Balanced performance measurement in research hospitals: the participative case study of a haematology department.
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ABSTRACT:
SUBMITTER: Catuogno S
PROVIDER: S-EPMC5543732 | biostudies-other | 2017 Aug
REPOSITORIES: biostudies-other
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Project description:BackgroundAll aspects of the heath care sector are being asked to account for their performance. This poses unique challenges for local public health units with their traditional focus on population health and their emphasis on disease prevention, health promotion and protection. Reliance on measures of health status provides an imprecise and partial picture of the performance of a health unit. In 2004 the provincial Institute for Clinical Evaluative Sciences based in Ontario, Canada introduced a public-health specific balanced scorecard framework. We present the conceptual deliberations and decisions undertaken by a health unit while adopting the framework.DiscussionPosing, pondering and answering key questions assisted in applying the framework and developing indicators. Questions such as: Who should be involved in developing performance indicators? What level of performance should be measured? Who is the primary intended audience? Where and how do we begin? What types of indicators should populate the health status and determinants quadrant? What types of indicators should populate the resources and services quadrant? What type of indicators should populate the community engagement quadrant? What types of indicators should populate the integration and responsiveness quadrants? Should we try to link the quadrants? What comparators do we use? How do we move from a baseline report card to a continuous quality improvement management tool?SummaryAn inclusive, participatory process was chosen for defining and creating indicators to populate the four quadrants. Examples of indicators that populate the four quadrants of the scorecard are presented and key decisions are highlighted that facilitated the process.
| S-EPMC2684743 | biostudies-literature
Project description:Cook et al. (Oper Res 61(3):666-676, 2013) propose a DEA-based model for the performance evaluation of non-homogeneous decision making units (DMUs) based on constant returns to scale (CRS), extended by Li et al. (Health Care Manag Sci 22(2):215-228, 2019) to variable returns to scale (VRS). This paper locates these models into more general DDF models to deal with nonhomogeneous DMUs and applies these to Hong Kong hospitals. The production process of each hospital is divided into subunits which have the same inputs and outputs and hospital performance is measured using the subunits. The paper provides CRS and VRS versions of DDF models and compares them with Cook et al. (Oper Res 61(3):666-676, 2013) and Li et al. (Health Care Manag Sci 22(2):215-228, 2019). A kernel-based method is used to estimate the distributions as well as a DEA-based efficiency analysis adapted by Simar and Zelenyuk to test the distributions. Both DDF CRS and VRS versions produce results similar to Cook et al. (Oper Res 61(3):666-676, 2013) and Li et al. (Health Care Manag Sci 22(2):215-228, 2019) respectively. However, the statistical tests find differences for the different technologies assumed as would be expected. For hospital managers, the more generalised DDF models expand their range of options in terms of directional improvements and priorities as well as dealing with non-homogeneity.
| S-EPMC9902815 | biostudies-literature
Project description:In 2004, Ethiopia introduced a community-based Health Extension Program to deliver basic and essential health services. We developed a comprehensive performance scoring methodology to assess the performance of the program. A balanced scorecard with six domains and 32 indicators was developed. Data collected from 1,014 service providers, 433 health facilities, and 10,068 community members sampled from 298 villages were used to generate weighted national, regional, and agroecological zone scores for each indicator. The national median indicator scores ranged from 37% to 98% with poor performance in commodity availability, workforce motivation, referral linkage, infection prevention, and quality of care. Indicator scores showed significant difference by region (P < 0.001). Regional performance varied across indicators suggesting that each region had specific areas of strength and deficiency, with Tigray and the Southern Nations, Nationalities and Peoples Region being the best performers while the mainly pastoral regions of Gambela, Afar, and Benishangul-Gumuz were the worst. The findings of this study suggest the need for strategies aimed at improving specific elements of the program and its performance in specific regions to achieve quality and equitable health services.
