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Quality Measures (quality + measure)
Selected AbstractsThe Relationship Between the Emergent Primary Percutaneous Coronary Intervention Quality Measure and Inpatient Myocardial Infarction MortalityACADEMIC EMERGENCY MEDICINE, Issue 8 2010Rahul K. Khare MD ACADEMIC EMERGENCY MEDICINE 2010; 17:793,800 © 2010 by the Society for Academic Emergency Medicine Abstract Background:, In the setting of acute ST-segment elevation myocardial infarction (STEMI), reperfusion therapy with emergent primary percutaneous coronary intervention (PCI) significantly reduces mortality. It is unknown whether a hospital's performance on the Centers for Medicare & Medicaid Services (CMS) quality metric for time from patient arrival to angioplasty is associated with its overall hospital acute myocardial infarction (AMI) mortality rate. Objectives:, The objective of this study was to evaluate if hospitals with higher performance on the time-to-PCI quality measure are more likely to achieve lower mortality for patients admitted for any type of AMI. Methods:, Using merged 2006 data from the Nationwide Inpatient Sample (NIS), the American Hospital Association (AHA) annual survey, and CMS Hospital Compare quality indicator data, we examined 69,101 admissions with an International Classification of Diseases, Ninth Revision (ICD-9)-coded principal diagnosis of AMI in the 116 hospitals that reported more than 24 emergent primary PCI admissions in that year. Hospitals were categorized into quartiles according to percentage of admissions in 2006 that achieved the primary PCI timeliness threshold (time-to-PCI quality measure). Using a random effects logistic regression model of inpatient mortality, we examined the significance of the hospital time-to-PCI quality measure after adjustment for other hospital and individual patient sociodemographic and clinical characteristics. Results:, The unadjusted inpatient AMI mortality rate at the 27 top quartile hospitals was 4.3%, compared to 5.1% at the 32 bottom quartile (worst performing) hospitals. The risk-adjusted odds ratio (OR) of inpatient death was 0.83 (95% confidence interval [CI] = 0.72 to 0.95), or 17% lower odds of inpatient death, among patients admitted to hospitals in the top quartile for the time-to-PCI quality measure compared to the case if the hospitals were in the bottom 25th percentile. Conclusions:, Hospitals with the highest and second highest quartiles of time-to-PCI quality measure had a significantly lower overall AMI mortality rate than the lowest quartile hospitals. Despite the fact that a minority of all patients with AMI get an emergent primary PCI, hospitals that perform this more efficiently also had a significantly lower mortality rate for all their patients admitted with AMI. The time-to-PCI quality measure in 2006 was a potentially important proxy measure for overall AMI quality of care. [source] Rule Quality Measures for Rule Induction Systems: Description and EvaluationCOMPUTATIONAL INTELLIGENCE, Issue 3 2001Aijun An A rule quality measure is important to a rule induction system for determining when to stop generalization or specialization. Such measures are also important to a rule-based classification procedure for resolving conflicts among rules. We describe a number of statistical and empirical rule quality formulas and present an experimental comparison of these formulas on a number of standard machine learning datasets. We also present a meta-learning method for generating a set of formula-behavior rules from the experimental results which show the relationships between a formula's performance and the characteristics of a dataset. These formula-behavior rules are combined into formula-selection rules that can be used in a rule induction system to select a rule quality formula before rule induction. We will report the experimental results showing the effects of formula-selection on the predictive performance of a rule induction system. [source] Using Patient Care Quality Measures to Assess Educational OutcomesACADEMIC EMERGENCY MEDICINE, Issue 5 2007Susan R. Swing PhD ObjectivesTo report the results of a project designed to develop and implement a prototype methodology for identifying candidate patient care quality measures for potential use in assessing the outcomes and effectiveness of graduate medical education in emergency medicine. MethodsA workgroup composed of experts in emergency medicine residency education and patient care quality measurement was convened. Workgroup members performed a modified Delphi process that included iterative review of potential measures; individual expert rating of the measures on four dimensions, including measures quality of care and educational effectiveness; development of consensus on measures to be retained; external stakeholder rating of measures followed by a final workgroup review; and a post hoc stratification of measures. The workgroup completed a structured exercise to examine the linkage of patient care process and outcome measures to educational effectiveness. ResultsThe workgroup selected 62 measures for inclusion in its final set, including 43 measures for 21 clinical conditions, eight medication measures, seven measures for procedures, and four measures for department efficiency. Twenty-six measures met the more stringent criteria applied post hoc to further stratify and prioritize measures for development. Nineteen of these measures received high ratings from 75% of the workgroup and external stakeholder raters on importance for care in the ED, measures quality of care, and measures educational effectiveness; the majority of the raters