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Sample records for quality infant-toddler care

  1. Partnerships for Quality Infant-Toddler Child Care.

    ERIC Educational Resources Information Center

    Fenichel, Emily, Ed.

    2003-01-01

    "Zero to Three" is a single-focus bulletin of the Zero to Three: National Center for Infants, Toddlers, and Families providing insight from multiple disciplines on the development of infants, toddlers, and their families. Noting that some communities are managing to establish and sustain good-quality infant-toddler care and to make it accessible…

  2. Which Combination of High Quality Infant-Toddler and Preschool Care Best Promotes School Readiness?

    ERIC Educational Resources Information Center

    Li, Weilin; Farkas, George; Duncan, Greg J.; Burchinal, Margaret R.; Vandell, Deborah L.; Ruzek, Erik A.; Dang, Tran T.

    2011-01-01

    This paper aims to test the following hypotheses: Hypothesis 1 (H1): Everything else the same, high quality infant-toddler care will increase children's cognitive scores immediately (i.e. at 24 months of age). However, without subsequent high quality preschool, children with high quality infant-toddler care will not have higher cognitive and…

  3. The Effectiveness of Coursework and Onsite Coaching at Improving the Quality of Care in Infant-Toddler Settings

    ERIC Educational Resources Information Center

    Moreno, Amanda J.; Green, Sheridan; Koehn, Jo

    2015-01-01

    Research Findings: This study evaluated the effectiveness of 2 professional development interventions aimed at improving the quality of care provided by caregivers in ordinary infant-toddler child care settings, both center- and home-based. In all, 183 participants in a community college course on infant-toddler theory and practice, an in-service…

  4. Quality Infant/Toddler Caregiving: Are There Magic Recipes?

    ERIC Educational Resources Information Center

    Honig, Alice Sterling

    1989-01-01

    Discusses ingredients of quality infant/toddler caregiving; these include individualized attentive loving, respect for children's tempos and exploration needs, language mastery experiences, activities shared by caregiver and child, nutrition and health care, promotion of babies' altruism, continuity of care and cognitive facilitation. (BB)

  5. Concepts for Care: 20 Essays on Infant/Toddler Development and Learning

    ERIC Educational Resources Information Center

    Lally, J. Ronald, Ed.; Mangione, Peter L., Ed.; Greenwald, Deborah, Ed.

    2006-01-01

    Leading experts in infant/toddler development have contributed succinct essays drawn from research, theory, clinical case studies, and carefully documented practice. Each essay represents current thinking in the field of infant/toddler development and care. Individually and as a collection, the essays provide a springboard for reflection,…

  6. Comparisons of Observed Process Quality in German and American Infant/Toddler Programs

    ERIC Educational Resources Information Center

    Tietze, Wolfgang; Cryer, Debby

    2004-01-01

    Observed process quality in infant/toddler classrooms was compared in Germany (n = 75) and the USA (n = 219). Process quality was assessed with the Infant/Toddler Environment Rating Scale(ITERS) and parent attitudes about ITERS content with the ITERS Parent Questionnaire (ITERSPQ). The ITERS had comparable reliabilities in the two countries and…

  7. The Evaluation of Child Care Centers and the "Infant/Toddler Environment Rating Scale": An Environmental Critique.

    ERIC Educational Resources Information Center

    Moore, Gary T.

    This paper questions the physical environmental adequacy of the Infant/Toddler Environment Rating Scale (ITERS) developed by Thelma Harms, Debby Cryer, and Richard Clifford at the University of North Carolina, Chapel Hill. ITERS is a 35-item scale designed to assess the quality of center-based infant and toddler care, and one of a family of child…

  8. The Quality of the Physical Environment in Private and Public Infant/Toddler and Preschool Greek Day-Care Programmes

    ERIC Educational Resources Information Center

    Rentzou, Konstantina

    2014-01-01

    The physical environment of the preschool programmes has been proven to affect both children's overall development and the quality of the programme. However, both nationally and internationally the contribution of the physical environment in the effectiveness of a programme and in the achievement of educational goals is often overlooked. The…

