Three commonly used indices of cost-effectiveness are compared for their usefulness to health care professionals. The methods are the cost-benefit ratio, the cost-effectiveness ratio, and the net benefit methods. The net benefit is considered the preferred index of cost-effectiveness. (TJH)

Studied variation in physicians' practice styles and policies through a survey of 46 family physicians and internists. Overall, the results indicate that a brief open-ended survey can assess practice variations quickly, providing a basis to guide interventions. (SLD)

Physician impact analysis (PIA) is a planning tool intended to provide a way to evaluate the impact of a new or replacement physician's practice profile on the clinical program priorities, staffing resources, and costs of a hospital. Key methods for PIA and issues related to its use are considered. (SLD)

In this review of the literature evaluating the effectiveness of continuing medical education (CME), 238 studies from 1935 to 1982 were reviewed and annotated using previously established and tested assessment criteria. CME interventions were found to have an impact on physician competence and, less consistently, on physician performance and…

The new quality assurance system for nursing homes implemented by the New York State Department of Health in 1981 was compared to the previous system. The new system devoted more resources to on-site activities and identified more patient-care deficiencies and more repeat deficiencies. (SLD)

Explores the nature of meta-analysis by placing it in the context of research synthesis. Methods of meta-analysis are described and compared with other forms of research integration, and findings for several meta-analyses are provided to show advantages of quantitative review methods. (SLD)

Factors that might bias outcomes of meta-analytic reviews are discussed. The role of meta-analysis in theory development is considered, describing three types of meta-analytic tests of theory. A final section discusses the applicability of meta-analysis in the assessment of convergent and discriminant construct validity. (SLD)

Some guidelines are offered for interpreting and evaluating meta-analytic reviews of research. The choice of unit of analysis, the issue of fixed versus random effects, the meaning of heterogeneity, the determination of appropriate contrasts, and the choice of measures of central tendency are discussed. (SLD)

This study derives the economic costs of misclassification in nursing home patient classification systems. These costs are then used as weights to estimate the reliability of a functional assessment instrument. Results suggest that reliability must be redefined and remeasured with each substantively new application of an assessment instrument.…

Ambulatory day patients at the Psoriasis Education and Research Center developed self-care and coping skill and learned more about their skin disease than a control group of hospitalized patients. Comparisons were obtained by medical case history and skin photography. (CP)

The concept of risk-adjusted measures of quality is discussed, and a methodology is proposed for risk-adjusting and integrating multiple adverse outcomes of anesthesia services into measures for quality assurance and quality improvement programs. Although designed for a new anesthesiology database, the methods should apply to other health…

Evidence indicates that subjective quality-of-life scales developed by N. M. Bradburn (1969) and by A. Campbell, P. Converse, and W. Rodgers (1976) can be as sensitive as physiological measures in distinguishing among medical treatment groups. These scales can complement more objective measures of patient status. (SLD)

A meta-analysis of studies examining the interrater reliability of the standard practice of peer assessments of quality of care was conducted through the use of several databases. The mean weighted kappa of 21 findings from 13 studies was 0.31, which suggests that the interrater reliability of peer assessment is limited. (SLD)

Second-year medical students (N=187) evaluated their own videotaped performances during physical assessment examinations. Peers and expert evaluators also rated the performances. Significant differences emerged across types of raters. Results show that these students do not accurately assess their own or peers' skills performances. (TJH)

This study compares physician performance on the Computer-Aided Simulation of the Clinical Encounter with peer ratings and performance on multiple choice questions and patient management problems. Results indicate that all formats are equally valid, although multiple choice is the most reliable method of assessment per unit of testing time.…