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PubMed1991

Comparison of mathematical indices of fetal heart rate variability with visual assessment in the human and sheep.

Mathematical indices for quantitation of fetal heart rate variability have been proposed by numerous authors, but there have only been infrequent attempts to determine which such indices correspond to the semi-subjective evaluation of variability observed by clinicians. We have previously examined most of the published indices by using them for calculation of the variability of sets of computer-generated numbers, and seeing if they fulfill certain criteria of validity. Two sets of indices (each measuring short-term and long-term variability) were selected as acceptable. Segments of fetal heart rate records from both humans and sheep, with a wide range of subjective variability, were used to compare the mathematically derived indices with the semi-subjective evaluation of three observers. The results show that the mathematical indices of short-term variability compare closely to its subjective evaluation of being present or absent. The long-term variability of indices also increase progressively with the observers' evaluations of increasing variability. The agreement among observers, measured by Cohen's kappa test, is generally "substantial", although for some indices the agreement was "moderate" to "almost perfect". We conclude that the two sets of indices examined do quantitate what is clinically regarded as fetal heart rate variability.

Animals↗
PubMed1991

Development of medication-use indicators by the Joint Commission on Accreditation of Healthcare Organizations.

The development of indicators for monitoring medication use is described. The Joint Commission on Accreditation of Healthcare Organizations is establishing a national database for use in measuring performance. Initially, indicators were developed for specialties or clinical departments and for disease entities or procedures; now, indicators for key functions that cross departmental and specialty lines, such as medication use, are under development. An interdisciplinary core group constructed a medication-use flow chart depicting prescribing, dispensing, administering, and monitoring patient response; systems management/control was recognized as a fifth component. Sixteen processes were identified for which indicators were developed. Proposed indicators are now being tested in a small number of hospitals. The indicator data will enable institutions to identify areas for improvement. Although the Joint Commission will not use indicator rates per se to determine accreditation, it will ask an institution to provide an interpretation of indicator data that differ markedly from previous data or data for comparable institutions and to review its strategy for analyzing the rates. Use of indicator data will enhance the accreditation process by allowing for ongoing monitoring of particular aspects of performance between onsite surveys.

Algorithms↗
PubMed1991

A mid-sized hospital's experience in indicator data collection.

A hospital pharmacy department's experience in selection and use of indicators for measuring quality of care is described. At a 410-bed community teaching hospital, indicators were selected that would use data the department was already collecting. For the first indicator, "Patients on total parenteral nutrition (TPN) experiencing acid-base disorders," the goal was for no more than 20% of patients on TPN to have blood pH values outside the normal range, but 35% of patients were found to be outside the range. The standard TPN formula was examined and changed, after which only 16% of patients had pH values outside the normal range. For the second indicator, "Patients on TPN having negative nitrogen balance results," and the next two indicators, based on data available from the department's pharmacokinetics service, a similar process was followed. The department next examined incident reports and adverse drug reaction reports, categorized the drug-related problems represented, and established the indicator, "Patients on [nursing unit X] experiencing category 4 drug-related errors." Problems with indicator use included determining how an indicator relates to the quality of care and knowing how to analyze the data once they are collected. To maintain stature within their institutions by helping with the overall quality improvement effort, pharmacy departments need to expeditiously institute the use of indicators.

Acid-Base Imbalance↗
PubMed1983

[Comparison of variability (STV and LTV) indices by computer-simulated data].

Many investigators have proposed their own formula for quantitative evaluation of STV (short term variability) and LTV (long term variability). There has even been confusion over the definition itself of STV. We compared those indices by using 'beat to beat interval' computer-simulated series and found that there is little difference between the STV indices. According to the definition of STV by the Japan Society of Obstetrics and Gynecology, it is the variance in beat to beat difference, which is determined by the variance in beat to beat intervals and the autocorrelation function of the same intervals. For all the 2,500 combinations of the variability and the autocorrelation, normal random interval series were generated by the computer and five indices (Dalton, Cabal, Yeh, Heilbron and de-Haan) were compared with calculated index values using these interval series. Assigning the variability and the autocorrelation to the X-axis and the Y-axis respectively, the Z-axis was used to indicate the value of the STV. Five curved surfaces thus formed have a similar shape, which shows us that these STV indices behave the same way in accordance with the change in STV. Further, the study of LTV indices with the same simulated data showed that Yeh's LTV index indicates only the variability but has no relation-ship with the autocorrelation and both de-Haan and Heilbron's LTV indices represent the variability and the autocorrelation. However, they increase as the autocorrelation increases unlike the STV indices.

