Mixed messages

first_imgIs quality in the eye of the beholder?Researchers at Harvard Medical School (HMS) and Massachusetts General Hospital (MGH) have found wide disparities among four common measures of hospital-wide mortality rates, with competing methods yielding both higher- and lower-than-expected rates for the same Massachusetts hospitals during the same year.The findings, published Dec. 23 in a special article in the New England Journal of Medicine, stoke a simmering debate over the value of hospital-wide mortality rates as a yardstick for health care quality. The measure, which compares a hospital’s actual patient death rate with statistical predictions, is reported publicly in countries including England, Canada, and Denmark, but some hospitals and policy experts have questioned its value due to the complexity and variability of diagnoses.“It’s troubling that four different methods for calculating hospital mortality rates as a measure of quality should yield such different results,” said lead author David M. Shahian, HMS professor of surgery at Massachusetts General Hospital. “Measurement theory — not to mention plain common sense — suggests there is a problem.”The potential of performance evaluation to improve both the quality and the cost of health care has fueled interest in provider “report cards,” including mandates by state and federal law.In 2008, the Massachusetts Division of Health Care Finance and Policy engaged researchers Shahian; Lisa I. Iezzoni, HMS professor of medicine at MGH; and Sharon-Lise T. Normand, HMS professor of health care policy (biostatistics) and professor in the Department of Biostatistics at Harvard School of Public Health, to evaluate four vendor-created measures of hospital-wide mortality. The state was looking for a means to measure hospital quality for the public report cards mandated under its 2006 health care reform law.The researchers compared four measures of hospital-wide mortality provided by commercial vendors. These vendors all believed that their hospital-wide mortality measures were an accurate reflection of hospital quality. Each vendor received identical data — three years of patient discharge data from all 83 general acute care hospitals in Massachusetts, representing 2.5 million discharges — and used the data to calculate each hospital’s mortality rate. The researchers then compared results.“The results of the horse race are that it’s really not clear who won,” said Iezzoni, who also is the director of the Mongan Institute for Health Policy at MGH. “The problem is that we were measuring the success of each of these measures against a gold standard we simply do not have: an objective measure of hospital quality.”Without that gold standard, the researchers were left to compare vendor tools with one another. Their conclusion: Methods and results varied widely. For example, every tool excluded some discharges from its calculations based on the details of each. But where one tool excluded 5 percent of all discharges, another excluded 72 percent.Even so, a high degree of convergence — different methods yielding similar final results — could have supported the validity of this approach to estimating hospital quality. But that’s not what researchers found. For example: Of 28 hospitals designated by one method as having higher-than-expected hospital-wide mortality in 2006, 12 were simultaneously classified as having lower-than-expected mortality by at least one other method.In August, the researchers told the state that they could not recommend any of the four vendor-created tools. “But the results should not be interpreted as an indictment of any particular technique,” said Normand. “Rather, they call into question the concept of measurement of hospital-wide mortality, as four different methods yielded four different results. Thus, this may not be a good way to assess hospital quality.”The authors are longtime advocates of performance assessment and public reporting to provide transparency and accountability in health care.Normand developed the statistical models used by Medicare and Medicaid for public reporting of heart attack, heart failure, and pneumonia mortality rates. Shahian has been a leader in the public reporting initiative of the Society of Thoracic Surgeons. Together, they were leaders in developing and implementing public report cards for coronary artery bypass grafting (CABG) surgery and percutaneous coronary intervention (PCI) in Massachusetts.But where mortality rates may reflect clearly the quality of care for some procedures, like coronary bypass, they may reveal less about care for other conditions, such as major trauma or advanced malignancy.“An alternative to hospital-wide mortality rates would be to construct a more limited portfolio of mortality results for individual common conditions such as heart attack, stroke, pneumonia, CABG surgery, and PCI,” said Shahian. “These have the advantage of large sample sizes at most hospitals, a generally accepted association between mortality and quality of care, and credible risk models to adjust for patient severity.”Iezzoni, an internationally recognized expert in risk adjustment, has edited “Risk Adjustment for Measuring Health Care Outcomes,” now in its third edition.“Underlying this finding is the more fundamental and as yet unanswered question about whether hospital-wide mortality rates provide meaningful insight into hospital quality,” she said.This work was funded by a contract with the Division of Health Care Finance & Policy, Executive Office of Health and Human Services (EOHHS), commonwealth of Massachusetts, Boston, Mass. The views expressed in this article are solely those of the authors and may not reflect the views of the division, the EOHHS, or the commonwealth.last_img read more

