Performance based compensation in Chinese public hospitals

This study was determined by innovatively integrating the equilibrium structure of "principal-agent- and beneficiary" in the principal-agent theory and Donabedian's "goal-process-result" theory. The "Operational Manual for Performance Appraisal of National Tertiary Public Hospitals" (2019 Ed.) was used as the source of indicators, complemented by two questionnaire surveys. Frequency analysis and ANOVA enabled the performance management index system of public hospitals. Furthermore, the index system was verified by key information interviews (KIS) to form a three-dimensional (3D) equilibrium performance incentive system for public hospitals. Selected professionals from First People's Hospital of R City participated in the survey, enabling the weight assignment of indicators in the 3D equilibrium performance incentive system of public hospitals by Analytic Hierarchy Process. In addition, the possible problems in the application of the system in public hospitals are discussed. This study has found that the 3D equilibrium performance incentive system of public hospitals can contribute to modernize the hospital administration system, improving the quality management and performance. At the same time, it was verified that in the design process of performance management, not all factors could be regarded as performance indicators, including some invisible but vital factors such as values and humanistic spirit that could not be included in the evaluation indicators. In addition to the quality of objective data and the accuracy of subjective data, cognitive biases in different ages, job types and position levels in hospitals will bring greater challenges to performance management.Este estudo faz uma integração inovadora da estrutura de equilíbrio da relação entre o "principal-agente-e beneficiário" e a teoria de Donabed da "meta-processo-resultado". O Manual Operacional para a Avaliação do Desempenho dos Hospitais Públicos Nacionais (Ed. de 2019)foi a fonte de indicadores, complementados por dois questionários. A análise de frequências e ANOVA permitiram construir um índice do desempenho dos hospitais públicos. Este índice foi validado com entrevistas chave para informação a partir das quais foi construído um modelo tridimensional (3D) de incentivos ao desempenho dos hospitais públicos. Foram selecionados profissionais do Primeiro Hospital do Povo da Cidade R que participaram no questionário, permitindo testar o peso dos indicadores no modelo tridimensional (3D) de incentivos ao desempenho dos hospitais públicos através do Processo de Hierarquia Analítica. Adicionalmente, são discutidos os possíveis problemas da aplicação deste modelo nos hospitais públicos. Este estudo permitiu concluir que o modelo tridimensional (3D) de incentivos ao desempenho dos hospitais públicos pode contribuir para a modernização do sistema de administração dos hospitais públicos, melhorando a qualidade da gestão e o desempenho. Foi também verificado que no processo de desenho da gestão do desempenho nem todos os fatores podem ser encarados como indicadores de desempenho. Fatores invisíveis mas vitais como valores e espírito humanístico não puderam ser incluídos nos indicadores de desempenho. Para além da qualidade de dados objetivos, e da adequação de dados subjetivos, as diferenças cognitivas em função da idade, tipo de função e e nível hierárquico nos hospitais trazem maiores desafios à gestão do desempenho

Non-adherence to medication in schizophrenia: the impact on service use and costs

Schizophrenia is a chronic illness which has severe consequences for the lives of patients and their families. The costs associated with treating individuals with schizophrenia are considerable. This thesis examined the relationship between non-adherence to medication, patient-, environmental- and medication-related factors and the costs associated with health and social care services used and the wider societal costs in treating individuals with schizophrenia. Analysis was undertaken of data from the 1993-4 and 2000 Psychiatric Morbidity Surveys and the Quality of Life following Adherence Therapy for People Disabled by Schizophrenia and their Carers study. An individual’s level of education, having had a recent inpatient stay and alcohol abuse were found to be associated with a greater likelihood of non-adherence in individuals taking antipsychotics. These results were not observed in analyses of individuals taking antidepressants. Common factors associated with non-adherence across individuals taking antipsychotics and antidepressants included experiencing side-effects and severity of illness. Community-based services were found to be used more by individuals with interruptions in their antipsychotic medication. In this group there may also be additional costs in hospitalisations and overall health and social care services attributable to non-adherence. Benefits to patients may be accrued by enabling health and social care professionals, particularly those working in the community, to encourage medication adherence in individuals with schizophrenia and to provide information on new interventions that are cost-effective in improving adherence. National Institute of Clinical Excellence (NICE) guidelines for treating individuals with schizophrenia, revised in 2009, address some key findings in my analyses, such as emphasising the role of carers and family members in successful management of the illness, the potentially adverse impact that illicit drug use can have on therapeutic effects and issues around service provision to individuals from ethnic minorities. Further analysis of data from long-term studies is required to determine the clinical, economic and personal consequences of non-adherence

