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1.
Multivariate Behav Res ; 56(3): 377-389, 2021.
Article in English | MEDLINE | ID: mdl-32077317

ABSTRACT

Wayne Velicer is remembered for a mind where mathematical concepts and calculations intrigued him, behavioral science beckoned him, and people fascinated him. Born in Green Bay, Wisconsin on March 4, 1944, he was raised on a farm, although early influences extended far beyond that beginning. His Mathematics BS and Psychology minor at Wisconsin State University in Oshkosh, and his PhD in Quantitative Psychology from Purdue led him to a fruitful and far-reaching career. He was honored several times as a high-impact author, was a renowned scholar in quantitative and health psychology, and had more than 300 scholarly publications and 54,000+ citations of his work, advancing the arenas of quantitative methodology and behavioral health. In his methodological work, Velicer sought out ways to measure, synthesize, categorize, and assess people and constructs across behaviors and time, largely through principal components analysis, time series, and cluster analysis. Further, he and several colleagues developed a method called Testing Theory-based Quantitative Predictions, successfully applied to predicting outcomes and effect sizes in smoking cessation, diet behavior, and sun protection, with the potential for wider applications. With $60,000,000 in external funding, Velicer also helped engage a large cadre of students and other colleagues to study methodological models for a myriad of health behaviors in a widely applied Transtheoretical Model of Change. Unwittingly, he has engendered indelible memories and gratitude to all who crossed his path. Although Wayne Velicer left this world on October 15, 2017 after battling an aggressive cancer, he is still very present among us.


Subject(s)
Behavioral Medicine , Mentoring , Humans
2.
Dev Psychopathol ; 31(2): 683-697, 2019 05.
Article in English | MEDLINE | ID: mdl-30037357

ABSTRACT

In an upper-middle class setting, we explored associations between students' peer reputation in Grades 6 and 7 with adjustment at Grade 12. With a sample of 209 students, a confirmatory factor analysis (CFA) of peer reputation dimensions supported a 4-factor model (i.e., popular, prosocial, aggressive, isolated). Structural equation models were used to examine prospective links between middle school peer reputation and diverse Grade 12 adjustment indices, including academic achievement (Scholastic Aptitude Test scores and grade point average), internalizing and externalizing symptoms, and use of cigarettes, alcohol, and marijuana. Prosocial reputation was connected to higher academic achievement levels and fewer externalizing symptoms. Both prosocial and isolated reputations were negatively associated with dimensions of substance use, whereas popularity was positively associated. Implications for future research and interventions are discussed.


Subject(s)
Peer Group , Schools , Social Adjustment , Adolescent , Aggression/psychology , Child , Female , Humans , Male , Models, Theoretical , Prospective Studies , Students
3.
Horm Behav ; 87: 96-114, 2017 01.
Article in English | MEDLINE | ID: mdl-27793768

ABSTRACT

Cognitive changes that occur during mid-life and beyond are linked to both aging and the menopause transition. Studies in women suggest that the age at menopause onset can impact cognitive status later in life; yet, little is known about memory changes that occur during the transitional period to the postmenopausal state. The 4-vinylcyclohexene diepoxide (VCD) model simulates transitional menopause in rodents by depleting the immature ovarian follicle reserve and allowing animals to retain their follicle-deplete ovarian tissue, resulting in a profile similar to the majority of perimenopausal women. Here, Vehicle or VCD treatment was administered to ovary-intact adult and middle-aged Fischer-344 rats to assess the trajectory of cognitive change across time with normal aging and aging with transitional menopause via VCD-induced follicular depletion, as well as to evaluate whether age at the onset of follicular depletion plays a role in cognitive outcomes. Animals experiencing the onset of menopause at a younger age exhibited impaired spatial memory early in the transition to a follicle-deplete state. Additionally, at the mid- and post- follicular depletion time points, VCD-induced follicular depletion amplified an age effect on memory. Overall, these findings suggest that age at the onset of menopause is a critical parameter to consider when evaluating learning and memory across the transition to reproductive senescence. From a translational perspective, this study illustrates how age at menopause onset might impact cognition in menopausal women, and provides insight into time points to explore for the window of opportunity for hormone therapy during the menopause transition period. Hormone therapy during this critical juncture might be especially efficacious at attenuating age- and menopause- related cognitive decline, producing healthy brain aging profiles in women who retain their ovaries throughout their lifespan.


