scholarly journals A method for measuring continuity of care in day-to-day general practice: a quantitative analysis of appointment data

2019 ◽  
Vol 69 (682) ◽  
pp. e356-e362 ◽  
Author(s):  
Kate Sidaway-Lee ◽  
Denis Pereira Gray ◽  
Philip Evans
Keyword(s):  
Decision Making ◽  
General Practice ◽  
Standard Deviation ◽  
Performance Management ◽  
Continuity Of Care ◽  
Face To Face ◽  
Personal Doctor ◽  
Audit Data ◽  
Part Time ◽  
The Mean

BackgroundDespite patient preference and many known benefits, continuity of care is in decline in general practice. The most common method of measuring continuity is the Usual Provider of Care (UPC) index. This requires a number of appointments per patient and a relatively long timeframe for accuracy, reducing its applicability for day-to-day performance management.AimTo describe the St Leonard’s Index of Continuity of Care (SLICC) for measuring GP continuity regularly, and demonstrate how it has been used in service in general practice.Design and settingAnalysis of appointment audit data from 2016–2017 in a general practice with 8823–9409 patients and seven part-time partners, in Exeter, UK.MethodThe percentage of face-to-face appointments for patients on each doctor’s list, with the patient’s personal doctor (the SLICC), was calculated monthly. The SLICC for different demographic groupings of patients (for example, sex and frequency of attendance) was compared. The UPC index over the 2 years was also calculated, allowing comparisons between indices.ResultsIn the 2-year study period, there were 35 622 GP face-to-face appointments; 1.96 per patient per year. Overall, 51.7% (95% confidence interval = 51.2 to 52.2) of GP appointments were with the patients’ personal doctor. Patients aged ≥65 years had a higher level of continuity with 64.9% of appointments being with their personal doctor. The mean whole-practice UPC score was 0.61 (standard deviation 0.23), with ‘usual provider’ being the personal GP for 52.8% and a trainee or locum for 8.1% of patients.ConclusionThis method could provide working GPs with a simple way to track continuity of care and inform practice management and decision making.

scholarly journals Patients’ Experiences of Remote Neurology Consultations during the COVID-19 Pandemic

2020 ◽  
pp. 1-4
Author(s):  
Mary Clare McKenna ◽  
Mahmood Al-Hinai ◽  
David Bradley ◽  
Elisabeth Doran ◽  
Isabelle Hunt ◽  
...  
Keyword(s):  
Standard Deviation ◽  
Continuity Of Care ◽  
Chronic Illnesses ◽  
Telephone Consultation ◽  
General Neurology ◽  
Face To Face ◽  
Global Pandemic ◽  
Neurology Clinic ◽  
The Mean ◽  
Remote Consultations

Telemedicine has been widely implemented during the COVID-19 global pandemic to enable continuity of care of chronic illnesses. We modified our general neurology clinic to be conducted using remote audio-only telephone consultations. We included all patients over a 10-week period who agreed to both a telephone consultation and a questionnaire afterwards in order to ascertain the patient’s perspective of the experience. There were 212 participants consisting of men (43.8%) and women (56.2%). The mean ± standard deviation of age was 47.8 ± 17.0 (range 17–93) years. For the most part, patients found remote consultations either “just as good” (67.1%) or “better” (9.0%) than face-to-face consultations. Those who deemed it to be “not as good” were significantly older (52.3 ± 17.9 years vs. 46.6 ± 16.6 years, <i>p =</i>0.045) or were more likely to have a neurological disorder that required clinical examination, namely, a neuromuscular condition (66.7%, <i>p =</i> 0.002) or an undiagnosed condition (46.7%, <i>p =</i> 0.031). At the height of the COVID-19 global pandemic, most patients were satisfied with remote consultations. The positive feedback for remote consultations needs to be verified outside of this unique scenario because the results were likely influenced by the patients’ apprehension to attend the hospital amongst other factors.

