The clinical representativeness of outcome studies is defined as the generalizability of recruitment processes, assessment/diagnostic procedures, treatment protocols, and therapeutic results from research settings to naturalistic treatment settings. The main goal of the present study was to examine the clinical representativeness of couple therapy in outcome studies. The data set was formed by 50 published clinical trials, including 34 couple therapy outcome studies for marital distress (CTMD) and 16 couple therapy outcome studies for comorbid relational and mental disorders (CTMD + C). The present findings showed that, overall, the clinical representativeness of couple therapy outcome studies is only fair (i.e., the mean global score is slightly lower than the midpoint of the rating scale used to assess representativeness). CTMD + C studies fared better than CTMD studies on many dimensions of clinical relevance. Studies in which pretherapy training was less intensive (for CTMD studies only), treatment was less structured, and therapists were more experienced showed larger effect sizes than those in which such was not the case.
The premise of the presentation is a challenge to health care providers to examine the quality of services currently provided in health care facilities across the country. While the Canadian health care system is under scrutiny with numerous reviews and commissions, the underlying question is: are the structural changes making a difference? We need to consider the recommendations in the latest report from the Institute of Medicine, Crossing the Quality Chasm. The report calls for a sweeping redesign and suggests a set often new rules to guide patient/clinician relationships. Dietitians must take the lead on implementation of systematic changes, model the way and get involved in the necessary changes. As the report suggests, the gap between where we are and where we need to go in providing quality health care services is not just a crack, it is in fact a chasm.
Primary care in the United States has been in the midst of a transformation from a system based solely on individual office interactions to one that includes managing health at a population level. The chronic care model provides a robust framework for health systems to transform and restructure their delivery of care to one that is committed to delivering multidisciplinary quality care with a proactive approach. Patient and disease registries are the essential tools necessary to inform all elements of the chronic care model and guide practices though this transformation. Nationally as well as internationally, when used as part of a robust continuous quality-improvement program, registries have demonstrated to improve patient outcomes and reduce healthcare costs. Despite challenges practices may confront when initially developing a patient registry, it is evident that population management is now an important and integral component of a successful primary-care practice whose aim is to improve quality of patient care.
Administrative data are becoming increasingly available to health care researchers across North America and Europe. Such data sources are generally thought to be useful for documenting health care utilization. In this report, data from the provincial health insurance system in Manitoba, Canada are used to develop control groups and adjust for case severity. These are necessary prerequisites for using administrative data to study health care outcomes.