Computers↗
PubMedDate not supplied

Coronary angiography and revascularization: defining procedural indications through formal group processes. The Canadian Revascularization Panel, the Canadian Coronary Angiography Panel.

OBJECTIVES: To summarize the process and extent of interphysician agreement within two panels convened to derive indications for the appropriate use of coronary angiography and for coronary revascularization procedures. PARTICIPANTS: Two panels, each with nine practitioners. METHODS: Panelists rated the appropriateness of intervention for a comprehensive set of indications for each procedure. Indications were brief profiles created by combining and permuting clinical characteristics pertinent to case selection for intervention. Ratings were first made at home, with a second round at the panel meeting following open discussion. Final rankings of indications as 'appropriate', 'uncertain' or 'inappropriate' were based on the pattern of panelists' responses on a nine-point scale, including the median rating and extent of agreement among panelists. Agreement was defined as at least seven panelists' ratings within the three-point region containing the median rating. Panelists were later mailed a much-reduced list of indications for which there was agreement on appropriateness. These were re-rated on a necessity scale. A procedure was rated 'necessary' only if a physician was ethically obligated to recommend it as the preferred treatment option. RESULTS: For appropriateness of angiography, agreement occurred in 38.2% of indications in round 1 and 64.4% in round 2 (P < 0.0001). For coronary artery bypass graft (CABG) versus medical therapy, the corresponding increase was from 43.5 to 54.0% (P < 0.0001). Agreement on necessity of angiography occurred for 44.3% of scenarios. For indications where CABG alone was appropriate, agreement on necessity was 56%. However, for indications where percutaneous transluminal coronary angioplasty (PTCA) could be regarded as the first-line intervention, agreement on necessity was only 5%. CONCLUSIONS: A two-step panel process permitted considerable convergence of panelists' ratings, highlighting the importance of formal panel methods in setting utilization management criteria. However, the extent of continuing disagreement on ratings underscores the need to avoid a forced consensus; instead, divergent opinions should be taken as indicative of uncertainty about the appropriateness of intervention. Interpanelist agreement on necessity ratings was modest, but may help in setting benchmarks to assess possible underprovision of invasive cardiac services in Canada.

Angioplasty, Balloon, Coronary↗
PubMed1996

[Prognostic indicators in patients with liver cirrhosis admitted to an intensive care unit].

OBJECTIVES: Assessment of prognosis in patients with cirrhosis admitted to an Intensive Care Unit remains unsatisfactory. The aims of this retrospective study were to determine the survival rates of patients admitted to an Intensive Care Unit, and to identify and validate prognostic indicators associated with a high mortality rate. METHODS: Two hundred and forty three patients with cirrhosis consecutively admitted to the Intensive Care Unit were studied. The main reasons for admission were upper gastrointestinal bleeding (n = 163), coma (n = 43), sepsis (n = 18), and liver failure (n = 13). Patients were divided into two groups: group 1 (n = 121) to identify prognostic indicators associated with a high mortality rate, and group 2 (n = 122) to validate these indicators. RESULTS: Intensive Care Unit and one year survival rates of patients with cirrhosis admitted for upper gastrointestinal hemorrhage were 76 and 50% respectively. These rates were 40 and 8% respectively for patients admitted for other reasons. In group 1, 4 predictive factors found at admission were identified to have independent significance by stepwise logistic regression: grade III or IV encephalopathy, prothrombin index, serum creatinine, and hypoxemia. On the other hand, the presence of shock on admission was associated with a 100% mortality rate. Two prognostic indicators were defined: shock requiring the administration of vasoactive drugs, and the presence of 3 out of the 4 following predictive factors: grade III or IV encephalopathy, mechanical ventilation, prothrombin index < 30%, and serum creatinine > 130 mumol/L. In group 2, the presence of at least one prognostic indicator at admission or during intensive care was associated with a 96% mortality rate. These indicators were present in 69% of patients who died. In 17 patients who died, but survived more than 24 hours in the Intensive Care Unit, indicators were present an average of 6.0 +/- 5.3 days before death. CONCLUSION: Common prognostic indicators may accurately predict death in patients with cirrhosis admitted to an Intensive Care Unit. These indicators could be helpful in identifying patients who will not benefit from intensive care.

Adult↗
PubMed1995

Gas exchange indices--how valid are they?

