Sample records for quality hospital care

  1. Patients' Perceptions of Care Are Associated With Quality of Hospital Care: A Survey of 4605 Hospitals.

    PubMed

    Stein, Spencer M; Day, Michael; Karia, Raj; Hutzler, Lorraine; Bosco, Joseph A

    2015-07-01

    Favorable patient experience and low complication rates have been proposed as essential components of patient-centered medical care. Patients' perception of care is a key performance metric and is used to determine payments to hospitals. It is unclear if there is a correlation between technical quality of care and patient satisfaction. The study authors correlated patient perceptions of care measured by the Hospital Consumer Assessment of Healthcare Providers and Systems scores with accepted quality of care indicators. The Hospital Compare database (4605 hospitals) was used to examine complication rates and patient-reported experience for hospitals across the nation in 2011. The majority of the correlations demonstrated an inverse relationship between patient experience and complication rates. This negative correlation suggests that reducing these complications can lead to a better hospital experience. Overall, these results suggest that patient experience is generally correlated with the quality of care provided. PMID:24740016

  2. Nursing + computerization (+ hospital integration) = quality patient care.

    PubMed

    Lyndgaard, D

    1988-08-01

    All health professionals understand pressure, patient needs and the importance of communications. I remember trying to cope as the lone nurse on the ICU night shift only one year our of school--frustrated with juggling all those needs, demands and information necessary just to get to the patient's bedside. Today's much-in-demand R.N. is seeking employment in a healthcare facility that provides the tools to function in these increasingly demanding positions; she looks for the hospital that is on the cutting edge of technology. Therefore, the hospital that provides a sophisticated, yet easy-to-use, information system is attracting the efficient nurse and multiplying her level of professional performance. The improved efficiency she can then offer and cost savings the hospital experiences are direct results of the quality of that information system. PMID:10290466

  3. Quality of care delivered to hospitalized inflammatory bowel disease patients.

    PubMed

    Weizman, Adam V; Nguyen, Geoffrey C

    2013-10-14

    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. PMID:24151354

  4. Manager traits and quality-of-care performance in hospitals.

    PubMed

    Aij, Kjeld Harald; Aernoudts, René L M C; Joosten, Gepke

    2015-07-01

    Purpose - This paper aims to assess the impact of the leadership traits of chief executive officers (CEOs) on hospital performance in the USA. The effectiveness and efficiency of the CEO is of critical importance to the performance of any organization, including hospitals. Management systems and manager behaviours (traits) are of crucial importance to any organization because of their connection with organizational performance. To identify key factors associated with the quality of care delivered by hospitals, the authors gathered perceptions of manager traits from chief executive officers (CEOs) and followers in three groups of US hospitals delivering different levels of quality of care performance. Design/methodology/approach - Three high- and three low-performing hospitals were selected from the top and bottom 20th percentiles, respectively, using a national hospital ranking system based on standard quality of care performance measures. Three lean hospitals delivering intermediate performance were also selected. A survey was used to gather perceptions of manager traits (providing a modern or lean management system inclination) from CEOs and their followers in the three groups, which were compared. Findings - Four traits were found to be significantly different (alpha < 0.05) between lean (intermediate-) and low-performing hospitals. The different perceptions between these two hospital groups were all held by followers in the low-performing hospitals and not the CEOs, and all had a modern management inclination. No differences were found between lean (intermediate-) and high-performing hospitals, or between high- and low-performing hospitals. Originality/value - These findings support a need for hospital managers to acquire appropriate traits to achieve lean transformation, support a benefit of measuring manager traits to assess progress towards lean transformation and lend weight to improved quality of care that can be delivered by hospitals adopting a lean system of management. PMID:26083635

  5. The quality of care in hospitals.

    PubMed

    Jarman, B

    2000-01-01

    In recent years there has been an increase in the regulation of the medical profession. In the past there have been problems. The GMC can act only when things go seriously wrong. It has, however, introduced the health and performance procedures, increased the proportion of lay members, is working on revalidation and has introduced Good Medical Practice which makes very clear what is expected of a doctor and will be relevant to doctors' contracts. The medical Royal Colleges can be influential in raising general standards but the activities of the different colleges are not well co-ordinated and they cannot compel doctors to take part in continuing medical education, although this is an aim. Without statutory powers to introduce changes they have to carry their members with them. Audit has its problems and these are understandable because of the natural defensiveness which can occur if there is a threat of possible litigation. The Department of Health has had no proper system for measuring the quality of the care for which it is responsible and largely sees this as the responsibility of individual doctors. Responsibility for the quality of care is shared in a confusing way between different groups. But there is change in the air. There are moves for a 'patient led NHS'. The Government has a new emphasis on quality of care, there is greater sophistication in the methods used for surveying patients' experiences. Measurement of hard outcome data such as adjusted death rates can reveal underlying system failures. Finally, there is a growing realisation that within medicine, as within other complex organisations, doctors are not perfect and will always make errors. Blaming individuals will not in itself make much contribution to the improvement of the overall system: we have to work towards ways of reducing system failures. PMID:10717887

  6. What does quality care mean to nurses in rural hospitals?

    PubMed Central

    Baernholdt, Marianne; Jennings, Bonnie Mowinski; Merwin, Elizabeth; Thornlow, Deirdre

    2013-01-01

    Aim This paper is a report of a study conducted to answer the question: ‘How do rural nurses and their chief nursing officers define quality care?’ Background Established indicators of quality care were developed primarily in urban hospitals. Rural hospitals and their environments differ from urban settings, suggesting that there might be differences in how quality care is defined. This has measurement implications. Methods Focus groups with staff nurses and interviews with chief nursing officers were conducted in 2006 at four rural hospitals in the South-Eastern United States of America. Data were analysed using conventional content analysis. Findings The staff nurse and chief nursing officer data were analysed separately and then compared, exposing two major themes: ‘Patients are what matter most’ and ‘Community connectedness is both a help and a hindrance’. Along with conveying that patients were the utmost priority and all care was patient-focused, the first theme included established indicators of quality such as falls, pressure ulcers, infection rates, readmission rates, and lengths of stay. A new discovery in this theme was a need for an indicator relevant for rural settings: transfer time to larger hospitals. The second theme, Community Connectedness, is unique to rural settings, exemplifying the rural culture. The community and hospital converge into a family of sorts, creating expectations for quality care by both patients and staff that are not typically found in urban settings and larger hospitals. Conclusion Established quality indicators are appropriate for rural hospitals, but additional indicators need to be developed. These must include transfer times to larger facilities and the culture of the community. PMID:20546364

  7. A two-stage estimation of hospital quality of care using mortality outcome measures: An application using Victorian hospital Data

    Microsoft Academic Search

    C. l. Chua; Alfons Palangkaraya; Jongsay Yong

    Abstract Inferring hospital quality of care using mortality outcomes: An empirical approach using Victorian Hospital Data We propose a method,of deriving a quality indicator for hospitals using mortality outcome

  8. Helping You Choose Quality Hospital Care

    MedlinePLUS

    ... Performer on Key Quality Measures CLABSI Toolkit Topics Topics Ebola Preparedness Emergency Management High Reliability Infection Prevention ... Details Sunday 3:11 CST, July 26, 2015 Topic Details Topic Library Item < Return to Topic Library ...

  9. Spatial competition for quality in the market for hospital care.

    PubMed

    Montefiori, Marcello

    2005-06-01

    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

  10. Using Assessing Care of Vulnerable Elders Quality Indicators to Measure Quality of Hospital Care for Vulnerable Elders

    Microsoft Academic Search

    Vineet M. Arora; Martha Johnson; Jared Olson; Paula M. Podrazik; Stacie Levine; Catherine E. DuBeau; Greg A. Sachs; David O. Meltzer

    2007-01-01

    OBJECTIVES: To assess the quality of care for hospital- ized vulnerable elders using measures based on Assessing Care of Vulnerable Elders (ACOVE) quality indicators (QIs). DESIGN: Prospective cohort study. SETTING: Single academic medical center. PARTICIPANTS: Subjects aged 65 and older hospitalized on the University of Chicago general medicine inpatient service who were defined as vulnerable using the Vulnerable Elder Survey-13

  11. Did Budget Cuts in Medicaid Disproportionate Share Hospital Payment Affect Hospital Quality of Care?

    PubMed Central

    Hsieh, Hui-Min; Bazzoli, Gloria J.; Chen, Hsueh-Fen; Stratton, Leslie S.; Clement, Dolores G.

    2014-01-01

    Background Medicaid Disproportionate Share Hospital (DSH) payments are one of the major sources of financial support for hospitals providing care to low-income patients. However, Medicaid DSH payments will be redirected from hospitals to subsidize individual health insurance purchase through US national health reform. Objectives The purpose of this study is to examine the association between Medicaid DSH payment reductions and nursing-sensitive and birth-related quality of care among Medicaid/uninsured and privately insured patients. Research Design and Method Economic theory of hospital behavior was used as a conceptual framework, and longitudinal data for California hospitals for 1996–2003 were examined. Hospital fixed effects regression models were estimated. The unit of analysis is at the hospital-level, examining two aggregated measures based on the payer category of discharged patients (i.e., Medicaid/uninsured and privately insured). Principal Findings The overall study findings provide at best weak evidence of an association between net Medicaid DSH payments and hospital quality of care for either Medicaid/uninsured or the privately insured patients. The magnitudes of the effects are small and only a few have significant DSH effects. Conclusions Although this study does not find evidence suggesting that reducing Medicaid DSH payments had a strong negative impact on hospital quality of care for Medicaid/uninsured or privately insured patients, the results are not necessarily predictive of the impact national health care reform will have. Research is necessary to monitor hospital quality of care as this reform is implemented. PMID:24714580

  12. Improving Service Quality in Long-term Care Hospitals: National Evaluation on Long-term Care Hospitals and Employees Perception of Quality Dimensions

    PubMed Central

    Kim, Jinkyung; Han, Woosok

    2012-01-01

    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. PMID:24159497

  13. Case management in an acute-care hospital: collaborating for quality, cost-effective patient care.

    PubMed

    Grootveld, Kim; Wen, Victoria; Bather, Michelle; Park, Joan

    2014-01-01

    Case management has recently been advanced as a valuable component in achieving quality patient care that is also cost-effective. At St. Michael's Hospital, in Toronto, Ontario, case managers from a variety of professional backgrounds are central to a new care initiative--Rapid Assessment and Planning to Inform Disposition (RAPID)--in the General Internal Medicine (GIM) Unit that is designed to improve patient care and reconcile high emergency department volumes through "smart bed spacing." Involved in both planning and RAPID, GIM's case managers are the link between patient care and utilization management. These stewards of finite resources strive to make the best use of dollars spent while maintaining a commitment to quality care. Collaborating closely with physicians and others across the hospital, GIM's case managers have been instrumental in bringing about significant improvements in care coordination, utilization management and process redesign. PMID:24844723

  14. Hospital ownership and cost and quality of care: is there a dime's worth of difference?

    PubMed

    Sloan, F A; Picone, G A; Taylor, D H; Chou, S Y

    2001-01-01

    Nonprofit organizations may predominate when output quality is difficult to monitor. Hospital care has this characteristic. This study compared program cost and quality of care for Medicare patients hospitalized following onset of four common conditions by hospital ownership. Payments on behalf of Medicare patients admitted to for-profit hospitals during the first 6 months following a health shock were higher than for those admitted to other hospitals. With quality measured in terms of survival, changes in functional and cognitive status, and living arrangements, we found no differences in outcomes by hospital ownership. PMID:11148866

  15. Quality in hospital care: analysis of health care workers perception in a hospital located in the Northern region of the State of Ceará, Brazil

    Microsoft Academic Search

    Maria Aparecida da Ponte; Maristela Inês; Osawa Chagas; Rogena Weaver; Noronha Brasil

    2008-01-01

    This study is intended to analyze quality conceptions and quality in hospital care given by health care workers in a general and maternity hospital in Cariré, State of Ceará. This is a qualitative and analytical exploratory survey based on case studies, performed from May to August, 2006, with 29 health care workers. A structured interview was used to collect data.

  16. Blue Shield ensures uninterrupted access to quality medical care after Palm Drive Hospital ceases operations

    E-print Network

    Ravikumar, B.

    Blue Shield ensures uninterrupted access to quality medical care after Palm Drive Hospital ceases emergency care and in-patient care at Palm Drive. We are working with our members to ensure a smooth of California member in the Sonoma County area seeking emergency medical services or inpatient care, please

  17. Intensive Care Unit Utilization and Interhospital Transfers As Potential Indicators of Rural Hospital Quality

    ERIC Educational Resources Information Center

    Wakefield, Douglas S.; Ward, Marcia; Miller, Thomas; Ohsfeldt, Robert; Jaana, Mirou; Lei, Yang; Tracy, Roger; Schneider, John

    2004-01-01

    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

  18. Quality of Care and Patient Satisfaction in Hospitals With High Concentrations of Black Patients

    PubMed Central

    Brooks-Carthon, J. Margo; Kutney-Lee, Ann; Sloane, Douglas M.; Cimiotti, Jeannie P.; Aiken, Linda H.

    2011-01-01

    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. PMID:21884376

  19. Quality of Care for Hospitalized Medicare Patients at Risk for Pressure Ulcers

    Microsoft Academic Search

    Courtney H. Lyder; Jeanette Preston; Jacqueline N. Grady; Jeanne Scinto; Richard Allman; Nancy Bergstrom; George Rodeheaver

    2001-01-01

    Background: No state peer review organization has at- tempted to identify processes of care related to pressure ulcer prediction and prevention in US hospitals. Objective: To profile and evaluate the processes of care for Medicare patients hospitalized at risk for pressure ul- cer development by means of the Medicare Quality In- dicator System pressure ulcer prediction and preven- tion module.

  20. Hospital staffing, organization, and quality of care: Cross-national findings

    Microsoft Academic Search

    Linda H. Aiken; Sean P. Clarke; Douglas M. Sloane

    2002-01-01

    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

  1. Quality improvement in pre-hospital critical care: increased value through research and publication

    PubMed Central

    2014-01-01

    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. PMID:24887186

  2. Evaluation of maternal and neonatal hospital care: quality index of completeness

    PubMed Central

    da Silva, Ana Lúcia Andrade; Mendes, Antonio da Cruz Gouveia; Miranda, Gabriella Morais Duarte; de Sá, Domicio Aurélio; de Souza, Wayner Vieira; Lyra, Tereza Maciel

    2014-01-01

    OBJECTIVE Develop an index to evaluate the maternal and neonatal hospital care of the Brazilian Unified Health System. METHODS This descriptive cross-sectional study of national scope was based on the structure-process-outcome framework proposed by Donabedian and on comprehensive health care. Data from the Hospital Information System and the National Registry of Health Establishments were used. The maternal and neonatal network of Brazilian Unified Health System consisted of 3,400 hospitals that performed at least 12 deliveries in 2009 or whose number of deliveries represented 10.0% or more of the total admissions in 2009. Relevance and reliability were defined as criteria for the selection of variables. Simple and composite indicators and the index of completeness were constructed and evaluated, and the distribution of maternal and neonatal hospital care was assessed in different regions of the country. RESULTS A total of 40 variables were selected, from which 27 single indicators, five composite indicators, and the index of completeness of care were built. Composite indicators were constructed by grouping simple indicators and included the following variables: hospital size, level of complexity, delivery care practice, recommended hospital practice, and epidemiological practice. The index of completeness of care grouped the five variables and classified them in ascending order, thereby yielding five levels of completeness of maternal and neonatal hospital care: very low, low, intermediate, high, and very high. The hospital network was predominantly of small size and low complexity, with inadequate child delivery care and poor development of recommended and epidemiological practices. The index showed that more than 80.0% hospitals had a low index of completeness of care and that most qualified heath care services were concentrated in the more developed regions of the country. CONCLUSIONS The index of completeness proved to be of great value for monitoring the maternal and neonatal hospital care of Brazilian Unified Health System and indicated that the quality of health care was unsatisfactory. However, its application does not replace specific evaluations. PMID:25210827

  3. Factors Influencing RNs' Perceptions of Quality Geriatric Care in Rural Hospitals.

    PubMed

    Cline, Daniel D; Dickson, Victoria Vaughan; Kovner, Christine; Boltz, Marie; Kolanowski, Ann; Capezuti, Elizabeth

    2013-12-01

    The rapidly aging population and their frequent use of hospital services will create substantial quality challenges in the near future. Redesigning rural hospital work environments is the key to improving the quality of care for older adults. This study explored how the work environment influences registered nurses' (RNs') perceived quality of geriatric care in rural hospitals. We used an exploratory mixed-methods research design emphasizing the qualitative data (in-depth, semi-structured interviews). Quantitative data (questionnaire) measuring the RN work environment were also collected to augment qualitative data. Four themes emerged: (a) collegial RN relationships, (b) poor staffing/utilization, (c) technology benefits/challenges, and (d) RN-physician interactions, which were identified as key factors influencing the quality of geriatric care. We concluded that rural hospital work environments may not be optimized to facilitate the delivery of quality geriatric care. Targeted interventions are needed to improve overall quality of care for hospitalized older adults in rural settings. PMID:24319004

  4. Exploring the relationship between inpatient hospital costs and quality of care.

    PubMed

    Siegrist, Richard B; Kane, Nancy M

    2003-06-01

    This research explores the potential benefit of improving the clinical quality and reducing the cost of inpatient care using administrative data to inform or restrict provider choice. Cost and quality measures derived from this source are already available to purchasers, payers, and consumers in support of insurance products designed to provide financial incentives for consumers to seek high-quality, low-cost care. It will be important to further refine the clinical and cost data to take into account measurable differences in the severity of illness of patients, and to acknowledge that some of the differences in cost or quality variation among hospitals may not be captured despite such refinements. Medicare cost report data is merged with Uniform Hospital Discharge Abstracts to identify the additional direct cost of patients experiencing 1 of 6 poor clinical outcomes, or admissions for ambulatory care sensitive conditions, or selected surgical procedures at low volume hospitals. Variability in case mix-adjusted cost per case among community and teaching hospital groups is also quantified; measurable quality differences between low cost and other hospitals in each group is described. Our results suggest that, despite implementation challenges, purchaser and payer initiatives that encourage consumers to seek lower cost inpatient care without sacrificing clinical quality are worth pursuing. PMID:12817615

  5. Impact of Physician Specialty on Quality Care for Patients Hospitalized with Decompensated Cirrhosis

    PubMed Central

    Lim, Nicholas; Lidofsky, Steven D.

    2015-01-01

    Background Decompensated cirrhosis is a common precipitant for hospitalization, and there is limited information concerning factors that influence the delivery of quality care in cirrhotic inpatients. We sought to determine the relation between physician specialty and inpatient quality care for decompensated cirrhosis. Design We reviewed 247 hospital admissions for decompensated cirrhosis, managed by hospitalists or intensivists, between 2009 and 2013. The primary outcome was quality care delivery, defined as adherence to all evidence-based specialty society practice guidelines pertaining to each specific complication of cirrhosis. Secondary outcomes included new complications, length-of-stay, and in-hospital death. Results Overall, 147 admissions (59.5%) received quality care. Quality care was given more commonly by intensivists, compared with hospitalists (71.7% vs. 53.1%, P = .006), and specifically for gastrointestinal bleeding (72% vs. 45.8%, P = .03) and hepatic encephalopathy (100% vs. 63%, P = .005). Involvement of gastroenterology consultation was also more common in admissions in which quality care was administered (68.7% vs. 54.0%, P = .023). Timely diagnostic paracentesis was associated with reduced new complications in admissions for refractory ascites (9.5% vs. 46.6%, P = .02), and reduced length-of-stay in admissions for spontaneous bacterial peritonitis (5 days vs. 13 days, P = .02). Conclusions Adherence to quality indicators for decompensated cirrhosis is suboptimal among hospitalized patients. Although quality care adherence appears to be higher among cirrhotic patients managed by intensivists than by hospitalists, opportunities for improvement exist in both groups. Rational and cost-effective strategies should be sought to achieve this end. PMID:25837700

  6. The Quality of Care Provided to Hospitalized Patients at the End of Life

    PubMed Central

    Walling, Anne M.; Asch, Steven M.; Lorenz, Karl A.; Roth, Carol P.; Barry, Tod; Kahn, Katherine L.; Wenger, Neil S.

    2010-01-01

    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. PMID:20585072

  7. Measuring efficiency: the association of hospital costs and quality of care.

    PubMed

    Jha, Ashish K; Orav, E John; Dobson, Allen; Book, Robert A; Epstein, Arnold M

    2009-01-01

    Providers with lower costs may be more efficient and, therefore, provide better care than those with higher costs. However, the relationship between risk-adjusted costs (often described as efficiency) and quality is not well understood. We examined the relationship between hospitals' risk-adjusted costs and their structural characteristics, nursing levels, quality of care, and outcomes. U.S. hospitals with low risk-adjusted costs were more likely to be for-profit, treat more Medicare patients, and employ fewer nurses. They provided modestly worse care for acute myocardial infarction and congestive heart failure but had comparable rates of risk-adjusted mortality. We found no evidence that low-cost providers provide better care. PMID:19414903

  8. Instrument for assessing the quality of mobile emergency pre-hospital care: content validation.

    PubMed

    Dantas, Rodrigo Assis Neves; Torres, Gilson de Vasconcelos; Salvetti, Marina de Góes; Dantas, Daniele Vieira; Mendonça, Ana Elza Oliveira de

    2015-01-01

    OBJECTIVES To validate an instrument to assess quality of mobile emergency pre-hospital care. METHOD A methodological study where 20 professionals gave their opinions on the items of the proposed instrument. The analysis was performed using Kappa test (K) and Content Validity Index (CVI), considering K> 0.80 and CVI ? 0.80. RESULTS Three items were excluded from the instrument: Professional Compensation; Job Satisfaction and Services Performed. Items that obtained adequate K and CVI indexes and remained in the instrument were: ambulance conservation status; physical structure; comfort in the ambulance; availability of material resources; user/staff safety; continuous learning; safety demonstrated by the team; access; welcoming; humanization; response time; costumer privacy; guidelines on care; relationship between professionals and costumers; opportunity for costumers to make complaints and multiprofessional conjunction/actuation. CONCLUSION The instrument to assess quality of care has been validated and may contribute to the evaluation of pre-hospital care in mobile emergency services. PMID:26107697

  9. A Correlational Analysis: Electronic Health Records (EHR) and Quality of Care in Critical Access Hospitals

    ERIC Educational Resources Information Center

    Khan, Arshia A.

    2012-01-01

    Driven by the compulsion to improve the evident paucity in quality of care, especially in critical access hospitals in the United States, policy makers, healthcare providers, and administrators have taken the advise of researchers suggesting the integration of technology in healthcare. The Electronic Health Record (EHR) System composed of multiple…

  10. Relationship of hospital teaching status with quality of care and mortality for Medicare patients with acute MI

    Microsoft Academic Search

    Jeroan J. Allison; Catarina I. Kiefe; Norman W. Weissman; Sharina D. Person; Matthew Rousculp; John G. Canto; Sejong Bae; O. Dale Williams; Robert Farmer; Robert M. Centor

    2000-01-01

    CONTEXT: Issues of cost and quality are gaining importance in the delivery of medical care, and whether quality of care is better in teaching vs nonteaching hospitals is an essential question in this current national debate.\\u000aOBJECTIVE: To examine the association of hospital teaching status with quality of care and mortality for fee-for-service Medicare patients with acute myocardial infarction (AMI).

  11. Payments and quality of care in private for-profit and public hospitals in Greece

    PubMed Central

    2011-01-01

    Background Empirical evidence on how ownership type affects the quality and cost of medical care is growing, and debate on these topics is ongoing. Despite the fact that the private sector is a major provider of hospital services in Greece, little comparative information on private versus public sector hospitals is available. The aim of the present study was to describe and compare the operation and performance of private for-profit (PFP) and public hospitals in Greece, focusing on differences in nurse staffing rates, average lengths of stay (ALoS), and Social Health Insurance (SHI) payments for hospital care per patient discharged. Methods Five different datasets were prepared and analyzed, two of which were derived from information provided by the National Statistical Service (NSS) of Greece and the other three from data held by the three largest SHI schemes in the country. All data referred to the 3-year period from 2001 to 2003. Results PFP hospitals in Greece are smaller than public hospitals, with lower patient occupancy, and have lower staffing rates of all types of nurses and highly qualified nurses compared with public hospitals. Calculation of ALoS using NSS data yielded mixed results, whereas calculations of ALoS and SHI payments using SHI data gave results clearly favoring the public hospital sector in terms of cost-efficiency; in all years examined, over all specialties and all SHI schemes included in our study, unweighted ALoS and SHI payments for hospital care per discharge were higher for PFP facilities. Conclusions In a mixed healthcare system, such as that in Greece, significant performance differences were observed between PFP and public hospitals. Close monitoring of healthcare provision by hospital ownership type will be essential to permit evidence-based decisions on the future of the public/private mix in terms of healthcare provision. PMID:21943020

  12. What Do Consumers Want to Know about the Quality of Care in Hospitals?

    PubMed Central

    Sofaer, Shoshanna; Crofton, Christine; Goldstein, Elizabeth; Hoy, Elizabeth; Crabb, Jenny

    2005-01-01

    Objective To guide the development of the Consumer Assessments of Healthcare Providers and Systems (CAHPS®) Hospital Survey by identifying which domains of hospital quality included in a survey of recent hospital patients, and which survey items within those domains, would be of greatest interest to consumers and patients. Data Sources/Study Setting Primary data were collected in four cities (Baltimore, Los Angeles, Phoenix, and Orlando), from a demographically varied mix of people of whom most, but not all, had recently been hospitalized or had a close loved one hospitalized. Study Design/Data Collection Method A total of 16 focus groups were held in these four cities. Groups were structured to be homogeneous with respect to type of health care coverage (Medicare, non-Medicare), and type of recent hospital experience (urgent admission, elective admission, maternity admission, no admission). They were heterogeneous with respect to race/ethnicity, gender, and educational attainment. In addition to moderated discussions, focus group participants completed a pregroup questionnaire and various paper and pencil exercises during the groups. Principal Findings A wide range of features were identified by participants as being relevant to hospital quality. Many were consonant with domains and items in the CAHPS Hospital Survey; however, some addressed structural features of hospitals and hospital outcomes that are not best derived from a patient experience survey. When shown the domains and items being considered for inclusion in the CAHPS Hospital Survey, participants were most interested in items relating to doctor communication with patients, nurse and hospital staff communication with patients, responsiveness to patient needs, and cleanliness of the hospital room and bathroom. Findings were quite consistent across groups regardless of location and participant characteristics. Conclusions Consumers and patients have a high degree of interest in hospital quality and found a very high proportion of the items being considered for the CAHPS Hospital Survey to be so important they would consider changing hospitals in response to information about them. Hospital choice may well be constrained for patients, but publicly reported information from a patient perspective can also be used to support patient discussions with facilities and physicians about how to ensure patients have the best hospital experience possible. PMID:16316436

  13. [Smarter hospital care].

    PubMed

    Ubbink, Dirk T; Papadopoulos, Niki E; Legemate, Dink A

    2014-01-01

    The quality of hospital care is being questioned. This calls for decisions and innovations both in terms of care process and content. Innovations do not always have the desired effect and are often insufficiently supported by scientific evidence. The adoption and application of evidence-based principles in the organization as well as in the content of healthcare are therefore pivotal, not only for care professionals, but for hospital managers and decision makers as well. Implementation of these ideas appears most successful when conducted on different levels: national, strategic, tactical, and operational, and in educational as well as clinical settings. PMID:24893809

  14. Variation in Surgical Readmissions and Relationship to Quality of Hospital Care

    PubMed Central

    Tsai, Thomas C.; Joynt, Karen E.; Orav, E. John; Gawande, Atul A.; Jha, Ashish K.

    2014-01-01

    Background Reducing readmissions is a clinical and policy priority, but little is known about variations in readmission rates after major surgery and whether a hospital's surgical readmission rates are related to other markers of high-quality surgical care. Methods Using national Medicare data, we calculated 30-day readmission rates after hospitalization for coronary artery bypass graft (CABG), pulmonary lobectomy, endovascular abdominal aortic aneurysm repair (EVAR), open abdominal aortic aneurysm repair (AAA), colectomy, and hip replacement. We used bivariate and multivariable techniques to assess the relationship between readmission rates and other measures of surgical quality, including performance on surgical process measures, procedure volume, and mortality. Results There were 479,471 discharges following one of the six index procedures from 3,004 hospitals. The median risk-adjusted six-procedure composite 30-day readmission rate was 13.1% [interquartile range, IQR 9.9%-17.1%}. Adjusting for hospital characteristics, we found that hospitals in the highest quartile of surgical volume had lower readmission rates than the lowest-volume hospitals (12.7% vs. 16.8%, p<0.001), and hospitals with the lowest mortality rates had significantly lower readmission rates than hospitals with high mortality rates (13.3% vs. 14.2%, p<0.001). High performance on surgical process of care performance measures was only marginally associated with readmission rates (13.1% versus 13.6%, p=0.021). Patterns were similar when each of the six major surgeries was examined individually. Conclusion Nearly one in seven patients is readmitted within 30 days of discharge following a major surgical procedure. High volume and low mortality hospitals have lower surgical readmissions than other hospitals. PMID:24047062

  15. The hospital standardised mortality ratio: a powerful tool for Dutch hospitals to assess their quality of care?

    PubMed Central

    Pieter, D; van der Veen, A A; Kool, R B; Aylin, P; Bottle, A; Westert, G P; Jones, S

    2010-01-01

    Aim of the study To use the hospital standardised mortality ratio (HSMR), as a tool for Dutch hospitals to analyse their death rates by comparing their risk-adjusted mortality with the national average. Method The method uses routine administrative databases that are available nationally in The Netherlands—the National Medical Registration dataset for the years 2005–2007. Diagnostic groups that led to 80% of hospital deaths were included in the analysis. The method adjusts for a number of case-mix factors per diagnostic group determined through a logistic regression modelling process. Results In The Netherlands, the case-mix factors are primary diagnosis, age, sex, urgency of admission, length of stay, comorbidity (Charlson Index), social deprivation, source of referral and month of admission. The Dutch HSMR model performs well at predicting a patient's risk of death as measured by a c statistic of the receiver operating characteristic curve of 0.91. The ratio of the HSMR of the Dutch hospital with the highest value in 2005–2007 is 2.3 times the HSMR of the hospital with the lowest value. Discussion Overall hospital HSMRs and mortality at individual diagnostic group level can be monitored using statistical process control charts to give an early warning of possible problems with quality of care. The use of routine data in a standardised and robust model can be of value as a starting point for improvement of Dutch hospital outcomes. HSMRs have been calculated for several other countries. PMID:20172876

  16. Hospital Quality: A PRIDIT Approach

    PubMed Central

    Lieberthal, Robert D

    2008-01-01

    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. PMID:18454777

  17. Impact of an Expanded Hospital Recognition Program for Heart Failure Quality of Care

    PubMed Central

    Heidenreich, Paul A.; Zhao, Xin; Hernandez, Adrian F.; Yancy, Clyde W.; Schwamm, Lee H.; Albert, Nancy M.; Fonarow, Gregg C.

    2014-01-01

    Background In 2009, the Get With The Guidelines–Heart Failure program enhanced the standard recognition of hospitals by offering additional recognition if hospitals performed well on certain quality measures. We sought to determine whether initiation of this enhanced recognition opportunity led to acceleration in quality of care for all hospitals participating in the program. Methods and Results We examined hospital?level performance on 9 quality?of?care (process) measures that were added to an existing recognition program (based on existing published performance measures). The rate of increase in use over time 6 months to 2 years after the start of the program was compared with the rate of increase in use for the measures during the 18?month period prior to the start of the program. Use increased for all 9 new quality measures from 2008 to 2011. Among 4 measures with baseline use near or lower than 50%, a statistically significant greater increase in use during the program was seen for implantable cardioverter defibrillator use (program versus preprogram use: odds ratio 1.14, 95% CI 1.06 to 1.23). Among the 5 measures for which baseline use was 50% or higher, the increase in influenza vaccination rates actually slowed. There was no evidence of adverse impact on the 4 established quality measures, a composite of which actually increased faster during the expanded program (adjusted odds ratio 1.08, 95% CI 1.01 to 1.15). Conclusions A program providing expanded hospital recognition for heart failure had mixed results in accelerating the use of 9 quality measures. PMID:25208954

  18. What do hospital mortality rates tell us about quality of care?

    PubMed

    Goodacre, Steve; Campbell, Mike; Carter, Angela

    2015-03-01

    Hospital mortality rates could be useful indicators of quality of care, but careful statistical analysis is required to avoid erroneously attributing variation in mortality to differences in health care when it is actually due to differences in case mix. The summary hospital mortality indicator is currently used by the English National Health Service (NHS). It adjusts mortality rates up to 30?days after discharge for patient age, sex, type of admission, year of discharge, comorbidity, deprivation and diagnosis. Such risk-adjustment methods have been used to identify poor performance, most notably at mid-Staffordshire NHS Foundation Trust, but their use is subject to a number of limitations. Studies exploring whether variation in risk-adjusted mortality can be explained by variation in healthcare have reached conflicting conclusions. Furthermore, concerns have been raised that the proportion of preventable deaths among hospital admissions is too small to produce a reliable 'signal' in risk-adjusted mortality rates. This provides hospital managers, regulators and clinicians with a considerable dilemma. Variation in mortality rates cannot be ignored, as they might indicate unacceptable variation in healthcare and avoidable mortality, but they also cannot be reliably used to judge the quality of healthcare, based on current evidence. PMID:24064042

  19. Reimbursement systems and quality of hospital care: an empirical analysis for Italy.

    PubMed

    Cavalieri, Marina; Gitto, Lara; Guccio, Calogero

    2013-08-01

    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

  20. I Brazilian Registry of Heart Failure - Clinical Aspects, Care Quality and Hospitalization Outcomes

    PubMed Central

    de Albuquerque, Denilson Campos; de Souza, João David; Bacal, Fernando; Rohde, Luiz Eduardo Paim; Bernardez-Pereira, Sabrina; Berwanger, Otavio; Almeida, Dirceu Rodrigues

    2015-01-01

    Background Heart failure (HF) is one of the leading causes of hospitalization in adults in Brazil. However, most of the available data is limited to unicenter registries. The BREATHE registry is the first to include a large sample of hospitalized patients with decompensated HF from different regions in Brazil. Objective Describe the clinical characteristics, treatment and prognosis of hospitalized patients admitted with acute HF. Methods Observational registry study with longitudinal follow-up. The eligibility criteria included patients older than 18 years with a definitive diagnosis of HF, admitted to public or private hospitals. Assessed outcomes included the causes of decompensation, use of medications, care quality indicators, hemodynamic profile and intrahospital events. Results A total of 1,263 patients (64±16 years, 60% women) were included from 51 centers from different regions in Brazil. The most common comorbidities were hypertension (70.8%), dyslipidemia (36.7%) and diabetes (34%). Around 40% of the patients had normal left ventricular systolic function and most were admitted with a wet-warm clinical-hemodynamic profile. Vasodilators and intravenous inotropes were used in less than 15% of the studied cohort. Care quality indicators based on hospital discharge recommendations were reached in less than 65% of the patients. Intrahospital mortality affected 12.6% of all patients included. Conclusion The BREATHE study demonstrated the high intrahospital mortality of patients admitted with acute HF in Brazil, in addition to the low rate of prescription of drugs based on evidence. PMID:25861035

  1. Health-related Quality of Life among hospitalized older people awaiting residential aged care

    Microsoft Academic Search

    Lynne C Giles; Graeme Hawthorne; Maria Crotty

    2009-01-01

    BACKGROUND: Health related quality of life (HRQoL) in very late life is not well understood. The aim of the present study was to assess HRQoL and health outcomes at four months follow-up in a group of older people awaiting transfer to residential aged care. METHODS: Secondary analysis of data from a randomized controlled trial conducted in three public hospitals in

  2. Hospital ownership and quality of care: what explains the different results in the literature?

    PubMed

    Eggleston, Karen; Shen, Yu-Chu; Lau, Joseph; Schmid, Christopher H; Chan, Jia

    2008-12-01

    This systematic review examines what factors explain the diversity of findings regarding hospital ownership and quality. We identified 31 observational studies written in English since 1990 that used multivariate analysis to examine quality of care at nonfederal general acute, short-stay US hospitals. We find that pooled estimates of ownership effects are sensitive to the subset of studies included and the extent of overlap among hospitals analyzed in the underlying studies. Ownership does appear to be systematically related to differences in quality among hospitals in several contexts. Whether studies find for-profit and government-controlled hospitals to have higher mortality rates or rates of adverse events than their nonprofit counterparts depends on data sources, time period, and region covered. Policymakers should be aware of the underlying reasons for conflicting evidence in this literature, and the strengths and weaknesses of meta-analytic synthesis. The 'true' effect of ownership appears to depend on institutional context, including differences across regions, markets, and over time. PMID:18186547

  3. Quality's New Frontier: Reducing Hospitalizations and Improving Transitions in Long-Term Care. Washington, DC: Mathematica Policy Research

    Microsoft Academic Search

    Debra J. Lipson; Samuel Simon

    2010-01-01

    Hospitals and post-acute care providers have developed quality measures to evaluate their effectiveness in preventing readmissions, but these measures are lacking in long-term care. This issue brief discusses the need for similar measures to assess the quality of long-term care for people in nursing homes and other home- and community-based service settings. It also identifies evidence-based care models and interventions

  4. Truly inefficient or providing better quality of care? Analysing the relationship between riskadjusted hospital costs and patients’ health outcomes

    Microsoft Academic Search

    Nils Gutacker; Chris Bojke; Silvio Daidone; Nancy Devlin; David Parkin

    2011-01-01

    Accounting for variation in the quality of care is a major challenge for the assessment of hospital cost performance. Because data on patients’ health improvement are generally not available, existing studies have resorted to inherently incomplete outcome measures such as mortality or re-admission rates. This opens up the possibility that providers of high quality care are falsely deemed inefficient and

  5. University Hospitals: creating the infrastructure for quality and value through accountable care.

    PubMed

    Zenty, Thomas F; Bieber, Eric J; Hammack, Elizabeth R

    2014-01-01

    University Hospitals Health System Inc. (UH), in Cleveland, Ohio, like many hospitals and healthcare systems, sought to anticipate the dramatic changes of healthcare reform, including its increased focus on quality and outcomes. UH evaluated incentives to keep patients out of hospital and to ease mounting pressures on reimbursement and costs. During UH's strategic planning sessions in 2009 and 2010, we identified value--the combination of quality and efficiency--to be a key driver of our future success. Ahead of the enactment of the Affordable Care Act, in early 2010 we chose to proceed with the formation of an accountable care organization (ACO). We believed the ACO was a novel vehicle by which to improve the efficient delivery of our high-quality healthcare to maximize the value of the services we provide. We also believed that the most successful strategy, if it can be achieved, is to build on success. A major success, or a series of smaller successes, will go a long way toward achieving operational buy-in, enhancing respect for strategic initiatives, and convincing physicians of the need for change. Through thoughtful governance, effective plan design, customized data analytics, physician networks and incentives, innovative patient engagement, and supplemental coordination resources, our ACOs have succeeded in improving population health and delivering value. PMID:25671992

  6. Hospital cost and quality performance in relation to market forces: an examination of U.S. community hospitals in the "post-managed care era".

    PubMed

    Jiang, H Joanna; Friedman, Bernard; Jiang, Shenyi

    2013-03-01

    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

  7. Assisted and Unassisted Falls: Different Events, Different Outcomes, Different Implications for Quality of Hospital Care

    PubMed Central

    Staggs, Vincent S.; Mion, Lorraine C.; Shorr, Ronald I.

    2014-01-01

    Background Many hospitals classify inpatient falls as assisted (if a staff member is present to ease the patient’s descent or break the fall) or unassisted for quality measurement purposes. Unassisted falls are more likely to result in injury, but there is limited research quantifying this effect or linking the assisted/unassisted classification to processes of care. A study was conducted to link the assisted/unassisted fall classification to both processes and outcomes of care, thereby demonstrating its suitability for use in quality measurement. This was only the second known published study to quantify the increased risk of injury associated with falling unassisted (versus assisted), and the first to estimate the effects of falling unassisted (versus assisted) on the likelihood of specific levels of injury. Methods A cross-sectional analysis of falls from all available 2011 data for 6,539 adult medical, surgical, and medical-surgical units in 1,464 general hospitals participating in the National Database of Nursing Quality Indicators® (NDNQI®) was performed. Results Participating units reported 166,883 falls (3.44 falls per 1,000 patient-days). Excluding repeat falls, 85.5% of falls were unassisted. Assisted and unassisted falls were associated with different processes and outcomes: Fallers in units without a fall prevention protocol in place were more likely to fall unassisted than those with a protocol in place (adjusted odds ratio [aOR], 1.39 [95% confidence interval (CI), 1.32, 1.46]), and unassisted falls were more likely to result in injury (aOR, 1.59 [95% CI, 1.52, 1.67]). Conclusions The assisted/unassisted fall classification is associated with care processes and patient outcomes, making it suitable for quality measurement. Unassisted falls are more likely than assisted falls to result in injury and should be considered as a target for future prevention efforts. PMID:25208441

  8. A survey of the quality of maternity care at the Norfolk & Norwich University Hospital NHS Foundation Trust

    Microsoft Academic Search

    J Ifionu; T Hamouda; M Saleh

    2010-01-01

    This study was planned to assess the quality of maternity care provided in a busy teaching maternity unit. An anonymous questionnaire based on the Royal College of Obstetricians and Gynaecologists (RCOG) standards of maternity care document (2008) was distributed among all women delivered at Norfolk and Norwich University Hospital between February and July 2009.1 Women who delivered stillbirths and babies

  9. Accelerating Best Care in Pennsylvania: adapting a large academic system's quality improvement process to rural community hospitals.

    PubMed

    Haydar, Ziad; Gunderson, Julie; Ballard, David J; Skoufalos, Alexis; Berman, Bettina; Nash, David B

    2008-01-01

    Industrial quality improvement (QI) methods such as continuous quality improvement (CQI) may help bridge the gap between evidence-based "best care" and the quality of care provided. In 2006, Baylor Health Care System collaborated with Jefferson Medical College of Thomas Jefferson University to conduct a QI demonstration project in select Pennsylvania hospitals using CQI techniques developed by Baylor. The training was provided over a 6-month period and focused on methods for rapid-cycle improvement; data system design; data management; tools to improve patient outcomes, processes of care, and cost-effectiveness; use of clinical guidelines and protocols; leadership skills; and customer service skills. Participants successfully implemented a variety of QI projects. QI education programs developed and pioneered within large health care systems can be adapted and applied successfully to other settings, providing needed tools to smaller rural and community hospitals that lack the necessary resources to establish such programs independently. PMID:18658097

  10. Situation analysis of quality of abortion care in the main maternity hospital in Hai Phòng, Viet Nam.

    PubMed

    Nguyen, My H Ng; Gammeltoft, Tine; Rasch, Vibeke

    2007-05-01

    Six months after a Comprehensive Abortion Care project was implemented in Phu-San Hospital, the main maternity hospital in Hai Phòng, northern Viet Nam, a study of quality of abortion services was carried out. The study explored the interaction between providers and women seeking abortion and how cultural values influenced quality of care. A quantitative and qualitative approach was employed: a three-part structured survey with 748 women before and after they had an abortion, 20 in-depth interviews with women just after abortion, seven informal interviews with health care staff and 100 participant observations. Both the women and the staff equated quality of care mainly with improved technical performance of abortion. Insufficient knowledge and skills had a negative impact on provision of information and good quality counselling in relation to understanding and uptake of contraception, treating reproductive tract infection and preventing post-abortion infection. To further improve abortion care in hospitals such as Phu-San, training programmes are needed that integrate counselling and clinical skills and address the cultural factors that hinder health staff and women from interacting in an equitable manner. A supportive supervisory system that holds health staff accountable for conducting high quality information and counselling sessions should also be established. PMID:17512388

  11. Assessment of quality of care in postpartum wards of Shaheed Beheshti Medical Science University hospitals, 2004

    Microsoft Academic Search

    M. Simbar; Z. Alizadeh Dibazari; J. Abed Saeidi; H. Alavi Majd

    2005-01-01

    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

  12. Measuring Rural Hospital Quality

    ERIC Educational Resources Information Center

    Moscovice, Ira; Wholey, Douglas R.; Klingner, Jill; Knott, Astrid

    2004-01-01

    Increased interest in the measurement of hospital quality has been stimulated by accrediting bodies, purchaser coalitions, government agencies, and other entities. This paper examines quality measurement for hospitals in rural settings. We seek to identify rural hospital quality measures that reflect quality in all hospitals and that are sensitive…

  13. Managing quality in hospital practice

    Microsoft Academic Search

    NORMAN S. WEINBERG; WILLIAM B. STASON

    1998-01-01

    Background. While routine clinical decision-making has a substantial effect on quality, most practising physicians do not routinely examine their outcomes. Objectives. To set up a practical process for identifying problems in hospital practices of primary care physicians, examine their causes, and develop a quality improvement process that intimately involves practising physicians in problem-solving. Design. All hospital admissions to the Primary

  14. Is quality of colorectal cancer care good enough? Core measures development and its application for comparing hospitals in Taiwan

    PubMed Central

    2010-01-01

    Background Although performance measurement for assessing care quality is an emerging area, a system for measuring the quality of cancer care at the hospital level has not been well developed. The purpose of this study was to develop organization-based core measures for colorectal cancer patient care and apply these measures to compare hospital performance. Methods The development of core measures for colorectal cancer has undergone three stages including a modified Delphi method. The study sample originated from 2004 data in the Taiwan Cancer Database, a national cancer data registry. Eighteen hospitals and 5585 newly diagnosed colorectal cancer patients were enrolled in this study. We used indicator-based and case-based approaches to examine adherences simultaneously. Results The final core measure set included seventeen indicators (1 pre-treatment, 11 treatment-related and 5 monitoring-related). There were data available for ten indicators. Indicator-based adherence possesses more meaningful application than case-based adherence for hospital comparisons. Mean adherence was 85.8% (79.8% to 91%) for indicator-based and 82.8% (77.6% to 88.9%) for case-based approaches. Hospitals performed well (>90%) for five out of eleven indicators. Still, the performance across hospitals varied for many indicators. The best and poorest system performance was reflected in indicators T5-negative surgical margin (99.3%, 97.2% - 100.0%) and T7-lymph nodes harvest more than twelve(62.7%, 27.6% - 92.2%), both of which related to surgical specimens. Conclusions In this nationwide study, quality of colorectal cancer care still shows room for improvement. These preliminary results indicate that core measures for cancer can be developed systematically and applied for internal quality improvement. PMID:20105287

  15. Peer pressure and public reporting within healthcare setting: improving accountability and health care quality in hospitals.

    PubMed

    Specchia, Maria Lucia; Veneziano, Maria Assunta; Cadeddu, Chiara; Ferriero, Anna Maria; Capizzi, Silvio; Ricciardi, Walter

    2012-01-01

    In the last few years, the need of public reporting of health outcomes has acquired a great importance. The public release of performance results could be a tool for improving health care quality and many attempts have been made in order to introduce public reporting programs within the health care context at different levels. It would be necessary to promote the introduction of a standardized set of outcome and performance measures in order to improve quality of health care services and to make health care providers aware of the importance of transparency and accountability. PMID:23369992

  16. Quality indicators for colorectal cancer surgery and care according to patient-, tumor-, and hospital-related factors

    PubMed Central

    2012-01-01

    Background Colorectal cancer (CRC) care has improved considerably, particularly since the implementation of a quality of care program centered on national evidence-based guidelines. Formal quality assessment is however still needed. The aim of this research was to identify factors associated with practice variation in CRC patient care. Methods CRC patients identified from all cancer centers in South-West France were included. We investigated variations in practices (from diagnosis to surgery), and compliance with recommended guidelines for colon and rectal cancer. We identified factors associated with three colon cancer practice variations potentially linked to better survival: examination of ?12 lymph nodes (LN), non-use and use of adjuvant chemotherapy for stage II and stage III patients, respectively. Results We included 1,206 patients, 825 (68%) with colon and 381 (32%) with rectal cancer, from 53 hospitals. Compliance was high for resection, pathology report, LN examination, and chemotherapy use for stage III patients. In colon cancer, 26% of stage II patients received adjuvant chemotherapy and 71% of stage III patients. 84% of stage US T3T4 rectal cancer patients received pre-operative radiotherapy. In colon cancer, factors associated with examination of ?12 LNs were: lower ECOG score, advanced stage and larger hospital volume; factors negatively associated were: left sided tumor location and one hospital district. Use of chemotherapy in stage II patients was associated with younger age, advanced stage, emergency setting and care structure (private and location); whereas under-use in stage III patients was associated with advanced age, presence of comorbidities and private hospitals. Conclusions Although some changes in practices may have occurred since this observational study, these findings represent the most recent report on practices in CRC in this region, and offer a useful methodological approach for assessing quality of care. Guideline compliance was high, although some organizational factors such as hospital size or location influence practice variation. These factors should be the focus of any future guideline implementation. PMID:22813349

  17. A Quality Control Program for Acute Pain Management in Out-of-Hospital Critical Care Medicine

    Microsoft Academic Search

    Agnès Ricard-Hibon; Charlotte Chollet; Sylvie Saada; Bertrand Loridant; Jean Marty

    1999-01-01

    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.

  18. Clinical Pathways - An Evaluation of its Impact on the Quality of Care in an Acute Care General Hospital in Singapore

    Microsoft Academic Search

    J Cheah

    A critical or clinical pathway defines the optimal care process, sequencing and timing of interventions by healthcare professionals for a particular diagnosis or procedure. It is a relatively new clinical process improvement tool that has been gaining popularity across hospitals and various healthcare organisations in many parts of the world. It is now slowly gaining momentum and popularity in Asia

  19. Is health care a special challenge to quality management? Insights from the Danderyd Hospital case.

    PubMed

    Striem, Jörgen; Øvretveit, John; Brommels, Mats

    2003-01-01

    A 10-year quality journey of a Swedish university hospital is described in this case study based on a variety of data sources. A series of quality initiatives were implemented according to total quality management (TQM) "best practice." Many projects were successful, but still a majority of those did not meet the staff's requirement of practical relevance, and they provoked scepticism toward instruments introduced and resistance to service-related quality definitions. The hospital's incentive structures did not reward an engagement in improvement activities. The findings are interpreted as demonstrating that the programs were viewed upon as part of a "management" rather than "professional" agenda, despite the underlying philosophy of TQM. It is suggested that applying professional practice development approaches to improvement initiatives might help to overcome the barrier thus created. PMID:14603787

  20. A 10?year (2000–2010) systematic review of interventions to improve quality of care in hospitals

    PubMed Central

    2012-01-01

    Background Against a backdrop of rising healthcare costs, variability in care provision and an increased emphasis on patient satisfaction, the need for effective interventions to improve quality of care has come to the fore. This is the first ten year (2000–2010) systematic review of interventions which sought to improve quality of care in a hospital setting. This review moves beyond a broad assessment of outcome significance levels and makes recommendations for future effective and accessible interventions. Methods Two researchers independently screened a total of 13,195 English language articles from the databases PsychInfo, Medline, PubMed, EmBase and CinNahl. There were 120 potentially relevant full text articles examined and 20 of those articles met the inclusion criteria. Results Included studies were heterogeneous in terms of approach and scientific rigour and varied in scope from small scale improvements for specific patient groups to large scale quality improvement programmes across multiple settings. Interventions were broadly categorised as either technical (n?=?11) or interpersonal (n?=?9). Technical interventions were in the main implemented by physicians and concentrated on improving care for patients with heart disease or pneumonia. Interpersonal interventions focused on patient satisfaction and tended to be implemented by nursing staff. Technical interventions had a tendency to achieve more substantial improvements in quality of care. Conclusions The rigorous application of inclusion criteria to studies established that despite the very large volume of literature on quality of care improvements, there is a paucity of hospital interventions with a theoretically based design or implementation. The screening process established that intervention studies to date have largely failed to identify their position along the quality of care spectrum. It is suggested that this lack of theoretical grounding may partly explain the minimal transfer of health research to date into policy. It is recommended that future interventions are established within a theoretical framework and that selected quality of care outcomes are assessed using this framework. Future interventions to improve quality of care will be most effective when they use a collaborative approach, involve multidisciplinary teams, utilise available resources, involve physicians and recognise the unique requirements of each patient group. PMID:22925835

  1. Opportunities for quality improvement in bereavement care at a children's hospital: assessment of interdisciplinary staff perspectives.

