The limits of objective assessment of medical practice

Medical work is increasingly being subjected to objective assessment as those who pay for it seek to grasp the quality of that work and how best to improve it. While objective measures have a role in the assessment of health care, I argue that this role is currently overestimated and that no human practice such as medicine can be fully comprehended by objective assessment. I suggest that the character of practices, in which formalizations are combined with judgment, requires that valid assessment involve the perspective of the skilled practitioner. Relying exclusively on objective measures in assessing health care will not only distort our assessments of it but lead to damage as the incentives of health care workers are directed away from the important aspects of their work that are not captured by objective measures.

Effects of the School-to-Work Group Method among young people

This study examines effects of the School-to-Work Group Method among 17-25-year-old young people facing the transition from vocational college to work. After baseline measurement (N = 416) participants were randomized into experimental and control groups. The results of ten month follow-up (N = 334) showed notable beneficial impacts of the group method on both employment itself and on how well it matched participants’ education and personal career plans. The group method also had a significant preventive effect on psychological distress and depression symptoms among those initially at risk of suffering from mental disorder. Moreover, it considerably increased participants’ personal work life, finances and property goals.     

Further Validation of a Need-based Quality-of-work-life (QWL) Measure: Evidence from Marketing Practitioners

This study further validates a need-based measure of quality of work life (QWL) developed by Sirgy et al. (Soc Indic Res 55:46–56, 2001). We conceptualized the QWL construct in terms of employee satisfaction with two sets of major needs: lower- and higher-order needs. Lower-order needs comprise health/safety needs and economic/family needs. Higher-order needs involve social needs, esteem needs, self-actualization needs, knowledge needs, and aesthetic needs. The results from a survey of marketing professionals largely supported the construct validity and predictive validity of the QWL measure. As expected, QWL has a positive influence on esprit de corps, job satisfaction, and organizational commitment among marketing managers. Managerial implications and directions for future research are also discussed.     

The concept of quality in clinical research

Quality in clinical research may be defined as compliance with requirements together with credibility and reliability of the data obtained. Sponsors usually apply Quality Management Systems (QMS) to ensure, control, maintain, and improve quality. These systems encompass several preventive measures, tools, and controls. Standard QMS applied by clinical research sponsors may be based on ISO 9000. An earlier version of the paper was presented at the 6th International Bioethics Conference on the subject of ‘The Responsible Conduct of Basic and Clinical Research’, held in Warsaw, Poland, 3–4 June 2005.     

Women–Focused Treatment Agencies and Process Improvement: Strategies to Increase Client Engagement

Behavioral health treatment agencies often struggle to keep clients engaged in treatment. Women clients often have additional factors such as family responsibilities, financial difficulties, or abuse histories that provide extra challenges to remaining in care. As part of a national initiative, four women-focused drug treatment agencies used process improvement to address treatment engagement. Interviews and focus groups with staff assessed the nature and extent of interventions. Women-focused drug treatment agencies selected relational-based interventions to engage clients in treatment and improved four-week treatment retention from 66% to 76%. Process improvement interventions in women-focused treatment may be useful to improve engagement.     

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.     

Q-Coh: A tool to screen the methodological quality of cohort studies in systematic reviews and meta-analyses

The evaluation of the methodological quality of primary studies in a systematic review is a key process to enhance the likelihood of achieving valid results. When considering non-randomized designs as cohort studies, this process becomes even more critical, since these designs are more susceptible to bias than randomized controlled trials are. Taking this into account, a tool, named Q-Coh, was designed with the aim to screen the methodological quality of the primary studies with a cohort design priming specificity over sensitivity in a reasonable application time. After applying it to 21 prospective cohort studies by three raters, all domains had a moderate to good agreement, with all except one of them having statistically significant kappa values. Despite there is no gold standard for the methodological quality, arguments supporting its validity are given. Future research should assess the psychometric properties of Q-Coh in the context of real meta-analyses, evaluate the influence of the raters’ substantive and methodological expertise on these properties, and explore different ways of including the domains-based ratings of the quality provided by Q-Coh into meta-analyses.     

Goal setting via videoconferencing

In two experiments (N = 126, N = 120) telework in an advertising company was simulated. Participants communicated either face-to-face or via a PC-videoconference with a supervisor who motivated employees to solve brainstorming tasks using several goal setting strategies. In addition, communication with the supervisor prior to goal setting was manipulated to examine the impact of a personal meeting with the supervisor and to investigate the effect of having some prior experience with this technology. In both experiments, stimulating challenging goals improved performance compared to “do your best” instructions when goal setting was conducted via a videoconference. Moreover, it was found that participative goal setting was more effective than directive goal setting. However, a prior personal meeting with a supervisor or an additional interaction via videoconference prior to goal setting had no impact on performance or the effectiveness of goal setting. In sum, these findings indicate that goal setting effects are robust and can be found even if communication is based on a videoconference. When difficult goals have to be set within a videoconference, participative goal setting strategies are most effective.     

Generic,Disease-Specific and Individualised Approaches to Measuring Health-Related Quality of Life Among People With Heart Disease - A Comparative Analysis

Increasing emphasis is being placed on the evaluation of health-related quality of life. However, there is no consensus on the definition of this concept and as a result there are a plethora of existing measurement instruments. Head-to-head comparisons of the psychometric properties of existing instruments are necessary to facilitate evidence-based decisions about which instrument should be chosen for routine use. Therefore, an individualised instrument (the modified Patient Generated Index (PGI)), a generic instrument (the Short Form 36) and a disease-specific instrument (the Quality of Life after Myocardial Infarction questionnaire) were administered to patients with ischaemic heart disease ( n = 117) and the evidence for the validity, reliability and sensitivity of each instrument was examined and compared. The modified PGI compared favourably with the other instruments but none of the instruments examined provided sound evidence for sensitivity to change. Therefore, any recommendation for the use of the individualised approach in the routine collection of health-related quality of life data in clinical practice must be conditional upon the submission of further evidence to support the sensitivity of such instruments.     

Methods for Assessing Quality of Life and Well-Being in Frail Older People

The appropriateness, reliability and convergence of differing methods and associated instruments for the assessment of quality of life and well-being in frail older people was examined in 60 ( S 65 years of age) nursing home residents. The feasibility of measuring quality of life and well-being via a variety of instruments was explored through observation (an adaptation of Dementia Care Mapping), structured interview (Schedule for the Evaluation of Individual Quality of Life - Direct Weighting), and proxy questionnaire (Pleasant Events Schedule - Alzheimer Disease; Apparent Emotion Rating Scale). The observational assessment and Pleasant Events Schedule demonstrated good reliability. Significant associations were found between well-being as assessed by observation, and active social interaction and engagement in recreation as assessed by observation, quality of life as assessed by structured interview, and enjoyment of activities as assessed by proxy questionnaire. These findings indicate the importance of social activity in later life, and the potential of different approaches for the appropriate assessment of key aspects of quality of life in frail older people.