Harnessing the power of the electronic health record for ALS research and quality improvement: CReATe CAPTURE-ALS and the ALS Toolkit.

The electronic health record (EHR) is designed principally to support the provision and documentation of clinical care, as well as billing and insurance claims. Broad implementation of the EHR, however, also yields an opportunity to use EHR data for other purposes, including research and quality improvement. Indeed, effective use of clinical data for research purposes has been a long-standing goal of physicians who provide care for patients with ALS, but the quality and completeness of clinical data, as well as the burden of double data entry into the EHR and into a research database, have been persistent barriers.

Meaningful variation in performance: a systematic literature review.

Background: Recommendations for directing quality improvement initiatives at particular levels (eg, patients, physicians, provider groups) have been made on the basis of empirical components of variance analyses of performance.

Objective: To review the literature on use of multilevel analyses of variability in quality.

Research Design: Systematic literature review of English-language articles (n = 39) examining variability and reliability of performance measures in Medline using PubMed (1949-November 2008).

Meaningful variation in performance: what does variation in quality tell us about improving quality?

Background: Variance reduction is sometimes considered as a goal of clinical quality improvement. Variance among physicians, hospitals, or health plans has been evaluated as the proportion of total variance (or intraclass correlation, ICC) in a quality measure; low ICCs have been interpreted to indicate low potential for quality improvement at that level. However, the absolute amount of variation, expressed in clinically meaningful units, is less frequently reported.

Comparison of video- and EMG-based evaluations of the magnitude of children's emotion-modulated startle response.

We investigated the reliability and validity of a video-based method of measuring the magnitude of children's emotion-modulated startle response when electromyographic (EMG) measurement is not feasible. Thirty-one children between the ages of 4 and 7 years were videotaped while watching short video clips designed to elicit happiness or fear. Embedded in the audio track of the video clips were acoustic startle probes.

Developmental and contextual influences on autonomic reactivity in young children.

Studies of cardiovascular reactivity in young children have generally employed integrated, physiologically complex measures, such as heart rate and blood pressure, which are subject to the multiple influences of factors such as blood volume, hematologic status, thermoregulation, and autonomic nervous system (ANS) tone. Reactivity studies in children have rarely employed more differentiated, proximal measures of autonomic function capable of discerning the independent effects of sympathetic and parasympathetic responses. We describe 1) the development, validity, and reliability of a psychobiology protocol assessing autonomic reactivity to challenge in 3- to 8-year-old children; 2) the influences of age, gender, and study context on autonomic measures; and 3) the distributions of reactivity measures in a normative sample of children and the prevalences of discrete autonomic profiles.

Revealing the relation between temperament and behavior problem symptoms by eliminating measurement confounding: expert ratings and factor analyses.

This study examined the hypothesis that item overlap, or measurement confounding, accounts for the correlation between temperament and behavior problem symptoms in children. First, a conceptual approach was taken in which 41 experts rated temperament (Children's Behavior Questionnaire, CBQ) and behavior problem symptom items (Preschool Behavior Questionnaire, PBQ) for their fit to both constructs. With this approach, 10% of temperament and 38% of symptom items were confounded.

Temperament, tympanum, and temperature: four provisional studies of the biobehavioral correlates of tympanic membrane temperature asymmetries.

Previous research in both humans and nonhuman primates suggests that subtle asymmetries in tympanic membrane (TM) temperatures may be related to aspects of cognition and socioaffective behavior. Such associations could plausibly reflect lateralities in cerebral blood flow that support side-to-side differences in regional cortical activation. Asymmetries in activation of the left and right frontal cortex, for example, are correlates of temperamental differences in child behavior and markers of risk status for affective and anxiety disorders.