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Abbreviated Injury Scale: not a reliable basis for summation of injury severity in trauma facilities?

https://arctichealth.org/en/permalink/ahliterature122288
Source
Injury. 2013 May;44(5):691-9
Publication Type
Article
Date
May-2013
Author
Kjetil G Ringdal
Nils Oddvar Skaga
Morten Hestnes
Petter Andreas Steen
Jo Røislien
Marius Rehn
Olav Røise
Andreas J Krüger
Hans Morten Lossius
Author Affiliation
Department of Research, Norwegian Air Ambulance Foundation, Drøbak, Norway. kjetil.ringdal@norskluftambulanse.no
Source
Injury. 2013 May;44(5):691-9
Date
May-2013
Language
English
Publication Type
Article
Keywords
Abbreviated Injury Scale
Benchmarking
Clinical Coding
Female
Humans
Injury Severity Score
Male
Norway
Reproducibility of Results
Trauma Centers
Wounds and Injuries - epidemiology
Abstract
Injury severity is most frequently classified using the Abbreviated Injury Scale (AIS) as a basis for the Injury Severity Score (ISS) and the New Injury Severity Score (NISS), which are used for assessment of overall injury severity in the multiply injured patient and in outcome prediction. European trauma registries recommended the AIS 2008 edition, but the levels of inter-rater agreement and reliability of ISS and NISS, associated with its use, have not been reported.
Nineteen Norwegian AIS-certified trauma registry coders were invited to score 50 real, anonymised patient medical records using AIS 2008. Rater agreements for ISS and NISS were analysed using Bland-Altman plots with 95% limits of agreement (LoA). A clinically acceptable LoA range was set at ± 9 units. Reliability was analysed using a two-way mixed model intraclass correlation coefficient (ICC) statistics with corresponding 95% confidence intervals (CI) and hierarchical agglomerative clustering.
Ten coders submitted their coding results. Of their AIS codes, 2189 (61.5%) agreed with a reference standard, 1187 (31.1%) real injuries were missed, and 392 non-existing injuries were recorded. All LoAs were wider than the predefined, clinically acceptable limit of ± 9, for both ISS and NISS. The joint ICC (range) between each rater and the reference standard was 0.51 (0.29,0.86) for ISS and 0.51 (0.27,0.78) for NISS. The joint ICC (range) for inter-rater reliability was 0.49 (0.19,0.85) for ISS and 0.49 (0.16,0.82) for NISS. Univariate linear regression analyses indicated a significant relationship between the number of correctly AIS-coded injuries and total number of cases coded during the rater's career, but no significant relationship between the rater-against-reference ISS and NISS ICC values and total number of cases coded during the rater's career.
Based on AIS 2008, ISS and NISS were not reliable for summarising anatomic injury severity in this study. This result indicates a limitation in their use as benchmarking tools for trauma system performance.
PubMed ID
22831922 View in PubMed
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Access to heart failure care post emergency department visit: do we meet established benchmarks and does it matter?

https://arctichealth.org/en/permalink/ahliterature114344
Source
Am Heart J. 2013 May;165(5):725-32
Publication Type
Article
Date
May-2013
Author
Debbie Ehrmann Feldman
Thao Huynh
Julie Des Lauriers
Nadia Giannetti
Marc Frenette
François Grondin
Caroline Michel
Richard Sheppard
Martine Montigny
Serge Lepage
Viviane Nguyen
Hassan Behlouli
Louise Pilote
Author Affiliation
Université de Montréal, Montreal, Quebec, Canada. debbie.feldman@umontreal.ca
Source
Am Heart J. 2013 May;165(5):725-32
Date
May-2013
Language
English
Publication Type
Article
Keywords
Aged
Benchmarking
Continuity of Patient Care - standards
Emergencies
Emergency Service, Hospital - organization & administration
Female
Heart Failure - therapy
Humans
Male
Office Visits - utilization
Quebec
Abstract
The Canadian Cardiology Society recommends that patients should be seen within 2 weeks after an emergency department (ED) visit for heart failure (HF). We sought to investigate whether patients who had an ED visit for HF subsequently consult a physician within the current established benchmark, to explore factors related to physician consultation, and to examine whether delay in consultation is associated with adverse events (AEs) (death, hospitalization, or repeat ED visit).
Patients were recruited by nurses at 8 hospital EDs in Québec, Canada, and interviewed by telephone within 6 weeks of discharge and subsequently at 3 and 6 months. Clinical variables were extracted from medical charts by nurses. We used Cox regression in the analysis.
We enrolled 410 patients (mean age 74.9 ± 11.1 years, 53% males) with a confirmed primary diagnosis of HF. Only 30% consulted with a physician within 2 weeks post-ED visit. By 4 weeks, 51% consulted a physician. Over the 6-month follow-up, 26% returned to the ED, 25% were hospitalized, and 9% died. Patients who were followed up within 4 weeks were more likely to be older and have higher education and a worse quality of life. Patients who consulted a physician within 4 weeks of ED discharge had a lower risk of AEs (hazard ratio 0.59, 95% CI 0.35-0.99).
Prompt follow-up post-ED visit for HF is associated with lower risk for major AEs. Therefore, adherence to current HF guideline benchmarks for timely follow-up post-ED visit is crucial.
PubMed ID
23622909 View in PubMed
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Access to palliative care varies widely across Canada.

