OBJECTIVES: The hospital standardized mortality ratio (HSMR) has been widely used because it allows for robust risk adjustment using administrative data and is important for improving the quality of patient care. METHODS: All inpatients discharged from hospitals with more than 700 beds (66 hospitals) in 2008 were eligible for inclusion. Using the claims data, 29 most responsible diagnosis (MRDx), accounting for 80% of all inpatient deaths among these hospitals, were identified, and inpatients with those MRDx were selected. The final study population included 703 571 inpatients including 27 718 (3.9% of all inpatients) in-hospital deaths. Using logistic regression, risk-adjusted models for predicting in-hospital mortality were created for each MRDx. The HSMR of individual hospitals was calculated for each MRDx using the model coefficients. The models included age, gender, income level, urgency of admission, diagnosis codes, disease-specific risk factors, and comorbidities. The Elixhauser comorbidity index was used to adjust for comorbidities. RESULTS: For 26 out of 29 MRDx, the c-statistics of these mortality prediction models were higher than 0.8 indicating excellent discriminative power. The HSMR greatly varied across hospitals and disease groups. The academic status of the hospital was the only factor significantly associated with the HSMR. CONCLUSIONS: We found a large variation in HSMR among hospitals; therefore, efforts to reduce these variations including continuous monitoring and regular disclosure of the HSMR are required.
*Hospital Mortality ; Hospitals/*statistics & numerical data ; Humans ; Logistic Models ; Outcome Assessment (Health Care)/standards ; Quality of Health Care/standards ; Republic of Korea

OBJECTIVEBy means of Delphi method and expert panel consultations, to choose suitable indicators and improve the score table for classifying the hygienic condition of hotels so that it can be widely used at nationwide.

METHODSA two-round Delphi consultation was held to choose suitable indicators among 78 experts from 18 provinces, municipalities and autonomous regions. The suitable indicators were selected according to the importance recognized by experts.

RESULTSThe average length of service in public health of the experts was (21.08 +/- 5.78) years and the average coefficient of experts' authorities C(r) was 0.89 +/- 0.07. The response rates of the two-round consultation were 98.72% (77/78) and 100.00% (77/77). The average feedback time were (8.49 +/- 4.48) d, (5.86 +/- 2.28) d, and the difference between two rounds was statistically significant (t = 4.60, P < 0.01). Kendall's coefficient were 0.26 (chi(2) = 723.63, P < 0.01), 0.32 (chi(2) = 635.65, P < 0.01) and opinions among experts became consistent. The score table for the hygienic quantifying and classification of hotels was composed of three first-class indicators (hygienic management, hygienic facilities and hygienic practices) and 36 second-class indicators. The weight coefficients of the three first-class indicators were 0.35, 0.34, 0.31.

CONCLUSIONDelphi method might be used in a large-scale consultation among experts and be propitious to improve the score table for the hygienic quantifying and classification.

Delphi Technique ; Housing ; classification ; standards ; Hygiene ; Outcome Assessment (Health Care) ; Public Health Administration ; methods

Health outcomes evaluation seeks to compare a new treatment or novel programme with the current standard of care, or to identify variation of outcomes across different healthcare providers. In the real world, it is not always possible to conduct randomised controlled trials to address the issue of comparator groups being different with respect to baseline risk factors for the outcomes. Therefore, risk adjustment is required to address patient factors that may lead to biases in estimates of treatment effects. It is essential when conducting outcomes evaluation of more than trivial significance. Risk adjustment begins by asking 4 questions: what outcome, what time frame, what population, and what purpose. Next, design issues are considered. This involves choosing the data source, planning data collection, defining the sample required, and selecting the variables carefully. Finally, analytical issues are considered. Regression modelling is central to every analytic strategy. Other methods that may augment regression include restriction, stratification, propensity scores, instrumental variables, and difference-in-differences. The construction of risk adjustment models is an iterative process requiring both art and science. Derived models should be validated. Limitations of risk adjustment include reliance on data availability and quality, imperfect method, ineffectiveness when comparators are very different, and sensitivity to different methods used. Thoughtful application of risk adjustment can improve the validity of comparisons between different treatments, programmes and providers. The extent of risk adjustment should be guided by its purpose. Finally, its methodology should be made explicit, so that informed readers can judge the robustness of results obtained.
Health Services Research ; Outcome Assessment (Health Care) ; Regression Analysis ; Risk Adjustment ; standards

