Comparing health system performance assessment and management approaches in the Netherlands and Ontario,Canada

Background  

Given the proliferation and the growing complexity of performance measurement initiatives in many health systems, the Netherlands and Ontario, Canada expressed interests in cross-national comparisons in an effort to promote knowledge transfer and best practise. To support this cross-national learning, a study was undertaken to compare health system performance approaches in The Netherlands with Ontario, Canada.     

Calcium and phosphorus contents of body parts of some domestic animals used as meat source in Nigeria

ObjectiveTo investigate the calcium and phosphorus contents of four domestic animals used as sources of meat in Nigeria.MethodsThe calcium contents of the body parts of the animals were determined using atomic absorption spectrometer. Their phosphorus contents were determined colorimetrically using the molybdenum blue method.ResultsThe calcium and phosphorus contents were significantly higher in the bone samples than in the other animal parts investigated (P<0.05). The calcium contents of all the edible parts were higher in chicken than in the other animals. High calcium and phosphorus contents were detected in the faeces of chicken and goat, and that of cattle and goat, respectively. Low calcium and phosphorus contents were detected in the urine samples. Calcium: phosphorus ratios calculated for the bones of chicken, cattle and goat were satisfactory.ConclusionsIn conclusion, calcium and phosphorus contents of the animal parts vary significantly and their relative contents may be related to the animal's diet. Chicken parts may be the preferred dietary source of these minerals. This study highlights the need for routine investigation of the mineral contents of food, which is necessary for proper nutritional guidelines.     

The metrics and correlates of physician migration from Africa

Background  

Physician migration from poor to rich countries is considered an important contributor to the growing health workforce crisis in the developing world. This is particularly true for Africa. The perceived magnitude of such migration for each source country might, however, depend on the choice of metrics used in the analysis. This study examined the influence of choice of migration metrics on the rankings of African countries that suffered the most physician migration, and investigated the correlates of physician migration.     

Doctor performance assessment in daily practise: does it help doctors or not? A systematic review

CONTEXT: Continuous assessment of individual performance of doctors is crucial for life-long learning and quality of care. Policy-makers and health educators should have good insights into the strengths and weaknesses of the methods available. The aim of this study was to systematically evaluate the feasibility of methods, the psychometric properties of instruments that are especially important for summative assessments, and the effectiveness of methods serving formative assessments used in routine practise to assess the performance of individual doctors. METHODS: We searched the MEDLINE (1966-January 2006), PsychINFO (1972-January 2006), CINAHL (1982-January 2006), EMBASE (1980-January 2006) and Cochrane (1966-2006) databases for English language articles, and supplemented this with a hand-search of reference lists of relevant studies and bibliographies of review articles. Studies that aimed to assess the performance of individual doctors in routine practise were included. Two reviewers independently abstracted data regarding study design, setting and findings related to reliability, validity, feasibility and effectiveness using a standard data abstraction form. RESULTS: A total of 64 articles met our inclusion criteria. We observed 6 different methods of evaluating performance: simulated patients; video observation; direct observation; peer assessment; audit of medical records, and portfolio or appraisal. Peer assessment is the most feasible method in terms of costs and time. Little psychometric assessment of the instruments has been undertaken so far. Effectiveness of formative assessments is poorly studied. All systems but 2 rely on a single method to assess performance. DISCUSSION: There is substantial potential to assess performance of doctors in routine practise. The longterm impact and effectiveness of formative performance assessments on education and quality of care remains hardly known. Future research designs need to pay special attention to unmasking effectiveness in terms of performance improvement.