How accurate is the data you send to JCAHO?

You can reduce or eliminate errors in the data collection and reporting process by implementing a "chain of command"-style communications process emphasizing education, quality oversight, and correction, and by building in a rapid-response mechanism that lets coders quickly double-check anything they're uncertain about before the data are submitted.     

Is this satisfaction survey satisfactory? Some points to consider in their planning and assessment

Measuring patient satisfaction is one of the commonest evaluation activities in the NHS. The main aim of the article is to highlight some of the most important aspects of planning, undertaking and critically appraising satisfaction surveys. Key areas considered include: survey aims; definition of concerns; nature of survey populations; methods; interpretation of results; and outcomes and implementation.     

Who do people talk to about healthy lifestyles? A South Australian survey.

To investigate who people talk to about healthy lifestyle a personal interview of people in a representative sample of South Australians was carried out. The information was collected by interview from all occupants of selected private dwellings who were aged 15 years or older. The interviewer used a prompt card with nine possible responses and the question asked was "which one of these would you be most likely to talk about healthy lifestyle changes?" Forty-four per cent nominated the general practitioner and 22% a family member. People who were either married or in a de facto relationship (30%) significantly chose a general practitioner more than others (14%) (P < 0.05). In the 30-59 age group more men (12%) than women (6%) chose a family member as a healthy lifestyle adviser (P < 0.05). There was no statistically significant difference in interest in healthy lifestyle in people born in Australia and outside Australia, or in the employed or unemployed. It is suggested that further attention needs to be paid to training in preventive medicine at all levels of general practice education and more needs to be known about the role of family members as healthy lifestyle advisers.     

Quality Oversight: Why Are Rural Hospitals Less Likely to be JCAHO Accredited?

There is a large rural-urban disparity in the proportion of hospitals that are accredited by the Joint Commission on the Accreditation of Health Care Organizations (JCAHO). Several factors can influence whether a hospital participates in the accreditation process. A few of those factors include the hospital's size, case mix and ownership. However, even after controlling for many of these factors, hospitals in the most rural locations are less likely to be accredited by the JCAHO than urban hospitals. A survey was conducted to explore why rural hospitals are not participating in the accreditation process. Survey results show that the largest factor contributing to rural hospital deterrence to seeking accreditation is cost. Without accreditation by the JCAHO and compliance with their movement into performance measurement, quality monitoring of rural hospitals will fall further behind that of urban hospitals. Policy initiatives that make accreditation more financially feasible should be considered.     

Is the thyroid to blame?

Treat the rare case of acute suppurative thyroiditis as a medical emergency, with attention to airway protection, intravenous antibiotics, and surgical drainage. Order a sedimentation rate if you suspect subacute thyroiditis. It is almost always elevated in patients with this disease. Treat subacute thyroiditis with prednisone 40 mg daily in patients refractory to treatment with nonsteroidal anti-inflammatory drugs.     

Macroprolactinemia. Is treatment necessary?

A 26-year old symptom-free woman was admitted to our Clinic for evaluation of hyperprolactinemia. The patient, who had normal menstrual cycles, was found accidentally to have a cystic adnexal mass and was placed on oral contraceptives (OC) for 3 months. During the first OC-cycle a bilateral breast nipple discharge was noticed and an elevated serum prolactin (PRL) was detected (2.7 nmol/l). The OC was discontinued and bromocriptine therapy was started. Serum PRL levels were restored and spontaneous menses resumed. The Pituitary magnetic resonance imaging (MRI), the anterior pituitary function, assessed by dynamic tests, and the thyroid hormone levels were normal. Upon bromocriptine discontinuation, PRL levels increased to 13.8 nmol/l. Poly-ethylene-glycol precipitation of the patient's serum, in two consecutive measurements, demonstrated the presence of macroprolactinemia. Since the patient was asymptomatic, a dopamine agonist was not resumed. Macroprolactinemia is characterized by most authors, as a benign condition with no clinical implications. However, a number of investigators challenge this view, suggesting that in some cases mild symptomatology is present possibly requiring therapeutic intervention.