Development and preliminary psychometric properties of the Care Experience Feedback Improvement Tool (CEFIT).

Objective To develop a structurally valid and reliable, yet brief measure of patient experience of hospital quality of care, the Care Experience Feedback Improvement Tool (CEFIT). Also, to examine aspects of utility of CEFIT. Background Measuring quality improvement at the clinical interface has become a necessary component of healthcare measurement and improvement plans, but the effectiveness of measuring such complexity is dependent on the purpose and utility of the instrument used. Methods CEFIT was designed from a theoretical model, derived from the literature and a content validity index (CVI) procedure. A telephone population surveyed 802 eligible participants (healthcare experience within the previous 12 months) to complete CEFIT. Internal consistency reliability was tested using Cronbach's α. Principal component analysis was conducted to examine the factor structure and determine structural validity. Quality criteria were applied to judge aspects of utility. Results CVI found a statistically significant proportion of agreement between patient and practitioner experts for CEFIT construction. 802 eligible participants answered the CEFIT questions. Cronbach's α coefficient for internal consistency indicated high reliability (0.78). Interitem (question) total correlations (0.28–0.73) were used to establish the final instrument. Principal component analysis identified one factor accounting for 57.3% variance. Quality critique rated CEFIT as fair for content validity, excellent for structural validity, good for cost, poor for acceptability and good for educational impact. Conclusions CEFIT offers a brief yet structurally sound measure of patient experience of quality of care. The briefness of the 5-item instrument arguably offers high utility in practice. Further studies are needed to explore the utility of CEFIT to provide a robust basis for feedback to local clinical teams and drive quality improvement in the provision of care experience for patients. Further development of aspects of utility is also required.

A longitudinal qualitative exploration of healthcare and informal support needs among survivors of critical illness: the RELINQUISH protocol.

Introduction and background: Survival following critical illness is associated with a significant burden of physical, emotional and psychosocial morbidity. Recovery can be protracted and incomplete, with important and sustained effects upon everyday life, including family life, social participation and return to work. In stark contrast with other critically ill patient groups (eg, those following cardiothoracic surgery), there are comparatively few interventional studies of rehabilitation among the general intensive care unit patient population. This paper outlines the protocol for a sub study of the RECOVER study: a randomised controlled trial evaluating a complex intervention of enhanced ward-based rehabilitation for patients following discharge from intensive care. Methods and analysis: The RELINQUISH study is a nested longitudinal, qualitative study of family support and perceived healthcare needs among RECOVER participants at key stages of the recovery process and at up to 1 year following hospital discharge. Its central premise is that recovery is a dynamic process wherein patients’ needs evolve over time. RELINQUISH is novel in that we will incorporate two parallel strategies into our data analysis: (1) a pragmatic health services-oriented approach, using an a priori analytical construct, the ‘Timing it Right’ framework and (2) a constructivist grounded theory approach which allows the emergence of new themes and theoretical understandings from the data. We will subsequently use Qualitative Health Needs Assessment methodology to inform the development of timely and responsive healthcare interventions throughout the recovery process. Ethics and dissemination: The protocol has been approved by the Lothian Research Ethics Committee (protocol number HSRU011). The study has been added to the UK Clinical Research Network Database (study ID. 9986). The authors will disseminate the findings in peer reviewed publications and to relevant critical care stakeholder groups.

Interim report of the South Carolina State Health and Human Services Finance Commission

This report summarizes the Commission's activities through June 30, 1984.

Annual report of the State Health and Human Services Finance Commission ... 1984-1985

This report summarizes the Commission's activities during the fiscal year which ended on June 30, 1985.

Annual report 1985-1986

This report summarizes the Commission's activities during the fiscal year which included accomplishments for FY 85-86, History and Organization of the Health and Human Services Finance Commission , Summary of Law/statutory authority, commission advisory committee, Medical Care Advisory Committee, Statewide Health Coordinating Council, management organization chart, and financial Statement for FY85-86.

Annual report 1986-1987

This report summarizes the Commission's activities during the fiscal year which included accomplishments for FY 85-86, History and Organization of the Health and Human Services Finance Commission , Summary of Law/statutory authority, commission advisory committee, Medical Care Advisory Committee, Statewide Health Coordinating Council, organizational chart, and financial Statement for FY86-87.

Annual report 1987-1988

This report summarizes the Commission's activities during the fiscal year which included accomplishments for FY 87-88, History and Organization of the Health and Human Services Finance Commission , Summary of Law/statutory authority, commission advisory committee, Medical Care Advisory Committee, Statewide Health Coordinating Council, management organization chart, and financial Statement for FY87-88.

Annual report 1988-1989

This report summarizes the Commission's activities during the fiscal year which included accomplishments for FY 88-89, History and Organization of the Health and Human Services Finance Commission , Summary of Law/statutory authority, commission advisory committee, Medical Care Advisory Committee, Statewide Health Coordinating Council, management organization chart, and year-end expenditure report.

Annual report 1989-1990

This report summarizes the Commission's activities during the fiscal year which included accomplishments for FY 89-90, History and Organization of the Health and Human Services Finance Commission , Summary of Law/statutory authority, commission advisory committee, Medical Care Advisory Committee, Statewide Health Coordinating Council, management organization chart, and financial Statement for FY 89-90.

Annual report 1990-1991

This report summarizes the Commission's activities during the fiscal year which included accomplishments for FY 90-91, History and Organization of the Health and Human Services Finance Commission , Summary of Law/statutory authority, commission advisory committee, Medical Care Advisory Committee, Statewide Health Coordinating Council, management organization chart, and expenditure report.

