a concert I attended for cancer wards ceremony held in Chi-Mei

July 15, 2008--Manana

A graphical health report constructed as a KIDMAP Using Rasch Analysis of IRT Mode

The new issue that generates a KIDMAP for a graphical health report is for us a flash experience to know the quality improvemnet when adopting an appropriate approacht to measure them. The topic will encourage us to know even the health examination can be investigated and compared with each other so as to improve them.
A proverb tells us that an improvement is always derived from a comparison..
Good luck and have a nice learning process.....

Rasch analysis of Picker 2004 Questionnaire

"Rasch analysis of Detecting Most Unfitted Items on Questionnaire of Picker Institute: Outpatient Survey for 2004" is our research material recently which helps us know more about the data analysis and report generation.
How to conduct a survey for quality improvement is an important issue. We will indeed have the chance to pratice it ones more again....

A Survey of the prevalence of thoracic scoliosis in Taiwan

Objective: Survey the prevalence of thoracic scoliosis through the chest x-ray examination of labor’s annual health.
Using univariate logistic regression was found that, the odds ratio for female was 2.61(95% CI: 1.93-3.51), old age and obesity (BMI＞27) had protective effect.
We can see that a study of surveying some regarding the chest x-ray examination of labor’s annual health is a interesting matter in healthcare.
If we could use another method like somehow the Rasch analysis to examine the abnormal interactions on items and persons, a newly developped resarch may be devived from that would-be published paper we have read in this week.

New Camera bought in Taiwan--A learning new weapon

maximum likelihood estimate

We talked about the MLE. Maybe it seems somewhat difficult for us to explain the real meaning of MLE, but there are several examples we used to let us know that made it easily undetstood.
Note that the maximum likelihood estimator may not be unique, or indeed may not even exist.

Maximum likelihood estimation (MLE) is a popular statistical method used for fitting a mathematical model to some data. Modeling real world data by estimating maximum likelihood offers a way of tuning the free parameters of the model to provide a good fit.

For examples, you are willing to assume that heights are normally distributed with some unknown mean and variance. The sample mean is then the maximum likelihood estimator of the population mean, and the sample variance is a close approximation to the maximum likelihood estimator of the population variance


http://raschsmile.blogspot.com/2006_08_01_archive.html

http://www.psy.vanderbilt.edu/faculty/palmeri/P351-modeling/readings/myung-tutorial-mle.pdf

my learning process in statistics

In these two weeks I have been learnign RASCH model and how to use winsteps, Mr. Chien and I discussed the goals, I think that I have learned more than I expected, I am not trying to know everything about RASCH model, the most important thing to learn is the way that Mr. Chien approaches health problems from a management point of view, if I learn how to apply RASCH model in my country will be a great achievement. We celebrate Dr. Ke's birthday on Saturday 20th, we had a great night.

A plan of introduction on nursing department of ChiMei

Why the measurement with interval scores is important to us when we conduct a survey...