scholarly journals 4525 Estimates of Dose Response using the Dixon Up-and-Down Method and BOIN study designs

2020 ◽  
Vol 4 (s1) ◽  
pp. 48-48
Author(s):  
Charles Gene Minard
Keyword(s):  
Decision Making ◽  
Standard Deviation ◽  
Effective Dose ◽  
Transition Probability ◽  
Experimental Unit ◽  
The Mean ◽  
Transition Probability Matrices ◽  
Probability Matrices ◽  
Study Designs ◽  
Dose Levels

OBJECTIVES/GOALS: The Dixon up-and-down method (U/D), original developed for testing explosives, is especially common in anesthesia research studies. The objective of this research is to compare the performance of the U/D method for obtaining and analyzing sensitivity data with that of the Bayesian Optimal Interval (BOIN) method. METHODS/STUDY POPULATION: A simulation study will compare the performance of the U/D method with the BOIN design. The two study designs offer alternative decision-making algorithms with respect to the dose at which the next experimental unit is treated. These alternative decisions may impact the precision of point estimates of the mean and standard deviation of the effective dose to elicit a response. Transition probability matrices are developed, and maximum likelihood estimates of the unknown parameters assessed for accuracy. For simulation, the effective dose is assumed to be randomly distributed with a known mean and standard deviation. Fixed dose levels are defined, and decisions for what level the next experimental unit should be treated at are defined by the Dixon up-and-down method and the BOIN design. For the U/D method, the stimulus is increased by one level in the absence of a response or decreased if a response occurs from an initial stimulus. A target toxicity probability of 0.50 is used to define the dose escalation or de-escalation rules for the application of the BOIN design. RESULTS/ANTICIPATED RESULTS: A feature of both methods is that the consecutive observations are concentrated about the mean value of the effective dose. However, the BOIN design tends to be more concentrated between these two dose levels. In the presence of severe adverse events, the BOIN design can choose to eliminate doses that are too toxic whereas the U/D design cannot eliminate any dose levels. Transition probability matrices are defined and parameters for the distribution of the effective dose are estimated using maximum likelihood estimation. Mean squared errors for the estimated mean and standard deviations compare the two study designs. DISCUSSION/SIGNIFICANCE OF IMPACT: The BOIN design offers an alternative method for decision-making compared with the U/D method. The BOIN design tends to concentrate dose levels about the mean more than the U/D. This may provide better estimates of the mean and standard deviation of the effective dose for eliciting a response in some circumstances.

scholarly journals Improving access to organ donor registration in general practice: a feasibility study

2020 ◽  
Vol 70 (696) ◽  
pp. e497-e504
Author(s):  
Catrin P Penn-Jones ◽  
Chris Papadopoulos ◽  
Gurch Randhawa ◽  
Zeeshan Asghar
Keyword(s):  
Decision Making ◽  
General Practice ◽  
Mixed Methods ◽  
Focus Groups ◽  
Feasibility Study ◽  
Organ Donor ◽  
Mixed Methods Design ◽  
Waiting Room ◽  
Face To Face ◽  
The Uk

BackgroundOrgan donor registration helps guide decision making for families. UK general practice provides the facility to register on the NHS Organ Donor Register, but only to new patients. An intervention was developed to present a registration opportunity to existing patients in this setting.AimTo assess the feasibility and acceptability of an organ donation intervention implemented in UK general practice.Design and settingThe intervention ran in a large practice in Luton in the UK, for 3 months in 2018. A single practice feasibility study was conducted using an embedded experimental mixed methods design.MethodStaff were trained to ask patients in consultations if they wished to join the register, and leaflets and posters were displayed in the waiting room. Data on feasibility and acceptability were captured using SystmONE questionnaires, surveys, and focus groups.ResultsOver 3 months, in 12.4% of face-to-face consultations, patients were asked if they would like to join the register (812 of 6569), and 244 (30.0%) of these patients joined the register. Common reasons staff did not ask patients were due to telephone consultations, lack of time, and it not being appropriate. Nurses and healthcare assistants performed prompted choice more than doctors (23.4%, 17.1%, and 1.6% respectively). Certain clinic types, such as phlebotomy or routine clinics, facilitated asking compared to those where patients presented with unknown or more serious issues.ConclusionThe intervention was found to be feasible and acceptable by some staff and patients. Feasibility criteria were met; therefore, the intervention can progress to further testing.