Jenkins announces voluntary pay cuts for University leaders to support student financial aid

first_imgIn order to increase funds towards student financial aid, University President Fr. John Jenkins announced a voluntary program where senior leaders at the University may elect to reduce their salaries as much as 20%, according to a press release from the University Monday.The savings will contribute to the Student Emergency Relief Fund, which was created to assist students and their families who are struggling financially as a result of the pandemic.“The University’s three executive officers, the deans, the vice presidents and leaders in the Athletics Department, including certain coaches, have been asked to reduce their salaries along a sliding scale of 5 percent to 20 percent for the highest compensated employees,” the press release said.The special payroll deduction plan is scheduled to begin July 1 and continue to June 30, 2021.As almost half of the University’s students receive financial aid, a third of the endowment’s spending distribution helps cover the cost of student tuition. Additional fundraising and more recently, utilizing savings produced by Notre Dame’s staff early retirement program also contribute to financial aid assistance.“In this crisis, we must do everything we can to ensure that no accepted or current students fail to enroll or return because they don’t have the money,” Jenkins said.Tags: COVID-19, Fr. John Jenkins, Student Emergency Relief Fundlast_img read more

Local Tops Stores Returning To Reusable Bags Next Week

first_imgPeteruetz / Wikipedia / CC BY-SA 4.0 JAMESTOWN – Next week, one of the area’s largest grocery store chains will be returning to reusable bags only at their locations in Jamestown.Tops Friendly Markets says by Monday, July 6 all stores in the state will no longer offer plastic bags when checking out.Reusable bags can be purchased for 99 cents each. Tops’ Totes for Changes, their reusable bags sold for charity, will also be available to buy.Customers are allowed to bring in their plastic bags to use, as long as they’re clean. Plastic bags will also be available for meat and produce in those departments. Those who would like to recycle their plastic bags can deposit them in bins at Tops’ stores.The change has already gone into effect in the Hudson Valley and North Country regions of New York. Vermont stores will make the change on Wednesday. Share:Click to share on Facebook (Opens in new window)Click to share on Twitter (Opens in new window)Click to email this to a friend (Opens in new window)last_img read more

The Belle of Amherst, Starring Joely Richardson, Opens Off-Broadway

first_img The limited engagement will run through January 25, 2015. View Comments In The Belle of Amherst, Emily Dickinson’s poems, diaries and letters are woven into an illuminating portrait of the prolific wordsmith. Dickinson’s encounters with close friends and family and her often-amusing observations come to life in the one-woman-play.center_img Stage and screen star Joely Richardson officially opens in William Luce’s The Belle of Amherst off-Broadway on October 19. Directed by Steve Cosson, the revival is playing at the Westside Theatre.last_img read more

