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Individual Programs (individual + program)
Selected AbstractsA survey of clinical productivity and current procedural terminology (CPT) coding patterns of pediatric hematologist/oncologistsPEDIATRIC BLOOD & CANCER, Issue 2 2004Timothy C. Griffin MD Abstract Background Subspecialty-specific normative values for clinical productivity of practicing pediatric hematologist/oncologists have not been well established. This information could be a useful adjunct in administrative decision-making in areas such as necessary levels of physician staffing and development of compensation plans. Methods Current procedural terminology (CPT) coding information was obtained from 27 pediatric hematology/oncology groups. Clinical productivity was assessed by overall number of patient encounters and the total number of physician work relative value units (RVU) as defined by the resource-based relative value scale. The average physician productivity within each individual program was calculated. To determine uniformity of CPT coding, an additional survey solicited mock patient encounter documentation and CPT coding for a simple clinical vignette. Results A broad range of clinical productivity was observed for both numbers of patient encounters and RVU. Evaluation of the CPT coding data of the surveyed groups revealed differences in usage of certain evaluation and management (E/M) codes and procedural and specimen interpretation codes. Within individual categories of E/M service codes, a wide variation in assigned CPT code levels was also observed. This observation was supported by differences in the E/M coding for the clinical vignette. Conclusions Assessment and tracking of physician productivity can provide useful information for the administrative management of pediatric hematology/oncology programs. Caution must be exercised, however, when making productivity comparisons with other subspecialties or even between pediatric hematology/oncology programs. Such comparisons should take into account the number of patient encounters, characteristics of E/M coding patterns, the use of physician extenders, as well as overall RVU production. © 2004 Wiley-Liss, Inc. [source] Alternatives to the Conference Status Quo: Summary Recommendations from the 2008 CORD Academic Assembly Conference Alternatives WorkgroupACADEMIC EMERGENCY MEDICINE, Issue 2009Annie T. Sadosty MD Abstract Objective:, A panel of Council of Emergency Medicine Residency Directors (CORD) members was asked to examine and make recommendations regarding the existing Accreditation Council of Graduate Medical Education (ACGME) EM Program Requirements pertaining to educational conferences, identified best practices, and recommended revisions as appropriate. Methods:, Using quasi-Delphi technique, 30 emergency medicine (EM) residency program directors and faculty examined existing requirements. Findings were presented to the CORD members attending the 2008 CORD Academic Assembly, and disseminated to the broader membership through the CORD e-mail list server. Results:, The following four ACGME EM Program Requirements were examined, and recommendations made: 1The 5 hours/week conference requirement: For fully accredited programs in good standing, outcomes should be driving how programs allocate and mandate educational time. Maintain the 5 hours/week conference requirement for new programs, programs with provisional accreditation, programs in difficult political environs, and those with short accreditation cycles. If the program requirements must retain a minimum hours/week reference, future requirements should take into account varying program lengths (3 versus 4 years). 2The 70% attendance requirement: Develop a new requirement that allows programs more flexibility to customize according to local resources, individual residency needs, and individual resident needs. 3The requirement for synchronous versus asynchronous learning: Synchronous and asynchronous learning activities have advantages and disadvantages. The ideal curriculum capitalizes on the strengths of each through a deliberate mixture of each. 4Educationally justified innovations: Transition from process-based program requirements to outcomes-based requirements. Conclusions:, The conference requirements that were logical and helpful years ago may not be logical or helpful now. Technologies available to educators have changed, the amount of material to cover has grown, and online on-demand education has grown even more. We believe that flexibility is needed to customize EM education to suit individual resident and individual program needs, to capitalize on regional and national resources when local resources are limited, to innovate, and to analyze and evaluate interventions with an eye toward outcomes. [source] Noah and Joseph Effects in Government Budgets: Analyzing Long-Term MemoryPOLICY STUDIES JOURNAL, Issue 3 2007Bryan D. Jones This article examines the combined effects of what mathematician Benoit Mandelbrot has termed "Noah" and "Joseph" effects in U.S. national government budgeting. Noah effects, which reference the biblical great flood, are large changes or punctuations, far larger than could be expected given the Gaussian or Normal models that social scientists typically employ. Joseph effects refer to the seven fat and seven lean years that Joseph predicted to the Pharaoh. They are "near cycles" or "runs" in time series that look cyclical, but are not, because they do not occur on a regular, predictable basis. The Joseph