  9. The Quality of the Physical Environment in Private and Public Infant/Toddler and Preschool Greek Day-Care Programmes

    ERIC Educational Resources Information Center

    Rentzou, Konstantina

    2014-01-01

    The physical environment of the preschool programmes has been proven to affect both children's overall development and the quality of the programme. However, both nationally and internationally the contribution of the physical environment in the effectiveness of a programme and in the achievement of educational goals is often overlooked. The

  10. La investigacion sobre la calidad de los programas para ninos de hasta dos anos de edad (Research on Quality in Infant-Toddler Programs). ERIC Digest.

    ERIC Educational Resources Information Center

    Honig, Alice Sterling

    Concern about the quality of infant-toddler care programs has grown recently in response to two factors. The first is the need of employed parents for such care, and the second is research emphasizing the importance of brain development in the early years. This Spanish-language Digest introduces some of the many issues related to the quality of…

  11. Making Connections: What Do Preschool Teachers Know about Infant/Toddler Care and Education?

    ERIC Educational Resources Information Center

    Gonzalez-Mena, Janet

    2011-01-01

    What do preschool teachers know about infant/toddler care and education? The answer to the question in the title is "Lots!" "if" they are fans of Lilian Katz. The author would not have said that before she sat down to read the new book Lilian wrote with her son Stephen. It's called "Intellectual Emergencies." It starts out with 12 of Lilian's

  12. Teacher-Child Interactions in Infant/Toddler Child Care and Socioemotional Development

    ERIC Educational Resources Information Center

    Mortensen, Jennifer A.; Barnett, Melissa A.

    2015-01-01

    Research Findings: The teacher-child relationships that develop in infant/toddler child care provide a critical caregiving context for young children's socioemotional development. However, gaps remain in researchers' understanding of the individual-level processes that facilitate socioemotional development, specifically in center-based…

  13. Program for Infant/Toddler Caregivers. Trainer's Manual, Module II: Group Care.

    ERIC Educational Resources Information Center

    Signer, Sheila M., Ed.; And Others

    This trainer's manual covers module II of the Program for Infant/Toddler Caregivers (PITC), a four-module video training course for providers of family and center day care. The manual is intended to be used by module instructors and includes an overview of the PITC and instructions for using the manual and its accompanying videos. The module…

  14. Making Connections: What Do Preschool Teachers Know about Infant/Toddler Care and Education?

    ERIC Educational Resources Information Center

    Gonzalez-Mena, Janet

    2011-01-01

    What do preschool teachers know about infant/toddler care and education? The answer to the question in the title is "Lots!" "if" they are fans of Lilian Katz. The author would not have said that before she sat down to read the new book Lilian wrote with her son Stephen. It's called "Intellectual Emergencies." It starts out with 12 of Lilian's…

  15. Promoting Change in State Policy Decisionmaking on Quality Infant/Toddler Child Care and Head Start Services: Study on a Technical Assistance Forum.

    ERIC Educational Resources Information Center

    Griffin, Abbey; Fiene, Richard

    In June 1991, the National Center for Clinical Infant Programs invited 320 state policymakers, leaders of national and state advocacy organizations, and practitioners to a technical assistance forum on "Finding and Funding Quality Child Care and Head Start Services for Infants and Toddlers." The forum focused on essential practices in high quality…

  16. Nap Schedules and Sleep Practices in Infant-Toddler Groups.

    ERIC Educational Resources Information Center

    Siren-Tiusanen, Helena; Robinson, Helja Antola

    2001-01-01

    Analyzed sleep-wake schedules and nap times in multiage infant-toddler groups through three case studies in Finnish day care centers. Found complex interactions among family daily patterns, day care patterns, and young children's sleep disturbances. Identified major differences in day care practices regarding sleep quality related to timing,

