RESUMEN
In today's managed care healthcare environment, there is a need for hospitals and physician groups alike to know the true quality and costs of healthcare services provided to patients. As the movement toward having providers accept risk via financial capitation escalates, quality improvement professionals involved in outcomes management are increasingly being asked to investigate information sources and systems that can prove helpful in managing effectively within these limitations. As a result, there is a high degree of interest in comparative performance outcomes measurement data based on risk-adjusted and severity-adjusted data. This article explains the key features of performance outcomes measurement systems and notes concerns that should be considered when evaluating these software systems for selection.
Asunto(s)
Benchmarking , Evaluación de Resultado en la Atención de Salud/métodos , Capitación , Costos y Análisis de Costo , Grupos Diagnósticos Relacionados , Educación Continua , Administración Hospitalaria/economía , Administración Hospitalaria/normas , Humanos , Auditoría Administrativa/métodos , Evaluación de Resultado en la Atención de Salud/economía , Administración de la Práctica Médica/economía , Administración de la Práctica Médica/normas , Pautas de la Práctica en Medicina/estadística & datos numéricos , Gestión de Riesgos , Programas Informáticos , Estados UnidosRESUMEN
BACKGROUND: The effect of urbanization on age-adjusted lung cancer mortality rates in US counties is investigated. The data come from National Cancer Institute, and urban trends are estimated in time periods 1970-1979 and 1980-1987, for both white males and white females. To account for possibly different gradients in different parts of the country, the 48 contiguous states are divided into seven regions. METHODS: A measure of urbanness, urbanicity, is defined and is used to stratify counties. A multiplicative model is proposed that relates county mortality rates to urbanicity. The residuals from this multiplicative model serve as age- and urban-adjusted rates. RESULTS: Urban-rural gradients are significant for nearly all regions for both white males and white females, diminishing slightly in the latter time period for white males but becoming stronger for white females. CONCLUSIONS: The age- and urban-adjusted rates may be used in mapping to investigate geographical patterns that remain after removal of the urban factor.
Asunto(s)
Neoplasias Pulmonares/mortalidad , Urbanización/tendencias , Población Blanca/estadística & datos numéricos , Femenino , Geografía , Humanos , Masculino , Modelos Estadísticos , Distribución de Poisson , Estados Unidos/epidemiologíaRESUMEN
A sensitive and reliable method was developed for the identification and quantitation of cannabinoids in blood. Samples were screened by fluorescence polarization immunoassay. Analysis was completed on a benchtop mass selective detector using selected ion monitoring. The limits of detection were 0.2 ng/mL for delta9-tetrahydrocannabinol (THC and 11-hydroxy-THC and 2 ng/mL for 11-nor-9-carboxy-THC. Extensive method validation is presented, including within-run variation, between-run variation, and results from external proficiency testing. Sample stability was studied over a 6-month period. Several derivatives and extraction techniques were evaluated to determine optimum performance. Data from a blind study of 217 samples were used to determine the predictive value of the screening procedure. The procedure is used routinely in the laboratory on samples from drivers issued a citation for impaired driving and also on postmortem blood from death investigations.