scores, which are limited versions of prognostic scores, have been used extensively by clinical and health services researchers. A comorbidity is an existing disease an individual has in addition to a primary condition of interest, such as cancer. Comorbidity scores are used to reduce the dimension of a vector of comorbidity variables into a single scalar variable. Such scores are often added to regression models with other non-comorbidity variables such as age and sex, both for analyzing prognosis and for confounder adjustment when analyzing treatment effects. Despite their widespread use, the properties of and conditions under which comorbidity scores are valid dimension reduction tools in statistical models is largely unknown. In this article, we show that under relatively standard assumptions, comorbidity scores can have equal prognostic and confounder-adjustment abilities as the individual comorbidity variables, but that biases can occur if there are additional effects, such as interactions, of covariates beyond that captured by the comorbidity score. Simulations were performed to illustrate empirical properties and a data example using breast cancer data from the SEER Medicare Database demonstrates the application of these results.

Current and future directions in culture and happiness research.

Once believed to be universal, a growing body of research shows that both the conception and predictors of happiness vary cross-culturally. First, the meaning and importance of happiness varies both across time and between nations. Americans, for instance, tend to define happiness in terms of pleasure or enjoyment and view happiness as universally positive, whereas East Asian and Middle Eastern cultures may highlight the transient and socially disruptive nature of happiness and be ambivalent about whether it is good. Second, predictors of happiness vary between cultures. Recent work highlights new mediators (e.g., relational mobility), individual predictors (e.g., person-culture fit), societal factors (e.g., good governance and wealth), within-culture variations (e.g., at the state or city level), and interventions (e.g., practicing gratitude) that differ cross-culturally or help explain cultural differences in happiness. Though many questions remain, this review highlights how these recent advances broaden and revise our understanding of culture and happiness.

Counterfactuals, control, and causation: why knowledgeable people get blamed more.

Legal and prescriptive theories of blame generally propose that judgments about an actor's mental state (e.g., her knowledge or intent) should remain separate from judgments about whether the actor caused an outcome. Three experiments, however, show that, even in the absence of intent or immorality, actors who have knowledge relevant to a potential outcome will be rated more causal of that outcome than their ignorant counterparts, even when their actions were identical. Additional analysis revealed that this effect was mediated by counterfactual thinking--that is, by imagining ways the outcome could have been prevented. Specifically, when actors had knowledge, participants generated more counterfactuals about ways the outcome could have been different that the actor could control, which in turn increased causal assignment to the actor. These results are consistent with the Crediting Causality Model, but conflict with some legal and moral theories of blame.

Training Addiction Counselors to Implement an Evidence-Based Intervention: Strategies for Increasing Organizational and Provider Acceptance.

One barrier to widespread public access to empirically supported treatments (ESTs) is the limited availability and high cost of professionals trained to deliver them. Our earlier work from two clinical trials demonstrated that front-line addiction counselors could be trained to deliver a manualized, group-based cognitive behavioral therapy (GCBT) for depression, a prototypic example of an EST, with a high level of adherence and competence. This follow-up article provides specific recommendations for the selection and initial training of counselors, and for the structure and process of their ongoing clinical supervision. Unique challenges in working with counselors unaccustomed to traditional clinical supervision are highlighted. The recommendations are based on comprehensive feedback derived from clinician notes taken throughout the clinical trials, a focus group with counselors conducted one year following implementation, and interviews with key organization executives and administrators.

Development of a continuous renal replacement program in critically ill patients.

BACKGROUND: Critically ill patients encounter many obstacles, such as acute renal failure, that increases length of stay as well as hospital cost. Dialysis in these patients is often ineffective thereby prolonging the inevitable and significantly increasing the cost of care. A dialysis program that could improve patient care, potentially improve outcome and be "revenue neutral" would be ideal. METHODS: A continuous renal replacement therapy (CRRT) program was developed to significantly impact the care of critically ill patients Using the latest CRRT equipment along with an innovative hands-on CRRT training program, a specialized CRRT team was created. Working in conjunction with the hospital business office, new revenue charge codes were created and existing codes were updated. Patients who underwent CRRT had their financial records reviewed for: hospital cost to perform CRRT, total hospital billing to the payer, CRRT revenue 881 (billing units) charged to the payer, total charges and reimbursement for the account, percentage of reimbursement, collected revenue, and payer. RESULTS: From April 2000 to February 2002, 39 critically ill patients underwent CRRT. Initial set-up cost was US$79,622.80 and the cost of CRRT was US$222,323.98. The hospital billed for US$656,090.63 and assuming 100% reimbursement, the potential profit was US$427,678.50. However, loss of revenue, mainly from noncompliance with charge capture resulted in the hospital billing only US$386,794.32 with a total reimbursement of US$165,779.86. The 21 burn patients who underwent CRRT yielded a net profit of US$10,294.12, with the highest reimbursement from workman's compensation and private payers. The overall mortality rate was 59% and 65% for the burn patients; significantly lower than published national averages. CONCLUSIONS: An in-house CRRT program improved patient care by providing dialysis in patients who normally would not tolerate the procedure. Although there was a loss of revenue, CRRT in the burn patients appeared "revenue neutral." Although not specifically studied in this review, based on published data, mortality rates in this population were lower than expected especially in critically ill burn patients.