As the primary providers of round-the-clock bedside care, nurses are well positioned to report on hospital quality of care. Researchers have not examined how nurses’ reports of quality correspond with standard process or outcomes measures of quality. We assess the validity of evaluating hospital quality by aggregating hospital nurses’ responses to a single item that asks them to report on quality of care. We found that a 10% increment in the proportion of nurses reporting excellent quality of care was associated with lower odds of mortality and failure to rescue; greater patient satisfaction; and higher composite process of care scores for acute myocardial infarction, pneumonia, and surgical patients. Nurse reported quality of care is a useful indicator of hospital performance.
McHugh, Matthew D.; Stimpfel, Amy Witkoski
The purpose of this project is to: (1) analyze the relationship between patients' perspectives of hospital quality of care and key hospital characteristics that may influence patients' experiences of hospital care, including rurality; and (2) assess wheth...
G. Davidson M. M. Casey
The objective of the research project was to determine the effects of Hospital Based Managed Care (HBMC) on the cost and quality of hospital care. HBMC is a delivery of care method that involved creating locally derived, multidisciplinary practice guideli...
M. A. Blegen
Quality improvement can not focus exclusively on peer review and the scientific evaluation of medical care processes. These essential elements have to be complemented with a focus on individual patient needs and preferences. Only then will hospitals create the competitive advantage needed to survive in an increasingly market-driven hospital industry. Hospital managers can identify these patients' needs by 'living the patient experience' and should then set the hospital's quality objectives according to its target patients and their needs. Excellent quality program design, however, is not sufficient. Successful implementation of a quality improvement program further requires fundamental changes in pivotal jobholders' behavior and mindset and in the supporting organizational design elements. PMID:10114504
This study analyses the market for secondary health care services when patient choice depends on the quality\\/distance mix that achieves utility maximization. First, the hospital’s equilibrium in a Hotelling spatial competition model under simultaneous quality choices is analyzed to define hospitals’ strategic behavior. A first equilibrium outcome is provided, the understanding of which is extremely useful for the policy maker
With the growth of Facebook, public health researchers are exploring the platform's uses in health care. However, little research has examined the relationship between Facebook and traditional hospital quality measures. The authors conducted an exploratory quantitative analysis of hospitals' Facebook pages to assess whether Facebook "Likes" were associated with hospital quality and patient satisfaction. The 30-day mortality rates and patient recommendation rates were used to quantify hospital quality and patient satisfaction; these variables were correlated with Facebook data for 40 hospitals near New York, NY. The results showed that Facebook "Likes" have a strong negative association with 30-day mortality rates and are positively associated with patient recommendation. These exploratory findings suggest that the number of Facebook "Likes" for a hospital may serve as an indicator of hospital quality and patient satisfaction. These findings have implications for researchers and hospitals looking for a quick and widely available measure of these traditional indicators. PMID:23378059
Timian, Alex; Rupcic, Sonia; Kachnowski, Stan; Luisi, Paloma
Hospitalized patients with inflammatory bowel disease (IBD) are at high risk for morbidity, mortality, and health care utilization costs. While the literature on trends in hospitalization rates for this disease is conflicting, there does appear to be significant variation in the delivery of care to this complex group, which may be a marker of suboptimal quality of care. There is a need for improvement in identifying patients at risk for hospitalization in an effort to reduce admissions. Moreover, appropriate screening for a number of hospital acquired complications such as venous thromboembolism and Clostridium difficile infection is suboptimal. This review discusses areas of inpatient care for IBD patients that are in need of improvement and outlines a number of potential quality improvement initiatives such as pay-for-performance models, quality improvement frameworks, and healthcare information technology.
Weizman, Adam V; Nguyen, Geoffrey C
Purpose – Organizational culture is a determinant for quality improvement. This paper aims to assess organizational culture in a hospital setting, understand its relationship with perceptions about quality of care and identify areas for improvement. Design\\/methodology\\/approach – The paper is based on a cross-sectional survey in a large clinical department that used two validated questionnaires. The first contained 20 items
Fauziah Rabanni; S. M. Wasim Jafri; Farhat Abbas; Firdous Jahan; Nadir Ali Syed; Gregory Pappas; Syed Iqbal Azam; Mats Brommels; Göran Tomson
This study analyses the market for secondary health care services when patient choice depends on the quality/distance mix that achieves utility maximization. First, the hospital's equilibrium in a Hotelling spatial competition model under simultaneous quality choices is analyzed to define hospitals' strategic behavior. A first equilibrium outcome is provided, the understanding of which is extremely useful for the policy maker wishing to improve social welfare. Second, patients are assumed to be unable, because of asymmetry of information, to observe the true quality provided. Their decisions reflect the perceived quality, which is affected by bias. Using the mean-variance method, the equilibrium previously found is investigated in a stochastic framework. PMID:15791476
Background Improving end-of-life care in the hospital is a national priority. Purpose To explore the prevalence and reasons for implementation of hospital-wide and ICU practices relevant to quality care in key end-of-life care domains,and to discern major structural determinants of practice implementation. Design Cross-sectional mixed-mode survey of Chief Nursing Officers of Pennsylvania structural determinants of practice implementation. Results The response rate was 74% (129 of 174). The prevalence of hospital and ICU practices ranged from 95% for a hospital-wide formal code policy to 6% for regularly scheduled family meetings with an attending physician in the ICU. Most practices had less than 50% implementation; most were implemented primarily for quality improvement or to keep up with the standard of care. In a multivariable model including hospital structural characteristics, only hospital size independently predicted the presence of one or more hospital initiatives (ethics consult service, OR 6.13, adjusted p=0.02; private conference room in the ICU for family meetings, OR 4.54, adjusted p<0.001). Conclusions There is low penetration of hospital practices relevant to quality end-of-life care in Pennsylvania acute care hospitals. Our results may serve to inform the development of future benchmark goals. It is critical establish a strong evidence base for the practices most associated with improved end-of-life care outcomes and to develop quality measures for end-of-life care to complement existing hospital quality measures that primarily focus on life extension.
Lin, Caroline Y.; Arnold, Robert; Lave, Judith R.; Angus, Derek C.; Barnato, Amber
Objectives To investigate predictors for specific dimensions of service quality perceived by hospital employees in long-term care hospitals. Methods Data collected from a survey of 298 hospital employees in 18 long-term care hospitals were analysed. Multivariate ordinary least squares regression analysis with hospital fixed effects was used to determine the predictors of service quality using respondents’ and organizational characteristics. Results The most significant predictors of employee-perceived service quality were job satisfaction and degree of consent on national evaluation criteria. National evaluation results on long-term care hospitals and work environment also had positive effects on service quality. Conclusion The findings of the study show that organizational characteristics are significant determinants of service quality in long-term care hospitals. Assessment of the extent to which hospitals address factors related to employeeperceived quality of services could be the first step in quality improvement activities. Results have implications for efforts to improve service quality in longterm care hospitals and designing more comprehensive national evaluation criteria.
Kim, Jinkyung; Han, Woosok
Background: Hospital performance reports based on administrative data should distinguish differences in quality of care between hospitals from case mix related variation and random error effects. A study was undertaken to determine which of 12 diagnosis-outcome indicators measured across all hospitals in one state had significant risk adjusted systematic (or special cause) variation (SV) suggesting differences in quality of care.
I Scott; D Youlden; M Coory
Background Recently, 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. Methods We 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. Results Controlling 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. Conclusions Hospital implementation of HIT was positively associated with activities intended to improve patient care quality and with higher performance on four of six performance measures.
Pre-hospital critical care is considered to be a complex intervention with a weak evidence base. In quality improvement literature, the value equation has been used to depict the inevitable relationship between resources expenditure and quality. Increased value of pre-hospital critical care involves moving a system from quality assurance to quality improvement. Agreed quality indicators can be integrated in existing quality improvement and complex intervention methodology. A QI system for pre-hospital critical care includes leadership involvement, multi-disciplinary buy-in, data collection infrastructure and long-term commitment. Further, integrating process control with governance systems allows evidence-based change of practice and publishing of results.
Background The extent to which patient experiences with hospital care are related to other measures of hospital quality and safety is unknown. Methods We examined the relationship between Hospital Consumer Assessment of Healthcare Providers and Systems scores and technical measures of quality and safety using service-line specific data in 927 hospitals. We used data from the Hospital Quality Alliance to assess technical performance in medical and surgical processes of care and calculated Patient Safety Indicators to measure medical and surgical complication rates. Results The overall rating of the hospital and willingness to recommend the hospital had strong relationships with technical performance in all medical conditions and surgical care (correlation coefficients ranging from 0.15 to 0.63; p<.05 for all). Better patient experiences for each measure domain were associated with lower decubitus ulcer rates (correlations ?0.17 to ?0.35; p<.05 for all), and for at least some domains with each of the other assessed complications, such as infections due to medical care. Conclusions Patient experiences of care were related to measures of technical quality of care, supporting their validity as summary measures of hospital quality. Further study may elucidate implications of these relationships for improving hospital care.
Isaac, Thomas; Zaslavsky, Alan M; Cleary, Paul D; Landon, Bruce E
Obtaining meaningful information from statistically valid and reliable measures of the quality of care for disease-specific care provided in small rural hospitals is limited by small numbers of cases and different definitive care capacities. An alternative approach may be to aggregate and analyze patient services that reflect more generalized care…
Wakefield, Douglas S.; Ward, Marcia; Miller, Thomas; Ohsfeldt, Robert; Jaana, Mirou; Lei, Yang; Tracy, Roger; Schneider, John
Background: In the mid-1990s, significant gaps existed in the quality of acute myocardial infarction (AMI) care between rural and urban hospitals. Since then, overall AMI care quality has improved. This study uses more recent data to determine whether rural-urban AMI quality gaps have persisted. Methods: Using inpatient records data for 34,776…
Baldwin, Laura-Mae; Chan, Leighton; Andrilla, C. Holly A.; Huff, Edwin D.; Hart, L. Gary
We examine the association between hospital community orientation and quality-of-care measures, which include process measures for patients admitted for acute myocardial infarction, heart failure, and pneumonia as well as measures of patient experience. The community orientation measure is obtained from the 2009 American Hospital Association's Annual Survey Database. Information on hospital quality of care and patient experience comes from 2009 Hospital Quality Alliance data and results from the 2009 Hospital Consumer Assessment of Healthcare Providers and Systems (Medicare.gov, 2009). To evaluate the relationship between community orientation and measures of quality and patient experience, we used multivariate linear regressions. Organizational and market control variables included bed size, ownership, teaching status, safety net status, number of nurses per patient day, multihospital system status, network status, extent of reliance on managed care, market competition, and location within an Aligning Forces for Quality community (these communities have multistakeholder alliances and focus on improving quality of care at the community level). After controlling for organizational factors, we found that hospitals with a stronger commitment to community orientation perform better on process measures for all three conditions, and they report higher patient experience of care scores for one measure, than do those demonstrating weaker commitment. Hospital commitment to community orientation is significantly related to the provision of high-quality care and to one measure of patient experience of care. PMID:24396948
Kang, Raymond; Hasnain-Wynia, Romana
Older persons are occasionally acutely ill and their hospitalizations frequently end up with complications and adverse outcomes. Medicare from U.S. federal government’s payment resource for older persons is facing financial strain. Medicare highlights both cost-saving and high quality of care while older persons are hospitalized. Several health policy changes were initiated to achieve Medicare’s goals. In response to Medicare’s health policy changes, U.S. hospital environments have been changed and these resulted in hospital quality measurements’ improvement. American seniors are facing the challenges during and around their hospital care. Several innovative measures are suggested to overcome these challenges.
Yoo, Ji Won; Kim, Sun Jung; Geng, Yan; Shin, Hyun Phil; Nakagawa, Shunichi
Purpose To examine the influence of nursing– specifically nurse staffing and the nurse work environment– on quality of care and patient satisfaction in hospitals with varying concentrations of Black patients. Design Cross-sectional secondary analysis of 2006–2007 nurse survey data collected across four states (Florida, Pennsylvania, New Jersey, and California), the Hospital Consumer Assessment of Healthcare Providers and Systems survey, and administrative data. Global analysis of variance and linear regression models were used to examine the association between the concentration of Black patients on quality measures (readiness for discharge, patient or family complaints, health care–associated infections) and patient satisfaction, before and after accounting for nursing and hospital characteristics. Results Nurses working in hospitals with higher concentrations of Blacks reported poorer confidence in patients’ readiness for discharge and more frequent complaints and infections. Patients treated in hospitals with higher concentrations of Blacks were less satisfied with their care. In the fully adjusted regression models for quality and patient satisfaction outcomes, the effects associated with the concentration of Blacks were explained in part by nursing and structural hospital characteristics. Conclusions This study demonstrates a relationship between nursing, structural hospital characteristics, quality of care, and patient satisfaction in hospitals with high concentrations of Black patients. Clinical Relevance Consideration of nursing factors, in addition to other important hospital characteristics, is critical to understanding and improving quality of care and patient satisfaction in minority-serving hospitals.
Brooks-Carthon, J. Margo; Kutney-Lee, Ann; Sloane, Douglas M.; Cimiotti, Jeannie P.; Aiken, Linda H.
The quality of nursing care as perceived by hospitalized patients with advanced illness has not been examined. A concept of quality nursing care for this population was developed by integrating the literature on constructs defining quality nursing care with empirical findings from interviews of 16 patients with advanced illness. Quality nursing care was characterized as competence and personal caring supported by professionalism and delivered with an appropriate demeanor. Although the attributes of competence, caring, professionalism, and demeanor were identified as common components of quality care across various patient populations, the caring domain increased in importance when patients with advanced illness perceived themselves as vulnerable. Assessment of quality nursing care for patients with advanced illness needs to include measures of patient perceptions of vulnerability.
Izumi, Shigeko; Baggs, Judith G.; Knafl, Kathleen A.
The word "serendipity" was coined by Horace Walpole, Earl of Orford, in a letter he wrote in January 1754. He defined serendipity as the making of "….discoveries, by accidents and sagacity, of things which [you] were not in quest of….you must observe that no discovery of a thing you are looking for comes under this description." I would like to make the case that a children's hospital can be a superb setting in which to attempt this feat-to generate Serendipity. I would also like to convince you that this attribute is absolutely essential to providing the very best care for children. PMID:24439574
Kandel, Jessica J
Objective: To examine the effects of nurse staffing and organizational support for nursing care on nurses' dissatisfaction with their jobs, nurse burnout, and nurse reports of quality of patient care in an international sample of hospitals. Design: Multisite cross-sectional survey Setting: Adult acute-care hospitals in the U.S. (Pennsylvania), Canada (Ontario and British Columbia), England and Scotland. Study Participants: 10319 nurses
Linda H. Aiken; Sean P. Clarke; Douglas M. Sloane
ObjectivesTo determine which of the two methods of case note review provide the most useful and reliable information for reviewing quality of care.DesignRetrospective, multiple reviews of 692 case notes were undertaken using both holistic (implicit) and criterion-based (explicit) review methods. Quality measures were evidence-based review criteria and a quality of care rating scale.SettingNine randomly selected acute hospitals in England.ParticipantsSixteen doctors,
A. Hutchinson; J. E. Coster; K. L. Cooper; A. McIntosh; S. J. Walters; P. A. Bath; M. Pearson; K. Rantell; M. J. Campbell; J. Nicholl; P. Irwin
Quality Of Care For Two Common Illnesses In Teaching And Nonteaching Hospitals Teaching status appears to make a difference, when physicians and nurses assess hospitals' quality of care in four states
Teaching hospitals are recognized for treating rare diseases, but their value in caring for common illnesses is less clear. To assess quality of care for congestive heart failure and pneumonia, we reviewed the medical records of Medicare beneficiaries in major teaching, other teaching, and nonteaching hospitals in four states. Overall quality was rated better in major and other teaching hospitals
John Z. Ayanian; Joel S. Weissman; Scott Chasan-Taber; Arnold M. Epstein
Several studies have found poor or mixed performance by safety net hospitals on national measures of quality. The study's purposes were to determine whether safety net hospital performance is similar to the average U.S. hospital, both currently and during earlier reporting periods, and to summarize features commonly used to assess performance, including definition of safety net and patient characteristics. This study reviewed quality performance data for the Joint Commission's accountability measures for hospitals that are members of the National Association of Public Hospitals and Health Systems (NAPH)-safety net hospitals that serve a large proportion of Medicaid and uninsured patients. Analyses of quality performance on the earliest data show that on average there was no statistically significant difference in performance between NAPH members and other hospitals on 6 of 15 measures. According to the most recent data, NAPH hospitals on average had no statistically significant differences as other hospitals on 13 of 18 measures and had statistically significantly better scores on two measures. These results are an important addition to the literature regarding safety net hospitals that serve a high proportion of Medicaid, low income, and uninsured patients, and support the case that quality of care at safety net hospitals is equivalent to that of non-safety net hospitals. PMID:22192517
Marshall, Lindsey; Harbin, Vanessa; Hooker, Jane; Oswald, John; Cummings, Linda
Evidence shows that hospital-based practices affect breastfeeding duration and exclusivity throughout the first year of life. However, a 2007 CDC survey of US maternity facilities documented poor adherence with evidence-based practice. Of a possible score of 100 points, the average hospital scored only 63 with great regional disparities. Inappropriate provision and promotion of infant formula were common, despite evidence that such practices reduce breastfeeding success. Twenty-four percent of facilities reported regularly giving non-breast milk supplements to more than half of all healthy, full-term infants. Metrics available for measuring quality of breastfeeding care, range from comprehensive Baby-Friendly Hospital Certification to compliance with individual steps such as the rate of in-hospital exclusive breastfeeding. Other approaches to improving quality of breastfeeding care include (1) education of hospital decision-makers (eg, through publications, seminars, professional organization statements, benchmark reports to hospitals, and national grassroots campaigns), (2) recognition of excellence, such as through Baby-Friendly hospital designation, (3) oversight by accrediting organizations such as the Joint Commission or state hospital authorities, (4) public reporting of indicators of the quality of breastfeeding care, (5) pay-for-performance incentives, in which Medicaid or other third-party payers provide additional financial compensation to individual hospitals that meet certain quality standards, and (6) regional collaboratives, in which staff from different hospitals work together to learn from each other and meet quality improvement goals at their home institutions. Such efforts, as well as strong central leadership, could affect both initiation and duration of breastfeeding, with substantial, lasting benefits for maternal and child health. PMID:19752082
Bartick, Melissa; Stuebe, Alison; Shealy, Katherine R; Walker, Marsha; Grummer-Strawn, Laurence M
Knowledge is limited about quality of care (QOC) in rural hospitals, including the smallest hospitals, critical access hospitals. Staff nurses from 7 critical access hospitals identified items important for QOC across 4 levels of care: patients, microsystems, organizations, and environments. Several items were unique to critical access hospitals. Most QOC items were at the microsystem level, yet few of these items are routinely measured. These findings offer beginning evidence about how to advance QOC evaluations in rural hospitals. PMID:23912705
Baernholdt, Marianne; Jennings, Bonnie Mowinski; Lewis, Erica Jeané
Background Patients in American hospitals receive intensive medical treatments. However, when lifesaving treatments are unsuccessful, patients often die in the hospital with distressing symptoms while receiving burdensome care. Systematic measurement of the quality of care planning and symptom palliation is needed. Methods Medical records were abstracted using sixteen Assessing Care of Vulnerable Elders quality indicators within the domains of end of life care and pain management designed to measure the quality of the dying experience for adult decedents hospitalized for at least 3 days between April 2005 and April 2006 (n=496) at a university medical center recognized for providing intensive care for the seriously ill. Results Over half of the patients (mean age 62, 47% female), were admitted to the hospital with end stage disease and 28% were age 75 or older. One third of the patients required extubation from mechanical ventilation prior to death and 15% died while receiving CPR. Overall, patients received recommended care for 70% of applicable indicators (range 25%–100%). Goals of care were addressed in a timely fashion for patients admitted to the ICU approximately half of the time, while pain assessments (94%) and treatments for pain (95%) and dyspnea (87%) were performed with fidelity. Follow-up for distressing symptoms was performed less well than initial assessment and 29% of patients extubated in anticipation of death had documented dyspnea assessments. Conclusions A practical, chart-based assessment identified discrete deficiencies in care planning and symptom palliation that can be targeted to improve care for patients dying in the hospital.
Walling, Anne M.; Asch, Steven M.; Lorenz, Karl A.; Roth, Carol P.; Barry, Tod; Kahn, Katherine L.; Wenger, Neil S.
Some hospital trusts and health authorities consistently outperform others on different dimensions of performance. Why? There is some evidence that “management matters”, as well as the combined efforts of individual clinicians and teams. However, studies that have been conducted on the link between the organisation and management of services and quality of patient care can be criticised both theoretically and
The goal of the study is to examine the effect of market competition and managed care penetration on hospital quality by focusing on one condition (acute myocardial infarction or AMI), in one state (California), during the period 1992 through 1995 (N=306 ...
J. F. O'Leary
Hospitals involve a complex socio-technical health system, where communication failures influence the quality of patient care. Research indicates the importance of social identity and intergroup relationships articulated through power, control, status and competition. This study focused on interspecialty communication among doctors for patients requiring the involvement of multiple specialist departments. The paper reports on an interview study in Australia, framed
David G. Hewett; Bernadette M. Watson; Cindy Gallois; Michael Ward; Barbara A. Leggett
Background With increasing incidence of traumatic fractures, the use of orthopedic intervention such as traction has increased. Inappropriate traction care may cause substantial morbidity and delay the patient rehabilitation. Objectives This study was conducted to evaluate the quality of care for patients with traction in the orthopedic unit of Kashan's Shahid Beheshti Hospital, Kashan, Iran. Patients and Methods This observational study was conducted on 100 patients with traumatic fractures of hip and femur bones who were admitted to Kashan Shahid-Beheshti Hospital during the first 6 months of 2012, and for whom skeletal or skin traction was performed. Data were collected using a checklist including questions about the personal characteristics and 23 items related to care for patients with tractions. These items were in three domains including caring while establishing traction, recording care and patient’s education. Descriptive statistics were calculated and data were analyzed using the independent sample t-test and Pearson correlation coefficient. Results The mean age of patients was 51.16 ± 23.28 years and 66% of them were male. In total, 47% of the patients were treated by skin traction and 53% by skeletal traction. The overall mean score of quality of care was 10.20 ± 2.64. Quality of establishing traction was good in 55% of patients, but the quality of care was poor in the domains of recording care (88%) and patient education (96%). Total mean of quality of care was significantly different between male and female patients (P < 0.02). Conclusions The quality of care of patients with traction was not optimal. Therefore it is necessary to improve measures in this area.
Adib Hajbaghery, Mohsen; Moradi, Tayebeh
The purpose of this study was to describe Japanese hospital nurses' perceptions of the nursing practice environment and examine its association with nurse-reported ability to provide quality nursing care, quality of patient care, and ward morale. A cross-sectional survey design was used including 223 nurses working in 12 acute inpatient wards in a large Japanese teaching hospital. Nurses rated their work environment favorably overall using the Japanese version of the Practice Environment Scale of the Nursing Work Index. Subscale scores indicated high perceptions of physician relations and quality of nursing management, but lower scores for staffing and resources. Ward nurse managers generally rated the practice environment more positively than staff nurses except for staffing and resources. Regression analyses found the practice environment was a significant predictor of quality of patient care and ward morale, whereas perceived ability to provide quality nursing care was most strongly associated with years of clinical experience. These findings support interventions to improve the nursing practice environment, particularly staffing and resource adequacy, to enhance quality of care and ward morale in Japan. PMID:23855754
Anzai, Eriko; Douglas, Clint; Bonner, Ann
OBJECTIVE. This study explores the relationship between quality of care and investment in property, plant, and equipment (PPE) in hospitals. DATA SOURCES. Hospitals' investment in PPE was derived from audited financial statements for the fiscal years 1984-1989. Peer Review Organization (PRO) Generic Quality Screen (GQS) reviews and confirmed failures between April 1989 and September 1990 were obtained from the Massachusetts PRO. STUDY DESIGN. Weighted least squares regression models used PRO GQS confirmed failure rates as the dependent variable, and investment in PPE as the key explanatory variable. DATA EXTRACTION. Investment in PPE was standardized, summed by the hospital over the six years, and divided by the hospital's average number of beds in that period. The number of PRO reviewed cases with one or more GQS confirmed failures was divided by the total number of cases reviewed to create confirmed failure rates. PRINCIPAL FINDINGS. Investment in PPE in Massachusetts hospitals is correlated with GQS confirmed failure rates. CONCLUSIONS. A financial variable, investment in PPE, predicts certain dimensions of quality of care in hospitals.
Levitt, S W
Background While process of care is a valuable dimension of quality, process-of-care-based quality indicators (POC-QIs) are ideally associated with meaningful patient outcomes. The relationship between POC-QIs for hospitalized older patients and functional decline, a relevant outcome for older patients, is unknown. Objective To assess the relationship between POC-QIs for hospitalized elders and functional decline Research Design Observational cohort study. Subjects Hospitalized vulnerable elder patients age 65 or older admitted to a general medicine inpatient service from 1 June 2004 to 1 June 2007. Measures POC-QIs received by hospitalized patients (measured by ACOVE QIs) and functional decline (increased Activities of Daily Living impairments post discharge). Results For 898 vulnerable elder patients, mean adherence to six universally applied quality indicators was 57.8%. After adjustment for factors likely associated with functional decline (comorbidity, vulnerability, baseline functional limitation, number of POC-QIs triggered, length of stay, code status, and interaction between frailty and QI adherence), there was no association between higher quality of care (using the composite score) and increased risk of functional decline. Patients who received a mobility plan were 1.48 (95% CI 1.07-2.05; p=0.017) times more likely to suffer functional decline after discharge. Patients who received an assessment of nutritional status had a lower odds of suffering functional decline after discharge (OR 0.37 (95% CI 0.21-0.64; p<0.001). Conclusions Hospitalized vulnerable elders who receive higher quality of care, as measured by ACOVE QIs, are not less likely to suffer decline after discharge.
Arora, Vineet M.; Plein, Colleen; Chen, Stuart; Siddique, Juned; Sachs, Greg A.; Meltzer, David O.
Background Quality of intrapartum care is an important intervention towards increasing clients’ utilization of skilled attendance at birth and accelerating improvements in newborn’s and maternal survival and wellbeing. Ensuring quality of care is one of the key challenges facing maternal and neonatal services in Uganda. The study assessed quality of intrapartum care services in the general labor ward of the Mulago national referral and teaching hospital in Uganda from clients’ perspective. Methods A cross sectional study was conducted using face to face interviews at discharge with 384 systematically selected clients, who delivered in general labor ward at Mulago hospital during May, 2012. Data analysis was done using STATA Version (10) software. Means and median general index scores for quality of intrapartum care services were calculated. Linear regression models were used to determine factors associated with quality of care. Results Overall, quality of intrapartum care mean index score was 49.4 (standard deviation (sd) 15.46, and the median (interquartile range (IQR)) was 49.1 (37.5–58.9). Median index scores (IQR) per selected quality of care indicators were; dignity and respect 75 (50–87.5); relief of pain and suffering 71.4 (42.8-85.7); information 42.1 (31.6-55.3); privacy and confidentiality 33.3 (1–66.7); and involvement in decision making 16.7 (1–33.3). On average, higher educational level (college/university) (?: 6.81, 95% CI: 0.85-15.46) and rural residence of clients (?: 5.67, 95% CI: 0.95-10.3) were statistically associated with higher quality scores. Conclusion This study has revealed that quality of intrapartum care services from clients’ perspective was low. Improvements should be focused on involving clients in decision making, provision of information about their conditions and care, and provision of privacy and confidentiality. There is also need to improve the number and availability of health care providers in the labor ward.
Introduction The ability of standard operating procedures to improve pre-hospital critical care by changing pre-hospital physician behaviour is uncertain. We report data from a prospective quality control study of the effect on pre-hospital critical care anaesthesiologists’ behaviour of implementing a standard operating procedure for pre-hospital controlled ventilation. Materials and methods Anaesthesiologists from eight pre-hospital critical care teams in the Central Denmark Region prospectively registered pre-hospital advanced airway-management data according to the Utstein-style template. We collected pre-intervention data from February 1st 2011 to January 31st 2012, implemented the standard operating procedure on February 1st 2012 and collected post intervention data from February 1st 2012 until October 31st 2012. We included transported patients of all ages in need of controlled ventilation treated with pre-hospital endotracheal intubation or the insertion of a supraglottic airways device. The objective was to evaluate whether the development and implementation of a standard operating procedure for controlled ventilation during transport could change pre-hospital critical care anaesthesiologists’ behaviour and thereby increase the use of automated ventilators in these patients. Results The implementation of a standard operating procedure increased the overall prevalence of automated ventilator use in transported patients in need of controlled ventilation from 0.40 (0.34-0.47) to 0.74 (0.69-0.80) with a prevalence ratio of 1.85 (1.57-2.19) (p?=?0.00). The prevalence of automated ventilator use in transported traumatic brain injury patients in need of controlled ventilation increased from 0.44 (0.26-0.62) to 0.85 (0.62-0.97) with a prevalence ratio of 1.94 (1.26-3.0) (p?=?0.0039). The prevalence of automated ventilator use in patients transported after return of spontaneous circulation following pre-hospital cardiac arrest increased from 0.39 (0.26-0.48) to 0.69 (0.58-0.78) with a prevalence ratio of 1.79 (1.36-2.35) (p?=?0.00). Conclusion We have shown that the implementation of a standard operating procedure for pre-hospital controlled ventilation can significantly change pre-hospital critical care anaesthesiologists’ behaviour.
There is an ongoing debate about the effect of different reimbursement systems on hospital performance and quality of care. The present paper aims at contributing to this literature by analysing the impact of different hospital payment schemes on patients' outcomes in Italy. The Italian National Health Service is, indeed, a particularly interesting case since it has been subject to a considerable decentralization process with wider responsibilities devolved to regional governments. Therefore, great variability exists in the way tariffs are used, as Regions have settled them in accordance with the characteristics of health care providers. An empirical analysis of the Italian hospital system is carried out using data from the National Program for Outcome Assessment on mortality and readmissions for Acute Myocardial Infarction (AMI), Congestive Heart Failure (CHF), stroke and Chronic Obstructive Pulmonary Diseases (COPD) in the years 2009-2010. The results show that hospitals operating in Regions where prospective payments are used more extensively are generally associated with better quality of care. PMID:23830561
Cavalieri, Marina; Gitto, Lara; Guccio, Calogero
Literature about pacemaker (PM) implantations shows that several clinical and technical factors determine the short- and long-term complications after the intervention. Annual hospital volume, however, does not negatively affect complications in contrast with the cumulative experience of the operator. In view of this observation, the current required number of 20 to 30 first PM implantations for cardiology training does not match standards for quality of care. In addition, concentration of implants and replacement of pacemakers to a limited number of operators per hospital to comply with the increasing demands of patients and other parties has to be seriously considered. PMID:24347235
van Hemel, N M
Background Access to high quality medical care is an important determinant of health outcomes, but the quality of care is difficult to determine. Objective To apply the PRIDIT methodology to determine an aggregate relative measure of hospital quality using individual process measures. Design Retrospective analysis of Medicare hospital data using the PRIDIT methodology. Subjects Four-thousand-two-hundred-seventeen acute care and critical access hospitals that report data to CMS' Hospital Compare database. Measures Twenty quality measures reported in four categories: heart attack care, heart failure care, pneumonia care, and surgical infection prevention and five structural measures of hospital type. Results Relative hospital quality is tightly distributed, with outliers of both very high and very low quality. The best indicators of hospital quality are patients given assessment of left ventricular function for heart failure and patients given ?-blocker at arrival and patients given ?-blocker at discharge for heart attack. Additionally, teaching status is an important indicator of higher quality of care. Conclusions PRIDIT allows us to rank hospitals with respect to quality of care using process measures and demographic attributes of the hospitals. This method is an alternative to the use of clinical outcome measures in measuring hospital quality. Hospital quality measures should take into account the differential value of different quality indicators, including hospital “demographic” variables.
Lieberthal, Robert D
Some hospital trusts and health authorities consistently outperform others on different dimensions of performance. Why? There is some evidence that "management matters", as well as the combined efforts of individual clinicians and teams. However, studies that have been conducted on the link between the organisation and management of services and quality of patient care can be criticised both theoretically and methodologically. A larger, and arguably more rigorous, body of work exists on the performance of firms in the private sector, often conducted within the disciplines of organisational behaviour or human resource management. Studies in these traditions have focused on the effects of decentralisation, participation, innovative work practices, and "complementarities" on outcome variables such as job satisfaction and performance. The aim of this paper is to identify a number of reviews and research traditions that might bring new ideas into future work on the determinants of hospital performance. Ideally, future research should be more theoretically informed and should use longitudinal rather than cross sectional research designs. The use of statistical methods such as multilevel modelling, which allow for the inclusion of variables at different levels of analysis, would enable estimation of the separate contribution that structure and process make to hospital outcomes. Key Words: hospital organisation; hospital performance; management; quality of care
Comparative outcomes data are widely used to monitor quality of care in the cardiovascular area; little is available in the respiratory field. We applied validated methods to compare hospital outcomes for chronic obstructive pulmonary disease (COPD) exacerbation. From the hospital information system, we selected all hospital admissions for COPD exacerbation in Rome (for 2001-2005). Vital status within 30 days was obtained from the municipality mortality register. Each hospital was compared to a pool of hospitals with the lowest adjusted mortality rate (the benchmark). Age, sex and several potential clinical predictors were covariates in logistic regression analysis. 12,756 exacerbated COPD patients were analysed (mean age 74 yrs, 71% males). Diabetes, hypertension, ischaemic heart disease, heart failure and arrhythmia were the most common coexisting conditions. The average crude mortality in the benchmark group was 3.8%; in the remaining population it was 7.5% (range 5.2-17.2%). In comparison with the benchmark, the relative risk of 30-day mortality varied widely across the hospitals (range 1.5-5.9%). A large variability in 30-day mortality after COPD exacerbation exists even considering patients' characteristics. Although these results do not detect mechanisms related to worse outcomes, they may be useful to stimulate providers to revision and improvement of COPD care management. PMID:19840969
Agabiti, N; Belleudi, V; Davoli, M; Forastiere, F; Faustini, A; Pistelli, R; Fusco, D; Perucci, C A
There currently is interest in evaluating medi- cal outcomes based on patient perceptions. However, in the US there may be biases associated with these perceptions because of past marketing activities and other factors, such as facility location. The research question examined is whether perceived overall quality could predict hospital occupancy. To assess this, the quality ratings of 155 local hospitals
JOSEPH A. BOSCARINO
Background: The literature on diagnosis and management prior to transfer paediatric surgical patients to a tertiary care center is scarce. In referral centers, it is common to receive patients previously subjected to inadequate or inappropriate health care. Aim: Analyze the prevalence of misdiagnosis and quality of management in patients before being referred and factors related to misdiagnosis and inadequate management. Design: Prospective, longitudinal, comparative study between patients with appropriate and inappropriate submission diagnosis and between patients with adequate or inadequate treatment. Setting: Third level care hospital, Mexico City. Participants: Newborn to adolescents referred to Paediatric Surgery Department. Intervention(s): None. Main Outcome Measure(s): Misdiagnosis and quality of management prior to being referred. Result: Two hundred patients were evaluated. Correlation between submission diagnosis and final diagnosis showed that 70% were correct and 30% incorrect; 48.5% were properly managed and 51.5% inappropriately managed. Incorrect diagnosis was more frequent when referred from first-or second-level hospitals and in inflammatory conditions. Patients referred by paediatricians had a higher rate of adequate management. Conclusion: We present the frequency of incorrect diagnosis and inadequate patient management in a highly selected population. Sample size should be increased as well as performing these studies in other hospital settings in order to determine whether the results are reproducible.
Cazares-Rangel, Joel; Zalles-Vidal, Cristian; Davila-Perez, Roberto
Contents: The Effects of the DRG-Based Prospective Payment System on Quality of Care for Hospitalized Medicare Patients; Studying the Effects of the DRG-Based Prospective Payment System on Quality of Care; Changes in Sickness at Admission Following the In...
K. L. Kahn D. Draper E. B. Keeler W. H. Rogers L. V. Rubenstein
There is growing international interest in the role that hospital boards of directors play in improving the quality of health care. In England the National Health Service created a program to help boards become more effective at ensuring quality. We sought to evaluate how boards at English hospitals are engaged in quality, and we conducted the first national survey of the governance practices of the chairpersons of English hospitals. The survey was completed by 132 of 171 board chairs. We compared the results to those of a survey of the chairs of US hospital boards that we published in 2010. We found that English board chairs had more expertise in quality-of-care issues and spent a greater proportion of their time on quality of care than their US counterparts. At the same time, the association in England between hospital performance on quality metrics and board engagement in quality was generally not as substantial as was evident in our earlier US survey. English board chairs tend to greatly overestimate the quality performance of their hospitals, much as their US counterparts do. Our analysis suggests that there is room for improvement in both countries to bolster board expertise and focus on key quality metrics, and to hold managers accountable for the delivery of safe, effective health care. PMID:23569047
Jha, Ashish K; Epstein, Arnold M
OBJECTIVE The aim of this study was to explore the relationship between Magnet Recognition® and nurse-reported quality of care. BACKGROUND Magnet® hospitals are recognized for nursing excellence and quality patient outcomes; however, few studies have explored contributing factors for these superior outcomes. METHODS This was a secondary analysis of linked nurse survey data, hospital administrative data, and a listing of American Nurses Credentialing Center Magnet hospitals. Multivariate regressions were modeled before and after propensity score matching to assess the relationship between Magnet status and quality of care. A mediation model assessed the indirect effect of the professional practice environment on quality of care. RESULTS Nurse-reported quality of care was significantly associated with Magnet Recognition after matching. The professional practice environment mediates the relationship between Magnet status and quality of care. CONCLUSION A prominent feature of Magnet hospitals, a professional practice environment that is supportive of nursing, plays a role in explaining why Magnet hospitals have better nurse-reported quality of care.
Stimpfel, Amy Witkoski; Rosen, Jennifer E.; McHugh, Matthew D.