https://arctichealth.org/en/permalink/ahliterature137996
Source
CMAJ. 2011 Feb 8;183(2):E87-8
Publication Type
Article
Date
Feb-8-2011
Author
Roger Collier
Source
CMAJ. 2011 Feb 8;183(2):E87-8
Date
Feb-8-2011
Language
English
Publication Type
Article
Keywords
Benchmarking
Canada
Health Services Accessibility
Healthcare Disparities
Humans
Palliative Care
PubMed ID
21220440 View in PubMed
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Accountability in public health units: using a modified nominal group technique to develop a balanced scorecard for performance measurement.

https://arctichealth.org/en/permalink/ahliterature183128
Source
Can J Public Health. 2003 Sep-Oct;94(5):391-6
Publication Type
Article
Author
Victoria A Robinson
Duncan Hunter
Samuel E D Shortt
Author Affiliation
Department of Community Health and Epidemiology, Queen's University, Kingston, ON. Robinson@hip.on.ca
Source
Can J Public Health. 2003 Sep-Oct;94(5):391-6
Language
English
Publication Type
Article
Keywords
Benchmarking - methods - standards
Consensus
Decision Making
Health Care Surveys
Humans
Ontario
Organizational Objectives
Planning Techniques
Process Assessment (Health Care)
Public Health Administration - standards
Quality Indicators, Health Care
Social Responsibility
Abstract
Little attention has been paid to the need for accountability instruments applicable across all health units in the public health system. One tool, the balanced scorecard was created for industry and has been successfully adapted for use in Ontario hospitals. It consists of 4 quadrants: financial performance, outcomes, customer satisfaction and organizational development. The aim of the present study was to determine if a modified nominal group technique could be used to reach consensus among public health unit staff and public health specialists in Ontario about the components of a balanced scorecard for public health units.
A modified nominal group technique consensus method was used with the public health unit staff in 6 Eastern Ontario health units (n=65) and public health specialists (n=18).
73.8% of the public health unit personnel from all six health units in the eastern Ontario region participated in the survey of potential indicators. A total of 74 indicators were identified in each of the 4 quadrants: program performance (n=44); financial performance (n=11); public perceptions (n=11); and organizational performance (n=8).
The modified nominal group technique was a successful method of incorporating the views of public health personnel and specialists in the development of a balanced scorecard for public health.
PubMed ID
14577752 View in PubMed
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Achievement of healthy people 2010 objective for adult pneumococcal vaccination in an American Indian community.

