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PubMed1994

User comments on a clinical event monitor.

Columbia-Presbyterian Medical Center's health care providers have access to alerts and interpretations generated by an Arden Syntax-based clinical event monitor. They have the opportunity to send comments to the clinical information services staff. Over a period of 26 months, they sent 126 comments. The comments were analyzed using the critical incident technique, resulting in a hierarchy of categories that summarizes user concerns. The majority of comments (65) indicated that the messages were actually (8) or at least potentially useful (57). A minority (28) indicated that they were unhelpful (27) or actually harmful (1). Another group (27) made suggestions or asked questions. The comments have been very helpful for the maintenance of Medical Logic Modules (MLMs) and the clinical event monitor itself.

Academic Medical Centers↗

PubMed1988

The effect of non-factual post-training negative comment on the recall of verbal information.

Healthy human volunteers were asked to study a 250-word account of the 1954 World Football Cup and submitted to a questionnaire on the verbally learned material 48 h later. The subjects were divided into 7 groups. One received no treatment between text and questionnaire. The others were shown either a brief laudatory or derogatory comment on the World Cup 0, 3, or 6 h after having read the text. The comment contained no facts relevant to the text. Subjects exposed to the derogatory comment 0 or 3 h after having studied the text performed much worse in the questionnaire than any of the other groups. Performance in another, unrelated, general knowledge memory test was not affected by reading the World Cup text or subsequent comments. Thus post-event non-factual information was able to affect recall of verbally acquired factual material even if presented 3 h later; the effect does not seem to be explicable by a general performance deficit, and may be due to integration of information acquired during and after the event into one single experience.

Adult↗

PubMed1991

Medicare program; Medicare Geographic Classification Review Board--procedures and criteria--HCFA. Final rule with comment period.

This final rule with comment period responds to public comments on the September 6, 1990 interim final rule with comment period that established the Medicare Geographic Classification Review Board (MGCRB) and sets forth the criteria for the MGCRB to use in issuing its decisions concerning the geographic reclassification of hospitals for purposes of payment under the prospective payment system. In addition, this final rule with comment period implements provisions of the Omnibus Budget Reconciliation Act of 1990 concerning the MGCRB.

Catchment Area, Health↗

PubMed1995

Medicare program; physician financial relationships with, and referrals to, health care entities that furnish clinical laboratory services and financial relationship reporting requirements--HCFA. Final rule with comment period.

This final rule with comment period provides that, if a physician or a member of a physician's immediate family has a financial relationship with an entity, the physician may not make referrals to the entity for the furnishing of clinical laboratory services under the Medicare program, except under specified circumstances. It contains revisions to our proposal of March 11, 1992, based on comments submitted by the public. Further, it incorporates the new expansions and exceptions created by the Omnibus Budget Reconciliation Act of 1993 and the amendments in the Social Security Act Amendments of 1994 (SSA '94), that are related to referrals for clinical laboratory services and have a retroactive effective date of January 1, 1992. In addition, we are responding to comments received on the interim final rule with comment period (published on December 3, 1991) that set forth Medicare reporting requirements for the submission by certain health care entities of information about their relationships with physicians. That document implemented the reporting requirements of section 1877(f) of the Social Security Act. This rule revises those requirements to incorporate the amendments to section 1877(f) made by SSA '94, to apply to any further reporting we may require.

Budgets↗

PubMed1992

Medicare program; update of ambulatory surgical center payment rates--HCFA. Notice with comment period.

This notice implements section 1833(i)(2)(A) of the Social Security Act, which requires that the payment rates for ambulatory surgical center (ASC) services be reviewed and updated annually, and responds to the public comments we received concerning the ASC payment rate update notice with comment published on December 31, 1991 (56 FR 67666), except for those concerning payment amounts for lithotripsy, which will be addressed in another Federal Register document. DATES: Effective date: The payment rates contained in this notice are effective for services furnished on or after October 1, 1992. Comments date: Comments will be considered if we receive them at the appropriate address, as provided below, by 5 p.m. on November 30, 1992.

