What is the empirical evidence that hospitals with higher-risk adjusted mortality rates provide poorer quality care? A systematic review of the literature

<p>Abstract</p> <p>Background</p> <p>Despite increasing interest and publication of risk-adjusted hospital mortality rates, the relationship with underlying quality of care remains unclear. We undertook a systematic review to ascertain the extent to which variations in risk-adjusted mortality rates were associated with differences in quality of care.</p> <p>Methods</p> <p>We identified studies in which risk-adjusted mortality and quality of care had been reported in more than one hospital. We adopted an iterative search strategy using three databases – Medline, HealthSTAR and CINAHL from 1966, 1975 and 1982 respectively. We identified potentially relevant studies on the basis of the title or abstract. We obtained these papers and included those which met our inclusion criteria.</p> <p>Results</p> <p>From an initial yield of 6,456 papers, 36 studies met the inclusion criteria. Several of these studies considered more than one process-versus-risk-adjusted mortality relationship. In total we found 51 such relationships in a widen range of clinical conditions using a variety of methods. A positive correlation between better quality of care and risk-adjusted mortality was found in under half the relationships (26/51 51%) but the remainder showed no correlation (16/51 31%) or a paradoxical correlation (9/51 18%).</p> <p>Conclusion</p> <p>The general notion that hospitals with higher risk-adjusted mortality have poorer quality of care is neither consistent nor reliable.</p

The changing nature of family formation in Ireland

The past century has seen striking changes in family formation in Ireland. Family dynamics are fundamental aspects of social change, but they have been neglected by social research in Ireland since the 1970s. This thesis draws on already available national data to study movements into marriage and parenthood in detail and thereby improve our understanding of family dynamics. The research focuses, in the main, on the 1926 to 1991 census period; a period characterised by the transition from high rates of nonmarriage and large family sizes to more standard European levels.The study primarily addresses the class dimension of family formation. Social class remains a strong predictor of marriage and fertility patterns. The study first maps the long-standing trend of higher rates of non-marriage and higher rates of marital fertility in the poorer sections of Irish society. The fertility levels of the class categories experiencing economic marginalisation have remained high so that the burden of dependency is heaviest among working class and farming families. Fertility decline was, however, evident in all socio-economic groups.Secondly, the thesis provides the first serious examination of quantitative evidence to assess the hypothesis that high rates of marital fertility act as a marriage deterrent. Despite the availability of more effective fertility controls, marriage plans continue to be influenced by the size of the prospective family. The results highlight the importance of economic resources as a prerequisite to marriage. Economic rationality is not, however, the only driving force.Thirdly, the thesis investigates the degree to which changes in family formation were related to changes in the composition of Irish society. A standardisation exercise isolating the effects of population structure revealed that class compositional changes cannot account for changes in male fertility rates over the course of the twentieth century but, were important in understanding declining rates of celibacy.</p

Teaching stats: A crisis in Irish sociology?

AbstractThere is now a lack of quantitative capacity among practitioners andteachers in sociology in Ireland. Yet interest in the value of quantitativemethods among governments, funding organisations and society in generalare on the increase. Social science research councils and funders inother countries, notably the UK, have realised there is a problem and arenow attempting to remedy this through increased funding for the recruitmentof quantitatively trained academics for example, Q-Step. The paperexamines a number of developments notably Big Data, increases in transdisciplinaryresearch and developments in mixed methods research which,it is argued, underline the need for more and better quantitative methodsteaching in sociology. The paper calls for sociology departments to rethinktheir curricula and actively promote the teaching of a range ofmethods at the undergraduate level

Beyond Networks: &apos;Social Cohesion&apos; and Unemployment Exit Rates. Working Papers of http://www.essex.ac.uk/chimera/ Page 34 of 45

