Attitudes of mental health staff to routine outcome measurement

Background: Routine outcome measurement is mandated in public mental health services in Australia, but uptake and compliance are variable. This may be because of uncertainties and resistances among clinicians.
Aims: To survey attitudes and practices to routine outcome measurement among staff in adult area mental health services and to elucidate their correlates.
Method: As part of a larger study, a specifically designed questionnaire was distributed to all staff.
Results: A high return rate was achieved. A wide range of opinion was found. Staff who had attended training reported the measures as easier to use than those who had not. Staff who had recently seen feedback rated outcome measures as more valuable but less easy to use than those who had not seen feedback. Compared to other disciplines, medical staff and psychologists tended to rate outcome measures as less useful.
Conclusions: The results have implications for the implementation and sustainability of routine outcome measurement. They highlight the need for staff to receive targeted training and usable reports, and to have access to resources to extract meaning and value from outcome measures.

Measurement and structural properties of organizational codes of ethics in private and public Sweden

Purpose – The purpose of this paper is to test the measurement and structural properties in a model of organizational codes of ethics (OCE) in Sweden.

Design/methodology/approach – The measurement and structural properties of four OCE constructs (i.e. surveillance/training, internal communication, external communication, and guidance) were described and tested in a dual sample based upon private and public sectors of Sweden.

Findings – Results show that the measurement and structural models of OCE in part have a satisfactory fit, validity, and reliability.

Research limitations/implications – The paper makes a contribution to theory as it outlines a set of OCE constructs and it presents an empirical test of and OCE model in respect to measurement and structural properties. A number of research limitations are provided.

Practical implications – It provides a model to be considered in the implementation and monitoring of OCE. The present research provides opportunities for further research in refining, extending, and testing the proposed OCE model in other cultural and organizational settings.

Originality/value – The OCE model extends previous studies that have been predominately descriptive, by using confirmatory factor analysis and structural equation modeling.

Not all roads lead to Rome - a review of quality of life measurement in diabetes

Aims Quality of life (QoL) is recognized widely as an important health outcome in diabetes, where the burden of selfmanagement places great demands on the individual. However, the concept of QoL remains ambiguous and poorly defined. The aim of our review is to clarify the measurement of QoL in terms of conceptualization, terminology and psychometric properties, to review the instruments that have been used most frequently to assess QoL in diabetes research and make recommendations for how to select measures appropriately.

Methods A systematic literature search was conducted to identify the ten measures most frequently used to assess QoL in diabetes research (including clinical trials) from 1995 to March 2008.

Results Six thousand and eight-five abstracts were identified and screened for instrument names. Of the ten instruments most frequently used to assess ‘QoL’, only three actually do so [i.e. the generic World Health Organization Quality of Life (WHOQOL) and the diabetes-specific Diabetes Quality of Life (DQOL) and Audit of Diabetes-Dependent Quality of Life (ADDQoL)]. Seven instruments more accurately measure health status [Short-Form 36 (SF-36), EuroQoL 5-Dimension (EQ-5D)], treatment satisfaction [Diabetes Treatment Satisfaction Questionnaire (DTSQ)] and psychological well-being [Beck Depression Inventory (BDI), Hospital Anxiety and Depression Scale (HADS), Well-Being Questionnaire (W-BQ), Problem Areas in Diabetes (PAID)].

Conclusions No single measure can suit every purpose or application but, when measures are selected inappropriately and data misinterpreted, any conclusions drawn are fundamentally flawed. If we value QoL as a therapeutic goal, we must ensure that the instruments we use are both valid and reliable. QoL assessment has the proven potential to identify ways in which treatments can be tailored to reduce the burden of diabetes. With careful consideration, appropriate measures can be selected and truly robust assessments undertaken successfully.

