Peter Veazie | University of Rochester (original) (raw)

Papers by Peter Veazie

Journal of the American Geriatrics Society, Jun 5, 2024

Journal of Evaluation in Clinical Practice, Jun 25, 2010

Rationale, aims and objectives It is well established that clinical inertia generates suboptimal ... more Rationale, aims and objectives It is well established that clinical inertia generates suboptimal care in patients with chronic diseases, and policies and interventions have yet to satisfactorily address the problem. Methods This paper integrates the relevant literatures on clinical inertia and Regulatory Focus Theory (RFT) from psychology to identify an actionable explanatory mechanism. Results We review RFT and show that it provides a mechanism that may explain key provider contributions to clinical inertia. We then identify two general intervention strategies based on RFT: one that changes individual sensitivity to positive/negative outcomes and another that maintains the sensitivity to positive/negative outcome but frames how information is provided to match the sensitivity. Conclusions We conclude that RFT is a plausible explanation to guide the development of policies and interventions for mitigating clinical inertia.

Medical Care, Jun 1, 2003

This article compares a linear risk-adjusted model of medical expenditures for Medicare patients ... more This article compares a linear risk-adjusted model of medical expenditures for Medicare patients with a model that explicitly account for skewness in distribution of expenditures. A model of expenditures and a model of the square root of expenditures, each expressed as linear combinations of risk adjusters, are estimated using data from the 1992 through 1994 Medicare Current Beneficiary Surveys. Five sets of risk adjusters are considered. Each combination of model and set of risk adjusters is tested for linearity, heteroscedasticity, in-sample fit (R2), forecast performance (forecast bias and forecast mean squared error), and overfitting the data. We analyze forecast performance (1)based on forecasts in same year used for estimation, and (2)based on forecasts in the year following that used for estimation. In the first analysis, the model using a square root transformation of expenditures as the dependent variable and the more parsimonious specification of risk adjusters performs best in terms of forecast squared error and overfitting. The untransformed model performs best in terms of forecast bias in each group based on severity of disability, with the exception of the severely disabled for whom the square root model is best. In the second analysis, the square root model performs better than the untransformed model in terms of forecast squared error, but neither model is statistically distinguishable from zero in terms of bias. Accounting for skewness in expenditures tends to improve precision but not necessarily bias, except among the severely disabled. Adjusting for health status improves risk adjustment.

Innovation in Aging, Dec 1, 2020

mediated the relationship between VF damage and fall rates, with VF damage remaining an independe... more mediated the relationship between VF damage and fall rates, with VF damage remaining an independent predictor of fall in models including gait and/or balance features (RR =1.36 to 1.48, p-value= <0.001 to 0.005). While balance and gait measures are associated with fall rates, they do not explain why persons with greater VF damage fall more frequently, suggesting the importance of other factors such as hazard perception. SESSION 7120 (SYMPOSIUM) FITNESS MATTERS AS WE AGE: A CELEBRATION OF THE VA GEROFIT PROGRAM Chair: Miriam Morey Discussant: Cathy Lee In recognition of the GSA's 75th Anniversary "Why Age Matters" we celebrate the 7th anniversary of the Gerofit dissemination initiative. Gerofit is an exercise and health promotion program for older Veterans that has been declared a Veterans Health Administration (VA) "Best Practice" and been disseminated to 17 VA's across the country. Over 7000 Veterans have participated in Gerofit initiated programs and have reported robust outcomes including improved quality of life, physical and mental health, and high levels of satisfaction with the programs. For this symposium, we focus on newly acquired program outcomes that emphasize the importance of fitness as we age. The first paper compares hospitalization and emergency room visits between individuals participating in Gerofit for 12 months compared to a matched control group. The second paper describes fouryear trajectories of physical performance to highlight the impact of becoming fit over expected normative trajectories. The third paper examines outcomes of a home-based geriatric walking clinic. The fourth paper describes the impact of exercise adherence on chronic pain. The fifth paper describes changes in medication utilization compared to a matched control group following 12-months of supervised exercise. These papers highlight the importance of fitness as a contributor to overall health during the aging process and celebrates that fitness matters, no matter when you start!

