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.     

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.     

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.     

Combining information about process and outcomes to improve clinical care

For some managers, clinical quality improvement begins and ends with measuring the clinical outcomes of care. For others, analyzing and altering processes of care are the central focus. To remove quality improvement from the realm of guesswork, these approaches must be intertwined. In health care, this linkage has appeared elusive. Now, using decision theory, there is a way.     

Social cognitions about adult male victims of female sexual assault

Although men are far less likely than women to be victims of heterosexual assault, such cases have been reported with increasing frequency in recent years. We compared social judgments about male and female victims of heterosexual and homosexual rape and tested hypotheses concerning social cognitions that are assumed to underlie a male rape mythology. In a 2 × 2 × 2 design, 77 male and 89 female subjects made a series of judgments about a sexual assault case in which sex of victim and sex of assailants were manipulated. Consistent with the hypotheses, the male victim of sexual assault by females was judged more likely to have initiated or encouraged the sex acts, and more enjoyment and less stress were attributed to him. This pattern of results was more pronounced among male subjects. The results are discussed in relation to stereotypic beliefs concerning male sex roles, sexual motivation, and sexual functioning that are likely to affect the social cognitions of both observers and male victims of heterosexual assault.     

Sharing the Baton,Not Passing It: Collaboration between Public and Private Child Welfare Agencies to Reunify Families

ABSTRACT

Increasingly, public sector child welfare agencies are contracting with private agencies for the provision of specialized services to clients while maintaining oversight and case management responsibilities. At the same time, funders, both private and public, are demanding that service providers partner and collaborate with one another. In this article, we present results from a study of a unique partnership between two state child welfare agencies and a private child welfare agency aimed at reunifying families whose children have been removed and placed in foster care. Data was obtained from 41 key informants using a questionnaire and a structured interview. Findings support earlier studies of collaboration, and indicate the strengths of this partnership and factors that facilitated and hindered it. The results have implications for agencies that both contract for and provide a range of child welfare services as well as other interagency relationships.