Articles: outcome-assessment-health-care.
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Neurorehabil Neural Repair · May 2008
Multicenter StudyChanges in activity after a complete spinal cord injury as measured by the Spinal Cord Independence Measure II (SCIM II).
The assessment of rehabilitation efficacy in spinal cord injury (SCI) should be based on a combination of neurological and functional outcome measures. The Spinal Cord Independence Measure II (SCIM II) is an independence scale that was specifically developed for subjects with SCI. However, little is know about the changes in SCIM II scores during and after rehabilitation. ⋯ The SCIM II is responsive to functional changes in patients with a persistent motor complete SCI. It is clinically useful for monitoring functional improvement during rehabilitation and after discharge. The SCIM II and the clinical examination based on the ASIA protocol are of complementary value and separately describe changes in independence and sensorimotor deficits in SCI patients.
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Multicenter Study
Do emergency department patients with possible acute coronary syndrome have better outcomes when admitted to cardiology versus other services?
Emergency physicians need to consider potential differences in quality of care across admitting services in their triage decisions. For emergency department (ED) patients with possible acute coronary syndrome who require hospitalization, there are relatively few data to guide emergency physicians in deciding whether admission to a cardiology service bed yields better outcomes than admission to a noncardiology service. ⋯ ED patients admitted for evaluation of possible acute coronary syndrome do not experience worsened short-term outcomes if admitted to a noncardiology service bed.
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Multicenter Study
Intensive care for extreme prematurity--moving beyond gestational age.
Decisions regarding whether to administer intensive care to extremely premature infants are often based on gestational age alone. However, other factors also affect the prognosis for these patients. ⋯ The likelihood of a favorable outcome with intensive care can be better estimated by consideration of four factors in addition to gestational age: sex, exposure or nonexposure to antenatal corticosteroids, whether single or multiple birth, and birth weight. (ClinicalTrials.gov numbers, NCT00063063 [ClinicalTrials.gov] and NCT00009633 [ClinicalTrials.gov].).
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Multicenter Study Comparative Study
Comparison of "risk-adjusted" hospital outcomes.
A frequent challenge in outcomes research is the comparison of rates from different populations. One common example with substantial health policy implications involves the determination and comparison of hospital outcomes. The concept of "risk-adjusted" outcomes is frequently misunderstood, particularly when it is used to justify the direct comparison of performance at 2 specific institutions. ⋯ Risk-adjusted outcomes, commonly the focus of public report cards, have a specific interpretation. Using indirect standardization, these outcomes reflect a provider's performance for its specific case mix relative to the expected performance of an average provider for that same case mix. Unless study design or post hoc adjustments have resulted in reasonable overlap of case-mix distributions, such risk-adjusted outcomes should not be used to directly compare one institution with another.
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Multicenter Study Comparative Study
Do palliative consultations improve patient outcomes?
To determine whether inpatient palliative consultation services improve outcomes of care. ⋯ Palliative consultations improve outcomes of care, and earlier consultations may confer additional benefit.