  17. Evaluation of Program for Infant/Toddler Care (PITC): An On-Site Training of Caregivers. Final Report. NCEE 2012-4003

    ERIC Educational Resources Information Center

    Weinstock, Phyllis; Bos, Johannes; Tseng, Fannie; Rosenthal, Emily; Ortiz, Lorena; Dowsett, Chantelle; Huston, Aletha; Bentley, Alison

    2012-01-01

    Little research has been conducted on the effectiveness of training strategies for child care providers. The current study used an experimental intent-to-treat design to measure the impact of an established intervention, the on-site caregiver training component of the Program for Infant/Toddler Care (PITC), on child development and child care…

  18. Infant-Toddler Child Care in the United States: Where Has It Been? Where Is It Now? Where Is It Going?

    ERIC Educational Resources Information Center

    Lally, J. Ronald

    2003-01-01

    The author summarizes trends in infant-toddler child care before 1960 and describes how interdisciplinary meetings on early development at the Mental Health Study Center of the National Institute of Mental Health in the 1970s led to the founding of The National Center for Clinical Infant Programs (now ZERO TO THREE) in 1977. Periodic legislative…

  19. Does Preschool Education Policy Impact Infant/Toddler Care? Preschool Policy Brief. Issue 20

    ERIC Educational Resources Information Center

    Ackerman, Debra J.; Barnett, W. Steven

    2009-01-01

    Finding affordable, high-quality child care for infants (children up to 12 months old) and toddlers (1- and 2-year-olds) can be difficult. As public support for the education and care of 3- and 4-year-olds has increased, questions have arisen about the extent this has helped or hurt the provision of care for young children. Concerns have been…

  20. Project CREATE: Bridging the Gap in Training for Infant/Toddler Child Care Providers.

    ERIC Educational Resources Information Center

    Buell, Martha; Hallam, Rena; Adams, Jennifer; Wilson, Kathy

    2000-01-01

    Describes Project CREATE (Caregiver Recruitment, Education, and Training Enhancement), designed to improve the quality of community-based child care programs in Delaware, and provided in three 1-credit modules at no cost to participants. Identifies barriers to providing education to infant and toddler caregivers. Presents preliminary evaluation…

  1. Zero to Three: National Center for Infants, Toddlers and Families

    MedlinePlus

    ... Kids™! Follow @ZEROTOTHREE - March 2016 Issue - Raising the Quality of Services for Infants, Toddlers, and Their Families The earliest ... have lasting effects on future development. Thus, high-quality services must be a priority for programs and professionals ...

  2. Infant/Toddler Day Care, Yes; BUT We'd Better Make It Good.

    ERIC Educational Resources Information Center

    Hignett, William F.

    1988-01-01

    Discusses some of the problems that infants and toddlers experience in infant and toddler day care programs, and suggests four program features that are vital in aiding infants and toddlers in the early years of care. (BB)

  3. Bambini: The Italian Approach to Infant/Toddler Care. Early Childhood Education Series.

    ERIC Educational Resources Information Center

    Gandini, Lella, Ed.; Edwards, Carolyn Pope, Ed.

    This book describes Italian experiences in providing early care and education, focusing on four cities--Milan, Parma, Reggio Emilia, and Pistoia--with outstanding city-run systems designed to serve children under 3 and their families. The book considers specific strategies or practices used, and interprets the significance of the Italian…

  4. Examining the Psychometric Properties of the Infant-Toddler Environment Rating Scale-Revised Edition in a High-Stakes Context

    ERIC Educational Resources Information Center

    Bisceglia, Rossana; Perlman, Michal; Schaack, Diana; Jenkins, Jennifer

    2009-01-01

    The psychometric properties of the Infant-Toddler Environment Rating Scale-Revised Edition (ITERS-R) were examined using 153 classrooms from child-care centers where resources were tied to center performance. An exploratory factor analysis revealed that the scale measures one global aspect of quality. To decrease redundancy, subsets of items were…