Ambulatory Surgical Procedures↗

PubMed2000

Medicare program; Medicare+Choice program. Health Care Financing Administration (HCFA), HHS. Final rule with comment period.

This final rule with comment period responds to comments on the June 26, 1998 interim final rule that implemented the Medicare+Choice (M+C) program and makes revisions to those regulations where warranted. We also are making revisions to the regulations that are necessary to reflect the changes to the M+C program resulting from the Balanced Budget Refinement Act of 1999 (BBRA). Revisions to the regulations reflecting changes in the law made by the BBRA are subject to public comment. Issues discussed in this rule include eligibility, election, and enrollment policies; marketing requirements; access requirements; service area and benefit policy; quality improvement standards; payment rates, risk adjustment methodology, and encounter data submission; provider participation rules; beneficiary appeals and grievances; contractual requirements; and preemption of State law by Federal law. This final rule also addresses comments on the interim final rule published on December 2, 1997, which implemented user fees for section 1876 risk contractors for 1998, and formed the basis for the M+C user fee provisions in the June 26, 1998 interim final rule, and the provider-sponsored organization (PSO) interim final rule published April 14, 1998.

Budgets↗

PubMed2000

Medicare program; prospective payment system for hospital outpatient services: revisions to criteria to define new or innovative medical devices, drugs, and biologicals eligible for pass-through payments and corrections to the criteria for the grandfather provision for certain Federally Qualified Health Centers. Health Care Financing Administration (HCFA), HHS. Interim final rule with comment period.

This interim final rule with comment period changes one criterion and postpones the effective date for two other criteria that a new device, drug, or biological must meet in order for its cost to be considered "not significant" for purposes of determining its eligibility for transitional pass-through payments. It also changes the transitional pass-through payment policy to include new single use medical devices that come in contact with human tissue and that are surgically implanted or inserted in a patient whether or not the devices remain with the patient after the patient is released from the hospital outpatient department. These policies represent a departure from those presented in the April 7, 2000 Federal Register final rule with comment period entitled, "Prospective Payment System for Hospital Outpatient Services." This interim final rule with comment period also corrects a trigger date for grandfathering of provider-based Federally Qualified Health Centers (FQHCs) to conform with the intent not to disrupt existing FQHCs with longstanding provider-based treatment that we discussed in the April 2000 final rule. Under the criteria in the April 2000 final rule with comment period, FQHCs are treated as departments of a provider without regard to the criteria for provider-based status in that document if they meet other criteria and were designated as FQHCs before 1995. Under this correction, facilities that meet those other criteria and were designated as FQHCs or "look-alikes" on or before April 7, 2000 would continue to be treated as provider-based. In addition, we are clarifying how the requirement for prior notice to beneficiaries is to be applied in emergency situations. Also, we are clarifying the protocols for off-campus departments in emergency situations.

Ambulatory Care↗

PubMed2001

Medicaid program; use of restraint and seclusion in psychiatric residential treatment facilities providing inpatient psychiatric services to individuals under age 21. Interim final rule; amendment and clarification with request for comment.

On January 22, 2001, we published an interim final rule with comment period (66 FR 7148) that established a definition of a "psychiatric residential treatment facility" that is not a hospital and that may furnish covered Medicaid inpatient psychiatric services for individuals under age 21. The interim final rule established standards for the use of restraints or seclusion that psychiatric residential treatment facilities must have in place to protect the health and safety of residents. In response to some of the concerns submitted in comments on that interim rule, this document clarifies what facilities are subject to the requirements of the interim final rule, modifies reporting requirements to facilitate HCFA monitoring, and amends staffing requirements applicable to restraints and seclusion. Due to the operational significance of these issues, amendment to the interim final rule is required by the May 22, 2001 effective date of the interim final rule. Without such amendments, we are concerned that substantial numbers of facilities would not be able to comply with certain requirements of our interim final rule, and that beneficiaries will suffer needless displacement from those facilities. We are also concerned that HCFA will not be able to timely obtain data necessary to monitor for situations involving jeopardy to program beneficiaries. We will accept comments on these amendments, and will address all comments on the interim final rule and these amendments at a later date.

