Measures Of Timeliness Research Articles

Patient access to medical records and healthcare outcomes: a systematic review.

We conducted a systematic review to determine the effect of providing patients access to their medical records (electronic or paper-based) on healthcare quality, as defined by measures of safety, effectiveness, patient-centeredness, timeliness, efficiency, and equity. Articles indexed in PubMed from January 1970 to January 2012 were reviewed. Twenty-seven English-language controlled studies were included. Outcomes were categorized as measures of effectiveness (n=19), patient-centeredness (n=16), and efficiency (n=2); no study addressed safety, timeliness, or equity. Outcomes were equivocal with respect to several aspects of effectiveness and patient-centeredness. Efficiency outcomes in terms of frequency of in-person and telephone encounters were mixed. Access to health records appeared to enhance patients' perceptions of control and reduced or had no effect on patient anxiety. Although few positive findings generally favored patient access, the literature is unclear on whether providing patients access to their medical records improves quality.

The Timeliness Project: Background Report

This Background Report (the Report) has been developed by the Australian Centre for Justice Innovation (ACJI) at Monash University, Australia, and explores issues relating to timeliness in the justice system. The justice system includes the various and extensive processes and schemes that support dispute resolution before proceedings commence, as well as those processes that relate to the court and tribunal system. This Report explores definitions and measures of timeliness in the justice system and examines some of the strategies and innovations that have been used both in Australia and internationally to improve timeliness.

Using NCCN clinical practice guidelines in oncology to measure the quality of colorectal cancer care in the veterans health administration.

Clinical practice guidelines can be used to help develop measures of quality of cancer care. This article describes the use of a Cancer Care Quality Measurement System (CCQMS) to monitor these measures for colorectal cancer in the Veterans Health Administration (VHA). The CCQMS assessed practice guideline concordance primarily based on colon (14 indicators) and rectal (11 indicators) cancer care guidelines of the NCCN. Indicators were developed with input from VHA stakeholders with the goal of examining the continuum of diagnosis, neoadjuvant therapy, surgery, adjuvant therapy, and survivorship surveillance and/or end-of-life care. In addition, 9 measures of timeliness of cancer care were developed. The measures/indicators formed the basis of a computerized data abstraction tool that produced reports on quality of care in real-time as data were entered. The tool was developed for a 28-facility learning collaborative, the Colorectal Cancer Care Collaborative (C4), aimed at improving colorectal cancer (CRC) care quality. Data on 1373 incident stage I-IV CRC cases were entered over approximately 18 months and were used to target and monitor quality improvement activities. The primary opportunity for improvement involved surveillance colonoscopy and services in patients after curative-intent treatment. NCCN Clinical Practice Guidelines in Oncology were successfully used to develop a measurement system for a VHA research-operations quality improvement partnership.

Noninvasive pulse CO-oximetry expedites evaluation and management of patients with carbon monoxide poisoning

PurposesPulse CO-oximetry (Rad-57; Masimo Corp, Irvine, CA) has been available since 2005. To date, all published clinical studies have focused on clinical reliability and whether the device enhances case finding through screening of various populations. This study examines whether use of pulse CO-oximetry shortens the time to diagnosis and treatment of patients with carbon monoxide (CO) poisoning. Basic ProceduresData from the joint Undersea and Hyperbaric Medical Society/Centers for Disease Control and Prevention CO poisoning surveillance system from August 2008 to July 2011 were analyzed. Of 1711 cases of CO poisoning treated with hyperbaric oxygen in the United States and reported through the system, 1606 had their initial carboxyhemoglobin (COHb) level measured by laboratory CO-oximetry and 105 by pulse CO-oximetry. Patients were selected from the laboratory CO-oximetry group to match each of the 105 patients evaluated by pulse CO-oximetry in 5 characteristics—age, sex, race/ethnicity, intent of poisoning, and occurrence of loss of consciousness. Measures of timeliness in measurement and management were compared between the 2 groups. Main FindingsPatients with initial COHb measurement by pulse CO-oximetry had significantly shorter time to measurement of COHb, higher average levels of COHb, and shorter time from the end of CO exposure to the initiation of hyperbaric oxygen treatment. On average, patients evaluated by pulse CO-oximetry reached the hyperbaric chamber 1 hour faster than did patients evaluated by laboratory CO-oximetry (P < .01). Principle ConclusionsPulse CO-oximetry is associated with more rapid diagnosis and initiation of hyperbaric oxygen therapy in CO-poisoned patients compared with laboratory CO-oximetry. The impact on clinical outcome remains to be determined.

