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Biomedical subjects

J Mant

Publications and source records attributed to J Mant.

45 records · Page 3Linked to original sources
PubMed1996

Assessing quality of care: what are the implications of the potential lack of sensitivity of outcome measures to differences in quality?

Measuring outcome can be an insensitive way to detect differences in the quality of health care. This paper captures the implications of this poor sensitivity for the interpretation of studies of outcome that compare provider performance, and considers in what circumstances monitoring outcome might be useful. When interpreting studies, it is important to consider the size of the effect that a difference in the quality of care might be expected to have on outcome and whether it is likely that important differences in quality might not have been detected. It is argued that outcome measures may be of value when how you do something is as important as what you do, when process measures are invalid or impractical, and when the overall effectiveness of an intervention is critically dependent upon its complication rate.

Health Services Research↗
PubMed1996

Cardiovascular disease prevention and the NHS reforms.

Since the late 1980s, there have been major reforms of the British National Health Service, including the setting up of an internal market for health care, a new GP contract, and the development of a health strategy. This paper describes these reforms and discusses their impact on the prevention of cardiovascular disease. There has been an increased emphasis on identifying and treating individuals at high risk of cardiovascular disease in general practice, but randomised controlled trials suggest that this will have only a limited impact on cardiovascular mortality. In contrast to this 'high risk' approach, population based approaches aimed at reducing the levels of risk factors in the whole population depend to a greater extent on the involvement of organisations outside the health service. Such approaches take time to develop, and it is premature to judge the impact of the reforms on such initiatives.

Cardiovascular Diseases↗
PubMed1995

Detecting differences in quality of care: the sensitivity of measures of process and outcome in treating acute myocardial infarction.

The merits or otherwise of publishing hospital specific death rates are much debated. This article compares the relative sensitivity of measures of process and outcome to differences in quality of care for the hospital treatment of myocardial infarction. Aspects of hospital care that have a proved impact on mortality from myocardial infarction are identified, and the results from meta-analysis and large randomised controlled trials are used to estimate the impact that optimal use of these interventions would have on mortality in a typical district general hospital. Sample size calculations are then performed to determine how many years of data would be needed to detect significant differences between hospitals. A comparison is then made with the amount of data that would be needed to detect significant differences if information about process of care was being collected. Process measures based on the results of randomised controlled trials were found to be able to detect relevant differences between hospitals that would not be identified by comparing hospital specific mortality, which is an insensitive indicator of the quality of care.

Hospital Mortality↗
PubMed1994

Getting research into practice: facing the issues.

The translation of research into practice is currently a high-profile issue in the NHS. A number of regions have undertaken work in this area. Reports on a project that is part of the Anglia and Oxford Regions's "getting Research into Practice" (GRiP) initiative. The work focuses on the use of steroids in pre-term delivery, a procedure that medical evidence suggests can reduce neo-natal mortality and morbidity. Presents a number of findings which suggest that getting research into practice does not merely rest on the availability of well-researched evidence.

Attitude of Health Personnel↗
PubMed1994

Is there a market for regional units in child and adolescent psychiatry?

BACKGROUND: An analysis of the demand for the services of a sub-regional Family and Young Persons Unit which offers both in-patient and out-patient treatment for children and adolescents with psychiatric, emotional or psychological problems was performed. METHODS: Interviews were held and questionnaires were sent to representatives of the principal and potential users of the service both within the local district and beyond. RESULTS: The results demonstrated unmet demand for outpatient services but only limited demand for in-patient services in some districts. The role of market research in the new National Health Service and some of the difficulties of applying it are discussed. The implications of the findings for both the Family and Young Persons Unit and for child and adolescent psychiatry are considered. CONCLUSION: It is concluded that the effect of the market may be to bring about the closure of regional units unless there is intervention to protect them.

Adolescent↗
PubMedDate not supplied

A systematic review of the evidence for rapid access chest pain clinics.

To determine the impact of rapid access chest pain clinics (RACPC) on patient management, a systematic search (1966-2000) was performed of electronic databases, recent conference abstracts, citations of all identified studies, and by contact with other researchers. Studies of any design were included. Assessment of eligibility, methodological quality of studies and data abstraction was conducted independently by two reviewers. Outcome measures were sought in terms of admission rate of patients without acute coronary syndrome detection rate of acute coronary syndrome unrecognised by the GP, timing of specialist assessment of patients with stable angina and speed and accuracy of detection of those with non-cardiac chest pain. Nine relevant studies were found, but all had methodological flaws when considered as evaluative studies. All clinics described reviewed patients within 24 hours of referral. Only three studies made comparisons with control groups, none of which were randomised, and a further three provided follow-up data only. Limited data were found for all four outcome measures, indicating possible benefits of RACPCs. However, all findings could be explained by potential biases in the original studies. In conclusion, the evidence base for the introduction of rapid access chest pain clinics is poor. The introduction of these clinics should include a randomised prospective evaluation of their worth.

Ambulatory Care↗