  5. Examining the Psychometric Properties of the Infant-Toddler Environment Rating Scale-Revised Edition in a High-Stakes Context

    ERIC Educational Resources Information Center

    Bisceglia, Rossana; Perlman, Michal; Schaack, Diana; Jenkins, Jennifer

    2009-01-01

    The psychometric properties of the Infant-Toddler Environment Rating Scale-Revised Edition (ITERS-R) were examined using 153 classrooms from child-care centers where resources were tied to center performance. An exploratory factor analysis revealed that the scale measures one global aspect of quality. To decrease redundancy, subsets of items were

  6. Program for Infant/Toddler Caregivers. Infant/Toddler Caregiving: A Guide to Cognitive Development and Learning.

    ERIC Educational Resources Information Center

    Mangione, Peter L., Ed.

    This guide is intended to be used in conjunction with the third module of the Program for Infant/Toddler Caregivers (PITC), a four-module video training course for providers of family and center day care. The videos illustrate key concepts and caregiving techniques for a specific area of care, and the guides provide extensive in-depth coverage of…

  7. Setting Up for Infant/Toddler Care: Guidelines for Centers and Family Child Care Homes. Revised Edition.

    ERIC Educational Resources Information Center

    Godwin, Annabelle; Schrag, Lorraine

    With increasing numbers of infants in need of child care, the demand for infant care programs has grown. This handbook was designed to meet the need for technical assistance regarding program components and workable practices geared specifically to infant and toddler care. Part 1 of the handbook, "Considerations in Infant and Toddler Care,"…

  8. The Science and Psychology of Infant-Toddler Care: How an Understanding of Early Learning Has Transformed Child Care

    ERIC Educational Resources Information Center

    Lally, J. Ronald

    2009-01-01

    Recent research on how infants and toddlers grow and learn has provided new evidence for creating child care practices that support healthy development. The author describes 6 program practices drawn from this research. The article discusses practices that support secure attachments, identity formation, family practices, attention to developmental…

  9. This Will Be Her Last Day: Supporting Infants, Toddlers, and Their Families as They Transition Out of Child Care

    ERIC Educational Resources Information Center

    Parlakian, Rebecca; Adams, Emily

    2010-01-01

    ZERO TO THREE's 2009 parent survey, "Parenting Infants and Toddlers Today," revealed that 25% of all parents surveyed had experienced child care-related hardships as a result of the recent economic downturn. The result is a significant number of children who are experiencing changes in their child care arrangements. Transitions into, and out of,…

  10. Babies (and Their Families) on Board! Directors Juggle the Key Elements of Infant/Toddler Care and Education

    ERIC Educational Resources Information Center

    McMullen, Mary Benson; Apple, Peggy

    2012-01-01

    Early childhood programs with infants and toddlers are bustling and alive in ways different from programs that have only preschoolers. Infants and toddlers can make group care environments more caring and family focused spaces, nurturing the well-being of all adults and children participating in the program. The number of infants and toddlers who…

  11. Quality Child Care for Infants and Toddlers: Case Studies of Three Community Strategies. Final Report.

    ERIC Educational Resources Information Center

    Paulsell, Diane; Nogales, Renee; Cohen, Julie

    To address the increasing child care needs of low-income families in the wake of welfare reform, federal and state governments have responded with increased funding for child care and for initiatives to improve quality. Some of these initiatives have been designed specifically to address the unique challenges of infant-toddler care. This report…

  12. Child Care Quality in the Netherlands over the Years: A Closer Look

    ERIC Educational Resources Information Center

    Helmerhorst, Katrien O. W.; Riksen-Walraven, J. Marianne A.; Gevers Deynoot-Schaub, Mirjam J. J. M.; Tavecchio, Louis W. C.; Fukkink, Ruben G.

