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PubMed2006

Beyond the initial indicators: lessons from the OECD Health Care Quality Indicators Project and the US National Healthcare Quality Report.

UNLABELLED: Interest in comparative quality measurement and evaluation has grown considerably over the past two decades because of factors such as the recognition of widespread variation in clinical practice, the increased availability of evidence about medical effectiveness, and increasing concern about the cost and quality of health care. This article describes and contrasts two current efforts to develop health performance reporting systems: one, an international initiative-the Health Care Quality Indicator (HCQI) Project, sponsored by the Organization for Economic Cooperation and Development (OECD); and the other, a national project-the National Healthcare Quality Report (NHQR), sponsored by the US Agency for Healthcare Quality and Research. There are a number of lessons learned from a comparison of the two efforts that are relevant for the future of each project and for other indicator-based reporting efforts in quality of health care. These lessons are discussed in the article and include: Conceptual frameworks should be established to guide the selection of indicators. Choices should be made early on in the process to focus on a wide range of clinical conditions or to report on a few priority areas. METHODS: should be developed to add and subtract indicators while maintaining a stable set of indicators to track over time. Resources should be allocated to communication strategies and how best to present data results to diverse audiences. Mechanisms should be put in place to maintain project momentum.

Benchmarking↗
PubMed1998

Comparison between the DMF indices and two alternative composite indicators of dental health.

The DMFT and DMFS indices employed in the majority of oral epidemiological studies have several limitations. In response to this problem, Sheiham et al. (Community Dent Health 1987;4:407-14) proposed two alternative dental health indicators: the number of functioning teeth (hereafter referred to as FS-T) and tissue health (T-Health). Using data from an epidemiological study on the dental health status of adults aged 35-44 from Quebec (N=2110), this article compares the alternative indices with the conventional DMFT and DMFS indices. By comparing Pearson's correlation coefficient for the four indices in this study with the number of decayed, missing and filled surfaces, it is noted that the FS-T index bears the strongest correlation to the three variables. It is also the only index whose correlation coefficient is greater than 0.3 for each of the three DMFS components. A risk group was created for each index, composed of the 18% of people demonstrating the poorest index. The risk group's FS-T index results in an average of 4.3 decayed surfaces (compared with 2.6 for the DMFT), 92.7 missing surfaces (74.4 for the DMFT) and 9.0 filled surfaces (compared with 26.9 for the DMFT). Using linear regression analysis with each index as a dependent variable, and people's socio-demographic characteristics, regular use of dental services and perception of dental health as independent variables, it appears that the percentage of the explained variance (R2) is 21.2% for the FS-T index, 13.8% for the T-Health index, 12.3% for the DMFS index and only 7.6% for the DMFT index.

Adult↗
PubMed2006

[Quality indicators in Hypertension Care Units: indicators of structure in the QUALIHTA study].

AIM: To evaluate the minimum-required indicators of quality of care in Hypertension Units at two levels of delivered care (secondary and tertiary) in Spain. METHODS: A total of 51 quality indicators were included (N) in order to evaluate: architectural resources (8), material resources (12 on devices and 22 on supportive services) and human resources (9), which were presented as a formulary to the head of the corresponding Hypertension Unit. As a measure of the indicator, the accomplishment (yes/no) was registered. RESULTS: Data from 61 participating centers were collected and included in the analysis: 42 (68,9%) centers of tertiary level and 19 (31,1%) of secondary level. The degree of compliance of the different quality indicators in the global sample is (range): architecture, 60%-100%; material resources, 83.3%-100% (devices); 57.4-100% auxiliary services; 51.7% with respect to human resources and 69-100% with respect to continuing education and the dedication of the personnel. As expected, the differences between care levels were observed mainly in the availability of auxiliary services. CONCLUSIONS: The Hypertension Units in Spain comply with a series of structural indicators of care quality at an acceptable level. The degree of compliance in certain aspects of human resources, mainly percent of dedication, number and continuing education could be improved. The evaluation of these aspects of care quality could allow the Scientific Societies to define the recommendation in order to deliver the best quality of care in hypertension.