Effectiveness of a clinical pathway for patients with cerebrospinal fluid shunt malfunction

Patients with CSF shunts often present to the emergency department (ED) with suspected shunt malfunction. Timely assessment and treatment are important factors affecting patient outcomes. A protocol was implemented at a tertiary children's hospital ED to expedite the care of these patients. This study evaluated the effectiveness of this protocol. The protocol assigned all patients with CSF shunts into 1 of 3 pathways. If a patient presented with altered mental status, the Cushing triad, acute focal neurological deficit, ongoing seizure activity, or severe dehydration due to emesis, an ED physician was immediately notified (emergency pathway). If a patient presented with emesis, headache, increasing frequency of seizure, or parental concern for shunt malfunction, the patient entered the expedited pathway, and imaging studies were ordered prior to physician evaluation. All other patients entered the default pathway, in which a physician would evaluate the patient before deciding on further workup. Outcomes of interest included measures of timeliness in the ED and clinical outcomes. Comparisons were made between preprotocol and protocol periods and among the 3 pathways. The total time to complete both ED physician evaluation and to initiate imaging studies was significantly shorter in the protocol period than in the preprotocol period (104 vs 147 minutes). Similar time saving over the 2 processes was demonstrated comparing expedited and default pathways during the protocol period (95 vs 134 minutes, a 29% difference). Clinically, more patients underwent surgery in the expedited pathway than the default pathway (36% vs 17%), and patients in the expedited pathway had a shorter hospital stay (3.4 ± 0.9 days vs 5.7 ± 4.0 days; p = 0.02). An ED-based protocol helped identify patients at risk for shunt failure early in the triage process and shortened the assessment process prior to neurosurgical intervention. Improving the timeliness of care for patients with shunt failure is important because morbidity and mortality associated with shunt failure are time dependent.

The development of earnings quality in Germany and its implication for further research. A quantitative empirical analysis of German listed companies between 1997 and 2006

This paper investigates the development of earnings quality for a sample of 5,817 firm years during the period between 1997 and 2006 using seven different measures (accounting- and market-based). As a result, overall earnings quality of German firms improves over time. However, the measures of timeliness and value relevance indicate a decreasing earnings quality. These findings are tested by taking firm-specific accounting style into consideration using firm fixed effects.

The Development of Earnings Quality in Germany and its Implication for Further Research: A Quantitative Empirical Analysis of German Listed Companies Between 1997 and 2006

This paper investigates the development of earnings quality for a sample of 5,817 firm years during the period between 1997 and 2006 using seven different measures (accounting- and market-based). As a result, overall earnings quality of German firms improves over time. However, the measures of timeliness and value relevance indicate a decreasing earnings quality. These findings are tested by taking firm-specific accounting style into consideration using firm fixed effects.

Effectiveness of a Clinical Pathway for the Emergency Treatment of Patients With Inborn Errors of Metabolism

The goal was to measure the effectiveness of a clinical pathway for the emergency department care of patients with inborn errors of metabolism. Two years after the implementation of a multidisciplinary clinical pathway for patients with inborn errors of metabolism in our urban, academic, pediatric emergency department, we compared measures of timeliness and effectiveness for patients treated before the pathway with the same measures for patients treated after implementation of the pathway. Measures of timeliness included time to room, time to doctor, time to glucose infusion, and total emergency department length of stay. Measures of clinical effectiveness included the proportion of patients receiving adequate glucose infusions, proportion of patients admitted, inpatient length of stay, and proportion of patients requiring PICU admission. A total of 214 emergency department visits for patients with inborn errors of metabolism were analyzed, 90 before and 124 after initiation of the pathway. All measures of timeliness of care except total emergency department length of stay demonstrated significant improvement in comparisons of values before and after initiation of the pathway. Measures of clinical effectiveness also demonstrated significant improvements after initiation of the pathway. There was improvement in the proportion of patients who received adequate glucose infusions, with a decrease in the proportion of patients who required admission to the PICU. Emergency department length of stay, inpatient length of stay, and the proportion of patients admitted to the hospital were not affected. Most measures of timeliness and 2 measures of effectiveness showed improvement after implementation of an emergency department pathway for patients with inborn errors of metabolism. Therefore, a clinical pathway can improve the emergency care of patients with inborn errors of metabolism.