    2015-01-01

    Research Findings: We assessed the quality of child care in a nationally representative sample of 200 Dutch child care centers using the Infant/Toddler Environment Rating Scale-Revised and/or Early Childhood Environment Rating Scale-Revised and compared it with a previous assessment in 2005. The Caregiver Interaction Profile (CIP) scales were used…

  13. Infants, Toddlers, and Terror: Supporting Parents, Helping Children.

    ERIC Educational Resources Information Center

    Fenichel, Emily, Ed.

    2002-01-01

    "Zero to Three" is a single-focus bulletin of the National Center for Infants, Toddlers, and Families providing insight from multiple disciplines on the development of infants, toddlers, and their families. Responding to family needs in the wake of September 11, 2001 terrorist attacks, this issue focuses on infants, toddlers, and terror. Articles…

  14. Celebrating 25 Years of Working with Infants, Toddlers, and Families.

    ERIC Educational Resources Information Center

    Fenichel, Emily, Ed.

    2003-01-01

    "Zero to Three" is a single-focus bulletin of the National Center for Infants, Toddlers, and Families providing insight from multiple disciplines on the development of infants, toddlers, and their families. This issue focuses on the organization's 25 years of working with infants, toddlers, and families. The articles are as follows: (1) "Hope Is a

  15. Towards a Predictive Model of Quality in Canadian Child Care Centers

    ERIC Educational Resources Information Center

    Goelman, Hillel; Forer, Barry; Kershaw, Paul; Doherty, Gillian; Lero, Donna; LaGrange, Annette

    2006-01-01

    This paper reports on the design, methodology, and results of a study of quality in 326 classrooms in 239 Canadian child care centers. This study, the largest and most extensive ever undertaken in Canada, used the Caregiver Interaction Scale (CIS) to rate the adult-child interactions in the classrooms and the Infant-Toddler Environment Rating

  16. Towards a Predictive Model of Quality in Canadian Child Care Centers

    ERIC Educational Resources Information Center

    Goelman, Hillel; Forer, Barry; Kershaw, Paul; Doherty, Gillian; Lero, Donna; LaGrange, Annette

    2006-01-01

    This paper reports on the design, methodology, and results of a study of quality in 326 classrooms in 239 Canadian child care centers. This study, the largest and most extensive ever undertaken in Canada, used the Caregiver Interaction Scale (CIS) to rate the adult-child interactions in the classrooms and the Infant-Toddler Environment Rating…

  17. Quality of Care and Education Provided by Greek Day-Care Centres: An Approach from Researcher's and Early Childhood Educators' Perspective

    ERIC Educational Resources Information Center

    Rentzou, Konstantina

    2012-01-01

    The present study is aimed at examining the level of quality and care provided by Greek preschool programmes, from the researcher's and early childhood educators' perspectives and verify whether they evaluate with the same way. Research results indicate that according to the researcher's assessment both preschool and infant/toddler classrooms…

  18. Child Care under Pressure: The Quality of Dutch Centers in 1995 and in 2001

    ERIC Educational Resources Information Center

    Deynoot-Schaub, Mirjam J. J. M. Gevers; Riksen-Walraven, J. Marianne

    2005-01-01

    In 2001, the authors assessed the quality of care provided to children in 51 care groups from 39 child-care centers in The Netherlands using the Infant/Toddler Environment Rating Scale (T. Harms, D. Cryer, & R. M. Clifford, 1990) and compared the results with the quality of child care assessed in 1995 (M. H. van IJzendoorn, L. W. C. Tavecchio, G.…

  19. Rocking and Rolling: Supporting Infants, Toddlers, and Their Families. New Year's Resolutions for Infant/Toddler Teachers

    ERIC Educational Resources Information Center

    Britt, Donna R.; Gillespie, Linda Groves

    2008-01-01

    Britt and Gillespie make suggestions for teachers' professional New Year's resolutions, including challenging oneself. They include a collection of resources and urge teachers to join NAEYC's Infant/Toddler Professionals Interest Forum. (Contains 27 resources.)

