Towards global consensus on outcome measures for atopic eczema research: results of the HOME II meeting.

The use of nonstandardized and inadequately validated outcome measures in atopic eczema trials is a major obstacle to practising evidence-based dermatology. The Harmonising Outcome Measures for Eczema (HOME) initiative is an international multiprofessional group dedicated to atopic eczema outcomes research. In June 2011, the HOME initiative conducted a consensus study involving 43 individuals from 10 countries, representing different stakeholders (patients, clinicians, methodologists, pharmaceutical industry) to determine core outcome domains for atopic eczema trials, to define quality criteria for atopic eczema outcome measures and to prioritize topics for atopic eczema outcomes research. Delegates were given evidence-based information, followed by structured group discussion and anonymous consensus voting. Consensus was achieved to include clinical signs, symptoms, long-term control of flares and quality of life into the core set of outcome domains for atopic eczema trials. The HOME initiative strongly recommends including and reporting these core outcome domains as primary or secondary endpoints in all future atopic eczema trials. Measures of these core outcome domains need to be valid, sensitive to change and feasible. Prioritized topics of the HOME initiative are the identification/development of the most appropriate instruments for the four core outcome domains. HOME is open to anyone with an interest in atopic eczema outcomes research.

[National and international sources for clinical quality indicators].

High quality healthcare necessitates taking appropriate steps to promote quality. One of the major tools used to promote quality in healthcare is clinical quality indicators. This paper briefly reviews major organizations dealing with quality indicators, in primary care as well as hospital medicine, in Israel and worldwide. This review includes international and national organizations, including organizations dedicated to quality indicators in nursing and pharmacy. Major organizations active in developing quality indicators have detailed Internet websites that allow the reader to learn about the indicator set they use. These websites could be used to develop new indicators for community and hospital medicine in Israel. The review indicates the worldwide achievements in promoting quality in health, and shows that clinical quality indicators are a major component in clinical quality improvement in many countries.

[The effect of the introduction of pneumococcal vaccination for adults as a quality measure on vaccination rates in Clalit Health Services].

BACKGROUND: The incidence of invasive pneumococcal infections in industrialized countries is above 50/100,000 annuaty in adults over the age of 65 years. The Israel Ministry of Health recommends 23-valent polysaccharide anti-pneumococcaL vaccination for patients with immune suppression or chronic diseases and citizens above the age of 65 years. METHODS: in 1.1.2008 pneumococcal vaccination for adults was introduced as a quality measure in CLalit Health Services (CHS). At the time of the introduction of pneumococcaL vaccination as a new quality measure in CHS, as one of 70 quality measures in community medicine, the target population included all CHS enrollees over 65 years of age and patients with specific chronic diseases. The relative weight of this quality measure within the set of CHS quality measures was set at 3.19%. The goal for the measure was set at 75%. Pneumococcal vaccination was paired with the influenza vaccination campaign. Mandatory copayment was reduced from NIS 57 to NIS 25 for enroLLees without supplementary medical insurance, and from NIS 11 to NIS 5 for enrollees with supplementary insurance. An alert for performing pneumococcaL vaccination for the target population was introduced into the medical software used by all CHS physicians. RESULTS: During a period of two years foLLowing the introduction of pneumococcaL vaccination as a quality measure in CHS, approximately 400,000 CHS enrollees within the target population received pneumococcaL vaccination, and the rate of immunization increased 10-fold (with respect to August 2007). CONCLUSION: The introduction of pneumococcal vaccination as a quality measure in CHS, coupled by other managerial and service-related actions, substantially increased the vaccination rates.

The association between continuity of care in the community and health outcomes: a population-based study.

BACKGROUND: The study goal was to assess indices of continuity of care in the primary care setting and their association with health outcomes and healthcare services utilization, given the reported importance of continuity regarding quality of care and healthcare utilization. METHODS: The study included a random sample of enrollees from Clalit Health Services 19 years-of-age or older who visited their primary care clinic at least three times in 2009. Indices of continuity of care were computed, including the Usual Provider Index (UPC), Modified Modified Continuity Index (MMCI), Continuity of Care Index (COC), and Sequential Continuity (SECON). Quality measures of preventive medicine and healthcare services utilization and their costs were assessed as outcomes. RESULTS: 1,713 randomly sampled patients were included in the study (mean age: 48.9 ± 19.2, 42% males). Continuity of care indices were: UPC: 0.75; MMCI: 0.81; COC: 0.67; SECON: 0.70. After controlling for patient characteristics in a multivariate analysis, a statistically significant association was found between higher values of UPC, COC, and SECON and a decrease in the number and cost of ED visits. Higher MMCI values were associated with a greater number and higher costs of medical consultation visits. Continuity of care indices were associated with BMI measurements, and inversely associated with blood pressure measurements. No association was found with other quality indicators, e.g., screening tests for cancer. CONCLUSIONS: Several continuity of care indices were associated with decreased number and costs of ED visits. There were both positive and negative associations of continuity of care indices with different aspects of healthcare utilization. The relatively small effects of continuity might be due to the consistently high levels of continuity in Clalit Health Services.