Cross-Sectional Studies↗
PubMed1975

Relationship between work environment and anamnestic health status. Use of predictors, indicators and indices for the evaluation of medical and environmental factors.

Experience with computerized medical record systems in handling medical data in hospital and health screening environments has led to the development of a new approach to the evaluation of medical data. Predictors and indicators quantify the "information value" of medical data and can, theoretically, do so for all types of data. This paper describes the methodology and presents the results obtained when the technique was applied to the anamnestic data of the medical history and environmental data about the conditions in the work environment. Over 4,000 individuals who underwent multiphasic health screening were used as a data base for this study. From these 4,000 persons 3,164 were used for the calculation of anamnestic predictors and indicators and 1,013 for the environmental predictors and indicators. Anamnestic environmental indices were calculated upon 77 test individuals so as to correlate the association and dependence of the two indices.

Environmental Exposure↗
PubMed2006

Paradox of estuarine quality: benthic indicators and indices, consensus or debate for the future.

The European Water Framework Directive will have instituted the concept of Ecological Quality Status (EQS) as a way to assess the biological quality of water masses. The EQS will be based mainly upon the composition of the different biological compartments in the ecosystem specially the benthos as compared to certain reference sites. Such management tools are already well established for freshwater (i.e. biotic indices), but not for coastal and estuarine (i.e. transitional) waters. In the framework of the Seine-Aval programme a workshop on benthic indicators was organized at Wimereux (France) in June 2005. The aim of this workshop and this paper is (1) to present the experiences of the Seine Aval researchers, and the French scientific approaches to benthic indicators, with those international experiences and approaches that have been published or are under development; and (2) to examine the existing benthic tools and their possible use in the characterization of the state of estuarine ecosystems. The debate during the workshop and the numerous recently published on the WFD are discussed in term of the implementation of the WFD in transitional water bodies using benthic indicators and indices. Some proposals for the future underline the needs to re-examine and adapt the different index thresholds, to take into account physical disturbances, to inventory the existing conditions vs reference conditions and to be as pragmatic as possible in using the WFD in transitional waters.

Animals↗
PubMed1998

[Differential indication for coronary stent implantation. Comparative study of acute cardial and vascular complications in relation to the indication].

BACKGROUND AND OBJECTIVE: Coronary stents are used nowadays not only for the reduction of restenosis and for treating acute vessel occlusions after PTCA but also after acute myocardial infarction. This study was undertaken to determine whether widening the indications has affected the incidence of acute complications and to compare acute cardiac and vascular complications. PATIENTS AND METHODS: The data on 197 consecutive patients (155 men, 42 women; mean age 62 +/- 9 [37-85] years) with coronary stents were analysed retrospectively, divided into 5 groups depending on the indications for the stent implantation: 1) acute or threatened vessel occlusion after elective PTCA ("bail-out"); 2) acute myocardial infarction (AMI); 3) unstable angina with threatened vessel occlusion; 4) suboptimal primary results (angiographically assessed) after PTCA; 5) elective stent implantation to prevent restenosis. Acute or subacute stent thrombosis, side-branch occlusion, intra- and transmural infarction, death and emergency aortocoronary bypass operation were classified as acute cardiac complications. Haemorrhage in the inguinal region requiring blood transfusion, false aneurysm and operative vascular reconstruction were classified as vascular complications. RESULTS: An intended stent implantation was impossible in 18 patients (primary success rate 91%). Independent of indication an acute or chronic stent stenosis occurred in three (1.6%) and seven (3.9%) patients, respectively. Side-branch occlusion was observed in 12 patients (6.7%), transmural infarction in nine (5.6%). No emergency bypass operation had to be performed. Comparing the different indication groups there was a significantly increased rate of "non-Q" infarctions in patients with unstable angina pectoris (P < 0.014). Among acute vascular complications (10 [5%] inguinal haemorrhages requiring transfusion and 5 [2.5%] operative vascular reconstructions), false aneurysm was significantly more common in patients with AMI (P < 0.014). Comparing emergency and elective stent implantations, side-branch occlusions were significantly more common in the former (12% vs. 0%; P < 0.08), as were also "non-Q" infarcts (10% vs. 0%; P < 0.002). CONCLUSION: Coronary stent implantation for these indications, including AMI, can be taken as firmly established. Stent thrombosis was not significantly increased after "bail out". Implantation in an acute ischaemic episode led to a significantly higher incidence of side-branch occlusion and "non-Q" infarction.

