background We have little systematic information about the extent to which standard processes involved in health care — a key element of quality — are delivered in the United States. methods We telephoned a random sample of adults living in 12 metropolitan areas in the United States and asked them about selected health care experiences. We also received written consent to copy their medical records for the most recent two-year period and used this information to evaluate performance on 439 indicators of quality of care for 30 acute and chronic conditions as well as preventive care. We then constructed aggregate scores. results Participants received 54.9 percent (95 percent confidence interval, 54.3 to 55.5) of recommended care. We found little difference among the proportion of recommended preventive care provided (54.9 percent), the proportion of recommended acute care provided (53.5 percent), and the proportion of recommended care provided for chronic conditions (56.1 percent). Among different medical functions, adherence to the processes involved in care ranged from 52.2 percent for screening to 58.5 percent for follow-up care. Quality varied substantially according to the particular medical condition, ranging from 78.7 percent of recommended care (95 percent confidence interval, 73.3 to 84.2) for senile cataract to 10.5 percent of recommended care (95 percent confidence interval, 6.8 to 14.6) for alcohol dependence. conclusions The deficits we have identified in adherence to recommended processes for basic care pose serious threats to the health of the American public. Strategies to reduce these deficits in care are warranted.

/pdf/the-quality-of-health-care-delivered-to-adults-in-the-united-22gtu1x925.pdf

The quality of health care delivered to adults in the United States.

https://www.chpso.org/sites/main/files/file-attachments/chest-2008-geerts-381s-453s.pdf

Prevention of Venous Thromboembolism* American College of Chest Physicians Evidence- Based Clinical Practice Guidelines (8th Edition)

Health providers face the problem of trying to make decisions in situations where there is insufficient information and also where there is an overload of (often contradictory) information. Statistical methods such as meta-analysis have been developed to summarise and to resolve inconsistencies in study findings—where information is available in an appropriate form. Consensus methods provide another means of synthesising information, but are liable to use a wider range of information than is common in statistical methods, and where published information is inadequate or non-existent these methods provide a means of harnessing the insights of appropriate experts to enable decisions to be made. Two consensus methods commonly adopted in medical, nursing, and health services research—the Delphi process and the nominal group technique (also known as the expert panel)—are described, together with the most appropriate situations for using them; an outline of the process involved in undertaking a study using each method is supplemented by illustrations of the authors' work. Key methodological issues in using the methods are discussed, along with the distinct contribution of consensus methods as aids to decision making, both in clinical practice and in health service development.



This is the sixth in a series of seven articles describing non-quantitative techniquesand showing their value in health research



Quantitative methods such as meta-analysis have been developed to provide statistical overviews of the results of clinical trials and to resolve inconsistencies in the results of published studies. Consensus methods are another means of dealing with conflicting scientific evidence. They allow a wider range of study types to be considered than is usual in statistical reviews. In addition they allow a greater role for the qualitative assessment of evidence (box 1). These methods, unlike those described in the other papers in this series, are primarily concerned with deriving quantitative estimates through qualitative …

/pdf/consensus-methods-for-medical-and-health-services-research-vfufdnfo1u.pdf

Consensus methods for medical and health services research.

Proposed international clinical diabetic retinopathy and diabetic macular edema disease severity scales

To comprehend the results of a randomized controlled trial (RCT), readers must understand its design, conduct, analysis and interpretation. That goal can only be achieved through complete transparency from authors. Despite several decades of educational efforts, the reporting of RCTs needs improvement. Investigators and editors developed the original CONSORT (Consolidated Standards of Reporting Trials) statement to help authors improve reporting by using a checklist and flow diagram. The revised CONSORT statement presented in this paper incorporates new evidence and addresses some criticisms of the original statement.

http://www.people.vcu.edu/~albest/Guidance/CONSORTjama.pdf

The CONSORT statement: revised recommendations for improving the quality of reports of parallel group randomized trials

BACKGROUND: Lack of consensus on the meaning of eHealth has led to uncertainty among academics, policymakers, providers and consumers. This project was commissioned in light of the rising profile of eHealth on the international policy agenda and the emerging UK National Programme for Information Technology (now called Connecting for Health) and related developments in the UK National Health Service.

OBJECTIVES: To map the emergence and scope of eHealth as a topic and to identify its place within the wider health informatics field, as part of a larger review of research and expert analysis pertaining to current evidence, best practice and future trends.

METHODS: Multiple databases of scientific abstracts were explored in a nonsystematic fashion to assess the presence of eHealth or conceptually related terms within their taxonomies, to identify journals in which articles explicitly referring to eHealth are contained and the topics covered, and to identify published definitions of the concept. The databases were Medline (PubMed), the Cumulative Index of Nursing and Allied Health Literature (CINAHL), the Science Citation Index (SCI), the Social Science Citation Index (SSCI), the Cochrane Database (including Dare, Central, NHS Economic Evaluation Database [NHS EED], Health Technology Assessment [HTA] database, NHS EED bibliographic) and ISTP (now known as ISI proceedings).We used the search query, “Ehealth OR e-health OR e*health”. The timeframe searched was 1997-2003, although some analyses contain data emerging subsequent to this period. This was supplemented by iterative searches of Web-based sources, such as commercial and policy reports, research commissioning programmes and electronic news pages. Definitions extracted from both searches were thematically analyzed and compared in order to assess conceptual heterogeneity.

