Medical care
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Comparative Study
Predicting in-hospital survival of myocardial infarction. A comparative study of various severity measures.
This study reports on the ability of several indices to predict in-hospital survival from acute myocardial infarction. The following indices were included: Acute Physiological and Chronic Health Evaluation (APACHE II), Medisgroups (MDGRP), Computerized Severity Index (CSI), Patient Management Categories (PMC), Coded Disease Staging (CDS), Ischemic Heart Disease Index (IHDI), and Predictive Index for Myocardial Infarction (PIMI). An arbitrary strategy of predicting that all patients will live was also applied and correctly classified 78% of the cases. ⋯ Indices based on discharge abstracts were as accurate as some of the indices based on physiologic variables, in particular PMC was as accurate as CSI, MDGRP, APACHE, and IHDI, and CDS was as accurate as MDGRP, APACHE, and IHDI. This study was limited in scope and application and should not be generalized to other settings until additional data confirm the findings. We discuss the implications of these findings for measuring quality of care and suggest improvements for design of future severity indices.
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Randomized Controlled Trial Clinical Trial
Ethical issues in administrative continuous improvement. Applying the concept of prior notification to the conduct of firm trials.
Consensus exists concerning the distinctions to be drawn between clinical practice and research. When the latter is undertaken, established regulations require that protocols including plans for obtaining subjects' informed consent be submitted to Institutional Review Boards for approval. Less consensus or codification exists concerning evaluations conducted by managers in health care settings. ⋯ Accordingly, the history of firm trials from an ethical perspective is reviewed. At the University of Washington, participants of such studies are informed through the process of prior notification, an adaptation of procedures employed widely to inform patients that records or specimens may be used in epidemiologic or biomedical research. Prior notification appears to be a useful refinement of the firm system methodology, one that may have application to managerial manipulations in other arenas.