Papers by William Cunningham
Quality of Life Research an International Journal of Quality of Life Aspects of Treatment Care and Rehabilitation, Dec 1, 2003
Background and objective: Various approaches have been employed to derive physical health and men... more Background and objective: Various approaches have been employed to derive physical health and mental health summary scores for the SF-36 and the RAND-36, but head-to-head comparisons of alternative scoring algorithms are rare. We determined whether the associations of the physical and mental health summary scores with chronic medical conditions and utilization would differ depending on the scoring algorithm used. Methods: We examined 5701 patients receiving medical care from an independent association of 48 physician groups located primarily in the western United States and compared SF-36 and RAND-36 scoring of physical health and mental health summary scores. Associations with the presence of diabetes, heart disease, and kidney disease, as well as with utilization of medical care and mental health care were compared using bivariate and multivariate analysis. To examine the relationship between SF-36 and RAND-36 scores, we regressed the SF-36 physical and mental health composite scores on the RAND-36 physical and mental health summary measures and vice versa. Results: We found that the SF-36 and RAND-36 summary scores generally yielded results similar to one another across measures of heart disease, diabetes, and kidney disease, as well as measures of utilization. However, for each chronic medical condition, the RAND-36 showed a slightly larger decrement in mental health than did the SF-36. Conclusions: Differences between the two sets of summary scores were consistent with their respective conceptual and analytic approaches. Where comparisons of results between the SF-36 and RAND-36 summary scores are desirable in future studies, they can be estimated using the regression equations derived in this study.
This study compares social functioning between one Black and one White urban, community-based sam... more This study compares social functioning between one Black and one White urban, community-based sample of older persons in Los Angeles.
American Journal of Ophthalmology, Sep 1, 2009
PURPOSE: To study the associations of eye diseases and visual symptoms with the most widely used ... more PURPOSE: To study the associations of eye diseases and visual symptoms with the most widely used healthrelated quality-of-life (HRQOL) generic profile measure.
Quality of Life Research an International Journal of Quality of Life Aspects of Treatment Care and Rehabilitation, Aug 1, 2006
Patient-centered measures of functioning and well-being are needed to monitor and improve health ... more Patient-centered measures of functioning and well-being are needed to monitor and improve health for HIV-infected persons. We estimated the associations between HRQOL and symptoms over time in HIVinfected persons, adjusting for demographic and clinical characteristics using a longitudinal study of a nationally representative cohort of 2267 patients in care for HIV infection surveyed in 1996 and again in 1998. We used two global measures of HRQOL (overall health and overall quality of life) scored to have a mean of 50 and standard deviation of 10 in the sample. The total number of symptoms decreased ()1.29, p<0.001 for the difference), and overall health (1.09, p<0.001 for the difference) and overall quality of life (1.31, p<0.001 for the difference) improved over the period. Controlling for baseline symptoms and HRQOL, each additional symptom at follow-up (B=)1.14, p<0.001) was associated with worsened overall health and worsened overall quality of life (B=)0.95, p<0.001). The association of two additional symptoms with lower global HRQOL was similar in magnitude to the effect of having significant depressive symptoms or the diagnosis of AIDS. In conclusion, among HIV-infected patients, symptoms are significantly related to HRQOL over time. The functioning and well-being of patients with HIV is inextricably linked to the symptoms they experience.
Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation, 1999
Health-related quality of life (HRQOL) instruments assess functioning and well-being. Generic HRQ... more Health-related quality of life (HRQOL) instruments assess functioning and well-being. Generic HRQOL measures are intended to be relevant to everyone whereas population-targeted measures are designed to be relevant to a particular population. We asked 99 African-American elderly (mean age 72, 33% female, 47% less than high school education) to rate the relevancy of 33 HRQOL items drawn largely from existing instruments. We assessed the reliability of the relevancy ratings across respondents, rank-ordered the items by relevancy, and tested the significance of difference in relevancy ratings for each item compared to the average of all other items. We also examined the associations of the relevancy ratings with sociodemographic and clinical characteristics. The relevancy ratings were reliable (intraclass correlation = 0.71) and relevancy was generally distinct from HRQOL and demographic characteristics. Items assessing spirituality and weight-related health status were rated as signifi...
Oral surgery, oral medicine, and oral pathology, 1980
Ultrasonic versus hand-powered K type files were compared for their ability to remove dentin from... more Ultrasonic versus hand-powered K type files were compared for their ability to remove dentin from a standardized canal. The ultrasonic energized file removed a significantly greater amount of dentin in a fixed time period.
Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation, 2003
Various approaches have been employed to derive physical health and mental health summary scores ... more Various approaches have been employed to derive physical health and mental health summary scores for the SF-36 and the RAND-36, but head-to-head comparisons of alternative scoring algorithms are rare. We determined whether the associations of the physical and mental health summary scores with chronic medical conditions and utilization would differ depending on the scoring algorithm used. We examined 5701 patients receiving medical care from an independent association of 48 physician groups located primarily in the western United States and compared SF-36 and RAND-36 scoring of physical health and mental health summary scores. Associations with the presence of diabetes, heart disease, and kidney disease, as well as with utilization of medical care and mental health care were compared using bivariate and multivariate analysis. To examine the relationship between SF-36 and RAND-36 scores, we regressed the SF-36 physical and mental health composite scores on the RAND-36 physical and men...
