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"In healthcare today, there is an increasing focus on measuring and improving health outcomes. This short, simple and practical guide provides the steps needed for healthcare professionals to start measuring health outcomes in a way that can improve how care is delivered day-to-day"--
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Performance monitoring is one of several quality enhancing activities designed to improve quality and accountability in health care. During the past years, there has been an increasing interest in such measurement and reporting systems worldwide. Particular emphasis seems to have been put in the design and implementation of systems monitoring hospital performance in a valid and reliable way. The aim of this project has been to gather evidence in the field of hospital performance monitoring systems, by evaluating and comparing six selected national initiatives with regard to policy and methodological approach. The monitoring systems included in the review were developed by the international organisations OECD and WHO, as well as by governmental agencies in Canada, the United States, Denmark and Sweden. Information on each system was identified by searches in Pub Med and on Internet, during the period April 2006 through April 2007. We performed an assessment of each system based on predefined criteria, covering:1. Context2. Conceptual framework3. Objectives and target groups4. Evaluation criteria5. Selection procedures6. Publication format7. Empirical testing8. System for updating and revision Even though the monitoring systems chosen represent only a small number of the ones we poten-tially might have included in our review, they illustrate several ways of approaching health policy and methodological issues. They also represent a great amount of background experience that may be valuable in a Norwegian context. The authorities and organisations responsible for the systems have put extensive resources into the course of their development, both with regard to economical input and scope of expertise. We recommend that the further development of the Norwegian national monitoring system: 1. Is based on internationally recognized procedures that are described in this report2. Particularly build on systems that give explicit information concerning their evidence base and selection procedures. In addition, theoretical and empirical tests for reliability and validity in a Norwegian context should be performed3. Ensure legitimacy and acceptance for the system by ivolving professional and other relevant user goups in the processes4. Design a conceptual framework that should form an overarching strategy and articulate guiding principles for both value-based and professional priorities5. Develop a long-term strategic plan, taking into account how expertise can be built up and how the needs and requirements concerning research and development in this area can be met.
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Patients who fail to maintain adequate respiration by themselves may need long-term mechanical ventilation (LTMV) for shorter or longer consecutive time periods. Patients who need LTMV are heterogeneous with respect to age, diagnosis and the progression of their disease. Recent Norwegian data also suggests considerable regional differences in the indication for initiation of LTMV. Commission The Norwegian Directorate of Health requested the Norwegian Knowledge Centre for Health Services to review the effects of LTMV. In response we have prepared and are publishing three consecutive reports to address this question. This is the second report in the series in which we review the effects of LTMV for patients with obesity hypoventilation syndrome (OHS) and for patients with chest wall diseases. Main findings Obesity hypoventilation syndrom (OHS)1. We did not identify studies of the effect of LTMV and patient survival.2. LTMV-treatment may be associated with a decrease in the number of hospital admittances and improvements in some parameters related to quality of life and sleep. However, the quality of the evidence is very low and it is not possible to draw clear conclusions about the effectiveness of LTMV. Chest wall disease (CWD)1. LTMV may be associated with increased survival compared to LTOT (Long Term Oxygen Treatment) alone, but the quality of the evidence is low and any conclusion is uncertain.2. LTMV may be associated with fewer hospital admissions and improvements in some parameters related to quality of life and sleep. However, the quality of the evidence is very low and it is not possible to draw any clear conclusions based on the available evidence.
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