This technical report explains the relationship between reliability measurement and misclassification for physician quality and cost measures in health care. It provides details and a practical method to calculate reliability and misclassification from the data typically available to health plans. This report builds on other RAND work on reliability and misclassification and has two main goals. First, it can serve as a tutorial for measuring reliability and misclassification. Second, it will describe the likelihood of misclassification in a situation not addressed in our prior work in which physicians are categorized using statistical testing. For any newly proposed system, the methods presented here should enable an evaluator to calculate the reliabilities and, consequently, the misclassification probabilities. It is our hope that knowing these misclassification probabilities will increase transparency about profiling methods and stimulate an informed debate about the costs and benefits of alternative profiling systems. The appendixes provide more technical detail on how to measure reliability with related program code as well as a set of lookup tables that can be used to obtain the rate of misclassification associated with a reliability estimate under various scenarios.

This technical report describes the methods and sensitivity analyses used by the authors in an article published in the New England Journal of Medicine. Purchasers are experimenting with a variety of approaches to control health care costs, including limiting network contracts to lower-cost physicians and offering patients differential copayments to encourage them to visit "high-performance" (i.e., higher-quality, lower-cost) physicians. These approaches require a method for analyzing physicians' costs and a classification system for determining which physicians have lower relative costs. There has been little analysis of the reliability of such methods. Reliability is determined by three factors: the number of observations, the variation between physicians in their use of resources, and random variation in the scores. A study of claims data from four Massachusetts health plans demonstrates that, according to the current methods of physician cost profiling, the majority of physicians did not have cost profiles that met common reliability thresholds and, importantly, reliability varied significantly by specialty. Low reliability results in a substantial chance that a given physician will be misclassified as lower-cost when he or she is not, or vice versa. Such findings raise concerns about the use of cost profiling tools and the utility of their results.

This book offers a comprehensive overview of performing return-on-investment (ROI) analyses for healthcare quality improvement (QI). In the United States, healthcare policy regarding physician and facility payment/reimbursement is steadily trending towards the use of “value-based” systems and away from the traditional “fee-for-service” (FFS) payment mechanisms. Healthcare professionals and organizations who have previously focused on quality metrics are now finding themselves burdened with having to define and assess value metrics, without much guidance or assistance. This volume aims to be a guide and a reference for healthcare professionals tasked with estimating and establishing ROI for QI. Chapters describe the general framework for how to perform QI; establish standard definitions of important terms, concepts, and calculations; and provide specific instructions for how to complete each step of an ROI analysis. These include: selecting a QI initiative and identifying the associated metrics, establishing measurable, monetizable, and attributable costs and benefits, determining the appropriate scope and perspective, calculating ROI and related metrics (payback period, benefit-to-cost ratio, etc.), comparing with established benchmarks or previously published results, and interpreting the results for the intended audience. In addition, chapters offer examples of real studies (or hypothetical studies of real situations), as well as templates for several of the necessary activities that readers can leverage for their own use. Return on Investment for Healthcare Quality Improvement is a must-have resource for healthcare providers, administrators, and other professionals who work in healthcare organizations, hospitals and other healthcare settings, health systems, and residency programs seeking to obtain outside funding, as well as policy makers and administrators of federal programs.

Year Book of Anesthesiology and Pain Management 2011

Bridging the gap between medical and surgical specialties in critical care, Textbook of Critical Care, 8th Edition, offers a practical, multidisciplinary approach to the effective management of adult and pediatric patients in the ICU. An outstanding editorial team, led by world-renowned intensivist Dr. Jean-Louis Vincent, assisted by Dr. Frederick A. Moore and new editors Drs. Rinaldo Bellomo and John J. Marini, provides the evidence-based guidance you need to overcome a full range of practice challenges. A full-color art program, relevant basic science and key summary points in every chapter, and expert contributing authors from all over the world make this an indispensable resource for every member of the critical care team. Provides a concise, readable understanding of the pathophysiology of critical illness and new therapeutic approaches to critical care. Addresses both medical and surgical aspects in critical care for adult and pediatric patients in one comprehensive, easy-to-use reference. Shares the knowledge and expertise of the most recognized and trusted leaders in the field, with more international contributing authors than in previous editions. Covers new information on procedural and diagnostic ultrasound, prone positioning, ECMO, and VADs. Discusses key topics such as organ support, telemedicine, echocardiography, antibiotic stewardship, antiviral agents, coagulation and anti-coagulation, and more. Features a wealth of tables, boxes, algorithms, diagnostic images, and key points that clarify important concepts and streamline complex information for quick reference. Includes companion videos and exclusive chapters online that cover commonly performed procedures. Takes a multidisciplinary approach to critical care, with contributions from experts in anesthesia, surgery, pulmonary medicine, and pediatrics.

Comprehensive, concise, and readable, Textbook of Critical Care, 7th Edition, brings you fully up to date with the effective management of critically ill patients, providing the evidence-based guidance you need to overcome a full range of practice challenges. Drs. Jean-Louis Vincent, Edward Abraham, Frederick A. Moore, Patrick Kochanek, and Mitchell P. Fink are joined by other international experts who offer a multidisciplinary approach to critical care, sharing expertise in anesthesia, surgery, pulmonary medicine, and pediatrics. This highly acclaimed text offers ICU clinicians a new understanding of the pathophysiology of critical illness and new therapeutic approaches to critical care. - Consult this title on your favorite e-reader, conduct rapid searches, and adjust font sizes for optimal readability. - Features a wealth of tables, boxes, algorithms, diagnostic images, and key points that clarify important concepts and streamline complex information for quick reference. - Includes many new chapters on echocardiography, antibiotic stewardship, antiviral agents, coagulation and anti-coagulation, , telemedicine, extracorporeal membrane oxygenation (ECMO), and more. - Offers new coverage of biomarkers, bedside ultrasound, and the management of increasingly complex critically ill patients. - Provides new approaches to sepsis, acute kidney injury, and management of acute respiratory distress syndrome (ARDS), and other forms of respiratory failure.

This User’s Guide is a resource for investigators and stakeholders who develop and review observational comparative effectiveness research protocols. It explains how to (1) identify key considerations and best practices for research design; (2) build a protocol based on these standards and best practices; and (3) judge the adequacy and completeness of a protocol. Eleven chapters cover all aspects of research design, including: developing study objectives, defining and refining study questions, addressing the heterogeneity of treatment effect, characterizing exposure, selecting a comparator, defining and measuring outcomes, and identifying optimal data sources. Checklists of guidance and key considerations for protocols are provided at the end of each chapter. The User’s Guide was created by researchers affiliated with AHRQ’s Effective Health Care Program, particularly those who participated in AHRQ’s DEcIDE (Developing Evidence to Inform Decisions About Effectiveness) program. Chapters were subject to multiple internal and external independent reviews. More more information, please consult the Agency website: www.effectivehealthcare.ahrq.gov)