Improving Fairness in Coverage Decisions: Performance Expectations for Quality Improvement

Patients and physicians often perceive the current health care system to be unfair, in part because of the ways in which coverage decisions appear to be made. To address this problem the Ethical Force Program, a collaborative effort to create quality improvement tools for ethics in health care, has developed five content areas specifying ethical criteria for fair health care benefits design and administration. Each content area includes concrete recommendations and measurable expectations for performance improvement, which can be used by those organizations involved in the design and administration of health benefits packages, such as purchasers, health plans, benefits consultants, and practitioner groups.     

No bridge too high: Infants decide whether to cross based on the probability of falling not the severity of the potential fall

Do infants, like adults, consider both the probability of falling and the severity of a potential fall when deciding whether to cross a bridge? Crawling and walking infants were encouraged to cross bridges varying in width over a small drop‐off, a large drop‐off, or no drop‐off. Bridge width affects the probability of falling, whereas drop‐off height affects the severity of the potential fall. For both crawlers and walkers, decisions about crossing bridges depended only on the probability of falling: As bridge width decreased, attempts to cross decreased, and gait modifications and exploration increased, but behaviors did not differ between small and large drop‐off conditions. Similarly, decisions about descent depended on the probability of falling: Infants backed or crawled into the small drop‐off, but avoided the large drop‐off. With no drop‐off, infants ran straight across. Results indicate that experienced crawlers and walkers accurately perceive affordances for locomotion, but they do not yet consider the severity of a potential fall when making decisions for action.     

Intraclass correlation associated with therapists: estimates and applications in planning psychotherapy research

It is essential that outcome research permit clear conclusions to be drawn about the efficacy of interventions. The common practice of nesting therapists within conditions can pose important methodological challenges that affect interpretation, particularly if the study is not powered to account for the nested design. An obstacle to the optimal design of these studies is the lack of data about the intraclass correlation coefficient (ICC), which measures the statistical dependencies introduced by nesting. To begin the development of a public database of ICC estimates, the authors investigated ICCs for a variety outcomes reported in 20 psychotherapy outcome studies. The magnitude of the 495 ICC estimates varied widely across measures and studies. The authors provide recommendations regarding how to select and aggregate ICC estimates for power calculations and show how researchers can use ICC estimates to choose the number of patients and therapists that will optimize power. Attention to these recommendations will strengthen the validity of inferences drawn from psychotherapy studies that nest therapists within conditions.     

Contrasting Regulatory Focus and Reinforcement Sensitivity: A Daily Diary Study of Goal Pursuit and Emotion

This study examined the moderating effects of motivational orientation on daily affect and goal pursuit. Based on recent revisions to Reinforcement Sensitivity Theory, measures of BIS (BIS-r and Fight-Flight-Freeze System or FFFS), BAS, and regulatory focus (Promotion and Prevention) were administered to 84 college students who participated in a 14-day diary study. Diary items assessed goal-directed activities and positive and negative affect (PA and NA). Results showed that higher FFFS and Promotion were consistently associated with higher NA and PA, respectively, and FFFS was also associated with avoidance of responsibilities. Higher Promotion predicted greater daily goal progress and tendencies to rate goals as more promotion- and prevention-focused. Relationships between daily goal-directed activities and both sadness and satisfaction were moderated by BIS-r. Inconsistent with our hypothesis, low BAS Reward Responsiveness predicted increased enthusiasm with greater goal progress. A trend in the data showed evidence of regulatory fit in daily activities predicted by both Promotion and Prevention. Implications for the theoretical and practical distinctions between measures of motivational orientation are discussed.     

The dimensionality of counterproductivity: Are all counterproductive behaviors created equal?

Most studies of counterproductive work behavior (CWB) assess it as one or two overall dimensions that might obscure relationships of potential antecedents with more specific forms of behavior. A finer-grained analysis of the relationship between counterproductive work behavior and antecedents was conducted with the five-subscales (abuse toward others, production deviance, sabotage, theft, and withdrawal) taken from the 45-item Counterproductive Work Behavior Checklist, a measure that has been used in a number of prior studies. Described is the rationale for each of the five dimensions, which have been discussed individually in the literature. Data from three combined studies provide evidence for differential relationships with potential antecedents that suggest the use of more specific subscales to assess CWB. Most notably, abuse and sabotage were most strongly related to anger and stress, theft was unrelated to emotion, and withdrawal was associated with boredom and being upset. Finally, the distinct forms of CWB may suggest distinct underlying dynamics, that vary in their balance of hostile and instrumental motivational systems.     

Cognitive Ability Tests and the Situational Interview: A Test of Incremental Validity

This study investigated the validity and incremental validity of a situational interview beyond that of a composite measure of cognitive ability. Forty-seven factory service technicians underwent an interview and took four cognitive ability tests. Supervisors rated the performance of these subjects in a concurrent validation study. The interview was found to be a valid predictor of a supervisor rating of performance (r = 0.32, p < 0.05 uncorrected), however, was unable to show incremental validity over ability tests (Incremental R²= 0.05, n.s.). Limitations of the present study and directions for future research are discussed.     

Using empowerment theory in collaborative partnerships for community health and development

Models of community empowerment help us understand the process of gaining influence over conditions that matter to people who share neighborhoods, workplaces, experiences, or concerns. Such frameworks can help improve collaborative partnerships for community health and development. First, we outline an interactive model of community empowerment that describes reciprocal influences between personal or group factors and environmental factors in an empowerment process. Second, we describe an iterative framework for the process of empowerment in community partnerships that includes collaborative planning, community action, community change, capacity building, and outcomes, and adaptation, renewal, and institutionalization. Third, we outline activities that are used by community leadership and support organizations to facilitate the process of community empowerment. Fourth, we present case stories of collaborative partnerships for prevention of substance abuse among adolescents to illustrate selected enabling activities. We conclude with a discussion of the challenges and opportunities of facilitating empowerment with collaborative partnerships for community health and development. This work was supported by Kansas Health Foundation Grants 9206032B and 9206032A to support and evaluate community partnerships to prevent adolescent substance abuse. Thanks to Tom Wolff for sharing his wisdom about community coalitions so generously, and to Bill Berkowitz and anonymous reviewers for thoughtful comments on an earlier version of this manuscrpt. We also thank our colleagues from the Kansas Health Foundation, Mary K. Campuzano, Steve Coen, and Marni Vliet, and those from collaborating communities, who continue to teach us about ways to enhance community capacities to address local concerns.