This paper provides convincing new evidence on the role of social resource patterns in shaping an individual’s chances of entry to the labour market. It links movements out of unemployment into employment to constructed indicators of ‘social cohesion’. These are social participation, social support and the social network. It was found that the current duration in a state has an influence on the probability of exit from that state. However, even after controlling for this and many other demographic and economic factors, the social network measure remained a significance influence on whether the unemployed found a job. Respondents who have close employed friends are significantly more likely than those who do not to exit unemployment. Why is this the case? Previous research has shown that the more socially integrated individuals have greater access to useful job information flows. In addition, this study has found that the unemployed who have close employed friends are significantly less likely to suffer psychological distress. In this sense, policies which isolate the unemployed into ghettos (for example, council housing schemes

The changing nature of family formation in Ireland

The past century has seen striking changes in family formation in Ireland. Family dynamics are fundamental aspects of social change, but they have been neglected by social research in Ireland since the 1970s. This thesis draws on already available national data to study movements into marriage and parenthood in detail and thereby improve our understanding of family dynamics. The research focuses, in the main, on the 1926 to 1991 census period; a period characterised by the transition from high rates of nonmarriage and large family sizes to more standard European levels. The study primarily addresses the class dimension of family formation. Social class remains a strong predictor of marriage and fertility patterns. The study first maps the long-standing trend of higher rates of non-marriage and higher rates of marital fertility in the poorer sections of Irish society. The fertility levels of the class categories experiencing economic marginalisation have remained high so that the burden of dependency is heaviest among working class and farming families. Fertility decline was, however, evident in all socio-economic groups. Secondly, the thesis provides the first serious examination of quantitative evidence to assess the hypothesis that high rates of marital fertility act as a marriage deterrent. Despite the availability of more effective fertility controls, marriage plans continue to be influenced by the size of the prospective family. The results highlight the importance of economic resources as a prerequisite to marriage. Economic rationality is not, however, the only driving force. Thirdly, the thesis investigates the degree to which changes in family formation were related to changes in the composition of Irish society. A standardisation exercise isolating the effects of population structure revealed that class compositional changes cannot account for changes in male fertility rates over the course of the twentieth century but, were important in understanding declining rates of celibacy.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

UNEMPLOYMENT: BLAME THE VICTIM?

This paper investigates a problem of ‘state dependency’. People who have been unemployed in the past are much more likely than others to become unemployed in the future. But is it unemployment itself that causes future unemployment or is there something else, some measured or unmeasured form of heterogeneity, in individual characteristics or environmental circumstances, that causes both the past and present unemployment? There is an extensive economic literature on this issue which comes to no absolutely firm conclusions as to the existence of state dependency in this case. We present a simple sociological model, of the ‘recursive determination ’ of the employment state. We estimate that time invariant personal characteristics not included in the model (or left altogether unmeasured) can only play a small part in the determination of unemployment. Which implies in turn that the association between successive periods of unemployment must be mostly the result of acquired or other time-varying characteristics (though we cannot tell whether these relate to the individual or to circumstances in his or her social or geographical environment)

Family figures: family dynamics and family types in Ireland, 1986-2006

This study examines family patterns and trends in Ireland over the twenty years from 1986 to 2006. Its primary objective is to use the available data and various quantitative techniques to elucidate trends in family structures and to explore what might lie behind them.Author has checked copyrightAD 12/05/201

Causality in life course research: the potential use of ‘natural experiments’ for causal inference

Recent decades have seen renewed attention to issues of causal inference in the social sciences, yet implications for life course research have not been spelled out nor is it clear what types of approaches are best suited for theoretical development on life course processes. We begin by evaluating a number of meta-theoretical perspectives, including critical realism, data mining and experimentation, and find them limited in their potential for causal claims in a life course context. From this, we initiate a discussion of the logic and practice of ‘natural experiments’ for life course research, highlighting issues of how to identify natural experiments, how to use cohort information and variation in the order and timing of life course transitions to isolate variation in exposure, how such events that alter social structures are the key to identification in causal processes of the life course and, finally, of analytic strategies for the extraction of causal conclusions from conventional statistical estimates. Through discussion of both positive and negative examples, we outline the key methodological issues in play and provide a road map of best practices. While we acknowledge that causal claims are not necessary for social explanation, our goal is to explain how causal inference can benefit life course scholarship and outline a set of practices that can complement conventional approaches in the pursuit of causal explanation in life course research