Further Development Of Indicators Research Articles

Measuring the Commercial Determinants of Health and Disease: A Proposed Framework.

The commercial determinants of health (CDoH) describe the adverse health effects associated with for-profit actors and their actions. Despite efforts to advance the definition, conceptualization, and empirical analyses of CDoH, the term's practical application to mitigate these effects requires the capacity to measure the influences of specific components of CDoH and the cumulative impacts of CDoH on the health and well-being of specific populations. Building on the Global Burden of Disease Study, we begin by conceptualizing CDoH as risk factor exposures that span agency and structural influences. We identify 6 components of these influences and propose an initial set of indicators and datasets to rank exposures as high, medium, or low. These are combined into a commercial determinants of health index (CDoHi) and illustrated by 3 countries. Although now a proof of concept, comparative analysis of CDoH exposures by population, over time and space, and their associated health outcomes will become possible with further development of indicators and datasets. Expansion of the CDoHi and application to varied populations groups will enable finer targeting of interventions to reduce health harms. The measurement of improvements to health and wellness from such interventions will, in turn, inform overall efforts to address the CDoH.

Implementation Outcomes and Indicators as a New Challenge in Health Services Research: A Systematic Scoping Review.

The aim of this systematic scoping review was to identify and analyze indicators that address implementation quality or success in health care services and to deduce recommendations for further indicator development. This review was conducted according to the Joanna Briggs Manual and the PRISMA Statement. CINAHL, EMBASE, MEDLINE, and PsycINFO were searched. Studies or reviews published between August 2008 and 2018 that reported monitoring of the quality or the implementation success in health care services by using indicators based on continuous variables and proportion-based, ratio-based, standardized ratio–based, or rate-based variables or indices were included. The records were screened by title and abstract, and the full-text articles were also independently double-screened by 3 reviewers for eligibility. In total, 4376 records were identified that resulted in 10 eligible studies, including 67 implementation indicators. There was heterogeneity regarding the theoretical backgrounds, designs, objectives, settings, and implementation indicators among the publications. None of the indicators addressed the implementation outcomes of appropriateness or sustainability. Service implementation efficiency was identified as an additional outcome. Achieving consensus in framing implementation outcomes and indicators will be a new challenge in health services research. Considering the new debates regarding health care complexity, the further development of indicators based on complementary qualitative and quantitative approaches is needed.

Accounting for land use, biodiversity and ecosystem services in life cycle assessment: Impacts of breakfast cereals

This study considers the life cycle impacts of land use on biodiversity and ecosystem services associated with the production of a ubiquitous food type: breakfast cereals. For biodiversity, the impacts on five taxonomic groups have been assessed: mammals, birds, vascular plants, amphibians and reptiles. For ecosystem services, the potential loss in the following ecosystem services of soil has been considered: biotic production, erosion resistance, groundwater regeneration, infiltration and physicochemical filtration. The findings indicate that the main hotspot for the biodiversity loss is cocoa cultivation for all taxonomic groups, with a contribution of 27–67%. Cocoa is also a major contributor (35%) to the loss of biotic production, while rice is the largest contributor to erosion (34%), reduction in groundwater replenishment (43%) and physiochemical filtration (23%). Corn is the main cause of the infiltration reduction, accounting for 44% of the impact. Unlike the biodiversity impacts, which are almost entirely caused by agricultural activities, non-agricultural land use occurring in other life cycle stages (transport, packaging and manufacturing), has significant contribution to the reductions in groundwater replenishment and infiltration. The impacts on ecosystem services are almost entirely driven by land occupation, while the biodiversity impacts are caused by both land use change and occupation. The identification of cocoa as the main hotspot is unexpected as it is used only in very small quantities (<5% by mass) in breakfast cereals. Its high contribution to the impacts is partly due to the land use change in the ecoregion of the Eastern Guinean forests, which are home to a relatively large number of endemic species. The paper also discusses the limitations of the impact assessment methods for evaluating the biodiversity and ecosystem services and highlights the need for further development of indicators and methods to assess the land use impacts in life cycle assessment.

