Communication and coordination: The keys to quality

Journal of Clinical Oncology (Impact Factor: 18.43). 10/2005; 23(27):6452-5. DOI: 10.1200/JCO.2005.05.026
Source: PubMed
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    ABSTRACT: The elimination of racial and ethnic disparities in health has become a national priority in the United States (U.S. Department of Health and Human Services, Healthy people 2010: understanding and improving health, 2nd ed. Washington, DC: U.S. Government Printing Office, 2000). These disparities have many causes and potential solutions. In the landmark Unequal Treatment report, the Institute of Medicine reviewed and highlighted racial and ethnic disparities in health care as an important factor contributing to disparities in health outcomes (Institute of Medicine, Unequal treatment: confronting racial and ethnic disparities in health care. Washington, DC: National Academy Press, 2002). This report concluded with a strong call for action to eliminate racial and ethnic disparities in the US healthcare system. Since 2003, the federal government has issued an annual National Healthcare Disparities Report to monitor racial, ethnic, and socioeconomic disparities in access to care and quality of care. Whereas the initial report released by the federal Department of Health and Human Services generated considerable controversy and debate about the content and interpretation of key findings (Bloche, N Engl J Med 350(15):1568–70, 2004), subsequent reports have become a useful tool for tracking national trends in disparities across a wide array of quality measures. In 2004, this report found that lower quality of care was experienced by African Americans for two-thirds of measures, by Hispanics for one-half of measures, and by American Indians/Alaskan Natives for one-third of measures (Moy et al., Health Aff (Millwood) 24(2):376–87, 2005). In this chapter, five principles are presented to guide policy makers, health care leaders, and healthcare professionals seeking to reduce and ultimately eliminate racial and ethnic disparities in health care. These principles are based on clinical and policy experience, the research literature on healthcare disparities, and findings and recommendations of key reports from the Institute of Medicine (Unequal treatment: confronting racial and ethnic disparities in health care. Washington, DC: National Academy Press, 2002) and the American College of Physicians (Groman and Ginsburg, Ann Intern Med 141(3):226–32, 2004). The principles have been refined with input from an advisory committee of clinical and academic leaders in minority health care convened by the Minority Health Institute. The principles address aspects of access to care and quality of care that are especially important for minority populations in the United States, including African Americans, Latinos, Asian Americans, Native Hawaiians and other Pacific Islanders, and American Indians and Alaska Natives. These principles have become more timely and attainable with passage of the federal Patient Protection and Affordable Care Act (PPACA) that was enacted by Congress and signed by President Obama in March 2010.
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    ABSTRACT: The Central Queensland University (CQU) Regional Seismic Network is made up of an array of six short-period seismometer and two strong motion accelerometer stations. The array has an aperture of about 50 km. CQU is able to resolve epicentral co-ordinates to about 2 kilometres, with a sample rate of 100 per second, and an absolute time accuracy of 100 milliseconds. This resolution is achieved by using triaxial seismometers which allow better secondary phase identification of shear, converted and depth phases.The network covers an area of above average seismic risk in continental Australia. The area has been affected in 1918 by one of the largest earthquakes ever recorded along the eastern seaboard of Australia. The network also monitors a large number of blasts carried out by the coal mines and hard rock, quarries in the region, and these are being used in a long-term study to determine the structure of the Crust and Upper Mantle in Central Queensland.Techniques for monitoring rockbursts and longwall caving in mines are similar, to those used for monitoring local earthquakes. CQU has successfully used a single triaxial seismometer to record seismic events produced by the strata failure and roof falls of a longwall coal mine. The case history presented shows that the initial fall under massive roof conditions appears to be predicted by a simple trend plot of microseismic event magnitude and longwall production rate. Extension of this technique to a closely spaced array of both surface and in-seam triaxial seismometers is required for a more detailed appraisal to be undertaken. Adequate resolution of event location requires a higher, sample rate (up to 1000 Hz) and more accurate timing (about 1 millisecond) than for earthquake monitoring. An appropriate stratigraphic model is also required, as is the case for earthquake location.
    Pure and Applied Geophysics 01/1995; 145(1):39-57. DOI:10.1007/BF00879482 · 1.85 Impact Factor
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    ABSTRACT: There is debate about the value of measuring health-related quality of life (HRQL) in clinical trials in oncology because of evidence suggesting that HRQL does not influence clinical decisions. Analysis of HRQL in surgical trials, however, may inform decision making because it provides detailed assessment of the immediate detrimental short-term impact of surgery on HRQL that needs to be considered against the long-term survival benefits and functional outcomes of surgery. This study evaluated whether HRQL in randomized trials in surgical oncology contributes to clinical decision making. A systematic review identified randomized trials in surgical oncology with HRQL. Trials were evaluated independently by two reviewers and the value of HRQL in clinical decision making was categorized in three ways: whether trial investigators reported that HRQL influenced final treatment recommendations, whether trial investigators reported that HRQL would be useful for informed consent, and whether HRQL was assessed robustly according to predefined criteria. Thirty-three randomized trials with valid HRQL questionnaires were identified; 22 (67%) concluded that HRQL outcomes influenced treatment decisions or provided valuable data for informed consent, and seven of these trials had robust HRQL design. Another five trials had robust HRQL design but investigators reported that HRQL outcomes were not clinically important enough to influence treatment recommendations. In surgical trials in oncology, HRQL informed clinical decision making. It is recommended that HRQL be included in relevant surgical trials, and that information be used to inform clinicians and patients about the impact of surgery on short- and long-term HRQL.
    Journal of Clinical Oncology 08/2006; 24(19):3178-86. DOI:10.1200/JCO.2005.05.2951 · 18.43 Impact Factor
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