Quality of Life Research, 2006
Patient-centered measures of functioning and well-being are needed to monitor and improve health ... more Patient-centered measures of functioning and well-being are needed to monitor and improve health for HIV-infected persons. We estimated the associations between HRQOL and symptoms over time in HIVinfected persons, adjusting for demographic and clinical characteristics using a longitudinal study of a nationally representative cohort of 2267 patients in care for HIV infection surveyed in 1996 and again in 1998. We used two global measures of HRQOL (overall health and overall quality of life) scored to have a mean of 50 and standard deviation of 10 in the sample. The total number of symptoms decreased ()1.29, p<0.001 for the difference), and overall health (1.09, p<0.001 for the difference) and overall quality of life (1.31, p<0.001 for the difference) improved over the period. Controlling for baseline symptoms and HRQOL, each additional symptom at follow-up (B=)1.14, p<0.001) was associated with worsened overall health and worsened overall quality of life (B=)0.95, p<0.001). The association of two additional symptoms with lower global HRQOL was similar in magnitude to the effect of having significant depressive symptoms or the diagnosis of AIDS. In conclusion, among HIV-infected patients, symptoms are significantly related to HRQOL over time. The functioning and well-being of patients with HIV is inextricably linked to the symptoms they experience.
Journal of Health Care for the Poor and Underserved, 2008
This study compared African American/Black and White Medicare enrollees&amp;amp;amp;amp;amp;a... more This study compared African American/Black and White Medicare enrollees&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; perceptions of care. Analyses of the 2002 Consumer Assessment of Healthcare Providers and Systems (CAHPS) 3.0 survey of 101,189 (White) and 8,791 (Black) Medicare enrollees (82% response rate) randomly sampled from 321 health plans, with data collected via mail (84%) and telephone (16%). Multivariate linear regression models were conducted with the CAHPS composites and global ratings as dependent variables, controlling for case-mix variables. Blacks reported significantly (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; or =.0001, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; or =.05) worse experiences with getting care quickly, office staff helpfulness, getting needed care, health plan customer service, rating of specialist care, and rating of the health plan (effect sizes ranging from 0.02 to 0.21). However, they reported better provider communication and rated their personal doctors/nurses and health care more positively (effect sizes ranging from 0.02 to 0.09).
Journal of Applied Gerontology, 2003
This study compares social functioning between one Black (n = 560) and one White (n = 1350) urban... more This study compares social functioning between one Black (n = 560) and one White (n = 1350) urban, community-based sample of older persons in Los Angeles. A 3-item social function scale that assessed visiting with family and friends, participating in community activities, and taking care of other people was administered; the instrument also assessed basic activities of daily living (BADL)
Journal of Aging and Health, 2006
Compare missing data and reliability of health care evaluations between African Americans and Whi... more Compare missing data and reliability of health care evaluations between African Americans and Whites in Medicare managed care health plans. Consumer Assessment of Healthcare Providers and Systems (CAHPS) 3.0 health plan survey data collected from 109,980 Medicare managed care enrollees (101,189 Whites, 8,791 African Americans) in 321 plans. Participants self-administered the survey and four single-item global ratings of care. Missing data rates were significantly higher for African Americans than Whites on all CAHPS items (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .0001). Internal consistency reliability estimates for the CAHPS scales did not differ significantly between African Americans and Whites, but plan-level reliability estimates for the scales and global rating items were significantly lower for African Americans than Whites. Higher missing data rates and lower plan-level reliability estimates for African American Medicare managed care enrollees suggest caution in making race/ethnicity comparisons. Future efforts are needed to enhance the quality of data collected from older African Americans.
Health and Quality of Life Outcomes, 2007
The SF-36 and SF-12 summary scores were derived using an uncorrelated (orthogonal) factor solutio... more The SF-36 and SF-12 summary scores were derived using an uncorrelated (orthogonal) factor solution. We estimate SF-36 and SF-12 summary scores using a correlated (oblique) physical and mental health factor model.
Haemophilia, 2003
Objective: The main objective of this study was to examine factors associated with utilization an... more Objective: The main objective of this study was to examine factors associated with utilization and costs for persons with haemophilia. Study design: Utilization data and patient characteristics were collected through medical record review of 336 patients receiving treatment for at least 90% of their haemophilia care at one of five comprehensive haemophilia treatment centres in California. Principal findings: The range of factor VIII deficiency in our sample was similar to the distribution among haemophilic patients in the Western United States; 215 (64%) had severe FVIII deficiency. The mean age in our sample was 21.4 (SD ¼ 16.2) years old and 114 (34%) were HIV-positive. In the multivariate model predicting the total cost of health care during 1995 (adjusted R 2 ¼ 0.40), total annual costs were significantly (P < 0.05) associated with being HIV-seropositive, infusing FVIII concentrate through a port vs. i.v. infusion, the number of comorbidities, moderate arthropathy (compared with no arthropathy), mild arthropathy, history of inhibitor to FVIII, and current prophylactic FVIII concentrate infusion. Conclusion: As expected, total health-care costs were correlated with comorbid medical conditions, such as HIV and sequelae of haemophilia such as arthropathy. Health policy should consider risk adjustment for the presence of complications such as arthropathy and HIV infection in the financing of haemophilia treatment to promote more equitable delivery of these services.
This research brief describes findings from HIV Costs and Services Utilization Study surveys on t... more This research brief describes findings from HIV Costs and Services Utilization Study surveys on the prevalence of mental health and substance abuse problems for persons with HIV, access to appropriate care, and ability to adhere to treatment. ... Use Adobe Acrobat Reader ...
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Papers by William Cunningham