Managed care substantially transformed the U.S. healthcare sector in the last two decades of the twentieth century, injecting price competition among hospitals for the first time in history. However, total HMO enrollment has declined since 2000. This study addresses whether managed care and hospital competition continued to show positive effects on hospital cost and quality performance in the "post-managed care era." Using data for 1,521 urban hospitals drawn from the Healthcare Cost and Utilization Project, we examined hospital cost per stay and mortality rate in relation to HMO penetration and hospital competition between 2001 and 2005, controlling for patient, hospital, and other market characteristics. Regression analyses were employed to examine both cross-sectional and longitudinal variation in hospital performance. We found that in markets with high HMO penetration, increase in hospital competition over time was associated with decrease in mortality but no change in cost. In markets without high HMO penetration, increase in hospital competition was associated with increase in cost but no change in mortality. Overall, hospitals in high HMO penetration markets consistently showed lower average costs, and hospitals in markets with high hospital competition consistently showed lower mortality rates. Hospitals in markets with high HMO penetration also showed lower mortality rates in 2005 with no such difference found in 2001. Our findings suggest that while managed care may have lost its strength in slowing hospital cost growth, differences in average hospital cost associated with different levels of HMO penetration across markets still persist. Furthermore, these health plans appear to put quality of care on a higher priority than before. PMID:23355253
Jiang, H Joanna; Friedman, Bernard; Jiang, Shenyi
Purpose – The purpose of this paper is to explore in a specific hospital care process the applicability in practice of the theories of quality costing and value chains. Design\\/methodology\\/approach – In a retrospective case study an in-depth evaluation of the use of a quality cost model (QCM) and the applicability of Porter's care delivery value chain (CDVC) was performed
Dirk F. de Korne; Thomas Custers; Esther van Sprundel; B. Martin van Ineveld; Hans G. Lemij; Niek S. Klazinga
Over a decade ago it was estimated that in the United States 98,000 patients die each year from hospital acquired conditions (HAC). Recently it has been reported that this many patients now die annually from hospital acquired infections (HAI) alone. Currently, HAI affects 1.7 million U.S. citizens each year. Although these conditions are often called "preventable errors," some are associated with particular hospital and physician cultures, and many of these conditions, such as pressure ulcer formation and infections, may be a sign of low facility staffing levels. Protocols have been developed that have been shown to lower the incidence of many HAC, but these have been slow to be adopted. Voluntary reporting mechanisms to ensure health care quality are reported as having reduced effectiveness by the Joint Commission and U.S. Department of Health and Human Services, Office of Inspector General reports. Transparency and public education have also met with resistance, but in the case of infections now have the support of major national medical organizations. As a further initiative to promote quality, financial incentives have been implemented by the Centers for Medicare and Medicaid Services. Surgeons have lived under stringent financial incentives since the mid-1980s when they were placed under global surgical fees. Medicare currently must make expenditure reductions because it is at risk of becoming insolvent within the decade. Implementation of financial incentives should depend upon a balance between the nonpayment of providers for nonpreventable HAC verses the promotion of health care quality and patient safety, the reduction in patient morbidity and mortality, the spurring of mechanisms to further reduce HAC, and the recouping of taxpayer dollars for HAC that could have been prevented. PMID:21902485
Kavanagh, Kevin T
We present a map of 27 indicators to measure the care quality given to patients with acute coronary syndrome attended in the pre- and hospital area. This includes technical process indicators (registration of care intervals, performance of electrocardiogram, monitoring and vein access, assessment of prognostic risk, hemorrhage and in-hospital mortality, use of reperfusion techniques and performance of echocardiograph), pharmacological process indicators (platelet receptors inhibition, anticoagulation, thrombolysis, beta-blockers, angiotensin converting inhibitors and lipid lowering drugs) and outcomes indicators (quality scales of the care given and mortality). PMID:20451303
Felices-Abad, F; Latour-Pérez, J; Fuset-Cabanes, M P; Ruano-Marco, M; Cuñat-de la Hoz, J; del Nogal-Sáez, F
Hospitals involve a complex socio-technical health system, where communication failures influence the quality of patient care. Research indicates the importance of social identity and intergroup relationships articulated through power, control, status and competition. This study focused on interspecialty communication among doctors for patients requiring the involvement of multiple specialist departments. The paper reports on an interview study in Australia, framed by social identity and communication accommodation theories of doctors' experiences of managing such patients, to explore the impact of communication. Interviews were undertaken with 45 doctors working in a large metropolitan hospital, and were analysed using Leximancer (text mining software) and interpretation of major themes. Findings indicated that intergroup conflict is a central influence on communication. Contested responsibilities emerged from a model of care driven by single-specialty ownership of the patient, with doctors allowed to evade responsibility for patients over whom they had no sense of ownership. Counter-accommodative communication, particularly involving interpersonal control, appeared as important for reinforcing social identity and winning conflicts. Strategies to resolve intergroup conflict must address structural issues generating an intergroup climate and evoke interpersonal salience to moderate their effect. PMID:19846246
Hewett, David G; Watson, Bernadette M; Gallois, Cindy; Ward, Michael; Leggett, Barbara A
Hospitalization represents an ideal time to address tobacco cessation. For a variety of reasons, current users do not always receive appropriate support or treatment during the hospitalization. An improvement team was created to improve the care for the hospitalized tobacco user. The team's aim was to develop a standardized process to increase the assessment, documentation, and delivery of cessation counseling, and increase community referrals upon discharge. After implementation of the project, percentages of hospitalized patients who had their tobacco use status documented in the electronic medical record increased to 80-90%. The percentage of patients admitted with heart failure or pneumonia had their rates of tobacco cessation counseling improved to 82-96%. The care of the hospitalized tobacco user can be improved and sustained by utilizing community resources and creating a team of motivated care providers. This improvement work stimulated the creation of a smoke-free institution and other preventive health measures throughout the institution. PMID:20532725
Liu, Stephen K; Prior, Ellen; Warren, Colleen; Brown, Teresa; Snide, Jennifer; Butterly, John R
This study uses a new paradigm to calculate the min imum and the optimum number of involuntary psychi atric beds at a state hospital in Maine with 5538 admissions over a 7-year period. The method measures quality of care (Q) based upon the accuracy of predic tion of length-of-stay for the hospital, and of commu nity length-of-stay for the community,
George E. Davis; Walter E. Lowell; Geoffrey L. Davis
OBJECTIVE: To understand factors associated with pediatric inpatient safety events, we test 2 hypotheses: (1) scarce resources (as measured by Medicaid burden) in safety-net hospitals relative to non–safety-net hospitals result in higher rates of safety events; and (2) higher levels of severity and more chronic conditions in patient populations lead to higher rates of safety events within hospital category and in children’s hospitals in comparison with non-children’s hospitals. METHODS: All nonnewborn pediatric hospital discharge records, which met criteria for potentially experiencing at least 1 pediatric quality indicator (PDI) event (using Agency for Healthcare Research and Quality’s 2009 Nationwide Inpatient Sample and PDI) and weighted to represent national level estimates, were analyzed for patterns of PDI events within and across hospital categories by using bivariate comparisons and multivariable logit models with robust SEs. The outcome measure “ANY PDI” captures the number of pediatric discharges at the hospital level with 1 or more PDI event. RESULTS: High Medicaid burden does not seem to be a factor in the likelihood of ANY PDI. Severity of illness (adjusted odds ratio high relative to low, 15.12) and presence of chronic conditions (adjusted odds ratio 1 relative to 0, 1.78; relative to 2 or more, 3.38) are the strongest predictors of ANY PDI events. CONCLUSIONS: Our findings suggest that the patient population served, rather than hospital category, best predicts measured quality, underscoring the need for robust risk adjustment when incentivizing quality or comparing hospitals. Thus, problems of quality may not be systemic across hospital categories.
Goudie, Anthony; Smith, Richard B.; Fairbrother, Gerry; Simpson, Lisa A.
Purpose – Despite 77 per cent antenatal care coverage and 90 per cent skilled attendant at delivery, adjusted maternal mortality in Iran is 76 per 100,000 births. Low quality of maternal health services is one cause of maternal morbidity and mortality. However, few and limited studies have been devoted to the quality of postpartum care in Iran. This study aims
M. Simbar; Z. Alizadeh Dibazari; J. Abed Saeidi; H. Alavi Majd
The objective of this study was to analyze hospital staff nurses’ shift length, scheduling characteristics, and nurse reported safety and quality. A secondary analysis of a large nurse survey linked with hospital administrative data was conducted. More than 22 000 registered nurses’ reports of shift length and scheduling characteristics were examined. Extended shift lengths were associated with higher odds of reporting poor quality and safety. Policies aimed at reducing the use of extended shifts may be advisable.
Stimpfel, Amy Witkoski; Aiken, Linda H.
Over the past 50 years, day hospitals have emerged and developed in Western psychiatric services in the process of deinstitutionalization. There is now great diversity in the aims and uses of services that fit under the umbrella term of ‘day hospital care’. The research literature has identified four models of day hospitals, varying from acute or crisis services as an
Jane Briscoe; Stefan Priebe
Background: In developing countries such as Papua New Guinea (PNG), district hospitals play a vital role in clinical care, training health-care workers, implementing immunization and other public health programmes and providing necessary data on disease burdens and outcomes. Pneumonia and neonatal conditions are a major cause of child admission and death in hospitals throughout PNG. Oxygen therapy is an essential component of the management of pneumonia and neonatal conditions, but facilities for oxygen and care of the sick newborn are often inadequate, especially in district hospitals. Improving this area may be a vehicle for improving overall quality of care. Method: A qualitative study of five rural district hospitals in the highlands provinces of Papua New Guinea was undertaken. A structured survey instrument was used by a paediatrician and a biomedical technician to assess the quality of paediatric care, the case-mix and outcomes, resources for delivery of good-quality care for children with pneumonia and neonatal illnesses, existing oxygen systems and equipment, drugs and consumables, infection-control facilities and the reliability of the electricity supply to each hospital. A floor plan was drawn up for the installation of the oxygen concentrators and a plan for improving care of sick neonates, and a process of addressing other priorities was begun. Results: In remote parts of PNG, many district hospitals are run by under-resourced non-government organizations. Most hospitals had general wards in which both adults and children were managed together. Paediatric case-loads ranged between 232 and 840 patients per year with overall case-fatality rates (CFR) of 3-6% and up to 15% among sick neonates. Pneumonia accounts for 28-37% of admissions with a CFR of up to 8%. There were no supervisory visits by paediatricians, and little or no continuing professional development of staff. Essential drugs were mostly available, but basic equipment for the care of sick neonates was often absent or incomplete. Infection control measures were inadequate in most hospitals. Cylinders were the major source of oxygen for the district hospitals, and logistical problems and large indirect costs meant that oxygen was under-utilized. There were multiple electricity interruptions, but hospitals had back-up generators to enable the use of oxygen concentrators. After 6 months in each of the five hospitals, high-dependency care areas were planned, oxygen concentrators installed, staff trained in their use, and a plan was set out for improving neonatal care. Interpretation: If MGD-4 targets for child health are to be met, reducing neonatal mortality and deaths from pneumonia will have to include better quality services in district hospitals. Establishing better oxygen supplies with a systems approach can be a vehicle for addressing other areas of quality and safety in district hospitals. PMID:24621233
Sa'avu, Martin; Duke, Trevor; Matai, Sens
Given an increasingly complex web of financial pressures on providers, studies have examined how hospitals' overall financial health affects different aspects of hospital operations. In our study, we develop an empirical proxy for the concept of soft budget constraint (SBC, Kornai, Kyklos 39:3-30, 1986) as an alternative financial measure of a hospital's overall financial health and offer an initial estimate of the effect of SBCs on hospital access and quality. An organization has a SBC if it can expect to be bailed out rather than shut down. Our conceptual model predicts that hospitals facing softer budget constraints will be associated with less aggressive cost control, and their quality may be better or worse, depending on the scope for damage to quality from noncontractible aspects of cost control. We find that hospitals with softer budget constraints are less likely to shut down safety net services. In addition, hospitals with softer budget constraints appear to have better mortality outcomes for elderly heart attack patients. PMID:19408114
Shen, Yu-Chu; Eggleston, Karen
At the request of Congressman Peter Roskam's office, the VA Office of Inspector General (OIG), Office of Healthcare Inspections conducted an inspection and oversight review to determine the validity of allegations regarding the quality of care received by...
Background Given the high mortality associated with neonatal illnesses and severe malnutrition and the development of packages of interventions that provide similar challenges for service delivery mechanisms we set out to explore how well such services are provided in Kenya. Methods As a sub-component of a larger study we evaluated care during surveys conducted in 8 rural district hospitals using convenience samples of case records. After baseline hospitals received either a full multifaceted intervention (intervention hospitals) or a partial intervention (control hospitals) aimed largely at improving inpatient paediatric care for malaria, pneumonia and diarrhea/dehydration. Additional data were collected to: i) examine the availability of routine information at baseline and their value for morbidity, mortality and quality of care reporting, and ii) compare the care received against national guidelines disseminated to all hospitals. Results Clinical documentation for neonatal and malnutrition admissions was often very poor at baseline with case records often entirely missing. Introducing a standard newborn admission record (NAR) form was associated with an increase in median assessment (IQR) score to 25/28 (22-27) from 2/28 (1-4) at baseline. Inadequate and incorrect prescribing of penicillin and gentamicin were common at baseline. For newborns considerable improvements in prescribing in the post baseline period were seen for penicillin but potentially serious errors persisted when prescribing gentamicin, particularly to low-birth weight newborns in the first week of life. Prescribing essential feeds appeared almost universally inadequate at baseline and showed limited improvement after guideline dissemination. Conclusion Routine records are inadequate to assess newborn care and thus for monitoring newborn survival interventions. Quality of documented inpatient care for neonates and severely malnourished children is poor with limited improvement after the dissemination of clinical practice guidelines. Further research evaluating approaches to improving care for these vulnerable groups is urgently needed. We also suggest pre-service training curricula should be better aligned to help improve newborn survival particularly.
Study objective: This study was conducted to evaluate a quality control program for improving pain treatment in the out-of-hospital setting. Methods: Pain was evaluated for all patients at the beginning (T0) and the end (Tend) of out-of-hospital management. During the first part of the study (part 1, n=108), the administration and choice of analgesics was left to the physician’s discretion.
Agnès Ricard-Hibon; Charlotte Chollet; Sylvie Saada; Bertrand Loridant; Jean Marty
Palliative care is medical care focused on the relief of suffering and support for the best possible quality of life for patients facing serious, life-threatening illness and their families. It aims to identify and address the physical, psychological, and practical burdens of illness. Palliative care may be delivered simultaneously with all appropriate curative and life-prolonging interventions. In practice, palliative care
Diane E. Meier
Within the context of the deinstitutionalization of psychiatric services across Europe in the last 40 years, day hospitals have emerged as a more flexible treatment model. There is great diversity in the uses and aims of day hospitals, with some functioning as an alternative to acute in-patient care, and others for the rehabilitation and support of patients with chronic needs,
Jane Briscoe; Stefan Priebe
Describes the development of a multi-item scale for assessing in-patient perceptions of service quality in an NHS or NHS Trust hospital. Presents evidence of the high reliability of the scale and its factor structure. Five intangible factors emerge: empathy, relationship of mutual respect, dignity, understanding of illness and religious needs, along with two tangible factors: food and physical environment. Results
Anne E. Tomes; Stephen Chee Peng Ng
Objective: The aim of this study was to assess the current status of care provided by the Diabetes Center at Armed Forces Hospital, Southern Region. Materials and Methods: A total of 260 patients were randomly selected from the diabetic patients attending the Diabetes Center. Study tools comprised patients’ data sheets and patients’ interview questionnaire. Results: Two-thirds of the patients were aged 50 years or more. Half of patients had had the disease for less than 10 years. Diet therapy alone was followed by 2.3% of diabetic patients. More than half of patients (56.5%) were on insulin. Most of the diabetic patients were tested for HbA1c at least once per year (88.1%), and 71.5% had their lipid profile done at least once within two years. Low indicators included having a dilated eye examination (35.4%), assessment for nephropathy (28.8%), and having a well-documented foot examination (12.7%). Highest risk HbA1c level (>9.5%) was reached by 38.8% of patients, 48.8% had a low-density lipoprotein level of <130 mg/dl, and 36.5% of patients had controlled blood pressure (?130/80 mmHg). Most patients were satisfied with their interaction with the treating doctor, 41.5% were satisfied with access to treatment. Hypertension was found to be the most frequent comorbidity (38.5%). Conclusion: The quality of services as regard to process and outcome are low at the Diabetes Center. The overall diabetic patients’ satisfaction was high, whereas their satisfaction was low as regards to access to treatment or health professionals.
Al-Arfaj, Ibrahim S.
Improving newborn health and survival is an essential part of progression toward Millennium Development Goal 4 in the World Health Organization Western Pacific and South East Asian regions. Both community and facility-based services are required. Strategies to improve the quality of care provided for newborns in health clinics and district- and referral-level hospitals have been relatively neglected in most countries in the region and in the published literature. Indirect historical evidence suggests that improving facility-based care will be an increasing priority for improving newborn survival in Asia and the Pacific as newborn mortality rates decrease and health systems contexts change. There are deficiencies in many aspects of newborn care, including immediate care and care for seriously ill newborns, which contribute substantially to regional newborn morbidity and mortality. We propose a practical quality improvement approach, based on models and standards of newborn care for primary-, district- and referral-level heath facilities and incorporated within existing maternal, newborn and child health programmes. There are examples where such approaches are being used effectively. There is a need to produce more nurses, community health workers and doctors with skills in care of the well and the sick newborn, and there are World Health Organization models of training to support this, including guidelines on emergency obstetric and newborn care and the Pocket Book of Hospital Care for Children. There are also simple data collection and analysis programmes that can assist in auditing outcomes, problem identification and health services planning. Finally, with increased survival rates there are gaps in follow-up care for newborns at high risk of long-term health and developmental impairments, and addressing this will be necessary to ensure optimal developmental and health outcomes for these children. PMID:23713996
Milner, Kate M; Duke, Trevor; Bucens, Ingrid
Research in healthcare settings reveals important links between work environment factors, burnout and organizational outcomes. Recently, research focuses on work engagement, the opposite (positive) pole from burnout. The current study investigated the relationship of nurse practice environment aspects and work engagement (vigour, dedication and absorption) to job outcomes and nurse-reported quality of care variables within teams using a multilevel design in psychiatric inpatient settings. Validated survey instruments were used in a cross-sectional design. Team-level analyses were performed with staff members (n?=?357) from 32 clinical units in two psychiatric hospitals in Belgium. Favourable nurse practice environment aspects were associated with work engagement dimensions, and in turn work engagement was associated with job satisfaction, intention to stay in the profession and favourable nurse-reported quality of care variables. The strongest multivariate models suggested that dedication predicted positive job outcomes whereas nurse management predicted perceptions of quality of care. In addition, reports of quality of care by the interdisciplinary team were predicted by dedication, absorption, nurse-physician relations and nurse management. The study findings suggest that differences in vigour, dedication and absorption across teams associated with practice environment characteristics impact nurse job satisfaction, intention to stay and perceptions of quality of care. PMID:22962847
Van Bogaert, P; Wouters, K; Willems, R; Mondelaers, M; Clarke, S
Hospital-based comparative effectiveness (CE) centers provide a model that clinical leaders can use to improve evidence-based practice locally. The model is used by integrated health systems outside the US, but is less recognized in the US. Such centers can identify and adapt national evidence-based policies for the local setting, create local evidence-based policies in the absence of national policies, and implement evidence into practice through health information technology (HIT) and quality initiatives. Given the increasing availability of CE evidence and incentives to meaningfully use HIT, the relevance of this model to US practitioners is increasing. This is especially true in the context of healthcare reform, which will likely reduce reimbursements for care deemed unnecessary by published evidence or guidelines. There are challenges to operating hospital-based CE centers, but many of these challenges can be overcome using solutions developed by those currently leading such centers. In conclusion, these centers have the potential to improve the quality, safety and value of care locally, ultimately translating into higher quality and more cost-effective care nationally. To better understand this potential, the current activity and impact of hospital-based CE centers in the US should be rigorously examined.
Williams, Kendal; Brennan, Patrick J.
The purpose of this study was to test the hypothesis that nurse perceptions of technology they use in practice would affect\\u000a their perception that they were able to provide high quality patient care. A survey assessing the variables was administered\\u000a to 337 pediatric nurses from two academic freestanding pediatric hospitals in the US. Two separate equations were constructed,\\u000a one to
Ben-tzion Karsh; Kamisha Escoto; Samuel Alper; Richard Holden; Matthew Scanlon; Kathleen Murkowski; Neal Patel; Theresa Shalaby; Judi Arnold; Rainu Kaushal; Kathleen Skibinski; Roger Brown
Despite substantial improvement in recent years in hospital performance in many quality measures for acute myocardial infarction (AMI), national performance lags in a key publicly reported quality indicator for AMI--door-to-balloon time, the period from patient (with ST-segment elevation myocardial infarction or STEMI) arrival to provision of percutaneous coronary intervention or balloon angioplasty. Previous research has elucidated distinguishing features of hospitals that routinely achieved recommended door-to-balloon times for patients with STEMI. However, what has not been fully explored is how top-performing hospitals handle setbacks during the improvement process. In this study, we used qualitative methods to characterize the range of setbacks in door-to-balloon improvement efforts and the strategies used to address these barriers among hospitals that were ultimately successful in reducing door-to-balloon time to meet clinical guidelines. Setbacks included (1) failure to anticipate and address implications of initial changes in door-to-balloon processes for the system as a whole; (2) tension between and within departments and disciplines, which needed to gain consensus about how to reduce door-to-balloon time; and (3) waning attention to door-to-balloon performance as a top priority after the perceived goal of reducing treatment times had been reached. Our findings demonstrate key aspects of technical capacity, organizational culture, and environmental conditions that were factors in maintaining improvement efforts despite setbacks and hence may be critical to sustaining top performance. Understanding how top-performing hospitals recognize and respond to setbacks can help senior management promote organizational resiliency, leading to an environment in which learning, growth, and quality improvement can be sustained. PMID:18546919
Webster, Tashonna R; Curry, Leslie; Berg, David; Radford, Martha; Krumholz, Harlan M; Bradley, Elizabeth H
Rapid changes in HIV treatment guidelines and antiretroviral therapy drug safety data add to the increasing complexity of caring for HIV-infected patients and amplify the need for continuous quality monitoring. The authors created an electronic HIV database of 642 patients who received care in the infectious disease (ID) and general medicine clinics in their academic center to monitor HIV clinical performance indicators. The main outcome measures of the study include process measures, including a description of how the database was constructed, and clinical outcomes, including HIV-specific quality improvement (QI) measures and primary care (PC) measures. Performance on HIV-specific QI measures was very high, but drug toxicity monitoring and PC-specific QI performance were deficient, particularly among ID specialists. Establishment of HIV QI data benchmarks as well as standards for how data will be measured and collected are needed and are the logical counterpart to treatment guidelines. PMID:22326983
Kerr, Christine A; Neeman, Naama; Davis, Roger B; Schulze, Joanne; Libman, Howard; Markson, Larry; Aronson, Mark; Bell, Sigall K
BACKGROUND: Despite increasing interest and publication of risk-adjusted hospital mortality rates, the relationship with underlying quality of care remains unclear. We undertook a systematic review to ascertain the extent to which variations in risk-adjusted mortality rates were associated with differences in quality of care. METHODS: We identified studies in which risk-adjusted mortality and quality of care had been reported in
David W Pitches; Mohammed A Mohammed; Richard J Lilford
Hospitals today are pressured to move away from the conventional health services management techniques and provide higher-quality health care to survive in intense competition. In our study, we aimed to develop health care evaluation criteria for the mental health care sector based on the existing Malcolm Baldrige National Quality Award model, and verify the causality of the evaluation model to lay groundwork for future research on the outcomes of national quality awards for mental health care. We focused on comparison groups comprising five state-operated mental hospitals in Korea using 92 survey questions derived from the MBNQA criteria for health care through structural equation modeling techniques. We verified that Leadership drives Foundation and Direction, which affect System that creates Results with 15 hypotheses supported out of 18 hypotheses established. We believe our findings will provide valuable implications to the top management of mental hospitals for self-examining quality management and promoting competitiveness. PMID:22015958
Kim, Yang-Kyun; Oh, Hyun-Jong
The present study examined the effects of certain hospital workplace factors on job involvement among healthcare employees\\u000a at the paramedical levels and quality of patient care in public hospitals in North India. The sample consisted of paramedical\\u000a healthcare employees (N?=?200), from a medical college affiliated teaching hospital and public hospitals (non-teaching) run by the railway services.\\u000a Data were analyzed statistically
Manisha Agarwal; Abhishek Sharma
This study tests whether changes in licensed nurse staffing led to changes in patient safety, using the natural experiment of 2004 California implementation of minimum staffing ratios. We calculated counts of six patient safety outcomes from California Patient Discharge Data from 2000 through 2006, using the Agency for Healthcare Research and Quality Patient Safety Indicators (PSI) software. For patients experiencing nonmortality-related PSIs, we measured mean lengths of stay. We estimated difference-in-difference equations of changes in PSIs using Poisson models and calculated the marginal impact of nurse staffing on outcomes from fixed-effect Poisson regressions. Licensed nurse staffing increased in the postregulation period, except for hospitals in the highest quartile of preregulation staffing. Growth in registered nurse staffing was associated with improvement for only one PSI and reduced length of stay for one PSI. Higher registered nurse staffing per patient day had a limited impact on adverse events in California hospitals. PMID:23401064
Spetz, Joanne; Harless, David W; Herrera, Carolina-Nicole; Mark, Barbara A
Describes the development of a multi-item scale for assessing in-patient perceptions of service quality in an NHS or NHS Trust hospital. Presents evidence of the high reliability of the scale and its factor structure. Five intangible factors emerge: empathy, relationship of mutual respect, dignity, understanding of illness and religious needs, along with two tangible factors: food and physical environment. Results in a trial hospital indicate that patients' perceptions meet or exceed expectations in respect of four of the seven factors and 22 of the 49 individual variables. Of concern, however, while possibly not generalizable, must be the unfulfilled expectations in respect of the factors "relationship of mutual respect" and "understanding of illness" and the individual variables relating to the various communications between doctors and patients. Not unexpectedly, dissatisfaction is also expressed with the physical environment. Argues that the situation can only be remedied, usually, by a large injection of cash--an unlikely scenario. PMID:10143994
Tomes, A E; Chee Peng Ng, S
Background Malawi has a high perinatal mortality rate of 40 deaths per 1,000 births. To promote neonatal health, the Government of Malawi has identified essential health care packages for improving maternal and neonatal health in health care facilities. However, regardless of the availability of health services, women’s perceptions of the care is important as it influences whether the women will or will not use the services. In Malawi 95% of pregnant women receive antenatal care from skilled attendants, but the number is reduced to 71% deliveries being conducted by skilled attendants. The objective of this study was to describe women’s perceptions on perinatal care among the women delivered at a district hospital. Methods A descriptive study design with qualitative data collection and analysis methods. Data were collected through face-to-face in-depth interviews using semi-structured interview guides collecting information on women’s perceptions on perinatal care. A total of 14 in depth interviews were conducted with women delivering at Chiradzulu District Hospital from February to March 2011. The women were asked how they perceived the care they received from health workers during antepartum, intrapartum and postpartum. They were also asked about the information they received during provision of care. Data were manually analyzed using thematic analysis. Results Two themes from the study were good care and unsatisfactory care. Subthemes under good care were: respect, confidentiality, privacy and normal delivery. Providers’ attitude, delay in providing care, inadequate care, and unavailability of delivery attendants were subthemes under unsatisfactory care. Conclusions Although the results show that women wanted to be well received at health facilities, respected, treated with kindness, dignity and not shouted at, they were not critical of the care they received. The women did not know the quality of care to expect because they were not well informed. The women were not critical of the care they received because they were not aware of the standard of care. Instead they had low expectations. Health workers have a responsibility to inform women and their families about the care that women should expect. There is also a need for standardization of the antenatal information that is provided.
The aim of the present study was to verify the important factors of tacesics that should be observed while touching the elderly. This qualitative and exploratory field of study was developed using 117 undergraduate students and healthcare professionals who participated in a training course regarding nonverbal communication in gerontology. The results revealed that the majority of the participants were able to identify at least one care factor that must be respected when touching the elderly. The discourses allowed for the construction of nine categories indicating the conditions that are necessary for high-quality affective care provided within the tacesics context; these conditions included the authorization for the touch to occur, location of the touch, intensity of the touch, condition of the elderly person, intentionality and type of touch, duration of the touch, gender and age of the person who touches and of the person being touched, frequency of the touch, and characteristics of the hands that touch. Touch is part of the quotidian practice of healthcare professionals and expresses their dedication and its related emotions, thereby revealing the quality of the care that is provided. PMID:23743911
Schimidt, Teresa Cristina Gioia; da Silva, Maria Julia Paes
Quality assurance is a backbone for the provision of health care. This has lead to the introduction of systems to evaluate and improve patient care. Currently, a 29-category monitoring is mandatory for all German hospitals (EQS, Einrichtungsübergreifende Qualitätssicherung). Since 2007, the incidence rate of pressure ulcers as an indicator for quality of care has been incorporated. A concern associated with the EQS is the requirement for active data entry by doctors and nurses, whereas the US-based patient safety indicator "PSI 3 - pressure ulcer" relies on routine clinical data without the need for additional documentation. In this study, we perform a head-to-head comparison of the 2 methods and analyze the feasibility of implementing the PSI 3 system in German hospitals on the example of pressure ulcer incidence in a German academic hospital. Our analysis shows that the usage of the PSI 3 is feasible. In particular, all clinical data are readily available. Critical advantages of the PSI 3 include the low time consumption and the positive economic impact due to increased work-flow. A prerequisite for the accuracy of the PSI 3 is the careful distinction and documentation of whether a condition (in our case: pressure ulcers) is pre-existing or hospital-acquired. In this regard, the accurate documentation of admission diagnoses is a potential weakness because these are not essential for reimbursement from health insurances and thus tend to be less well documented. In the US and Australia this problem has been addressed by introducing "present on admission" tabs into patient records. In conclusion, our study demonstrates that the usage of a quality assurance system based on routinely acquired clinical data in German hospitals is feasible, and encourages further evaluation. PMID:20859847
Theisen, S; Drabik, A; Lüngen, M; Stock, S
Introduction: The clean bedding and clean clothes installs psychological confidence in the patients and the public and enhances their faith in the services rendered by the hospital. Being an important Component in the management of the patients, a study was carried out to find out the current quality status and its conformity with the known standards and identify the areas of intervention in order to further increase the patient and staff satisfaction regarding the services provided by linen and laundry department Methods: Quality control practised in the Linen and Laundry Service was studied by conducting a prospective study on the concept of Donabedian model of structure, process and outcome. Study was done by pre-designed Proforma along with observation / Interviews / Questionnaire and study of records. The input studied included physical facilities, manpower, materials, equipments and environmental factors. The various elements of manpower studied consisted of number of staff working, their qualification, training, promotion avenues, motivation and job satisfaction. Process was studied by carrying out observations in linen and laundry service through a predesigned flow chart which was supplemented by interviews with different category of staff. Patient satisfaction, staff satisfaction and microbial count of laundered linen (quality dimensions) were studied in the outcome. Results: The current study found that in spite of certain deficiencies in the equipment, manpower and process, the linen and laundry service is providing a satisfactory service to its users. However the services can be further improved by removing the present deficiencies both at structure and process level.
Singh, Dara; Qadri, GJ; Kotwal, Monica; Syed, AT; Jan, Farooq
BACKGROUND: Sleep disorder is one of the common problems patients face in ICU and CCU and it is usually treated by sleeping pills. Nowadays, the complementary medicine is highly considered because of its effectiveness and safety. Aromatherapy is one of the holistic nursing cares which sees human beings as a biological, mental and social unit while the psychological dimension has the central role. Each of these dimensions is dependent on each other and is affected by each other. Therefore, it is fundamental for nurses to provide aromatherapy in their clinical performance. Aromatherapy helps treatment of diseases by using vegetable oils and it seems to be effective in reducing sleeplessness. METHODS: This was a clinical trial on 64 patients (male and female) hospitalized in CCU in Al-zahra and Chamran hospitals. The intervention included 3 nights, each time 9 hours aromatherapy with lavender oil for the experiment group, while the controls received no intervention. Both groups filled out the SMHSQ that includes 11 items to assess sleep quality before and after intervention. RESULTS: Data analysis showed that the mean scores of sleep quality in the two groups of experiment and control were significantly different after the aromatherapy with lavender oil (p < 0.001). CONCLUSIONS: Quality of sleep in ischemic heart disease patients was significantly improved after aromatherapy with lavender oil. Therefore, using aromatherapy can improve the quality of their sleep and health.
Moeini, Mahin; Khadibi, Maryam; Bekhradi, Reza; Mahmoudian, Seyed Ahmad; Nazari, Fatemeh
Purpose – Quality improvement of reproductive health care has been announced as one of five global strategies to accelerate progress toward reproductive health goals. The World Health Organization emphasises the evaluation of structure, procedure and outcome of health services to improve quality of care. This study aims to assess the quality of provided care in labour and delivery units in
Masoumeh Simbar; Farideh Ghafari; Shahnaz Tork Zahrani; Hamid Alavi Majd
OBJECTIVE: To analyze whether elderly patients who are black or from poor neighborhoods receive worse hospital care than other patients, taking account of hospital effects and using validated measures of quality of care. DESIGN: We compare quality of care provided to insured, hospitalized Medicare patients who are black or live in poor neighborhoods as compared with others, using simple and
Marjorie L. Pearson; Ellen R; Katherine A; William H; Robert H. Brook; Emmett B. Keeler
The spate of hospital consolidations that occurred in the late 1990s and early 2000s had a profound impact on the US hospital industry. However, only two published studies using data from five states examined the effects of these consolidations on inpatient quality of care. This paper examines the impacts of hospital consolidations that occurred in 1999 and 2000 in 16
Ryan L. Mutter; Patrick S. Romano; Herbert S. Wong
Context: Epilepsy is associated with profound physical, psychological, and social consequences. Aims: To assess the quality of life (QOL) among people with epilepsy attending the outpatient department of a secondary care hospital and to determine the various social and demographic factors affecting it. Materials and Methods: The QOL of 100 people with epilepsy attending the outpatient department of a community-based secondary care hospital was assessed using the WHOQOL-BREF (WHOQOL: World Health Organization QOL) questionnaire. Univariate analysis and logistic regression was done to determine the factors associated with poor QOL. Results: The QOL scores for all the domains ranged between 15.7 and 74.55 with a mean score of 51.49 [standard deviation (SD) 12.3]. The mean scores in the physical, psychological, social, and environmental domains were 55.7, 37.92, 57.75, and 50.56, respectively. Age more than 30 years [odds ratio (OR): 4.33, 95% confidence interval (CI): 1.73-10.82], female gender (OR: 2.90, 95% CI: 1.16-7.28), and currently married (OR: 3.82, 95% CI: 1.21-12.11) were the factors significantly associated with lower QOL scores. Conclusions: The QOL among people with epilepsy was lower in the psychological domain. Age more than 30 years, female gender, and being married were identified as the factors associated with poor QOL scores among people with seizure disorders.
Ashwin, M; Rakesh, PS; Pricilla, Ruby A; Manjunath, K; Jacob, KS; Prasad, Jasmin
Objective The Medicare and Premier Inc. Hospital Quality Incentive Demonstration (HQID), a hospital-based pay-for-performance program, changed its incentive design from one rewarding only high performance (Phase 1) to another rewarding high performance, moderate performance, and improvement (Phase 2). We tested whether this design change reduced the gap in incentive payments among hospitals treating patients across the gradient of socioeconomic disadvantage. Data To estimate incentive payments in both phases, we used data from the Premier Inc. website and from Medicare Provider Analysis and Review files. We used data from the American Hospital Association Annual Survey and Centers for Medicare and Medicaid Services Impact File to identify hospital characteristics. Study Design Hospitals were divided into quartiles based on their Disproportionate Share Index (DSH), from lowest disadvantage (Quartile 1) to highest disadvantage (Quartile 4). In both phases of the HQID, we tested for differences across the DSH quartiles for three outcomes: (1) receipt of any incentive payments; (2) total incentive payments; and (3) incentive payments per discharge. For each of the study outcomes, we performed a hospital-level difference-in-differences analysis to test whether the gap between Quartile 1 and the other quartiles decreased from Phase 1 to Phase 2. Principal Findings In Phase 1, there were significant gaps across the DSH quartiles for the receipt of any payment and for payment per discharge. In Phase 2, the gap was not significant for the receipt of any payment, but it remained significant for payment per discharge. For the receipt of any incentive payment, difference-in-difference estimates showed significant reductions in the gap between Quartile 1 and the other quartiles (Quartile 2, 17.5 percentage points [p < .05]; Quartile 3, 18.1 percentage points [p < .01]; Quartile 4, 28.3 percentage points [p < .01]). For payments per discharge, the gap was also significantly reduced between Quartile 1 and the other quartiles (Quartile 2, $14.92 per discharge [p < .10]; Quartile 3, $17.34 per discharge [p < .05]; Quartile 4, $21.31 per discharge [p < .01]). There were no significant reductions in the gap for total payments. Conclusions The design change in the HQID reduced the disparity in the receipt of any incentive payment and for incentive payments per discharge between hospitals caring for the most and least socioeconomically disadvantaged patient populations.
Ryan, Andrew M; Blustein, Jan; Doran, Tim; D Michelow, Marilyn; Casalino, Lawrence P
Background. Development of a pediatric palliative care program was preceded by a needs assess- ment that included a staff survey and family interviews regarding improving pediatric palliative care. Methods. Four hundred forty-six staff members and community physicians responded to a written survey regarding comfort and expertise in delivering end of life care. Sixty-eight family members of 44 deceased children were
Nancy A. Contro; Judith Larson; Sarah Scofield; Barbara Sourkes; Harvey J. Cohen
Payer-driven competition has been widely advocated as a means of increasing efficiency in health care markets. The 1990s reforms to the UK health service followed this path. We examine whether competition led to better outcomes for patients, as measured by death rates after treatment following heart attacks. Using data that until 1999 was not publicly available in any form on
Carol Propper; Simon Burgess; Katherine Green
Over a decade ago it was estimated that in the United States 98,000 patients die each year from hospital acquired conditions (HAC). Recently it has been reported that this many patients now die annually from hospital acquired infections (HAI) alone. Currently, HAI affects 1.7 million U.S. citizens each year. Although these conditions are often called “preventable errors,” some are associated
Kevin T. Kavanagh
... Reauthorization Act (CHIPRA) National Evaluation of the Quality Demonstration Grant Program CHIPRA Archives Impact Case Studies Child ... AHRQ publishes first evaluation highlight on CHIPRA quality demonstration grant program AHRQ free online tutorials teach how ...
Introduction: No studies have systematically asked larger groups of health professionals about their own experience as patients. This study estimated the level of satisfaction with hospital care among health professionals based on experience from their own hospital admission or that of a close family member. Methodology: A cross-sectional questionnaire study of 1995 doctors (41% women) and 1472 nurses (98% women)
Finn Gyntelberg; Poul Suadicani; Bo Andreassen Rix; Peder Skov; Poul Ebbe Nielsen; Erik Juhl
Objective The objective of this study was to describe the involvement of patients or their representatives in quality management (QM) functions and to assess associations between levels of involvement and the implementation of patient-centred care strategies. Design A cross-sectional, multilevel study design that surveyed quality managers and department heads and data from an organizational audit. Setting Randomly selected hospitals (n = 74) from seven European countries (The Czech Republic, France, Germany, Poland, Portugal, Spain and Turkey). Participants Hospital quality managers (n = 74) and heads of clinical departments (n = 262) in charge of four patient pathways (acute myocardial infarction, stroke, hip fracture and deliveries) participated in the data collection between May 2011 and February 2012. Main Outcome Measures Four items reflecting essential patient-centred care strategies based on an on-site hospital visit: (1) formal survey seeking views of patients and carers, (2) written policies on patients' rights, (3) patient information literature including guidelines and (4) fact sheets for post-discharge care. The main predictors were patient involvement in QM at the (i) hospital level and (ii) pathway level. Results Current levels of involving patients and their representatives in QM functions in European hospitals are low at hospital level (mean score 1.6 on a scale of 0 to 5, SD 0.7), but even lower at departmental level (mean 0.6, SD 0.7). We did not detect associations between levels of involving patients and their representatives in QM functions and the implementation of patient-centred care strategies; however, the smallest hospitals were more likely to have implemented patient-centred care strategies. Conclusions There is insufficient evidence that involving patients and their representatives in QM leads to establishing or implementing strategies and procedures that facilitate patient-centred care; however, lack of evidence should not be interpreted as evidence of no effect.
Groene, Oliver; Sunol, Rosa; Klazinga, Niek S.; Wang, Aolin; Dersarkissian, Maral; Thompson, Caroline A.; Thompson, Andrew; Arah, Onyebuchi A.; Klazinga, N; Kringos, DS; Lombarts, MJMH; Plochg, T; Lopez, MA; Secanell, M; Sunol, R; Vallejo, P; Bartels, P; Kristensen, S; Michel, P; Saillour-Glenisson, F; Vlcek, F; Car, M; Jones, S; Klaus, E; Bottaro, S; Garel, P; Saluvan, M; Bruneau, C; Depaigne-Loth, A; Shaw, C; Hammer, A; Ommen, O; Pfaff, H; Groene, O; Botje, D; Wagner, C; Kutaj-Wasikowska, H; Kutryba, B; Escoval, A; Livio, A; Eiras, M; Franca, M; Leite, I; Almeman, F; Kus, H; Ozturk, K; Mannion, R; Arah, OA; DerSarkissian, M; Thompson, CA; Wang, A; Thompson, A
Background Despite increasing interest and publication of risk-adjusted hospital mortality rates, the relationship with underlying quality of care remains unclear. We undertook a systematic review to ascertain the extent to which variations in risk-adjusted mortality rates were associated with differences in quality of care. Methods We identified studies in which risk-adjusted mortality and quality of care had been reported in more than one hospital. We adopted an iterative search strategy using three databases – Medline, HealthSTAR and CINAHL from 1966, 1975 and 1982 respectively. We identified potentially relevant studies on the basis of the title or abstract. We obtained these papers and included those which met our inclusion criteria. Results From an initial yield of 6,456 papers, 36 studies met the inclusion criteria. Several of these studies considered more than one process-versus-risk-adjusted mortality relationship. In total we found 51 such relationships in a widen range of clinical conditions using a variety of methods. A positive correlation between better quality of care and risk-adjusted mortality was found in under half the relationships (26/51 51%) but the remainder showed no correlation (16/51 31%) or a paradoxical correlation (9/51 18%). Conclusion The general notion that hospitals with higher risk-adjusted mortality have poorer quality of care is neither consistent nor reliable.
