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Patients with co-morbidities pose particular difficulties for performance measurement, and around 37% of Dutch citizens over 55 years of age have two or more chronic illnesses [ 74].
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Chapter 9 discusses some of the psychological and Human Factors issues that can be introduced, and the difficulties for human performance that can arise, when automation changes the role of people from being hands-on controllers and operators of equipment, to becoming supervisors of highly automated systems.
This creates difficulty for EMS performance index comparison and benchmarking.
For the Ile-de-France, the limited number of regional hospitals does not appear to present a difficulty for evaluating performance.
In our series, these factors appeared to present no increased difficulty for the performance of ultrasound guided puncture, as long as the first tracheal ring was clearly visible above the sternal notch.
This lack of accepted clinical endpoints makes standardization of study results difficult, and results in significant difficulties for the successful performance of a clinical trial for novel therapeutics for lupus.
In Canada the assessment of performance by medical regulatory authorities has mostly focused on physicians considered to be at risk for performance difficulties or for whom there has been evidence of poor performance requiring competence remediation [ 20- 22].
All in all, on-call stress (i.e., the experience of stress due to the unpredictability of being on-call) seemed to be the most important predictor as it was positively related to all "outcome" variables except for performance difficulties.
Potential risk factors for performance difficulties were evident in the demographic differences between the group of flagged physicians and the most recent PAR longitudinal study [ 15], including non-certification in family practice and medical graduation outside Canada.
Policy-makers should not under-estimate the difficulties faced in promoting ownership of local pay-for-performance schemes.
Pay-for-performance re-emerged briefly in Canada in 1876, but it ran into similar difficulties and was terminated in 1883.
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CEO of Professional Science Editing for Scientists @ prosciediting.com