| S-EPMC4856618 | biostudies-literature
Project description:IntroductionIntracranial haemorrhage (ICH) is one of the most serious side-effects of severe thrombocytopenia in haematology patients. ICH is rare, but can have devastating consequences (death or major morbidity). It is unknown why some patients with severe thrombocytopenia bleed and others do not.Study aimsPrimary aim was to identify risk factors for ICH in patients with haematological malignancies. Secondary aims were to identify short-term outcomes for these patients at 30 days (major morbidity and mortality) and produce a more accurate estimate of ICH incidence in this population. This information is key to identifying means to improve treatment and quality of care.Methods/analysisThis is a UK-wide case-control study of ICH nested within a 4-year prospective surveillance study set up specifically for the case-control study. Each case will be matched to one control. Cases will be adult haematology patients (?16 years) who have had any type or severity of ICH who are receiving, about to receive or have just received myeloablative chemotherapy (defined as chemotherapy expected to cause a significant thrombocytopenia <50×10(9)/L for >5 days) or a haemopoietic stem cell transplant. Only patients being treated with curative intent will be included. Controls will be patients who fulfil the same inclusion criteria as cases (apart from ICH) and were treated at the same hospital immediately before the index case. Cases and controls will be matched to type of treatment (myeloablative chemotherapy or haemopoietic stem cell transplant). Hospitals across the UK will participate in a monthly email reporting strategy (started June 2011), as to whether a case of ICH occurred during the preceding calendar month. Case and control forms will be sent to any hospital reporting an eligible case. Conditional logistic regression will be used to calculate ORs. Denominator data for incidence estimates will use national registry data.Study registrationISRCTN05026912 (prospective registration). NIHR Portfolio (UKCRN ID 10712).
| S-EPMC3919001 | biostudies-literature
Project description:BACKGROUND:In resource-constrained settings, primary health centers (PHCs) are critical for universal health coverage. Laboratory service is one of its important components. While PHC and its performance are focused, its laboratory service has been neglected in developing countries like India. AIM:To determine the role of different level of PHC laboratory services on the overall PHC performance. METHODS:Cross-sectional study based on 42 PHCs of Osmanabad District, Maharashtra, India was performed. The study used levels of laboratory services in PHC as independent parameter and PHC outpatient department (OPD) visits per day (≤ 80 versus > 80) as dependent parameter. The control parameters used in the study were number of medical doctors, availability of laboratory technicians (LTs) and population coverage by PHC. Field visit was done to collect data on levels of laboratory services, but secondary source was used for other parameters. The logistic regression analysis was performed in study. FINDINGS:The study found variation in PHC population coverage (10 788-74 702) and OPD visits per day (40-182) across PHC. Strong positive association was observed between levels of laboratory services and number of OPD visits per day in PHC. PHC offering both malaria and tuberculosis in-house testing had higher odds (4.81) of getting more OPDs (≥ 80 OPD visits per day) as compared to PHC not offering in-house testing facility for malaria and tuberculosis. This association was stronger in PHCs with lower population coverage (0-75 quartile) as compared to PHCs with higher population coverage (75-100 quartile). CONCLUSION:Focus on laboratory services is needed to enhance the existing PHCs performance. Skill-up gradation of existing LT could help in improving the contribution of the existing laboratories in PHC functioning.
| S-EPMC6635801 | biostudies-literature
Project description:ImportanceDiagnostic acumen is a fundamental skill in the practice of medicine. Scalable, practical, and objective tools to assess diagnostic performance are lacking.ObjectiveTo validate a new method of assessing diagnostic performance that uses automated techniques to assess physicians' diagnostic performance on brief, open-ended case simulations.Design, setting, and participantsRetrospective cohort study of 11 023 unique attempts to solve case simulations on an online software platform, The Human Diagnosis Project (Human Dx). A total of 1738 practicing physicians, residents (internal medicine, family medicine, and emergency medicine), and medical students throughout the United States voluntarily used Human Dx software between January 21, 2016, and January 15, 2017.Main outcomes and measuresInternal structure validity was assessed by 3 measures of diagnostic performance: accuracy, efficiency, and a combined score (Diagnostic Acumen Precision Performance [DAPP]). These were each analyzed by level of training. Association with other variables' validity evidence was evaluated by correlating diagnostic performance and affiliation with an institution ranked in the top 25 medical schools by US News and World Report.ResultsData were analyzed for 239 attending physicians, 926 resident physicians, 347 intern physicians, and 226 medical students. Attending physicians had higher mean accuracy scores than medical students (difference, 8.1; 95% CI, 4.2-12.0; P < .001), as did residents (difference, 8.0; 95% CI, 4.8-11.2; P < .001) and interns (difference, 5.9; 95% CI, 2.3-9.6; P < .001). Attending physicians had higher mean efficiency compared with residents (difference, 4.8; 95% CI, 1.8-7.8; P < .001), interns (difference, 5.0; 95% CI, 1.5-8.4; P = .001), and medical students (difference, 5.4; 95% CI, 1.4-9.3; P = .003). Attending physicians also had significantly higher mean DAPP scores than residents (difference, 2.6; 95% CI, 0.0-5.2; P = .05), interns (difference, 3.6; 95% CI, 0.6-6.6; P = .01), and medical students (difference, 6.7; 95% CI, 3.3-10.2; P < .001). Attending physicians affiliated with a US News and World Report-ranked institution had higher mean DAPP scores compared with nonaffiliated attending physicians (80 [95% CI, 77-83] vs 72 [95% CI, 70-74], respectively; P < .001). Resident physicians affiliated with an institution ranked in the top 25 medical schools by US News and World Report also had higher mean DAPP scores compared with nonaffiliated peers (75 [95% CI, 73-77] vs 71 [95% CI, 69-72], respectively; P < .001).Conclusions and relevanceThe data suggest that diagnostic performance is higher in those with more training and that DAPP scores may be a valid measure to appraise diagnostic performance. This diagnostic assessment tool allows individuals to receive immediate feedback on performance through an openly accessible online platform.