Acute Disease↗
PubMed1991

Demographic indices as social indicators.

"A social indicator is derived from readily available demographic data: population age structures, mortality rates, sex ratios, and children-women ratios (fertility). It is suggested that an indicator based on just two of these variables can be as reliable a measure of the physical quality of life in a population as a multivariable indicator based directly on socioeconomic data. Unlike multivariable indicators, which are expensive to collect, the demographic data are readily available. Their use as social indicators would thus offer a simple, cheap, and effective means of monitoring the standard of living in small, geographically defined populations and in evaluating the effects of policy interventions. The analysis is based on Israeli towns, with use of data from the census of 1983."

Asia↗
PubMed1997

Detection in living cells of Ca2+-dependent changes in the fluorescence emission of an indicator composed of two green fluorescent protein variants linked by a calmodulin-binding sequence. A new class of fluorescent indicators.

We have designed a novel fluorescent indicator composed of two green fluorescent protein variants joined by the calmodulin-binding domain from smooth muscle myosin light chain kinase. When (Ca2+)4-calmodulin is bound to the indicator (Kd = 0.4 nM), fluorescence resonance energy transfer between the two fluorophores is attenuated; the ratio of the fluorescence intensity measured at 505 nm to the intensity measured at 440 nm decreases 6-fold. Images of microinjected living cells demonstrate that emission ratios can be used to monitor spatio-temporal changes in the fluorescence of the indicator. Changes in indicator fluorescence in these cells are coupled with no discernible lag (<1 s) to changes in the cytosolic free Ca2+ ion concentration, ranging from below 50 nM to approximately 1 microM. This observation suggests that the activity of a calmodulin target with a typical 1 nM affinity for (Ca2+)4-calmodulin is responsive to changes in the intracellular Ca2+ concentration over the physiological range. It is likely that the indicator we describe can be modified to detect the levels of ligands and proteins in the cell other than calmodulin.

Amino Acid Sequence↗
PubMed1993

The agreed indications and contra-indications for cholecystectomy.

Indications as to which patients should undergo cholecystectomy remain, at least in part, a matter of controversy. In 1987, a panel of nine Israeli physicians from different specialties established a list of indications for the performance of cholecystectomy based on the literature available at the time. The panel agreed that cholecystectomy was appropriate for 59 indications and that it was inappropriate for 58. The major indications for surgery were biliary colic and acute cholecystitis. Patients who were asymptomatic or had vague symptoms were not recommended to undergo surgery unless they had stones in the common bile duct and were less than 71 years of age. Patients with pancreatitis were recommended for surgery if they had stones in the common bile duct and did not have a history of alcohol abuse. Performing a cholecystectomy at the same time as abdominal surgery was being performed for other reasons was indicated only if the patient was symptomatic from his gall-stones.

Acute Disease↗
PubMedDate not supplied

[Differential indications in the clinical field. Empirical study of management of indications for analytic individual and group psychotherapy respectively in a psychotherayp clinic ].

This study aims at a systematic description of factors which influence the practice of differential indication between psycho-analytic individual and group-therapy in apsychotherapeutic clinic. The self-description of inclinic patients for who individual therapy was indicated, was compared to the self-description of those who were expected to join a therapeutic group. Two personality-tests (Giessentest "GT" and Freiburger Persönlichkeitsinventar "FPI") and a symptom-questionnaire (Beschwerdenliste"BSB") were applicated. If the self-description fo patients is an important factor influencing differential indication, then a difference should be found in comparison of the self-description of both samples. The result is , that important differences are not to be found, and that, moreover the little differences are variable by the time. In conclusion, patient-centered explorations give no sufficient explanation, why group therapy was indicated in some cases and individual therapy in others. Basing on these results, differential indication in clinical psychotherapy is defined as an interactional process which is influenced by specific cognitive factors of the therapist and his clinical socialisation on the background of variable institution-bound experience.

