Administrative organization of the college of agriculture.

Mode of access: Internet.

Directory of administrative and supervisory personnel of California public schools.

Mode of access: Internet.

Federal hiring : testing for entry-level administrative positions falls short of expectations : report to the Chairman, Subcommittee on the Civil Service, Committee on Post Office and Civil Service, House of Representatives /

"B-249943"--P. 1.

Laws and regulations relating to rabies; excerpts from the California health and safety code and the California administrative code.

Mode of access: Internet.

Administrative Reference Service Report

Mode of access: Internet.

Bibliographical index to North American botany : or, citations of authorities for all the recorded indigenous and naturalized species of the flora of North America, with a chronological arrangement of the synonymy /

No more published.

Administrative guide covering public health problems in recreational areas.

Mode of access: Internet.

An Administrative survey of the schools of ... County.

"Supplement to eighty-third annual report"

Antietam National Battlefield and National Cemetery, Sharpsburg, Maryland : an administrative history /

Spine title: Antietam administrative history.

Mahommedan law : compiled from the authorities in the original Arabic /

At head of title, v. 2: Personal law of the Mahommedans

Connecticut digest of administrative reports to the Governor.

Report year 1956/57-1958/59 ends June 30.

Are diagnosis specific outcome indicators based on administrative data useful in assessing quality of hospital care?

Background: Hospital performance reports based on administrative data should distinguish differences in quality of care between hospitals from case mix related variation and random error effects. A study was undertaken to determine which of 12 diagnosis-outcome indicators measured across all hospitals in one state had significant risk adjusted systematic ( or special cause) variation (SV) suggesting differences in quality of care. For those that did, we determined whether SV persists within hospital peer groups, whether indicator results correlate at the individual hospital level, and how many adverse outcomes would be avoided if all hospitals achieved indicator values equal to the best performing 20% of hospitals. Methods: All patients admitted during a 12 month period to 180 acute care hospitals in Queensland, Australia with heart failure (n = 5745), acute myocardial infarction ( AMI) ( n = 3427), or stroke ( n = 2955) were entered into the study. Outcomes comprised in-hospital deaths, long hospital stays, and 30 day readmissions. Regression models produced standardised, risk adjusted diagnosis specific outcome event ratios for each hospital. Systematic and random variation in ratio distributions for each indicator were then apportioned using hierarchical statistical models. Results: Only five of 12 (42%) diagnosis-outcome indicators showed significant SV across all hospitals ( long stays and same diagnosis readmissions for heart failure; in-hospital deaths and same diagnosis readmissions for AMI; and in-hospital deaths for stroke). Significant SV was only seen for two indicators within hospital peer groups ( same diagnosis readmissions for heart failure in tertiary hospitals and inhospital mortality for AMI in community hospitals). Only two pairs of indicators showed significant correlation. If all hospitals emulated the best performers, at least 20% of AMI and stroke deaths, heart failure long stays, and heart failure and AMI readmissions could be avoided. Conclusions: Diagnosis-outcome indicators based on administrative data require validation as markers of significant risk adjusted SV. Validated indicators allow quantification of realisable outcome benefits if all hospitals achieved best performer levels. The overall level of quality of care within single institutions cannot be inferred from the results of one or a few indicators.

Public reporting of hospital outcomes based on administrative data: risks and opportunities

In the wake of findings from the Bundaberg Hospital and Forster inquiries in Queensland, periodic public release of hospital performance reports has been recommended. A process for developing and releasing such reports is being established by Queensland Health, overseen by an independent expert panel. This recommendation presupposes that public reports based on routinely collected administrative data are accurate; that the public can access, correctly interpret and act upon report contents; that reports motivate hospital clinicians and managers to improve quality of care; and that there are no unintended adverse effects of public reporting. Available research suggests that primary data sources are often inaccurate and incomplete, that reports have low predictive value in detecting outlier hospitals, and that users experience difficulty in accessing and interpreting reports and tend to distrust their findings.