Unambiguous examples of ecological causes of animal sexual dimorphism are rare. Here we present evidence for ecological causation of sexual dimorphism in the bill morphology of a hummingbird, the purple-throated carib. This hummingbird is the sole pollinator of two Heliconia species whose flowers correspond to the bills of either males or females. Each sex feeds most quickly at the flower species approximating its bill dimensions, which supports the hypothesis that floral specialization has driven the evolution of bill dimorphism. Further evidence for ecological causation of sexual dimorphism was provided by a geographic replacement of one Heliconia species by the other and the subsequent development of a floral dimorphism, with one floral morph matching the bills of males and the other of females.
BackgroundRecently, there has been considerable effort to promote the use of health information technology (HIT) in order to improve health care quality. However, relatively little is known about the extent to which HIT implementation is associated with hospital patient care quality. We undertook this study to determine the association of various HITs with: hospital quality improvement (QI) practices and strategies; adherence to process of care measures; risk-adjusted inpatient mortality; patient satisfaction; and assessment of patient care quality by hospital quality managers and front-line clinicians.MethodsWe conducted surveys of quality managers and front-line clinicians (physicians and nurses) in 470 short-term, general hospitals to obtain data on hospitals’ extent of HIT implementation, QI practices and strategies, assessments of quality performance, commitment to quality, and sufficiency of resources for QI. Of the 470 hospitals, 401 submitted complete data necessary for analysis. We also developed measures of hospital performance from several publicly data available sources: Hospital Compare adherence to process of care measures; Medicare Provider Analysis and Review (MEDPAR) file; and Hospital Consumer Assessment of Healthcare Providers and Systems HCAHPS® survey. We used Poisson regression analysis to examine the association between HIT implementation and QI practices and strategies, and general linear models to examine the relationship between HIT implementation and hospital performance measures.ResultsControlling for potential confounders, we found that hospitals with high levels of HIT implementation engaged in a statistically significant greater number of QI practices and strategies, and had significantly better performance on mortality rates, patient satisfaction measures, and assessments of patient care quality by hospital quality managers; there was weaker evidence of higher assessments of patient care quality by front-line clinicians.ConclusionsHospital implementation of HIT was positively associated with activities intended to improve patient care quality and with higher performance on four of six performance measures.
Sharing lessons from high-performing hospitals facilitates quality improvement. High-performing hospitals have usually been identified using a small number of performance measures. The objective was to analyze how well 1,006 hospitals performed across a broader range of measures. Five measures were developed from publicly available data: adherence to processes of care, 30-day readmission rates, in-hospital mortality, efficiency, and patient satisfaction. For a subset of hospitals, the authors included two survey-based assessments of patient care quality, one by chief quality officers and one by frontline clinicians. In general, there was little correlation among the publicly available measures (r ≤ .10), though there was notable correlation between objective measures and survey-based measures (r = .23). Hospitals that performed well on a composite measure calculated from the publicly available measures were often not in the top quintile on most individual measures. This highlights the challenge in identifying high-performing hospitals to learn organizational-level best practices.
Little is known about unwarranted clinical practice variations within US hospitals. The objectives of this study were to investigate whether hospitals are concerned about variations and their experiences with strategies to reduce variations. Case studies were conducted at 5 hospitals, and a survey of acute care hospitals was conducted in 4 states. Each of the case studies presented a different experience. Unwarranted variations were a concern for 90% of survey respondents, with no differences by state (P = .7) or hospital size (P = .2). Of these, 75% had a strategy in place to reduce variation. The likelihood of a multipronged approach was significantly higher in larger hospitals (P = .0009). This study revealed disparate approaches to reducing unwarranted clinical practice variations and also highlighted barriers to reducing variation. The case studies identified some models that could be emulated, but questions remain about whether there is a single best way forward.
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