American Journal of Medical Quality RSS feed -- OnlineFirst Articles

Using Administrative Data to Identify Mental Illness: What Approach Is Best?

Fri, 23 Oct 2009 11:05:07 PDT

The authors estimated the validity of algorithms for identification of mental health conditions (MHCs) in administrative data for the 133 068 diabetic patients who used Veterans Health Administration (VHA) nationally in 1998 and responded to the 1999 Large Health Survey of Veteran Enrollees. They compared various algorithms for identification of MHCs from International Classification of Diseases, 9th Revision (ICD-9) codes with self-reported depression, posttraumatic stress disorder, or schizophrenia from the survey. Positive predictive value (PPV) and negative predictive value (NPV) for identification of MHC varied by algorithm (0.65-0.86, 0.68-0.77, respectively). PPV was optimized by requiring ≥2 instances of MHC ICD-9 codes or by only accepting codes from mental health visits. NPV was optimized by supplementing VHA data with Medicare data. Findings inform efforts to identify MHC in quality improvement programs that assess health care disparities. When using administrative data in mental health studies, researchers should consider the nature of their research question in choosing algorithms for MHC identification. (Am J Med Qual XXXX;XX: xx-xx)

Approaching the Evidence Basis for Aviation-Derived Teamwork Training in Medicine

Zeltser, M. V., Nash, D. B. — Fri, 02 Oct 2009 10:07:02 PDT

The Institute of Medicine has suggested that training in team behavior, leadership, communication, and other human factors could reduce medical errors and improve patient safety. Training on such topics has been adapted from teamwork training programs used in military and commercial aviation, called crew resource management (CRM). The principles behind CRM programs have been deployed in a number of clinical settings over the past 2 decades, and there are now several CRM vendors. Little is known about this nascent industry, and the emerging research supporting CRM programs lacks standardization and conclusive evidence. The objectives of this study were to report on the body of empirical data about CRM training in clinical settings and to provide a conceptual framework for evaluating its effectiveness in medicine. Using the proposed conceptual framework, the authors further examine currently published methods of measuring effectiveness and identify future directions for the use of teamwork training in medicine. (Am J Med Qual XXXX;XX:xx-xx)

Community-Based Primary Care: Improving and Assessing Diabetes Management

Gannon, M., Qaseem, A., Snow, V. — Mon, 28 Sep 2009 10:22:36 PDT

Morbidity and mortality associated with diabetes make it a prime target for quality improvement research. Quality gaps and racial/gender disparities persist throughout this population of patients necessitating a sustainable improvement in the clinical management of diabetes. The authors of this study sought (1) to provide a population perspective on diabetes management, and (2) to reinforce evidence-based clinical guidelines through a Web-based educational module. The project also aimed to gain insight into working remotely with a community of rural physicians. This longitudinal pre-post intervention study involved 18 internal medicine physicians and included 3 points of medical record data abstraction over 24 months. A Web-based educational module was introduced after the baseline data abstraction. This module contained chapters on clinical education, practice tools, and self-assessment. The results showed a sustained improvement in most clinical outcomes and demonstrated the effectiveness of using Web-based mediums to reinforce clinical guidelines and change physician behavior. (Am J Med Qual 2009;24:xx-xx)

Current Efforts of Regional and National Performance Measurement Initiatives Around the United States

Roski, J., Kim, M. G. — Thu, 03 Sep 2009 10:42:18 PDT

Performance measurement and reporting has become widespread. The authors provide a status snapshot of regional (n = 20) and nonregional (n = 24) initiatives that have issued at least 1 performance report since 2005. Most regional initiatives around the United States are in the very early stages of acquiring data and devising data collection strategies. The authors recommend that a framework and approach for generating nationally consistent and locally adaptable performance information for communities across the United States should be formulated. This would allow better coordination of promising regional initiatives to improve their impact and reduce operating costs/burden. (Am J Med Qual 2009;24:xx-xx)

Book Review: The Globalization of Managerial Innovation in Health Care, edited by John Kimberly, Gerard de Pouvourville, and Thomas D'Aunno

Jutkowitz, E. — Wed, 08 Jul 2009 10:07:30 PDT