PubMed, Mar 1, 2017

To determine the use of fluoride varnish (FV) to prevent dental caries and explore related factor... more To determine the use of fluoride varnish (FV) to prevent dental caries and explore related factors, a survey was mailed to all 540 licensed general and pediatric dentists in eight Western New York counties. Of 193 surveys analyzed, 47.5% of dentists used FV in children. Only 44% accurately assessed high-risk cases for caries. Dentists serving children under age 2 and those correctly assessing high-risk children for caries were more likely to use FV in children under 7. Only 28% correctly recommended the first visit at 6/12 months; 38.7% recommended age 3. The authors concluded that FV was underutilized, suggesting a need for guide-line based strategies.

Item Response Theory (IRT) has enjoyed increased interest in recent years as a method for scaling... more Item Response Theory (IRT) has enjoyed increased interest in recent years as a method for scaling health-related constructs. However, the context of this application is different from the context of IRT’s development. The shift in context has important implications for proper model specification. This paper reviews the common one, two, and three parameter IRT models, discusses their limitations as used in healthcare research, and argues for the four parameter hierarchical model as an alternative. The use of IRT as a pragmatic means to test item bias has merit, but the general use of IRT in healthcare research without consideration of underlying assumptions may lead to a less appropriate application. Healthcare research would benefit from development of models such as the 4-parameter IRT to account for plausible underlying assumptions.

Medical Decision Making, Oct 30, 2017

Background-Multi-criteria decision making (MCDM) methods are well-suited to serve as the foundati... more Background-Multi-criteria decision making (MCDM) methods are well-suited to serve as the foundation for clinical decision support systems. To do so, however, they need to be appropriate for use in busy clinical settings. We compared decision making processes and outcomes of patientlevel analyses done with a range of multi-criteria methods that vary in ease of use and intensity of decision support, two factors that could affect their ease of implementation into practice. Methods-We conducted a series of Internet surveys to compare the effects of five multi-criteria methods that differ in user interface and required user input format on decisions regarding selection of a preferred method for lowering risk of cardiovascular disease. The study sample consisted of members of an online Internet panel maintained by Fluidsurveys, an Internet survey company. Study outcomes were changes in preferred option, decision confidence, preparation for decision making, the values clarification and decisional uncertainty subscales of the decisional conflict scale, and method ease of use. Results-The frequency of changes in preferred option ranged from 9% to 38%, p < 0.001, and rose progressively as the level of decision support provided by MCDM method increased. The proportion of respondents who rated the method as easy ranged from 57% to 79% and differed significantly among MCDM methods, p=0.003, but was not consistently related to intensity of decision support or ease of use. Conclusion-Decision support based on multi-criteria decision methods is not necessarily limited by decreases in ease of use. This result suggests that it is possible to develop decision support tools using sophisticated multicriteria techniques suitable for use in routine clinical care settings.

Journal of Periodontology, Mar 16, 2020

Background:Cigarette smoking remains one of the leading public health threats worldwide. Electron... more Background:Cigarette smoking remains one of the leading public health threats worldwide. Electronic cigarettes (e-cigs) provide an alternative to conventional cigarette smoking; however, the evidence base of risks and benefits of e-cig use is new and growing. In this cross-sectional pilot study, the effect of e-cig use on biological profiles in saliva and gingival crevicular fluid (GCF) was assessed and compared with the profiles of cigarette smokers (CS), dual users, and non-users. The systemic inflammatory mediators between e-cig users (EC) and these other groups were also assessed.Methods:This pilot cross-sectional study recruited volunteer participants consisting of four groups, non-smokers (NS), CS, EC, and dual EC and cigarette smokers (DS). Saliva and GCF samples were collected and analyzed for biomarkers of inflammation, oxidative stress, anti-inflammatory lipid mediators, tissue injury and repair, and growth factors with immunoassay (enzyme-linked immunosorbent assay and Luminex).Results:Smoking status was confirmed via salivary cotinine. Prostaglandin E2 level was significantly increased in CS compared with EC and DS, but not significantly different in EC and DS groups compared with non-smokers (NS). Statistically significant differences were observed between groups of EC and NS (myeloperoxidase [MPO], matrix metalloproteinase-9) as well as between DS and EC for biomarkers of inflammatory mediators (receptor for advanced glycation end products [RAGE], MPO, uteroglobin/CC-10); between groups of DS and NS for extracellular newly identified RAGE binding protein and between CS and NS for MPO. No statistically significant differences in biomarkers of immunity (S100A8, S100A9, galectin-3), tissue injury and repair (Serpine1/PAI-1) and growth factors (brain-derived neurotrophic factor, fibroblast growth factors, platelet-derived growth factor-AA, vascular endothelial growth factor, and others) were found between any of groups.Conclusion:Statistically significant differences in measurable health outcomes were found between different smoking status groups, suggesting that smoking/vaping produces differential effects on oral health.