    PubMed

    Contro, Nancy; Sourkes, Barbara M

    2012-01-01

    This study examined the current state of bereavement care at a university-based children's hospital from the perspective of the interdisciplinary staff. In all, 60 staff members from multiple disciplines participated in in-depth interviews. In at least two-thirds of the interviews, issues related to the bereavement experience of both staff and families emerged and were consistently identified. Themes included: disparities in bereavement care based on relationship factors; logistics of time and space; geographical distances; the different cultures and languages of families; continuity in family follow-up; needs of siblings and other family members; staff communication, cooperation, and care coordination; staff suffering; and education, mentoring, and support for staff. This evidence-based needs assessment furnishes an empirical basis for the design and implementation of bereavement services for both families and staff. It can serve as a template for evaluation at other children's hospitals and thus contribute to the sound and creative development of the field of pediatric palliative care. PMID:22582469

  2. The Influence of Primary Care Quality on Hospital Admissions for People with Dementia in England: A Regression Analysis

    PubMed Central

    Kasteridis, Panagiotis; Mason, Anne R.; Goddard, Maria K.; Jacobs, Rowena; Santos, Rita; McGonigal, Gerard

    2015-01-01

    Objectives To test the impact of a UK pay-for-performance indicator, the Quality and Outcomes Framework (QOF) dementia review, on three types of hospital admission for people with dementia: emergency admissions where dementia was the primary diagnosis; emergency admissions for ambulatory care sensitive conditions (ACSCs); and elective admissions for cataract, hip replacement, hernia, prostate disease, or hearing loss. Methods Count data regression analyses of hospital admissions from 8,304 English general practices from 2006/7 to 2010/11. We identified relevant admissions from national Hospital Episode Statistics and aggregated them to practice level. We merged these with practice-level data on the QOF dementia review. In the base case, the exposure measure was the reported QOF register. As dementia is commonly under-diagnosed, we tested a predicted practice register based on consensus estimates. We adjusted for practice characteristics including measures of deprivation and uptake of a social benefit to purchase care services (Attendance Allowance). Results In the base case analysis, higher QOF achievement had no significant effect on any type of hospital admission. However, when the predicted register was used to account for under-diagnosis, a one-percentage point improvement in QOF achievement was associated with a small reduction in emergency admissions for both dementia (-0.1%; P=0.011) and ACSCs (-0.1%; P=0.001). In areas of greater deprivation, uptake of Attendance Allowance was consistently associated with significantly lower emergency admissions. In all analyses, practices with a higher proportion of nursing home patients had significantly lower admission rates for elective and emergency care. Conclusion In one of three analyses at practice level, the QOF review for dementia was associated with a small but significant reduction in unplanned hospital admissions. Given the rising prevalence of dementia, increasing pressures on acute hospital beds and poor outcomes associated with hospital stays for this patient group, this small change may be clinically and economically relevant. PMID:25816231

  3. 76 FR 59263 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-09-26

    ...2011. FOR FURTHER INFORMATION CONTACT: Brian...786-5229, Hospital inpatient wage...Long-term care hospital wage data. Caroline...Long-term care hospital quality measures. SUPPLEMENTARY INFORMATION: I....

  4. Relationship of Workplace Factors and Job Involvement of Healthcare Employees with Quality of Patient Care in Teaching and Non-teaching Hospitals

    Microsoft Academic Search

    Manisha Agarwal; Abhishek Sharma

    2010-01-01

    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

  5. Making an impact on the hospital environment to improve quality care.

    PubMed

    2003-10-01

    All hospitals and health systems in the country face the same problem: What do they do with the millions of tons of waste they generate each year? This issue of The Quality Letter for Healthcare Leaders reveals what a number of award-winning organizations and individuals are doing to make a difference in the healthcare environment through new and innovative ways while impacting the lives of patients, employees, community members, and future generations. Their methods include eliminating the use of products containing mercury, recycling to creating new consumer products, and reviewing the hazards of pharmaceutical disposal. PMID:14621639

  6. Quality of emergency medical care in Gondar University Referral Hospital, Northwest Ethiopia: a survey of patients’ perspectives

    PubMed Central

    2014-01-01

    Background Ethiopia has fairly good coverage but very low utilization of health care services. Emergency medical care services require fast, correct and curious services to clients as they present with acute problems. In Ethiopia and Gondar in particular, the quality of emergency medical care has not been studied. The main aim of this study was to assess the disease profile and patients’ satisfaction in Gondar University Referral Hospital (GURH). Methods A facility based cross-sectional study was conducted among patients visiting GURH for emergency care. Ethical clearance was obtained from the Institutional Review Board of University of Gondar. Patients were selected by systematic random sampling, using patient flow list in the day and night emergency services. Data were collected using a standard Press Ganey questionnaire by BSc health science graduates. Data were entered in to Epi Info 3.5.3 software and exported to SPSS version 20.0 for windows for analysis. Results A total of 963 patients (response rate?=?96.8%) were studied. The mean (+ s.d.) age of patients was 28.4 (+17.9) years. The overall satisfaction using the mean score indicates that 498 (51.7%) 95%CI: (48.4% - 54.9%) were satisfied with the service, the providers and the facility suitability whereas 465(48.3%) 95%CI: (45.1%- 51.6%) were not satisfied. Seven hundred and six (73.3%) 95%CI: 70.4%-76.1%, patients reported that they have been discriminated or treated badly during the service provision in the hospital. OPD site visited (p?hospital (AOR?=?1.9, 95%CI: 1.1, 3.1), reported discrimination/bad treatment of patients with service (AOR?=?0.4, 95%CI: 0.2, 0.7), were significantly associated determinants of patient satisfaction. Conclusions Non-communicable disease emergencies like injuries and cardiovascular diseases are common. There is a low level of patient satisfaction related to lack of confidence in the hospital for treatment, discrimination towards patient care, and under and delayed treatment of patients who were not in serious medical conditions. Hospitals shall prepare themselves to address the increasing challenge of non-communicable disease emergencies. It is important to revise the service delivery in the emergency department to improve staff courtesy and politeness, commitment, reduce discrimination and bad treatment and proper triage of emergencies at all points of care to increase patient satisfaction giving emphasis to earlier working days. PMID:24456203

  7. Quality care in pediatric trauma

    PubMed Central

    Simpson, Amelia J; Rivara, Frederick P; Pham, Tam N

    2012-01-01

    Infrastructure, processes of care and outcome measurements are the cornerstone of quality care for pediatric trauma. This review aims to evaluate current evidence on system organization and concentration of pediatric expertise in the delivery of pediatric trauma care. It discusses key quality indicators for all phases of care, from pre-hospital to post-discharge recovery. In particular, it highlights the importance of measuring quality of life and psychosocial recovery for the injured child. PMID:23181209

  8. 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 reporting requirements for specific providers and for ambulatory surgical centers. final rule.

    PubMed

    2012-08-31

    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 of 2010 (collectively known as the Affordable Care Act) and other legislation. These changes will be applicable to discharges occurring on or after October 1, 2012, unless otherwise specified in this final rule. We also are updating the rate-of-increase limits for certain hospitals excluded from the IPPS that are paid on a reasonable cost basis subject to these limits. The updated rate-of-increase limits will be effective for cost reporting periods beginning on or after October 1, 2012. We are updating the payment policies and the annual payment rates for the Medicare prospective payment system (PPS) for inpatient hospital services provided by long-term care hospitals (LTCHs) and implementing certain statutory changes made by the Affordable Care Act. Generally, these changes will be applicable to discharges occurring on or after October 1, 2012, unless otherwise specified in this final rule. In addition, we are implementing changes relating to determining a hospital's full-time equivalent (FTE) resident cap for the purpose of graduate medical education (GME) and indirect medical education (IME) payments. We are establishing new requirements or revised requirements for quality reporting by specific providers (acute care hospitals, PPS-exempt cancer hospitals, LTCHs, and inpatient psychiatric facilities (IPFs)) that are participating in Medicare. We also are establishing new administrative, data completeness, and extraordinary circumstance waivers or extension requests requirements, as well as a reconsideration process, for quality reporting by ambulatory surgical centers (ASCs) that are participating in Medicare. We are establishing requirements for the Hospital Value-Based Purchasing (VBP) Program and the Hospital Readmissions Reduction Program. PMID:22937544

  9. Health Care for Black and Poor Hospitalized Medicare Patients

    Microsoft Academic Search

    Marjorie L. Pearson; Ellen R; Katherine A; William H; Robert H. Brook; Emmett B. Keeler

    1994-01-01

    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

  10. Assessment of quality of midwifery care in labour and delivery wards of selected Kordestan Medical Science University hospitals

    Microsoft Academic Search

    Masoumeh Simbar; Farideh Ghafari; Shahnaz Tork Zahrani; Hamid Alavi Majd

    2009-01-01

    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

  11. The effect of soft budget constraints on access and quality in hospital care

    Microsoft Academic Search

    Yu-Chu Shen; Karen Eggleston

    2009-01-01

    Given an increasingly complex web of financial pressures on providers, studies have examined how hospitals’ overall financial\\u000a health affects different aspects of hospital operations. In our study, we develop an empirical proxy for the concept of soft\\u000a budget constraint (SBC, Kornai, Kyklos 39:3–10, 1986) as an alternative financial measure of a hospital’s overall financial\\u000a health and offer an initial estimate

  12. Clinical pathways--an evaluation of its impact on the quality of care in an acute care general hospital in Singapore.

    PubMed

    Cheah, J

    2000-07-01

    A critical or clinical pathway defines the optimal care process, sequencing and timing of interventions by healthcare professionals for a particular diagnosis or procedure. It is a relatively new clinical process improvement tool that has been gaining popularity across hospitals and various healthcare organisations in many parts of the world. It is now slowly gaining momentum and popularity in Asia and Singapore. Clinical pathways are developed through collaborative efforts of clinicians, case managers, nurses, and other allied healthcare professionals with the aim of improving the quality of patient care, while minimising cost to the patient. Clinical pathways have been shown to reduce unnecessary variation in patient care, reduce delays in discharge through more efficient discharge planning, and improve the cost-effectiveness of clinical services. The approach and objectives of clinical pathways are consistent with those of total quality management (TQM) and continuous clinical quality improvement (CQI), and is essentially the application of these principles at the patient's bedside. However, despite the growing popularity of pathways, their impact on clinical outcomes and their clinical effectiveness remains largely untested and unproven through rigorous clinical trials. This paper begins with an overview of the nature of clinical pathways and the analysis of variances from the pathway, their benefits to the healthcare organisation, their application as a tool for CQI activities in direct relation to patient care, and their effectiveness in a variety of healthcare settings. The paper describes an evaluation of the impact of a clinical pathway on the quality of care for patients admitted for uncomplicated acute myocardial infarction (AMI) through an analysis of variances. The author carried out a one year evaluation of a clinical pathway on uncomplicated AMI in Changi General Hospital (CGH) to determine its effectiveness and impact on a defined set of outcomes. A before and after nonrandomized study of two groups of patients admitted to the Hospital for uncomplicated AMI was done. A total of 169 patients were managed on the clinical pathway compared to 100 patients in the control (historical comparison) group. Outcomes were compared between the two groups of patients. Restriction and matching of study subjects in both groups ensured that the patients selected were comparable in terms of severity of illness. The results showed that the patients on the clinical pathway and the comparison group were similar with respect to demographic variables, prevalence of risk factors and comorbidities. There was a statistically significant reduction in the average length of stay after implementation of the clinical pathway. This was achieved without any adverse effect on short term clinical outcomes such as in-hospital mortality, complication rate and morbidity. There were no significant difference in readmission rates at 6 months after discharge. The paper concludes that clinical pathways, implemented in the context of an acute care general hospital, is able to significantly improve care processes through better collaboration among healthcare professionals and improvements in work systems. PMID:11026801

  13. Impact of a statewide intensive care unit quality improvement initiative on hospital mortality and length of stay: retrospective comparative analysis

    PubMed Central

    2011-01-01

    Objective To evaluate whether implementation of the Michigan Keystone ICU project, a comprehensive statewide quality improvement initiative focused on reduction of infections, was associated with reductions in hospital mortality and length of stay for adults aged 65 or more admitted to intensive care units. Design Retrospective comparative study, using data from Medicare claims. Setting Michigan and Midwest region, United States. Population The study period (October 2001 to December 2006) spanned two years before the project was initiated to 22 months after its implementation. The study sample included hospital admissions for patients treated in 95 study hospitals in Michigan (238?937 total admissions) compared with 364 hospitals in the surrounding Midwest region (1?091?547 total admissions). Main outcome measures Hospital mortality and length of hospital stay. Results The overall trajectory of mortality outcomes differed significantly between the two groups upon implementation of the project (Wald test ?2=8.73, P=0.033). Reductions in mortality were significantly greater for the study group than for the comparison group 1-12 months (odds ratio 0.83, 95% confidence interval 0.79 to 0.87 v 0.88, 0.85 to 0.90, P=0.041) and 13-22 months (0.76, 0.72 to 0.81 v 0.84, 0.81 to 0.86, P=0.007) after implementation of the project. The overall trajectory of length of stay did not differ significantly between the groups upon implementation of the project (Wald test ?2=2.05, P=0.560). Group differences in adjusted length of stay compared with baseline did not reach significance during implementation of the project (?0.45 days, 95% confidence interval ?0.62 to ?0.28 v ?0.35, ?0.52 to ?0.19) or during post-implementation months 1-12 (?0.59, ?0.80 to ?0.37 v ?0.42, ?0.59 to ?0.25) and 13-22 (?0.67, ?0.91 to ?0.43 v ?0.54, ?0.72 to ?0.37). Conclusions Implementation of the Keystone ICU project was associated with a significant decrease in hospital mortality in Michigan compared with the surrounding area. The project was not, however, sufficiently powered to show a significant difference in length of stay. PMID:21282262

  14. Criteria for clinical audit of the quality of hospital-based obstetric care in developing countries.

    PubMed Central

    Graham, W.; Wagaarachchi, P.; Penney, G.; McCaw-Binns, A.; Antwi, K. Y.; Hall, M. H.

    2000-01-01

    Improving the quality of obstetric care is an urgent priority in developing countries, where maternal mortality remains high. The feasibility of criterion-based clinical audit of the assessment and management of five major obstetric complications is being studied in Ghana and Jamaica. In order to establish case definitions and clinical audit criteria, a systematic review of the literature was followed by three expert panel meetings. A modified nominal group technique was used to develop consensus among experts on a final set of case definitions and criteria. Five main obstetric complications were selected and definitions were agreed. The literature review led to the identification of 67 criteria, and the panel meetings resulted in the modification and approval of 37 of these for the next stage of audit. Criterion-based audit, which has been devised and tested primarily in industrialized countries, can be adapted and applied where resources are poorer. The selection of audit criteria for such settings requires local expert opinion to be considered in addition to research evidence, so as to ensure that the criteria are realistic in relation to conditions in the field. Practical methods for achieving this are described in the present paper. PMID:10859855

  15. Method to Develop Health Care Peer Groups for Quality and Financial Comparisons Across Hospitals

    PubMed Central

    Byrne, Margaret M; Daw, Christina N; Nelson, Harlan A; Urech, Tracy H; Pietz, Kenneth; Petersen, Laura A

    2009-01-01

    Objective To develop and explore the characteristics of a novel “nearest neighbor” methodology for creating peer groups for health care facilities. Data Sources Data were obtained from the Department of Veterans Affairs (VA) databases. Statistical Methods and Findings Peer groups are developed by first calculating the multidimensional Euclidean distance between each of 133 VA medical centers based on 16 facility characteristics. Each medical center then serves as the center for its own peer group, and the nearest neighbor facilities in terms of Euclidean distance comprise the peer facilities. We explore the attributes and characteristics of the nearest neighbor peer groupings. In addition, we construct standard cluster analysis-derived peer groups and compare the characteristics of groupings from the two methodologies. Conclusions The novel peer group methodology presented here results in groups where each medical center is at the center of its own peer group. Possible advantages over other peer group methodologies are that facilities are never on the “edge” of a group and group size—and thus group dispersion—is determined by the researcher. Peer groups with these characteristics may be more appealing to some researchers and administrators than standard cluster analysis and may thus strengthen organizational buy-in for financial and quality comparisons. PMID:19178585

  16. Investigating organizational quality improvement systems, patient empowerment, organizational culture, professional involvement and the quality of care in European hospitals: the 'Deepening our Understanding of Quality Improvement in Europe (DUQuE)' project

    PubMed Central

    2010-01-01

    Background Hospitals in European countries apply a wide range of quality improvement strategies. Knowledge of the effectiveness of these strategies, implemented as part of an overall hospital quality improvement system, is limited. Methods/Design We propose to study the relationships among organisational quality improvement systems, patient empowerment, organisational culture, professionals' involvement with the quality of hospital care, including clinical effectiveness, patient safety and patient involvement. We will employ a cross-sectional, multi-level study design in which patient-level measurements are nested in hospital departments, which are in turn nested in hospitals in different EU countries. Mixed methods will be used for data collection, measurement and analysis. Hospital/care pathway level constructs that will be assessed include external pressure, hospital governance, quality improvement system, patient empowerment in quality improvement, organisational culture and professional involvement. These constructs will be assessed using questionnaires. Patient-level constructs include clinical effectiveness, patient safety and patient involvement, and will be assessed using audit of patient records, routine data and patient surveys. For the assessment of hospital and pathway level constructs we will collect data from randomly selected hospitals in eight countries. For a sample of hospitals in each country we will carry out additional data collection at patient-level related to four conditions (stroke, acute myocardial infarction, hip fracture and delivery). In addition, structural components of quality improvement systems will be assessed using visits by experienced external assessors. Data analysis will include descriptive statistics and graphical representations and methods for data reduction, classification techniques and psychometric analysis, before moving to bi-variate and multivariate analysis. The latter will be conducted at hospital and multilevel. In addition, we will apply sophisticated methodological elements such as the use of causal diagrams, outcome modelling, double robust estimation and detailed sensitivity analysis or multiple bias analyses to assess the impact of the various sources of bias. Discussion Products of the project will include a catalogue of instruments and tools that can be used to build departmental or hospital quality and safety programme and an appraisal scheme to assess the maturity of the quality improvement system for use by hospitals and by purchasers to contract hospitals. PMID:20868470

  17. Comparing Health Care Quality: A National Directory

    MedlinePLUS

    Comparing Health Care Quality: A National Directory Print Email Measuring and publicly reporting on the care doctors and hospitals provide ... RSS Our mission: to improve the health and health care of all Americans. About RWJF Annual Messages Financials ...

  18. Involvement of patients or their representatives in quality management functions in EU hospitals: implementation and impact on patient-centred care strategies

    PubMed Central

    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; Lívio, 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

    2014-01-01

    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. PMID:24615596

  19. Improving the quality of obstetric care at the teaching hospital, Zaria, Nigeria

    Microsoft Academic Search

    D Ifenne; E Essien; N Golji; K Sabitu; M Alti-Mu'azu; A Musa; V Adidu; M Mukaddas

    1997-01-01

    Preliminary studies: Research at Ahmadu Bello University Teaching Hospital (ABUTH), Zaria, Nigeria, showed delay in treating women with obstetric complications and highlighted multiple contributing factors. Interventions: In response, a surgical theater was restored to working order, the maternity ward renovated, resident physicians trained in obstetrics and an emergency drug pack system instituted. A system of blood donation from families of

  20. Quality of Care is Similar for Safety-Net and Non-Safety-Net Hospitals

    MedlinePLUS

    ... Research Policies Grant Application, Review & Award Process Post-award Grant Management Funding Priorities & ... The U.S. Government's Official Web Portal Agency for Healthcare Research and Quality ...

  1. End-of-Life Care in an Acute Care Hospital: Linking Policy and Practice

    Microsoft Academic Search

    Ros Sorensen; Rick Iedema

    2011-01-01

    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 effective, health

  2. End-of-Life Care in an Acute Care Hospital: Linking Policy and Practice

    ERIC Educational Resources Information Center

    Sorensen, Ros; Iedema, Rick

    2011-01-01

    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…

  3. Policies to improve end-of-life decisions in Flemish hospitals: communication, training of health care providers and use of quality assessments

    PubMed Central

    2009-01-01

    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. PMID:20042090

  4. A quest for quality in home healthcare. A perspective of work in the 6 and 7SOW into the 8SOW: improving acute care hospitalization.

    PubMed

    Burt, Patricia; Pabin, Alina M

    2006-03-01

    This article discusses the effect that the quality improvement organizations (QIOs) have achieved in the home healthcare industry under their contracts with the Centers for Medicare and Medicaid Services (CMS). Specific successes are related to partnerships between QIOs and home health agencies (HHAs) and the future of outcome-based quality improvement (OBQI) in improving acute care hospitalization (ACH). Data are from the OBQI evaluation system and show outcomes for the baseline collection period (May 2001-April 2002) through the remeasurement period (April 2003-July 2004). Data reported are for cardiac care measures that affect ACH. PMID:16531779

  5. Healthcare Equity: Providing Quality Care for

    E-print Network

    Finley Jr., Russell L.

    , especially for minority and low-income groups Overall quality is improving, access is getting worse of diabetes care, maternal and child health care, and adverse events Disparities in cancer care Quality of care among states in the South Evidence Institute on Multicultural Health #12;Figure 2.45. Hospital

  6. Hospital Quality, Efficiency, and Input Slack Differentials

    PubMed Central

    Valdmanis, Vivian G; Rosko, Michael D; Mutter, Ryan L

    2008-01-01

    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. PMID:18783457

  7. Quality of Care

    Cancer.gov

    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.

  8. Paying for the quantity and quality of hospital care: the foundations and evolution of payment policy in England.

    PubMed

    Graši?, Katja; Mason, Anne R; Street, Andrew

    2015-12-01

    Prospective payment arrangements are now the main form of hospital funding in most developed countries. An essential component of such arrangements is the classification system used to differentiate patients according to their expected resource requirements. In this article we describe the evolution and structure of Healthcare Resource Groups (HRGs) in England and the way in which costs are calculated for patients allocated to each HRG. We then describe how payments are made, how policy has evolved to incentivise improvements in quality, and how prospective payment is being applied outside hospital settings. PMID:26062538

  9. Nurses' Reports On Hospital Care In Five Countries

    Microsoft Academic Search

    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

    2001-01-01

    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

  10. Incorporating health care quality into health antitrust law

    Microsoft Academic Search

    Helen Schneider

    2008-01-01

    BACKGROUND: Antitrust authorities treat price as a proxy for hospital quality since health care quality is difficult to observe. As the ability to measure quality improved, more research became necessary to investigate the relationship between hospital market power and patient outcomes. This paper examines the impact of hospital competition on the quality of care as measured by the risk-adjusted mortality

  11. Do competition and managed care improve quality?

    PubMed

    Sari, Nazmi

    2002-10-01

    In recent years, the US health care industry has experienced a rapid growth of managed care, formation of networks, and an integration of hospitals. This paper provides new insights about the quality consequences of this dynamic in US hospital markets. I empirically investigate the impact of managed care and hospital competition on quality using in-hospital complications as quality measures. I use random and fixed effects, and instrumental variable fixed effect models using hospital panel data from up to 16 states in the 1992-1997 period. The paper has two important findings: First, higher managed care penetration increases the quality, when inappropriate utilization, wound infections and adverse/iatrogenic complications are used as quality indicators. For other complication categories, coefficient estimates are statistically insignificant. These findings do not support the straightforward view that increases in managed care penetration are associated with decreases in quality. Second, both higher hospital market share and market concentration are associated with lower quality of care. Hospital mergers have undesirable quality consequences. Appropriate antitrust policies towards mergers should consider not only price and cost but also quality impacts. PMID:12369060

  12. Quality and performance improvement in critical care

    PubMed Central

    Chelluri, Lakshmi P.

    2008-01-01

    In the past decade, there is an increased focus on quality and safety in health care. Decreasing variation, increasing adherence to evidence based guidelines, monitoring processes, and measuring outcomes are critical for improving quality of care. Intensivists have broad knowledge of hospital organization, and need to be leaders in quality improvement efforts. PMID:19742245

  13. [An existential health care approach in hospital psychiatric nursing].

    PubMed

    Furlan, Marcela Martins; Ribeiro, Cléa Regina de Oliveira

    2011-04-01

    The focus of Mental Health Care in Brazil has been on community psychiatric care services that replace the asylum model. However, individuals with mental disorders continue to shift between community services and psychiatric hospitals, besides becoming a target of the disciplinarization and violence that question the quality of the nursing care being delivered. The objective of this study is to understand the ontology of nursing care in psychiatric hospitalization. Participants were four individuals with mental disorders who attended a center for psychosocial care, who agreed to talk about their psychiatric hospitalization experience by means of a semi-directed interview. The subjects remembered about their psychiatric hospitalization and assigned meanings to it. Heidegger's Existential Analysis was used, and thus generated the Meaning Unit: Being-in-the-world cared with impersonality; which allowed to unveil the phenomenon through Dasein's structure, and thus made it possible to outline the ontological care in nursing in psychiatric hospitals. PMID:21655789

  14. Electronic nursing documentation in a paediatrics hospital: impact on quality of care by using OpenEHR, IHE and HL7.

    PubMed

    Oštir, Majda; Purkart, Marinka; Stih, Anita; Prin?i?, Biljana; Orel, Andrej

    2012-01-01

    The acuity of illness of sick children requiring care in hospital is increasing. There are many more children now with disabilities and complicated long term illnesses. Respiratory illness is the commonest cause of morbidity in young children. Nurses have a pivotal role in the anticipation of and/or early identification of the sick child with potential or actual respiratory failure through the assessment and measurement of the child's pattern of breathing, including rate, rhythm and effort. It should also be conducted and interpreted in association with other clinical assessments, for example cardiovascular. Record keeping is an essential part of nursing care because it details the patient journey through the healthcare process. Good quality record keeping can improve the quality of patient care and for this reason nurses must seek to ensure that their documentation practices meet high standards. Poor standards of documentation were a contributory factor in the failure to detect patients who were clinically deteriorating. In this article we searched for evidence whether electronic health records has positive impact on quality of nursing care and present our experiences with electronic nursing documentation in the field of respiratory assessment of the children and young people. PMID:22874358

  15. Measuring the quality of medical care for women who experience sexual assault with data from the National Hospital Ambulatory Medical Care Survey

    Microsoft Academic Search

    Annette L. Amey; David Bishai

    2002-01-01

    Study Objective: We provide new descriptive epidemiology on the demography and quality of care of women who experience sexual assault. Two limited aspects of emergency department treatment received by women who have experienced sexual assault are examined: (1) administration of emergency contraception to prevent pregnancy and (2) screening and treatment for sexually transmitted diseases (STDs). Methods: A nationally representative survey

  16. Do variations in hospital mortality patterns after weekend admission reflect reduced quality of care or different patient cohorts? A population-based study

    PubMed Central

    Concha, Oscar Perez; Gallego, Blanca; Hillman, Ken; Delaney, Geoff P; Coiera, Enrico

    2014-01-01

    Background Proposed causes for increased mortality following weekend admission (the ‘weekend effect’) include poorer quality of care and sicker patients. The aim of this study was to analyse the 7?days post-admission time patterns of excess mortality following weekend admission to identify whether distinct patterns exist for patients depending upon the relative contribution of poorer quality of care (care effect) or a case selection bias for patients presenting on weekends (patient effect). Methods Emergency department admissions to all 501 hospitals in New South Wales, Australia, between 2000 and 2007 were linked to the Death Registry and analysed. There were a total of 3?381?962 admissions for 539?122 patients and 64?789 deaths at 1?week after admission. We computed excess mortality risk curves for weekend over weekday admissions, adjusting for age, sex, comorbidity (Charlson index) and diagnostic group. Results Weekends accounted for 27% of all admissions (917?257/3?381?962) and 28% of deaths (18?282/64?789). Sixteen of 430 diagnosis groups had a significantly increased risk of death following weekend admission. They accounted for 40% of all deaths, and demonstrated different temporal excess mortality risk patterns: early care effect (cardiac arrest); care effect washout (eg, pulmonary embolism); patient effect (eg, cancer admissions) and mixed (eg, stroke). Conclusions The excess mortality patterns of the weekend effect vary widely for different diagnostic groups. Recognising these different patterns should help identify at-risk diagnoses where quality of care can be improved in order to minimise the excess mortality associated with weekend admission. PMID:24163392

  17. Screening for inter-hospital differences in cesarean section rates in low-risk deliveries using administrative data: An initiative to improve the quality of care

    Microsoft Academic Search

    Willem Aelvoet; Francis Windey; Geert Molenberghs; Hans Verstraelen; Patrick Van Reempts; Jean-Michel Foidart

    2008-01-01

    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

  18. On measuring the hospital cost|quality trade-off

    Microsoft Academic Search

    Kathleen Carey; James F. Burgess

    1999-01-01

    This paper explores the relationship between cost and quality of hospital care. A total operating cost function is estimated for 137 US Department of Veterans Affairs hospitals for 1988-1993 using three rate-based measures of quality as regressors. The high likelihood of the existence of measurement error in quality in the cross section leads to the application of novel instrumental variable

  19. [Emergency care at the hospital].

    PubMed

    Larcan, A

    1991-03-01

    Emergencies are very diversified: clinical setting, age, sex, circumstances, medicine, surgery, psychiatry, specialties. The admission into the specific departments depends on geographical, demographical features (distances to be covered...). They are theoretically unscheduled but sometimes out-hospital messages can be sent to improve the reception or to decide a very short circuit. Emergency rooms exist in most hospitals and are not so often appropriate. Emergency reception requires a place and a technical assistance where to get in touch with and to perform as quick as possible the formalities, first diagnosis and first aid procedures and orientation to the appropriate department. As a main frame in the network of assistance and care, emergency department ought to be a unique place with multiple disciplines (medicine, surgery, psychiatry), where universal first aid technical assistance and unified working would open to al hospital departments or a piece of hospitals. This structure relies on well dispatched areas, with easy ways, many examinations, simultaneous actions, urgent complementary tests and families reception. A hospital, practitioner must be in charge, whom speciality deals with emergency. Staff must include on-call doctors who can be helped by at-home physicians and many competent paramedics: nurses, health workers, stretcher-bearers, X-ray handlers, drivers, operators, secretaries, social workers, hostesses... Specific arrangements must be taken for special X-rays, biology and hospital reception of medico-surgical, obstetrical, psychiatric, social, medico-legal and medico-judicial emergencies. Running of that structure, mainly facing severe emergencies, must go together with out-hospital medical advises, patients admission for some time or a brief relief (control and social cases). In all cases, connection between out-hospital set-ups, various medical sittings and hospitals in the main goal which must be achieved with the S.A.M.U. Emergency medicine is universal, sequential, discontinuous with a social aspect open to a town or a district. If someone wants to be technically irreproachable, he needs to get together most of the existent structures to have a performant material and as much and efficient staff as possible. PMID:1933461

  20. Controlling for quality in the hospital cost function

    Microsoft Academic Search

    Kathleen Carey; Theodore Stefos

    2011-01-01

    This paper explores the relationship between the cost and quality of hospital care from the perspective of applied microeconomics.\\u000a It addresses both theoretical and practical complexities entailed in incorporating hospital quality into the estimation of\\u000a hospital cost functions. That literature is extended with an empirical analysis that examines the use of 15 Patient Safety\\u000a Indicators (PSIs) as measures of hospital

  1. Continuous quality improvement, total quality management, and reengineering: one hospital's continuous quality improvement journey.

    PubMed

    Klein, D; Motwani, J; Cole, B

    1998-01-01

    In recent years, there has been significantly increasing interest in the application of continuous quality improvement (CQI) and total quality management (TQM) in the health care arena. This case analysis is designed to identify and assess the strategies and processes that led to the successful implementation of CQI in the Emergency Care Center at St. Mary's Hospital in Grand Rapids, MI. PMID:9735478

  2. Supply chain automation and the effects on clinician satisfaction and patient care quality in the hospital setting

    E-print Network

    Xie, Yue, M. Eng. Massachusetts Institute of Technology

    2006-01-01

    The healthcare industry, more specifically hospitals, has in recent times been experiencing a steady rise in nursing shortages and cost pressures. To offset these problems hospitals have increasingly relied upon supply ...

  3. [Hospitalization and assessment of nursing care].

    PubMed

    da Silva, João Fernandes

    2007-01-01

    The purpose is to promote the reflection concerning the family role and the evidence of nursing practice, in hospital discharge of the elderly patient. In the settings where elderly patients prevail, the family must be valorised as a partner to guarantee the continuity of care when they return home. A communication strategy concerning what the meaning of being a nurse is and what she/he does, can contribute to unveil the role of nursing in the promotion of health and the quality of life of patients and their families. PMID:17824409

  4. Health care professional staffing, hospital characteristics, and hospital mortality rates.

    PubMed

    Bond, C A; Raehl, C L; Pitterle, M E; Franke, T

    1999-02-01

    To evaluate associations among hospital characteristics, staffing levels of health care professionals, and mortality rates in 3763 United States hospitals, a data base was constructed from the American Hospital Association's Abridged Guide to the Health Care Field and hospital Medicare mortality rates from the Health Care Financing Administration. A multivariate regression analysis controlling for severity of illness was employed to determine the associations. Hospital characteristics associated with lower mortality were occupancy rate and private nonprofit and private for-profit ownership. Mortality rates decreased as staffing level per occupied bed increased for medical residents, registered nurses, registered pharmacists, medical technologists, and total hospital personnel. Mortality rates increased as staffing level per occupied bed increased for hospital administrators and licensed practical-vocational nurses. To our knowledge, this is the first study to show that pharmacists were associated with lower mortality rates. PMID:10030762

  5. Hospital value-based purchasing (VBP) program: measurement of quality and enforcement of quality improvement.

    PubMed

    Szablowski, Katarzyna M

    2014-01-01

    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

  6. Quality of life outcomes after intensive care

    Microsoft Academic Search

    R. Brooks; R. Kerridge; K. Hillman; A. Bauman; K. Daffurn

    1997-01-01

    Objective: Compare the health related quality of life of intensive care patients with a community sample. Design: Self-completed questionnaire posted to a consecutive sample of 238 patients 16 months after discharge from an intensive\\u000a care unit (ICU) and to a random community sample (n = 242). Setting: The Liverpool Hospital is the main referral and teaching hospital in a community

  7. JAMA Patient Page: Quality of Care

    MedlinePLUS

    ... professionals, as well as institutions (such as hospitals, nursing homes, mental health centers, and home health care agencies). Part of providing quality health care involves following standards, guidelines, and evidence-based practices. Evidence-based medicine involves using results from research ...

  8. 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

    Microsoft Academic Search

    JoAnne Micale Foody; Saif S Rathore; Yongfei Wang; Jeph Herrin; Frederick A Masoudi; Edward P Havranek; Martha J Radford; Harlan M Krumholz

    2004-01-01

    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.

  9. Hospitalization of older adults due to ambulatory care sensitive conditions

    PubMed Central

    Marques, Aline Pinto; Montilla, Dalia Elena Romero; de Almeida, Wanessa da Silva; de Andrade, Carla Lourenço Tavares

    2014-01-01

    OBJECTIVE To analyze the temporal evolution of the hospitalization of older adults due to ambulatory care sensitive conditions according to their structure, magnitude and causes. METHODS Cross-sectional study based on data from the Hospital Information System of the Brazilian Unified Health System and from the Primary Care Information System, referring to people aged 60 to 74 years living in the state of Rio de Janeiro, Souhteastern Brazil. The proportion and rate of hospitalizations due to ambulatory care sensitive conditions were calculated, both the global rate and, according to diagnoses, the most prevalent ones. The coverage of the Family Health Strategy and the number of medical consultations attended by older adults in primary care were estimated. To analyze the indicators’ impact on hospitalizations, a linear correlation test was used. RESULTS We found an intense reduction in hospitalizations due to ambulatory care sensitive conditions for all causes and age groups. Heart failure, cerebrovascular diseases and chronic obstructive pulmonary diseases concentrated 50.0% of the hospitalizations. Adults older than 69 years had a higher risk of hospitalization due to one of these causes. We observed a higher risk of hospitalization among men. A negative correlation was found between the hospitalizations and the indicators of access to primary care. CONCLUSIONS Primary healthcare in the state of Rio de Janeiro has been significantly impacting the hospital morbidity of the older population. Studies of hospitalizations due to ambulatory care sensitive conditions can aid the identification of the main causes that are sensitive to the intervention of the health services, in order to indicate which actions are more effective to reduce hospitalizations and to increase the population’s quality of life. PMID:25372173

  10. Transitional Care Strategies From Hospital to Home

    PubMed Central

    Ranji, Sumant R.

    2015-01-01

    Hospitals are challenged with reevaluating their hospital’s transitional care practices, to reduce 30-day readmission rates, prevent adverse events, and ensure a safe transition of patients from hospital to home. Despite the increasing attention to transitional care, there are few published studies that have shown significant reductions in readmission rates, particularly for patients with stroke and other neurologic diagnoses. Successful hospital-initiated transitional care programs include a “bridging” strategy with both predischarge and postdischarge interventions and dedicated transitions provider involved at multiple points in time. Although multicomponent strategies including patient engagement, use of a dedicated transition provider, and facilitation of communication with outpatient providers require time and resources, there is evidence that neurohospitalists can implement a transitional care program with the aim of improving patient safety across the continuum of care. PMID:25553228

  11. Keys for successful implementation of total quality management in hospitals.

    PubMed

    Carman, James M; Shortell, Stephen M; Foster, Richard W; Hughes, Edward F X; Boerstler, Heidi; O' Brien, James L; O'Connor, Edward J

    2010-01-01

    Editor's Note: This article reports the findings of an analysis of the implementation of continuous quality improvement (CQI) or total quality management (TQM) programs in 10 hospitals. This analysis is the result of a 2-year study designed to identify and assess the ingredients that lead to the successful implementation of CQI programs in acute care hospitals. This article first appeared in Health Care Management Review 21(1), 48-60. Copyright © 1996 Aspen Publishers, Inc. (Lippincott Williams & Wilkins). PMID:20844354

  12. Coordination between a district hospital and a reference hospital: evaluation of chest disease care models.

    PubMed

    Verea-Hernando, Héctor; Valdés-Cuadrado, Luis; López-Campos, José María; Fandiño-Orgeira, José; Blanco-Ramos, Manuel

    2011-06-01

    Specialised medical care at district hospitals has not been thoroughly defined. Respiratory care data from 2008 in Barbanza and Cee hospitals (Galicia, Spain), were analysed to evaluate different approaches, as they are both similar. Barbanza hospital has a chest diseases clinic run by specialist doctors from the reference hospital three days per week, while Cee hospital is operated by the staff on site. In both cases hospitalisation is the responsibility of the Internal Medicine department. Data was provided by the administrative departments of each hospital and the regional government. Average CDM4 stays were similar for both district hospitals; however, they were lower than in the reference hospital. Charlson scores and re-admissions a month after discharge were similar in both. Barbanza's hospital carried out more functional explorations, both at the centre (957 spirometries vs 21; P<.0001) and at the reference hospital (214 volume/diffusion tests vs 99; P<.001). CPAP treatments were more prevalent in the Barbanza area (3.9 vs 2/1,000 habitants; P<.0001). No differences were found in oxygen therapy and home mechanical ventilation. Mortality due to respiratory disease in 2007 was similar in both regions. Data suggests that in a district hospital scheme supported by chest disease consultants and outpatient clinics gives easier access to specialised, comprehensive and probably, higher quality care than district hospitals without them. PMID:21492983

  13. Hospital financing and neonatal intensive care.

    PubMed Central

    Glied, S A; Gnanasekaran, S

    1996-01-01

    OBJECTIVE: To investigate the relationship between hospital financing patterns and hospital resources for the care of babies born at low birthweight in New York City. DATA SOURCES AND STUDY SETTING: Data on neonatal care beds in New York City hospitals for 1991, obtained from the Greater New York Hospital Association, which were matched to 1991 hospital-specific birthweight and payment distributions from the New York State Department of Health. STUDY DESIGN: Statistical analyses were used to assess the relationship between insurance and beds across all hospitals and across hospitals classified by ownership and teaching status. PRINCIPAL FINDINGS: After adjusting for low birthweight and other measures of patient need and for hospital affiliation, the study finds that hospitals with more privately insured patients, especially those with more privately insured low-birthweight newborns, have statistically significantly more neonatal intensive care beds than do those with fewer such patients. This result persists within hospital affiliation categories. CONCLUSIONS: These results suggest that differences in the care received by privately insured, Medicaid insured, and uninsured low-birthweight babies may stem from differences in the resources available to the hospitals that treat these patients. PMID:8943992

  14. Demand, selection and patient outcomes in German acute care hospitals.

    PubMed

    Schwierz, Christoph; Augurzky, Boris; Focke, Axel; Wasem, Jürgen

    2012-03-01

    This paper examines the effects of variation in unexpected demand on patient outcomes in acute care German hospitals. Naturally, an unexpected surge in demand may negatively affect the quality of care and thus patient outcomes, such as in-hospital mortality. We estimate models explaining patient outcomes depending on demand, unobservable patient selection and seasonal factors, as well as patient-specific risk factors and unobservable hospital and department fixed-effects. The main message of this analysis is that hospitals are well prepared to deal with this unexpected volatility in demand, as by and large it does not negatively affect patient outcomes. Hospitals seem to deal with high unexpected workload by steering the patients' length of stay relating to their severity of illness. Elective patients are discharged earlier, while discharges of high-risk emergency patients are postponed. PMID:21294219

  15. Observational study on patient's satisfactions and quality of life (QoL) among cancer patients receiving treatment with palliative care intent in a tertiary hospital in Malaysia.

    PubMed

    Sharifa Ezat, Wan Puteh; Fuad, Ismail; Hayati, Yaakub; Zafar, Ahmed; Wanda Kiyah, George Albert

    2014-01-01

    The main objective of palliative treatment for cancer patients has been to maintain, if not improve, the quality of life (QoL). There is a lack of local data on satisfaction and QoL among cancer patients receiving palliative treatment in Malaysia. This study covers patients with incurable, progressive cancer disease receiving palliative treatment in a teaching hospital in Kuala Lumpur, comparing the different components of QoL and correlations with patient satisfaction. A cross-sectional survey using Malay validated SF36 QoL and PSQ-18 (Short Form) tools was carried out between July 2012 -January 2013 with 120 cancer patients receiving palliative treatment, recruited into the study after informed consent using convenient sampling. Results showed that highest satisfaction were observed in Communication Aspect (50.6±9.07) and the least in General Satisfaction (26.4±5.90). The Mental Component Summary (44.9±6.84) scored higher when compared with the Physical Component Summary (42.2±7.91). In this study, we found that patient satisfaction was strongly associated with good quality of life among cancer patients from a general satisfaction aspect (r=0.232). A poor significant negative correlation was found in Physical Component (technical quality, r=-0.312). The Mental Component showed there was a poor negative correlation between time spent with doctor (r=-0.192) and accessibility, (r=-0.279). We found that feeling at peace and having a sense of meaning in life were more important to patients than being active or achieving good physical comfort. More studyis needed to investigate patients who score poorly on physical and mental component aspects to understand their needs in order to achieve better cancer care. PMID:24568481

  16. Organization of Care for Acute Myocardial Infarction in Rural and Urban Hospitals in Kansas

    ERIC Educational Resources Information Center

    Ellerbeck, Edward F.; Bhimaraj, Arvind; Perpich, Denise

    2004-01-01

    One in 4 Americans lives in a rural community and relies on rural hospitals and medical systems for emergent care of acute myocardial infarctions (AMI). The infrastructure and organization of AMI care in rural and urban Kansas hospitals was examined. Using a nominal group process, key elements within hospitals that might influence quality of AMI…

  17. Issues in quality of high-tech home care: sources of information and staff training in Quebec primary care organizations and relationships with hospitals

    Microsoft Academic Search

    P. Lehoux; R. Pineault; L. Richard; J. St-Arnaud; S. Law; H. Rosendal

    2003-01-01

    This study examined the provision of high-tech home care by Quebec primary care organizations (CLSCs). Four technologies were selected: IV antibiotic therapy, oxygen therapy, parenteral nutrition, and peritoneal dialysis. A postal survey was sent to all CLSCs and a response rate of 69 percent was obtained; 57 percent of CLSCs have been involved in the provision of services related to

  18. Global Initiatives for Improving Hospital Care for Children: State of the Art and Future Prospects

    Microsoft Academic Search

    Harry Campbell; Mike English; Susanne Carai; Giorgio Tamburlini; Burlo Garofolo

    Deficiencies in the quality of health care are major limiting factors to the achievement of the Millennium Development Goals for child and maternal health. Quality of patient care in hospitals is firmly on the agendas of Western countries but has been slower to gain traction in developing countries, despite evidence that there is substantial scope for improvement, that hospitals have

  19. Changes in hospital quality after conversion in ownership status.

    PubMed

    Farsi, Mehdi

    2004-09-01

    This paper examines the effects of conversions between For-Profit and Not-For-Profit forms on quality of medical care in California hospitals. The sample includes elderly patients treated in California's private hospitals from 1990 to 1998 for Acute Myocardial Infarction and Congestive Heart Failure. The results suggest that converted hospitals have experienced quality changes before conversion and that ignoring these changes may bias the estimates of conversion effects. Both conversions are found to have some adverse consequences: Hospitals that converted to FP form show an increase in AMI mortality rates, while those converted to NFP status indicate an increase in CHF mortality outcomes. PMID:15277779

  20. Care pathways across the primary-hospital care continuum: using the multi-level framework in explaining care coordination

    PubMed Central

    2013-01-01

    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. PMID:23919518

  1. A new framework for quality partnerships in Children's Hospitals.

    PubMed

    Levy, Fiona Howard; Brilli, Richard J; First, Lewis R; Hyman, Daniel; Kohrt, Alan E; Ludwig, Stephen; Miles, Paul V; Saffer, Marian

    2011-06-01

    Children's hospitals and their affiliated departments of pediatrics often pursue separate programs in quality and safety; by integrating these programs, they can accelerate progress. Hospital executives and pediatric department chairs from 14 children's hospitals have been exploring practical approaches for integrating quality programs. Three components provide focus: (1) alignment of quality priorities and resources across the organizations; (2) education and training for physicians in the science of improvement; and (3) professional development and career progression for physicians in recognition of quality-improvement activities. Process and resource requirements are identified for each component, and specific, actionable steps are identified. The action steps are arrayed on a continuum from basic to advanced integration. The resulting matrix serves as an "integration framework," useful to a hospital and its pediatric academic department at any stage of integration for assessing its current state, plotting a path toward further integration, tracking its progress, and identifying potential collaborators and models of advanced integration. The framework contributes to health care's quality-improvement movement in multiple ways: it addresses a basic impediment to quality and safety improvement; it is an implementable model for integrating quality programs; it offers career-advancement potential for physicians interested in quality; it helps optimize investments in quality and safety; and it can be applied both within a single children's hospital and across multiple children's hospitals. Widespread adoption of the integration framework could have a transformative effect on the children's hospital sector, not the least of which is improved quality and safety on a large scale. PMID:21576310

  2. Dutch hospitals provide reliable "one click" patient information using a Quality Window.

    PubMed

    Van Rooy, Yvonne

    2014-01-01

    In 2014, the Dutch Association of Hospitals (Nederlandse Vereniging van Ziekenhuizen, NVZ) launched the "Quality Window" at general hospitals across the Netherlands. The Quality Window is an online platform for patients which shares a hospital's current and previous scores on ten quality indicators, from patient experience to employee satisfaction. The Quality Window therefore responds to the growing demand for information and transparency when it comes to hospital care and performance. Not only can patients access helpful information about a hospital's quality through the Quality Window, they can also compare results with other hospitals, the national average, and more. Many hospitals also take the opportunity to expand on how indicators work in practice and the actions being taken towards improvement. The Quality Window was developed with the help of hospitals and patients. Over the coming years it will be expanded to university hospitals across the country. General hospitals will also begin developing Quality Windows for specific patient groups, such as cancer patients. PMID:25985551

  3. Personalizing Care: Integration of Hospital and Homecare

    Microsoft Academic Search

    Isabel Román; Jorge Calvillo; Laura M. Roa

    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

  4. Patient Experience Shows Little Relationship with Hospital Quality Management Strategies

    PubMed Central

    Groene, Oliver; Arah, Onyebuchi A.; Klazinga, Niek S.; Wagner, Cordula; Bartels, Paul D.; Kristensen, Solvejg; Saillour, Florence; Thompson, Andrew; Thompson, Caroline A.; Pfaff, Holger; DerSarkissian, Maral; Sunol, Rosa

    2015-01-01

    Objectives Patient-reported experience measures are increasingly being used to routinely monitor the quality of care. With the increasing attention on such measures, hospital managers seek ways to systematically improve patient experience across hospital departments, in particular where outcomes are used for public reporting or reimbursement. However, it is currently unclear whether hospitals with more mature quality management systems or stronger focus on patient involvement and patient-centered care strategies perform better on patient-reported experience. We assessed the effect of such strategies on a range of patient-reported experience measures. Materials and Methods We employed a cross-sectional, multi-level study design randomly recruiting hospitals from the Czech Republic, France, Germany, Poland, Portugal, Spain, and Turkey between May 2011 and January 2012. Each hospital contributed patient level data for four conditions/pathways: acute myocardial infarction, stroke, hip fracture and deliveries. The outcome variables in this study were a set of patient-reported experience measures including a generic 6-item measure of patient experience (NORPEQ), a 3-item measure of patient-perceived discharge preparation (Health Care Transition Measure) and two single item measures of perceived involvement in care and hospital recommendation. Predictor variables included three hospital management strategies: maturity of the hospital quality management system, patient involvement in quality management functions and patient-centered care strategies. We used directed acyclic graphs to detail and guide the modeling of the complex relationships between predictor variables and outcome variables, and fitted multivariable linear mixed models with random intercept by hospital, and adjusted for fixed effects at the country level, hospital level and patient level. Results Overall, 74 hospitals and 276 hospital departments contributed data on 6,536 patients to this study (acute myocardial infarction n = 1,379, hip fracture n = 1,503, deliveries n = 2,088, stroke n = 1,566). Patients admitted for hip fracture and stroke had the lowest scores across the four patient-reported experience measures throughout. Patients admitted after acute myocardial infarction reported highest scores on patient experience and hospital recommendation; women after delivery reported highest scores for patient involvement and health care transition. We found no substantial associations between hospital-wide quality management strategies, patient involvement in quality management, or patient-centered care strategies with any of the patient-reported experience measures. Conclusion This is the largest study so far to assess the complex relationship between quality management strategies and patient experience with care. Our findings suggest absence of and wide variations in the institutionalization of strategies to engage patients in quality management, or implement strategies to improve patient-centeredness of care. Seemingly counterintuitive inverse associations could be capturing a scenario where hospitals with poorer quality management were beginning to improve their patient experience. The former suggests that patient-centered care is not yet sufficiently integrated in quality management, while the latter warrants a nuanced assessment of the motivation and impact of involving patients in the design and assessment of services. PMID:26151864

  5. A Framework for the Production and Analysis of Hospital Quality Indicators

    Microsoft Academic Search

    Alberto Freitas; Tiago Costa; Bernardo Marques; Juliano Gaspar; Jorge Gomes; Fernando Lopes; Isabel Lema

    \\u000a Quality indicators are fundamental to health care managers as they can give valuable insight into how care is being delivered.\\u000a Quality indicators are measures of health care quality that can make use of readily available hospital administrative data\\u000a (e.g. inpatient data). This paper describes the development of a framework for the production and analysis of hospital quality\\u000a indicators. The framework

  6. National Hospital Ambulatory Medical Care Survey (NHAMCS)

    NSDL National Science Digital Library

    The National Center for Health Statistics (NCHS) released public-use data files for the 1997 National Hospital Ambulatory Medical Care Survey (NHAMCS). The NHAMCS "collect[s] data on the utilization and provision of ambulatory care services in hospital emergency and outpatient departments." The Website for the survey describes methodology and data, provides technical documentation for accessing and manipulating the data, and links users to related reports. The data and documentation for the survey may be downloaded from the Website or from the NCHS FTP server.