considered these indicators feasible to measure. The workgroup utilized a simple framework for exploring the relationship of residency program educational activities, competencies from the six Accreditation Council for Graduate Medical Education general competency domains, patient care quality measures, and external factors that could intervene to affect care quality. ConclusionsNumerous patient care quality measures have potential for use in assessing the educational effectiveness and performance of graduate medical education programs in emergency medicine. The measures identified in this report can be used as a starter set for further development, implementation, and study. Implementation of the measures, especially for high-stakes use, will require resolution of significant measurement issues. [source] Automatic quality assessment in structural brain magnetic resonance imaging,MAGNETIC RESONANCE IN MEDICINE, Issue 2 2009Bénédicte Mortamet Abstract MRI has evolved into an important diagnostic technique in medical imaging. However, reliability of the derived diagnosis can be degraded by artifacts, which challenge both radiologists and automatic computer-aided diagnosis. This work proposes a fully-automatic method for measuring image quality of three-dimensional (3D) structural MRI. Quality measures are derived by analyzing the air background of magnitude images and are capable of detecting image degradation from several sources, including bulk motion, residual magnetization from incomplete spoiling, blurring, and ghosting. The method has been validated on 749 3D T1 -weighted 1.5T and 3T head scans acquired at 36 Alzheimer's Disease Neuroimaging Initiative (ADNI) study sites operating with various software and hardware combinations. Results are compared against qualitative grades assigned by the ADNI quality control center (taken as the reference standard). The derived quality indices are independent of the MRI system used and agree with the reference standard quality ratings with high sensitivity and specificity (>85%). The proposed procedures for quality assessment could be of great value for both research and routine clinical imaging. It could greatly improve workflow through its ability to rule out the need for a repeat scan while the patient is still in the magnet bore. Magn Reson Med, 2009. © 2009 Wiley-Liss, Inc. [source] Rule Quality Measures for Rule Induction Systems: Description and EvaluationCOMPUTATIONAL INTELLIGENCE, Issue 3 2001Aijun An A rule quality measure is important to a rule induction system for determining when to stop generalization or specialization. Such measures are also important to a rule-based classification procedure for resolving conflicts among rules. We describe a number of statistical and empirical rule quality formulas and present an experimental comparison of these formulas on a number of standard machine learning datasets. We also present a meta-learning method for generating a set of formula-behavior rules from the experimental results which show the relationships between a formula's performance and the characteristics of a dataset. These formula-behavior rules are combined into formula-selection rules that can be used in a rule induction system to select a rule quality formula before rule induction. We will report the experimental results showing the effects of formula-selection on the predictive performance of a rule induction system. [source] Audit committees and earnings qualityACCOUNTING & FINANCE, Issue 2 2009Peter Baxter G30; G38; M41 Abstract This research investigates whether audit committees are associated with improved earnings quality for a sample of Australian listed companies prior to the introduction of mandatory audit committee requirements in 2003. Two measures of earnings quality are used based on models first developed by Jones (1991) and Dechow and Dichev (2002). Our results indicate that formation of an audit committee reduces intentional earnings management but not accrual estimation errors. We also find differences in the associations between audit committee accounting expertise and the two earnings quality measures. Other audit committee characteristics examined are not significantly related to either earnings quality measure. [source] A back-tracking procedure for optimization of simplex meshesINTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING, Issue 12 2005Joaquim B. Cavalcante-Neto Abstract This work presents a back-tracking procedure for the optimization of meshes. It can be applied to all ill-shaped elements in a mesh in order to improve quality in mesh optimization. Basically, the original mesh is reconstructed in regions around the ill-shaped elements by means of a set of deletion and reconstruction operations based on visibility tests. The back-tracking procedure fixes problems related to the quality of generated meshes in general and can be applied in two or three dimensions. The procedure works by deleting elements ranked below a predefined shape quality measure. It is important to mention that, although the presented procedure was devised for advancing-front algorithms, it can also be used in meshes generated by different approaches, such as Delaunay and others, requiring no modification. The proposed procedure is applicable to simplex elements (triangles and tetrahedra), although ideally it could be extended to other types of elements. Examples of improved meshes using the back-tracking procedure are presented, in which the quality of these meshes is assessed in order to validate the procedure proposed in this work. Copyright © 2005 John Wiley & Sons, Ltd. [source] A projection-based image quality