Subject(s)
Aging/psychology , Cognition/physiology , Menopause/psychology , Ovarian Reserve/physiology , Ovary/physiology , Spatial Memory/physiology , Animals , Cyclohexenes/pharmacology , Female , Menopause/drug effects , Ovarian Follicle/cytology , Ovarian Follicle/drug effects , Ovarian Reserve/drug effects , Ovary/cytology , Ovary/drug effects , Rats , Rats, Inbred F344 , Spatial Memory/drug effects , Vinyl Compounds/pharmacology
4.
Multivariate Behav Res ; 52(4): 445-464, 2017.
Article in English | MEDLINE | ID: mdl-28463014

ABSTRACT

In multiple regression researchers often follow up significant tests of the interaction between continuous predictors X and Z with tests of the simple slope of Y on X at different sample-estimated values of the moderator Z (e.g., ±1 SD from the mean of Z). We show analytically that when X and Z are randomly sampled from the population, the variance expression of the simple slope at sample-estimated values of Z differs from the traditional variance expression obtained when the values of X and Z are fixed. A simulation study using randomly sampled predictors compared four approaches: (a) the Aiken and West ( 1991 ) test of simple slopes at fixed population values of Z, (b) the Aiken and West test at sample-estimated values of Z, (c) a 95% percentile bootstrap confidence interval approach, and (d) a fully Bayesian approach with diffuse priors. The results showed that approach (b) led to inflated Type 1 error rates and 95% confidence intervals with inadequate coverage rates, whereas other approaches maintained acceptable Type 1 error rates and adequate coverage of confidence intervals. Approach (c) had asymmetric rejection rates at small sample sizes. We used an empirical data set to illustrate these approaches.


Subject(s)
Models, Statistical , Multivariate Analysis , Regression Analysis , Bayes Theorem , Computer Simulation , Confidence Intervals , Data Interpretation, Statistical , Female , Humans
5.
Ann Behav Med ; 50(2): 272-84, 2016 Apr.
Article in English | MEDLINE | ID: mdl-26637185

ABSTRACT

BACKGROUND: The infertility associated with primary ovarian insufficiency (POI) presents significant emotional challenges requiring psychosocial adjustment. Few investigations have explored the longitudinal process of adaptation to POI. PURPOSE: This longitudinal investigation tests a model of adjustment to POI that includes separate psychosocial vulnerability and resilience resource factors. METHODS: Among 102 women with POI, personal attributes reflective of vulnerability and resilience were assessed at baseline. Coping strategies were assessed 4 months later and measures of distress and well-being 12 months later. RESULTS: As hypothesized, confirmatory factor analysis yielded separate, inversely correlated vulnerability and resilience resource factors at baseline, and distress and well-being factors at 12 months. Contrary to predictions, maladaptive and adaptive coping strategies were not bi-factorial. Moreover, a single stand-alone strategy, avoidance (i.e., refusing to acknowledge stress), mediated the association between baseline vulnerability and 12-month distress. CONCLUSIONS: For women with POI, interventional studies targeted to reduce avoidance are indicated.


Subject(s)
Adaptation, Psychological , Infertility, Female/psychology , Primary Ovarian Insufficiency/psychology , Resilience, Psychological , Stress, Psychological/psychology , Adolescent , Adult , Female , Humans , Longitudinal Studies , Young Adult
6.
Ann Behav Med ; 49(3): 411-9, 2015 Jun.
Article in English | MEDLINE | ID: mdl-25380634

ABSTRACT

BACKGROUND: Fatigue is a debilitating symptom of fibromyalgia (FM) that has limited treatment options. Some evidence, however, has linked positive social engagement with reduced within-day fatigue. PURPOSE: This study elaborated longitudinal within-day and across-day relations between FM fatigue and social enjoyment. METHODS: One hundred seventy-six women with FM completed 21-day automated diaries assessing morning and end-of-day fatigue, and both afternoon social enjoyment and stress within two social domains: non-spousal and spousal. RESULTS: In the non-spousal domain, analysis supported a mediational path from lower morning fatigue to higher afternoon social enjoyment, which predicted lower end-of-day fatigue, and subsequently, lower next-morning fatigue. Enjoyment exerted a greater impact on within-day fatigue than did stress. Patterns in the spousal domain were similar, but the mediated path was nonsignificant. CONCLUSIONS: Positive social engagement offers relief from FM fatigue that carries over across days and may provide an additional target to enhance the effectiveness of current interventions.