Response Rates in Online Surveys With Affective Disorder Participants

2020 ◽  
Vol 228 (1) ◽  
pp. 14-24 ◽  
Author(s):  
Tanja Burgard ◽  
Michael Bošnjak ◽  
Nadine Wedderhoff
Keyword(s):  
Meta Analysis ◽  
Response Rates ◽  
Contact Mode ◽  
General Anxiety Disorder ◽  
General Anxiety ◽  
Face To Face ◽  
Survey Participation ◽  
The Mean ◽  
Design Characteristics ◽  
E Mail

Abstract. A meta-analysis was performed to determine whether response rates to online psychology surveys have decreased over time and the effect of specific design characteristics (contact mode, burden of participation, and incentives) on response rates. The meta-analysis is restricted to samples of adults with depression or general anxiety disorder. Time and study design effects are tested using mixed-effects meta-regressions as implemented in the metafor package in R. The mean response rate of the 20 studies fulfilling our meta-analytic inclusion criteria is approximately 43%. Response rates are lower in more recently conducted surveys and in surveys employing longer questionnaires. Furthermore, we found that personal invitations, for example, via telephone or face-to-face contacts, yielded higher response rates compared to e-mail invitations. As predicted by sensitivity reinforcement theory, no effect of incentives on survey participation in this specific group (scoring high on neuroticism) could be observed.

At Least One Standard Deviation Above the Mean

1969 ◽  
Vol 14 (9) ◽  
pp. 470-471
Author(s):  
M. DAVID MERRILL
Keyword(s):  
Standard Deviation ◽  
The Mean

The Estimation of Blood Platelet Survival

1972 ◽  
Vol 28 (03) ◽  
pp. 447-456 ◽  
Author(s):  
E. A Murphy ◽  
M. E Francis ◽  
J. F Mustard
Keyword(s):  
Standard Deviation ◽  
Least Squares ◽  
Experimental Error ◽  
Blood Platelet ◽  
Least Squares Estimation ◽  
Systematic Relationship ◽  
Platelet Survival ◽  
The Mean ◽  
Normally Distributed

SummaryThe characteristics of experimental error in measurement of platelet radioactivity have been explored by blind replicate determinations on specimens taken on several days on each of three Walker hounds.Analysis suggests that it is not unreasonable to suppose that error for each sample is normally distributed ; and while there is evidence that the variance is heterogeneous, no systematic relationship has been discovered between the mean and the standard deviation of the determinations on individual samples. Thus, since it would be impracticable for investigators to do replicate determinations as a routine, no improvement over simple unweighted least squares estimation on untransformed data suggests itself.

Evaluating the relational continuity of care of four GP practices, one of which uses personalised lists

2020 ◽  
Vol 70 (suppl 1) ◽  
pp. bjgp20X711713
Author(s):  
Riaan Swanepoel
Keyword(s):  
General Practice ◽  
Patient Satisfaction ◽  
Chronic Disease ◽  
Continuity Of Care ◽  
Financial Incentive ◽  
Working Hours ◽  
Psychological Problems ◽  
Relational Continuity ◽  
Care Index