Consequences of big data on the individual: Interview

The speed with which data has moved from being scarce, expensive and valuable, thus justifying detailed and careful verification and analysis to a situation where the streams of detailed data are almost too large to handle has caused a series of shifts to occur. Legal systems already have severe problems keeping up with, or even in touch with, the rate at which unexpected outcomes flow from information technology. The capacity to harness massive quantities of existing data has driven Big Data applications until recently. Now the data flows in real time are rising swiftly, become more invasive and offer monitoring potential that is eagerly sought by commerce and government alike. The ambiguities as to who own this often quite remarkably intrusive personal data need to be resolved – and rapidly - but are likely to encounter rising resistance from industrial and commercial bodies who see this data flow as ‘theirs’. There have been many changes in ICT that has led to stresses in the resolution of the conflicts between IP exploiters and their customers, but this one is of a different scale due to the wide potential for individual customisation of pricing, identification and the rising commercial value of integrated streams of diverse personal data. A new reconciliation between the parties involved is needed. New business models, and a shift in the current confusions over who owns what data into alignments that are in better accord with the community expectations. After all they are the customers, and the emergence of information monopolies needs to be balanced by appropriate consumer/subject rights. This will be a difficult discussion, but one that is needed to realise the great benefits to all that are clearly available if these issues can be positively resolved. The customers need to make these data flow contestable in some form. These Big data flows are only going to grow and become ever more instructive. A better balance is necessary, For the first time these changes are directly affecting governance of democracies, as the very effective micro targeting tools deployed in recent elections have shown. Yet the data gathered is not available to the subjects. This is not a survivable social model. The Private Data Commons needs our help. Businesses and governments exploit big data without regard for issues of legality, data quality, disparate data meanings, and process quality. This often results in poor decisions, with individuals bearing the greatest risk. The threats harbored by big data extend far beyond the individual, however, and call for new legal structures, business processes, and concepts such as a Private Data Commons. This Web extra is the audio part of a video in which author Marcus Wigan expands on his article "Big Data's Big Unintended Consequences" and discusses how businesses and governments exploit big data without regard for issues of legality, data quality, disparate data meanings, and process quality. This often results in poor decisions, with individuals bearing the greatest risk. The threats harbored by big data extend far beyond the individual, however, and call for new legal structures, business processes, and concepts such as a Private Data Commons.

Annual report 1991-1992

This report summarizes the Commission's activities during the fiscal year which included accomplishments for FY 91-92, History and Organization of the Health and Human Services Finance Commission , Summary of Law/statutory authority, commission advisory committee, Medical Care Advisory Committee, Statewide Health Coordinating Council, management organization chart, and expenditure report.

Annual report 1992-1993

This report summarizes the Commission's activities during the fiscal year which included accomplishments for FY 92-93, History and Organization of the Health and Human Services Finance Commission , Summary of Law/statutory authority, commission advisory committee, Medical Care Advisory Committee, Statewide Health Coordinating Council, management organization chart, and expenditure report.

Annual report 1993-1994

This report summarizes the Commission's activities during the fiscal year which included accomplishments for FY 93-94, History and Organization of the Health and Human Services Finance Commission , Summary of Law/statutory authority, commission advisory committee, Medical Care Advisory Committee, Statewide Health Coordinating Council, management organization chart, and expenditure report.

The impact of social housing on health in Glasgow and Baltimore, 1930-1980

This dissertation seeks to discern the impact of social housing on public health in the cities of Glasgow, Scotland and Baltimore, Maryland in the twentieth century. Additionally, this dissertation seeks to compare the impact of social housing policy implementation in both cities, to determine the efficacy of social housing as a tool of public health betterment. This is accomplished through the exposition and evaluation of the housing and health trends of both cities over the course of the latter half of the twentieth century. Both the cities of Glasgow and Baltimore had long struggled with both overcrowded slum districts and relatively unhealthy populations. Early commentators had noticed the connection between insanitary housing and poor health, and sought a solution to both of these problems. Beginning in the 1940s, housing reform advocates (self-dubbed ‘housers') pressed for the development of social housing, or municipally-controlled housing for low-income persons, to alleviate the problems of overcrowded slum dwellings in both cities. The impetus for social housing was twofold: to provide affordable housing to low-income persons and to provide housing that would facilitate healthy lives for tenants. Whether social housing achieved these goals is the crux of this dissertation. In the immediate years following the Second World War, social housing was built en masse in both cities. Social housing provided a reprieve from slum housing for both working-class Glaswegians and Baltimoreans. In Baltimore specifically, social housing provided accommodation for the city’s Black residents, who found it difficult to occupy housing in White neighbourhoods. As the years progressed, social housing developments in both cities faced unexpected problems. In Glasgow, stable tenant flight (including both middle class and skilled artisan workers)+ resulted in a concentration of poverty in the city’s housing schemes, and in Baltimore, a flight of White tenants of all income levels created a new kind of state subsidized segregated housing stock. The implementation of high-rise tower blocks in both cities, once heralded as a symbol of housing modernity, also faced increased scrutiny in the 1960s and 1970s. During the period of 1940-1980, before policy makers in the United States began to eschew social housing for subsidized private housing vouchers and community based housing associations had truly taken off in Britain, public health professionals conducted academic studies of the impact of social housing tenancy on health. Their findings provide the evidence used to assess the second objective of social housing provision, as outlined above. Put simply, while social housing units were undoubtedly better equipped than slum dwellings in both cities, the public health investigations into the impact of rehousing slum dwellers into social housing revealed that social housing was not a panacea for each city’s social and public health problems.