Are there researcher allegiance effects in diagnostic validation studies of the PHQ-9? : A systematic review and meta-analysis

OBJECTIVES: To investigate whether an authorship effect is found that leads to better performance in studies conducted by the original developers of the Patient Health Questionnaire (PHQ-9) (allegiant studies). DESIGN: Systematic review with random effects bivariate diagnostic meta-analysis. Search strategies included electronic databases, examination of reference lists and forward citation searches. INCLUSION CRITERIA: Included studies provided sufficient data to calculate the diagnostic accuracy of the PHQ-9 against a gold standard diagnosis of major depression using the algorithm or the summed item scoring method at cut-off point 10. DATA EXTRACTION: Descriptive information, methodological quality criteria and 2×2 contingency tables. RESULTS: Seven allegiant and 20 independent studies reported the diagnostic performance of the PHQ-9 using the algorithm scoring method. Pooled diagnostic OR (DOR) for the allegiant group was 64.40, and 15.05 for non-allegiant studies group. The allegiance status was a significant predictor of DOR variation (p<0.0001).Five allegiant studies and 26 non-allegiant studies reported the performance of the PHQ-9 at recommended cut-off point of 10. Pooled DOR for the allegiant group was 49.31, and 24.96 for the non-allegiant studies. The allegiance status was a significant predictor of DOR variation (p=0.015).Some potential alternative explanations for the observed authorship effect including differences in study characteristics and quality were found, although it is not clear how some of them account for the observed differences. CONCLUSIONS: Allegiant studies reported better performance of the PHQ-9. Allegiance status was predictive of variation in the DOR. Based on the observed differences between independent and non-independent studies, we were unable to conclude or exclude that allegiance effects are present in studies examining the diagnostic performance of the PHQ-9. This study highlights the need for future meta-analyses of diagnostic validation studies of psychological measures to evaluate the impact of researcher allegiance in the primary studies

Alexithymia in a psychiatric population: Stability and relationship with therapeutic outcome

