HSO Performance: A Critical Appraisal of Current Research

This document reviews the findings of studies of the clinical and economic performance of Ontario’s Health Service Organizations and makes recommendations for further evaluation. The tentative conclusions regarding HSO performance indicate that: 1. The HSO program in total and some HSOs individually have lower rates of hospitalization of their patients. 2. The use of ambulatory care by HSO and FFS patients is about the same. 3. HSO physicians manager greater patient loads. 4. HSOs employ more non-physician health personnel. 5. Some HSOs provide higher quality of care. 6. Some HSOs are better structured to deliver preventive services to their patients. 7. HSO physicians are more likely to believe their method of remuneration favours the delivery of preventive services. 8. HSO patients are less satisfied with their care. These conclusions are tentative because there are several methodological problems with the studies on which they are based: eg. The estimation of the true size of a practice, the self-selection of patients and providers, and the calculation of costs (particularly for hospital care). As well, the existing evaluations involve few centres and there are many differences among the centres. Hence generalizations of the findings to the wider population of providers may be invalid. It appears that although payment mechanisms can affect the cost and quality of health care, the differences within modalities are as great or greater than the differences between modalities. Factors, other than payment mechanism which have been found to affect the quality or cost of health care include: group practice, peer review, other financial incentives, other organizational determinants (eg. Institutional links), the use of non-physician providers, and the provider selection process. An important step in evaluation is to set out the core objectives of the program under evaluation. Primary objects might include shifting physicians to non-FFS practice, reducing hospital utilization, enhancing disease prevention and health promotion activities, promoting better maintenance care for chronic illness, and enhancing the health status of the population. Once the primary objectives are clearly specified measureable targets may be selected. To guide the development of the HSO program it is important to identify other practice features associated with better performance rather than simply study the effects of payment mechanism alone.

Developing a benchmarking tool for measuring the effectiveness of local authority domestic energy reduction policies

The Department of Energy and Climate Change (DECC) promote Local Authorities as their preferred route for implementing policies aimed at reducing domestic sector energy consumption, and delivering the Government’s 2050 energy and climate targets. DECC provide data at lower layer super output area (LSOA) to aid monitoring strategies. These data in principle enable the change in energy demand over time and the relative energy use in different regions to be understood. However there is at present little incentive for Local Authorities to initiate local domestic reduction policies. Furthermore it remains unclear if national datasets are suitable for measuring and monitoring the success of Local Authorities. This paper argues the need for an improved benchmarking tool to measure the effectiveness of Local Authorities in this task. It utilises data – covering demographic, economic and climatic factors – to calculate descriptive statistics, and correlation and regression analysis to examine the relationships between these factors and domestic energy consumption. The analysis is to be expanded, incorporating further demographic, economic and built form data to try and develop a stronger statistical model, while collaboration with Local Authorities is to be sought in order to develop practical applications

Turing’s Genius – Defining an apt microcosm

Alan Turing (1912–1954) is widely acknowledged as a genius. As well as codebreaking during World War II and taking a pioneering role in computer hardware design and software after the War, he also wrote three important foundational papers in the fields of theoretical computer science, artificial intelligence, and mathematical biology. He has been called the father of computer science, but he also admired by mathematicians, philosophers, and perhaps more surprisingly biologists, for his wide-ranging ideas. His influence stretches from scientific to cultural and even political impact. For all these reasons, he was a true polymath. This paper considers the genius of Turing from various angles, both scientific and artistic. The four authors provide position statements on how Turing has influenced and inspired their work, together with short biographies, as a starting point for a panel session and visual music performance

Understanding factors associated with the translation of cardiovascular research: A multinational case study approach

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited.This article has been made available through the Brunel Open Access Publishing Fund.Background: Funders of health research increasingly seek to understand how best to allocate resources in order to achieve maximum value from their funding. We built an international consortium and developed a multinational case study approach to assess benefits arising from health research. We used that to facilitate analysis of factors in the production of research that might be associated with translating research findings into wider impacts, and the complexities involved. Methods: We built on the Payback Framework and expanded its application through conducting co-ordinated case studies on the payback from cardiovascular and stroke research in Australia, Canada and the United Kingdom. We selected a stratified random sample of projects from leading medical research funders. We devised a series of innovative steps to: minimize the effect of researcher bias; rate the level of impacts identified in the case studies; and interrogate case study narratives to identify factors that correlated with achieving high or low levels of impact. Results: Twenty-nine detailed case studies produced many and diverse impacts. Over the 15 to 20 years examined, basic biomedical research has a greater impact than clinical research in terms of academic impacts such as knowledge production and research capacity building. Clinical research has greater levels of wider impact on health policies, practice, and generating health gains. There was no correlation between knowledge production and wider impacts. We identified various factors associated with high impact. Interaction between researchers and practitioners and the public is associated with achieving high academic impact and translation into wider impacts, as is basic research conducted with a clinical focus. Strategic thinking by clinical researchers, in terms of thinking through pathways by which research could potentially be translated into practice, is associated with high wider impact. Finally, we identified the complexity of factors behind research translation that can arise in a single case. Conclusions: We can systematically assess research impacts and use the findings to promote translation. Research funders can justify funding research of diverse types, but they should not assume academic impacts are proxies for wider impacts. They should encourage researchers to consider pathways towards impact and engage potential research users in research processes. © 2014 Wooding et al.; licensee BioMed Central Ltd.RAND Europe and HERG, with subsequent funding from the NHFA, the HSFC and the CIHR. This research was also partially supported by the Policy Research Programme in the English Department of Health