Practicing with Professionalism changes suggested

first_img Practicing with Professionalism changes suggested Senior Editor With agreement from affected Bar sections, the Board of Governors has approved the Young Lawyers Division’s plans to revamp its education program for new Bar members. Those changes including ending the government lawyer deferment for the Practicing with Professionalism seminar.YLD President Mark Romance reported to the board, at its December 5 meeting on Amelia Island, that an agreement had been worked out with the Government Lawyer Section over the PWP course. However, the Florida Prosecuting Attorneys Association objected to ending the course deferment for prosecutors.Currently, new Bar members who are government lawyers are exempted from taking PWP within a year of joining the Bar and two additional basic skills courses within their first three years.Under the YLD’s proposed revisions, PWP is being reduced from two days to one, with the number of basic skills courses required increased from two to three. Government lawyers would maintain their deferment from taking the basic skills courses but be mandated to take PWP along with other new members, Romance told the board.Government lawyers who remain on the public payroll for six years and complete other required CLE would not be required to take the basic skills courses if they enter private practice, Romance said. Also, the new PWP requirement would not be retroactive, so all current public lawyers would maintain the deferment, and would be exempt upon six years of government service.The board was presented a letter from Government Lawyer Section Chair Keith Rizzardi endorsing the compromise worked out with the YLD. Rizzardi also wrote that his section and the YLD would jointly work to get financial help to pay the tuition for government lawyers who require it. Romance also said that the Criminal Law; City, County, and Local Government Law sections, and Attorney General Charlie Crist approved the new plan.The objections from prosecutors came from their long-time legislative consultant, Buddy Jacobs.“Essentially their objection is their assistant state attorneys and assistant public defenders should not have to attend a program at all because they adequately take care of that in-house,” Romance said.In his letter, Jacobs said prosecutors have both statewide and circuit programs aimed specifically at the needs of prosecutors which incorporate ethics and other topics in the PWP seminar.“The prosecutors of Florida have extraordinary case loads and are very much below the pay grade of the average young lawyer in Florida,” Jacobs wrote. “This proposed rule amendment would require them to do something that has already been accomplished by our own educational efforts and programs as accredited by The Florida Bar. This course would be superfluous and would require them to pay out of their own pockets to attend a seminar which would be, at best, redundant.”During the board’s debate on the issue, board member Louis Kwall agreed with Jacobs’ sentiment. “If there was a question that they didn’t receive any training, I would agree with our position,” Kwall said.“All we’re doing is taking them out of the courtroom and the court system more than they need to be. I don’t see any evidence historically that the deferment is hurting the system.”But Romance said the impetus for revising the program was “to have a uniform program for all new lawyers, no matter what their practice is.” He added cutting the course to one day reduced the out-of-office time.President-elect Kelly Overstreet Johnson agreed. “I think uniformity is the key, and we should have all young lawyers do it,” she said. “To the extent you make that argument for state attorneys and public defenders, the same argument can be made by other government lawyers.”Romance also noted the YLD program has been recognized for its excellence by the ABA and that the division recently was invited to present it at an ABA conference as a model professionalism program for new lawyers. The board approved the amendments on a voice vote, and they now go to the Supreme Court for consideration.Sotolongo petitions for Bar reinstatement Pursuant to Rule 3-7.10, Felipe Sotolongo has petitioned the Florida Supreme Court for Bar reinstatement.Sotolongo was suspended for 91 days for misconduct including misdemeanor criminal charges and neglect of, and lack of communication with, a client.Anyone having knowledge bearing upon Sotolongo’s fitness or qualifications to resume the practice of law should contact Eric Montel Turner, Chief Branch Discipline Counsel, The Florida Bar, 5900 N. Andrews Ave., Suite 900, Ft. Lauderdale 33309, telephone (954) 772-2245.Novo petitions for Bar reinstatement Pursuant to Rule 3-7.10, Jesus Novo III has petitioned the Florida Supreme Court for Bar reinstatement.Novo was suspended for 18 months, nunc pro tunc to August 31, 2001.Anyone having knowledge bearing upon Novo’s fitness or qualifications to resume the practice of law should contact Vivian M. Reyes, Bar Counsel, The Florida Bar, Suite M-100, 444 Brickell Avenue, Miami 33131, telephone (305) 377-4445. Practicing with Professionalism changes suggested January 1, 2004 Gary Blankenship Senior Editor Regular Newslast_img read more

Pan-European pension concept to be presented to parliament

first_imgThe EU’s plans for a pan-European personal pension plan (PEPP) will proceed to the European Parliament in the new year.Dutch MEP Sophie in ’t Veld has been appointed as rapporteur in charge of taking the policy to the parliament’s Economic and Monetary Affairs committee (ECON).Speaking at the European Insurance and Occupational Pensions Authority’s annual conference in Frankfurt last month, In ’t Veld said MEPs would have to find solutions to cross-border pension taxation issues.The European Commission has proposed that providers would have to feature “compartments” in all member states to cope with taxation challenges. In ’t Veld said other solutions would have to be found. There was a need for a clear definition of the PEPP suited to meet “taxation relief measures”, she said. Sophia in ’t Veld, MEPCredit: Sebastiaan ter Burg In countries where pension systems were functioning well, such as in the Netherlands, lawmakers would need to be “very, very careful” not to undermine good situations, the MEP said.center_img A working document is due in January, with a draft report due to presented by In ’t Veld on 21 February. The closing deadline for amendments is 22 March, and MEPs will consider amendments on 25-26 April before voting in June.In ’t Veld’s Frankfurt speech followed a public hearing held in the ECON committee, during which Tobias Buecheler – head of supervision and financial market regulation at the Allianz Group – was the only speaker in favour of a mandatory guarantee and annuities to be attached to PEPPs.In contrast, Anne Fily, special adviser to European consumer body BEUC, questioned the need for guaranteed minimum payouts. She spoke out against the “product complexity and the associated costs” that were likely to result.In his keynote speech, EIOPA chairman Gabriel Bernardino said: “To strengthen the transparency of PEPP supervision towards EU consumers, I would propose that EIOPA should be mandated to publish an annual report on PEPP supervision activities, performed throughout Europe.”last_img read more