https://arctichealth.org/en/permalink/ahliterature97145
Source
Public Health Rep. 2010 May-Jun;125(3):448-56
Publication Type
Article
Author
Marc S Traeger
Kenneth R Say
Verna Hastings
David A Yost
Author Affiliation
Whiteriver Service Unit, Indian Health Service, Whiteriver, AZ 85941, USA. marc.traeger@ihs.gov
Source
Public Health Rep. 2010 May-Jun;125(3):448-56
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Arizona
Benchmarking
Health Plan Implementation
Healthy People Programs - organization & administration
Humans
Immunization Programs - organization & administration
Indians, North American
Middle Aged
Outcome Assessment (Health Care)
Pneumococcal Infections - prevention & control
Vaccination - utilization
Abstract
OBJECTIVE: Streptococcus pneumoniae (S. pneumoniae) causes significant mortality throughout the United States and greater mortality among American Indian/Alaska Natives. Vaccination reduces S. pneumoniae illness. We describe the methods used to achieve the Healthy People 2010 coverage rate goals for adult pneumococcal vaccine among those at high risk for severe disease in this population. METHODS: We implemented a pneumococcal vaccination project to bolster coverage followed by an ongoing multidisciplinary program. We used community, home, inpatient, and outpatient vaccinations without financial barriers together with data improvement, staff and patient education, standing orders, and electronic and printed vaccination reminders. We reviewed local and national coverage rates and queried our electronic database to determine coverage rates. RESULTS: In 2007, pneumococcal vaccination coverage rates among people > or = 65 years of age and among high-risk people aged 18-64 years were 96.0% and 61.2%, respectively, exceeding Healthy People 2010 goals. Government Performance and Results Act analyses reports revealed a 2.7-fold increase (36.0% to 98.0%) of coverage from 2000 to 2007 among people > or = 65 years of age at Whiteriver Service Unit in Whiteriver, Arizona. CONCLUSIONS: We achieved pneumococcal vaccination rates in targeted groups of an American Indian population that reached Healthy People 2010 goals and were higher than rates in other U.S. populations. Our program may be a useful model for other communities attempting to meet Healthy People 2010 goals.
PubMed ID
20433040 View in PubMed
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Achieving quality indicator benchmarks and potential impact on coronary heart disease mortality.

https://arctichealth.org/en/permalink/ahliterature131252
Source
Can J Cardiol. 2011 Nov-Dec;27(6):756-62
Publication Type
Article
Author
Harindra C Wijeysundera
Nicholas Mitsakakis
William Witteman
Mike Paulden
Gabrielle van der Velde
Jack V Tu
Douglas S Lee
Shaun G Goodman
Robert Petrella
Martin O'Flaherty
Simon Capewell
Murray Krahn
Author Affiliation
Division of Cardiology, Schulich Heart Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada. wijeysundera@gmail.com
Source
Can J Cardiol. 2011 Nov-Dec;27(6):756-62
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Benchmarking - methods
Coronary Disease - mortality - therapy
Female
Follow-Up Studies
Humans
Male
Middle Aged
Myocardial Revascularization - methods - standards
Ontario - epidemiology
Prognosis
Quality Indicators, Health Care - utilization
Retrospective Studies
Risk Assessment - methods
Risk factors
Abstract
Quality indicators in coronary heart disease (CHD) measure the practice gap between optimal care and current clinical practice. However, the potential impact of achieving quality indicator benchmarks remains unknown.
Using a validated, epidemiologic model of CHD in Ontario, Canada, we estimated the potential impact on mortality of improved utilization on CHD quality indicators from 2005 levels to recommend benchmark utilization of 90%. Eight CHD disease subgroups were evaluated, including inpatients with acute myocardial infarction (AMI), acute coronary syndromes, and heart failure, in addition to ambulatory patients who were post-acute myocardial infarction survivors, or had heart failure, chronic stable angina, hypertension, or hyperlipidemia. The primary outcome was the predicted mortality reduction associated with meeting quality indicator targets for each CHD subgroup-treatment combination.
In 2005, there were 10,060 CHD deaths in Ontario, representing an age-adjusted CHD mortality of 191 per 100,000 people. By meeting quality indicator utilization benchmarks, mortality could be potentially reduced by approximately 20% (95% confidence interval 17.8-21.1), representing approximately 1960 avoidable deaths. The bulk of this potential benefit was in ambulatory patients with chronic stable angina (36% of reduction) and heart failure (31% of reduction). The biggest drivers were optimizing angiotensin-converting enzyme inhibitor use in chronic stable angina patients (approximately 440 avoidable deaths) and ß-blocker use in heart failure (approximately 400 avoidable deaths).
These findings reinforce the importance of quality indicators and could aid policy makers in prioritizing strategies to meet the goals outlined in the Canadian Heart Health Strategy and Action Plan for reducing cardiovascular mortality.
PubMed ID
21920697 View in PubMed
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Acting on audit & feedback: a qualitative instrumental case study in mental health services in Norway.

