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There is an increasing interest in divesting activities, giving rise to several initiatives both academic and governmental to identify and address one of the problems of health systems. In 2013 the Spanish Atlas of Variability in Clinical Practice (VPM) in collaboration with the Spanish Network of Health Technology Assessment (HTA) Agencies started a project with the purpose of providing elements to support a national strategy aimed at minimizing the use of doubtful procedures in the Spanish National Health System (1).
The identification, selection and definition of low added value procedures and the determination of the most cost-effective alternatives were carried out jointly between the AtlasVPM group and the HTA agencies of Andalusia (AETSA), Catalonia (AQUAS), Galicia (Avalia-t), Basque Country (Osteba), Madrid (UETS) and Aragon (IACS). The process consisted of the following phases: (i) Literature review; (ii) Preliminary list of procedures of dubious value; (iii) Analysis of feasibility and construction of the indicators (variability); and (iv) Empirical validation of the defined indicators. Different lists and sources of evidence were used to identify the procedures and evidence that support their low-value.
The synthesis of the evidence gave rise to an initial list of fifty-nine procedures of doubtful value that could be classified as: obsolete or outdated procedures in comparison to more effective / cost-effective alternatives (n = 31), procedures of doubtful value when used outside their main indication (n = 17) and procedures for which the evidence around effectiveness was still insufficient (n = 11). With the advice of clinical experts and coders, the original list was reduced to seventeen procedures and after some adjustments to thirteen.
Identifying procedures of low-added value is a complex task and is context dependent. Literature could be useful to identify a preliminary list but the analysis of the clinical practice, its variability and reasons that justify it are required to determine which procedures are good candidates for disinvestment.
DATA ACQUISITION, REDUCTION, ANALYSIS, AND INTERPRETATION: CONSIDERATIONS AND CAVEATS
William J. Gavin, Research Scientist/Scholar III and Director of the Brainwaves Research Laboratory in the Department of Occupational Therapy Colorado State University,
Patricia L. Davies, Associate Professor and Director of the Brainwaves Research Laboratory in the Department of Occupational Therapy and Psychology Colorado State University
Developmental psychophysiological research is a relatively young field that is rapidly expanding partly because sophisticated, cost-effective technology now allows researchers to collect physiological data much more efficiently and effectively. This volume of developmental psychophysiology reflects both the newness as well as the growth of the field. As alluded to by many of the authors included in this volume, researchers collecting valid psychophysiological data in children face challenges that are magnified when compared to the collection of these same data in adults. However, developmental psychophysiologists are not alone in addressing these challenges as we can readily draw upon the experiences from specialists working in other related fields.
The fields of psychology and education have also contributed to our general knowledge about effective methods of assessing children. Notably, the number of texts written on behavioral and neuropsychological assessment of children is plentiful, and we can apply this knowledge to assessment of psychophysiological information as well. For example, the recent editions of assessment of children (Sattler 2001, 2002) comprehensively discuss skills necessary for test administrators to have in order to successfully assess children. Some of these skills include effective listening, building rapport with the child, and how to handle difficult behaviors and individual temperaments. A researcher who develops these assessment skills discussed by psychologists, neuropsychologists, and education professionals, along with the technical skills necessary for obtaining the desired psychophysiological measurements will be much more successful in obtaining reliable and valid research data.
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