Benchmarking National AI Strategies: Why and How Indicators and Monitoring Can Support Agile Implementation

Artificial Intelligence (AI) is considered to be the key technology for the 21st century. Many countries have adopted national AI strategies in order to take advantage of the opportunities of AI and to address important challenges. The German government has also followed suit and formally adopted and published its own national strategy in November 2018. Like many other AI strategies, the German government takes a comprehensive approach, covering implications of AI for research, transfer between research and business development, employment, education, and regulation to name just a few of the most important issue areas. However, the strategy has been criticized for not defining clear and measurable objectives. The lack of concrete goals and clear indicators of success is symptomatic of many strategy papers and announcements in German digital policy. Definitions of clear goals are missing as well as policies to monitor progress and measure success. Politicians and citizens are therefore often left wondering what precisely we are trying to achieve, when it will be achieved, and whether we are making progress. The government’s AI strategy provides the opportunity to do better this time. The advantages are clear. Defining indicators requires the development of cross-departmental goals, which lays the foundation for tracking progress and thus creates the conditions for an effective implementation of the strategy. With this paper, we would like to stimulate a discussion about input and output indicators related to national AI strategies. To generate ideas for the development of such indicators, we examined whether and how already-published AI strategies define their goals and measures to validate the achievement of those goals. The national AI strategies provide some good approaches and ideas, but lack an in-depth and systematic engagement with indicators and benchmarks. In a further chapter, we examine the methodologies of existing AI indices. In both cases, we were concerned with working through core questions and providing an initial overview. We would like to caution the reader that this is not a comprehensive study. But we hope to stimulate further discussion and research with this paper. The majority of indices and reports we examined suffer from significant methodological weaknesses. The reports have generally been received uncritically by the media and the public. Therefore, we also want to spark a critical debate around AI reports and benchmarks. That said, we do not wish to generally call into question the importance and utility of these reports. So, in the third chapter, we set out our own ideas for the development of an empirical foundation for an AI strategy. Our approach hinges on a dynamic interaction with AI trend monitoring, as a means to providing the basis for the continuing engagement with and further development of indicators. With this paper, we hope to contribute to the discussion about how to define goals for national AI strategies and about how to measure them.

Commissioning for equity in the NHS: rhetoric and practice.

This paper reviews evidence on equity as a policy goal of resource allocation in the English NHS, focussing on the role of clinical commissioning groups (CCGs) as purchasers of health services since 2013 and their capacity to achieve equity through the process of commissioning. A systematic search of literature published since 1990 and review of grey literature, including policy documents published by CCGs and other organizations in the healthcare system. Despite a stated policy commitment to equity of access in the NHS, the 2012 reforms have created a structure that allows and encourages great variation between devolved purchasers of care. Evidence suggests that CCGs, which are structurally separated from public health, have limited capacity and incentives to commission for equity. Concepts of equity of access and health inequalities lack consistent definitions and may not be implemented. However, it remains unclear whether variation between CCGs implies inequity. The 2012 reforms have sought to contain costs and improve quality, thus achieving efficiency gains, while equity has remained an afterthought. The NHS should be expected to work towards equity of access to healthcare and can contribute to reducing health inequalities; however to achieve a more equitable distribution of health, wider social policies are also needed. Additional assessments of structural capacity should be complemented by further development of indicators of equity of access and studies that quantify inequities. Research should also explore how an equity principle can be embedded in commissioning, which currently revolves around cost containment and efficiency.