Alexithymia has been defined as a personality construct that involves difficulties identifying and describing feelings, as well as an externally oriented thinking style and impoverished fantasy life, which places individuals at risk for various psychopathologies. For psychiatric populations, it represents an obstacle to therapeutic success. Despite extensive research, there is no consensus on the prevalence rate of alexithymia in the general psychiatric population and no data on alexithymia prevalence in the Australian general psychiatric population. In addition, there is inconsistency in the literature regarding the role of alexithymia in therapeutic intervention and a lack of robust studies involving control or comparative therapeutic conditions. Two systematic literature reviews were conducted to evaluate the prevalence rate of alexithymia in the psychiatric and community populations and the role of alexithymia in the therapeutic process, respectively. The first review, comprising 124 studies, revealed that prevalence rates of alexithymia, although extremely varied, were much higher in psychiatric samples compared to community samples. While different psychiatric diagnoses were likely to have contributed to the variation in rates of alexithymia across psychiatric samples, it was unclear whether other sample characteristics may have contributed. The second review, involving 31 studies, identified a balance between studies that found a negative influence of alexithymia on some therapeutic outcomes and studies that found no influence of alexithymia on therapeutic outcomes. In addition, numerous types of therapeutic intervention reduced alexithymic features on average. All of the reviewed studies found a consistent degree of change between individual’s alexithymia scores from before to after treatment (relative stability). Study 1 examined differences in alexithymia between 166 general psychiatric outpatients and 216 community participants from Australia. Alexithymia was measured with the 20-item Toronto Alexithymia Scale. Analysis of variance indicated that the psychiatric sample, independent of demographic factors, had higher alexithymia scores than the community sample. Chi-Square analysis showed a greater proportion of alexithymic participants in the psychiatric sample compared to the community sample. The strength of the associations between alexithymia and psychological distress (measured with the Depression Anxiety Stress Scale) were found to be similar for both sample groups. Study 2 examined the role of alexithymia in the therapeutic process in a subset (n = 61) of the original psychiatric sample who were subject to one of two treatment conditions: emotion focused group therapy or cognitive-behavioural focused group therapy. Higher alexithymia scores before treatment were associated with less change in psychological distress severity during treatment. This association was not significant in either treatment condition when examined separately. Analysis of variance showed that mean-level change in alexithymia from before to after treatment was not dependent on treatment condition. Correlation and hierarchical regression analyses showed a high degree of relative stability in alexithymia despite moderate change in psychological distress severity. Regression analysis showed that change in alexithymia could not be directly accounted for by change in psychological distress. Regression analysis also showed that less change in alexithymia severity during treatment significantly predicted higher psychological distress scores after treatment, even after controlling for group therapy type and psychological distress severity before treatment. The theoretical, research, and clinical implications of these research findings are discussed. The importance of identifying alexithymic patients prior to conducting therapeutic intervention was emphasised, as was the need to provide those patients, who were alexithymic after treatment, with further psychiatric care

Support management in schizophrenia: a systematic review of current literature

Maurizio Pompili,1 Franco Montebovi,1 Alberto Forte,1 Mario Palermo,1 Henry Stefani,1 Ludovica Telesforo,1 Sandra Campi,1 Gloria Giordano,1 Lucia Longo,1 Dorian A Lamis,2 Gianluca Serafini,1 Paolo Girardi11Department of Neurosciences, Mental Health and Sensory Functions, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy; 2Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USABackground: Schizophrenia is generally considered a chronic disorder characterized by psychotic symptoms and relatively stable neurocognitive and interpersonal deficits. Antipsychotic medication has proven beneficial in reducing psychotic symptoms, but is often not enough to treat cognitive or functional impairments. Residual cognitive impairments are barriers to a patient's full recovery from schizophrenia. Rehabilitation is an alternative and important approach which may be useful, and encompasses a variety of treatments including social skills training and psychoeducational and cognitive behavioral treatments.Objective: To investigate the efficacy of psychosocial treatments in schizophrenia, evaluating its effects in the short and long term, comparing psychosocial treatments with pharmacotherapy, and assessing the effects of treatment and the main indications for use in patients with schizophrenia.Methods: A careful MEDLINE®, Excerpta Medica, PsycLIT®, PsycINFO®, and Index Medicus search was performed to identify all papers and book chapters in English for the period 1970–2012.Results: Findings from the studies included in this qualitative analysis suggest that social skills therapy, cognitive behavioral therapy, family intervention therapy, cognitive remediation therapy, and other nonpharmacological therapeutic strategies may be beneficial for patients with significant functional and symptomatic impairments.Conclusion: Schizophrenic patients treated with nonpharmacological techniques have more rapid remission and relapse less frequently than patients treated only pharmacologically.Keywords: schizophrenia, support management, nonpharmacological treatment, cognitive behavioral therap

Developing an integrated MDT service model for the management of patients with lung cancer