Measurement and analysis of household carbon: the case of a UK city

There is currently a lack of data recording the carbon and emissions inventory at household level. This paper presents a multi-disciplinary, bottom-up approach for estimation and analysis of the carbon emissions, and the organic carbon (OC) stored in gardens, using a sample of 575 households across a UK city. The annual emission of carbon dioxide emissions from energy used in the homes was measured, personal transport emissions were assessed through a household survey and OC stores estimated from soil sampling and vegetation surveys. The results showed that overall carbon patterns were skewed with highest emitting third of the households being responsible for more than 50% of the emissions and around 50% of garden OC storage. There was diversity in the relative contribution that gas, electricity and personal transport made to each household’s total and different patterns were observed for high, medium and low emitting households. Targeting households with high carbon emissions from one source would not reliably identify them as high emitters overall. While carbon emissions could not be offset by growing trees in gardens, there were considerable amounts of stored OC in gardens which ought to be protected. Exploratory analysis of the multiple drivers of emissions was conducted using a combination of primary and secondary data. These findings will be relevant in devising effective policy instruments for combatting city scale green-house gas emissions from domestic end-use energy demand

Monitoring Antimicrobial Use and Resistance: Comparison with a National Benchmark on Reducing Vancomycin Use and Vancomycin-Resistant Enterococci

To determine if local monitoring data on vancomycin use directed quality improvement and decreased vancomycin use or vancomycin-resistant enterococci (VRE), we analyzed data from 50 intensive-care units (ICUs) at 20 U.S. hospitals reporting data on antimicrobial-resistant organisms and antimicrobial agent use. We compared local data with national benchmark data (aggregated from all study hospitals). After data were adjusted for changes in prevalence of methicillin-resistant Staphylococcus aureus, changes in specific prescriber practice at ICUs were associated with significant decreases in vancomycin use (mean decrease -48 defined daily doses per 1,000 patient days, p<0.001). These ICUs also reported significant decreases in VRE prevalence compared with those not using unit-specific changes in practice (mean decrease of 7.5% compared with mean increase of 5.7%, p<0.001). In this study, practice changes focused towards specific ICUs were associated with decreases in ICU vancomycin use and VRE prevalence

Systematic In Vivo Analysis of the Intrinsic Determinants of Amyloid β Pathogenicity

Protein aggregation into amyloid fibrils and protofibrillar aggregates is associated with a number of the most common neurodegenerative diseases. We have established, using a computational approach, that knowledge of the primary sequences of proteins is sufficient to predict their in vitro aggregation propensities. Here we demonstrate, using rational mutagenesis of the Aβ42 peptide based on such computational predictions of aggregation propensity, the existence of a strong correlation between the propensity of Aβ42 to form protofibrils and its effect on neuronal dysfunction and degeneration in a Drosophila model of Alzheimer disease. Our findings provide a quantitative description of the molecular basis for the pathogenicity of Aβ and link directly and systematically the intrinsic properties of biomolecules, predicted in silico and confirmed in vitro, to pathogenic events taking place in a living organism

A systematic review of frameworks for the interrelationships of mental health evidence and policy in low- and middle-income countries

Background: The interrelationships between research evidence and policy-making are complex. Different theoretical frameworks exist to explain general evidence–policy interactions. One largely unexplored element of these interrelationships is how evidence interrelates with, and influences, policy/political agenda-setting. This review aims to identify the elements and processes of theories, frameworks and models on interrelationships of research evidence and health policy-making, with a focus on actionability and agenda-setting in the context of mental health in low- and middle-income countries (LMICs). Methods: A systematic review of theories was conducted based on the BeHeMOTh search method, using a tested and refined search strategy. Nine electronic databases and other relevant sources were searched for peer-reviewed and grey literature. Two reviewers screened the abstracts, reviewed full-text articles, extracted data and performed quality assessments. Analysis was based on a thematic analysis. The included papers had to present an actionable theoretical framework/model on evidence and policy interrelationships, such as knowledge translation or evidence-based policy, specifically target the agenda-setting process, focus on mental health, be from LMICs and published in English. Results: From 236 publications included in the full text analysis, no studies fully complied with our inclusion criteria. Widening the focus by leaving out ‘agenda-setting’, we included ten studies, four of which had unique conceptual frameworks focusing on mental health and LMICs but not agenda-setting. The four analysed frameworks confirmed research gaps from LMICs and mental health, and a lack of focus on agenda-setting. Frameworks and models from other health and policy areas provide interesting conceptual approaches and lessons with regards to agenda-setting. Conclusion: Our systematic review identified frameworks on evidence and policy interrelations that differ in their elements and processes. No framework fulfilled all inclusion criteria. Four actionable frameworks are applicable to mental health and LMICs, but none specifically target agenda-setting. We have identified agenda-setting as a research theory gap in the context of mental health knowledge translation in LMICs. Frameworks from other health/policy areas could offer lessons on agenda-setting and new approaches for creating policy impact for mental health and to tackle the translational gap in LMICs