Enhancing Quality Care in Ontario Long-Term Care Homes Through Audit and Feedback for Physicians.

The province of Ontario in Canada is an example of a jurisdiction that is using a specific quality improvement mechanism, known as "audit and feedback," to help clinicians enhance the care they provide to long-term care (LTC) home residents. This program, launched in 2015, is unique in that the reports are provided across an entire jurisdiction. These reports were co-designed with clinicians, including medical directors, scientists, and other stakeholders, and are updated regularly to maintain their relevance to medical practice in LTC. The data for the reports is calculated using record linkage with available administrative data sources. The reports are updated with new data 4 times each year and emailed directly to physicians who have requested their report. The reports are designed to have an overall dashboard summarizing the practice level data with a comparison to all physicians in Ontario. More detailed information on their data such as trend data and resources for quality improvement are found in subsequent pages of the report. These reports are a tool to support physicians in quality improvement efforts in their LTC practice. We believe the role of a medical director is very important in both the uptake and use of these reports as the medical director would act as a trusted advisor who can influence quality of care overall within an LTC home. We are also testing a new format for delivering the reports in an interactive online format that enables more options for viewing practice data. Initial evaluation of these reports shows that there is a statistically significant impact on reducing the prescription of antipsychotic medications in LTC homes. In future, we hope to see a larger effect on the latest topic included in the reports: antibiotic prescribing.

Integrated care: incentives, approaches, and future considerations.

The research and demonstration programs sponsored by CMS collectively address all the dimensions of the continuum of care ranging across multiple settings of care, providers, disease types, and severity of conditions. This article reviews current CMS activities and discusses several delivery programs in local communities that include disease management and the Program in All-Inclusive Care for the Elderly (PACE) and the contributions these have made to care integration and social policy development. Methods for accelerating knowledge development affecting the development of social policy, particularly collaborative efforts with PACE programs at the local level are discussed.

A grouping interpretation of the modality effect in immediate probed recognition.

In a series of experiments on immediate probed recognition for eight 3-digit numbers, it was shown that if the target modality involved auditory components and the effect of the similarity of the modality of the probe to that of the targets was controlled, unequivocal evidence was obtained for an auditory superiority effect (modality effect) for hit rates for the final items of the list. Moreover, false-alarm rates were significantly lower following targets with an auditory component than they were following silently seen targets. It is argued that this pattern of hits and false alarms is consistent with the idea that targets that have an auditory component yield memory representations that are better grouped as units than are those for targets that are only silently seen; in particular, if a new probe has a first digit that accidentally matches the first digit of a target item, it is more likely that the subject will mistakenly identify this new probe as old (give a false alarm) if the target has only been partially encoded because it was only silently seen.