Pitches, David W; Mohammed, Mohammed A; Lilford, Richard J
Objective To examine the association between the scope of quality improvement (QI) implementation in hospitals and hospital performance on selected indicators of clinical quality. Data Sources Secondary data from 1997 mailed survey of hospital QI practices, Medicare Inpatient Database, American Hospital Association's Annual Survey of Hospitals, the Bureau of Health Professions' Area Resource File, and two proprietary data sets compiled by Solucient Inc. containing data on managed care penetration and hospital financial performance. Study Design Cross-sectional study of 1,784 community hospitals to assess relationship between QI implementation approach and six hospital-level quality indicators. Data Collection/Abstraction Methods Two-stage instrumental variables estimation in which predicted values (instruments) of four QI scope variables and control (exogenous) variables used to estimate hospital-level quality indicators. Principal Findings Involvement by multiple hospital units in QI effort is associated with worse values on hospital-level quality indicators. Percentage of hospital staff and percentage of senior managers participating in formally organized QI teams are associated with better values on quality indicators. Percentage of physicians participating in QI teams is not associated with better values on the hospital-level quality indicators studied. Conclusions Results supported the proposition that the scope of QI implementation in hospitals is significantly associated with hospital-level quality indicators. However, the direction of the association varied across different measures of QI implementation scope.
Weiner, Bryan J; Alexander, Jeffrey A; Shortell, Stephen M; Baker, Laurence C; Becker, Mark; Geppert, Jeffrey J
This document corrects technical and typographical errors in the proposed rule that appeared in the May 11, 2012 Federal Register entitled ``Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Fiscal Year 2013 Rates; Hospitals' Resident Caps for Graduate Medical Education Payment Purposes; Quality......
This document corrects technical errors in the correcting document that appeared in the October 3, 2012 Federal Register entitled ``Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long Term Care Hospital Prospective Payment System and Fiscal Year 2013 Rates; Hospitals' Resident Caps for Graduate Medical Education Payment Purposes; Quality......
This document corrects technical and typographical errors in the proposed rule that appeared in the May 10, 2013 Federal Register titled ``Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long Term Care Hospital Prospective Payment System and Proposed Fiscal Year 2014 Rates; Quality Reporting Requirements for Specific Providers; Hospital Conditions......
The subvention from the government for public health care system hospitals will decrease in Finland 1993. This causes that in future hospitals will work more like private enterprises. Expenses have to be covered by incomes from sales of health care services. Hospitals have to be able to estimate the demand of their services and the situation caused by the competition. They have to be able to create new profile and also be able to market their services. The presupposition for all things mentioned above is the creativity of people working in different wards. Creativity helps to obtain the same or even better quality of services with smaller resources. PMID:8427951
Miettinen, M; Miettinen, S
Background The prevalence and implementation of institutional end-of-life policies has been comprehensively studied in Flanders, Belgium, a country where euthanasia was legalised in 2002. Developing end-of-life policies in hospitals is a first step towards improving the quality of medical decision-making at the end-of-life. Implementation of policies through quality assessments, communication and the training and education of health care providers is equally important in improving actual end-of-life practice. The aim of the present study is to report on the existence and nature of end-of-life policy implementation activities in Flemish acute hospitals. Methods A cross-sectional mail survey was sent to all acute hospitals (67 main campuses) in Flanders (Belgium). The questionnaire asked about hospital characteristics, the prevalence of policies on five types of end-of-life decisions: euthanasia, palliative sedation, alleviation of symptoms with possible life-shortening effect, do-not-resuscitate decision, and withdrawing or withholding of treatment, the internal and external communication of these policies, training and education on aspects of end-of-life care, and quality assessments of end-of-life care on patient and family level. Results The response rate was 55%. Results show that in 2007 written policies on most types of end-of-life decisions were widespread in acute hospitals (euthanasia: 97%, do-not-resuscitate decisions: 98%, palliative sedation: 79%). While standard communication of these policies to health care providers was between 71% and 91%, it was much lower to patients and/or family (between 17% and 50%). More than 60% of institutions trained and educated their caregivers in different aspects on end-of-life care. Assessment of the quality of these different aspects at patient and family level occurred in 25% to 61% of these hospitals. Conclusions Most Flemish acute hospitals have developed a policy on end-of-life practices. However, communication, training and the education of health care providers about these policies is not always provided, and quality assessment tools are used in less than half of the hospitals.
The care of people who die in hospitals is often suboptimal. Involving patients in decisions about their care is seen as one way to improve care outcomes. Federal and state government policymakers in Australia are promoting shared decision making in acute care hospitals as a means to improve the quality of end-of-life care. If policy is to be…
Sorensen, Ros; Iedema, Rick
Do differences in rates of use among managed care and Fee-for-Service Medicare beneficiaries reflect selection bias or successful care management by insurers? I demonstrate a new method to estimate the treatment effect of insurance status on health care utilization. Using clinical information and risk-adjustment techniques on data on acute admission that are unrelated to recent medical care, I create a proxy measure of unobserved health status. I find that positive selection accounts for between one-quarter and one-third of the risk-adjusted differences in rates of hospitalization for ambulatory care sensitive conditions and elective procedures among Medicare managed care and Fee-for-Service enrollees in 7 years of Healthcare Cost and Utilization Project State Inpatient Databases from Arizona, Florida, New Jersey and New York matched to Medicare enrollment data. Beyond selection effects, I find that managed care plans reduce rates of potentially preventable hospitalizations by 12.5 per 1,000 enrollees (compared to mean of 46 per 1,000) and reduce annual rates of elective admissions by 4 per 1,000 enrollees (mean 18.6 per 1,000).
Nicholas, Lauren Hersch
Inpatient Care Intensity And Patients' Ratings Of Their Hospital Experiences: What could explain the fact that Americans with chronic illnesses who receive less hospital care report better hospital experiences?
The intensity of hospital care provided to chronically ill Medicare patients varies greatly among regions, independent of illness. We examined the associations among hospital care intensity, the technical quality of hospital care, and patients’ ratings of their hospital experiences. Greater inpatient care intensity was associated with lower quality scores and lower patient ratings; lower quality scores were associated with lower patient ratings. The common thread linking greater care intensity with lower quality and less favorable patient experiences may be poorly coordinated care.
Bronner, Kristen; Skinner, Jonathan S.; Fisher, Elliott S.; Goodman, David C.
The Institute of Medicine (IOM) defines quality of care as "the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge." In 1999, the IOM issued Ensuring Quality Cancer Care, a report that documented significant gaps in the quality of cancer care in the United States.
Objective To use an advance in data envelopment analysis (DEA) called congestion analysis to assess the trade-offs between quality and efficiency in U.S. hospitals. Study Setting Urban U.S. hospitals in 34 states operating in 2004. Study Design and Data Collection Input and output data from 1,377 urban hospitals were taken from the American Hospital Association Annual Survey and the Medicare Cost Reports. Nurse-sensitive measures of quality came from the application of the Patient Safety Indicator (PSI) module of the Agency for Healthcare Research and Quality (AHRQ) Quality Indicator software to State Inpatient Databases (SID) provided by the Healthcare Cost and Utilization Project (HCUP). Data Analysis In the first step of the study, hospitals’ relative output-based efficiency was determined in order to obtain a measure of congestion (i.e., the productivity loss due to the occurrence of patient safety events). The outputs were adjusted to account for this productivity loss, and a second DEA was performed to obtain input slack values. Differences in slack values between unadjusted and adjusted outputs were used to measure either relative inefficiency or a need for quality improvement. Principal Findings Overall, the hospitals in our sample could increase the total amount of outputs produced by an average of 26 percent by eliminating inefficiency. About 3 percent of this inefficiency can be attributed to congestion. Analysis of subsamples showed that teaching hospitals experienced no congestion loss. We found that quality of care could be improved by increasing the number of labor inputs in low-quality hospitals, whereas high-quality hospitals tended to have slack on personnel. Conclusions Results suggest that reallocation of resources could increase the relative quality among hospitals in our sample. Further, higher quality in some dimensions of care need not be achieved as a result of higher costs or through reduced access to health care.
Valdmanis, Vivian G; Rosko, Michael D; Mutter, Ryan L
The Paul Coverdell National Acute Stroke Registry prototypes baseline data collection demonstrated a significant gap in the use of evidenced-based interventions. Barriers to the use of these interventions can be characterized as relating to lack of knowledge, attitudes, and ineffective behaviors and systems. Quality improvement programs can address these issues by providing didactic presentations to disseminate the science and peer interactions to address the lack of belief in the evidence, guidelines, and likelihood of improved patient outcomes. Even with knowledge and intention to provide evidenced-based care, the absence of effective systems is a significant behavioral barrier. A program for quality improvement that includes multidisciplinary teams of clinical and quality improvement professionals has been successfully used to carry out redesign of stroke care delivery systems. Teams are given a methodology to set goals, test ideas for system redesign, and implement those changes that can be successfully adapted to the hospital's environment. Bringing teams from several hospitals together substantially accelerates the process by sharing examples of successful change and by providing strategies to support the behavior change necessary for the adoption of new systems. The participation of many hospitals also creates momentum for the adoption of change by demonstrating observable and successful improvement. Data collection and feedback are useful to demonstrate the need for change and evaluate the impact of system change, but improvement occurs very slowly without a quality improvement program. This quality improvement framework provides hospitals with the capacity and support to redesign systems, and has been shown to improve stroke care considerably, when coupled with an Internet-based decision support registry, and at a much more rapid pace than when hospitals use only the support registry. PMID:17178313
LaBresh, Kenneth A
The Inpatient Prospective Payment System proposed rule for fiscal 2015 continues the Centers for Medicare & Medicaid Services' move toward basing reimbursement on quality of care, not quantity. The rule also asks for public input on the two-midnight rule and a policy to address short-stay patients. CMS is implementing the Hospital-Acquired Condition Reduction Program, which penalizes hospitals that perform poorly. The agency proposes to add two safety measures to value-based purchasing in the future. PMID:24946382
Background: Maternal health improvement is one of the eight goals of the third millennium development, set in 2000. Pregnancy complications are the most important causes of maternal mortality worldwide. Proper and qualified health care access is one the most important factors for reducing maternal and neonatal mortality rates. Objectives: This study aimed to determine quality of peripartum care in Lorestan province in 2013. Materials and Methods: This was a descriptive cross-sectional study, in which quality of peripartum care was assessed among 200 women (sample size was determined according to other studies), referred to Lorestan province public hospitals. Quality assessment according to the WHO was used for the framework of structure, process and outcome. Data was collected by a researcher-made checklist, developed based on the administered instructions by Iran Health Ministry. The checklists were filled by observation. The calculated quality scores were expressed as percentage. SPSS version 18 was used for data analysis. Results: The mean percentages of compatibility with desirable situation were 54%, 57% and 66% in first, second and third stage of labor, respectively. The lowest scores were related to: Leopold maneuvers in the first stage, hand washing in the second stage and pulse control in the third stage of labor. Conclusions: Quality of peripartum care is moderate in Lorestan province, therefore, continuous evaluation of quality of care by administrators and hospital staff is essential to improve this quality and will ultimately result in maternal and neonatal health improvement.
Changaee, Farahnaz; Simbar, Masoumeh; Irajpour, Alireza; Akbari, Soheyla
Background Rising national cesarean section rates (CSRs) and unexplained inter-hospital differences in CSRs, led national and international bodies to select CSR as a quality indicator. Using hospital discharge abstracts, we aimed to document in Belgium (1) inter-hospital differences in CSRs among low risk deliveries, (2) a national upward CSR trend, (3) lack of better neonatal outcomes in hospitals with high CSRs, and (4) possible under-use of CS. Methods We defined a population of low risk deliveries (singleton, vertex, full-term, live born, <4500 g, >2499 g). Using multivariable logistic regression techniques, we provided degrees of evidence regarding the observed departure ([relative risk-1]*100) of each hospital (N = 107) from the national CSR and its trend. To determine a benchmark, we defined three CSR groups (high, average and low) and compared them regarding 1 minute Apgar scores and other neonatal endpoints. An anonymous feedback is provided to the hospitals, the College of Physicians (with voluntary disclosure of the outlying hospitals for quality improvement purposes) and to the policy makers. Results Compared with available information, the completeness and accuracy of the data, regarding the variables selected to determine our study population, showed adequate. Important inter-hospital differences were found. Departures ranged from -65% up to +75%, and 9 "high CSR" and 13 "low CSR" outlying hospitals were identified. We observed a national increasing trend of 1.019 (95%CI [1.015; 1.022]) per semester, adjusted for age groups. In the "high CSR" group 1 minute Apgar scores < 4 were over-represented in the subgroup of vaginal deliveries, suggesting CSs not carried out for medical reasons. Under-use of CS was also observed. Given their questionable completeness, except Apgar scores, our neonatal results, showing a significant association of CS with adverse neonatal endpoints, are to be cautiously interpreted. Taking the available evidence into account, the "Average CSR" group seemed to be the best benchmark candidate. Conclusion Rather than firm statements about quality of care, our results are to be considered a useful screening. The inter-hospital differences in CSR, the national CS upward trend, the indications of over-use and under-use, the geographically different obstetric patterns and the admission day-related concentration of deliveries, whether or not by CS, may trigger initiatives aiming at improving quality of care.
Aelvoet, Willem; Windey, Francis; Molenberghs, Geert; Verstraelen, Hans; Van Reempts, Patrick; Foidart, Jean-Michel
Results: Hospital-at-home care was feasible and efficacious in delivering hospital-level care to patients at home. In 2 of 3 sites studied, 69% of patients who were offered hospital-at-home care chose it over acute hospital care; in the third site, 29% of patients chose hospital-at-home care. Although less procedurally oriented than acute hospital care, hospital-at-home care met quality stan- dards at
Bruce Leff; Lynda Burton; Scott L. Mader; Bruce Naughton; Jeffrey Burl; Sharon K. Inouye; William B. Greenough III; Susan Guido; Christopher Langston; Kevin D. Frick; Donald Steinwachs; John R. Burton
Objective To determine the extent to which hospitals vary in the use of intensive care, and the proportion of variation attributable to differences in hospital practice that is independent of known patient and hospital factors. Data source Hospital discharge data in the State Inpatient Database for Maryland and Washington states in 2006. Study design Cross sectional analysis of 90 short-term acute, care hospitals with critical care capabilities. Data collection/methods We quantified the proportion of variation in intensive care use attributable to hospitals using intraclass correlation coefficients derived from mixed effects logistic regression models after successive adjustment for known patient and hospital factors. Principal findings The proportion of hospitalized patients admitted to an ICU across hospitals ranged from 3% to 55% (median 12%; IQR:9, 17%). After adjustment for patient factors, 19.7% (95%CI: 15.1, 24.4) of total variation in ICU use across hospitals was attributable to hospitals. When observed hospital characteristics were added, the proportion of total variation in intensive care use attributable to unmeasured hospital factors decreased by 26% to 14.6% (95% CI:11, 18.3%). Conclusions Wide variability exists in the use of intensive care across hospitals, not attributable to known patient or hospital factors, and may be a target to improve efficiency and quality of critical care.
Seymour, Christopher W.; Iwashyna, Theodore I.; Ehlenbach, William J.; Wunsch, Hannah; Cooke, Colin R.
Although there are quite good examples of quality management in Swiss hospitals available (the guidelines of quality management in the Swiss hospital etc.), the distribution of measures of quality assurance in Swiss hospitals is insufficient and focuses more on Hotel services and technical equipment rather than on the care by physicians and nurses. Beginning with Jan. 1, 1998, contracts of quality assurance between health care providers and sponsors have to be presented according to the new health insurance act. These contracts are proofed periodically by a national office. This necessitates a country-wide introduction of statistics (ICD-codes) and computerization. This is currently only in the process of realization. Additionally, hospitals and medical practices already undertake a comprehensive quality control due to local and regional initiatives. The society of Swiss physicians FMH supports mainly three areas: compulsory continuing medical education (80 hours annually, including 50 hours in recognized meetings), the development of guidelines by medical societies, and data collection including the development of a network for measures of quality assurance. The ISO-standard 9000 was changed for health care as ordered by the NAQ (National workshop for quality assurance) and the FMH. It is supposed to be used mainly for the certification of facilities for continuing medical education, perhaps also for the certification of hospitals. PMID:9441034
ABSTRACT: The current nursing shortage, high hospital nurse job dissatisfac- tion, and reports of uneven quality of hospital care are not uniquely American phenomena. This paper presents reports from 43,000 nurses from more than 700 hospitals in the United States, Canada, England, Scotland, and Germany in 1998–1999. Nurses in countries,with distinctly different health care systems report,similar shortcomings,in their work,environments,and,the quality
Linda H. Aiken; Sean P. Clarke; Douglas M. Sloane; J. A. Sochalski; Reinhard Busse; Heather Clarke; Phyllis Giovannetti; Jennifer Hunt; Anne Marie Rafferty; Judith Shamian
Background Several studies have demonstrated the usefulness of medical checklists to improve quality of care in surgery and the ICU. The feasibility, effectiveness, and sustainability of a checklist was explored. Methods Literature on checklists and adherence to quality indicators in general medicine was reviewed to develop evidence-based measures for the IBCD checklist: (I) pneumococcal immunization (I), (B) pressure ulcers (bedsores), (C) catheter-associated urinary tract infections (CAUTIs), and (D) deep venous thrombosis (DVT) were considered conditions highly relevant to the quality of care in general medicine inpatients. The checklist was used by attending physicians during rounds to remind residents to perform four actions related to these measures. Charts were audited to document actions prompted by the checklist. Results The IBCD checklist was associated with significantly increased documentation of and adherence to care processes associated with these four quality indicators. Seventy percent (46/66) of general medicine teams during the intervention period of July 2010–March 2011 voluntarily used the IBCD checklist, for 1,168 (54%) of 2,161 patients. During the intervention period, average adherence for all four checklist items increased from 68% on admission to 82% after checklist use (p < .001). Average adherence after checklist use was also higher when compared to a historical control group from one year before implementation (82% versus 50%, p < .0001). In the six weeks after the checklist was transitioned to the electronic medical record (EMR), IBCD was noted in documentation of 133 (59%) of 226 patients admitted to general medicine. Conclusion A checklist is a useful and sustainable tool to improve adherence to, and documentation of, care processes specific to quality indicators in general medicine.
Aspesi, Anthony V.; Kauffmann, Greg E.; Davis, Andrew M.; Schulwolf, Elizabeth M.; Press, Valerie G.; Stupay, Kristen L.; Lee, Janey J.; Arora, Vineet M.
Can a community optometrist-based referral refinement scheme reduce false-positive glaucoma hospital referrals without compromising quality of care? The community and hospital allied network glaucoma evaluation scheme (CHANGES)
Background\\/AimsTo describe the design, activity, and quality of the referral refinement phase of a novel glaucoma shared-care scheme.MethodsEight Optometrists with a Specialist Interest in glaucoma (OSI) were trained to perform a community-based comprehensive glaucoma evaluation of low-risk glaucoma hospital referrals (only one\\/none of the following factors noted for either eye: abnormal optic disc, abnormal visual field, abnormal intraocular pressure (IOP;
R R A Bourne; K A French; L Chang; A D Borman; M Hingorani; W D Newsom; RRA Bourne
Background: In Andalusia, Spain, a legislative framework was put in place in 2010 to guarantee dignity in dying and quality of care in the last phase of life. Aim: The aim of this study was to determine whether health professionals have incorporated the requirements of this legislation into their clinical practice and whether there have been improvements in decision-making procedures affecting the quality of dying in hospitals. Methods: A cross-sectional analysis was carried out in an acute hospital in Andalusia, Spain. Clinical records of patients who died in the Costa del Sol Hospital were evaluated before and after the new legislative framework was introduced. Participants were all the patients aged over 18 years (n=398) who died in 2009 (n=216) or 2011 (n=182) of oncological disease or non-oncological chronic disease. Bivariate analyses evaluated differences between the two periods and associations among the patients' characteristics and the context of care. Results: Provision of information on measures to facilitate comfort and the relief of physical suffering increased from 15.7% to 22.0%, although this was not significant. There was a significant increase in the number of patients who received joint counselling in this regard from doctors and nurses, from 0% in 2009 to 7.1% in 2011. Conclusions: The minimal changes found 1 year after the implementation of the framework confirm that culture change is a lengthy, difficult task that cannot be achieved through laws alone. PMID:24852029
María Sepúlveda Sánchez, Juana; Carlos Canca Sánchez, José; Pérez Trueba, Enrique; Rueda Dominguez, Antonio; Miguel Morales Asencio, José; María Morales Gil, Isabel
Objective We aimed to improve pediatric inpatient surveillance at a busy referral hospital in Malawi with 2 new programs: (1) the provision of vital sign equipment and implementation of an inpatient triage program (ITAT) that includes a simplified pediatric severity-of-illness score; (2) task-shifting ITAT to a new cadre of health care workers called “Vital Sign Assistants” (VSAs). Methods This study, conducted on the pediatric inpatient ward of a large referral hospital in Malawi, was divided into 3 phases, each lasting 4 weeks. In Phase A, we collected baseline data. In Phase B, we provided 3 new automated vital sign poles and implemented ITAT with current hospital staff. In Phase C, VSAs were introduced and performed ITAT. Our primary outcome measures were the number of vital sign assessments performed and clinician notifications to reassess patients with high ITAT scores. Results We enrolled 3,994 patients who received 5,155 vital sign assessments. Assessment frequency was equal between Phases A (0.67 assessments/patient) and B (0.61 assessments/patient), but increased 3.6-fold in Phase C (2.44 assessments/patient, p<0.001). Clinician notifications increased from Phases A (84) and B (113) to Phase C (161, p=0.002). Inpatient mortality fell from Phase A (9.3%) to Phases B (5.7) and C (6.9%). Conclusions ITAT with VSAs improved vital sign assessments and nearly doubled clinician notifications of patients needing further assessment due to high ITAT scores, while equipment alone made no difference. Task-shifting ITAT to VSAs may improve outcomes in pediatric hospitals in the developing world.
Olson, Dan; Preidis, Geoffrey A.; Milazi, Robert; Spinler, Jennifer K.; Lufesi, Norman; Mwansambo, Charles; Hosseinipour, Mina C.; McCollum, Eric D.
... problems in order to achieve the best possible outcomes. Quality of care is a cooperative effort that involves patients, doctors, nurses, and other health care professionals, as well as institutions (such as hospitals, nursing homes, mental health centers, and home health care ...
This is a quantitative exploratory, descriptive study performed with the objective to identify and analyze the performance of the average time of nursing care delivered to patients of the Inpatient Units of the University Hospital at University of São Paulo (UH-USP), from 2001 to 2005. The average nursing care time delivered to patients of the referred units was identified by applying of a mathematical equation proposed in the literature, after surveying data from the Medical and Statistical Service and based on the monthly working shifts of the nursing professionals. Data analysis was performed using descriptive statistics. The average nursing care time observed in most units, despite some variations, remained stable during the analyzed period. Based on this observed stability, it is concluded that the nursing staff in the referred HU-USP units has been continuously evaluated with the purposes of maintaining the average time of assistance and, thus, the quality of the care being delivered. PMID:21445512
Rogenski, Karin Emília; Fugulin, Fernanda Maria Togeiro; Gaidzinski, Raquel Rapone; Rogenski, Noemi Marisa Brunet
Desired health outcomes include survival and health-related quality of life. For cancer, high quality care means delivering the full range of evidence-based interventions that are safe, patient-centered, effective (i.e., likely to provide more benefit than harm), timely, efficient, and equitable. Such care must be provided with technical competence and cultural sensitivity and must foster patient choice based on informed decision making.
The goal of this study was to develop improved measures of the quality of neonatal intensive care for infants with very low birth weights (under 1500 grams) and to study the hospital characteristics associated with high quality care.
We conducted a quality improvement project in order to evaluate the effect of nurse-to-nurse bedside "rounding" as a strategy to decrease hospital-acquired pressure ulcers (HAPU) in a surgical intensive care unit. We instituted weekly peer-to-peer bedside skin rounds in a 17-bed surgical intensive care unit. Two nurses were identified as skin champions and trained by the hospital's certified WOC nurse to conduct skin rounds. The skin champion nurses conducted weekly peer-to-peer rounds that included discussions about key elements of our patients' skin status including current Braden Scale for Pressure Sore Risk score, and implementation of specific interventions related to subscale risk assessment. If a pressure ulcer was present, the current action plan was reevaluated for effectiveness. Quarterly HAPU prevalence studies were conducted from January 2008 to December 2010. Nineteen patients experienced a HAPU: 17 were located on the coccyx and 2 on the heel. Ten ulcers were classified as stage II, 3 PU were stage IV, 5 were deemed unstageable, and 1 was classified as a deep tissue injury. The frequency of preventive interventions rose during our quality improvement project. Specifically, the use of prevention surfaces increased 92%, repositioning increased 30%, nutrition interventions increased 77%, and moisture management increased 100%. Prior to focused nursing rounds, the highest HAPU prevalence rate was 27%. After implementing focused nursing rounds, HAPU rates trended down and were 0% for 3 consecutive quarters. PMID:22415120
Kelleher, Alyson Dare; Moorer, Amanda; Makic, MaryBeth Flynn
Background Surgical patients are at risk for preventable adverse drug events (ADEs) during hospitalization. Usually, preventable ADEs are measured as an outcome parameter of quality of pharmaceutical care. However, process measures such as QIs are more efficient to assess the quality of care and provide more information about potential quality improvements. Objective To assess the quality of pharmaceutical care of medication-related processes in surgical wards with quality indicators, in order to detect targets for quality improvements. Methods For this observational cohort study, quality indicators were composed, validated, tested, and applied on a surgical cohort. Three surgical wards of an academic hospital in the Netherlands (Academic Medical Centre, Amsterdam) participated. Consecutive elective surgical patients with a hospital stay longer than 48 hours were included from April until June 2009. To assess the quality of pharmaceutical care, the set of quality indicators was applied to 252 medical records of surgical patients. Results Thirty-four quality indicators were composed and tested on acceptability and content- and face-validity. The selected 28 candidate quality indicators were tested for feasibility and ‘sensitivity to change’. This resulted in a final set of 27 quality indicators, of which inter-rater agreements were calculated (kappa 0.92 for eligibility, 0.74 for pass-rate). The quality of pharmaceutical care was assessed in 252 surgical patients. Nearly half of the surgical patients passed the quality indicators for pharmaceutical care (overall pass rate 49.8%). Improvements should be predominantly targeted to medication care related processes in surgical patients with gastro-intestinal problems (domain pass rate 29.4%). Conclusions This quality indicator set can be used to measure quality of pharmaceutical care and detect targets for quality improvements. With these results medication safety in surgical patients can be enhanced.
de Boer, Monica; Ramrattan, Maya A.; Boeker, Eveline B.; Kuks, Paul F. M.; Boermeester, Marja A.; Lie-A-Huen, Loraine
Background In assessing quality of care in developing countries, retrospectively collected data are usually used given their availability. Retrospective data however suffer from such biases as recall bias and non-response bias. Comparing results obtained using prospectively and retrospectively collected data will help validate the use of the easily available retrospective data in assessing quality of care in past and future studies. Methods Prospective and retrospective datasets were obtained from a cluster randomized trial of a multifaceted intervention aimed at improving paediatric inpatient care conducted in eight rural Kenyan district hospitals by improving management of children admitted with pneumonia, malaria and diarrhea and/or dehydration. Four hospitals received a full intervention and four a partial intervention. Data were collected through 3 two weeks surveys conducted at baseline, after 6 and 18 months. Retrospective data was sampled from paediatric medical records of patients discharged in the preceding six months of the survey while prospective data was collected from patients discharged during the two week period of each survey. Risk Differences during post-intervention period of16 quality of care indicators were analyzed separately for prospective and retrospective datasets and later plotted side by side for comparison. Results For the prospective data there was strong evidence of an intervention effect for 8 of the indicators and weaker evidence of an effect for one indicator, with magnitude of effect sizes varying from 23% to 60% difference. For the retrospective data, 10 process (these include the 8 indicators found to be statistically significant in prospective data analysis) indicators had statistically significant differences with magnitude of effects varying from 10% to 42%. The bar-graph comparing results from the prospective and retrospective datasets showed similarity in terms of magnitude of effects and statistical significance for all except two indicators. Conclusion Multifaceted interventions can help improve adoption of clinical guidelines and hence improve the quality of care. The similar inference reached after analyses based on prospective assessment of case management is a useful finding as it supports the utility of work based on examination of retrospectively assembled case records allowing longer time periods to be studied while constraining costs. Trial registration Current Controlled Trials ISRCTN42996612. Trial registration date: 20/11/2008
Existing quality models focus on some specific diseases, clinics or clinical areas. Although they contain structure, process, or output type measures, there is no model which measures quality of health care processes comprehensively. In addition, due to the not measured overall process quality, hospitals cannot compare quality of processes internally and externally. To bring a solution to above problems, a new model is developed from software quality measures. We have adopted the ISO/IEC 9126 software quality standard for health care processes. Then, JCIAS (Joint Commission International Accreditation Standards for Hospitals) measurable elements were added to model scope for unifying functional requirements. Assessment (diagnosing) process measurement results are provided in this paper. After the application, it was concluded that the model determines weak and strong aspects of the processes, gives a more detailed picture for the process quality, and provides quantifiable information to hospitals to compare their processes with multiple organizations. PMID:22874345
Yildiz, Ozkan; Demirörs, Onur
Work is underway to make cancer a working model for quality of care research and the translation of this research into practice. This requires addressing how data collection about cancer care can be standardized and made most useful to a variety of audiences including providers, patients and their families, purchasers, payers, researchers, and policymakers. The Applied Research Program has spearheaded several key activities to carry out this initiative.
Developments in and goals of quality of care assessment are noted, with special reference to the nurse practitioner, and a quality of care evaluation model is proposed. The effectiveness of systems for monitoring quality depends primarily on the cooperati...
H. Bailit J. Lewis L. Hochheiser N. Bush
VBP program is a novel medicare payment estimatin tool used to encourage clinical care quality improvement as well as improvement of patient experience as a customer of a health care system. The program utilizes well established tools of measuring clinical care quality and patient satisfaction such as the hospital IQR program and HCAHPS survey to estimate Medicare payments and encourage hospitals to continuosly improve the level of care they provide. PMID:24600783
Szablowski, Katarzyna M
BACKGROUND: Starting in 2005, Germany's health law required hospital quality reports to be published every two years by all acute care hospitals. The reports were intended to help patients and physicians make informed choices of hospitals. However, while establishing the quality indicators that form the content of the reports, the information needs of the target groups were not explicitly taken
Max Geraedts; David Schwartze; Tanja Molzahn
Context Current efforts to improve and coordinate healthcare rely on hospital readmission rates as a marker of quality and transitions in care during the post acute care period. Emergency department (ED) visits are also a marker of hospital based acute care needs following discharge but little is known about ED utilization in this period. Objective We studied patients who were discharged from acute care hospitals to 1) determine the degree to which ED visits and hospital readmissions contribute to overall use of acute care services within 30-days of hospital discharge; 2) describe the reasons patients return for ED visits; and 3) describe these patterns among Medicare beneficiaries and those not covered by Medicare insurance. Design, Setting, and Participants Using the Healthcare Cost and Utilization Project State Inpatient and Emergency Department Databases, we identified adult patients discharged from acute care hospitals in three large, geographically diverse states (California, Florida and Nebraska) between July 2008 and September 2009. Main Outcome Measures We defined three primary outcomes during the 30-day period after hospital discharge: ED visits not resulting in admission (treat-and-release encounters), hospital readmissions from any source, and a combined measure of ED visits and hospital readmissions termed hospital-based, acute care. Results Our final cohort included 5,032,254 index hospitalizations among 4,028,555 unique patients. Nearly 18% (95% confidence interval (CI), 17.9–18.0) of hospitalizations in our study resulted in at least one acute care encounter in the 30 days following discharge. For every 1,000 discharges, there were 97.5 ED (95% CI, 97.2–97.8) treat-and-release visits and 147.6 (95% CI, 147.3–147.9) hospital readmissions in the 30 days following discharge. ED visits comprised 39.8% (95% CI, 39.7–39.9) of the 1,233,402 acute care encounters. Hospital-based, acute care encounters ranged from 42.1 (95% CI, 41.5–42.7)–947.5 (95% CI, 896.3–1001.0) encounters per 1,000 hospital discharges across 470 unique conditions. Among the highest volume discharges, the most common reason patients returned to the ED was always related to their index hospitalization. Conclusions Among adult hospitalizations from acute care hospitals in three states, ED visits within thirty days were common and accounted for 39.8% of post-discharge hospital-based, acute care visits.
Vashi, Anita A.; Fox, Justin P.; Carr, Brendan G.; D'Onofrio, Gail; Pines, Jesse M.; Ross, Joseph S.; Gross, Cary P.
Critical access hospitals (CAHs) face many challenges in implementing quality improvement (QI) initiatives, which include limited resources, low volume of patients, small staffs, and inadequate information technology. A primary goal of the Medicare Rural Hospital Flexibility Program is to improve the quality of care provided by CAHs. This article…
Casey, Michelle M.; Moscovice, Ira
... Health Systems Hospital Resources Long-Term Care Resources Primary Care Resources System Design Resources Prevention & Chronic Care Announcements Evidence-Based Decisionmaking Improving Primary Care Practice Resources Quality & Patient Safety Comprehensive Unit-based ...
With current healthcare reform and calls for improving care quality and safety, there is renewed emphasis on high-value care. Moreover, given the significant healthcare resource utilization for patients with chronically progressive illnesses or for patients at the end of life, innovative and efficient care delivery models are urgently needed. We propose here the concept of a sentinel hospitalization, defined as a transitional point in the patient's disease course that heralds a need to reassess prognosis, patient understanding, treatment options and intensities, and goals of care. Hospitalists are well positioned to recognize a patient's sentinel hospitalization and use it as an opportunity for active integration of palliative care that provides high-quality and cost-saving care through its patient- and family-oriented approach, its interdisciplinary nature, and its focus on symptom control and care coordination. PMID:24474682
Lin, Richard J; Adelman, Ronald D; Diamond, Randi R; Evans, Arthur T
Predictors of cardiologist care for older patients hospitalized for heart failure 1 1 The analyses upon which this publication is based were performed under Contract Number 500-02CO01, titled “Utilization and Quality Control Peer Review Organization for the State of Colorado,” sponsored by the Centers for Medicare and Medicaid Services (CMS, formerly the Health Care Financing Administration), US Department of Health and Human Services. The content of this publication does not necessarily reflect the views or policies of the US Department of Health and Human Services, nor does mention of trade names, commercial products, or organization imply endorsement by the US Government. The author assumes full responsibility for the accuracy and completeness of the ideas presented. This article is a direct result of the Health Care Quality Improvement Program initiated by the Health Care Financing Administration, which has encouraged identification of quality improvement projects derived from a
BackgroundStudies have suggested that cardiologists may provide higher quality heart failure care than generalists. However, national rates of specialty care during hospitalization for heart failure and factors associated with care by a cardiologist are unknown.
JoAnne Micale Foody; Saif S Rathore; Yongfei Wang; Jeph Herrin; Frederick A Masoudi; Edward P Havranek; Martha J Radford; Harlan M Krumholz
Reducing avoidable hospital readmissions and improving care transitions and coordination continues to be a national health care priority and fundamental issue in improving care quality across the country. ADT alerts are automatic electronic notifications ...
Providing holistic orientation for all hospital personnel of a newly constructed acute care facility without patient presence proved challenging and rewarding to staff development educators. Early planning, multidisciplinary involvement of key stakeholders for hospital-wide and nursing orientation, and on-boarding of unit nursing educators shortly after unit nursing managers promoted success. Using an interdisciplinary approach to address hospital policies, procedures, and education ensured a quality healthcare facility in the community. PMID:22617779
Whicker, Mary Ann; Huebner, Maggie
...strategies for inpatient hospital care...However, the treatment of certain...two ways. First, if a hospital...prevention and treatment practices for...addresses the first five of these...PSIs) and Inpatient Quality Indicators...addresses the first priority of...prevention and treatment...
To improve the measurement of the quality of neonatal intensive care for infants with very low birth weights (VLBW)-under 1500 grams-and to study the hospital characteristics associated with high quality care. Measuring quality of care for VLBW infants tr...
J. A. Rogowski
Background: Nursing costs are poorly estimated in economic studies conducted in hospitals because of a lack of data on nursing times for day-to-day activities relating to patient care. Objective: To determine standard time values for nursing activities for specific indications in a cohort of hospital patients. Study design: Patient care hours scores, calculated using the Grace Reynolds Application and Study
Nicole Mittmann; Soo Jin Seung; Luca F. Pisterzi; Pierre K. Isogai; Donna Michaels
... in various kinds of facilities (like assisted living facilities). LTCHs are hospitals that give inpatient services to people who need a much longer ... re admitted to a hospital or skilled nursing facility (SNF), and ends when you haven’t gotten any inpatient care in a hospital or SNF for 60 ...
As the quality movement in health care now enters its fourth decade, the language of quality is ubiquitous. Practitioners, organizations, and government agencies alike vociferously testify their commitments to quality and accept numerous forms of governance aimed at improving quality of care. Remarkably, the powerful phrase "quality of care" is rarely defined in the health care literature. Instead it operates as an accepted and assumed goal worth pursuing. The status of evidence-based medicine, for instance, hinges on its ability to improve quality of care, and efforts are made by both proponents and detractors to unpack the contents and outcomes of evidence-based practice while the contents of "quality of care" are presumed to be understood. Because the goals of medicine are far from obvious, this paper investigates the neglected term, "quality of care," in an effort to understand what it is that health care practices are so uncritically assumed to be striving for. Finding lack of consensus on the terminology in the quality literature, I propose that the term operates rhetorically by way of persuasive appeal (and lack of descriptive meaning). Unsatisfied that "quality of care" operates as a mere buzzword in morally contentious debates over resource allocation and duties of care, I implore health care communities to go beyond mere commitments to quality and, instead, to focus attention on the difficult task of specifying what counts as quality care within an economically constrained health care system. PMID:22810582
Goldenberg, Maya J
This article describes the development of a reliable measurement instrument for the quality of perinatal care. The Hospital Perinatal Mortality Comparison (HPMC) predicts the expected perinatal mortality for individual hospitals, based on the perinatal mortality experienced in a group of similar newborns in a large reference population. Out of the 76 hospitals analyzed in 1990, 2 performed significantly better and 5 performed significantly worse than expected according to the logistic regression model. These results may lead to the identification of opportunities for improving the process of medical care in these hospitals. PMID:8366682
Holthof, B; Prins, P
Objective: We evaluated the effect of performance feedback on acute ischemic stroke care quality in Minnesota hospitals. Methods: A cluster-randomized controlled trial design with hospital as the unit of randomization was used. Care quality was defined as adherence to 10 performance measures grouped into acute, in-hospital, and discharge care. Following preintervention data collection, all hospitals received a report on baseline care quality. Additionally, in experimental hospitals, clinical opinion leaders delivered customized feedback to care providers and study personnel worked with hospital administrators to implement changes targeting identified barriers to stroke care. Multilevel models examined experimental vs control, preintervention and postintervention performance changes and secular trends in performance. Results: Nineteen hospitals were randomized with a total of 1,211 acute ischemic stroke cases preintervention and 1,094 cases postintervention. Secular trends were significant with improvement in both experimental and control hospitals for acute (odds ratio = 2.7, p = 0.007) and in-hospital (odds ratio = 1.5, p < 0.0001) care but not discharge care. There was no significant intervention effect for acute, in-hospital, or discharge care. Conclusion: There was no definite intervention effect: both experimental and control hospitals showed significant secular trends with performance improvement. Our results illustrate the potential fallacy of using historical controls for evaluating quality improvement interventions. Classification of evidence: This study provides Class II evidence that informing hospital leaders of compliance with ischemic stroke quality indicators followed by a structured quality improvement intervention did not significantly improve compliance more than informing hospital leaders of compliance with stroke quality indicators without a quality improvement intervention. GLOSSARY CI = confidence interval; HERF = Healthcare Evaluation and Research Foundation; ICC = intracluster correlation coefficient; ITT = intent-to-treat; MCCAP = Minnesota Clinical Comparison and Assessment Program; OR = odds ratio; PRISMM = Project for the Improvement of Stroke Care Management in Minnesota; PSC = Primary Stroke Center Certification; QI = quality improvement; RCT = randomized controlled trial; tPA = tissue plasminogen activator.
