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PubMedDate not supplied

Measuring quality of care for vulnerable children: challenges and conceptualization of a pediatric outcome measure of quality.

This article addresses conceptual and practical issues in the assessment of pediatric health care quality, outlines a conceptual model for measuring quality, and describes ongoing research to validate an outcome measure of health care quality for vulnerable children. Pediatric quality measurement is distinct from that for adults due to development, dependence, differential epidemiology, demographic factors, and differences between the child and adult health services systems. A noncategorical approach to quality measurement, rather than one based on illness status or specific condition, is necessary to adequately measure quality for the majority of children, both healthy and ill. One promising noncategorical measure of pediatric health care quality is health outcome, specifically health-related quality of life (HRQOL). The Pediatric Quality of Life Inventory (PedsQL), a brief, practical, reliable, valid, generic pediatric HRQOL measure, is a suitable candidate measure. Ongoing research to validate the PedsQL as an outcome measure of health care quality is described.

Adult↗

PubMed2001

Does adding MS-specific items to a generic measure (the SF-36) improve measurement?

OBJECTIVE: The 36-item Short Form Health Survey Questionnaire (SF-36) is a widely used generic health status measure. Recently it has been adapted to produce a disease-specific measure for MS-the 54-item Multiple Sclerosis Quality of Life Scale (MSQOL-54)-composed of five unchanged SF-36 scales; three altered SF-36 scales (one item added to each scale); and five new scales incorporating 15 additional items. This study evaluates the impact of these additions by comparing the measurement properties of the MSQOL-54 with the SF-36. METHODS: A total of 150 patients with MS, representing a broad spectrum of disease severity, completed a range of questionnaires, which included the MSQOL-54 (from which the SF-36 score was computed). Of these, 44 people completed the measures before and after inpatient rehabilitation to evaluate responsiveness. Standard psychometric methods were used to evaluate the measurement properties. RESULTS: The measurement properties of the unchanged scales, inevitably, remain identical. Those of the three altered scales are virtually identical. Of the five new scales, the validity of the two sexual scales is questioned because of the high percentage of missing data, and the validity of the overall quality-of-life scale is limited as demonstrated by the low to moderate correlations with other related and unrelated measures. Responsiveness of the new scales also appears limited. CONCLUSION: Modifying existing measures by simply adding clinically chosen items may not be as useful as anticipated in improving the measurement properties of an instrument.

Adult↗

PubMed2000

Comparison of morphological measurements extracted from digitized dental radiographs with lumbar and femoral bone mineral density measurements in postmenopausal women.

BACKGROUND: We set out to determine whether morphologic measurements extracted from digitized images of bite-wing radiographs correlated with lumbar and femoral bone mineral density (BMD) measurements in 45 postmenopausal women who had no or only mild periodontal disease (no probing depths >5 mm). METHODS: Lumbar spine and femoral BMDs were determined by dual-energy x-ray absorptiometry. Vertical bite-wing radiographs were taken and digitized. Crestal and apical regions of interest (ROIs) were drawn on the digital images of the maxillary and mandibular alveolar bone on the patient's right and left sides. For each patient, a single morphologic measurement was made for each of 8 ROIs. Correlation analysis was performed to determine the strengths of the relationships between the morphologic measurements made at the 8 locations and between these morphologic measurements and BMD measurements. RESULTS: The correlations (r) between the morphologic operator (MO) measurements and lumbar spine and femoral BMDs were weak (mean r = 0.02, range = 0.32 to -0.26) and not statistically significant, with no clear trends discernible. Correlations between MO measurements made at the 8 alveolar sites were also weak (mean r = 0.05, range = 0.35 to -0.38) and not statistically significant. CONCLUSIONS: The MO measurements used in this study were weakly correlated with lumbar spine and femoral BMDs, with no clear trends discernible in this population of postmenopausal women with no or mild periodontal disease.

Absorptiometry, Photon↗

PubMed1989

[Three dimensional shape measurement of teeth (3). The divisional measurement method of abutment teeth].