OBJECTIVE: This study examined the arterial-alveolar oxygen tension difference (AaDO2), arterial oxygen tension to inspired oxygen fraction ratio (PaO2/FiO2) and alveolar to arterial oxygen tension ratio (PAO2/PaO2) with regard to: (i) their correlation with the calculated pulmonary shunt in critically ill patients; and (ii) the influence of the inspired oxygen fraction on these indices before, during and after general anaesthesia. DESIGN: This study comprised two sections: (i) retrospective analyses of blood gas data retrieved from the intensive care computerised database; and (ii) analyses of arterial blood gases before, during and after abdominal and orthopaedic surgery in patients subjected to various inspired fractions of oxygen. SETTING: The study was conducted at an academic hospital. PATIENTS: The first section of the study was a retrospective analysis of blood gases retrieved from a computerised database from the surgical and respiratory intensive care units. Blood gases which indicated hypoxaemia (arterial haemoglobin saturation less than 90%) were collected from patients who suffered from adult respiratory distress syndrome. The calculated pulmonary shunt was correlated with the AaDO2, PaO2/FiO2 and PAO2/PaO2. In the second section of this study, 15 patients of American Society of Anesthesiologists status 1, scheduled to undergo peripheral orthopaedic and intra-abdominal surgery, were exposed to various concentrations of inspired oxygen before, during and after general anaesthesia. At the end of a 15-minute period of exposure to a particular level of inspired oxygen (which was varied at random), arterial blood gases were analysed. A correlation was attempted between the inspired oxygen fraction and the various indices of pulmonary gas exchange. INTERVENTION: Patients were subjected to the various inspired fractions of oxygen before, during and after general anaesthesia. A radial artery cannula, inserted under local anaesthesia, allowed the researchers to collect arterial blood gas analysis. RESULTS: The correlation between the calculated pulmonary shunt and indices of gas exchange showed r = 0.35 for the AaDO2, r = 0.08 for the PaO2/FiO2 and r = 0.40 for the PAO2/PaO2. Stepwise variable selection demonstrated that the FiO2, PaCO2, PAO2 and shunt were the main components of the final models. The inspired oxygen fraction had an effect on the indices of gas exchange inasmuch as they all varied directly with the change in inspired oxygen concentration. Furthermore, the slope of this relationship was less steep during anaesthesia than in the case of values obtained before and after anaesthesia. CONCLUSIONS: The so-called non-invasive indices of pulmonary gas exchange do not correlate well with the calculated pulmonary shunt, which is regarded as the gold standard that reflects the various components of gas exchange. We speculate that the poor performance of these indices can be explained by the fact that they do not take into account the mixed venous saturation and, except for the alveolar to arterial oxygen tension ratio, ignore the effects of alveolar ventilation. The effect of the inspired oxygen fraction on these ratios makes them difficult to interpret if similar inspired oxygen fractions are not used. The effect of the FiO2 on these indices could possibly be explained by the denitrogenation and collapse of alveoli with low ventilation perfusion ratios. The change in the slope of the FiO2 and the indices that was demonstrated during anaesthesia could possibly be explained by the expected change in the mixed venous saturation that occurs during anaesthesia.

Adult↗
PubMed1996

[The use of biological indices on environmental quality assessment].

The aquatic ecosystems quality can be evaluated through the analysis of physico-chemical and biological parameters. However, the biological parameters differ from the physico-chemical ones, having the advantage of providing information on the water quality concerning longer periods of time--specially if one considers sessil organisms--thus reflecting, in a better way, the general ecological conditions of the water body. It is necessary, though, that the taxonomic information be translated into simple numerical values (indices), in order to simplify its interpretation as well as providing subsidies for the elaboration of water quality criteria. Several numerical biological indices can be applied, some of them to specific communities, and others to the hole biological community of an aquatic environment. Three kinds of indices are more generally applied to evaluate the pollutant impacts on aquatic communities: biotic, diversity and community comparison indices. The biotic indices will measure the variation in terms of tolerance and relative sensitivity of the occurring organisms to a certain pollution condition; the diversity indices evaluate the effect of pollution in terms of the community structure; the community comparison indices (also named similarity or dissimilarity indices) establish the effects of pollutants on the community composition. It is important, for the numerical indices users, to know the limitations of each method, so that the interpretation of the values obtained may be made in the light of such limitations.

Animals↗
PubMed1998

Time-dependent changes of serum carboxy-terminal peptide of type I procollagen and carboxy-terminal telopeptide of type I collagen concentrations in patients with acute myocardial infarction after successful reperfusion: correlation with left ventricular volume indices.

