Coordinated computerized systems aimed at management, control, and quality assurance of medical processes and informatics.

PURPOSE: As part of the routine work of the medical committees in the Israel Defense Forces, a unique nationwide computerized control system is being implemented to assess and manage medical processes. The purpose of this paper is to report on that implementation. DESIGN/METHODOLOGY/APPROACH: The computerized system consists of three main components: a specific status indicating the processes in each file, an appointment system, and an internal computerized system that uses a magnetic card for the regulation of the local waiting lists. FINDINGS: The combined computerized system improves the control and management of the medical processes and informatics from the point-of-view of both the patients and system operators. Different parameters of quality control regarding the medical and administrative processes are assessed (such as efficiency), and solutions are sought. Computerized system-based design and re-allocation of human and medical resources were implemented according to the capacities and limitations of the medical system. A reduction in the daily number of invited recruits improved the quality of the medical encounters. Specific combined status codes were introduced for the efficient planning of the medical encounters. Implementation and automation of medical regulations and procedures within the computerized system make the latter play a key role and serve as a control tool during the decision-making process. ORIGINALITY/VALUE: The computerized system allows efficient follow-up and management of medical processes and informatics, led to a better utilization of human and medical resources, and becomes a component of the decision making by the system operators and the administrative staff. Such a system could be used with success in clinics, hospitals, and other medical facilities.

Quality-assuring intervention for technical medical staff at medical committees.

PURPOSE: This paper seeks to examine an intervention program which was developed in order to improve the performance and skills of technical medical personnel at the military recruitment medical committees. DESIGN/METHODOLOGY/APPROACH: Evaluation of the technician soldiers' performance was carried out by the usage of a specifically farmed survey, comprising a designed questionnaire, and direct observation of their work, including appraisal of their measurements and interpretation skills. FINDINGS: Prior to intervention, analysis revealed: insufficient knowledge of normal range of blood pressure and pulse values, visual acuity of color vision, urinalysis and their relation to the classification process at medical committees; and inadequate technicalities such as incorrect weight and height measurements. ORIGINALITY/VALUE: The model of the intervention program could be modified and adopted by medical committees, sports medicine examinations, periodic screening procedures, and primary care medicine in order to improve the quality of medical records and medical care.

Quality control and quality assurance of medical committee performance in the Israel Defense Forces.

PURPOSE: The paper aims to focus on a unique quality control system that was set up ten years ago to evaluate Medical Classification Committee decision-making processes at the Israel Defense Forces (IDF) conscription center. DESIGN/METHODOLOGY/APPROACH: Two main approaches were deployed by the control system to assess medical classification committees' performance. The first was direct assessment of the medical committees' clinical work and decision-making processes. The second applied data mining procedures to the computerized medical databases. The functional classification codes (FCCs)--codes for the most common medical disorders assigned to male recruits from the central computerized central IDF database, the sub-districts comprising the recruitment centers, and the chairmen assigning the FCCs to recruits--were all analyzed. FINDINGS: A total of 26 FCCs, each indicating a common medical problem and its severity, constituted approximately 90 percent of all FCCs assigned at recruitment centers between 2001 and 2006. Major contributors to medical profiling outcomes were underweight, asthma, chronic headache, mental illness, symptomatic scoliosis, hypnosis, chronic back pain, knee joint disorders, allergic rhinitis and sinusitis. Evaluating the computerized medical database revealed significant differences in: medical profile prevalence; recruitment center FCCs; different sub-districts in a given recruitment center; and profiling by medical committee chairmen. PRACTICAL IMPLICATIONS: Findings indicate disparities between recruitment centers and their chairmen in the medical profiling process owing to variations in recruitment center working methods and medical history taking, physical examinations, interpreting medical information and individual differences in the chairmen's decision-making process. Other reasons include technician and laboratory staff inaccuracies. These significant discrepancies highlighted the need for an intervention program. To minimize variations and create a uniform work platform, an orderly instruction system and training programs for the committee chairmen, technicians and laboratory staff were established. These actions resulted in improved performance in 2007 as confirmed by a decreased variability in the assignment of medical FCCs. ORIGINALITY/VALUE: The paper highlights methods that can be used to assess disability screening, sports medicine committees and primary care setting procedures.

Controlled whole body vibration to decrease fall risk and improve health-related quality of life of nursing home residents.

OBJECTIVE: To investigate the effects of whole body vibration in the elderly. DESIGN: Randomized controlled trial. SETTING: Nursing home. PARTICIPANTS: Forty-two elderly volunteers. INTERVENTIONS: Six-week vibration intervention plus physical therapy (PT) (n=22) or PT alone (n=20). MAIN OUTCOME MEASURES: We assessed gait and body balance using the Tinetti test (maximum scores of 12 for gait, 16 for body balance, 28 for global score), motor capacity using the Timed Up & Go (TUG) test, and health-related quality of life (HRQOL) using the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36). RESULTS: After 6 weeks, the vibration intervention group improved by a mean +/- standard deviation of 2.4+/-2.3 points on the gait score compared with no score change in the control group ( P <.001). The intervention group improved by 3.5+/-2.1 points on the body balance score compared with a decrease of 0.3+/-1.2 points in the control group ( P <.001). TUG test time decreased by 11.0+/-8.6 seconds in the treated group compared with an increase of 2.6+/-8.8 seconds in the control group ( P <.001). The intervention group had significantly greater improvements from baseline on 8 of 9 items on the SF-36 compared with the control group. CONCLUSIONS: Controlled whole body vibration can improve elements of fall risk and HRQOL in elderly patients.