Subject(s)
Fatigue/psychology , Fibromyalgia/psychology , Interpersonal Relations , Adult , Aged , Fatigue/etiology , Female , Fibromyalgia/complications , Humans , Middle Aged , Spouses/psychology , Stress, Psychological/psychology , Time Factors
7.
Ann Behav Med ; 43(1): 50-61, 2012 Feb.
Article in English | MEDLINE | ID: mdl-22037963

ABSTRACT

BACKGROUND: Neighborhood social cohesion (NSC) may contribute to understanding how neighborhood contexts influence the physical and mental health of residents. PURPOSE: We examined the relation of NSC to self-rated mental and physical health and evaluated the mediating role of NSC on relations between neighborhood socioeconomic status, ethnic composition, and health. METHODS: A sample of 3,098 Hispanic and non-Hispanic residents within 597 census tracts in metropolitan Phoenix, Arizona rated their health, psychological distress, and their perceptions of NSC. Census tract estimates provided neighborhood contextual measures. RESULTS: Neighborhood social cohesion was significantly related to better physical and mental health. Both individually rated NSC and neighborhood-level NSC mediated relations between neighborhood contexts and health outcomes. Substantive findings were consistent across Hispanic and non-Hispanic residents. CONCLUSIONS: The findings have implications for improving ethnic and socioeconomic disparities in physical and mental health through attention to social cohesion among neighborhood residents.


Subject(s)
Ethnicity/psychology , Health Status , Hispanic or Latino/psychology , Mental Health/ethnology , Residence Characteristics , Social Class , Social Environment , Adult , Aged , Aged, 80 and over , Arizona , Ethnicity/statistics & numerical data , Female , Hispanic or Latino/statistics & numerical data , Humans , Male , Middle Aged , Urban Population
8.
Multivariate Behav Res ; 47(6): 840-876, 2012 Nov.
Article in English | MEDLINE | ID: mdl-23457417

ABSTRACT

A Monte Carlo simulation was conducted to investigate the robustness of four latent variable interaction modeling approaches (Constrained Product Indicator [CPI], Generalized Appended Product Indicator [GAPI], Unconstrained Product Indicator [UPI], and Latent Moderated Structural Equations [LMS]) under high degrees of non-normality of the observed exogenous variables. Results showed that the CPI and LMS approaches yielded biased estimates of the interaction effect when the exogenous variables were highly non-normal. When the violation of non-normality was not severe (normal; symmetric with excess kurtosis < 1), the LMS approach yielded the most efficient estimates of the latent interaction effect with the highest statistical power. In highly non-normal conditions, the GAPI and UPI approaches with ML estimation yielded unbiased latent interaction effect estimates, with acceptable actual Type-I error rates for both the Wald and likelihood ratio tests of interaction effect at N ≥ 500. An empirical example illustrated the use of the four approaches in testing a latent variable interaction between academic self-efficacy and positive family role models in the prediction of academic performance.

10.
Am Psychol ; 64(1): discussion 51-2, 2009 Jan.
Article in English | MEDLINE | ID: mdl-19209970

ABSTRACT

Replies to the comment Ramifications of increased training in quantitative methodology by Herbet Zimiles on the current authors original article "Doctoral training in statistics, measurement, and methodology in psychology: Replication and extension of Aiken, West, Sechrest, and Reno's (1990) survey of PhD programs in North America". The current authors state that in their recent article, they reported the results of an extensive survey of quantitative training in all PhD programs in North America. They compared these results with those of a similar survey conducted 12 years earlier (Aiken, West, Sechrest, & Reno, 1990), and raised issues for the future methodological training of substantive and quantitative researchers in psychology. The authors then respond to Zimiles three questions.