http://www.winsteps.com/aftp/measure.pdf


http://www.winsteps.com/aftp/measure.pps

The schedule of Roberto's trekking Chi-Mei Hospital

The schedule of Roberto's  trekking Chi-Mei Hospital (Roberto的學習計劃)
Learning direction: application of information and statistics(學習方向: 資訊及統計之應用)
Programs: inspiring ideas to let application reliazed in Nnicaragua within 2 years
(課程: 激發概念進而形成策略方案, 以在2年內可以在尼國推動及發展)
Schedule: each week has its own specific subject and objective to be achieved(每週主題,每週完成既定目標)
approaches: tour and look at facilities and flowwork and post ideas onto blog
blog: http://robertochimei.blogspot.com/
weeks
date
Title
一
2008/7/8
Coming &  Schedule for trekking Chi-Mei set up
objective: to construct a system regarding
internet network applied to management
　
Excise
to plan and construct a feasible projecwith regard to  appointment making on referring approaches
二
2008/7/15
course: learning system and web-meeting
objective:  to communicate efficiently on internet
and to apply it to a lelearning organization
　
Excise
to building up a brotherhood relations with CHI-MEI
三
2008/7/22
course: measuring employee's health status and level
objective: to apply statistics onto health check-up, to analyze data and to generate reports
　
Excise
data collection and analysis
四
2008/7/29
course: physician entry system on computers
objective: to understand the SOAP entry process of a physician
 to see the function of dictation and transcription
　
Excise
preparing the 1st presentaion of Roberto's drafts and projects
五
2008/8/5
course: indicator management for medical qualtity
objective:to know the statistics appied to indication management(graphical reporting and monitoring system)
　
Excise
blog, referring system, brotherhood, health physical report(8/8 at 9:00)
六
2008/8/12
course: qualtiy and patient safty management
objecitve: to know the papers presented in ISQUA
　
Excise
organize those papers to be a briefing for 2nd sharing meeting
七
2008/819
Geriatric Medicine & community health
objecitve: to know the development of our government and the CHI-MEI views of points
　
Excise
home care and community service rendered by CHI-MEI
八
2008/8/26
course: health mental report for questionnaire
　
　
objective:to know the statistics appied to indication management(grafical reporting and monitoring system)
　
Excise
indicator management, ISQUA papers, community service possiblly rendered in Nnicaragua, health mental report(8/29 at 9:00)
九
2008/9/2
course: total qualtity management and information HIS system in CHI-MEI
objective: TQC activities and intranet information system blue print in CHI-MEI
　
Excise
What should be adopted in  Nnicaragua in future
十
2008/9/9
course:patient satisfatory survey and analysis
objective: to know how to use the SPSS on data analysis
　
Excise
Chi-square, regression, ANOVA and survival analysis
十一
2008/9/16
course: visualized graphic reports in management
objective: Loren's curve and gini coefficient, system dynamics
　
Excise
practice those graphically visualized reports
十二
2008/9/23
 course: cofference in Chi-Mei
objective: education, research and servece in Chi-Mei
　
Excise
say good-bye to each chief of department in Chi-Mei
十三
2008/9/30
 course: arrange the reports of trekking Chi-Mei hospital and say good-bye tour around Chi-Mei hospital
 objective:
　
Excise
blog, statistics and information application, clussions and suggestions to Chi-Mei (10/3 at 9:00)
十四
2008/10/7
say good-bye and taking a city tour
Move to Taipei

In Taiwan, any one can check the record which they had seen the doctor on internet if they have the card of MOICA Certification

More informationfor detail at http://moica.nat.gov.tw/html/en/index.htm

http://moica.nat.gov.tw/html/matter/9707/index.htm
Because in Taiwan, evey persons almost are recruited in the system of heatlh care coverage. any one who have seen the doctor will keep the record in hospital computer and then check it on internet to see how much money had been reibursed or claimed by that specific hospital or other related informaiton by means of a so-called MOICA card issued by the Taiwan government.

Who should be concerned for abnormal item responded by the examinee...

1
Chest X-ray; 2Urine dipstick; 6 triglyceride; 4 hematin; 9 SGPT; 3 WBC; 5 cholesterol
7 blood sugar; 8 Creatinine

As for the service lenght in the hospital, the yougest needs to care for SGPT

For age, aged employees not well on Creatinine(8), yongest ones well on X-ray

For gender, Urine dipstick happened onto Female,but SGPT not well onto Male.

SGPT of physician performed not well, but surpassed on Urine dipstick

Under the condition of patient privacy, we render the service of most unexpected response report disclosing the item to be rechecked or concerned for further examination....

any difference between groups for health ability?

difference in

difference in service length for the hospital

No difference in age No difference in gender...

No difference in dept, i.e., administration, nurse, technician and physiscian.

Aug/ 10 will be the date of presentation for telling them what I have known in Chi-Mei

1> describe the Web-blog and introduce what I have veiw in Chi-Mei
2> the referring system for making appointment which can be adopted in Nicaragua whithin 2 years.
3> coorporation with hospitals between the two contries vis internet meeting of which we will connect to Nicaragua at 9:30
4> the health examination using Rasch analysis will be introduced in that presentation which will let the employees know the measurement plays a vital role while implementing the health promotion in an organization. We will also compare the group health status with each other in a hospital. Very interesting is it in that presentation date...
Date: Aug. 10
Time: 9:00 - 10:00
Participants: employees of Chi-Mei who interested in that topic.

7/26-7/30 course: Kidmap for health report of employees using WINSPEPS Rasch analysis

We will plan to research on the health report and analysis of a hospital's employees using Rasch analysis to know if the health statuses of them are good or not. It is of interest for us to introduce the method to others and to let a hospital to implement the health promotion.