https://arctichealth.org/en/permalink/ahliterature295007
Source
BMC Health Serv Res. 2018 01 31; 18(1):71
Publication Type
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't
Date
01-31-2018
Author
Monica Stolt Pedersen
Anne Landheim
Merete Møller
Lars Lien
Author Affiliation
Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, P.B. 104, 2340, Brumunddal, Norway. monica.stolt.pedersen@sykehuset-innlandet.no.
Source
BMC Health Serv Res. 2018 01 31; 18(1):71
Date
01-31-2018
Language
English
Publication Type
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't
Keywords
Benchmarking
Evidence-Based Practice
Feedback
Health Personnel
Humans
Medical Audit
Mental Disorders - rehabilitation - therapy
Mental Health Services - organization & administration - standards
Norway
Organizational Case Studies
Qualitative Research
Quality Improvement
Abstract
The National Guideline for Assessment, Treatment and Social Rehabilitation of Persons with Concurrent Substance Use and Mental Health Disorders, launched in 2012, is to be implemented in mental health services in Norway. Audit and feedback (A&F) is commonly used as the starting point of an implementation process. It aims to measure the research-practice gap, but its effect varies greatly. Less is known of how audit and feedback is used in natural settings. The aim of this study was to describe and investigate what is discussed and thematised when Quality Improvement (QI) teams in a District Psychiatric Centre (DPC) work to complete an action form as part of an A&F cycle in 2014.
This was an instrumental multiple case study involving four units in a DPC in Norway. We used open non-participant observation of QI team meetings in their natural setting, a total of seven teams and eleven meetings.
The discussions provided health professionals with insight into their own and their colleagues' practices. They revealed insufficient knowledge of substance-related disorders and experienced unclear role expectations. We found differences in how professional groups sought answers to questions of clinical practice and that they were concerned about whether new tasks fitted in with their routine ways of working.
Acting on A&F provided an opportunity to discuss practice in general, enhancing awareness of good practice. There was a general need for arenas to relate to practice and QI team meetings after A&F may well be a suitable arena for this. Self-assessment audits seem valuable, particular in areas where no benchmarked data exists, and there is a demand for implementation of new guidelines that might change routines and develop new roles. QI teams could benefit from having a unit leader present at meetings. Nurses and social educators and others turn to psychiatrists or psychologists for answers to clinical and organisational questions beyond guidelines, and show less confidence or routine in seeking research-based information. There is a general need to emphasise training in evidence-based practice and information seeking behaviour for all professional groups.
Notes
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PubMed ID
29386020 View in PubMed
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Administrative Data Feedback for Effective Cardiac Treatment: AFFECT, a cluster randomized trial.

https://arctichealth.org/en/permalink/ahliterature173735
Source
JAMA. 2005 Jul 20;294(3):309-17
Publication Type
Article
Date
Jul-20-2005
Author
Christine A Beck
Hugues Richard
Jack V Tu
Louise Pilote
Author Affiliation
Division of Clinical Epidemiology, McGill University Health Centre, Montreal, Quebec, Canada.
Source
JAMA. 2005 Jul 20;294(3):309-17
Date
Jul-20-2005
Language
English
Publication Type
Article
Keywords
Adrenergic beta-Antagonists - therapeutic use
Benchmarking
Cluster analysis
Hospitals - standards
Humans
Medical Record Linkage
Myocardial Infarction - mortality - therapy
Outcome and Process Assessment (Health Care)
Quality Indicators, Health Care
Quebec
Abstract
Hospital report cards are increasingly being implemented for quality improvement despite lack of strong evidence to support their use.
To determine whether hospital report cards constructed using linked hospital and prescription administrative databases are effective for improving quality of care for acute myocardial infarction (AMI).
The Administrative Data Feedback for Effective Cardiac Treatment (AFFECT) study, a cluster randomized trial.
Patients with AMI who were admitted to 76 acute care hospitals in Quebec that treated at least 30 AMI patients per year between April 1, 1999, and March 31, 2003.
Hospitals were randomly assigned to receive rapid (immediate; n = 38 hospitals and 2533 patients) or delayed (14 months; n = 38 hospitals and 3142 patients) confidential feedback on quality indicators constructed using administrative data.
Quality indicators pertaining to processes of care and outcomes of patients admitted between 4 and 10 months after randomization. The primary indicator was the proportion of elderly survivors of AMI at each study hospital who filled a prescription for a beta-blocker within 30 days after discharge.
At follow-up, adjusted prescription rates within 30 days after discharge were similar in the early vs late groups (for beta-blockers, odds ratio [OR], 1.06; 95% confidence interval [CI], 0.82-1.37; for angiotensin-converting enzyme inhibitors, OR, 1.17; 95% CI, 0.90-1.52; for lipid-lowering drugs, OR, 1.14; 95% CI, 0.86-1.50; and for aspirin, OR, 1.05; 95% CI, 0.84-1.33). In addition, adjusted mortality was similar in both groups, as were length of in-hospital stay, physician visits after discharge, waiting times for invasive cardiac procedures, and readmissions for cardiac complications.
Feedback based on one-time, confidential report cards constructed using administrative data is not an effective strategy for quality improvement regarding care of patients with AMI. A need exists for further studies to rigorously evaluate the effectiveness of more intensive report card interventions.
Notes
Comment In: ACP J Club. 2005 Nov-Dec;143(3):7916262236
Comment In: JAMA. 2005 Jul 20;294(3):369-7116030283
PubMed ID
16030275 View in PubMed
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Adult attention-deficit/hyperactivity disorder: a survey of diagnosis and treatment practices.