Subject(s)
Data Collection/statistics & numerical data , Education, Medical, Graduate/methods , Psychology/education , Research Design/statistics & numerical data , Statistics as Topic/education , Biomedical Research/methods , Curriculum , Data Collection/methods , Humans , Psychology/statistics & numerical data , Statistics as Topic/methods
11.
J Pediatr Psychol ; 34(10): 1069-83, 2009.
Article in English | MEDLINE | ID: mdl-19386771

ABSTRACT

OBJECTIVE: To explain, through mediation analyses, the mechanisms by which ATHENA (Athletes Targeting Healthy Exercise and Nutrition Alternatives), a primary prevention and health promotion intervention designed to deter unhealthy body shaping behaviors among female high school athletes, produced immediate changes in intentions for unhealthy weight loss and steroid/creatine use, and to examine the link to long-term follow-up intentions and behaviors. METHODS: In a randomized trial of 1668 athletes, intervention participants completed coach-led peer-facilitated sessions during their sport season. Participants provided pre-test, immediate post-test, and 9-month follow-up assessments. RESULTS: ATHENA decreased intentions for steroid/creatine use and intentions for unhealthy weight loss behaviors at post-test. These effects were most strongly mediated by social norms and self-efficacy for healthy eating. Low post-test intentions were maintained 9 months later and predicted subsequent behavior. CONCLUSIONS: ATHENA successfully modified mediators that in turn related to athletic-enhancing substance use and unhealthy weight loss practices. Mediation analyses aid in the understanding of health promotion interventions and inform program development.


Subject(s)
Doping in Sports/prevention & control , Feeding and Eating Disorders/prevention & control , Health Education , Sports/psychology , Weight Loss , Adolescent , Athletic Performance , Basketball/psychology , Body Image , Creatine , Female , Humans , Longitudinal Studies , Models, Psychological , Outcome and Process Assessment, Health Care , Peer Group , Self Efficacy , Soccer/psychology , Social Values , Steroids , Volleyball/psychology
13.
J Pers Assess ; 91(2): 121-36, 2009 Mar.
Article in English | MEDLINE | ID: mdl-19205933

ABSTRACT

Count data reflect the number of occurrences of a behavior in a fixed period of time (e.g., number of aggressive acts by children during a playground period). In cases in which the outcome variable is a count with a low arithmetic mean (typically < 10), standard ordinary least squares regression may produce biased results. We provide an introduction to regression models that provide appropriate analyses for count data. We introduce standard Poisson regression with an example and discuss its interpretation. Two variants of Poisson regression, overdispersed Poisson regression and negative binomial regression, are introduced that may provide more optimal results when a key assumption of standard Poisson regression is violated. We also discuss the problems of excess zeros in which a subgroup of respondents who would never display the behavior are included in the sample and truncated zeros in which respondents who have a zero count are excluded by the sampling plan. We provide computer syntax for our illustrations in SAS and SPSS. The Poisson family of regression models provides improved and now easy to implement analyses of count data. [Supplementary materials are available for this article. Go to the publisher's online edition of Journal of Personality Assessment for the following free supplemental resources: the data set used to illustrate Poisson regression in this article, which is available in three formats-a text file, an SPSS database, or a SAS database.].


Subject(s)
Aggression , Child Behavior , Models, Statistical , Poisson Distribution , Aggression/psychology , Child , Child Behavior/psychology , Data Interpretation, Statistical , Humans , Psychometrics , Regression Analysis
14.
Am Psychol ; 63(1): 32-50, 2008 Jan.
Article in English | MEDLINE | ID: mdl-18193979

ABSTRACT

In a survey of all PhD programs in psychology in the United States and Canada, the authors documented the quantitative methodology curriculum (statistics, measurement, and research design) to examine the extent to which innovations in quantitative methodology have diffused into the training of PhDs in psychology. In all, 201 psychology PhD programs (86%) participated. This survey replicated and extended a previous survey (L. S. Aiken, S. G. West, L. B. Sechrest, & R. R. Reno, 1990), permitting examination of curriculum development. Most training supported laboratory and not field research. The median of 1.6 years of training in statistics and measurement was mainly devoted to the modally 1-year introductory statistics course, leaving little room for advanced study. Curricular enhancements were noted in statistics and to a minor degree in measurement. Additional coverage of both fundamental and innovative quantitative methodology is needed. The research design curriculum has largely stagnated, a cause for great concern. Elite programs showed no overall advantage in quantitative training. Forces that support curricular innovation are characterized. Human capital challenges to quantitative training, including recruiting and supporting young quantitative faculty, are discussed. Steps must be taken to bring innovations in quantitative methodology into the curriculum of PhD programs in psychology.