Humans↗
PubMed1992

[Indications and counter-indications for non-mutilating treatment of breast cancer].

Progress achieved in understanding the biology of breast cancer, as well as the desire of patients to avoid major mutilation, have resulted in ever increasing indications for breast-conserving surgery. Such indications depend on two considerations: the medical consideration which seeks to achieve the same rate of control of loco-regional disease as mutilating surgery and the aesthetic consideration, permitting a satisfactory result on a functional plane. Nevertheless, a case of breast cancer appearing unifocal under clinical examination and radiology is frequently accompanied by tumoral intramammal dissemination, the evaluation of which after histological examination varies according to the author. Should the coexistence of cancer in situ and invasive cancer radically modify the choice of therapy? It seems absurd to accept non-mutilating surgery for invasive cancer and to choose mutilating treatment for certain cases of cancer in situ. Although there appears to be only relative counter-indication for conservatory treatment in cases of advanced cancer (T3N1b and above), it is not recommended in the presence of several types of histology and in certain specific circumstances when associated with cancer in situ. A review of the literature will enable us to cover in detail other risk factors and to enumerate indications and counter-indications for non-mutilating treatment of breast cancer.

Biomarkers, Tumor↗
PubMed2005

Correlation between short-term heart rate variability indices and heart rate, blood pressure indices, pressor reactivity to isometric handgrip in healthy young male subjects.

The purpose of the present study was to determine whether readily measured blood pressure (BP) indices and, responses to autonomic reflex tests could be used as surrogates of short-term heart rate variability (HRV), which is an established marker of autonomic regulation of SA node. Therefore, we examined the correlation between short-term HRV and heart rate (HR), BP indices viz. systolic pressure, diastolic pressure, pulse pressure (PP), and rate-pressure product (RPP), during supine rest and head-up tilt in 17 young healthy normotensive subjects, aged 19.8 +/- 1 yr (mean +/- SD). Three classic autonomic indices viz. Valsalva ratio, HR response to deep breathing and pressor response to isometric handgrip were also determined. We noted two interesting and statistically significant (P < 0.05 in both cases) correlations viz. i) a positive correlation (r = 0.6) between change in RPP during tilt and change in low frequency (LF) RR spectral power expressed in normalized units (LF nu) during tilt, and ii) a negative correlation (r = -0.6) between change in PP during isometric handgrip and LF nu during tilt. The possible physiologic significance of these and other correlations is discussed in this paper. In conclusion, the presence of a statistically significant correlation between RPP, PP and spectral measures of short-term HRV supports a simplistic approach to autonomic assessment, in that, easily measurable BP indices could be used as surrogates of HRV when it is not feasible to determine HRV indices directly. However, the same have to be tested in healthy subjects belonging to various age groups and in patients with conditions known to be associated with autonomic dysregulation.

Adolescent↗
PubMed1994

[Comparison of sensitivity of six indices indicating genetic damage to human blood lymphocytes by benzo(a)pyrene].

Comparison of sensitivity of six indices, i.e., SCE, MN, CA, FADU, DRSI and UDS, in detection of genetic damage to human peripheral blood lymphocytes caused by benzo(a)pyrene were studied under the same condition for in vitro toxicant treatment and cell culture. Ratio of the slope of regression straight line of concentration-response to the standard deviation of regression staigy line from observed values was used as an indicator reflecting sensitivity of all the above indices. The results showed the order of sensitivities of all the above indices are as follows: SCE > MN > CA > FADU > DRSI > UDS. SCE and MN (cytokinesis block method) should be choice of indices to monitor genetic damage in human population exposed to benzo(a)pyrene. And, it is warranted to use FADU, as a simple, convenient and rapid method, in human population monitoring.

