Evaluating the collection, comparability and findings of six global surgery indicators.

BACKGROUND: In 2015, six indicators were proposed to evaluate global progress towards access to safe, affordable and timely surgical and anaesthesia care. Although some have been adopted as core global health indicators, none has been evaluated systematically. The aims of this study were to assess the availability, comparability and utility of the indicators, and to present available data and updated estimates. METHODS: Nationally representative data were compiled for all World Health Organization (WHO) member states from 2010 to 2016 through contacts with official bodies and review of the published and grey literature, and available databases. Availability, comparability and utility were assessed for each indicator: access to timely essential surgery, specialist surgical workforce density, surgical volume, perioperative mortality, and protection against impoverishing and catastrophic expenditure. Where feasible, imputation models were developed to generate global estimates. RESULTS: Of all WHO member states, 19 had data on the proportion of the population within 2h of a surgical facility, 154 had data on workforce density, 72 reported number of procedures, and nine had perioperative mortality data, but none could report data on catastrophic or impoverishing expenditure. Comparability and utility were variable, and largely dependent on different definitions used. There were sufficient data to estimate that worldwide, in 2015, there were 2 038 947 (i.q.r. 1 884 916-2 281 776) surgeons, obstetricians and anaesthetists, and 266·1 (95 per cent c.i. 220·1 to 344·4) million operations performed. CONCLUSION: Surgical and anaesthesia indicators are increasingly being adopted by the global health community, but data availability remains low. Comparability and utility for all indicators require further resolution.

Patient Load per RN Decreases in New Jersey Over Seven-Year Period.

Decrease coincides with national trends and public reporting of nurse staffing levels.

Taking the measure of the profession: Physician associations in the measurement age.

Systematic measurement of healthcare services enables evaluation of health professionals' quality of work. Whereas policy makers find measurement a useful mechanism for quality improvement, a public choice perspective implies that physicians would resent such an initiative, which undermines their professional autonomy. In this article, we compare two healthcare systems of economically developed countries - Israel and the UK. Both systems share common features such as universal coverage, strong state intervention, and enthusiasm for New Public Management. In both countries, quality measurement was introduced in acute care hospitals at around the same time. However, while the UK succeeded in establishing a framework of surgical outcome measures during the 2000s, a similar initiative in Israel failed completely during the 1990s. We also refer to subsequent quality indicator efforts in Israel, in both community and hospital frameworks, that were more successful, but in a way that reinforces our central thesis. We contend that differences in reform outcomes stem from the medical profession's reaction to government's endeavors. This response, in turn, hinges on the professional organizations' relative institutional position vis-a-vis state authorities. This study constitutes a unique investigation of the medical profession's response to critical quality measurement reforms. Most importantly, it stresses the institutional position of medical associations as the primary factor in explaining cross-case variation in government's success in introducing quality measurement.

Medicare's Physician Quality Reporting System (PQRS): quality measurement and beneficiary attribution.

PURPOSE: To explore two issues that are relevant to inclusion of PQRS reporting in a value-based payment system: (1) what are the characteristics of PQRS reports and the providers who file them; and (2) could PQRS provide active attribution information to supplement existing attribution algorithms? DESIGN AND METHODS: Using data from five states for the years 2008 (the first full year of the program) and 2009, we examined the number and type of providers who reported PQRS measures and the types of measures that were reported. We then compared the PQRS reporting provider to the provider who supplied the plurality of the beneficiary's non-hospital evaluation and management (NH-E&M) visits. RESULTS: Although PQRS-reporting providers provide only 17 percent of the beneficiary's NH-E&M visits on average in 2009, the provider who provided the plurality of visits supplied only 50 percent of such visits, on average. IMPLICATIONS: PQRS reporting alone cannot solve the attribution problem that is inherent in traditional fee-for-service Medicare, but as PQRS participation increases, it could help improve both attribution and information regarding the quality of health care services delivered to Medicare beneficiaries.