In order to improve the accuracy of the three dimensional shape measurement, the divisional measurement method, which tilts and rotates the abutment teeth was attempted. This system is composed of a high precision laser displacement meter, teeth model scanning machine and personal computer. For the measurement of a crown abutment tooth with indistinct margin lines, the measuring area was divided into four regions of the mesio-distal sides and the buccal-lingual sides. The tooth was tilted on the gonio stage +/- 30 degrees around the mesio and distal direction, rotated 180 degrees around the tooth axis, and measured divisionally. The partial data thus obtained were combined by means of the software program into the composed data. Using this method of measurement, the margin of the abutment tooth was recognizable, and the faulted data, which arose from shielding of the receiving beam, was eliminated. Overlapping data from divisional measurements were deducted and the complete data for the single abutment tooth was saved into a file. In the case of a MOD inlay abutment tooth, the divisional measurements with only rotation were carried out, since each curved wall makes nearly a square angle and sharp boundary. A couple of data sets were combined and complete data without error was obtained. Thus, measurements of abutment teeth were obtained without error. It is possible to get the basic data for the production of crown and inlay by means of CAM technique.

Computer Graphics↗

PubMed1998

The reliability of measuring active and passive cervical range of motion: an observer-blinded and randomized repeated-measures design.

PURPOSE: To study the intra- and interexaminer reliability of measuring active and passive cervical range of motion (ROM). STUDY DESIGN: Observer-blinded, randomized repeated measures of active or passive cervical ROM by two different examiners. SETTING: Institute of Medical Biology (Center of Biomechanic) at Odense University. PARTICIPANTS: Forty asymptomatic students, 20 of each gender, aged 20 to 30 yr, from the University of Odense. INTERVENTION: Measurements of either active or passive cervical ROM using the electrogoniometer CA-6000 Spine Motion Analyzer by two blinded examiners. Each subject was measured four times, twice by each examiner in random order, using a mean-of-three-measurements protocol. MAIN OUTCOME MEASURES: The reliability within and between examiners in active and passive ROM was assessed by the Intraclass Correlation Coefficient [ICC (2,k)]. Coefficient of variation (CV) was used to assess the reproducibility within and between examiners in active and passive ROM. RESULTS: Intraexaminer ICCs for active ROM ranged from .81 to .97 and for passive ROM from .85 to .98. The interexaminer ICCs for active ROM ranged from .76 to .98 and for passive ROM from .65 to .95. Intraexaminer CVs for active ROM ranged from 2.42 to 10.93 and for passive ROM, from 1.82 to 5.77. The interexaminer CVs for active ROM ranged from 2.30 to 14.43 and for passive ROM, from 2.58 to 10.93. CONCLUSION: Active and passive ROM could be measured reliably in six movement directions by the same examiner. Measurements were reliable when measured by different examiners for active cervical ROM in six movement directions and passive total ROM in three motion planes.

Adult↗

PubMed2000

Nonlinear measures of heart period variability: decreased measures of symbolic dynamics in patients with panic disorder.

Time series of heart period are not linear and recent studies illustrated the importance of using nonlinear methods to quantify the complexity of these time series. We compared different techniques to quantify the nonlinear complexity of these time series in patients with panic disorder and normal controls and correlated these measures with spectral powers in different bands of interest. Twenty-four hour ECG was recorded in 23 normal controls and 29 patients with panic disorder by using Holter records. Time series of heart period were analyzed by using approximate entropies, slopes of 1/f scaling, two algorithms to calculate fractal dimension, and word sequences using symbolic dynamics. Measures using symbolic dynamics, especially word count (WC-100), showed highly significant differences between the two groups similar to some of the frequency domain (spectral) measures, while the other techniques were relatively ineffective to distinguish between the two groups. Different nonlinear techniques may relate to different aspects of nonlinear complexity of the time series. These nonlinear techniques were also not uniform in showing the differences between awake and sleep periods. Some correlate with the measures of respiratory sinus arrhythmia and some measures obtained from symbolic dynamics may reflect not only the nonlinear complexity of the time series but also the total variability in the 24 hr HP time series, especially power in the ultra-low frequency band (< 0.0033 Hz). However, word count (WC-100) had only weak correlations with other measures and discriminated best between the two groups and showed that this nonlinear measure was of additional value to the linear measures in classifying the two groups.

