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PubMedDate not supplied

Managing Medicaid managed care: are states becoming prudent purchasers?

This paper examines the extent to which five states are becoming "prudent purchasers" in their oversight of Medicaid managed care. Our conclusions are mixed. These states are making more sustained efforts along these lines than most private purchasers are and have improved the amount and quality of the data they collect on the experiences of Medicaid clients when compared with the traditional fee-for-service program. They have been less successful in ensuring data quality that is adequate to support contracting decisions and in developing the analytical or political capacity to use data to "manage" the managed care system. Becoming a prudent purchaser appears to be a complex task for states that may prove difficult to achieve.

Contract Services↗
PubMed2002

Linking physician characteristics and medicare claims data: issues in data availability, quality, and measurement.

BACKGROUND: Increasingly, investigators are using administrative databases to answer research questions requiring physician characteristics information. This article provides a roadmap for investigators who use Medicare data to answer such questions, focusing on use of the Surveillance, Epidemiology, and End Results (SEER)-Medicare files. METHODS: Three data sources that can be linked to identify physician characteristics-Medicare claims, the Unique Physician Identification Number (UPIN) Registry, and the American Medical Association (AMA) Masterfile-were examined for data availability, linkage rates, and quality. These databases also were used to explore measurement issues regarding physician specialty and practice volume. RESULTS: Over 98 percent of UPINs identified from the Medicare claims could be linked with both the AMA Masterfile and the UPIN Registry. The AMA Masterfile is the best source of sociodemographic and medical training information; the Medicare claims are the best source of practice ZIP code; and the UPIN Registry is the best source of practice organization data. The operationalization of variables such as physician specialty and practice volume is dependent on the specific research question that is being addressed. CONCLUSION: Administrative databases, such as SEER-Medicare data linked to AMA Masterfile or UPIN Registry data, are an important resource for investigators interested in assessing the relationship between physicians' personal and practice characteristics and the content or outcomes of clinical care.

American Medical Association↗
PubMed2000

Cognitive behaviour therapy for schizophrenia.

BACKGROUND: Although medication is the mainstay of treatment for schizophrenia, always, some sort of informal or formal talking therapy is indicated. In cognitive behavioural therapy (CBT) links are made between the person's feelings and patterns of thinking which underpin their distress. OBJECTIVES: To review the effects of cognitive behaviour therapy (CBT) for those with schizophrenia compared to standard care, specific medication and non-intervention; also to review the effects of CBT for those with schizophrenia who are concurrently receiving standard care compared to no additional intervention to standard care, specific medication, additional drug interventions to standard care and other additional psychosocial interventions to standard care. SEARCH STRATEGY: Electronic searches of Biological Abstracts (1980-1998), CINAHL (1982-1998), The Cochrane Library (Issue 2, 1998), The Cochrane Schizophrenia Group's Register of Trials (August 1998), EMBASE (1980-1998), MEDLINE (1966-1998), PsycLIT (1887-1998), SIGLE (1990-1998), and Sociofile (1980-1998) were undertaken. All references of articles selected were searched for further relevant trials. SELECTION CRITERIA: Randomised trials of cognitive behaviour therapy for people with a diagnosis of schizophrenia, possible schizophrenia or mental illnesses where specific diagnoses have not been employed. Outcomes such as death, metal state, relapse, psychological well-being and acceptability of treatment were sought. DATA COLLECTION AND ANALYSIS: Studies were reliably selected and assessed for methodological quality. Data were extracted by two reviewers working independently. Dichotomous data were analysed on an intention-to-treat basis and continuous data with 70% completion rate are presented. MAIN RESULTS: Four small trials were identified. All presented data suggested that there was a difference favouring CBT plus standard care over standard care alone in terms of reducing relapse rates (short term OR 0.31 CI 0.1-0.98; medium term OR 0.38 CI 0.17-0.83; long term OR 0.46 CI 0.26-0.83, NNT 6 CI 3-30). These findings were supported within the trials by scale-derived data. CBT, however, did not keep more people in care than a standard approach and there is no data relating to the effect of CBT on compliance with medication. One study also presented data on the effects of CBT when compared to supportive psychotherapy. No effect statistically significantly favoured either group but all were suggestive that the trial may have been underpowered to find an effect in favour of CBT. REVIEWER'S CONCLUSIONS: The results of well conducted and reported ongoing trials are eagerly awaited. Currently, for those with schizophrenia willing to receive CBT, access to this treatment approach is associated with a substantially reduced risk of relapse. However, at present CBT is a fairly scarce commodity, often provided by highly skilled and experienced therapists. Therefore, its application in day to day practice may be restricted by the availability of suitable practitioners. Similarly, the present data provides little indication of how effective CBT procedures might be when they are applied by less experienced practitioners.

Cognitive Behavioral Therapy↗
PubMed1997

Setting thresholds for MDS (Minimum Data Set) quality indicators for nursing home quality improvement reports.

