Objectives.This study attempts to develop a comprehensive set of comorbidity measures for use with large administrative inpatient datasets.Methods.The study involved clinical and empirical review of comorbidity measures, development of a framework that attempts to segregate comorbidities from other

https://czresearch.com/dropbox/Elixhauser_MedCare_1998v36p8.pdf

Comorbidity measures for use with administrative data.

Pedagosko i psiholosko testiranje i procjenjivanje spadaju među najvažnije doprinose znanosti o ponasanju nasem drustvu i pružaju temeljna i znacajna poboljsanja u odnosu na ranije postupke. Iako se ne može ustvrditi da su svi testovi dovoljno usavrseni niti da su sva testiranja razborita i korisna, postoji velika kolicina informacija koje ukazuju na ucinkovitost kvalitetnih instrumenata u onim situacijama u kojima je njihovo koristenje potkrijepljeno validacijskim podacima. Pravilna upotreba testova može dovesti do boljih odluka o pojedincima i programima nego sto bi to bio slucaj bez njihovog koristenja, a također i ukazati na put za siri i pravedniji pristup obrazovanju i zaposljavanju. Međutim, losa upotreba testova može dovesti do zamjetne stete nanesene ispitanicima i drugim sudionicima u procesu donosenja odluka na temelju testovnih podataka. Cilj Standarda je promoviranje kvalitetne i eticne upotrebe testova te uspostavljanje osnovice za ocjenu kvalitete postupaka testiranja. Svrha objavljivanja Standarda je uspostavljanje kriterija za evaluaciju testova, provedbe testiranja i posljedica upotrebe testova. Iako bi evaluacija prikladnosti testa ili njegove primjene trebala ovisiti prvenstveno o strucnim misljenjima, Standardi pružaju okvir koji osigurava obuhvacanje svih relevantnih pitanja. Bilo bi poželjno da svi autori, sponzori, nakladnici i korisnici profesionalnih testova usvoje Standarde te da poticu druge da ih također prihvate.

Standards for educational and psychological testing

The Triple Aim—enhancing patient experience, improving population health, and reducing costs—is widely accepted as a compass to optimize health system per- formance. Yet physicians and other members of the health care workforce report widespread burnout and dissatisfaction. Burnout is associated with lower patient satisfaction, reduced health outcomes, and it may increase costs. Burnout thus imperils the Triple Aim. This article recommends that the Triple Aim be expanded to a Quadruple Aim, adding the goal of improving the work life of health care providers, including clinicians and staff.

/pdf/from-triple-to-quadruple-aim-care-of-the-patient-requires-3fmv5oblqa.pdf

From Triple to Quadruple Aim: Care of the Patient Requires Care of the Provider

PurposeTo systematically review articles reporting on depression, anxiety, and burnout among U.S. and Canadian medical students.MethodMedline and PubMed were searched to identify peer-reviewed English-language studies published between January 1980 and May 2005 reporting on depression, anxie

http://www.medical-mastermind-community.com/uploads/63-Systematic_Review_of_Depression_Anxiety_and.9.pdf

Systematic review of depression, anxiety, and other indicators of psychological distress among U.S. and Canadian medical students.

Self-Directed Learning, A Guide for Learners and Teachers

Purpose This longitudinal study was designed to examine changes in medical students’ empathy during medical school and to determine when the most significant changes occur. Method Four hundred fifty-six students who entered Jefferson Medical College in 2002 (n 227) and 2004 (n 229) completed the Jefferson Scale of Physician Empathy at five different times: at entry into medical school on orientation day and subsequently at the end of each academic year. Statistical analyses were performed for the entire cohort, as well as for the “matched” cohort (participants who identified themselves at all five test administrations) and the “unmatched” cohort (participants who did not identify themselves in all five test administrations). Results Statistical analyses showed that empathy scores did not change significantly during the first two years of medical school. However, a significant decline in empathy scores was observed at the end of the third year which persisted until graduation. Findings were similar for the matched cohort (n 121) and for the rest of the sample (unmatched cohort, n 335). Patterns of decline in empathy scores were similar for men and women and across specialties. Conclusions It is concluded that a significant decline in empathy occurs during the third year of medical school. It is ironic that the erosion of empathy occurs during a time when the curriculum is shifting toward patient-care activities; this is when empathy is most essential. Implications for retaining and enhancing empathy are discussed.

/pdf/the-devil-is-in-the-third-year-a-longitudinal-study-of-3qojt95jqj.pdf

The Devil is in the Third Year: A Longitudinal Study of Erosion of Empathy in Medical School

OBJECTIVE: There is a dearth of empirical research on physician empathy despite its mediating role in patient-physician relationships and clinical outcomes. This study was designed to investigate the components of physician empathy, its measurement properties, and group differences in empathy scores. METHOD: A revised version of the Jefferson Scale of Physician Empathy (with 20 Likert-type items) was mailed to 1,007 physicians affiliated with the Jefferson Health System in the greater Philadelphia region; 704 (70%) responded. Construct validity, reliability of the empathy scale, and the differences on mean empathy scores by physicians’ gender and specialty were examined. RESULTS: Three meaningful factors emerged (perspective taking, compassionate care, and standing in the patient’s shoes) to provide support for the construct validity of the empathy scale that was also found to be internally consistent with relatively stable scores over time. Women scored higher than men to a degree that was nearly signifi...

