Efficacy of Statistical Outlier Analysis for Monitoring Quality of Care

Researchers have proposed that hospitals with excessive statistically unexplained mortality rates are more likely to have quality-of-care problems. The U.S. Health Care Financing Administration currently uses this statistical “outlier” approach to screen for poor quality in hospitals. Little is known, however, about the validity of this technique, since direct measures of quality are difficult to obtain. We use Monte Carlo methods to evaluate the performance of the outlier technique as parameters of the true mortality process are varied. Results indicate that the screening ability of the technique may be very sensitive to how widespread quality-related mortality is among hospitals but insensitive to other factors generally thought to be important.     

The recruitment and selection of hospital medical consultants

Abstract

The literature on selection has been dominated in recent decades by the ‘prediction’ paradigm. Such an approach requires a substantial number of positions to be filled in order to compute validity coefficients. There are other approaches, using a different paradigm, when concentrated on adjusting the organization and the employee. Here careful analysis of job demands is essential. This article describes such an analysis, taking the medical consultant as an example. The method can be used in an iterative way. It is useful when one has to work with small numbers of positions.     

A Test for Instrument Validity

This paper develops a specification test for instrument validity in the heterogeneous treatment effect model with a binary treatment and a discrete instrument. The strongest testable implication for instrument validity is given by the condition for nonnegativity of point‐identifiable compliers' outcome densities. Our specification test infers this testable implication using a variance‐weighted Kolmogorov–Smirnov test statistic. The test can be applied to both discrete and continuous outcome cases, and an extension of the test to settings with conditioning covariates is provided.     

积极心理学视角下大学生心理健康教育实效性研究

积极心理学是当今时代下心理学界所兴起的一种全新的研究领域,并在一定程度上应用到了大学的心理健康教育当中,从而能够在一定程度上,增加教育的时效性。通过积极心理学的教学观念,将心理学视角下的健康教育深入大学生的日常教学当中,进而能够深入挖掘以及培养大学生的积极心理品质,全面优化大学生的心理教育的环境,进而用更加先进的积极心理学理念,指导并帮助大学生构建更加完善的心理观念。     

户籍类型与城乡居民医疗服务利用 ——基于Andersen模型的经验分析

本文利用中国社会科学院经济研究所2018年城乡居民入户调查数据,从户籍改革角度分析户口类型改变对城乡居民医疗服务利用的影响。研究发现:与户口类型未发生改变的城乡居民相比,户口类型发生过改变(农转非)的城乡居民门急诊服务利用的可能性更高,住院医疗服务支出水平更低。从户籍改革与参保类型交互效应看,相对于户口类型未发生过改变的居民医保参保人群,户口类型发生改变(农转非)会显著提高居民医保参保人群门急诊服务利用,同时降低其住院服务利用。进一步采用PSM方法进行稳健性检验,户籍改革对提高城乡居民门急诊服务利用,降低住院医疗服务利用的结论依然成立。此外,本文还发现,直接结算提高了城乡居民门急诊和住院的就诊概率;健康自评状况越差,门急诊和住院医疗服务利用可能性越高,门急诊医疗支出、住院医疗支出和跨省异地就医支出也越高。本文认为,相对于推行基层分级诊疗制度,以户籍改革推动农村居民自由流入医疗资源更丰富的城镇地区,改革基层卫生院制度,以及改变基层医疗服务提供激励机制,可能更有助于改善农村居民健康状况。     

Breaking through the silence in antenatal care: Fetal movement and stillbirth education

BackgroundFetal movements are a key indicator of fetal health. Research has established significant correlations between altered fetal activity and stillbirth. However, women are generally unaware of this relationship. Providing pregnant women with information about the importance of fetal movements could improve stillbirth rates. However, there are no consistent fetal movements awareness messages globally for pregnant women.AimsThis study aimed to explore the antenatal care experiences of Australian mothers who had recently had a live birth to determine their knowledge of fetal movements, the nature and source of that information.MethodsAn online survey method was used for 428 women who had a live birth and received antenatal care in Australia. Women’s knowledge of fetal movements, stillbirth risk, and the sources of this knowledge was explored.FindingsA large proportion of participants (84.6%; n = 362) stated they had been informed by health care professionals of the importance of fetal movements during pregnancy. Open-ended responses indicate that fetal movements messages are often myth based. Awareness that stillbirth occurs was high (95.2%; n = 398), although, 65% (n = 272) were unable to identify the current incidence of stillbirth in Australia.ConclusionWomen who received antenatal care have high-awareness of fetal movements, but the information they received was inconsistent. Participants knew stillbirth occurred but did not generally indicate they had obtained that knowledge from health care professionals. We recommend a consistent approach to fetal movements messaging throughout pregnancy which focuses on stillbirth prevention.     