Education, Medical, Continuing ; standards ; Faculty, Medical ; Humans ; Outcome Assessment (Health Care) ; Program Evaluation ; methods ; Singapore

PURPOSE: The purpose of this study was to develop and validate a hospice / palliative care performance measure which would cover more than just physical symptoms or quality of life. METHODS: Through an intensive literature review, the author chose questions that measured aspects of physical, emotional, spiritual, social, or practical domains pertinent to hospice / palliative care for inclusion in the scale. Content validation of the questions was established by 15 hospice / palliative care professionals. A preliminary Hospice Palliative Care Performance Scale (HPCPS) of 20 questions was administered to 134 pairs of terminal cancer patients from 5 hospice palliative care units and their main family caregiver. A validation study was conducted to evaluate construct validity and internal consistency. RESULTS: Factor analysis showed 14 significant questions in five subscales; Physical, Emotional, Spiritual, Social, and Patient' rights. There were no significant differences between the ratings by patients and family members except for three out of the 14 questions. The measure demonstrated construct validity, and Cronbach's alpha of the subscales ranged from .73 to .79. CONCLUSION: The HPCOS demonstrated acceptable validity and reliability. It can be used to assess effectiveness of hospice / palliative care for terminal cancer patients in practice and research.
Aged ; Caregivers/psychology ; Factor Analysis, Statistical ; Female ; Hospice Care/*standards ; Humans ; Male ; Middle Aged ; Outcome Assessment (Health Care)/standards ; Palliative Care/*standards ; Program Development ; Questionnaires

OBJECTIVETo survey the reporting quality of traditional Chinese medicine (TCM) case reports published in recent years and understand the common problems. The assessment results would lay the foundation for the development of recommendations for case report in Chinese medicine.

METHODSThis survey determined the reporting quality of cases with Chinese herbal decoction, Chinese proprietary medicine, acupuncture, moxibustion and other traditional therapies published in 20 core medical journals of China by searching the China Academic Journals Full-text Database from 2006 to 2010. Fifty survey items in 16 domains were used to determine the reporting quality. One point was assigned to each item (Yes=1 point; No=0 point), and total score was 50 points. The domain of treatment was assessed independently, ranging from 2 to 9 items for different TCM interventions.

RESULTSThe total of 1,858 case reports, covering 3,417 cases were included to analyze from 13 out of 20 core medical journals of China. There were 74.8% of them did not identify the nature of study in title, while 73.9% did not comprise an abstract. Incomplete reporting was found in discussions/ comment, and only 38.9% had made recommendations or take-away messages. Figures and tables were infrequently used. Three cases cited the full names of patients, but without declaring that any consent was obtained. Over 90% reported the symptoms and signs of TCM, and characteristics on tongue and pulse, but less than 50% did mention other medical history and diagnostic rationale. More than 90% treatments of the included cases were herbal decoction, with clear reporting on the ingredients and dosages. However, the reporting rate of the dosages of each ingredient was just 48.4%. Almost none reported the quality control of crude herbs, manufacturers and lot numbers of herbal proprietary medicine. Besides, advices and precautions on diet, emotions and living were rare to be illustrated.

CONCLUSIONSystematic reporting recommendations are urged to develop for improving the contents and format of case reports in TCM.