This is a very brief introduction to measure theory and measure-theoretic probability, designed t... more This is a very brief introduction to measure theory and measure-theoretic probability, designed to familiarize the student with the concepts used in a PhD-level mathematical statistics course. The presentation of this material was influenced by Williams [1991].

Medical Decision Making, Dec 5, 2018

In the process of developing an evidence-based decision dashboard to support treatment decisions ... more In the process of developing an evidence-based decision dashboard to support treatment decisions for patients with newly diagnosed prostate cancer, we found that the clinical evidence base is insufficient to provide high-quality comparative outcome data. We therefore sought to determine if clinically acceptable outcome estimates could be created using a modified version of the Sheffield Elicitation Framework (SHELF), a formal method for eliciting judgments regarding probability distributions of expected decision outcomes. Methods. We asked a panel of 3 urologists, 4 radiation oncologists, and 2 medical oncologists to estimate the probabilities of 11 treatment outcomes based on their clinical experience and an annotated evidence summary. The estimates were elicited using a Microsoft Excel spreadsheet containing a self-guided, adapted version of the SHELF Roulette method distributed via email. We created combined outcome estimates by taking the mean values of the panel members' upper and lower 95% bounds for each outcome. The combined estimates were then distributed via email to the panel for final approval. Results. Eight of the 9 responses were judged to be correct applications of the SHELF method and included in the combined outcome estimates. The final set of outcome estimates was unanimously accepted by the clinician panel members and used to create a decision dashboard suitable for clinical use and evaluation. Conclusions. Many important health care decisions need to be made in situations where the evidence base is inadequate. Use of a formal protocol for eliciting expert judgments is feasible and can be used to promote evidence-based practice by providing a powerful tool to facilitate the combination of professional judgment with research evidence and patient preferences to guide clinical decisions.

Medical Decision Making, Jul 30, 2015

Background-Conscious and unconscious biases can influence how people interpret new information an... more Background-Conscious and unconscious biases can influence how people interpret new information and make decisions. Current standards for creating decision aids, however, do not address this issue. Method-Using a 2×2 factorial design we sent surveys to members of two Internet survey panels containing a decision scenario involving a choice between aspirin or a statin drug to lower risk of heart attack and a decision aid. Each aid presented identical information about reduction in heart attack risk and likelihood of a major side effect. They differed in whether the options were labeled and amount of decisional guidance: information only (a balance sheet) versus information plus values clarification (a multicriteria decision analysis). After using the decision aid, participants indicated their preferred medication. Those using a multicriteria decision aid also judged differences in the comparative outcome data provided for the two options and the relative importance of achieving benefits versus avoiding risks in making the decision. Results-The study sample size is 536. Participants using decision aids with unlabeled options were more likely to choose a statin: 56% versus 25%, p < 0.001. The type of decision aid made no difference. This effect persists after adjusting for differences in survey company, age, gender, education level, health literacy, and numeracy. Participants using unlabeled decision aids were also more likely to interpret the data presented as favoring a statin with regard to both treatment benefits and risk of side effects (p ≤ 0.01). There were no significant differences in decision priorities (p=0.21). Conclusion-Identifying the options in patient decision aids can influence patient preferences and change how they interpret comparative outcome data.