To test the hypothesis that in patients with acute myocardial infarction (AMI), changes in the concentrations of the serum carboxy-terminal peptide of type I procollagen (PICP) and the carboxy-terminal telopeptide of type I collagen (ICTP) reflect extracellular matrix reformation and degradation, respectively, in the infarct healing processes, we measured these serum concentrations by RIA and compared their values with left ventricular (LV) indices obtained by left ventriculography. We studied 13 consecutive patients with their first AMI who underwent successful reperfusion. Blood samples were taken the day of admission and on days 2, 3, 4, 5, 7, and 14. LV volume indices were determined at 1 month after AMI, when LV remodeling was almost completed. The serum concentrations of both PICP and ICTP changed in a time-dependent manner. The average serum PICP concentration was lower than 1 SD below the mean control values on days 2 and 3 and increased thereafter, returning to the lower end of the control range at day 14. The area under the curve (AUC) for PICP was significantly correlated with the LV end systolic (ES) and end diastolic (ED) volume indices and LV ejection fraction for the first 14 days after AMI. The serum PICP on days 5-14 was inversely correlated or tended to be correlated with the LVES and LVED volume indices. The average serum ICTP concentrations on admission were within the control range, began to increase on day 2, and reached maximal concentrations on day 5, remaining at a plateau concentration until day 14. Although the AUC of ICTP for 14 days, the ICTP concentrations on days 1 and 14, and the minimal and maximal concentrations were significantly correlated with creatine kinase (CK) release and the period from AMI onset to the peak CK time, the concentrations were not significantly correlated with any LV indices except for the concentration on day 4, which was weakly correlated with the LVES volume index. The serum concentrations of PICP showed a significant time-dependent change that correlated with LV indices, indicating that PICP may provide additional information for evaluating the healing process because it affects LV remodeling after AMI. Although the serum concentration of ICTP changed in association with CK release, the ICTP concentration was found to be a poor indicator for LV indices.

Adult↗
PubMed2005

[Integrated sustainability-oriented reporting--key indicators for communities and cities. Results of a research and development project].

In our research project -- supported by the German Federal Ministry for Education and Research (BMBF) - 35 key indicators were developed in an ongoing process in co-operation with 10 East German cities, which are all members in the German cities healthy network. With these indicators the cities should take up integrated sustainability - oriented health reporting, from which actions and projects for health promotion and prevention can be derived. The conceptual background for the research project and the reports to be made by the project in co-operation with the cities, are the three policy programmes that to be realised on a county level: Healthy Cities, Local Agenda 21 and the German city development programme "Soziale Stadt (socially oriented city)". The common goal of these programmes is the sustainable improvement of the quality of life in the counties. The project is part of the BMBF-supported research field "problem - oriented regional reporting systems", in which other projects are involved which are mainly being conducted in the newly-formed East German "Lander". In this article we describe the co-operative process of the development of the indicators. A synopsis of already applied or proposed sets of indicators for municipal reporting was the basis for the development of the project's set of 35 key indicators. The set of indicators is presented according to its usefulness for planning and realisation of actions for health promotion on county level. For each of the 35 indicators a meta - data description was made to support the counties and cities in our project for health reporting. These indicator profiles are also helpful and supportive for all counties and citiesaiming at such health reporting. The project started in May 2002 and lasts till Mai 2005, so that most reports should be completed in the spring of 2005.

Community Health Services↗
PubMed2003

The ECHI project: health indicators for the European Community.

BACKGROUND: Within the EU Health Monitoring Programme (HMP), the ECHI project has proposed a comprehensive list of 'European Community Health Indicators'. METHODS: In the design of the indicator set, a set of explicit criteria was applied. These included: i) be comprehensive and coherent, i.e. cover all domains of the public health field; ii) take account of earlier work, especially that by WHO-Europe, OECD and Eurostat; and iii) cover the priority areas that Member States and Community health policies currently pursue. Flexibility is an important characteristic of the present proposal. In ECHI, this has been emphasized by the definition of 'user-windows'. These are subsets from the overall indicator list, each of which should reflect a specific user's requirement or interest. RESULTS: The proposed indicators are, in most cases, defined as generic indicators, i.e. their actual operational definitions have not yet been attempted. This work has been, and is being carried out to a large part by other projects financed under the HMP, which cover specific areas of public health or areas of data collection. Apart from indicators covered by regularly available data, indicators (or issues) have been proposed for which data are currently difficult to collect but which from a policy point of view would be needed. CONCLUSION: All this points to the fact that establishing an indicator list which is actually used by Member States is a continuously developing process. This process is now continued by the first strand of the new EU Public Health Action Programme.

