ABSTRACT
OBJECTIVE: Collecting unnecessary data when assessing quality of care wastes valuable resources. We evaluated three approaches for estimating quality-measure adherence and determined minimum visit data required to achieve accurate estimates. DESIGN: We abstracted medical records for calculating physician-level pain screening rates as: visit-specific, using single-visit data for each patient; visit-level average, using data for all patients and visits; and patient-level average, using data from a subset of patients and visits. SETTING: VA Greater Los Angeles Health-care System, 2006. PARTICIPANTS: One hundred and six patients with Stage IV solid tumors. INTERVENTION: Pain screening at every medical encounter, measured by a 0-10 numeric rating scale and reported to the national Medicare insurance program under a 'pay-for-reporting' program. MAIN OUTCOME MEASURES: Amount of visit data needed to reach the smallest 95% confidence interval (CI) and stable pain screening estimates. RESULTS: Pain screening occurred at 22% (23/106; 95% CI: 14-30%) of initial visits and 50% (8/16; 95% CI: 25-75%) of single visits. Across all visits, screening adherence averaged 34% when estimated at the visit-level precision and 30% at the patient level. Maximum patient-level precision was reached at visit 4 (95% CI: ± 8%) and visit level at visit 14 (95% CI: ± 6%). Using patient-level and visit-level approaches, estimates stabilized at visits 8 and 11, respectively, and reached within 1 percentage point of the steady-state value at visits 4 and 9. CONCLUSION: To address low-pain screening among cancer patients, an oncology pain screening measure may be most efficiently evaluated with data from a sample of patients and visits. This approach may be valid for visit-level quality measures in other settings.
Subject(s)
Efficiency, Organizational , Pain Measurement/standards , Quality Assurance, Health Care/methods , Aged , Confidence Intervals , Female , Guideline Adherence , Humans , Los Angeles , Male , Medical Audit , Middle Aged , Quality Assurance, Health Care/standardsABSTRACT
A radioimmunoassay was developed for the detection of IgG and IgE canine antibodies against partially purified flea antigen. Low background levels were found in flea naive dogs, but high levels of both IgE and IgG antibodies were found in many sera from dogs with clinical flea hypersensitivity. In sera from non-allergic dogs exposed chronically to fleas, IgE levels differed little from background, and levels of IgG anti-flea antibodies were much lower than those from the flea allergic group. The results suggest that chronic flea exposure may result in partial or complete tolerance rather than hyposensitization in the commonly accepted sense.
Subject(s)
Dog Diseases/immunology , Hypersensitivity/veterinary , Immunoglobulin E/analysis , Immunoglobulin G/analysis , Siphonaptera/immunology , Animals , Antigens/immunology , Dogs , Hypersensitivity/immunology , Immune Tolerance , RadioimmunoassayABSTRACT
The immunoglobulins IgA, IgG, IgG(T) and IgM were measured in uterine secretions from mares with normal uterine defense capability against bacterial contamination, and in mares with lowered resistance. Samples were collected for analysis at two stages of estrus and two stages of diestrus. All mares were then challenged with a pathogenic culture of Streptococci inoculated into the uterus. The immunoglobulins were quantitated on a similar schedule post-inoculation. Generally higher amounts of IgA, IgG and IgG(T) were found in the uterine secretions of mares which had an imparied resistance to endometritis than in mares with an efficient defense mechanisms. IgM was not detected in enough samples to suggest any differences.