BACKGROUND: Determining meaningful thresholds to reinforce excellent performance and flag potential problem areas is critical for quality improvement reports. Without thresholds, an organization may interpret its performance as superior to others because it is "better than average" and falsely assume it does not have care problems in certain areas. SETTING THRESHOLDS: The Minimum Data Set (MDS) assessment instrument is mandated for use nationwide in all nursing homes participating in Medicaid or Medicare programs. Since 1993 a research team at the University of Missouri-Columbia has been developing and testing quality indicators (QIs) derived from MDS data as a foundation for quality improvement activities. In July 1996, a cross-section of 13 clinical care personnel from nursing homes participated on an expert panel for threshold setting for QIs derived from MDS assessment data. Panel members individually determined good and poor threshold scores for each QI, reviewed statewide distributions of MDS QIs, and, two weeks later, completed a follow-up Delphi round. Three members of the research team reviewed the results of the expert panel and set the final thresholds. With thresholds established for good and poor scores, MDS QI scores are reported to a sample of Missouri nursing homes using the thresholds. CONCLUSIONS: To ensure that thresholds reflect current practice, threshold setting with another panel of experts will be repeated as needed, but at least biannually. The report format will be revised on the basis of user input, and a statewide study testing different educational support methods for quality improvement using MDS QIs is now underway.

Aged↗
PubMed1998

Double data entry: what value, what price?

We challenge the notion that double data entry is either sufficient or necessary to ensure good-quality data in clinical trials. Although we do not completely reject that notion, we quantify some of the effects that poor quality data have on final study results in terms of estimation, significance testing, and power. By introducing digit errors into simulated blood pressure measurements we demonstrate that simple range checks allow us to detect (and therefore correct) the main errors that impact the final study results and conclusions. The errors that cannot easily be detected by such range checks, although possibly numerous, are shown to be of little importance in drawing the correct conclusions from the statistical analysis of data. Exploratory data analysis cannot identify all errors that a second data entry would detect, but on the other hand, not all errors that are found by exploratory data analysis are detectable by double data entry. Double data entry is concerned solely with ensuring, to a high degree of certainty, that what is recorded on the case record form is transcribed into the database. Exploratory data analysis looks beyond the case record form to challenge the plausibility of the written data. In this sense, the second entering of data has some benefit, but the use of exploratory data analysis methods, either as data entry is ongoing or at the end of data entry and as the first stage in an analysis strategy, should always be mandatory.

Algorithms↗
PubMed2004

Fault detection in a real-time monitoring network for water quality in the lagoon of Venice (Italy).

In the context of monitoring water quality in natural ecosystems in real time, on-line data quality control is a very important issue for effective system surveillance and for optimizing maintenance of the monitoring network. This paper presents some applications of recursive state-parameter estimation algorithms to real-time detection of signal drift in high-frequency observations. Two continuous-discrete recursive estimation schemes, namely the Extended Kalman Filter and the Recursive Prediction Error algorithm, were applied to assuring the quality of the dissolved oxygen (DO) time series, as obtained from the Lagoon of Venice (Italy) during August 2002, through the real-time monitoring network of the Magistrato alle Acque (the Venice Water Authority). Results demonstrate the effectiveness of the methodology in early detection of a probable drift in the DO signal. Comparison of these results with those obtained from the application of a related recursive scheme (a Dynamic Linear Regression procedure) suggests the strong benefits of approaching the problem of on-line data quality control with several (not merely a single) independent such estimation methods.

Algorithms↗
PubMed2006

Benchmark for evaluating the quality of DNA sequencing: proposal from an international external quality assessment scheme.

BACKGROUND: In the past 15 years, clinical laboratory science has been transformed by the use of technologies that cross the traditional boundaries between laboratory disciplines. However, during this period, issues of quality have not always been given adequate attention. The European Molecular Genetics Quality Network (EMQN) has developed a novel external quality assessment scheme for evaluation of DNA sequencing. We report the results of an international survey of the quality of DNA sequencing among 64 laboratories from 21 countries. METHODS: Current practice for DNA sequence analysis was established by use of an online questionnaire. Participating laboratories were provided with 4 DNA samples of validated genotype. Evaluation of the results included assessing the quality of sequence data, variant genotypes, and mutation nomenclature. To accommodate variations in mutation nomenclature, variants indicated by participants were scored for compliance with 3 acceptable marking schemes. RESULTS: A total of 346 genotypes were analyzed. Of these, 19 (5%) genotyping errors were made. Of these, 10 (53%) were false-negative and 9 (47%) were false-positive results. A further 27 (8%) errors were made in naming mutations. Results were analyzed for 3 indicators of data quality: PHRED quality scores, Quality Read Length, and Quality Read Overlap. Most laboratories produced results of acceptable diagnostic quality as judged by these indicators. The results were used to calculate a consensus benchmark for DNA sequencing against which individual laboratories could rank their performance. CONCLUSIONS: We propose that the consensus benchmark can be used as a baseline against which the aggregate and individual laboratory standard of DNA sequencing may be tracked from year to year.

Benchmarking↗
PubMed2005

Simpleaffy: a BioConductor package for Affymetrix Quality Control and data analysis.