  7. Managed care's price bargaining with hospitals.

    PubMed

    Wu, Vivian Y

    2009-03-01

    Research has shown that managed care (MC) slowed the rate of growth in health care spending in the 1990s, primarily via lower unit prices paid. However, the mechanism of MC's price bargaining has not been well studied. This article uses a unique panel dataset with actual hospital prices in Massachusetts between 1994 and 2000 to examine the sources of MC's bargaining power. I find two significant determinants of price discounts. First, plans with large memberships are able to extract volume discounts across hospitals. Second, health plans that are more successful at channeling patients can extract greater discounts. Patient channeling can add to the volume discount that plans negotiate. PMID:19108922

  8. 75 FR 31118 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-06-02

    ...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 &...

  9. HOSPITAL PERFORMANCE IMPROVEMENT: TRENDS IN QUALITY AND EFFICIENCY A QUANTITATIVE ANALYSIS OF PERFORMANCE IMPROVEMENT IN U.S. HOSPITALS

    Microsoft Academic Search

    Eugene A. Kroch; Michael Duan; Sharon Silow-Carroll; Jack A. Meyer

    This report presents results of a quantitative examination of the dynamics of hospital performance: the degree to which hospitals are improving (or deteriorating) in quality and efficiency over time. Results indicate significant improvements across hospitals in reducing mortality and increasing efficiency over 2001-2005, with mixed results in complication and morbidity rates. Reduced mortality is likely due to improvements in care,

  10. Proceed with care. Hospital board fiduciary responsibilities.

    PubMed

    Burns, L P

    1997-01-01

    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

  11. 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

    PubMed Central

    Iloh, GUP; Ofoedu, JN; Njoku, PU; Okafor, GOC; Amadi, AN; Godswill-Uko, EU

    2013-01-01

    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. PMID:23634326

  12. This is a test. Exams for governance boards on quality measures could be a way to improve care, accountability in hospitals.

    PubMed

    Evans, Melanie

    2009-11-16

    Hospital board members have little or no training on quality or safety issues and a spotty record of oversight in those areas, a new study published by Health Affairs has found. Many are convinced that boards have a big role to play in improving quality and safety, and that by focusing on those issues, they can spark change. "I think it's a question of calling it out. It's all laid out and everybody sees it", says former MedStar Chairman E. F. Shaw Wilgis, left. PMID:20050231

  13. Impact of quality strategies on hospital outputs

    Microsoft Academic Search

    R. Suñol; P. Vallejo; A. Thompson; M. J. M. H. Lombarts; C. D. Shaw; N. Klazinga

    2009-01-01

    Context:This study was part of the Methods of Assessing Response to Quality Improvement Strategies (MARQuIS) research project on patients crossing borders, a study to investigate quality improvement strategies in healthcare systems across the European Union (EU).Aim:To explore the association between the implementation of quality improvement strategies in hospitals and hospitals’ success in meeting defined quality requirements that are considered intermediate

  14. Assessing the effect of increased managed care on hospitals.

    PubMed

    Mowll, C A

    1998-01-01

    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

  15. [Quality management--quo vadis? Perspectives for quality management in hospitals].

    PubMed

    Eckert, Hans; Resch, Karl-Ludwig

    2003-06-01

    Since January 1, 2000 licensed acute care hospitals as well as prevention and rehabilitation hospitals are under legal obligation to implement an internal quality management system. Uncertainty remains, though, about the minimal standards required for these quality systems and which requirements hospitals will have to meet in terms of quality assurance and transparency. The respective provisions of the German Book V of Social Security Code do not define such measures, but leave it to a joint commission of providers and purchasers to agree on fundamental standards and general conditions. This paper aims to outline the development of standards of quality systems for hospitals in the Federal Republic of Germany, considering current trends and tendencies in health care on the basis of legal preconditions, government initiatives and activities of the self-government bodies. PMID:12856550

  16. Hospitals and managed care: catching up with the networks.

    PubMed

    Buckanavage, S R; Lyons, T J

    1997-02-01

    Although the growth of managed care is having a significant impact on hospitals, organizational response to managed care remains fragmented. We conducted a survey of 83 hospitals nationwide that indicated that most hospitals now have at least one person devoted to managed care initiatives. These individuals, however, often spend most of their time on current issues, such as contracting with managed care organizations and physician relations. Concerns for the future, such as network development and marketing, although important, receive less immediate attention form these individuals. Hospital managed care executives must take a more proactive role in long range managed care planning by collaborating with managed care organizations and pharmaceutical companies. PMID:10169264

  17. Discharge phone calls: a technique to improve patient care during the transition from hospital to home.

    PubMed

    Schuller, Kristin A; Lin, Szu-Hsuan; Gamm, Larry D; Edwardson, Nicholas

    2015-01-01

    The discharge process is a transitional period when the patient's care is shifted from the hospital to the home and can be stressful for patients. One technique used to improve the quality and continuity of care is the discharge phone call (DPC). A large, metropolitan hospital implemented the DPC program to improve quality of care and decrease readmission rates. Qualitative interviews were performed with 24 hospital leaders, managers, and staff to determine the impact of the DPC program on the quality of care during the discharge process. Interviewees responded that the main benefits to the DPCs related to patient's medication management, follow-up appointment reminders, and answering questions. From a hospital perspective, the DPC can provide feedback to help improve the care delivery process related to discharge planning through improved discharge instructions and reinforcement of prescribed steps upon the patient's return home. PMID:24102704

  18. Evaluating implementation of quality management systems in a teaching hospital's clinical departments

    Microsoft Academic Search

    PATRICE FRANCOIS; JEAN-CLAUDE PEYRIN; MURIEL TOUBOUL; THOMAS REVERDY; DOMINIQUE VINCK

    2003-01-01

    Objectives. This study evaluated a strategy for implementing continuous quality improvement based on a decentralized quality management system in the clinical departments of a hospital. Setting. The institution is a 2000-bed teaching hospital of tertiary health care employing 8000 people. Methods. The quality management intervention was tested in six volunteer departments. This intervention comprised an instructional seminar, methodological assistance, and

  19. Total quality in health care.

    PubMed

    Brannan, K M

    1998-05-01

    Quality is at the top of American consumers' demand list, and consequently American manufacturing companies have been forced to assign priority to the development of high-quality products. To improve the quality of what they offer, many manufacturers use the management philosophy known as total quality management (TQM), and now the service sector is following in their footsteps. The health care industry is a good example of a service industry that can benefit greatly from TQM, and it is the purpose of this article to show how a health care provider can implement TQM and evaluate its effects. PMID:10178544

  20. Effectiveness of self-management interventions on mortality, hospital readmissions, chronic heart failure hospitalization rate and quality of life in patients with chronic heart failure: A systematic review

    Microsoft Academic Search

    Joanne B. Ditewig; Helene Blok; Jeroen Havers; Haske van Veenendaal

    2010-01-01

    ObjectiveThis review examined the effectiveness of self-management interventions compared to usual care on mortality, all-cause hospital readmissions, chronic heart failure hospitalization rate and quality of life in patients with chronic heart failure.

  1. Helping You Choose Quality Behavioral Health Care

    MedlinePLUS

    Helping You Choose Quality Behavioral Health Care Selecting quality behavioral health care services for yourself, a relative or friend requires special thought and attention. The Joint Commission on ...

  2. The Effect of Hospital Service Quality on Patient's Trust

    PubMed Central

    Zarei, Ehsan; Daneshkohan, Abbas; Khabiri, Roghayeh; Arab, Mohammad

    2014-01-01

    Background: The trust is meant the belief of the patient to the practitioner or the hospital based on the concept that the care provider seeks the best for the patient and will provide the suitable care and treatment for him/her. One of the main determinants of patient’s trust is the service quality. Objectives: This study aimed to examine the effect of quality of services provided in private hospitals on the patient’s trust. Patients and Methods: In this descriptive cross-sectional study, 969 patients were selected using the consecutive method from eight private general hospitals of Tehran, Iran, in 2010. Data were collected through a questionnaire containing 20 items (14 items for quality, 6 items for trust) and its validity and reliability were confirmed. Data were analyzed using descriptive statistics and multivariate regression. Results: The mean score of patients' perception of trust was 3.80 and 4.01 for service quality. Approximately 38% of the variance in patient trust was explained by service quality dimensions. Quality of interaction and process (P < 0.001) were the strongest factors in predicting patient’s trust, but the quality of the environment had no significant effect on the patients' degree of trust. Conclusions: The interaction quality and process quality were the key determinants of patient’s trust in the private hospitals of Tehran. To enhance the patients' trust, quality improvement efforts should focus on service delivery aspects such as scheduling, timely and accurate doing of the service, and strengthening the interpersonal aspects of care and communication skills of doctors, nurses and staff. PMID:25763258

  3. Effective nursing care of children and young people outside hospital.

    PubMed

    Whiting, Lisa; Caldwell, Chris; Donnelly, Mary; Martin, Debbie; Whiting, Mark

    2015-06-10

    Aim To assess the preparation required to ensure a workforce of nurses who can provide high quality out-of-hospital services for children and young people. Methods Using mixed methods, questionnaires were sent to young people and community children's nursing teams, interviews were conducted with academic staff and clinical nurses, and focus groups were undertaken with pre-registration children's nursing students. Findings Nurses' communication skills and clinical abilities were most important to young people. There is a range of opinions about optimum out-of-hospital clinical experience. Pre- and post-qualification education and recruitment in this area, therefore, need attention. Conclusion Out-of-hospital care presents problems, but is developing rapidly. Adequate, updated training, supervision and resources are needed. PMID:26059588

  4. Hospital Competition, Technical Efficiency, and Quality

    Microsoft Academic Search

    C. L. Chua; Alfons Palangkaraya; Jongsay Yong

    2009-01-01

    This paper studies the link between competition and technical efficiency of public hospitals in the State of Victoria, Australia by accounting both quantity and quality of hospital output using a two-stage semi-parametric model of hospital production and Data Envelopment Analysis. On the one hand, it finds a positive relationship between efficiency and competition measured by the Hirschman-Herfindahl Index (HHI). On

  5. Quality of surgical care and readmission in elderly glioblastoma patients

    PubMed Central

    Nuño, Miriam; Ly, Diana; Mukherjee, Debraj; Ortega, Alicia; Black, Keith L.; Patil, Chirag G.

    2014-01-01

    Background Thirty-day readmissions post medical or surgical discharge have been analyzed extensively. Studies have shown that complex interactions of multiple factors are responsible for these hospitalizations. Methods A retrospective analysis was conducted using the Surveillance, Epidemiology and End Results (SEER) Medicare database of newly diagnosed elderly glioblastoma multiforme (GBM) patients who underwent surgical resection between 1991 and 2007. Hospitals were classified into high- or low-readmission rate cohorts using a risk-adjusted methodology. Bivariate comparisons of outcomes were conducted. Multivariate analysis evaluated differences in quality of care according to hospital readmission rates. Results A total of 1,273 patients underwent surgery in 338 hospitals; 523 patients were treated in 228 high-readmission hospitals and 750 in 110 low-readmission hospitals. Patient characteristics for high-versus low-readmission hospitals were compared. In a confounder-adjusted model, patients treated in high- versus low-readmission hospitals had similar outcomes. The hazard of mortality for patients treated at high- compared to low-readmission hospitals was 1.06 (95% CI, 0.095%–1.19%). While overall complications were comparable between high- and low-readmission hospitals (16.3% vs 14.3%; P = .33), more postoperative pulmonary embolism/deep vein thrombosis complications were documented in patients treated at high-readmission hospitals (7.5% vs 4.1%; P = .01). Adverse events and levels of resection achieved during surgery were comparable at high- and low-readmission hospitals. Conclusions For patients undergoing GBM resection, quality of care provided by hospitals with the highest adjusted readmission rates was similar to the care delivered by hospitals with the lowest rates. These findings provide evidence against the preconceived notion that 30-day readmissions can be used as a metric for quality of surgical and postsurgical care.

  6. The relative effectiveness of managed care penetration and the healthcare safety net in reducing avoidable hospitalizations.

    PubMed

    Pracht, Etienne E; Orban, Barbara L; Comins, Meg M; Large, John T; Asin-Oostburg, Virginia

    2011-01-01

    Avoidable hospitalizations represent a key indicator for access to, and the quality of, primary care. Therefore, understanding their behavior is essential in terms of management of healthcare resources and costs. This analysis examines the affect of 2 healthcare strategies on the rate of avoidable hospitalization, managed care and the healthcare safety net. The avoidable hospitalizations definition developed by Weissman et al. (1992) was used to identify relevant inpatient episodes. A 2-stage simultaneous equations multivariate regression model with instrumental variables was used to estimate the relative influence of HMO penetration and the composition of local hospital markets on the rate of avoidable hospitalizations. Control variables in the model include healthcare supply and demand, demographic, socioeconomic, and health status characteristics. Increased market presence of public hospitals significantly reduced avoidable hospitalizations. HMO penetration did not influence the rate of avoidable hospitalizations. The results suggest that public investments in healthcare facilities and infrastructure are more effective in reducing avoidable hospitalizations. PMID:21733024

  7. Hospital Competition, Technical Efficiency and Quality

    Microsoft Academic Search

    CHEW LIAN CHUA; ALFONS PALANGKARAYA; JONGSAY YONG

    2011-01-01

    This paper studies the link between competition and technical efficiency of public hospitals in the state of Victoria, Australia. It finds a positive relationship between efficiency and competition as measured by the Hirschman–Herfindahl Index (HHI) and a negative relationship when the number of competing private hospitals is used instead of HHI. It also finds that whether or not quality is

  8. Identifying Key Hospital Service Quality Factors in Online Health Communities

    PubMed Central

    Jung, Yuchul; Hur, Cinyoung; Jung, Dain

    2015-01-01

    Background The volume of health-related user-created content, especially hospital-related questions and answers in online health communities, has rapidly increased. Patients and caregivers participate in online community activities to share their experiences, exchange information, and ask about recommended or discredited hospitals. However, there is little research on how to identify hospital service quality automatically from the online communities. In the past, in-depth analysis of hospitals has used random sampling surveys. However, such surveys are becoming impractical owing to the rapidly increasing volume of online data and the diverse analysis requirements of related stakeholders. Objective As a solution for utilizing large-scale health-related information, we propose a novel approach to identify hospital service quality factors and overtime trends automatically from online health communities, especially hospital-related questions and answers. Methods We defined social media–based key quality factors for hospitals. In addition, we developed text mining techniques to detect such factors that frequently occur in online health communities. After detecting these factors that represent qualitative aspects of hospitals, we applied a sentiment analysis to recognize the types of recommendations in messages posted within online health communities. Korea’s two biggest online portals were used to test the effectiveness of detection of social media–based key quality factors for hospitals. Results To evaluate the proposed text mining techniques, we performed manual evaluations on the extraction and classification results, such as hospital name, service quality factors, and recommendation types using a random sample of messages (ie, 5.44% (9450/173,748) of the total messages). Service quality factor detection and hospital name extraction achieved average F1 scores of 91% and 78%, respectively. In terms of recommendation classification, performance (ie, precision) is 78% on average. Extraction and classification performance still has room for improvement, but the extraction results are applicable to more detailed analysis. Further analysis of the extracted information reveals that there are differences in the details of social media–based key quality factors for hospitals according to the regions in Korea, and the patterns of change seem to accurately reflect social events (eg, influenza epidemics). Conclusions These findings could be used to provide timely information to caregivers, hospital officials, and medical officials for health care policies. PMID:25855612

  9. Defining high quality health care.

    PubMed

    Cooperberg, Matthew R; Birkmeyer, John D; Litwin, Mark S

    2009-01-01

    Most health care quality improvement efforts target measures of health care structures, processes, and/or outcomes. Structural measures examine relatively fixed aspects of health care delivery such as physical plant and human resources. Process measures, the focus of the largest proportion of quality improvement efforts, assess specific transactions in clinical-patient encounters, such as use of appropriate surgical antibiotic prophylaxis, which are expected to improve outcomes. Outcome measures, which comprise quality of life endpoints as well as morbidity and mortality, are of greatest interest to clinicians and patients, but entail the greatest complexity, as the majority of variance in outcomes is attributable to patient and environmental factors that may not be readily modifiable. Selecting among structure, process, and outcome measures for quality improvement efforts generally will be dictated by the specific clinical situation for which improvement is desired. One aspect of health care quality that has received a great deal of attention in recent years is the relationship between surgical volume and health outcomes. Volume, an inherent characteristic of a health care facility or provider, is generally considered a structural measure of quality. Many studies have demonstrated a positive association between volume and outcomes, and policymakers in the private and public sectors have begun to consider volume in certification and reimbursement decisions. The volume-outcome association is not without controversy, however. Most studies in the field are limited by the nature of the administrative data on which they are based, and some studies have found that variation in quality within volume quantiles exceeds differences between quantiles. Moreover, regionalization driven by a focus on volume may exert adverse effects on access to care. The movement for health care quality improvement faces substantial methodological, clinical, financial, and political challenges. Despite these challenges, it is a movement that is gaining momentum, and the emphasis on quality in health care delivery is likely only to increase in the future. It is crucial, therefore, that physicians assume increasing leadership roles in efforts to define, measure, report, and improve quality of care. PMID:19573771

  10. A framework of pediatric hospital discharge care informed by legislation, research, and practice.

    PubMed

    Berry, Jay G; Blaine, Kevin; Rogers, Jayne; McBride, Sarah; Schor, Edward; Birmingham, Jackie; Schuster, Mark A; Feudtner, Chris

    2014-10-01

    To our knowledge, no widely used pediatric standards for hospital discharge care exist, despite nearly 10?000 pediatric discharges per day in the United States. This lack of standards undermines the quality of pediatric hospital discharge, hinders quality-improvement efforts, and adversely affects the health and well-being of children and their families after they leave the hospital. In this article, we first review guidance regarding the discharge process for adult patients, including federal law within the Social Security Act that outlines standards for hospital discharge; a variety of toolkits that aim to improve discharge care; and the research evidence that supports the discharge process. We then outline a framework within which to organize the diverse activities that constitute discharge care to be executed throughout the hospitalization of a child from admission to the actual discharge. In the framework, we describe processes to (1) initiate pediatric discharge care, (2) develop discharge care plans, (3) monitor discharge progress, and (4) finalize discharge. We contextualize these processes with a clinical case of a child undergoing hospital discharge. Use of this narrative review will help pediatric health care professionals (eg, nurses, social workers, and physicians) move forward to better understand what works and what does not during hospital discharge for children, while steadily improving their quality of care and health outcomes. PMID:25155156

  11. Quality competition and uncertainty in a horizontally differentiated hospital market.

    PubMed

    Montefiori, Marcello

    2014-01-01

    The chapter studies hospital competition in a spatially differentiated market in which patient demand reflects the quality/distance mix that maximizes their utility. Treatment is free at the point of use and patients freely choose the provider which best fits their expectations. Hospitals might have asymmetric objectives and costs, however they are reimbursed using a uniform prospective payment. The chapter provides different equilibrium outcomes, under perfect and asymmetric information. The results show that asymmetric costs, in the case where hospitals are profit maximizers, allow for a social welfare and quality improvement. On the other hand, the presence of a publicly managed hospital which pursues the objective of quality maximization is able to ensure a higher level of quality, patient surplus and welfare. However, the extent of this outcome might be considerably reduced when high levels of public hospital inefficiency are detectable. Finally, the negative consequences caused by the presence of asymmetric information are highlighted in the different scenarios of ownership/objectives and costs. The setting adopted in the model aims at describing the up-coming European market for secondary health care, focusing on hospital behavior and it is intended to help the policy-maker in understanding real world dynamics. PMID:24864388

  12. Hospital Coding Practice, Data Quality, and DRG-Based Reimbursement under the Thai Universal Coverage Scheme

    ERIC Educational Resources Information Center

    Pongpirul, Krit

    2011-01-01

    In the Thai Universal Coverage scheme, hospital providers are paid for their inpatient care using Diagnosis Related Group (DRG) reimbursement. Questionable quality of the submitted DRG codes has been of concern whereas knowledge about hospital coding practice has been lacking. The objectives of this thesis are (1) To explore hospital coding…

  13. Building a mission for quality care.

    PubMed

    Peterson, R

    1999-12-01

    Clearly, there is a benefit to the group process in helping to establish teamwork. Teamwork and cooperation can assist with promoting effective communication, improving work quality, and building a sense of well-being within the group. With this cooperation, setting goals and looking toward the future can become a reality. Once goals are set, then developing a professional image can begin. Developing a mission statement can be an effective means to help create that professional image. Having the opportunity to develop a mission for a patient care area and articulating it through a mission statement coalesces the values, beliefs, and philosophy of a group of neuroscience staff. The following is the mission statement developed by the neurosciences unit at the University of Wisconsin Hospital and Clinics: We, the staff of UWHC Neuroscience unit embrace a vision of excellence in health care for all. Our mission is to deliver consistent quality patient care, while fostering our own professional growth. As caring healers, teachers and patient advocates in an ever-changing health care environment, we are empowered by the code for nurses. Within our scope of practice, we strive to maintain a balance of basic human respect and dignity for patients and their families in their quest for wellness, adaptation, rehabilitation or comfort care. It is our hope that patients and families will work with the health care team to construct a plan of care that best meets the patient's needs and goals. We are committed to accommodate special communication, religious or cultural needs of patients and their families. Our final acknowledgment is to ourselves, as members of the health care team. We celebrate the dignity of the staff by recognizing each individual as a special person capable of making unique and significant contributions to the unit. PMID:10726245

  14. The Loneliest Babies: Foster Care in the Hospital

    ERIC Educational Resources Information Center

    Dicker, Sheryl

    2012-01-01

    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.…

  15. 38 CFR 17.196 - Aid for hospital care.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ...2013-07-01 2013-07-01 false Aid for hospital care. 17.196 Section...DEPARTMENT OF VETERANS AFFAIRS MEDICAL Aid to States for Care of Veterans in State Homes § 17.196 Aid for hospital care. Aid may be...

  16. 38 CFR 17.196 - Aid for hospital care.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ...2014-07-01 2014-07-01 false Aid for hospital care. 17.196 Section...DEPARTMENT OF VETERANS AFFAIRS MEDICAL Aid to States for Care of Veterans in State Homes § 17.196 Aid for hospital care. Aid may be...

  17. 38 CFR 17.196 - Aid for hospital care.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ...2012-07-01 2012-07-01 false Aid for hospital care. 17.196 Section...DEPARTMENT OF VETERANS AFFAIRS MEDICAL Aid to States for Care of Veterans in State Homes § 17.196 Aid for hospital care. Aid may be...

  18. 38 CFR 17.196 - Aid for hospital care.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ...2011-07-01 2011-07-01 false Aid for hospital care. 17.196 Section...DEPARTMENT OF VETERANS AFFAIRS MEDICAL Aid to States for Care of Veterans in State Homes § 17.196 Aid for hospital care. Aid may be...

  19. 38 CFR 17.196 - Aid for hospital care.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ...2010-07-01 2010-07-01 false Aid for hospital care. 17.196 Section...DEPARTMENT OF VETERANS AFFAIRS MEDICAL Aid to States for Care of Veterans in State Homes § 17.196 Aid for hospital care. Aid may be...

  20. Improving post-abortion care in a public hospital in Oaxaca, Mexico

    Microsoft Academic Search

    Ana Langer; Cecilia Garcia-Barrios; Angela Heimburger; Karen Stein; Beverly Winikoff; Vilma Barahona; Beatriz Casas; Francisca Ramirez

    1997-01-01

    This paper describes patients' and providers' perceptions of the quality of care in the treatment of 132 women who arrived at the emergency room of a public hospital in Oaxaca, Mexico, with complications of abortion, whether spontaneous or induced clandestinely. This hospital was interested in assessing and improving its services. Questionnaires, on-site observation and indepth interviews revealed insensitive personal treatment

  1. Emergency and critical care services in Tanzania: a survey of ten hospitals

    PubMed Central

    2013-01-01

    Background While there is a need for good quality care for patients with serious reversible disease in all countries in the world, Emergency and Critical Care tends to be one of the weakest parts of health systems in low-income countries. We assessed the structure and availability of resources for Emergency and Critical Care in Tanzania in order to identify the priorities for improving care in this neglected specialty. Methods Ten hospitals in four regions of Tanzania were assessed using a structured data collection tool. Quality was evaluated with standards developed from the literature and expert opinion. Results Important deficits were identified in infrastructure, routines and training. Only 30% of the hospitals had an emergency room for adult and paediatric patients. None of the seven district and regional hospitals had a triage area or intensive care unit for adults. Only 40% of the hospitals had formal systems for adult triage and in less than one third were critically ill patients seen by clinicians more than once daily. In 80% of the hospitals there were no staff trained in adult triage or critical care. In contrast, a majority of equipment and drugs necessary for emergency and critical care were available in the hospitals (median 90% and 100% respectively. The referral/private hospitals tended to have a greater overall availability of resources (median 89.7%) than district/regional hospitals (median 70.6). Conclusions Many of the structures necessary for Emergency and Critical Care are lacking in hospitals in Tanzania. Particular weaknesses are infrastructure, routines and training, whereas the availability of drugs and equipment is generally good. Policies to improve hospital systems for the care of emergency and critically ill patients should be prioritised. PMID:23590288

  2. Synergies between blood center and hospital quality systems.

    PubMed

    Rhamy, Jennifer F

    2010-12-01

    Blood centers have expertise in following federally mandated standards and establishing rigorous quality systems. Medicare participating hospitals and their laboratories must be compliant with the requirements of the Centers for Medicare and Medicaid Services. Following standards and experiencing unannounced surveys allow blood centers and hospitals to organize and strengthen their patient safety efforts and achieve high-reliability operations. Blood centers provide essential services to hospitals and laboratories according to written contracts; therefore, blood centers need to understand the CMS requirements for blood administration activities and supplier management within these written agreements. Sharing expertise gained from experience with the US Food and Drug Administration and professional standard-setting organizations may be an opportunity for blood centers to build deeper customer relationships and assist in the delivery of high-quality patient care. PMID:21128951

  3. The results of a randomized trial of a quality improvement intervention in the care of patients with heart failure

    Microsoft Academic Search

    Edward F Philbin; Thomas A Rocco; Norman W Lindenmuth; Kathleen Ulrich; Maureen McCall; Paul L Jenkins

    2000-01-01

    PURPOSE: Quality improvement and disease management programs for heart failure have improved quality of care and patient outcomes at large tertiary care hospitals. The purpose of this study was to measure the effects of a regional, multihospital, collaborative quality improvement intervention on care and outcomes in heart failure in community hospitals.PATIENTS AND METHODS: This randomized controlled study included 10 acute

  4. Team-based Care for Patients Hospitalized with Heart Failure.

    PubMed

    Larsen, Paul M; Teerlink, John R

    2015-07-01

    Hospitalizations for acute heart failure (HF) and subsequent readmissions have received increased attention because of the burden they place on patients, providers, and the health care system. These hospitalizations represent a significant portion of the total cost of HF care and health care in general. Although much of the care of the patient with HF occurs outside of the hospital, the genesis of the programs that attempt to limit repeat hospitalizations begin in the impatient setting. By using evidence-based guidelines, interdisciplinary teams, and comprehensive discharge planning, costly readmissions can be reduced and outcomes improved. PMID:26142635

  5. Organizing integrated care in a university hospital: application of a conceptual framework

    PubMed Central

    Axelsson, Runo; Axelsson, Susanna Bihari; Gustafsson, Jeppe; Seemann, Janne

    2014-01-01

    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. PMID:24966806

  6. Accountable Care Organizations: roles and opportunities for hospitals.

    PubMed

    Schoenbaum, Stephen C

    2011-08-01

    Federal health reform has established Medicare Accountable Care Organizations (ACOs) as a new program, and some states and private payers have been independently developing ACO pilot projects. The objective is to hold provider groups accountable for the quality and cost of care to a population. The financial models for providers generally build off of shared savings between the payers and providers or some type of global payment that includes the possibility of partial or full capitation. For ACOs to achieve the same outcomes with lower costs or, better yet, improved outcomes with the same or lower costs, the delivery system will need to become more oriented toward primary care and care coordination than is currently the case. Providers of clinical services, in order to be more effective, efficient, and coordinated, will need to be supported by a variety of shared services, such as off-hours care, easy access to specialties, and information exchanges. These services can be organized by an ACO as a medical neighborhood or community. Hospitals, because they have a management structure, history of developing programs and services, and accessibility 24/7/365, are logical leaders of this enhancement of health care delivery for populations and other providers. PMID:21881401

  7. Family Perspectives on the Quality of Pediatric Palliative Care

    Microsoft Academic Search

    Nancy Contro; Judith Larson; Sarah Scofield; Barbara Sourkes; Harvey Cohen

    2002-01-01

    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

  8. A two-stage estimation of hospital quality using mortality outcome measures: an application using hospital administrative data.

    PubMed

    Chua, Chew Lian; Palangkaraya, Alfons; Yong, Jongsay

    2010-12-01

    This paper proposes a method of deriving a quality indicator for hospitals using mortality outcome measures. The method aggregates any number of mortality outcomes into a single indicator via a two-stage procedure. In the first stage, mortality outcomes are risk-adjusted using a system of seemingly unrelated regression equations. These risk-adjusted mortality rates are then aggregated into a single quality indicator in the second stage via weighted least squares. This method addresses the dimensionality problem in measuring hospital quality, which is multifaceted in nature. In addition, our method also facilitates further analyses of determinants of hospital quality by allowing the resulting quality estimates be associated with hospital characteristics. The method is applied to a sample of heart-disease episodes extracted from hospital administrative data from the state of Victoria, Australia. Using the quality estimates, we show that teaching hospitals and large regional hospitals provide higher quality of care than other hospitals and this superior performance is related to hospital case-load volume. PMID:19937614

  9. Implementing continuous quality improvement (CQI) in hospitals: lessons learned from the International Quality Study.

    PubMed

    Anderson, C A; Cassidy, B; Rivenburgh, P

    1991-01-01

    Continuous Quality Improvement is in the process of being implemented in hospitals around the world. In an attempt to gain a better understanding of the "best management practices" the International Quality Study is being conducted in four countries--Canada, Germany, Japan and the United States--and across four industries--Health Care, Banking, Automotive and Computers. Information collected through a survey process will be analysed through causal modeling to determine correlations between management practices and achievement of quality objectives. Given both the complexity of the models and the number of key concepts involved, 400 hospitals have been invited to participate. The preliminary results show direct correlations between cultural influences and the concept of quality. The perceived definition of quality by the various countries varies and therefore the application of "quality concepts" differs. Once complete, this database of "best management practices" will serve as a worldwide benchmark for quality progress. PMID:1782382

  10. Hospital ownership and community benefit: looking beyond uncompensated care.

    PubMed

    Song, Paula H; Lee, Shoou-Yih D; Alexander, Jeffrey A; Seiber, Eric E

    2013-01-01

    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

  11. Managing variability to improve quality, capacity and cost in the perioperative process at Massachusetts General Hospital

    E-print Network

    Price, Devon J. (Devon Jameson)

    2011-01-01

    The widely held assumption is that to improve access and quality of health care, we need to spend more. In fact, that is not necessarily true. The results of this project, performed at Massachusetts General Hospital (MGH), ...

  12. Increasing compliance with maternal and child care quality standards in Ecuador

    Microsoft Academic Search

    JORGE HERMIDA; MARIA E. ROBALINO

    2002-01-01

    Objective. To determine the effects of hospital quality assurance interventions on compliance with clinical standards, availability of essential drugs, client satisfaction, and utilization. Design. Quasi-experimental, prospective study with four intervention hospitals and four control hospitals. All eight facilities were purposively selected and of comparable complexity. Setting. Ministry of Health secondary care facilities in Ecuador. Interventions. Facility-based quality improvement teams, job

  13. Hospitals on the path to accountable care: highlights from a 2011 national survey of hospital readiness to participate in an accountable care organization.

    PubMed

    Audet, Anne-Marie J; Kenward, Kevin; Patel, Shreya; Joshi, Maulik S

    2012-08-01

    Accountable care organizations (ACOs) are forming in communities across the country. In ACOs, health care providers take responsibility for a defined patient popu­lation, coordinate their care across settings, and are held jointly accountable for the quality and cost of care. This issue brief reports on results from a survey that assesses hospitals' readiness to participate in ACOs. Results show we are at the beginning of the ACO adop­tion curve. As of September 2011, only 13 percent of hospital respondents reported partici­pating in an ACO or planning to participate within a year, while 75 percent reported not considering participation at all. Survey results indicate that physician-led ACOs are the second most common governance model, far exceeding payer-led models, highlighting an encouraging paradigm shift away from acute care and toward primary care. Findings also point to significant gaps, including the infrastructure needed to take on financial risks and to manage population health. PMID:22928221

  14. Organisational quality, nurse staffing and the quality of chronic disease management in primary care: Observational study using routinely collected data

    Microsoft Academic Search

    Peter Griffiths; Jill Maben; Trevor Murrells

    2011-01-01

    Background An association between quality of care and staffing levels, particularly registered nurses, has been established in acute hospitals. Recently an association between nurse staffing and quality of care for several chronic conditions has also been demonstrated for primary care in English general practice. A smaller body of literature identifies organisational factors, in particular issues of human resource management, as

  15. [Accreditation model for acute hospital care in Catalonia, Spain].

    PubMed

    López-Viñas, M Luisa; Costa, Núria; Tirvió, Carmen; Davins, Josep; Manzanera, Rafael; Ribera, Jaume; Constante, Carles; Vallès, Roser

    2014-07-01

    The implementation of an accreditation model for healthcare centres in Catalonia which was launched for acute care hospitals, leaving open the possibility of implementing it in the rest of lines of service (mental health and addiction, social health, and primary healthcare centres) is described. The model is based on the experience acquired over more tan 31 years of hospital accreditation and quality assessment linked to management. In January 2006 a model with accreditation methodology adapted to the European Foundation for Quality Management (EFQM) model was launched. 83 hospitals are accredited, with an average of 82.6% compliance with the standards required for accreditation. The number of active assessment bodies is 5, and the accreditation period is 3 years. A higher degree of compliance of the so-called "agent" criteria with respect to "outcome" criteria is obtained. Qualitative aspects for implementation to be stressed are: a strong commitment both from managers and staff in the centres, as well as a direct and fluent communication between the accreditation body (Ministry of Health of the Government of Catalonia) and accredited centres. Professionalism of audit bodies and an optimal communication between audit bodies and accredited centres is also added. PMID:25128363

  16. Hospital service quality: a managerial challenge.

    PubMed

    Rose, Raduan Che; Uli, Jegak; Abdul, Mohani; Ng, Kim Looi

    2004-01-01

    While much is known generally about predictions of customer-perceived service quality, their application to health services is rarer. No attempt has been made to examine the impact of social support and patient education on overall service quality perception. Together with six quality dimensions identified from the literature, this study seeks to provide a more holistic comprehension of hospital service quality prediction. Although 79 percent of variation is explained, other than technical quality the impact of the remaining factors on quality perception is far from constant, and socio-economic variables further complicate unpredictability. Contrary to established beliefs, the cost factor was found to be insignificant. Hence, to manage service quality effectively, the test lies in how well healthcare providers know the customers they serve. It is not only crucial in a globalized environment, where trans-national patient mobility is increasingly the norm, but also within homogeneous societies that appear to converge culturally. PMID:15301271

  17. The Effect of the MassHealth Hospital Pay-for-Performance Program on Quality

    PubMed Central

    Ryan, Andrew M; Blustein, Jan

    2011-01-01

    Objective To test the effect of Massachusetts Medicaid's (MassHealth) hospital-based pay-for-performance (P4P) program, implemented in 2008, on quality of care for pneumonia and surgical infection prevention (SIP). Data Hospital Compare process of care quality data from 2004 to 2009 for acute care hospitals in Massachusetts (N = 62) and other states (N = 3,676) and American Hospital Association data on hospital characteristics from 2005. Study Design Panel data models with hospital fixed effects and hospital-specific trends are estimated to test the effect of P4P on composite quality for pneumonia and SIP. This base model is extended to control for the completeness of measure reporting. Further sensitivity checks include estimation with propensity-score matched control hospitals, excluding hospitals in other P4P programs, varying the time period during which the program was assumed to have an effect, and testing the program effect across hospital characteristics. Principal Findings Estimates from our preferred specification, including hospital fixed effects, trends, and the control for measure completeness, indicate small and nonsignificant program effects for pneumonia (?0.67 percentage points, p>.10) and SIP (?0.12 percentage points, p>.10). Sensitivity checks indicate a similar pattern of findings across specifications. Conclusions Despite offering substantial financial incentives, the MassHealth P4P program did not improve quality in the first years of implementation. PMID:21210796

  18. A Survey of Nursing Home Organizational Characteristics Associated with Potentially Avoidable Hospital Transfers and Care Quality in One Large British Columbia Health Region

    ERIC Educational Resources Information Center

    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

    2011-01-01

    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…

  19. Prehospital and In-Hospital Delays in Acute Stroke Care

    Microsoft Academic Search

    Kelly R. Evenson; Wayne D. Rosamond; Dexter L. Morris

    2001-01-01

    Current guidelines emphasize the need for early stroke care. However, significant delays occur during both the prehospital and in-hospital phases of care, making many patients ineligible for stroke therapies. The purpose of this study was to systematically review and summarize the existing scientific literature reporting prehospital and in-hospital stroke delay times in order to assist future delivery of effective interventions

  20. Benchmarking and audit of breast units improves quality of care

    PubMed Central

    van Dam, P.A.; Verkinderen, L.; Hauspy, J.; Vermeulen, P.; Dirix, L.; Huizing, M.; Altintas, S.; Papadimitriou, K.; Peeters, M.; Tjalma, W.

    2013-01-01

    Quality Indicators (QIs) are measures of health care quality that make use of readily available hospital inpatient administrative data. Assessment quality of care can be performed on different levels: national, regional, on a hospital basis or on an individual basis. It can be a mandatory or voluntary system. In all cases development of an adequate database for data extraction, and feedback of the findings is of paramount importance. In the present paper we performed a Medline search on “QIs and breast cancer” and “benchmarking and breast cancer care”, and we have added some data from personal experience. The current data clearly show that the use of QIs for breast cancer care, regular internal and external audit of performance of breast units, and benchmarking are effective to improve quality of care. Adherence to guidelines improves markedly (particularly regarding adjuvant treatment) and there are data emerging showing that this results in a better outcome. As quality assurance benefits patients, it will be a challenge for the medical and hospital community to develop affordable quality control systems, which are not leading to excessive workload. PMID:24753926

  1. A hospital CEO's perspective: radiology should lead the way in reforming health care delivery.

    PubMed

    Franklin, Michael A

    2013-04-01

    Radiology and medical imaging systems play a central role in most health care systems. As science and technology have advanced, the ability to medically image and diagnose anatomic and physiologic pathology has increased exponentially. This capability is identified as a necessary core competency of all "general hospitals" by the American Hospital Association. Medical imaging accounts for 7.5% of health care spending in the United States, with $175 billion spent annually. Accordingly, the facilities and the physicians who provide this patient care will be a central focus in the crusade for patient-centered, efficient, and transportable patient care. As the demand in hospitals and health care systems for quality, safety, and efficiency through IT and clinical systems improvement continues to accelerate, the demand for more systems that use best-practice support and discrete data results for incorporation into systems reporting initiatives will also accelerate and grow. Medical imaging and the radiologist's report are central to creating this integrated, patient-centric system with hospitals. Ancillary to the patient care component of the functional use of the data reporting systems is the ability to use the clinical reporting information efficiently to support or defend clinical decisions associated with hospital care and to provide an improved means by which required quality metrics are made available for ensuring safety and improving care in the future. PMID:23545085

  2. National Hospital Ambulatory Medical Care Survey: 2005 Emergency Department Summary

    Microsoft Academic Search

    Eric W. Nawar; Richard W. Niska; Jianmin Xu

    2007-01-01

    Objective—This report presents the most current (2005) nationally representative data on visits to hospital emergency departments (ED) in the United States. Statistics are presented on selected hospital, patient, and visit characteristics. Selected trends in ED utilization from 1995 through 2005 are also presented. Methods—Data are from the 2005 National Hospital Ambulatory Medical Care Survey (NHAMCS), the longest continuously running nationally

  3. Innovative and successful approaches to improving care transitions from hospital to home.

    PubMed

    Labson, Margherita C

    2015-02-01

    Effective transitions to home care have been identified as among the factors leading to reducing hospital readmissions within 30 days of discharge and improvements on various other quality measures. Innovative applications of published evidence-based models and best practices designed to improve care transitions have been implemented in various settings across the country in an effort to enhance quality performance. For this article, The Joint Commission collected a series of case examples to examine how evidence-based innovations in care transitions are reducing readmissions and improving other quality outcomes. The organizations providing the case examples were interviewed and asked to provide performance data demonstrating quality improvement, as well as information about their care processes and data-gathering techniques. Their innovative approaches are reducing hospital readmissions; improving patient safety, satisfaction, and engagement; and contributing to other positive outcomes. PMID:25654457

  4. Global initiatives for improving hospital care for children: state of the art and future prospects

    PubMed Central

    Campbell, Harry; Duke, Trevor; Weber, Martin; English, Mike; Carai, Susanne; Tamburlini, Giorgio

    2009-01-01

    Deficiencies in the quality of health care are major limiting factors to the achievement of the Millennium Development Goals for child and maternal health. Quality of patient care in hospitals is firmly on the agendas of Western countries, but has been slower to gain traction in developing countries, despite evidence that there is substantial scope for improvement, that hospitals have a major role in child survival and that inequities in quality may be as important as inequities in access. There is now substantial global experience of strategies and interventions that improve the quality of care for children in hospitals with limited resources. WHO has developed a toolkit containing adaptable instruments, including a framework for quality improvement, evidence-based clinical guidelines in the form of the Pocketbook of Hospital Care for Children, teaching material, assessment and mortality audit tools. These tools have been field-tested by doctors, nurses and other child health workers in many developing countries. This collective experience was brought together in a global WHO meeting in Bali in 2007. This article describes how many countries are achieving improvements in quality of paediatric care, despite limited resources and other major obstacles, and how the evidence has progressed in recent years from documenting the nature and scope of the problems to describing the effectiveness of innovative interventions. The challenges remain to bring these and other strategies to scale, and to support research into their use, impact and sustainability in different environments. PMID:18381526

  5. Global initiatives for improving hospital care for children: state of the art and future prospects.

    PubMed

    Campbell, Harry; Duke, Trevor; Weber, Martin; English, Mike; Carai, Susanne; Tamburlini, Giorgio

    2008-04-01

    Deficiencies in the quality of health care are major limiting factors to the achievement of the Millennium Development Goals for child and maternal health. Quality of patient care in hospitals is firmly on the agendas of Western countries but has been slower to gain traction in developing countries, despite evidence that there is substantial scope for improvement, that hospitals have a major role in child survival, and that inequities in quality may be as important as inequities in access. There is now substantial global experience of strategies and interventions that improve the quality of care for children in hospitals with limited resources. The World Health Organization has developed a toolkit that contains adaptable instruments, including a framework for quality improvement, evidence-based clinical guidelines in the form of the Pocket Book of Hospital Care for Children, teaching material, assessment, and mortality audit tools. These tools have been field-tested by doctors, nurses, and other child health workers in many developing countries. This collective experience was brought together in a global World Health Organization meeting in Bali in 2007. This article describes how many countries are achieving improvements in quality of pediatric care, despite limited resources and other major obstacles, and how the evidence has progressed in recent years from documenting the nature and scope of the problems to describing the effectiveness of innovative interventions. The challenges remain to bring these and other strategies to scale and to support research into their use, impact, and sustainability in different environments. PMID:18381526

  6. National Surgical Quality Improvement Program-Pediatric (NSQIP) and the Quality of Surgical Care in Pediatric Orthopaedics.

    PubMed

    Brighton, Brian K

    2015-01-01

    In recent years, the safety, quality, and value of surgical care have become increasingly important to surgeons and hospitals. Quality improvement in surgical care requires the ability to collect, measure, and act upon reliable and clinically relevant data. One example of a large-scale quality effort is the American College of Surgeons National Surgical Quality Improvement Program-Pediatric (ACS NSQIP-Pediatric), the only nationwide, risk-adjusted, outcomes-based program evaluating pediatric surgical care. PMID:26049305

  7. [Sensitive female-specific hospitalization in primary care].

    PubMed

    Pitilin, Érica de Brito; Gutubir, Driele; Molena-Fernandes, Carlos Alexandre; Pelloso, Sandra Marisa

    2015-02-01

    The scope of this paper was to analyze female-specific sensitive hospitalization occurring in primary care conditions and factors that determine or affect the occurrence of such hospitalizations (social, economic and demographic factors; health control). Analysis was performed by surveys on hospital morbidity with a sample of 429 females attended in Unified Health System (SUS) contracted hospitals. The sensitive hospitalizations percentage in primary care reached 49.42% (n = 212), highlighting female-specific hospitalization at 19.35% (n = 83). Hospitalization risks comprised elderly people over sixty, low schooling, previous hospitalizations, normal health control, lack of association with the Family Health Strategy and pregnancy. Evident causes were related to conditions of pregnancy, childbirth, post-partum and inflammations of the female pelvic organs. Results suggested flaws in outpatient attendance that should be adequate and provide solutions in women's health. PMID:25715138

  8. Quality assurance and organizational effectiveness in hospitals.

    PubMed Central

    Hetherington, R W

    1982-01-01

    The purpose of this paper is to explore some aspects of a general theoretical model within which research on the organizational impacts of quality assurance programs in hospitals may be examined. Quality assurance is conceptualized as an organizational control mechanism, operating primarily through increased formalization of structures and specification of procedures. Organizational effectiveness is discussed from the perspective of the problem-solving theory of organizations, wherein effective organizations are those which maintain at least average performance in all four system problem areas simultaneously (goal-attainment, integration, adaptation and pattern-maintenance). It is proposed that through the realization of mutual benefits for both professionals and the bureaucracy, quality assurance programs can maximize such effective performance in hospitals. PMID:7096096

  9. Factors Associated with Ambulatory Care—Sensitive Hospitalizations among Nursing Home Residents

    Microsoft Academic Search

    Mary W. Carter

    2003-01-01

    Objectives: This study examined patient-level, facility-level, and area market-level factors affecting ambulatory care-sensitive hospitalization (ACSH) rates among nursing home residents. Although ACSH has long been used to monitor accessibility to health care services among community-dwelling populations, the use of ACSH rates as an indicator of potential quality-of-care problems affecting nursing home residents has not been employed. Methods: Three years of

  10. Preferences for hospital quality in Zambia: results from a discrete choice experiment

    Microsoft Academic Search

    Kara Hanson; Barbara McPake; Pamela Nakamba; Luke Archard

    2005-01-01

    This study reports on the results of a discrete choice experiment undertaken in Zambia to assess the factors influencing the demand for hospital care in Zambia, in particular the role of (perceived) quality and trade-offs between price and quality. Valuations of quality were evaluated for the treatment of two acute medical conditions, cerebral malaria in adults and acute pneumonia in

  11. Managing the quality of health care.

    PubMed

    Larson, James S; Muller, Andreas

    2002-01-01

    This article reviews quality of health care initiatives beginning with the quality assessment/quality assurance movement of the 1970s. Conceptually, modern quality of care management is rooted in the intellectual work of Avedis Donabedian who defined quality of care as a combination of structure, process, and outcome. Donabedian's model is presented and some limitations are pointed out. In the late 1980s and 1990s. the health care industry adopted total quality management (TQM). More recently, the pursuit of health care quality has led to substantial performance measurement initiatives such as ORYX by the Joint Commission on Accreditation of Healthcare Organizations and MEDIS by the National Commission of Quality Assurance. The importance of CONQUEST, a freely available performance measurement database developed at the Harvard School of Public Health, is noted and discussed. The article concludes with a list of challenges facing public and private parties interests in health care quality improvement. PMID:15188996

  12. Care left undone’ during nursing shifts: associations with workload and perceived quality of care

    PubMed Central

    Ball, Jane E; Murrells, Trevor; Rafferty, Anne Marie; Morrow, Elizabeth; Griffiths, Peter

    2014-01-01

    Background There is strong evidence to show that lower nurse staffing levels in hospitals are associated with worse patient outcomes. One hypothesised mechanism is the omission of necessary nursing care caused by time pressure—‘missed care’. Aim To examine the nature and prevalence of care left undone by nurses in English National Health Service hospitals and to assess whether the number of missed care episodes is associated with nurse staffing levels and nurse ratings of the quality of nursing care and patient safety environment. Methods Cross-sectional survey of 2917 registered nurses working in 401 general medical/surgical wards in 46 general acute National Health Service hospitals in England. Results Most nurses (86%) reported that one or more care activity had been left undone due to lack of time on their last shift. Most frequently left undone were: comforting or talking with patients (66%), educating patients (52%) and developing/updating nursing care plans (47%). The number of patients per registered nurse was significantly associated with the incidence of ‘missed care’ (p<0.001). A mean of 7.8 activities per shift were left undone on wards that are rated as ‘failing’ on patient safety, compared with 2.4 where patient safety was rated as ‘excellent’ (p?<0.?001). Conclusions Nurses working in English hospitals report that care is frequently left undone. Care not being delivered may be the reason low nurse staffing levels adversely affects quality and safety. Hospitals could use a nurse-rated assessment of ‘missed care’ as an early warning measure to identify wards with inadequate nurse staffing. PMID:23898215

  13. Hospital Markets and the Effect of Competition on Quality

    Microsoft Academic Search

    Alfons Palangkaraya; Jongsay Yong

    2009-01-01

    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

  14. Construction of a questionnaire measuring outpatients' opinion of quality of hospital consultation departments

    Microsoft Academic Search

    Isabelle Gasquet; Sylvie Villeminot; Carla Estaquio; Pierre Durieux; Philippe Ravaud; Bruno Falissard

    2004-01-01

    BACKGROUND: Few questionnaires on outpatients' satisfaction with hospital exist. All have been constructed without giving enough room for the patient's point of view in the validation procedure. The main objective was to develop, according to psychometric standards, a self-administered generic outpatient questionnaire exploring opinion on quality of hospital care. METHOD: First, a qualitative phase was conducted to generate items and

  15. Organisational Learning, Transformational Leadership and Implementation of Continuous Quality Improvement in Canadian Hospitals

    Microsoft Academic Search

    Rolland LeBrasseur; Robert Whissell; Abhoy Ojha

    2002-01-01

    Implementing continuous quality improvement (CQI) in acute care general hospitals was investigated as an occurrence of a paradigm shift and organisational learning. Presented within a contextual framework, two case studies are reported, and are complemented by a survey of hospitals operating in Ontario, Canada. The findings support a top-down approach where the CEO exhibits transformational leadership and aligns the organisation's

  16. [A Recreation Room for adolescents who are hospitalized at a tertiary-care Center: Care Program for Hospitalized Adolescents].