| S-EPMC6484555 | biostudies-literature
Project description:ObjectivesTo determine whether the prior performance of maternity services, as measured by Royal College of Obstetricians and Gynaecologists performance indicators, is associated with ratings by the Care Quality Commission at subsequent inspection, and whether performance changes occur after inspection.MethodsWe used hospital activity data from 176 maternity sites inspected between October 2013 and March 2016 to generate a set of performance indicators developed by the Royal College of Obstetricians and Gynaecologists. We linked these data to Care Quality Commission data on inspection dates and rating scores and used regression models, controlling for site level effects, to estimate the relationships between inspection ratings and performance indicators before and after inspections.ResultsCoefficients measuring the relationship between indicator performance and subsequent inspection rating score had wide confidence intervals which crossed zero suggesting no statistically significant relationship prior to inspection. The same absence of statistical significance was observed for changes in indicator performance after inspection.ConclusionsThe use of routine data for performance monitoring is becoming increasingly important as regular inspection is costly and regulators require accurate and timely intelligence. However, we found no statistically significant relationships between inspection ratings and performance indicators before or after inspections in maternity services. This calls into question the validity and reliability of the performance indicators, the inspection process and ratings, or both, as measures of performance.
| S-EPMC7584108 | biostudies-literature
Project description:Bacterial community composition and its functional potential in Ulcerative colitis patients: A case study
| PRJEB64262 | ENA
Project description:OBJECTIVE::We estimate associations between emergency department (ED) diagnoses and suicide among youth to guide ED care. METHOD::This ED-based case-control study used data from the Office of the Chief Coroner and all EDs in Ontario, Canada. Cases ( n = 697 males and n = 327 females) were aged 10 to 25 years who died by suicide in Ontario between April 2003 and March 2014, with an ED contact in the year before their death. Same-aged ED-based controls were selected during this time frame. Crude and adjusted odds ratios (aORs) and 95% confidence intervals were calculated. RESULTS::Among youth diagnosed with a mental health problem at their most recent ED contact (41.9% cases, 5% controls), suicide was elevated among nonfatal self-inflicted: 'other' injuries, including hanging, strangulation, and suffocation in both sexes (aORs > 14); cut/pierce injuries in males (aOR > 5); poisonings in both sexes (aORs > 2.2); and mood and psychotic disorders in males (aORs > 1.7). Among those remaining, 'undetermined' injuries and poisonings in both sexes (aORs > 5), 'unintentional' poisonings in males (aOR = 2.1), and assault in both sexes (aORs > 1.8) were significant. At least half of cases had ED contact within 106 days. CONCLUSIONS::The results highlight the need for timely identification and treatment of mental health problems. Among those with an identified mental health problem, important targets for suicide prevention efforts are youth with self-harm and males with mood and psychotic disorders. Among others, youth with unintentional poisonings, undetermined events, and assaults should raise concern.
| S-EPMC6405805 | biostudies-other
Project description:Abstract Public health research requires sound design and thoughtful consideration of potential biases that may influence the validity of results. It also requires careful implementation of protocols and procedures that are likely to translate from the research environment to actual clinical practice. This article is the product of a breakout session from the 2009 Academic Emergency Medicine consensus conference entitled "Public Health in the ED: Screening, Surveillance, and Intervention" and serves to describe in detail aspects of performing emergency department (ED)-based public health research, while serving as a resource for current and future researchers. In doing so, the authors describe methodologic features of study design, participant selection and retention, and measurements and analyses pertinent to public health research. In addition, a number of recommendations related to research methods and future investigations related to public health work in the ED are provided. Public health investigators are poised to make substantial contributions to this important area of research, but this will only be accomplished by employing sound research methodology in the context of rigorous program evaluation.
| S-EPMC3082772 | biostudies-literature