Medical Malpractice Review Panels and Medical Liability System Cost, Timeliness, and Efficiency: A Cross‐Sectional Study

The medical malpractice review panel is a widely adopted tort reform, but few empirical data exist regarding its utility. This cross‐sectional study evaluated potential associations between the medical malpractice panel status of a state (mandatory submission panel, optional submission panel, or no panel) and measures of cost, timeliness, and efficiency of medical malpractice claims resolution for the year 2002. Effects of differences in baseline state characteristics that could affect those associations were analyzed using a multiple regression analysis. After adjusting for significant covariates among measures of socioeconomic characteristics, judicial system frequency and function, and other statutory tort reforms, multiple regression analysis found no significant relationship at the state level in the year 2002 between the predictor variable, panel status, and the dependent variables of paid loss ratio, paid defense cost ratio, reported physician malpractice payment, dollars of paid defense cost per dollar of paid loss, reported annual physician malpractice insurance premium for internal medicine, general surgery, and obstetrics/gynecology, time from incident of malpractice to payment of claim, and ratio of paid to unpaid claims (p values &gt; 0.05). These observations are consistent with the hypothesis that the medical malpractice review panel is a statutory reform of secondary or neutral effect.

Pengaruh Ketepatwaktuan Publikasi Laporan Keuangan Terhadap Kandungan Kualitas Informasi Laba Akuntansi di Pasar Modal Indonesia

The main objective of this research is to investigate the effect of timeliness on the information quality of accounting earnings. In addition, the study also examines the effect of timeliness differences on the information content of accounting earnings. I use two measures of timeliness: absolute timeliness and relative timeliness. Absolute timeliness is defined as (1) the length of reporting delay since the reporting date of financial statement and (2) the length of reporting delay since the date of the report signed by the independent auditor but it is still under the time allowed by the authority (BAPEPAM). On the other hands, relative timeliness is defined as (1) the difference between the length of reporting delay of current and previous report, or (2) weighted scores of the difference between the length of reporting delay of current and previous report. The length of reporting delay is measured by the number of day toward the deadline date set by market authority (BAPEPAM). Thus, the higher the number of day toward the deadline means that firms publish their report more timely. Using 122 company’s audited annual financial statement from the period of 2003 to 2005, the study shows that timeliness, particularly absolut timeliness, is positively associated with the information quality of accounting earnings suggesting that delaying publication of financial report will decrease the quality of information content. In addition, the study also finds that consistent with previous studies, other factors such as risk, market to book value , capital structure, and size together determine the quality of information of accounting earning. The result of the study should be of interest to the market authority, BAPEPAM in particular, to put efforts to increase the value relevance of accounting information by increasing the timeliness.

International Differences in Conditional Conservatism – The Role of Unconditional Conservatism and Income Smoothing

Prior research documents that conditional conservatism, measured as the asymmetric timeliness of earnings reflecting bad vs. good news, varies with cross-country differences in institutional regimes. In this paper, we examine the determinants of conditional conservatism and related earnings attributes internationally. First, using panel data, we investigate whether competing earnings attributes such as unconditional conservatism and income smoothing affect conditional conservatism and its international differences. We find that these attributes are predictably correlated with conditional conservatism. Second, we address the question whether income smoothing and conditional conservatism are two fundamentally different earnings attributes. We show theoretically that both attributes yield different earnings distributions and that the motivations for producing earnings which possess these attributes differ. To test these predictions empirically, we calculate firm-specific time-series measures of asymmetric timeliness, using a novel trigonometric measure based on the standard Basu (1997)-type regression. Using this cross-sectional data, we test whether conditional conservatism and income smoothing are different and find them to be only weakly correlated for a broad international sample. Also, we demonstrate that income smoothing explains international differences in conditional conservatism. Finally, we estimate simple determinant models of conditional conservatism and income smoothing, showing that both earnings attributes are driven by different explanatory firm-level factors: Conditional conservatism increases with the importance of debt financing, while income smoothing increases with the importance of dividends. Despite some important limitations, we believe our results to be meaningful because they show that cross-country differences in conditional conservatism are influenced by the effects of other accounting properties, predominantly income smoothing. Especially, legal regime appears to drive income smoothing while losing its explanatory power for conditional conservatism when firm-specific factors are controlled for.

