scholarly journals Markers of assimilation of problematic experiences in dementia within the LivDem project

Dementia ◽  
2015 ◽  
Vol 16 (4) ◽  
pp. 443-460 ◽  
Author(s):  
Richard Cheston ◽  
Lauren Gatting ◽  
Ann Marshall ◽  
John H Spreadbury ◽  
Peter Coleman
Keyword(s):  
Outcome Measures ◽  
Clinical Implications ◽  
Problem Solution ◽  
Rater Reliability ◽  
Process Measures ◽  
Initial Analysis ◽  
Marker Code ◽  
Problematic Experiences ◽  
The Way

This study aimed to determine whether the Markers of Assimilation of Problematic Experiences in Dementia scale (MAPED) can be used to identify whether the way in which participants talk about dementia changed during the group. All eight sessions of a LivDem group, which were attended by participants were recorded and transcribed. An initial analysis identified 160 extracts, which were then rated using the MAPED system. Inter-rater reliability was 61% and following a resolution meeting, 35 extracts were discarded, leaving 125 extracts with an agreed marker code. All of the participants were identified as producing a speech marker relating to dementia, and these varied between 0 (warding off) to 6 (problem solution). Examples of these markers are provided. The proportion of emergence markers (indicating the initial stages of assimilation) compared to later markers changed significantly between the first four sessions and the final sessions. This difference was still significant even when the markers produced by the most verbal participant, Graham, were excluded. The use of process measures within psychotherapy complements more conventional outcome measures and has both theoretical and clinical implications.

scholarly journals Electronic health records systems and hospital clinical performance: a study of nationwide hospital data

2019 ◽  
Vol 26 (10) ◽  
pp. 999-1009 ◽  
Author(s):  
Neal Yuan ◽  
R Adams Dudley ◽  
W John Boscardin ◽  
Grace A Lin
Keyword(s):  
Electronic Health Records ◽  
Outcome Measures ◽  
Meaningful Use ◽  
Mortality Rates ◽  
National Study ◽  
Health Records ◽  
Process Measures ◽  
American Hospital ◽  
American Hospital Association ◽  
Electronic Health

Abstract Objective Electronic health records (EHRs) were expected to yield numerous benefits. However, early studies found mixed evidence of this. We sought to determine whether widespread adoption of modern EHRs in the US has improved clinical care. Methods We studied hospitals reporting performance measures from 2008–2015 in the Centers for Medicare and Medicaid Services Hospital Compare database that also reported having an EHR in the American Hospital Association 2015 IT supplement. Using interrupted time-series analysis, we examined the association of EHR implementation, EHR vendor, and Meaningful Use status with 11 process measures and 30-day hospital readmission and mortality rates for heart failure, pneumonia, and acute myocardial infarction. Results A total of 1246 hospitals contributed 8222 hospital-years. Compared to hospitals without EHRs, hospitals with EHRs had significant improvements over time on 5 of 11 process measures. There were no substantial differences in readmission or mortality rates. Hospitals with CPSI EHR systems performed worse on several process and outcome measures. Otherwise, we found no substantial improvements in process measures or condition-specific outcomes by duration of EHR use, EHR vendor, or a hospital’s Meaningful Use Stage 1 or Stage 2 status. Conclusion In this national study of hospitals with modern EHRs, EHR use was associated with better process of care measure performance but did not improve condition-specific readmission or mortality rates regardless of duration of EHR use, vendor choice, or Meaningful Use status. Further research is required to understand why EHRs have yet to improve standard outcome measures and how to better realize the potential benefits of EHR systems.

scholarly journals Evaluating the credibility of anchor based estimates of minimal important differences for patient reported outcomes: instrument development and reliability study

BMJ ◽  
2020 ◽  
pp. m1714 ◽  
Author(s):  
Tahira Devji ◽  
Alonso Carrasco-Labra ◽  
Anila Qasim ◽  
Mark Phillips ◽  
Bradley C Johnston ◽  
...  
Keyword(s):  
Instrument Development ◽  
Outcome Measures ◽  
Policy Decision ◽  
Reliability Study ◽  
Rater Reliability ◽  
Patient Reported ◽  
Minimal Important Differences ◽  
Transition Rating ◽  
Reliability Coefficients