/pdf/physician-empathy-definition-components-measurement-and-4jqulyl3sk.pdf

Physician empathy: definition, components, measurement, and relationship to gender and specialty.

Purpose To test the hypothesis that physicians’ empathy is associated with positive clinical outcomes for diabetic patients. Method A correlational study design was used in a university-affiliated outpatient setting. Participants were 891 diabetic patients, treated between July 2006 and June 2009, by 29 family physicians. Results of the most recent hemoglobin A1c and LDL-C tests were extracted from the patients’ electronic records. The results of hemoglobin A1c tests were categorized into good control (7.0%) and poor control (9.0%). Similarly, the results of the LDL-C tests were grouped into good control (100) and poor control (130). The physicians, who completed the Jefferson Scale of Empathy in 2009, were grouped into high, moderate, and low empathy scorers. Associations between physicians’ level of empathy scores and patient outcomes were examined. Results Patients of physicians with high empathy scores were significantly more likely to have good control of hemoglobin A1c (56%) than were patients of physicians with low empathy scores (40%, P .001). Similarly, the proportion of patients with good LDL-C control was significantly higher for physicians with high empathy scores (59%) than physicians with low scores (44%, P .001). Logistic regression analyses indicated that physicians’ empathy had a unique contribution to the prediction of optimal clinical outcomes after controlling for physicians’ and patients’ gender and age, and patients’ health insurance. Conclusions The hypothesis of a positive relationship between physicians’ empathy and patients’ clinical outcomes was confirmed, suggesting that physicians’ empathy is an important factor associated with clinical competence and patient outcomes. Empathy, an essential component of the physician–patient relationship, may be linked to positive patient outcomes. Although this notion is consistent with the conceptual view of physician–patient relationships, 1–3 empirical data supporting the association between physicians’ empathy and tangible clinical outcomes are difficult to find. Several studies generally support the notion that the quality of the physician–patient relationship (as a proxy for empathic engagement in patient care) has a positive influence on patient

/pdf/physicians-empathy-and-clinical-outcomes-for-diabetic-3tnsgqmecm.pdf

Physicians' Empathy and Clinical Outcomes for Diabetic Patients

The present study was designed to develop a brief instrument to measure empathy in health care providers in patient care situations. Three groups participated in the study: Group 1 consisted of 55 physicians, Group 2 was 41 internal medicine residents, and Group 3 was composed of 193 third-year medical students. A 90-item preliminary version of the Empathy scale was developed based on a review of the literature and distributed to Group 1 for feedback. After pilot testing, a revised and shortened 45-item version of the instrument was distributed to Groups 2 and 3. A final version of the Jefferson Scale of Physician Empathy containing 20 items based on statistical analyses was constructed. Psychometric findings provided support for the construct validity, criterion-related validity (convergent and discriminant), and internal consistency reliability (coefficient alpha) of the scale scores.

The Jefferson Scale of Physician Empathy: Development and Preliminary Psychometric Data:

Context It has been reported that medical students become more cynical as they progress through medical school. This can lead to a decline in empathy. Empirical research to address this issue is scarce because the definition of empathy lacks clarity, and a tool to measure empathy specifically in medical students and doctors has been unavailable.

Objective  To examine changes in empathy among medical students as they progress through medical school.

Materials and subjects  A newly developed scale (Jefferson Scale of Physician Empathy [JSPE], with 20 Likert-type items) was administered to 125 medical students at the beginning (pretest) and end (post-test) of Year 3 of medical school. This scale was specifically developed for measuring empathy in patient care situations and has acceptable psychometric properties.

Methods  In this prospective longitudinal study, the changes in pretest/post-test empathy scores were examined by using t-test for repeated measure design; the effect size estimates were also calculated.

Results  Statistically significant declines were observed in 5 items (P < 0.01) and the total sores of the JSPE (P < 0.05) between the 2 test administrations.

Conclusions  Although the decline in empathy was not clinically important for all of the statistically significant findings, the downward trend suggests that empathy could be amenable to change during medical school. Further research is needed to identify factors that contribute to changes in empathy and to examine whether targeted educational programmes can help to retain, reinforce and cultivate empathy among medical students for improving clinical outcomes.

/pdf/an-empirical-study-of-decline-in-empathy-in-medical-school-3nv5gie5jp.pdf

Joseph S. Gonnella

Papers

The Devil is in the Third Year: A Longitudinal Study of Erosion of Empathy in Medical School

Physician empathy: definition, components, measurement, and relationship to gender and specialty.

Physicians' Empathy and Clinical Outcomes for Diabetic Patients

The Jefferson Scale of Physician Empathy: Development and Preliminary Psychometric Data:

An empirical study of decline in empathy in medical school