Arrhythmias, Cardiac↗

PubMed1995

Relationship between portal blood flow measured by image-directed Doppler ultrasonography and hepatic blood flow measured by indocyanine green constant infusion in patients with cirrhosis.

The validity of portal blood flow measurement in image-directed Doppler ultrasound (PBF-IDU) is still under debate. In this study PBF-IDU has been compared with hepatic blood flow measured by the indocyanine green constant infusion technique (HBF-ICG), which is the reference invasive method with which to measure total hepatic blood flow in man (ie, the sum of hepatic artery and portal vein blood flow). In 27 cirrhotic patients with hepatopetal portal blood flow, PBF-IDU was measured by multiplying the portal vein cross-sectional area by the averaged mean velocity of blood in the vessel. About 1 hour later HBF-ICG was measured during hepatic vein catheterization performed to evaluate portal hypertension. In 19 of 27 patients, intrahepatic arterial resistance indices were also measured. PBF-IDU and HBF-ICG were 1.010 +/- 0.555 L/min (M +/- SD) and 1.496 +/- 0.731 L/min, respectively. Blood flow measured by the two methods showed a close correlation (r = 0.80, p < 0.001). The regression line showed that HBF-ICG was systematically higher than PBF-IDU (mean difference +29 +/- 30%). The hepatic artery component of HBF-ICG probably accounted for the difference. An inverse correlation was found between the differences between the two procedures and intrahepatic arterial resistance indices (r = -0.52, p = 0.04), which may be considered indirect parameters of arterial supply. It can be concluded that image-directed Doppler ultrasound is a sufficiently accurate method to measure portal blood flow in cirrhotics.

Adult↗

PubMed1995

Correlation of urodynamic measures of urethral resistance with clinical measures of incontinence severity in women with pure genuine stress incontinence. The Continence Program for Women Research Group.

OBJECTIVE: Our aim was to correlate multiple measures of urethral resistance with five clinical measures of incontinence severity in women with pure genuine stress incontinence. STUDY DESIGN: Seventy-five women with pure genuine stress incontinence underwent passive and dynamic urethral pressure profilometry and Valsalva leak point pressure determinations. The standardized and validated measures of incontinence severity included (1) the number of incontinent episodes, (2) the number of continence pads used recorded in a prospective 1-week urinary dairy, (3) grams of fluid loss on a pad quantitation test, and (4) two condition-specific quality-of-life scales, the urogenital distress inventory and the incontinence impact questionnaire. The urodynamic and severity measures were compared with Pearson product-moment correlation analysis. RESULTS: There were no significant correlations between dynamic urethral pressure profile pressure transmission ratios and any measure of incontinence severity. Passive urethral pressure profile variables correlated significantly with incontinence episodes and pad use. Valsalva leak point pressures correlated significantly with pad use and quantitation testing. None of the urodynamic measurements was significantly correlated with either of the quality-of-life scales, but our power to demonstrate a correlation was limited. CONCLUSIONS: Both passive urethral pressure profile measures and Valsalva leak point pressures correlate with some severity measures of genuine stress incontinence. Although inefficient pressure transmission during stress is critical to the pathogenesis of genuine stress incontinence, the severity of the pressure transmission defect is not related to clinical severity. Conversely, impairment of intrinsic urethral resistance is not essential to the pathogenesis of genuine stress incontinence, but the degree of sphincteric impairment is related to severity once the condition exists.

Adult↗

PubMed2006

Measurement and feedback of infection control process measures in the intensive care unit: Impact on compliance.

