Does nonresponse bias the results of retrospective surveys of end-of-life care?
Casarett, David; Smith, Dawn; Breslin, Sean; Richardson, Diane
OBJECTIVES/OBJECTIVE:To evaluate the effect of nonresponse bias on reports of the quality of end-of-life care that older adults receive. DESIGN/METHODS:Nationwide retrospective survey of end-of-life care. SETTING/METHODS:Sixty-two Veterans Affairs Medical Centers. PARTICIPANTS/METHODS:Patients were eligible if they died in a participating facility. One family member per patient was selected from medical records and invited to participate. MEASUREMENTS/METHODS:The telephone survey included 14 items describing important aspects of the patient's care in the last month of life. Scores (0-100) reflect the percentage of items for which the family member reported that the patient received the best possible care, and a global item defined the proportion of families who said the patient received "excellent" care. To examine the effect of nonresponse bias, a model was created to predict the likelihood of response based on patient and family characteristics; then this model was used to apply weights that were equivalent to the inverse of the probability of response for that individual. RESULTS:Interviews were completed with family members of 3,897 of 7,110 patients (55%). Once results were weighted to account for nonresponse bias, the change in mean individual scores was 2% of families reporting "excellent" care. Of the 62 facilities in the sample, the scores of only 19 facilities (31%) changed more than 1% in either direction, and only 10 (16%) changed more than 2%. CONCLUSION/CONCLUSIONS:Although nonresponse bias is a theoretical concern, it does not appear to have a significant effect on the facility-level results of this retrospective family survey.
Synthesis of a 7-azaindole by chichibabin cyclization: reversible base-mediated dimerization of 3-picolines
Ma, Yun; Breslin, Sean; Keresztes, Ivan; Lobkovsky, Emil; Collum, David B
The lithium diisopropylamide (LDA)-mediated condensation of 2-fluoro-3-picoline and benzonitrile to form 2-phenyl-7-azaindole via a Chichibabin cyclization is described. Facile dimerization of the picoline via a 1,4-addition of the incipient benzyllithium to the picoline starting material and fast 1,2-addition of LDA to benzonitrile cause the reaction to be complex. Both adducts are shown to reenter the reaction coordinate to produce the desired 7-azaindole. The solution structures of the key intermediates and the underlying reaction mechanisms are studied by a combination of IR and NMR spectroscopies.