Lakshminarayan, K.; Borbas, C.; McLaughlin, B.; Morris, N.E.; Vazquez, G.; Luepker, R.V.; Anderson, D.C.
This paper presents the findings of an exploratory research study which considers the effect of organisational change on social work practice in hospitals in four local authorities in England. Its aims were (1) to obtain the views of hospital social workers and their managers about the effect of implementing the NHS (National Health Service) and Community Care Act of 1990
Objective To examine the effectiveness of hospital-based comprehensive care programs in improving the quality of care for children with special health care needs. Data Sources A systematic review was conducted using Ovid MEDLINE, CINAHL, EMBASE, PsycINFO, Sociological Abstracts SocioFile, and Web of Science. Study Selection Evaluations of comprehensive care programs for categorical (those with single disease) and noncategorical groups of children with special health care needs were included. Selected articles were reviewed independently by 2 raters. Data Extraction Models of care focused on comprehensive care based at least partially in a hospital setting. The main outcome measures were the proportions of studies demonstrating improvement in the Institute of Medicine’s quality-of-care domains (effectiveness of care, efficiency of care, patient or family centeredness, patient safety, timeliness of care, and equity of care). Data Synthesis Thirty-three unique programs were included, 13 (39%) of which were randomized controlled trials. Improved outcomes most commonly reported were efficiency of care (64% [49 of 76 outcomes]), effectiveness of care (60% [57 of 95 outcomes]), and patient or family centeredness (53% [10 of 19 outcomes). Outcomes less commonly evaluated were patient safety (9% [3 of 33 programs]), timeliness of care (6% [2 of 33 programs]), and equity of care (0%). Randomized controlled trials occurred more frequently in studies evaluating categorical vs noncategorical disease populations (11 of 17 [65%] vs 2 of 16 [17%], P = .008). Conclusions Although positive, the evidence supporting comprehensive hospital-based programs for children with special health care needs is restricted primarily to nonexperimental studies of children with categorical diseases and is limited by inadequate outcome measures. Additional high-quality evidence with appropriate comparative groups and broad outcomes is necessary to justify continued development and growth of programs for broad groups of children with special health care needs.
Cohen, Eyal; Jovcevska, Vesna; Kuo, Dennis Z.; Mahant, Sanjay
Background Care pathways are widely used in hospitals for a structured and detailed planning of the care process. There is a growing interest in extending care pathways into primary care to improve quality of care by increasing care coordination. Evidence is sparse about the relationship between care pathways and care coordination. The multi-level framework explores care coordination across organizations and states that (inter)organizational mechanisms have an effect on the relationships between healthcare professionals, resulting in quality and efficiency of care. The aim of this study was to assess the extent to which care pathways support or create elements of the multi-level framework necessary to improve care coordination across the primary - hospital care continuum. Methods This study is an in-depth analysis of five existing local community projects located in four different regions in Flanders (Belgium) to determine whether the available empirical evidence supported or refuted the theoretical expectations from the multi-level framework. Data were gathered using mixed methods, including structured face-to-face interviews, participant observations, documentation and a focus group. Multiple cases were analyzed performing a cross case synthesis to strengthen the results. Results The development of a care pathway across the primary-hospital care continuum, supported by a step-by-step scenario, led to the use of existing and newly constructed structures, data monitoring and the development of information tools. The construction and use of these inter-organizational mechanisms had a positive effect on exchanging information, formulating and sharing goals, defining and knowing each other’s roles, expectations and competences and building qualitative relationships. Conclusion Care pathways across the primary-hospital care continuum enhance the components of care coordination.
Background The European Union (EU) Migrant-Friendly Hospital (MFH) Initiative, introduced in 2002, promotes the adoption of care approaches adapted to meet the service needs of migrants. However, for paediatric hospitals, no specific recommendations have been offered for MFH care for children. Using the Swiss MFH project as a case study, this paper aims to identify hospital-based care needs of paediatric migrants (PMs) and good service approaches. Methods Semi-structured interviews were conducted with principal project leaders of five paediatric hospitals participating in the Swiss MFH project. A review of the international literature on non-clinical hospital service needs and service responses of paediatric MFHs was conducted. Results Paediatric care can be complex, usually involving both the patient and the patient’s family. Key challenges include differing levels of acculturation between parents and children; language barriers; cultural differences between patient and provider; and time constraints. Current service and infrastructural responses include interpretation services for PMs and parents, translated information material, and special adaptations to ensure privacy, e.g., during breastfeeding. Clear standards for paediatric migrant-friendly hospitals (P-MFH) are lacking. Conclusions International research on hospital care for migrant children is scarce. The needs of paediatric migrants and their families may differ from guidance for adults. Paediatric migrant needs should be systematically identified and used to inform paediatric hospital care approaches. Hospital processes from admission to discharge should be revised to ensure implementation of migrant-sensitive approaches suitable for children. Staff should receive adequate support, such as training, easily available interpreters and sufficient consultation time, to be able to provide migrant-friendly paediatric services. The involvement of migrant groups may be helpful. Improving the quality of care for PMs at both policy and service levels is an investment in the future that will benefit native and migrant families.
Commercially insured and Medicare patients who are not in health maintenance organizations (HMOs) tend to use different hospitals than HMO patients use. This phenomenon, called market segmentation, raises important questions about how hospitals that treat many HMO patients differ from those that treat few HMO patients, especially with regard to quality of care. This study of patients undergoing coronary artery bypass graft surgery found no evidence that HMOs in southeast Florida systematically channel their patients to high-volume or low-mortality hospitals. These findings are consistent with other evidence that in many areas of the country, incentives for managed care plans to reduce costs may outweigh incentives to improve quality. PMID:9444826
Escarce, J J; Shea, J A; Chen, W
Background Consumer-directed policies, including health savings accounts, have been proposed and implemented to involve individuals more directly with the cost of their health care. The hope is this will ultimately encourage providers to compete for patients based on price or quality, resulting in lower health care costs and better health outcomes. Objective To evaluate American hospital websites to learn whether hospitals advertise directly to consumers using price or quality data. Methods Structured review of websites of 10% of American hospitals (N=474) to evaluate whether price or quality information is available to consumers and identify what hospitals advertise about to attract consumers. Results On their websites, 1.3% (6/474) of hospitals advertised about price and 19.0% (90/474) had some price information available; 5.7% (27/474) of hospitals advertised about quality outcomes information and 40.9% (194/474) had some quality outcome data available. Price and quality information that was available was limited and of minimal use to compare hospitals. Hospitals were more likely to advertise about service lines (56.5%, 268/474), access (49.6%, 235/474), awards (34.0%, 161/474), and amenities (30.8%, 146/474). Conclusions Insufficient information currently exists for consumers to choose hospitals on the basis of price or quality, making current consumer-directed policies unlikely to realize improved quality or lower costs. Consumers may be more interested in information not related to cost or clinical factors when choosing a hospital, so consumer-directed strategies may be better served before choosing a provider, such as when choosing a health plan.
Wilks, Chrisanne E A; Richter, Jason P
New reimbursement policies developed by the Centers for Medicare and Medicaid Services (CMS) are revolutionizing the health care landscape in America. The policies focus on clinical quality and patient outcomes. As part of the new policies, certain hospital acquired conditions have been identified by Medicare as \\
Jonathan F Rivera
... false Hospital care for research purposes. 17.45 Section...Domiciliary and Nursing Home Care § 17.45 Hospital care for research purposes. Subject...are insufficient veteran-patients suitable for the...
... false Hospital care for research purposes. 17.45 Section...Domiciliary and Nursing Home Care § 17.45 Hospital care for research purposes. Subject...are insufficient veteran-patients suitable for the...
... false Hospital care for research purposes. 17.45 Section...Domiciliary and Nursing Home Care § 17.45 Hospital care for research purposes. Subject...are insufficient veteran-patients suitable for the...
Hospital and homecare must be understood as a necessary conjunction to accomplish efficient personalized care. In this sense,\\u000a the integration of hospital and homecare protocols and technologies should be considered from the moment that they begin to\\u000a be designed. The proliferation of healthcare units and services complicates this task, as multiple administrative domains\\u000a can be found, usually spread out in
Isabel Román; Jorge Calvillo; Laura M. Roa
The author, former chief of a medical department and experienced in quality management, describes the development of quality standards by palliative ch, the Swiss Society for Palliative Care. These standards are the basis for explicit quality-criteria. The performance of an institution for palliative care is evaluated against these criteria, during an audit and peer review. Further information is given concerning the label Quality in Palliative Care. The author describes the importance oft the PDCA-cycle as an instrument for permanent improvement. Institutions with little experience in quality management are adviced to start on a smaller scale and use internal audits. Finally the author gives some thoughts as to the limitations of quality management in palliative care. PMID:22334204
Objectives Seoul National University Bundang Hospital, which is the first Stage 7 hospital outside of North America, has adopted and utilized an innovative and emerging information technology system to improve the efficiency and quality of patient care. The objective of this paper is to briefly introduce the major components of the SNUBH information system and to describe our progress toward a next-generation hospital information system (HIS). Methods SNUBH opened in 2003 as a fully digital hospital by successfully launching a new HIS named BESTCare, "Bundang hospital Electronic System for Total Care". Subsequently, the system has been continuously improved with new applications, including close-loop medication administration (CLMA), clinical data warehouse (CDW), health information exchange (HIE), and disaster recovery (DR), which have resulted in the achievement of Stage 7 status. Results The BESTCare system is an integrated system for a university hospital setting. BESTCare is mainly composed of three application domains: the core applications, an information infrastructure, and channel domains. The most critical and unique applications of the system, such as the electronic medical record (EMR), computerized physician order entry (CPOE), clinical decision support system (CDSS), CLMA, CDW, HIE, and DR applications, are described in detail. Conclusions Beyond our achievement of Stage 7 hospital status, we are currently developing a next-generation HIS with new goals of implementing infrastructure that is flexible and innovative, implementing a patient-centered system, and strengthening the IT capability to maximize the hospital value.
Yoo, Sooyoung; Lee, Kee Hyuck; Lee, Hak Jong; Ha, Kyooseob; Lim, Cheong; Chin, Ho Jun; Yun, Jonghoar; Cho, Eun-Young; Chung, Eunja; Baek, Rong-Min; Chung, Chin Youb; Wee, Won Ryang; Lee, Chul Hee; Lee, Hai-Seok; Byeon, Nam-Soo
This paper analyzes the problem of contracting with hospitals with hidden information when the number of patients wanting treatment depends on the quality of health care services offered. The optimal policy is characterized in the case of a single hospital. It is demonstrated that the regulator can reduce the information rent by decreasing the quality. When the regulator is assumed to be able to organize an auction for awarding the right to provide the service, we characterize the optimal auction and the first score tendering procedure implementing it. The regulator can reimburse a unit price per treated patient and let the hospital choose the level of quality. It is proved that the expected quality of health care services is greater and the expected payment is lower than in the monopoly case. PMID:14626010
Mougeot, Michel; Naegelen, Florence
Background Hospitals are constantly being challenged to provide high-quality care despite ageing populations, diminishing resources, and budgetary restraints. While the costs of care depend on the patients' needs, it is not clear which patient characteristics are associated with the demand for care and inherent costs. The aim of this study was to ascertain which patient-related characteristics or models can predict the need for medical and nursing care in general hospital settings. Methods We systematically searched MEDLINE, Embase, Business Source Premier and CINAHL. Pre-defined eligibility criteria were used to detect studies that explored patient characteristics and health status parameters associated to the use of hospital care services for hospitalized patients. Two reviewers independently assessed study relevance, quality with the STROBE instrument, and performed data analysis. Results From 2,168 potentially relevant articles, 17 met our eligibility criteria. These showed a large variety of factors associated with the use of hospital care services; models were found in only three studies. Age, gender, medical and nursing diagnoses, severity of illness, patient acuity, comorbidity, and complications were the characteristics found the most. Patient acuity and medical and nursing diagnoses were the most influencing characteristics. Models including medical or nursing diagnoses and patient acuity explain the variance in the use of hospital care services for at least 56.2%, and up to 78.7% when organizational factors were added. Conclusions A larger variety of factors were found to be associated with the use of hospital care services. Models that explain the extent to which hospital care services are used should contain patient characteristics, including patient acuity, medical or nursing diagnoses, and organizational and staffing characteristics, e.g., hospital size, organization of care, and the size and skill mix of staff. This would enable healthcare managers at different levels to evaluate hospital care services and organize or reorganize patient care.
van Oostveen, Catharina J.; Ubbink, Dirk T.; Huis in het Veld, Judith G.; Bakker, Piet J.; Vermeulen, Hester
Reducing avoidable hospital readmissions and improving care transitions and coordination continues to be a national health care priority and fundamental issue in improving care quality across the country. ADT alerts are automatic electronic notifications ...
...Inpatient Prospective Payment Systems for Acute Care Hospitals and Fiscal Year 2010 Rates and to the Long- Term Care Hospital Prospective Payment System and...Payment Rates Implementing the Affordable Care Act AGENCY: Centers for Medicare &...
Satisfaction with Quality of Care Received by Patients without National Health Insurance Attending a Primary Care Clinic in a Resource-Poor Environment of a Tertiary Hospital in Eastern Nigeria in the Era of Scaling up the Nigerian Formal Sector Health Insurance Scheme
Background: The increasing importance of the concept of patients’ satisfaction as a valuable tool for assessing quality of care is a current global healthcare concerns as regards consumer-oriented health services. Aim: This study assessed satisfaction with quality of care received by patients without national health insurance (NHI) attending a primary care clinic in a resource-poor environment of a tertiary hospital in South-Eastern Nigeria. Subject and Methods: This was a cross-sectional study carried out on 400 non-NHI patients from April 2011 to October 2011 at the primary care clinic of Federal Medical Centre, Umuahia, Nigeria. Adult patients seen within the study period were selected by systematic sampling using every second non-NHI patient that registered to see the physicians and who met the selection criteria. Data were collected using pretested, structured interviewer administered questionnaire designed on a five points Likert scale items with 1 and 5 indicating the lowest and highest levels of satisfaction respectively. Satisfaction was measured from the following domains: patient waiting time, patient–staff communication, patient-staff relationship, and cost of care, hospital bureaucracy and hospital environment. Operationally, patients who scored 3 points and above in the assessed domain were considered satisfied while those who scored less than 3 points were dissatisfied. Results: The overall satisfaction score of the respondents was 3.1. Specifically, the respondents expressed satisfaction with patient–staff relationship (3.9), patient–staff communication (3.8), and hospital environment (3.6) and dissatisfaction with patient waiting time (2.4), hospital bureaucracy (2.5), and cost of care (2.6). Conclusion: The overall non-NHI patient's satisfaction with the services provided was good. The hospital should set targets for quality improvement in the current domains of satisfaction while the cost of care has implications for government intervention as it mirrors the need to make NHI universal for all Nigerians irrespective of the employment status.
Iloh, GUP; Ofoedu, JN; Njoku, PU; Okafor, GOC; Amadi, AN; Godswill-Uko, EU
Concern about inadequate emergency care for children was raised in 1984 when researchers in Los Angeles County reported higher death rates from trauma among children in the field and at the hospital. In the years that followed, the U.S. Department of Heal...
R. K. Randolph R. T. Slifkin S. Friedman S. Poley V. A. Freeman
Used patient records of 184 adults to examine the relationship of cause of dying, length of hospital stay, and age to medical treatment effort orientation and work effort. Findings showed medical treatment orientation was overwhelmingly toward the cure end of the care/cure continuum, despite no-code designations or terminal conditions. (JAC)
Mumma, Christina M.; Benoliel, Jeanne Quint
Historically, there has been a tendency to give deference to the business deliberations and decisions of non-profit hospital boards. Today there is growing evidence that these decisions are coming under closer scrutiny as the result of an increase in transactional activity in the health care corporate environment and corresponding regulatory initiatives. PMID:10165606
Burns, L P
The Dublin cardiac ambulance service operates two specially-equipped ambulances from a private ambulance station; five metropolitan hospitals provide coronary care beds on a rota system. The service covers an area of 450 square miles (1,165 sq km) and a population of 800,000. The ambulances are staffed solely by trained ambulance personnel. During the first three years 1,973 patients were transported to hospital. Primary ventricular fibrillation was encountered in 20 patients and successfully treated in 17. No deaths occurred in the ambulance. Over 98% of the patients were transferred uneventfully to hospital, so a medical team from the hospital on duty was called on 30 occasions only. A feature of the Dublin service is the low cost of a standard ambulance call, at about £7·50.
Gearty, G. F.; Hickey, N.; Bourke, G. J.; Mulcahy, R.
This study uses a new relative risk methodology developed by the author to assess and compare certain performance indicators to determine a hospital's relative degree of financial vulnerability, based on its location, to the effects of increased managed care market penetration. The study also compares nine financial measures to determine whether hospital in states with a high degree of managed-care market penetration experience lower levels of profitability, liquidity, debt service, and overall viability than hospitals in low managed care states. A Managed Care Relative Financial Risk Assessment methodology composed of nine measures of hospital financial and utilization performance is used to develop a high managed care state Composite Index and to determine the Relative Financial Risk and the Overall Risk Ratio for hospitals in a particular state. Additionally, financial performance of hospitals in the five highest managed care states is compared to hospitals in the five lowest states. While data from Colorado and Massachusetts indicates that hospital profitability diminishes as the level of managed care market penetration increases, the overall study results indicate that hospitals in high managed care states demonstrate a better cash position and higher profitability than hospitals in low managed care states. Hospitals in high managed care states are, however, more heavily indebted in relation to equity and have a weaker debt service coverage capacity. Moreover, the overall financial health and viability of hospitals in high managed care states is superior to that of hospitals in low managed care states. PMID:10178794
Mowll, C A
The National Hospital Ambulatory Medical Care Survey (NHAMCS) provides data on ambulatory care rendered in hospital emergency and outpatient departments (EDs and OPDs). The NHAMCS is a national probability sample of visits to the emergency and outpatient ...
The National Hospital Ambulatory Medical Care Survey (NHAMCS) provides data on ambulatory care rendered in hospital emergency and outpatient departments (EDs and OPDs). The NHAMCS is a national probability sample of visits to the emergency and outpatient ...
We analyze a duopolistic health care market in which a rural public hospital competes against an urban public hospital on medical quality, by using a Hotelling-type spatial competition model extended into a two-region model. We show that the rural public hospital provides excess quality for each unit of medical service as compared to the first-best quality, and the profits of the rural public hospital are lower than those of the urban public hospital because the provision of excess quality requires larger expenditure. In addition, we investigate the impact of the partial (or full) privatization of local public hospitals. PMID:20552270
Aiura, Hiroshi; Sanjo, Yasuo
... hospitals in the health care system in 2010. Keywords: National Hospital Discharge Survey, inpatient hospital utilization What ... but according to the U.S. Agriculture Department’s Economic Research Service ( 14 ), metropolitan status is used to determine ...
Background Telephone counseling in chronic disease self-management is increasing, but has not been tested in studies that control for quality of medical care. Objective To test the effectiveness of a six-session outpatient telephone-based counseling intervention to improve secondary prevention (behaviors, medication) in patients with acute coronary syndrome (ACS) following discharge from hospital, and impact on physical functioning and quality of life at 8 months post-discharge. Design Patient-level randomized trial of hospital quality improvement (QI-only) versus quality improvement plus brief telephone coaching in three months post-hospitalization (QI-plus). Data: medical record, state vital records, patient surveys (baseline, three and eight months post-hospitalization). Analysis: pooled-time series generalized estimating equations to analyze repeated measures; intention-to-treat analysis. Participants Seven hundred and nineteen patients admitted to one of five hospitals in two contiguous mid-Michigan communities enrolled; 525 completed baseline surveys. Measurements We measured secondary prevention behaviors, physical functioning, and quality of life. Results QI-plus patients showed higher self-reported physical activity (OR?=?1.53; ?=?.01) during the first three months, with decline after active intervention was withdrawn. Smoking cessation and medication use were not different at 3 or 8 months; functional status and quality of life were not different at 8 months. Conclusions Telephone coaching post-hospitalization for ACS was modestly effective in accomplishing short-term, but not long-term life-style behavior change. Previous positive results shown in primary care did not transfer to free-standing telephone counseling as an adjunct to care following hospitalization.
Stommel, Manfred; Corser, William D.; Olomu, Adesuwa; Holtrop, Jodi Summers; Siddiqi, Azfar; Dunn, Susan L.
...long-term care hospitals within hospitals and satellites of long-term care hospitals. 412...long-term care hospitals within hospitals and satellites of long-term care hospitals. ...criteria in Â§ 412.22(e)(2), or satellite facilities of long-term care...
Background The policy in a number of countries is to provide people with a terminal illness the choice of dying at home. This policy is supported by surveys indicating that the general public and patients with a terminal illness would prefer to receive end of life care at home. Objectives To determine if providing home-based end of life care reduces the likelihood of dying in hospital and what effect this has on patients’ symptoms, quality of life, health service costs and care givers compared with inpatient hospital or hospice care. Search methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library) to October 2009, Ovid MED-LINE(R) 1950 to March 2011, EMBASE 1980 to October 2009, CINAHL 1982 to October 2009 and EconLit to October 2009. We checked the reference lists of articles identified for potentially relevant articles. Selection criteria Randomised controlled trials, interrupted time series or controlled before and after studies evaluating the effectiveness of home-based end of life care with inpatient hospital or hospice care for people aged 18 years and older. Data collection and analysis Two authors independently extracted data and assessed study quality. We combined the published data for dichotomous outcomes using fixed-effect Mantel-Haenszel meta-analysis. When combining outcome data was not possible we presented the data in narrative summary tables. Main results We included four trials in this review. Those receiving home-based end of life care were statistically significantly more likely to die at home compared with those receiving usual care (RR 1.33, 95% CI 1.14 to 1.55, P = 0.0002; Chi 2 = 1.72, df = 2, P = 0.42, I2 = 0% (three trials; N=652)). We detected no statistically significant differences for functional status (measured by the Barthel Index), psychological well-being or cognitive status, between patients receiving home-based end of life care compared with those receiving standard care (which included inpatient care). Admission to hospital while receiving home-based end of life care varied between trials and this was reflected by high levels of statistically significant heterogeneity in this analysis. There was some evidence of increased patient satisfaction with home-based end of life care, and little evidence of the impact this form of care has on care givers. Authors’ conclusions The evidence included in this review supports the use of end of life home-care programmes for increasing the number of patients who will die at home, although the numbers of patients being admitted to hospital while receiving end of life care should be monitored. Future research should also systematically assess the impact of end of life home care on care givers.
Shepperd, Sasha; Wee, Bee; Straus, Sharon E
OBJECTIVE: To examine the financial, market, and organizational determinants of hospital diversification into subacute inpatient care by acute care hospitals in order to guide hospital managers in undertaking such diversification efforts. STUDY SETTING: All nongovernment, general, acute care, community hospitals that were operating during the years 1985 through 1991 (3,986 hospitals in total). DATA SOURCES: Cross-sectional, time-series data were drawn from the American Hospital Association's (AHA) Annual Survey of Hospitals, the Health Care Financing Administration's (HCFA) Medicare Cost Reports, a latitude and longitude listing for all community hospital addresses, and the Area Resource File (ARF) published in 1992, which provides county level environmental variables. STUDY DESIGN: The study is longitudinal, enabling the specification of temporal patterns in conversion, causal inferences, and the treatment of right-censoring problems. The unit of analysis is the individual hospital. KEY FINDINGS: Significant differences were found in the average level of subacute care offered by investor-owned versus tax-exempt hospitals. After controlling for selection bias, financial performance, risk, size, occupancy, and other variables, IO hospitals offered 31.3 percent less subacute care than did NFP hospitals. Financial performance and risk are predictors of IO hospitals' diversification into subacute care, but not of NFP hospitals' activities in this market. Resource availability appears to expedite expansion into subacute care for both types of hospitals. CONCLUSIONS: Investment criteria and strategy differ between investor-owned and tax-exempt hospitals.
Wheeler, J R; Burkhardt, J; Alexander, J A; Magnus, S A
In this study a representative sample of German acute care hospitals is used to describe the effects of dementia within acute care hospitals. Data from hospital patients above age 60 with the diagnosis dementia (ICD 290, 293, 294 and 310), collected over an observation period of 12 years, are compared with nondemented hospital patients at the same ages. The differences
Reiner H. Dinkel; Uwe H. Lebok
Quality improvement is as central to home health care as to any other field of health care. With the mandated addition in 2000 of Outcome Assessment and Information Set (OASIS) and outcome-based quality improvement (OBQI), Medicare home health agencies entered a new era of documenting, tracking, and systematically improving quality. OBQI is augmented by the Medicare Quality Improvement Organization (QIO) program, which is now entering the ninth in a series of work assignments, with the tenth scope in the planning stages. Evidence has shown that applied quality improvement methods can drive better outcomes using important metrics, such as acute care hospitalization. This article reviews key findings from the past 2 decades of home care quality improvement research and public policy advances, describes specific examples of local and regional programmatic approaches to quality improvement, and forecasts near-future trends in this vital arena of home health care. PMID:19217497
Rosati, Robert J
Quality improvement in health care organizations requires structural reorganization and system reform and the development of an appropriate organizational "culture." In 2007, the Division of Quality and Excellence in Civil Service in Israel developed a concept to improve quality management in governmental institutions throughout the country. To put this strategy into practice, Western Galilee Hospital, a governmental hospital, in northern Israel, developed a plan to advance the quality management system where each department and unit is autonomously responsible for its own quality and excellence. Since the hospital has been certificated by ISO 9001 for more than 10 years (the only hospital in Israel to have this certificate), the main challenge now is to improve the quality and excellence system in every department. The aim of this article is to describe the implementation of a comprehensive program designed to raise the ability of managers and workers in Western Galilee Hospital in addressing all of the government's requirements for quality and excellence in service in Israel. PMID:19369858
Haron, Yafa; Segal, Zvi; Barhoum, Masad
The pursuit of high-quality patient care within a community hospital highlights the tenuous relationship between the hospital board and administration on one side and the voluntary medical staff on the other. Craddick describes the need to monitor and improve patient management, the commitment of physicians and administrators to high quality care, and the unfortunate failure of most hospital programs to go beyond paper exercises designed to satisfy the Joint Commission of Accreditation of Hospitals (JCAH). The American College of Surgeons summarizes current methods of monitoring the quality of patient care, and gives four examples of successful programs. The JCAH Manual sets standards for hospitals and medical staffs to achieve. However, thus far no one has described how a hospital's medical staff, board, and administration join forces to implement a comprehensive quality assurance program. This paper presents the experience of one community hospital in dealing with this problem over a two-year period. PMID:10292617
Fader, T; Gunzburger, L K; Hartmann, J; Chase, R; Christie, B; Meyer, P; Whitcombe, J
The goals of the study were to examine: (a) the tasks that migrant live-in care workers are expected to perform and actually perform during the hospitalization of their care recipients, and (b) the factors that explain the level of involvement by care workers in caring for hospitalized care recipients. A sample of 535 dyads of family caregivers and care workers of hospitalized care recipients in two general hospitals in Israel was interviewed. Results showed a high level of congruence between the care workers' and family caregivers' perceptions of the roles that the paid carers should perform. Paid carers' involvement in care provision varied by hospital and type of ward and was best explained by the hospital characteristics and congruence in the care workers' perceived roles. The extensive needs of hospitalized functionally disabled older adults necessitate explicit policies and guidelines regarding private care provided in hospital wards. PMID:23937645
Iecovich, Esther; Rabin, Barbara; Penchak, Michal
OBJECTIVE: To determine the prevalence and types of medical quality assurance practices in Ontario hospitals. DESIGN: Survey. SETTING: All teaching, community, chronic care, rehabilitation and psychiatric hospitals that were members of the Ontario Hospital Association as of May 1990. PARTICIPANTS: The person deemed by the chief executive officer of each hospital to be most responsible for medical administration. INTERVENTION: A questionnaire to obtain information on each hospital's use of criteria audit, indicators inventory, occurrence screening and reporting, and utilization review and management (URM) activities. OUTCOME MEASURES: Prevalence of the use of the quality assurance activities, the people responsible for the activities and the relative success of the URM program in modifying physicians' performance. RESULTS: Of the 245 member hospitals participants from 179 (73%) responded. Criteria audits were performed in 136 (76%), indicators inventory in 43 (24%), occurrence screening in 44 (25%), occurrence reporting in 61 (34%) and URM in 123 (69%). In-hospital deaths were reviewed in 157 (88%) of the hospitals. In all, 87 (55%) of the respondents from hospitals that had a URM program or were developing one indicated that their program was successful in modifying physicians' practices, and 29 (18%) reported that it was not successful; 26 (16%) stated that the effect was still unknown, and 16 (10%) did not respond. Seventy (40%) stated that results of tissue reviews were reported at least 10 times per year and 94 (83%) that medical record reviews were reported at least as often. The differences in the prevalence of the quality assurance activities between the hospitals were not found to be significant. CONCLUSIONS: Many Ontario hospitals are conducting a wide variety of quality assurance activities. Further study is required to determine whether the differences in prevalence of these activities between hospitals would be significant in a larger, perhaps national, sample. Strategies are needed to ensure universal involvement and participation in the improvement of the quality of care and the assessment of the cost-effectiveness of health care treatments. Recommendations to achieve these objectives are suggested.
This article offers a definition of quality medical care. Quality itself is defined not as consisting of the properties of an object but rather as the capacity of these properties to achieve goals. Accordingly, quality medical care is the capacity of the elements of that care to achieve legitimate medical and nonmedical goals. This definition is compared with other current definitions. I offer answers to the questions of how to choose goals, who chooses goals, and what are legitimate goals. Implications of this definition are discussed, particularly with reference to chart review. Because patient values shape goals and because these values are not always assessed and recorded, it is recommended that a formal assessment of patient values become part of the patient's record. PMID:3379723
Steffen, G E
A trauma surgeon expressed concern with lack of consistency in care for patients receiving nutrition support (NS) i.e. tube feeding (TF) or total parenteral nutrition (TPN) at our 250 bed inpatient hospital. Medical Nutrition Therapy (MNT) identified this as a quality assurance issue relating to differences in care provided by individual physicians and lack of clearly defined standards of care
Maureen O’Keefe Ralph
Research objective This study examines the perspectives of a range of key hospital staff on the use, importance, scientific background, availability of data, feasibility of data collection, cost benefit aspects and availability of professional personnel for measurement of quality indicators among Iranian hospitals. The study aims to facilitate the use of quality indicators to improve quality of care in hospitals. Study design A cross-sectional study was conducted over the period 2009 to 2010. Staff at Iranian hospitals completed a self-administered questionnaire eliciting their views on organizational, clinical process, and outcome (clinical effectiveness, patient safety and patient centeredness) indicators. Population studied 93 hospital frontline staff including hospital/nursing managers, medical doctors, nurses, and quality improvement/medical records officers in 48 general and specialized hospitals in Iran. Principal findings On average, only 69% of respondents reported using quality indicators in practice at their affiliated hospitals. Respondents varied significantly in their reported use of organizational, clinical process and outcome quality indicators. Overall, clinical process and effectiveness indicators were reported to be least used. The reported use of indicators corresponded with their perceived level of importance. Quality indicators were reported to be used among clinical staff significantly more than among managerial staff. In total, 74% of the respondents reported to use obligatory indicators, while this was 68% for voluntary indicators (p<0.05). Conclusions There is a general awareness of the importance and usability of quality indicators among hospital staff in Iran, but their use is currently mostly directed towards external accountability purposes. To increase the formative use of quality indicators, creation of a common culture and feeling of shared ownership, alongside an increased uptake of clinical process and effectiveness indicators is needed to support internal quality improvement processes at hospital level.
Aghaei Hashjin, Asgar; Ravaghi, Hamid; Kringos, Dionne S.; Ogbu, Uzor C.; Fischer, Claudia; Azami, Saeid Reza; Klazinga, Niek S.
We analyze the cost of quality improvement in hospitals, dealing with two challenges. Hospital quality is multidimensional and hard to measure, while unobserved productivity may influence quality supply. We infer the quality of hospitals in Los Angeles from patient choices. We then incorporate ‘revealed quality’ into a cost function, instrumenting with hospital demand. We find that revealed quality differentiates hospitals, but is not strongly correlated with clinical quality. Revealed quality is quite costly, and tends to increase with hospital productivity. Thus, non-clinical aspects of the hospital experience (perhaps including patient amenities) play important roles in hospital demand, competition, and costs.
Romley, John A.; Goldman, Dana P.
This document corrects technical errors in the regulations text of the final rule that appeared in the August 31, 2012 Federal Register entitled ``Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Fiscal Year 2013 Rates; Hospitals' Resident Caps for Graduate Medical Education Payment Purposes;......
This document corrects technical errors and typographical errors in the final rule entitled ``Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and FY 2012 Rates; Hospitals' FTE Resident Caps for Graduate Medical Education Payment; Corrections'' which appeared in the August 18, 2011 Federal...
Background The aim of this study was to determine the relationship between inpatient satisfaction and health outcomes, quality of life, and adherence to treatment in a sample of patients with schizophrenia, while considering key sociodemographic and clinical confounding factors. Methods This cross-sectional study was conducted in the psychiatric departments of two public university hospitals in France. The data collected included sociodemographic information, clinical characteristics, quality of life (using the 36-Item Short Form Health Survey), nonadherence to treatment (Medication Adherence Report Scale), and satisfaction (a specific self-administered questionnaire based exclusively on patient point of view [Satispsy-22] and a generic questionnaire for hospitalized patients [QSH]). Multiple linear regressions were performed to assess the associations between satisfaction and quality of life and between satisfaction and nonadherence. Two sets of models were performed, ie, scores on the Satispsy-22 and scores on the QSH. Results Ninety-one patients with schizophrenia were enrolled. After adjustment for confounding factors, patients with better personal experience during hospitalization (Satispsy-22) had a better psychological quality of life (SF36-mental composite score, ?=0.37; P=0.004), and patients with higher levels of satisfaction with quality of care (Satispsy-22) showed better adherence to treatment (Medication Adherence Report Scale total score, ?=?0.32; P=0.021). Higher QSH scores for staff and structure index were linked to better adherence with treatment (respectively, ?=?0.33; P=0.019 and ?=?0.30; P=0.032), but not with quality of life. Conclusion Satisfaction was the only factor associated with quality of life and was one of the most important features associated with nonadherence. These findings confirm that satisfaction with hospitalization should not be neglected in clinical practice and that it may improve the management of patients with schizophrenia.
Zendjidjian, Xavier-Yves; Baumstarck, Karine; Auquier, Pascal; Loundou, Anderson; Lancon, Christophe; Boyer, Laurent
This study compared the quality of child care programs serving children receiving government subsidies to those not serving such children. Thirty-four classrooms in full day programs serving preschool aged children (19 subsidized, 15 unsubsidized) were observed using the Early Childhood Environment Rating Scales-Revised (ECERS-R). (1) Research…
Jones-Branch, Julie A.; Torquati, Julia C.; Raikes, Helen; Edwards, Carolyn Pope
The usefulness of hospital charges for instructing medical students on the quality and cost of medical care provided by physicians in general internal medicine and family practice specialists is examined. Hospital cost data were obtained during 1972 and 1...
M. L. Garg J. L. Mulligan M. J. McNamara J. K. Skipper R. R. Parekh
We analyze a duopolistic health care market in which a rural public hospital competes against an urban public hospital on\\u000a medical quality, by using a Hotelling-type spatial competition model extended into a two-region model. We show that the rural\\u000a public hospital provides excess quality for each unit of medical service as compared to the first-best quality, and the profits\\u000a of
Hiroshi Aiura; Yasuo Sanjo
Objective The objective of this study was to analyze the net effects of nurse practice environments on nurse and patient outcomes after accounting for nurse staffing and education. Background Staffing and education have well-documented associations with patient outcomes, but evidence on the effect of care environments on outcomes has been more limited. Methods Data from 10,184 nurses and 232,342 surgical patients in 168 Pennsylvania hospitals were analyzed. Care environments were measured using the practice environment scales of the Nursing Work Index. Outcomes included nurse job satisfaction, burnout, intent to leave, and reports of quality of care, as well as mortality and failure to rescue in patients. Results Nurses reported more positive job experiences and fewer concerns with care quality, and patients had significantly lower risks of death and failure to rescue in hospitals with better care environments. Conclusion Care environment elements must be optimized alongside nurse staffing and education to achieve high quality of care.
Aiken, Linda H.; Clarke, Sean P.; Sloane, Douglas M.; Lake, Eileen T.; Cheney, Timothy
Reducing preventable hospitalizations is fundamental to the "triple aim" of improving care, improving health, and reducing costs. New federal government initiatives that create strong pressure to reduce such hospitalizations are being or will soon be implemented. These initiatives use quality measures to define which hospitalizations are preventable. Reducing hospitalizations could greatly benefit frail and chronically ill adults and older people who receive long-term care (LTC) because they often experience negative effects of hospitalization, including hospital-acquired conditions, morbidity, and loss of functional abilities. Conversely, reducing hospitalizations could mean that some people will not receive hospital care they need, especially if the selected measures do not adequately define hospitalizations that can be prevented without jeopardizing the person's health and safety. An extensive literature search identified 250 measures of preventable hospitalizations, but the measures have not been validated in the LTC population and generally do not account for comorbidity or the capacity of various LTC settings to provide the required care without hospitalization. Additional efforts are needed to develop measures that accurately differentiate preventable from necessary hospitalizations for the LTC population, are transparent and fair to providers, and minimize the potential for gaming and unintended consequences. As the new initiatives take effect, it is critical to monitor their effect and to develop and disseminate training and resources to support the many community- and institution-based healthcare professionals and emergency department staff involved in decisions about hospitalization for this population. PMID:23194066
Ouslander, Joseph G; Maslow, Katie
The quality of care delivered to patients with diabetes has an impact on long-term outcomes. The purpose of this quality improvement project was to examine the effect of a Diabetes Disease Management Program (DDMP) on compliance with recommended process measures of care in primary care practice settings. Certified diabetes nurse educators visited five participating primary care practices biweekly for 1
Janice C. Zgibor; Harsha Rao; Jacqueline Wesche-Thobaben; Nancie Gallagher; Janis McWilliams; Mary T. Korytkowski
Background: As a prelude to establishing a Pediatric Palliative Care Program, we solicited information from families about their experiences and their suggestions for improving the quality of end-of-life care. Participants were English- and Spanish-speaking family members of de- ceased pediatric patients who received care at Lucile Salter Packard Children's Hospital, Stanford University Medi- cal Center, Palo Alto, Calif. Methods: Sixty-eight
Nancy Contro; Judith Larson; Sarah Scofield; Barbara Sourkes; Harvey Cohen
This article discusses an ignored problem--the plight of infants and toddlers in foster care who find themselves hospitalized. A majority of the children in foster care will be hospitalized for medical treatment while in foster care because they are more likely to have serious medical problems or developmental disabilities than their age peers.…
Background: Residents play an important role in the delivery of hospital care. They regularly work overnight, in emergency situations and with workload and stress which can affect their performance and quality of working life (QWL). This study explores the QWL and its contributory factors in residents working at hospitals affiliated with Tehran University of Medical Sciences (TUMS), Tehran, Iran. Methods: Medline was searched to identify questionnaires for measuring QWL in healthcare professionals and these questionnaires were used to design a comprehensive questionnaire for measuring residents QWL. Face and content validity of the questionnaire were examined by 7 experts. The questionnaire then was completed twice with one-week interval by 14 residents to assess the intera-rater reliability. Then 310 questionnaires were distributed among residents working at different specialties in 7 hospitals affiliated to TUMS including a large general hospital, two medium general hospitals and four small single specialty hospitals. Statistical analyses were performed by SPSS. Results: Totally, 263 residents (84%) completed the questionnaire. The quality of working life was very well in 18%, well in 32%, moderate in 31%, low in 14% and very low in 5% of residents. Pediatric residents had the highest and urology and internal medicine residents had the lowest quality of working life. Conclusion: The QWL is high in the majority of residents, but the QWL is still not desirable in a significant proportion of them. The questionnaire used in this study is reliable and valid. The residents’ QWL still need improvement.
