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.     

Where does informatics fit in health care organizations?

Why is medical informatics important to health care leaders? As an emerging science, informatics focuses on applying computing and communication technology to decision making for clinicians and managers. It enhances the understanding of how information and communication systems can impact the work health care managers must accomplish. As the cost of technology for digital information management continues to decline, organizations and individuals will look for ways to offset the human costs of managing and conveying information. The way of the paper medical record is being replaced by the less expensive and more efficient digital information systems. Leaders of health care organizations need to look for every opportunity to deploy networks and computers to reduce the labor costs of data collection, storage, retrieval, and analysis.     

Haunts on the Web for physician executives

Listed here are some medical management and health care related Web sites on the Internet worth visiting, as well as favorite search engines and how to use them. From health care systems and hospitals, to health plans and insurers, the industry is using Web technology to promote programs and outcomes, and to provide information on health and wellness.     

Implementation and process evaluation of a student "school-as-community" group. A component of a school-based drug abuse prevention program

Little documentation exists regarding the functioning of formalized adolescent groups as drug abuse prevention agents. Two studies are described that were conducted at high schools whose students are at high risk for drug abuse. Twenty-one schools were randomly assigned to one of three conditions: (a) standard care, (b) classroom drug abuse education only, or (c) classroom plus school-as-community. Results of the first study indicated that the school-as-community component--which involved weekly meetings and periodic events at seven schools--was implemented as planned, drug abused focused, and perceived as productive in discouraging drug abuse. In the second study, staff in the classroom plus school-as-community condition self-reported involvement in the greatest number of community activities across the school year, compared with staff from the other two conditions. These two studies support the feasibility of formalized groups of high-risk youth to promote drug-free events.     

Nevada gaming: revenues and taxes (1945-95)

In 1931, Nevada legalized casino gambling, an act which allowed its gaming industry to develop. Because many jurisdictions outside Nevada are now embracing legalized gambling as a path to a brighter economic future and because this proliferation presents Nevada with new challenges and opportunities, it is a good time to review the Nevada experience. Here, the focus is on gaming revenues and gaming tax collections during the 1945–95 period. We find that the growth rate of Nevada's gaming industry has slowed over time, with the relative importance of gaming in the Nevada economy peaking in the late 1970's. The Nevada economy has since been gradually diversifying, something which will increasingly pressure Nevadans to look for government revenue sources other than gaming if current levels of government services are to be maintained.     

"How much do you spend gambling?" ambiguities in survey questionnaire items

The validity of a survey's findings is dependent upon the clarity and lack of ambiguity contained in each individual item yet minimal attention has been directed to this issue in most prevalence studies. Researchers have shown a tendency to accept the uncritical assumption that respondents interpret seemingly simple and straightforward items such as 'how much do you spend gambling?' in a consistent manner. No attempt is made to confirm the uniformity of responses by clarifying the mathematical formulae used by respondents to derive their answers. The purpose of this paper was to examine the consistency shown by a sample of 181 medical undergraduate subjects in estimating the level of gambling expenditure in a series of five case vignettes describing various scenarios of wins and losses during a session of gambling. Results revealed a wide variation in calculated figures depending upon whether or not subjects interpreted the item to mean net expenditure or turnover. Only two thirds or less of subjects calculated the figure to be the difference between the initial amount risked and the residual at the conclusion of the session. It is suggested that more attention be paid in prevalence and clinical studies to providing subjects with clear instructions on how to calculate expenditure estimates.     

Chinese Communist Party Central Committee calls on Party and Youth League members to take the lead in having only one child (per couple), [open letter,September 25, 1980

This open letter from the Central Committee of the Chinese Communist Party concerns the question of controlling China's population growth. To limit the total population of China to 1.2 billion by the end of this century, the State Council has advocated 1 couple giving birth to only 1 child. China's total population will reach 1.3 billion after 20 years and will exceed 1.5 billion after 40 years. Besides the family needing to increase the cost of upbringing, increasing population also requires the state, in order to solve their education, employment, and otheer problem, to raise education expenditures, investments of equipment, and outlays for social and public utilities. The phenomenon of population "aging" will not occur within this century because at present 1/2 of the total national population is below the age of 21, while elderly people above age 65 consist of less than 5%. After 40 years of the practice of 1 child per couple, some families may experience the problem where the elderly lack people to care for them. In the future when production is developed and the people's lives are improved, social welfare and social security will certainly increase and improve continuously. To control population growth, the Party and government have already adopted a series of concrete policies; considerations and allowances are to be given to single children and their families with respect to admission to childcare centers and primar schools. Young comrades must begin with themselves, while old comrades must educate and supervise their own sons and daughters.     

Child and spouse replacement mechanisms: a life cycle perspective on family composition in Peru

The author assesses the patterns of family extension in Peru by examining variations in family composition over the family life cycle. The amount and type of extension among Peruvian families at successive stages of family development are examined. The relative importance of general overlap and of child and spouse replacement mechanisms as processes that help to ensure the viability of residential family units is studied. The empirical analysis is based on a 1970-1971 survey of a national sample of Peruvian households