Medical Hypotheses, 2007

Adherence to treatment regimens is important to achieve optimal disease management. However, nona... more Adherence to treatment regimens is important to achieve optimal disease management. However, nonadherence is evident across numerous clinical contexts, which leads to a higher disease burden on society. Among the various factors associated with patient adherence behavior, patient beliefs are the most influential set of factors. Several cognitive-social models and constructs that incorporate patient belief have been developed to explain patient health behaviors, such as the Health Belief Model, Self-Efficacy Model, Theory of Planned Behavior and so on. However, these models do not explain the formulation of health beliefs. The underlying mechanism accounting for patient variation in information processing that generates beliefs needs to be investigated, which will inform the development of interventions. We propose that patient's sense of uniqueness moderates the self-attribution of statistically-based information. Self-attribution is defined as a person's perceived probability that a statement applies to herself, and is influenced by experience and sense of uniqueness. Sense of uniqueness is a person's general belief regarding how unique she is. Statistically-based information is defined as information derived from or regarding aggregated effects or influences. Basically, the proposed hypothesis is that patients who have a stronger belief that they are unique are less likely to attribute to themselves statistically-based propositions regarding the majority of their group and are more likely to attribute to themselves statistically-based propositions regarding the minority. We further model the relationship between sense of uniqueness and self-attribution of information in terms of an idealized inexperienced person, and then extend the model to include the effect of personal experience. The estimation of hypothesis-specific effect parameters can be achieved by maximum likelihood. In conclusion, the sense of uniqueness hypothesis is general to the formulation of personal beliefs and consequently has implications for deliberate health behavior and indeed personal behavior in general.

Journal of Rural Health, 2011

Context-Emergency Department (ED) use among the rural elderly may present a different pattern fro... more Context-Emergency Department (ED) use among the rural elderly may present a different pattern from the urban elderly, thus requiring different policy initiatives. However, ED use among the rural elderly has seldom been studied and is little understood. Purpose-To characterize factors associated with having any versus no ED use among the rural elderly. Methods-A cross-sectional and observational study of 1736 Medicare beneficiaries age 65 and older who lived in non-metropolitan areas. The data are from the 2002-2005 Medical Expenditure Panel Survey (MEPS). A logistic regression model was estimated that included measures of predisposing characteristics, enabling factors, need variables, and health behavior as suggested by Anderson's behavioral model of health service utilization. Findings-20.8% of the sample had at least one ED visit during one year period. Being widowed, more education, Medicaid enrollment, fair/poor self perceived physical health, respiratory diseases and heart disease were associated with higher likelihood of having any ED visits while residing in the Western and Southern U.S. and being enrolled in Medicaid managed care were associated with lower probability of having any ED visits. While Medicaid enrollees who reported excellent, very good, good, or fair physical health were more likely to have at least one ED visit than those not on Medicaid, Medicaid enrollees reporting poor physical health may be less likely to have any ED visits. Conclusion-Policy makers and hospital administrators should consider these factors when managing the need for emergency care, including developing interventions to provide needed care through alternate means.

Urologic Oncology-seminars and Original Investigations, Mar 1, 2012

The Surveillance, Epidemiology, and End Results (SEER) program is a commonly used data source in ... more The Surveillance, Epidemiology, and End Results (SEER) program is a commonly used data source in cancer research. This article provides an introduction to the SEER database, describes important data items available from SEER on the most commonly diagnosed urologic malignancies (prostate, bladder, and kidney cancers), and reviews limitations of SEER data for urologic oncology research.

Social Science & Medicine, Jul 1, 2021

RATIONALE Research has identified psychosocial factors related to the use of health services amon... more RATIONALE Research has identified psychosocial factors related to the use of health services among the older population; however, the specific roles by which these factors drive behavior have not been identified and empirically tested. OBJECTIVE This study tested whether previously identified psychosocial factors decrease or increase the motivational potential to seek care, the motivational sensitivity to perceived access, or the motivational sensitivity to perceived need. METHODS The 2014 U.S. Health and Retirement Study was used. Analysis was based on 2589 older noninstitutionalized respondents (age greater than 64). The dependent variable was the number of healthcare provider visits in the preceding two years. Psychosocial factors included were life satisfaction, social network indicators, optimism, pessimism, positive social support, hopelessness, loneliness, self-efficacy, health efficacy, positive affect, negative affect, and purpose in life. Covariates included age and sex. Maximum likelihood estimation of an interpretable structural model was used. RESULTS Results of the study provide evidence that psychosocial variables are related to health care seeking through both motivational potential and sensitivity parameters. Some psychosocial variables are related to multiple roles. For example, pessimism is related to a lower motivational potential and is more sensitive to access at higher levels of access, whereas hopelessness is related to a higher motivational potential and more sensitive to need and access at lower levels of each. CONCLUSIONS Findings imply psychosocial characteristics are related to health care seeking and utilization of older adults via different roles that can countervail each other, and therefore the influence of interventions can be complex. To address this, complex interventions may be required.