BackgroundContinuity of care is a fading type of care because GPs are working more flexibly and at reduced working hours. The GP Contract gave a financial incentive to provide prompt GP appointments, but to the detriment of continuity of care. Increased patient demand for appointments has seemingly led to patients favouring ‘any’ appointment with a GP rather than ‘an appointment with the same GP’. Continuity of care in general practice is associated with greater patient satisfaction and is the preferred type of care for patients with chronic disease or psychological problems. In the Northeast of England there is a multi-partner GP practice that operates a true personalised list system. Other GP practices in the area do offer a degree of continuity of care, but this has not been measured.AimTo measure and compare the relational continuity of care index of four matched GP practices, one of which operates a personalised list.MethodA written protocol enabled the authors to extract comparable anonymised data from four GP practices over a year (January to December 2019). Two standardised indexes of continuity of care (UPC and SLICC) were calculated and compared.ResultsContinuity of care was consistently higher with personalised lists. UPC index results show that all GP practices provide surprisingly high continuity of care, albeit not with patients’ assigned GPs. Higher monthly UPC scores versus overall scores indicate patients are receiving continuity of care in relation to their condition.ConclusionContinuity of care is still observed in GP practices that do not have personalised lists.

PENGARUH PENDIDIKAN KESEHATAN REPRODUKSI PADA PEER GROUP (TEMAN SEBAYA) TERHADAP PENGETAHUAN DAN PERSEPSI REMAJA TENTANG PENDEWASAAN USIA PERKAWINAN DI SMA NEGERI 1 KECAMATAN NAMORAMBE KAB. DELI SERDANG 2018

2020 ◽  
Vol 1 (2) ◽  
pp. 56-66
Author(s):  
Irma Linda
Keyword(s):  
Standard Deviation ◽  
Health Education ◽  
Reproductive Health ◽  
Peer Group ◽  
Peer Groups ◽  
A Value ◽  
Significant Difference ◽  
Reproductive Health Education ◽  
The Mean ◽  
Adolescent Perceptions

Background: Early marriages are at high risk of marital failure, poor family quality, young pregnancies at risk of maternal death, and the risk of being mentally ill to foster marriage and be responsible parents. Objective: To determine the effect of reproductive health education on peer groups (peers) on the knowledge and perceptions of adolescents about marriage age maturity. Method: This research uses the Quasi experimental method with One group pre and post test design, conducted from May to September 2018. The statistical analysis used in this study is a paired T test with a confidence level of 95% (α = 0, 05). Results: There is an average difference in the mean value of adolescent knowledge between the first and second measurements is 0.50 with a standard deviation of 1.922. The mean difference in mean scores of adolescent perceptions between the first and second measurements was 4.42 with a standard deviation of 9.611. Conclusion: There is a significant difference between adolescent knowledge on the pretest and posttest measurements with a value of P = 0.002, and there is a significant difference between adolescent perceptions on the pretest and posttest measurements with a value of p = 0.001. Increasing the number of facilities and facilities related to reproductive health education by peer groups (peers) in adolescents is carried out on an ongoing basis at school, in collaboration with local health workers as prevention of risky pregnancy.

Applying Deep Learning to Audit Procedures: An Illustrative Framework

2019 ◽  
Vol 33 (3) ◽  
pp. 89-109 ◽  
Author(s):  
Ting (Sophia) Sun
Keyword(s):  
Decision Making ◽  
Deep Learning ◽  
Data Warehouse ◽  
Visual Recognition ◽  
Prediction Models ◽  
Historical Data ◽  
Structured Data ◽  
Text Understanding ◽  
Audit Data ◽  
Learning Functions

SYNOPSIS This paper aims to promote the application of deep learning to audit procedures by illustrating how the capabilities of deep learning for text understanding, speech recognition, visual recognition, and structured data analysis fit into the audit environment. Based on these four capabilities, deep learning serves two major functions in supporting audit decision making: information identification and judgment support. The paper proposes a framework for applying these two deep learning functions to a variety of audit procedures in different audit phases. An audit data warehouse of historical data can be used to construct prediction models, providing suggested actions for various audit procedures. The data warehouse will be updated and enriched with new data instances through the application of deep learning and a human auditor's corrections. Finally, the paper discusses the challenges faced by the accounting profession, regulators, and educators when it comes to applying deep learning.

Sign in / Sign up

Export Citation Format

Share Document