KM value creation : evidence from a case

One of the fundamental knowledge management questions is how organizations can use their knowledge to create value. There is general agreement that knowledge management should add value. It is not clear, however, what value means in the context of knowledge management and how it is created. This fundamental question is complex as value has different meanings to different people. Understanding value in the context of KM will lead to better understanding of the potential sources of value creation from knowledge management and better management of knowledge assets. It will inform the measurement of knowledge and its impacts on organizations. It will lead to recognition of the contribution of knowledge assets to organizational success.

This paper provides a review of prior research on value creation and how this can improve the understanding of value in the context of knowledge management. Based on this review it poses questions to explore value creation in the context of knowledge management. It then reports on preliminary analysis of a case study of a process-based knowledge management system and the expressions of value, value creating actions and value capture as perceived by different stakeholders.

Measurement issues in the evaluation of chronic disease self-management programs

Objectives: 

Cross-cultural adaption of the Health Educaiton Impact Questionnaire: experimental study showed expert committee, not back-translation, added value

Objectives
To assess the contribution of back-translation and expert committee to the content and psychometric properties of a translated multidimensional questionnaire.

Study Design and Setting
Recommendations for questionnaire translation include back-translation and expert committee, but their contribution to measurement properties is unknown. Four English to French translations of the Health Education Impact Questionnaire were generated with and without committee or back-translation. Face validity, acceptability, and structural properties were compared after random assignment to people with rheumatoid arthritis (N = 1,168), chronic renal failure (N = 2,368), and diabetes (N = 538). For face validity, 15 bilingual people compared translations quality with the original. Psychometric properties were examined using confirmatory factor analysis (metric and scalar invariance) and item response theory.

Results
Qualitatively, there were five types of translation errors: style, intensity, frequency/time frame, breadth, and meaning. Bilingual assessors ranked best the translations with committee (P = 0.0026). All translations had good structural properties (root mean square error of approximation <0.05; comparative fit index [CFI], ≥0.899; and Tucker–Lewis index, ≥0.889). Full measurement invariance was observed between translations (ΔCFI ≤ 0.01) with metric invariance between translations and original (lowest ΔCFI = 0.022 between fully constrained models and models with free intercepts). Item characteristic curve analyses revealed no significant differences.

Conclusion
This is the first experimental evidence that back-translation has moderate impact, whereas expert committee helps to ensure accurate content.

The value of visual fleece assessment in addition to objective measurements in identifying Angora goats of greater clean mohair production

Visual assessment of the fleece of Merino sheep is an accepted method to aid genetic improvement but there is little evidence to support the use of visual assessment for improving mohair production. This paper examines the extent that visual traits, including staple length, character (staple crimp), staple definition, tippiness, style and staple entanglement, are related to clean fleece weight in animals of similar live weight and mean fibre diameter (MFD) from the same flock. Measurements were made over 9 shearing periods on a population of castrated Angora males (wethers) goats representing the current range and diversity of genetic origins in Australia, including South African, Texan and interbred admixtures of these and Australian sources (these different genetic origins are defined as Breed in this work). Data on genetic origin, sire, dam, lifetime characteristics (date of birth, dam age, birth weight, birth parity (single or twin), weaning weight), live weight, fleece growth and visual fleece attributes were recorded. A restricted maximum likelihood (REML) model was developed to relate clean fleece weight with age, MFD, average fleece-free live weight, lifetime characteristics and visual fleece attributes. There were separate linear responses of clean fleece weight to MFD and staple length for each age group, a quadratic response to the square root of average fleece-free live weight, an effect of sire breed and linear responses to dam age, staple definition score and character. Depending on age at shearing, the increase in clean fleece weight was between about 50 and 80. g for each increase of 1. μm in MFD. At similar MFD, clean fleece weight was generally greater at summer shearings compared with winter shearings. There was a strong increase in clean fleece weight with average fleece-free live weight up to around 50. kg but little response in clean fleece weight for animals larger than 50. kg. There was some evidence of a smaller increase in clean fleece weight as the age of dam increased. There was an effect of Breed in the model but this effect disappeared when a random sire effect was included in the model. There was a positive response to staple length at some age groups but the response did not differ from zero in other age groups. This response varied from negligible to about 70. g per 1. cm increase in staple length. Clean fleece weight increased about 40. g per unit increase in staple definition score and increased about 30. g for every 4 units increase in the number of staple crimps. There was no evidence that clean fleece weight was affected by staple style, staple tip score or staple entanglement score or lifetime factors such as birth weight, date of birth, birth parity, or weaning weight. The results show that using a combination of measuring MFD and visually assessing the fleece for staple length, staple definition and crimps can help identify the most profitable Angora goats. In this process, the objective measurement of MFD appears essential. Visual assessment will provide some extra benefit in identifying these animals above that provided by measuring MFD alone. Animal size should be considered by mohair producers when identifying more productive mohair producing animals. © 2014 Elsevier B.V.

