Is Anyone Paying Attention to Physician Report Cards? The Impact of Increased Availability on Consumers' Awareness and Use of Physician Quality Information.

OBJECTIVE: To determine if the release of health care report cards focused on physician practice quality measures leads to changes in consumers' awareness and use of this information. PRIMARY DATA SOURCES: Data from two rounds of a survey of the chronically ill adult population conducted in 14 regions across the United States, combined with longitudinal information from a public reporting tracking database. Both data were collected as part of the evaluation for Aligning Forces for Quality, a nationwide quality improvement initiative funded by the Robert Wood Johnson Foundation. STUDY DESIGN: Using a longitudinal design and an individual-level fixed effects modeling approach, we estimated the impact of community public reporting efforts, measured by the availability and applicability of physician quality reports, on consumers' awareness and use of physician quality information (PQI). PRINCIPAL FINDINGS: The baseline level of awareness was 12.6 percent in our study sample, drawn from the general population of chronically ill adults. Among those who were not aware of PQI at the baseline, when PQI became available in their communities for the first time, along with quality measures that are applicable to their specific chronic conditions, the likelihood of PQI awareness increased by 3.8 percentage points. For the same group, we also find similar increases in the uses of PQI linked to newly available physician report cards, although the magnitudes are smaller, between 2 and 3 percentage points. CONCLUSIONS: Specific contents of physician report cards can be an important factor in consumers' awareness and use of PQI. Policies to improve awareness and use of PQI may consider how to customize quality report cards and target specific groups of consumers in dissemination.

Simulated thermal decomposition and detonation of nitrogen cubane by molecular dynamics.

We present simulations of a model molecular solid of nitrogen cubane subject to thermal agitation and mechanical shock. A new approach, a reactive state summation potential, has been used to model nitrogen cubane dissociation. At elevated temperatures, the system decomposes to N(2) mixed with a small amount of oligomeric nitrogen. When subject to shock loading the system detonates above some critical threshold after which a shock front is self-sustained by the energy release from chemical reactions at a constant intrinsic speed. This is the first example of a fully three-dimensional atomic simulation of a chemically-sustained detonation. The spatial confinement of the shock front results in longer chain intermediates than in the case of thermal decomposition, suggesting that shock intermediates can be structurally very different from the same material subject to comparable temperatures and pressures.