Zare, M Hosseini; Ahmadi, B; Sari, A Akbari; Arab, M; Kor, E Movahed
This study measures the effect of TennCare, a Medicaid managed care reform initiated in 1994, on the efficiency of hospitals in Tennessee. We apply a multiple-output stochastic frontier approach to a panel dataset that represents all short-term acute care hospitals operating in Tennessee for 1990-2001 and find a modest gain in operating efficiency overall. Our results also reveal that the effect of reform on hospital efficiency varies significantly with the admitting hospital's TennCare patient load and whether the hospital is located in an urban or rural area. During the study period, high-TennCare hospitals in urban areas saw efficiency gains in the 4 years immediately after the implementation of the program while high-TennCare hospitals in rural areas had significant efficiency losses. The effects immediately following the program's implementation on low-TennCare urban and rural hospitals are similar to those experienced by hospitals with high-TennCare admissions but the magnitude of the effects are much smaller. Policymakers considering large scale reforms of this type should be careful to take into consideration the likely differential responses from urban and rural hospitals that are prone to differ in payer mix and capacity to improve efficiency. PMID:19739355
Chang, Cyril F; Troyer, Jennifer L
Purposes: To assess the relationship between hospitals' X-inefficiency levels and overall care quality based on the National Quality Forum's 30 safe practices score and to improve the analytic strategy for assessing X-inefficiency. Methodology: The 2005 versions of the American Hospital Association and Leapfrog Group's annual surveys were the basis of the study. Additional case mix indices and market variables were
Timothy R. Huerta; Eric W. Ford; Lori T. Peterson; Keith H. Brigham
This proposal for a federal government program of health services research, written in spring of 1966, played a key role in development of the National Center for Health Services Research and Development, announced by the President early this year. The paper points to the lack of economic incentives for development of cost-saving innovations for hospitals compared to incentives to develop innovations improving the quality of care. It indicates the analytic procedure which, if followed, would lead to an efficient program of research, and points out several aspects of the analysis that are critical requirements for its successful application.
Background Medication discrepancies at the time of hospital discharge are common and can result in error, patient\\/carer inconvenience or patient harm. Providing accurate medication information to the next care provider is necessary to prevent adverse events. Aims To investigate the quality and consistency of medication details generated for such transfer from an Irish teaching hospital. Methods This was an observational
T. Grimes; T. Delaney; C. Duggan; J. G. Kelly; I. M. Graham
This paper presents an analysis of how Clifford Geertz' anthropological approach contributes to studies and investigations on health care. Geertz' approach relies basically on a semiotic conception of culture adopting thick description as the axis for interpretive elaborations and defending cultural interpretation as a science allowing to understand processes and to construct knowledge. We will present an overview of some constitutive elements of that author's thoughts we consider relevant for understanding the human experience of dealing with the disease/health process. The challenging question is how families deal with the need to provide care to a diseased relative after hospital discharge. We use this issue as an excuse for expounding this theoretical approach, interweaving the two areas. The micro-focus is the kind of healthcare that takes place outside the cultural environment where the technical forms of care based on scientific knowledge occur. We will briefly discuss how this question becomes evident in an object of study, and how it can be investigated according to the ethnography proposed by Geertz (op. cit.), allowing, in the end, for some considerations that further contribute to the construction of knowledge in public health. PMID:19039391
de Castro, Edna Aparecida Barbosa; de Camargo Junior, Kenneth Rochel
This document corrects technical errors that occurred in the Addendum of the final rule entitled ``Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Fiscal Year 2012 Rates'' which appeared in the August 18, 2011 Federal...
Objective The assessment of integral quality management (QM) in a hospital requires measurement and monitoring from different perspectives and at various levels of care delivery. Within the DUQuE project (Deepening our Understanding of Quality improvement in Europe), seven measures for QM were developed. This study investigates the relationships between the various quality measures. Design It is a multi-level, cross-sectional, mixed-method study. Setting and Participants As part of the DUQuE project, we invited a random sample of 74 hospitals in 7 countries. The quality managers of these hospitals were the main respondents. Furthermore, data of site visits of external surveyors assessing the participating hospitals were used. Main Outcome Measures Three measures of QM at hospitals level focusing on integral systems (QMSI), compliance with the Plan-Do-Study-Act quality improvement cycle (QMCI) and implementation of clinical quality (CQII). Four measures of QM activities at care pathway level focusing on Specialized expertise and responsibility (SER), Evidence-based organization of pathways (EBOP), Patient safety strategies (PSS) and Clinical review (CR). Results Positive significant associations were found between the three hospitals level QM measures. Results of the relationships between levels were mixed and showed most associations between QMCI and department-level QM measures for all four types of departments. QMSI was associated with PSS in all types of departments. Conclusion By using the seven measures of QM, it is possible to get a more comprehensive picture of the maturity of QM in hospitals, with regard to the different levels and across various types of hospital departments.
Wagner, Cordula; Groene, Oliver; Thompson, Caroline A.; Dersarkissian, Maral; Klazinga, Niek S.; Arah, Onyebuchi A.; Sunol, Rosa; Klazinga, N; Kringos, DS; Lombarts, K; Plochg, T; Lopez, MA; Secanell, M; Sunol, R; Vallejo, P; Bartels, P; Kristensen, S; Michel, P; Saillour-Glenisson, F; Vlcek, F; Car, M; Jones, S; Klaus, E; Garel, P; Hanslik, K; Saluvan, M; Bruneau, C; Depaigne-Loth, A; Shaw, C; Hammer, A; Ommen, O; Pfaff, H; Groene, O; Botje, D; Wagner, C; Kutaj-Wasikowska, H; Kutryba, B; Escoval, A; Franca, M; Almeman, F; Kus, H; Ozturk, K; Mannion, R; Arah, OA; Chow, A; DerSarkissian, M; Thompson, C; Wang, A; Thompson, A
The medical care of hospitalized geriatric patients must differ from the care of younger adults. Because of reduced “reserve capacity,” hospitalized older adults are at high risk of development of geriatric syndromes such as delirium and falls. Geriatric syndromes often lead to functional decline and dependence. Patients who experience geriatric syndromes in the hospital are more likely to have a longer length of stay, higher risk of readmissions, and worse medical outcomes. Incident delirium in hospitalized geriatric patients has been shown to be preventable by intervening in established risk factors. Prevention of hospital-related falls has not been consistently demonstrated. Analysis from Kaiser Permanente data demonstrated a correlation with delirium and hospital-related falls. We propose that age-specific quality metrics should be made to reduce the risk of the development of geriatric syndromes in hospitalized older adults. By preventing delirium, we believe that health care practitioners can reduce hospital-related falls in geriatric patients and improve the quality of care delivered to hospitalized older adults. An illustrative fictional case study is presented.
Lee, Eric A; Gibbs, Nancy E; Fahey, Linda; Whiffen, Teri L
Background and aim As a result of New Public Management, a number of industrial models of quality management have been implemented in health care, mainly in hospitals. At the same time, the concept of integrated care has been developed within other parts of the health sector. The aim of the article is to discuss the relevance of integrated care for hospitals. Theory and methods The discussion is based on application of a conceptual framework outlining a number of organizational models of integrated care. These models are illustrated in a case study of a Danish university hospital implementing a new organization for improving the patient flows of the hospital. The study of the reorganization is based mainly on qualitative data from individual and focus group interviews. Results The new organization of the university hospital can be regarded as a matrix structure combining a vertical integration of clinical departments with a horizontal integration of patient flows. This structure has elements of both interprofessional and interorganizational integration. A strong focus on teamwork, meetings and information exchange is combined with elements of case management and co-location. Conclusions It seems that integrated care can be a relevant concept for a hospital. Although the organizational models may challenge established professional boundaries and financial control systems, this concept can be a more promising way to improve the quality of care than the industrial models that have been imported into health care. This application of the concept may also contribute to widen the field of integrated care.
Axelsson, Runo; Axelsson, Susanna Bihari; Gustafsson, Jeppe; Seemann, Janne
The purpose of this article is to examine the issue of quality of care in rural America and to help others examine this issue in a way that is consistent with the very real challenges faced by rural communities in ensuring the availability of adequate health services. Rural citizens have a right to expect that their local health care meets certain basic standards. Unless rural providers can document that the quality of local health care meets objective external standards, third-party payers might refuse to contract with rural providers, and increasingly sophisticated consumers might leave their communities for basic medical care services. To improve the measurement of health care quality in a rural setting, a number of issues specific to the rural environment must be addressed, including small sample sizes (volume and outcome issues), limited data availability, the ability to define rural health service areas, rural population preferences and the lower priority of formal quality-of-care assessment in shortage areas. Several current health policy initiatives have substantial implications for monitoring and measuring the quality of rural health services. For example, to receive community acceptance and achieve fiscal stability, critical access hospitals (CAHs) must be able to document that the care they provide is at least comparable to that of their predecessor institutions. The expectations for quality assurance activities in CAHs should consider their limited institutional resources and community preferences. As managed care extends from urban areas, there will be an inevitable collision between the ability to provide care and the ability to measure quality. As desirable as it might be to have a national standard for health care quality, this is not an attainable goal. The spectrum and content of rural health care are different from the spectrum and content of care provided in large cities. Accrediting agencies, third-party carriers and health insurance purchasers need to develop rural health care quality standards that are practical, useful and affordable. PMID:10981369
Moscovice, I; Rosenblatt, R
The reason that probably prompted Dame Cicely Saunders to launch the palliative care movement was the need to move away from the impersonal, technocratic approach to death that had become the norm in hospitals after the Second World War. Palliative care focuses on relieving the suffering of patients and families. Not limited to just management of pain, it includes comprehensive management of any symptom, which affects the quality of life. Care is optimized through early initiation and comprehensive implementation throughout the disease trajectory. Effective palliative care at the outset can help accelerate a positive clinical outcome. At the end of life, it can enhance the opportunity for the patient and family to achieve a sense of growth, resolve differences, and find a comfortable closure. It helps to reduce the suffering and fear associated with dying and prepares the family for bereavement. PMID:21811377
Kulkarni, Priya Darshini
Measures of the quality of hospital postnatal nursing care were developed for an evaluative study of the benefits of combined mother-infant versus traditional separate staffing patterns. Two hundred mothers completed instruments designed to measure maternal competence, patient satisfaction, establishment of breast-feeding in hospital and breast-feeding success at 6 weeks, and 28 nursing staff completed measures of staff satisfaction. The internal consistency and test-retest reliability of scales were supported by alpha coefficients of .60 to .89 and correlation coefficients of .74 to .80. A 90% participation rate and a 97% completion rate were achieved for the maternal sample. Evidence is presented for instrument content, construct, and predictive validity. PMID:2798950
Watters, N E; Kristiansen, C M
Study objective Assessment of patients’ perception of pain control in hospitals in the United States. Background Limited data are available regarding the quality of pain care in the hospitalized patient. This is particularly valid for data that allow for comparison of pain outcomes from one hospital to another. Such data are critical for numerous reasons, including allowing patients and policy-makers to make data-driven decisions, and to guide hospitals in their efforts to improve pain care. The Hospital Quality Alliance was recently created by federal policy makers and private organizations in conjunction with the Centers for Medicare and Medicare Services to conduct patient surveys to evaluate their experience including pain control during their hospitalization. Methods In March 2008, the results of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey was released for review for health care providers and researchers. This survey includes a battery of questions for patients upon discharge from the hospital including pain-related questions and patient satisfaction that provide valuable data regarding pain care nationwide. This study will review the results from the pain questions from this available data set and evaluate the performance of these hospitals in pain care in relationship to patient satisfaction. Furthermore, this analysis will be providing valuable information on how hospital size, geographic location and practice setting may play a role in pain care in US hospitals. Results The data indicates that 63% of patients gave a high rating of global satisfaction for their care, and that an additional 26% of patients felt that they had a moderate level of global satisfaction with the global quality of their care. When correlated to satisfaction with pain control, the relationship with global satisfaction and “always” receiving good pain control was highly correlated (r >0.84). In respect to the other HCAHPS components, we found that the patient and health care staff relationship with the patient is also highly correlated with pain relief (r >0.85). The patients’ reported level of pain relief was significantly different based upon hospital ownership, with government owned hospitals receiving the highest pain relief, followed by nonprofit hospitals, and lastly proprietary hospitals. Hospital care acuity also had an impact on the patient’s perception of their pain care; patients cared for in acute care hospitals had lower levels of satisfaction than critical access hospitals. Conclusions The results of this study are a representation of the experiences of patients in US hospitals with regard to pain care specifically and the need for improved methods of treating and evaluating pain care. This study provides the evidence needed for hospitals to make pain care a priority in to achieve patient satisfaction throughout the duration of their hospitalization. Furthermore, future research should be developed to make strategies for institutions and policy-makers to improve and optimize patient satisfaction with pain care.
Gupta, Anita; Daigle, Sarah; Mojica, Jeffrey; Hurley, Robert W
BACKGROUND: Reports of higher quality care by higher-volume secondary care providers have fuelled a shift of services from smaller provider units to larger hospitals and units. In the United Kingdom, most patients are managed in primary care. Hence if larger practices provide better quality of care; this would have important implications for the future organization of primary care services. We
Sonia Saxena; Josip Car; Darren Eldred; Michael Soljak; Azeem Majeed
Not-for-profit (NFP) hospitals have come under increased public scrutiny for management practices that are inconsistent with their charitable focus. Of particular concern is the amount of community benefit provided by NFP hospitals compared to for-profit (FP) hospitals given the substantial tax benefits afforded to NFP hospitals. This study examines hospital ownership and community benefit provision beyond the traditional uncompensated care comparison by using broader measures of community benefit that capture charitable services, community assessment and partnership, and community-oriented health services. The study sample includes 3,317 nongovernment, general, acute care, community hospitals that were in operation in 2006. Data for this study came from the 2006 American Hospital Association Hospital Survey and the 2006 Area Resource File. We used multivariate regression analyses to examine the relationship between hospital ownership and five indicators of community benefit, controlling for hospital characteristics, market demand, hospital competition, and state regulations for community benefit. We found that NFP hospitals report more community benefit activities than do FP hospitals that extend beyond uncompensated care. Our findings underscore the importance of defining and including activities beyond uncompensated care when evaluating community benefit provided by NFP hospitals. PMID:23650697
Song, Paula H; Lee, Shoou-Yih D; Alexander, Jeffrey A; Seiber, Eric E
We are revising the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital-related costs of acute care hospitals to implement changes arising from our continuing experience with these systems. Some of the changes implement certain statutory provisions contained in the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act......
Hospitalization of nursing home residents can be futile as well as costly, and now evidence indicates that treating nursing home residents in place produces better outcomes for some conditions. We examined facility organizational characteristics that previous research showed are associated with potentially avoidable hospital transfers and with…
McGregor, Margaret J.; Baumbusch, Jennifer; Abu-Laban, Riyad B.; McGrail, Kimberlyn M.; Andrusiek, Dug; Globerman, Judith; Berg, Shannon; Cox, Michelle B.; Salomons, Kia; Volker, Jan; Ronald, Lisa
Objective The study evaluates the performance of Medicare managed care (Medicare Advantage [MA]) Plans in comparison to Medicare fee-for-service (FFS) Plans in three states with historically high Medicare managed care penetration (New York, California, Florida), in terms of lowering the risks of preventable or ambulatory care sensitive conditions (ACSC) hospital admissions and providing increased referrals for admissions for specialty procedures. Study Design/Methods Using 2004 hospital discharge files from the Healthcare Cost and Utilization Project (HCUP-SID) of the Agency for Healthcare Research and Quality, ACSC admissions are compared with ‘marker’ admissions and ‘referral-sensitive’ admissions, using a multinomial logistic regression approach. The year 2004 represents a strategic time to test the impact of MA on preventable hospitalizations, because the HMOs dominated the market composition in that time period. Findings MA enrollees in California experienced 22% lower relative risk (RRR= 0.78, p<0.01), those in Florida experienced 16% lower relative risk (RRR= 0.84, p<0.01), while those in New York experienced 9% lower relative risk (RRR=0.91, p<0.01) of preventable (versus marker) admissions compared to their FFS counterparts. MA enrollees in New York experienced 37% higher relative risk (RRR=1.37, p<0.01) and those in Florida had 41% higher relative risk (RRR=1.41, p<0.01)—while MA enrollees in California had 13% lower relative risk (RRR=0.87, p<0.01)—of referral-sensitive (versus marker) admissions compared to their FFS counterparts. Conclusion While MA plans were associated with reductions in preventable hospitalizations in all three states, the effects on referral-sensitive admissions varied, with California experiencing lower relative risk of referral-sensitive admissions for MA plan enrollees. The lower relative risk of preventable admissions for MA plan enrollees in New York and Florida became more pronounced after accounting for selection bias.
Basu, Jayasree; Mobley, Lee Rivers
People with psychiatric problems often visit a general hospital. Many of them require emergency service. B P Koirala Institute of Health Sciences (BPKIHS) is one of the few health institutes in Nepal providing comprehensive 24-hour psychiatric emergency service. This study aims to document the pattern of psychiatric emergencies in a tertiary care hospital of Eastern Nepal. All psychiatric emergencies referred from different departments in 30 random days during a six-month period were enrolled. This is a descriptive study with convenience sampling method where the diagnoses were made based on the'International Classification of Disease and Infirmity' (ICD-10). One hundred twenty-nine cases were referred in the study period. The M:F ratio was 1.3:1. The service users were predominantly young adults. The majority of cases were seen in the emergency department and medical ward. The most common causes for the consultation were behavioral problems (39%), altered consciousness (32%) and somatic complaints (17%). Approximately 83% received the diagnosis of Category F of the ICD-10. Mental and behavioral disorder due to substance use (F10-19) was the most common disorder (30%), followed by mood/affective disorders (23%) and neurotic, stress-related anxiety disorders (16%). Roughly 46% had co-morbid physical illnesses and 8% received only a physical diagnosis. About 20% had attempted suicide using different means, poisoning being the most common. Emergency psychiatric consultation for mental problems is sought by almost all departments of a general hospital. These consultations are most commonly sought for substance use, mood or anxiety disorders. PMID:18552889
Shakya, D R; Shyangwa, P M; Shakya, R
Background. Review of the literature reveals a need to develop a questionnaire that measures patient perceptions of factors impacting continuity of care following discharge from hospital. Such a measure has the potential to guide quality improvement initiatives related to continuity of care. Objective. Our objective was to develop and examine the psychometric properties of a measure that would meet this
HEATHER HADJISTAVROPOULOS; HENRY BIEM; DONALD SHARPE; MICHELLE BOURGAULT; JENNIFER JANZEN
This notice announces the inpatient hospital deductible and the hospital and extended care services coinsurance amounts for services furnished in calendar year (CY) 2014 under Medicare's Hospital Insurance Program (Medicare Part A). The Medicare statute specifies the formulae used to determine these amounts. For CY 2014, the inpatient hospital deductible will be $1,216. The daily coinsurance......
Recent national policies use risk-standardized readmission rates to measure hospital performance on the theory that readmissions reflect dimensions of the quality of patient care that are influenced by hospitals. In this article our objective was to assess readmission rates as a hospital quality measure. First we compared quartile rankings of hospitals based on readmission rates in 2009 and 2011 to see whether hospitals maintained their relative performance or whether shifts occurred that suggested either changes in quality or random variation. Next we examined the relationship between readmission rates and several commonly used hospital quality indicators, including risk-standardized mortality rates, volume, teaching status, and process-measure performance. We found that quartile rankings fluctuated and that readmission rates for lower-performing hospitals in 2009 tended to improve by 2011, while readmission rates for higher-performing hospitals tended to worsen. Regression to the mean (a form of statistical noise) accounted for a portion of the changes in hospital performance. We also found that readmission rates were higher in teaching hospitals and were weakly correlated with the other indicators of hospital quality. Policy makers should consider augmenting the use of readmission rates with other measures of hospital performance during care transitions and should build on current efforts that take a communitywide approach to the readmissions issue. PMID:23733983
Press, Matthew J; Scanlon, Dennis P; Ryan, Andrew M; Zhu, Jingsan; Navathe, Amol S; Mittler, Jessica N; Volpp, Kevin G
Allegations about quality-of-care problems have raised questions about the oversight of long-term care hospitals (LTCH), which provide care to individuals with multiple acute or chronic conditions. Medicare pays for about 80 percent of LTCH patient care. ...
The study assessed the validity of using Medicare hospital claims data to identify adverse events following repair of hip fracture. The study identified adverse events from diagnostic and procedure codes (International Classification of Diseases, 9th Revi...
E. B. Keeler K. L. Kahn S. S. Bentow
Context: Rural hospitals face multiple financial burdens. Due to federal law, emergency departments (ED) provide a gateway for uninsured and self-pay patients to gain access to treatment. It is unknown how much uncompensated care in rural hospitals is due to ED visits. Purpose: To develop a national estimate of uncompensated care from patients…
Bennett, Kevin J.; Moore, Charity G.; Probst, Janice C.
The lack of use of high technology in the healthcare delivery system is especially apparent in the emergency medical information systems (EMIS) area. For example, in New York State, all patients who enter the emergency medical service (EMS) are tracked through their pre-hospital care to the emergency room using a pre-hospital care report (PCR). Our goal is to automate the
Venu Govindaraju; Robert Milewski
To date, researchers have lacked a validated instrument to measure stroke caregivers' satisfaction with hospital care. We adjusted a validated patient version of satisfaction with hospital care for stroke caregivers and tested the 11-item caregivers' satisfaction with hospital care (C-SASC hospital scale) on caregivers of stroke patients admitted to nine stroke service facilities in the Netherlands. Stroke patients were identified through the stroke service facilities; caregivers were identified through the patients. We collected admission demographic data from the caregivers and gave them the C-SASC hospital scale. We tested the instrument by means of structural equation modeling and examined its validity and reliability. After the elimination of three items, the confirmatory factor analyses revealed good indices of fit with the resulting eight-item C-SASC hospital scale. Cronbach's ? was high (0.85) and correlations with general satisfaction items with hospital care ranged from 0.594 to 0.594 (convergent validity). No significant relations were found with health and quality of life (divergent validity). Such results indicate strong construct validity. We conclude that the C-SASC hospital scale is a promising instrument for measuring stroke caregivers' satisfaction with hospital stroke care. PMID:21181184
Cramm, Jane M; Strating, Mathilde M H; Nieboer, Anna P
Analyzes the interaction between psychiatric services in public general hospitals and in other institutional settings. A one-day census of patients in a New York general hospital showed the hospital was providing care to a large number of patients in need of other, less intensive institutional settings. (BH)
Marcos, Luis R.; Gil, Rosa M.
Postoperative morbidity and mortality is low following radical prostatectomy (RP), though not inconsequential. Due to the natural history of the disease process, the implications of treatment on long-term oncologic control and functional outcomes are of increased significance. Structures, processes and outcomes are the three main determinants of quality of RP care and provide the framework for this review. Structures affecting quality of care include hospital and surgeon volume, hospital teaching status and patient insurance type. Process determinants of RP care have been poorly studied, by and large, but there is a developing trend toward the performance of randomized trials to assess the merits of evolving RP techniques. Finally, the direct study of RP outcomes has been particularly controversial and includes the development of quality of life measurement tools, combined outcomes measures, and the use of utilities to measure operative success based on individual patient priority.
Sammon, Jesse; Jhaveri, Jay; Sun, Maxine; Ghani, Khurshid R.; Schmitges, Jan; Jeong, Wooju; Peabody, James O.; Karakiewicz, Pierre I.; Menon, Mani
While hospitals have widely adopted quality improvement (QI) initiatives, primary care practices continue to face unique challenges to QI implementation. The purpose of this article is to outline a strategy for promoting QI in primary care practices by introducing specially trained nurses. Two case examples are described, one with a QI nurse external to the practice and one with a nurse internal to the practice. Lessons learned and barriers and facilitators to QI in primary care are presented. Barriers and facilitators are identified in the following categories: practice infrastructure, practice leadership, and practice organizational culture. Implications for primary care practitioners and avenues for future work are discussed. PMID:24978164
Hudson, Shannon M; Hiott, Deanna B; Cole, Jeff; Davis, Robert; Egan, Brent M; Laken, Marilyn A
Quality in health care is important as it is directly linked with patient safety. Quality as we know is driven either by regulation or by market demand. Regulation in most developing countries has not been effective, as there is shortage of health care providers and governments have to be flexible. In such circumstances, quality has taken a back seat. Accreditation symbolizes the framework for quality governance of a hospital and is based on optimum standards. Not only is India establishing numerous state of the art hospitals, but they are also experiencing an increase in demand for quality as well as medical tourism. India launched its own accreditation system in 2006, conforming to standards accredited by ISQua. This article shows the journey to accreditation in India and describes the problems encountered by hospitals as well as the benefits it has generated for the industry and patients. PMID:24938026
Gyani, Girdhar J; Krishnamurthy, B
...2009-10-01 2009-10-01 false Special payment provisions for long-term care hospitals within hospitals and satellites of long-term care hospitals. 412.534 Section 412.534 Public Health CENTERS FOR MEDICARE &...
...2010-10-01 2010-10-01 false Special payment provisions for long-term care hospitals within hospitals and satellites of long-term care hospitals. 412.534 Section 412.534 Public Health CENTERS FOR MEDICARE &...
This survey of 25 day care centers in 5 regions of Italy was designed to determine the characteristics of competent centers and the effects of differing local regulations on the quality of care provided. The Infant and Toddler Environment Rating Scale (ITERS) and a questionnaire were utilized to assess the quality of the day care centers in the…
It is widely accepted that high quality child care enhances children's cognitive and social development, but some question whether what constitutes quality care depends on the child's ethnic and cultural background. To address this question, secondary analysis of data from the two largest studies of child care experiences in the United States,…
Burchinal, Margaret R.; Cryer, Debby
This study measures the effect of TennCare, a Medicaid managed care reform initiated in 1994, on the efficiency of hospitals\\u000a in Tennessee. We apply a multiple-output stochastic frontier approach to a panel dataset that represents all short-term acute\\u000a care hospitals operating in Tennessee for 1990–2001 and find a modest gain in operating efficiency overall. Our results also\\u000a reveal that the
Cyril F. Chang; Jennifer L. Troyer
Background Medical care at the end of life is often expensive and ineffective. Objective To explore associations between primary care and hospital utilization at the end of life. Design Retrospective analysis of Medicare data. We measured hospital utilization during the final 6 months of life and the number of primary care physician visits in the 12 preceding months. Multivariate cluster analysis adjusted for the effects of demographics, comorbidities, and geography in end-of-life healthcare utilization. Subjects National random sample of 78,356 Medicare beneficiaries aged 66+ who died in 2001. Non-whites were over-sampled. All subjects with complete Medicare data for 18 months prior to death were retained, except for those in the End Stage Renal Disease program. Measurements Hospital days, costs, in-hospital death, and presence of two types of preventable hospital admissions (Ambulatory Care Sensitive Conditions) during the final 6 months of life. Results Sample characteristics: 38% had 0 primary care visits; 22%, 1–2; 19%, 3–5; 10%, 6–8; and 11%, 9+ visits. More primary care visits in the preceding year were associated with fewer hospital days at end of life (15.3 days for those with no primary care visits vs. 13.4 for those with ?9 visits, P?0.001), lower costs ($24,400 vs. $23,400, P?0.05), less in-hospital death (44% vs. 40%, P?0.01), and fewer preventable hospitalizations for those with congestive heart failure (adjusted odds ratio, aOR?=?0.82, P?0.001) and chronic obstructive pulmonary disease (aOR?=?0.81, P?=?0.02). Conclusions Primary care visits in the preceding year are associated with less, and less costly, end-of-life hospital utilization. Increased primary care access for Medicare beneficiaries may decrease costs and improve quality at the end of life.
Ash, Arlene S.; Freund, Karen M.; Hanchate, Amresh; Emanuel, Ezekiel J.
Abstract Perinatal morbidity and mortality are key indicators of a nation's health status. These measures of our nation's health are influenced by decisions made in health care facilities and by health care providers. As our health systems and health care for women and infants can be improved, there is an expectation that these measures of health will also improve. State-based perinatal quality collaboratives (PQCs) are networks of perinatal care providers including hospitals, clinicians, and public health professionals working to improve pregnancy outcomes for women and newborns through continuous quality improvement. Members of the collaborative are healthcare facilities, primarily hospitals, which identify processes of care that require improvement and then use the best available methods to effect change and improve outcomes as quickly as possible. The Division of Reproductive Health at the Centers for Disease Control and Prevention is collaborating with state-based PQCs to enhance their ability to improve perinatal care by expanding the range of neonatal and maternal health issues addressed and including higher proportions of participating hospitals in their state PQC. The work of PQCs is cross-cutting and demonstrates how partnerships can act to translate evidence-based science to clinical care. PMID:24655150
Henderson, Zsakeba T; Suchdev, Danielle B; Abe, Karon; Johnston, Emily Osteen; Callaghan, William M
This paper investigates the effects of competition on hospital quality. It proposes to extend the Elzinga-Hogarty quantity flow approach of defining markets by first determining the trading cluster to which each hospital belongs and then delineating markets using patient flow information. After defining hospital markets and computing measures of competition, this paper examines the effect of competition on hospital quality
Alfons Palangkaraya; Jongsay Yong
Where minorities receive their care may contribute to disparities in care, yet, the racial concentration of care in the Veterans Health Administration is largely unknown. We sought to better understand which Veterans Affairs (VA) hospitals treat Black veterans and whether location of care impacted disparities. We assessed differences in mortality rates between Black and White veterans across 150 VA hospitals for any of six conditions (acute myocardial infarction, hip fracture, stroke, congestive heart failure, gastrointestinal hemorrhage, and pneumonia) between 1996 and 2002. Just 9 out of 150 VA hospitals (6% of all VA hospitals) cared for nearly 30% of Black veterans, and 42 hospitals (28% of all VA hospitals) cared for more than 75% of Black veterans. While our findings show that overall mortality rates were comparable between minority-serving and non-minority-serving hospitals for four conditions, mortality rates were higher in minority-serving hospitals for acute myocardial infarction (AMI) and pneumonia. The ratio of mortality rates for Blacks compared with Whites was comparable across all VA hospitals. In contrast to the private sector, there is little variation in the degree of racial disparities in 30-day mortality across VA hospitals, although higher mortality among patients with AMI and pneumonia requires further investigation. PMID:20946426
Jha, Ashish K; Stone, Roslyn; Lave, Judith; Chen, Huanyu; Klusaritz, Heather; Volpp, Kevin
Objective To understand perceptions of palliative care in acute care hospitals and identify barriers to earlier use of palliative care in the illness trajectory. Methods We conducted semistructured interviews with 120 providers involved in decision making or discharge planning and “shadowed” health care providers on intensive care unit rounds in 11 Pennsylvania hospitals, and then used qualitative methods to analyze field notes and transcripts. Results Most participants characterized palliative care as end-of-life or hospice care that is initiated after the decision to limit treatment is made. Few recognized the role of palliative care in managing symptoms and addressing the psychosocial needs of patients with chronic illnesses other than cancer. Participants viewed earlier and broader palliative care consultations less in terms of clinical benefits than in terms of cost savings accrued from shorter terminal hospitalizations. In general, participants thought nurses were most likely to facilitate palliative care consults, surgeons were most likely to resist them, and intensive care specialists were most likely to view palliative care as within their own scope of practice. Suggestions for increasing and broadening palliative care integration and utilization included providing workforce development, education, and training; improving financial reimbursement and sustainability for palliative care; and fostering a hospital culture that turns to high -intensity care only if it meets the individual needs and goals of patients with chronic illnesses. Conclusions Initiating palliative care consultations earlier during hospitalization will require an emphasis on patient benefits and assurances that palliative care will not threaten provider autonomy.
RODRIGUEZ, KERI L.; BARNATO, AMBER E.; ARNOLD, ROBERT M.
The purpose of the report is to quantify the effect on infant mortality and complications of premature birth of delivering in a high-level neonatal intensive care unit (NICU) versus delivering at a local hospital.
POC studies began in 1987 with SEER cases serving as controls for a study that examined the provision of state-of-the-art therapy in Community Clinical Oncology Program hospitals. In 1990, the number of cases included in the POC initiative was increased substantially to obtain more stable estimates of community practice in a population-based sample of cases.
Modern hospitals are facing several challenges and, over the last decade in particular, many of these institutions have become dysfunctional. Paradoxically as medicine has become more successful the demand for acute hospital care has increased, yet there is no consensus on what conditions or complaints require hospital admission and there is wide variation in the mortality rates, length of stay
The observational study reported here was part of a wider evaluation of long stay care for elderly people. The observational study showed that it was essential not to rely on interview material alone. Qualitative techniques provided insights into behaviours, moods and interactions which would have been difficult to measure using traditional survey techniques. The data collected was analyzed in relation
Patricia Clark; Ann Bowling
Study Objective: We characterize repeat pediatric emergency department visits and determine the cause for such visits as an indicator of potential need for quality improvement. We hypothesized that most repeat ED visits resulting in hospitalization do not represent medical errors. Methods: The study was performed at a large, tertiary care, academic children's hospital. Patients who returned to the ED within
Andrew D. DePiero; Daniel W. Ochsenschlager; James M. Chamberlain
The Child Care Facility Schedule (CCFS) represents an effort to develop a measure to assess quality child care. Initially 80 criteria, covering 8 areas considered important for attaining quality, were defined. These were subsequently tested in three different cultural contexts: Athens (Greece), Manila (Philippines), and Ibadan (Nigeria). Reliability studies were conducted in Athens and Ibadan, and a validity study was
Thalia Dragonas; John Tsiantis; Anna Lambidi
Background: Although today parents’ participation in taking care of hospitalized children is considered as an indispensable principle, it is still among the concepts with no consensus about. The main objective of this study is to define parents’ participation in taking care of hospitalized children. Materials and Methods: The concept of “parents’ participation in taking care of hospitalized children” was analyzed using a hybrid model in three phases: Literature review (theoretical phase), fieldwork, and combination of literature review and fieldwork (analytical phase). Results: Based on the results of theoretical (literature review), fieldwork, and analytical phases, the best definitions for the concept of “parents’ participation in taking care of hospitalized children” are mutual relationship and gaining parents’ trust toward nurses, giving the required information and education to the parents about care and treatment process, assigning the needed home care to the parents, involving the parents in caregiving process, and finally, defining their participation in decision making (clarifying the parents’ role) in order to improve the quality of care given to the children. Conclusions: The findings of this study showed that the dimensions of parents’ participation can be applied in pediatric wards, and nurses can improve the quality of care through application of the obtained findings.
Vasli, Parvaneh; Salsali, Mahvash
Background The quality of nursing home care for residents with advanced dementia has been described as suboptimal. One relatively understudied factor is the impact of special care units (SCUs) for dementia for residents at the end-stage of this disease. Objective To examine the association between residence in an SCU and the quality of end-of-life care for nursing home residents with advanced dementia. Research Design This study employed longitudinal data on 323 nursing home residents with advanced dementia living in 22 Boston-area facilities. Using multivariate methods, we analyzed the association between residence in an SCU and measures of quality of end-of-life care including: treatment of pain and dyspnea, prevalence of pressure ulcers, hospitalization, tube feeding, antipsychotic drug use, advance care planning, and health care proxy (HCP) satisfaction with care. Results A total of 43.7% residents were cared for in an SCU. After multivariate adjustment, residents in SCUs were more likely to receive treatment for dyspnea, had fewer hospitalizations, were less likely to be tube fed, and more likely to have a do-not-hospitalize order, compared to non-SCU residents. However, non-SCU residents were more likely to be treated for pain, had fewer pressure ulcers, and less frequent use of antipsychotic drugs than SCU residents. HCPs of SCU residents reported greater satisfaction with care than HCPs of non-SCU residents. Conclusions Residence in an SCU is associated with some, but not all, markers of better quality end-of-life care among nursing home residents with advanced dementia.
Cadigan, Rebecca Orfaly; Grabowski, David C.; Givens, Jane L.; Mitchell, Susan L.
The effects of key factors in the nursing practice environment--management style, group cohesion, job stress, organizational job satisfaction, and professional job satisfaction--on staff nurse retention and process aspects of quality of care were examined. Hinshaw and Atwood's (1985) anticipated turnover model was modified and expanded to include relevant antecedent and outcome variables. The four-stage theoretical model was tested using data from 50 nursing units at four acute care hospitals in the southeast. The model explained 49% of the variance in staff nurse retention and 39% of the variance in process aspects of quality of nursing care. Study findings warrant careful consideration in light of recent practice environment changes: experience on the unit and professional job satisfaction were predictors of staff nurse retention; job stress and clinical service were predictors of quality of care. The variable contributing the most to indirect, and in turn, total model effects, was that of management style. These results substantiate the belief that aspects of the practice environment affect staff nurse retention, and most importantly, the quality of care delivered on hospital nursing units. PMID:8773556
Leveck, M L; Jones, C B
Medical and surgical care of children with severe obesity is complicated and requires recognition of the problem, appropriate equipment, and safe management. There is little literature describing patient, provider, and institutional needs for the severely obese pediatric patient. Nonetheless, the limited data suggest 3 broad categories of needs unique to this population: (a) airway management, (b) drug dosing and pharmacology, and (c) equipment and infrastructure. We describe an opportunity at the Children’s Hospital Colorado to better prepare and optimize care for this patient population by creation of a Pediatric Obesity Care Guideline that focused on key areas of quality and safety.
Porter, Renee M.; Thrasher, Jodi; Krebs, Nancy F.
Background Cultural competency has been espoused as an organizational strategy to reduce health disparities in care. Objective To examine the relationship between hospital cultural competency and inpatient experiences with care. Research Design The first model predicted Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores from hospital random effects, plus fixed effects for hospital cultural competency, individual race/ethnicity/language, and case-mix variables. The second model tested if the association between a hospital’s cultural competency and HCAHPS scores differed for minority and non-Hispanic white patients. Subjects The National CAHPS® Benchmarking Database’s (NCBD) HCAHPS Surveys and the Cultural Competency Assessment Tool of Hospitals (CCATH) Surveys for California hospitals were merged, resulting in 66 hospitals and 19,583 HCAHPS respondents in 2006. Measures Dependent variables include ten HCAHPS measures: six composites (communication with doctors, communication with nurses, staff responsiveness, pain control, communication about medications, and discharge information), two individual items (cleanliness, and quietness of patient rooms), and two global items (overall hospital rating, and whether patient would recommend hospital). Results Hospitals with greater cultural competency have better HCAHPS scores for doctor communication, hospital rating, and hospital recommendation. Furthermore, HCAHPS scores for minorities were higher at hospitals with greater cultural competency on four other dimensions: nurse communication, staff responsiveness, quiet room, and pain control. Conclusions Greater hospital cultural competency may improve overall patient experiences, but may particularly benefit minorities in their interactions with nurses and hospital staff. Such effort may not only serve longstanding goals of reducing racial/ethnic disparities in inpatient experience, but may also contribute to general quality improvement.