Associations between the physiological basis of fabric-evoked prickle, fiber and yarn characteristics and the Wool ComfortMeter value

The association between the incidents counted by the measurement wire of the Wool ComfortMeter (WCM) and the previously published neurophysiological basis for fabric-evoked prickle have been investigated for lightweight knitted woolen fabrics. The fiber lengths and diameters capable of triggering the fabric-evoked prickle sensation were calculated using Euler’s buckling formula, and it is suggested that fibers as fine as 10 mm are capable of triggering the prickle response if they have a short enough free length protruding from the surface. Good agreement was found between the sensory assessed human prickle sensation and the wearer prickle response predicted using the WCM outputs, especially when the latter were transformed using Stevens’s Psychophysical Power Law.

Valuing and desiring purposes of education to transcend miseducative measurement practices

The separating and isolating tendencies of measuring practices can lead educators to lose sight of the aims and purposes of education. These end purposes can be used to guide and ensure that the activities of educators are educational, and therefore, Biesta recommends there is a need for educators to reconnect with them. This article. explores this notion of a ‘reconnection’ and argues that if educators are to challenge any potentially miseducative measuring practices, then this reconnection must require educators to value and desire particular end purposes. Desires are recognised to be existential in character and are identified as being necessary for initiating actions. It is argued here that this aspect of desires is important for understanding the significance of a ‘reconnection’ because without it the purposes of education may remain only as abstract philosophical ideals. To make a difference and to challenge the isolating and miseducative tendencies of some measuring practices, educators must come to value particular purposes of education, and in addition, they must exercise the courage to enact them. This can be made possible because educators strongly care for and desire the actualisation of the purposes to which they are connected.

A non-contact measurement system for the range of motion of the hand

An accurate and standardised tool to measure the active range of motion (ROM) of the hand is essential to any progressive assessment scenario in hand therapy practice. Goniometers are widely used in clinical settings for measuring the ROM of the hand. However, such measurements have limitations with regard to inter-rater and intra-rater reliability and involve direct physical contact with the hand, possibly increasing the risk of transmitting infections. The system proposed in this paper is the first non-contact measurement system utilising Intel Perceptual Technology and a Senz3D Camera for measuring phalangeal joint angles. To enhance the accuracy of the system, we developed a new approach to achieve the total active movement without measuring three joint angles individually. An equation between the actual spacial position and measurement value of the proximal inter-phalangeal joint was established through the measurement values of the total active movement, so that its actual position can be inferred. Verified by computer simulations, experimental results demonstrated a significant improvement in the calculation of the total active movement and successfully recovered the actual position of the proximal inter-phalangeal joint angles. A trial that was conducted to examine the clinical applicability of the system involving 40 healthy subjects confirmed the practicability and consistency in the proposed system. The time efficiency conveyed a stronger argument for this system to replace the current practice of using goniometers.