Adolescent↗

PubMed2002

GP recruitment and retention: a qualitative analysis of doctors' comments about training for and working in general practice.

BACKGROUND AND AIMS: General practice in the UK is experiencing difficulty with medical staff recruitment and retention, with reduced numbers choosing careers in general practice or entering principalships, and increases in less-than-full-time working, career breaks, early retirement and locum employment. Information is scarce about the reasons for these changes and factors that could increase recruitment and retention. The UK Medical Careers Research Group (UKMCRG) regularly surveys cohorts of UK medical graduates to determine their career choices and progression. We also invite written comments from respondents about their careers and the factors that influence them. Most respondents report high levels of job satisfaction. A noteworthy minority, however, make critical comments about general practice. Although their views may not represent those of all general practitioners (GPs), they nonetheless indicate a range of concerns that deserve to be understood. This paper reports on respondents' comments about general practice. ANALYSIS OF DOCTORS' COMMENTS: Training Greater exposure to general practice at undergraduate level could help to promote general practice careers and better inform career decisions. Postgraduate general practice training in hospital-based posts was seen as poor quality, irrelevant and run as if it were of secondary importance to service commitments. In contrast, general practice-based postgraduate training was widely praised for good formal teaching that met educational needs. The quality of vocational training was dependent upon the skills and enthusiasm of individual trainers. Recruitment problems Perceived deterrents to choosing general practice were its portrayal, by some hospital-based teachers, as a second class career compared to hospital medicine, and a perception of low morale amongst current GPs. The choice of a career in general practice was commonly made for lifestyle reasons rather than professional aspirations. Some GPs had encountered difficulties in obtaining posts in general practice suited to their needs, while others perceived discrimination. Newly qualified GPs often sought work as non-principals because they felt too inexperienced for partnership or because their domestic situation prevented them from settling in a particular area. Changes to general practice The 1990 National Health Service (NHS) reforms were largely viewed unfavourably, partly because they had led to a substantial increase in GPs' workloads that was compounded by growing public expectations, and partly because the two-tier system of fund-holding was considered unfair. Fund-holding and, more recently, GP commissioning threatened the GP's role as patient advocate by shifting the responsibility for rationing of health care from government to GPs. Some concerns were also expressed about the introduction of primary care groups (PCGs) and trusts (PCTs). Together, increased workload and the continual process of change had, for some, resulted in work-related stress, low morale, reduced job satisfaction and quality of life. These problems had been partially alleviated by the formation of GP co-operatives. Retention difficulties Loss of GPs' time from the NHS workforce occurs in four ways: reduced working hours, temporary career breaks, leaving the NHS to work elsewhere and early retirement. Child rearing and a desire to pursue interests outside medicine were cited as reasons for seeking shorter working hours or career breaks. A desire to reduce pressure of work was a common reason for seeking shorter working hours, taking career breaks, early retirement or leaving NHS general practice. Other reasons for leaving NHS general practice, temporarily or permanently, were difficulty in finding a GP post suited to individual needs and a desire to work abroad. CONCLUSIONS: A cultural change amongst medical educationalists is needed to promote general practice as a career choice that is equally attractive as hospital practice. The introduction of Pre-Registration House Officer (PRHO) placements in general practice and improved flexibility of GP vocational training schemes, together with plans to improve the quality of Senior House Officer (SHO) training in the future, are welcome developments and should address some of the concerns about poor quality GP training raised by our respondents. The reluctance of newly qualified GPs to enter principalships, and the increasing demand from experienced GPs for less-than-full-time work, indicates a need for a greater variety of contractual arrangements to reflect doctors' desires for more flexible patterns of working in general practice.

Attitude of Health Personnel↗

PubMed2002

Medicaid program; Medicaid managed care. Withdrawal of final rule with comment period.