Abstract Objective To develop an instrument to evaluate the credibility of anchor based minimal important differences (MIDs) for outcome measures reported by patients, and to assess the reliability of the instrument. Design Instrument development and reliability study. Data sources Initial criteria were developed for evaluating the credibility of anchor based MIDs based on a literature review (Medline, Embase, CINAHL, and PsycInfo databases) and the experience of the authors in the methodology for estimation of MIDs. Iterative discussions by the team and pilot testing with experts and potential users facilitated the development of the final instrument. Participants With the newly developed instrument, pairs of masters, doctoral, or postdoctoral students with a background in health research methodology independently evaluated the credibility of a sample of MID estimates. Main outcome measures Core credibility criteria applicable to all anchor types, additional criteria for transition rating anchors, and inter-rater reliability coefficients were determined. Results The credibility instrument has five core criteria: the anchor is rated by the patient; the anchor is interpretable and relevant to the patient; the MID estimate is precise; the correlation between the anchor and the outcome measure reported by the patient is satisfactory; and the authors select a threshold on the anchor that reflects a small but important difference. The additional criteria for transition rating anchors are: the time elapsed between baseline and follow-up measurement for estimation of the MID is optimal; and the correlations of the transition rating with the baseline, follow-up, and change score in the patient reported outcome measures are satisfactory. Inter-rater reliability coefficients (ĸ) for the core criteria and for one item from the additional criteria ranged from 0.70 to 0.94. Reporting issues prevented the evaluation of the reliability of the three other additional criteria for the transition rating anchors. Conclusions Researchers, clinicians, and healthcare policy decision makers can consider using this instrument to evaluate the design, conduct, and analysis of studies estimating anchor based minimal important differences.

scholarly journals An audit of risk assessment in an emergency setting

2002 ◽  
Vol 26 (3) ◽  
pp. 88-90 ◽  
Author(s):  
James Stone ◽  
George Szmukler
Keyword(s):  
Risk Factors ◽  
Risk Assessment ◽  
Clinical Implications ◽  
Junior Doctors ◽  
Emergency Setting ◽  
Patient Records ◽  
Changing Practice ◽  
Self Harm ◽  
Harm To Others ◽  
The Way

Aims and MethodPatient records from the emergency clinic at the Maudsley Hospital were analysed from July 1999 to assess the standard of risk assessment for self-harm and for harm to others routinely recorded by junior doctors. The recorded risk factors for the consultation and the evidence that risk had been considered were noted. An intervention that comprised two seminars and two written reminders about the importance of risk assessment was made and the analysis of records in the emergency clinic repeated for July 2000.ResultsRisk factors were recorded more frequently for harm to self than for harm to others. There was little recorded evidence that consideration had been given to the overall risk of harm to self, and there was no evidence of this for harm to others. Recording of risk did not change significantly between 1999 and 2000.Clinical ImplicationsAssessment for risk of harm to others is not a part of the emergency consultation that is emphasised by the majority of junior psychiatrists. Changing practice will require a shift in the way that risk to others is presented in psychiatric teaching.

scholarly journals I SURVIVE: inter-rater reliability of three physical functional outcome measures in intensive care unit survivors

2019 ◽  
Vol 66 (10) ◽  
pp. 1173-1183
Author(s):  
F. Aileen Costigan ◽  
Bram Rochwerg ◽  
Alexander J. Molloy ◽  
Magda McCaughan ◽  
Tina Millen ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Functional Outcome ◽  
Outcome Measures ◽  
Rater Reliability ◽  
Functional Outcome Measures

scholarly journals Getting the measure of outcomes in clinical practice

2014 ◽  
Vol 20 (3) ◽  
pp. 165-171 ◽  
Author(s):  
Glyn Lewis ◽  
Helen Killaspy
Keyword(s):  
Outcome Measures ◽  
Outcome Measurement ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Quality Of Services ◽  
List Type ◽  
Regression To The Mean ◽  
Process Measures ◽  
Patient Reported