Benzo(a)pyrene↗
PubMed1993

Indications for colonoscopy. An analysis based on indications and diagnostic yield.

Open access colonoscopy for patients with suspected colonic disease is often not practical and some form of patient selection may be necessary. One year's colonoscopic data from our unit were analysed to determine the major indications for the procedure and the diagnostic yield, and to evaluate the suitability of colonoscopy for each indication. The seven major indications were rectal bleeding, iron deficiency anaemia, cancer follow-up, polyp follow-up, abdominal pain, abnormal bowel habit and 'other'. Four hundred and forty-eight procedures were included in the analysis, with rectal bleeding, polyp follow-up and iron deficiency anaemia producing the highest diagnostic yields of 69.1%, 53.3% and 47.7% respectively. Lower yields were obtained for cancer follow-up (21%), abdominal pain (38.2%) and abnormal bowel habit (46.8%). The indication, 'other', produced a combined yield of 66.7%; the majority of patients in this group were known to have colitis. On the basis of these findings we propose that where facilities and expertise do not allow for routine colonoscopy, some form of patient selection should be employed and we believe this selection should take place according to the diagnostic yield for each indication.

Abdominal Pain↗
PubMed2003

Are performance indicators generic? The international experience of the Quality Indicator Project.

Performance indicators for healthcare organizations represent a strategy for accountability worldwide. A universal approach to either the design for indicators or their applicability to local needs remains a work in progress. The Maryland Hospital Association's Quality Indicator Project (QIP) is the only indicator-based performance measurement system used worldwide. This paper presents, for the first time in QIP's 17 years of existence, data showing why MHA's QIP may qualify as the most accepted generic methodology for healthcare performance measurement and evaluation.

Cesarean Section↗
PubMed1995

An approach to the evaluation of quality indicators of the outcome of care in hospitalized patients, with a focus on nosocomial infection indicators.

The Quality Indicator Study Group was created by the governing boards of three national professional organizations that have interest and experience in epidemiology, nosocomial infection control and prevention, and quality of care improvement. The Study Group has reviewed the existing literature concerning quality indicators (QIs), interviewed experts in the field, and focused on how best to evaluate such indicators, with an emphasis on nosocomial infection indicators as a paradigm for all QIs. In this report, we review pertinent issues and, where possible, provide specific advice on how to evaluate QIs and QI systems.

Cross Infection↗
PubMed2001

Indicators without a cause. Reflections on the development and use of indicators in health care from a public health perspective.

Indicators have a long history in public health. Since the end of the 18th century information on the health of communities has been gathered on a health system level and public health indicators have become more sophisticated over the vears. However, in many modern health care systems there is a separation between public health and health services. This paper discusses the need for integration and promotes a stronger public health orientation of health services. This has consequences for the nature of indicators on the health services level. The methodological problems of turning epidemiological data into management information for health services are discussed. The key message is that the health of the community should be the ultimate cause of all indicators.

Delivery of Health Care↗
PubMedDate not supplied

[Change in the quality of life as an indicator of the clinical course of disease. Comparison of 2 indices].

Quality of life is an important outcome measurement to judge disease impact and response to treatment; however it is very difficult to measure. We compared the MacKenzie's Change in Maximal Function Index (CMFI) with the Change in Quality of Life Index (CQLI) developed by our group. Both indices were applied on admission and upon discharge of 23 medical and surgical inpatients. The CQLI's interobserver reliability was somewhat better (Ri = 0.69) than that of the CMFI (Kw = 0.49). Both indices correlated with patient, close relative and physician assessments (rs = 0.52 to 0.86, p < 0.05). There was no correlation with Karnofsky scores. Both showed adequate responsiveness with Guyatt's coefficients between 2 and 4. Ninety five percent of the patients thought the questionnaires were easy to answer and approximately 5 minutes were enough to complete them. Both indices seem to perform better when applied by a social worker than when applied by a physician. Our results suggest that it is feasible to obtain consistent estimates of changes in quality of life. Either one of these indices may be used to assess the impact of medical intervention.

Adolescent↗