NZ’s end-of-life care third best worldwide

first_img3News 7 October 2015New Zealand’s end-of-life care is the third best in the world, according to a global study.The research, compiled by the Economist Intelligence Unit, ranked New Zealand behind only Britain and Australia when comparing the overall quality and availability of palliative care found in hospitals and hospices in 80 countries.New Zealand was also found to have the world’s highest community engagement around end of the life care – one of the five statistics considered.“New Zealand has excellent facilities and a qualified workforce, and access to palliative care is free and universal,” the report’s authors noted.But they said different standards for assessment of care across DHBs made it difficult to get a broad picture of some issues.The EIU noted top ranked countries tended to be richer, and income levels were a “a strong indicator of the availability and quality of palliative care”.When the survey was last conducted in 2010, New Zealand also came in third.http://www.3news.co.nz/nznews/nzs-end-of-life-care-third-best-worldwide-2015100707#axzz3nk6Rj5vnlast_img read more

Iran’s virus death toll rises to 43

first_imgIran, which has the highest death tolloutside China, has ordered the shutting of schools until Tuesday and thegovernment has extended the closure of universities and a ban on concerts andsports events for a week. DUBAI, UAE – Iran’s death toll from thecoronavirus outbreak has reached 43, a health official told state TV onSaturday, adding that the number of infected people across the country hasreached 593.“Unfortunately nine people died of the virus in the last 24 hours. The deathtoll is 43 now. The new confirmed infected cases since yesterday is 205 thatmakes the total number of confirmed infected people 593,” Kianush Jahanpur toldstate TV. Iran’s death toll from the coronavirus outbreak has reached to 43, while the number of infected people across the country has reached to 593.center_img Several high-ranking officials,including a vice minister, deputy health minister and five lawmakers, havetested positive for the coronavirus as the rapid spread of the outbreak forcedthe government to call on people to stay at home.(Reuters)last_img read more

New Horizons looking for job shadowing opportunities

first_imgBatesville, In. — New Horizons Rehabilitation is looking for job shadow opportunities for students with learning disabilities. Pre-employment transition career coach, Crystal Lynam says, “My students are high functioning and capable of employment within the community. I’m reaching out to you to see if businesses within our community may be interested.”Job shadowing sessions would be about one hour long and could include activities or just observation. The students will be accompanied by a New Horizons Rehabilitation staff member.last_img read more

Video: Lewandowski nets 27th goal of the season against Frankfurt

first_img What is completely normal is Robert Lewandowski finding the net, as he did to hand the Bavarians a 3-0 lead in their Saturday evening match, his 27th of the 2019/20 season. With no supporters in the stands, per the coronavirus protocols, every word could be easily heard, making for background noise, or lack of it, that will probably never feel right. Promoted Content10 Dystopian Movie Worlds You’d Never Want To Live In8 Things You Didn’t Know About CoffeeTop 7 Best Car Manufacturers Of All TimeWho Is The Most Powerful Woman On Earth?7 Black Hole Facts That Will Change Your View Of The UniverseTop 10 Most Romantic Nations In The WorldThese Are The Best Stargazing Locations You Can Find On EarthEver Thought Of Sleeping Next To Celebs? This Guy Will Show You8 Superfoods For Growing Hair Back And Stimulating Its Growth14 Hilarious Comics Made By Women You Need To Follow Right NowInsane 3D Spraying Skills Turn In Incredible Street ArtA Hurricane Can Be As Powerful As 10 Atomic Bombs Read Also: La Liga: Spanish Prime Minister confirms restart date His superior movement in the area gave him half a yard on his marker and he powered home a header. Different game, same Lewandowski. Footage courtesy of BT Sport and Eleven Sport. FacebookTwitterWhatsAppEmail分享 center_img Loading… Another eerie atmosphere greeted Bayern Munich at the Allianz Arena for their match against Eintracht Frankfurt.last_img read more