measureINTERNATIONAL JOURNAL OF IMAGING SYSTEMS AND TECHNOLOGY, Issue 2-3 2008Jianxin Pang Abstract Objective image quality measure, evaluating the image quality consistently with human perception automatically, could be employed in image and video retrieval. And the measure with high efficiency and low computational complexity plays an important role in numerous image and video processing applications. On the assumption that any image's distortion could be modeled as the difference between the projection-based values (PV) of reference image and the counterpart of distorted image, we propose a new objective quality assessment method based on signal projection for full reference model. The proposed metric is developed by simple parameters to achieve high efficiency and low computational complexity. Experimental results show that the proposed method is well consistent with the subjective quality score. © 2008 Wiley Periodicals, Inc. Int J Imaging Syst Technol, 18, 94,100, 2008 [source] Collaborative Clinical Quality Improvement for Pressure Ulcers in Nursing HomesJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 10 2007(See editorial comments by Dr. George Taler on pp 167, 1675) The National Nursing Home Improvement Collaborative aimed to reduce pressure ulcer (PU) incidence and prevalence. Guided by subject matter and process experts, 29 quality improvement organizations and six multistate long-term care corporations recruited 52 nursing homes in 39 states to implement recommended practices using quality improvement methods. Facilities monitored monthly PU incidence and prevalence, healing, and adoption of key care processes. In residents at 35 regularly reporting facilities, the total number of new nosocomial Stage III to IV PUs declined 69%. The facility median incidence of Stage III to IV lesions declined from 0.3 per 100 occupied beds per month to 0.0 (P<.001) and the incidence of Stage II to IV lesions declined from 3.2 to 2.3 per 100 occupied beds per month (P=.03). Prevalence of Stage III to IV lesions trended down (from 1.3 to 1.1 residents affected per 100 occupied beds (P=.12). The incidence and prevalence of Stage II lesions and the healing time of Stage II to IV lesions remained unchanged. Improvement teams reported that Stage II lesions usually healed quickly and that new PUs corresponded with hospital transfer, admission, scars, obesity, and immobility and with noncompliant, younger, or newly declining residents. The publicly reported quality measure, prevalence of Stage I to IV lesions, did not improve. Participants documented disseminating methods and tools to more than 5,359 contacts in other facilities. Results suggest that facilities can reduce incidence of Stage III to IV lesions, that the incidence of Stage II lesions may not correlate with the incidence of Stage III to IV lesions, and that the publicly reported quality measure is insensitive to substantial improvement. The project demonstrated multiple opportunities in collaborative quality improvement, including improving the measurement of quality and identifying research priorities, as well as improving care. [source] The Relationship Between the Emergent Primary Percutaneous Coronary Intervention Quality Measure and Inpatient Myocardial Infarction MortalityACADEMIC EMERGENCY MEDICINE, Issue 8 2010Rahul K. Khare MD ACADEMIC EMERGENCY MEDICINE 2010; 17:793,800 © 2010 by the Society for Academic Emergency Medicine Abstract Background:, In the setting of acute ST-segment elevation myocardial infarction (STEMI), reperfusion therapy with emergent primary percutaneous coronary intervention (PCI) significantly reduces mortality. It is unknown whether a hospital's performance on the Centers for Medicare & Medicaid Services (CMS) quality metric for time from patient arrival to angioplasty is associated with its overall hospital acute myocardial infarction (AMI) mortality rate. Objectives:, The objective of this study was to evaluate if hospitals with higher performance on the time-to-PCI quality measure are more likely to achieve lower mortality for patients admitted for any type of AMI. Methods:, Using merged 2006 data from the Nationwide Inpatient Sample (NIS), the American Hospital Association (AHA) annual survey, and CMS Hospital Compare quality indicator data, we examined 69,101 admissions with an International Classification of Diseases, Ninth Revision (ICD-9)-coded principal diagnosis of AMI in the 116 hospitals that reported more than 24 emergent primary PCI admissions in that year. Hospitals were categorized into quartiles according to percentage of admissions in 2006 that achieved the primary PCI timeliness threshold (time-to-PCI quality measure). Using a random effects logistic regression model of inpatient mortality, we examined the significance of the hospital time-to-PCI quality measure after adjustment for other hospital and individual patient sociodemographic and clinical characteristics. Results:, The unadjusted inpatient AMI mortality rate at the 27 top quartile hospitals was 4.3%, compared to 5.1% at the 32 bottom quartile (worst performing) hospitals. The risk-adjusted odds ratio (OR) of inpatient death was 0.83 (95% confidence interval [CI] = 0.72 to 0.95), or 17% lower odds of inpatient death, among patients admitted to hospitals in the top quartile for the time-to-PCI quality measure compared to the case if the hospitals were in the bottom 25th percentile. Conclusions:, Hospitals with the highest and second highest quartiles of time-to-PCI quality measure had a significantly lower overall AMI mortality rate than the lowest quartile hospitals. Despite the fact that a minority of all patients with