BACKGROUND: Infection control process measures provide actionable and measurable indicators for performance improvement. OBJECTIVE: To determine the relationship between the measurement and feedback of selected infection control process measures and compliance with infection control practices. METHODS: We measured selected infection control process measures (hand hygiene, femoral catheter use as a proportion of all central venous catheter (CVC) days and proportion of head of bed elevations) in the medical respiratory intensive care unit (ICU) (MRICU) and the surgical trauma ICU (STICU). All data were collected by trained infection control practitioners. Baseline data were obtained April through June 2004. Baseline hand hygiene data were obtained from May to June. Follow-up observations were obtained from July 2004 through March 2005. Both baseline and follow-up observations were reported to the units' leadership. The data were reviewed for improvement in compliance with process measures. Differences in proportions were analyzed for statistical significance by the chi(2) test. RESULTS: There was a statistically significant improvement in the head of bed elevation rates: 54.9% versus 98.4% (P < .001) for the MRICU and 46.5% versus 77.2% (P < .001) for the STICU, respectively. There was also a statistically significant decline in femoral catheter rates in both ICUs: 17.8% versus 10% (P = .001) in the MRICU and 8.4% versus 3% (P < .001) in the STICU, respectively. There was no significant improvement in hand hygiene rates in either ICU: 31.8% versus 39.3% (P = .1) in the MRICU and 50% versus 50.3% (P = .9) in the STICU, respectively. CONCLUSION: Feedback of process measures lowered the use of femoral catheters and improved the proportion of elevated head of beds in 2 ICUs, but there was no significant improvement in hand hygiene.

Catheterization, Central Venous↗

PubMed2005

Measuring standing hindfoot alignment: reliability of goniometric and visual measurements.

OBJECTIVE: To examine the reliability of a functional weight-bearing measure of hindfoot alignment, the standing tibiocalcaneal angle (STCA), and to compare the relative reliabilities of goniometrically and visually estimated STCAs. DESIGN: Prospective blinded comparison. SETTING: Sports medicine center. PARTICIPANTS: Eighteen asymptomatic volunteer subjects (10 men, 8 women; age range, 22-41y). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Two experienced examiners completed 2 blinded goniometric STCA and 2 blinded visual STCA measurements on each subject's right and left ankles in random order. RESULTS: Quantitative visual and goniometric STCAs were similar (visual mean range, 5.61 degrees -6.50 degrees valgus vs goniometric mean range, 5.50 degrees -6.94 degrees valgus), and both measurements exhibited good to excellent intrarater reliabilities (intraclass correlation coefficient [ICC] range, .80-.94; 95% prediction limits, 1.51 degrees -2.06 degrees ). Interrater ICCs were only fair for both measurement methods (.50-.75; 95% prediction limits, 2.2 degrees -4.1 degrees ). In terms of relative reliability, the visual STCA and goniometric STCA exhibited good to excellent agreement (ICC range, .64-.95). CONCLUSIONS: The STCA as described herein exhibited acceptable intrarater reliability for clinical use but may not be acceptably reliable between experienced examiners. The visual and goniometric STCA measurements were quantitatively similar and exhibited similar reliability. Using either method, changes of up to 2 degrees over time may be attributable to measurement error. Clinicians may consider using either STCA measurement in evaluating patients with lower-limb injuries or during screening of high-risk populations.

Adult↗

PubMed2005

Concurrent validity of flexicurve instrument measurements: sagittal skin contour of the cervical spine compared with lateral cervical radiographic measurements.

OBJECTIVES: The aim of this study was to compare flexicurve surface contour measurements of the cervical spine with radiographic measurements of cervical lordosis. METHODS: One examiner evaluated 96 patients with chronic neck pain in neutral posture using a flexible ruler, flexicurve, to measure sagittal contour of the skin over the cervical spine from the external occipital protuberance to the vertebra prominens. The flexicurve skin contour and neutral lateral radiographs were digitized and compared. The flexicurve and radiographs were categorized into height-length ratio, curve angle, curve depth, sum of depths, modified Ishihara's index, and inverse of radius. Mean values, SDs, mean differences, and limits of agreement were calculated. The differences between flexicurve measurement mean values and x-ray mean values were deemed significant if the lower limit of agreement exceeded 15% of the mean values for the x-ray measurements. RESULTS: For all variables, except the height-length ratio, the mean values of the flexicurve variables differed significantly from the corresponding mean values of the radiographic measurements. All Pearson correlation coefficients were in the very poor range (r < 0.15). CONCLUSION: The flexicurve sagittal skin contour measurement has poor concurrent validity compared with established radiographic measurements of the cervical lordosis. The flexicurve tracings always predicted lordosis, overestimated the lordosis compared with x-ray values, and cannot discriminate between radiographic lordosis, straightened, S curves, and kyphotic alignments of the cervical curve.

