Functional mapping of hospitals by diagnosis-dominant case-mix analysis

BACKGROUND: Principles and methods for the allocation of healthcare resources among healthcare providers have long been health policy research issues in many countries. Healthcare reforms including the development of a new case-mix system, Diagnosis Procedure Combination (DPC), and the introduction of a DPC-based payment system are currently underway in Japan, and a methodology for adequately assessing the functions of healthcare providers is needed to determine healthcare resource allocations. METHODS: By two-dimensional mapping of the rarity and complexity of diagnoses for patients receiving treatment, we were able to quantitatively demonstrate differences in the functions of different healthcare service provider groups. RESULTS: On average, inpatients had diseases that were 3.6-times rarer than those seen in outpatients, while major teaching hospitals treated inpatients with diseases 3.0-times rarer on average than those seen at small hospitals. CONCLUSION: We created and evaluated a new indicator for DPC, the diagnosis-dominant case-mix system developed in Japan, whereby the system was used to assess the functions of healthcare service providers. The results suggest that it is possible to apply the case-mix system to the integrated evaluation of outpatient and inpatient healthcare services and to the appropriate allocation of healthcare resources among health service providers

Computer literacy and attitudes towards e-learning among first year medical students

BACKGROUND: At the Medical University of Vienna, most information for students is available only online. In 2005, an e-learning project was initiated and there are plans to introduce a learning management system. In this study, we estimate the level of students' computer skills, the number of students having difficulty with e-learning, and the number of students opposed to e-learning. METHODS: The study was conducted in an introductory course on computer-based and web-based training (CBT/WBT). Students were asked to fill out a questionnaire online that covered a wide range of relevant attitudes and experiences. RESULTS: While the great majority of students possess sufficient computer skills and acknowledge the advantages of interactive and multimedia-enhanced learning material, a small percentage lacks basic computer skills and/or is very skeptical about e-learning. There is also a consistently significant albeit weak gender difference in available computer infrastructure and Internet access. As for student attitudes toward e-learning, we found that age, computer use, and previous exposure to computers are more important than gender. A sizable number of students, 12% of the total, make little or no use of existing e-learning offerings. CONCLUSION: Many students would benefit from a basic introduction to computers and to the relevant computer-based resources of the university. Given to the wide range of computer skills among students, a single computer course for all students would not be useful nor would it be accepted. Special measures should be taken to prevent students who lack computer skills from being disadvantaged or from developing computer-hostile attitudes

Mapping the Future: Policy Applications of Climate Vulnerability Mapping in West Africa

We describe the development of climate vulnerability maps for three Sahelian countries – Mali, Burkina Faso, and Niger – and for coastal West Africa, with a focus on the way the maps were designed to meet decision-making needs and their ultimate influence and use in policy contexts. The paper provides a review of the literature on indicators and maps in the science-policy interface. We then assess the credibility, salience, and legitimacy of the maps as tools for decision-making. Results suggest that vulnerability maps are a useful boundary object for generating discussions among stakeholders with different objectives and technical backgrounds, and that they can provide useful input for targeting development assistance. We conclude with a discussion of the power of maps to capture policy maker attention, and how this increases the onus on map developers to communicate clearly uncertainties and limitations. The assessment of policy uptake in this paper is admittedly subjective; the article includes a discussion of ways to conduct more objective and rigorous assessments of policy impact so as to better evaluate the value and use of vulnerability mapping in decision-making processes