AMI get an emergent primary PCI, hospitals that perform this more efficiently also had a significantly lower mortality rate for all their patients admitted with AMI. The time-to-PCI quality measure in 2006 was a potentially important proxy measure for overall AMI quality of care. [source] Sequential design in quality control and validation of land cover databasesAPPLIED STOCHASTIC MODELS IN BUSINESS AND INDUSTRY, Issue 2 2009Elisabetta Carfagna Abstract We have faced the problem of evaluating the quality of land cover databases produced through photo-interpretation of remote-sensing data according to a legend of land cover types. First, we have considered the quality control, that is, the comparison of a land cover database with the result of the photo-interpretation made by a more expert photo-interpreter, on a sample of the polygons. Then we have analysed the problem of validation, that is, the check of the photo-interpretation through a ground survey. We have used the percentage of area correctly photo-interpreted as a quality measure. Since the kind of land cover type and the size of the polygons affect the probability of making mistakes in the photo-interpretation, we stratify the polygons according to two variables: the land cover type of the photo-interpretation and the size of the polygons. We have proposed an adaptive sequential procedure with permanent random numbers in which the sample size per stratum is dependent on the previously selected units but the sample selection is not, and the stopping rule is not based on the estimates of the quality parameter. We have proved that this quality control and validation procedure allows unbiased and efficient estimates of the quality parameters and allows reaching high precision of estimates with the smallest sample size. Copyright © 2009 John Wiley & Sons, Ltd. [source] Measuring Quality of Care in Syncope: Case Definition Affects Reported Electrocardiogram Use but Does Not Bias ReportingACADEMIC EMERGENCY MEDICINE, Issue 1 2009Jeremiah D. Schuur MD Abstract Objectives:, The objective was to calculate agreement between syncope as a reason for visiting (RFV) an emergency department (ED) and as a discharge diagnosis (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9]), to determine whether syncope case definition biases reported electrocardiogram (ECG) usage, a national quality measure. Methods:, The authors analyzed the ED portion of the National Hospital Ambulatory Medical Care Survey (NHAMCS), 1993,2004, for patients age ,18 years. A visit was defined as being for syncope if it received one of three RFV or ICD-9 codes. Agreement between RFV and ICD-9 codes was calculated, and the percentages of syncope patients (RFV vs. ICD-9) who had an ECG were compared using chi-square and multivariate logistic regression. Results:, Raw agreement between syncope as an RFV and as an ICD-9 diagnosis code was 30.1% (95% confidence interval [CI] = 32.6% to 35.5%), representing only moderate agreement beyond chance (, = 0.50). ECG utilization was lower among visits defined by RFV (64.1%; 95% CI = 62.0% to 66.3%) than for ICD-9 diagnosis (73.6%; 95% CI = 71.4% to 75.8%). There was no meaningful variation in adjusted ECG use by patient, visit, or hospital characteristics between case definitions. Adjusted ECG use was lower under both case definitions among female patients and discharged patients and increased with age (p < 0.05). Conclusions:, Despite only moderate agreement, syncope case definition should not bias reported ECG rate by patient, visit, or hospital characteristics. Among ED patients with syncope, ECG is performed less frequently in women, a potentially important disparity. [source] Lymph node evaluation as a colon cancer quality measureCA: A CANCER JOURNAL FOR CLINICIANS, Issue 1 2009Mary Desmond Pinkowish News & Views Editor No abstract is available for this article. [source] Emergency Department Operational Changes in Response to Pay-for-performance and Antibiotic Timing in PneumoniaACADEMIC EMERGENCY MEDICINE, Issue 6 2007Jesse M. Pines MD Background:The percentage of adult patients admitted with pneumonia who receive antibiotics within four hours of hospital arrival is publicly reported as a quality and pay-for-performance measure by the Department of Health and Human Services and is called PN-5b. Objectives:To determine attitudes among physician leaders at emergency medicine training programs toward using PN-5b as a quality measure for pay for performance, and to determine what operational changes academic emergency departments (EDs) have made to ensure early antibiotic administration for patients with pneumonia. Methods:The authors administered an online questionnaire to 129 chairpersons and medical directors of 135 academic ED training programs in the United States on attitudes toward performance measurement in pneumonia and changes that academic EDs have made in response to PN-5b; one response was sought from each institution. Respondents were identified through the Society for Academic Emergency Medicine Web site and e-mailed five times to maximize survey participation. Results:Ninety chairpersons and medical directors (70%) completed the survey; 47% were medical directors, 51% were chairpersons, and 2% were medical directors and chairpersons. Forty-five (50%) did not agree that PN-5b was an accurate quality measure, and 61 (69%) did not agree that pay for performance targeting this measure would lead to improved pneumonia care. The most common strategy to address PN-5b was to provide information to providers on the importance of early treatment with antibiotics (n = 63; 70%). For patients with suspected pneumonia, 46 (51%) automate chest radiograph (CXR) ordering at triage, 37 (41%) prioritize patients with suspected pneumonia, and 33 (37%) administer antibiotics before obtaining CXR results. Overall ED changes include improved turnaround time for CXR (n= 33; 37%), prioritized CXRs over other radiographs (n= 13; 14%), and improved inpatient bed availability (n= 12; 13%). Of 13 strategies identified to improve PN-5b, the median number that programs have implemented is five (interquartile range, 5,7). All sites reported engaging in at least three operational changes to address PN-5b. Conclusions:All EDs in this study have addressed early antibiotic administration with multiple operational changes despite mixed sentiment that these changes will improve care. Future research is needed to measure the impact of pay-for-performance initiatives. [source] Review and Restore for Case-Base MaintenanceCOMPUTATIONAL INTELLIGENCE, Issue 2 2001Thomas Reinartz Case-base maintenance is one of the most important issues for current research in case-based reasoning (CBR). In this article we propose an extended six-step CBR cycle and discuss its two additional steps as part of the maintenance phase of the CBR process. The review step covers assessment and monitoring of the knowledge containers, whereas the restore step actually modifies the contents of the containers according to recommendations resulting from the review step in order to keep the knowledge containers in a usable state. Here we focus our attention on the case base. For the review step, we define several quality measures based on different case and case-base properties that describe specific characteristics of the case base such as correctness, consistency, uniqueness, minimality, and incoherence. Then we use these measures to realize monitoring capabilities for the case-base container that indicate when the restore step is necessary. Finally, we also describe several methods for modifications of the case base in the restore step and their relation to the review step. An initial experimental evaluation shows the appropriateness of the proposed concepts and methods before we conclude the article with a discussion of related work and an outline of future directions to extend these aspects of maintenance in CBR. [source] Exposure Fusion: A Simple and Practical Alternative to High Dynamic Range PhotographyCOMPUTER GRAPHICS FORUM, Issue 1 2009T. Mertens I.4.8 [Image Processing]: Scene Analysis , Photometry, Sensor Fusion Abstract We propose a technique for fusing a bracketed exposure sequence into a high quality image, without converting to High dynamic range (HDR) first. Skipping the physically based HDR assembly step simplifies the acquisition pipeline. This avoids camera response curve calibration and is computationally efficient. It also allows for including flash images in the sequence. Our technique blends multiple exposures, guided by simple quality measures like saturation and contrast. This is done in a multiresolution fashion to account for the brightness variation in the sequence. The resulting image quality is comparable to existing tone mapping operators. [source] Capability, Quality, and Performance of Offshore IS Vendors: A Theoretical Framework and Empirical InvestigationDECISION SCIENCES, Issue 2 2010Prashant C. Palvia ABSTRACT Information systems (IS) offshoring has become a widespread practice and a strategic sourcing choice for many firms. While much has been written by researchers about the factors that lead to successful offshoring arrangements from the client's viewpoint, the vendor's perspective has been largely scarce. The vendor perspective is equally important as offshore IS vendors need to make important decisions in terms of delivering operational and strategic performance and aligning their resources and processes in order to meet or exceed targeted outcomes. In this article, we propose and test a three-level capability,quality,performance (CQP) theoretical framework to understand vendor outcomes and their antecedents. The first level of the framework represents three vendor capabilities: relationship management, contract management, and information technology management. The second level has three mediating variables representing process quality: partnership, service, and deliverable quality. The third level has three dependent variables representing vendor outcomes: operational performance, strategic performance, and satisfaction. The model was tested with 188 vendor firms from India and China, the two most popular destinations for IS offshoring. Results support the CQP framework; vendor capabilities are significant predictors of intermediate quality measures, which in turn affect vendor outcomes. Implications of the study findings to both theory development and IS offshore vendor strategic decision making are discussed. [source] The Role of Political Instability in Stock Market Development and Economic Growth: The Case of GreeceECONOMIC NOTES, Issue 3 2000Dimitrios Asteriou This article examines empirically the relationship between stock market development, political instability and economic growth in Greece. We measure socio-political instability by constructing an index which captures the occurrence of various phenomena of political violence using time-series data. The main advantages of analysing political instability in a case study framework using time-series, in contrast with the widely used cross-country empirical studies, are: (a) a more careful and in-depth examination of institutional and historical characteristics of a particular country; (b) the use of a data set comprised of the most appropriate and highest quality