Twelve questions to ask about your outcomes monitoring system--Part I

Outcomes monitoring is an integral part of any decision maker's information resources--the cornerstone of a provider's commitment to quality improvement or of a purchaser's strategy for seeking value. In their eagerness to obtain useful information about provider performance, purchasers and consumers naively may accept flawed evaluations and thereby create perverse incentives for providers that undermine the very qualities they wish to foster. Inaccurate or misleading information about provider performance will lead managers to reward the wrong behavior and so induce more of it. Inaccurate information also can discourage better providers whose performances are not recognized and can lead all providers to distrust and denounce clinical monitoring in general. When these things happen, the great value of outcomes monitoring systems as a tool for quality improvement is lost.     

Meet the mandate to measure clinical quality

The mandate for health care organizations to be accountable for quality, as well as price, is now unavoidable. The Joint Commission's ORYX project is requiring every hospital to measure clinical outcomes of a majority of its patients within the next three years. This mandate can be met best with systems of clinical outcomes measurement that provide valid, reliable risk adjustment; yield meaningful information about many different diseases and procedures; and measure more than mortality or cost--all using primarily billing data. New outcomes measurement tools with all of these capabilities are available and have already enabled quality improvement in dozens of hospitals across the U.S.     

Large scale communication networks—Design and analysis

The paper discusses the problem of design and analysis of large scale communication systems. An iterative process, composed of a minimum cost network design algorithm and a network performance algorithm, is presented for the solution of these problems. Computational considerations, using these algorithms, are discussed.     

Effective child welfare practice with immigrant and refugee children and their families

This article presents a multistage migration framework to broaden the lens through which child welfare personnel can view immigrant and refugee families and their children. By better understanding the family's experiences in both emigration and immigration, including reasons for leaving their home country, experiences in transit, and reception and resettlement experiences in the United States, child welfare personnel are better equipped to assess their needs and provide effective prevention, protection, permanency, and family preservation services. Case examples illustrating the application of the framework and guidelines for program and practice are included.     

Important considerations in using indicators to profile providers

The demand is accelerating for information about the clinical performance of providers. In the more competitive and value-sensitive marketplace that is already developing, purchasers (consumers, employers, and insurers) of health care services will require more information to better assess the relative value of providers' (professional and hospital) services. The cornerstone of a wise, value-based strategy in selecting health care services is careful assessment of each provider's performance based on detailed, quantitative data in the form of clinical indicators. The use of indicators to profile the comparative performances of providers allows purchasers to compare as well as to influence provider performance.     

Rolling with the shakes: an insight into teenagers’ perceptions of recovery after the Canterbury earthquakes

Natural disasters are harmful worldwide events that inflict multiple psychosocial impacts on disaster-exposed individuals. A significant proportion of affected individuals are teenagers (13–18 years old) who, compared with adults, have been historically overlooked in disaster research. The literature is particularly sparse concerning teenagers’ recovery from natural disasters, specifically what recovery means to them and the contributing factors towards their positive recovery. Therefore, the aim of the current study was to gain deeper insight into this largely unexplored area by conducting five focus groups with teenagers (16–18 years) who experienced at least one of the Canterbury, New Zealand, earthquakes since and including the initial September 2010 earthquake. This study directly asked teenagers about their recovery over the three years after the initial earthquakes, with data being analysed using thematic analysis. Two main themes were identified: (1) perceptions of recovery, with three sub-themes (i) knowledge and being less frightened, (ii) talking about the earthquakes and (iii) shift in perspectives; and (2) contributing factors to recovery, with three sub-themes (i) participation in the community response, (ii) returning to school and (iii) the rebuild of Christchurch. These factors provide insight into how we can better support the recovery process for disaster-exposed teenagers to reduce long-term distress.     

Assessing the effectiveness of strategic planning

This paper describes a method for assessing the effectiveness of strategic planning systems in terms of the results actually observed subsequent to planning activity. The paper explains in particular how, in making the assessment, one might cope with the fact of environmental change subsequent to the setting of planned goals. This ends oriented approach to measuring effectiveness is shown to be complementary to process oriented approaches and is illustrated by an example from the coal industry.     

Improving homeless persons' utilisation of primary care: lessons to be learned from an outreach programme in The Netherlands

Elissen AMJ, Van Raak AJA, Derckx EWCC, Vrijhoef HJM. Improving homeless persons' utilisation of primary care: lessons to be learned from an outreach programme in The Netherlands Faced with rising homelessness, countries around the world are in need of innovative approaches to caring for those without shelter, who, more often than not, suffer from severe health problems. We conducted a case study of an innovative Dutch Primary Care for the Homeless (PCH) programme to gain insight into clients' demographic characteristics, health problems and service use, and to develop an explanation for its success in increasing the latter. Our analyses are based on a combination of quantitative and qualitative data. The results of the study suggest that the success of the PCH programme can be explained by the providers' pragmatism and will to adapt their mode of care provision to the behavioural patterns and needs of their homeless clients.     

Severity-of-illness systems. An overview for medical directors--Part two

In Part One of this article in the March-April 1990 issue of Physician Executive, the authors explored severity-of-illness systems that relied on administrative data for their formulation. In the second part of the article, the authors deal with systems that use clinical and/or physiologic data as their basis.