https://arctichealth.org/en/permalink/ahliterature139518
Source
J Am Acad Nurse Pract. 2010 Nov;22(11):593-601
Publication Type
Article
Date
Nov-2010
Author
Kathleen C Knutson
Maureen O'Malley
Author Affiliation
Anchorage Medical and Surgical Clinic, Anchorage, Alaska. k2c2knutson@ak.net
Source
J Am Acad Nurse Pract. 2010 Nov;22(11):593-601
Date
Nov-2010
Language
English
Publication Type
Article
Keywords
Adult
Alaska - epidemiology
Attention Deficit Disorder with Hyperactivity - complications - diagnosis - epidemiology - therapy
Attitude of Health Personnel
Benchmarking
Comorbidity
Diagnostic Errors - statistics & numerical data
Female
Health Care Surveys
Health Knowledge, Attitudes, Practice
Humans
Male
Middle Aged
Nurse Practitioners - education - organization & administration - psychology
Nurse's Practice Patterns - organization & administration
Nurse's Role
Nursing Evaluation Research
Questionnaires
Referral and Consultation
Abstract
To review the literature to ascertain best practices in the diagnosis and treatment of adult attention-deficit/hyperactivity disorder (ADHD) and to determine the current beliefs and practices of nurse practitioners (NPs) regarding adult ADHD.
Licensed NPs (n= 260) responded to a questionnaire that inquired about numbers of patients seen with ADHD and about current diagnostic and treatment methods. Diagnostic confidence and referral patterns were also surveyed. Best practices were identified through a review of current and classic nursing, medical, and psychological literature on ADHD.
The results of the survey showed that most NPs believe that adult ADHD exists, although the majority diagnose and treat this condition infrequently. Psychiatric NPs were an exception.
NPs are diagnosing and treating adult ADHD at levels far below expected based on population prevalence data. While those NPs who suspected ADHD were using appropriate diagnostic and treatment methods, more education is warranted to increase confidence for a greater number of nonpsychiatric NPs to improve targeted diagnosis and treatment for this condition.
PubMed ID
21054633 View in PubMed
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Aggregate Health Status: a benchmark index for community health.

https://arctichealth.org/en/permalink/ahliterature186408
Source
J Med Syst. 2003 Apr;27(2):177-89
Publication Type
Article
Date
Apr-2003
Author
James F Reed
James N Burdine
Michael Felix
Author Affiliation
St. Luke's Hospital & Health Network Research Institute, 801 Ostrum Street, Bethlehem, Pennsylvania 18015, USA. reedj@slhn.org
Source
J Med Syst. 2003 Apr;27(2):177-89
Date
Apr-2003
Language
English
Publication Type
Article
Keywords
Benchmarking
Canada - epidemiology
Health Behavior
Health status
Health Status Indicators
Humans
Models, Statistical
Population Surveillance
Public Health Informatics
Residence Characteristics
United States - epidemiology
Abstract
A qualitative review of population health assessment models used throughout the United States and Canada indicate both individual and community-level domains of health. Individual-level domains of health include health habits, education, public safety, environment, social, government, culture, and mobility. Community-level domains include the same general health domains but aggregated to the community level Aggregate Health Status (AHS). In the development of the AHS portion of our model, the dependent variable was the general health question from the Medical Outcomes Study. The remainder of the survey was partitioned into mutually exclusive individual measure subsets. A linear combination of these global variables then produces a single estimate relating the multiple domains of the broader determinants of health to health status. This global variable uniquely discriminates between the five categories of general health. This model serves as a framework and benchmark indicator that (1) provides a summary indicator of the overall health status of the population, (2) is broadly representative of populations rather than individuals, (3) is a population perspective rather than a provider perspective, and (4) emphasizes outcomes versus inputs and processes.
PubMed ID
12617359 View in PubMed
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366 records – page 1 of 37.