American Heart Journal, Jul 1, 2017

Background Effects of implantable cardioverter/defibrillator (ICD) shocks and antitachycardia pac... more Background Effects of implantable cardioverter/defibrillator (ICD) shocks and antitachycardia pacing (ATP) on anxiety and quality of life (QoL) in ICD patients are poorly understood. Methods We evaluated changes in QoL from baseline to 9‐month follow‐up using the EQ‐5D questionnaire in patients enrolled in the Multicenter Automatic Defibrillator Implantation Trial—Reduce Inappropriate Therapy (MADIT‐RIT) (n = 1,268). We assessed anxiety levels using the Florida Shock Anxiety Scale (1‐10 score) in patients with appropriate or inappropriate shocks or ATP compared to those with no ICD therapy during the first 9 months postimplant. The analysis was stratified by number of ATP or shocks (0‐1 vs ≥2) and adjusted for covariates. Results In MADIT‐RIT, 15 patients (1%) had ≥2 appropriate shocks, 38 (3%) had ≥2 appropriate ATPs. Two or more inappropriate shocks were delivered in 16 patients (1%); ≥2 inappropriate ATPs, in 70. In multivariable analysis, patients with ≥2 appropriate shocks had higher levels of shock‐related anxiety than those with ≤1 appropriate shock (P < .01). Furthermore, ≥2 inappropriate shocks produced more anxiety than ≤1 inappropriate shock (P = .005). Consistently, ≥2 appropriate ATPs resulted in more anxiety than ≤1 (P = .028), whereas the number of inappropriate ATPs showed no association with anxiety levels (P = .997). However, there was no association between QoL and appropriate or inappropriate ATP/shock (all P values > .05). Conclusions In MADIT‐RIT, ≥2 appropriate or inappropriate ICD shocks and ≥2 appropriate ATPs are associated with more anxiety at 9‐month follow‐up despite no significant changes in the assessment of global QoL by the EQ‐5D questionnaire. Innovative ICD programming reducing inappropriate therapies may help deal with patient concerns about the device.

Annals of Emergency Medicine, Oct 1, 2021

Blood Pressure Monitoring, Feb 1, 2017

Significant research has been done regarding renin profiling in the adult hypertension (HTN) popu... more Significant research has been done regarding renin profiling in the adult hypertension (HTN) population and 20-30% of these patients have low renin levels. Specifically, it has been shown that African Americans have lower renin levels compared to other ethnicities. Although research in adults has been ongoing since the 1970's, there remains limited data regarding renin profiling or its role in guiding management of pediatric essential HTN. The purpose of this study is to characterize the plasma renin activity (PRA) in an ethnically diverse population of pediatric essential HTN patients. Clinical and demographic data (ethnicity, gender, age, BMI, clinic BP, ABPM results, renin and aldosterone levels, serum electrolytes, and serum creatinine) were analyzed to determine renin trends among pediatric patients with essential HTN. Low renin was defined as PRA <0.65 ng/mL/hr. Inclusion criteria include diagnosis of essential HTN, age 18 years, normal renal ultrasound, and normal renal function. Exclusion criteria include no measured PRA or diagnosis of secondary HTN.Kruskal-Wallis test indicates a significant difference in median PRA values between ethnic groups (p ¼ 0.005). The median PRA was 1.58 ng/mL/hr for African Americans, 2.17 ng/mL/hr for Caucasians, 2.54 ng/mL/hr for Hispanics, and 2.88 ng/mL/hr for Asians (Table). However, there were no significant ethnic differences, even in the African American population, in the prevalence of ''low renin'' individuals (p ¼ 0.35). As seen in the adult data, median PRA is significantly lower in pediatric African American patients with essential HTN compared to other ethnicities. However, there is no ethnic bias in this study for occurrence of ''low renin'' as defined by the adult literature.

The Journal of ambulatory care management, 1996

Advertisement. Close Window. Close Window. Thank you for choosing to subscribe to the eTOC for Th... more Advertisement. Close Window. Close Window. Thank you for choosing to subscribe to the eTOC for The Journal of Ambulatory Care Management. Enter your Email address: Wolters Kluwer Health may email you for journal alerts ...

Chapman and Hall/CRC eBooks, May 18, 2017