effect is long-term memory in time series. Public expenditures in the United States from 1800 to 2004 shows clear Noah and Joseph effects. For the whole budget, these effects are strong prior to World War II (WWII) and weaker afterward. For individual programs, however, both effects are clearly detectable after WWII. Before WWII, budgeting was neither incremental nor well behaved because punctuations were even more severe and memory was not characterized by simple autoregressive properties. The obvious break that occurred after WWII could have signaled a regime shift in how policy was made in America, but even the more stable modern world is far more uncertain than the traditional incremental view. [source] SRTR Program-Specific Reports on Outcomes: A Guide for the New ReaderAMERICAN JOURNAL OF TRANSPLANTATION, Issue 4p2 2008D. M. Dickinson Differences in outcomes indeed exist among transplant programs and organ procurement organizations (OPO). A growing set of tools are available from the Scientific Registry of Transplant Recipients (SRTR) to measure and assess these outcomes in the different phases of the transplant process. These tools are not intended to compare two individual programs, rather to help identify programs whose practices may need further scrutiny, to be either avoided, corrected or emulated. To understand which differences in outcomes might be due to underlying differences in populations served and which might be due to differences in treatment, it is important to compare outcomes to ,risk-adjusted' expected values. Further, it is important to recognize and assess the role that random chance may play in these outcomes by considering the p-value or confidence interval of each estimate. We present the reader with a basic explanation of these tools and their interpretation in the context of reading the SRTR Program-Specific Reports. We describe the intended audience of these reports, including patients, monitoring and process improvement bodies, payers and others such as the media. Use of these statistics in a way that reflects a basic understanding of these concepts and their limitations is beneficial for all audiences. [source] The intergovernmental dimensions of the social union: A sectoral analysisCANADIAN PUBLIC ADMINISTRATION/ADMINISTRATION PUBLIQUE DU CANADA, Issue 1 2006Harvey Lazar The studies ask three questions. What kinds of intergovernmental regimes prevail in the social sector? What is the impact of regime type on the public interest? For individual programs, is there an alternative to the existing regime that might better serve the public interest? Intergovernmental regimes are defined by reference to two sets of variables: the extent to which there is independence or interdependence between orders of government; and the extent to which a hierarchical or non-hierarchical relationship prevails. Four types of regimes are defined: unilateral (hierarchical, interdependent), collaborative (non-hierarchical, interdependent), classical (non-hierarchical, independent), and beggar-thy-partner (hierarchical, independent). Regarding the first question, all four regime types are found in the eleven cases and no one type dominates. More generally, the regimes vary from sector to sector, from program to program, and over time suggesting that there is no single theory of federalism guiding the management of the social union. The effect of regime type on the public interest is analysed on the basis of policy, democratic, and federalism criteria. In most cases, the intergovernmental regime is analysed as appropriate, suggesting that something is right with the social union, at least from its intergovernmental perspective. In cases where the intergovernmental regime is considered inappropriate, the analysis argues for more collaborative federalism. Sommaire: Le présent article fait un rapport sur le fédéralisme pratiqué dans l'union sociale canadienne à partir de onze études de cas. Trois questions sont posées. Quels types de régimes intergouvernementaux l'emportent dans le secteur social? Quel est l'impact du type de régime sur l'intérêt public? Pour les programmes individuels, existe-t-il une alternative au régime existant qui pourrait mieux servir l'intérêt public? Les régimes intergouvernementaux sont définis par référence à deux ensembles de variables: la mesure dans laquelle il existe une indépendance ou une interdépendance entre les ordres de gouvernement; et la mesure dans laquelle une relation hiérarchique ou non hiérarchique prévaut. Quatre types de régimes sont définis: unilatéral (hiérarchique, interdépendant), coopératif (non hiérarchique, interdépendant), classique (non hiérarchique, indépendant) et le chacun pour soi (hiérarchique, indépendant). En ce qui concerne la première question, on trouve les quatre types de régimes dans les onze études de cas et aucun type ne domine. Plus généralement, les régimes varient d'un secteur à l'autre, d'un programme à l'autre, et au fil des ans, laissant supposer qu'il n'existe pas une théorie unique de fédéralisme pour guider la gestion de l'union sociale. L'effet du type de régime sur l'intérêt public est analysé sur la base des critères de politique, de démocratie et de fédéralisme. Dans la plupart des cas, le régime intergouvernemental est considéré approprié, laissant entendre que l'union sociale fonctionne bien, du moins selon sa perspective intergouvernementale. Dans les cas où le régime intergouvernemental est considéré inapproprié, l'analyse plaide pour un fédéralisme plus coopératif. [source] | ||||||||||