Weech-Maldonado, Robert; Elliott, Marc N.; Pradhan, Rohit; Schiller, Cameron; Hall, Allyson; Hays, Ron D.
Background Strategic leadership is an important organizational capability and is essential for quality improvement in hospital settings. Furthermore, the quality of leadership depends crucially on a common set of shared values and mutual trust between hospital management board members. According to the concept of social capital, these are essential requirements for successful cooperation and coordination within groups. Objectives We assume that social capital within hospital management boards is an important factor in the development of effective organizational systems for overseeing health care quality. We hypothesized that the degree of social capital within the hospital management board is associated with the effectiveness and maturity of the quality management system in European hospitals. Methods We used a mixed-method approach to data collection and measurement in 188 hospitals in 7 European countries. For this analysis, we used responses from hospital managers. To test our hypothesis, we conducted a multilevel linear regression analysis of the association between social capital and the quality management system score at the hospital level, controlling for hospital ownership, teaching status, number of beds, number of board members, organizational culture, and country clustering. Results The average social capital score within a hospital management board was 3.3 (standard deviation: 0.5; range: 1-4) and the average hospital score for the quality management index was 19.2 (standard deviation: 4.5; range: 0-27). Higher social capital was associated with higher quality management system scores (regression coefficient: 1.41; standard error: 0.64, p=0.029). Conclusion The results suggest that a higher degree of social capital exists in hospitals that exhibit higher maturity in their quality management systems. Although uncontrolled confounding and reverse causation cannot be completely ruled out, our new findings, along with the results of previous research, could have important implications for the work of hospital managers and the design and evaluation of hospital quality management systems.
Hammer, Antje; Arah, Onyebuchi A.; DerSarkissian, Maral; Thompson, Caroline A.; Mannion, Russell; Wagner, Cordula; Ommen, Oliver; Sunol, Rosa; Pfaff, Holger
Background Physicians, particularly in hospitals, suffer from adverse working conditions. There is a close link between physicians’ psychosocial work environment and the quality of the work they deliver. Our study aimed to explore whether a participatory work-design intervention involving hospital physicians is effective in improving working conditions and quality of patient care. Methods A prospective, controlled intervention study was conducted in two surgical and two internal departments. Participants were 57 hospital physicians and 1581 inpatients. The intervention was a structured, participatory intervention based on continuous group meetings. Physicians actively analyzed problematic working conditions, developed solutions, and initiated their implementation. Physicians’ working conditions and patients’ perceived quality of care were outcome criteria. These variables were assessed by standardized questionnaires. Additional data on implementation status were gathered through interviews. Results Over the course of ten months, several work-related problems were identified, categorized, and ten solutions were implemented. Post-intervention, physicians in the intervention departments reported substantially less conflicting demands and enhanced quality of cooperation with patients’ relatives, compared to control group physicians. Moreover, positive changes in enhanced colleague support could be attributed to the intervention. Regarding patient reports of care quality of care, patient ratings of physicians organization of care improved for physicians in the intervention group. Five interviews with involved physicians confirm the plausibility of obtained results, provide information on implementation status and sustainability of the solutions, and highlight process-related factors for re-design interventions to improve hospital physicians work. Conclusions This study demonstrates that participatory work design for hospital physicians is a promising intervention for improving working conditions and promoting patient quality of care.
The second volume of a report on the simulation of pediatric hospital care units contains supporting documentation relative to the study described in Volume I. Materials include: (1) instruments and instructions for collection of patient data; (2) instrum...
J. B. Brayton
A methodology for identifying and comparing various conceptual solutions to the problem of matching pediatric hospital services to patients' needs is presented. A simulation was designed to predict the impact that projected alternate care units would have...
J. B. Brayton
Pediatric hospitalization rates for specific ambulatory care sensitive conditions (ACSCs) vary significantly across states, even after adjusting for rurality, poverty, uninsurance, and physician supply. In all six states combined, asthma, diabetes short-t...
Seamless care is a smooth and safe transition of a patient from the hospital to the home. Our goal was to identify ways to maximize improvement in postdischarge patient outcomes. This research targeted patients at risk for unscheduled readmissions, examin...
A. M. Spehar R. R. Campbell C. Cherrie P. Palacios D. Scott
When old people suffering from chronic diseases are hospitalized, they need some wellness as younger people. Anxiety and depression associated to the hospitalisation and the disease are very lound. The need for any attention, touch and encouragement is sometimes not clearly expressed among the elderly, Aesthetic care may valorise old patients as healthy people. This has not been reported. Our study has evaluated 47 voluntary old women. Mini mental state was considered. They had one aesthetic care during their hospitalisation. The care evaluation's questionnaire proved the wellness feeling however the desire to open themselves to others was not significant. The depression, health state scales could not be influenced by only one such a care. Aesthetic care was generally very well accepted by the institution and health care professionals as a tool for hospital quality of life. PMID:18950085
Tarteaut, Marie-Hélène; Herrmann, François; Grandjean, Raphaël; Toutous-Trellu, Laurence
Background: Consumer satisfaction is recognized as an important parameter for assessing the quality of patient care services. Materials and Methods: By using quota sampling method and questionnaire device, 392 mothers were selected who had been hospitalized for cesarean section in the public and private hospitals of Tabriz. statistical package for social sciences (SPSS) version 13, descriptive statistics, independent t-test, analysis of variance (ANOVA), and correlation tests were used for data analysis. Results: Findings indicated that the highest rate for mothers’ satisfaction was in the physical and comfort categories and the least satisfaction was in the informational aspect. The analysis of data showed significant difference between mothers’ satisfaction with all aspects of care in the public and private hospitals (P < 0.001). Conclusion: The results showed that mothers were more satisfied of physical and comfortable aspects, but informational aspect of care in both kinds of hospitals was low and there is a need for promote aspect.
Azari, Sahar; Sehaty, Fahimmeh; Ebrahimi, Hosseyn
There is increasing emphasis on screening, brief intervention, and referral to treatment (SBIRT) for unhealthy alcohol use in the general hospital, as highlighted by new Joint Commission recommendations on SBIRT. However, the evidence supporting this approach is not as robust relative to primary care settings. This review is targeted to hospital-based clinicians and administrators who are responsible for generally ensuring the provision of high quality care to patients presenting with a myriad of conditions, one of which is unhealthy alcohol use. The review summarizes the major issues involved in caring for patients with unhealthy alcohol use in the general hospital setting, including prevalence, detection, assessment of severity, reduction in drinking with brief intervention, common acute management scenarios for heavy drinkers, and discharge planning. The review concludes with consideration of Joint Commission recommendations on SBIRT for unhealthy alcohol use, integration of these recommendations into hospital work flows, and directions for future research.
Summary Patient satisfaction with in-hospital psychiatric care in a community-oriented care organization was studied by means of a questionnaire mailed to a 1-year population of hospitalized patients. The response rate was 43.5%. The results showed that the level of patient satisfaction was high in some areas and low in others. It was higher with regard to staff-patient relationships, treatment programs
"America's Best Hospitals," by US News & World Report, is a sophisticated and influential appraisal of hospital care. Using measures of health care structure, process, and outcome, the report identifies outstanding hospitals in 16 medical specialties through an overall "index of hospital quality." This strong conceptual design, however, has not been adequately implemented because national data sources for all 3 components are severely limited. Most importantly, since there are no national data on process of care, a reputation survey has been used to measure this component of quality. One consequence of reliance on reputation is that a small group of prominent hospitals in each specialty receives such high scores that they automatically rise to the top of the rankings, regardless of structure or outcome score. "America's Best Hospitals" identifies America's best regarded hospitals, but provides limited additional insight into quality. Adequate surveillance and protection of quality in an era of managed care requires measurement systems beyond the scope of existing data and methods. PMID:9087471
Green, J; Wintfeld, N; Krasner, M; Wells, C
This paper presents a profile of Iowa's Child Care Quality Rating System prepared as part of the Child Care Quality Rating System (QRS) Assessment Study. The profile is divided into the following categories: (1) Program Information; (2) Rating Details; (3) Quality Indicators for Center-Based Programs; (4) Indicators for Family Child Care Programs;…
Child Trends, 2010
Background Cultural and language discordance between patients and providers constitutes a significant challenge to provision of quality healthcare. This study aims to evaluate minority patients’ discharge from hospital to community care, specifically examining the relationship between patient–provider language concordance and the quality of transitional care. Methods This was a multi-method prospective study of care transitions of 92 patients: native Hebrew, Russian or Arabic speakers, with a pre-discharge questionnaire and structured observations examining discharge preparation from a large Israeli teaching hospital. Two weeks post-discharge patients were surveyed by phone, on the transition from hospital to community care (the Care Transition Measure (CTM-15, 0–100 scale)) and on the primary-care post-discharge visit. Results Overall, ratings on the CTM indicated fair quality of the transition process (scores of 51.8 to 58.8). Patient–provider language concordance was present in 49% of minority patients’ discharge briefings. Language concordance was associated with higher CTM scores among minority groups (64.1 in language-concordant versus 49.8 in non-language-concordant discharges, P <0.001). Other aspects significantly associated with CTM scores: extent of discharge explanations (P <0.05), quality of discharge briefing (P <0.001), and post-discharge explanations by the primary care physician (P <0.01). Conclusion Language-concordant care, coupled with extensive discharge briefings and post-discharge explanations for ongoing care, are important contributors to the quality of care transitions of ethnic minority patients.
The issue of quality of care involves many different components, including what cancer care quality looks like, which patients are more likely to receive poor quality care, and ways to measure healthcare quality.
Medicare spending is expected to increase by 79% between the years 2010 and 2020, caused, in-part, by hospital readmissions within 30 days of discharge. This study identified factors contributing to hospital readmissions in a midwest heath service area (HSA), using Coleman's Transition Care Model as the theoretical framework. The researchers…
DeCoster, Vaughn; Ehlman, Katie; Conners, Carolyn
iRevive is a sensor-supported, pre-hospital patient care system for the capture and transmittal of electronic patient data from the field to hospitals. It is being developed by 10Blade and Boston MedFlight. iRevive takes advantage of emerging technologies to offer a robust, flexible, and extensible IT infrastructure for patient data collection. PMID:18048264
Gaynor, Mark; Myung, Dan; Hashmi, Nada; Shankaranarayanan, G
...provisions for long-term care hospitals and satellites of long-term care hospitals that...as the long-term care hospital or satellite of the long-term care hospital...provisions for long-term care hospitals and satellites of long-term care hospitals...
Following deinstitutionalization, inpatient psychiatric services moved from state institutions to general hospitals. Despite the magnitude of these changes, evaluations of the quality of inpatient care environments in general hospitals are limited. This study examined the extent to which organizational factors of the inpatient psychiatric environments are associated with psychiatric nurse burnout. Organizational factors were measured by an instrument endorsed by the National Quality Forum. Robust clustered regression analysis was used to examine the relationship between organizational factors in 67 hospitals and levels of burnout for 353 psychiatric nurses. Lower levels of psychiatric nurse burnout was significantly associated with inpatient environments that had better overall quality work environments, more effective managers, strong nurse-physician relationships, and higher psychiatric nurse-to-patient staffing ratios. These results suggest that adjustments in organizational management of inpatient psychiatric environments could have a positive effect on psychiatric nurses' capacity to sustain safe and effective patient care environments. PMID:20144031
Hanrahan, Nancy P; Aiken, Linda H; McClaine, Lakeetra; Hanlon, Alexandra L
Following deinstitutionalization, inpatient psychiatric services moved from state institutions to general hospitals. Despite the magnitude of these changes, evaluations of the quality of inpatient care environments in general hospitals are limited. This study examined the extent to which organizational factors of the inpatient psychiatric environments are associated with psychiatric nurse burnout. Organizational factors were measured by an instrument endorsed by the National Quality Forum. Robust clustered regression analysis was used to examine the relationship between organizational factors in 67 hospitals and levels of burnout for 353 psychiatric nurses. Lower levels of psychiatric nurse burnout was significantly associated with inpatient environments that had better overall quality work environments, more effective managers, strong nurse-physician relationships, and higher psychiatric nurse-to-patient staffing ratios. These results suggest that adjustments in organizational management of inpatient psychiatric environments could have a positive effect on psychiatric nurses’ capacity to sustain safe and effective patient care environments.
Hanrahan, Nancy P.; Aiken, Linda H.; McClaine, Lakeetra; Hanlon, Alexandra L
Background The demand for high quality hospital care for children in low resource countries is not being met. This paper describes a number of strategies to improve emergency care at a children's hospital and evaluates the impact of these on inpatient mortality. In addition, the cost-effectiveness of improving emergency care is estimated. Methods and Findings A team of local and international staff developed a plan to improve emergency care for children arriving at The Ola During Children's Hospital, Freetown, Sierra Leone. Following focus group discussions, five priority areas were identified to improve emergency care; staff training, hospital layout, staff allocation, medical equipment, and medical record keeping. A team of international volunteers worked with local staff for six months to design and implement improvements in these five priority areas. The improvements were evaluated collectively rather than individually. Before the intervention, the inpatient mortality rate was 12.4%. After the intervention this improved to 5.9%. The relative risk of dying was 47% (95% CI 0.369–0.607) lower after the intervention. The estimated number of lives saved in the first two months after the intervention was 103. The total cost of the intervention was USD 29 714, the estimated cost per death averted was USD 148. There are two main limitation of the study. Firstly, the brevity of the study and secondly, the assumed homogeneity of the clinical cases that presented to the hospital before and after the intervention. Conclusions This study demonstarted a signficant reductuion in inpatient mortality rate after an intervention to improve emergency hospital care If the findings of this paper could be reproduced in a larger more rigorous study, improving the quality of care in hospitals would be a very cost effective strategy to save children's lives in low resource settings.
Clark, Matthew; Spry, Emily; Daoh, Kisito; Baion, David; Skordis-Worrall, Jolene
\\u000a Radical cystectomy is the gold standard treatment for invasive bladder cancer, and requires high standards for both surgical\\u000a skill and ancillary support to achieve consistently good outcomes. As is the case elsewhere in the health care system, increasing\\u000a attention has been paid in recent years to the quality of care delivered before, during, and after surgery. Defining high-quality\\u000a care in
Matthew R. Cooperberg; Badrinath R. Konety
The purpose of these efforts, substantially supported by the Applied Research Program, is to enhance the state of the science on the quality of cancer care and inform federal and private-sector decision making on care delivery, coverage, regulation, and standard setting. Work is underway to make cancer a working model for quality of care research and the translation of this research into practice.
Background Total quality management (TQM) has a great potential to address quality problems in a wide range of industries and improve the organizational performance. The growing need to take initiatives by hospitals in countries like India and Iran to improve the service quality and reduce wastage of resources has inspired the authors to develop a survey instrument to measure health care quality and performance in the two countries. Methods Based on the Baldrige health care criteria for performance excellence 2009-2010 and the guidelines proposed by the American Hospitals Association for hospitals in pursuit of excellence, compared health care services in three countries. The data are collected from the capital cities and their nearby places in India and Iran. Using ANOVAs, three groups in quality planning and performance have been compared. Result Results showed there is significantly difference between groups and in no case the hospitals from India and Iran are found scoring close to the benchmarks. The average scores of Indian and Iranian hospitals on different constructs of the IHCQPM model are compared with the major results achieved by the recipients of the MBNQ award. Conclusion In no case the hospitals from India and Iran are found scoring close to the benchmarks (Baldrige health care criteria for performance excellence 2009-2010 and the guidelines proposed by the American Hospitals Association for hospitals). These results suggested to health care services more attempt to achieve high quality in management and performance.
Evaluation of health care outcomes has become increasingly important as we strive to improve quality and efficiency while controlling cost. Many groups feel that analysis of large datasets will be useful in optimizing resource utilization; however, the ideal blend of clinical and administrative data points has not been developed. Hospitals and health care systems have several tools to measure cost and resource utilization, but the data are often housed in disparate systems that are not integrated and do not permit multisystem analysis. Systems Outcomes and Clinical Resources AdministraTive Efficiency Software (SOCRATES) is a novel data merging, warehousing, analysis, and reporting technology, which brings together disparate hospital administrative systems generating automated or customizable risk-adjusted reports. Used in combination with standardized enhanced care pathways, SOCRATES offers a mechanism to improve the quality and efficiency of care, with the ability to measure real-time changes in outcomes.
Lawrence, Justin; Delaney, Conor P.
Context Long-term acute care hospitals have emerged as a novel approach for the care of patients recovering from severe acute illness, but the extent and growth of their activity at the national level is unknown. Objective To examine temporal trends in long-term acute care hospital utilization after an episode of critical illness among fee-for-service Medicare beneficiaries ? 65 years of age. Design, Setting and Patients Retrospective cohort study using the Medicare Provider Analysis and Review files from 1997 to 2006. We included all Medicare hospitalizations involving admission to an intensive care unit of an acute-care, non-federal hospital within the continental United States. Main outcome measures Overall long-term acute care utilization, associated costs, and survival following transfer. Results The number of long-term acute care hospitals in the United States increased at a mean rate of 8.8% per year, from 192 in 1997 to 408 in 2006. During that time, the annual number of long-term acute care admissions after critical illness increased from 13,732 to 40,353, with annual costs increasing from $484 million to $1.325 billion. The age-standardized population incidence of long-term acute care utilization after critical illness increased from 38.1/100,000 in 1997 to 99.7/100,000 in 2006, with greater use among male individuals and black individuals in all time periods. Over time, transferred patients had higher numbers of comorbidities (5.0 in 1997–2000 versus 5.8 in 2004–2006, p<0.001), and were more likely to receive mechanical ventilation at the long-term acute care hospital (16.4% in 1997–2000 versus 29.8% in 2004–2006, p<0.001). One-year mortality after long-term acute care hospital admission was high throughout the study period: 50.7% in 1997–2000 and 52.2% in 2004–2006. Conclusions Long-term acute care hospital utilization after critical illness is common and increasing. Survival among Medicare beneficiaries transferred to long-term acute care after critical illness is poor.
Kahn, Jeremy M.; Benson, Nicole M.; Appleby, Dina; Carson, Shannon S.; Iwashyna, Theodore J.
Exclusive breastfeeding is a public health priority. A strong body of evidence links maternity care practices, based on the Ten Steps to Successful Breastfeeding, to increased breastfeeding initiation, duration and exclusivity. Despite having written breastfeeding policies, New York (NY) hospitals vary widely in reported maternity care practices and in prevalence rates of breastfeeding, especially exclusive breastfeeding, during the birth hospitalization. To improve hospital maternity care practices, breastfeeding support, and the percentage of infants exclusively breastfeeding, the NY State Department of Health developed the Breastfeeding Quality Improvement in Hospitals (BQIH) Learning Collaborative. The BQIH Learning Collaborative was the first to use the Institute for Health Care Improvement's Breakthrough Series methodology to specifically focus on increasing hospital breastfeeding support. The evidence-based maternity care practices from the Ten Steps to Successful Breastfeeding provided the basis for the Change Package and Data Measurement Plan. The present article describes the development of the BQIH Learning Collaborative. The engagement of breastfeeding experts, partners, and stakeholders in refining the Learning Collaborative design and content, in defining the strategies and interventions (Change Package) that drive hospital systems change, and in developing the Data Measurement Plan to assess progress in meeting the Learning Collaborative goals and hospital aims is illustrated. The BQIH Learning Collaborative is a model program that was implemented in a group of NY hospitals with plans to spread to additional hospitals in NY and across the country. PMID:23586627
Fitzpatrick, Eileen; Dennison, Barbara A; Welge, Sara Bonam; Hisgen, Stephanie; Boyce, Patricia Simino; Waniewski, Patricia A
Patients with severe heart failure require large quantities of health care resources, and more intensive interventions are not always related to a decrease in need for medical care, including hospitalization. A thoughtful approach to the efficient and expeditious allocation of these resources is required. In fact, the nonpharmacologic therapy of patients with chronic congestive heart failure (CHF) has to include
Michele D’Alto; Giuseppe Pacileo; Raffaele Calabrò
Patients with severe heart failure require large quantities of health care resources, and more intensive interven- tions are not always related to a decrease in need for medical care, including hospitalization. A thoughtful ap- proach to the efficient and expeditious allocation of these resources is required. In fact, the nonpharmaco- logic therapy of patients with chronic congestive heart failure (CHF)
Michele D'Alto; Giuseppe Pacileo
Volume III of a report on the simulation of pediatric hospital care units contains users manuals for the computer programs involved in the simulation. Instructions for and listings of computer programs developed to perform the care unit loading part of th...
J. B. Brayton
The increasing costs and complexity of technologic advances in diagnosis and treatment have been accompanied by other important issues. They are often moral or ethical in nature; they include the public's desire and determination to have access to these "high-tech" advances; and the quality and equity with which those advances are apportioned and applied must be addressed. Seven criteria that can be applied to technology assessment are identified as is a process for that assessment. Together, these procedures can provide valuable information and assistance to those who make decisions about health benefits coverage--both in the public and the private sectors. PMID:2980910
Schaffarzick, R W
Observed and birthweight-specific neonatal mortality rates have been used for assessing quality of neonatal care, but these are crude and affected by risk characteristics of the population served. Even when neonatal mortality rate is corrected for four risk factors, race, sex, birthweight, and multiple births, (California Data Research Facility, Santa Barbara, CA) it is possible that the corrected neonatal mortality rate is not comparable among institutions because of population differences not corrected for, eg, prenatal care. To analyze whether our high neonatal mortality rate is primarily dependent on population risk or quality of neonatal care, we used contemporaneous data collection by senior physicians and a microcomputer database system to construct indices of quality of care that are based on diagnoses graded according to disease severity. For the 1987/1988 academic year, we found: neonatal intensive care unit nosocomial infection rate, 20%; severe intraventricular hemorrhage per 100 very low birthweight infants (1500 g), 20%; bronchopulmonary dysplasia per 100 cases of severe respiratory distress syndrome, 27%; necrotizing enterocolitis per 100 neonatal intensive care unit discharges, 5%; air leak per 100 cases of severe respiratory distress syndrome, 21%; and neonatal mortality rate per very low birthweight delivery rate, 0.4. We propose that microcomputer, hospital-based analyses will improve comparisons of neonatal intensive care unit quality of care if appropriate indices can be sufficiently well-defined and shared. PMID:2352285
Ekelem, I; Taeusch, H W
Background In the Netherlands, the first formal haemophilia comprehensive care centre was established in 1964, and Dutch haemophilia doctors have been organised since 1972. Although several steps were taken to centralise haemophilia care and maintain quality of care, treatment was still delivered in many hospitals, and formal criteria for haemophilia treatment centres as well as a national haemophilia registry were lacking. Material and methods In collaboration with patients and other stakeholders, Dutch haemophilia doctors have undertaken a formal process to draft new quality standards for the haemophilia treatment centres. First a project group including doctors, nurses, patients and the institute for harmonisation of quality standards undertook a literature study on quality standards and performed explorative visits to several haemophilia treatment centres in the Netherlands. Afterwards concept standards were defined and validated in two treatment centres. Next, the concept standards were evaluated by haemophilia doctors, patients, health insurance representatives and regulators. Finally, the final version of the standards of care was approved by Central body of Experts on quality standards in clinical care and the Dutch Ministry of Health. Results A team of expert auditors have been trained and, together with an independent auditor, will perform audits in haemophilia centres applying for formal certification. Concomitantly, a national registry for haemophilia and allied disorders is being set up. Discussion It is expected that these processes will lead to further concentration and improved quality of haemophilia care in the Netherlands.
Leebeek, Frank W.G.; Fischer, Kathelijn
The Australian Commission for Quality and Safety in Health Care (ACQSHC) has articulated 10 clinical standards with the aim of improving the consistency of quality healthcare delivery. Currently, the majority of Australians die in acute hospitals. But despite this, no agreed standard of care exists to define the minimum standard of care that people should accept in the final hours to days of life. As a result, there is limited capacity to conduct audits that focus on the gap between current care and recommended care. There is, however, accumulating evidence in the end of life literature to define which aspects of care are likely to be considered most important to those people facing imminent death. These themes offer standards against which to conduct audits. This is very apt given the national recommendation that healthcare should be delivered in the context of considering people's wishes while always treating people with dignity and respect. PMID:24589365
Clark, Katherine; Byfieldt, Naomi; Green, Malcolm; Saul, Peter; Lack, Jill; Philips, Jane L
Consumers, payers, and policymakers are demanding to know more about the quality of the services they are purchasing or might purchase. The information provided, however, is often driven by data availability rather than by epidemiologic and clinical considerations. In this article, we present an approach for selecting topics for measuring technical quality of care, based on the expected impact on health of improved quality. This approach employs data or estimates on disease burden, efficacy of available treatments, and the current quality of care being provided. We use this model to select measures that could be used to measure the quality of care in health plans, but the proposed framework could also be used to select quality of care measures for other purposes or in other contexts (for example, to select measures for hospitals). Given the limited resources available for quality assessment and the policy consequences of better information on provider quality, priorities for assessment efforts should focus on those areas where better quality translates into improved health.
Siu, A L; McGlynn, E A; Morgenstern, H; Beers, M H; Carlisle, D M; Keeler, E B; Beloff, J; Curtin, K; Leaning, J; Perry, B C
...residential treatment facilities PSF Provider-Specific...Care Hospital Inpatient Prospective...drugs on the inpatient bill (under...services on the inpatient bill (under...eligible for treatment with Fidaxomicin...Under the first...
Falls are one of the most common adverse events in hospitals and fall management remains a major challenge in the medical care quality. Falls in patients are associated with major health complications that can result in health decline and increased medical care cost. To deliver medical care in time, reliable location-aware fall detection is needed. In this paper, we propose
Chih-ning Huang; Chih-yen Chiang; Jui-sheng Chang; Yi-chieh Chou; Ya-xuan Hong; Steen J. Hsu; Woei-chyn Chu; Chia-tai Chan
Introduction Intermediate care is an organisational approach to improve the coordination of health care services between health care levels. In Central Norway an intermediate care hospital was established in a municipality to improve discharge from a general hospital to primary health care. The aim of this study was to investigate how health professionals experienced hospital discharge of elderly patients to primary health care with and without an intermediate care hospital. Methods A qualitative study with data collected through semi-structured focus groups and individual interviews. Results Discharge via the intermediate care hospital was contrasted favourably compared to discharge directly from hospital to primary health care. Although increased capacity to receive patients from hospital and prepare them for discharge to primary health care was viewed as a benefit, professionals still requested better communication with the preceding care level concerning further treatment and care for the elderly patients. Conclusions The intermediate care hospital reduced the coordination challenges during discharge of elderly patients from hospital to primary health care. Nevertheless, the intermediate care was experienced more like an extension of hospital than an included part of primary health care and did not meet the need for communication across care levels.
Dahl, Unni; Steinsbekk, Aslak; Jenssen, Svanhild; Johnsen, Roar
Safety-net hospitals will continue to play a critical role in the US health care system, as they will need to care for the more than twenty-three million people who are estimated to remain uninsured after the Affordable Care Act is implemented. Yet such hospitals will probably have less federal and state support for uncompensated care. At the same time, safety-net hospitals will need to reposition themselves in the marketplace to compete effectively for newly insured people who will have a choice of providers. We examine how five leading safety-net hospitals have begun preparing for reform. Building upon strong organizational attributes such as health information technology and system integration, the study hospitals' preparations include improving the efficiency and quality of care delivery, retaining current and attracting new patients, and expanding the medical home model. PMID:22869646
Coughlin, Teresa A; Long, Sharon K; Sheen, Edward; Tolbert, Jennifer
Summary To assess the impact of the aging population on the occurrence of fragility fractures, we examined hospital discharges for\\u000a hip fracture among U.S. women and men aged 45 years and older from 1993 through to 2003. The number of hospitalizations declined\\u000a by 5%, and age-adjusted rates fell by over 20% for both women and men during this period.\\u000a \\u000a \\u000a \\u000a Introduction Although the aging
S. H. Gehlbach; J. S. Avrunin; E. Puleo
Nephrologists worldwide are gradually coping with elderly patients. This is because of the burden of chronic disease in the aging population and specifically chronic kidney disease (CKD). CKD in the elderly rarely occurs in isolation from other chronic conditions and can often be a marker of these conditions themselves. Geriatricians usually take care of chronic conditions and are trained to perform comprehensive geriatric assessment, a tool to estimate frailty, that is the risk of adverse outcome, disability, and death in the clinical setting of elderly inpatients. Unfortunately, they are not used to a CHD invasive and non-invasive approach and so there is no doubt about the need for a co-managed care model for these patients. However, where and how this model must be realized is still questionable. New hospital care models are patient-centered and encompass the concepts of departments to embrace the differentiated levels of care approach. According to this model the hospital is subdivided into three different standards of care: 1-high; 2 -intermediate; 3- low and this organization avoids inpatients being transferred frequently to different units, receiving specific care easily obtained by moving and changing the medical staff in charge of the patient. The lean care approach integrates the principles of the Toyota Producing System (TPS), a leading system of the industrial world, into intensity-based hospital care, thereby maximizing quality processes and promoting co-managed care as in the nephro-geriatric clinical setting. PMID:22641567
Greco, Antonio; Cascavilla, Leandro; Paris, Francesco; Addante, Filomena; Miscio, Leonardo; De Vincentis, Gabriella; Di Bisceglie, Domenico; Crupi, Domenico
The article examines hospital administrators' perceptions of health information professionals moving into leadership positions within health care organizations. Data for this study were collected from a national random sample of hospital administrators (N = 62). Findings from the study suggest that, although health information managers are viewed as integral to the success of the health care organization, health information managers are perceived as lacking appropriate educational training to move into administrative or leadership positions. For the health information professional to move into a leadership position, educational training (at the master's level) must focus on quality management, statistical process control, and performance evaluation. PMID:10140307
Rudman, W J; Kearns, L
Abstract Objective To gain a deeper understanding of how primary care (PC) practices belonging to different models manage resources to provide high-quality care. Design Multiple-case study embedded in a cross-sectional study of a random sample of 37 practices. Setting Three regions of Quebec. Participants Health care professionals and staff of 5 PC practices. Methods Five cases showing above-average results on quality-of-care indicators were purposefully selected to contrast on region, practice size, and PC model. Data were collected using an organizational questionnaire; the Team Climate Inventory, which was completed by health care professionals and staff; and 33 individual interviews. Detailed case histories were written and thematic analysis was performed. Main findings The core common feature of these practices was their ongoing effort to make trade-offs to deliver services that met their vision of high-quality care. These compromises involved the same 3 areas, but to varying degrees depending on clinic characteristics: developing a shared vision of high-quality care; aligning resource use with that vision; and balancing professional aspirations and population needs. The leadership of the physician lead was crucial. The external environment was perceived as a source of pressure and dilemmas rather than as a source of support in these matters. Conclusion Irrespective of their models, PC practices’ pursuit of high-quality care is based on a vision in which accessibility is a key component, balanced by appropriate management of available resources and of external environment expectations. Current PC reforms often create tensions rather than support PC practices in their pursuit of high-quality care.
Beaulieu, Marie-Dominique; Geneau, Robert; Grande, Claudio Del; Denis, Jean-Louis; Hudon, Eveline; Haggerty, Jeannie L.; Bonin, Lucie; Duplain, Rejean; Goudreau, Johanne; Hogg, William
Objective In myocardial infarction (MI), we studied whether documentation of ischemic symptoms is associated with quality of care and outcomes, and compared patient reports of ischaemic symptoms during interviews with chart documentation Design Observational acute myocardial infarction study from 2003–2004 (Prospective Registry Evaluating Myocardial Infarction: Event and Recovery) Setting 19 diverse US hospitals Patients 2,094 consecutive MI patients (10,911 patients screened; 3,953 patients were eligible and enrolled) with both positive cardiac enzymes and other evidence of infarction (e.g., symptoms, electrocardiographic changes). Transferred patients and those with confounding noncardiac comorbidity were not included (n=1859). Main outcome measures Quality of care indicators and adjusted in-hospital survival Results The records of 10% of all MI patients (217/2094) contained no documented ischaemic symptoms at presentation. Patients without documented symptoms were less likely (p<0.05) to: receive aspirin (89% vs. 96%) or beta-blockers (77% vs. 90%) within 24hr, reperfusion therapy for STEMI (7% vs. 58%) or to survive their hospitalization (adjusted OR=3.2, 95% CI 1.8–5.8). Survivors without documented symptoms were also less likely (p<0.05) to be discharged with aspirin (87% vs. 93%), beta-blockers (81% vs. 91%), ACE/ARB (67% vs. 80%), or smoking cessation counseling (46% vs. 66%). In the subset of 1,356 (65%) interviewed patients, most of those without documented ischaemic symptoms (75%) reported presenting symptoms consistent with ischaemia. Conclusions Failure to document patients’ presenting MI symptoms is associated with poorer quality of care from admission to discharge, and higher in-hospital mortality. Symptom recognition may represent an important opportunity to improve the quality of MI care.
Schelbert, Erik B.; Rumsfeld, John S.; Krumholz, Harlan M.; Canto, John G.; Magid, David J.; Masoudi, Frederick A.; Reid, Kimberly J.; Spertus, John A.
The Act to Partially Amend the Act on Mental Health and Welfare for the Mentally Disabled was passed on June 13, 2013. Major amendments regarding hospitalization for medical care and protection include the points listed below. The guardianship system will be abolished. Consent by a guardian will no longer be required in the case of hospitalization for medical care and protection. In the case of hospitalization for medical care and protection, the administrators of the psychiatric hospital are required to obtain the consent of one of the following persons: spouse, person with parental authority, person responsible for support, legal custodian, or curator. If no qualified person is available, consent must be obtained from the mayor, etc. of the municipality. The following three obligations are imposed on psychiatric hospital administrators. (1) Assignment of a person, such as a psychiatric social worker, to provide guidance and counseling to patients hospitalized for medical care and protection regarding their postdischarge living environment. (2) Collaboration with community support entities that consult with and provide information as necessary to the person hospitalized, their spouse, a person with parental authority, a person responsible for support, or their legal custodian or curator. (3) Organizational improvements to promote hospital discharge. With regard to requests for discharge, the revised law stipulates that, in addition to the person hospitalized with a mental disorder, others who may file a request for discharge with the psychiatric review board include: the person's spouse, a person with parental authority, a person responsible for support, or their legal custodian or curator. If none of the above persons are available, or if none of them are able to express their wishes, the mayor, etc. of the municipality having jurisdiction over the place of residence of the person hospitalized may request a discharge. In order to promote transition to life in the community by persons with mental disorders, efforts will be made to enhance psychiatric care for them, with guidelines to be developed to ensure the provision of medical care to persons with mental disorders. The revised law clarifies that members of psychiatric review boards shall be "persons with expert knowledge and experience pertaining to the health and/or welfare of persons with mental disorders." Provision is made for a review of conditions related to implementation of the revised law approximately three years after it takes effect, with measures to be taken as necessary based on results of the review. The main focus of this presentation will be the revisions to the system of hospitalization for medical care and protection, and the deletion of provisions relating to the system of guardianship. PMID:24864562
Injuries remain the leading cause of death in children and young adults. Management of multiple trauma patients has improved in recent years by quality initiatives (trauma network, S3 guideline "Polytrauma"). On this basis, strong links with preclinical management, structured treatment algorithms, training standards (ATLS®), clear diagnostic rules and an established risk- and quality management are the important factors of a modern emergency room trauma care. We describe the organizational components that lead to successful management of trauma in hospital. PMID:23235903
Boschin, Matthias; Vordemvenne, Thomas
Background. As the cost of acute care in hospitals increases, there is an increasing need to find alternative means of providing acute care. Hospital in the home (HITH) has developed in response to this challenge. Current evidence is conflicting as to whether HITH provides cost savings compared with in-hospital care (IHC). The heterogeneous nature of HITH and the clinical complexity
C. RAINA MACINTYRE; DENISE RUTH; ZAHID ANSARI
Deep vein thrombosis and pulmonary embolism, the common clinical manifestations of venous thromboembolism (VTE), are among the most preventable complications of hospitalized patients. However, survey data repeatedly show poor rates of compliance with guideline-based preventive strategies. This has led the Centers for Medicare and Medicaid Services to deny reimbursement for hospital readmission for thromboembolic complications in patients undergoing total hip or knee arthroplasty. Multiple strategies and national initiatives have been developed to improve rates of VTE prophylaxis during hospitalization; however, most VTE occurs in the outpatient setting. Epidemiologic data suggest that recent surgery or hospitalization is a strong risk factor for the development of VTE and that this risk may persist for up to 6 months. These observations call into question whether VTE prophylaxis should be administered only during hospitalization or if this preventive strategy should be continued after hospital discharge. Many of the randomized trials showing efficacy of VTE prophylaxis have used longer durations of prophylaxis than are typical for current length of hospital stay, highlighting the issue of how long the duration of prophylaxis should be. Several patient groups have undergone formal testing to evaluate the risks and benefits of extended-duration VTE prophylaxis, but this issue is less clear for other categories of patients. Although there is clear consensus that most hospitalized patients should receive VTE prophylaxis, there is uncertainty about whether to continue VTE prophylaxis in the immediate post-hospital period or for an extended duration. The transition from inpatient to outpatient care is a key event in the coordination of continuity of care, but VTE-specific care transition guidance is limited. In this article, we review the evidence for both standard- and extended-duration VTE prophylaxis and discuss the difficulties in effectively maintaining VTE prophylaxis during the transition from inpatient to outpatient care. PMID:21881387
Kaatz, Scott; Spyropoulos, Alex C
The delivery of safe high quality patient care is a major issue in clinical settings. However, the implementation of evidence-based practice and educational interventions are not always effective at improving performance. A staff-led behavioral management process was implemented in a large single-site acute (secondary and tertiary) hospital in the North of England for 26 weeks. A quasi-experimental, repeated-measures, within-groups design was used. Measurement focused on quality care behaviors (ie, documentation, charting, hand washing). The results demonstrate the efficacy of a staff-led behavioral management approach for improving quality-care practices. Significant behavioral change (F [6, 19] = 5.37, p < 0.01) was observed. Correspondingly, statistically significant (t-test [t] = 3.49, df = 25, p < 0.01) reductions in methicillin-resistant Staphylococcus aureus (MRSA) were obtained. Discussion focuses on implementation issues.
Cooper, Dominic; Farmery, Keith; Johnson, Martin; Harper, Christine; Clarke, Fiona L; Holton, Phillip; Wilson, Susan; Rayson, Paul; Bence, Hugh
Context: Quality measures focused on outpatient settings are of increasing interest to policy makers, but little research has been conducted on hospital outpatient quality measures, especially in rural settings. Purpose: To evaluate the relevance of Centers for Medicare and Medicaid Services' (CMS) outpatient quality measures for rural hospitals,…
Casey, Michelle M.; Prasad, Shailendra; Klingner, Jill; Moscovice, Ira
This paper discuses mobile phone (cell phone) and wireless applications for linking patients who manage their healthcare outside the hospital using point of care testing (POCT) to hospital information systems (HIS). Certain medical conditions require patients to manage their healthcare by performing on themselves POC testing and act faithfully on the result. This raises quality control issue, as these POC
John McGrory; Owen Lynch; Eugene Coyle
...restructuring-hospitals and health care facilities. 1956...UTILITIES SERVICE, AND FARM SERVICE AGENCY, DEPARTMENT...restructuringâhospitals and health care facilities. This...Facility hospital and health care facility loans....
...restructuring-hospitals and health care facilities. 1956...UTILITIES SERVICE, AND FARM SERVICE AGENCY, DEPARTMENT...restructuringâhospitals and health care facilities. This...Facility hospital and health care facility loans....
Hospitalization rates for ambulatory care sensitive conditions, diseases for which primary care in the preceding six months could have reduced or eliminated the need for hospitalization, are a commonly used indicator of disparities in access to care. Prev...
