Towards actionable international comparisons of health system performance: expert revision of the OECD framework and quality indicators

Objective To review and update the conceptual framework, indicator content and research priorities of the Organisation for Economic Cooperation and Development's (OECD) Health Care Quality Indicators (HCQI) project, after a decade of collaborative work. Design A structured assessment was carried out using a modified Delphi approach, followed by a consensus meeting, to assess the suite of HCQI for international comparisons, agree on revisions to the original framework and set priorities for research and development. Setting International group of countries participating to OECD projects. Participants Members of the OECD HCQI expert group. Results A reference matrix, based on a revised performance framework, was used to map and assess all seventy HCQI routinely calculated by the OECD expert group. A total of 21 indicators were agreed to be excluded, due to the following concerns: (i) relevance, (ii) international comparability, particularly where heterogeneous coding practices might induce bias, (iii) feasibility, when the number of countries able to report was limited and the added value did not justify sustained effort and (iv) actionability, for indicators that were unlikely to improve on the basis of targeted policy interventions. Conclusions The revised OECD framework for HCQI represents a new milestone of a long-standing international collaboration among a group of countries committed to building common ground for performance measurement. The expert group believes that the continuation of this work is paramount to provide decision makers with a validated toolbox to directly act on quality improvement strategie

Prävalenz und Charakteristika von Kindern und Jugendlichen mit speziellem Versorgungsbedarf im Kinder- und Jugendgesundheitssurvey (KiGGS) in Deutschland

Um zu bevölkerungsrepräsentativen Einschätzungen der Prävalenz und der Charakteristika von Kindern und Jugendlichen mit gesundheitsbedingtem Versorgungsbedarf zu gelangen, sind Screening-Instrumente entwickelt worden. Diese zielen auf eine Erfassung von Konsequenzen körperlicher, seelischer und verhaltensbedingter Störungen ab, unabhängig von den zugrunde liegenden medizinischen Diagnosen. Eines der bestuntersuchten und unter Machbarkeitsaspekten bewährtesten Instrumente, der CSHCN-(Children with Special Health Care Needs)Screener, wurde in den Elternfragebogen des Kinder- und Jugendgesundheitssurveys (KiGGS) in Deutschland integriert. Die gewichtete Gesamtprävalenz von Kindern und Jugendlichen mit speziellem Versorgungsbedarf betrug 16,0% für Jungen und 11,4% für Mädchen. Bei Kindern im Vorschul- und Schulalter lag nach den Befragungsergebnissen ein spezieller Versorgungsbedarf 2- bis 3-mal häufiger vor als bei Kleinkindern. Bis zu einem Alter von 14 Jahren war ein deutlich höherer Versorgungsbedarf bei Jungen als bei Mädchen für alle Altersgruppen ersichtlich. Am deutlichsten ausgeprägt war der Geschlechtsunterschied bei den 3- bis 10-Jährigen. Kinder und Jugendliche mit Migrationshintergrund wiesen einen signifikant niedrigeren Versorgungsbedarf auf als Kinder ohne Migrationshintergrund. Dies traf insbesondere auf die Jungen (8,0% vs. 17,1%) zu. Signifikante Unterschiede im Versorgungsbedarf nach Sozialstatus, Größe des Wohnortes oder Zugehörigkeit des Wohnortes zu den alten oder neuen Ländern wurden nicht beobachtet. Mit Ausnahme eines fehlenden Zusammenhangs zwischen Versorgungsbedarf und sozioökonomischem Status zeigen die hier berichteten Ergebnisse gute Übereinstimmung mit Beobachtungen im US-amerikanischen National Survey of CSHCN.In order to arrive at population-based estimates on the prevalence and characteristics of children and adolescents with specific health care needs (CSHCN), screening instruments focussing on the consequences of physical, mental and behavioral problems rather than on medical diagnoses have been developed. One of the most feasible and widely tested instruments, the CSHCN screener was added to the self-administered questionnaire for parents of children participating in the German Health Interview and Examination Survey for Children and Adolescents (KiGGS). The overall weighted prevalence of CSHCN was 16.0% among boys and 11.4% among girls. Children at kindergarten or school age were more than 2-3 times more likely to screen positive compared to toddlers. Up to 14 years, the sex difference persisted through all age groups and was most pronounced between the ages of 3 and 10 years. Children with a migrant background had significantly lower rates of CSHCN compared to non-migrants. This was particularly true for boys (8.0% vs. 17.1%). CSHCN status was not related to social status, urbanization or residence in former West vs. former East Germany. Except for the lack of association with social status, these results are in good accordance with observations from the US National Survey of CSHCN