Aug. 10 will be the presentataion date. Next week will be excise it and know how to run the data and interprete the reports.

a relationship between Chi-Mei and Nicaragua

we can do this job for both of contris

Talking about the Gini coefficient applied to hospital management

http://tnc.k12.edu.tw/1002017184/class/equality.swf
We learned how to draw colored pattern (using VBA as cell.Interior.color = RGB(color, color, color) to explain the properties of something regarding to the relationship between multi-variables in addition to the calcaulation of Gini coefficient describing some phenomenon for the equaltity of resource allocation.

Carrying out these analyses is essential to reducing the inequities that are characteristic of the health profile of the Region.

http://www.paho.org/English/SHA/be_v22n1-Gini.htm

That is a example at http://people.hofstra.edu/geotrans/eng/ch4en/meth4en/ch4m1en.html and clicked onto http://people.hofstra.edu/geotrans/eng/gallery/Demo-Gini.xls

SUB COLOR()  

  for jk=102 to 149

  for jk2=2 to 49

             aa=.cells(jk-50,jk2) 

             .cells(jk,jk2).interior.color=rgb(AA,AA,AA)  
    NEXT JK2

NEXT JK

END WITH 

END SUB

the referring system of patients making appointment with permission of primary doctor

http://tnc.k12.edu.tw/1002017184/class/A%20referred%20system%20for%20patients%20to%20hospitals%20on.swf

That are the slides regarding the referring system of patients making appointment with permission of primary doctor to connecting to the designated hospital via point of service of a charted agency.
There are several web sites designed by www internet and a wonderful system prototyping for a blueprintwhich is readily submited to that Govenment.

meu irmao

weekend in Tai nan

two fabulous days, I went to pick up stones with Mr. Ke and his fammily. He brought us, to a National Park in the mountains. Impressive, how they take care of Nature, also their tolerance. Mrs. Ke is so nice, she was too kind to us.

My first week in Tai nan at Chi Mei Hospital

I arrived to Taiwan on Monday 7, and on tuesday 8 we had the opening ceremony of the learning programm, I knew Dr. Ke from Chi Mei, he brougth us to our final destiny in Taiwan, Tai Nan, at the south of the country. I was assigned to Chi Mei Hospital, also my actually room mate Oswaldo from Sao Tome, he is a maxilo fascial MD. We had the first big experience, we traveled by the High Speed Railroad of Taiwan, that means 300 kms/hr. We were received by Mr. Chein, and He gave the orientations for the next day.
First impressions: these people respect nature, it is amazing how you can see little forest all over the big city.
Second day: I walked around with Mrs. Allison (Mrs. Liu) in the hospital, and visited various departments at the Hospital, Farmacy, Rehabilitation, and Others. In the noon I met Dr. Hwang, and Dr. Chuang and Dr. Ke, I was asked what I wanted to learn in Chi Mei, and I felt like a 8 years old kid that recieved 1,000 dolllars, only crazy thing could ask for. I wanted to know every thing, learn every thing, I do not have an specific plann. I have to write a proposal for the next three years at my job, so they can help me in this matter. I was assigned to an office, so I have my own office, during afternoon I discuss some ideas with Mr. Chien for the next days.
10/7: was incredible this day Mr. Chien assigned me my chinese name and how to write it down, also how to do my blog. We discuss about my programm for these three months, we decided that we are going to work in: design a communicating system in my region and in the field of quality, I realized he is a good researcher. He explainded me some tools in management and I noticed his point of view in health management, I know I will learn a lot from them. I was with Dr. Ke in a session of his clinic of neurology. One of the thing that most has impressed me is the humbleness of these people and their discipline. I enjoyed eating dinner with Mr. Chein's fammily. I noticed that the first days taiwanesse food tasted bad for me, and since noon I like it.
Friday: I went to visit the center of transcription of Chi Mei Hospital, that is quit impressive!!! during the afternoon, Mr. Chein and I discuss more over my planns, now I know with more accuracy what I want to learn, during weekend I will think about it, I am writing my proposal, I am still shock because the development of this country.

http://raschsmile.blogspot.com/ Rasch Analysis of Hospital Bed Vacancy will be introduced on July 13, 2008.

First day in Chi Mei Hosptial and the trekking schedule

(What we should do from the above flowwork in that image, especially for application in hospital's registration system) It is amazing to see the reserved registration for outpatients, the snapshot of the computer screen is shown above.

I have been here for accommodation and learning programs in the first day in July 8. The luggage has not received yet until July 9 at 17:00.
The most interested things I have encountered are the friendship and the kidness of these people.