On the Timeliness of Price Discovery

Price discovery is the process whereby value-relevant, private information becomes impounded or reflected in a stock's publicly-observable market price. The timeliness of price discovery refers to how quickly that process takes effect. There is no reason to believe either that all private information is discovered equally quickly or that price discovery is equally speedy for all firms. The latter observation suggests it would be worthwhile knowing why the timeliness of price discovery differs across firms, even the more so in an environment where all listed companies by law must disclose most material price-sensitive information as soon as they become aware of it. The other observation, that not all private information is discovered equally quickly, implies we should focus on a material, periodic event when we compare timeliness across firms. A good candidate is the announcement of the company's annual results, since for many years is has been known that annual earnings alone captures at least half the value-relevant information released by the average firm over the 12 months leading up to this date. We use various approaches to explore measures of timeliness and what they can tell us. We review a number of studies that have considered various aspects of timeliness in different countries and extend and contrast their findings. We also examine the relationship between the timeliness of price discovery and analogous measures based upon firms' formal disclosures to the share market and upon analysts' consensus earnings forecasts. Finally, we report on an issue of major concern to regulators and market operators, namely the influence of corporate governance on the timeliness of price discovery.

Assessing surveillance using sensitivity, specificity and timeliness

Monitoring ongoing processes of illness to detect sudden changes is an important aspect of practical epidemiology and medicine more generally. Most commonly, the monitoring has been restricted to a unidimensional stream of data over time. In such situations, analytic results from the industrial process monitoring have suggested optimal approaches to monitor the data streams. Data streams including spatial location as well as temporal sequence are becoming available. Monitoring methods that incorporate spatial data may prove superior to those that ignore it. However, analytically, optimal methods for spatial surveillance data may not exist. In the present article, we introduce and discuss evaluation metrics that can be used to compare the performance of statistical methods of surveillance. Our general approach is to generalize receiver operating characteristic (ROC) curves to incorporate the time of detection in addition to the usual test characteristics of sensitivity and specificity. In addition to weighting ordinary ROC curves by two measures of timeliness, we describe three three-dimensional generalizations of ROC curves that result in timeliness-ROC surfaces. Working in the context of surveillance of cases of disease to detect a sudden outbreak, we demonstrate these in an artificial example and in a previously described simulation context and show how the metrics differ. We also discuss the differences and under which circumstances one might prefer a given method.

International Differences in Conditional Conservatism: The Role of Unconditional Conservatism and Income Smoothing

Prior research documents that conditional conservatism, measured as the asymmetric timeliness of earnings reflecting bad versus good news, varies with cross-country differences in institutional regimes. In this paper, we examine the determinants of conditional conservatism and related earnings attributes internationally. First, using panel data, we investigate whether competing earnings attributes such as unconditional conservatism and income smoothing affect conditional conservatism and its international differences. We find that these attributes are predictably correlated with conditional conservatism. Second, we address the question whether income smoothing and conditional conservatism are two fundamentally different earnings attributes. We show theoretically that both attributes yield different earnings distributions and that the motivations for producing earnings which possess these attributes differ. To test these predictions empirically, we calculate firm-specific time-series measures of asymmetric timeliness, using a novel trigonometric measure based on the standard Basu (1997)-type regression. Using this cross-sectional data, we test whether conditional conservatism and income smoothing are different and find them to be only weakly correlated for a broad international sample. Also, we demonstrate that income smoothing explains international differences in conditional conservatism. Finally, we estimate simple determinant models of conditional conservatism and income smoothing, showing that both earnings attributes are driven by different explanatory firm-level factors: conditional conservatism increases with the importance of debt financing, while income smoothing increases with the importance of dividends. Despite some important limitations, we believe our results to be meaningful because they show that cross-country differences in conditional conservatism are influenced by the effects of other accounting properties, predominantly income smoothing. Especially, legal regime appears to drive income smoothing while losing its explanatory power for conditional conservatism when firm-specific factors are controlled for.