measures; and (c) a more detailed exposition of the dynamic evolution of the economy. The empirical results indicate the existence of a strong negative relationship between uncertain socio-political conditions and the general index of the Athens Stock Exchange (ASE) and support the theoretical hypothesis that uncertain socio-political conditions affect economic growth negatively, is true for the Greek case. (J.E.L.: G10, G14, O40, C32) [source] Audit committees and earnings qualityACCOUNTING & FINANCE, Issue 2 2009Peter Baxter G30; G38; M41 Abstract This research investigates whether audit committees are associated with improved earnings quality for a sample of Australian listed companies prior to the introduction of mandatory audit committee requirements in 2003. Two measures of earnings quality are used based on models first developed by Jones (1991) and Dechow and Dichev (2002). Our results indicate that formation of an audit committee reduces intentional earnings management but not accrual estimation errors. We also find differences in the associations between audit committee accounting expertise and the two earnings quality measures. Other audit committee characteristics examined are not significantly related to either earnings quality measure. [source] The Impact of Public School Attributes on Home Sale Prices in CaliforniaGROWTH AND CHANGE, Issue 3 2000David E. Clark The quality of public schools is often cited as an important attribute which distinguishes a community. Indeed, a recent public opinion poll conducted by the California Public Education Partnership indicates that residents rank improvements in public education higher than such high profile issues as environmental quality and crime reduction. In order to explore the role of educational quality in determining residential property values, a hedonic housing price model is used on a large sample of homes which sold within Fresno County in California over the period 1990-1994. After controlling for a wide range of housing characteristics and neighborhood features, the findings indicate that the school district does significantly influence the real sale price. Then the relative importance of inputs into the production of educational services is investigated as compared to output measures of productivity. These findings suggest that both input and output measures are important. However, elasticity estimates of input measures tend to be higher than those of output measures, with the average class size by far the strongest influence. There is some evidence to suggest that the benefits of additional teachers likely outweigh the costs. Finally, the findings suggest that attributes of schools are more highly valued by local residents than either crime or environmental quality measures within the community. [source] Measuring the productive efficiency and clinical quality of institutional long-term care for the elderlyHEALTH ECONOMICS, Issue 3 2005Juha Laine Abstract The authors consider the association between productive efficiency and clinical quality in institutional long-term care for the elderly. Cross-sectional data were collected from 122 wards in health-centre hospitals and residential homes in Finland in 2001. Productive efficiency was measured in terms of technical efficiency, which was defined as the unit's distance from the (best practice) production frontier. The analysis employed stochastic production frontier estimation, where technical inefficiency in the production function was specified to be a function of ward characteristics and clinical quality of care. Several quality indicators based on the Resident Assessment Instrument, such as prevalence of pressure ulcers and depression with no treatment, were used in the analysis. The results did not reveal systematic association between technical efficiency and clinical quality of care. However, the prevalence of pressure ulcers, indicating poor quality of care was associated with technical efficiency, a fact which highlights the importance of including quality measures in the assessment of efficiency in long-term care. Copyright © 2004 John Wiley & Sons, Ltd. [source] Do competition and managed care improve quality?HEALTH ECONOMICS, Issue 7 2002Nazmi SariArticle first published online: 22 JUL 200 Abstract In recent years, the US health care industry has experienced a rapid growth of managed care, formation of networks, and an integration of hospitals. This paper provides new insights about the quality consequences of this dynamic in US hospital markets. I empirically investigate the impact of managed care and hospital competition on quality using in-hospital complications as quality measures. I use random and fixed effects, and instrumental variable fixed effect models using hospital panel data from up to 16 states in the 1992,1997 period. The paper has two important findings: First, higher managed care penetration increases the quality, when inappropriate utilization, wound infections and adverse/iatrogenic complications are used as quality indicators. For other complication categories, coefficient estimates are statistically insignificant. These findings do not support the straightforward view that increases in managed care penetration are associated with decreases in quality. Second, both higher hospital market share and market concentration are associated with lower quality of care. Hospital mergers have undesirable quality consequences. Appropriate antitrust policies towards mergers should consider not only price and cost but also quality impacts. Copyright © 2002 John Wiley & Sons, Ltd. [source] Modeling three-dimensional crack propagation,A comparison of crack