OECD Health Care Quality Indicator Project. The expert panel on primary care prevention and health promotion.

PURPOSE: This article describes a project undertaken as part of the Organization for Economic Co-operation and Development (OECD)'s Healthcare Quality Indicator (HCQI) Project, which aimed to develop a set of quality indicators representing the domains of primary care, prevention and health promotion, and which could be used to assess the performance of primary care systems. METHODS: Existing quality indicators from around the world were mapped to an organizing framework which related primary care, prevention, and health promotion. The indicators were judged against the US Institute of Medicine's assessment criteria of importance and scientific soundness, and only those which met these criteria and were likely to be feasible were included. An initial large set of indicators was reduced by the primary care expert panel using a modified Delphi process. RESULTS: A set of 27 indicators was produced. Six of them were related to health promotion, covering health-related behaviours that are typically targeted by health education and outreach campaigns, 13 to preventive care with a focus on prenatal care and immunizations and eight to primary clinical care mainly addressing activities related to risk reduction. The indicators selected placed a strong emphasis on the public health aspects of primary care. CONCLUSIONS: This project represents an important but preliminary step towards a set of measures to evaluate and compare primary care quality. Further work is required to assess the operational feasibility of the indicators and the validity of any benchmarking data drawn from international comparisons. A conceptual framework needs to be developed that comprehensively captures the complex construct of primary care as a basis for the selection of additional indicators.

Nice guys finish first: the competitive altruism hypothesis.

Three experimental studies examined the relationship between altruistic behavior and the emergence of status hierarchies within groups. In each study, group members were confronted with a social dilemma in which they could either benefit themselves or their group. Study 1 revealed that in a reputation environment when contributions were public, people were more altruistic. In both Studies 1 and 2, the most altruistic members gained the highest status in their group and were most frequently preferred as cooperative interaction partners. Study 3 showed that as the costs of altruism increase, the status rewards also increase. These results support the premise at the heart of competitive altruism: Individuals may behave altruistically for reputation reasons because selective benefits (associated with status) accrue to the generous.