This document withdraws all provisions of the final rule with comment period on Medicaid managed care that we published in the Federal Register on January 19, 2001 (66 FR 6228) with an initial effective date of April 19, 2001. This January 19, 2001 final rule, which has never taken effect, would have combined Medicaid managed care regulations in a new part 438, implemented Medicaid managed care requirements of the Balanced Budget Act of 1997 (Pub. L. 105-33), and imposed new requirements on entities currently regulated as "prepaid health plans'' (PHPs). The regulations set forth in the final rule being withdrawn have been superseded by regulations promulgated in a subsequent rulemaking initiated on August 20, 2001 (66 FR 43613). In addition, this document addresses comments received in response to an interim final rule with comment period that we published on August 17, 2001 in the Federal Register (66 FR 43090) that further delayed, until August 16, 2002, the effective date of the January 19, 2001 final rule with comment period.

Humans↗

PubMed2002

Medicare program; changes to the hospital outpatient prospective payment system and calendar year 2003 payment rates; and changes to payment suspension for unfiled cost reports. Final rule with comment period.

This final rule with comment period revises the Medicare hospital outpatient prospective payment system to implement applicable statutory requirements and changes arising from our continuing experience with this system. In addition, it describes changes to the amounts and factors used to determine the payment rates for Medicare hospital outpatient services paid under the prospective payment system. These changes are applicable to services furnished on or after January 1, 2003. This rule also allows the Secretary to suspend Medicare payments "in whole or in part" if a provider fails to file a timely and acceptable cost report. In addition, this rule responds to public comments received on the November 2, 2001 interim final rule with comment period (66 FR 55850) that set forth the criteria the Secretary will use to establish new categories of medical devices eligible for transitional pass-through payment under the Medicare's hospital outpatient prospective payment system. Finally, this rule responds to public comments received on the August 9, 2002 proposed rule for revisions to the hospital outpatient prospective payment system and payment rates (67 FR 52092). CMS finds good cause to waive proposed rulemaking for the assignment of new codes to Ambulatory Payment Classifications and for the payment of influenza and pneumococcal vaccines under reasonable cost; justification for the waiver will follow in a subsequent Federal Register notice.

Centers for Medicare and Medicaid Services, U.S.↗

PubMed2001

Reply to "Comment on 'Surface restructuring, kinetic oscillations, and chaos in heterogeneous catalytic reactions' ".

In my numeration, the criticism of my simulations of kinetic oscillations in NO reduction by H2 on Pt(100) [V. P. Zhdanov, Phys. Rev. E 59, 6292 (1999)] by Kuzovkov, Kortlüke, and von Niessen [preceding paper, Phys. Rev. 63, 023101 (2001)] contains 19 comments. I show that four comments are irrelevant. The other 15 comments are wrong, because they either contradict the basic principles of the theory of phase transitions, Monte Carlo simulations, and catalytic chemistry or ignore numerous experimental data on adsorbate-induced restructuring of the Pt(100) surface.

Comment↗

PubMed2002

Three-systems theory of human visual motion perception: review and update: comment.

This comment addresses two issues raised by Lu and Sperling [J. Opt. Soc. Am. A 18, 2331 (2001)]. These authors stated that stereomotion (movement of binocular disparity) is processed exclusively by a third-order motion system that involves feature tracking. This comment discusses evidence that clearly shows that stereomotion is processed by a low-level mechanism that does not track features. Lu and Sperling also claimed that motion signals from binocular rivalry have confounded many stereomotion experiments in the past. This comment discusses how stimuli employed in most previous studies of stereomotion processing would not produce rivalry.

Depth Perception↗

PubMedDate not supplied

Critical comments made to schizophrenic patients by their families in Japan.

