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Outcome Indicators (outcome + indicator)
Selected AbstractsOutcome indicators for vitrectomy in Terson syndromeACTA OPHTHALMOLOGICA, Issue 2 2009Justus G. Garweg Abstract. Purpose:, There is no general agreement on the best indication and timing of vitrectomy in patients suffering from Terson syndrome. Therefore, we reviewed our cases in order to assess factors interfering with the functional outcome and complication rates after vitrectomy. Methods:, In this retrospective consecutive case series, the records from all patients undergoing vitrectomy for Terson syndrome between 1975 and 2005 were evaluated. Results:, Thirty-seven patients (45 eyes) were identified, 36 of whom (44 corresponding eyes) were eligible. The best-corrected visual acuity (BCVA) at first and last presentation was 0.07 ± 0.12 and 0.72 ± 0.31, respectively. Thirty-five eyes (79.5%) achieved a postoperative BCVA of , 0.5; 26 (59.1%) eyes achieved a postoperative BCVA of , 0.8. Patients operated on within 90 days of vitreous haemorrhage achieved a better final BCVA than those with a longer latency (BCVA of 0.87 ± 0.27 compared to 0.66 ± 0.31; P = 0.03). Patients younger than 45 years of age achieved a better final BCVA than older patients (0.85 ± 0.24 compared to 0.60 ± 0.33; P = 0.006). Retinal detachment developed in four patients between 6 and 27 months after surgery. Seven patients (16%) required epiretinal membrane peeling and seven cataract surgery. Conclusion:, Ninety-eight per cent of our patients experienced a rapid and persisting visual recovery after removal of a vitreous haemorrhage caused by Terson syndrome. A shorter time between occurrence of vitreous haemorrhage and surgery as well as a younger patient age are predictive of a better outcome. Generally, the surgical risk is low, but complications (namely retinal detachment) may occur late after surgery. [source] Assessing the validity of potential alcohol-related non-fatal injury indicatorsADDICTION, Issue 3 2008John Langley ABSTRACT Aim To assess critically the face validity of the World Health Organization's (WHO's) International Guide for Monitoring Alcohol Consumption and Related Harm (MACRH) for deriving indicators, for the purposes of developing non-fatal alcohol-related injury indicators in New Zealand. Design MACRH's five solutions for deriving indicators are: (i) use only alcohol-specific cases; (ii) identify subsets of events known to be highly alcohol-related; (iii) utilize control indicators that are rarely alcohol-related; (iv) estimate alcohol attributable fractions (AAFs) and adjust indicators accordingly; and (v) develop composite indicators. These were assessed in terms of their face validity with particular reference to New Zealand. Findings There are significant face validity issues with each of the five options. Solution 4 offers the greatest promise, provided that: (i) valid AAFs can be derived and they are updated regularly; and (ii) appropriate adjustment is made for extraneous influences on the estimates of alcohol-related harm. To date, the latter has not been carried out. Conclusions Most potential sources of data on alcohol-related harm are subject to extraneous influences, which vary over time and space. While the attempt by WHO to offer solutions to this problem is laudable, the solutions do not address the problem adequately. MACRH guidelines need to be revised to include criteria for a valid outcome indicator. [source] Overall self-rated health: a new quality indicator for primary careJOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 1 2007James E. Rohrer PhD Abstract Rationale, aims and objectives, Patient ,empowerment' gives patients choices about their own care and about the outcomes they would most prefer. Many patients can be presumed to regard overall self-rated health as an important outcome. Therefore, overall self-rated health can be considered a relevant and important outcome measure for a patient-centred medical clinic. The purpose of this study was to use this new outcome measure as a dependent variable and to test the hypothesis that patients who are confident about their ability to manage their health will have better health, in comparison to more dependent patients. Methods, We conducted a randomized cross-sectional postal survey of 500 veteran patients from the Panhandle of Texas and the surrounding areas; and 302 participated in the study. Multiple logistic regression analysis was used to test the hypothesis that health confidence is positively related to self-rated health, controlling for obesity, cigarette smoking and participation in recreational activities. Results, Veterans who strongly disagreed with the statement that they usually could overcome illnesses on their own were less likely to report good, very good or excellent self-rated health (adjusted odds ratio = 0.25). Conclusions, Overall self-rated health as measured by a single question proved to be significantly related to behavioural risk factors in this sample of primary care patients, attesting to its validity as an outcome indicator. Furthermore, health confidence was associated with better health. Most primary providers believe that they can, through good communication and providing self-care