Integration of data and management tools into the new york state medicaid managed care encounter data system

The New York State Department of Health has created a data warehouse to analyze and evaluate the Medicaid managed care program. Online query tools and reports, grouping tools such as Diagnostic Related Groups, and measurement tools such as Health Plan Data and Information Set (HEDIS) measures have been incorporated into the data warehouse. Other public health data sets including birth certificate data have also been integrated. The result is a powerful data set that can analyze information quickly and efficiently, with built-in data intelligence. Developed over time, this system can provide states, health insurance companies, and health data consortiums a roadmap on how to implement an integrated data warehouse solution.     

Pain management: tools of the trade

Hospitals, pain consultants and academic centers around the country have developed patient interviews, treatment standards, pathways and guidelines to help clinicians treat pain more effectively. This special section features examples of several of the most useful tools, as well as resources for further exploration. Highlights include: standards of pain management, cardiovascular surgery standing orders, patient pain interview, guidelines and quality aides.     

Proteomics: analytical tools and techniques

Scientists have long been interested in measuring the effects of different stimuli on protein expression and metabolism. Analytical methods are being developed for the automated separation, identification, and quantitation of all of the proteins within the cell. Soon, investigators will be able to observe the effects of an experiment on every protein (as opposed to a selected few). This review presents a discussion of recent technological advances in proteomics in addition to exploring current methodological limitations.     

Potential toxicological hazard due to endocrine-disrupting chemicals on Mediterranean top predators: state of art, gender differences and methodological tools

Man-made endocrine-disrupting chemicals (EDCs) range across all continents and oceans. Some geographic areas are potentially more threatened than others: one of these is the Mediterranean Sea. Levels of some xenobiotics are much higher here than in other seas and oceans. In this paper we review the final results of a project supported by the Italian Ministry of the Environment, in which the hypothesis that Mediterranean top predator species (such as large pelagic fish and marine mammals) are potentially at risk due to EDCs was investigated. We illustrate the need to develop and apply sensitive methodological tools, such as biomarkers (Vitellogenin, Zona Radiata proteins and CYP1A activities) for evaluation of toxicological risk in large pelagic fish top predators (Swordfish, (Xiphias gladius), Bluefin Tuna (Thunnus thynnus thynnus)) and nondestructive biomarkers (CYP1A activities and fibroblast cell culture in skin biopsy), for the hazard assessment of threatened marine mammals species (Striped Dolphin, (Stenella coeruleoalba), Bottlenose Dolphin (Tursiops truncatus), Common Dolphin (Delphinus delphis) and Fin Whale (Balaenoptera physalus))exposed to EDCs. Differential gender susceptibility to EDCs is also explored both in large pelagic fish and in cetaceans. In cetaceans, male specimens showed higher cytochrome P450 induction (BPMO in skyn biopsies, CYP2B in fibroblasts cell cultures) by xenobiotics with respect to females.     

COMMENTARY: THE ART OF THE POSSIBLE

The theme of this ‘commentary’ will be limitations on policy and planning. Recognition of limitations has now been the angst of the times for ten or fifteen years, as the titles of popularly influential writing, say ‘Limits to Growth’ or ‘Small is Beautiful’ and even ‘Limits to Medicine’, illustrate. However, the books I shall draw upon for this review article emphasise, by and large, limitations of a different character from the apocalyptic ‘Limits to Growth’ school or the Utopian obverse of the same coin. The limitations described by the writers I have chosen arise not from inexorable outside forces, but from our own choices, or inability to choose, and from the complexity of our own social artifacts. “The fault dear Brutus lies not in our stars but in ourselves”.     

Targeting tachycardia: diagnostic tips and tools

Many narrow QRS complex tachycardias are benign, but some require rapid intervention. The review, EKG strips, and algorithm you'll find here will help you get to the source of the problem without delay.     

Measuring inequality: tools and an illustration

Background

This paper examines an aspect of the problem of measuring inequality in health services. The measures that are commonly applied can be misleading because such measures obscure the difficulty in obtaining a complete ranking of distributions. The nature of the social welfare function underlying these measures is important. The overall object is to demonstrate that varying implications for the welfare of society result from inequality measures.

Method

Various tools for measuring a distribution are applied to some illustrative data on four distributions about mental health services. Although these data refer to this one aspect of health, the exercise is of broader relevance than mental health. The summary measures of dispersion conventionally used in empirical work are applied to the data here, such as the standard deviation, the coefficient of variation, the relative mean deviation and the Gini coefficient. Other, less commonly used measures also are applied, such as Theil's Index of Entropy, Atkinson's Measure (using two differing assumptions about the inequality aversion parameter). Lorenz curves are also drawn for these distributions.

Results

Distributions are shown to have differing rankings (in terms of which is more equal than another), depending on which measure is applied.

Conclusion

The scope and content of the literature from the past decade about health inequalities and inequities suggest that the economic literature from the past 100 years about inequality and inequity may have been overlooked, generally speaking, in the health inequalities and inequity literature. An understanding of economic theory and economic method, partly introduced in this article, is helpful in analysing health inequality and inequity.     

Aquatic effects assessment: needs and tools

In the assessment of the adverse effects pollutants can produce on exposed ecosystems, different approaches can be followed depending on the quality and quantity of information available, whose advantages and limits are discussed with reference to the aquatic compartment. When experimental data are lacking, a predictive approach can be pursued by making use of validated quantitative structure-activity relationships (QSARs), which provide reliable ecotoxicity estimates only if appropriate models are applied. The experimental approach is central to any environmental hazard assessment procedure, although many uncertainties underlying the extrapolation from a limited set of single species laboratory data to the complexity of the ecosystem (e.g., the limitations of common summary statistics, the variability of species sensitivity, the need to consider alterations at higher level of integration) make the task difficult. When adequate toxicity information are available, the statistical extrapolation approach can be used to predict environmental compatible concentrations.     

Tutorial: management and planning tools of TQM

While most leaders recognize the value of good planning, most lack the experience and methods to do it systematically. As a result, group planning efforts are often frustrating, generating plans that are shallow and poorly understood by those who must carry them out. The seven management and planning tools are a set of easy to use, systematic methods from the quality management literature that can help planning teams in the same way that the familiar quality improvement tools like flow charts and histograms aid problem-solving teams.     

Computers and the Internet: tools for lifelong learning.

Mastery of computer technology and the resources it brings to renal dietitians will be essential for future practice. The Internet, probably the most valuable resource computers bring to clinical practice, is a potential tool to fulfill goals of lifelong learning. A basic introduction to the Internet and a review of search engines and successful search strategies are provided. Major flaws of the Internet include uncertain quality and accuracy of many materials it provides. Guidelines to evaluate World Wide Web (WWW) materials are similar to guidelines dietitians use to assess written materials. The identification of certain anchor WWW sites with reliable information is a key to successful information retrieval on the Internet.