Richard Chambers

Patient and physician satisfaction in a clinical study of telemedicine in a hypertensive patient population.

We studied patient and physician satisfaction with telemedicine for the care of a hypertensive population. Once recruited, participants were seen both in person and via telemedicine (in random order) on the same day. After each meeting, patient and physician satisfaction surveys were completed. In the 12-month study, there were 107 pairs of visits. The physicians reported a small but significant increase in workload, mental effort, technical skills and visit duration for telemedicine when compared with face-to-face consultations. They noted that the telemedicine system worked well in the majority of cases and could reduce the need for future treatment. Patients reported slightly but significantly higher satisfaction scores for the following for in-person than for telemedicine meetings: technical quality, interpersonal care and time spent. Patients reported high satisfaction scores for both telemedicine and in-person visits.

Application of the combined quality improvement ratio in the evaluation of a quality improvement activity in a managed care organization.

Assessing the impact of clinically relevant quality improvement activities (QIA) is important to managed care organizations; yet, turnover in enrollment can reduce the data available for analyses, thus decreasing the chance that a difference post-QIA will be detected. The Combined Quality Improvement Ratio (CQuIR) uses matching of patients into pairs pre-and post-QIA to systematically and validly increase the data included in the analysis for evaluation of the QIA. Using a paired cohort study design, 456 pairs of patients with diabetes were identified using the Health Plan Employer Data Information Set (HEDIS) specifications. Patients having retinal examinations were identified pre and post-QIA. The change in retinal examination rates was analyzed and results compared using repeated pairs (RP), matched pairs (MP), and combined pairs (CP). The CQuIR methodology (which uses CP = RP + MP) resulted in an increase in sample size (n = 456 [CPI versus n = 156 [RP] and n = 300 [MP]) and consequently an increase in power (0.92 [CP] versus 0.38 [RPI and 0.82 [MPI) and a decrease in the confidence interval range (0.97 [CP] versus 2.06 [RP] and 1.14 [MPI). The CQuIR uses a statistically valid approach to increase the data available for the evaluation of QLAs.

Combined Quality Improvement Ratio: A Method for a More Robust Evaluation of Changes in Screening Rates

INTRODUCTION It has been proposed that a ratio of the discordant cells from a McNemars Chi-square table be used as a measure of quality improvement, and that this measure be called the Quality Improvement Ratio (QuIR). As proposed, patients enrolled in only one year of a two-year study are excluded from the McNemars table of the QuIR. Since the original proposal of the McNemars Chi-square in 1947 included application to matched pair data, a more comprehensive analysis would be possible if the single-year enrollees were matched into pairs. METHODS Patients enrolled in only the first study year are matched and paired with patients enrolled in only the second study year. The pairs are matched on variables important to the disease or process being evaluated. The matched pairs are combined with the repeatedly measured subjects to increase the statistical power of the analysis. The Combined Quality Improvement Ratio (CQuIR) is demonstrated with parameters from the original articles, in a--Markov chain Monte-Carlo simulation, so a direct comparison can be made. RESULTS CQuIR improved statistical power, especially in simulations of small populations. In some simulations the statistical power was double that of the QuIR alone. DISCUSSION Although the QuIR provides important information, the CQuIR allows more of the data to be used to evaluate the effect of interventions in policy, delivery, and practice. The increase in statistical power of the CQuIR over the QuIR can facilitate successful evaluation of health care services.