    PubMed

    Mato, Roberto; Rodríguez, M Susana

    2015-06-01

    Hospital admission is a high-impact event in children. Adolescence is a critical and complex period of human development that may be adversely affected by hospitalization. At the Garrahan Hospital, where adolescents account for more than 30% of inpatients, a program for comprehensive care of adolescents was set up in 2008 with a special focus on their specific needs. As a part of this program, the aim of the Recreation Room for Hospitalized Adolescents is to provide a friendly environment to reduce stress and anxiety and to facilitate the learning of healthy behaviors, under the permanent care of nurses and medical doctors. Interventions in health, leisure time, education, and emotional care are effective in diminishing the negative impact of hospitalization and prevent risk behaviors. Our objective was to report our experience in the Recreation Room for Hospitalized Adolescents. PMID:25996325

  17. Measuring pediatric hospital readmission rates to drive quality improvement.

    PubMed

    Nakamura, Mari M; Toomey, Sara L; Zaslavsky, Alan M; Berry, Jay G; Lorch, Scott A; Jha, Ashish K; Bryant, Maria C; Geanacopoulos, Alexandra T; Loren, Samuel S; Pain, Debanjan; Schuster, Mark A

    2014-01-01

    The Pediatric Quality Measures Program is developing readmission measures for pediatric use. We sought to describe the importance of readmissions in children and the challenges of developing readmission quality measures. We consider findings and perspectives from research studies and commentaries in the pediatric and adult literature, characterizing arguments for and against using readmission rates as measures of pediatric quality and discussing available evidence and current knowledge gaps. The major topic of debate regarding readmission rates as pediatric quality measures is the relative influence of hospital quality versus other factors within and outside of health systems on readmission risk. The complex causation of readmissions leads to disagreement, particularly when rates are publicly reported or tied to payment, about whether readmissions can be prevented and how to achieve fair comparisons of readmission performance. Despite these controversies, the policy focus on readmissions has motivated widespread efforts by hospitals and outpatient providers to evaluate and reengineer care processes. Many adult studies demonstrate a link between successful initiatives to improve quality and reductions in readmissions. More research is needed on methods to enhance adjustment of readmission rates and on how to prevent pediatric readmissions. PMID:25169456

  18. Quality improvement in nursing care facilities: extent, impetus, and impact.

    PubMed

    Zinn, J S; Brannon, D; Weech, R

    1997-01-01

    This study examines the extent, motivation, and performance implications of normal quality improvement (QI) programs in Pennsylvania nursing care facilities. Responses to a 20-item survey sent to facility administrators indicate that continuous quality improvement/total quality management (CQI/TQM) adopters are more motivated by quality of care and human resource concerns in implementing QI, more satisfied with the results of QI efforts, and more aware of a competitive environment than are non-adopters. There are few differences between adopters and non-adopters with respect to organizational characteristics or performance on quality of care measures. Comparison with the results of a study of QI implementation in hospitals reveals some differences in motivation, but similarities in satisfaction with results. PMID:9116533

  19. Quality in health care. Medical or managerial?

    PubMed

    Hansson, J

    2000-01-01

    Explores the notion that the introduction of total quality management (TQM) in the public health-care sector indicates a conceptual break with a tradition in which the authority to define and interpret the meaning of medical practice has been located solely within the medical profession. It also serves to shift the focus of medical practice away from its contextual and interactional character towards numerical representations and codification in monetary terms. Further, it is argued that the realization of management ideals in everyday practice is dependent more on the availability of pre-existing technologies and standard procedures than on the ingenuity of particular organizational and institutional actors. These arguments are illustrated with the reutilization for TQM purposes of "local incident reports" in a Swedish hospital organization. PMID:11200301

  20. Critical access hospitals (CAHs) are essential to rural health care and play an important role in its

    E-print Network

    Kostic, Milivoje M.

    with each passing fiscal year, effective management of the quality of care delivered in the American health. The challenges facing health care delivery are changing due to demographic shifts in population and economic­ 1 ­ ABSTRACT Critical access hospitals (CAHs) are essential to rural health care and play

  1. Measuring quality in hospitals: is there a difference between for-profits and not-for-profits?

    PubMed

    Huffman, J; Miller, M; Simmons, C; Simpson, B

    1999-01-01

    Health care professionals agree that by measuring quality, improvements can be made in care delivery. There are measurable differences between not-for-profit and for-profit hospitals, both in public perception and care outcomes. The ability by consumers, insurers and providers to easily access quality data will drive the health care industry to take a quality focus in their daily business. Quality providers with measurable results will gain a larger share of health care dollars and consumer trust. Physicians will choose to partner with the quality leaders and will refine their practices as part of the quality evolution. PMID:10557399

  2. Care for hospitalized patients with unhealthy alcohol use: a narrative review

    PubMed Central

    2013-01-01

    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. PMID:23738519

  3. Improvement in inpatient glycemic care: pathways to quality.

    PubMed

    Aloi, Joseph A; Mulla, Christopher; Ullal, Jagdeesh; Lieb, David C

    2015-04-01

    The management of inpatient hyperglycemia is a focus of quality improvement projects across many hospital systems while remaining a point of controversy among clinicians. The association of inpatient hyperglycemia with suboptimal hospital outcomes is accepted by clinical care teams; however, the clear benefits of targeting hyperglycemia as a mechanism to improve hospital outcomes remain contentious. Glycemic management is also frequently confused with efforts aimed at intensive glucose control, further adding to the confusion. Nonetheless, several regulatory agencies assign quality rankings based on attaining specified glycemic targets for selected groups of patients (Surgical Care Improvement Project (SCIP) measures). The current paper reviews the data supporting the benefits associated with inpatient glycemic control projects, the components of a successful glycemic control intervention, and utilization of the electronic medical record in implementing an inpatient glycemic control project. PMID:25715828

  4. COMPETITION AND QUALITY IN HOME HEALTH CARE MARKETS†

    PubMed Central

    JUNG, KYOUNGRAE; POLSKY, DANIEL

    2013-01-01

    SUMMARY Market-based solutions are often proposed to improve health care quality; yet evidence on the role of competition in quality in non-hospital settings is sparse. We examine the relationship between competition and quality in home health care. This market is different from other markets in that service delivery takes place in patients’ homes, which implies low costs of market entry and exit for agencies. We use 6 years of panel data for Medicare beneficiaries during the early 2000s. We identify the competition effect from within-market variation in competition over time. We analyze three quality measures: functional improvements, the number of home health visits, and discharges without hospitalization. We find that the relationship between competition and home health quality is nonlinear and its pattern differs by quality measure. Competition has positive effects on functional improvements and the number of visits in most ranges, but in the most competitive markets, functional outcomes and the number of visits slightly drop. Competition has a negative effect on discharges without hospitalization that is strongest in the most competitive markets. This finding is different from prior research on hospital markets and suggests that market-specific environments should be considered in developing polices to promote competition. PMID:23670849

  5. WSU SPOKANE'S HEALTH CARE PARTNERS Pullman Memorial Hospital

    E-print Network

    Collins, Gary S.

    WSU SPOKANE'S HEALTH CARE PARTNERS · Pullman Memorial Hospital · Kootenai · Community Health Association of Spokane (CHAS) · Health Sciences and Services Authority · Inland Northwest Health Services · Spokane Oral and Maxillofacial Surgery · Inland Imaging · MEDEX Northwest · Pacific

  6. [Evaluation of the efficiency and quality of hospitals publicly owned with private management and hospitals of the public sector].

    PubMed

    Giraldes, Maria Do Rosário

    2007-01-01

    The main aim of this article is to evaluate the hospital expenditure by user in an efficiency perspective and to evaluate the quality of the health system using process indicators and outcome indicators. In an efficiency perspective the concept of technical efficiency has been chosen, and a correction has been made, as well, in what concerns a case-mix index (CMI). The indicators have been calculated by user in what concerns the main hospital activities (the expenditure in inpatient care by treated patient, in day hospital by treated patient, in outpatient care by consultation, etc), and as well the auxiliary sections of clinic support and the hotel support services. All the indicators have been corrected according to the case-mix index, in 2004, and have been weighted according to the relevance of its expenditure in total expenditure. In a quality perspective two types of indicators have been considered: process indicators and outcome indicators. Process indicators, as the percentage of surgeries in ambulatory care, the percentage of caesareans in total deliveries and the rate of autopsy. The outcome indicator number of episodes of inpatient care due to surgery infection in total days of inpatient care The composite indicator of efficiency, weighted by the inverse of the case-mix index presents the lower values in Tondela, Seia, and Fafe, while the Hospital of the Litoral Alentejano is, in this group, the most inefficient. The Agueda Hospital presents the better Composite Efficiency Indicator, in Group II, followed by the Barcelos and S. João da Madeira Hospitals, while the Figueira da Foz Hospital presents the worst situation. In hospitals from Group III the Hospitals of Vale de Sousa, EPE, and the Vila Franca de Xira Hospital present the better Composite Efficiency Indicator followed by the Barreiro Hospital, EPE. In Group IV it is the Hospital of S. Sebastião, EPE, that presents the lowest Composite Efficiency Indicator, followed by the Cascais Hospital, SPA, and by the Garcia de Orta Hospital, which are the less efficient hospitals. In Group V, with central hospitals and hospitals with functions of central hospital, it is the Hospital of Vila Real/Régua, EPE, to present the best situation of the Composite Efficiency Indicator, followed by the Santo António Hospital, EPE, the Santa Maria Hospital, EPE, and the HUC, while the hospitals with a worst situation of the Composite Efficiency Indicator are the Hospitals of Faro, Evora and S. José. In Group VI hospitals with a better Composite Efficiency Indicator are the hospitals of Santa Marta, Gama Pinto Institute and Orthopedic Hospital of Outão, while the Estefânia Hospital is the most inefficient. Tondela, Valongo and Peniche Hospitals (Group I), have a good value of the Composite Efficiency and Quality Indicator, while Barcelos, Oliveira de Azeméis and Póvoa de Varzim/Vila do Conde Hospitals (Group II) present also good values of this indicator. The Hospitals of Vila Franca de Xira, Bragança and Setúbal (Group III), the Hospitals of Santarém, Garcia de Orta, and Curry Cabral (Group IV), the Hospital of Vila Real/Régua, the Egas Moniz Hospital and the Santa Maria Hospital (Group V), and the Gama Pinto Institute, the Orthopedic Hospital of Outão, and the Santa Cruz Hospital (Group VI) are the best classified in their groups. EPE Hospitals (Hospitals publicly owned with private management) are the best classified in their groups in what efficiency is concerned, what is a better result tan the one shown in 2003. The lower inequality in relation to management indicators, in all hospital groups, exists in the areas of expenditure with inpatient care by user, what shows the existence of a norm of proceeding, in this traditional hospital area. The higher inequalities are those of day hospital, drugs in day hospital, drugs in outpatient care and rehabilitation by user. In what management indicators are concerned incentives must be created. The most efficient hospitals should be compensated and contract-programmes, between other, must be celebrated. The low rate o

  7. Confronting competing demands to improve quality: a five-country hospital survey.

    PubMed

    Blendon, Robert J; Schoen, Cathy; DesRoches, Catherine M; Osborn, Robin; Zapert, Kinga; Raleigh, Elizabeth

    2004-01-01

    This paper reports on a 2003 comparative survey of hospital executives in Australia, Canada, New Zealand, the United Kingdom, and the United States. Reflecting higher spending levels, U.S. hospitals as a group stand out for generally more positive ratings of facilities and finances and short or no waiting times. Yet U.S. hospital executives are also the most negative about their country's health care system. Hospital executives in all five countries expressed concerns about staffing shortages and emergency department waiting times and quality. Asked about future strategies to improve quality, executives in all five countries expressed support for making information technology an investment priority. PMID:15160810

  8. Effective Marketing of Quality Child Care.

    ERIC Educational Resources Information Center

    Caldwell, Bettye M.; Boyd, Harper W., Jr.

    1984-01-01

    Identifies negative public and professional attitudes that lie beneath the contemporary negative image of quality child care. Argues that concepts and principles of marketing are appropriate for influencing parents to choose high quality services and helping ensure that supplementary care is of sufficient quality to enhance, not inhibit, the…

  9. Transitions from hospital to community care: the role of patient–provider language concordance

    PubMed Central

    2014-01-01

    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. PMID:25075273

  10. Current status of quality evaluation of nursing care through director review and reflection from the Nursing Quality Control Centers

    PubMed Central

    Duan, Xia; Shi, Yan

    2014-01-01

    Background: The quality evaluation of nursing care is a key link in medical quality management. It is important and worth studying for the nursing supervisors to know the disadvantages during the process of quality evaluation of nursing care and then to improve the whole nursing quality. This study was to provide director insight on the current status of quality evaluation of nursing care from Nursing Quality Control Centers (NQCCs). Material and Methods: This qualitative study used a sample of 12 directors from NQCCs who were recruited from 12 provinces in China to evaluate the current status of quality evaluation of nursing care. Data were collected by in-depth interviews. Content analysis method was used to analyze the data. Results: Four themes emerged from the data: 1) lag of evaluation index; 2) limitations of evaluation content; 3) simplicity of evaluation method; 4) excessive emphasis on terminal quality. Conclusion: It is of great realistic significance to ameliorate nursing quality evaluation criteria, modify the evaluation content based on patient needs-oriented idea, adopt scientific evaluation method to evaluate nursing quality, and scientifically and reasonably draw horizontal comparisons of nursing quality between hospitals, as well as longitudinal comparisons of a hospital’s nursing quality. These methods mentioned above can all enhance a hospital’s core competitiveness and benefit more patients. PMID:25419427

  11. Panel: Physicians Use Small Microcomputers for Hospital Patient Care

    PubMed Central

    Splitstone, Dale; Hartney, Thomas C.; Kaplan, Robert; Keene, Beverly; Masencup, Bonnie; Trotter, John

    1984-01-01

    “Physician's Use Small Microcomputers for Hospital Patient Care - A Panel Presentation” advances the view-points of the participants. Physician, Nurse, Pharmacist, Records Librarian, Computer Services and the Administrator present perspectives on small microcomputer use by Physicians. The Panelists have inaugurated a program of such nature in their four hundred beds, private, general hospital and discuss salient features.

  12. Patient satisfaction surveys and quality of care: an information paper.

    PubMed

    Farley, Heather; Enguidanos, Enrique R; Coletti, Christian M; Honigman, Leah; Mazzeo, Anthony; Pinson, Thomas B; Reed, Kevin; Wiler, Jennifer L

    2014-10-01

    With passage of the Patient Protection and Affordable Care Act of 2010, payment incentives were created to improve the "value" of health care delivery. Because physicians and physician practices aim to deliver care that is both clinically effective and patient centered, it is important to understand the association between the patient experience and quality health outcomes. Surveys have become a tool with which to quantify the consumer experience. In addition, results of these surveys are playing an increasingly important role in determining hospital payment. Given that the patient experience is being used as a surrogate marker for quality and value of health care delivery, we will review the patient experience-related pay-for-performance programs and effect on emergency medicine, discuss the literature describing the association between quality and the patient-reported experience, and discuss future opportunities for emergency medicine. PMID:24656761

  13. Do hospital-acquired condition scores correlate with patients' perspectives of care?

    PubMed

    Menendez, Mariano E; Ring, David

    2015-01-01

    Beginning in fiscal year 2015, the federal Hospital-Acquired Condition (HAC) Reduction Program requires the Centers for Medicare & Medicaid Services to reduce payments by 1% for hospitals in the top quartile of risk-adjusted national HAC scores. The HAC penalty underscores the need for hospitals to become increasingly quality- and safety-focused, which could negatively affect their performance on patient satisfaction with care, another key performance metric tied to reimbursement. Using publicly available data through the Centers for Medicare & Medicaid Services Hospital Compare program, we assessed the correlation between preliminary HAC scores and patients' perspectives of care, as measured by the Hospital Consumer Assessment of Healthcare Providers and Systems survey. Higher quality of care (lower HAC score) was modestly associated with a better patient experience (r = -0.090, P < .001). Additional research is needed to ensure that national policy efforts are not working at cross purposes and there need not be a trade-off between delivering high quality of care and patient satisfaction. PMID:25830614

  14. Patterns of Care/Quality of Care

    Cancer.gov

    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.

  15. Longitudinal analysis on the development of hospital quality management systems in the Netherlands

    Microsoft Academic Search

    M. L. A. Duckers; P. Makai; L. Vos; P. P. Groenewegen; C. Wagner

    2009-01-01

    Objective. Many changes have been initiated in the Dutch hospital sector to optimize health-care delivery: national agenda-setting, increased competition and transparency, a new system of hospital reimbursement based on diagnosis-treatment combinations, intensified monitoring of quality and a multi-layered organizational development programme based on quality improvement collaboratives. The objective is to answer the question as to whether these changes were accompanied

  16. Increasing Access to Health Care: Examination of Hospital Community Benefits and Free Care Programs

    ERIC Educational Resources Information Center

    Giffords, Elissa D.; Wenze, Linda; Weiss, David M.; Kass, Donna; Guercia, Rosemarie

    2005-01-01

    The present study explored hospital community benefits and free care programs at seven hospitals in Nassau and Suffolk counties in Long Island, New York. There were two components to this project: (1) assessment of information regarding the availability of free care and (2) an analysis of the community benefits information filed with state…

  17. Basic issues related to quantity and quality of health care, and quality assurance in Indonesia.

    PubMed

    Jacobalis, S

    1989-01-01

    Issues and problems related to the needs for quantity and quality in health care have been presented. The need for quantity has been quite successfully addressed in the last 20 years. Better quality of health care is very much in the minds of policy makers, providers and the informed public. Quality assessment and assurance as a programmed and on-going process in individual hospitals is systematically promoted and developed. An accreditation system for hospitals is planned for the future. This paper has not been able to contribute anything of value to the current practice of quality assurance. The industrialized world has passed the stages Indonesia is now going through. To some Australian colleagues, this presentation perhaps has revealed that one of their closest neighbours is struggling hard to improve the quality of life of its people, despite the tremendous problems and constraints with which it is confronted. Australia has always provided a helping hand in this struggle. PMID:2486044

  18. Reorganizing a hospital ward as an accountable care unit.

    PubMed

    Stein, Jason; Payne, Christina; Methvin, Amanda; Bonsall, Joanna M; Chadwick, Liam; Clark, Diaz; Castle, Bryan W; Tong, David; Dressler, Daniel D

    2015-01-01

    Traditional hospital wards are not specifically designed as effective clinical microsystems. The feasibility and sustainability of doing so are unclear, as are the possible outcomes. To reorganize a traditional hospital ward with the traits of an effective clinical microsystem, we designed it to have 4 specific features: (1) unit-based teams, (2) structured interdisciplinary bedside rounds, (3) unit-level performance reporting, and (4) unit-level nurse and physician coleadership. We called this type of unit an accountable care unit (ACU). In this narrative article, we describe our experience implementing each feature of the ACU. Our aim was to introduce a progressive approach to hospital care and training. PMID:25399928

  19. Costs of measuring outcomes of acute hospital care in a longitudinal outcomes measurement system.

    PubMed

    Schneeweiss, Sebastian; Manstetten, Astrid; Wildner, Manfred; Sangha, Oliver; Liebetrau, Michael; Paeger, Axel

    2003-01-01

    It is widely acknowledged that the measurement of outcomes of care and the comparison of outcomes over time within health care providers and risk-adjusted comparisons among providers are important parts of improving quality and cost-effectiveness of care. However, few studies have assessed the costs of measuring outcomes of care. We sought to evaluate the personnel and financial resources spent for a prospective assessment of outcomes of acute hospital care by health professionals in internal medicine. The study included 15 primary care hospitals participating in a longitudinal outcomes measurement program and 2005 patients over an assessment period with an average duration of 6 months. Each hospital project manager participated in a previously-tested structured 30-minute telephone interview. Outcome measures include time spent by the individual job titles in implementing and running the outcomes measurement program. Job-title-specific times were used to calculate costs from the hospitals' perspective. One-time costs (2132 +/- 1352 Euros) and administrative costs (95 +/- 97 Euros per week) varied substantially. Costs per patient were fairly stable at around 20 Euros. We estimated that the total cost for each hospital to assess outcomes of care for accreditation (10 tracer diagnoses over 6 months) would be 9700 Euros and that continuous monitoring of outcomes (5 tracer diagnoses) would cost 12,400 Euros per year. This study suggests that outcomes of acute hospital care can be assessed with limited resources and that standardized training programs would reduce variability in overall costs. This study should help hospital decision makers to estimate the necessary funding for outcomes measurement initiatives. PMID:12583639

  20. Perceived hospital environment quality indicators: A study of orthopaedic units

    Microsoft Academic Search

    Ferdinando Fornara; Marino Bonaiuto; Mirilia Bonnes

    2006-01-01

    The purposes of this study are to develop perceived hospital environment quality indicators for rating hospital settings, and to use those scales to compare hospitals selected to differ in their spatial–physical humanization (design features that support users’ needs and well-being). Orthopaedic units in three different hospitals in a major Italian city were selected to represent low, moderate and high levels

  1. Perceived hospital environment quality indicators: A study of orthopaedic units

    Microsoft Academic Search

    Ferdinando Fornaraa

    The purposes of this study are to develop perceived hospital environment quality indicators for rating hospital settings, and to use those scales to compare hospitals selected to differ in their spatial-physical humanization (design features that support users' needs and well- being). Orthopaedic units in three different hospitals in a major Italian city were selected to represent low, moderate and high

  2. 80 FR 24323 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2015-04-30

    ...FY 2016 12. Review of Procedure...Hospital Wage Index for Acute Care...for 3 Years L. Process for Requests...peer reviewed literature, which may be...fatality rate: systematic review of the literature....

  3. A comparative study of total quality management of health care system in India and Iran

    PubMed Central

    2011-01-01

    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. PMID:22204664

  4. Dying in two acute hospitals: would usual care meet Australian national clinical standards?

    PubMed

    Clark, Katherine; Byfieldt, Naomi; Green, Malcolm; Saul, Peter; Lack, Jill; Philips, Jane L

    2014-05-01

    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

  5. Managed care and vertical integration: implications for the hospital industry.

    PubMed

    Higgins, C W; Meyers, E D

    1987-08-01

    Efforts to control health care costs are encouraging vertical integration in the health services industry. This restructuring is uniting the financing and delivery of health services into one organizational structure. Current trends in health insurance suggest that the principal insurance products of vertically integrated systems will be carefully managed to reduce unnecessary utilization. As integrated health systems come to dominate the markets of health insurance and medical services, the hospital industry will be dramatically affected. Hospitals will be the principal cost centers while insurance products will be the principal sources of revenue in integrated systems. Accordingly, management will face incentives to minimize hospital utilization and sell or convert excess hospital assets. This article discusses specific changes that hospitals may face if current trends continue. PMID:10283402

  6. Self-care program for inpatients in a mental hospital.

    PubMed Central

    Voineskos, G.; Butler, J. A.; Bullock, L. J.; El-Gaaly, A. A.

    1975-01-01

    Summary: A self-care program for selected inpatients in a mental hospital has been developed and has been in operation for more than a year. The 12-bed unit operates without any nursing or other professional staff during the night and weekend. Certain factors, including the mental hospital as an organization, tend to hamper the development of this type of program as well as the progress and growth of other programs in psychiatric hospitals. It is suggested that the much needed progress in the mental hospital would be facilitated by an open-systems approach to its organization. Mental hospitals should consider the introduction of self-care programs for selected patients, mainly in view of their therapeutic potential, but also because of the financial savings such programs offer. PMID:1111874

  7. How five leading safety-net hospitals are preparing for the challenges and opportunities of health care reform.

    PubMed

    Coughlin, Teresa A; Long, Sharon K; Sheen, Edward; Tolbert, Jennifer

    2012-08-01

    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

  8. 38 CFR 17.55 - Payment for authorized public or private hospital care.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ...false Payment for authorized public or private hospital care. 17.55 Section 17...VETERANS AFFAIRS MEDICAL Use of Public Or Private Hospitals § 17.55 Payment for authorized public or private hospital care. Except as...

  9. 38 CFR 17.55 - Payment for authorized public or private hospital care.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ...false Payment for authorized public or private hospital care. 17.55 Section 17...VETERANS AFFAIRS MEDICAL Use of Public Or Private Hospitals § 17.55 Payment for authorized public or private hospital care. Except as...

  10. Iowa Child Care Quality Rating System: QRS Profile. The Child Care Quality Rating System (QRS) Assessment

    ERIC Educational Resources Information Center

    Child Trends, 2010

    2010-01-01

    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;…

  11. [The revised system of hospitalization for medical care and protection].

    PubMed

    Fukuo, Yasuhisa

    2014-01-01

    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

  12. The Problem of Late Hospitalization: A Quality and Cost Issue.

    ERIC Educational Resources Information Center

    Gonnella, Joseph S.; And Others

    1990-01-01

    This study was designed to determine whether opportunities exist to reduce patient morbidity and health care costs by utilizing health care services before diseases progress to advanced stages. Hospital admissions were categorized based on the timing of the initial hospitalizations of patients admitted with any of 14 diagnoses. (Author/MLW)

  13. Child Care Subsidy and Program Quality Revisited

    Microsoft Academic Search

    Becky F. Antle; Andy Frey; Anita Barbee; Shannon Frey; Jennifer Grisham-Brown; Megan Cox

    2008-01-01

    Research Findings: Previous research has documented conflicting results on the relationship between program quality and the percentage of children receiving subsidized child care (subsidy density) in early childhood centers. This research examined the relationship between subsidy density and the quality of infant and preschool classrooms in child care centers, taking into consideration teacher education and salary as well as other

  14. Pre-hospital care in burn injury.

    PubMed

    Shrivastava, Prabhat; Goel, Arun

    2010-09-01

    The care provided to the victims of burn injury immediately after sustaining burns can largely affect the extent and depth of the wound. Although standard guidelines have been formulated by various burn associations, they are still not well known to public at large in our country. In burn injuries, most often, the bystanders are the first care providers. The swift implementation of the measures described in this article for first aid in thermal, chemical, electrical and inhalational injuries in the practical setting, within minutes of sustaining the burn, plays a vital role and can effectively reduce the morbidity and mortality to a great extent. In case of burn disasters, triage needs to be carried out promptly as per the defined protocols. Proper communication and transport from the scene of the accident to the primary care centre and onto the burn care facility greatly influences the execution of the management plans. PMID:21321651

  15. Pre-hospital care in burn injury

    PubMed Central

    Shrivastava, Prabhat; Goel, Arun

    2010-01-01

    The care provided to the victims of burn injury immediately after sustaining burns can largely affect the extent and depth of the wound. Although standard guidelines have been formulated by various burn associations, they are still not well known to public at large in our country. In burn injuries, most often, the bystanders are the first care providers. The swift implementation of the measures described in this article for first aid in thermal, chemical, electrical and inhalational injuries in the practical setting, within minutes of sustaining the burn, plays a vital role and can effectively reduce the morbidity and mortality to a great extent. In case of burn disasters, triage needs to be carried out promptly as per the defined protocols. Proper communication and transport from the scene of the accident to the primary care centre and onto the burn care facility greatly influences the execution of the management plans PMID:21321651

  16. Registered nurses perception of work satisfaction at a Tertiary Care University Hospital.

    PubMed

    Khowaja, Khurshid; Merchant, Rashida J; Hirani, Doulat

    2005-01-01

    Hospitals are facing serious challenges to provide high quality care with current nursing shortages. Nursing shortages are of major concern for Nursing Management, clinicians and administrators as they lead to impact on quality of care. Under-stressed, frustrated and demoralized nurses give rise to concern for hospital Nursing Management in providing quality care according to set standards. A descriptive qualitative research design was used to explore the registered nurses' perceptions regarding the high turnover rates among nurses at a Tertiary Care University Hospital. Data was collected from nurses working at various speciality areas, which were: Critical Care, Medical and Surgical Care, Ambulatory Care, Maternal/Child and Emergency departments. A convenience sample of 45 registered nurses from nine subspecialty groups was selected for a focus group interview and five focus groups were selected for a study population. Findings of exit interviews (from 1 September 2001 to 28 February 2002) were also included in the data analysis. These exit interviews of RNs were conducted by Nurse Recruiter at the time of their resignations. The data analysis showed that the most dissatisfying factors at work and within the work setting were identified as: high workload, stress associated with high workload, biased Nursing Management, lack of appreciation and monetary incentives, finally a rigid attitude of Nursing Management. However, the most satisfying factors were: working with an internationally reputable organization, patients' positive feedback and availability of required material or equipment. The study participants recommended that nursing retention could be improved at the Tertiary Care University Hospital by launching the following strategies by Nursing Management: reducing workload by adequate nurse-patient ratios according to international standards, promoting respect of nurses in front of patients and other staff, rewards and recognition of nurses, simplifying nursing documentation, increasing recreational activities for nurses and empowering nurses and Nursing Management group. PMID:15613092

  17. Bridging the gap between hospital and primary care: the pharmacist home visit.

    PubMed

    Ensing, Hendrik T; Koster, Ellen S; Stuijt, Clementine C M; van Dooren, Ad A; Bouvy, Marcel L

    2015-06-01

    Bridging the gap between hospital and primary care is important as transition from one healthcare setting to another increases the risk on drug-related problems and consequent readmissions. To reduce those risks, pharmacist interventions during and after hospitalization have been frequently studied, albeit with variable effects. Therefore, in this manuscript we propose a three phase approach to structurally address post-discharge drug-related problems. First, hospitals need to transfer up-todate medication information to community pharmacists. Second, the key phase of this approach consists of adequate follow-up at the patients' home. Pharmacists need to apply their clinical and communication skills to identify and analyze drug-related problems. Finally, to prevent and solve identified drug related problems a close collaboration within the primary care setting between pharmacists and general practitioners is of utmost importance. It is expected that such an approach results in improved quality of care and improved patient safety. PMID:25759280

  18. Validation Protocol: First Step of a Lean-Total Quality Management Principle in a New Laboratory Set-up in a Tertiary Care Hospital in India.

    PubMed

    Das, Barnali

    2011-07-01

    Method validation is pursued as the first step in establishing Lean-Total Quality Management in a new clinical laboratory, in order to eliminate error in test results. Validation of all the new tests were done (with particular reference to alkaline phosphatase) by verifying reference intervals, analytical accuracy and precision, inter-assay and intra-assay variations, analytical sensitivity, limit of detection, linearity and reportable range, i.e. (i) Analytical measurement range (AMR) and (ii) Clinically reportable range (CRR). Our obtained reference range was within that of the manufacturer's and showed high degree of analytical accuracy between two laboratories (r(2) = 0.99). Precision was comparable with the manufacturer's claim with inter-assay variation CV 1.04% and intra-assay variation CV 1.54%. Lowest limit of detection was 1.0324 ± 0.007 with CV 0.34%. AMR was also verified with CV 1.26 and 0.69%, for level 1 and level 2 control sera, respectively. The assay was linear with different dilutions. Lean concept was also verified with high recovery percentage. Validation ensures that accurate and precise results are reported in a clinically relevant turn around time. PMID:22754186

  19. Quality of Care Indicators for Radical Cystectomy

    Microsoft Academic Search

    Matthew R. Cooperberg; Badrinath R. Konety

    \\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

  20. Choosing quality of care measures based on the expected impact of improved care on health.

    PubMed Central

    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

    1992-01-01

    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. PMID:1464537

  1. Massachusetts General Hospital Cancer Center Advancing cancer care through groundbreaking research

    E-print Network

    de Bakker, Paul

    Massachusetts General Hospital Cancer Center Advancing cancer care through groundbreaking research Massachusetts General Hospital Cancer Center combines a commitment to further the most innovative scientific advancements to impact cancer care. An emphasis on delivering compassionate care to each individual patient

  2. Patient Experience of Nursing Quality in a Teaching Hospital in Saudi Arabia

    PubMed Central

    Al Momani, M; Al Korashy, H

    2012-01-01

    Background: Examining the quality of nursing care from the patient's perspective is an important element in quality evaluation. The extent to which patients’ expectations are met will influence their perceptions and their satisfaction with the quality of care received. Methods: A cross-sectional survey was conducted among admitted patients at King Khalid Teaching Hospital, Riyadh, Saudi Arabia. Data were collected (from January 2011 to March 2011) from a convenience sample of 448 patients using a 42-items questionnaire assessing six dimensions of the nursing care provided to, during hospitalization. Results: On a four–point scale (4-higly agree,3-agree, 2-disagree, and 1-higly disagree). The individual items of nursing care showing the lowest means were the information received from the nurses about self-help (2.81), the information about the laboratory results (2.76) and the way the nurse shared the patient's feeling (2.72). A strong correlation existed between the overall perception level and the variables of gender (P=0.01), and the types of department (0.004). Conclusion: The findings of this study demonstrate negative experiences of patients with nursing care in dimensions of information, caring behavior, and nurse competency and technical care. Awareness of the importance of these dimensions of nursing care and ongoing support to investigate patients’ perception periodically toward quality of nursing care are critical to success the philosophy of patient centered health care. PMID:23113223

  3. Hospital discharge planning and continuity of care for aged people in an Italian local health unit: does the care-home model reduce hospital readmission and mortality rates?

    Microsoft Academic Search

    Gianfranco Damiani; Bruno Federico; Antonella Venditti; Lorella Sicuro; Silvia Rinaldi; Franco Cirio; Cristiana Pregno; Walter Ricciardi

    2009-01-01

    BACKGROUND: Hospital discharge planning is aimed to decrease length of stay in hospitals as well as to ensure continuity of health care after being discharged. Hospitalized patients in Turin, Italy, who are in need of medical, social and rehabilitative care are proposed as candidates to either discharge planning relying on a care-home model (DPCH) for a period of about 30

  4. Basics of quality improvement in health care.

    PubMed

    Varkey, Prathibha; Reller, M Katherine; Resar, Roger K

    2007-06-01

    With the rapid expansion of knowledge and technology and a health care system that performs far below acceptable levels for ensuring patient safety and needs, front-line health care professionals must understand the basics of quality improvement methodologies and terminology. The goals of this review are to provide clinicians with sufficient information to understand the fundamentals of quality improvement, provide a starting point for improvement projects, and stimulate further inquiry into the quality improvement methodologies currently being used in health care. Key quality improvement concepts and methodologies, including plan-do-study-act, six-sigma, and lean strategies, are discussed, and the differences between quality improvement and quality-of-care research are explored. PMID:17550754

  5. Hospital Epidemiology and Infection Control in Acute-Care Settings

    PubMed Central

    Sydnor, Emily R. M.; Perl, Trish M.

    2011-01-01

    Summary: Health care-associated infections (HAIs) have become more common as medical care has grown more complex and patients have become more complicated. HAIs are associated with significant morbidity, mortality, and cost. Growing rates of HAIs alongside evidence suggesting that active surveillance and infection control practices can prevent HAIs led to the development of hospital epidemiology and infection control programs. The role for infection control programs has grown and continues to grow as rates of antimicrobial resistance rise and HAIs lead to increasing risks to patients and expanding health care costs. In this review, we summarize the history of the development of hospital epidemiology and infection control, common HAIs and the pathogens causing them, and the structure and role of a hospital epidemiology and infection control program. PMID:21233510

  6. Collaborative quality improvement in the cardiac intensive care unit: development of the Paediatric Cardiac Critical Care Consortium (PC4).

    PubMed

    Gaies, Michael; Cooper, David S; Tabbutt, Sarah; Schwartz, Steven M; Ghanayem, Nancy; Chanani, Nikhil K; Costello, John M; Thiagarajan, Ravi R; Laussen, Peter C; Shekerdemian, Lara S; Donohue, Janet E; Willis, Gina M; Gaynor, J William; Jacobs, Jeffrey P; Ohye, Richard G; Charpie, John R; Pasquali, Sara K; Scheurer, Mark A

    2015-06-01

    Despite many advances in recent years for patients with critical paediatric and congenital cardiac disease, significant variation in outcomes remains across hospitals. Collaborative quality improvement has enhanced the quality and value of health care across specialties, partly by determining the reasons for variation and targeting strategies to reduce it. Developing an infrastructure for collaborative quality improvement in paediatric cardiac critical care holds promise for developing benchmarks of quality, to reduce preventable mortality and morbidity, optimise the long-term health of patients with critical congenital cardiovascular disease, and reduce unnecessary resource utilisation in the cardiac intensive care unit environment. The Pediatric Cardiac Critical Care Consortium (PC4) has been modelled after successful collaborative quality improvement initiatives, and is positioned to provide the data platform necessary to realise these objectives. We describe the development of PC4 including the philosophical, organisational, and infrastructural components that will facilitate collaborative quality improvement in paediatric cardiac critical care. PMID:25167212

  7. Collaborative quality improvement in the cardiac intensive care unit: development of the Paediatric Cardiac Critical Care Consortium (PC4)

    PubMed Central

    Gaies, Michael; Cooper, David S.; Tabbutt, Sarah; Schwartz, Steven M.; Ghanayem, Nancy; Chanani, Nikhil K.; Costello, John M.; Thiagarajan, Ravi R.; Laussen, Peter C.; Shekerdemian, Lara S.; Donohue, Janet E.; Willis, Gina M.; Gaynor, J. William; Jacobs, Jeffrey P.; Ohye, Richard G.; Charpie, John R.; Pasquali, Sara K.; Scheurer, Mark A.

    2014-01-01

    Despite many advances in recent years for patients with critical paediatric and congenital cardiac disease, significant variation in outcomes remains across hospitals. Collaborative quality improvement has enhanced the quality and value of health care across specialties, partly by determining the reasons for variation and targeting strategies to reduce it. Developing an infrastructure for collaborative quality improvement in paediatric cardiac critical care holds promise for developing benchmarks of quality, to reduce preventable mortality and morbidity, optimise the long-term health of patients with critical congenital cardiovascular disease, and reduce unnecessary resource utilisation in the cardiac intensive care unit environment. The Pediatric Cardiac Critical Care Consortium (PC4) has been modelled after successful collaborative quality improvement initiatives, and is positioned to provide the data platform necessary to realise these objectives. We describe the development of PC4 including the philosophical, organisational, and infrastructural components that will facilitate collaborative quality improvement in paediatric cardiac critical care. PMID:25167212

  8. Changes in general hospital psychiatric care, 1980-1985.

    PubMed

    Kiesler, C A

    1991-04-01

    More than 60% of all inpatient psychiatric episodes occur in general hospitals. The need for psychologists' involvement in this important area is discussed. Changes in general hospital inpatient care from 1980 to 1985 are described. These include important and controversial changes in public policy, most notably Medicare's prospective payment system. Substantial changes in the de facto system occurred in patterns of diagnosis, sites of care, and the role of third-party payers. Implications for public policy and future investigations are drawn. PMID:2048799

  9. Effects of competition on hospital quality: an examination using hospital administrative data.

    PubMed

    Palangkaraya, Alfons; Yong, Jongsay

    2013-06-01

    This paper investigates the effects of competition on hospital quality using hospital administration data from the State of Victoria, Australia. Hospital quality is measured by 30-day mortality rates and 30-day unplanned readmission rates. Competition is measured by Herfindahl-Hirschman index and the numbers of competing public and private hospitals. The paper finds that hospitals facing higher competition have lower unplanned admission rates. However, competition is related negatively to hospital quality when measured by mortality, albeit the effects are weak and barely statistically significant. The paper also finds that the positive effect of competition on quality as measured by unplanned readmission differs greatly depending on whether the hospital is publicly or privately owned. PMID:22395668

  10. Leadership and the quality of care

    PubMed Central

    Firth-Cozens, J; Mowbray, D

    2001-01-01

    The importance of good leadership is becoming increasingly apparent within health care. This paper reviews evidence which shows that it has effects, not only on financial management, but on the quality of care provided. Some theories of leadership are discussed, primarily in terms of how different types of leaders might affect quality in different ways, including the effects that they might have on the stress or wellbeing of their staff which, in turn, is related to the quality of care produced. Finally, the conflicts shown in terms of leadership within the context of health care are discussed, leading to the conclusion that development programmes must be specially tailored to address the complexities of this arena. Key Words: leadership; quality of care; stress; personality PMID:11700372

  11. Health care communication networks: disseminating employee information for hospital security.

    PubMed

    Sumner, Jennifer; Liberman, Aaron; Rotarius, Timothy; Wan, Thomas T H; Eaglin, Ronald

    2009-01-01

    Health care in the United States is a system that, organizationally speaking, is fragmented. Each hospital facility is independently operated and is responsible for the hiring of its own employees. Corrupt individuals can take advantage of this fragmentation and move from hospital to hospital, gaining employment while hiding previous employment history. However, the need to exchange pertinent information regarding employees will become necessary as hospitals seek to fill positions throughout their organizations. One way to promote this information exchange is to develop trusted information sharing networks among hospital units. This study examined the problems surrounding organizational information sharing and the cultural factors necessary to enhance the exchange of employee information. Surveys were disseminated to 2,603 hospital chief executive officers and chief information officers throughout the nation. A sample of 154 respondents provided data into their current hiring practices and on their willingness to engage in the sharing of employee information. Findings indicated that, although fear of defamation and privacy violations do hinder the exchange of information between hospitals during the hiring process, by increasing external trust, linking the sharing process with the organizational goals of the hospital, and developing a "sharing culture" among hospitals, the exchange of employee information could be enhanced. PMID:19910705

  12. A system-wide analysis using a senior-friendly hospital framework identifies current practices and opportunities for improvement in the care of hospitalized older adults.

    PubMed

    Wong, Ken S; Ryan, David P; Liu, Barbara A

    2014-11-01

    Older adults are vulnerable to hospital-associated complications such as falls, pressure ulcers, functional decline, and delirium, which can contribute to prolonged hospital stay, readmission, and nursing home placement. These vulnerabilities are exacerbated when the hospital's practices, services, and physical environment are not sufficiently mindful of the complex, multidimensional needs of frail individuals. Several frameworks have emerged to help hospitals examine how organization-wide processes can be customized to avoid these complications. This article describes the application of one such framework-the Senior-Friendly Hospital (SFH) framework adopted in Ontario, Canada-which comprises five interrelated domains: organizational support, processes of care, emotional and behavioral environment, ethics in clinical care and research, and physical environment. This framework provided the blueprint for a self-assessment of all 155 adult hospitals across the province of Ontario. The system-wide analysis identified practice gaps and promising practices within each domain of the SFH framework. Taken together, these results informed 12 recommendations to support hospitals at all stages of development in becoming friendly to older adults. Priorities for system-wide action were identified, encouraging hospitals to implement or further develop their processes to better address hospital-acquired delirium and functional decline. These recommendations led to collaborative action across the province, including the development of an online toolkit and the identification of accountability indicators to support hospitals in quality improvement focusing on senior-friendly care. PMID:25355067

  13. The optimal outcomes of post-hospital care under medicare.

    PubMed Central

    Kane, R L; Chen, Q; Finch, M; Blewett, L; Burns, R; Moskowitz, M

    2000-01-01

    OBJECTIVE: To estimate the differences in functional outcomes attributable to discharge to one of four different venues for post-hospital care for each of five different types of illness associated with post-hospital care: stroke, chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF), hip procedures, and hip fracture, and to estimate the costs and benefits associated with discharge to the type of care that was estimated to produce the greatest improvement. STUDY SETTING/DATA SOURCES: Consecutive patients with any of the target diagnoses were enrolled from 52 hospitals in three cities. Data sources included interviews with patients or their proxies, medical record reviews, and the Medicare Automated Data Retrieval System. ANALYSIS: A two-stage regression model looked first at the factors associated with discharge to each type of post-hospital care and then at the outcomes associated with each location. An instrumental variables technique was used to adjust for selection bias. A predictive model was created for each patient to estimate how that person would have fared had she or he been discharged to each type of care. The optimal discharge location was determined as that which produced the greatest improvement in function after adjusting for patients' baseline characteristics. The costs of discharge to the optimal type of care was based on the differences in mean costs for each location. DATA COLLECTION/EXTRACTION METHODS: Data were collected from patients or their proxies at discharge from hospital and at three post-discharge follow-up times: six weeks, six months, and one year. In addition, the medical records for each participant were abstracted by trained abstractors, using a modification of the Medisgroups method, and Medicare data were summarized for the years before and after the hospitalization. PRINCIPAL FINDINGS: In general, patients discharged to nursing homes fared worst and those sent home with home health care or to rehabilitation did best. Because the cost of rehabilitation is high, greater use of home care could result in improved outcomes at modest or no additional cost. CONCLUSIONS: Better decisions about where to discharge patients could improve the course of many patients. It is possible to save money by making wiser discharge planning decisions. Nursing homes are generally associated with poorer outcomes and higher costs than the other post-hospital care modalities. PMID:10966088

  14. Patients' satisfaction and opinions of their experiences during admission in a tertiary care hospital in Pakistan – a cross sectional study

    Microsoft Academic Search

    Sardar Zakariya Imam; Khezar Shahzada Syed; Syed Ahad Ali; Syed Umer Ali; Kiran Fatima; Marium Gill; Muhammad Ovais Hassan; Saad Hasan Hashmi; Maham T Siddiqi; Hadi Muhammad Khan; Omar Farooq Jameel

    2007-01-01

    BACKGROUND: It is often felt that developing countries need to improve their quality of healthcare provision. This study hopes to generate data that can help managers and doctors to improve the standard of care they provide in line with the wishes of the patients. METHODS: It was a cross sectional study carried out at a major tertiary care hospital of

  15. Total quality management (TQM) in a hospital library: identifying service benchmarks.

    PubMed Central

    Fischer, W W; Reel, L B

    1992-01-01

    Hospitals are turning to total quality management (TQM) to lower costs of providing care. A hospital library in a TQM environment needs to embrace corporate goals while maintaining its accountability as a contributor to quality patient care. Alliant Health System (AHS) Library at Norton Hospital and Kosair Children's Hospital in Louisville, Kentucky, conducted a study to establish TQM benchmarks and to examine the significance of its role in clinical care. Using a methodology designed to allow both library user and nonuser to respond, 2,091 surveys were distributed to physicians and nursing and allied health personnel. Areas surveyed included frequency of library use, impact of information received on clinical judgments, cognitive value of the information, and satisfaction with library products and services. Results confirm that the library has a substantial clinical role. Eighty-eight percent of reporting physicians agreed that information from the library contributed to higher quality care. Nursing and allied health were less convinced of the importance of the library's clinical role. Sixty-nine percent of nursing personnel and 58% of allied health personnel agreed that the library contributed to higher quality care. Nursing and allied health personnel also used the library less frequently than physicians. With these results as benchmarks, improving the clinical role of the library will take commitment to the TQM process and a willingness to change. PMID:1422505

  16. A Conceptual Framework for Quality of Care

    PubMed Central

    Mosadeghrad, Ali Mohammad

    2012-01-01

    Despite extensive research on defining and measuring health care quality, little attention has been given to different stakeholders’ perspectives of high-quality health care services. The main purpose of this study was to explore the attributes of quality healthcare in the Iranian context. Exploratory in-depth individual and focus group interviews were conducted with key healthcare stakeholders including clients, providers, managers, policy makers, payers, suppliers and accreditation panel members to identify the healthcare service quality attributes and dimensions. Data analysis was carried out by content analysis, with the constant comparative method. Over 100 attributes of quality healthcare service were elicited and grouped into five categories. The dimensions were: efficacy, effectiveness, efficiency, empathy, and environment. Consequently, a comprehensive model of service quality was developed for health care context. The findings of the current study led to a conceptual framework of healthcare quality. This model leads to a better understanding of the different aspects of quality in health care and provides a better basis for defining, measuring and controlling quality of health care services. PMID:23922534

  17. [Quality improvement of health care services in Croatian emergency medicine].

    PubMed

    Predavec, Sanja; Sogori?, Selma; Jurkovi?, Drazen

    2010-12-01

    Emergency medical services (EMS) in the Republic of Croatia are currently organized as part of the existing health care system and delivered in the form of pre-hospital and hospital EMS. The pre-hospital EMS are delivered by standalone EMS Centers, EMS units set up in community health centers, and by general practitioners working in shifts and on call in remote and scarcely populated areas. In hospitals, each ward usually has its own emergency reception area, and only in a couple of cases there is an integrated emergency admission unit for the entire hospital. The current EMS structure does not meet the basic requirements that would make an EMS system optimal, i.e. equal quality, equal access, effectiveness and appropriate equipment. The EMS Restructuring Project is part of the Croatian health care system reform and is addressed by the National Health Development Strategy 2006-2011. As part of restructuring efforts, the Croatian National Institute of Emergency Medicine, 21 County Institutes of Emergency Medicine and county-level call centers are going to be set up. In addition, the project will introduce the following: integrated emergency admission areas at hospitals; telemedicine as part of emergency medicine; emergency medicine specialty for physicians and additional specialized training for nurses/technicians; separation of emergency and non-emergency transport; standards for vehicles and equipment and guidelines/protocols/algorithms for care. The Croatian National Institute of Emergency Medicine is an umbrella EMS organization. It shapes the EMS in Croatia and proposes, plans, monitors and analyzes EMS actions in Croatia. In addition, it submits a proposal of the Emergency Medicine Network to the minister, sets standards for EMS transport, and coordinates, guides and supervises the work of County Institutes of Emergency Medicine. County Institutes organize and deliver pre-hospital EMS in their counties. Integrated hospital emergency admission units represent a single point of entry for all emergencies at a particular hospital. Upon triage, depending on the level of emergency, patients are provided with appropriate care and treatment. The introduction of EMS specialty for physicians and additional specialized training for nurses/ technicians is going to increase competencies of all EMS team members. The main objectives of the EMS Restructuring Project to be achieved in the 5-year period are the following: to reduce the response time of pre-hospital EMS teams to 10 minutes in urban areas and 20 minutes in rural areas in 20% of team interventions; to bring patients to hospital within the "golden hour" in 80% of cases; to have 200 physicians specialized in emergency medicine; and to have 220 nurses/technicians that have successfully completed their specialized training in emergency medicine. The objectives are going to be monitored through indicators as part of the World Bank Project for which data have already been collected throughout Croatia: number of interventions; number of emergency interventions; time between call receipt and arrival to scene; time between call receipt and arrival to hospital emergency reception area; percentage of arrivals to hospital by EMS vehicles within 12 hours of symptom onset; polytrauma and cardiac arrest survival rate before admission to hospital; time spent in hospital emergency reception areas and integrated hospital emergency admission units; polytrauma and cardiac arrest survival rate within 24 hours of hospital admission; number of integrated hospital emergency admission units per county; and number of pre-hospital EMS teams per capita. PMID:21692265

  18. How Hospitals Choose a Quality Management System: Relevant Criteria in Large Spanish Hospitals

    Microsoft Academic Search

    Marta Sangüesa; Ricardo Mateo; Laura Ilzarbe

    2007-01-01

    This article examines the selection criteria used by hospital managers when choosing a quality management system (QMS): ISO 9001, Joint Commission (JC), EFQM, or a combination of them. Furthermore, this study provides a view of how extensive is the use of QMS in the main Spanish hospitals. Between December 2004 and March 2005, a questionnaire was sent to Spanish hospitals

  19. University of Stirling PhD studentship in Diabetes and Pre-hospital Emergency Care

    E-print Network

    Little, Tony

    University of Stirling PhD studentship in Diabetes and Pre-hospital Emergency Care Background in maternity care, mental health and pre-hospital emergency care. The programme has a strong track record collaboration focusing on pre-hospital paramedic emergency care with the Scottish Ambulance Service. This strand

  20. Guaranteeing Quality in Child Care.

    ERIC Educational Resources Information Center

    Morgan, Gwen G.

    This paper presents a discussion of state and federal licensing and regulation of child care services. A hierarchy of the kinds of regulation is defined: (1) basic preventive/protective requirements (related to zoning, fire and safety, sanitation, and basic day care licensing); (2) administrative standards for publicly operated programs (equal to…

  1. An interview with: David Sine on trends in hospital safety/quality management.

    PubMed

    Sine, D

    1992-04-01

    David M. Sine, president of David M. Sine & Associates, Inc., Austin, TX, is a safety and quality management consultant specializing in pre-accreditation auditing of health care facilities. Prior to becoming an independent consultant in 1980, he was a senior staff engineer for the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and has worked as a consultant to the American Hospital Association. He has lectured throughout the country and published numerous trade articles on safety and quality management issues. Here, he discusses recent trends and developments in hospital safety and quality management, and offers advice on measures to take in preparation for a Joint Commission accreditation survey. PMID:10118781

  2. Post-Hospital Medical Respite Care and Hospital Readmission of Homeless Persons

    Microsoft Academic Search

    Stefan G. Kertesz; Michael A. Posner; James J. OConnell; Stacy Swain; Ashley N. Mullins; Michael Shwartz; Arlene S. Ash

    2009-01-01

    Medical respite programs offer medical, nursing, and other care as well as accommodation for homeless persons discharged from acute hospital stays. They represent a community-based adaptation of urban health systems to the specific needs of homeless persons. This article examines whether post-hospital discharge to a homeless medical respite program was associated with a reduced chance of 90-day readmission compared to

  3. Improving medication safety during hospital-based transitions of care.

    PubMed

    Sponsler, Kelly C; Neal, Erin B; Kripalani, Sunil

    2015-06-01

    Medication errors are common during transitions of care such as hospital admission and discharge. Problems range from minor discrepancies to actual patient harm. A systematic routine for medication reconciliation can minimize errors, thereby preventing adverse drug events and improving patient safety. PMID:26086494

  4. Hospitality and Facility Care Services. Ohio's Competency Analysis Profile.

    ERIC Educational Resources Information Center

    Ohio State Univ., Columbus. Vocational Instructional Materials Lab.