tools, increase healthy behaviours in their patients. If we are indeed able to increase health confidence in our patients, this study would suggest that self-rated health would improve. [source] Performance measurement in mental health care: present situation and future possibilitiesINTERNATIONAL JOURNAL OF HEALTH PLANNING AND MANAGEMENT, Issue 3 2010Irma J. Baars Abstract This paper describes performance measurement and its indicators for mental health care services. Performance measurement can serve several goals such as accountability, quality improvement and performance management. For all three purposes structure, process and outcome indicators should be measured. Literature was retrieved from Medline and PsychInfo in order to see which performance indicators were used for the three purposes of performance measurement in mental health care. The indicators were classified in structure, process and outcome indicators. The results show no big differences in the indicators used among studies. Performance management is the performance measurement purpose most referred to, followed by accountability, and quality improvement. Outcome and process indicators are used most, structure indicators are in the minority. Several levels of measurement, that is national or service level, came forward in the literature review. To overcome misinterpretation of data and to be able to improve quality and manage performances, performance indicator sets should refer to structure, process and outcome. Indicators should be chosen carefully with the aim of the measurement taken into mind. Based on this review, a conceptual framework is presented to support managers in their decisions about which indictors can best be used for performance measurement. Additionally, a model that provides an understanding of the use of information gained by performance measurement is given. Copyright © 2009 John Wiley & Sons, Ltd. [source] Development of a registry for monitoring psychotropic drug prescriptions: aims, methods and implications for ordinary practice and researchINTERNATIONAL JOURNAL OF METHODS IN PSYCHIATRIC RESEARCH, Issue 3 2005Dr Corrado Barbui Abstract In psychiatry, individual-based registries have provided key information on risks and benefits associated with the use of psychotropic drugs but they have rarely been employed for monitoring and evaluating the everyday prescribing of psychopharmacological treatments. This article describes the cultural background that gave impetus to the idea of registering all prescriptions of psychotropic drugs dispensed by physicians working in the South Verona community mental health service, and presents the methodology employed to develop such a registry in a community psychiatric service where a psychiatric case register (PCR) has been operating since 1978. We developed a registry including every patient receiving psychotropic medications in ordinary practice. This registry is linked to the PCR in order to obtain data on social and demographic characteristics, clinical symptoms, diagnosis, use of services, and outcomes. No exclusion criteria are allowed , anyone receiving treatment is automatically included. This system, which can link drug and service-use data with hard outcome indicators, can generate information on the proportion of subjects discontinuing treatment, switching medication because of side-effects, recovery or inefficacy, as well as on the proportion of subjects failing to return to the physician, and the proportion of patients who improve. The innovative aspect of this approach is that this registry is developed, organized and used by physicians interested in monitoring their clinical practice and in providing patients, relatives and the public with accurate information on drug use in their specific context of care. Copyright © 2005 John Wiley & Sons, Ltd. [source] Review of nursing care for patients undergoing percutaneous coronary intervention: a patient journey approachJOURNAL OF CLINICAL NURSING, Issue 17 2009John X Rolley Aim., To evaluate the existing literature to inform nursing management of people undergoing percutaneous coronary intervention. Background., Percutaneous coronary intervention is an increasingly important revascularisation strategy in coronary heart disease management and can be an emergent, planned or rescue procedure. Nurses play a critical role in delivering care in both the independent and collaborative contexts of percutaneous coronary intervention management. Design., Systematic review. Method., The method of an integrative literature review, using the conceptual framework of the patient journey, was used to describe existing evidence and to determine important areas for future research. The electronic data bases CINAHL, Medline, Cochrane and the Joanna Briggs data bases were searched using terms including: (angioplasty, transulminal, percutaneous coronary), nursing care, postprocedure complications (haemorrhage, ecchymosis, haematoma), rehabilitation, emergency medical services (transportation of patients, triage). Results., Despite the frequency of the procedure, there are limited data to inform nursing care for people undergoing percutaneous coronary intervention. Currently, there are no widely accessible nursing practice guidelines