RESULTS: The term eHealth only came into use in the year 2000, but has since become widely prevalent. The scope of the topic was not immediately discernable from that of the wider health informatics field, for which over 320000 publications are listed in Medline alone, and it is not explicitly represented within the existing Medical Subject Headings (MeSH) taxonomy. Applying eHealth as narrative search term to multiple databases yielded 387 relevant articles, distributed across 154 different journals, most commonly related to information technology and telemedicine, but extending to such areas as law. Most eHealth articles are represented on Medline. Definitions of eHealth vary with respect to the functions, stakeholders, contexts and theoretical issues targeted. Most encompass a broad range of medical informatics applications either specified (eg, decision support, consumer health information) or presented in more general terms (eg, to manage, arrange or deliver health care). However the majority emphasize the communicative functions of eHealth and specify the use of networked digital technologies, primarily the Internet, thus differentiating eHealth from the field of medical informatics. While some definitions explicitly target health professionals or patients, most encompass applications for all stakeholder groups. The nature of the scientific and broader literature pertaining to eHealth closely reflects these conceptualizations.

CONCLUSIONS: We surmise that the field – as it stands today – may be characterized by the global definitions suggested by Eysenbach and Eng.

 [J Med Internet Res 2005;7(1):e9]

/pdf/what-is-ehealth-4-a-scoping-exercise-to-map-the-field-2f66a3soet.pdf

What Is eHealth (4): A Scoping Exercise to Map the Field

Background To assess the overuse and underuse of medical procedures, various methods have been developed, but their reproducibility has not been evaluated. This study estimates the reproducibility of one commonly used method. Methods We performed a parallel, three-way replication of the RAND–University of California at Los Angeles appropriateness method as applied to two medical procedures, coronary revascularization and hysterectomy. Three nine-member multidisciplinary panels of experts were composed for each procedure by stratified random sampling from a list of experts nominated by the relevant specialty societies. Each panel independently rated the same set of clinical scenarios in terms of the appropriateness of the relevant procedure on a risk–benefit scale ranging from 1 to 9. Final ratings were used to classify the procedure in each scenario as necessary or not necessary (to evaluate underuse) and inappropriate or not inappropriate (to evaluate overuse). Reproducibility was measured by overall agr...

The Reproducibility of a Method to Identify the Overuse and Underuse of Medical Procedures

Theories of coalition formation

Purpose Most patients with colorectal liver metastases present to general surgeons and oncologists without a specialist interest in their management. Since treatment strategy is frequently dependent on the response to earlier treatments, our aim was to create a therapeutic decision model identifying appropriate procedure sequences. Methods We used the RAND Corporation/University of California, Los Angeles Appropriateness Method (RAM) assessing strategies of resection, local ablation and chemotherapy. After a comprehensive literature review, an expert panel rated appropriateness of each treatment option for a total of 1,872 ratings decisions in 252 cases. A decision model was constructed, consensus measured and results validated using 48 virtual cases, and 34 real cases with known outcomes. Results Consensus was achieved with overall agreement rates of 93.4 to 99.1%. Absolute resection contraindications included unresectable extrahepatic disease, more than 70% liver involvement, liver failure, and being su...

https://ascopubs.org/doi/pdf/10.1200/JCO.2005.08.722

OncoSurge: A Strategy for Improving Resectability With Curative Intent in Metastatic Colorectal Cancer

This study explores the relationship between group size and member cooperation when individual and group interests conflict. Existing theories incorrectly imply that larger groups should experience more difficulty in providing “public goods” (goods whose benefits are not confined to the purchaser). A theoretically based typology that identifies nine systematic patterns associated with changes in group size and parameters of individual and group payoff structure is presented. The typology describes nine different ways in which group size can affect cooperation in the provision of public goods. In a computer-administered experiment using three of these nine types and group sizes of three, six, and nine, 90 college students were given sequences of opportunities to choose between “cooperation” (which benefited everyone) and “noncooperation” (which benefited the chooser but harmed everyone else). For one of these types, a counter-intuitive but theoretically predicted positive relationship between group size an...

James P. Kahan

Papers

What Is eHealth (4): A Scoping Exercise to Map the Field

The Reproducibility of a Method to Identify the Overuse and Underuse of Medical Procedures

Theories of coalition formation

OncoSurge: A Strategy for Improving Resectability With Curative Intent in Metastatic Colorectal Cancer

Cooperation and Group Size in the N-Person Prisoners' Dilemma