Toward a standard approach to measurement and reporting of perioperative mortality rate as a global indicator for surgery

INTRODUCTION: The proportion of patients who die during or after surgery, otherwise known as the perioperative mortality rate (POMR), is a credible indicator of the safety and quality of operative care. Its accuracy and usefulness as a metric, however, particularly one that enables valid comparisons over time or between jurisdictions, has been limited by lack of a standardized approach to measurement and calculation, poor understanding of when in relation to surgery it is best measured, and whether risk-adjustment is needed. Our aim was to evaluate the value of POMR as a global surgery metric by addressing these issues using 4, large, mixed, surgical datasets that represent high-, middle-, and low-income countries. METHODS: We obtained data from the New Zealand National Minimum Dataset, the Geelong Hospital patient management system in Australia, and purpose-built surgical databases in Pietermaritzburg, South Africa, and Port Moresby, Papua New Guinea. For each site, we calculated the POMR overall as well as for nonemergency and emergency admissions. We assessed the effect of admission episodes and procedures as the denominator and the difference between in-hospital POMR and POMR, including postdischarge deaths up to 30 days. To determine the need for risk-adjustment for age and admission urgency, we used univariate and multivariate logistic regression to assess the effect on relative POMR for each site. RESULTS: A total of 1,362,635 patient admissions involving 1,514,242 procedures were included. More than 60% of admissions in Pietermaritzburg and Port Moresby were emergencies, compared with less than 30% in New Zealand and Geelong. Also, Pietermaritzburg and Port Moresby had much younger patient populations (P < .001). A total of 8,655 deaths were recorded within 30 days, and 8-20% of in-hospital deaths occurred on the same day as the first operation. In-hospital POMR ranged approximately 9-fold, from 0.38 per 100 admissions in New Zealand to 3.44 per 100 admissions in Pietermaritzburg. In New Zealand, in-hospital 30-day POMR underestimated total 30-day POMR by approximately one third. The difference in POMR if procedures were used instead of admission episodes ranged from 7 to 70%, although this difference was less when central line and pacemaker insertions were excluded. Age older than 65 years and emergency admission had large, independent effects on POMR but relatively little effect in multivariate analysis on the relative odds of in-hospital death at each site. CONCLUSION: It is possible to collect POMR in countries at all level of development. Although age and admission urgency are strong, independent associations with POMR, a substantial amount of its variance is site-specific and may reflect the safety of operative and anesthetic facilities and processes. Risk-adjustment is desirable but not essential for monitoring system performance. POMR varies depending on the choice of denominator, and in-hospital deaths appear to underestimate 30-day mortality by up to one third. Standardized approaches to reporting and analysis will strengthen the validity of POMR as the principal indicator of the safety of surgery and anesthesia care.

Perspectives on social impact measurement and non-profit organisations

Purpose– Acknowledgement of the social impact created by organisations has become an increasingly frequent discussion among practitioners. The importance of such value creation cannot be understated, yet in an increasingly competitive funding environment, the need to articulate “true” value is paramount. The purpose of this paper is to examine how Australian and US managers of non-profit organisations (NPOs) and foundations view the measurement of the social impact of NPOs.Design/methodology/approach– The paper includes 19 in-depth interviews of non-profit professionals in the USA and Australia. Respondents included non-profit managers, foundation managers and consultants in both countries.Findings– The in-depth interviews found that in both countries respondents generally agreed that objective measures of impact are desirable, but recognised the difficulties in developing objective assessment frameworks enabling comparisons across the non-profit sector. These difficulties, as well as the implications for developing assessments of social value for NPOs, are discussed. This paper demonstrates that there is an opportunity to reposition reporting expectations. The NPO sector can pool together and build on each other’s strengths and market their outcomes as a collective entity. A sector-wide approach provides potential for much needed within-sector mentoring and will showcase the rich and varied outcomes generated by NPOs.Originality/value– This research compares viewpoints in two Western countries, thus offering at least an exploratory examination of social impact assessment from an international perspective. Additionally, this research shows commonalities in terms of what is valued and what is most difficult for non-profits when determining social impact.

Construction industry performance measurement with carbon reduction

The research developed non-parametric approaches for measuring construction industry performance in sustainable development. The research results support the improvement of value added and the reduction of carbon emissions, which have positive environmental and economic implications in the Australian construction industry.