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- Hoffmann, Rasmus, et al.
(författare)
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Amenable mortality revisited : the AMIEHS study
- 2013
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Ingår i: Gaceta Sanitaria. - : Elsevier BV. - 0213-9111 .- 1578-1283. ; 27:3, s. 199-206
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Tidskriftsartikel (refereegranskat)abstract
- ObjectivesThere is a renewed interest in health system indicators. In 1976 a measure of quality of healthcare, amenable mortality, was introduced by Rutstein. This indicator is based on the concept that deaths from certain causes should not occur in the presence of timely and effective healthcare. In the project “Amenable mortality in the European Union: toward better indicators for the effectiveness of health systems” (AMIEHS), we introduce a new approach to the selection of indicators of amenable mortality.MethodsBased on predefined selection criteria and a broad review of the literature on the effectiveness of medical interventions, a first set of potential indicators of amenable mortality (causes of death) was selected. The timing of the introduction of medical innovations was established through reviews and questionnaires sent to national experts from seven participating European countries. The preselected indicators were then validated by a trend analysis that identified associations between the timing of innovations and cause-specific mortality trends and by a Delphi-procedure.ResultsAfter a short review of previous lists of amenable mortality indicators and a detailed description of the innovative procedure in the AMIEHS project we present a list of 14 causes of death that passed our selection criteria. We illustrate our empirical validation of these indicators using the examples of peptic ulcer and renal failure.ConclusionsThe innovation developed in the AMIEHS study is a rigorous new approach to the concept of amenable mortality that includes empirical validation. Only validated indicators can be successfully used to assess the quality of healthcare systems in international comparisons.
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- Aarnio, H., et al.
(författare)
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Photoinduced absorption in an alternating polyfluorene copolymer for photovoltaic applications
- 2006
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Ingår i: Chemical Physics. ; 321:1-2, s. 127-132
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Tidskriftsartikel (refereegranskat)abstract
- The authors present a detailed study of a novel alternating polyfluorene copolymer, poly[2,7-(9,9-dioctyl-fluorene)-alt-5,5-(4',7'-di-2-thienyl-2',1',3-benzo-thiadiazole)], and its blends with the fullerene deriv. [6,6]-phenyl-C61-butyric acid Me ester, using continuous wave photoinduced absorption (PA) techniques. The authors also present the use of phase information from the PA measurements for estg. the no. of different photoexcitation types present in the PA spectra as well as their lifetimes. In all blends the PA spectra show a broad high-energy PA band ranging from .apprx.1 to 2 eV as well as a low-energy band at .apprx.0.35 eV. The authors find two kinds of excitations present at 80 DegK, polarons showing dispersive recombination with lifetimes of roughly a millisecond, and a 2nd kind of photoexcitation tentatively assigned to coulombically bound intrachain polaron pairs showing practically nondispersive recombination with a lifetime of .apprx.20 ms. [on SciFinder (R)]
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- Mackenbach, Johan, et al.
(författare)
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Using 'amenable mortality' as indicator of healthcare effectiveness in international comparisons : results of a validation study
- 2013
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Ingår i: Journal of Epidemiology and Community Health. - : BMJ. - 0143-005X .- 1470-2738. ; 67:2, s. 139-146
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Tidskriftsartikel (refereegranskat)abstract
- Background and study aimsThere is widespread consensus on the need for better indicators of the effectiveness of healthcare. We carried out an analysis of the validity of amenable mortality as an indicator of the effectiveness of healthcare, focusing on the potential use in routine surveillance systems of between-country variations in rates of mortality. We assessed whether the introduction of specific healthcare innovations coincided with declines in mortality from potentially amenable causes in seven European countries. In this paper, we summarise the main results of this study and illustrate them for four conditions.Data and methodsWe identified 14 conditions for which considerable declines in mortality have been observed and for which there is reasonable evidence in the literature of the effectiveness of healthcare interventions to lower mortality. We determined the time at which these interventions were introduced and assessed whether the innovations coincided with favourable changes in the mortality trends from these conditions, measured using Poisson linear spline regression. All the evidence was then presented to a Delphi panel.Main resultsThe timing of innovation and favourable change in mortality trends coincided for only a few conditions. Other reasons for mortality decline are likely to include diffusion and improved quality of interventions and in incidence of diseases and their risk factors, but there is insufficient evidence to differentiate these at present. For most conditions, a Delphi panel could not reach consensus on the role of current mortality levels as measures of effectiveness of healthcare.Discussion and conclusionsImprovements in healthcare probably lowered mortality from many of the conditions that we studied but occurred in a much more diffuse way than we assumed in the study design. Quantification of the contribution of healthcare to mortality requires adequate data on timing of innovation and trends in diffusion and quality and in incidence of disease, none of which are currently available. Given these gaps in knowledge, between-country differences in levels of mortality from amenable conditions should not be used for routine surveillance of healthcare performance. The timing and pace of mortality decline from amenable conditions may provide better indicators of healthcare performance.
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