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2.
Science ; 366(6471)2019 12 13.
Artículo en Inglés | MEDLINE | ID: mdl-31831643

RESUMEN

Natural and seminatural ecosystems must be at the forefront of efforts to mitigate and adapt to climate change. In the urgency of current circumstances, ecosystem restoration represents a range of available, efficient, and effective solutions to cut net greenhouse gas emissions and adapt to climate change. Although mitigation success can be measured by monitoring changing fluxes of greenhouse gases, adaptation is more complicated to measure, and reductions in a wide range of risks for biodiversity and people must be evaluated. Progress has been made in the monitoring and evaluation of adaptation and mitigation measures, but more emphasis on testing the effectiveness of proposed strategies is necessary. It is essential to take an integrated view of mitigation, adaptation, biodiversity, and the needs of people, to realize potential synergies and avoid conflict between different objectives.

3.
Mitig Adapt Strateg Glob Chang ; 23(2): 187-209, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-30093829

RESUMEN

Adaptation is increasingly recognised as essential when dealing with the adverse impacts of climate change on societies, economies and the environment. However, there is insufficient information about the effectiveness of adaption policies, measures and actions. For this reason, the establishment of monitoring programmes is considered to be necessary. Such programmes can contribute to knowledge, learning and data to support adaptation governance. In the European Union (EU), member states are encouraged to develop National Adaptation Strategies (NASs). The NASs developed so far vary widely because of differing views, approaches and policies. A number of member states have progressed to monitoring and evaluating the implementation of their NAS. It is possible to identify key elements in these monitoring programmes that can inform the wider policy learning process. In this paper, four generic building blocks for creating a monitoring and evaluation programme are proposed: (1) definition of the system of interest, (2) selection of a set of indicators, (3) identification of the organisations responsible for monitoring and (4) definition of monitoring and evaluation procedures. The monitoring programmes for NAS in three member states-Finland, the UK and Germany-were analysed to show how these elements have been used in practice, taking into account their specific contexts. It is asserted that the provision of a common framework incorporating these elements will help other member states and organisations within them in setting up and improving their adaptation monitoring programmes.

4.
J Health Serv Res Policy ; 10(3): 167-72, 2005 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-16053593

RESUMEN

OBJECTIVES: To assess and quantify the impact of guarantees on maximum waiting times on clinical decisions to admit patients from waiting lists for orthopaedic surgery. METHODS: Before and after comparative study, analysing changes in waiting times distributions between 1997/8 and 2001/2 for waiting list and booked inpatients and day cases admitted for elective treatments in trauma and orthopaedics in English hospitals. RESULTS: The 2001/2 maximum waiting time target of 15 months did change the pattern of admissions for trauma and orthopaedic elective inpatients, with a net increase in admissions in that year, compared with 1997/8 (and over and above the 30,259 (7.6%) overall increase in all admissions) of patients who had waited around 15 months, of 9333. There was little indication that these additional admissions displaced shorter wait patients. In absolute and proportional terms, admissions increased for all waiting time categories except very short waiter-- one to two weeks (an absolute fall of 2901 and a relative fall of 6591), and those waiting 40--41 weeks. The latter fall was only 111 patients in absolute terms (or 577 relative to the expected increase), however. The former much larger reduction may be an indication of clinical distortions, but it is unclear why very short wait (presumably more urgent) patients should disproportionately suffer compared with longer wait (presumably less urgent) cases. In addition, there was little indication that more minor cases usurped more major cases: 57% of the increase consisted of knee and hip replacement procedures, for example. CONCLUSIONS: While the 2001/2 waiting times target demonstrably changed admission patterns (and was a major contribution to the reduction in long waits), the extent to which this represented significant and clinically relevant distortions is questionable given the lack of widely accepted admission criteria. However, as targets become progressively tougher, there is a need to monitor consultants' concerns more closely.


Asunto(s)
Objetivos Organizacionales , Ortopedia/organización & administración , Listas de Espera , Inglaterra , Humanos , Medicina Estatal/organización & administración
5.
BMJ ; 330(7497): 929, 2005 Apr 23.
Artículo en Inglés | MEDLINE | ID: mdl-15833750

