Does delayed measurement affect patient reports of provider performance? Implications for performance measurement of medical assistance with tobacco cessation: A Dental PBRN study

<p>Abstract</p> <p>Background:</p> <p>We compared two methods of measuring provider performance of tobacco control activities: immediate "exit cards" versus delayed telephone follow-up surveys. Current standards, e.g. HEDIS, use delayed patient measures that may over or under-estimate overall performance.</p> <p>Methods:</p> <p>Patients completed exit cards in 60 dental practices immediately after a visit to measure whether the provider "asked" about tobacco use, and "advised" the patient to quit. One to six months later patients were asked the same questions by telephone survey. Using the exit cards as the standard, we quantified performance and calculated sensitivity (agreement of those responding yes on telephone surveys compared with exit cards) and specificity (agreement of those responding no) of the delayed measurement.</p> <p>Results:</p> <p>Among 150 patients, 21% reporting being asked about tobacco use on the exit cards and 30% reporting being asked in the delayed surveys. The sensitivity and specificity were 50% and 75%, respectively. Similarly, among 182 tobacco users, 38% reported being advised to quit on the exit cards and this increased to 51% on the delayed surveys. The sensitivity and specificity were 75% and 64%, respectively. Increasing the delay from the visit to the telephone survey resulted in increasing disagreement.</p> <p>Conclusion:</p> <p>Patient reports differed considerably in immediate versus delayed measures. These results have important implications because they suggest that our delayed measures may over-estimate performance. The immediate exit cards should be included in the armamentarium of tools for measuring providers' performance of tobacco control, and perhaps other service delivery.</p

A retrospective cohort study on lifestyle habits of cardiovascular patients: how informative are medical records?

Contains fulltext : 79771.pdf (publisher's version ) (Open Access)BACKGROUND: To evaluate the vigilance of medical specialists as to the lifestyle of their cardiovascular outpatients by comparing lifestyle screening as registered in medical records versus a lifestyle questionnaire (LSQ), a study was carried out at the cardiovascular outpatient clinic of the university hospital of Nijmegen, The Netherlands, between June 2004 and June 2005. METHODS: For 209 patients information from medical records on lifestyle habits, physician feedback, and interventions in the past year was compared to data gathered in the last month by a self-report LSQ. RESULTS: Doctors register smoking habits most consistently (90.4%), followed by alcohol use (81.8%), physical activity (50.2%), and eating habits (27.3%). Compared to the LSQ, smoking, unhealthy alcohol use, physical activity, and unhealthy eating habits are underreported in medical records by 31, 83, 54 and 97%, respectively. Feedback, advice or referral was documented in 8% for smoking, 3% for alcohol use, 12% for physical activity, and 26% for eating habits. CONCLUSION: Lifestyle is insufficiently registered or recognized by doctors providing routine care in a cardiovascular outpatient setting. Of the unhealthy lifestyle habits that are registered, few are accompanied by notes on advice or intervention. A lifestyle questionnaire facilitates screening and interventions in target patients and should therefore be incorporated in the cardiovascular setting as a routine patient intake procedure

Smart building management vs. intuitive human control—Lessons learnt from an office building in Hungary

Smart building management and control are adopted nowadays to achieve zero-net energy use in buildings. However, without considering the human dimension, technologies alone do not necessarily guarantee high performance in buildings. An office building was designed and built according to state-of-the-art design and energy management principles in 2008. Despite the expectations of high performance, the owner was facing high utility bills and low user comfort in the building located in Budapest, Hungary. The objective of the project was to evaluate the energy performance and comfort indices of the building, to identify the causes of malfunction and to elaborate a comprehensive energy concept. Firstly, current building conditions and operation parameters were evaluated. Our investigation found that the state-of-the-art building management system was in good conditions but it was operated by building operators and occupants who are not aware of the building management practice. The energy consumption patterns of the building were simulated with energy modelling software. The baseline model was calibrated to annual measured energy consumption, using actual occupant behaviour and presence, based on results of self-reported surveys, occupancy sensors and fan-coil usage data. Realistic occupant behaviour models can capture diversity of occupant behaviour and better represent the real energy use of the building. This way our findings and the effect of our proposed improvements could be more reliable. As part of our final comprehensive energy concept, we proposed intervention measures that would increase indoor thermal comfort and decrease energy consumption of the building. A parametric study was carried out to evaluate and quantify energy, comfort and return on investment of each measure. It was found that in the best case the building could save 23% of annual energy use. Future work includes the follow-up of: occupant reactions to intervention measures, the realized energy savings, the measurement of occupant satisfaction and behavioural changes