The motivation for this research was the publication in 1995 of the Calman-Hine report. This provided a strategic framework for the delivery of cancer care by creating a network of cancer care centres in England and Wales to enable patients to receive a uniformly high standard of care. The report acknowledged the fact that although the evidence on optimal cancer care used to prepare the report was based on two key sources (i) medical literature and (ii) audit data provided by UK cancer registries, they did not lend themselves to controlled experiments as most information came from retrospective analyses; hence they were subject to a number of possible flaws and biases. Yet the report recommended some key structural changes to be implemented. The focus of the research described in this thesis was centred on the recommendation of a multidisciplinary team (MDT) review of patients prior to a treatment decision, both in general cancer units as well as in specialised cancer centres. Given the mandate to implement these recommendations, the research questions addressed were “can the current configuration support this recommendation?”, “what evidence was there to support the effectiveness of the MDT?” and “was there a model of care to support the service delivery of cancer care?” A literature review established that there was no existing template upon which MDT services could be set up. This research therefore set out to develop an MDT model to support operational delivery of care in the setting of a cancer centre. The clinical specialty in which this research was undertaken was that of lung cancer. The research successfully developed a conceptual model. However, in the process, a number of operational and practical constraints were identified within the revised service configuration designed to deliver high quality cancer care through the incorporation of the MDT service, and this ultimately limited the extent to which the model could be deployed in the particular clinical setting. Nevertheless, the modelling process did enable a range of core issues to be identified, enabling design solutions to be formulated and tested, thereby confirming the effectiveness of the MDT model. In particular, the adoption of a soft modelling approach was shown to be beneficial in addressing operational problems. By engaging clinical and other end-users right from the start in the modelling process, the models did become operationally accepted, allowing resistance to change to be overcome and the solution to be integrated into the business process. MDT services are now well established, both in cancer units and cancer centres and published data on their effectiveness in the treatment of lung cancer, although not conclusive; demonstrate an increase in resection rates. However, assessing the long-term impact of MDTs on lung cancer outcomes remains a topic for future research

International Delphi study to assess the need for multiaxial criteria in diagnosis and management of functional gastrointestinal disorders

Purpose: While there are diagnostic criteria for functional gastrointestinal disorders (FGIDs), their evaluation is challenging. This is because criteria are based on symptoms, and the underlying pathophysiology is not clear; as such, there are no gold standard tests. Diagnosis is further challenged by considerable clinical overlap between different FGIDs as well as other organic diseases, while many people with FGIDs have more anxiety and depression than healthy individuals. I hypothesised that assessment of separate components of FGIDs that also indicate their effect on the patient could improve diagnosis. My aim was to investigate the evolution of opinions from experts involved in the development of FGID diagnostic criteria on the proposal for the development of multiaxial assessment criteria (MAC) for FGIDs. Methods: I conducted a web-based Delphi study using a group of purposively sampled experts identified from committees of the Rome Foundation and the International Foundation for Gastrointestinal Disorders. From a systematic search of relevant articles, I generated132 items that were sent to experts as a first round survey. The items assessed risk and contributing factors, the therapeutic relationship, areas of evaluation and the advantages and disadvantages of multiaxial assessment. Consensus on an item was reached when 75% of experts indicated that they agreed or strongly agreed with the statement. Key results: 36 of 68 eligible participants (52%) responded to the first round. Consensus was reached on 96 items. Using participant feedback, thematic analysis was used to generate 33 additional items for round two. Thirty-one of 36 participants (86%) replied to rounds two and three. In round two, 19 items gained consensus, and in round three, nine items gained consensus. Participants agreed that multiaxial assessment was needed, using a systematic approach to establish the physiological and psychosocial components of FGIDs. Participants were unable to agree on the importance of physical risk factors such as previous surgery and genetic association. Overall, 124 of the 167 items achieved consensus. Conclusion and inferences: The key finding from my study shows that experts agree that multiaxial assessment of FGIDs is needed. I also identified expert agreement on the consideration of psychological risk factors and the importance of the impact of FGID symptoms on daily life. Findings also show that experts disagreed on the impact of physical risk factors, socioeconomic status and spirituality on people with FGIDs. While experts could not agree on genetic and gender-based risk factors, they considered that these areas are important and require further research