Discussions of quality assurance mechanisms for health professions are increasing in Canada. In their roles of protecting the public from incompetent or unsafe health care, and enhancing the quality of care provided by practitioners, provincial licensing organizations are taking an interest in quality assurance programmes. The paper reports the results from a national survey of five self-regulating health professions (dentistry, medicine, nursing, optometry and pharmacy) in Canada. The study found two types of activities in place--a complaints programme and a routine audit programme. Both programmes use a similar approach to identifying poor performers within a health profession. The paper discusses the results of the study, the advantages and disadvantages of the approach used, and suggests a second approach to quality assurance which could be used in conjunction with current activities.
Quality of life (QoL) is a ubiquitous yet poorly defined concept; the precise determinants of QoL are rarely identified. We used pilot data from the GapS Questionnaire to investigate the most important determinants of QoL in children with chronic somatic illness.
We enrolled 92 participants including 60 parents and 32 of their children. The sample comprised rheumatology, diabetes, epilepsy, gastroenterology, cystic fibrosis, and day unit patients. Trained interviewers administered the GapS Questionnaire to parents, and to children if = 10 years. We determined the relative importance of different items for QoL.
Child participants had a mean age of 14.7 years. Children identified "having good friendships", "being happy most days", and "getting along with parents" as most important. Parents ranked most highly "being allowed to do all the things you like doing", "getting told you have done a good job at something", and "being physically able to do everything you enjoy doing".
Physical health items were not as important as social and psychological determinants of QoL in our pilot sample.
To compare the prevalence of eating disturbances in preteen and early teenage girls with type 1 diabetes to their nondiabetic peers.
A cross-sectional, case-controlled study of 101 girls with type 1 diabetes, ages 9-14 years, and 303 age-matched, female nondiabetic control subjects was conducted. Participants completed a Children's Eating Disorder Examination interview. Socioeconomic status, BMI, and diabetes-related variables were assessed. Groups were compared using chi(2) analyses.
Binge eating; the use of intense, excessive exercise for weight control; the combination of two disturbed eating-related behaviors; and subthreshold eating disorders were all more common in girls with type 1 diabetes. Metabolic control was not related to eating behavior in this study population.
Eating disturbances, though mostly mild, were significantly more common in preteen and early teenage girls with type 1 diabetes. Screening and prevention programs for this high-risk group should begin in the preteen years.
The current study evaluated an online education and support website intervention for adolescents with Type 1 diabetes. Participants were enrolled in an 8-week, online program addressing diabetes-related issues for adolescents. The evaluation comprised an intervention trial in which participants were assigned to an intervention or control group, and pre- and post-intervention measures of social support were administered. Outcomes indicated interventional gains approaching significance in participants' quality of relationships with others external to their family. Post-intervention qualitative interviews with intervention group participants identified beneficial impacts of decreased isolation, knowledge gain, and normalization of experience. Findings suggest that online information and support is an important resource in augmenting clinical care. Implications and recommendations for clinical practice are discussed.
The Career Development and Compensation Program (CDCP) was created by the Department of Paediatrics at The Hospital for Sick Children, in Toronto, Ontario, to provide clearly defined job expectations, enhance career development and assess performance through two distinct processes: the annual review and the triennial review. Staff are expected to advance the goals of the department and the hospital through activities in clinical care, education and mentorship, and research and are rewarded for excellence through compensation and career advancement. We evaluated the CDCP and conducted interviews with 27 members of the department; these formed the primary basis for our summative evaluation. The study objectives were to evaluate (1) mechanisms to recognize contributions, (2) processes used to ensure staff accountability and (3) opportunities to increase efficiencies. Interviews with members of the department resulted in a broad and comprehensive understanding of the CDCP. It is regarded as a rigorous, transparent and fair program. Concerns about the CDCP stem from the potential negative outcomes of assigning value to particular activities, the inequitable level of support provided to staff across the department and the costs of the review processes. Several recommendations were identified that serve to increase equality and strengthen supports for members of the department, to improve the ability of the CDCP to evaluate the softer aspects of clinical care and scholarship and to adopt a more holistic and integrated approach in the evaluation of staff. These re-formed arrangements build upon past modifications to the CDCP and represent natural progressions in the development of a program that has wide support from members of the department.
Given the increasing prevalence of childhood obesity, effective and cost-efficient strategies to enhance children's physical activity levels are needed. Unfortunately, exercise interventions evaluated to date have had little impact on overweight and obesity in youth. Physical activity counseling interventions have emerged as an effective and inexpensive alternative to traditional, structured exercise programs in adults, and may be an interesting option for the treatment of obesity in youth.
Peer assessment has become an important component of physician evaluation. In an academic health sciences centre, in addition to clinical care there is a significant focus on education, training and research. The literature suggests that the use of a 360-degree evaluation can provide physicians with valuable information on many aspects of their practice and can inform both professional and personal development. We conducted a pilot study to determine the feasibility of using peer assessment as part of the evaluation of our academic physicians. To maintain anonymity, an outside company was engaged to conduct the study. Participants completed a self-assessment and provided the names of eight physician peers and eight non-physician peers who were then requested to complete an evaluation. In addition, 25 patients were asked to provide their feedback. All questionnaires were forwarded directly to the outside company, which then compiled the data and provided each participant with a final report. Results indicate that it is feasible to carry out peer assessment within an academic health sciences centre. Participants noted the value of the process for career development and quality improvement.