Needs Assessment in Postgraduate Medical Education:A Review

Although the concept of needs assessment in continuing medical education is well accepted, there is limited information on needs assessment in postgraduate medical education. We discuss the learning needs of postgraduate trainees and review the various methods of needs assessment such as: questionnaire surveys, interviews, focus groups, chart audits, chart-stimulated recall, standardized patients, and environmental scans in the context of post graduate medical education

Semi-Annual Report to Congress for the Period of April 1, 2006 to September 30, 2006

[Excerpt] I am pleased to submit this Semiannual Report to the Congress, which highlights the significant activities and accomplishments of the Office of Inspector General (OIG) for the six-month period ending September 30, 2006. During this reporting period, our investigative work led to 295 indictments, 260 convictions, and over $76 million in monetary accomplishments. In addition, we issued 66 audit reports and questioned$90.2 million in costs. During this reporting period, the OIG continued to provide audit and investigative oversight of the Department of Labor’s (DOL’s) response to Hurricanes Katrina and Rita. We issued six management letters related to this effort. One of the letters identified individuals who had received disaster unemployment assistance (DUA) from one state, while also receiving DUA or state unemployment compensation from another state. In addition, an OIG investigation led to the indictment of a disaster-reconstruction company owner who had allegedly neglected to pay approximately $1.4 million in employee taxes owed to the Federal and state governments. OIG audits included significant recommendations to address vulnerabilities identified in DOL programs and operations. For example, we issued a performance audit that determined that DOL’s coal mine hazardous condition complaint process needed improvement. We also conducted several audits assessing the adequacy of the Department’s information security program and identified challenges in the areas of access controls and protection over personally identifiable information. Our investigations continue to combat labor racketeering in the workplace and fraud involving DOL programs. One particular investigation resulted in several former high-ranking officials of Laborers’ International Union of North America Local 91 in the State of New York either pleading guilty or being sentenced for conspiring to commit violations of the Hobbs Act. Another significant case involved Ralphs Grocery Company. Ralphs pled guilty to several felony counts related to charges that it illegally rehired locked-out workers during the supermarket labor dispute in Southern California more than two years ago. In June 2006, the company agreed to pay$70 million in fines and restitution. Finally, recognizing the need to collaboratively combat document and benefit fraud, the OIG joined with the Departments of Homeland Security, Justice, State, and other agencies to form task forces in 10 major cities. Led by the U.S. Immigration and Customs Enforcement, the task forces have been highly effective in targeting criminal organizations and ineligible beneficiaries engaged in this type of fraud. In one case, an investigation found that the owner of a labor leasing company used counterfeit labor certification forms to apply for at least 250 green cards. The owner of the company pled guilty to charges and faces 37 to 46 months’ incarceration. The OIG remains committed to promoting the economy, integrity, effectiveness, and efficiency of DOL programs and detecting waste, fraud, and abuse against those programs. I would like to express my sincere appreciation to a professional and dedicated OIG staff for their significant achievements during this reporting period

Assessing preventable hospitalisation indicators (APHID): protocol for a data-linkage study using cohort study and administrative data

Introduction Potentially preventable hospitalisation (PPH) has been adopted widely by international health systems as an indicator of the accessibility and overall effectiveness of primary care. The Assessing Preventable Hospitalisation InDicators (APHID) study will validate PPH as a measure of health system performance in Australia and Scotland. APHID will be the first large-scale study internationally to explore longitudinal relationships between primary care and PPH using detailed person-level information about health risk factors, health status and health service use. Methods and analysis APHID will create a new longitudinal data resource by linking together data from a large-scale cohort study (the 45 and Up Study) and prospective administrative data relating to use of general practitioner (GP) services, dispensing of pharmaceuticals, emergency department presentations, hospital admissions and deaths. We will use these linked person-level data to explore relationships between frequency, volume, nature and costs of primary care services, hospital admissions for PPH diagnoses, and health outcomes, and factors that confound and mediate these relationships. Using multilevel modelling techniques, we will quantify the contributions of person-level, geographic-level and service-level factors to variation in PPH rates, including socioeconomic status, country of birth, geographic remoteness, physical and mental health status, availability of GP and other services, and hospital characteristics. Ethics and dissemination Participants have consented to use of their questionnaire data and to data linkage. Ethical approval has been obtained for the study. Dissemination mechanisms include engagement of policy stakeholders through a reference group and policy forum, and production of summary reports for policy audiences in parallel with the scientific papers from the study.</p

Working as one: a road map to disaster resilience for Australia

This report offers a roadmap for enhancing Australia’s disaster resilience, building on the 2011 National Strategy for Disaster Resilience. It includes a snapshot of relevant issues and current resilience efforts in Australia, outlining key challenges and opportunities. Overview Natural disasters cause widespread disruption, costing the Australian economy $6.3 billion per year, and those costs are projected to rise incrementally to$23 billion by 2050. With more frequent natural disasters with greater consequences, Australian communities need the ability to prepare and plan for them, absorb and recover from them, and adapt more successfully to their effects. Enhancing Australian resilience will allow us to better anticipate disasters and assist in planning to reduce losses, rather than just waiting for the next king hit and paying for it afterwards. This report offers a roadmap for enhancing Australia’s disaster resilience, building on the 2011 National Strategy for Disaster Resilience. It includes a snapshot of relevant issues and current resilience efforts in Australia, outlining key challenges and opportunities. The report sets out 11 recommendations to help guide Australia towards increasing national resilience, from individuals and local communities through to state and federal agencies