Critical comments (CCs) are one of the components of expressed emotion (EE), an excess of which is related to relapse. Therefore, CCs could be a target of family psychoeducation. We examined the nature of CCs for clues to family therapy. We classified CCs expressed in the Camberwell Family Interview (CFI) into nine categories: (1) positive symptoms, (2) negative symptoms, (3) compliance with medical care, (4) life problems, (5) socially inappropriate behavior, (6) aggression, (7) rejection, (8) premorbid personality, and (9) other. Positive symptoms were the most frequently commented on (34%). Negative symptoms were not so frequently commented on (11%), as expected. In comparing high-EE and low-EE relatives or relapsers and nonrelapsers, there were no significant differences in the distribution of the nine CC categories. We conclude that positive symptoms should be a main topic of family psychoeducation in such cases.

Adolescent↗

PubMed1991

The patient comment card: a system to gather customer feedback.

Continuous patient feedback can give important information to hospitals about the quality of care they provide. The Patient Comment Card (PCC), a brief form that can be used to gather open-ended comments from patients and to measure quality, was developed during a two-year period and was extensively evaluated in a series of three pilot tests involving more than 2,000 patients discharged from five hospitals. Evaluation results demonstrate that the questionnaire elicits useful comments from patients and can generate statistically reliable scores and valid quality measures. However, in a field trial in four hospitals, low response rates (15%-27%) reflected, first, lack of follow-up of non-respondents, and second, the fact that most of the PCC quality scores were upwardly biased; these inflated scores were likely to reflect the low response rate. Tools such as the PCC should be used judiciously, given the possible abuses and misinterpretations of hospital quality scores.

Bias↗

PubMed1997

The patient comment line. An innovative and unique tool in the evaluation of patient satisfaction.

Evaluation of patient satisfaction is key to continuous quality improvement in the healthcare setting. The authors describe a Patient Comment Line, an innovative and cost-effective method for evaluating patient satisfaction. Designed to elicit, track, and follow up on patients' telephone comments, the methods, results, recommendations, and outcomes of a hospital comment line pilot project are presented.

Costs and Cost Analysis↗

PubMed2000

The effect of comments about shoe construction on impact forces during walking.

UNLABELLED: Comparisons of ground reaction forces (GRF) during gait are not typically conducted with blinding of the varied shoe characteristic, raising concerns related to the existence of a placebo effect, or a subject response based on a perceived expectation of change. PURPOSE: To determine whether investigator comments on shoe construction influenced GRF measures and ratings of shoe cushioning during walking. METHODS: 19 female college students volunteered for a study presented as a test of a new shoe material. The study involved walking (2.5 m x s(-1)) under three shoe conditions (SC). Shoes in SC2 and SC3 were harder than those in SC1, but shoes in SC1 and SC3 looked similar. Subjects in a mislead group (N = 9) were told SC1 and SC3 were baseline measures in a standard shoe, with SC2 misleadingly described as a shoe constructed of unique new material. A control group performed the same three conditions without investigator description. GRF data were collected for 10 trials for each subject in each condition, and subjects rated the perceived cushioning of each shoe. GRF data and perceived cushioning scores were analyzed using mixed-factor (group by shoe) ANOVA. RESULTS: A significant shoe main effect was found for loading rate. Post hoc tests identified the difference between SC1 and both SC2 and SC3. The group main effect was not significant for any dependent variable. CONCLUSIONS: Results suggest that, as a group, GRF data and cushioning scores are not affected by investigator comments that do not match shoe construction characteristics. However, ratings of perceived shoe cushioning by some individual subjects reflected investigator comments and not the vertical GRF variables.

Adolescent↗

PubMed2000

Reply to comments on "Simple measure for complexity"

We respond to the comment by Crutchfield, Feldman, and Shalizi [Comment in this issue, Phys. Rev. E 62, 2996 (2000)] and that by Binder and Perry [preceding Comment, Phys. Rev. E 62, 2998 (2000)], pointing out that there may be many maximum entropies, and therefore "disorders" and "simple complexities." Which ones are appropriate depend on the questions being addressed. "Disorder" is not restricted to be the ratio of a nonequilibrium entropy to the corresponding equilibrium entropy; therefore, "simple complexity" need not vanish for all equilibrium systems, nor must it be nonvanishing for a nonequilibrium system.

Journal Article↗