Humans ; Medicine, Chinese Traditional ; Outcome Assessment (Health Care) ; Periodicals as Topic ; Quality Assurance, Health Care ; Research Report ; standards

Chinese medical soft indexes provided by the four diagnostic methods of traditional Chinese medicine (TCM) are the important basis for syndrome differentiation and treatment. Whereas, the difficulty in scientific measurement and objective evaluation of these soft indexes is intensified due to the complexity and nonlinearity of Chinese medical practice and thinking of diagnosis and treatment, as well as the subjectivity and complexity hold by the person, who plays as the host and the guest of practice and research. Referring to the knowledge and technique of sociology, psychology and statistics, it is tried, in this study, to probe in the basic processes for soft index dependent efficacy evaluation of TCM, and build its mode preliminarily, i.e. , standardization - screening and reconstruction - measurement - weighing and quantification - evaluation.
Diagnosis, Differential ; Humans ; Medicine, Chinese Traditional ; methods ; standards ; Outcome Assessment (Health Care) ; methods ; standards ; Research Design ; Surveys and Questionnaires

OBJECTIVETo study the impact of organized stroke ward on the therapeutic effect in stroke patients.

METHODSA total of 2637 patients with acute stroke were randomly assigned to organized stroke ward or the general ward for treatment, and the rates of mortality, nonrecovery, improvement, and recovery were compared between the two groups.

RESULTSThe rates of mortality, nonrecovery, improvement, and recovery in 5 years were 2.00%, 0.90%, 74.94% and 22.16% respectively in the organized stroke ward group, as compared to 3.26%, 1.02%, 74.01% and 21.71% in the general ward group, respectively. The mortality rate was significantly lower in organized stroke ward (P<0.05), but no significant difference was found in the rates of nonrecovery, improvement, or recovery between the two groups (P>0.05).

CONCLUSIONAdmission of the stroke patients in organized stroke ward for treatment can be associated with lowered mortality rate.

Female ; Hospital Units ; standards ; Humans ; Intensive Care Units ; Male ; Outcome Assessment (Health Care) ; Patient Care Team ; organization & administration ; Stroke ; mortality ; therapy ; Stroke Rehabilitation ; Survival Rate ; Treatment Outcome

The modern clinical evaluation methods and index system are the tools for clinical evaluation in traditional Chinese medical trial, and more importantly the prerequisite for approbation of their outcomes. From the view of syndrome differentiation theory of traditional Chinese medicine, the previous therapeutic process is also a diagnostic process for the following therapeutic course, so to make repeated clinical trials aiming at finding specific indications would be one of the important ways to improve the clinical efficacy of traditional Chinese medicine.
Clinical Trials as Topic ; methods ; Diagnosis, Differential ; Humans ; Medicine, Chinese Traditional ; methods ; Outcome Assessment (Health Care) ; standards ; Phytotherapy

The assessing contents of the health related quality of life (HRQOL) and the patient reported outcomes (PRO) are identical with the inquiry of traditional Chinese medicine (TCM), which are uniformly soft indicators which could be evaluated with the scales for instruments. The assessing method for the soft indicator in the HRQOL and PRO was gradually accepted by TCM practitioners and applied in evaluating the curative effect of TCM. The applying scale in the assessment of curative effect of TCM and the developing scale with the TCM features just started in the TCM field. There was much inadequacy in the scale study, such as no penetrating understanding of the theory and connotation of the scale in the HRQOL and PRO, on scale system for TCM, no direction in selecting scale, not standardizing in the design of the study with scale in the practice. So, it is necessary that the international guideline of developing scale applied for worldwide should be carried out in the study for developing scale. Meanwhile, it must also be under the guidance of TCM theory in the whole course. It will promote the normalization development of applying scale in the assessment of curative effect in the TCM practice.
Drugs, Chinese Herbal ; therapeutic use ; Humans ; Medicine, Chinese Traditional ; standards ; Outcome Assessment (Health Care) ; methods ; Phytotherapy ; Quality of Life