C. G. Moore E. G. Baxley J. C. Probst J. L. Lammie
This paper presents a profile of Oregon's Child Care Quality Indicators Program prepared as part of the Child Care Quality Rating System (QRS) Assessment Study. The profile consists of several sections and their corresponding descriptions including: (1) Program Information; (2) Rating Details; (3) Quality Indicators for Center-Based Programs; (4)…
Child Trends, 2010
Background This study examines quality of cardiometabolic care among veterans receiving care in the Veterans Affairs (VA) health system. We assess whether quality of care disparities by mental disorder status are magnified for individuals living in rural areas. Research Design We identified all patients in a 2005 national Veterans Administration cardiometabolic quality of care chart review. The intersection of this cohort and VA registries, that include patients with and without mental disorder, permitted identification of chart review patients with and without mental disorder. Using residential ZIP code, patients were assigned to rural-urban commuting area codes. We used logistic regression adjusting for age, demographics, comorbidities, and income. Measures We assessed association between rural residence and 9 cardiometabolic care quality indicators including care processes and intermediate outcomes. Results Compared with those without mental disorder, patients with mental disorder were less likely to receive diabetes sensory foot exams (OR: 0.82; 95% CI: 0.72–0.94), retinal exams (OR: 0.82; 95% CI: 0.73–0.93), and renal tests (OR: 0.79; CI: 0.74–0.90). Rural residence was associated with no differences in quality measures. Primary care visit volume was associated with significantly greater likelihood of obtaining diabetic retinal examination and renal testing, but did not explain disparities among patients with mental disorder. Conclusions Mental disorder is associated with lesser attainment of quality cardiometabolic care. In this integrated VA care system, rurality and visit volume did not explain this disparity. Other explanations for disparities must be explored to improve the health and health care of this population.
Morden, Nancy E.; Berke, Ethan M.; Welsh, Deborah E.; McCarthy, John F.; Mackenzie, Todd A.; Kilbourne, Amy M.
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Publicity for (and laterly increased economic stringency which makes more likely), failures of care in the NHS engender concern for care quality while its assurance remains the subject of a fragmented and unhelpful literature. A selective attempt is made to examine some underlying principles by posing and answering three questions. What is the quality of care? What basic principles must be followed in defining `standards'? How then may quality be assured? Any definition of care must be multi-faceted and in common use pervaded with the patients' pre-occupation with a search for cures. Nevertheless, it is argued that there are gains in restricting the technical use of the term `care' to those systematic processes of health services and their culture which impinge on the personal experience of patients and which fashion their response. In contemporary society care ought to be designed to restore and enhance the independence, dignity and choice of the patient. Although there is a contrary tendency to abandon problems of care to the professionals, standards for care should be judged ultimately not from the specialised professional but from the viewpoint of lay people whose behaviour in the outside world fashions those norms by which independence, dignity and choice are judged. A number of difficulties in identifying and securing improvements in care are discussed. In particular, it is argued that such is the interdependence of the style of management of an institution and the style of care it provides that enforcement of high quality care is likley to be a contradiction in terms. Only trained and sensitive staff can act intuitively and pre-emptively to prevent even incipient deterioration in care. They cannot carefully foster at all times the independence and dignity of their patients unless they are treated in a similar way as professional employees. As an initial step in improving the quality of care a simple start is urged upon implementing an inventory of checks. These are designed to establish the identification and operation of health care policies and practices which give appropriate recognition to the characteristics of care that patients and public expect, coming as they do from a lay rather than professional world. The article concludes with an appropriate inventory of questions to be put to professionals by those laymen who are increasingly imported into health care management through community representation (in CHCs) and staff participation (in joint consultation) and whose interest and concern should be harnessed appropriately.
Donald, B. L.; Southern, R. M.
In September 1998, the Child Care Bureau and the Head Start Bureau of the Administration for Children and Families, U.S. Department of Health and Human Services, sponsored a National Leadership Forum on Quality Care for Infants and Toddlers. State child c...
E. Fenichel A. Griffin E. Lurie-Hurvitz
In the Netherlands, a quality incentive is expected to ensue from improved collaboration between healthcare professionals. Whether this view is supported by sufficient evidence is, however, questionable. Therefore, the first study included in this thesis is a systematic review of studies on the effects of sharing and delegating diabetes care tasks. It became apparent that sharing and delegating care tasks
J. A. R. van Bruggen
Data from 67 acute care hospitals in the Philadelphia metropolitan area indicate that there were 7,613 discharges against medical advice (AMA) in fiscal year 1987, or 1.20 percent of all discharges that year. Diagnosis-related group (DRG), type of insurance, and sex had independent effects on the rate of AMA discharges. Urban community hospitals had the highest percent of AMA discharges. Previous studies, done in teaching facilities, may have underestimated the rate of AMA discharges. PMID:1899322
Smith, D B; Telles, J L
Background Care pathways have become a popular tool to enhance the quality of care by improving patient outcomes, promoting patient safety, increasing patient satisfaction, and optimizing the use of resources. We performed a disease specific systematic review to determine how care pathways in the hospital treatment of heart failure affect in-hospital mortality, length of in-hospital stay, readmission rate and hospitalisation cost when compared with standard care. Methods Medline, Cinahl, Embase and the Cochrane Central Register of Controlled Trials were searched from 1985 to 2010. Each study was assessed independently by two reviewers. Methodological quality of the included studies was assed using the Jadad methodological approach for randomised controlled trials, controlled clinical trials and the New Castle Ottawa Scale for case–control studies, cohort studies and time interrupted series. Results Seven studies met the study inclusion criteria and were included in the systematic review with a total sample of 3,690 patients. The combined overall results showed that care pathways have a significant positive effect on mortality and readmission rate. A shorter length of hospital stay was also observed compared with the standard care group. No significant difference was found in the hospitalisation costs. More positive results were observed in controlled trials compared to randomized controlled trials. Conclusion By combining all possible results, it can be concluded that care pathways for treatment of heart failure decrease mortality rates and length of hospital stay, but no statistically significant difference was observed in the readmission rates and hospitalisation costs. However, one should be cautious with overall conclusions: what works for one organization may not work for another because of the subtle differences in processes and bottlenecks.
In developing countries, lack of trust in the quality of care provided is often cited as a major factor promoting reluctance to seek biomedical help for obstetric emergencies. This article draws on fieldwork among Mayan informants in Sololá, Guatemala, to explore poor perceptions of the quality of care received when seeking obstetric care in the hospital. Using data collected over two years, I set out to understand why interviewees repeatedly complain that hospital staff "do not attend to you." I maintain that the powerlessness of patients to influence the treatment they receive further reduces their trust in the quality of care delivered, ultimately negatively impacting the decision to seek obstetric care. Finally, I argue for the importance of recognizing the influence of the wider historical and social context in creating the dynamics of this interaction. The implications of this research in defining the quality of care and skilled attendance within the quest to make pregnancy safer are discussed. PMID:18464128
Berry, Nicole S
Medical troops supply in local armed conflicts demonstrated advantages of fast evacuation of wounded personnel by aviation from the seat of combat actions to the stage of specialized surgical care. Wounded in head, breast, abdomen (particularly in case of multiple and combined character of wounds) are evacuated for treatment to central military hospitals equipped with modern diagnostic and medical equipment, completed with qualified specialists and having the opportunity of prolonged treatment. Surgical care in the zone of combat actions is confined to hemostasis, intensive therapy -to supporting of main vital functions. The article contains the data about terminations of wounded personnel treatment in central military-fleet clinical hospital. PMID:8754084
Sharaevski?, G Iu; Tkachev, A E; Kovalev, V I; Gurich, V D; Levchuk, A L; Umerov, E Kh
We explored the relationship between nurse burnout and ratings of quality of care in 53,846 nurses from six countries. In this secondary analysis, we used data from the International Hospital Outcomes Study; data were collected from1998 to 2005. The Maslach Burnout Inventory and a single-item reflecting nurse-rated quality of care were used inmultiple logistic regression modeling to investigate the association between nurse burnout and nurse-rated quality of care. Across countries, higher levels of burnout were associated with lower ratings of the quality of care independent of nurses’ ratings of practice environments. These findings suggest that reducing nurse burnout may be an effective strategy for improving nurse-rated quality of care in hospitals.
Clarke, Sean P.; Finlayson, Mary; Aiken, Linda H.
ABSTRACT Health Evidence Network (HEN) synthesis report on the best strategies for ensuring quality in hospitals Ensuring the safety of patients and personnel and improving,quality have become,important objectives for
This study aimed to analyze care management actions performed by nurses in a hospital emergency service. This is a qualiative research of the case study type, carried out with nurses from the Emergency Service of a University Hospital in southern Brazil. The data were collected through participant observation and semi-structured interviews, and analyzed using thematic analysis. The results show nurses' actions in care planning, forecasting and provisioning of resources, supervision, leadership and training of the nursing team. In care planning, there is the execution of the nursing process and the control of the realization of laboratory and radiological tests. The actions of forecasting and provisioning of resources were: elaboration of the monthly schedule of employees, daily distribution of the staff and the management of material resources. Leadership encourages the planning of care, the coordination of the nursing staff and the delegation of activities. PMID:22299271
dos Santos, José Luís Guedes; Lima, Maria Alice Dias da Silva
Objective To better understand associations between organizational culture (OC), organizational management structure (OS) and quality management in hospitals. Design A multi-method, multi-level, cross-sectional observational study. Setting and participants As part of the DUQuE project (Deepening our Understanding of Quality improvement in Europe), a random sample of 188 hospitals in 7 countries (France, Poland, Turkey, Portugal, Spain, Germany and Czech Republic) participated in a comprehensive questionnaire survey and a one-day on-site surveyor audit. Respondents for this study (n = 158) included professional quality managers and hospital trustees. Main outcome measures Extent of implementation of quality management systems, extent of compliance with existing management procedures and implementation of clinical quality activities. Results Among participating hospitals, 33% had a clan culture as their dominant culture type, 26% an open and developmental culture type, 16% a hierarchical culture type and 25% a rational culture type. The culture type had no statistically significant association with the outcome measures. Some structural characteristics were associated with the development of quality management systems. Conclusion The type of OC was not associated with the development of quality management in hospitals. Other factors (not culture type) are associated with the development of quality management. An OS that uses fewer protocols is associated with a less developed quality management system, whereas an OS which supports innovation in care is associated with a more developed quality management system.
Wagner, C.; Mannion, R.; Hammer, A.; Groene, O.; Arah, O.A.; Dersarkissian, M.; Sunol, R.
This research sought to develop and test measures of quality of care for vulnerable children through two aims: (1) To validate the PedsQL(trademark) as an outcome measure of quality of healthcare services; (2) To develop and validate a non-categorical mea...
Introduction Protocols for the delivery of analgesia, sedation and delirium care of the critically ill, mechanically ventilated patient have been shown to improve outcomes but are not uniformly used. The extent to which elements of analgesia, sedation and delirium guidelines are incorporated into order sets at hospitals across a geographic area is not known. We hypothesized that both greater hospital volume and membership in a hospital network are associated with greater adherence of order sets to sedation guidelines. Methods Sedation order sets from all nonfederal hospitals without pediatric designation in Washington State that provided ongoing care to mechanically ventilated patients were collected and their content systematically abstracted. Hospital data were collected from Washington State sources and interviews with ICU leadership in each hospital. An expert-validated score of order set quality was created based on the 2002 four-society guidelines. Clustered multivariable linear regression was used to assess the relationship between hospital characteristics and the order set quality score. Results Fifty-one Washington State hospitals met the inclusion criteria and all provided order sets. Based on expert consensus, 21 elements were included in the analgesia, sedation and delirium order set quality score. Each element was equally weighted and contributed one point to the score. Hospital order set quality scores ranged from 0 to 19 (median = 8, interquartile range 6 to 14). In multivariable analysis, a greater number of acute care days (P = 0.01) and membership in a larger hospital network (P = 0.01) were independently associated with a greater quality score. Conclusions Hospital volume and membership in a larger hospital network were independently associated with a higher quality score for ICU analgesia, sedation and delirium order sets. Further research is needed to determine whether greater order-set quality is associated with improved outcomes in the critically ill. The development of critical care networks might be one strategy to improve order set quality scores.
Ensuring and maintaining a high level of quality in nursing care becomes more and more important as economic pressure is increasing and personnel is being reduced. The nursing executives of four large Swiss hospitals therefore commissioned a group of nursing scientists and nursing experts with the task of developing a trendsetting model to represent, assess, and interpret the quality of nursing care. The "Quality of Health Outcome Model" (QHOM) served as a basis for development. More than 60 nurses from acute care hospitals and specialized clinics assessed a first draft of the model in hearings and by means of questionnaires. The model integrated earlier attempts at quality screening regarding structures, processes and results, complementing these three elements with a fourth: the patients, whose characteristics influence the results of nursing care remarkably. Thus, the former one-dimensional, linear viewpoint was resolved into a dynamic representation of all four elements, illustrating a specific concept of nursing care. Through the multi-dimensionality of the model the complexity of the nursing process is better represented. The model's core consists of eight exemplary indicators of quality, each of which is relevant to nursing and for each of which criteria and assessment tools have been formulated. The model is seen as a basis and reference for the quality development and first opportunities for clinical application have been succesfully employed. The project can serve as a paradigm of networking amongst hospitals and cooperation between nursing scientists and experts, and of the critical significance of such collaboration to the advancement of nursing quality. PMID:18850535
Schmid-Büchi, Silvia; Rettke, Horst; Horvath, Eva; Marfurt-Russenberger, Katrin; Schwendimann, René
The problem of defining a quality model to be used in the evaluation of the software components of a Health Care System (HCS) is addressed. The model, based on the ISO/IEC 9126 standard, has been interpreted to fit the requirements of some classes of applications representative of Health Care Systems, on the basis of the experience gained both in the field of medical Informatics and assessment of software products. The values resulting from weighing the quality characteristics according to their criticality outline a set of quality profiles that can be used both for evaluation and certification. PMID:10179767
Braccini, G; Fabbrini, F; Fusani, M
Background With market-oriented economic and health-care reform, public hospitals in China have received unprecedented pressures from governmental regulations, public opinions, and financial demands. To adapt the changing environment and keep pace of modernizing healthcare delivery system, public hospitals in China are expanding clinical services and improving delivery efficiency, while controlling costs. Recent experiences are valuable lessons for guiding future healthcare reform. Here we carefully study three teaching hospitals, to exemplify their experiences during this period. Methods We performed a systematic analysis on hospitalization costs, health-care quality and delivery efficiencies from 2006 to 2010 in three teaching hospitals in Beijing, China. The analysis measured temporal changes of inpatient cost per stay (CPS), cost per day (CPD), inpatient mortality rate (IMR), and length of stay (LOS), using a generalized additive model. Findings There were 651,559 hospitalizations during the period analyzed. Averaged CPS was stable over time, while averaged CPD steadily increased by 41.7% (P<0.001), from CNY 1,531 in 2006 to CNY 2,169 in 2010. The increasing CPD seemed synchronous with the steady rising of the national annual income per capita. Surgical cost was the main contributor to the temporal change of CPD, while medicine and examination costs tended to be stable over time. From 2006 and 2010, IMR decreased by 36%, while LOS reduced by 25%. Increasing hospitalizations with higher costs, along with an overall stable CPS, reduced IMR, and shorter LOS, appear to be the major characteristics of these three hospitals at present. Interpretations These three teaching hospitals have gained some success in controlling costs, improving cares, adopting modern medical technologies, and increasing hospital revenues. Effective hospital governance and physicians' professional capacity plus government regulations and supervisions may have played a role. However, purely market-oriented health-care reform could also misguide future healthcare reform.
Zhao, Lue-Ping; Yu, Guo-Pei; Liu, Hui; Ma, Xie-Min; Wang, Jing; Kong, Gui-Lan; Li, Yi; Ma, Wen; Cui, Yong; Xu, Beibei; Yu, Na; Bao, Xiao-Yuan; Guo, Yu; Wang, Fei; Zhang, Jun; Li, Yan; Xie, Xue-Qin; Jiang, Bao-Guo; Ke, Yang
BACKGROUND: This prospective and retrospective study carried out over a period of one month (50 patients) looked at the quality of hospital records of urethral catheterisation with reference to the hospital protocol. The patients were catheterised on general surgical wards as well as in theatre. RESULTS: The quality of hospital records of this procedure was poor and a number of complications noted. CONCLUSIONS: Good documentation of urethral catheterisation would result in a better quality of audit and, therefore, identify potential ways of minimising complications. We recommend this by regular audit of hospital records, re-inforcement of protocols and informed consent of this procedure, with particular reference to theatre.
Conybeare, A.; Pathak, S.; Imam, I.
The self-care of nurses is a requirement for the care of the patient, so that the care provided will not imply on the resignation of the nursing professional or the client. The objective of the present study is to verify how the work of hospital nurses has been done, regarding the self-care of these professionals and the care provided to patients. Semi-structured interviews were carried out with nurses from two different districts in Rio Grande do Sul, who had graduated from public universities in the same state and worked in hospitals of the respective districts. Results showed that these professionals expressed the need of taking care of themselves in order to provide care for their patients. It was also reported that nurses assume responsibilities of other professionals and lack, in their professional environment, human and material resources. This situation generates negative consequences for the nurse's self-care, as well as for the care of the patients. It is important that nursing professionals implement strategies to deal with asymmetric power relations in the hospital, based on their beliefs, values and knowledge. This can lead to more appropriate conditions of work, which can guarantee a more qualified self-care of the professional, and a better care for the patient. PMID:12222029
Beneri, R L; Santos, L R; Lunardi, V L
Empathy is a complex multi-dimensional concept that has moral cognitive emotive and behavioural components Clinical empathy involves an ability to: (a) understand the patient's situation, perspective, and feelings (and their attached meanings); (b) to communicate that understanding and check its accuracy; and (c) to act on that understanding with the patient in a helpful (therapeutic) way. Research on the effect of empathy on health outcomes in primary care is lacking, but studies in mental health and in nursing suggest it plays a key role. Empathy can be improved and successfully taught at medical school especially if it is embedded in the students actual experiences with patients. A variety of assessment and feedback techniques have also been used in general medicine psychiatry and nursing. Further work is required to determine if clinical empathy needs to be, and can be, improved in the primary care setting.
Mercer, Stewart W; Reynolds, William J
Describes a program model, Medical Foster Care, which uses registered nurses as foster parents who work closely with biological parents of abused and neglected children with acute health problems. The program reunites families, improves parenting skills, and saves money in long-term hospitalization. (Author/BB)
Foster, Patricia H.; Whitworth, J. M.
Objectives: Primary care audits in Bahrain have consistently revealed a failure to meet recognised standards of delivery of process and outcome measures to patients with diabetes. This study aimed to establish for the first time the quality of diabetes care in a Bahraini hospital setting. Methods: A retrospective clinical audit was conducted of a random sample of patients attending the Diabetes and Endocrine Center at the Bahrain Defence Forces Hospital over a 15-month period which ended in June 2010. The medical records of 287 patients with diabetes were reviewed electronically and manually for process and outcome measures, and a statistical analysis was performed. Results: Of the patients, 47% were male, with a median age of 54 years, and 5% had type 1 diabetes. Measured processes, including haemoglobin A1c, blood pressure, lipids, creatinine and weight, were recorded in over 90% of the patients. Smoking (8%) and the patient’s body mass index (19%) were less frequently recorded. Screening for complications was low, with retinal screening in 42%, foot inspection in 22% and microalbuminuria in 23% of patients. Conclusion: This study shows that the implementation of recognised evidence-based practice continues to pose challenges in routine clinical care. Screening levels for the complications of diabetes were low in this hospital diabetes clinic. It is important to implement a systematic approach to diabetes care to improve the quality of care of patients with diabetes which could lead to a lowering of cardiovascular risk and a reduction in healthcare costs in the long term.
Al-Baharna, Marwa M.; Whitford, David L.
Objective Although general hospitals receive nearly 60% of all inpatient psychiatric admissions, little is known about the care environment and related adverse events. The purpose of this study was to determine the occurrence of adverse events and examine the extent to which organizing factors of inpatient psychiatric care environments were associated with the occurrence of these events. The events examined were wrong medication, patient falls with injuries, complaints from patients and families, work-related staff injuries, and verbal abuse directed toward nurses. Methods This cross-sectional study used data from a 1999 nurse survey linked with hospital data. Nurse surveys from 353 psychiatric registered nurses working in 67 Pennsylvania general hospitals provided information on nurse characteristics, organizational factors, and the occurrence of adverse events. Linear regression models and robust clustering methods at the hospital level were used to study the relationship of organizational factors of psychiatric care environments and adverse event outcomes. Results Verbal abuse toward registered nurses (79%), complaints (61%), patient falls with injuries (44%), and work-related injuries (39%) were frequent occurrences. Better management skill was associated with fewer patient falls and fewer work-related injuries to staff. In addition, fewer occurrences of staff injuries were associated with better nurse-physician relationship and lower patient-to-nurse staffing ratios. Conclusions Adverse events are frequent for inpatient psychiatric care in general hospitals, and organizational factors of care environments are associated with adverse event outcomes. Further development of evidence-based quality and safety monitoring of inpatient psychiatric care in general hospitals is imperative.
Kumar, Aparna; Aiken, Linda H.
Background Healthcare technology and quality improvement programs have been identified as a means to influence healthcare costs and healthcare quality in Canada. This study seeks to identify whether the ability to implement healthcare technology by a hospital was related to usage of quality improvement programs within the hospital and whether the culture within a hospital plays a role in the adoption of quality improvement programs. Methods A cross-sectional study of Canadian hospitals was conducted in 2010. The sample consisted of hospital administrators that were selected by provincial review boards. The questionnaire consisted of 3 sections: 20 healthcare technology items, 16 quality improvement program items and 63 culture items. Results Rasch model analysis revealed that a hierarchy existed among the healthcare technologies based upon the difficulty of implementation. The results also showed a significant relationship existed between the ability to implement healthcare technologies and the number of quality improvement programs adopted. In addition, culture within a hospital served a mediating role in quality improvement programs adoption. Conclusions Healthcare technologies each have different levels of difficulty. As a consequence, hospitals need to understand their current level of capability before selecting a particular technology in order to assess the level of resources needed. Further the usage of quality improvement programs is related to the ability to implement technology and the culture within a hospital.
Nearly fourteen years ago the Institute of Medicine's report, To Err Is Human: Building a Safer Health System, triggered a national movement to improve patient safety. Despite the substantial and concentrated efforts that followed, quality and safety problems in health care continue to routinely result in harm to patients. Desired progress will not be achieved unless substantial changes are made to the way in which quality improvement is conducted. Alongside important efforts to eliminate preventable complications of care, there must also be an effort to seriously address the widespread overuse of health services. That overuse, which places patients at risk of harm and wastes resources at the same time, has been almost entirely left out of recent quality improvement endeavors. Newer and much more effective strategies and tools are needed to address the complex quality challenges confronting health care. Tools such as Lean, Six Sigma, and change management are proving highly effective in tackling problems as difficult as hand-off communication failures and patient falls. Finally, the organizational culture of most American hospitals and other health care organizations must change. To create a culture of safety, leaders must eliminate intimidating behaviors that suppress the reporting of errors and unsafe conditions. Leaders must also hold everyone accountable for adherence to safe practices. PMID:24101066
Chassin, Mark R
Purpose Patients leaving the hospital are at increased risk of functional decline and hospital readmission. The Employee and Community Health service at Mayo Clinic in Rochester developed a care transition program (CTP) to provide home-based care services for medically complex patients. The study objective was to determine the relationship between CTP use, 30-day hospital readmission, and Emergency Room (ER) visits for adults over 60 years with high Elder Risk Assessment scores. Patients and methods This was a pilot prospective cohort study that included 20 patients that used the CTP and 20 patients discharged from the hospital without using the CTP. The medically complex study patients were drawn from the department of Employee and Community Health population between October 14, 2011 and September 27, 2012. The primary outcomes were 30-day hospital readmission or ER visit after discharge from the hospital. The secondary outcomes were within-group changes in grip strength, gait speed, and quality of life (QOL). Patients underwent two study visits, one at baseline and one at 30 days postbaseline. The primary analysis included time-to-event from baseline to rehospitalization or ER visit. Paired t-tests were used for secondary outcomes, with continuous scores. Results Of the 40 patients enrolled, 36 completed all study visits. The 30-day hospital readmission rates for usual care patients were 10.5% compared with no readmissions for CTP patients. There were 31.6% ER visits in the UC group and 11.8% in the CTP group (P = 0.37). The secondary analysis showed some improvement in physical QOL scores (pre: 32.7; post: 39.4) for the CTP participants (P < 0.01) and no differences in gait speed or grip strength. Conclusion Based on this pilot study of care transition, we found nonsignificant lower hospital and ER utilization rates and improved physical QOL scores for patients in the CTP group. However, the data leads us to recommend future studies with larger sample sizes (N = 250).
Takahashi, Paul Y; Haas, Lindsey R; Quigg, Stephanie M; Croghan, Ivana T; Naessens, James M; Shah, Nilay D; Hanson, Gregory J
It is thought that new technologies like computers at the patient's bedside, or point of care technology (PCT) improve nursing productivity, documentation, patient satisfaction and decrease costs. Using the Health Care Technology Assessment (HCTA) framework, (safety, cost, effectiveness, social impact), a descriptive and quasi-experimental study was performed to test the effectiveness and explain the social impact of PCT. A sample of 90 patients from five nursing units in three hospitals were obtained for the study. Half of the patients had computers at their bedside. Data were collected on a hospital pretest/posttest unit and two comparison and experimental units. The main null hypothesis was: There is no difference in the quality of patient care on nursing units with and without PCT. Quality of patient care was measured by patient satisfaction and a nursing care documentation instruments. This hypothesis was rejected. While patients were generally very satisfied with their nursing care on all units, when controlling for time and the presence of the computer, patients who did not have PCT were more satisfied than patients in rooms with PCT. Furthermore, the charts of patients with PCT were less compliant to documentation standards. Conversely, a sub sample of these same patients expressed positive responses to the bedside computer and technologies in their room and this concurred with the current literature. The benefits of the technology were found to outweigh the costs of PCT from the literature review. There was not enough in the literature to draw conclusions about the safety of PCT. In summary, the quality of patient care did not improve with the implementation of PCT in this study.(ABSTRACT TRUNCATED AT 250 WORDS)
Happ, B. A.
A joint project team consisting of personnel from Parkview Episcopal Medical Center, Pueblo, Colorado, and Patient Care Technologies, Atlanta, Georgia, a software vendor, codeveloped a point-of-care based system of electronic patient records and administrative data capture for home health care. Well established continuous quality improvement techniques, in use at Parkview for approximately 6 years, guided the development project and the subsequent alpha and beta testing of the system. Significant results to date include an overall productivity gain approaching 20%, the potential to increase annual home care revenue $876,000 with the same staffing level, and an 83% reduction in billing errors. Although not directly measured as a part of the study, the project team believes the quality of charting has improved because it is now done at the point-of-care in the home rather than in the office--some period of time after care is delivered. Anticipated future development includes integration of the home care clinical record with the hospital's clinical data repository and explicit support of critical pathways. PMID:7641132
Israel has made impressive progress in improving performance on key measures of the quality of health care in the community in recent years. These achievements are all the more notable given Israel's modest overall spending on health care and because they have accrued to virtually the entire population of the country. Health care systems in most developed nations around the world find themselves in a similar position today with respect to health care quality. Despite significantly increased improvement efforts over the past decade, routine safety processes, such as hand hygiene and medication administration, fail routinely at rates of 30% to 50%. People with chronic diseases experience preventable episodes of acute illness that require hospitalization due to medication mix-ups and other failures of outpatient management. Patients continue to be harmed by preventable adverse events, such as surgery on the wrong part of the body and fires in operating theaters. Health care around the world is not nearly as safe as other industries, such as commercial aviation, that have mastered highly effective ways to manage serious hazards. Health care organizations will have to undertake three interrelated changes to get substantially closer to the superlative safety records of other industries: leadership commitment to zero major quality failures, widespread implementation of highly effective process improvement methods, and the adoption of all facets of a culture of safety. Each of these changes represents a major challenge to the way today's health care organizations plan and carry out their daily work. The Israeli health system is in an enviable position to implement these changes. Universal health insurance coverage, the enrolment of the entire population in a small number of health plans, and the widespread use of electronic health records provide advantages available to few other countries. Achieving and sustaining levels of safety comparable to, say, commercial aviation will be a long journey for health care--one we should begin promptly. This is a commentary on http://www.ijhpr.org/content/1/1/3/
OBJECTIVE--To evaluate the medical impact of reactive pharmacy intervention. DESIGN--Analysis of all interventions during 28 days by all 35 pharmacists in hospitals in Nottingham. SETTING--All (six) hospitals in the Nottingham health authority (a teaching district), representing 2530 mainly acute beds, 781 mental illness beds, and 633 mainly health care of the elderly beds. PATIENTS--Hospital inpatients and outpatients. INTERVENTIONS--Recording of every
C J Hawkey; S Hodgson; A Norman; T K Daneshmend; S T Garner
Objective To analyse hospital admissions in the first 2?years of life among children with cleft lip and/or palate in England. Design Analysis of national administrative data of hospital admissions. Setting National Health Service hospitals. Patients Patients born alive between 1997 and 2008 who underwent surgical cleft repair. Outcome measures Number of admissions, including the birth episode, and days spent in hospital were examined. Children were analysed according to cleft type and whether or not they had additional congenital anomalies. Results 10?892 children were included. In their first 2?years, children without additional anomalies (n=8482) had on average 3.2 admissions and 13.2?days in hospital, which varied from 2.6 admissions and 9.2?days with cleft lip to 4.7 admissions and 19.7?days with bilateral cleft lip and palate (BCLP). Children with additional anomalies (n=2410) had on average 6.7 admissions and 51.4?days in hospital, which varied from 6.4 admissions and 48.5?days with cleft palate to 8.8 admissions and 67.5?days with BCLP. The mean number and duration of cleft-related admissions was similar in children without (1.6 admissions and 6.4?days) and in those with additional anomalies (1.5 admissions and 8.5?days). 35.2% of children without additional anomalies had at least one emergency admission, whereas the corresponding figure was 67.3% with additional anomalies. Conclusions The burden of hospital care in the first 2?years of life varied according to cleft type and presence of additional anomalies. However, cleft-specific hospital care did not differ between children with and without additional anomalies.
Fitzsimons, Kate J; Copley, Lynn P; Deacon, Scott A; van der Meulen, Jan H
Objectives: To evaluate the evidence for strategies to prevent falls or fractures in residents in care homes and hospital inpatients and to investigate the effect of dementia and cognitive impairment. Design: Systematic review and meta-analyses of studies grouped by intervention and setting (hospital or care home). Meta-regression to investigate the effects of dementia and of study quality and design. Data
David Oliver; James B. Connelly; Christina R. Victor; Fiona E. Shaw; Anne Whitehead; Yasemin Genc; Alessandra Vanoli; Finbarr C. Martin; Margot A. Gosney; Kurrle
Prehospital pediatric care is an important component in the treatment of the injured child, as the prehospital responders are the first medical providers performing life saving and directed medical care. Traumatic injuries are the leading cause of morbidity and mortality in the pediatric patient population. Nevertheless, for most prehospital provider it is a rare event to treat pediatric trauma patients and there is a still existing gap between the quality of care for pediatric patients compared to adults. To improve pediatric prehospital trauma care more provider need to be trained in identifying the specific differences between adult and pediatric patients.
Seid, Terrence; Ramaiah, Ramesh; Grabinsky, Andreas
BACKGROUND: The goals of the study were to assess the relationship between age and processes of care in emergency department (ED) patients admitted with pneumonia and to identify independent predictors of failure to meet recommended quality care measures. METHODS: This was a prospective cohort study of a pre-existing database undertaken at a university hospital ED in the Midwest. ED patients
Jeffrey M Caterino; Brian C Hiestand; Daniel R Martin
We examined the relationship between registered nurse (RN) workgroup job satisfaction and hospital-acquired pressure ulcers (HAPUs) among older adults on six types of acute care units. Random-intercept logistic regression analyses were performed using 2009 unit-level data from the National Database of Nursing Quality Indicators® (NDNQI®) and the NDNQI RN Survey. Overall, RN workgroup job satisfaction was negatively associated with HAPU rates, although the relationship varied by unit type. RN workgroup satisfaction was significantly associated with HAPU rates on critical care, medical, and rehabilitation units. No significant association was found on step-down, surgical, and medical-surgical units. Findings provide evidence that higher RN workgroup job satisfaction is related to lower HAPU rates among older adult patients in acute care hospitals. PMID:23408439
Choi, Jisun; Bergquist-Beringer, Sandra; Staggs, Vincent S
The hospital admission for ambulatory care sensitive conditions (ACSCs) is a validated indicator of impeded access to good primary and preventive care services. The authors examine the predictors of ACSC admissions in small geographic areas in two cross-sections spanning an 11-year time interval (1995-2005). Using hospital discharge data from the Healthcare Cost and Utilization Project of the Agency for Healthcare Research and Quality for Arizona, California, Massachusetts, Maryland, New Jersey, and New York for the years 1995 and 2005, the study includes a multivariate cross-sectional design, using compositional factors describing the hospitalized populations and the contextual factors, all aggregated at the primary care service area level. The study uses ordinary least squares regressions with and without state fixed effects, adjusting for heteroscedasticity. Data is pooled over 2 years to assess the statistically significant changes in associations over time. ACSC admission rates were inversely related to the availability of local primary care physicians, and managed care was associated with declines in ACSC admissions for the elderly. Minorities, aged elderly, and percent under federal poverty level were found to be associated with higher ACSC rates. The comparative analysis for 2 years highlights significant declines in the association with ACSC rates of several factors including percent minorities and rurality. The two policy-driven factors, primary care physician capacity and Medicare-managed care penetration, were not found significantly more effective over time. Using small area analysis, the study indicates that improvements in socioeconomic conditions and geographic access may have helped improve the quality of primary care received by the elderly over the last decade, particularly among some minority groups. PMID:24405202
Basu, Jayasree; Mobley, Lee R; Thumula, Vennela
This paper explores the historical development of quality measures, examines the dimensions of quality assessment, and compares the application of these dimensions to medical\\/surgical and psychiatric care. The implications for assessing quality care in psychiatric settings are discussed.
William E. Turner
...costs of inpatient hospital...use in the treatment of peripheral...lesion will first be treated...computations. The first computation...days, or inpatient days of Medicaid...proxy for the treatment costs of...care during first year or years...proxies for the treatment costs of...low-income inpatient days...
Because of the high proportion of nursing home residents with a mental illness other than dementia, the quality of mental health care in nursing homes is a major clinical and policy issue. The authors apply Donabedian's framework for assessing quality of care based on the triad of structure, process, and outcome-based measures in reviewing the literature on the quality of mental health care in nursing homes. Quality measures used within the literature include mental health consultations and hospitalizations, inappropriate use of medications, and mental health survey deficiencies. Factors related to the resident's welfare (nurse staffing), provider norms (locality), and financial factors (payer mix) were associated with the quality of mental health care. Although future research is necessary, the extant literature suggests that persons with mental illness are frequently admitted to nursing homes and their care is often of poor quality and related to a series of resident and facility factors.
Grabowski, David C.; Aschbrenner, Kelly A.; Rome, Vincent F.; Bartels, Stephen J.
The National Hospital Ambulatory Medical Care Survey (NHAMCS) provides data on ambulatory medical care rendered in hospital emergency and outpatient departments (EDs and OPDs). The NHAMCS is a nationally probability sample survey of visits to the emergenc...
Diabetes mellitus is a chronic disease with an increasing prevalence. Appropriate treatment of the disease and prevention of chronic complications reduce morbidity and mortality in a cost-effective manner. These actions should be measured through the use of validated indicators for quality of care. The goal of this study was to assess the quality of care in diabetic patients under pharmacologic treatment in a private university hospital. A retrospective study was conducted in adult patients who bought insulin or oral hypoglycemic agents during a 3 month period; demographic and clinical data were obtained for 12 consecutive months following the buying period. The study included 305 adult patients; most were males (60%), with type 2 diabetes (95%), and using oral hipoglycemic agents (86%). Control of blood pressure was registered in 80%, foot exam in 5%, eye exam in 27%, HbA1C blood level in 85%, complete lipid profile in 82%, microalbuminuria in 27% and creatinine clearance in 22% of patients, respectively. Mean values were HbA1C 7.1(+/- 1.6)%, and < or = 7% in 66%, LDL 113 (+/- 33.6) mg/dl and <100 mg/dl in 30%, BP 136-79 mm Hg and < 130-80 mm Hg in 46% of patients, respectively. This study emphasizes the need for quality of care assessment through validated indicators and points out the aspects that should be improved within a health care system. PMID:18051222
Lombraña, María A; Capetta, María E; Ugarte, Alejandro; Correa, Viviana; Giganti, Jorge; Saubidet, Cristian Lopez; Stryjewski, Martin E
Context The quality of health care and the financial costs affected by receiving care represent two fundamental dimensions for judging health care performance. No existing conceptual framework appears to have described how quality influences costs. Methods We developed the Quality-Cost Framework, drawing from the work of Donabedian, the RAND/UCLA Appropriateness Method, reports by the Institute of Medicine, and other sources. Findings The Quality-Cost Framework describes how health-related quality of care (aspects of quality that influence health status) affects health care and other costs. Structure influences process, which, in turn, affects proximate and ultimate outcomes. Within structure, subdomains include general structural characteristics, circumstance-specific (e.g., disease-specific) structural characteristics, and quality-improvement systems. Process subdomains include appropriateness of care and medical errors. Proximate outcomes consist of disease progression, disease complications, and care complications. Each of the preceding subdomains influences health care costs. For example, quality improvement systems often create costs associated with monitoring and feedback. Providing appropriate care frequently requires additional physician visits and medications. Care complications may result in costly hospitalizations or procedures. Ultimate outcomes include functional status as well as length and quality of life; the economic value of these outcomes can be measured in terms of health utility or health-status-related costs. We illustrate our framework using examples related to glycemic control for type 2 diabetes mellitus or the appropriateness of care for low back pain. Conclusions The Quality-Cost Framework describes the mechanisms by which health-related quality of care affects health care and health status–related costs. Additional work will need to validate the framework by applying it to multiple clinical conditions. Applicability could be assessed by using the framework to classify the measures of quality and cost reported in published studies. Usefulness could be demonstrated by employing the framework to identify design flaws in published cost analyses, such as omitting the costs attributable to a relevant subdomain of quality.
Nuckols, Teryl K; Escarce, Jose J; Asch, Steven M
We investigate a health care market with uncertainty in a mixed duopoly, where a partially privatized public hospital competes\\u000a against a private hospital in terms of quality choice. We use a simple Hotelling-type spatial competition model by incorporating\\u000a mean–variance analysis and the framework of partial privatization. We show how the variance in the quality perceived by patients\\u000a affects the true
Background: Few studies, especially in Iran, have assessed the status of family participation in the care of the hospitalized patients. Objectives: This study was conducted to assess why family members partake in caregiving of their patients in hospitals, the type of care that family provide, and the outcomes of the participation in the opinions of nurses and family members. Patients and Methods: In this comparative-descriptive study, data was collected by a two- version researcher-developed questionnaire, from 253 family members of patients by quota sampling method and 83 nurses by census sampling method from wards which had licensed for entering the families. Each questionnaire has three sections: the care needs of the patients which family participated to provide, the reasons to take part, and the outcomes of this collaborative care. The data was analyzed using descriptive statistics and also chi-squared test through SPSS software version 11.5. Results: The patients received more unskilled and non- professional nursing care from their family members. Most of the nurses and families believed that family participation is both voluntary and compulsory. The shortage of personnel in different categories of nursing and speeding up the patient-related affairs were the most important outcome of the participation, from the nurses’ viewpoint was speeding up the patient-related affairs and from the side of the family members, it was the patients’ feeling of satisfaction from the presence of one of their relatives beside them. Conclusions: Co understanding, skillfulness and competence of families and nurses in collaboration with each other were not good enough.Few studies, especially in Iran, have assessed the status of family participation in the care of the hospitalized patients.