    Developed through a modified DACUM (Developing a Curriculum) process involving business, industry, labor, and community agency representatives in Ohio, this document is a comprehensive and verified employer competency profile for hospitality and facility care occupations. The list contains units (with and without subunits), competencies, and…

  5. Quality Measurement in Diabetes Care

    Microsoft Academic Search

    Brian F. Leas; Bettina Berman; Kathryn M. Kash; Albert G. Crawford; Richard W. Toner; Neil I. Goldfarb; David B. Nash

    2009-01-01

    This study aimed to evaluate diabetes quality measurement efforts, assess their strengths and areas for im- provement, and identify gaps not adequately addressed by these measures. We conducted an environmental scan of diabetes quality measures, focusing on metrics included in the National Quality Measures Clearinghouse or promulgated by leading measurement organizations. Key informant interviews were also completed with thought leaders

  6. Oregon Child Care Quality Indicators Program: QRS Profile. The Child Care Quality Rating System (QRS) Assessment

    ERIC Educational Resources Information Center

    Child Trends, 2010

    2010-01-01

    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)…

  7. Association between a Hospital’s Quality Performance for In-Hospital Cardiac Arrest and Common Medical Conditions

    PubMed Central

    Chen, Lena M.; Nallamothu, Brahmajee K.; Krumholz, Harlan M.; Spertus, John A.; Tang, Fengming; Chan, Paul S.

    2015-01-01

    Background Public reporting on hospital quality has been widely adopted for common medical conditions. Adding a measure of inpatient survival after cardiac arrest is being considered. It is unknown if this measure would be redundant, given evidence that hospital organization and culture can have hospital-wide effects on quality. Therefore, we sought to evaluate the correlation between inpatient survival after cardiac arrest and 30-day risk-standardized mortality rates for common medical conditions. Methods and Results Using data between 2007 and 2010 from a national in-hospital cardiac arrest registry, we calculated risk-standardized in-hospital survival rates for cardiac arrest at each hospital. We obtained risk-standardized 30-day mortality rates for acute myocardial infarction (AMI), heart failure (HF), and pneumonia from Hospital Compare for the same period. The relationship between a hospital’s performance on cardiac arrest and these other medical conditions was assessed using weighted Pearson correlation coefficients. Among 26,270 patients with in-hospital cardiac arrest at 130 hospitals, survival rates varied across hospitals, with a median risk-standardized hospital survival rate of 22.1% and an inter-quartile range (IQR) of 19.7% to 24.2%. There were no significant correlations between a hospital’s outcomes for its cardiac arrest patients and its patients admitted for AMI (correlation of ?0.12; P=0.16), HF (correlation of ?0.05; P=0.57), or pneumonia (correlation of ?0.15, P=0.10). Conclusions Hospitals that performed better on publicly reported outcomes for three common medical conditions did not necessarily have better cardiac arrest survival rates. Public reporting on cardiac arrest outcomes could provide new information about hospital quality. PMID:24221831

  8. Patient service navigator: improving quality and services and reducing cost under the Affordable Care Act.

    PubMed

    Piper, Llewellyn E

    2014-01-01

    This article proposes the implementation of a Patient Service Navigator to improve quality, service, and the patient and family experience and to reduce costs in caring for patients in a hospital setting. Under the Affordable Care Act, the Patient Service Navigator is a means to address value-based purchasing whereby hospitals will be reimbursed based on quality and Hospital Consumer Assessment of Healthcare Providers and System scores for Medicare patients. In this article, the reader will learn the history, background, purpose, and role of the Patient Service Navigator as a critical component of a multidisciplinary health care team in supporting inpatient care with a human touch. Navigating for the patient and family in a confusing and complex health care delivery environment is critical today in order to survive the mandates of the Affordable Care Act. PMID:24463591

  9. Primary Care Sensitive Hospitalization: users detect flaws on the access to services.

    PubMed

    Rehem, Tania Cristina Morais Santa Barbara; Ciosak, Suely Itsuko; Egry, Emiko Yoshikawa

    2014-12-01

    The aim of this study is to analyze and understand the reasons for the occurrence of sensitive hospitalizations in accordance with users. Qualitative study conducted with users who were admitted to Pedreira General Hospital, in São Paulo. The data was collected through semi structured interviews and thereafter, transcribed and processed in the electronic program Alceste. When analyzing the content, the access was seized fundamentally as an empirical category, bringing up problems that later deserved, from the Brazilian Ministry of Health, a specific Program to improve the quality and access to primary care. The hierarchical and pyramidal organization shape from the health system in the city of São Paulo can be one of the important aspects for the access matter and established as an important restricting factor in the primary care role in reducing or even preventing the occurrence of these hospitalizations. PMID:25830738

  10. Responsibility for quality improvement and patient safety: hospital board and medical staff leadership challenges.

    PubMed

    Goeschel, Christine A; Wachter, Robert M; Pronovost, Peter J

    2010-07-01

    Concern about the quality and safety of health care persists, 10 years after the 1999 Institute of Medicine report To Err is Human. Despite growing awareness of quality and safety risks, and significant efforts to improve, progress is difficult to measure. Hospital leaders, including boards and medical staffs, are accountable to improve care, yet they often address this duty independently. Shared responsibility for quality and patient safety improvement presents unique challenges and unprecedented opportunities for boards and medical staffs. To capitalize on the pressure to improve, both groups may benefit from a better understanding of their synergistic potential. Boards should be educated about the quality of care provided in their institutions and about the challenges of valid measurement and accurate reporting. Boards strengthen their quality oversight capacity by recruiting physicians for vacant board seats. Medical staff members strengthen their role as hospital leaders when they understand the unique duties of the governing board. A quality improvement strategy rooted in synergistic efforts by the board and the medical staff may offer the greatest potential for safer care. Such a mutually advantageous approach requires a clear appreciation of roles and responsibilities and respect for differences. In this article, we review these responsibilities, describe opportunities for boards and medical staffs to collaborate as leaders, and offer recommendations for how boards and medical staff members can address the challenges of shared responsibility for quality of care. PMID:20605815

  11. In their own words: Patients and families define high-quality palliative care in the intensive care unit*

    PubMed Central

    Nelson, Judith E.; Puntillo, Kathleen A.; Pronovost, Peter J.; Walker, Amy S.; McAdam, Jennifer L.; Ilaoa, Debra; Penrod, Joan

    2011-01-01

    Objective Although the majority of hospital deaths occur in the intensive care unit and virtually all critically ill patients and their families have palliative needs, we know little about how patients and families, the most important “stakeholders,” define high-quality intensive care unit palliative care. We conducted this study to obtain their views on important domains of this care. Design Qualitative study using focus groups facilitated by a single physician. Setting A 20-bed general intensive care unit in a 382-bed community hospital in Oklahoma; 24-bed medical–surgical intensive care unit in a 377-bed tertiary, university hospital in urban California; and eight-bed medical intensive care unit in a 311-bed Veterans’ Affairs hospital in a northeastern city. Patients Randomly-selected patients with intensive care unit length of stay ?5 days in 2007 to 2008 who survived the intensive care unit, families of survivors, and families of patients who died in the intensive care unit. Interventions None. Measurements and Main Results Focus group facilitator used open-ended questions and scripted probes from a written guide. Three investigators independently coded meeting transcripts, achieving consensus on themes. From 48 subjects (15 patients, 33 family members) in nine focus groups across three sites, a shared definition of high-quality intensive care unit palliative care emerged: timely, clear, and compassionate communication by clinicians; clinical decision-making focused on patients’ preferences, goals, and values; patient care maintaining comfort, dignity, and personhood; and family care with open access and proximity to patients, interdisciplinary support in the intensive care unit, and bereavement care for families of patients who died. Participants also endorsed specific processes to operationalize the care they considered important. Conclusions Efforts to improve intensive care unit palliative care quality should focus on domains and processes that are most valued by critically ill patients and their families, among whom we found broad agreement in a diverse sample. Measures of quality and effective interventions exist to improve care in domains that are important to intensive care unit patients and families. PMID:20198726

  12. Effects of a Psychosocial Transitional Care Model on Hospitalizations and Cost of Care for High Utilizers.

    PubMed

    Weerahandi, Himali; Basso Lipani, Maria; Kalman, Jill; Sosunov, Eugene; Colgan, Claudia; Bernstein, Susan; Moskowitz, Alan J; Egorova, Natalia

    2015-07-01

    Evidence of care coordination programs to reduce readmissions is limited. We examined whether a social work transitional care model reduced hospital utilization and costs with a retrospective cohort study conducted from 9/3/2010-8/31/2012. Patients enrolled in the Preventable Admissions Care Team (PACT) program were matched to controls. PACT patients received follow-up from a social worker to address psychosocial strain. PACT reduced thirty-day readmission rate by 34% (p = <0.001), Sixty-day hospitalization rate by 22% (p = 0.004); ninety-day hospitalization rate by 19% (p = 0.006), and but not 180-day hospitalization rate. Inpatient costs thirty days post-index were $2.7 million for PACT patients and $3.6 million for controls. PMID:26186421

  13. Telemedicine in pre-hospital care: a review of telemedicine applications in the pre-hospital environment

    PubMed Central

    2014-01-01

    The right person in the right place and at the right time is not always possible; telemedicine offers the potential to give audio and visual access to the appropriate clinician for patients. Advances in information and communication technology (ICT) in the area of video-to-video communication have led to growth in telemedicine applications in recent years. For these advances to be properly integrated into healthcare delivery, a regulatory framework, supported by definitive high-quality research, should be developed. Telemedicine is well suited to extending the reach of specialist services particularly in the pre-hospital care of acute emergencies where treatment delays may affect clinical outcome. The exponential growth in research and development in telemedicine has led to improvements in clinical outcomes in emergency medical care. This review is part of the LiveCity project to examine the history and existing applications of telemedicine in the pre-hospital environment. A search of electronic databases including Medline, Excerpta Medica Database (EMBASE), Cochrane, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) for relevant papers was performed. All studies addressing the use of telemedicine in emergency medical or pre-hospital care setting were included. Out of a total of 1,279 articles reviewed, 39 met the inclusion criteria and were critically analysed. A majority of the studies were on stroke management. The studies suggested that overall, telemedicine had a positive impact on emergency medical care. It improved the pre-hospital diagnosis of stroke and myocardial infarction and enhanced the supervision of delivery of tissue thromboplasminogen activator in acute ischaemic stroke. Telemedicine presents an opportunity to enhance patient management. There are as yet few definitive studies that have demonstrated whether it had an effect on clinical outcome. PMID:25635190

  14. Telemedicine in pre-hospital care: a review of telemedicine applications in the pre-hospital environment.

    PubMed

    Amadi-Obi, Ahjoku; Gilligan, Peadar; Owens, Niall; O'Donnell, Cathal

    2014-01-01

    The right person in the right place and at the right time is not always possible; telemedicine offers the potential to give audio and visual access to the appropriate clinician for patients. Advances in information and communication technology (ICT) in the area of video-to-video communication have led to growth in telemedicine applications in recent years. For these advances to be properly integrated into healthcare delivery, a regulatory framework, supported by definitive high-quality research, should be developed. Telemedicine is well suited to extending the reach of specialist services particularly in the pre-hospital care of acute emergencies where treatment delays may affect clinical outcome. The exponential growth in research and development in telemedicine has led to improvements in clinical outcomes in emergency medical care. This review is part of the LiveCity project to examine the history and existing applications of telemedicine in the pre-hospital environment. A search of electronic databases including Medline, Excerpta Medica Database (EMBASE), Cochrane, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) for relevant papers was performed. All studies addressing the use of telemedicine in emergency medical or pre-hospital care setting were included. Out of a total of 1,279 articles reviewed, 39 met the inclusion criteria and were critically analysed. A majority of the studies were on stroke management. The studies suggested that overall, telemedicine had a positive impact on emergency medical care. It improved the pre-hospital diagnosis of stroke and myocardial infarction and enhanced the supervision of delivery of tissue thromboplasminogen activator in acute ischaemic stroke. Telemedicine presents an opportunity to enhance patient management. There are as yet few definitive studies that have demonstrated whether it had an effect on clinical outcome. PMID:25635190

  15. Innovative and Successful Approaches to Improving Care Transitions From Hospital to Home.

    PubMed

    Labson, Margherita C

    2014-12-01

    Effective transitions to home care have been identified as among the factors leading to reducing hospital readmissions within 30 days of discharge and improvements on various other quality measures. Innovative applications of published evidence-based models and best practices designed to improve care transitions have been implemented in various settings across the country in an effort to enhance quality performance. For this article, The Joint Commission collected a series of case examples to examine how evidence-based innovations in care transitions are reducing readmissions and improving other quality outcomes. The organizations providing the case examples were interviewed and asked to provide performance data demonstrating quality improvement, as well as information about their care processes and data-gathering techniques. Their innovative approaches are reducing hospital readmissions; improving patient safety, satisfaction, and engagement; and contributing to other positive outcomes.This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivitives 3.0 License, where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially. http://creativecommons.org/licenses/by-nc-nd/3.0. PMID:25494403

  16. Quality assurance in hospitals following the Health Reform Law of the Federal Republic of Germany.

    PubMed

    Bruckenberger, E

    1990-04-01

    Since January 1, 1989, hospitals licensed in accordance with section 108 of the Social Legal Code, Statute Book V (SGB V) as well as the prevention or rehabilitation facilities under contract in accordance with section 111 SGB V are obliged to participate in quality assurance measures. According to the statement of reasons in the government draft of the Health Reform Law, "quality management in the hospital as well as in the prevention or rehabilitation facilities must ensure high-quality and economic provision of medical services". Quality assurance of medical services in the hospital is intended to disclose professional, structural, and organizational deficits, and thus to create the prerequisites for their elimination. It is not primarily intended to serve as a basis for questions of economy in the hospital. Nonetheless, demands for quality management (above all on the part of the health insurance funds) will also increase continuously for this reason under the pressure of the constantly increasing costs of hospital care. Medical associations and the specialist scientific societies are therefore called on to ensure that not only economic and technical quality are primarily considered, but that the quality of professionally and technically qualified medical action is secured by qualified and convincing contributions to quality assurance. PMID:2349550

  17. Effect of reactive pharmacy intervention on quality of hospital prescribing

    Microsoft Academic Search

    C J Hawkey; S Hodgson; A Norman; T K Daneshmend; S T Garner

    1990-01-01

    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

  18. Child Care Subsidy and Program Quality Revisited

    ERIC Educational Resources Information Center

    Antle, Becky F.; Frey, Andy; Barbee, Anita; Frey, Shannon; Grisham-Brown, Jennifer; Cox, Megan

    2008-01-01

    Research Findings: Previous research has documented conflicting results on the relationship between program quality and the percentage of children receiving subsidized child care (subsidy density) in early childhood centers. This research examined the relationship between subsidy density and the quality of infant and preschool classrooms in child…

  19. Pre-hospital care of pediatric patients with trauma.

    PubMed

    Seid, Terrence; Ramaiah, Ramesh; Grabinsky, Andreas

    2012-09-01

    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. PMID:23181204

  20. 38 CFR 17.43 - Persons entitled to hospital or domiciliary care.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ...Compensation Programs, and other Federal agencies. (3) Pensioners of nations allied with the United States in World War I and World War II may be supplied hospital care when duly authorized. (b) Emergency hospital care may be provided...

  1. 38 CFR 17.43 - Persons entitled to hospital or domiciliary care.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ...Compensation Programs, and other Federal agencies. (3) Pensioners of nations allied with the United States in World War I and World War II may be supplied hospital care when duly authorized. (b) Emergency hospital care may be provided...

  2. 38 CFR 17.43 - Persons entitled to hospital or domiciliary care.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ...Compensation Programs, and other Federal agencies. (3) Pensioners of nations allied with the United States in World War I and World War II may be supplied hospital care when duly authorized. (b) Emergency hospital care may be provided...

  3. 38 CFR 17.43 - Persons entitled to hospital or domiciliary care.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ...Compensation Programs, and other Federal agencies. (3) Pensioners of nations allied with the United States in World War I and World War II may be supplied hospital care when duly authorized. (b) Emergency hospital care may be provided...

  4. 28 CFR 549.45 - Involuntary hospitalization in a suitable facility for psychiatric care or treatment.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ...suitable facility for psychiatric care or treatment. 549.45 Section 549.45 Judicial...SERVICES Psychiatric Evaluation and Treatment § 549.45 Involuntary hospitalization...suitable facility for psychiatric care or treatment. (a) Hospitalization of...

  5. 28 CFR 549.45 - Involuntary hospitalization in a suitable facility for psychiatric care or treatment.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ...suitable facility for psychiatric care or treatment. 549.45 Section 549.45 Judicial...SERVICES Psychiatric Evaluation and Treatment § 549.45 Involuntary hospitalization...suitable facility for psychiatric care or treatment. (a) Hospitalization of...

  6. 28 CFR 549.45 - Involuntary hospitalization in a suitable facility for psychiatric care or treatment.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ...suitable facility for psychiatric care or treatment. 549.45 Section 549.45 Judicial...SERVICES Psychiatric Evaluation and Treatment § 549.45 Involuntary hospitalization...suitable facility for psychiatric care or treatment. (a) Hospitalization of...

  7. Physician Assistant and Advance Practice Nurse Care in Hospital Outpatient Departments: United States, 2008-2009

    MedlinePLUS

    ... November 2011 Physician Assistant and Advance Practice Nurse Care in Hospital Outpatient Departments: United States, 2008–2009 ... department visits Are PAs and APNs providing more care at visits to hospital OPDs? Between 2000–2001 ...

  8. [Quality of care: from theory to practice].

    PubMed

    Guillain, H; Raetzo, M A

    1997-03-29

    Quality of care is growing concern among health care professionals and managers. As a multidimensional concept, it cannot be reduced to simple customer satisfaction. Taking into account the views of the three major players in the health care system-patients, providers and payers-quality can be defined as the capacity to satisfy patients' needs according to professional knowledge and within available resources. Efficacy, efficiency, appropriateness, acceptability, legitimacy and equity are dimensions of health care quality. Contrary to popular belief, quality is neither maximum performance, nor satisfaction at all costs, nor punishment or elimination of "bad apples". In ambulatory medicine, quality implies first of all the ability to master the processes occurring during an office visit. However, although history taking and physical examination are the cornerstones of medical practice, they have not been well studied. Improving quality of care in the ambulatory sector will require better knowledge about medical decision-making processes, in particular identification of the most relevant information required for a decision and the optimal way of obtaining it in any specific clinical situation. PMID:9190666

  9. Hospital Quality and Selective Contracting: Evidence from Kidney Transplantation*

    PubMed Central

    Howard, David H.

    2008-01-01

    Most private health insurers offer a limited network of providers to enrollees. Critics have questioned whether selective contracting benefits patients. Plans counter that they take quality into account when choosing providers. Using data on five plans’ networks for kidney transplant hospitals, this study shows that in-network hospitals have better outcomes than out-of-network facilities. Conditional logit estimates using patient level data confirm this result: compared to Medicare patients, privately-insured patients are more likely to register at hospitals with higher survival rates. Restricting choice has the potential to improve patient welfare if plans steer uninformed patients to high quality hospitals and physicians. PMID:19079762

  10. An assessment of quality of sleep and the use of drugs with sedating properties in hospitalized adult patients

    Microsoft Academic Search

    Luciana Frighetto; Carlo Marra; Shakeel Bandali; Kerry Wilbur; Terryn Naumann; Peter Jewesson

    2004-01-01

    BACKGROUND: Hospitalization can significantly disrupt sleeping patterns. In consideration of the previous reports of insomnia and apparent widespread use of benzodiazepines and other hypnotics in hospitalized patients, we conducted a study to assess quality of sleep and hypnotic drug use in our acute care adult patient population. The primary objectives of this study were to assess sleep disturbance and its

  11. 38 CFR 17.46 - Eligibility for hospital, domiciliary or nursing home care of persons discharged or released from...

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ...Eligibility for hospital, domiciliary or nursing home care of persons discharged or...MEDICAL Hospital, Domiciliary and Nursing Home Care § 17.46 Eligibility for hospital, domiciliary or nursing home care of persons discharged...

  12. 38 CFR 17.46 - Eligibility for hospital, domiciliary or nursing home care of persons discharged or released from...

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ...Eligibility for hospital, domiciliary or nursing home care of persons discharged or...MEDICAL Hospital, Domiciliary and Nursing Home Care § 17.46 Eligibility for hospital, domiciliary or nursing home care of persons discharged...

  13. 38 CFR 17.46 - Eligibility for hospital, domiciliary or nursing home care of persons discharged or released from...

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ...Eligibility for hospital, domiciliary or nursing home care of persons discharged or...MEDICAL Hospital, Domiciliary and Nursing Home Care § 17.46 Eligibility for hospital, domiciliary or nursing home care of persons discharged...

  14. 38 CFR 17.46 - Eligibility for hospital, domiciliary or nursing home care of persons discharged or released from...

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ...Eligibility for hospital, domiciliary or nursing home care of persons discharged or...MEDICAL Hospital, Domiciliary and Nursing Home Care § 17.46 Eligibility for hospital, domiciliary or nursing home care of persons discharged...

  15. 38 CFR 17.46 - Eligibility for hospital, domiciliary or nursing home care of persons discharged or released from...

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ...Eligibility for hospital, domiciliary or nursing home care of persons discharged or...MEDICAL Hospital, Domiciliary and Nursing Home Care § 17.46 Eligibility for hospital, domiciliary or nursing home care of persons discharged...

  16. Family Participation in the Nursing Care of the Hospitalized Patients

    PubMed Central

    Khosravan, Shahla; Mazlom, Behnam; Abdollahzade, Naiemeh; Jamali, Zeinab; Mansoorian, Mohammad Reza

    2014-01-01

    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. PMID:24719705

  17. Quality of care in Crohn's disease

    PubMed Central

    Makharia, Govind K

    2014-01-01

    Crohn’s disease (CD) is a chronic and progressive inflammatory disease of the intestine. Overall, healthcare delivery for patients with CD is not optimal at the present time and therefore needs improvement. There are evidences which suggest that there is a variation in the care provided to patients with CD by the inflammatory bowel disease (IBD) experts and community care providers. The delivery of healthcare for patients with CD is often complex and requires coordination between gastroenterologists/IBD specialist, gastrointestinal surgeon, radiologists and IBD nurses. In order to improve the quality of health care for patients with CD, there is need that we focus on large-scale, system-wide changes including creation of IBD comprehensive care units, provision to provide continuous care, efforts to standardize care, and education of the community practitioners. PMID:25400990

  18. Hospital Information Systems Quality: A Customer Satisfaction Assessment Tool

    Microsoft Academic Search

    Vincent Ribière; Anita J. La Salle; Reza Khorramshahgol; Yvon Gousty

    1999-01-01

    Hospital Information Systems (HIS) play a significant role in providing quality healthcare services. However, HIS lag behind their industrial counterparts in providing quality (i.e., timely, accurate, complete) information and have been the target of many criticisms for alleged shortcomings. The aim of this research is to identify the requirements for HIS to assist in providing quality healthcare service. To this

  19. Medical groups can reduce costs by investing in improved quality of care for patients with diabetes.

    PubMed

    Kralewski, John E; Dowd, Bryan E; Xu, Yi Wendy

    2012-08-01

    A major feature of many new contracts between providers and payers is shared savings programs, in which providers can earn a percentage of the savings if the cost of the care they provide is lower than the projected cost. Unless providers are also held accountable for meeting quality benchmarks, some observers fear that these programs could erode quality of care by rewarding only cost savings. We estimated the effects on Medicare expenditures of improving the quality of care for patients with diabetes. Analyzing 234 practices that provided care for 133,703 diabetic patients, we found a net savings of $51 per patient with diabetes per year for every one-percentage-point increase in a score of the quality of care. Cholesterol testing for all versus none of a practice's patients with diabetes, for example, was associated with a dramatic drop in avoidable hospitalizations. These results show that improving the quality of care for patients with diabetes does save money. PMID:22869662

  20. [Quality management in the German health care system].

    PubMed

    Bangha, E; Fritze, B; Yaguboglu, R; Amon, U

    1999-05-01

    With the increasing demands on hospitals for improved quality and lower costs, hospitals have been forced to reevaluate their manner of operation and quality assurance programs. Hospitals have also been faced with customer dissatisfaction and intense competition. This article reviews current quality-management systems and examines their position in dermatology. PMID:10412629

  1. Patient satisfaction scores and their relationship to hospital website quality measures.

    PubMed

    Ford, Eric W; Huerta, Timothy R; Diana, Mark L; Kazley, Abby Swanson; Menachemi, Nir

    2013-01-01

    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

  2. NURSES' PERCEPTIONS OF QUALITY NURSING CARE PROVIDED TO POST PROCEDURE ELECTIVE PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY PATIENTS

    Microsoft Academic Search

    Sonja Cleary; Sansnee Jirojwong; Sandra Walker

    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

  3. Improving Breast Cancer Care Measurement and Reporting in a Complex, Urban Hospital Setting

    PubMed Central

    McAlearney, Ann Scheck; Wellner, Jill; Bickell, Nina A.

    2012-01-01

    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. PMID:23821899

  4. Caring and Learning Environments: Quality in Regulated Family Child Care across Canada. You Bet I Care!

    ERIC Educational Resources Information Center

    Doherty, Gillian; Lero, Donna S.; Goelman, Hillel; Tougas, Jocelyne; LaGrange, Annette

    Canadian experts in diverse fields as well as people concerned about social justice and cohesion have identified quality child care as a crucial component in addressing a variety of broad societal goals. This study explored the relationships between quality in Canadian family child care homes and: provider characteristics and attitudes about…

  5. Evaluating the impact of ICT-tools on health care delivery in sub-Saharan hospitals.

    PubMed

    Verbeke, Frank; Karara, Gustave; Nyssen, Marc

    2013-01-01

    This research explores to what extent Information and Communication Technology (ICT)-based information management methods can help to improve efficiency and effectiveness of health services in sub-Saharan hospitals and how clinical information can be made available for secondary use enabling non-redundant reporting of health- and care performance indicators. In the course of a 6 years research effort between 2006 and 2012, it was demonstrated that patient identification, financial management and structured reporting improved dramatically after implementation of well adapted ICT-tools in a set of 19 African health facilities. Real-time financial management metrics helped hospitals to quickly identify fraudulent practices and defective invoicing procedures. Out-patient case load significantly increased compared to the national average, average length of stay has been shortened in 15 of 19 health facilities and global hospital mortality decreased. Hospital workforce-evaluated impact of hospital information system implementation on local working conditions and quality of care was very positive. It was demonstrated that local sub-Saharan health professionals strongly believe in the importance of health information systems. PMID:23920609

  6. Patient participation in hospital care: Nursing staffs' point of view.

    PubMed

    Kolovos, Petros; Kaitelidou, Daphne; Lemonidou, Chrysoula; Sachlas, Athanasios; Zyga, Sofia; Sourtzi, Panayota

    2015-06-01

    The aim was to investigate nursing staff's perceptions related to patient participation and the parameters affecting it during nursing care. A cross-sectional study with both a quantitative and qualitative orientation was conducted. The sample consisted of all nursing staff working in medical and surgical wards in three Greek hospitals. A questionnaire was developed and the data were analysed with exploratory factor analysis, whereas content analysis was used for qualitative data. Nursing staff perceived participation as the process of information giving to patients, communication of symptoms by patients and compliance with the staff's orders. 'Information providing' and 'ability to influence and responsibility' were significant aspects of the content of participation, whereas the parameters affecting participation were related to patients, nursing staff and the care context. These results support patient engagement in dialogue and shared decision-making, while highlighting the need to implement participation systematically and stimulate changes in nursing care organization. PMID:24666538

  7. [Assessment of medical care quality in craniocerebral trauma on the base of data analysis].

    PubMed

    Moguchaia, O V; Gumanenko, E K; Simonova, I A; Shchedrenok, V V; Romashova, O V; Kaurova, T A

    2014-01-01

    An analysis of 658 medical records of inpatient treatment from 15 hospitals of St.Petersburg was made using a computer-aided technology of the assessment of medical care quality. It was revealed that a proper quality of medical care in craniocerebral trauma was only in 52.9% cases. Different defects of medical care were noted in the rest of observations. It influenced on the condition of the patients (1.0%), the delivery and assessment of health care (40% and 38%, respectively), health resources (18%), social resources (1.0%). Defects of medical records were indicated in 38% patients. It caused a reduction of medical care. Risks of occurrence of medical care defects are low in children hospitals in the case of combined craniocerebral trauma. PMID:25552116

  8. Quality of Big Data in health care.

    PubMed

    Sukumar, Sreenivas R; Natarajan, Ramachandran; Ferrell, Regina K

    2015-01-01

    Purpose - The current trend in Big Data analytics and in particular health information technology is toward building sophisticated models, methods and tools for business, operational and clinical intelligence. However, the critical issue of data quality required for these models is not getting the attention it deserves. The purpose of this paper is to highlight the issues of data quality in the context of Big Data health care analytics. Design/methodology/approach - The insights presented in this paper are the results of analytics work that was done in different organizations on a variety of health data sets. The data sets include Medicare and Medicaid claims, provider enrollment data sets from both public and private sources, electronic health records from regional health centers accessed through partnerships with health care claims processing entities under health privacy protected guidelines. Findings - Assessment of data quality in health care has to consider: first, the entire lifecycle of health data; second, problems arising from errors and inaccuracies in the data itself; third, the source(s) and the pedigree of the data; and fourth, how the underlying purpose of data collection impact the analytic processing and knowledge expected to be derived. Automation in the form of data handling, storage, entry and processing technologies is to be viewed as a double-edged sword. At one level, automation can be a good solution, while at another level it can create a different set of data quality issues. Implementation of health care analytics with Big Data is enabled by a road map that addresses the organizational and technological aspects of data quality assurance. Practical implications - The value derived from the use of analytics should be the primary determinant of data quality. Based on this premise, health care enterprises embracing Big Data should have a road map for a systematic approach to data quality. Health care data quality problems can be so very specific that organizations might have to build their own custom software or data quality rule engines. Originality/value - Today, data quality issues are diagnosed and addressed in a piece-meal fashion. The authors recommend a data lifecycle approach and provide a road map, that is more appropriate with the dimensions of Big Data and fits different stages in the analytical workflow. PMID:26156435

  9. Quality-of-care standards for early arthritis clinics.

    PubMed

    Ivorra, José Andrés Román; Martínez, Juan Antonio; Lázaro, Pablo; Navarro, Federico; Fernandez-Nebro, Antonio; de Miguel, Eugenio; Loza, Estibaliz; Carmona, Loreto

    2013-10-01

    The diagnosis and treatment of early arthritis is associated with improved patient outcomes. One way to achieve this is by organising early arthritis clinics (EACs). The objective of this project was to develop standards of quality for EACs. The standards were developed using the two-round Delphi method. The questionnaire, developed using the best-available scientific evidence, includes potentially relevant items describing the dimensions of quality of care in the EAC. The questionnaire was completed by 26 experts (physicians responsible for the EACs in Spain and chiefs of the rheumatology service in Spanish hospitals). Two hundred and forty-four items (standards) describing the quality of the EAC were developed, grouped by the following dimensions: (1) patient referral to the EAC; (2) standards of structure for an EAC; (3) standards of process; (4) relation between primary care physicians and the EAC; (5) diagnosis and assessment of early arthritis; (6) patient treatment and follow-up in the EAC; (7) research and training in an EAC; and (8) quality of care perceived by the patient. An operational definition of early arthritis was also developed based on eight criteria. The standards developed can be used to measure/establish the requirements, resources, and processes that EACs have or should have to carry out their treatment, research, and educational activities. These standards may be useful to health professionals, patient associations, and health authorities. PMID:23568381

  10. Additional hospital stay and charges due to hospital-acquired infections in a neonatal intensive care unit

    Microsoft Academic Search

    L. M. Mahieu; N. Buitenweg; Ph. Beutels; J. J. De Dooy

    2001-01-01

    A comparative retrospective cohort study was performed to evaluate the influence of hospital-acquired infection (HAI) in neonates on additional charges and hospital stay. Neonates admitted between October 1993 and discharged alive before December 1995 at the neonatal intensive care unit of a university hospital were studied. Of 515 neonates, 69 (13%) had one or more HAI; 45 (20 with proven

  11. Comparison of health care professionals' and surveyors' opinions on problems and obstacles in implementing quality management system in Thailand: a national survey

    Microsoft Academic Search

    KRIT PONGPIRUL; JIRUTH SRIRATANABAN; SANTAWAT ASAVAROENGCHAI; JADEJ THAMMATACH-AREE; PORANEE LAOITTHI

    2006-01-01

    Objectives. To explore problems and obstacles of hospitals in Thailand implementing quality management systems according to the hospital accreditation (HA) standards. Design. Questionnaire survey. Setting. Thirty-nine hospitals in all 13 regions of Thailand. Participants. A total of 728 health care professionals and 41 surveyors of the national accreditation program. Main outcome measures. Health care professionals' and surveyors' opinions on problems

  12. Improving transitions of care at hospital discharge--implications for pediatric hospitalists and primary care providers.

    PubMed

    Harlan, Gregory A; Nkoy, Flory L; Srivastava, Rajendu; Lattin, Gena; Wolfe, Doug; Mundorff, Michael B; Colling, Dayvalena; Valdez, Angelika; Lange, Shay; Atkinson, Sterling D; Cook, Lawrence J; Maloney, Christopher G

    2010-01-01

    Delays, omissions, and inaccuracy of discharge information are common at hospital discharge and put patients at risk for adverse outcomes. We assembled an interdisciplinary team of stakeholders to evaluate our current discharge process between hospitalists and primary care providers (PCPs). We used a fishbone diagram to identify potential causes of suboptimal discharge communication to PCPs. Opportunities for improvement (leverage points) to achieve optimal transfer of discharge information were identified using tally sheets and Pareto charts. Quality improvement strategies consisted of training and implementation of a new discharge process including: (1) enhanced PCP identification at discharge, (2) use of an electronic discharge order and instruction system, and (3) autofaxing discharge information to PCPs. The new discharge process's impact was evaluated on 2,530 hospitalist patient discharges over a 34-week period by measuring: (1) successful transfer of discharge information (proportion of discharge information sheets successfully faxed to PCPs), (2) timeliness (proportion of sheets faxed within 2 days of discharge), and (3) content (presence of key clinical elements in discharge sheets). Postintervention, success, and timeliness of discharge information transfer between pediatric hospitalists and PCPs significantly improved while content remained high. PMID:20854359

  13. Ten Components of Quality Child Care

    E-print Network

    McQuade, D. Tyler

    be placed on their backs to sleep. 2. Well Trained Staff in Early Childhood Development The strongest and level of participation in ongoing training in the field of early childhood development and care. Having in continuous quality improvement. COMPONENT DESCRIPTION 1. Licensed Programs Following Appropriate Health

  14. Competition among Turkish hospitals and its effect on hospital efficiency and service quality.

    PubMed

    Torun, Nazan; Celik, Yusuf; Younis, Mustafa Z

    2013-01-01

    The level of competition among hospitals in Turkey was analyzed for the years 1990 through 2006 using the Herfindahl-Hirschman Index (HHI). Multiple and simple regression analyses were run to observe the development of competition among hospitals over this period of time, to examine likely determinants of competition, and to calculate the effects of competition on efficiency and quality in individual hospitals. This study found that the level of competition among hospitals in Turkey has increased throughout the years. Also, competition has had a positive effect on the efficiency of hospitals; however, it did not have a significant positive effect on their quality. Moreover, there are important differences in the level of competition among hospitals that vary according to the geographical region, the type of ownership, and the type of hospital. This study is one of the first to evaluate the effects of health policies on competition as well as the effects of increasing competition on hospital quality and efficiency in Turkey. PMID:24551961

  15. Total quality management issues in managed care.

    PubMed

    McLaughlin, C P; Kaluzny, A D

    1997-01-01

    The implementation of total quality management (TQM) in health care has gone on in parallel with the growth of managed care. What is the interaction between the two? Key issues are the ascendance of cost control over quality in many areas, erosion of employee commitment and loyalty, and a short-run orientation. Associated with this is an emphasis on organizational learning rather than learning by autonomous professionals. Both TQM and managed care acknowledge the dynamic nature of clinical processes and the ability and responsibility of both institutions and clinicians to improve their processes. Both are consistent with efforts to identify and implement best practices. However, these similarities should not mask fundamental differences. Continuous improvement must shift its focus from avoiding unnecessary variation to facilitating rapid organizational learning and institutionalizing mass customization into the delivery of health services. PMID:9327355

  16. Are Older Patients More Satisfied With Hospital Care Than Younger Patients?

    PubMed Central

    Jaipaul, C Komal; Rosenthal, Gary E

    2003-01-01

    OBJECTIVE Determine relationships between age, self-reported health, and satisfaction in a large cohort of hospitalized patients. DESIGN Cross-sectional survey. SETTING Thirty-one hospitals in a large Midwestern metropolitan area. PATIENTS/PARTICIPATION Randomly selected medical and surgical patients (N = 64,900; mean age, 61 years; 56% female; 84% white) discharged during specific time periods from July 1990 to March 1995 who responded to a mailed survey (overall response rate, 48%). MEASUREMENTS AND MAIN RESULTS Patients' overall ratings of hospital quality and satisfaction with 5 aspects of care (physician care, nursing care, information provided, discharge instructions, and coordination of care) were measured by a validated survey, which was mailed to patients after discharge. Analyses compared satisfaction in 5 age groups (18 to 35, 36 to 50, 51 to 65, 66 to 80, and > 80 years). Scores for the 5 aspects of care initially increased with age (P < .001) and then declined (P < .001). A similar relationship was found in analyses of the proportion of patients who rated overall quality as “excellent” or “very good.” Satisfaction was also higher in patients with better self-reported health (P < .001). In analyses of patients with poor to fair health, satisfaction scores peaked at age 65 before declining. However, for patients with good to excellent health, scores peaked at age 80. Moreover, declines in satisfaction in older patients were lower in patients with better health. These findings were consistent in multivariable analyses adjusting for potential confounders. CONCLUSIONS Satisfaction exhibits a complex relationship with age, with scores increasing until age 65 to 80 and then declining. This relationship was consistent across individual satisfaction scales, but was modified by health status. The results suggest that age and health status should be taken into account when interpreting patient satisfaction data. PMID:12534760

  17. Approaches to Quality of Control in Diabetes Care

    Microsoft Academic Search

    F. Chiarelli; A. Verrotti; L. di Ricco; M. de Martino; G. Morgese

    1998-01-01

    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

  18. Patients' functioning as predictor of nursing workload in acute hospital units providing rehabilitation care: a multi-centre cohort study

    Microsoft Academic Search

    Martin Mueller; Stefanie Lohmann; Ralf Strobl; Christine Boldt; Eva Grill

    2010-01-01

    BACKGROUND: Management decisions regarding quality and quantity of nurse staffing have important consequences for hospital budgets. Furthermore, these management decisions must address the nursing care requirements of the particular patients within an organizational unit. In order to determine optimal nurse staffing needs, the extent of nursing workload must first be known. Nursing workload is largely a function of the composite

  19. [Quality of abortion care in the Unified Health System of Northeastern Brazil: what do women say?].

    PubMed

    Aquino, Estela M L; Menezes, Greice; Barreto-de-Araújo, Thália Velho; Alves, Maria Teresa; Alves, Sandra Valongueiro; de Almeida, Maria da Conceição Chagas; Schiavo, Eleonora; Lima, Luci Praciano; de Menezes, Carlos Augusto Santos; Marinho, Lilian Fátima Barbosa; Coimbra, Liberata Campos; Campbell, Oona

    2012-07-01

    Abortion is a serious health problem in Brazil and complications can be avoided by adequate and timely care. The article evaluates the quality of care given to women admitted for abortion in hospitals operated by the Unified Health System, in Salvador, Recife and São Luis, the benchmarks being Ministry of Health norms and user satisfaction. The article analyzes 2804 women admitted to hospital for abortion complications in 19 hospitals, between August and December 2010. Four dimensions were defined: reception and guidance; inputs and physical environment; technical quality and continuity of care. There was a closer fit to norms on reception and guidance. Social support and the right to information were not well rated in all three cities. The technical quality of care was rated poor. With respect to inputs and physical environment, cleanliness was the least adequate criterion. Continuity of care was the most critical situation in all three cities, due to the lack of scheduled follow-up appointments, information about care available after hospital discharge, the risk of further pregnancy and family planning. Abortion care falls short of that advocated under Brazilian norms and by international agencies. PMID:22872338

  20. Quality optimization in the hospital laundry service: an application case

    Microsoft Academic Search

    Virginia García Fernández; Pilar L. González Torre; B. Adenso Díaz

    2001-01-01

    In industrial installations, the Taguchi methodology has come to play an important role in recent years in the achievement of improvements in quality objectives. This article presents the experiences and results obtained in the installations of a hospital laundry, where the aim was to minimize operating costs while guaranteeing standards of disinfection and the quality of the wash. Owing to

  1. Using clinical registries to improve the quality of neurosurgical care.

    PubMed

    Asher, Anthony L; Parker, Scott L; Rolston, John D; Selden, Nathan R; McGirt, Matthew J

    2015-04-01

    Despite rising and unsustainable US health care costs, many stakeholders feel that the quality of medical services is limited and inconsistent. Value-based reforms are touted as the key to achieving health care system sustainability. Health care value is defined as quality delivered divided by cost incurred. Unfortunately, quality in health care is difficult to accurately define and methods to reliably assess and report health care quality are often lacking. Clinical registries have emerged as important mechanisms to define, measure, and promote health care quality. The purpose of this article is to describe the role of registries in neurosurgical quality improvement. PMID:25771281

  2. Markers of Access to and Quality of Primary Care for Aboriginal People in Ontario, Canada

    PubMed Central

    Shah, Baiju R.; Gunraj, Nadia; Hux, Janet E.

    2003-01-01

    Objectives. We evaluated primary care accessibility and quality for Ontario’s aboriginal population. Methods. We compared a defined aboriginal cohort with nonaboriginal populations with analogous geographic isolation and low socioeconomic status. We determined rates of hospitalization for the following indicators of adequacy of primary care: ambulatory care–sensitive (ACS) conditions and utilization of referral care–sensitive (RCS) procedures from administrative databases. Results. ACS hospitalization rates, relative to the general population, were 2.54, 1.50, and 1.14 for the aboriginal population, the geographic control populations, and the socioeconomic control populations, respectively. The relative RCS procedure utilization rates were 0.64, 0.91, and 1.00, respectively. Conclusions. The increased ACS hospitalization rate and reduced RCS procedure utilization rate suggest that northern Ontario’s aboriginal residents have insufficient or ineffective primary care. PMID:12721147

  3. Do hospitalist physicians improve the quality of inpatient care delivery? A systematic review of process, efficiency and outcome measures

    Microsoft Academic Search

    Heather L White; Richard H Glazier

    2011-01-01

    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

  4. Self-Care Activities Among Patients with Diabetes Attending a Tertiary Care Hospital in Mangalore Karnataka, India

    PubMed Central

    Rajasekharan, D; Kulkarni, V; Unnikrishnan, B; Kumar, N; Holla, R; Thapar, R

    2015-01-01

    Background: Increasing prevalence of diabetes in India is resulting in an epidemiological transition. The care of the people with diabetes is traditionally seen as doctor centered, but the concept of self-care of people with diabetes is a new domain and is proven beneficial. Aim: The aim was to determine the practice of self-care activities among people with diabetes attending a tertiary care hospital in Mangalore. Subjects and Methods: A facility-based cross-sectional study was conducted in Government Wenlock Hospital, Mangalore during September–October 2012. A total of 290 patients with >1-year duration of diabetes mellitus (DM) were asked to respond to summary diabetes self-care activities questionnaire after obtaining the consent from them. The statistical analysis was performed in terms of descriptive statistics and association between the variables was tested using Mann–Whitney U-test. Results: A healthy eating plan on a daily basis was followed by 45.9% (133/290) of the participants, daily exercises for 30 min were followed by 43.4% (126/290), and regular blood sugar monitoring was done by 76.6% (222/290). Regarding the adherence to oral hypoglycemic agents and insulin, daily adherence to medication was seen among 60.5% (155/256) and 66.9% (138/206) were found to be adherent to insulin injections on a daily basis. Conclusions: Self-care practices were found to be unsatisfactory in almost all aspects except for blood sugar monitoring and treatment adherence. As these practices are essential for prevention of complications and better quality-of -life, more efforts should be put to educate the people with diabetes. PMID:25745579

  5. The effectiveness of substitution of hospital ward care from medical doctors to physician assistants: a study protocol

    PubMed Central

    2014-01-01

    Background Because of an expected shrinking supply of medical doctors for hospitalist posts, an increased emphasis on efficiency and continuity of care, and the standardization of many medical procedures, the role of hospitalist is increasingly allocated to physician assistants (PAs). PAs are nonphysician clinicians with medical tasks. This study aims to evaluate the effects of substitution of hospital ward care to PAs. Methods/Design In a multicenter matched controlled study, the traditional model in which the role of hospitalist is taken solely by medical doctors (MD model) is compared with a mixed model in which a PA functions as a hospitalist, contingent with MDs (PA/MD model). Twenty intervention and twenty control wards are included across The Netherlands, from a range of medical specialisms. Primary outcome measure is patients’ length of hospital stay. Secondary outcomes include indicators for quality of hospital ward care, patients experiences with medical ward care, patients health-related quality of life, and healthcare providers’ experiences. An economic evaluation is conducted to assess the cost implications and potential efficiency of the PA/MD model. For most measures, data is collected from medical records or questionnaires in samples of 115 patients per hospital ward. Semi-structured interviews with healthcare professionals are conducted to identify determinants of efficiency, quality and continuity of care and barriers and facilitators for the implementation of PAs in the role of hospitalist. Discussion Findings from this study will help to further define the role of nonphysician clinicians and provides possible key components for the implementation of PAs in hospital ward care. Like in many studies of organizational change, random allocation to study arms is not feasible, which implies an increased risk for confounding. A major challenge is to deal with the heterogeneity of patients and hospital departments. Trial registration ClinicalTrials.gov ID NCT01835444 PMID:24472112

  6. Systematic review of the effectiveness of planned short hospital stays for mental health care

    Microsoft Academic Search

    Paul Johnstone; Gabriella Zolese; Pathfinder Mental

    1999-01-01

    Objective To determine the effectiveness of planned short hospital stays versus standard care for people with serious mental illness. Design Systematic review of all randomised controlled trials comparing planned short hospital stay versus long hospital stay or standard care for people with serious mental illness. Subjects Four trials enrolled 628 patients. Main outcomes measures Relapse; readmission; death (suicides and all

  7. Hospital utilization for ambulatory care sensitive conditions: health outcome disparities associated with race and ethnicity

    Microsoft Academic Search

    James N. Laditka; Sarah B. Laditka; Melanie P. Mastanduno

    2003-01-01

    Our study examines associations between race and ethnicity and hospitalization for ambulatory care sensitive (ACS) conditions for working age adults, and for individuals age 65 or older. We use ACS hospitalization as an outcome indicator to evaluate access to primary care. The prevalence of ACS conditions in the population, including those not hospitalized, and the occurrence of ACS and non-ACS

  8. Pregnancy care of the low risk woman: the community-hospital interface

    Microsoft Academic Search

    Lucy H. Kean; David T. Y. Liu; Sue Macquisten

    1996-01-01

    Aims to determine the extent to which women suitable for community-based antenatal and intrapartum care will require hospital contact. Reports on an historical cohort study of low risk women who underwent standard shared care and for whom the records for both pregnancy and delivery were complete at The City Hospital and University Hospital, Nottingham. Concludes that the shift to community-based

  9. Visualization of hospital cleanliness in three Japanese hospitals with a tendency toward long-term care

    PubMed Central

    2014-01-01

    Background Hospital cleanliness in hospitals with a tendency toward long-term care in Japan remains unevaluated. We therefore visualized hospital cleanliness in Japan over a 2-month period by two distinct popular methods: ATP bioluminescence (ATP method) and the standard stamp agar method (stamp method). Methods The surfaces of 752 sites within nurse and patient areas in three hospitals located in a central area of Sapporo, Japan were evaluated by the ATP and stamp methods, and each surface was sampled 8 times in 2 months. These areas were located in different ward units (Internal Medicine, Surgery, and Obstetrics and Gynecology). Detection limits for the ATP and stamp methods were determined by spike experiments with a diluted bacterial solution and a wipe test on student tables not in use during winter vacation, respectively. Values were expressed as the fold change over the detection limit, and a sample with a value higher than the detection limit by either method was defined as positive. Results The detection limits were determined to be 127 relative light units (RLU) per 100 cm2 for the ATP method and 5.3 colony-forming units (CFU) per 10 cm2 for the stamp method. The positive frequency of the ATP and stamp methods was 59.8% (450/752) and 47.7% (359/752), respectively, although no significant difference in the positive frequency among the hospitals was seen. Both methods revealed the presence of a wide range of organic contamination spread via hand touching, including microbial contamination, with a preponderance on the entrance floor and in patient rooms. Interestingly, the data of both methods indicated considerable variability regardless of daily visual assessment with usual wiping, and positive surfaces were irregularly seen. Nurse areas were relatively cleaner than patient areas. Finally, there was no significant correlation between the number of patients or medical personnel in the hospital and organic or microbiological contamination. Conclusions Ongoing daily hospital cleanliness is not sufficient in Japanese hospitals with a tendency toward long-term care. PMID:24593868

  10. Service quality of private hospitals: The Iranian Patients' perspective

    PubMed Central

    2012-01-01

    Background Highly competitive market in the private hospital industry has caused increasing pressure on them to provide services with higher quality. The aim of this study was to determine the different dimensions of the service quality in the private hospitals of Iran and evaluating the service quality from the patients' perspective. Methods A cross-sectional study was conducted between October and November 2010 in Tehran, Iran. The study sample was composed of 983 patients randomly selected from 8 private general hospitals. The study questionnaire was the SERVQUAL questionnaire, consisting of 21 items in service quality dimensions. Results The result of factor analysis revealed 3 factors, explaining 69% of the total variance. The total mean score of patients' expectation and perception was 4.91(SD = 0.2) and 4.02(SD = 0.6), respectively. The highest expectation and perception related to the tangibles dimension and the lowest expectation and perception related to the empathy dimension. The differences between perception and expectation were significant (p < 0.001). There was a significant difference between the expectations scores based on gender, education level, and previous hospitalization in that same hospital. Also, there was a significant difference between the perception scores based on insurance coverage, average length of stay, and patients' health conditions on discharge. Conclusion The results showed that SERVQUAL is a valid, reliable, and flexible instrument to monitor and measure the quality of the services in private hospitals of Iran. Our findings clarified the importance of creating a strong relationship between patients and the hospital practitioners/personnel and the need for hospital staff to be responsive, credible, and empathetic when dealing with patients. PMID:22299830

  11. Imaging choices hold key for reduced cost and improved quality of care.

    PubMed

    Goodwin, Kevin; Hochman, Rodney

    2013-10-01

    Finance leaders should understand the drivers of cost and quality in their organizations, including how best to make cost-effective use of technologies. Ultrasound, in particular, can provide a means to improve quality of care and reduce costs because it can help a hospital avoid costly mistakes, can sometimes serve as a substitute for more expensive scans, and can help reduce the risk of extra days in the hospital. Optimum use of ultrasound can help to improve performance on measures that determine a hospital's eligibility to receive valued-based incentive payments. PMID:24244991

  12. [The multi-factorial model of satisfaction of medical care by hospital patients suffering from borderline psychic disorders].