SummaryIt has been argued that the routine use of patient-reported outcome measures (PROMs) should be encouraged in order to improve the quality of services and even to determine payment. Clinician-rated outcome measures (CROMs), patient-reported experience measures (PREMs) and process measures also should be considered in evaluating healthcare quality. We discuss difficulties that the routine use of outcome measures might pose for psychiatric services. When outcome and experience measures are used to evaluate services they are difficult to interpret because of differences in case mix and regression to the mean. We conclude that PROMs and CROMs could be useful for monitoring the progress of individuals and that clinical audit still has an important role to play in improving the quality of services.LEARNING OBJECTIVESUnderstand the difference between process measurement and outcome measurement.Understand the limitation of using outcome measures to assess and promote quality of services.Understand the difficulties in assessing the psychometric properties and validity of outcome measures.

Impact of a Novel Multiparameter Decision Support System on Intraoperative Processes of Care and Postoperative Outcomes

2018 ◽  
Vol 128 (2) ◽  
pp. 272-282 ◽  
Author(s):  
Sachin Kheterpal ◽  
Amy Shanks ◽  
Kevin K. Tremper
Keyword(s):  
Decision Support ◽  
Decision Support System ◽  
Tidal Volume ◽  
Outcome Measures ◽  
Support System ◽  
Secondary Outcome ◽  
Process Measures ◽  
Processes Of Care ◽  
Crystalloid Administration ◽  
Historical Controls

Abstract Background The authors hypothesized that a multiparameter intraoperative decision support system with real-time visualizations may improve processes of care and outcomes. Methods Electronic health record data were retrospectively compared over a 6-yr period across three groups: experimental cases, in which the decision support system was used for 75% or more of the case at sole discretion of the providers; parallel controls (system used 74% or less); and historical controls before system implementation. Inclusion criteria were adults under general anesthesia, advanced medical disease, case duration of 60 min or longer, and length of stay of two days or more. The process measures were avoidance of intraoperative hypotension, ventilator tidal volume greater than 10 ml/kg, and crystalloid administration (ml · kg–1 · h–1). The secondary outcome measures were myocardial injury, acute kidney injury, mortality, length of hospital stay, and encounter charges. Results A total of 26,769 patients were evaluated: 7,954 experimental cases, 10,933 parallel controls, and 7,882 historical controls. Comparing experimental cases to parallel controls with propensity score adjustment, the data demonstrated the following medians, interquartile ranges, and effect sizes: hypotension 1 (0 to 5) versus 1 (0 to 5) min, P < 0.001, beta = –0.19; crystalloid administration 5.88 ml · kg–1 · h–1 (4.18 to 8.18) versus 6.17 (4.32 to 8.79), P < 0.001, beta = –0.03; tidal volume greater than 10 ml/kg 28% versus 37%, P < 0.001, adjusted odds ratio 0.65 (0.53 to 0.80); encounter charges $65,770 ($41,237 to $123,869) versus $69,373 ($42,101 to $132,817), P < 0.001, beta = –0.003. The secondary clinical outcome measures were not significantly affected. Conclusions The use of an intraoperative decision support system was associated with improved process measures, but not postoperative clinical outcomes.

Process Measures, Outcome Measures, and Heart Failure—Reply

JAMA ◽  
2010 ◽  
Vol 303 (1) ◽  
pp. 35
Author(s):  
Gregg C. Fonarow
Keyword(s):  
Heart Failure ◽  
Outcome Measures ◽  
Process Measures

Practice Makes Perfect

2000 ◽  
Vol 31 (2) ◽  
pp. 182-186 ◽  
Author(s):  
Alan G. Kamhi
Keyword(s):  
Clinical Implications ◽  
Meaningful Communication ◽  
The Way

In this article, the possibility is raised that some children may implicitly view the therapy situation as one in which new sounds and language forms are learned and practiced. In contrast, the primary purpose of talking outside of therapy is meaningful communication. Inherent in this view of therapy and non-therapy is the incompatibility or inconsistency between practicing speech and communicating effectively. What led me to recognize this inconsistency and consider its potential clinical implications was the way in which my daughter Franne dealt with her phonological disorder.

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