Current perspectives in assessment: the assessment of performance at work

BACKGROUND: Traditional assessment has improved significantly over the past 50 years. A number of new testing methods are now in place, the computer is improving both the fidelity and efficiency of examinations, and the psychometric principles on which assessment rests are more sophisticated than ever. AIM: There is growing interest in quality improvement and there are increasing demands for public accountability. This has shifted the focus of testing from education to work. The purpose of this paper is to describe the assessment of work. DISCUSSION: In contrast to traditional assessment, there are no 'methods' for the evaluation of work because the content and difficulty of the examination are not controlled in any fashion. Instead it is a matter of identifying the basis for the judgements (outcomes, process, or volume), deciding how the data will be gathered (practice records, administrative databases, diaries/logs, or observation), and avoiding threats to validity and reliability (patient mix, patient complexity, attribution, and numbers of patients). FUTURE DIRECTIONS: Overall, the assessment of doctors' performance at work is in its infancy and much research and development is needed. Nonetheless, it is being used increasingly in programmes of continuous quality improvement and accountability. It is critical that refinements occur quickly to ensure that patients receive the highest quality of care and that doctors are treated fairly and provided with the information they need to guide their professional development.     

Technical assessment of the HELLODOC service

SUMMARY: A technical assessment activity has been conducted by Istituto Superiore di Sanità (ISS) in the European project HELLODOC (Healthcare service linking tele-rehabilitation to disabled people and clinicians) for evaluating the tele-rehabilitation service. The activity was mainly focussed on architectural aspects and a step by step monitoring of the service. It was mainly related to the following aspects: service implementation, service performances, service integration and fault management. The technical assessment analysis demonstrated that the service worked in a quite satisfactory way, also considering the pioneering aspect of the project; the set of malfunctioning occurred, which had a low impact on the service continuity, are typical of a post-debug phase.     

On the assessment of maternal mortality

Well over 1/2 the maternal deaths in the world occur in 3 countries in southern Asia: India, Pakistan, and Bangladesh. In general, the incidence of maternal death correlates with 2 factors: a high risk of dying during or just after pregnancy due to sepsis, inadequate facilities for dealing with complicated births or other health problems such as exacerbation of existing disease, poor nutrition, overwork, and/or closely spaced pregnancies; and a high fertility rate. This report outlines methods for measuring maternal mortality and presents data for developing nations in each continent, comparing it to developed nations and determing its contribution to overall mortality. The risk of dying as a result of a given pregnancy in a developed nation is at least 100-fold smaller than that in the poorest countries in Africa and Asia. Estimated mortality due to pregnancy is 460,000 more women in the undeveloped nations compared to the developed nations.