RESUMEN

OBJECTIVES: To investigate whether routinely collected data from hospital episode statistics could be used to identify the gynaecologist Rodney Ledward, who was suspended in 1966 and was the subject of the Ritchie inquiry into quality and practice within the NHS. DESIGN: A mixed scanning approach was used to identify seven variables from hospital episode statistics that were likely to be associated with potentially poor performance. A blinded multivariate analysis was undertaken to determine the distance (known as the Mahalanobis distance) in the seven indicator multidimensional space that each consultant was from the average consultant in each year. The change in Mahalanobis distance over time was also investigated by using a mixed effects model. SETTING: NHS hospital trusts in two English regions, in the five years from 1991-2 to 1995-6. Population Gynaecology consultants (n = 143) and their hospital episode statistics data. MAIN OUTCOME MEASURE: Whether Ledward was a statistical outlier at the 95% level. RESULTS: The proportion of consultants who were outliers in any one year (at the 95% significance level) ranged from 9% to 20%. Ledward appeared as an outlier in three of the five years. Our mixed effects (multi-year) model identified nine high outlier consultants, including Ledward. CONCLUSION: It was possible to identify Ledward as an outlier by using hospital episode statistics data. Although our method found other outlier consultants, we strongly caution that these outliers should not be overinterpreted as indicative of "poor" performance. Instead, a scientific search for a credible explanation should be undertaken, but this was outside the remit of our study. The set of indicators used means that cancer specialists, for example, are likely to have high values for several indicators, and the approach needs to be refined to deal with case mix variation. Even after allowing for that, the interpretation of outlier status is still as yet unclear. Further prospective evaluation of our method is warranted, but our overall approach may be potentially useful in other settings, especially where performance entails several indicator variables.


Asunto(s)
Competencia Clínica/normas , Ginecología/normas , Indicadores de Calidad de la Atención de Salud , Consultores/estadística & datos numéricos , Recolección de Datos , Interpretación Estadística de Datos , Inglaterra , Episodio de Atención , Ginecología/estadística & datos numéricos , Hospitales Públicos/normas , Hospitales Públicos/estadística & datos numéricos , Humanos , Análisis Multivariante , Estudios Retrospectivos
6.
J Health Serv Res Policy ; 9(2): 100-3, 2004 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-15099457

RESUMEN

OBJECTIVES: In-hospital death counts derived from hospital computer systems have been used in England by an independent company, 'Dr Foster', to rank the quality of care of hospitals, but the validity of the underlying data remains unclear. This study compares counts of in-hospital deaths using two different sources - the hospital computer system and the mortuary register - to determine: whether the counts of in-hospital deaths from these two sources differed; qualitative explanations for possible sources of discrepancy; the direction and magnitude of any differences; and the possible impact of any differences on the Dr Foster rankings. METHODS: The four highest and the four lowest National Health Service (NHS) hospitals in the West Midlands, as ranked by Dr Foster, participated. Each hospital was asked to compare the monthly counts of in-hospital deaths from the hospital computer system and the hospital mortuary register for the fiscal year 1999/2000. RESULTS: One hospital, with a computerised mortuary register, had identical counts of in-hospital deaths. Two hospitals reported 4-5% more deaths and four hospitals reported fewer deaths (0.4-7%) from their hospital computer system than from their mortuary register. These differences were not large enough to change their Dr Foster rankings. Wide discrepancies were noted on a monthly basis (range: -13.9% to +15.9%). DISCUSSION: The differences between the two sources of in-hospital death counts were not large enough to influence the Dr Foster ranks but were sufficient to raise concern about the validity and completeness of mortality data in the NHS.


Asunto(s)
Sistemas de Información en Hospital/normas , Mortalidad Hospitalaria , Hospitales Públicos/estadística & datos numéricos , Sistema de Registros/normas , Actitud del Personal de Salud , Certificado de Defunción , Inglaterra/epidemiología , Episodio de Atención , Administradores de Hospital/psicología , Sistemas de Información en Hospital/estadística & datos numéricos , Hospitales Públicos/clasificación , Hospitales Públicos/normas , Humanos , Auditoría Médica , Sistema de Registros/estadística & datos numéricos , Reproducibilidad de los Resultados , Medicina Estatal/estadística & datos numéricos
7.
Health Serv J ; 113(5849): 24-7, 2003 Apr 03.
Artículo en Inglés | MEDLINE | ID: mdl-12698725

RESUMEN

Trusts vary greatly on their progress in achieving waiting-list targets, particularly for 2005. A study of trusts with a range of performances identified four key criteria: information use, managerial focus, capacity and long-term efficiency. Actions that help a trust 'catch up' rarely help them 'keep up; strategies may need to change once waiting lists have fallen markedly. Flexibility, forward planning and 'expecting the unexpected' are characteristics of successful trusts.


Asunto(s)
Eficiencia Organizacional , Hospitales Públicos/organización & administración , Listas de Espera , Investigación sobre Servicios de Salud , Técnicas de Planificación , Medicina Estatal , Reino Unido
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