Comparación de dos técnicas de estimación del consumo y digestibilidad en pastoreo de Panicum coloratum L. diferido

Voluntary intake (OMI) and digestibility (OMD) of organic matter were estimated on a deferred pasture of Panicum coloratum L., using grazing rams, by two different methods. Four treatments, corresponding to tour forage allowances (in g. DM. Kg-1 ot liveweight.day-1) were established: T1: 15; T2: 30; T3: 45; T4: 60. Six Pampinta rams by treatment grazed during 22 days, being the last 6 days the measurement period The first method estimated OMI as the difference between initial and final biomass (OMldir), and digestibility (OMDdir) from OMldir, and fecal organic matter production (F). The second method of estimation used Iignin as internal marker. The organic matter digestibility (OMO~ was estimated through the concentrations of Iignin in diet and faeces, and the voluntary intake (OMILDA), from (OMDLDA) and F. No differences (p>0.05) between treatments could be detected in any of the measured variables. The OMI, as estimated through both methods, were highly correlated (r = 0.97; p<0.01). II seems Iikely that Iignin ls a suitable internal marker in Panicum coloratum L. Both, digestibility and voluntary in lake of grazing animals can be estimated through this technique, with good precision.Sobre una pastura de Panicum coloratum L. diferida, se estimó el consumo voluntario (CMO) y la digestibilidad (DMO) de la materia orgánica, por dos métodos distintos, utilizando ovinos en pastoreo. Se establecieron cuatro tratamientos, correspondientes a cuatro asignaciones forrajeras (en g MS.Kg-1 de peso vívo.dia-1): T1: 15; T2: 30; T3: 45; T4: 60. En cada tratamiento pastorearon 6 carneros Pampinta durante 22 días, con cambio diario de parcela, correspondiendo los 6 últimos al período de medición. En el primer método, el CMO se estimó por diferencia entre la biomasa inicial y final (CMOdir), y la digestibilidad (DMOdir a partir de CMOdir, y la producción de materia orgánica en heces (H). El segundo método de estimación fue a través de la utilización de Iignina como marcador interno. Se estableció la digestibilidad de la materia orgánica (DMOLDA) a través de la concentración de Iignina en dieta y heces, y el consumo voluntario (CMOLDA) a partir de DMOLDA y H. En ninguna de las variables estimadas se encontraron diferencias (p>0,05) entre tratamientos. El CMO, estimado a través de ambos métodos, tuvo alta correlación (r = 0,97; p<0,01). También el grado de asociación de la DMO fue alto, aunque algo menor entre los métodos (r = 0,84; p<0,01). La Iignina tiene buen comportamiento como marcador interno en Panicum coloratum L. Mediante esta técnica, puede estimarse la digestibilidad y el consumo voluntario de animales en pastoreo con buena precisión

Monitoring compliance with standards of care for chronic diseases using healthcare administrative databases in Italy: Strengths and limitations

<div><p>Background</p><p>A recent comprehensive report on healthcare quality in Italy published by the Organization of Economic Co-operation and Development (OECD) recommended that regular monitoring of quality of primary care by means of compliance with standards of care for chronic diseases is performed. A previous ecological study demonstrated that compliance with standards of care could be reliably estimated on regional level using administrative databases. This study compares estimates based on administrative data with estimates based on GP records for the same persons, to understand whether ecological fallacy played a role in the results of the previous study.</p><p>Methods</p><p>We compared estimates of compliance with diagnostic and therapeutic standards of care for type 2 diabetes (T2DM), hypertension and ischaemic heart disease (IHD) from administrative data (IAD) with estimates from medical records (MR) for the same persons registered with 24 GP’s in 2012. Data were linked at an individual level.</p><p>Results</p><p>32,688 persons entered the study, 12,673 having at least one of the three diseases according to at least one data source. Patients not detected by IAD were many, for all three conditions: adding MR increased the number of cases of T2DM, hypertension, and IHD by +40%, +42%, and +104%, respectively. IAD had imperfect sensitivity in detecting population compliance with therapies (adding MR increased the estimate, from +11.5% for statins to +14.7% for antithrombotics), and, more substantially, with diagnostic recommendations (adding MR increased the estimate, from +23.7% in glycated hemoglobin tests, to +50.5% in electrocardiogram). Patients not detected by IAD were less compliant with respect to those that IAD correctly identified (from -4.8 percentage points in proportion of IHD patients compliant with a yearly glycated hemoglobin test, to -40.1 points in the proportion of T2DM patients compliant with the same recommendation). IAD overestimated indicators of compliance with therapeutic standards (significant differences ranged from 3.3. to 3.6 percentage points) and underestimated indicators of compliance with diagnostic standards (significant differences ranged from -2.3 to -14.1 percentage points).</p><p>Conclusion</p><p>IAD overestimated the percentage of patients compliant with therapeutic standards by less than 6 percentage points, and underestimated the percentage of patients compliant with diagnostic standards by a maximum of 14 percentage points. Therefore, both discussions at local level between GP's and local health unit managers and discussions at central level between national and regional policy makers can be informed by indicators of compliance estimated by IAD, which, based on those results, have the ability of signalling critical or excellent clusters. However, this study found that estimates are partly flawed, because a high number of patients with chronic diseases are not detected by IAD, patients detected are not representative of the whole population of patients, and some categories of diagnostic tests are markedly underrecorded in IAD (up to 50% in the case of electrocardiograms). Those results call to caution when interpreting IAD estimates. Audits based on medical records, on the local level, and an interpretation taking into account information external to IAD, on the central level, are needed to assess a more comprehensive compliance with standards.</p></div

Comparison of compliance measured by IAD, by MR or by either of the two data sources, on the whole population.

<p>Difference in the value of indicators between the patients that IAD correctly identified as having the disease and patients not detected by IAD (ND), and between the patients that IAD correctly identified as having the disease and patients that IAD only classified as having the disease (FD). Difference was computed using EITHER for compliance, and adjusting per age, gender and LHU. Standards are listed in decreasing order of Cohen’s kappa.</p

Indicators of compliance with standards of care during a year of follow-up.

<p><b>ATC</b>: Anatomical Therapeutic Chemical classification system for drugs. ICSO: Italian coding system for outpatient services.</p

Scatter plots comparing age-and- gender standardised measures of compliance with standards of care, in the two governance scenarios.

<p>In the Local governance scenario the 24 clusters of patients of the same GP are measured by IAD on the Y-axis and MR on the X-axis. In the Central governance scenario the 5 clusters of patients in the same LHU are measured by IAD on the Y-axis and best estimate (proportion of patients detected by MR with are compliant according to EITHER) on the X-axis.</p