Evaluation & the Health Professions

Spector, William D.; Mukamel, Dana B.

doi: 10.1177/016327879802100301pmid: 10350953

Recent concerns about containing the growth of public expenditures on nursing home care and the development of prospective and casemix reimbursement systems with incentives for cost containment have increased the importance of monitoring quality in nursing homes. The current view is that quality assurance systems should include more outcome measures to improve quality. This article discusses why it is difficult to develop facilitylevel outcome measures that can be used to evaluate and compare the quality of care of nursing homes. The article places the current interest in outcomes measures in its historical policy context and reviews important conceptual and methodological issues associated with outcome-based quality assessment. The authors discuss the difficulty in isolating the facility effect when studying nursing home outcomes and implications of using different estimation approaches. In conclusion, they discuss the need to integrate research with outcome-based quality assurance systems to allow ongoing evaluation and quality improvement.

Rosenthal, Gary E.; Chren, Mary-Margaret; Lasek, Rebecca J.; Landefeld, C. Seth

doi: 10.1177/016327879802100302pmid: 10350954

Consumers' guides that profile the quality of care of individual health care providers may be influential in shaping health care markets. We propose four simple questions that can be used to evaluate such guides: (a) Does the guide measure distinct and important domains of health care quality? (b) Are the individual measures of quality described simply and precisely? (c) Do the measures take into account relevant differences between patients? (d) Are the ratings of quality presentedfairly? Using these four questions, we examine the validity of one prominent guide that annually identifies America's best hospitals and present a set of recommendationsfor the design of future guides. Although the evaluation of health care quality is undoubtedly complex, the four questions that we pose provide a basisfordeveloping a more rational approach to informing the public about health care quality.

McConnochie, Kenneth M.; Roghmann, Klaus J.; Liptak, Gregory S.

doi: 10.1177/016327879802100303pmid: 10350955

Objectives were to examine geographic variation in rates of infant hospitalizationfor diagnostic clusters in Monroe County (Rochester), New York and to assess these clusters as indexes of child health. ICD-9 codes were used to cluster all 7,883 hospitalizations of infants (< 24 months) between 1985 and 1991 on the basis oftheiravoidability. Environmentally sensitive clusters accounted for 63% of admissions. These clusters included environmental, environmental/constitutional, and other infectious disease. Disparities in morbidity between inner city and suburbs were greatest for the environmental cluster, followed by the environmental/constitutional, and other infectious disease clusters. For the constitutional and quality indicator clusters, differences between inner-city and suburban risk were minimal. Environmental interventions may be more important than improved health services to reducing racial and economic disparities in child health. Analysis of morbidity clusters, ascertained from available administrative data bases and aggregated.for small geographic areas, may guide child health policy well.

Griffith, Charles H.; Wilson, John F.; Rich, Eugene C.

doi: 10.1177/016327879802100304pmid: 10350956

The purpose of this project was to assess if providing physicians (house staff) with routine comprehensive social history information on their patients will improve patient outcomes. Comprehensive social history information was gathered over a S-month period on 134 consecutive patients. Patients were randomized to have social history information provided or not provided to the resident physician caringfor them. Outcomes of interest were: patient satisfaction, length of stay, and early unplanned readmission. Analysis was with analysis of covariance, controlling for patient severity of illness and amount of social history information documented by the house officer Outcomes were the same for patients for whom house staff were provided social history information versus those for whom the information was not provided. The authors conclude that providing house staff with routine comprehensive social history information did not influence patient outcomes.

Card, Josefina J.; Peterson, James L.; Niego, Starr; Brindis, Claire

doi: 10.1177/016327879802100305pmid: 10350957

This article presents the Prevention Minimum Evaluation Data Set (PMEDS), a ready-to-use questionnaire or tool for evaluating teen pregnancy prevention and teen STD/HIV/AIDS prevention programs. Recognizing the diversity of approaches taken by these programs, PMEDS has two parts. Part I contains a primary questionnaire applicable to all programs. Part 2 consists of 15 additional supplementary modules for optional use by programs with a more specific target population or intervention approach that matches the module's content. It is hoped that PMEDS will facilitate the conducting of high-quality evaluations, first by highlighting important aspects of a program model that should be included in an evaluation, such as the demographic profile of the target population, the specific aspects of the intervention or treatment received by each participant, and the short-term outcomes and long-term goals that the program is trying to affect; second, by presenting measuresfor these evaluation constructs that have been extensively pretested and used in large-scale national studies and .for which national comparison norms and data exist.

Mavis, Brian E.; Brocato, Joseph J.

doi: 10.1177/016327879802100306pmid: 10350958

The advent of computer-based technology has led to a consideration of change in research methods that exploit the advantages of computer-mediated communications. In survey research, electronic mail (e-mail) has anecdotally shown particular promise as a data collection tool. This article compares traditional postal and nontraditional e-mail surveys within the context of a larger listserv evaluation project in terms of overall return rate, distribution of survey returns over time, response to initial and follow-up mailings, representativeness of respondent groups, thoroughness of survey completion, and the likelihood of respondents to include additional written comments. In summary, whereas postal surveys were shown to be superior to e-mail surveys with regard to response rate, all things being equal, the decision of which to use may be situation-specific, dependent on issues such as survey cost, desire for convenience and timeliness in data collection, and need for higher response rates, among others.