Paula Diehr is emeritus professor of Biostatistics and Health Services at the University of Washington in Seattle. Dr. Diehr has worked primarily in health services research. She is best known for her early work in statistical diagnosis of headaches, community-acquired pneumonia and ankle fracture, small-area variation analysis, health insurance and use and cost of services, and community randomized trials for health promotion. She is currently working on issues surrounding aging, such as obesity, exercise, diet, years of healthy life, and accounting for death in longitudinal studies. Her statistical methodology interests include methods for the reliability of instruments, medical costs, small-area variation, grouped randomized trials, the paired t-test for small numbers of pairs, cohort versus cross-sectional designs, longitudinal data where many people die, and multi-state life tables.
Methodology
Social Marketing, Stages of Change, and Public Health Smoking Interventions, Health Education Behavior (2011)
As a "thought experiment," the authors used a modified stages of change model for smoking...
Health benefits of increased walking for sedentary, generally healthy older adults: using longitudinal data to approximate an intervention trial, J Gerontol A Biol Sci Med Sci. (2010)
BACKGROUND: Older adults are often advised to walk more, but randomized trials have not conclusively...
Age-specific prevalence and years of healthy life in a system with 3 health states, Statistics in Medicine (2007)
Consider a 3-state system with one absorbing state, such as Healthy, Sick, and Dead. Over...
Quality of life at the end of life (with Bill Lafferty), Health and Quality of Life Outcomes (2007)
Background: Little is known about self-perceived quality of life (QOL) near the end of life,...
Accounting for missing data in end-of-life research (with Laura Lee Johnson), J Palliat Med (2005)
End-of-life studies are likely to have missing data because sicker persons are less likely to...
Medical Decision Making
Identification of ovarian cancer symptoms in health insurance claims data. (with Sean Devlin), Journal of Women's Health (2010)
Background: Women with ovarian cancer have reported abdominal=pelvic pain, bloating, difficulty eating or feeling full...
Prediction of fracture in patients with acute musculoskeletal ankle trauma, Med Decis Making (1988)
X-rays taken for ankle trauma contribute significantly to the cost of health care in this...
Prediction of pneumonia in outpatients with acute cough - a statistical approach, J Chron Dis (1984)
Cough is the fifth most common reason for physician visits, but data on acute cough...
Cluster analysis to determine headache types, J Chronic Dis (1982)
Cluster analysis was used to separate 726 headache patients into clusters of patients with similar...
On the relationships among headache symptoms, Journal of Chronic Disease (now J Clin Epidem) (1982)
Headache classification has evolved through clinical experience because there are no objective findings which define...
Community Randomized Trials
Social Marketing, Stages of Change, and Public Health Smoking Interventions, Health Education Behavior (2011)
As a "thought experiment," the authors used a modified stages of change model for smoking...
Reliability, effect size, and responsiveness of health status measures in the design of randomized and cluster-randomized trials, Contemp Clin Trials (2005)
BACKGROUND: New health status survey instruments are often described by their psychometric (measurement) properties, such...
Optimal survey design for community intervention evaluations: cohort or cross-sectional?, J Clin Epidemiol (1995)
Community intervention evaluations that measure changes over time may conduct repeated cross-sectional surveys, follow a...
Breaking the matches in a paired t-test for community interventions when the number of pairs is small, Stat Med (1995)
There is considerable interest in community interventions for health promotion, where the community is the...
Do communities differ in health behaviors?, J Clin Epidemiol (1993)
Communities differ in the prevalence of various health behaviors, but it is not known to...
Small Area Variation
Small area variation analysis. Methods for comparing several diagnosis-related groups., Med Care (1993)
In small-area variation analysis, the variation of health care utilization rates, e.g., admission rates, among...
Can small-area analysis detect variation in surgery rates? The power of small-area variation analysis., Med Care (1992)
A variety of statistical methods can be used in small-area analysis to test whether there...
Testing the null hypothesis in small area analysis (with Kevin Cain), Health Services Research (1992)
The goal of small area analysis is often to demonstrate that hospital admission rates or...
A small area simulation approach to determining variation in dental procedure rates, Am J Public Health (1990)
All small area analyses need to compare the observed variability in rates to that expected...
