Adaptive behavior of 4- through 8-year-old children with Williams syndrome.

The adaptive behavior of forty-one 4- through 8-year-olds with Williams syndrome was assessed using the Vineland Adaptive Behavior Scales-Interview Edition. Based on the cognitive and personality profiles characteristic of children with this syndrome, we predicted that the domains of Socialization and Communication would be relative strengths, whereas Daily Living Skills and Motor Skills would be relative weaknesses. We also expected that Socialization Skills would be more advanced than Communication skills, and that within the Socialization domain, interpersonal skills would be stronger than play/leisure or coping skills. All predictions were confirmed. Adaptive behavior standard score was not related to CA. The children earned similar overall standard scores on the Vineland and the Differential Ability Scales. Interrelations among adaptive behavior, cognitive abilities, and personality characteristics are discussed.

Performance standards: piece of cake or pie in the sky?

BACKGROUND: Centrally mandated levels of performance are now common in the Veterans Health Administration. Performance standards for ambulatory procedures were developed based on HCFA data. The 11 procedures to be measured were arthroscopy, breast biopsy, eyelid procedures, lens/cataracts, bronchoscopy, endoscopy, colonoscopy, hernia repair, cystoscopy, laparoscopy, and cardiac catheterization. Were the performance standards for ambulatory procedures reasonable and achievable in a tertiary care VA? METHODS: Ambulatory procedure performance standards for the 11 selected procedures were evaluated for Fiscal Year 1998 at one tertiary care VA and at each of the 22 Veteran's Integrated Service Networks (VISNs). Further review was undertaken for those procedures in which performance was below the fully successful level. This included chart reviews at the tertiary care VA and analysis of caseloads by VISN. Descriptive statistics were used as well as Student's t test to analyze the difference in means. RESULTS: The tertiary care VA performed at the fully successful level for 6 procedures and at the exceptional level for 3 procedures. Performance levels for bronchoscopy and laparoscopy were below the preset goals. At the VISN level, 8 VISNs performed at the fully successful/exceptional level for all 11 procedures. The remaining 14 were deficient in 1 to 4 procedures. Eight of the VISNs were deficient in 2 or 3 procedures. Six VISNs were deficient in laparoscopy. CONCLUSIONS: The majority of centrally mandated performance standards appear to be reasonable and achievable. One notable exception is laparoscopy. Surgeons should understand how performance standards are calculated at their institution and review the data carefully for any systematic errors. Underperformance can be used as an opportunity to improve both data collection and outcomes.

Using the Veterans Administration National Surgical Quality Improvement Program to improve patient outcomes.

BACKGROUND: The primary goal of collecting quality assurance data is to ultimately improve patient care. The VA National Surgical Quality Improvement Program (NSQIP) provides each station with risk-adjusted morbidity and mortality data on a regular basis. This report of one medical center's use of the risk-adjusted data shows how it can be used to improve patient care. MATERIALS AND METHODS: Risk-adjusted surgical outcome data for Fiscal Year 1996 (FY96) was received from the NSQIP coordinating center. The Salt Lake City VA medical center was identified as a high outlier for morbidity in general surgery. Patient charts were reviewed and data analyzed to determine practice patterns and to determine if there were any provider issues. Data analysis revealed a large number of wound complications and uncovered a practice pattern of closure of contaminated wounds. Using these data and data from the literature, wound infection and disruption prevention protocols were instituted in the fall of 1997. Wound complications from January to December 1996 (preprotocol) and January to December 1998 (postprotocol) were compared using Student's t test. RESULTS: The total number of operations in 1998 was 719 compared with 634 in 1996. Superficial wound infections dropped from 3.6 to 1.7%, while overall wound complications dropped from 5.5 to 2.9%. None of these changes were statistically significant. CONCLUSIONS: Although introduction of wound infection and disruption prevention protocols did not result in a statistically significant decrease in wound complication, it did result in a clinically significant improvement in patient care.