UNLABELLED: Quality Control is a fundamental aspect of successful microarray data analysis. Simpleaffy is a BioConductor package that provides access to a variety of QC metrics for assessing the quality of RNA samples and of the intermediate stages of sample preparation and hybridization. Simpleaffy also offers fast implementations of popular algorithms for generating expression summaries and detection calls. AVAILABILITY: Simpleaffy can be downloaded from http://www.bioconductor.org. SUPPLEMENTARY INFORMATION: Additional information can be found on the supplementary website located at http://bioinformatics.picr.man.ac.uk.

Computational Biology↗
PubMedDate not supplied

Using observational information in planning and implementation of field studies with children as subjects.

Children have been one of the least-studied populations for estimating environmental exposure, even though they are cited as a sensitive subgroup for diseases derived from environmental exposure. This trend appears to be changing as more studies are conducted with children as subjects. It consequently becomes increasingly important to gather and use observational data in all phases of the study. Observational data are the key for both defining the pathway of exposure and for assessing effectiveness of the data-collection protocols. Obtaining quality data from a study involving children requires: efficient use of observational data, collection of meaningful personal and microenvironmental samples, linkage of observational data to the collected samples, and personnel trained to work with children using pilot-tested protocols. Although all of these help to ensure the quality of the data, the utility of the data is often determined by observational feedback from those who collected it. Laboratory-derived protocols should be living documents and observations from the field should be used to modify the data-collection methods when practical.

Child↗
PubMed1994

Using lot quality assessment techniques to evaluate quality of data in a community-based health information system.

We report here on the application of lot quality assessment (LQA) techniques by managers of a Save the Children (SC) Child Survival Project in Mbalachanda, Malawi, to evaluate data contained in a community-based health information system. By defining 'lots' as the health records for all households with children under 5 years old which were listed on the rosters of village health promoters supervised by a given community health supervisor, and by establishing criteria for 'acceptability' of samples drawn from these lots, we were able to identify and offer additional supervision to health workers (supervisors as well as village health promoters) who were not performing adequately. As LQA sampling procedures require that only a small sample be drawn from each lot, the assessment could be conducted easily and quickly. Health workers were found to have the greatest need for help in updating demographic data and information about home-based oral rehydration therapy (ORT) training sessions, and the least for help in recording children's immunization status. We conclude that LQA can be a useful supervisory tool for health programme managers.

Child Health Services↗
PubMed1981

A simple strategy convenient for processing of RIA data and quality control in the laboratory on a desk-top-calculator.

The experience with a computer strategy of mathematically simple models for the description of standard curves and continuous quality control calculations with outlier diagnostics for the processing of RIA data in laboratory is discussed. To get over the difficulties associated with the approximation of the nonlinear shape of standard curves, the combination of weighted iterative linear logit-log regression and point-to point logit-log interpolation is proposed. Monitoring of assay performance is based on three large pool sera determined in triplicates. The control data are checked by statistical tests for the rejection of single outlying observations, followed by calculation of objective criteria on within- and between-assay precision by means of analysis of variance for a one-way classification on the basis of which actual triplicates and whole assays can be assessed. Combined with quality control chart technique and the construction of a rough three-point precision profile the empirical knowledge of an experienced assayist should be included in the RIA interpretation as can be easily organized by way of a dialogue-program on a desk-top-calculator.

Computers↗
PubMed2006

Improved signal and reduced noise in neural recordings from close-spaced electrode arrays using independent component analysis as a preprocessor.

Noise can greatly complicate the isolation of individual cell action potential waveforms for the sake of electrophysiological analysis. For an experiment involving recording in the thalamus/subthalamus areas of a rat brain, a hybrid hardware/software method was utilized to improve the signal-to-noise quality of the recorded signal on each recording channel. The procedure uses closely spaced recording electrode arrays and independent component analysis (ICA) to fortify the signal energy of a single spike by combining input from several channels, and concurrently to reduce the noise on each channel by isolating common mode components such as artifacts, slow waves, and correlated distant spike activation. In the next step, a wavelet denoising-based signal-to-noise assessment is used to quantify the improvement in data quality for each data record. The data presented here demonstrate that this method, which can be applied off-line as a preprocessor to other time domain or transform domain spike sorting methods, is consistently effective at improving data quality and facilitating subsequent detection and classification of neurons.

Action Potentials↗
PubMed2001

Future of benchmarking: more data, more sharing, and better patient care.

Automated systems that provide whatever regulatory information is needed when it is needed; sharing of data to improve quality; data mined for specific groups of patients: Those are just a few of the trends predicted by health care experts asked to comment on the future of benchmarking and data strategies. Such improvements are needed; many hospitals continually run into problems when it comes to finding the right data sets for targeted patient groups.

Benchmarking↗
PubMed1997

Comparability and compatibility: issues in combining data from central cancer registries.

Before combining or comparing data from different registries, one should consider similarities and differences in data collection methods, data quality, and underlying populations. What are important population demographic differences? What about differences in data quality: How can these be measured and evaluated? What factors can affect data compatibility? How can one assess data comparability? If registries are compatible, are they always comparable? Are comparable data from registries compatible data? When data are combined, what issues should be considered to determine whether the combined result is meaningful? These are some of the common questions that need to be addressed to determine whether and when data from different registries should be combined or compared.

Data Collection↗