What is too much variation? The null hypothesis in small-area analysis, Health Serv Res (1990)
A small-area analysis (SAA) in health services research often calculates surgery rates for several small...
Death in Longitudinal Studies
The number of sick persons in a cohort, Research on Aging (2007)
To see if the number of sick persons in a cohort was approximately constant over...
Quality of life at the end of life (with Bill Lafferty), Health and Quality of Life Outcomes (2007)
Background: Little is known about self-perceived quality of life (QOL) near the end of life,...
Accounting for missing data in end-of-life research (with Laura Lee Johnson), J Palliat Med (2005)
End-of-life studies are likely to have missing data because sicker persons are less likely to...
Methods for incorporating death into health-related variables in longitudinal studies, J Clin Epidemiol (2005)
BACKGROUND AND OBJECTIVES: Longitudinal studies of health over time may be misleading if some people...
Accounting for deaths in longitudinal studies using the SF-36: the performance of the Physical Component Scale of the Short Form 36-Item Health Survey and the PCTD, Med Care (2003)
BACKGROUND: Commonly used measures such as the Physical Component Scale of the Short Form 36-item...
Health Insurance and Utilization
Identification of ovarian cancer symptoms in health insurance claims data. (with Sean Devlin), Journal of Women's Health (2010)
Background: Women with ovarian cancer have reported abdominal=pelvic pain, bloating, difficulty eating or feeling full...
The importance of the normality assumption in large public health data sets (with Thomas Lumley), Annu Rev Public Health (2002)
It is widely but incorrectly believed that the t-test and linear regression are valid only...
Measuring the "managedness" and covered benefits of health plans (with David Grembowski), Health Serv Res (2000)
STUDY AIMS: (1) To develop indexes measuring the degree of managedness and the covered benefits...
Methods for analyzing health care utilization and costs, Annu Rev Public Health (1999)
Important questions about health care are often addressed by studying health care utilization. Utilization data...
Will unininsured people volunteer for voluntary health insurance? Experience from Washington State, American Journal of Public Health (1996)
OBJECTIVES: In national and local discussions of health care reform, there is disagreement about whether...
Health Status and Years of Healthy Life
Transitions among health states using 12 measures of successful aging in men and women: results from the cardiovascular health study (with Stephen Thlelke), Journal of Aging Research (2012)
Introduction. Successful aging hasmany dimensions, whichmay manifest differently inmen and women at different ages.
Methods....
Social Marketing, Stages of Change, and Public Health Smoking Interventions, Health Education Behavior (2011)
As a "thought experiment," the authors used a modified stages of change model for smoking...
Health benefits of increased walking for sedentary, generally healthy older adults: using longitudinal data to approximate an intervention trial, J Gerontol A Biol Sci Med Sci. (2010)
BACKGROUND: Older adults are often advised to walk more, but randomized trials have not conclusively...
Weight, mortality, years of healthy life, and active life expectancy in older adults, Journal of the American Geriatric Society (2007)
OBJECTIVES: To determine whether weight categories predict subsequent mortality and morbidity in older adults. DESIGN:...
The number of sick persons in a cohort, Research on Aging (2007)
To see if the number of sick persons in a cohort was approximately constant over...
Health Behaviors
Transitions among health states using 12 measures of successful aging in men and women: results from the cardiovascular health study (with Stephen Thlelke), Journal of Aging Research (2012)
Introduction. Successful aging hasmany dimensions, whichmay manifest differently inmen and women at different ages.
Methods....
Social Marketing, Stages of Change, and Public Health Smoking Interventions, Health Education Behavior (2011)
As a "thought experiment," the authors used a modified stages of change model for smoking...
Health benefits of increased walking for sedentary, generally healthy older adults: using longitudinal data to approximate an intervention trial, J Gerontol A Biol Sci Med Sci. (2010)
BACKGROUND: Older adults are often advised to walk more, but randomized trials have not conclusively...
Weight, mortality, years of healthy life, and active life expectancy in older adults, Journal of the American Geriatric Society (2007)
OBJECTIVES: To determine whether weight categories predict subsequent mortality and morbidity in older adults. DESIGN:...
The relation of dietary patterns to future survival, health, and cardiovascular events in older adults, J Clin Epidemiol (2003)
BACKGROUND: There have been few long-term follow-up studies of older adults who follow different dietary...