  20. Quality Childcare Top Priority in South Dakota

    ERIC Educational Resources Information Center

    Daniels, Ann Michelle; Wilson, Ann

    2005-01-01

    The importance of quality care for infants, toddlers, and young children continues to be emphasized. The Frank Porter Graham Child Development Center provided data that support the importance of quality childcare. Their longitudinal study showed that infants who received quality care were more likely to score higher on IQ, reading, and math tests,

  1. Quality Childcare Top Priority in South Dakota

    ERIC Educational Resources Information Center

    Daniels, Ann Michelle; Wilson, Ann

    2005-01-01

    The importance of quality care for infants, toddlers, and young children continues to be emphasized. The Frank Porter Graham Child Development Center provided data that support the importance of quality childcare. Their longitudinal study showed that infants who received quality care were more likely to score higher on IQ, reading, and math tests,…

  2. A Mixed Methods Investigation of Maternal Perspectives on Transition Experiences in Early Care and Education

    ERIC Educational Resources Information Center

    Swartz, Rebecca Anne; Speirs, Katherine Elizabeth; Encinger, Amy Johnson; McElwain, Nancy L.

    2016-01-01

    Research Findings: Strong relationships among children, families, and early care and education (ECE) providers are key to quality infant-toddler care. These relationships are shaped during the initial transition period to group care. We used a mixed methods approach to (a) assess maternal perspectives on the transition to group care, (b) explore

  3. A Mixed Methods Investigation of Maternal Perspectives on Transition Experiences in Early Care and Education

    ERIC Educational Resources Information Center

    Swartz, Rebecca Anne; Speirs, Katherine Elizabeth; Encinger, Amy Johnson; McElwain, Nancy L.

    2016-01-01

    Research Findings: Strong relationships among children, families, and early care and education (ECE) providers are key to quality infant-toddler care. These relationships are shaped during the initial transition period to group care. We used a mixed methods approach to (a) assess maternal perspectives on the transition to group care, (b) explore…

  4. Quality Curriculum for Under-Threes: The Impact of Structural Standards

    ERIC Educational Resources Information Center

    Wertfein, Monika; Spies-Kofler, Anita; Becker-Stoll, Fabienne

    2009-01-01

    The purpose of this study conducted in 36 infant-toddler centres ("Kinderkrippen") in the city of Munich in Bavaria/Germany was to explore structural characteristics of early child care and education and their effects on child care quality. Stepwise regressions and variance analysis (Manova) examined the relation between quality of care and…

  5. My Vision for Infants, Toddlers, and Their Families

    ERIC Educational Resources Information Center

    Dodd, Christopher J.; Castle, Michael N.

    2006-01-01

    Two members of the U.S. Congress share their visions for infants, toddlers, and families. Senator Christopher Dodd (D-CT), Ranking Member of the Subcommittee on Education and Early Childhood Development, Senate Committee on Health, Education, Labor, and Pensions, advocates shifting priorities and resources toward young children and families and…

  6. The Development of Play in Infants, Toddlers, and Young Children.

    ERIC Educational Resources Information Center

    Casby, Michael W.

    2003-01-01

    The first of two articles on play reviews the development of play in typically developing infants, toddlers, and young children, including Piaget's observations on the development of play; developmental play research following Piaget (research by Lunzer, Sinclair, Lezine, Lowe, Rosenblatt, Uzgiris and Hunt, Fenson and others, Watson and Fischer,…

  7. [Training Practitioners to Work with Infants, Toddlers and Their Families].