Self‐Reported Delay in Seeking Care Has Poor Validity for Predicting Adverse Outcomes

To determine whether self-reports of delayed care predict increased mortality and functional decline in community-dwelling elderly. Longitudinal cohort study. Five counties in North Carolina. A total of 4,162 randomly sampled individuals aged 65 and older. The primary outcome was the proportional hazard ratio (HR) for death in cohorts stratified by self-reports of delayed or foregone care. A secondary outcome, functional decline, measured the cohorts' odds of developing increased dependency in activities of daily living (ADLs). Control variables included predisposing, enabling, and need factors. Of 3,964 eligible participants reporting, 61% never, 27% once in a while, and 12% quite often delayed care. Over 3 years, 13% of participants died, and 17% developed increased ADL dependency. Nevertheless, in unadjusted and adjusted models, neither 3-year mortality HRs nor the odds of functional decline differed between cohorts reporting varying degrees of delayed care. Survival probabilities remained higher for 15 years among those reporting delaying care often. The inability of self-reported delay to predict adverse outcomes in community-dwelling elderly suggests the need for better understanding and support of the care-seeking process and additional measures of timeliness of access.

Irrigation timeliness indicators and application in smallholder irrigation systems in Zimbabwe

Timing of supply of irrigation water is an important measure of water management performance. Yet despite this widely accepted importance of timeliness, few studies have attempted to quantify this performance indicator. This paper suggests a methodology for quantifying timeliness. The indices thus generated are used to compare the performance of some types of smallholder irrigation schemes in Zimbabwe. Results indicate that applying measures of timeliness helps to assess water management practices across scheme types. The methodology given in this paper differentiates between timely irrigation deliveries which meet Crop Water Requirements (CWR) and surplus water supplies due to poor timeliness which cannot be used by the crop, hence denoting wastage. The timeliness indices provide more information regarding management practices than simple measures of total water applications over a given season.

Timeliness of irrigation

Despite considerable discussion of the importance of timeliness as a key dimension of irrigation performance, few studies have assessed how well irrigation systems deliver timely water supplies, nor the magnitude of the effect on agricultural production. This paper lays out indicators of timeliness of irrigation supply which distinguish between deliveries which meet crop needs, and surplus water supplies which cannot be used by crops. These indicators are then applied to empirical data from the Sone Irrigation System of Bihar, India. Using these indicators in an analysis of the contribution of irrigation to rice production shows that incorporating measures of timeliness explains much more of the variability in agricultural production than do simple measures of total water applications over a season. Results of production functions show that if water deliveries cannot be matched with crop requirements, they have a negative, rather than a positive, impact on yields. Water scarcity has the greatest adverse impact in production in the middle of the season, while surpluses are most damaging at the beginning and end of the season. Temporal redistribution from surplus periods to times of water scarcity therefore offers considerable scope to increase productivity without increasing water use.

Accuracy and Timeliness in Decision-making Organization

Abstract Two measures of performance, accuracy and timeliness of response, are introduced for information processing and decision-making organizations. Accuracy is computed by comparing the actual response of an organization to a glven task to the desired response and assigning a cost to the discrepancy. Timeliness reflects the ability of the organization to produce a response within an allotted timee determined bv the task requirements. Delays in completing a task are due both to the time required for processing information and making decisions and to the time required to effect communicnions among decisionmakers. A simple model is introduced that models transmission delays, The method is applied to two organizational structures. The accuracy - expected response time locus is constructed and the accuracy-timeliness trade-off is investigated. The workload constraints on decisionmakers are considered in evaluating the two designs.

The Structured Meeting System

The effectiveness of a structured meeting system, incorporating weekly meetings, deadlines and task monitoring was evaluated with four middle managers. The manager/experimenter introduced the system according to a multiple-baseline across-subjects design, and each supervisee improved markedly during intervention on measures of timeliness and productivity. A behavioral analysis suggested that the meeting system changed both the manager's and the supervisees' contingencies, and made the planned consequence of manager approval more contingent on desired supervisee behavior.