Aging and Older Adults
Transitions among health states using 12 measures of successful aging in men and women: results from the cardiovascular health study (with Stephen Thlelke), Journal of Aging Research (2012)
Introduction. Successful aging hasmany dimensions, whichmay manifest differently inmen and women at different ages.
Methods....
Social Marketing, Stages of Change, and Public Health Smoking Interventions, Health Education Behavior (2011)
As a "thought experiment," the authors used a modified stages of change model for smoking...
Health benefits of increased walking for sedentary, generally healthy older adults: using longitudinal data to approximate an intervention trial, J Gerontol A Biol Sci Med Sci. (2010)
BACKGROUND: Older adults are often advised to walk more, but randomized trials have not conclusively...
Prevalence, incidence, and persistence of major depressive symptoms in the Cardiovascular Health Study (with Stephen M. Thielke MD, MS), Aging and Mental Health (2010)
PURPOSE: To explore the association of major depressive symptoms with advancing age, sex, and self-rated...
Weight, mortality, years of healthy life, and active life expectancy in older adults, Journal of the American Geriatric Society (2007)
OBJECTIVES: To determine whether weight categories predict subsequent mortality and morbidity in older adults. DESIGN:...
Transition Probabilities and Multistate Life Tables
Transitions among health states using 12 measures of successful aging in men and women: results from the cardiovascular health study (with Stephen Thlelke), Journal of Aging Research (2012)
Introduction. Successful aging hasmany dimensions, whichmay manifest differently inmen and women at different ages.
Methods....
Social Marketing, Stages of Change, and Public Health Smoking Interventions, Health Education Behavior (2011)
As a "thought experiment," the authors used a modified stages of change model for smoking...
Prevalence, incidence, and persistence of major depressive symptoms in the Cardiovascular Health Study (with Stephen M. Thielke MD, MS), Aging and Mental Health (2010)
PURPOSE: To explore the association of major depressive symptoms with advancing age, sex, and self-rated...
Weight, mortality, years of healthy life, and active life expectancy in older adults, Journal of the American Geriatric Society (2007)
OBJECTIVES: To determine whether weight categories predict subsequent mortality and morbidity in older adults. DESIGN:...
The number of sick persons in a cohort, Research on Aging (2007)
To see if the number of sick persons in a cohort was approximately constant over...
Cardiovascular Health Study (CHS)
Transitions among health states using 12 measures of successful aging in men and women: results from the cardiovascular health study (with Stephen Thlelke), Journal of Aging Research (2012)
Introduction. Successful aging hasmany dimensions, whichmay manifest differently inmen and women at different ages.
Methods....
Health benefits of increased walking for sedentary, generally healthy older adults: using longitudinal data to approximate an intervention trial, J Gerontol A Biol Sci Med Sci. (2010)
BACKGROUND: Older adults are often advised to walk more, but randomized trials have not conclusively...
Prevalence, incidence, and persistence of major depressive symptoms in the Cardiovascular Health Study (with Stephen M. Thielke MD, MS), Aging and Mental Health (2010)
PURPOSE: To explore the association of major depressive symptoms with advancing age, sex, and self-rated...
Weight, mortality, years of healthy life, and active life expectancy in older adults, Journal of the American Geriatric Society (2007)
OBJECTIVES: To determine whether weight categories predict subsequent mortality and morbidity in older adults. DESIGN:...
The number of sick persons in a cohort, Research on Aging (2007)
To see if the number of sick persons in a cohort was approximately constant over...
CHPGP (Kaiser)
Social Marketing, Stages of Change, and Public Health Smoking Interventions, Health Education Behavior (2011)
As a "thought experiment," the authors used a modified stages of change model for smoking...
Optimal survey design for community intervention evaluations: cohort or cross-sectional?, J Clin Epidemiol (1995)
Community intervention evaluations that measure changes over time may conduct repeated cross-sectional surveys, follow a...
Breaking the matches in a paired t-test for community interventions when the number of pairs is small, Stat Med (1995)
There is considerable interest in community interventions for health promotion, where the community is the...
Do communities differ in health behaviors?, J Clin Epidemiol (1993)
Communities differ in the prevalence of various health behaviors, but it is not known to...
