The Global State of Democracy Indices Technical Procedures Guides, Version 5 (2021)

The Global State of Democracy is a biennial report that aims to provide policymakers with an evidence-based analysis of the state of global democracy, supported by the Global State of Democracy (GSoD) Indices, in order to inform policy interventions and identify problem-solving approaches to trends affecting the quality of democracy around the world. The third edition of the report provides analyses of the current trends in democracy and human rights at the national, regional, and global levels, with special attention to the effects of the Covid-19 pandemic. This document presents revised and updated information about all the variables included in the GSoD indices data set that enabled the construction of Version 5 of the GSoD Indices, which depicts democratic trends at the country, regional and global levels across a broad range of different attributes of democracy in the period 1975–2020. The data underlying the GSoD Indices is based on a total of 116 indicators developed by various scholars and organizations using different types of source, including expert surveys, standards-based coding by research groups and analysts, observational data and composite measures.

The Global State of Democracy Indices Methodology, Conceptualization and Measurement Framework, Version 5 (2021)

The Global State of Democracy is a biennial report that aims to provide policymakers with an evidence-based analysis of the state of global democracy, supported by the Global State of Democracy (GSoD) Indices, in order to inform policy interventions and identify problem-solving approaches to trends affecting the quality of democracy around the world. This document revises and updates the conceptual and measurement framework that guided the construction of Version 5 of the GSoD Indices, which depicts democratic trends at the country, regional and global levels across a broad range of different attributes of democracy in the period 1975–2020. The data underlying the GSoD Indices is based on a total of 116 indicators developed by various scholars and organizations using different types of source, including expert surveys, standards-based coding by research groups and analysts, observational data and composite measures.

The Global State of Democracy Indices Codebook, Version 5 (2021)

The Global State of Democracy is a biennial report that aims to provide policymakers with an evidence-based analysis of the state of global democracy, supported by the Global State of Democracy Indices (GSoD Indices), in order to inform policy interventions and identify problem-solving approaches to trends affecting the quality of democracy around the world. This document presents revised and updated information about all the variables included in the GSoD indices data set that enabled the construction of Version 5 of the GSoD Indices, which depicts democratic trends at the country, regional and global levels across a broad range of different attributes of democracy in the period 1975–2020. The data underlying the GSoD Indices is based on a total of 116 indicators developed by various scholars and organizations using different types of source, including expert surveys, standards-based coding by research groups and analysts, observational data and composite measures.

Operationalizing Healthspan as an Outcome for Clinical Trials in Geroscience

Efforts targeting biological aging pathways are advancing interventions which could extend healthy lifespan. Design of clinical trials to test such interventions necessitates an operational definition of healthspan, such as slowed accumulation or progression of multiple chronic diseases, functional decline, and disability. In this talk we explore these composite measures of healthspan proposed as outcomes for clinical trials in aging. This will be examined in example cases including multimorbidity and deficit accumulation frailty indices in an 8-Year intensive lifestyle intervention trial, and an update on multimordbity, functional, and biomarker endpoints in the trial Targeting Aging with MEtformin (TAME). Through these examples we will explore issues related to effect sizes and statistical challenges related to composite endpoints. Finally, we will discuss the role existing and emerging biomarkers of aging in clinical trials in geroscience and summarize evidence linking biomarkers to clinically meaningful outcomes.

Early life blood lead levels and asthma diagnosis at age 4–6 years

The USA has a high burden of childhood asthma. Previous studies have observed associations between higher blood lead levels and greater hypersensitivity in children. The objective of the present study was to estimate the association between blood lead concentrations during early childhood and an asthma diagnosis between 48 and 72 months of age amongst a cohort with well-characterized blood lead concentrations. Blood lead concentrations were measured at 6, 12, 18, 24, 36, and 48 months of age in 222 children. The presence of an asthma diagnosis between 48 and 72 months was assessed using a questionnaire which asked parents or guardians whether they had been told by a physician, in the past 12 months, that their child had asthma. Crude and adjusted risk ratios (RR) of an asthma diagnosis were estimated for several parameterizations of blood lead exposure including lifetime average (6 to 48 months) and infancy average (6 to 24 months) concentrations. After adjustment for child sex, birthweight, daycare attendance, maternal race, education, parity, breastfeeding, income, and household smoking, age-specific or composite measures of blood lead were not associated with asthma diagnosis by 72 months of age in this cohort.

Measuring the Nature of Individual Sequences

This study reviews and compares indicators that can serve to characterize numerically the nature of state sequences. It also introduces several new indicators. Alongside basic measures such as the length, the number of visited distinct states, and the number of state changes, we shall consider composite measures such as turbulence and the complexity index, and measures that take account of the nature (e.g., positive vs. negative or ranking) of the states. The discussion points out the strange behavior of some of the measures—Elzinga’s turbulence and the precarity index of Ritschard, Bussi, and O’Reilly in particular—and propositions are made to avoid these flaws. The usage of the indicators is illustrated with two applications using data from the Swiss Household Panel. The first application tests the U-shape hypothesis about the evolution of life satisfaction along the life course, and the second one examines the scarring effect of earlier employment sequences.