Khosravan, Shahla; Mazlom, Behnam; Abdollahzade, Naiemeh; Jamali, Zeinab; Mansoorian, Mohammad Reza
Aims: The objective of the study was to study the prescribing patterns of drugs used in the coronary artery disease (CAD) and to identify, which drug is mostly prescribed at that hospital. Settings and Design: This was a prospective observational survey including case series analysis of patients with CAD who met the inclusion criteria. It was conducted in the cardiology unit of multidisciplinary Tertiary Care Hospital in Kanpur. Materials and Methods: Data of patients who met the inclusion criteria was collected in specially designed case record forms. It was designed to include the patient data such as, demographics, risk factors, clinical and biochemical characteristics, procedures and investigations performed during the hospital stay, in-hospital and discharge drug therapy. Statistical Analysis Used: Descriptive statistics were performed for baseline characteristics, risk factors and medication use. All the analyses were performed using Statistical Package for Social Sciences version 16.0. Results: Subjects of age groups 65-74 (33.34%) were found to be more susceptible to CAD. In this study, we see that Aspirin, Clopidogrel and Statins were mostly prescribed in this hospital. Conclusions: In this study, Aspirin and Clopidogrel were mostly prescribed. According to 2009 focused updates of American College of Cardiology/American Heart Association (ACC/AHA) guidelines for the management of patients with ST-elevation Myocardial Infarction. So in this hospital prescription for CAD were according to the guideline.
Wal, Pranay; Wal, Ankita; Nair, Vandana R.; Rai, A. K.; Pandey, Umeshwar
Patients who have been hospitalized often experience care coordination problems that worsen outcomes and increase costs. One reason is that hospital care and ambulatory care are often provided by different physicians. However, interventions to improve care coordination for hospitalized patients have not consistently improved outcomes and generally have not reduced costs. We describe the rationale for the Comprehensive Care Physician model, in which physicians focus their practice on patients at increased risk of hospitalization so that they can provide both inpatient and outpatient care to their patients. We also describe the design and implementation of a study supported by the Center for Medicare and Medicaid Innovation to assess the model's effects on costs and outcomes. Evidence concerning the effectiveness of the program is expected by 2016. If the program is found to be effective, the next steps will be to assess the durability of its benefits and the model's potential for dissemination; evidence to the contrary will provide insights into how to alter the program to address sources of failure. PMID:24799573
Meltzer, David O; Ruhnke, Gregory W
This paper will present some of the findings of a qualitative study that utilised grounded theory to discover nurses perceptions of quality and factors that affect quality nursing care provided to Percutaneous Transluminal Coronary Angioplasty (PTCA) patients in a large Queensland Metropolitan Hospital. The study used focus group interviews, participant observation, in-depth interviews and published literature to gather data. Fifteen
Sonja Cleary; Sansnee Jirojwong; Sandra Walker
Accountable care organizations (ACOs) are groups of providers who agree to accept the responsibility for elevating the health status of a defined group of patients, with the goal of enabling people to take charge of their health and enroll in shared decision making with providers. The large initial investment required (estimated at $1.8 million) to develop an ACO implies that the participation of large health care organizations, especially hospitals and health systems, is required for success. Findings of this study suggest that ACOs based in a larger hospital organization are more likely to meet Centers for Medicare and Medicaid Services criteria for formation because of financial and structural assets of those entities. PMID:24776829
Camargo, Rodrigo; Camargo, Thaisa; Deslich, Stacie; Paul, David P; Coustasse, Alberto
Rationale: The National Quality Forum recently endorsed in-hospital mortality and intensive care unit length of stay (LOS) as quality indicators for patients in the intensive care unit. These measures may be affected by transferring patients to long-term acute care hospitals (LTACs). Objectives: To quantify the implications of LTAC transfer practices on variation in mortality index and LOS index for patients in academic medical centers. Methods: We used a cross-sectional study design using data reported to the University HealthSystem Consortium from 2008–2009. Data were from patients who were mechanically ventilated for more than 96 hours. Measurements and Main Results: Using linear regression, we measured the association between mortality index and LTAC transfer rate, with the hospital as the unit of analysis. Similar analyses were conducted for LOS index and cost index. A total of 137 hospitals were analyzed, averaging 534 transfers to LTAC per hospital during the study period. Mean ± SD in-hospital mortality was 24 ± 6.4%, and observed LOS was 30.4 ± 8.2 days. The mean LTAC transfer rate was 15.7 ± 13.7%. Linear regression demonstrated a significant correlation between transfer rate and mortality index (R2 = 0.14; P < 0.0001) and LOS index (R2 = 0.43; P < 0.0001). Conclusions: LTAC hospital transfer rate has a significant impact on reported mortality and LOS indices for patients requiring prolonged acute mechanical ventilation. This is an example of factors unrelated to quality of medical care or illness severity that must be considered when interpreting mortality and LOS as quality indicators.
Hall, William B.; Willis, Laura E.; Medvedev, Sofia
An increase in chronic disease prevalence is contributing to health care cost growth and decreased quality of life in industrialized nations worldwide. Inadequate management of chronic diseases is a leading cause of hospitalizations and, thus, avoidable expenditures. In this study, we evaluated the impact of nurse-delivered care calls, the primary intervention of a proactive chronic care management (CCM) program, in a population aged 65 and older in Germany. In this analysis, hospital admission rates were evaluated among program enrollees who were diagnosed with diabetes, heart failure, coronary heart disease, or chronic obstructive pulmonary disease. The Intervention group comprised those members who participated in care calls (n=13,486), whereas the Comparison group included enrollees who did not participate in these calls (n=4,582). Changes in admission rates were calculated between the year prior to and year after program commencement. Comparative analyses were adjusted for age, sex, region of residence, and disease severity (stratification of 3 [least severe] to 1 [most severe]). Overall, a 6.0% decrease in admissions was observed among Intervention group members compared with an 18.9% increase among Comparison group members (P ? 0.0001). This decrease in admissions was driven by participants with the highest levels of risk. In addition, a dose-response relationship was observed in which admissions decreased with an increased number of care calls (P=0.0001). These results indicate that proactive CCM interventions are effective in reducing hospital admission rates in a senior population with chronic disease. PMID:21323617
Hamar, Brent; Wells, Aaron; Gandy, William; Bradley, Chastity; Coberley, Carter; Pope, James E; Rula, Elizabeth Y
...Eligibility for hospital, domiciliary or nursing home care of persons discharged or...MEDICAL Hospital, Domiciliary and Nursing Home Care Â§ 17.46 Eligibility for hospital, domiciliary or nursing home care of persons discharged...
A plethora of research links professional nurses' qualifications to patient outcomes. Also, research has shown that reports by nurses on the quality of care correspond with process or outcome measures of quality in a hospital. New to the debate is whether professional nurses' qualifications impact on their perceptions of patient safety and quality of care. This research aims to investigate professional nurses' perceptions of patient safety and quality of care in South Africa, and the relationship between these perceptions and professional nurses' qualifications. A cross-sectional survey of 1117 professional nurses from medical and surgical units of 55 private and 7 public hospitals was conducted. Significant problems with regard to nurse-perceived patient safety and quality of care were identified, while adverse incidents in patients and professional nurses were underreported. Qualifications had no correlation with perceptions of patient safety and quality of care, although perceptions may serve as a valid indicator of patient outcomes. Creating an organizational culture that is committed to patient safety and encourages the sharing of adverse incidents will contribute to patient safety and quality of care in hospitals. PMID:24102916
Blignaut, Alwiena J; Coetzee, Siedine K; Klopper, Hester C
Objective Childbirth is the leading reason for hospitalization in the United States, and maternity-related expenditures are substantial for many health insurance programs, including Medicaid. We studied the relationship between primary payer and trends in hospital-based childbirth care. Study design Retrospective analysis of hospital discharge data from the Nationwide Inpatient Sample (NIS) of the Healthcare Cost and Utilization Project, a 20% stratified sample of US hospitals. Methods Data on 6,717,486 hospital-based births for the years 2002 through 2009 came from the NIS. We used generalized estimating equations to measure associations over time between primary payer (Medicaid, private insurance, or self) and cesarean delivery, vaginal birth after cesarean (VBAC), labor induction, and episiotomy. Results Controlling for clinical, demographic, and hospital factors, births covered by Medicaid had lower odds of cesarean delivery (AOR, 0.91), labor induction (AOR, 0.73), and episiotomy (AOR, 0.62) and higher odds of VBAC (AOR, 1.20; P < .001 for all AORs) compared with privately insured births. Cesarean rates increased 6% annually among births paid by private insurance (AOR, 1.06; P < .001) and less rapidly (5% annually) among those covered by Medicaid. Conclusions US hospital-based births covered by private insurance were associated with higher rates of obstetric intervention than births paid for by Medicaid. After controlling for clinical, demographic, and hospital factors, cesarean delivery rates increased more rapidly among births covered by private insurance, compared with Medicaid. Changes in insurance coverage associated with healthcare reform may impact costs and quality of care for women giving birth in US hospitals.
Kozhimannil, Katy B.; Shippee, Tetyana P.; Adegoke, Olusola; Virnig, Beth A.
Objective: To examine the prevalence, nature, causes, and consequences of suboptimal care before admission to intensive care units, and to suggest possible solutions. Design: Prospective confidential inquiry on the basis of structured interviews and questionnaires. Setting: A large district general hospital and a teaching hospital. Subjects: A cohort of 100 consecutive adult emergency admissions, 50 in each centre. Main outcome measures: Opinions of two external assessors on quality of care especially recognition, investigation, monitoring, and management of abnormalities of airway, breathing, and circulation, and oxygen therapy and monitoring. Results: Assessors agreed that 20 patients were well managed (group 1) and 54 patients received suboptimal care (group 2). Assessors disagreed on quality of management of 26 patients (group 3). The casemix and severity of illness, defined by the acute physiology and chronic health evaluation (APACHE II) score, were similar between centres and the three groups. In groups 1, 2, and 3 intensive care mortalities were 5 (25%), 26 (48%), and 6 (23%) respectively (P=0.04) (group 1 versus group 2, P=0.07). Hospital mortalities were 7 (35%), 30 (56%), and 8 (31%) (P=0.07) and standardised hospital mortality ratios (95% confidence intervals) were 1.23 (0.49 to 2.54), 1.4 (0.94 to 2.0), and 1.26 (0.54 to 2.48) respectively. Admission to intensive care was considered late in 37 (69%) patients in group 2. Overall, a minimum of 4.5% and a maximum of 41% of admissions were considered potentially avoidable. Suboptimal care contributed to morbidity or mortality in most instances. The main causes of suboptimal care were failure of organisation, lack of knowledge, failure to appreciate clinical urgency, lack of supervision, and failure to seek advice. Conclusions: The management of airway, breathing, and circulation, and oxygen therapy and monitoring in severely ill patients before admission to intensive care units may frequently be suboptimal. Major consequences may include increased morbidity and mortality and requirement for intensive care. Possible solutions include improved teaching, establishment of medical emergency teams, and widespread debate on the structure and process of acute care. Key messages Suboptimal management of oxygen therapy, airway, breathing, circulation, and monitoring before admission to intensive care occurred in over half of a consecutive cohort of acute adult emergency patients. This may be associated with increased morbidity, mortality, and avoidable admissions to intensive care At least 39% of acute adult emergency patients were admitted to intensive care late in the clinical course of the illness Major causes of suboptimal care included failure of organisation, lack of knowledge, failure to appreciate clinical urgency, lack of supervision, and failure to seek advice A medical emergency team may be useful in responding pre-emptively to the clinical signs of life threatening dysfunction of airway, breathing, and circulation, rather than relying on a cardiac arrest team The structure and process of acute care and their importance require major re-evaluation and debate
McQuillan, Peter; Pilkington, Sally; Allan, Alison; Taylor, Bruce; Short, Alasdair; Morgan, Giles; Nielsen, Mick; Barrett, David; Smith, Gary
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IN 1996 WE ESTABLISHED A DAY HOSPITAL DEDICATED to acute respiratory care, as an alternative to emergency department and inpatient treatment. The unit is staffed by respirologists, family physicians and specialized nurses; patients have access to all standard inpatient treatments and services. Between 1996/97 and 1998/99 the annual number of admissions to the day hospital increased from 658 to 922. By 1998/99 more than 75% of patients were referred for acute treatment, with a mean stay of 2.3 days. The most common diagnoses were asthma and chronic obstructive pulmonary disease, which accounted for 58% and 32% respectively of treatment-related admissions. Treatment most often involved intravenous corticosteroid therapy and inhaled bronchodilator therapy. Between 1996/97 and 1998/9 the proportion of patients requiring transfer to overnight care decreased from 22% to 14%; complications and unscheduled return visits were rare. We believe that a respiratory day hospital provides a useful alternative to emergency department and inpatient care.
Schwartzman, Kevin; Duquette, Guylaine; Zaoude, May; Dion, Marie-Josee; Lagace, Marie-Annie; Poitras, Jacinthe; Cosio, Manuel G.
Hospitals and health systems are using web-based and social media tools to market themselves to consumers with increasingly sophisticated strategies. These efforts are designed to shape the consumers' expectations, influence their purchase decisions, and build a positive reputation in the marketplace. Little is known about how these web-based marketing efforts are taking form and if they have any relationship to consumers' satisfaction with the services they receive. The purpose of this study is to assess if a relationship exists between the quality of hospitals' public websites and their aggregated patient satisfaction ratings. Based on analyses of 1,952 U.S. hospitals, our results show that website quality is significantly and positively related to patients' overall rating of the hospital and their intention to recommend the facility to others. The potential for web-based information sources to influence consumer behavior has important implications for policymakers, third-party payers, health care providers, and consumers. PMID:24308412
Ford, Eric W; Huerta, Timothy R; Diana, Mark L; Kazley, Abby Swanson; Menachemi, Nir
Management methods for quality of diabetes care need new approaches because of the poor metabolic control of most of these patients. Poor quality of care generally results from poor instruction and training rather than from misbehaviour of both patients and their families. Structure quality of care (who and where?), process quality (how?, which are the goals, what resolution is taken
F. Chiarelli; A. Verrotti; L. di Ricco; M. de Martino; G. Morgese
The full-service US hospital has been described organizationally as a "solution shop," in which medical problems are assumed to be unstructured and to require expert physicians to determine each course of care. If universally applied, this model contributes to unwarranted variation in care, which leads to lower quality and higher costs. We purposely disrupted the adult cardiac surgical practice that we led at Mayo Clinic, in Rochester, Minnesota, by creating a "focused factory" model (characterized by a uniform approach to delivering a limited set of high-quality products) within the practice's solution shop. Key elements of implementing the new model were mapping the care process, segmenting the patient population, using information technology to communicate clearly defined expectations, and empowering nonphysician providers at the bedside. Using a set of criteria, we determined that the focused-factory model was appropriate for 67 percent of cardiac surgical patients. We found that implementation of the model reduced resource use, length-of-stay, and cost. Variation was markedly reduced, and outcomes were improved. Assigning patients to different care models increases care value and the predictability of care process, outcomes, and costs while preserving (in a lesser clinical footprint) the strengths of the solution shop. We conclude that creating a focused-factory model within a solution shop, by applying industrial engineering principles and health information technology tools and changing the model of work, is very effective in both improving quality and reducing costs. PMID:24799570
Cook, David; Thompson, Jeffrey E; Habermann, Elizabeth B; Visscher, Sue L; Dearani, Joseph A; Roger, Veronique L; Borah, Bijan J
Background: Effective implementation of evidence-based practice guidelines has the potential to improve quality of hospital care for children. To achieve this in Indonesia, a locally adapted version of the WHO Pocket Book of Hospital Care for Children was published in 2009. Objectives: To document implementation of the Pocket Book in Indonesia and to compare uptake in health facilities in which there has been a quality-improvement approach involving audit and feedback with uptake in settings in which there has been only passive dissemination. Methods: Indonesian district health offices, district hospitals, health centres with beds, and medical schools were surveyed by telephone, and an online and telephone survey of paediatricians was conducted. Health facilities in four provinces were visited, and key stakeholders were interviewed. Health facilities were assessed on availability of the guidelines, use by staff, and their incorporation into hospital procedures and activities. Results: There was evidence of use of the Pocket Book across Indonesia, despite limited funding for implementation. Its distribution had reached all provinces; 61% (33/54) of health facilities surveyed had a copy of the guidelines. Hospitals involved in a related quality audit were more likely to report use of the guidelines than hospitals exposed to passive dissemination, although this difference was not significant. Of 150 paediatricians sampled, 109 (73%) reported referring to the guidelines in their clinical practice. The guidelines have been incorporated into the postgraduate paediatric curriculum in four of 13 universities sampled. Conclusion: There was encouraging evidence of uptake of the Pocket Book in Indonesia following local adaptation, nationwide mailing distribution and small-scale local implementation activities. PMID:24090481
Li, Michelle Y; Puspita, Ratih; Duke, Trevor; Agung, Fransisca H; Hegar, Badriul; Pritasari, Kirana; Weber, Martin W
Objectives There is a need for effective processes in healthcare clinics, especially in tertiary hospitals, that consist of a set of complex steps for outpatient care, in order to provide high quality care and reduce the time cost. This study aimed to discover the potential of a process mining technique to determine an outpatient care process that can be utilized for further improvements. Methods The outpatient event log was defined, and the log data for a month was extracted from the hospital information system of a tertiary university hospital. That data was used in process mining to discover an outpatient care process model, and then the machine-driven model was compared with a domain expert-driven process model in terms of the accuracy of the matching rate. Results From a total of 698,158 event logs, the most frequent pattern was found to be "Consultation registration > Consultation > Consultation scheduling > Payment > Outside-hospital prescription printing" (11.05% from a total cases). The matching rate between the expert-driven process model and the machine-driven model was found to be approximately 89.01%, and most of the processes occurred with relative accuracy in accordance with the expert-driven process model. Conclusions Knowledge regarding the process that occurs most frequently in the pattern is expected to be useful for hospital resource assignments. Through this research, we confirmed that process mining techniques can be applied in the healthcare area, and through detailed and customized analysis in the future, it can be expected to be used to improve actual outpatient care processes.
Kim, Eunhye; Kim, Seok; Song, Minseok; Kim, Seongjoo; Yoo, Donghyun; Hwang, Hee
The aim of all diabetes treatment in childhood and adolescence is to counteract the development of complications (acute as well as late), to achieve normal growth and development, and to provide the patients with as good as possible a quality of life. Many studies have confirmed the benefits of intensified medical management regarding the prevalence and/or the progression of diabetic microvascular complications. Intensified medical management means of course much more than intensified insulin substitution; diabetes care includes diet, physical exercise, diabetes education, continuous monitoring, and psychosocial support. To improve the outcome of patients with diabetes mellitus, optimizing structure quality is one of the goals. A number of prerequisites (regarding the social-socioeconomic-health care system) are not yet fulfilled everywhere; structures necessary to provide qualified diabetes care (e.g. pediatric diabetes center, team of experts, outpatient care) are not yet sufficiently available in some areas. According to both the declarations of St. Vincent and of Kos, every effort should be made to enhance structure quality in an attempt to improve the situation and the outcome of our young patients with diabetes. PMID:9676998
Borkenstein, M H; Limbert, C; Reiterer, E; Stalzer, C; Zinggl, E
In hospitals and health systems, ensuring that organizational standards for patient care quality are adopted and that processes for monitoring and improving clinical services are in place are among governing boards' most important duties. A recent study examined board oversight of patient care quality in 14 of the country's 15 largest private nonprofit health systems. The findings show that 13 of the 14 boards have standing committees with oversight responsibility for patient quality and safety within their system; 11 of the 14 system boards formally adopt systemwide quality measures and standards; and all 14 regularly receive written reports on systemwide and hospital performance. In recent months, most of these boards had adopted action plans directed at improving their system's performance with respect to patient care quality. PMID:23652335
Prybil, Lawrence D; Bardach, David R; Fardo, David W
Objective To examine the reliability of the SF-36 general health questionnaire when used to evaluate the health status of critically ill patients before admission to intensive care and to measure their health-related quality of life prior to admission and its relation to severity of illness and length of stay in the intensive care unit. Methods Prospective cohort study conducted in the intensive care unit of a public teaching hospital. Over three months, communicative and oriented patients were interviewed within the first 72 hours of intensive care unit admission; 91 individuals participated. The APACHE II score was used to assess severity of illness, and the SF-36 questionnaire was used to measure health-related quality of life. Results The reliability of SF-36 was verified in all dimensions using Cronbach's alpha coefficient. In six dimensions of eight domains the value exceeded 0.70. The average SF-36 scores of the health-related quality of life dimensions for the patients before admission to intensive care unit were 57.8 for physical functioning, 32.4 for role-physical, 53.0 for bodily pain, 63.2 for general health, 50.6 for vitality, 56.2 for social functioning, 54.6 for role-emotional and 60.3 for mental health. The correlations between severity of illness and length of stay and the health-related quality of life scores were very low, ranging from -0.152 to 0.175 and -0.158 to 0.152, respectively, which were not statistically significant. Conclusion In the sample studied, the SF-36 demonstrated good reliability when used to measure health-related quality of life in critically ill patients before admission to the intensive care unit. The worst score was role-physical and the best was general health. Health-related quality of life of patients before admission was not correlated with severity of illness or length of stay in the intensive care unit.
Tereran, Nathalia Perazzo; Zanei, Suely Sueko Viski; Whitaker, Iveth Yamaguchi
Development and implementation of guidelines constitutes the basis of quality management systems for any organization. The authors have studied the internal documentation produced by professionals on 88 functional units of a university hospital. Reveals the existence of many documents concerning quality of care with an average of 102 available procedures or protocols per unit. However, this documentation is badly organized, making it difficult to consult and to put into practice. The results of this study were provided to other professionals at our hospital in order to make them aware of the necessity of rigorous document management. We have also written and sent recommendations for drawing up procedures and implementing an efficient documentary management system. This effort complements development of the hospital quality assurance plan. PMID:10173354
François, P; Labarère, J; Bontemps, H; Weil, G; Calop, J
In 2002, several hospitals in the Tenet system were accused of overbilling Medicare for cardiac surgery. This led to increased scrutiny of so-called outlier payments, which are used to compensate hospitals when actual costs far exceed those anticipated under prospective payment. Since then, the overall proportion of coronary artery bypass graft (CABG) procedures associated with outlier payments has fallen from 13 percent in 2000–02 to 8 percent in 2003–06. Still, there is variation across U.S. hospitals, with some hospitals experiencing much higher rates. These findings imply that there is potential for quality improvement to reduce costs while improving morbidity and mortality.
Baser, Onur; Fan, Zhahoui; Dimick, Justin B.; Staiger, Douglas O.; Birkmeyer, John D.
Executive Summary Increasing scrutiny of clinical data reporting by healthcare accrediting organizations is challenging hospitals to improve measurement and reporting, especially in the area of cancer care. We sought to explore barriers to breast cancer adjuvant treatment measurement and reporting to a hospital tumor registry (TR), and identify opportunities to improve these processes. We conducted 31 key informant interviews with administrators and clinicians associated with a large urban hospital that treats a high volume of breast cancer patients. In this setting, up to 40% of early-stage breast cancer cases are treated by community-based oncologists, but reporting to the hospital’s TR has been problematic. We asked about barriers to treatment measurement and reporting, and sought suggestions to improve these processes. We used deductive and inductive methods to analyze interview transcripts. We found seven management barriers to adjuvant treatment measurement and reporting: process complexity; limited understanding of TR reporting; competing priorities; resource needs; communication issues; lack of supporting information technologies (IT); and mistrust of management. Facilitators included: increasing awareness; improving communications and relationships; enhancing IT; and promoting the value of measurement and reporting. Four factors deemed critical to successful improvements were organizational commitment, leadership support, resources, and communication. Organizations striving to improve cancer care quality must overcome key barriers, especially those involving gaps in understanding and communication. In practice, hospitals should make explicit efforts to educate physicians and administrators about the importance of treatment reporting, and improve communications between the hospital’s TR and physicians to ensure that needed adjuvant therapies are appropriately delivered.
McAlearney, Ann Scheck; Wellner, Jill; Bickell, Nina A.
Provider profiling and performance-based incentive programs have expanded in recent years but need a theoretical framework for measuring and comparing the "value'' of clinical care across medical providers. Cost-effectiveness analysis provides such a framework but has rarely been used outside of the treatment choice context. The authors present a profiling framework based on cost-effectiveness methods and illustrate their approach using data on in-hospital survival and the cost of care for a heart attack from a sample of Massachusetts hospitals during fiscal year 2003. They model each outcome using hierarchical models that allow performance to vary across hospitals as a function of a latent quality effect and an effect of case mix. They also estimate incremental outcomes by conditioning on each hospital's pair of random effects, using indirect standardization to estimate "expected'' outcomes, and then taking their difference. Incremental cost and effectiveness outcomes are combined using incremental net monetary benefits. Using cost-effectiveness methods to profile hospital "value'' permits the comparison of the benefit of a service relative to the cost using existing societal weights. PMID:18480038
Timbie, Justin W; Newhouse, Joseph P; Rosenthal, Meredith B; Normand, Sharon-Lise T
Abstract The matched-case control study investigated the effect of inpatient music therapy (MT), including the gift of a compact disc, on patient satisfaction and quality of life. Overall rating of the hospital and likelihood to recommend it (n = 210), and SF-12 quality of life scores (n = 160) were compared between groups. Although no significant difference in overall hospital rating was found, MT patients' recommendation scores were higher (p =.02). The MT patients had marginally better quality of life pain scores (p =.06). Integration of MT with inpatient care can improve the likelihood that patients will recommend the hospital and may impact their perception of pain. PMID:24926737
Mandel, Susan E; Davis, Beth A; Secic, Michelle
Background Gaps in quality of care are seriously affecting maternal and neonatal health globally but reports of successful quality improvement cycles implemented at large scale are scanty. We report the results of a nation-wide program to improve quality of maternal and neonatal hospital care in a lower-middle income country focusing on the role played by standard-based participatory assessments. Methods Improvements in the quality of maternal and neonatal care following an action-oriented participatory assessment of 19 areas covering the whole continuum from admission to discharge were measured after an average period of 10 months in four busy referral maternity hospitals in Uzbekistan. Information was collected by a multidisciplinary national team with international supervision through visit to hospital services, examination of medical records, direct observation of cases and interviews with staff and mothers. Scores (range 0 to 3) attributed to over 400 items and combined in average scores for each area were compared with the baseline assessment. Results Between the first and the second assessment, all four hospitals improved their overall score by an average 0.7 points out of 3 (range 0.4 to 1), i.e. by 22%. The improvements occurred in all main areas of care and were greater in the care of normal labor and delivery (+0.9), monitoring, infection control and mother and baby friendly care (+0.8) the role of the participatory action-oriented approach in determining the observed changes was estimated crucial in 6 out of 19 areas and contributory in other 8. Ongoing implementation of referral system and new classification of neonatal deaths impede the improved process of care to be reflected in current statistics. Conclusions Important improvements in the quality of hospital care provided to mothers and newborn babies can be achieved through a standard-based action-oriented and participatory assessment and reassessment process.
Tamburlini, Giorgio; Yadgarova, Klara; Kamilov, Asamidin; Bacci, Alberta
Conventional wisdom views state psychiatric hospitals as a problem as much as a solution in the fight against mental illness. The legacy of the historic shortcomings of these hospitals--overcrowding, dreary environment, ineffective treatments, understaffing--frames the discussions of their future. The authors argue that a positive, constructive mission and vision for state hospitals is emerging in New York. This vision calls for fewer, smaller, specialized centers redefined as academically affiliated, community based, consumer oriented, tertiary care centers. To transform these centers, a major reengineering is proposed, including centralized treatment, patient and family participation, continuing education for all staff, outcome research, specialization, multi-service campuses, and technology transfer programs. With this transformation, State Psychiatric Centers become partners in efforts to improve the quality of life for people with mental illness throughout society. PMID:7568531
Bopp, J H; Fisher, W A
To complement the role of primary care teams working with patients with HIV disease and AIDS within greater London and to ease the load on the special hospital units a home support team was developed. It comprises six specialist nurses, a general practitioner trained medical officer, and a receptionist and is funded from regional and district sources and charities. A
A Smits; S Mansfield; S Singh
Title. Impact of hospital nursing care on 30-day mortality for acute medical patients Aim. This paper reports on structures and processes of hospital care influencing 30-day mortality for acute medical patients. Background. Wide variation in risk-adjusted 30-day hospital mortality rates for acute medical patients indicates that hospital structures and processes of care affect patient death. Because nurses provide the majority
Ann E. Tourangeau; Diane M. Doran; Linda McGillis Hall; Linda O'Brien Pallas; Dorothy Pringle; Jack V. Tu; Lisa A. Cranley
The Automated Quality of Care Evaluation Support System (AQCESS) is a microcomputer based, integrated, terminal oriented, interactive, on-line computer system designed to support Patient Administration, Clinical Records and Quality of Care Evaluation func...
M. D. Rodman
Background The Medicare accountable care organization (ACO) programs rely on delivery system integration and provider risk sharing to lower spending while improving quality of care. Methods Using 2009 Medicare claims and linked American Medical Association Group Practice data, we assigned 4.29 million beneficiaries to provider groups based on primary care use. We categorized group size according to eligibility thresholds for the Shared Savings (?5,000 assigned beneficiaries) and Pioneer (?15,000) ACO programs and distinguished hospital-based from independent groups. We compared spending and quality of care between larger and smaller provider groups and examined how size-related differences varied by 2 factors considered central to ACO performance: group primary care orientation (measured by the primary care share of large groups’ specialty mix) and provider risk sharing (measured by county health maintenance organization penetration and its relationship to financial risk accepted by different group types for managed care patients). Spending and quality of care measures included total medical spending, spending by type of service, 5 process measures of quality, and 30-day readmissions, all adjusted for sociodemographic and clinical characteristics. Results Compared with smaller groups, larger hospital-based groups had higher total per-beneficiary spending in 2009 (mean difference: +$849), higher 30-day readmission rates (+1.3% percentage points), and similar performance on 4 of 5 process measures of quality. In contrast, larger independent physician groups performed better than smaller groups on all process measures and exhibited significantly lower per-beneficiary spending in counties where risk sharing by these groups was more common (?$426). Among all groups sufficiently large to participate in ACO programs, a strong primary care orientation was associated with lower spending, fewer readmissions, and better quality of diabetes care. Conclusions Spending was lower and quality of care better for Medicare beneficiaries served by larger independent physician groups with strong primary care orientations in environments where providers accepted greater risk.
McWilliams, J. Michael; Chernew, Michael E.; Zaslavsky, Alan M.; Hamed, Pasha; Landon, Bruce E.
The main objective of a hospital-acquired infections control program is to decrease the risk of acquisition and the morbidity and costs associated. The organization of a team with technical and humanistic leadership is essential. Every infection control program must also develop strategies that allow: a) identification of the problems, b) to establish the importance of each one, c) to determine their causes, d) to develop solutions and e) the evaluation of the recommended solutions. The development of technical and humanistic abilities by the leader and the members of the team, and the use of the tools mentioned above have produced the only validate and highly effective program of quality improvement in the hospital. PMID:10608180
Navarrete-Navarro, S; Rangel-Frausto, M S
Background Despite more than a decade of research on hospitalists and their performance, disagreement still exists regarding whether\\u000a and how hospital-based physicians improve the quality of inpatient care delivery. This systematic review summarizes the findings\\u000a from 65 comparative evaluations to determine whether hospitalists provide a higher quality of inpatient care relative to traditional\\u000a inpatient physicians who maintain hospital privileges with concurrent
Heather L White; Richard H Glazier
This study was devoted to collecting information from 57 psychiatric hospitals in the Federal Republic of Germany with regard to the quality of the care afforded to chronic psychiatric patients. The study took place during 1977/1978, and concerned the therapeutic and general quality of transitional hostels, homes for long-term follow-up care, and homes for the aged and multiple-handicapped patients. At the same time, the present-day effectivity of sociolegal rehabilitation aid measures was compared with the results of corresponding opinions polls conducted in 1973/1974. The following conclusions were drawn: 1. "Non-clinical" mental health care of chronic psychiatric patients (mentally handicapped persons) requires specific pedagogico-therapeutic programmes specially adapted to the requirements of these patients. These requirements differ considerably from the conventional style of "ward care" which has developed in psychiatric hospitals. Regional fusion or co-operation of these homes is strongly recommended. 2. The effectivity of sociolegal rehabilitation aids for the mentally handicapped continues to be very low. This is partly due to the poor level of training and knowledge of the therapeutic personnel. Hence it is absolutely imperative to arrange for knowledge of this admittedly rather dry sociolegal subject matter, by means of suitable training and instruction. PMID:6255503
Introduction We aimed (1) to demonstrate the application of national pediatric quality measures derived from claims-based data, for use with Electronic Medical Record (EMR) data, and (2) to determine the extent to which rates differ if specifications were modified to allow for flexibility in measuring receipt of care. Methods We reviewed EMR data for all patients up to 15 years with?1 office visit to a safety net family medicine clinic in 2010 (n=1,544). We assessed rates of appropriate well-child visits (WCVs), immunizations, and body mass index (BMI) documentation, defined strictly by national guidelines versus by guidelines with clinically relevant modifications. Results Among children <3 years, 52.4% attended ?6 WCVs by 15 months; 60.8% had ?6 visits by 2 years. Less than 10% completed 10 vaccination series before their 2nd birthday; with modifications, 36% were up-to-date. Among children aged 3-15 years, 63% had a BMI percentile recorded; 91% had BMI recorded within 36 months of the measurement year. Discussion Applying relevant modifications to national quality measure definitions captured a substantial number of additional services. Strict adherence to measure definitions might miss the true quality of care provided, especially in populations who may have sporadic patterns of care utilization.
Casciato, Allison; Angier, Heather; Milano, Christina; Gideonse, Nicholas; Gold, Rachel; DeVoe, Jennifer
Objective To determine if there is a hierarchy of improvement program adoption by hospitals and outline that hierarchy. Data Sources Primary data were collected in the spring of 2007 via e-survey from 210 individuals representing 109 Minnesota hospitals. Secondary data from 2006 were assembled from the Leapfrog database. Study Design As part of a larger survey, respondents were given a list of improvement programs and asked to identify those programs that are used in their hospital. Data Collection/Data Extraction Rasch Model Analysis was used to assess whether a unidimensional construct exists that defines a hospital's ability to implement performance improvement programs. Linear regression analysis was used to assess the relationship of the Rasch ability scores with Leapfrog Safe Practices Scores to validate the research findings. Principal Findings The results of the study show that hospitals have widely varying abilities in implementing improvement programs. In addition, improvement programs present differing levels of difficulty for hospitals trying to implement them. Our findings also indicate that the ability to adopt improvement programs is important to the overall performance of hospitals. Conclusions There is a hierarchy of improvement programs in the health care context. A hospital's ability to successfully adopt improvement programs is a function of its existing capabilities. As a hospital's capability increases, the ability to successfully implement higher level programs also increases.
Olson, John R; Belohlav, James A; Cook, Lori S; Hays, Julie M
Background Demographic changes together with an increasing demand among older people for hospital beds and other health services make allocation of resources to the most efficient care level a vital issue. The aim of this trial was to study the efficacy of intermediate care at a community hospital compared to standard prolonged care at a general hospital. Methods In a randomised controlled trial 142 patients aged 60 or more admitted to a general hospital due to acute illness or exacerbation of a chronic disease 72 (intervention group) were randomised to intermediate care at a community hospital and 70 (general hospital group) to further general hospital care. Results In the intervention group 14 patients (19.4%) were readmitted for the same disease compared to 25 patients (35.7%) in the general hospital group (p = 0.03). After 26 weeks 18 (25.0%) patients in the intervention group were independent of community care compared to seven (10.0%) in the general hospital group (p = 0.02). There were an insignificant reduction in the number of deaths and an insignificant increase in the number of days with inward care in the intervention group. The number of patients admitted to long-term nursing homes from the intervention group was insignificantly higher than from the general hospital group. Conclusion Intermediate care at a community hospital significantly decreased the number of readmissions for the same disease to general hospital, and a significantly higher number of patients were independent of community care after 26 weeks of follow-up, without any increase in mortality and number of days in institutions.
Garasen, Helge; Windspoll, Rolf; Johnsen, Roar
Objective To determine the percentage of hospitals with adequate sample size to meaningfully compare performance using the Agency for Healthcare Research and Quality (AHRQ) pediatric inpatient quality indicators (PDIs), which measure pediatric inpatient adverse events such as decubitus ulcer rate and infections due to medical care, have been nationally endorsed, and are currently publicly reported in at least two states. Methods We performed a cross-sectional analysis of California hospital discharges from 2005–2007 for patients <18 years old. For nine hospital-level PDIs, after excluding discharges with PDIs indicated as present on admission, we determined for each PDI: the volume of eligible pediatric patients for each measure at each hospital, the statewide mean rate, and the percent of hospitals with adequate volume to identify an adverse event rate twice the statewide mean. Results Unadjusted California-wide event rates for PDIs during the study period (N=2,333,556 discharges) were 0.2-38/1000 discharges. Event rates for specific measures were, for example, 0.2/1000 (iatrogenic pneumothorax in non-neonates), 19/1000 (post-operative sepsis) and 38/1000 (pediatric heart surgery mortality), requiring patient volumes of 49,869, 419, and 201 to detect an event rate twice the statewide average; 0%, 6.6%, and 25% of California hospitals had this pediatric volume, respectively. Conclusion Using these AHRQ-developed, nationally-endorsed measures of the quality of inpatient pediatric care, one would not be able to identify many hospitals with performance two times worse than the statewide average due to extremely low event rates and inadequate pediatric hospital volume.
Bardach, Naomi S.; Chien, Alyna T.; Dudley, R. Adams
Hospitals need excellent leadership to be efficient in the use of scarce stakeholder resources and to be effective in the competitive provision of services to multiple customers. This study was conducted with the cooperation of the executive team at a large government-funded hospital in Brisbane. It focused on understanding the conceptual models of leadership held by members of the executive and comparing this model with an externally derived model of leadership. Performance on the local model was estimated by cross-linking performance assessment on the external model. Members of the executive espoused, and were also rated by others in the hospital as practising, to a moderate degree, a transformational style of leadership. An overall evaluation of quality practice in the hospital revealed the use of data, the understanding of processes and the formation of supplier partnerships as the areas of hospital activity most limiting the ability to improve. The implications of the conceptual model and performance levels are discussed in relation to the introduction of quality management practice in the hospital, and in terms of management development. A complementary paper focusing on quality implementation as perceived at different staff levels in the hospital is in preparation. PMID:10152277
Preston, A P; Saunders, I W; O'Sullivan, D; Garrigan, E; Rice, J
This project was inspired by a belief that too little attention is paid by the academic structure to its responsibility within the school experience of developing "caring" individuals. The project's goal was to test the idea that "Caring Quality" could be "taught". (Author/RK)
In Stockholm County Council (SLL), budgets for hospital care have been allocated to geographically responsible authorities\\u000a for a long time. This hospital care includes all publicly financed specialist care, also privately owned hospitals, except\\u000a private practitioner care. The old needs-index model, a 6D capitation matrix based on demography and socio-economy, was generated\\u000a on linked individual data for 1994–96. In this
Per-Åke Andersson; Daniel Bruce; Anders Walander; Inga Viberg
CONTEXT: Medicare has a legislative mandate for quality assurance, but the effectiveness of its population-based quality improvement programs has been difficult to establish.\\u000aOBJECTIVE: To improve the quality of care for Medicare patients with acute myocardial infarction.\\u000aDESIGN: Quality improvement project with baseline measurement, feedback, remeasurement, and comparison samples.\\u000aSETTING: All acute care hospitals in the United States.\\u000aPATIENTS: Preintervention
Thomas A. Marciniak; Edward F. Ellerbeck; Martha J. Radford; Timothy F. Kresowik; Jay A. Gold; Harlan M. Krumholz; Catarina I. Kiefe; Richard M. Allman; Robert A. Vogel; Stephen F. Jencks