KTC De Marke: twee decennia innovaties voor duurzame melkveehouderij

De Marke, Proefbedrijf voor Melkveehouderij en Milieu bestaat dit jaar 20 jaar. Met militaire precisie is destijds de strategie, opzet en ontwikkeling van dit melkveeproefbedrijf door Frans Aarts, Edo Biewinga en Richard Donker vastgelegd in De Marke-rapport nr. 1: 'Melkveehouderij bij stringente milieunormen'. Nu, 20 jaar later, is er mede door hun aanzet meer bereikt dan we voor mogelijk hielden. Koeien melken met minimale belasting van de omgeving: de melkveehouderij is en blijft een gewaardeerde voedselproducent die schoon werkt in een fraai landschap. Alle reden om hier in 2012 uitgebreid bij stil te staan

Progressive vertebral deformities despite unchanged bone mineral density in patients with sarcoidosis: a 4-year follow-up study

To evaluate the incidence of new and/or progressive vertebral deformities and changes in bone mineral density, we re-examined 66 patients with sarcoidosis after a follow-up period of four years. In 17 subjects (26%) new and/or progressive vertebral deformities were found, though BMD did not change significantly. INTRODUCTION: Previous studies from our group have shown that morphometric vertebral deformities suggestive of fractures can be found in 20% of patients with sarcoidosis, despite a normal bone mineral density (BMD). The aim of this study was to determine the incidence of new and/or progressive vertebral deformities and the evolution of BMD during the course of this disease. METHODS: BMD of the hip (DXA) and vertebral fracture assessment (VFA) with lateral single energy densitometry was performed at baseline and after 45 months in 66 patients with sarcoidosis. Potential predictors of new/ progressive vertebral deformities were assessed using logistic regression analysis. RESULTS: The BMD of the total group was unchanged after follow-up. The prevalence of vertebral deformities increased from 20 to 32% (p < 0.05); in 17 subjects (26%) new or progressive vertebral deformities were diagnosed. A lower T-score of the femoral neck [(OR = 2.5 (CI: 1.0-5.9), p < 0.05)] and mother with a hip fracture [(OR = 14.1 (CI: 1.4-142.6), p < 0.05)] were independent predictors of new/progressive deformities. CONCLUSIONS: In subjects with sarcoidosis the number of vertebral deformities increases in the course of this disease, despite unchanged BMD. The combination of low normal BMD and family history of fragility fractures confers an increased risk of the incidence of these deformities

Markers of Dysglycaemia and Risk of Coronary Heart Disease in People without Diabetes: Reykjavik Prospective Study and Systematic Review

BACKGROUND: Associations between circulating markers of dysglycaemia and coronary heart disease (CHD) risk in people without diabetes have not been reliably characterised. We report new data from a prospective study and a systematic review to help quantify these associations. METHODS AND FINDINGS: Fasting and post-load glucose levels were measured in 18,569 participants in the population-based Reykjavik study, yielding 4,664 incident CHD outcomes during 23.5 y of mean follow-up. In people with no known history of diabetes at the baseline survey, the hazard ratio (HR) for CHD, adjusted for several conventional risk factors, was 2.37 (95% CI 1.79-3.14) in individuals with fasting glucose > or = 7.0 mmol/l compared to those or = 7 mmol/l at baseline were excluded, relative risks for CHD, adjusted for several conventional risk factors, were: 1.06 (1.00-1.12) per 1 mmol/l higher fasting glucose (23 cohorts, 10,808 cases, 255,171 participants); 1.05 (1.03-1.07) per 1 mmol/l higher post-load glucose (15 cohorts, 12,652 cases, 102,382 participants); and 1.20 (1.10-1.31) per 1% higher HbA(1c) (9 cohorts, 1639 cases, 49,099 participants). CONCLUSIONS: In the Reykjavik Study and a meta-analysis of other Western prospective studies, fasting and post-load glucose levels were modestly associated with CHD risk in people without diabetes. The meta-analysis suggested a somewhat stronger association between HbA(1c) levels and CHD risk