    ERIC Educational Resources Information Center

    Pawl, Jeree, Ed.; And Others

    1989-01-01

    This newsletter theme issue focuses on the training of practitioners to work with infants, toddlers, and their families with emphasis on the activities of the TASK (Training Approaches for Skills and Knowledge) Project of the National Center for Clinical Infant Programs. The TASK project addresses the concerns of four "stakeholder" groups:

  8. Leavetakings and Reunions of Infants, Toddlers, Preschoolers and Their Parents.

    ERIC Educational Resources Information Center

    Field, Tiffany; And Others

    The leavetakings and reunions of infants, toddlers, preschoolers, and their parents were observed as 56 children were dropped off and picked up at nursery school. During the pilot phase of the study, shorthand running records were made of the behaviors of each child and his or her parent for all of their leavetaking and reunion episodes. From 100

  9. Accessing Programs for Infants, Toddlers, and Preschoolers with Disabilities.

    ERIC Educational Resources Information Center

    Horne, Richard, Ed.

    1990-01-01

    Intended for use by parents of infants, toddlers and preschoolers, this guide presents, in question and answer format, basic information about early intervention and special education services. Questions about services for the period from birth through 2 years include the following: "What are early intervention services?""What is an assessment?"

  10. Quality in Inclusive and Noninclusive Infant and Toddler Classrooms

    ERIC Educational Resources Information Center

    Hestenes, Linda L.; Cassidy, Deborah J.; Hegde, Archana V.; Lower, Joanna K.

    2007-01-01

    The quality of care in infant and toddler classrooms was compared across inclusive (n=64) and noninclusive classrooms (n=400). Quality was measured using the Infant/Toddler Environment Rating Scale-Revised (ITERS-R). An exploratory and confirmatory factor analysis revealed four distinct dimensions of quality within the ITERS-R. Inclusive…

  11. Quick Quality Check for Infant and Toddler Programs.

    ERIC Educational Resources Information Center

    Knoll, Michelle; O'Brien, Marion

    Intended for use by childcare center directors, this guide presents the Quick Quality Check, a practical method for measuring and improving the quality of care in infant/toddler classrooms. The four chapters of the guide discuss the specifics of the Quick Quality Check method for both infants and toddlers, including the instrument development, as…

  12. Teacher-Child Interactions during Mealtimes: Observations of Toddlers in High Subsidy Child Care Settings

    ERIC Educational Resources Information Center

    Hallam, Rena A.; Fouts, Hillary N.; Bargreen, Kaitlin N.; Perkins, Kelley

    2016-01-01

    In the U.S., experiences of infants and toddlers in group care are often overshadowed by the policy and research focus on preschool education just prior to formal school entry. When infant-toddler care is studied, it is often described relative to the global quality of classroom environments. Little research has focused on the day-to-day…

  13. Assessing Quality in Toddler Classrooms Using the CLASS-Toddler and the ITERS-R

    ERIC Educational Resources Information Center

    La Paro, Karen M.; Williamson, Amy C.; Hatfield, Bridget

    2014-01-01

    Many very young children attend early care and education programs, but current information about the quality of center-based care for toddlers is scarce. Using 2 observation instruments, the Infant/Toddler Environment Rating Scale-Revised (ITERS-R) and the Classroom Assessment Scoring System, Toddler Version (CLASS-Toddler), 93 child care…

  14. Routines and Rituals in the Lives of Infants, Toddlers, and Families.

    ERIC Educational Resources Information Center

    Fenichel, Emily, Ed.

    2002-01-01

    "Zero to Three" is a single-focus bulletin of the National Center for Infants, Toddlers, and Families providing insight from multiple disciplines on the development of infants, toddlers, and their families. Noting that during the earliest years of life, much of children's learning about themselves and the world around them occurs in connection…

  15. Infant-Toddler Teachers Can Successfully Employ Authentic Assessment: The "Learning through Relating" System

    ERIC Educational Resources Information Center

    Moreno, Amanda J.; Klute, Mary M.

    2011-01-01

    This study documents the reliability and validity of a new infant-toddler authentic assessment, the Learning Through Relating Child Assets Record (LTR-CAR), and its feasibility of use by infant-toddler caregivers in an Early Head Start program. In a sample of 136 children, results indicated a strong internal structure of the LTR-CAR as evidenced…

  16. Infant-Toddler Teachers Can Successfully Employ Authentic Assessment: The "Learning through Relating" System

    ERIC Educational Resources Information Center

    Moreno, Amanda J.; Klute, Mary M.