Toward a systematized framework for resource efficiency indicators

The transition toward resource efficient production and consumption patterns is currently one of the main challenges in engineering, environmental science and especially in governmental policies. This transition has led to a proliferation of meanings related to the resource efficiency concept, resulting in a wide variety of indicators. In this paper, we propose a systematized framework in which resource efficiency indicators can be structured and comprehensively positioned. The aim is to provide a proper understanding of the scope and limitations of particular existing resource efficiency indicators in order to assist policy makers and the scientific community in the application and further development of indicators. This framework covers all different resource use-related aspects evaluated in existing approaches, including simple accounting of resource extraction and use; environmental impact assessment due to resource extraction and use; accounting and environmental impact assessment of specific processes and of full supply chains; analyses at micro-scale and macro-scale; and analysis of both natural resources versus waste-as-resources. To illustrate the potential application of the framework, a set of currently used indicators was selected, whereupon these indicators were structured and evaluated within the framework.

Cross-National Indicators on Teachers and the Condition of Teaching

Network C develops indicators on policy malleable conditions of the learning environment at the system, school and (possibly) classroom levels. To date it has produced system-level indicators on teachers and on the locus of decision making. School-level indicators, seen as hypothetical determinants of educational success, have also been developed Major new activities concern developments in the area of indicators on teachers and teaching. Efforts to expand and improve the set of indicators on teachers are explained and recent development activities on preservice training, teacher qualifications, and professional development are clarified, along with recommendations for further work. To illustrate data currently available, indicators on teaching time and teacher salaries published in Education at a Glance 2002 are presented. In conclusion, further development of indicators on teachers is likely to be time consuming and costly. Both short- and long-term data strategies are needed to weigh the policy relevance, feasibility and costs of the types of data suggested in this article.

Do we need individualised prescribing quality assessment? The case of diabetes treatment

Prescribing quality assessment is increasingly used in improvement programs and pay-for-performance policies. Within the area of diabetes many quality indicators have been developed. Some measure prescribing on a general level, e.g. calculating percentages of patients prescribed any statins. Others are very specific, e.g. percentages of patients with an elevated LDL-cholesterol in whom lipid-lowering treatment is started unless contraindicated or return to control within 3 months. Although the latter seems more precise, we question how far one should go in developing such indicators. Using the example of diabetes treatment, we highlight the need, opportunities, and feasibility of assessing prescribing quality in the context of individualised treatment. We conclude that it is not realistic to develop indicators that take all possible aspects of therapy non-response, intolerance and patient preferences into account. We do recommend further development of indicators that better address subpopulations in need of adjusted treatment, such as elderly or patients with comorbidity.

Developing child road safety indicators for communities

BackgroundIn Israel similar to the European region road traffic injuries are the leading cause of injury-related death and disability in children age 1–17. Children are vulnerable road users in the...

Indicators of resource use and environmental impact for use in a decision aid for Danish livestock farmers

Farmers lack well documented sets of farm level indicators to allow their own evaluation of environmental impact and to stimulate the development of more environment friendly farming practices. A set of farm level indicators of resource use and environmental impact on livestock farms was developed as part of a decision aid for farmers. The indicators were meant to be part of an extended farm account and included the surpluses and efficiencies of N, P and Cu, the energy use per kg grain and per kg milk or meat, pesticide treatment index (TFI), % unsprayed area, % small biotopes on the farm, and % weeds in grain crops. The indicators were tested on 20 Danish dairy and pig farms over a period of 3 years in order to see if they were suitable for use in the farmer’s management. The third year, farm gate surpluses varied between 89 and 265 kg N ha −1, 2 and 31 kg P ha −1 and 0.1 and 0.8 kg Cu ha −1. Energy use varied between 2.1 and 4.1 MJ kg −1 milk and between 14 and 20 MJ kg −1 live weight pig sold. For all indicators, except energy use per kg grain, the variation in indicator levels between farms was more important than the variation between years within each farm. There was significant variation between farms after correction for stocking rates and soil-and farm types, which suggests that the indicators reflect differences in management practise on comparable farms. It was demonstrated that these differences between similar farms and between the years on the individual farms might be explained by the detailed knowledge of management of the farms’ different subsystems (herd and crops). The information given by the indicators is discussed from environmental and management points of view and problems of defining and interpreting the indicators are identified. Given further development of indicators for soil quality and nature values, the farm level indicators seem a promising way of enabling farmers to include environmental topics in their management.