path tracking strategiesINTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN ENGINEERING, Issue 9 2008P. Jäger Abstract The development of a new finite element technique for the simulation of discontinuous failure phenomena in three dimensions is the key objective of this study. In contrast to the widely used extended finite element technique, we apply a purely deformation-based strategy based on an independent interpolation of the deformation field on both sides of the discontinuity. This method has been applied successfully for two-dimensional crack propagation problems in the past. However, when it comes to three-dimensional failure phenomena, it faces the same difficulties as the extended finite element method. Unlike in two dimensions, the characterization for the three-dimensional failure surface is non-unique and the tracking of the discrete crack can be performed in several conceptually different ways. In this work, we review the four most common three-dimensional crack tracking strategies. We perform a systematic comparison in terms of standard algorithmic quality measures such as mesh independency, efficiency, robustness, stability and computational cost. Moreover, we discuss more specific issues such as crack path continuity and integratability in commercial finite element packages. The features of the suggested crack tracking algorithms will be elaborated by means of characteristic benchmark problems in failure analysis. Copyright © 2008 John Wiley & Sons, Ltd. [source] Predicting time-specific changes in demographic processes using remote-sensing dataJOURNAL OF APPLIED ECOLOGY, Issue 2 2006HENRIK B. RASMUSSEN Summary 1Models of wildlife population dynamics are crucial for sustainable utilization and management strategies. Fluctuating ecological conditions are often key factors influencing both carrying capacity, mortality and reproductive rates in ungulates. To be reliable, demographic models should preferably rely on easily obtainable variables that are directly linked to the ecological processes regulating a population. 2We compared the explanatory power of rainfall, a commonly used proxy for variability in ecological conditions, with normalized differential vegetation index (NDVI), a remote-sensing index value that is a more direct measure of vegetation productivity, to predict time-specific conception rates of an elephant population in northern Kenya. Season-specific conception rates were correlated with both quality measures. However, generalized linear logistic models compared using Akaike's information criteria showed that a model based on the NDVI measure outperformed models based on rainfall measures. 3A predictive model based on coarse demographic data and the maximum seasonal NDVI value was able to trace the large variation in observed season-specific conception rates (Range 0,0·4), with a low median deviation from observed values of 0·07. 4By combining the model of season-specific conception rates with the average seasonal distribution of conception dates, the monthly number of conceptions (range 0,22) could be predicted within ±3 with 80% confidence. 5Synthesis and applications. The strong predictive power of the normalized differential vegetation index on time-specific variation in a demographic variable is likely to be generally applicable to resource-limited ungulate species occurring in ecologically variable ecosystems, and could potentially be a powerful factor in demographic population modelling. [source] Transitioning the patient with acute coronary syndrome from inpatient to primary care,JOURNAL OF HOSPITAL MEDICINE, Issue S4 2010FACPE, Tomás Villanueva DO Abstract Patients with acute coronary syndrome (ACS) undergo several transitions in care throughout the hospital stay, from prehospitalization to the postdischarge period when patients return to primary care. Hospitalist core competencies promote safe transitions in care for patients with ACS, including hospital discharge. These competencies also highlight the central role of the hospitalist in facilitating the continuity of care and as a key link between the patient and the primary care provider (PCP). Core competencies address key decision points and processes that occur during hospitalization for ACS including the initial evaluation and risk stratification, medication reconciliation, and discharge planning. Discharge is a crucial transition and one where hospitalists can both facilitate the transition to primary care and improve adherence to quality measures established for ACS. Poor communication during discharge reportedly results in postdischarge adverse events, most often related to medications and lack of follow-up related to pending test results. Standards for a safe discharge such as Project RED (Re-Engineered Discharge), initiatives to improve outcomes after discharge like Project BOOST (Better Outcomes for Older Adults Through Safe Transitions), and adaptive tools including the ACS Transitions Tool support timely and accurate communication of complex information between the hospitalist, the PCP, and the patient. While the role of hospitalists is evolving, it is clear that they have a central role in ensuring safe transitions in care for ACS. Journal of Hospital Medicine 2010;5:S8,S14. © 2010 Society of Hospital Medicine. [source] A Nested Logit Approach to Household MobilityJOURNAL OF REGIONAL SCIENCE, Issue 1 2001Thomas A. Knapp This study analyzes personal and site characteristics in a model of intraMSA and interMSA mobility. Households are assumed to choose a single type of move, intraMSA or interMSA, while simultaneously choosing a central city or suburban destination. We