Adult↗

PubMed2005

Measuring a behaviorally inhibited temperament style: development and initial validation of new self-report measures.

An inhibited temperament early in life has been implicated as a risk factor for the later development of clinically meaningful anxiety and possibly depression. Most empirical investigations study young children, with fewer data obtained from older subjects. Two self-report measures, the Adult Measure of Behavioral Inhibition (AMBI) and the Retrospective Measure of Behavioral Inhibition (RMBI), were developed and evaluated psychometrically. Both instruments were multifactorial with satisfactory psychometric properties. Results indicated that the RMBI performed favorably as a measure of (retrospectively reported) childhood temperament, with good construct and discriminant validity. Designed as a measure of trait behavioral inhibition in adulthood, the AMBI also performed as a measure of contemporaneous anxiety proneness. Although the identified factor structure of both measures requires further examination in independent samples, current results support their use as valid measurement tools for studies examining the link between normal range temperament and psychopathology, especially where more rigorous prospective methods are unavailable. The RMBI may be a particularly useful instrument in this regard.

Adolescent↗

PubMed2003

Rasch analysis of the Gross Motor Function Measure: validating the assumptions of the Rasch model to create an interval-level measure.

OBJECTIVES: To describe the Rasch analysis of the Gross Motor Function Measure (GMFM-88) and to demonstrate how the assumptions of unidimensionality, sample-free measurement, and test-free measurement were validated to create an interval level measure. DESIGN: Cross-sectional and longitudinal (12-mo) data from a prospective study of motor development in children with cerebral palsy (CP) were used for the analysis. SETTING: Motor assessments were completed at 18 children's ambulatory rehabilitation centers in Ontario, Canada, by pediatric physical therapists trained in the use of the GMFM-88. PARTICIPANTS: The first 537 of 682 children enrolled into a longitudinal study of motor development in children with CP. Children had a mean age of 6.43+/-2.75 years (range, 11mo-12y) with varying types and severity of CP. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: The GMFM-88. RESULTS: The Rasch analysis, in conjunction with clinical decisions, identified 66 items from the GMFM-88 that formed a unidimensional measure (GMFM-66). Assumptions of sample-free and test-free measurement were confirmed, and a user-friendly scoring program was developed. CONCLUSIONS: The GMFM-66 is an interval-level measure of gross motor function for children with CP; it should improve the scoring, interpretation, and overall clinical and research utility over the original GMFM.

Algorithms↗

PubMed2004

Inter- and intra-observer variability in the measurement of length at endoscopy: Implications for the measurement of Barrett's esophagus.

BACKGROUND: Endoscopic measurements are frequently used to determine the length of Barrett's epithelium. Decreases in measured length also are used to assess response to pharmacotherapy. The aim of this study was to determine the accuracy of the endoscopic measurement of length under standardized conditions. METHODS: A life-size model of the esophagus was built by using an opaque polyvinyl tube. Transparent plastic inserts designed to resemble Barrett's epithelium were created. Ten different insert lengths were randomly studied. Trained endoscopists and fellows in training blinded to the lengths of the inserts performed measurements twice in random order. RESULTS: A total of 240 measurements were made by 12 endoscopists. The mean difference (1 standard deviation) between the measured and correct length was 1.10 (1.7) cm. Overestimation of the length occurred in 47% and underestimation in 37%. The kappa statistic for the first and second measurement (within 0.5 cm) performed by the same individual (intra-observer) was 0.40, suggesting only fair agreement. There was considerable variability between endoscopists. CONCLUSIONS: Accurate measurement of length at endoscopy is difficult even under ideal conditions. Intra-observer agreement is fair, but results obtained by different endoscopists are widely divergent. Small improvements in the length of Barrett's epithelium observed in some clinical trials could be because of chance instead of therapeutic effect.