focusing on the nursing management in percutaneous coronary intervention. Findings of the review were summarised under the headings: Symptom recognition; Treatment decision; Peri-percutaneous coronary intervention care, describing the acute management and Postpercutaneous coronary intervention management identifying the discharge planning and secondary prevention phase. Conclusions., Cardiovascular nurses need to engage in developing evidence to support guideline development. Developing consensus on nurse sensitive patient outcome indicators may enable benchmarking strategies and inform clinical trial design. Relevance to clinical practice., To improve the care given to individuals undergoing percutaneous coronary intervention, it is important to base practice on high-level evidence. Where this is lacking, clinicians need to arrive at a consensus as to appropriate standards of practice while also engaging in developing evidence. This must be considered, however, from the central perspective of the patient and their family. [source] Public disclosure of comparative clinical performance data: lessons from the Scottish experienceJOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 2 2003Russell Mannion PhD Abstract There is growing international interest in making information available on the clinical quality and performance of health care providers. In the United States of America, where public reporting is most advanced, comparative performance information in the form of ,report cards', ,provider profiles' and ,consumer reports' has been published for over a decade. In Europe, Scotland has been at the forefront of releasing clinical performance data and has disseminated such information since 1994. This paper reviews the Scottish experience of public disclosure and distils the key lessons for other countries seeking to implement similar programmes. It is based on the findings of the first empirical evaluation of a national clinical reporting initiative outside the United States. The study examined the impact of publication of Scottish (CRAG) clinical outcome indicators on four key stakeholder groups: health care providers, regional government health care purchasers, general practitioners and consumer advocacy agencies. We conclude that those responsible for developing clinical reporting systems should not only pay close attention to developing technically valid and professionally credible data which are tailored to the information needs of different end users, but should also focus on developing a suitable incentive structure and organizational environment that fosters the constructive use of such information. [source] Baseline indicators for measuring progress in preventing falls injury in older peopleAUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 5 2009Annaliese M. Dowling Abstract Objective: Over recent years, there has been increasing attention given to preventing falls and falls injury in older people through policy and other initiatives. This paper presents a baseline set of fall injury outcome indicators against which these preventive efforts can be assessed in terms of monitoring the rate of fall-related deaths and hospitalisations. Methods: ICD-10-AM coded hospital separations, Australian Bureau of Statistics (ABS) mortality and ABS population data were used to determine the rate of fall-related injury mortality and hospitalisations occurring in people aged 65+ years in New South Wales (NSW), Australia, over the six-year period from 1998/99 to 2003/04, inclusive. Results: Baseline trends for one fatality and five separations-based metrics are presented. Overall, fall mortality rates increased over the six years, with higher rates in males. Falls hospitalisation rates also increased slightly, with higher rates in females. The rates of hip fracture and pelvic fracture hospital separations generally declined over the six years and were highest in females. The level of unspecified and missing information about the place where falls occur increased by 1.5%. Conclusion: Baseline trends in fall injury outcome metrics highlight the severity and frequency of fall injuries before wide scale implementation of the Management Policy to Reduce Fall Injury Among Older People in NSW. Implications: Future use of these metrics will help to evaluate and monitor the progress of falls prevention in older people in NSW. They could also be adopted in other jurisdictions. [source] Updating the Determinants of Firm Performance: Estimation using the 1998 UK Workplace Employee Relations SurveyBRITISH JOURNAL OF INDUSTRIAL RELATIONS, Issue 3 2001John T. Addison We examine the determinants of establishment performance in the UK, using cross-sectional data from the 1998 Workplace Employee Relations Survey to replicate research by Fernie and Metcalf (1995) who used data from the 1990 Workplace Employee Relations Survey; specifically, we test whether employee representation, contingent pay and efforts to boost employee participation affect a set of economic and industrial relations outcome indicators in the manner they suggest. We also re-estimate the influential WERS90-based study of Machin and Stewart (1996) on the links between union status and financial performance. In both cases we report very different