Community Health Services↗
PubMed2007

Quality of integrated care for patients with head and neck cancer: Development and measurement of clinical indicators.

BACKGROUND: To improve the quality of integrated care, we developed indicators for assessing current practice in a large reference center for head and neck oncology. METHODS: We defined a set of indicators based on integrated care literature, national evidence-based guidelines for patients with head and neck cancer, and the opinions of professionals and patients. We tested this set regarding assessment of current practice and clinimetric characteristics. RESULTS: The final set consisted of 8 integrated care indicators and 23 specific indicators for patients with head and neck cancer. Current practice assessment produced high scores for the integrated care indicators, but the specific indicators showed room for improvement. The practice test showed that 9 indicators had good applicability. CONCLUSIONS: The indicators, while based on evidence-based guidelines and the principles of integrated care, should incorporate patients' opinions and include a practice test. Our results show that the quality of integrated care for patients with head and neck cancer could be improved.

Comprehensive Health Care↗
PubMed2006

Monitoring population disability: evaluation of a new Global Activity Limitation Indicator (GALI).

OBJECTIVE: To evaluate a single item instrument, the Global Activity Limitation Indicator (GALI), to measure long-standing health related activity limitations, against several health indicators: a composite morbidity indicator, instruments measuring mental health (SCL-90R, GHQ-12), physical co-morbidity and physical limitations (ADLs, SF-36). METHODS: Cross-sectional data (n = 9168) of the 2001-National Health Interview Survey in Belgium was used to compare the GALI with other health indicators across gender, age, educational attainment and language. RESULTS: Responses to the GALI were similar to responses to other indicators of physical limitations (Limitations in Activities of Daily Living (by severity or by number of limitations), the SF-36 physical domain), to an indicator of chronic physical comorbidity and to indicators of mental health. The probability of reporting absence of long-standing activity limitation with the GALI was high in subjects without physical limitations or physical or mental conditions. This probability decreased as the severity or number of limitations, the number of physical or mental conditions increased. CONCLUSIONS: The GALI performs appropriately against other health indicators and appears to reflect long-standing activity limitation associated with both mental and physical conditions.

Activities of Daily Living↗
PubMed2001

[Concept of indicators: central element of quality management].

BACKGROUND: Explicit data on the quality of health care in addition to economic data represent major instruments of internal as well as external controlling and resource allocation. INDICATORS: Indicators are selected parameters, which are able to monitor health care in regard to particular features and (adverse) events. They have to be evaluated for their feasibility, reliability and validity. Indicators are expected to play a central role in external quality assurance in Germany, and are a key issue in recent health legislation. Combinations of indicators lead to indicator systems, which have to undergo validation as well. The "Kooperation für Transparenz und Qualität" (KTQ) which is now extensively used in Germany, is an example for an indicator-based accreditation system. PERSPECTIVES: Issues of further discussion are loss of validity of indicators due to awareness and alteration of documentation habits, public disclosure, and the evaluation of indicators by means of evidence-based medicine.

Germany↗
PubMed2005

The application of prescribing indicators to a primary care prescription database in Ireland.

OBJECTIVE: To develop appropriate prescribing indicators and apply these to Irish prescription data. METHODS: A postal survey of 145 randomly selected general practitioners working within the Eastern Health Board region of the State-supported General Medical Services scheme in Ireland regarding the applicability of selected prescribing indicators was carried out. Such indicators were then applied to aggregate prescription data. RESULTS: Prescribing indicators based on agents of questionable efficacy/poor quality prescribing and those based on good prescribing practice were thought to make suitable indicators. Low rates of prescribing were noted for indicators based on drugs of limited efficacy, e.g. cerebral and peripheral vasodilators (rate 3.1 per 1,000 prescriptions), whilst indicators based on drugs associated with good prescribing practice were associated with higher prescribing rates, e.g. the prescription of aspirin in patients receiving nitrate therapy(rate 7.13 per 1,000 patients). However, a low rate of generic prescribing (4.6%) was found amongst general practitioners in the study. The largest variability in prescribing was seen with the prescribing of peripheral and cerebral vasodilators (75th/25th centile=5.6) and the prescription of long-acting sulphonylureas (75th/25th centile=66.6). CONCLUSIONS: Quality indicators based on aggregate prescribing provide valuable information on prescribing standards and should be developed with the close involvement of prescribers.