Assessing response bias in random-digit dialling surveys: the telephone-prefix method, Stat Med (1992)
Knowledge of the characteristics of survey non-respondents is important to determine generalizability to the population...
Basic Health Plan (BHP)
Will unininsured people volunteer for voluntary health insurance? Experience from Washington State, American Journal of Public Health (1996)
OBJECTIVES: In national and local discussions of health care reform, there is disagreement about whether...
Who enrolled in a state program for the uninsured: was there adverse selection?, Med Care (1993)
Managed care plans may hesitate to participate in programs for uninsured persons because they fear...
Estimating county percentages of people without health insurance, Inquiry (1991)
County data on the percentage of people without health insurance are seldom available, although state...
Cancer
Identification of ovarian cancer symptoms in health insurance claims data. (with Sean Devlin), Journal of Women's Health (2010)
Background: Women with ovarian cancer have reported abdominal=pelvic pain, bloating, difficulty eating or feeling full...
Treatment modality and quality differences for black and white breast cancer patients treated in community hospitals, Med Care (1989)
This study assessed the relationship of race and patterns of care, defined by an expert...
The effect of age on the care of women with breast cancer in community hospitals (with Joe Chu), J Gerontol (1987)
We studied the process of care received by 1,680 female breast cancer patients treated in...
Pacific Medical-Public Health Hospital
Use of a preferred provider plan by employees of the City of Seattle, Med Care (1990)
Little is known about the use of services in a preferred provider organization (PPO). We...
Prediction of fracture in patients with acute musculoskeletal ankle trauma, Med Decis Making (1988)
X-rays taken for ankle trauma contribute significantly to the cost of health care in this...
Prediction of pneumonia in outpatients with acute cough - a statistical approach, J Chron Dis (1984)
Cough is the fifth most common reason for physician visits, but data on acute cough...
Cluster analysis to determine headache types, J Chronic Dis (1982)
Cluster analysis was used to separate 726 headache patients into clusters of patients with similar...
Acute headaches; presenting symptoms and diagnostic rules to identify patients with tension and migraine headache , J Chron Dis (1981)
Headache is the ninth most common cause of physician visits, but data on acute headaches...
evggfp exc/vgood/good/fair/poor/(dead) self-rated health
Transitions among health states using 12 measures of successful aging in men and women: results from the cardiovascular health study (with Stephen Thlelke), Journal of Aging Research (2012)
Introduction. Successful aging hasmany dimensions, whichmay manifest differently inmen and women at different ages.
Methods....
Health benefits of increased walking for sedentary, generally healthy older adults: using longitudinal data to approximate an intervention trial, J Gerontol A Biol Sci Med Sci. (2010)
BACKGROUND: Older adults are often advised to walk more, but randomized trials have not conclusively...
Weight, mortality, years of healthy life, and active life expectancy in older adults, Journal of the American Geriatric Society (2007)
OBJECTIVES: To determine whether weight categories predict subsequent mortality and morbidity in older adults. DESIGN:...
The number of sick persons in a cohort, Research on Aging (2007)
To see if the number of sick persons in a cohort was approximately constant over...
Age-specific prevalence and years of healthy life in a system with 3 health states, Statistics in Medicine (2007)
Consider a 3-state system with one absorbing state, such as Healthy, Sick, and Dead. Over...
Weight, obesity, body-mass index
Comparing years of healthy life, measured in 16 ways, for normal weight and overweight older adults, Journal of Obesity (2012)
Introduction. The traditional definitions of overweight and obesity are not age specific, even though the...
Weight, mortality, years of healthy life, and active life expectancy in older adults, Journal of the American Geriatric Society (2007)
OBJECTIVES: To determine whether weight categories predict subsequent mortality and morbidity in older adults. DESIGN:...
The aging and dying processes and the health of older adults, J Clin Epidemiol (2002)
It is difficult to distinguish changes in health due to aging from those related to...
Weight-modification trials in older adults: what should the outcome measure be?, Curr Control Trials Cardiovasc Med (2002)
BACKGROUND: Overweight older adults are often counseled to lose weight, even though there is little...
Body mass index and mortality in nonsmoking older adults: the Cardiovascular Health Study, Am J Public Health (1998)
OBJECTIVES: This study assesses the relationship of body mass index to 5-year mortality in a...