    PubMed

    Tsigankov, B D; Maligin, Ya V

    2015-01-01

    The satisfaction of patients with medical care determines their consumer behavior. The factors of satisfaction with medical care vary depending on level of its provision and profile of medical specialty. At that, there are only sporadic studies dedicated to factors of satisfaction with psychiatric care. The study was carried out to examine factors of satisfaction with hospital psychiatric care by patients suffering from depressive and neurotic disorders. The sampling consisted of 356 hospital patients suffering from depressive and neurotic disorders. The survey in written form was carried out using originally developed questionnaire. The statistical analysis was implemented by compiling equation of multiple regression. It is established that key factors of satisfaction include functioning of medical nurses of department, functioning of attending physician, comfort of wards, proportions and quality of psychiatric care capability of physician to empathic listening. The developed mathematical model explains 81% of variation of satisfaction with treatment. PMID:26012273

  13. Introduction to the transforming dementia care in hospitals series.

    PubMed

    Evans, Simon; Brooker, Dawn; Thompson, Rachel; Bray, Jennifer; Milosevic, Sarah; Bruce, Mary; Carter, Christine

    2015-06-25

    A short series of articles in Nursing Older People, starting in September, presents case study examples of the positive work achieved by trusts that participated in the RCN's development programme to improve dementia care in acute hospitals. This introductory article reports on the independent evaluation of the programme. The programme included a launch event, development days, site visits, ongoing support by the RCN lead and carer representatives and a conference to showcase service improvements. The evaluation drew on data from a survey, the site visits, trust action plans and a range of self-assessment tools for dementia care. The findings highlight substantial progress towards programme objectives and learning outcomes and suggest that the programme provided the focus, impetus and structure for trusts to make sustainable changes. It also equipped participants with the strategies and confidence to change practice. Recommendations are made for taking the programme forward. PMID:26108943

  14. Improving the quality of care for Medicare patients with acute myocardial infarction: results from the Cooperative Cardiovascular Project

    Microsoft Academic Search

    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

    1998-01-01

    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

  15. 38 CFR 17.47 - Considerations applicable in determining eligibility for hospital, nursing home or domiciliary care.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ...determining eligibility for hospital, nursing home or domiciliary care. 17.47... MEDICAL Hospital, Domiciliary and Nursing Home Care § 17.47 Considerations...determining eligibility for hospital, nursing home or domiciliary...

  16. 38 CFR 17.47 - Considerations applicable in determining eligibility for hospital, nursing home or domiciliary care.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ...determining eligibility for hospital, nursing home or domiciliary care. 17.47... MEDICAL Hospital, Domiciliary and Nursing Home Care § 17.47 Considerations...determining eligibility for hospital, nursing home or domiciliary...

  17. 38 CFR 17.47 - Considerations applicable in determining eligibility for hospital, nursing home or domiciliary care.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ...determining eligibility for hospital, nursing home or domiciliary care. 17.47... MEDICAL Hospital, Domiciliary and Nursing Home Care § 17.47 Considerations...determining eligibility for hospital, nursing home or domiciliary...

  18. Impact of Timing and Setting of Palliative Care Referral on Quality of End-of-Life Care in Cancer Patients

    PubMed Central

    Hui, David; Kim, Sun Hyun; Roquemore, Joyce; Dev, Rony; Chisholm, Gary; Bruera, Edurado

    2014-01-01

    Background Limited data is available on how the timing and setting of palliative care referral can affect end-of-life care. In this retrospective cohort study, we examined how the timing and setting of palliative care (PC) referral were associated with the quality of end-of-life care. Methods All adult patients residing in the Houston area who died of advanced cancer between 9/1/2009 and 2/28/2010 and had a PC consultation were included. We retrieved data on PC referral and quality of end-of-life care indicators. Results Among 366 decedents, 120 (33%) had early PC referral (>3 months before death) and 169 (46%) were first seen as outpatients. Earlier PC referral was associated with fewer emergency room visits (39% vs. 68%, P<0.001), hospitalizations (48% vs. 81%, P<0.003), and hospital deaths (17% vs. 31%, P=0.004) in the last 30 days of life. Similarly, outpatient PC referral was associated with fewer emergency room visits (48% vs. 68%, P<0.001), hospital admissions (52% vs. 86%, P<0.001), hospital deaths (18% vs. 34%, P=0.001) and intensive care unit admissions (4% vs. 14%, P=0.001). In multivariate analysis, outpatient PC referral (odds ratio [OR]=0.42, 95% confidence interval [CI] 0.28-0.66; P<0.001) was independently associated with less aggressive end-of-life care. Male sex (OR=1.63, 95%CI 1.06-2.50; P=0.03) and hematologic malignancy (OR=2.57, 95%CI 1.18-5.59; P=0.02) were associated with more aggressive end-of-life care. Conclusion Patients referred to outpatient PC had improved end-of-life care compared to inpatient PC. Our findings support the need to increase the availability of PC clinics and to streamline the process of early referral. PMID:24967463

  19. Impact of long-term home care on hospital and nursing home use and cost.

    PubMed Central

    Hughes, S L; Manheim, L M; Edelman, P L; Conrad, K J

    1987-01-01

    This article reports the long-range impact of a long-term home care program in Chicago on hospital and nursing home use and on overall health care costs over four client-years of observation. The evaluation utilized a quasi-experimental design with a comparison group composed of clients who received home-delivered meals. The health services utilization experience of consecutively accepted treatment (N = 157) and comparison group (N = 156) subjects was monitored for 48 client-months following acceptance to care. Imputed costs were then assigned to each type of care measured. Findings include a significantly lower risk of permanent admission to sheltered and intermediate-level nursing home care in the treatment group but no difference in risk of permanent admission to skilled-level nursing home care. Despite savings in low-intensity nursing home days, preliminary findings indicate that total costs of care were 25 percent higher in the treatment group. However, these costs are accompanied by significant quality-of-life benefits in the treatment group (reported elsewhere). PMID:3106268

  20. Quality in transitional care of the elderly: Key challenges and relevant improvement measures

    PubMed Central

    Storm, Marianne; Siemsen, Inger Margrete D.; Laugaland, Kristin; Dyrstad, Dagrunn Nåden; Aase, Karina

    2014-01-01

    Introduction Elderly people aged over 75 years with multifaceted care needs are often in need of hospital treatment. Transfer across care levels for this patient group increases the risk of adverse events. The aim of this paper is to establish knowledge of quality in transitional care of the elderly in two Norwegian hospital regions by identifying issues affecting the quality of transitional care and based on these issues suggest improvement measures. Methodology Included in the study were elderly patients (75+) receiving health care in the municipality admitted to hospital emergency department or discharged to community health care with hip fracture or with a general medical diagnosis. Participant observations of admission and discharge transitions (n = 41) were carried out by two researchers. Results Six main challenges with belonging descriptions have been identified: (1) next of kin (bridging providers, advocacy, support, information brokering), (2) patient characteristics (level of satisfaction, level of insecurity, complex clinical conditions), (3) health care personnel's competence (professional, system, awareness of others’ roles), (4) information exchange (oral, written, electronic), (5) context (stability, variability, change incentives, number of patient handovers) and (6) patient assessment (complex clinical picture, patient description, clinical assessment). Conclusion Related to the six main challenges, several measures have been suggested to improve quality in transitional care, e.g. information to and involvement of patients and next of kin, staff training, standardisation of routines and inter-organisational staff meetings. PMID:24868196

  1. [Improvement approaches in the hospital setting: From total quality management to Lean].

    PubMed

    Curatolo, N; Lamouri, S; Huet, J-C; Rieutord, A

    2015-07-01

    Hospitals have to deal strong with economic constraints and increasing requirements in terms of quality and safety of care. To address these constraints, one solution could be the adoption of approaches from the industry sector. Following the decree of April 6, 2011 on the quality management of the medication use process, some of these approaches, such as risk management, are now part of the everyday work of healthcare professionals. However, other approaches, such as business process improvement, are still poorly developed in the hospital setting. In this general review, we discuss the main approaches of business process improvements that have been used in hospitals by focusing specifically on one of the newest and most currently used: Lean. PMID:25558800

  2. Transitional Care of Older Adults Hospitalized with Heart Failure: A Randomized, Controlled Trial

    Microsoft Academic Search

    Mary D. Naylor; Dorothy A. Brooten; Roberta L. Campbell; Greg Maislin; Kathleen M. McCauley; J. Sanford Schwartz

    2004-01-01

    OBJECTIVES: To examine the effectiveness of a transi- tional care intervention delivered by advanced practice nurses (APNs) to elders hospitalized with heart failure. DESIGN: Randomized, controlled trial with follow-up through 52 weeks postindex hospital discharge. SETTING: Six Philadelphia academic and community hospitals. PARTICIPANTS: Two hundred thirty-nine eligible pa- tients were aged 65 and older and hospitalized with heart failure. INTERVENTION:

  3. Quality improvement activity in radiology reading and reporting in a rural setting hospital in Indonesia.

    PubMed

    Frelita, Grace; Wongso, Christlyn; Pasaribu, Marganda Dapot Asi

    2012-01-01

    The Republic of Indonesia is an archipelago country, which is located between Asia and Australia. With a population of more than 200 million people, Indonesia only has about 600 Radiologists, whose majority resides in urban areas. In such a challenging situation, the Siloam Hospitals Group (SHG) established a strategy to improve its remote hospitals' Radiologists' quality care standard of patient safety. Although the strategy has produced a positive result, resistance towards cultural change was unavoidable throughout the strategy implementation. By learning from several resources and experiences, SHG's leaders tried to develop a strategy improvement towards better processes, particularly in recognizing and solving interpersonal conflicts. PMID:22913128

  4. Did a quality improvement collaborative make stroke care better? A cluster randomized trial

    PubMed Central

    2014-01-01

    Background Stroke can result in death and long-term disability. Fast and high-quality care can reduce the impact of stroke, but UK national audit data has demonstrated variability in compliance with recommended processes of care. Though quality improvement collaboratives (QICs) are widely used, whether a QIC could improve reliability of stroke care was unknown. Methods Twenty-four NHS hospitals in the Northwest of England were randomly allocated to participate either in Stroke 90:10, a QIC based on the Breakthrough Series (BTS) model, or to a control group giving normal care. The QIC focused on nine processes of quality care for stroke already used in the national stroke audit. The nine processes were grouped into two distinct care bundles: one relating to early hours care and one relating to rehabilitation following stroke. Using an interrupted time series design and difference-in-difference analysis, we aimed to determine whether hospitals participating in the QIC improved more than the control group on bundle compliance. Results Data were available from nine interventions (3,533 patients) and nine control hospitals (3,059 patients). Hospitals in the QIC showed a modest improvement from baseline in the odds of average compliance equivalent to a relative improvement of 10.9% (95% CI 1.3%, 20.6%) in the Early Hours Bundle and 11.2% (95% CI 1.4%, 21.5%) in the Rehabilitation Bundle. Secondary analysis suggested that some specific processes were more sensitive to an intervention effect. Conclusions Some aspects of stroke care improved during the QIC, but the effects of the QIC were modest and further improvement is needed. The extent to which a BTS QIC can improve quality of stroke care remains uncertain. Some aspects of care may respond better to collaboratives than others. Trial registration ISRCTN13893902. PMID:24690267

  5. Staffing in postnatal units: is it adequate for the provision of quality care? Staff perspectives from a state-wide review of postnatal care in Victoria, Australia

    PubMed Central

    Forster, Della A; McLachlan, Helen L; Yelland, Jane; Rayner, Jo; Lumley, Judith; Davey, Mary-Ann

    2006-01-01

    Background State-wide surveys of recent mothers conducted over the past decade in Victoria, one state of Australia, have identified that women are consistently less satisfied with the care they received in hospital following birth compared with other aspects of maternity care. Little is known of caregivers' perspectives on the provision ofhospital postnatal care: how care is organised and provided in different hospitals; what constrains the provision of postnatal care (apart from funding) and what initiatives are being undertaken to improve service delivery. A state-widereview of organisational structures and processes in relation to the provision of hospital postnatal care in Victoria was undertaken. This paper focuses on the impact of staffing issues on the provision of quality postnatal care from the perspective of care providers. Methods A study of care providers from Victorian public hospitals that provide maternity services was undertaken. Datawere collected in two stages. Stage one: a structured questionnaire was sent to all public hospitals in Victoria that provided postnatal care (n = 73), exploring the structure and organisation of care (e.g. staffing, routine observations, policy framework and discharge planning). Stage two: 14 maternity units were selected and invited to participate in a more in-depth exploration of postnatal care. Thirty-eight key informant interviews were undertaken with midwives (including unit managers, associate unit managers and clinical midwives) and a medical practitioner from eachselected hospital. Results Staffing was highlighted as a major factor impacting on the provision of quality postnatal care. There were significant issues associated with inadequate staff/patient ratios; staffing mix; patient mix; prioritisation of birth suites over postnatal units; and the use of non-permanent staff. Forty-three percent of hospitals reported having only midwives (i.e. no non-midwives) providing postnatal care. Staffing issues impact on hospitals' ability to provide continuity of care. Recruitment and retention of midwives are significant issues, particularly in rural areas. Conclusion Staffing in postnatal wards is a challenging issue, and varies with hospital locality and model of care. Staff/patient ratios and recruitment of midwives in rural areas are the two areas that appear to have the greatest negative impact on staffing adequacy and provision of quality care. Future research on postnatal care provision should include consideration of any impact on staff and staffing. PMID:16817974

  6. Assessment of foodservice quality and identification of improvement strategies using hospital foodservice quality model.

    PubMed

    Kim, Kyungjoo; Kim, Minyoung; Lee, Kyung-Eun

    2010-04-01

    The purposes of this study were to assess hospital foodservice quality and to identify causes of quality problems and improvement strategies. Based on the review of literature, hospital foodservice quality was defined and the Hospital Foodservice Quality model was presented. The study was conducted in two steps. In Step 1, nutritional standards specified on diet manuals and nutrients of planned menus, served meals, and consumed meals for regular, diabetic, and low-sodium diets were assessed in three general hospitals. Quality problems were found in all three hospitals since patients consumed less than their nutritional requirements. Considering the effects of four gaps in the Hospital Foodservice Quality model, Gaps 3 and 4 were selected as critical control points (CCPs) for hospital foodservice quality management. In Step 2, the causes of the gaps and improvement strategies at CCPs were labeled as "quality hazards" and "corrective actions", respectively and were identified using a case study. At Gap 3, inaccurate forecasting and a lack of control during production were identified as quality hazards and corrective actions proposed were establishing an accurate forecasting system, improving standardized recipes, emphasizing the use of standardized recipes, and conducting employee training. At Gap 4, quality hazards were menus of low preferences, inconsistency of menu quality, a lack of menu variety, improper food temperatures, and patients' lack of understanding of their nutritional requirements. To reduce Gap 4, the dietary departments should conduct patient surveys on menu preferences on a regular basis, develop new menus, especially for therapeutic diets, maintain food temperatures during distribution, provide more choices, conduct meal rounds, and provide nutrition education and counseling. The Hospital Foodservice Quality Model was a useful tool for identifying causes of the foodservice quality problems and improvement strategies from a holistic point of view. PMID:20461206

  7. Assessment of foodservice quality and identification of improvement strategies using hospital foodservice quality model

    PubMed Central

    Kim, Kyungjoo; Kim, Minyoung

    2010-01-01

    The purposes of this study were to assess hospital foodservice quality and to identify causes of quality problems and improvement strategies. Based on the review of literature, hospital foodservice quality was defined and the Hospital Foodservice Quality model was presented. The study was conducted in two steps. In Step 1, nutritional standards specified on diet manuals and nutrients of planned menus, served meals, and consumed meals for regular, diabetic, and low-sodium diets were assessed in three general hospitals. Quality problems were found in all three hospitals since patients consumed less than their nutritional requirements. Considering the effects of four gaps in the Hospital Foodservice Quality model, Gaps 3 and 4 were selected as critical control points (CCPs) for hospital foodservice quality management. In Step 2, the causes of the gaps and improvement strategies at CCPs were labeled as "quality hazards" and "corrective actions", respectively and were identified using a case study. At Gap 3, inaccurate forecasting and a lack of control during production were identified as quality hazards and corrective actions proposed were establishing an accurate forecasting system, improving standardized recipes, emphasizing the use of standardized recipes, and conducting employee training. At Gap 4, quality hazards were menus of low preferences, inconsistency of menu quality, a lack of menu variety, improper food temperatures, and patients' lack of understanding of their nutritional requirements. To reduce Gap 4, the dietary departments should conduct patient surveys on menu preferences on a regular basis, develop new menus, especially for therapeutic diets, maintain food temperatures during distribution, provide more choices, conduct meal rounds, and provide nutrition education and counseling. The Hospital Foodservice Quality Model was a useful tool for identifying causes of the foodservice quality problems and improvement strategies from a holistic point of view. PMID:20461206

  8. The John D. Stoeckle Center for Primary Care Innovation Massachusetts General Hospital

    E-print Network

    Mootha, Vamsi K.

    The John D. Stoeckle Center for Primary Care Innovation Massachusetts General Hospital Center for Excellence in Primary Care University of California, San Francisco Primary Care: A Miracle of Modern Medicine with us! (see details, back cover) #12;Primary care: The foundation of our health care system may

  9. Palliative care: experience with 156 cases in a general hospital.

    PubMed

    Khoo, S B

    2002-12-01

    The concept of Palliative Care is still quite new in Malaysia and there is a need to promote the awareness of its importance for patients with incurable and advanced illnesses, not only to the public but also to the nursing and medical professionals. These patients especially the poor ones very often have no one to turn to; they cannot afford to seek treatment from the private hospitals, they are turned away from acute General Hospitals and are told that there is nothing more to be done because their illnesses are no longer curable, they cannot pay for GPs to come to their homes, and there is difficulty in purchasing opiate drugs for pain relief. This is a retrospective observational study of the palliative care services we try to provide to those few patients referred to us. This study showed that out of the total of 156 patients, majority were Chinese, peak age between 50-59 years, referrals were mainly from the community and the Obstetrics + Gynaecology department, patients were referred rather late, 60% of patients died at home, most common malignancies being those of the breast, colorectal and cervix, common sites of metastases being the lungs, liver, bones, peritoneum and local infiltration, 87% of patients experienced pain, about 40% of patients were not fully aware of both diagnosis and prognosis, common drugs used being opiate analgesics followed by dexamethasone, H2 antagonist, antiemetics and NSAID. PMID:12733165

  10. Disparities in Health Care Quality among Minority Women

    MedlinePLUS

    ... 3-EF Go to Online Store Disparities in Health Care Quality Among Minority Women Selected Findings From the ... race and ethnicity are combined. Return to Contents Health Care Delivery and Systems Information about health care delivery ...

  11. Blending Key Ingredients to Assure Quality in Home Health Care.

    ERIC Educational Resources Information Center

    Griffith, Deloris G.

    1986-01-01

    Careful staff selection, training, and review are among the methods the author recommends to home care agencies striving to provide top-notch services. Discusses measuring the quality of care employees are providing, accreditation, and the benefits of accreditation. (CT)

  12. Quality of care indicators for gout management

    Microsoft Academic Search

    Ted R. Mikuls; Catherine H. MacLean; Jason Olivieri; Fausto G. Patino; Jeroan J. Allison; John T. Farrar; Warren B. Bilker; Kenneth G. Saag

    2004-01-01

    OBJECTIVE: Despite the significant health impact of gout, there is no consensus on management standards. To guide physician practice, we sought to develop quality of care indicators for gout management.\\u000aMETHODS: A systematic literature review of gout therapy was performed using the Medline database. Two abstractors independently reviewed each of the articles for relevance and satisfaction of minimal inclusion criteria.

  13. The need for quality hospice care

    Microsoft Academic Search

    Robert N. Butler

    1979-01-01

    The following was excerpted by the editor from an address entitled “The Need for Quality Hospice Care” delivered to the National Hospice Organization in Washington, D.C., October 6, 1978, by Robert N. Butler, M.D., director of the National Institute on Aging and author of the Pulitzer prize-winning book Why Survive? Being Old In America, New York: Harper, 1975. Permission by

  14. Searching for a single voice. Various factors and groups affect the quality movement's quest to coalesce around a main strategy that will improve patient care.

    PubMed

    Robeznieks, Andis

    2006-03-01

    According to industry experts, there are too many cooks in the quality kitchen, each with different recipes and ingredients for the perfect way to improve patient safety and care. Some, like Cassy Horack, left, who is director of her hospital's quality initiatives, say that hospitals should work on quality from the inside out. Others believe universal benchmarks should determine what is quality care. PMID:16579421

  15. 38 CFR 17.86 - Provision of hospital care and medical services during certain disasters and emergencies under 38...

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ...false Provision of hospital care and medical services during certain disasters and...Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Care During Certain Disasters and Emergencies...86 Provision of hospital care and medical services during certain disasters...

  16. 38 CFR 17.86 - Provision of hospital care and medical services during certain disasters and emergencies under 38...

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ...false Provision of hospital care and medical services during certain disasters and...Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Care During Certain Disasters and Emergencies...86 Provision of hospital care and medical services during certain disasters...

  17. 38 CFR 17.86 - Provision of hospital care and medical services during certain disasters and emergencies under 38...

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ...false Provision of hospital care and medical services during certain disasters and...Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Care During Certain Disasters and Emergencies...86 Provision of hospital care and medical services during certain disasters...

  18. Influence of Structural Features on Portuguese Toddler Child Care Quality

    ERIC Educational Resources Information Center

    Pessanha, Manuela; Aguiar, Cecilia; Bairrao, Joaquim

    2007-01-01

    Whereas child care quality has been extensively studied in the U.S., there is much less information about the quality of child care in other countries. With one of the highest maternal employment rates in Europe, it is important to examine child care in Portugal. Thirty toddler classrooms in child care centers were observed. The purpose of this…

  19. Compliance with universal precautions among health care workers at three regional hospitals

    Microsoft Academic Search

    Robyn R. M. Gershon; David Vlahov; Sarah A. Felknor; Donald Vesley; Philip C. Johnson; George L. Delcios; Lawrence R. Murphy

    1995-01-01

    Objective: To assess and characterize self-reported levels of compliance with universal precautions among hospital-based health care workers and to determine correlates of compliance.Design: Confidential questionnaire survey of 1716 hospital-based health care workers. Participants: Participants were recruited from three geographically distinct hospitals. A stratified convenience sample of physicians, nurses, technicians, and phlebotomists working in emergency, surgery, critical care, and laboratory departments

  20. The production of health care services and changing hospital reimbursement. The role of hospital-medical staff relationships.

    PubMed

    Custer, W S; Moser, J W; Musacchio, R A; Willke, R J

    1990-09-01

    The production of health care services has the unique feature that physicians do not face explicit costs for hospital inputs. This paper develops models of the production process given alternative hospital and medical staff relationships, and analyzes the impact of the change in hospital reimbursement under Medicare from a cost-based system to the Prospective Payment System (PPS). A basic theoretical result finds that the switch to PPS forces physicians to alter their input mix, changing both physician and hospital income. The effects of the introduction of PPS on hospital inputs, physician income, and hours of work are empirically examined. PMID:10107500

  1. Nurses' Emotional Intelligence Impact on the Quality of Hospital Services

    PubMed Central

    Ranjbar Ezzatabadi, Mohammad; Bahrami, Mohammad Amin; Hadizadeh, Farzaneh; Arab, Masoomeh; Nasiri, Soheyla; Amiresmaili, Mohammadreza; Ahmadi Tehrani, Gholamreza

    2012-01-01

    Background Emotional intelligence is the potential to feel, use, communicate, recognize, remember, describe, identify, learn from, manage, understand and explain emotions. Service quality also can be defined as the post-consumption assessment of the services by consumers that are determined by many variables. Objectives This study was aimed to determine the nurses’ emotional intelligence impact on the delivered services quality. Materials and Methods This descriptive - applied study was carried out through a cross-sectional method in 2010. The research had 2 populations comprising of patients admitted to three academic hospitals of Yazd and the hospital nurses. Sample size was calculated by sample size formula for unlimited (patients) and limited (nursing staff) populations and obtained with stratified- random method. The data was collected by 4 valid questionnaires. Results The results of study indicated that nurses' emotional intelligence has a direct effect on the hospital services quality. The study also revealed that nurse's job satisfaction and communication skills have an intermediate role in the emotional intelligence and service quality relation. Conclusions This paper reports a new determinant of hospital services quality. PMID:23482866

  2. Quality of care: how good is good enough?

    PubMed

    Chassin, Mark R

    2012-01-01

    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/ PMID:22913581

  3. Intraclass correlation coefficients for cluster randomized trials in care pathways and usual care: hospital treatment for heart failure

    PubMed Central

    2014-01-01

    Background Cluster randomized trials are increasingly being used in healthcare evaluation to show the effectiveness of a specific intervention. Care pathways (CPs) are becoming a popular tool to improve the quality of health-care services provided to heart failure patients. In order to perform a well-designed cluster randomized trial to demonstrate the effectiveness of Usual care (UC) and CP in heart failure treatment, the intraclass correlation coefficient (ICC) should be available before conducting a trial to estimate the required sample size. This study reports ICCs for both demographical and outcome variables from cluster randomized trials of heart failure patients in UC and care pathways. Methods To calculate the degree of within-cluster dependence, the ICC and associated 95% confidence interval were calculated by a method based on analysis of variance. All analyses were performed in R software version 2.15.1. Results ICCs for baseline characteristics ranged from 0.025 to 0.058. The median value and interquartile range was 0.043 [0.026-0.052] for ICCs of baseline characteristics. Among baseline characteristics, the highest ICCs were found for admission by referral or admission from home (ICC?=?0.058) and the disease severity at admission (ICC?=?0.046). Corresponding ICCs for appropriateness of the stay, length of stay and hospitalization cost were 0.069, 0.063, and 0.001 in CP group and 0.203, 0.020, 0.046 for usual care, respectively. Conclusion Reported values of ICCs from present care pathway trial and UC results for some common outcomes will be helpful for estimating sample size in future clustered randomized heart failure trials, in particular for the evaluation of care pathways. PMID:24565441

  4. Relationship between quality of life and self-care ability in patients receiving hemodialysis

    PubMed Central

    Heidarzadeh, Mehdi; Atashpeikar, Solmaz; Jalilazar, Tahereh

    2010-01-01

    BACKGROUND: Although hemodialysis has a therapeutic effect on end stage renal disease (ESRD), these patients encounter many physical, psychological, and social stressful factors that lead to a decrease in their quality of life (QOL). One of the factors that are effective on increasing the QOL is the self-care ability. Review of literature demonstrated a few studies done on different aspects of QOL in ESRD patients under hemodialysis and their relationships with self-care ability in Iran. So, in this research besides determining the quality of life and its dimensions and self-care ability of hemodialysis patients, we evaluated their relationships with each other. METHODS: For this purpose, all hemodialysis patients who had inclusion criteria and were hospitalized in hemodialysis wards of Bonab, Maragheh, and Miandoab hospitals were selected and data were collected by interview using a questionnaire that included three parts, demographic factors, quality of life, and self-care ability. RESULTS: The results indicated that quality of life in 34%, and self-care ability in 78.3% of hemodialysis patients were desirable, and there was a direct and significant relationship between these two variables (p < 0.001, r = 0.4), as self-care ability explained 29% of variance of QOL. In quality of life subsectors, social dimension in 98.3% of patients was desirable, while physical dimension (80%) and psychological dimension (63.5%) in most patients were undesirable. Physical dimension was the most impressible dimension of quality of life in self-care ability whereas self-care ability explained 27% of total variance of physical dimension of QOL. CONCLUSIONS: Nearly two thirds of mentioned patients had no desirable QOL and regarding the positive relationship between QOL and self-care ability, it is suggested that health care planner and managers prepare the condition that through educating and reinforcing self-care ability in these patients improve the QOL in hemodialysis patients. PMID:21589783

  5. Child Care Quality in Different State Policy Contexts

    ERIC Educational Resources Information Center

    Rigby, Elizabeth; Ryan, Rebecca M.; Brooks-Gunn, Jeanne

    2007-01-01

    Using data from the Child Care Supplement to the Fragile Families and Child Wellbeing Study, we test associations between the quality of child care and state child care policies. These data, which include observations of child care and interviews with care providers and mothers for 777 children across 14 states, allow for comparisons across a…

  6. CDC Vital Signs: Making Health Care Safer Antibiotic Rx in Hospitals

    MedlinePLUS

    ... Press Kit Read the MMWR Science Clips Making Health Care Safer Antibiotic Rx in Hospitals: Proceed with Caution ... resistance and improving prescribing practices. Work with other health care facilities to prevent infections, transmission, and resistance. Problem ...

  7. Analysis of the quality of hospital information systems audit trails

    PubMed Central

    2013-01-01

    Background Audit Trails (AT) are fundamental to information security in order to guarantee access traceability but can also be used to improve Health information System’s (HIS) quality namely to assess how they are used or misused. This paper aims at analysing the existence and quality of AT, describing scenarios in hospitals and making some recommendations to improve the quality of information. Methods The responsibles of HIS for eight Portuguese hospitals were contacted in order to arrange an interview about the importance of AT and to collect audit trail data from their HIS. Five institutions agreed to participate in this study; four of them accepted to be interviewed, and four sent AT data. The interviews were performed in 2011 and audit trail data sent in 2011 and 2012. Each AT was evaluated and compared in relation to data quality standards, namely for completeness, comprehensibility, traceability among others. Only one of the AT had enough information for us to apply a consistency evaluation by modelling user behaviour. Results The interviewees in these hospitals only knew a few AT (average of 1 AT per hospital in an estimate of 21 existing HIS), although they all recognize some advantages of analysing AT. Four hospitals sent a total of 7 AT – 2 from Radiology Information System (RIS), 2 from Picture Archiving and Communication System (PACS), 3 from Patient Records. Three of the AT were understandable and three of the AT were complete. The AT from the patient records are better structured and more complete than the RIS/PACS. Conclusions Existing AT do not have enough quality to guarantee traceability or be used in HIS improvement. Its quality reflects the importance given to them by the CIO of healthcare institutions. Existing standards (e.g. ASTM:E2147, ISO/TS 18308:2004, ISO/IEC 27001:2006) are still not broadly used in Portugal. PMID:23919501

  8. The Comparative Assessment and Improvement of Quality of Surgical Care in the Department of Veterans Affairs

    Microsoft Academic Search

    Shukri F. Khuri; Jennifer Daley; William G. Henderson

    2002-01-01

    rompted by the need to assess comparatively the quality of surgical care in 133 Veter- ans Affairs (VA) hospitals, the Department of Veterans Affairs conducted the National VA Surgical Risk Study between October 1, 1991, and December 31, 1993, in 44 VA medical centers. The study developed and validated models for risk adjustment of 30- day morbidity and 30-day mortality

  9. Comparison between two mobile pre-hospital care services for trauma patients

    PubMed Central

    2012-01-01

    Objectives Pre-hospital care (PH) in Brazil is currently in the phase of implementation and expansion, and there are few studies on the impacts of this public health service. The purpose of this study is to assess the quality of care and severity of trauma among the population served, using trauma scores, attendance response times, and mortality rates. This work compares two pre-hospital systems: the Mobile Emergency Care Service, or SAMU 192, and the Fire Brigade Group, or CB. Method Descriptive study evaluating all patients transported by both systems in Catanduva, SP, admitted to a single hospital. Results 850 patients were included, most of whom were men (67.5%); the mean age was 38.5 ± 18.5 years. Regarding the use of PH systems, most patients were transported by SAMU (62.1%). The trauma mechanisms involved motorcycle accidents in 32.7% of cases, transferred predominantly by SAMU, followed by falls (25.8%). Regarding the response time, CB showed the lowest rates. In relation to patient outcome, only 15.5% required hospitalization. The average score on the Glasgow Coma Scale was 14.7 ± 1.3; average RTS was 7.7 ± 0.7; ISS 3.8 ± 5.9; and average TRISS 97.6 ± 9.3. The data analysis showed no statistical differences in mortality between the groups studied (SAMU - 1.5%; CB - 2.5%). The trauma scores showed a higher severity of trauma among the fatal victims. Conclusion Trauma victims are predominantly young and male; the trauma mechanism that accounted for the majority of PH cases was motorcycle accidents; CB responded more quickly than SAMU; and there was no statistical difference between the services of SAMU and CB in terms of severity of the trauma and mortality rates. PMID:23531089

  10. The Presence of Nursing Students and Its Influence in the Quality of Care Provided by Staff Nurses.

    ERIC Educational Resources Information Center

    Zisberg, Anna; Bar-Tal, Yoram; Krulik, Tamar

    2003-01-01

    Protocol-guided observations in 15 Israeli hospitals were used to grade nursing activities. The presence of nursing students in hospitals improved the quality of care provided by 67 nurses compared to their performance in the absence of students. (Contains 30 references.) (JOW)

  11. Issues experienced while administering care to patients with dementia in acute care hospitals: A study based on focus group interviews

    PubMed Central

    Fukuda, Risa; Shimizu, Yasuko

    2015-01-01

    Objective Dementia is a major public health problem. More and more patients with dementia are being admitted to acute care hospitals for treatment of comorbidities. Issues associated with care of patients with dementia in acute care hospitals have not been adequately clarified. This study aimed to explore the challenges nurses face in providing care to patients with dementia in acute care hospitals in Japan. Methods This was a qualitative study using focus group interviews (FGIs). The setting was six acute hospitals with surgical and medical wards in the western region of Japan. Participants were nurses in surgical and internal medicine wards, excluding intensive care units. Nurses with less than 3 years working experience, those without experience in dementia patient care in their currently assigned ward, and head nurses were excluded from participation. FGIs were used to collect data from February to December 2008. Interviews were scheduled for 1–1.5 h. The qualitative synthesis method was used for data analysis. Results In total, 50 nurses with an average experience of 9.8 years participated. Eight focus groups were formed. Issues in administering care to patients with dementia at acute care hospitals were divided into seven groups. Three of these groups, that is, problematic patient behaviors, recurrent problem, and problems affecting many people equally, interact to result in a burdensome cycle. This cycle is exacerbated by lack of nursing experience and lack of organization in hospitals. In coping with this cycle, the nurses develop protection plans for themselves and for the hospital. Conclusions The two main issues experienced by nurses while administering care to patients with dementia in acute care hospitals were as follows: (a) the various problems and difficulties faced by nurses were interactive and caused a burdensome cycle, and (b) nurses do their best to adapt to these conditions despite feeling conflicted. PMID:25716983

  12. Developing evidence-based maternity care in Iran: a quality improvement study

    Microsoft Academic Search

    Siamak Aghlmand; Feizollah Akbari; Aboulfath Lameei; Kazem Mohammad; Rhonda Small; Mohammad Arab

    2008-01-01

    BACKGROUND: Current Iranian perinatal statistics indicate that maternity care continues to need improvement. In response, we implemented a multi-faceted intervention to improve the quality of maternity care at an Iranian Social Security Hospital. Using a before-and-after design our aim was to improve the uptake of selected evidence based practices and more closely attend to identified women's needs and preferences. METHODS:

  13. Randomised controlled trial of routine hospital clinic care versus routine general practice care for type II diabetics

    Microsoft Academic Search

    T M Hayes; J Harries

    1984-01-01

    Two hundred patients with type II diabetes were entered into a randomised controlled trial lasting five years to compare routine care of this condition by a hospital diabetic clinic with routine care in general practice. Fewer patients in the group being cared for by their general practitioner (general practice group) were regularly reviewed or had regular estimations of blood glucose

  14. The physician-hospital team: a successful approach to improving care in a large academic medical center.

    PubMed

    Feldman, Arthur M; Weitz, Howard; Merli, Geno; DeCaro, Matthew; Brechbill, Alan L; Adams, Suzanne; Bischoff, Lindsay; Richardson, Rory; Williams, Melissa J; Wenneker, Mark; Epstein, Andrew

    2006-01-01

    Initiatives to improve the quality and efficiency of care in academic medical centers (AMCs, teaching hospitals) can benefit the performance of academic departments as well as the hospital. However, the value of performance improvement programs in an AMC is often challenging. At Jefferson Medical College, clinical efficiency and bed availability are important priorities to the Department of Medicine. To this end, a multidisciplinary program was designed to (1) improve the quality and consistency of care by adapting and adopting national guidelines for patients with heart failure and acute coronary syndrome; (2) identify and improve hospital operational supports and maximize resource utilization; (3) increase hospital functional capacity to make way for increased volume; and (4) improve housestaff education and practice by using evidence-based approaches and by optimizing teaching relationships between housestaff and attending faculty. The eight-month project (November 2002 to July 2003) resulted in improvement in several quality measures including increased use of beta blockers and angiotensin converting enzyme inhibitors for heart failure patients, reduced length of stay for heart failure and acute coronary syndrome patients, and increased satisfaction of the clinicians involved in caring for these patients. However, the project was not without barriers including individual physician's unwillingness to embrace change and an inability to incentivize change. Development of faculty leadership skills and enhanced physician accountability helped in overcoming the challenges of change. PMID:16377816

  15. Competition on quality in managed care.

    PubMed

    Schoenbaum, S C; Coltin, K L

    1998-10-01

    There is intense competition between managed care organizations (MCOs) in the USA based on cost and benefit coverage, but scant attention to differences in quality. Consumer preference for 'choice' has stimulated the growth of overlapping networks of providers across competing MCOs. These networks have tended to perform less well on the quality indicators in report cards than staff model MCOs. Ideally one would measure individual provider performance; but the overlapping networks, and the fact that each MCO represents a small fraction of each provider's practice, make that difficult to do. MCOs could potentially collaborate to measure individual provider performance. Financial incentives and risk-adjusted premiums might stimulate competition on quality within MCOs. It seems more likely that true competition on quality will occur between groups of providers, organized or integrated delivery systems, than between MCOs. Nevertheless, MCOs are likely to offer some quality-improving programs directly to their members, and can stimulate the competition between providers by collaborating to obtain provider-specific measurements. PMID:9828031

  16. Molecular epidemiology of vancomycin-resistant enterococci isolated from non-tertiary-care and tertiary-care hospitals in Korea.

    PubMed

    Jung, M K; Ahn, S H; Lee, W G; Lee, E H

    2014-11-01

    This study compared the molecular characteristics of vancomycin-resistant Enterococcus faecium (VREF) isolates recovered from 20 non-tertiary-care hospitals (36 isolates) and three tertiary-care hospitals (26 isolates) in diverse geographical areas of Korea from October 2010 to April 2011. All isolates carried the vanA gene only, but 42% and 73% of non-tertiary and tertiary-care isolates expressed the VanB phenotype (teicoplanin minimum inhibitory concentration ?16 ?g/ml). All isolates harboured insertion sequences, IS1542 and IS1216V, within Tn1546. The isolates from tertiary-care hospitals tended to have reduced Tn1546 lengths by deletion of sequences adjacent to IS elements. Multilocus sequence typing revealed eight sequence types within clonal complex 17 (CC17), but DNA fingerprinting by rep-PCR did not show clonal relatedness between the intra- and inter-hospital isolates. These results suggest that vanA, which has prevailed in tertiary-care hospitals of Korea since the 1990s, had been transferred horizontally to non-tertiary-care hospitals while the genetic rearrangement driven by evolutionary adaptation to adverse environments may have occurred in tertiary-care hospitals. PMID:25267406

  17. Availability and quality of prehospital care on pakistani interurban roads.

    PubMed

    Bhatti, Junaid A; Waseem, Hunniya; Razzak, Junaid A; Shiekh, Naeem-Ul-Lah; Khoso, Ajmal Khan; Salmi, L-Rachid

    2013-01-01

    Interurban road crashes often result in severe Road Traffic Injuries (RTIs). Prehospital emergency care on interurban roads was rarely evaluated in the low- and middle-income countries. The study highlighted the availability and quality of prehospital care facilities on interurban roads in Pakistan, a low-income country. The study setting was a 592-km-long National highway in the province of Sindh, Pakistan. Using the questionnaires adapted from the World Health Organization prehospital care guidelines [Sasser et al., 2005], managers and ambulance staff at the stations along highways were interviewed regarding the process of care, supplies in ambulances, and their experience of trauma care. Ambulance stations were either managed by the police or the Edhi Foundation (EF), a philanthropic organization. All highway stations were managed by the EF; the median distance between highway stations was 38 km (Interquartile Range [IQR]=27-46). We visited 14 stations, ten on the highway section, and four in cities, including two managed by the police. Most highway stations (n=13) received one RTI call per day. Half of stations (n=5) were inside highway towns, usually near primary or secondary-level healthcare facilities. Travel time to the nearest tertiary healthcare facility ranged from 31 to 70 minutes (median=48 minutes; IQR=30-60). Other shortcomings noted for stations were not triaging RTI cases (86%), informing hospitals (64%), or recording response times (57%). All ambulances (n=12) had stretchers, but only 58% had oxygen cylinders. The median schooling of ambulance staff (n=13) was 8 years (IQR=3-10), and the median paramedic training was 3 days (IQR=2-3). Observed shortcomings in prehospital care could be improved by public-private partnerships focusing on paramedic training, making available essential medical supplies, and linking ambulance stations with designated healthcare facilities for appropriate RTI triage. PMID:24406963

  18. The John D. Stoeckle Center for Primary Care Innovation Massachusetts General Hospital

    E-print Network

    Mootha, Vamsi K.

    2007 The John D. Stoeckle Center for Primary Care Innovation Massachusetts General Hospital 50.stoecklecenter.org reshaping primary care for a healthier future The John D. Stoeckle Center for PRIMARY CARE INNOVATION How You Can Help The need for outstanding primary care is great, and your charitable support

  19. Graduate medical education's new focus on resident engagement in quality and safety: will it transform the culture of teaching hospitals?

    PubMed

    Myers, Jennifer S; Nash, David B

    2014-10-01

    The Accreditation Council for Graduate Medical Education recently announced its Clinical Learning Environment Review (CLER) program, which is designed to catalyze and promote the engagement of physician trainees in health care quality and patient safety activities that are essential to the delivery of high-quality patient care in U.S. teaching hospitals. In this Commentary, the authors argue that a strong organizational culture in quality improvement and patient safety is a necessary foundation for resident engagement in these areas. They describe residents' influence via their social networks on the behaviors and attitudes of peers and other health care providers and highlight this as a powerful driver for culture change in teaching hospitals. They also consider some of the potential unintended consequences of the CLER program and offer strategies to avoid them. The authors suggest that the CLER program provides an opportunity for health care and graduate medical education leaders to closely examine organizational quality and safety culture and the degree to which their residents are integrated in these efforts. They highlight the importance of developing collaborative interprofessional strategies to reach common goals to improve patient care. By sharpening the focus on patient safety, supervision, professionalism, patient care transitions, and the overall quality of health care delivery in the clinical learning environment during residents' formative training years, the hope is that the CLER program will inspire a new generation of physicians who possess and value these skills. PMID:25054414

  20. Hospital organizational change and financial status: costs and outcomes of care in Philadelphia.

    PubMed

    Crawford, Albert G; Goldfarb, Neil; May, Reuel; Moyer, Kerry; Jones, Jayne; Nash, David B

    2002-01-01

    Two recent changes in Philadelphia-area hospital organizations are consolidation into systems and acquisition of 2 medical school hospitals by a for-profit chain. This study explored whether such consolidation and conversion affected costs and outcomes of care. The analysis included 1,617,581 discharges from 49 acute-care hospitals from 1997 to 1999. Analyses within and between medical school hospitals examined trends in discharges, case mix, length of stay, and mortality. The study addressed 2 questions: whether, as hospitals consolidate into medical school hospital-based systems, volume, severity, length of stay, and mortality increase in those hospitals; and whether for-profit conversion redistributes complex, high-cost admissions to nonprofit hospitals. The 2 medical school hospitals that became for-profit experienced decreases in volume and resource intensity, coupled at one with an increase in severity. However, these patterns were produced more by the system's financial instability than by consolidation or conversion. PMID:12487339

  1. Emergency care and the national quality strategy: highlights from the centers for medicare & medicaid services.

    PubMed

    Venkatesh, Arjun K; Goodrich, Kate

    2015-04-01

    The Centers for Medicare & Medicaid Services (CMS) of the US Department of Health and Human Services seeks to optimize health outcomes by leading clinical quality improvement and health system transformation through a variety of activities, including quality measure alignment, prioritization, and implementation. CMS manages more than 20 federal quality measurement and public reporting programs that cover the gamut of health care providers and facilities, including both hospital-based emergency departments (EDs) and individual emergency physicians. With more than 130 million annual visits, and as the primary portal of hospital admission, US hospital-based EDs deliver a substantial portion of acute care to Medicare beneficiaries. Given the position of emergency care across clinical conditions and between multiple settings of care, the ED plays a critical role in fulfilling all 6 priorities of the National Quality Strategy. We outline current CMS initiatives and future opportunities for emergency physicians and EDs to effect each of these priorities and help CMS achieve the triple aim of better health, better health care, and lower costs. PMID:25128008

  2. Coordinated hospital-home care for kidney patients on hemodialysis from the perspective of nursing personnel1

    PubMed Central

    Tejada-Tayabas, Luz María; Partida-Ponce, Karla Lizbeth; Hernández-Ibarra, Luis Eduardo

    2015-01-01

    OBJECTIVE: To examine, from the nursing perspective, the needs and challenges of coordinated hospital-home care for renal patients on hemodialysis. METHODS: A qualitative analysis was conducted with an ethnographic approach in a hemodialysis unit in San Luis Potosi, Mexico. Semistructured interviews were conducted with nine nurses, selected by purposeful sampling. Structured content analysis was used. RESULTS: Nurses recounted the needs and challenges involved in caring for renal patients. They also identified barriers that limit coordinated patient care in the hospital and the home, mainly the work overload at the hemodialysis unit and the lack of a systematic strategy for education and lifelong guidance to patients, their families and caregivers. CONCLUSIONS: This study shows the importance and necessity of establishing a strategy that goes beyond conventional guidance provided to caregivers of renal patients, integrating them into the multidisciplinary group of health professionals that provide care for these patients in the hospital to establish coordinated hospital-home care that increases therapeutic adherence, treatment substitution effectiveness and patient quality of life. PMID:26039292

  3. Prospects for comparing European hospitals in terms of quality and safety: lessons from a comparative study in five countries

    PubMed Central

    Burnett, Susan; Renz, Anna; Wiig, Siri; Fernandes, Alexandra; Weggelaar, Anne Marie; Calltorp, Johan; Anderson, Janet E.; Robert, Glenn; Vincent, Charles; Fulop, Naomi

    2013-01-01

    Purpose Being able to compare hospitals in terms of quality and safety between countries is important for a number of reasons. For example, the 2011 European Union directive on patients' rights to cross-border health care places a requirement on all member states to provide patients with comparable information on health-care quality, so that they can make an informed choice. Here, we report on the feasibility of using common process and outcome indicators to compare hospitals for quality and safety in five countries (England, Portugal, The Netherlands, Sweden and Norway). Main Challenges Identified The cross-country comparison identified the following seven challenges with respect to comparing the quality of hospitals across Europe: different indicators are collected in each country; different definitions of the same indicators are used; different mandatory versus voluntary data collection requirements are in place; different types of organizations oversee data collection; different levels of aggregation of data exist (country, region and hospital); different levels of public access to data exist; and finally, hospital accreditation and licensing systems differ in each country. Conclusion Our findings indicate that if patients and policymakers are to compare the quality and safety of hospitals across Europe, then further work is urgently needed to agree the way forward. Until then, patients will not be able to make informed choices about where they receive their health care in different countries, and some governments will remain in the dark about the quality and safety of care available to their citizens as compared to that available in neighbouring countries. PMID:23292003

  4. Interactional aspects of care during hospitalization: perspectives of family caregivers of psychiatrically ill in a tertiary care setting in India.

    PubMed

    Dinakaran, P; Mehrotra, Seema; Bharath, Srikala

    2014-12-01

    There are very few studies on user-perspectives about mental health care services that explore perspectives of family caregivers in India. An exploratory study was undertaken to understand the perceived importance of various aspects of interactions with mental health service providers during hospitalization, from the perspectives of family caregivers. In addition, it also aimed at documenting their actual experience of interactional aspects of care during the hospitalization of their relatives. The study was conducted on fifty family caregivers of patients with varied psychiatric diagnoses hospitalized in a tertiary psychiatric care setting in South India. Measures of Interactional aspects of care were developed to assess perceived importance of six different interactional domains of care and the actual experience of care in these domains. Provision of informational inputs and addressing of concerns raised emerged as the domains of care given highest importance. The item pertaining to 'sharing with the caregiver about different alternatives for treatment' received negative ratings in terms of actual experience by maximum number of participants (18%). Significant differences on perceived importance of four domains of interactional aspects of care (dignity, confidentiality and fairness, addressing concerns raised, informational inputs and prompt attention and consistent care) emerged between caregiver subgroups based on educational level of the caregiver, socio-economic status, hospitalization history and broad diagnostic categories. In addition, the care givers of patients with psychoses assigned significantly more positive ratings on actual experience for all the domains of interactional aspects of care. The findings have implications for further research and practice. PMID:25440563

  5. Effects of the Program of All-Inclusive Care for the Elderly on Hospital Use

    ERIC Educational Resources Information Center

    Meret-Hanke, Louise A.

    2011-01-01

    Purpose of the Study: This study evaluates the effects of the Program of All-Inclusive Care for the Elderly (PACE) on hospital use. PACE's capitated financing creates incentives to reduce the use of costly services. Furthermore, its emphasis on preventative care and regular monitoring by provides a mechanism for reducing unnecessary hospital use…

  6. Primary Care Provider Turnover and Quality in Managed Care Organizations

    Microsoft Academic Search

    Mary E. Plomondon; David J. Magid; John F. Steiner; Samantha MaWhinney; Blair D. Gifford; Sarah C. Shih; Gary K. Grunwald; John S. Rumsfeld

    Although associations with continuity of care have been studied, little is known about associations with a specific aspect of continuity of care, namely, primary care provider turnover. From literature, primary care provider turnover is the rate at which primary care providers leave a health plan organization. Known to be costly, healthcare turnover, including physicians, nurses, allied health personnel, and staff,

  7. Theory and practice for measuring health care quality

    PubMed Central

    Berwick, Donald M.; Knapp, Marian Gilbert

    1987-01-01

    As competition, cost control, and new modes of delivery emerge in health care, there is a need to reexamine both the traditional definitions of health care quality and the methods by which it is measured. Industries other than health care have much to teach regarding the methods for obtaining, analyzing, and displaying data; techniques for problem identification, problem solving, and reassessment; and ideas about organizational factors that produce a high quality product or service. The Quality-of-Care Measurement Department at the Harvard Community Health Plan has built a program that draws from a distinguished health care quality assurance tradition and incorporates techniques that have been successful in other industries. PMID:10312319

  8. Maternity care practices that support breastfeeding: CDC efforts to encourage quality improvement.

    PubMed

    Grummer-Strawn, Laurence M; Shealy, Katherine R; Perrine, Cria G; MacGowan, Carol; Grossniklaus, Daurice A; Scanlon, Kelley S; Murphy, Paulette E

    2013-02-01

    Breastfeeding has important consequences for women's health, including lower risk of breast and ovarian cancers as well as type 2 diabetes. Although most pregnant women want to breastfeed, a majority encounter difficulties and are not able to breastfeed as long as they want. Routine maternity care practices can pose significant barriers to successful breastfeeding. To address these practices, CDC has taken on a number of initiatives to promote hospital quality improvements in how new mothers are supported to start breastfeeding. The CDC survey on Maternity Practices in Infant Nutrition and Care is a tool to educate hospitals on how their current practices compare to recommended standards. The Best Fed Beginnings program is working with 90 hospitals across the United States to achieve optimal care and create tools for future hospital changes. CDC-funded programs in numerous state health departments have created programs to instigate improvements across the state. These efforts have begun to show success, with significant hospital quality score increases seen between 2009 and 2011. In 2011, more hospitals were designated as Baby-Friendly than in any previous year. PMID:23398126

  9. Investigating the Mediating Effect of the Accuracy of Information in the Relationship between IT and the Quality of Healthcare in Hospitals

    Microsoft Academic Search

    Linda W. Byrd; Terry Anthony Byrd; Laura Jacome Madariaga; Victor Wacham A. Mbarika

    2011-01-01

    The safety and quality of healthcare is of great concern in the United States. Hospital administrators, healthcare providers, and healthcare delivery systems all strive to provide safe and quality care for patients in complex environments. Many have suggested that information technology (IT) may reduce medical errors and increase the quality of healthcare in healthcare organizations. This study investigates how clinical

  10. Parental Perceptions of Hospital Care in Children with Accidental or Alleged Non-Accidental Trauma

    ERIC Educational Resources Information Center

    Ince, Elif E.; Rubin, David; Christian, Cindy W.

