Policy Spotlight Effect in Critical Time-Sensitive Diseases

Background: Categorization of hospital emergency capability (CHEC) is a policy implemented worldwide to regionalize critical emergent care. The CHEC policy mainly uses time-based indicators as emergency care quality measurements.Objectives: We aimed to explore the CHEC policy spotlight effect on critical time-sensitive diseases with and without the influence of time-based surveillance indicators and guidelines. Research Design: We conducted a nationwide retrospective cohort study between 2005–2011. Regarding critical time-sensitive diseases, our study targeted acute ischemic stroke (AIS), ST-segment elevation myocardial infarction (STEMI), septic shock, and major trauma. We selected diagnosis and treatment guideline adherence as process quality measures and defined medical utilization, upward transfer rate, and short-term mortality rate as outcome indicators. Subjects: The Taiwan National Health Insurance 2005 Longitudinal Health Insurance Database contains one million random cases, including medical records and hospital information. Results: During this 7-year study AIS, STEMI, septic shock, and major trauma, respectively. AIS and STEMI cohorts had significantly higher rates of guideline adherence and better process quality than those of septic shock and major trauma cohorts. Furthermore, AIS and STEMI cohorts had a significant increase in diagnosis costs. Conclusion: The CHEC policy spotlight effect exists in critical time-sensitive diseases with time-based quality indicators. Importantly, disease entities without these indicators may experience decreases in diagnosis and treatment guideline adherence, indirectly jeopardizing their outcomes.

Policy Spotlight Effect In Critical Time-Sensitive Diseases

Background: Categorization of hospital emergency capability (CHEC) is a policy implemented worldwide to regionalize critical emergent care. The CHEC policy mainly uses time-based indicators as emergency care quality measurements.Objectives: We aimed to explore the CHEC policy spotlight effect on critical time-sensitive diseases with and without the influence of time-based surveillance indicators and guidelines. Research Design: We conducted a nationwide retrospective cohort study between 2005–2011. Regarding critical time-sensitive diseases, our study targeted acute ischemic stroke (AIS), ST-segment elevation myocardial infarction (STEMI), septic shock, and major trauma. We selected diagnosis and treatment guideline adherence as process quality measures and defined medical utilization, upward transfer rate, and short-term mortality rate as outcome indicators. Subjects: The Taiwan National Health Insurance 2005 Longitudinal Health Insurance Database contains one million random cases, including medical records and hospital information. Results: During this 7-year study AIS, STEMI, septic shock, and major trauma, respectively. AIS and STEMI cohorts had significantly higher rates of guideline adherence and better process quality than those of septic shock and major trauma cohorts. Furthermore, AIS and STEMI cohorts had a significant increase in diagnosis costs. Conclusion: The CHEC policy spotlight effect exists in critical time-sensitive diseases with time-based quality indicators. Importantly, disease entities without these indicators may experience decreases in diagnosis and treatment guideline adherence, indirectly jeopardizing their outcomes.

How Egocentric Biases Maintain Social Anxiety: A Literature Review

Biases and heuristics are mental shortcuts that help guide our daily decision making and cognitive processing but can often lead us astray when they account for inaccurate or misinterpreted information. In this review I aim to understand how the spotlight effect (Gilovich et al., 2000), the overestimation of how attentive others are to our actions, and the illusion of transparency (Gilovich et al., 1998), the overestimation of how easily others can discern our internal state, maintain social anxiety by disrupting the anchoring component these shortcuts rely on. Through a detailed analysis of major research conducted by Brown and Stopa (2007) and Haikal and Hong (2010), I was able to synthesize the empirical findings, discuss clinical implications, and propose future directions for research.