The nutrition-related information seeking behaviours and attitudes of pregnant women with a high BMI: A qualitative study

BackgroundThe prevalence of high body mass index is increasing amongst women of child bearing age. High maternal body mass index has ramifications for both mother and baby including increased health risks from gestational diabetes mellitus, caesarean section and stillbirth. Despite the increasing prevalence of high maternal body mass index little is known of the experiences of these women regarding nutrition information access and use during the antenatal period.MethodsA qualitative study using individual interviews was undertaken at a tertiary hospital in south-eastern Australia. Twenty-Eight women with a body mass index ≥30 kg/m² participated. Interviews were audio recorded, transcribed, cross-checked for consistency and entered into a word processing document for further scrutiny. Data was analysed using interpretative phenomenological analysis (IPA). In any phenomenological study the researcher’s objective is to elicit the participant’s views on their lived experiences.FindingsThree major themes emerged: (1) Nutrition-related information attainment; (2) Nutrition-related information management; (3) Nutrition-related information needs and wants.ConclusionThe findings from this study may assist the future development and dissemination of nutrition-related information for pregnant women with a high body mass index. Women want more individualised support regarding nutritional requirements during pregnancy.     

Analyzing free-text survey responses: An accessible strategy for developing patient-centered programs and program evaluation

Despite widespread availability of yoga in the Veterans Health Administration (VA), it remains unclear how to best evaluate yoga programs. This is particularly problematic for programs aimed at veterans with mental health concerns, as evaluation typically focuses narrowly upon mental health symptom severity, even though program participants may have other health-related priorities. We analyzed responses to free-text questions on 237 surveys completed by veterans with mental health concerns enrolled in a yoga program at six VA clinics in Louisiana to characterize veteran participants’ experiences with yoga. Qualitative analysis resulted in 15 domains reflecting veterans’ individual health-related values and priorities. We use results to illustrate the potential for analysis of free-text responses to reveal valuable insights into patient experiences, demonstrating how these data can inform patient-centered program evaluation. The approach we present is more accessible to those responsible for decision-making about local programs than conventional methods of analyzing qualitive evaluation data.     

Contribution analysis to analyze the effects of the health impact assessment at the local level: A case of urban revitalization

The health impact assessment (HIA) is a tool used to estimate the potential impact on health of non-health-related proposals prior to implementation. While it is increasingly used in Quebec, Canada, studies have not analyzed its medium-term impacts and potential long-term impacts. We conducted a contribution analysis using in-depth interviews with key stakeholders, as well as documents, observation and images related to HIA in order to analyze its impacts on the revitalization of road infrastructure, parks and green spaces, and residential housing. Our analysis not only reflects on the decision-making process through the adoption and implementation of HIA recommendations, but also on the link between actions implemented in the field and health outcomes.     

Effective elements of care-physical activity initiatives for adults with a low socioeconomic status: A concept mapping study with health promotion experts

In care-physical activity (care-PA) initiatives, primary care and sports are combined to stimulate PA among adults at risk of lifestyle related diseases. Preliminary results from Dutch care-PA initiatives for adults with a low socioeconomic status (SES) indicate a decrease in participants’ body weight and an improved quality of life, however, the elements that make these initiatives successful are yet to be identified. In total, 19 Dutch health promotion experts participated in our concept mapping (CM) of the effective elements of care-PA initiatives for adults with a low SES. The experts identified 111 effective elements of these initiatives, which were grouped into 11 clusters, focusing on: 1) approaching participants within the care-PA initiative, 2) barriers experienced throughout the initiative, 3) long-term implementation, 4) customizing the care-PA initiative to the target population, 5) social support, 6) structure and guidance, 7) the professionals within the care-PA initiative, 8) the accessibility of the care-PA initiative, 9) targeted behaviour and progression, 10) recruitment and administration, and 11) intersectoral collaboration. CM was useful for creating a valuable overview of these effective elements. Our results could be used to improve the development and implementation of future care-PA initiatives for adults with a low SES.