results. [source] Photodynamic therapy for chronic central serous chorioretinopathyACTA OPHTHALMOLOGICA, Issue 3 2010José M. Ruiz-Moreno Abstract. Purpose:, This study aimed to evaluate the efficacy of photodynamic therapy (PDT) in treating chronic central serous chorioretinopathy (CSC). Methods:, We describe a non-randomized, multicentre, interventional case series. A total of 82 eyes of 72 patients with chronic CSC were treated by conventional PDT. LogMAR best corrected visual acuity (BCVA) (ETDRS charts) and central foveal thickness (CFT) measured by optical coherence tomography before and after PDT, number of PDT treatments and complications were used as outcome indicators. Results:, Mean follow-up was 12 ± 10 months and mean age was 46 ± 10 years. Mean logMAR BCVA changed from 0.53 (standard deviation [SD] 0.43) before PDT to 0.38 (SD 0.41) at 3 months and 0.48 (SD 0.50) at 6 months (p < 0.0001 and p = 0.007, respectively, Student's t- test for paired data). Mean BCVA at the end of follow-up was 0.37 (SD 0.45; p < 0.0001 from baseline). Macular detachment was resolved and subretinal fluid (SRF) disappeared in all cases. Central foveal thickness decreased from 325 ,m (SD 95), to 229 ,m (SD 70) at 1 month after PDT, 206 ,m (SD 68) at 3 months, and 202 ,m (SD 76) at 6 months (all p < 0.0001, Student's t- test for paired data). No cases developed severe visual loss or complications derived from PDT. Reactive retinal pigment epithelium hypertrophy appeared in nine cases after PDT. Conclusions:, Photodynamic therapy with verteporfin may be useful in chronic CSC for improving BCVA and reducing SRF and CFT. Randomized studies with longer follow-up are needed to assess the real role of this treatment in chronic CSC. [source] Working with managers to improve services: changes in the role of research in social careCHILD & FAMILY SOCIAL WORK, Issue 1 2004Harriet Ward ABSTRACT The setting of specific objectives for children's services and the identification of key outcome indicators, together with the development of a core information specification for children's services with its practical application in the implementation of the Integrated Children's System, all mean that substantially more data are now available to child welfare agencies. Not so long ago in the UK it was the role of research teams to collect and analyse such data. Now that so much of it is already available to agencies, are researchers who work in this area of applied social policy research becoming redundant? Using data from the cohorts of looked after children being studied at the Centre for Child and Family Research, Loughborough University, the paper demonstrates how researchers can work in consultation with the managers of child welfare agencies to make better sense of the data at their disposal. It considers three issues: what additional variables need to be explored to help agencies better understand their performance; how groups of children could be identified who follow predictable pathways through social care; and how qualitative information is necessary to gain a true picture of what is happening. All of these examples demonstrate a fundamental role for researchers in working with social services personnel to identify how services can be improved. [source] Effectiveness of staged diabetes management on the quality of diabetes care in MexicoPRACTICAL DIABETES INTERNATIONAL (INCORPORATING CARDIABETES), Issue 6 2010J Rodriguez-Saldana MD Abstract The aim of this study was to investigate the effectiveness of staged diabetes management, a structured programme developed by the International Diabetes Center in Minneapolis, USA, on the quality of outpatient diabetes care at the primary level in Mexico. A prospective study was conducted in patients treated at outpatient diabetes clinics established in public health centres in 2001,2007 in Hidalgo, Mexico. Diabetes care was provided by multidisciplinary teams which included general physicians and nurses as a minimum. Organisational arrangements were made to reduce waiting times, avoid rotation of staff, and provide adequate time for baseline and follow-up visits. Process and outcomes indicators of quality of diabetes care included body mass index, blood pressure, fasting/casual blood glucose, lipoprotein measurement, haemoglobin A1c, and foot examination. Analysis of 4393 patients showed increases in the percentage of recorded process indicators of quality of diabetes care between baseline and the fifth visit: body mass index 85.5 vs 95.9%; blood pressure measurement 74.4 vs 95.6%; HbA1c 12.9 vs 17.7%; total cholesterol 18.3 vs 55.9%; and foot examination 19.1 vs 94.9%. Significant differences were noted by a decrease in fasting blood glucose (185.75±79.01 vs 162.89±72.53mg/dl, p<0.001), and a 3.6 percentage point decrease in HbA1c (12.05±4.47 vs 8.45±1.89%, p<0.001). These results suggest that it is possible to improve the quality of diabetes care at the primary level; this can be done through the implementation of a programme that integrates: changes in the structure and in the process of care, customised clinical guidelines, and a standardised system of information that enables measuring clinical results with very limited resources. Copyright © 2010 John Wiley & Sons. [source] | ||||||||||