demonstrate that a nested logit model is appropriate on both theoretical and empirical grounds. The sample consists of intrametropolitan and intermetropolitan movers drawn from the 1990 U.S. Census PUMS. Personal characteristics drawn from the PUMS are matched to numerous site characteristics (climatic measures, other amenities, state and local fiscal characteristics, and other urban quality measures) drawn from a variety of sources. Nested logit direct and cross elasticities are presented for a number of site attributes. [source] Appropriate use of quality measures: Response to "risk factors for hospital readmission within 30 days: A new quality measure for children with sickle cell disease"PEDIATRIC BLOOD & CANCER, Issue 7 2009Ellen Schwalenstocker PhD No abstract is available for this article. [source] Rural Hospital Patient Safety Systems Implementation in Two StatesTHE JOURNAL OF RURAL HEALTH, Issue 3 2007Daniel R. Longo ScD ABSTRACT:,Context and Purpose:With heightened attention to medical errors and patient safety, we surveyed Utah and Missouri hospitals to assess the "state of the art" in patient safety systems and identify changes over time. This study examines differences between urban and rural hospitals.Methods:Survey of all acute care hospitals in Utah and Missouri at 2 points in time (2002 and 2004). Factor analysis was used to develop 7 latent variables to summarize the data, comparing rural and urban hospitals at each point in time and on change between the 2 survey times.Findings:On 3 of the 7 latent variables, there was a statistically significant difference between rural and urban hospitals at the first survey, with rural hospitals indicating lower levels of implementation. The differences remained present on 2 of those latent variables at the second survey. In both cases, 1 of those variables was computerized physician order entry (CPOE) systems. Rural hospitals reported more improvement in systems implementation between the 2 survey times, with the difference statistically significant on 1 of the 7 latent variables; the greatest improvement was in implementation of "root cause analysis."Conclusions:Adoption of patient safety systems overall is low. Although rates of adoption among rural versus urban hospitals appear lower, most differences are not statistically significant; the gap between rural and urban hospitals relative to quality measures is narrowing. Change in rural and urban hospitals is in the right direction, with the rate of change higher in rural hospitals for many systems. [source] Weekly E-mail Reminders Influence Emergency Physician Behavior: A Case Study Using the Joint Commission and Centers for Medicare and Medicaid Services Pneumonia GuidelinesACADEMIC EMERGENCY MEDICINE, Issue 7 2009Scott G. Weiner MD Abstract Objectives:, Improving physician compliance with evidence-based guidelines is challenging. The authors wanted to determine if weekly e-mail reminders to emergency department (ED) staff increase compliance with Joint Commission and the Centers for Medicare and Medicaid Services (CMS) community-acquired pneumonia quality measures. Methods:, One nurse administrator reviewed records on a weekly basis for all adult patients admitted to the hospital from the ED with a working diagnosis of pneumonia. An e-mail was then sent to all ED staff indicating the percentage of patients with antibiotic timing less than 4 hours from arrival. The names of individuals who administered antibiotics in less than 1 hour were highlighted. This study compared the time to antibiotics for 11 months before and 11 months after commencing this intervention. Results:, There were 281 patients in the control cohort, and 37 met exclusion criteria, leaving 244 for analysis. There were 342 patients in the intervention cohort, and 40 met exclusion criteria, leaving 302 for analysis. The median time from arrival to chest radiograph order decreased significantly from 61 to 47 minutes (p < 0.001). The median time interval from chest radiograph order to antibiotic administration did not change significantly (92 to 88 minutes, p = 0.294). The overall median time from arrival to antibiotic administration decreased significantly from 162 to 146 minutes (p = 0.018). The percentage of patients with antibiotic administration within 4 hours increased from 77.5% to 86.1% (p = 0.009). Conclusions:, Weekly e-mail reminders listing performance on antibiotic administration recommendations are associated with increased compliance with a clinical guideline. [source] What is the meaning of palliative care in the Asia-Pacific region?ASIA-PACIFIC JOURNAL OF CLINICAL ONCOLOGY, Issue 3 2010Margaret O'CONNOR Abstract This paper describes the preliminary work required to understand cultural differences in palliative care in the United Kingdom and three countries in the Asia-Pacific region, in preparation for a cross-country study. The study is intended to address cultural understandings of palliative care, the role of the family in end of life care, what constitutes good care and the ethical issues in each country. Suggestions are then made to shape the scope of the study and to be considered as outcomes to improve care of the dying in these countries. It is anticipated that the method used to achieve consensus on cross-country palliative care issues will be both qualitative and quantitative. Identifying key priorities in the delivery and quality measures of palliative care will involve participants in focus groups, a Delphi survey and in the development of clinical indicators towards creating standards of palliative care common to the Asian Pacific region. [source] | |||||||||||||||||||||||||||||||||||||