Performance of three composite measures for disease activity in peripheral spondyloarthritis

Objective To investigate concurrent validity and discrimination of the Disease Activity Psoriatic Arthritis score (DAPSA), Psoriatic Arthritis Disease Activity Score (PASDAS) and Ankylosing Spondylitis Disease Activity Score (ASDAS) in peripheral spondyloarthritis (pSpA) in clinical practice. Methods Data from a Dutch registry for SpA (SpA-Net) were used. Predefined hypotheses on concurrent validity of the composite measures with 15 other outcome measures of disease activity, physical function and health-related quality of life were tested. Concurrent validity was considered acceptable if ≥75% of the hypotheses were confirmed. Discrimination was assessed by stratifying patients in DAPSA, PASDAS and ASDAS predefined disease activity states and studying mean differences in health outcomes by one-way ANOVA. Furthermore, the concordance in disease activity states was determined. All analyses were repeated in subgroups with and without psoriasis. Results DAPSA, PASDAS and ASDAS scores were available for 191, 139 and 279 patients with pSpA, respectively. The concurrent validity and discrimination of all composite measures were acceptable as the strength of correlations were as hypothesized in ≥75% of the studied correlations. With increasing disease activity states, scores in nearly all outcome measures worsened significantly. The DAPSA, PASDAS and ASDAS classified 22%, 56% and 48% of the patients, respectively, in the two highest disease activity states. Stratified analyses for concomitant psoriasis revealed no relevant subgroup differences. Conclusion The performance of DAPSA, PASDAS and ASDAS in pSpA was acceptable, and independent of concomitant psoriasis. Due to discrepancy in classification, the validity of existing thresholds for disease activity states warrants further study in pSpA.

Development and pilot testing of survey items to assess the culture of value and efficiency in hospitals and medical offices

BackgroundGiven rising costs and changing payment models, healthcare organisations are increasingly focused on value and efficiency. The goal of our study was to develop survey items to assess clinician and staff perspectives about the extent to which the organisational culture in hospitals and medical offices supports value and efficiency.MethodsDevelopment began with a literature review and interviews with experts and clinicians and staff from hospitals and medical offices. We identified key areas of value and efficiency culture, drafted survey items and conducted cognitive testing. Using purposive sampling to select sites, the 36-item surveys were pilot tested in 47 hospitals and 96 medical offices. Psychometric analysis was conducted on data from 3951 hospital respondents (42% response) and 1458 medical office respondents (63% response).ResultsFactor loadings, multilevel confirmatory factor analysis model fit and reliability estimates were acceptable for the 13 items grouped into 4 composite measures: Empowerment to Improve Efficiency (3 items), Efficiency and Waste Reduction (3 items), Patient Centeredness and Efficiency (3 items) and Management Support for Improving Efficiency and Reducing Waste (4 items). All composite measures were significantly intercorrelated and related to the four Overall Ratings of Healthcare Quality, indicating adequate conceptual convergence among the measures. Eight items assessing Experiences With Activities to Improve Efficiency were also included.ConclusionWe developed psychometrically sound survey items measuring value and efficiency culture. When added to the Agency for Healthcare Research and Quality Surveys on Patient Safety Culture, the item sets extend those surveys by assessing additional dimensions of organisational culture that affect care delivery. Healthcare organisations can use these item sets to assess how well their organisational culture supports value and efficiency and identify areas for improvement.

Development and psychometric properties of surveys to assess patient and family caregiver experience with care transitions

Background The purpose of this study was to develop and administer surveys that assess patient and family caregiver experiences with care transitions and examine the psychometric properties of the surveys. The surveys were designed to ask about 1) the transitional care services that matter most to patients and their caregivers and 2) care outcomes, including the overall quality of transitional care they received, patient self-reported health, and caregiver effort/stress. Methods Survey items were developed based on a review of the literature, existing surveys, focus groups, site visits, stakeholder and expert input, and patient and caregiver cognitive interviews. We administered mail surveys with telephone follow up to patients recently discharged from 43 U.S. hospitals. Patients identified the caregivers who helped them during their hospital stay (Time 1 caregiver) and when they were home (Time 2 caregiver). Time 1 and Time 2 caregivers were surveyed by telephone only. The psychometric properties of the survey items and outcome composite measures were examined for each of the three surveys. Items that performed poorly across multiple analyses, including those with low variability and/or a high missing data, were dropped except when they were conceptually important. Results The analysis datasets included responses from 9282 patients, 1245 Time 1 caregivers and 1749 Time 2 caregivers. The construct validity of the three proposed outcome composite measures—Overall Quality of Transitional Care (patient and caregiver surveys), Patient Overall Health (patient survey) and Caregiver Effort/Stress (caregiver surveys) —was supported by acceptable exploratory factor analysis results and acceptable internal consistency reliability. Site-level reliability was acceptable for the two patient outcome composite measures, but was low for Caregiver Effort/Stress (< 0.70). In all surveys, the Overall Quality of Transitional Care outcome composite measure was significantly correlated with other outcome composite measures and most of the single-item measures. Conclusions Overall, the final patient and caregiver surveys are psychometrically sound and can be used by health systems, hospitals, and researchers to assess the quality of care transitions and related outcomes. Results from these surveys can be used to improve care transitions, focusing on what matters most to patients and their family caregivers.