    2010-01-01

    Objective: To determine whether a suspicion or diagnosis of child abuse during hospitalization influences parental perceptions of hospital care in families of children admitted with traumatic injuries. Method: Parents of children younger than 6 years of age admitted with traumatic injuries to a large urban children's hospital were recruited to…

  11. Taking the Time to Care: Empowering Low Health Literacy Hospital Patients with Virtual Nurse Agents

    E-print Network

    Bickmore, Timothy

    1 Taking the Time to Care: Empowering Low Health Literacy Hospital Patients with Virtual Nurse.jack@bmc.org} ABSTRACT Ninety million Americans have inadequate health literacy, resulting in a reduced ability to read interface for educating and counseling hospital patients with inadequate health literacy in their hospital

  12. Lessons from tele-emergency: improving care quality and health outcomes by expanding support for rural care systems.

    PubMed

    Mueller, Keith J; Potter, Andrew J; MacKinney, A Clinton; Ward, Marcia M

    2014-02-01

    Tele-emergency services provide immediate and synchronous audio/video connections, most commonly between rural low-volume hospitals and an urban "hub" emergency department. We performed a systematic literature review to identify tele-emergency models and outcomes. We then studied a large tele-emergency service in the upper Midwest. We sent a user survey to all seventy-one hospitals that used the service and received 292 replies. We also conducted telephone interviews and site visits with ninety clinicians and administrators at twenty-nine of these hospitals. Participants reported that tele-emergency improves clinical quality, expands the care team, increases resources during critical events, shortens time to care, improves care coordination, promotes patient-centered care, improves the recruitment of family physicians, and stabilizes the rural hospital patient base. However, inconsistent reimbursement policy, cross-state licensing barriers, and other regulations hinder tele-emergency implementation. New value-based payment systems have the potential to reduce these barriers and accelerate tele-emergency expansion. PMID:24493765

  13. Quality of care for ruptured uterus in Sagamu, Nigeria.

    PubMed

    Oladapo, O T; Durojaiye, B O

    2010-04-01

    A retrospective study was conducted at a Nigerian tertiary hospital to assess the quality of emergency care provided to women managed for a ruptured uterus over an 11-year period. There were 76 cases of ruptured uterus and 4,770 deliveries (1.6%) during the period. Ten women died from a ruptured uterus, giving a case fatality rate of 13.2%. The mean admission-assessment interval by a senior clinician was 48.4 min. The mean decision-laparotomy interval was 6.9 h. Deviations from management protocol were noted in 66 women (86.8%) and underlying reasons were classified as patient-orientated (59.2%), medical personnel (13.2%) and administrative (22.4%) problems. Among women who died, there were more administrative problems, intraoperative and total blood losses were significantly more and preoperative haematocrit was significantly less compared with survivors. The poor quality of care for ruptured uterus in this centre is attributable to patients' financial limitations, which is compounded by administrative problems, particularly those regarding inefficient blood transfusion services. This study demonstrates the urgent need for implementation of a national health insurance scheme at this centre and reiterates the feasibility of employing detailed enquiry of peripartal circumstances to identify specific problems underlying major causes of maternal morbidity and mortality. PMID:20373929

  14. Exploring Reasons for Bed Pressures in Winnipeg Acute Care Hospitals

    ERIC Educational Resources Information Center

    Menec, Verena H.; Bruce, Sharon; MacWilliam, Leonard R.

    2005-01-01

    Hospital overcrowding has plagued Winnipeg and other Canadian cities for years. This study explored factors related to overcrowding. Hospital files were used to examine patterns of hospital use from fiscal years 1996/1997 to 1999/2000. Chart reviews were conducted to examine appropriateness of admissions and hospital stays during one pressure…

  15. Cost cutting in health systems without compromising quality care.

    PubMed

    Clark, David D; Savitz, Lucy A; Pingree, Scott B

    2010-01-01

    Intermountain Healthcare is a high-performing health system and a recognized leader in quality improvement. We use a clinical integration strategy focused on eight clinical programs to support the practice of evidence-based care. Accelerated improvements that enhance patient safety, clinical excellence, and operational efficiency are tested and then spread across the system via care process models and program-specific board goals. While we have nearly 60 evidence-based care process models in place (in addition to multiple operational effectiveness initiatives), we provide three exemplars to illustrate cost savings and the relative impact on hospital/medical group versus payer benefit. These clinical best practices include very early lung recruitment (VE LR) for neonates with respiratory distress syndrome, guidelines for elective inductions in labor and delivery, and prevention of congestive heart failure (CHF) readmissions. Due to perverse incentives in the third party payment system--where healthcare providers are often paid to do more tests and treatments as opposed to providing clinical value--doing what's right for our patients commonly yields savings to our payers while negatively impacting the delivery system budget. In this article, we present a suggested strategy for negotiated capture of these savings. PMID:21449483

  16. Social support, self-care, and quality of life in cancer patients receiving radiotherapy in Thailand

    SciTech Connect

    Hanucharurnkul, S.

    1988-01-01

    The purpose of the study was two-fold: (1) to examine the relationships among self-care, social support, and quality of life in adult cancer patients receiving radiotherapy while the selected basic conditioning factors of age, marital and socio-economic status, living arrangement, stage and site of cancer were statistically controlled; and (2) to test a theoretical model which postulated that (a) quality of life was predicted jointly by the selected basic conditioning factors, social support and self-care, and (b) self-care was predicted jointly by the selected basic conditioning factors and social support. A convenience sample of 112 adult cervical and head/neck cancer patients receiving radiotherapy was obtained from radiotherapy outpatient clinic in three hospitals located in Bangkok, Thailand. Results of the study indicated positive relationships among self-care, social support, and quality of life. Socio-economic status, site of cancer, and self-care were significant predictors for reported quality of life. Social support appeared to be a significant predictor of quality of life indirectly through self-care. Socio-economic status and social support were also significant predictors of self-care, whereas, stage and site of cancer seemed to predict self-care indirectly through social support.

  17. Primary health care access and ambulatory sensitive hospitalizations in New Zealand.

    PubMed

    Milne, Barry John; Parker, Karl; McLay, Jessica; von Randow, Martin; Lay-Yee, Roy; Hider, Phil; Cumming, Jacqueline; Davis, Peter

    2015-01-01

    Ambulatory sensitive hospitalizations (ASH) are those thought to be preventable by timely and effective primary health care. Better access to primary health care has been associated with lower ASH rates. Funding increases to primary health care in New Zealand beginning in 2001 led to an improvement in access. Analysis of hospitalizations to all New Zealand public hospitals revealed that, for most age groups, ASH rates did not show long-term reductions from 2001 to 2009, while socioeconomic differences in ASH rates widened across this period. We conclude that increasing funding and access to primary health care will not, by itself, reduce ASH rates. PMID:25748266

  18. [Measuring quality of life in palliative care].

    PubMed

    Lopes Ferreira, Pedro; Pinto Barros, Ana; Barros Brito, Ana

    2008-01-01

    This paper describes the process followed to create and validate the Portuguese versión of a quality of life measurement instrument for patients in palliative care. After a literature review about the measurement of the quality of life in this particular and very specific kind of patients, we opt by the Irene Higginson's measurement instrument called Palliative Care Outcome Scale (POS). It has been selected as the one most appropriate to Portuguese patients' reality. For the creation of the Portuguese version we followed the recommended methodologies for the forward-backward translations. These methodologies allow us to determine semantic and linguistic equivalences of health outcomes measurement instruments. The validation was performed on a sample of 104 cancer patients aged between 40 and 85 years old. 70% were female, 29% had lung cancer, 46% breast cáncer and 22% had melanoma. Content validity was assured by two cognitive debriefing tests, respectively performed in oncologists and in patients. Construct validation allow us to find five ortogonal factors, including 'emotional well being' (19.7% of variance explained), 'consequences of the disease in life' (18.2%), 'received information and support' (11.7%), 'anxiety' (10.1%), and 'burden of illness' (9.8%). Criterion validity was tested by comparing the results obtained by POS to the ones obtained by the EORTC QLQ-C30, a genetic instrument especially designed for cancer patients. The found correlation values were moderated to strong and ranged from 0.51 to 0.63. The reliability of the Portuguese version was assured through the reproducibility test and the search for the internal consistency. The scores obtained by a one-week testrestest ranged from 0.66 to 1.00. Cronbach's alpha was 0.68, acceptable and allowing us to consider POS as a unique index Time responsiveness and diagnosis responsiveness were also analysed. Comparing values measured with a one-month interval showed sensibility to the lack of the quality of life felt by patients. This measurement instrument was also sensitive to the various pathologies. In conclusion, we may defend the quality of the performance of the Portuguese versión of the POS. This version may be used to prospectively assess the palliative care on advances cancer patients. PMID:18625090

  19. Toward estimating the impact of changes in immigrants' insurance eligibility on hospital expenditures for uncompensated care

    PubMed Central

    Castel, Liana D; Timbie, Justin W; Sendersky, Veronica; Curtis, Lesley H; Feather, Keith A; Schulman, Kevin A

    2003-01-01

    Background The Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) of 1996 gave states the option to withdraw Medicaid coverage of nonemergency care from most legal immigrants. Our goal was to assess the effect of PRWORA on hospital uncompensated care in the United States. Methods We collected the following state-level data for the period from 1994 through 1999: foreign-born, noncitizen population and health uninsurance rates (US Census Current Population Survey); percentage of teaching hospitals (American Hospital Association Annual Survey of Hospitals); and each state's decision whether to implement the PRWORA Medicaid bar for legal permanent residents or to continue offering nonemergency Medicaid coverage using state-only funds (Urban Institute). We modeled uncompensated care expenditures by state (also from the Annual Survey of Hospitals) in both univariate and multivariable regression analyses. Results When measured at the state level, there was no significant relationship between uncompensated care expenditures and states' percentage of noncitizen immigrants. Uninsurance rates were the only significant factor in predicting uncompensated hospital care expenditures by state. Conclusions Reducing the number of uninsured patients would most surely reduce hospital expenditures for uncompensated care. However, data limitations hampered our efforts to obtain a monetary estimate of hospitals' financial losses due specifically to the immigrant eligibility changes in PRWORA. Quantifying the impact of these provisions on hospitals will require better data sources. PMID:12523939

  20. Child Care in the American South: Poverty, Costs, and Quality

    ERIC Educational Resources Information Center

    Collins, Vikki K.

    2012-01-01

    High-quality child care has been shown to improve the academic success and life adjustments of children living in poverty. During the past decade, many American states have adopted voluntary Quality Rating and Improvement (QRI) systems in an attempt to increase the level of quality in child care. Using data compiled by the National Association of…

  1. Pattern of Blood Stream Infections within Neonatal Intensive Care Unit, Suez Canal University Hospital, Ismailia, Egypt

    PubMed Central

    Kishk, Rania Mohammed; Mandour, Mohamed Fouad; Farghaly, Rasha Mohamed; Ibrahim, Ahmed; Nemr, Nader Attia

    2014-01-01

    Introduction. Blood stream infection (BSI) is a common problem of newborn in neonatal intensive care units (NICUs). Monitoring neonatal infections is increasingly regarded as an important contributor to safe and high-quality healthcare. It results in high mortality rate and serious complications. So, our aim was to determine the incidence and the pattern of BSIs in the NICU of Suez Canal University Hospital, Egypt, and to determine its impact on hospitalization, mortality, and morbidity. Methods. This study was a prospective one in which all neonates admitted to the NICUs in Suez Canal University hospital between January, 2013 and June 2013 were enrolled. Blood stream infections were monitored prospectively. The health care associated infection rate, mortality rate, causative organism, and risk factors were studied. Results. A total of 317 neonates were admitted to the NICU with a mortality rate of 36.0%. During this study period, 115/317 (36.3%) developed clinical signs of sepsis and were confirmed as BSIs by blood culture in only 90 neonates with 97 isolates. The total mean length of stay was significantly longer among infected than noninfected neonates (34.5 ± 18.3 and 10.8 ± 9.9 days, resp., P value < 0.001). The overall mortality rates among infected and noninfected neonates were 38.9% and 34.8%, respectively, with a significant difference. Klebsiella spp. were the most common pathogen (27.8%) followed by Pseudomonas (21.6%) and Staphylococcus aureus (15.4%). Conclusion. The rate of BSIs in NICU at Suez Canal University Hospital was relatively high with high mortality rate (36.0%). PMID:25389439

  2. Impact of an integrated transition management program in primary care on hospital readmissions.

    PubMed

    Farrell, Timothy W; Tomoaia-Cotisel, Andrada; Scammon, Debra L; Brunisholz, Kimberly; Kim, Jaewhan; Day, Julie; Gren, Lisa H; Wallace, Stephanie; Gunning, Karen; Tabler, Jennifer; Magill, Michael K

    2015-01-01

    Poorly executed transitions in care from hospital to home are associated with increased vulnerability to adverse medication events and hospital readmissions, and also excess healthcare costs. Efforts to improve care coordination on hospital discharge have been shown to reduce hospital readmission rates but often rely on interventions that are not fully integrated within the primary care setting. The Patient Centered Medical Home (PCMH) model, whose core principles include care coordination in the posthospital setting, is an approach that addresses transitions in care in a more integrated fashion. We examined the impact of multicomponent transition management (TM) services on hospital readmission rates and time to hospital readmission among 118 patients enrolled in a TM program that is part of Care By Design™, the University of Utah Community Clinics' version of the PCMH. We conducted a retrospective analysis comparing outcomes for patients before receiving TM services with outcomes for the same patients after receiving TM services. The all-cause 30-day hospital readmission rate decreased from 17.9% to 8.0%, and the mean time to hospital readmission within 180 days was delayed from 95 to 115 days. These findings support the effectiveness of TM activities integrated within the primary care setting. PMID:26042380

  3. Effect of a national primary care pay for performance scheme on emergency hospital admissions for ambulatory care sensitive conditions: controlled longitudinal study

    PubMed Central

    Harrison, Mark J; Dusheiko, Mark; Sutton, Matt; Gravelle, Hugh; Doran, Tim

    2014-01-01

    Objective To estimate the impact of a national primary care pay for performance scheme, the Quality and Outcomes Framework in England, on emergency hospital admissions for ambulatory care sensitive conditions (ACSCs). Design Controlled longitudinal study. Setting English National Health Service between 1998/99 and 2010/11. Participants Populations registered with each of 6975 family practices in England. Main outcome measures Year specific differences between trend adjusted emergency hospital admission rates for incentivised ACSCs before and after the introduction of the Quality and Outcomes Framework scheme and two comparators: non-incentivised ACSCs and non-ACSCs. Results Incentivised ACSC admissions showed a relative reduction of 2.7% (95% confidence interval 1.6% to 3.8%) in the first year of the Quality and Outcomes Framework compared with ACSCs that were not incentivised. This increased to a relative reduction of 8.0% (6.9% to 9.1%) in 2010/11. Compared with conditions that are not regarded as being influenced by the quality of ambulatory care (non-ACSCs), incentivised ACSCs also showed a relative reduction in rates of emergency admissions of 2.8% (2.0% to 3.6%) in the first year increasing to 10.9% (10.1% to 11.7%) by 2010/11. Conclusions The introduction of a major national pay for performance scheme for primary care in England was associated with a decrease in emergency admissions for incentivised conditions compared with conditions that were not incentivised. Contemporaneous health service changes seem unlikely to have caused the sharp change in the trajectory of incentivised ACSC admissions immediately after the introduction of the Quality and Outcomes Framework. The decrease seems larger than would be expected from the changes in the process measures that were incentivised, suggesting that the pay for performance scheme may have had impacts on quality of care beyond the directly incentivised activities. PMID:25389120

  4. Dual diagnosis patients in community or hospital care: One-year outcomes and health care utilization and costs

    Microsoft Academic Search

    Christine Timko; Shuo Chen; Jill Sempel; Paul Barnett

    2006-01-01

    Background: Services for dual diagnosis patients are strained by reductions in hospital-based inpatient treatment facilities and the lengths of inpatient stays in order to reduce health care costs. Aims: This study evaluated the effectiveness and cost-effectiveness of community- and hospital-based acute residential treatment for dually disordered patients, and whether moderately-ill patients benefitted more from community care, and severely-ill patients from

  5. Testing payment-for-performance in French acute care hospitals: a point of view from the French Federation of Comprehensive Cancer Centres.

    PubMed

    Boucher, Sandrine

    2013-01-01

    In 2004, France began a diagnosis related groups-based financing system for both public and private acute care hospitals. France opted for a mix of financing systems with over 80% of funding based on diagnosis related groups (DRG). After seven years of DRG-based financing, the French government is testing a payment-for-performance system in acute care hospitals, based on the USA experience. France is currently fine-tuning this model. So far, observations have raised doubts as to whether this approach will improve the value of health care in French hospitals: the budget appears insufficient, the quality of the available indicators is poor and the model is complex. However, it has focused attention on the question of health care quality. PMID:24683810

  6. Patient Care Partnership: Understanding Expectations, Rights and Responsibilities

    MedlinePLUS

    `e Patient Care Partnership Understanding Expectations, Rights and Responsibilities • High quality hospital care. • A clean and safe environment. • Involvement in your care. • Protection of your privacy. • Help ...

  7. Postacute rehabilitation quality of care: toward a shared conceptual framework.

    PubMed

    Jesus, Tiago Silva; Hoenig, Helen

    2015-05-01

    There is substantial interest in mechanisms for measuring, reporting, and improving the quality of health care, including postacute care (PAC) and rehabilitation. Unfortunately, current activities generally are either too narrow or too poorly specified to reflect PAC rehabilitation quality of care. In part, this is caused by a lack of a shared conceptual understanding of what construes quality of care in PAC rehabilitation. This article presents the PAC-rehab quality framework: an evidence-based conceptual framework articulating elements specifically pertaining to PAC rehabilitation quality of care. The widely recognized Donabedian structure, process, and outcomes (SPO) model furnished the underlying structure for the PAC-rehab quality framework, and the International Classification of Functioning, Disability and Health (ICF) framed the functional outcomes. A comprehensive literature review provided the evidence base to specify elements within the SPO model and ICF-derived framework. A set of macrolevel-outcomes (functional performance, quality of life of patient and caregivers, consumers' experience, place of discharge, health care utilization) were defined for PAC rehabilitation and then related to their (1) immediate and intermediate outcomes, (2) underpinning care processes, (3) supportive team functioning and improvement processes, and (4) underlying care structures. The role of environmental factors and centrality of patients in the framework are explicated as well. Finally, we discuss why outcomes may best measure and reflect the quality of PAC rehabilitation. The PAC-rehab quality framework provides a conceptually sound, evidence-based framework appropriate for quality of care activities across the PAC rehabilitation continuum. PMID:25542676

  8. Medicare Spending, The Physician Workforce, And Beneficiaries' Quality Of Care

    Microsoft Academic Search

    Katherine Baicker; Amitabh Chandra

    2004-01-01

    ABSTRACT: The quality of care received by Medicare beneficiaries varies across areas. We find that states with higher Medicare spending,have lower-quality care. This negative rela- tionship may be driven by the use of intensive, costly care that crowds out the use of more effective care. One mechanism,for this trade-off may be the mix of the provider workforce: States with more

  9. 75 FR 9102 - Recovery of Cost of Hospital and Medical Care and Treatment Furnished by the United States...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-03-01

    ...furnishing of hospital, medical, surgical, or dental care. This change responds to the increase in medical costs since 1992, when the...furnishing of hospital, medical, surgical, or dental care. During the...

  10. Outcome as a Measure of Quality of Care in Oncology

    PubMed Central

    Burney, Ikram A; Al Moundhri, Mansour S; Rizvi, Azhar J; Ganguly, Shyam S; Al Abri, Rashid; Ashrafi, Rafi A

    2008-01-01

    Objectives: Measurement of outcomes is increasingly employed as an indicator of the quality of clinical care. The most commonly measured outcome in many clinical studies, especially in oncology, still remains the overall survival rate. Sultan Qaboos University Hospital (SQUH), Oman, is striving for excellence through quality management. In seeking continual improvement, quality measurement exercises have been initiated throughout the Hospital. We present the overall survival rate of four of the ten most common cancers diagnosed in Oman. Methods: The cancers included non-Hodgkin’s lymphoma (NHL), Hodgkin’s lymphoma (HL), breast cancer, and stomach cancer. The studies were all retrospective and had been conducted previously. For present purposes, only the overall survival was compared with studies both from the region, and with bench-mark studies. Results: For NHL, with a median follow-up of 8 months, the 2-year overall survival rate was 64%; 90% for low risk, 55% for intermediate risk, and 15% for high risk groups. For HL, the 5-year overall survival rate was 64%; 76% for low risk and 42% for high risk. For breast cancer, the 5-year survival rate was 67%; percentages were 88%, 75% and 59% for Groups I, II, and III respectively. For gastric cancer, the 5-year survival rate was 16.5 %; 24% for the non-metastatic group. Conclusion: The outcome of patients with early stages and fewer adverse prognostic factors is comparable to what has been reported in the international literature; however, the outcome is inferior for patients presenting with advanced stage disease and several adverse prognostic factors. PMID:21654954

  11. Palliative care of cancer patients: audit of current hospital procedures.

    PubMed

    Sessa, C; Pampallona, S; Carobbio, M; Neuenschwander, H; Cavalli, F

    1998-05-01

    The palliative care of cancer patients admitted for tumour-related symptoms to three different departments (medical oncology, radiotherapy, internal medicine) of a general hospital was prospectively audited. The physicians directly responsible for the patients provided prospective data by reporting both the diagnostic and therapeutic interventions performed and the degree of control achieved for each symptom. A patient form for evaluation of the control achieved in the case of each symptom by means of linear analogue scales was also provided. The appropriateness of all procedures was evaluated by two external auditors. Over 6 months, 125 such admissions were recorded: 24 patients entered the study and the management of 56 symptoms, the most common of which were pain and dyspnoea, was reviewed. A total of 72 diagnostic procedures were performed, deemed necessary for only 50% of symptoms, optional for 15%, and performed as part of a logical sequence for 38%. A total of 130 therapeutic interventions were undertaken, deemed necessary for 55% of symptoms, optional for 15% and carried out as part of a logical sequence for 44%. Re-evaluations of symptoms and physician and patient evaluations of the degree of control achieved could not be assessed because of lack of information. The audit could not be repeated owing to the low accrual of patients and incompleteness of the data collection. Reasons for failure of the study and proposals for feasible methods of auditing the management of symptoms in cancer patients are discussed. PMID:9629881

  12. Effects of the Premier Hospital Quality Incentive Demonstration on Medicare Patient Mortality and Cost

    PubMed Central

    Ryan, Andrew M

    2009-01-01

    Objective To evaluate the effects of the Premier Inc. and Centers for Medicare and Medicaid Services Hospital Quality Incentive Demonstration (PHQID), a public quality reporting and pay-for-performance (P4P) program, on Medicare patient mortality, cost, and outlier classification. Data Sources The 2000–2006 Medicare inpatient claims, Medicare denominator files, and Medicare Provider of Service files. Study Design Panel data econometric methods are applied to a retrospective cohort of 11,232,452 admissions from 6,713,928 patients with principal diagnoses of acute myocardial infarction (AMI), heart failure, pneumonia, or a coronary-artery bypass grafting (CABG) procedure from 3,570 acute care hospitals between 2000 and 2006. Three estimators are used to evaluate the effects of the PHQID on risk-adjusted (RA) mortality, cost, and outlier classification in the presence of unobserved selection, resulting from the PHQID being voluntary: fixed effects (FE), FE estimated in the subset of hospitals eligible for the PHQID, and difference-in-difference-in-differences. Data Extraction Methods Data were obtained from CMS. Principal Findings This analysis found no evidence that the PHQID had a significant effect on RA 30-day mortality or RA 60-day cost for AMI, heart failure, pneumonia, or CABG and weak evidence that the PHQID increased RA outlier classification for heart failure and pneumonia. Conclusions By not reducing mortality or cost growth, this study suggests that the PHQID has made little impact on the value of inpatient care purchased by Medicare. PMID:19674427

  13. Organizational Determinants of Work Outcomes and Quality Care Ratings Among Army Medical Department Registered Nurses

    PubMed Central

    Patrician, Patricia A.; Shang, Jingjing; Lake, Eileen T.

    2010-01-01

    The Practice Environment Scale of the Nursing Work Index, the Maslach Burnout Inventory, and several single-item measures were administered to registered nurses (RNs) working within 23 U.S.-based Army Medical Department (AMEDD) hospitals. Data were analyzed with logistic regression for nested data. Unfavorable nursing practice environments had a substantial association with job dissatisfaction (OR 13.75, p < .01), emotional exhaustion (OR 12.70, p < .01), intent to leave (OR 3.03, p < .01), and fair to poor quality of care (OR 10.66, p < .01). This study provides the first system-wide analyses of nursing practice environments in AMEDD hospitals in the U.S. Similar to findings in civilian samples, poor quality work environments are associated with less favorable RN work outcomes and quality of care ratings. PMID:20151409

  14. Parents’ Perceptions of Primary Care: Measuring Parents’ Experiences of Pediatric Primary Care Quality

    Microsoft Academic Search

    Michael Seid; James W. Varni; Laura Olson Bermudez; Mirjana Zivkovic; Maryam Davodi Far; Melissa Nelson; Paul S. Kurtin

    ABSTRACT. Objective. A measure of pediatric pri- mary care quality that is brief, practical, reliable, and valid would be useful to patients and pediatricians, policymak- ers, and health system leaders. Parents have a unique per- spective from which to report their experiences with their child’s primary care, and these reports may be valid indi- cators of pediatric primary care quality.

  15. Child Care and Mothers' Mental Health: Is High-Quality Care Associated with Fewer Depressive Symptoms?

    ERIC Educational Resources Information Center

    Gordon, Rachel A.; Usdansky, Margaret L.; Wang, Xue; Gluzman, Anna

    2011-01-01

    Finding high-quality child care may pose financial and logistical challenges and create ongoing emotional strains for some mothers. We use the Study of Early Child Care and Youth Development to ask (a) are child-care settings that mothers select on the basis of their own perceptions of quality rated more highly by independent observers (and more…

  16. Beyond ‘unloving care’: linking human resource management and patient care quality in nursing homes

    Microsoft Academic Search

    Susan C. Eaton

    2000-01-01

    This study examines the link between human resource management, (HRM), work organization and patient care quality in US long-term care settings, proposing a key role for both management philosophy and improved front-line staffing arrangements in delivering consistently higher quality care, defined to include both physical and psychological outcomes. Using the ‘high performance’ model from industrial relations as a lens, the

  17. Priority Queuing Models for Hospital Intensive Care Units and Impacts to Severe Case Patients

    PubMed Central

    Hagen, Matthew S.; Jopling, Jeffrey K; Buchman, Timothy G; Lee, Eva K.

    2013-01-01

    This paper examines several different queuing models for intensive care units (ICU) and the effects on wait times, utilization, return rates, mortalities, and number of patients served. Five separate intensive care units at an urban hospital are analyzed and distributions are fitted for arrivals and service durations. A system-based simulation model is built to capture all possible cases of patient flow after ICU admission. These include mortalities and returns before and after hospital exits. Patients are grouped into 9 different classes that are categorized by severity and length of stay (LOS). Each queuing model varies by the policies that are permitted and by the order the patients are admitted. The first set of models does not prioritize patients, but examines the advantages of smoothing the operating schedule for elective surgeries. The second set analyzes the differences between prioritizing admissions by expected LOS or patient severity. The last set permits early ICU discharges and conservative and aggressive bumping policies are contrasted. It was found that prioritizing patients by severity considerably reduced delays for critical cases, but also increased the average waiting time for all patients. Aggressive bumping significantly raised the return and mortality rates, but more conservative methods balance quality and efficiency with lowered wait times without serious consequences. PMID:24551379

  18. Patterns of antimicrobial resistance in a surgical intensive care unit of a university hospital in Turkey

    Microsoft Academic Search

    Aysen Bayram; Iclal Balci

    2006-01-01

    BACKGROUND: Several studies have reported higher rates of antimicrobial resistance among isolates from intensive care units than among isolates from general patient-care areas. The aims of this study were to review the pathogens associated with nosocomial infections in a surgical intensive care unit of a university hospital in Turkey and to summarize rates of antimicrobial resistance in the most common

  19. Quality assurance in the surgical intensive care unit. Where it came from and where it's going.

    PubMed

    Osler, T; Horne, L

    1991-08-01

    The early history of QA is one of stunning achievements. Men and women led by a vision of what hospital health care should be brought about fundamental changes in the structure of hospitals and medical schools. These successes required lifetimes of work and enormous capital (Flexner's war chest would have amounted to billions of 1990 dollars). A second wave of reform included the creation of credentialing committees, tissue committees, and infection control efforts. Although less dramatic in their impact, these efforts have had measurable influence on the outcome of health care and, under the joint administration of local hospitals and the JCAHO, continue to guarantee excellence in health care. The most recent attempts at quality assurance, driven at least in part by a federal mandate to control costs, have been much more modest in their success. Committed groups working within a sound theoretical framework have had great difficulty monitoring and evaluating centrally a process as decentralized as health care. The regularity with which new fashions in QA have appeared underscores the frustration felt with this approach. If the quality of health care is to be monitored centrally, reliable measures of quality will be required. No one knows if such measures actually exist. The absence of objective evidence that quality has been improved by these efforts suggests that little has been accomplished, perhaps because all easily attainable improvements had already been implemented. The basic concept of a centrally monitored hospital structure within which provision is made for ongoing observation and innovation by those actually involved in the care of patients retains the advantages of central monitoring and local invention. It is a model that will be hard to improve on. We should persist in our efforts, but fundamental advances are unlikely. In the end, quality is only doing everything the best it can be done. The best quality assurance requires an excellent hospital in which a well-trained and committed staff has a central mandate and local purview to do the best possible job. Two thousand years after Hammurabi's minions busied themselves determining the appropriate punishment for various medical misadventures, the Greek Hippocrates advocated a less complex approach to the same problem. He suggested that the quality of health care could be best guaranteed by administering an oath to physicians, exhorting them simply to do what was best for their fellow men. This approach has seen us through two millennia and, however variable its results, may not be easily improved on. PMID:1907408

  20. Paying for hospital care: the experience with implementing activity-based funding in five European countries.

    PubMed

    O'Reilly, Jacqueline; Busse, Reinhard; Häkkinen, Unto; Or, Zeynep; Street, Andrew; Wiley, Miriam

    2012-01-01

    Following the US experience, activity-based funding has become the most common mechanism for reimbursing hospitals in Europe. Focusing on five European countries (England, Finland, France, Germany and Ireland), this paper reviews the motivation for introducing activity-based funding, together with the empirical evidence available to assess the impact of implementation. Despite differences in the prevailing approaches to reimbursement, the five countries shared several common objectives, albeit with different emphasis, in moving to activity-based funding during the 1990s and 2000s. These include increasing efficiency, improving quality of care and enhancing transparency. There is substantial cross-country variation in how activity-based funding has been implemented and developed. In Finland and Ireland, for instance, activity-based funding is principally used to determine hospital budgets, whereas the models adopted in the other three countries are more similar to the US approach. Assessing the impact of activity-based funding is complicated by a shortage of rigorous empirical evaluations. What evidence is currently available, though, suggests that the introduction of activity-based funding has been associated with an increase in activity, a decline in length of stay and/or a reduction in the rate of growth in hospital expenditure in most of the countries under consideration. PMID:22221929

  1. The impact of critical total quality management practices on hospital performance in the ministry of health hospitals in saudi arabia.

    PubMed

    Alaraki, Mohammad Shamsuddin

    2014-01-01

    Total Quality Management (TQM) offers a method for solving quality and patient safety problems and bringing significant improvement to hospital performance. However, only few studies have been conducted in this area in developing countries, particularly in Saudi Arabia. This research is carried out in an attempt to address this gap, exploring the impact of applying TQM practices on hospital performance in the Saudi Ministry of Health hospitals. The study has included 4 hospitals in Tabuk Region, namely, King Khaled Hospital, King Fahad Hospital, Maternity and Children Hospital, and Hagel General Hospital. The data collection was done by the researcher when 400 questionnaires were distributed using a convenient sampling technique to access the required data. The response rate was 67.25% of the total questionnaires distributed. The TQM practices used in the study were as follows: leadership, employee management, information analysis, training, customer focus, continuous improvement, process management, and supplier management. The findings of the research show a significant positive correlation between the 8 practices of TQM and hospital performance with a correlation coefficient r value of 0.9 (P = .0001). The study also reveals that Saudi hospitals are facing difficulties in engaging the clinical staff in their quality initiative. Moreover, our findings show that accredited hospitals have significantly applied TQM practices more than unaccredited hospitals. PMID:24368721

  2. The Quality of Mental Health Care for African Americans

    Microsoft Academic Search

    Jerome Richardson; Tanya Anderson; Joseph Flaherty; Carl Bell

    2003-01-01

    In response to the Surgeon General's request for more research on racial disparities in mental health care, especially research that includes high-need populations (e.g., the homeless, incarcerated, children in foster care, and substance abusers), we examined racial disparities in the provision of mental health counseling, psychotherapy, and pharmacotherapy in hospital outpatient settings using nationally representative data from the 1997 National

  3. Transitional care strategies from hospital to home: a review for the neurohospitalist.

    PubMed

    Rennke, Stephanie; Ranji, Sumant R

    2015-01-01

    Hospitals are challenged with reevaluating their hospital's transitional care practices, to reduce 30-day readmission rates, prevent adverse events, and ensure a safe transition of patients from hospital to home. Despite the increasing attention to transitional care, there are few published studies that have shown significant reductions in readmission rates, particularly for patients with stroke and other neurologic diagnoses. Successful hospital-initiated transitional care programs include a "bridging" strategy with both predischarge and postdischarge interventions and dedicated transitions provider involved at multiple points in time. Although multicomponent strategies including patient engagement, use of a dedicated transition provider, and facilitation of communication with outpatient providers require time and resources, there is evidence that neurohospitalists can implement a transitional care program with the aim of improving patient safety across the continuum of care. PMID:25553228

  4. An exploration of the leadership attributes and methods associated with successful lean system deployments in acute care hospitals.

    PubMed

    Steed, Airica

    2012-01-01

    The lean system has been shown to be a viable and sustainable solution for the growing number of cost, quality, and efficiency issues in the health care industry. While there is a growing body of evidence to support the outcomes that can be achieved as a result of the successful application of the lean system in hospital organizations, there is not a complete understanding of the leadership attributes and methods that are necessary to achieve successful widespread mobilization and sustainment. This study was an exploration of leadership and its relevant association with successful lean system deployments in acute care hospitals. This research employed an exploratory qualitative research design encompassing a research questionnaire and telephonic interviews of 25 health care leaders in 8 hospital organizations across the United States. The results from this study identified the need to have a strong combination of personal characteristics, learned behaviors, strategies, tools, and tactics that evolved into a starting adaptable framework for health care leaders to leverage when starting their own transformational change journeys using the lean system. Health care leaders could utilize the outcomes reported in this study as a conduit to enhance the effective deployment, widespread adoption, and sustainment of the lean system in practice. PMID:22207019

  5. Assessing Coverage, Equity and Quality Gaps in Maternal and Neonatal Care in Sub-Saharan Africa: An Integrated Approach

    PubMed Central

    Wilunda, Calistus; Putoto, Giovanni; Riva, Donata Dalla; Manenti, Fabio; Atzori, Andrea; Calia, Federico; Assefa, Tigist; Turri, Bruno; Emmanuel, Onapa; Straneo, Manuela; Kisika, Firma; Tarmbulini, Giorgio

    2015-01-01

    Background Gaps in coverage, equity and quality of health services hinder the achievement of the Millennium Development Goals 4 and 5 in most countries of sub-Saharan Africa as well as in other high-burden countries, yet few studies attempt to assess all these dimensions as part of the situation analysis. We present the base-line data of a project aimed at simultaneously addressing coverage, equity and quality issues in maternal and neonatal health care in five districts belonging to three African countries. Methods Data were collected in cross-sectional studies with three types of tools. Coverage was assessed in three hospitals and 19 health centres (HCs) utilising emergency obstetric and newborn care needs assessment tools developed by the Averting Maternal Death and Disability program. Emergency obstetrics care (EmOC) indicators were calculated. Equity was assessed in three hospitals and 13 HCs by means of proxy wealth indices and women delivering in health facilities were compared with those in the general population to identify inequities. Quality was assessed in three hospitals using the World Health Organization’s maternal and neonatal quality of hospital care assessment tool which evaluates the whole range of aspects of obstetric and neonatal care and produces an average score for each main area of care. Results All the three hospitals qualified as comprehensive EmOC facilities but none of the HCs qualified for basic EmOC. None of the districts met the minimum requisites for EmOC indicators. In two out of three hospitals, there were major quality gaps which were generally greater in neonatal care, management of emergency and complicated cases and monitoring. Higher access to care was coupled by low quality and good quality by very low access. Stark inequities in utilisation of institutional delivery care were present in all districts and across all health facilities, especially at hospital level. Conclusion Our findings confirm the existence of serious issues regarding coverage, equity and quality of health care for mothers and newborns in all study districts. Gaps in one dimension hinder the potential gains in health outcomes deriving from good performances in other dimensions, thus confirm the need for a three-dimensional profiling of health care provision as a basis for data-driven planning. PMID:26000964

  6. The association between managed care enrollments and potentially preventable hospitalization among adult Medicaid recipients in Florida

    PubMed Central

    2014-01-01

    Background The intent of adopting managed care plans is to improve access to health care services while containing costs. To date, there have been a number of studies that examine the relationship between managed care and access to health care. However, the results from previous studies have been inconsistent. Specifically, previous studies did not demonstrate a clear benefit of Medicaid managed care. In this study we have examine whether Medicaid managed care is associated with the probabilities of preventable hospitalizations. This study also analyzes the spillover effect of Medicaid managed care into Medicaid patients in traditional FFS plans and the interaction effects of other patient- and county-level variables on preventable hospitalizations. Methods The study included 254,321 Medicaid patients who were admitted to short-term general hospital in the 67 counties in Florida. Using 2008 hospital inpatient discharge data for working-age adult Medicaid enrollees (18-64 years) in Florida, we conduct multivariate logistic regression analyses to identify possible factors associated with preventable hospitalizations. The first model includes patient- and county-level variables. Then, we add interaction terms between Medicaid HMO and other variables such as race, rurality, market-level factors, and resource for primary care. Results The results show that Medicaid HMO patients are more likely to be hospitalized for ambulatory care sensitive conditions (ACSCs) (OR?=?1.30; CI?=?1.21, 1.40). We also find that market structure (i.e., competition) is significantly associated with preventable hospitalizations. However, our study does not support that there are spillover effects of Medicaid managed care on preventable hospitalizations for other Medicaid recipients. We find that interactions between Medicaid managed care and race, rurality and market structure are significant. Conclusions The results of our study show that the Medicaid managed care program in Florida was associated with an increase in potentially preventable hospitalizations for Medicaid enrollees. The results suggest that lower capitation rate has been associated with a greater likelihood of preventable hospitalizations for Medicaid managed care patients. Our findings also indicate that increased competition in the Medicaid managed care market has no clear benefit in Medicaid managed care patients. PMID:24916077

  7. Trends in quality of non-Hodgkin's lymphoma care: is it getting better?

    PubMed

    Stienen, J J C; Ottevanger, P B; Wennekes, L; van de Schans, S A M; Dekker, H M; van der Maazen, R W M; van Krieken, J H J M; Blijlevens, N M A; Hermens, R P M G

    2015-07-01

    This study outlines trends in quality of delivered non-Hodgkin's lymphoma (NHL) care in the Netherlands between 2007 and 2011 and to what extend this was influenced by the national Visible Care program, which aimed at increasing transparency by providing insight into the quality of healthcare. We analyzed data collected from medical records in two observational studies, combined into 20 validated quality indicators (QIs) of which 6 were included in the national program. A random sample of 771 patients, diagnosed with NHL in 26 Dutch hospitals, was examined. Multilevel regression analyses were used to assess differences in quality of NHL care and to provide insight into the effect of the national program. We reported improved adherence to only 3 out of 6 QIs involved in the national program and none of the other 14 validated QIs. Improvement was shown for performance of all recommended staging techniques (from 26? to ?43 %), assessment of International Prognostic Index (from 21? to ?43 %), and multidisciplinary discussion of patients (from 23? to ?41 %). We found limited improvement in quality of NHL care between 2007 and 2011; improvement potential (<80 % adherence) was still present for 13 QIs. The national program seems to have a small positive effect, but has not influenced all 20 indicators which represent the most important, measurable parts in quality of NHL care. These results illustrate the need for tailored implementation and quality improvement initiatives. PMID:25772630

  8. Supply chain management with cost-containment & financial-sustainability in a tertiary care hospital.

    PubMed

    Chandra, Hem; Rinkoo, Arvind Vashishta; Verma, Jitendra Kumar; Verma, Shuchita; Kapoor, Rakesh; Sharma, R K

    2013-01-01

    Financial crunch in the present recession results in the non-availability of the right materials at the right time in large hospitals. However due to insufficient impetus towards systems development, situation remains dismal even when funds are galore. Cost incurred on materials account for approximately one-third of the total recurring expenditures in hospitals. Systems development for effective and efficient materials management is thus tantamount to cost-containment and sustainability. This scientific paper describes an innovative model, Hospital Revolving Fund (HRF), developed at a tertiary care research institute in Asia. The main idea behind inception of HRF was to ensure availability of all supplies in the hospital so that the quality of healthcare delivery was not affected. The model was conceptualized in the background of non-availability of consumables in the hospital leading to patient as well as staff dissatisfaction. Hospital supplies have been divided into two parts, approximately 3250 unit items and 1750 miscellaneous items. This division is based on cost, relative-utility and case-specific utilization. 0.1 Million USD, separated from non-planned budget, was initially used as seed money in 1998. HRF procures supplies from reputed firms on concessional rates (8-25%) and make them available to patients at much lesser rates vis-à-vis market rates, levying minimal maintenance charges. In 2009-10, total annual purchases of 14 Million USD were made. The balance sheet reflected 1.4 Million USD as fixed deposit investment. The minimal maintenance charges levied on the patients along with the interest income were sufficient to pay for all recurring expenses related to HRF. Even after these expenses, HRF boosted of 0.2 Million USD as cash-in-hand in financial year 2009-10. In-depth analysis of 'balance sheet' and 'Income and Expenditure' statement of the fund for last five financial years affirms that HRF is a self-sustainable and viable supply chain mechanism to ensure availability of the right materials at the right time at a reasonable cost. Thus innovations like HRF will prove robust in rendering quality healthcare at an affordable cost. PMID:24010261

  9. National and State Trends in Quality of Care for Acute Myocardial Infarction Between 1994-1995 and 1998-1999

    Microsoft Academic Search

    Dale R. Burwen; Deron H. Galusha; Jennifer M. Lewis; Marjorie R. Bedinger; Martha J. Radford; Harlan M. Krumholz; JoAnne Micale Foody

    2003-01-01

    Methods: We sought to determine national and state trends in quality of care for Medicare patients hospital- ized with acute myocardial infarction (AMI) between 1994-1995 (n =2 34 754 discharges) and 1998-1999 (n=35713 discharges) as part of the Centers for Medi- care & Medicaid Services (CMS) National AMI Project. We assessed change in evidence-based, guideline- recommended processes of care.

  10. 77 FR 70786 - Request for Information Regarding Health Care Quality for Exchanges

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-11-27

    ...Request for Information Regarding Health Care Quality for Exchanges AGENCY...Strategy for Quality Improvement in Health Care (National Quality Strategy) to...efforts to improve the quality of health care in the United States. The...

  11. Effects of multidisciplinary integrated care on quality of care in residential care facilities for elderly people: a cluster randomized trial

    PubMed Central

    Boorsma, Marijke; Frijters, Dinnus H.M.; Knol, Dirk L.; Ribbe, Miel E.; Nijpels, Giel; van Hout, Hein P.J.

    2011-01-01

    Background: Sophisticated approaches are needed to improve the quality of care for elderly people living in residential care facilities. We determined the effects of multidisciplinary integrated care on the quality of care and quality of life for elderly people in residential care facilities. Methods: We performed a cluster randomized controlled trial involving 10 residential care facilities in the Netherlands that included 340 participating residents with physical or cognitive disabilities. Five of the facilities applied multidisciplinary integrated care, and five provided usual care. The intervention, inspired by the disease management model, consisted of a geriatric assessment of functional health every three months. The assessment included use of the Long-term Care Facility version of the Resident Assessment Instrument by trained nurse-assistants to guide the design of an individualized care plan; discussion of outcomes and care priorities with the family physician, the resident and his or her family; and monthly multidisciplinary meetings with the nurse-assistant, family physician, psychologist and geriatrician to discuss residents with complex needs. The primary outcome was the sum score of 32 risk-adjusted quality-of-care indicators. Results: Compared with the facilities that provided usual care, the intervention facilities had a significantly higher sum score of the 32 quality-of-care indicators (mean difference ? 6.7, p = 0.009; a medium effect size of 0.72). They also had significantly higher scores for 11 of the 32 indicators of good care in the areas of communication, delirium, behaviour, continence, pain and use of antipsychotic agents. Interpretation: Multidisciplinary integrated care resulted in improved quality of care for elderly people in residential care facilities compared with usual care. Trial registration: www.controlled-trials.com trial register no. ISRCTN11076857. PMID:21708967

  12. Hospital DRGs and the need for long-term care services: an empirical analysis.

    PubMed Central

    Meiners, M R; Coffey, R M

    1985-01-01

    The Medicare DRG-based Prospective Payment System (PPS) encourages hospitals to reduce length of stay for elderly patients. Thus, discharges to long-term care services are expected to increase. Maryland hospital data for 1980 are used to identify those DRGs which most frequently represent patients discharged to nursing home and home health care services; explores the incentive to discharge earlier under PPS those patients needing long-term care versus short-term care; and describes characteristics of patients most likely to face increased pressure of earlier discharge to nursing homes and home health programs. Because only a limited set of patient characteristics are available from Maryland hospitals, data from a study of San Diego nursing homes are used to explore further the sociodemographic and health status measures associated with unusually long stays in a hospital prior to nursing home placement. This research suggests that the DRG reimbursement system gives hospitals a strong incentive for earlier discharge of patients needing long-term care services. However, hospitals that target only long-term care patients for early discharge will not substantially gain under PPS because these patients represent a small portion of the cases treated in the hospital and a small percentage of unreimbursed days. PMID:3926721

  13. Deepening our understanding of quality improvement in Europe (DUQuE): overview of a study of hospital quality management in seven countries

    PubMed Central

    Secanell, Mariona; Groene, Oliver; Arah, Onyebuchi A.; Lopez, Maria Andrée; Kutryba, Basia; Pfaff, Holger; Klazinga, Niek; Wagner, Cordula; Kristensen, Solvejg; Bartels, Paul Daniel; Garel, Pascal; Bruneau, Charles; Escoval, Ana; França, Margarida; Mora, Nuria; Suñol, Rosa; Klazinga, N; Kringos, DS; 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; Lívio, A; Eiras, M; Franca, M; Leite, I; Almeman, F; Kus, H; Ozturk, K; Mannion, R; Arah, OA; Chow, A; DerSarkissian, M; Thompson, CA; Wang, A; Thompson, A

    2014-01-01

    Introduction and Objective This paper provides an overview of the DUQuE (Deepening our Understanding of Quality Improvement in Europe) project, the first study across multiple countries of the European Union (EU) to assess relationships between quality management and patient outcomes at EU level. The paper describes the conceptual framework and methods applied, highlighting the novel features of this study. Design DUQuE was designed as a multi-level cross-sectional study with data collection at hospital, pathway, professional and patient level in eight countries. Setting and Participants We aimed to collect data for the assessment of hospital-wide constructs from up to 30 randomly selected hospitals in each country, and additional data at pathway and patient level in 12 of these 30. Main outcome measures A comprehensive conceptual framework was developed to account for the multiple levels that influence hospital performance and patient outcomes. We assessed hospital-specific constructs (organizational culture and professional involvement), clinical pathway constructs (the organization of care processes for acute myocardial infarction, stroke, hip fracture and deliveries), patient-specific processes and outcomes (clinical effectiveness, patient safety and patient experience) and external constructs that could modify hospital quality (external assessment and perceived external pressure). Results Data was gathered from 188 hospitals in 7 participating countries. The overall participation and response rate were between 75% and 100% for the assessed measures. Conclusions This is the first study assessing relation between quality management and patient outcomes at EU level. The study involved a large number of respondents and achieved high response rates. This work will serve to develop guidance in how to assess quality management and makes recommendations on the best ways to improve quality in healthcare for hospital stakeholders, payers, researchers, and policy makers throughout the EU. PMID:24671120

  14. Trends in the Quality of Care and Racial Disparities in Medicare Managed Care

    Microsoft Academic Search

    Amal N. Trivedi; Alan M. Zaslavsky; Eric C. Schneider; John Z. Ayanian

    2009-01-01

    background Since 1997, all managed-care plans administered by Medicare have reported on qual- ity-of-care measures from the Health Plan Employer Data and Information Set (HEDIS). Studies of early data found that blacks received care that was of lower quality than that received by whites. In this study, we assessed changes over time in the overall quality of care and in

  15. Experiences of the quality of care of women with near-miss maternal morbidities in the UK.

    PubMed

    Hinton, L; Locock, L; Knight, M

    2014-09-01

    We undertook a qualitative interview study of women's and their partners' experiences of severe pregnancy complications. Across the care pathway, women identified a number of examples of good practice that made an important difference to their recovery. There were some areas where women felt the quality of care could be improved, for example during points of transition between higher level and routine care or from hospital to the community. Longer-term support and counselling were felt to be particularly valuable, and yet not always universally available. These results emphasise the importance of integrated quality care across the whole patient pathway. PMID:25236629

  16. Effect of the Transformation of the Veterans Affairs Health Care System on the Quality of Care

    Microsoft Academic Search

    Ashish K. Jha; Jonathan B. Perlin; Kenneth W. Kizer; R. Adams Dudley

    2010-01-01

    methods Using data from an ongoing performance-evaluation program in the VA, we evaluated the quality of preventive, acute, and chronic care. We assessed the change in quality-of- care indicators from 1994 (before reengineering) through 2000 and compared the qual- ity of care with that afforded by the Medicare fee-for-service system, using the same in- dicators of quality. results In fiscal

  17. Migrants' and professionals' views on culturally sensitive pre-hospital emergency care.

    PubMed

    Kietzmann, Diana; Hannig, Christian; Schmidt, Silke

    2015-08-01

    This study was designed to explore the views of migrants and professionals on culturally sensitive pre-hospital emergency care in order to adapt such care to migrants' needs. Interviews were conducted with 41 migrants who had received direct (as a patient) or indirect (as a significant other) pre-hospital emergency care. Furthermore, 20 professionals in the field of pre-hospital emergency care were interviewed. The content analysis showed five distinguishable categories based on the statements by the migrants and six categories based on the statements by the professionals. While migrants gave priority to basic proficiencies of first responders such as 'social/emotional competencies' and 'communication skills', the professionals considered '(basic) cultural knowledge', 'awareness' and 'attitude' the most important. Furthermore, migrants provided practical indications, e.g. regarding areas of cultural knowledge, whereas professionals seemed to view the issue of culturally pre-hospital emergency care from a more theoretical perspective. The issues of the culturally sensitive pre-hospital emergency care itself, as well as the varying points of view of the two groups interviewed, resulted in eight recommendations for culturally sensitive pre-hospital emergency care. PMID:26123882

  18. Assessing Child-Care Quality with a Telephone Interview.

    ERIC Educational Resources Information Center

    Holloway, Susan D.; Kagan, Sharon L.; Fuller, Bruce; Tsou, Lynna; Carroll, Jude

    2001-01-01

    Examined whether data on child care quality obtained from a telephone interview with the provider could serve as an adequate proxy for data obtained from direct observation of 89 child care homes and 92 centers. Found that a 25-item interview predicted accurately the quality classification of 92 percent of homes and 89 percent of centers.…

  19. Evaluation of the Prevention and Reactivation Care Program (PreCaP) for the hospitalized elderly: a prospective nonrandomized controlled trial

    PubMed Central

    Asmus-Szepesi, Kirsten J; Flinterman, Linda E; Koopmanschap, Marc A; Nieboer, Anna P; Bakker, Ton J; Mackenbach, Johan P; Steyerberg, Ewout W

    2015-01-01

    Background The hospitalized elderly are at risk of functional decline. We evaluated the effects and care costs of a specialized geriatric rehabilitation program aimed at preventing functional decline among at-risk hospitalized elderly. Methods The prospective nonrandomized controlled trial reported here was performed in three hospitals in the Netherlands. One hospital implemented the Prevention and Reactivation Care Program (PReCaP), while two other hospitals providing usual care served as control settings. Within the PReCaP hospital we compared patients pre-implementation with patients post-implementation of the PReCaP (“within-hospital analysis”), while our nonrandomized controlled trial compared patients of the PReCaP hospital post-implementation with patients from the two control hospitals providing usual care (“between-hospital analysis”). Hospitalized patients 65 years or older and at risk of functional decline were interviewed at baseline and at 3 and 12 months using validated questionnaires to score functioning, depression, and health-related quality of life (HRQoL). We estimated costs per unit of care from hospital information systems and national data sources. We used adjusted general linear mixed models to analyze functioning and HRQoL. Results Between-hospital analysis showed no difference in activities of daily living (ADL) or instrumental activities of daily living (IADL) between PReCaP patients and control groups. PReCaP patients did have slightly better cognitive functioning (Mini Mental State Examination; 0.4 [95% confidence interval (CI) 0.2–0.6]), lower depression (Geriatric Depression Scale 15; ?0.9 [95% ?1.1 to ?0.6]) and higher perceived health (Short-Form 20; 5.6 [95% CI 2.8–8.4]) than control patients. Analyses within the PReCaP hospital comparing patients pre-and post-implementation of the PReCaP showed no improvement over time in functioning, depression, and HRQoL. One-year health care costs were higher for PReCaP patients, both for the within-hospital analysis (+€7,000) and the between-hospital analysis (+€2,500). Conclusion We did not find any effect of the PReCaP on ADL and IADL. The PReCaP may possibly provide some benefits to hospitalized patients at risk of functional decline with respect to cognitive functioning, depression, and perceived health. Further evaluations of integrated intervention programs to limit functional decline are therefore required. PMID:25878492

  20. A randomized study of a domiciliary antenatal care scheme: the effect on hospital admissions.

    PubMed

    Dawson, A J; Middlemiss, C; Coles, E C; Gough, N A; Jones, M E

    1989-11-01

    A preliminary randomized study has been made of a domiciliary management scheme which incorporates telephonic fetal heart rate monitoring for women with high-risk pregnancies. In this paper we report effects of the scheme on the pattern of hospital admissions. Sixty women were randomized 2:1 for domiciliary surveillance or for conventional hospital care, with 40 and 17 records finally available for analysis. The groups were well matched for maternal, obstetric and socio-economic characteristics. In the domiciliary group, 21 (53%) of the women avoided hospital admission altogether, the admission rate was more than halved, and the mean proportion of the time spent in hospital was reduced from 50% to 16% of the observation period. The women who received domiciliary care were generally satisfied with the scheme. Our study confirms expectations that carefully planned domiciliary surveillance can reduce the number and duration of hospital admissions. PMID:2611171

  1. Using Quality Experts from Manufacturing to Transform Primary Care

    ERIC Educational Resources Information Center

    Steiner, Rose M.; Walsworth, David T.