Subject(s)
Data Collection/statistics & numerical data , Education, Medical, Graduate/methods , Education, Medical, Graduate/statistics & numerical data , Psychology/education , Psychology/statistics & numerical data , Statistics as Topic/education , Curriculum/statistics & numerical data , Data Collection/methods , Humans , North America , Research Design/statistics & numerical data , Surveys and Questionnaires
16.
J Speech Lang Hear Res ; 61(10): 2547-2560, 2018 10 26.
Article in English | MEDLINE | ID: mdl-30304364

ABSTRACT

Purpose: This study examined whether the Predictive Early Assessment of Reading and Language (PEARL), a dynamic assessment of narratives that measures language comprehension and production, accurately classifies Navajo preschoolers with typically developing (TD) language or with language impairment (LI). Method: Ninety 4- and 5-year-old Navajo preschoolers were identified as having LI or are TD (n = 45 each) via a 5-measure battery: parent report, teacher report, English narrative, independent educational plan, and the Clinical Evaluation of Language Fundamental Preschool-Second Edition (Wiig, Secord, & Semel, 2004). Children completed a PEARL pretest, a narrative mediation phase providing principles of narrative structure, and a PEARL posttest. A modifiability score reflected responsiveness to mediation. Results: The PEARL pretest and posttest each distinguished children with LI versus TD children with 89% accuracy; modifiability scores identified children with 100% accuracy. The PEARL story grammar subtest at pretest and posttest best distinguished LI versus TD. A revised cutoff score on the PEARL pretest decreased the diagnosis of TD children as having LI; the standard PEARL posttest cutoff was retained. Conclusion: The PEARL is a promising assessment for accurately differentiating Navajo preschool children with LI from those with TD language, particularly with a revised pretest cutoff score.


Subject(s)
Comprehension/physiology , Indians, North American/psychology , Language Development Disorders/physiopathology , Language , Narration , Child, Preschool , Female , Humans , Indians, North American/ethnology , Language Development Disorders/diagnosis , Language Development Disorders/ethnology , Language Tests , Male , Reading
17.
Health Psychol ; 26(5): 577-87, 2007 Sep.
Article in English | MEDLINE | ID: mdl-17845109

ABSTRACT

OBJECTIVE: To examine the putative determinants of two osteoporosis-preventive behaviors, calcium consumption and weight-bearing exercise, in 2 samples of young women (Sample 1, n = 202; Sample 2, n = 209). A common psychosocial model of both behaviors, comprising the health belief model and augmented with constructs drawn from social cognitive theory and the theory of planned behavior, was developed, tested, and replicated. DESIGN: A prospective 2-panel design was used. Baseline data were obtained in fall 1997 for Sample 1 and in spring 2002 for Sample 2. Behavioral follow-up data were obtained 6 months after initial data collection for both samples. MAIN OUTCOME MEASURES: Baseline measures of behavioral intentions served as proximal outcomes. Behavioral measures obtained 6 months later served as distal outcomes. RESULTS: Perceived barriers and self-efficacy directly predicted intentions to consume calcium and to exercise. Descriptive norms predicted intentions, in part indirectly through barriers and self-efficacy. Constructs specific to osteoporosis (e.g., susceptibility, severity) did not contribute to prediction. With initial behavior controlled, intentions to consume calcium and to exercise predicted the corresponding behaviors measured 6 months later; intentions fully mediated the relationship of model constructs to behavior. CONCLUSION: Health beliefs associated with a negative health outcome, here osteoporosis, distal to young women's lives did not contribute to prediction. In contrast, constructs related to the current behaviors of calcium consumption and weight-bearing exercise (barriers, self-efficacy, norms) were highly predictive. Implications for behavioral interventions are discussed.


Subject(s)
Calcium/administration & dosage , Models, Theoretical , Osteoporosis/prevention & control , Psychology , Weight Lifting , Adolescent , Adult , Arizona , Female , Humans , Prospective Studies
18.
Health Psychol ; 25(1): 34-46, 2006 Jan.
Article in English | MEDLINE | ID: mdl-16448296

ABSTRACT

An appearance-based sun-protection intervention program was developed, implemented, and evaluated in a sample of 211 Caucasian women (ages 18-25) randomly assigned to the sun-protection program or to a stress management (control) program. The sun-protection program incorporated a novel construct of image norms of aspirational peers (i.e., female media figures, fashion models) approving paleness. The authors targeted these image norms as well as the advantages of tanning, health beliefs about photoaging and skin cancer, and self-efficacy for sun protection. The intervention produced significant differences across conditions favoring sun protection on all constructs but severity of skin cancer and barriers to sun protection. At follow-up, treatment participants exceeded controls both in intention to sun protect and sun-protective behavior and reported lower intention to sunbathe and fewer hours of sunbathing. A mediational model of intervention outcomes revealed distinct mediators for sun protection versus sunbathing.


