Reducing questionnaire length did not improve physician response rate: a randomized trial

ObjectivesTo examine the effect of reducing questionnaire length on the response rate in a physician survey.Study Design and SettingA postal four double-page questionnaire on end-of-life decision making was sent to a random sample of 1,100 general practitioners, 400 elderly care physicians, and 500 medical specialists. Another random sample of 500 medical specialists received a shorter questionnaire of two double pages. After 3 months and one reminder, all nonresponding physicians received an even shorter questionnaire of one double page.ResultsTotal response was 64% (1,456 of 2,269 eligible respondents). Response rate of medical specialists for the four double-page questionnaire was equal to that of the two double-page questionnaire (190 and 191 questionnaires were returned, respectively). The total response rate increased from 53% to 64% after sending a short one double-page questionnaire (1,203–1,456 respondents).ConclusionThe results of our study suggest that reducing the length of a long questionnaire in a physician survey does not necessarily improve response rate. To improve response rate and gather more information, researchers could decide to send a drastically shortened version of the questionnaire to nonresponders.     

Cross-ministry data on service use and limitations faced by children in special education

BackgroundChildren with disabilities often face limitations that cross support sectors. Objective: Our aim was to measure cross-ministry service use, outcomes, and functional limitations faced by children who qualified for special education.MethodsWe used longitudinal British Columbia ministry data linked to children (0-18y) registered in K-12 education. Children were grouped by special education funding (most to least; Level 1, Level 2, Level 3, Unfunded, and no special education), and related to 1) service use patterns, 2) the age they first used disability services, and 3) functional limitations reported in health visits. We also reported how length of special education use related to disability service use.ResultsOf 111,274 children, 154(0.1%) were Level 1, 4427(4.0%) Level 2, 2897(2.6%) Level 3, 13472(12.1%) Unfunded, and 90324(81.2%) not in special education. Children with higher funding levels, compared to lower levels of funding, generally were more likely to experience poorer outcomes, have functional limitations, have service needs, and receive early support. One exception was children with serious behavioral/mental health special education coding, which had poorer outcomes for their level of funding. Children received child disability supports early (about half of users started by 4y), but use was mostly limited to those with many years (9+years) of funded special education (70.7% of the all users) and biased to certain special education codes (i.e., Level 1, severe intellectual disability, and autism).ConclusionsThis study provides evidence of the long-term, diverse needs of children in special education and may be used to inform decisions surrounding their support.     

Modeling the determinants of Medicaid home care payments for children with special health care needs: A structural equation model approach

BackgroundThe management of children with special needs can be very challenging and expensive.ObjectiveTo examine direct and indirect cost drivers of home care expenditures for this vulnerable and expensive population.MethodsWe retrospectively assessed secondary data on children, ages 4–20, receiving Medicaid Personal Care Services (PCS) (n = 2760). A structural equation model assessed direct and indirect effects of several child characteristics, clinical conditions and functional measures on Medicaid home care payments.ResultsThe mean age of children was 12.1 years and approximately 60% were female. Almost half of all subjects reported mild, moderate or severe ID diagnosis. The mean ADL score was 5.27 and about 60% of subjects received some type of rehabilitation services. Caseworkers authorized an average of 25.5 h of PCS support per week. The SEM revealed three groups of costs drivers: indirect, direct and direct + indirect. Cognitive problems, health impairments, and age affect expenditures, but they operate completely through other variables. Other elements accumulate effects (externalizing behaviors, PCS hours, and rehabilitation) and send them on a single path to the dependent variable. A few elements exhibit a relatively complex position in the model by having both significant direct and indirect effects on home care expenditures – medical conditions, intellectual disability, region, and ADL function.ConclusionsThe most important drivers of home care expenditures are variables that have both meaningful direct and indirect effects. The only one of these factors that may be within the sphere of policy change is the difference among costs in different regions.     

血液采集操作技术量化体系构建与实证研究

目的构建血液采集操作技术量化体系,探讨其对员工进行技能培训的效果,以寻求行之有效的技能培训体系。方法采用已构建的采血岗操作技术量化体系,对员工的实际操作能力进行评估。抽取招募、体检、初步检测、血液采集工作人员各10人,共40人,随机分成实验组和对照组进行比赛。结果实验组各项得分均高于对照组,两组比较具有统计学意义（P〈0.05）。结论对采供血操作技术进行量化,能提高员工培训效果,可缩短培训时间,节省培训成本,具有很高的技术效益和社会效益。