Risk Adjustment: A Tool for Leveling the Playing Field

1997 ◽  
2011 ◽  
Vol 32 (10) ◽  
pp. 987-989 ◽  
Author(s):  
Rebekah W. Moehring ◽  
Deverick J. Anderson

Feedback of surgical site infection (SSI) rates to surgeons improves patient outcomes and should be considered a cornerstone of any infection control program. For as long as feedback of SSI data has occurred, those in infection control have often heard a searing retort from indignant surgeons: “But my patients are different!”Fortunately, epidemiologists have several tools to use in response. One of the most commonly used approaches involves risk adjustment for differences in case mix between the group of interest (eg, a surgeon's patients) and a comparator. In other words, risk adjustment levels the playing field.Formal risk adjustment for rates of SSI has existed for almost 50 years but is still an imperfect science. In fact, risk adjustment for different variables can lead to different conclusions. Over the past 2 decades, the National Healthcare Safety Network (NHSN) risk index has been used by many hospitals to perform risk adjustment for rates of SSI. The NHSN risk index is simple and effective but has undergone considerable scrutiny. Numerous investigators have described scenarios and/or procedures for which the risk index performed poorly and have offered suggestions for improvement. Indeed, Robert Gaynes summarized some of the shortcomings of the NHSN risk index in 2 editorials 10 years ago, stating, “A composite risk index that captures the joint influence of [intrinsic patient risk] and other risk factors is required before meaningful comparisons of SSI rates can be made by surgeons, among institutions, or across time.”


2011 ◽  
Vol 2 (1) ◽  
pp. 29-54
Author(s):  
Clyde Forsberg Jr.

In the history of American popular religion, the Latter-day Saints, or Mormons, have undergone a series of paradigmatic shifts in order to join the Christian mainstream, abandoning such controversial core doctrines and institutions as polygamy and the political kingdom of God. Mormon historians have played an important role in this metamorphosis, employing a version (if not perversion) of the Church-Sect Dichotomy to change the past in order to control the future, arguing, in effect, that founder Joseph Smith Jr’s erstwhile magical beliefs and practices gave way to a more “mature” and bible-based self-understanding which is then said to best describe the religion that he founded in 1830. However, an “esoteric approach” as Faivre and Hanegraaff understand the term has much to offer the study of Mormonism as an old, new religion and the basis for a more even methodological playing field and new interpretation of Mormonism as equally magical (Masonic) and biblical (Evangelical) despite appearances. This article will focus on early Mormonism’s fascination with and employment of ciphers, or “the coded word,” essential to such foundation texts as the Book of Mormon and “Book of Abraham,” as well as the somewhat contradictory, albeit colonial understanding of African character and destiny in these two hermetic works of divine inspiration and social commentary in the Latter-day Saint canonical tradition.


2019 ◽  
Vol 5 (2) ◽  
pp. 32
Author(s):  
Gabriela E. Gui

In today’s America, not every child starts on a level playing field, and very few children move ahead based solely on hard work or talent. Generational poverty and a lack of cultural capital hold many students back, robbing them of the opportunity to move up professionally and socially. Children of immigrants are especially at-risk because, in addition to facing poverty, race, geographical location or economic disadvantages, they are also confronted with failure due to their limited or non-existent English proficiency. This study focuses on the degree to which teachers in a mid-sized urban school district take into consideration the individual needs of immigrant children in the process of their education. The study also examines the preparation teachers have had to equip them with knowledge of best practices in teaching immigrant children, and the relationship between teachers’ practices, beliefs, and their demographic and personal characteristics (age, gender, years of experience, level of education, etc.). Quantitative data was collected via a survey. Interviews with teachers and one central office administrator provided data for the qualitative section of the study. The findings revealed that teachers, in general, appeared to lack knowledge of specific policies for mainstreaming immigrant students into general education classrooms; their use of effective teaching practices for working with immigrant children were limited; and most of the teachers had not participated actively in professional development that focused on teaching immigrant children.


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