Subject(s)
Health Promotion/methods , Program Evaluation , Sunburn/prevention & control , Sunscreening Agents , Adolescent , Adult , Arizona , Female , Humans
19.
Maturitas ; 55(3): 227-37, 2006 Oct 20.
Article in English | MEDLINE | ID: mdl-16650699

ABSTRACT

OBJECTIVES: To assess women's perceptions of risk for osteoporosis and to identify factors that shape those perceptions. METHODS: A community sample of 358 women (aged 40-86) rated their perceived risk of osteoporosis and provided detailed information about factors underlying their risk perceptions. Their open-ended responses were content analysed. RESULTS: On average, participants believed they were less likely to develop osteoporosis than other women their age. In all, 63% perceived their risk as lower than other women their age; only 16% as higher. In explaining their risk, women mentioned more risk-decreasing factors than risk-increasing factors. Women who rated their risk as low attributed their risk primarily to their own preventive behaviors (e.g. taking calcium, exercising), whereas women who rated their risk as high attributed their risk primarily to their family history. Risk-increasing and risk-decreasing personal actions, hereditary factors, and physiological factors accounted for 53% of the variance in perceived risk for osteoporosis. Only one-half and one-third of all women, however, mentioned calcium consumption and exercise, respectively, as protective factors employed to reduce osteoporosis risk. Women also held misconceptions about osteoporosis risk and protective factors. CONCLUSIONS: The current findings yield a detailed portrait of women's risk perceptions for osteoporosis. Increasing awareness of osteoporosis should be a priority for future osteoporosis prevention campaigns. Interventions should address misconceptions women may hold about their risk for the disease and promote specific behavioral strategies for osteoporosis prevention.


Subject(s)
Osteoporosis/psychology , Adult , Aged , Aged, 80 and over , Disease Susceptibility/psychology , Female , Health Knowledge, Attitudes, Practice , Humans , Interviews as Topic , Middle Aged , Risk Factors , Surveys and Questionnaires
20.
J Palliat Med ; 9(1): 111-26, 2006 Feb.
Article in English | MEDLINE | ID: mdl-16430351

ABSTRACT

OBJECTIVE: To document outcomes of a randomized trial of the PhoenixCare demonstration program of palliative care and coordinated care/case management for seriously chronically ill individuals who simultaneously received active treatment from managed care organizations (MCOs). DESIGN: Patients, continuously enrolled between July 1999, and March 2001, were randomly assigned to the PhoenixCare program or a control group receiving usual MCO care. SETTING: Hospice of the Valley, Phoenix, Arizona. PARTICIPANTS: Participants were 192 patients with chronic obstructive pulmonary disease (COPD) or chronic heart failure (CHF), who had an estimated 2-year life expectancy. INTERVENTION: Intensive home-based case management provided by registered nurse casemanagers, in coordination with patients' existing source of medical care, comprised the intervention. Program foci included disease and symptom management, patient self-management of illness and knowledge of illness-related resources, preparation for end-of life, physical and mental functioning, and utilization of medical services. OUTCOME MEASURES: Outcomes, assessed every 3 months by telephone interview, included measures related to all program foci; the SF-36 was used to evaluate physical and mental functioning; emergency department visits exemplified medical service utilization. RESULTS: Compared to controls, PhoenixCare patients exhibited significantly better outcomes on self-management of illness, awareness of illness-related resources, and legal preparation for end of life. They reported lower symptom distress, greater vitality, better physical functioning and higher self-rated health than randomized controls. Emergency department utilization was equivalent across groups. Patients with COPD showed stronger responsiveness to the intervention. CONCLUSION: A novel model of patient care that combined greatly enhanced palliative carefocused case management with ongoing MCO-based treatment was associated with improved functioning of chronically severely ill patients in the last years of life.


Subject(s)
Case Management/organization & administration , Hospices/organization & administration , Outcome Assessment, Health Care , Palliative Care/organization & administration , Pulmonary Disease, Chronic Obstructive/therapy , Adult , Analysis of Variance , Arizona , Humans , Managed Care Programs/organization & administration
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