    2010-01-01

    Introduction: Improving Performance in Practice (IPIP) is an initiative convened by the American Board of Medical Specialties. It investigates the efficacy of coaches in helping primary-care practices improve the care of patients with diabetes and asthma. Most IPIP states use coaches who have a health care background, and are trained in quality

  2. Collaborating across organizational boundaries to improve the quality of care

    Microsoft Academic Search

    Paul E. Plsek

    1997-01-01

    The paradigm of modern quality management is in wide use in health care. Although much of the initial effort in health care has focused on improving service, administrative, and support processes, many organizations are also using these concepts to improve clinical care. The analysis of data on clinical outcomes has undoubtedly led to many local improvements, but such analysis is

  3. Prospective cohort study protocol to describe the transfer of patients from intensive care units to hospital wards

    PubMed Central

    Buchner, Denise L; Bagshaw, Sean M; Dodek, Peter; Forster, Alan J; Fowler, Robert A; Lamontagne, François; Turgeon, Alexis F; Potestio, Melissa; Stelfox, Henry T

    2015-01-01

    Introduction The transfer of patient care between the intensive care unit (ICU) and the hospital ward is associated with increased risk of medical error and adverse events. This study will describe patient transfer from ICU to hospital ward by documenting (1) patient, family and provider experiences related to ICU transfer, (2) communication between stakeholders involved in ICU transfer, (3) adverse events that follow ICU transfer and (4) opportunities to improve ICU to hospital ward transfer. Methods This is a mixed methods prospective observational study of ICU to hospital ward transfer practices in 10 ICUs across Canada. We will recruit 50 patients at each site (n=500) who are transferred from ICU to hospital ward, and distribute surveys to enrolled patients, family members, and healthcare providers (ICU and ward physicians and nurses) after patient transfer. A random sample of 6 consenting study participants (patients, family members, healthcare providers) from each study site (n=60) will be offered an opportunity to participate in interviews to further describe stakeholders’ experience with ICU to hospital ward transfer. We will abstract information from patient health records to identify clinical data and use of transfer tools, and identify adverse events that are related to the transfer. Ethics and Dissemination Research ethics board approval has been obtained at the coordinating study centre (UofC REB13-0021) and 5 study sites (UofA Pro00050646; UBC-PHC H14-01667; Sunnybrook 336-2014; QCH 14-07; Sherbrooke 14-172). Dissemination of the findings will provide a comprehensive description of transfer from ICU to hospital ward in Canada including the uptake of validated or local transfer tools, a conceptual framework of the experiences and needs of stakeholders in the ICU transfer process, a summary of adverse events experienced by patients after transfer from ICU to hospital ward, and opportunities to guide quality improvement efforts. PMID:26155820

  4. Understanding Afghan healthcare providers: a qualitative study of the culture of care in a Kabul maternity hospital

    PubMed Central

    Arnold, R; van Teijlingen, E; Ryan, K; Holloway, I

    2015-01-01

    Objective To analyse the culture of a Kabul maternity hospital to understand the perspectives of healthcare providers on their roles, experiences, values and motivations and the impact of these determinants on the care of perinatal women and their babies. Design Qualitative ethnographic study. Setting A maternity hospital, Afghanistan. Population Doctors, midwives and care assistants. Methods Six weeks of observation followed by 22 semi-structured interviews and four informal group discussions with staff, two focus group discussions with women and 41 background interviews with Afghan and non-Afghan medical and cultural experts. Main outcome measures The culture of care in an Afghan maternity hospital. Results A large workload, high proportion of complicated cases and poor staff organisation affected the quality of care. Cultural values, social and family pressures influenced the motivation and priorities of healthcare providers. Nepotism and cronyism created inequality in clinical training and support and undermined the authority of management to improve standards of care. Staff without powerful connections were vulnerable in a punitive inequitable environment—fearing humiliation, blame and the loss of employment. Conclusions Suboptimal care put the lives of women and babies at risk and was, in part, the result of conflicting priorities. The underlying motivation of staff appeared to be the socio-economic survival of their own families. The hospital culture closely mirrored the culture and core values of Afghan society. In setting priorities for women's health post-2015 Millennium Development Goals, understanding the context-specific pressures on staff is key to more effective programme interventions and sustainability. PMID:25394518

  5. Study of patient satisfaction in a surgical unit of a tertiary care teaching hospital

    PubMed Central

    Mishra, P.H.; Gupta, Shakti

    2012-01-01

    Background The hospitals have evolved from being an isolated sanatorium to a place with five star facilities. Patients and their relatives coming to the hospital not only expect world-class treatment, but also other facilities to make their stay comfortable in the hospital. This change in expectation has come due to tremendous growth of media and its exposure, as well as commercialization and improvement in facilities. The aim of this study was to evaluate the level of patient/relatives satisfaction at tertiary care teaching hospital and feedback from them for improvement of the same. Methods The study was conducted by 1. Review of available national and international literature on the subject. 2. Carrying out survey amongst 50 patients and their relatives at one of the surgical unit by using structured questionnaire. 3. By analyzing the data using appropriate statistical methods. Results Eighty two percent people were satisfied with the service at admission counter while 81% were satisfied with room preparation at the time of admission. The nursing services satisfied 80% of people while 92% were satisfied with explanation about disease and treatment by doctor. The behavior of nurses, doctors and orderlies satisfied 92, 92 and 83% of people. The cleanliness of toilets satisfied only 49% while diet services satisfied 78% of people. Conclusion The five major satisfiers were behavior of doctors, explanation about disease and treatment, courtesy of staff at admission counter, behavior and cooperation of nurses. The five major dissatisfiers were cleanliness of toilets, quality of food, explanation about rules and regulation, behavior of orderlies and sanitary attendant and room preparedness. PMID:25983455

  6. Financial incentives and measurement improved physicians' quality of care in the Philippines.

    PubMed

    Peabody, John; Shimkhada, Riti; Quimbo, Stella; Florentino, Jhiedon; Bacate, Marife; McCulloch, Charles E; Solon, Orville

    2011-04-01

    The merits of using financial incentives to improve clinical quality have much appeal, yet few studies have rigorously assessed the potential benefits. The uncertainty surrounding assessments of quality can lead to poor policy decisions, possibly resulting in increased cost with little or no quality improvement, or missed opportunities to improve care. We conducted an experiment involving physicians in thirty Philippine hospitals that overcomes many of the limitations of previous studies. We measured clinical performance and then examined whether modest bonuses equal to about 5 percent of a physician's salary, as well as system-level incentives that increased compensation to hospitals and across groups of physicians, led to improvements in the quality of care. We found that both the bonus and system-level incentives improved scores in a quality measurement system used in our study by ten percentage points. Our findings suggest that when careful measurement is combined with the types of incentives we studied, there may be a larger impact on quality than previously recognized. PMID:21471500

  7. In sickness and in wealth : hospitals, community benefits, and the Affordable Care Act

    E-print Network

    Mella, Katherine M. (Katherine Manuela)

    2014-01-01

    The new community benefit guidelines for non-profit hospitals enacted by the 2010 Patient Protection and Affordable Care Act (ACA) present major opportunities for the public health and planning fields alike. Given that ...

  8. Translating Readmission Risk into Clinical Care: Testing a Readmission Risk Calculator among Elderly Hospitalized Veterans

    E-print Network

    Sackett, Nathan B

    2013-01-01

    factors of readmission to hospital for a COPD exacerbation:readmission. These include diabetes 45 , hypertension 63 , COPDCOPD) and increased patient satisfaction with access to emergency room care. C.VA Readmission

  9. INFRASTRUCTURAL MECHANISMS LEADING TOWARD PRO-ACCOUNTABLE CARE ORGANISATION ORIENTATION: A SURVEY OF HOSPITAL MANAGERS

    PubMed Central

    Wan, Thomas T.H.; Masri, Maysoun Dimachkie; Ortiz, Judith

    2013-01-01

    Organisations across the country are transforming the way they deliver care, in ways similar to the accountable care organisation (ACO) model supported by Medicare. ACOs modalities are varying in size, type, and financing structure. Little is known about how specific infrastructural mechanisms influence hospital managers’ pro-ACO orientation. Using an electronic-survey of hospital managers, this study explores how pro-ACO orientation, as a latent construct, is captured from the perceptions of hospital managers; and identify infrastructural mechanisms leading to the formation of pro-ACO orientation. Of the total hospital respondents, 58% are moving toward the establishment of ACOs; 56% are planning to join in the next two years; 48% are considering joining ACOs; while 25% had already participated in ACOs during 2012. Urban hospitals are more likely than rural hospitals to be engaged in ACO development. The health provider network size is one of the strongest indicators in predicting pro-ACO orientation. PMID:25374609

  10. Systems and processes that ensure high quality care.

    PubMed

    Bassett, Sally; Westmore, Kathryn

    2012-10-01

    This is the second in a series of articles examining the components of good corporate governance. It considers how the structures and processes for quality governance can affect an organisation's ability to be assured about the quality of care. Complex information systems and procedures can lead to poor quality care, but sound structures and processes alone are insufficient to ensure good governance, and behavioural factors play a significant part in making sure that staff are enabled to provide good quality care. The next article in this series looks at how the information reporting of an organisation can affect its governance. PMID:23252087

  11. Development and implementation of a clinical pathway programme in an acute care general hospital in Singapore

    Microsoft Academic Search

    JASON CHEAH

    2000-01-01

    A critical or clinical pathway defines the optimal care process, sequencing and timing of interventions by doctors, nurses and other health care professionals for a particular diagnosis or procedure. Clinical pathways are developed through collaborative efforts of clinicians, case managers, nurses, pharmacists, physiotherapists and other allied health care professionals with the aim of improving the quality of patient care, while

  12. Scenario based outdoor simulation in pre-hospital trauma care using a simple mannequin model

    Microsoft Academic Search

    Per P Bredmose; Karel Habig; Gareth Davies; Gareth Grier; David J Lockey

    2010-01-01

    INTRODUCTION: We describe a system of scenario-based training using simple mannequins under realistic circumstances for the training of pre-hospital care providers. METHODS: A simple intubatable mannequin or student volunteers are used together with a training version of the equipment used on a routine basis by the pre-hospital care team (doctor + paramedic). Training is conducted outdoors at the base location

  13. Hospital Deaths of People Aged 90 and Over: End-of-Life Palliative Care Management

    Microsoft Academic Search

    Francesc Formiga; Alfons López-Soto; Margarita Navarro; Antoni Riera-Mestre; Xavier Bosch; Ramón Pujol

    2008-01-01

    Background: In developed countries, hospital deaths at very advanced age are increasingly common.Few studies have addressed end-of-life care in very elderly patients with non-cancer chronic diseases. Objective: To evaluate the circumstances related to end-stage death of non-cancer nonagenarians in an acute care hospital. The results were compared with those from a sample of younger patients. Methods: We conducted a prospective

  14. The national database of hospital-based cancer registries: a nationwide infrastructure to support evidence-based cancer care and cancer control policy in Japan.

    PubMed

    Higashi, Takahiro; Nakamura, Fumiaki; Shibata, Akiko; Emori, Yoshiko; Nishimoto, Hiroshi

    2014-01-01

    Monitoring the current status of cancer care is essential for effective cancer control and high-quality cancer care. To address the information needs of patients and physicians in Japan, hospital-based cancer registries are operated in 397 hospitals designated as cancer care hospitals by the national government. These hospitals collect information on all cancer cases encountered in each hospital according to precisely defined coding rules. The Center for Cancer Control and Information Services at the National Cancer Center supports the management of the hospital-based cancer registry by providing training for tumor registrars and by developing and maintaining the standard software and continuing communication, which includes mailing lists, a customizable web site and site visits. Data from the cancer care hospitals are submitted annually to the Center, compiled, and distributed as the National Cancer Statistics Report. The report reveals the national profiles of patient characteristics, route to discovery, stage distribution, and first-course treatments of the five major cancers in Japan. A system designed to follow up on patient survival will soon be established. Findings from the analyses will reveal characteristics of designated cancer care hospitals nationwide and will show how characteristics of patients with cancer in Japan differ from those of patients with cancer in other countries. The database will provide an infrastructure for future clinical and health services research and will support quality measurement and improvement of cancer care. Researchers and policy-makers in Japan are encouraged to take advantage of this powerful tool to enhance cancer control and their clinical practice. PMID:23448800

  15. RFID and NFC in healthcare: Safety of hospitals medication care

    Microsoft Academic Search

    Antti Lahtela; Marko Hassinen; V. Jylha

    2008-01-01

    Use of information technology has become commonplace in healthcare. In an ideal world a patient always gets first class treatment and everything goes smoothly and as planned. Applications of information technology are created to help the hospital staff achieve this. However, hospital staff is often working under a heavy workload and minimal workforce. This may contribute to human error, for

  16. [The Serious Game, a care tool for hospitalized children].

    PubMed

    Wemeau, Catherine; Dosset, Christine; Dubat, Brice

    2012-01-01

    For the last 4 years, the paediatric department of Seclin hospital in the north of France has provided children and professionals with a fun tool which helps to inform young children and assess their pain, Dolo:kids. This Serious Game also helps to make the hospital environment less traumatic for the patient. PMID:22616459

  17. HCFA's health care quality improvement program: the medical informatics challenge.

    PubMed Central

    Grant, J B; Hayes, R P; Pates, R D; Elward, K S; Ballard, D J

    1996-01-01

    The peer-review organizations (PROs) were created by Congress in 1984 to monitor the cost and quality of care received by Medicare beneficiaries. In order to do this, the Health Care Financing Administration (HCFA) contracted with the PROs through a series of contracts referred to as "Scopes of Work." Under the Fourth Scope of Work, the HCFA initiated the Health Care Quality Improvement Program (HCQIP) in 1990, as an application of the principles of continuous quality improvement. Since then, the PROs have participated with health care providers in cooperative projects to improve the quality of primarily inpatient care provided to Medicare beneficiaries. Through HCFA-supplied administrative data and clinical data abstracted from patient records, the PROs have been able to identify opportunities for improvements in patient care. In May 1995, the HCFA proposed a new Fifth Scope of Work, which will shift the focus of HCQIP from inpatient care projects to projects in outpatient and managed care settings. This article describes the HCQIP process, the types of data used by the PROs to conduct cooperative projects with health care providers, and the informatics challenges in improving the quality of care received by Medicare beneficiaries. PMID:8750387

  18. Hospital staff nurse perceptions of competency to care for patients with psychiatric or behavioral health concerns.

    PubMed

    Rutledge, Dana N; Wickman, Mary E; Cacciata, Marysol; Winokur, Elizabeth J; Loucks, Jeannine; Drake, Diane

    2013-01-01

    Disruptive behaviors are common among hospitalized patients with psychiatric and substance abuse behaviors. Nurses working on nonpsychiatric units, however, may lack competencies to care for patients with such behaviors. A survey was developed and administered to 844 nurses across three hospital settings that revealed a lack of nurse confidence to intervene in situations that require de-escalation techniques and crisis communication. This study provides direction for further research and interventions in hospital settings with similar professional development needs. PMID:24060662

  19. Clinical Judgement On Alternative Care for Longstay Patients in Dutch Mental Hospitals

    Microsoft Academic Search

    M. J. Haveman

    1989-01-01

    How many longstay patients could be equally served by less sheltered facilities, and what are the main reasons for staff members to judge patients suitable for such alternative care? These were two questions in a Dutch study (1984-1985) of five mental hospitals. The attending psychiatrists in these hospitals and members of the nursing staff, were asked to give an independent

  20. [Special challenges in the highest-elevation acute-care hospital in Europe].

    PubMed

    Marugg, Donat

    2015-04-22

    Oberengadin Hospital in Samedan is faced with particular challenges, as the highest-elevation acute-care hospital in Europe (1750 m = 5,740 ft above sea level). The factors responsible for this are elevation-related and meteorological/climatic influences, as well as seasonal variations in Südbünden's demographic structure due to tourism. PMID:26072605

  1. On-site availability of Legionella testing in acute care hospitals, United States.

    PubMed

    Garrison, Laurel E; Shaw, Kristin M S; McCollum, Jeffrey T; Dexter, Carol; Vagnone, Paula M Snippes; Thompson, Jamie H; Giambrone, Gregory; White, Benjamin; Thomas, Stepy; Carpenter, L Rand; Nichols, Megin; Parker, Erin; Petit, Susan; Hicks, Lauri A; Langley, Gayle E

    2014-07-01

    We surveyed 399 US acute care hospitals regarding availability of on-site Legionella testing; 300 (75.2%) did not offer Legionella testing on site. Availability varied according to hospital size and geographic location. On-site access to testing may improve detection of Legionnaires disease and inform patient management and prevention efforts. PMID:24915225

  2. Checking the Pulse of Diversity among Health Care Professionals: An Analysis of West Coast Hospitals

    Microsoft Academic Search

    Sheryl L. Skaggs; Julie A. Kmec

    2012-01-01

    What factors are associated with variation in the racial\\/ethnic composition of hospital health care professionals? Institutional theories suggest that organizations react to external environmental and internal structural pressures for the racial\\/ethnic integration of workers. Using an institutional framework, we bring to bear new insight into how hospitals respond to such pressure for diversity. Models estimated with original data from 328

  3. Use of Acute Care Hospitals by Long-Stay Patients: Who, How Much, and Why?

    ERIC Educational Resources Information Center

    De Coster, Carolyn; Bruce, Sharon; Kozyrskyj, Anita

    2005-01-01

    The effects of long-term hospitalizations can be severe, especially among older adults. In Manitoba, between fiscal years 1991/1992 and 1999/2000, 40 per cent of acute care hospital days were used by the 5 per cent of patients who had long stays, defined as stays of more than 30 days. These proportions were remarkably stable, despite major changes…

  4. Post-Acute Home Care and Hospital Readmission of Elderly Patients with Congestive Heart Failure

    ERIC Educational Resources Information Center

    Li, Hong; Morrow-Howell, Nancy; Proctor, Enola K.

    2004-01-01

    After inpatient hospitalization, many elderly patients with congestive heart failure (CHF) are discharged home and receive post-acute home care from informal (family) caregivers and formal service providers. Hospital readmission rates are high among elderly patients with CHF, and it is thought that use of informal and formal services may reduce…

  5. Indiana Critical Access Hospitals --Purdue HealthcareAdvisors' Lean training to improve transitions of care

    E-print Network

    Ginzel, Matthew

    percent as well as reducing avoidable inpatient readmissions by more than 40 percent -- tell us that LeanIndiana Critical Access Hospitals -- Purdue HealthcareAdvisors' Lean training to improve transitions of care NEED IMPACT STATEMENT INITIATIVE Scott Memorial Hospital in Scottsburg, Ind., was among 20

  6. Organization Complexity and Primary Care Providers' Perceptions of Quality Improvement Culture Within the Veterans Health Administration.

    PubMed

    Korom-Djakovic, Danijela; Canamucio, Anne; Lempa, Michele; Yano, Elizabeth M; Long, Judith A

    2014-11-20

    This study examined how aspects of quality improvement (QI) culture changed during the introduction of the Veterans Health Administration (VHA) patient-centered medical home initiative and how they were influenced by existing organizational factors, including VHA facility complexity and practice location. A voluntary survey, measuring primary care providers' (PCPs') perspectives on QI culture at their primary care clinics, was administered in 2010 and 2012. Participants were 320 PCPs from hospital- and community-based primary care practices in Pennsylvania, West Virginia, Delaware, New Jersey, New York, and Ohio. PCPs in community-based outpatient clinics reported an improvement in established processes for QI, and communication and cooperation from 2010 to 2012. However, their peers in hospital-based clinics did not report any significant improvements in QI culture. In both years, compared with high-complexity facilities, medium- and low-complexity facilities had better scores on the scales assessing established processes for QI, and communication and cooperation. PMID:25414376

  7. Using self-care theory to guide nursing management of the older adult after hospitalization.

    PubMed

    Jopp, M; Carroll, M C; Waters, L

    1993-01-01

    This article describes Orem's Self-Care Theory (Orem, 1985) and applies it to the home setting. The purpose of the study was to identify how older adults manage self-care activities at home following discharge from a hospital. Results of the survey indicated that 66% of the clients reported self-care deficits after discharge. In addition, 15% reported inability to care for themselves totally after discharge. Analysis of the information indicated the lack of a supportive-educative system to promote self-care at home. The solution to the management of self-care is the rehabilitation nurse clinical specialist, who can provide nursing strategies that promote partnership with the older adult in planning self-care activities after hospitalization. PMID:8383870

  8. Bridging a divide: architecture for a joint hospital-primary care data warehouse.

    PubMed

    An, Jeff; Keshavjee, Karim; Mirza, Kashif; Vassanji, Karim; Greiver, Michelle

    2015-01-01

    Healthcare costs are driven by a surprisingly small number of patients. Predicting who is likely to require care in the near future could help reduce costs by pre-empting use of expensive health care resources such as emergency departments and hospitals. We describe the design of an architecture for a joint hospital-primary care data warehouse (JDW) that can monitor the effectiveness of in-hospital interventions in reducing readmissions and predict which patients are most likely to be admitted to hospital in the near future. The design identifies the key governance elements, the architectural principles, the business case, the privacy architecture, future work flows, the IT infrastructure, the data analytics and the high level implementation plan for realization of the JDW. This architecture fills a gap in bridging data from two separate hospital and primary care organizations, not a single managed care entity with multiple locations. The JDW architecture design was well received by the stakeholders engaged and by senior leadership at the hospital and the primary care organization. Future plans include creating a demonstration system and conducting a pilot study. PMID:25676945

  9. Quality of paediatric blood transfusions in two district hospitals in Tanzania: a cross-sectional hospital based study

    Microsoft Academic Search

    Dominic Mosha; Anja Poulsen; Hugh Reyburn; Elimsaada Kituma; Frank Mtei; Ib C Bygbjerg

    2009-01-01

    BACKGROUND: Blood transfusion (BT) can be lifesaving for children; however, monitoring the quality of BT is important. The current study describes the quality of paediatric BT delivered in two district hospitals in north-east Tanzania in order to identify areas for quality assurance and improvement in the administration of BT. METHODS: All 166 children admitted in the paediatric wards and receiving

  10. Trends in Canadian hospital standardised mortality ratios and palliative care coding 2004–2010: a retrospective database analysis

    PubMed Central

    Chong, Christopher AKY; Nguyen, Geoffrey C; Wilcox, M Elizabeth

    2012-01-01

    Background The hospital standardised mortality ratio (HSMR), anchored at an average score of 100, is a controversial macromeasure of hospital quality. The measure may be dependent on differences in patient coding, particularly since cases labelled as palliative are typically excluded. Objective To determine whether palliative coding in Canada has changed since the 2007 national introduction of publicly released HSMRs, and how such changes may have affected results. Design Retrospective database analysis. Setting Inpatients in Canadian hospitals from April 2004 to March 2010. Patients 12?593?329 hospital discharges recorded in the Canadian Institute for Health Information (CIHI) Discharge Abstract Database from April 2004 to March 2010. Measurements Crude mortality and palliative care coding rates. HSMRs calculated with the same methodology as CIHI. A derived hospital standardised palliative ratio (HSPR) adjusted to a baseline average of 100 in 2004–2005. Recalculated HSMRs that included palliative cases under varying scenarios. Results Crude mortality and palliative care coding rates have been increasing over time (p<0.001), in keeping with the nation's advancing overall morbidity. HSMRs in 2008–2010 were significantly lower than in 2004–2006 by 8.55 points (p<0.001). The corresponding HSPR rises dramatically between these two time periods by 48.83 points (p<0.001). Under various HSMR scenarios that included palliative cases, the HSMR would have at most decreased by 6.35 points, and may have even increased slightly. Limitations Inability to calculate a definitively comparable HSMR that include palliative cases and to account for closely timed changes in national palliative care coding guidelines. Conclusions Palliative coding rates in Canadian hospitals have increased dramatically since the public release of HSMR results. This change may have partially contributed to the observed national decline in HSMR. PMID:23131397

  11. Microbiological quality of ice in hospital and community.

    PubMed

    Wilson, I G; Hogg, G M; Barr, J G

    1997-07-01

    A survey was undertaken in response to a report of a clinical infection which had been related to an ice-making machine on a hospital ward. A detailed study of the ice microflora of 27 ice-making machines was performed. In a subsequent survey, ice samples (N = 194) from establishments such as bars and hotels were examined for bacterial indicators of hygiene. Samples from hospital ice-making machines yielded low numbers of a wide range of potentially opportunistic micro-organisms, many of environmental rather than clinical origin. For ice sampled in the community, the total aerobic plate count (TAPC) at 37 degrees C for 95% of the samples was < 500 cfu/mL, and at 22 degrees C 75% had < 500 cfu/mL. Examination for coliforms showed that 69% of samples contained no coliforms, but 20% contained > 100 coliforms/100 mL. Escherichia coli was detected in three samples but in very low numbers. This report investigates the relevance of ice machines to the control of hospital infection, the hygiene of ice in the community, discusses the microbiological quality of ice and proposes possible guidelines. PMID:9253698

  12. Estimating the incidence of adverse events in Portuguese hospitals: a contribution to improving quality and patient safety

    PubMed Central

    2014-01-01

    Background Several review studies have shown that 3.4% to 16.6% of patients in acute care hospitals experience one or more adverse events. Adverse events (AEs) in hospitals constitute a significant problem with serious consequences and a challenge for public health. The occurrence of AEs in Portuguese hospitals has not yet been systematically studied. The main purpose of this study is to estimate the incidence, impact and preventability of adverse events in Portuguese hospitals. It is also our aim to examine the feasibility of applying to Portuguese acute hospitals the methodology of detecting AEs through record review, previously used in other countries. Methods This work is based on a retrospective cohort study and was carried out at three acute care hospitals in the Administrative Region of Lisbon. The identification of AEs and their impact was done using a two-stage structured retrospective medical records review based on the use of 18 screening criteria. A random sample of 1,669 medical records (representative of 47,783 hospital admissions) for the year 2009 was analyzed. Results The main results found in this study were an incidence rate of 11.1% AEs, of which around 53.2% were considered preventable. The majority of AEs were associated with surgical procedures (27%), drug errors (18.3%) and hospital acquired infections (12.2%). Most AEs (61%) resulted in minimal or no physical impairment or disability, and 10.8% were associated with death. In 58.6% of the AEs’ cases, the length of stay was prolonged on average 10.7 days. Additional direct costs amounted to €470,380.00. Conclusion The magnitude of these results was critical, reinforcing the need of more detailed studies in this area. The knowledge of the incidence and nature of AEs that occur in hospitals should be seen as a first step towards the improvement of quality and safety in health care. PMID:25034870

  13. Early Medicaid Expansion In Connecticut Stemmed The Growth In Hospital Uncompensated Care.

    PubMed

    Nikpay, Sayeh; Buchmueller, Thomas; Levy, Helen

    2015-07-01

    As states continue to debate whether or not to expand Medicaid under the Affordable Care Act (ACA), a key consideration is the impact of expansion on the financial position of hospitals, including their burden of uncompensated care. Conclusive evidence from coverage expansions that occurred in 2014 is several years away. In the meantime, we analyzed the experience of hospitals in Connecticut, which expanded Medicaid coverage to a large number of childless adults in April 2010 under the ACA. Using hospital-level panel data from Medicare cost reports, we performed difference-in-differences analyses to compare the change in Medicaid volume and uncompensated care in the period 2007-13 in Connecticut to changes in other Northeastern states. We found that early Medicaid expansion in Connecticut was associated with an increase in Medicaid discharges of 7-9 percentage points, relative to a baseline rate of 11 percent, and an increase of 7-8 percentage points in Medicaid revenue as a share of total revenue, relative to a baseline share of 10 percent. Also, in contrast to the national and regional trends of increasing uncompensated care during this period, hospitals in Connecticut experienced no increase in uncompensated care. We conclude that uncompensated care in Connecticut was roughly one-third lower than what it would have been without early Medicaid expansion. The results suggest that ACA Medicaid expansions could reduce hospitals' uncompensated care burden. PMID:26153312

  14. “DEMENTIA-FRIENDLY HOSPITALS: CARE NOT CRISIS” AN EDCUATIONAL PROGRAM DESIGNED TO IMPROVE THE CARE OF THE HOSPITALIZED PATIENT WITH DEMENTIA

    PubMed Central

    Galvin, James E.; Kuntemeier, Barbara; Al-Hammadi, Noor; Germino, Jessica; Murphy-White, Maggie; McGillick, Janis

    2010-01-01

    Background Approximately 3.2 million hospital stays annually involve a person with dementia, leading to higher costs, longer lengths of stay and poorer outcomes. Older adults with dementia are vulnerable when hospitals are unable to meet their special needs. Methods We developed, implemented and evaluated a training program for 540 individuals at 4 community hospitals. Pre-test, post-test and a 120-day delayed post-test were collected to assess knowledge, confidence and practice parameters. Results The mean age of the sample was 46y; 83% were Caucasian, 90% were female and 60% were nurses. Upon completion, there were significant gains (p’s <.001) in knowledge and confidence in recognizing, assessing and managing dementia. Attendees reported gains in communication skills and strategies to improve the hospital environment, patient safety and behavioral management. At 120 days, 3 of 4 hospitals demonstrated maintenance of confidence. In the hospital that demonstrated lower knowledge and confidence scores, the sample was older and had more nurses and more years in practice. Conclusion We demonstrate the feasibility of training hospital staff about dementia and its impact on patient outcomes. At baseline, there was low knowledge and confidence in the ability to care for dementia patients. Training had an immediate impact on knowledge, confidence and attitudes with lasting impact in 3 of 4 hospitals. We identified targets for intervention and the need for ongoing training and administrative reinforcement in order to sustain behavioral change. Community resources, such as local chapters of the Alzheimer’s Association, may be key community partners in improving care outcomes for hospitalized persons with dementia. PMID:20625267

  15. "Who Says What Is Quality?": Setting Quality Standards for Family Child Care

    ERIC Educational Resources Information Center

    Modigliani, Kathy

    2011-01-01

    This article tells the story of the 4-year consensus-building process to design quality standards for the field of family child care. Working with the National Association for Family Child Care, the Family Child Care Project at Wheelock College was funded to create an accreditation system for home-based child care programs using innovative methods…

  16. System Change: Quality Assessment and Improvement for Medicaid Managed Care

    PubMed Central

    Smith, Wally R; Cotter, J. James; Rossiter, Louis F.

    1996-01-01

    Rising Medicaid health expenditures have hastened the development of State managed care programs. Methods to monitor and improve health care under Medicaid are changing. Under fee-for-service (FFS), the primary concern was to avoid overutilization. Under managed care, it is to avoid underutilization. Quality enhancement thus moves from addressing inefficiency to addressing insufficiency of care. This article presents a case study of Virginia's redesign of Quality Assessment and Improvement (QA/I) for Medicaid, adapting the guidelines of the Quality Assurance Reform Initiative (QARI) of the Health Care Financing Administration (HCFA). The article concludes that redesigns should emphasize Continuous Quality Improvement (CQI) by all providers and of multi-faceted, population-based data. PMID:10165716

  17. Quality of Health Care: The Views of Homeless Youth

    PubMed Central

    Ensign, Josephine

    2004-01-01

    Objective To develop homeless-youth-identified process and outcome measures of quality of health care. Data Sources/Study Setting Primary data collection with homeless youth from both street and clinic settings in Seattle, Washington, for calendar year 2002. Study Design The research was a focused ethnography, using key informant and in-depth individual interviews as well as focus groups with a purposeful sample of 47 homeless youth aged 12–23 years. Data Collection/Extraction Methods All interviews and focus groups were tape-recorded, transcribed, and preliminarily coded, with final coding cross-checked and verified with a second researcher. Principal Findings Homeless youth most often stated that cultural and interpersonal aspects of quality of care were important to them. Physical aspects of quality of care reported by the youth were health care sites separate from those for homeless adults, andsites that offered a choice of allopathic and complementary medicine. Outcomes of health care included survival of homelessness, functional and disease-state improvement, and having increased trust and connections with adults and with the wider community. Conclusions Homeless youth identified components of quality of care as well as how quality of care should be measured. Their perspectives will be included in a larger follow-up study to develop quality of care indicators for homeless youth. PMID:15230923

  18. Multimorbidity and Quality of Preventive Care in Swiss University Primary Care Cohorts

    PubMed Central

    Streit, Sven; da Costa, Bruno R.; Bauer, Douglas C.; Collet, Tinh-Hai; Weiler, Stefan; Zimmerli, Lukas; Frey, Peter; Cornuz, Jacques; Gaspoz, Jean-Michel; Battegay, Edouard; Kerr, Eve; Aujesky, Drahomir; Rodondi, Nicolas

    2014-01-01

    Background Caring for patients with multimorbidity is common for generalists, although such patients are often excluded from clinical trials, and thus such trials lack of generalizability. Data on the association between multimorbidity and preventive care are limited. We aimed to assess whether comorbidity number, severity and type were associated with preventive care among patients receiving care in Swiss University primary care settings. Methods We examined a retrospective cohort composed of a random sample of 1,002 patients aged 50–80 years attending four Swiss university primary care settings. Multimorbidity was defined according to the literature and the Charlson index. We assessed the quality of preventive care and cardiovascular preventive care with RAND’s Quality Assessment Tool indicators. Aggregate scores of quality of provided care were calculated by taking into account the number of eligible patients for each indicator. Results Participants (mean age 63.5 years, 44% women) had a mean of 2.6 (SD 1.9) comorbidities and 67.5% had 2 or more comorbidities. The mean Charlson index was 1.8 (SD 1.9). Overall, participants received 69% of recommended preventive care and 84% of cardiovascular preventive care. Quality of care was not associated with higher numbers of comorbidities, both for preventive care and for cardiovascular preventive care. Results were similar in analyses using the Charlson index and after adjusting for age, gender, occupation, center and number of visits. Some patients may receive less preventive care including those with dementia (47%) and those with schizophrenia (35%). Conclusions In Swiss university primary care settings, two thirds of patients had 2 or more comorbidities. The receipt of preventive and cardiovascular preventive care was not affected by comorbidity count or severity, although patients with certain comorbidities may receive lower levels of preventive care. PMID:24760077

  19. Effect of home-based intervention on hospital readmission and quality of life in middle-aged patients with severe congestive heart failure: a 12-month follow up study

    Microsoft Academic Search

    I. Vavouranakis; E. Lambrogiannakis; G. Markakis; A. Dermitzakis; Z. Haroniti; C. Ninidaki; A. Borbantonaki; K. Tsoutsoumanou

    2003-01-01

    Objective: Home care surveillance has been shown to reduce hospital readmission and improve functional status and quality of life of elderly patients with mild to moderate or severe congestive heart failure and in younger patients candidates for transplantation. The present study aimed to investigate the effect of home-based intervention on hospital readmission and quality of life of middle-aged patients with

  20. Quality pain management practices in a university hospital.

    PubMed

    Zoëga, Sigridur; Ward, Sandra E; Sigurdsson, Gisli H; Aspelund, Thor; Sveinsdottir, Herdis; Gunnarsdottir, Sigridur

    2015-06-01

    Despite available guidelines and efforts to improve pain management, pain remains prevalent in hospitals. The aim of this study was to explore whether pain management practices in a university hospital were in line with guidelines on acute, geriatric, and cancer pain. This was a descriptive, correlational, and point-prevalence study conducted at a university hospital with 282 adults, who were hospitalized for 24 hours and were alert and able to participate. Patient self-report data were collected with the American Pain Society questionnaire and pain management data were collected from medical records. Adequacy of treatment was measured with the Pain Management Index, calculated for prescribed and administered treatments. The mean age of participants was 68.9 years (SD = 17; range 18-100); 49% were women; and 72% were on medical services. Pain assessment was documented for 57% of patients, of those, 27% had pain severity documented with a standardized scale. Most patients (85%) were prescribed analgesics and multimodal therapy was prescribed for 60%. Prescribed treatment was adequate for 78% of patients, whereas 64% were administered adequate treatment. The odds of receiving adequate treatment were higher (odds ratio, 3.44; 95% confidence interval, 1.38-8.60) when pain severity was documented. Nonpharmacologic methods were used by 34% of patients. Although the majority of patients had an analgesic prescription, many did not receive adequate treatment. The use of pain severity scales was associated with the provision of more adequate pain treatment. To provide quality pain management, pain assessment needs to be improved and available treatments used to meet patient needs. PMID:25439117

  1. Quality Matters in Early Childhood Education and Care: Slovak Republic

    ERIC Educational Resources Information Center

    Taguma, Miho; Litjens, Ineke; Makowiecki, Kelly

    2012-01-01

    Early childhood education and care (ECEC) is a topic of increased policy interest in the Slovak Republic where improving quality in the ECEC sector is a subject of growing importance. The OECD has identified five effective policy levers to encourage quality in the sector: 1) quality goals and regulations; 2) curriculum and guidelines; 3)…

  2. Nursing Home Care Quality: Insights from a Bayesian Network Approach

    ERIC Educational Resources Information Center

    Goodson, Justin; Jang, Wooseung; Rantz, Marilyn

    2008-01-01

    Purpose: The purpose of this research is twofold. The first purpose is to utilize a new methodology (Bayesian networks) for aggregating various quality indicators to measure the overall quality of care in nursing homes. The second is to provide new insight into the relationships that exist among various measures of quality and how such measures…

  3. Capitation of Medicare: Quality Care or Third-Class Care for the Poor.

    ERIC Educational Resources Information Center

    Wintringham, Karen

    Experience gathered to date confirms that capitation of Medicare does not necessarily decrease quality of health care and may in fact encourage an improvement in health care quality. Incentives inherent in capitated reimbursement are threefold. First, practitioners, by not receiving more payment for more service, are discouraged from providing…

  4. Introduction of abortion technologies: a quality of care management approach.

    PubMed

    Greenslade, F C; Winkler, J; Leonard, A H

    1992-01-01

    Development of antiprogestins for use to induce early abortion clearly advances reproductive health to a higher level. A heated debate has arisen over the appropriateness of its being introduced in health care settings, however. Since the introduction of new contraceptive technologies into health care and family planning programs has produced serious shortcomings, some abortion care specialists propose a management approach to introducing RU-486/prostaglandin which stresses women's needs and preferences. This quality of care framework is based on 20 years of experience of introducing manual vacuum aspiration into developing countries. It takes into consideration that decisions about introducing RU-486/prostaglandin are country-specific and often program- or clinic-specific. Decision makers need to look at preparedness of local policy and service delivery infrastructure to take on the specific responsibilities of integrating it into ongoing programs and how this new technology will affect quality of care. The quality of care framework consists of those elements appropriate to women' access to care which include appropriate abortion care technology; technical competence of all members of the health care team at all levels of the health system; interactions between women and providers/staff (respect and support for women and nonjudgemental attitudes); comprehensive information and counseling; quality and accessible postabortion family planning and reproductive health care; and equipment, supplies, and medication. Decision makers need to consider whether RU-486/prostaglandin is acceptable to women and providers, manufactured to high standards, consistent with relevant regulatory requirements and appropriate to specific service delivery settings. PMID:1434757

  5. The Quality of Care under a Managed-Care Program for Dual Eligibles

    ERIC Educational Resources Information Center

    Kane, Robert L.; Homyak, Patricia; Bershadsky, Boris; Lum, Terry; Flood, Shannon; Zhang, Hui

    2005-01-01

    Purpose: Our objective in this study was to compare the quality of care provided under the Minnesota Senior Health Options (MSHO), a special program designed to serve dually eligible older persons, to care provided to controls who received fee-for-service Medicare and Medicaid managed care. Design and Methods: Two control groups were used; one was…

  6. Better Kid Care Program Improves the Quality of Child Care: Results from an Interview Study

    ERIC Educational Resources Information Center

    Ostergren, Carol S.; Riley, David A.; Wehmeier, Jenny M.

    2011-01-01

    More high quality child care is needed in the United States. This article evaluates the Better Kid Care (BKC) program produced by Pennsylvania State University Extension. Child care staff in Wisconsin were interviewed about changes they had made in their early childhood programs following participation in the BKC program. Findings show that 2…

  7. The Health of Female Child Care Providers: Implications for Quality of Care

    Microsoft Academic Search

    Dee Baldwin; Sherry Gaines; Judith Lupo Wold; Armenia Williams; Janie Leary

    2007-01-01

    The purpose of this investigation was to determine the health behaviors and perceived health status of child care providers. Health behaviors and health status were also examined in relation to caring for children and the providers’ perceptions of quality child care. A researcher-developed questionnaire, adapted from Williams, Mason, and Wold (2001), was mailed to a random sample of 1,000 child

  8. Child-Care Subsidies: Do They Impact the Quality of Care Children Experience?

    ERIC Educational Resources Information Center

    Johnson, Anna D.; Ryan, Rebecca M.; Brooks-Gunn, Jeanne

    2012-01-01

    The federal child-care subsidy program represents one of the government's largest investments in early care and education, but little is known about whether it increases low-income children's access to higher quality child care. This study used newly available nationally representative data on 4-year-old children (N = 750) to investigate whether…

  9. MICRO-CARES: An Information Management System for Psychosocial Services in Hospital Settings

    PubMed Central

    Hammer, Jeffrey S.; Lyons, John S.; Strain, James J.

    1984-01-01

    This paper presents a flexible software system that is adaptable to a variety of information management uses across different psychosocial service departments in hospital settings. Initially developed for Consultation Liaison Psychiatry, the present system has now been adapted for a Social Work department and is being adapted to Hospice, Home Care, Patient Representative, and Pastoral Care departmental uses.

  10. Mortality in Low Birth Weight Infants According to Level of Neonatal Care at Hospital of Birth

    Microsoft Academic Search

    Javier Cifuentes; Janet Bronstein; Ciaran S. Phibbs; Roderic H. Phibbs; Susan K. Schmitt; Waldemar A. Carlo

    Objective. In 1976, the Committee on Perinatal Health recommended that hospitals with no neonatal intensive care unit (NICU) or intermediate NICUs transfer high-risk mothers and infants that weigh <2000 g to a regional NICU. This standard was based on expert opinion and has not been validated carefully. This study evaluated the effect of NICU level and patient volume at the

  11. The Benefits of a Hospital-Based Inpatient Palliative Care Consultation Service: Preliminary Outcome Data

    Microsoft Academic Search

    Sean O'Mahony; Arthur E. Blank; Leah Zallman; Peter A. Selwyn

    2005-01-01

    This report describes the multiple complementary analytic methods used to create a com- posite evaluation of the benefits of a hospital-based inpatient palliative care consultation ser- vice at Montefiore Medical Center in its preliminary phase. We evaluated data regarding 592 consecutive patients consulted by the palliative care service between November 2000, through March 2002. Standardized medical record reviews indicated that

  12. Standardized clinical care pathways for major thoracic cases reduce hospital costs

    Microsoft Academic Search

    Kenton J Zehr; Patty B Dawson; Stephen C Yang; Richard F Heitmiller

    1998-01-01

    Background. Standardized clinical care pathways have been developed for postoperative management in an attempt to contain costs in an era of rising health care costs and limited resources. The purpose of this study was to assess the effect of these pathways on length of stay, hospital charges, and outcome for major thoracic surgical procedures.Methods. All anatomic lung (segmentectomy, lobectomy, and

  13. Patterns of Treatment Use and Barriers to Care Among Hospitalized Adults with HIV

    Microsoft Academic Search

    Mary A. Cavaleri; Laura Elwyn; Alicene Pilgrim; Karyn London; Debbie Indyk; Jerrold Jackson; Mary M. McKay

    2011-01-01

    This study explores utilization of treatment for HIV and barriers to care among 22 low-income adults of color who were hospitalized at an urban medical center in New York City. A semistructured interview assessing use of medical care and adherence to HIV medications, psychosocial stressors (e.g., social support, substance abuse, and mental health need), and logistical, perceptual, and environmental barriers

  14. Mental Hospitals and Alternative Care: Noninstitutionalization as Potential Public Policy for Mental Patients.

    ERIC Educational Resources Information Center

    Kiesler, Charles A.

    1982-01-01

    Reviews 10 studies in which psychiatric patients considered seriously ill were randomly assigned to either inpatient care or some alternative mode of outpatient care. Finds that in no case were the outcomes of hospitalization more positive than alternative treatment. (Author/GC)

  15. Convergence and divergence: Assessing criteria of consumer satisfaction across general practice, dental and hospital care settings

    Microsoft Academic Search

    Simon J. Williams; Michael Calnan

    1991-01-01

    This paper describes the results of the first-stage of a study carried out in the spring of 1988 in the South East of England. The study looked at general and specific aspects of consumer satisfaction with general practitioner services, general dental care services and hospital in-patients care. It also examined which specific consumer criteria were the key predictors of overall

  16. Continuity of care and risk of hospital readmission among dual diagnosis patients

    Microsoft Academic Search

    Fabian Termorshuizen; Bas E. A. van der Hoorn; Peter Blanken; Albert M. van Hemert; Hans W. Hoek; Vincent M. Hendriks

    2012-01-01

    The present study investigated the effects of added outpatient services aimed at reintegration assistance and prolonged aftercare on continuity of care and risk of re-hospitalization among patients suffering from both a severe mental illness and a substance use disorder. Administrative data on inpatient and outpatient care of all patients with at least one inpatient treatment episode at the treatment facility

  17. Continuity of care and risk of hospital readmission among dual diagnosis patients

    Microsoft Academic Search

    Fabian Termorshuizen; Bas E. A. van der Hoorn; Peter Blanken; Albert M. van Hemert; Hans W. Hoek; Vincent M. Hendriks

    2011-01-01

    The present study investigated the effects of added outpatient services aimed at reintegration assistance and prolonged aftercare on continuity of care and risk of re-hospitalization among patients suffering from both a severe mental illness and a substance use disorder. Administrative data on inpatient and outpatient care of all patients with at least one inpatient treatment episode at the treatment facility

  18. Delivering High-Quality Cancer Care: The Critical Role of Quality Measurement.

    PubMed

    Spinks, Tracy; Ganz, Patricia A; Sledge, George W; Levit, Laura; Hayman, James A; Eberlein, Timothy J; Feeley, Thomas W

    2014-03-01

    In 1999, the Institute of Medicine (IOM) published Ensuring Quality Cancer Care, an influential report that described an ideal cancer care system and issued ten recommendations to address pervasive gaps in the understanding and delivery of quality cancer care. Despite generating much fervor, the report's recommendations-including two recommendations related to quality measurement-remain largely unfulfilled. Amidst continuing concerns regarding increasing costs and questionable quality of care, the IOM charged a new committee with revisiting the 1999 report and with reassessing national cancer care, with a focus on the aging US population. The committee identified high-quality patient-clinician relationships and interactions as central drivers of quality and attributed existing quality gaps, in part, to the nation's inability to measure and improve cancer care delivery in a systematic way. In 2013, the committee published its findings in Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis, which included two recommendations that emphasize coordinated, patient-centered quality measurement and information technology enhancements: Develop a national quality reporting program for cancer care as part of a learning health care system; and,Develop an ethically sound learning health care information technology system for cancer that enables real-time analysis of data from cancer patients in a variety of care settings. These recommendations underscore the need for independent national oversight, public-private collaboration, and substantial funding to create robust, patient-centered quality measurement and learning enterprises to improve the quality, accessibility, and affordability of cancer care in America. PMID:24839592

  19. Improving Newborn Preventive Services at the Birth Hospitalization: A Collaborative, Hospital-Based Quality-Improvement Project

    Microsoft Academic Search

    Charles E. Mercier; Sara E. Barry; Thomas V. Delaney; Jeffrey D. Horbar; Richard C. Wasserman; Patricia Berry; Judith S. Shaw

    2009-01-01

    OBJECTIVE.The goal was to test the effectiveness of a statewide, collaborative, hospi- tal-based quality-improvement project targeting preventive services delivered to healthy newborns during the birth hospitalization. METHODS.All Vermont hospitals with obstetric services participated. The quality- improvement collaborative (intervention) was based on the Breakthrough Series Collaborative model. Targeted preventive services included hepatitis B immuni- zation; assessment of breastfeeding; assessment of risk

  20. 42 CFR 412.541 - Method of payment under the long-term care hospital prospective payment system.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ...the long-term care hospital has payment experience...the long-term care hospital prospective payment...supported by substantiated information for the current year...services furnished by hospital-employed nonphysician...supported by substantiated information for the current...