Barrett Esophagus↗

PubMed2000

Femoral head measurement in hemiarthroplasty: assessment of interobserver error using 3 measuring systems.

We have assessed the consistency of measurement of femoral head circumference using 3 standard measuring instruments used in hemiarthroplasty of the hip. Fifty femoral heads were independently sized by ten independent observers using a caliper, a half circular measuring template, each allowing measurement to the nearest millimeter. We found significantly greater variance of the results using the half-circular templates (p=0.001) and the calipers (p=0. 011) compared with the full circular measuring templates. Measurement with calipers underestimated femoral head size by 0.72 mm compared with full circular measuring templates (p=0.02). Insertion of an undersized hemiarthroplasty head is a cause of increased point loading of the acetabulum and may result in increased rates of acetabular erosion. The use of full circular measurement templates is recommended as the most consistent method for head sizing in hemiarthroplasty of the hip.

Anthropometry↗

PubMed2000

Stadiometry: on measurement technique to reduce variability in spine shrinkage measurement.

OBJECTIVE: To test the effect of two measurement techniques for repeated measures of spine height using stadiometry following five experimental activity conditions.DESIGN. Six subjects were repeatedly measured while they stepped in and out of the stadiometer for each pair of measures and again on another day when they remained in place in the stadiometer for all 10 measures.RESULTS. There was much greater variability in height measures with the "in-out" method while the "in place" method demonstrated a steady shrinkage over the 3-3.5 min required to obtain the repeated measures. RelevanceContrary to popular practice, leaving a subject in the stadiometer during repeated measures includes the shrinkage that occurs over the 3-3.5 min of measurement when standing and reduces random variation due to posture change.

Anthropometry↗

PubMedDate not supplied

Disability measurement in the anxiety disorders: comparison of three brief measures.

General measures of disablement are powerful tools in clinical settings as they provide a link between clinic and community populations and allow cross-disorder comparisons. Because of their generic nature, they allow the transmittal of comprehensible health planning information to decision makers. We located no studies of such general disability measures in the anxiety disorders and decided to examine the properties of three brief generic measures in an anxiety disorders clinic. Consecutive attenders (N=168) were administered the Medical Outcomes Study Short Form-12 item (SF-12), the Brief Disability Questionnaire (BDQ), and a measure of the number of disability days due to health over the past 4 weeks. These measures were compared on their ability to discriminate within the clinic and in comparison to a representative community group. The mental health scale of the SF-12 was the most sensitive of the generic measures to differences in functioning, and is recommended as a measure of such for people with anxiety disorders. Attenders at this anxiety clinic reported high levels of disablement, and normative data on the general measures are provided.

Anxiety Disorders↗

PubMed2002

Evaluation of the performance of a wrist blood pressure measuring device with a position sensor compared to ambulatory 24-hour blood pressure measurements.

This randomized, single-center, open, within-subject study evaluated the performance of the Braun PrecisionSensor 2000 blood pressure (BP) measurement wrist device (BP 2000, Braun GmbH, Germany) with and without the position sensor, and compared the results with data obtained from 24-h ambulatory BP measurement (ABPM, A&D TM 2430). In a crossover design, 43 subjects performed BP measurements with the BP 2000 during two 7-day periods, one with the position sensor and the other without the position sensor. The correlation coefficients between all wrist self-measurements and ABPM were 0.73 for systolic and 0.65 for diastolic BP (with position sensor) compared to 0.70 and 0.60 for readings without position sensor, respectively. The categorization of subjects as normotensive or hypertensive, using the wrist device in subjects without specific training, achieved a correct classification of 84% (with position sensor) and 81% (without position sensor) in comparison to ABPM. When the measurements were performed in the clinic by an experienced observer, the correct classification was 79% in comparison to ABPM. The crossover study design did not show any significant variation between the two devices with regard to reproducibility of readings at the wrist. In conclusion, self-BP measurements with BP 2000, by untrained subjects, produced results consistent with those found recently with self-BP measurements with upper arm devices, when both data sets are compared with ABPM. The rates of false classification of normotension/hypertension with the wrist device were small and at least as reliable as office measurements.

Adult↗