Databases, Factual↗
PubMed1990

Tracking of health and risk indicators of cardiovascular diseases from teenager to adult: Amsterdam Growth and Health Study.

Cardiovascular disease is recognized as a serious public health problem. Because the underlying pathological processes start shortly after birth, tracking of recognized cardiovascular disease indicators during childhood and adolescence can help in developing preventive pediatric strategies. A prospective follow-up of both genetic and behavioral lifestyle parameters (serum cholesterol, blood pressure, percentage body fat, maximal oxygen uptake (VO2max), smoking, physical inactivity, and type A behavior) was designed. In the Amsterdam Growth and Health Study a population of 93 males and 107 females was measured annually from 1977 to 1980 and a fifth measurement was made in 1985. In that way longitudinal data covering a period of 8 years was collected for a group of adolescents/adults between 13 and 21 years of age. Analyses of these parameters provided the following results: The stability over the 9 years of tracking cardiovascular disease indicators, measured as the interperiod correlations, is fairly high. It varies from 0.4 to 0.8 in percentage body fat, cholesterol, and VO2max. Blood pressure values are low (between 0.3 and 0.4). The probability of 13-year-olds having relatively high values of cardiovascular disease indicators on the basis of a quartile distribution with that at age 21 indicated a moderate to high predictive value. According to the literature, the levels of subjects that are continuously relatively high over the years are more in the direction of optimal health than risk values. The exception is for percentage body fat. Interrelation of the seven cardiovascular disease indicators in constantly relatively high-risk and relatively low-risk groups during the teenage period, measured during young adulthood (21.5 years), appeared to be weak: only males and females with a high percentage body fat and a low VO2max showed significantly high total cholesterol, low high-density lipoprotein cholesterol, and high total cholesterol/high-density lipoprotein cholesterol levels. From the three environmental cardiovascular disease indicators (smoking, physical activity, and type A/B behavior) measured in 1985, only physical activity was significantly correlated among males and females with high-density lipoprotein cholesterol, percentage body fat, and VO2max. It can be concluded that measurement of percentage body fat in the early teenage period seems to be the most important cardiovascular disease indicator in predicting risk levels in the young adult. The amount of physical activity measured at young adult age is the only behavioral parameter to show a significant interrelation with other cardiovascular disease risk indicators.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed2006

Usefulness of the nursing home quality measures and quality indicators for assessing skilled nursing facility rehabilitation outcomes.

OBJECTIVE: To examine the usefulness of the nursing home quality indicators and nursing home quality measures for differentiating among providers from a rehabilitation outcomes perspective. DESIGN: Retrospective. SETTING: Skilled nursing facilities (SNFs) across the United States. PARTICIPANTS: A total of 211 SNFs. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: All quality indicators, all quality measures except for CWLS01 (residents who lose too much weight), and a set of rehabilitation outcomes including residualized FIM motor gain, the percentage of patients discharged to community, and the percentage of patients reporting "quite a lot" or "completely" prepared to manage their care at discharge from SNF-based rehabilitation. RESULTS: No quality measures correlated with any rehabilitation outcomes. Residualized FIM motor gain did not correlate with any quality indicators or quality measures. Only 1 quality indicator-prevalence of daily use of restraints (QI 22)-correlated with the rehabilitation indicator community discharge percentage. The third rehabilitation indicator, prepared to manage care at discharge, correlated (negatively) only with QI 18 incidence of decrease in range of motion. Among the rehabilitation outcomes, residualized FIM motor gain correlated significantly with both community discharge percentage and prepared to manage care at discharge. CONCLUSIONS: Patients and referrers choosing SNF-based medical rehabilitation need tools that differentiate among prospective providers from a rehabilitation outcomes perspective. Data in this study indicate that nursing home quality indicators and quality measures are inadequate for this purpose.

Aged↗
PubMed2003

Reproductive health indicators for China's rural areas.

We report community-based development of reproductive health indicators for China's rural areas. To generate these indicators, we sequenced two participatory techniques known as nominal group process and Delphi survey methodology. Nominal group process entailed grassroots reproductive health workers' generating indicators, followed by refinement and prioritization of these indicators through a consensus-building Delphi process among nationally and internationally known reproductive health experts. Major criteria for the indicators were practicality, feasibility, and measurability within China's rural areas. We explain the importance of establishing these indicators for application in rural China and other developing countries as a complement to the World Health Organization's reproductive health indicators for global monitoring; present the identified indicators; and describe lessons learned from field testing in low-, middle-, and high-income counties of China's countryside.

Adult↗