Development and use of clinical performance indicators for ambulance services and prehospital care: a discussion paper for a clinical quality improvement framework for ambulance services

Clinical Performance Indicators for ambulance services should be developed in line with best evidence, in partnership with clinicians and service users, and linked to national structures for knowledge and evidence, clinical expertise and research and development. Their development should be guided by a performance monitoring protocol. Clinical Performance Indicators for ambulance services should be meaningful, measurable and realistic, aiming to address issues that matter to patients and clinicians, to benchmark performance, to reduce variations within and between health services and to bring about improvements in care for patients and users. Indicators should function as part of a planned clinical quality improvement framework that draws on modern improvement principles, methods, tools and techniques. Clinical Performance Indicators for ambulance services should be designed to provide safe, effective, patient centred, timely, efficient and equitable healthcare. Importantly, they should support clinicians and services in providing better care to their patients. Resources should be made available to trusts to undertake such measurements, to contribute to the national data set, to participate in future development and to deliver the aims of quality improvement

Population Health Solutions for Assessing Cognitive Impairment in Geriatric Patients.

In December 2017, the National Academy of Neuropsychology convened an interorganizational Summit on Population Health Solutions for Assessing Cognitive Impairment in Geriatric Patients in Denver, Colorado. The Summit brought together representatives of a broad range of stakeholders invested in the care of older adults to focus on the topic of cognitive health and aging. Summit participants specifically examined questions of who should be screened for cognitive impairment and how they should be screened in medical settings. This is important in the context of an acute illness given that the presence of cognitive impairment can have significant implications for care and for the management of concomitant diseases as well as pose a major risk factor for dementia. Participants arrived at general principles to guide future screening approaches in medical populations and identified knowledge gaps to direct future research. Key learning points of the summit included: recognizing the importance of educating patients and healthcare providers about the value of assessing current and baseline cognition;emphasizing that any screening tool must be appropriately normalized and validated in the population in which it is used to obtain accurate information, including considerations of language, cultural factors, and education; andrecognizing the great potential, with appropriate caveats, of electronic health records to augment cognitive screening and tracking of changes in cognitive health over time

What is the effect of a formalised trauma tertiary survey procedure on missed injury rates in multi-trauma patients? Study protocol for a randomised controlled trial

Background: Missed injury is commonly used as a quality indicator in trauma care. The trauma tertiary survey (TTS) has been proposed to reduce missed injuries. However a systematic review assessing the effect of the TTS on missed injury rates in trauma patients found only observational studies, only suggesting a possible increase in early detection and reduction in missed injuries, with significant potential biases. Therefore, more robust methods are necessary to test whether implementation of a formal TTS will increase early in-hospital injury detection, decrease delayed diagnosis and decrease missed injuries after hospital discharge. Methods/Design: We propose a cluster-randomised, controlled trial to evaluate trauma care enhanced with a formalised TTS procedure. Currently, 20 to 25% of trauma patients routinely have a TTS performed. We expect this to increase to at least 75%. The design is for 6,380 multi-trauma patients in approximately 16 hospitals recruited over 24 months. In the first 12 months, patients will be randomised (by hospital) and allocated 1:1 to receive either the intervention (Group 1) or usual care (Group 2). The recruitment for the second 12 months will entail Group 1 hospitals continuing the TTS, and the Group 2 hospitals beginning it to enable estimates of the persistence of the intervention. The intervention is complex: implementation of formal TTS form, small group education, and executive directive to mandate both. Outcome data will be prospectively collected from (electronic) medical records and patient (telephone follow-up) questionnaires. Missed injuries will be adjudicated by a blinded expert panel. The primary outcome is missed injuries after hospital discharge; secondary outcomes are maintenance of the intervention effect, in-hospital missed injuries, tertiary survey performance rate, hospital and ICU bed days, interventions required for missed injuries, advanced diagnostic imaging requirements, readmissions to hospital, days of work and quality of life (EQ-5D-5 L) and mortality. Discussion: The findings of this study may alter the delivery of international trauma care. If formal TTS is (cost-) effective this intervention should be implemented widely. If not, where already partly implemented, it should be abandoned. Study findings will be disseminated widely to relevant clinicians and health funders.Griffith Health, School of MedicineFull Tex

Why Not the Best? Results From a National Scorecard on U.S. Health System Performance

Compares the national average healthcare system performance to benchmarks of higher performance. Provides a mechanism for monitoring change over time across goals of health outcomes, quality, access, efficiency, and equity

Advancing Physician Performance Measurement: Using Administrative Data to Assess Physician Quality and Efficiency

Summarizes national initiatives to advance the practice of standardized measurement and outlines goals for developing a method for tracking efficiency and quality that will reward physicians and enable patients to make informed healthcare choices