    2011-01-01

    This study documents the reliability and validity of a new infant-toddler authentic assessment, the Learning Through Relating Child Assets Record (LTR-CAR), and its feasibility of use by infant-toddler caregivers in an Early Head Start program. In a sample of 136 children, results indicated a strong internal structure of the LTR-CAR as evidenced

  17. Diversity and Infant/Toddler Caregiving.

    ERIC Educational Resources Information Center

    Gonzalez-Mena, Janet; Bhavnagri, Navaz Peshotan

    2000-01-01

    Discusses the importance of cultural sensitivity and specific cultural knowledge when providing care for infants and toddlers. Makes suggestions for responding to cultural differences. Describes dialogue and reflective-thinking strategies for identifying and responding to cultural differences. Asserts that caregivers need diversity training to see…

  18. Routines. Infant/Toddler Caregiving: A Guide.

    ERIC Educational Resources Information Center

    Gonzalez-Mena, Janet

    Intended for use in conjunction with videos illustrating key concepts and caregiving techniques, this guide focuses on how the daily routines of caring for infants and toddlers can become opportunities for promoting the child's learning and development and for deepening the relationship between child and caregiver. Special attention is given to…

  19. Recent Infant/Toddler Researches: A Helpful Guide for Caregivers.

    ERIC Educational Resources Information Center

    Honig, Alice Sterling; Wittmer, D. S.

    Designed for child caregivers, this guide to research on infants and toddlers offers references to works that provide reasons for high quality care and increase caregivers' understanding of ways to facilitate the optimal development of babies. Citations concern abuse, attachment, caregiver role, child care effects, child care quality, child…

  20. Zero to Three: National Center for Infants, Toddlers and Families

    MedlinePlus

    ... All Early Learning Child Care Early Literacy Early Math and Science Language and Communication Play School Readiness ... Quality Child Care Infographic Series Let's Talk About Math: Early Math Video Series 7 Dec Event Annual ...

  1. Comparison of ICD-10 and DC: 0-3R Diagnoses in Infants, Toddlers and Preschoolers

    ERIC Educational Resources Information Center

    Equit, Monika; Paulus, Frank; Fuhrmann, Pia; Niemczyk, Justine; von Gontard, Alexander

    2011-01-01

    The purpose of this study was to analyze and compare diagnoses of patients from a special outpatient department for infants, toddlers and preschoolers. Specifically, overlap, age and gender differences according to the two classification systems DC: 0-3R and ICD-10 were examined. 299 consecutive children aged 0-5;11 years received both ICD-10 and…

  2. Comparison of ICD-10 and DC: 0-3R Diagnoses in Infants, Toddlers and Preschoolers

    ERIC Educational Resources Information Center

    Equit, Monika; Paulus, Frank; Fuhrmann, Pia; Niemczyk, Justine; von Gontard, Alexander

    2011-01-01

    The purpose of this study was to analyze and compare diagnoses of patients from a special outpatient department for infants, toddlers and preschoolers. Specifically, overlap, age and gender differences according to the two classification systems DC: 0-3R and ICD-10 were examined. 299 consecutive children aged 0-5;11 years received both ICD-10 and

  3. Rocking & Rolling: Supporting Infants, Toddlers, and Their Families. One Language, Two Languages, Three Languages . . . More?

    ERIC Educational Resources Information Center

    Prieto, H. Victoria

    2009-01-01

    The belief that a child has to abandon his home language to learn English implies that the young brain has limited learning capacity. Early childhood teachers need to help families understand that children can learn two languages at the same time. What matters is that the infant/toddler is in an effective language-learning environment, whether it

  4. Improving Learning Environment for Infant/Toddler and Preschool Children through Planning a Developmentally Oriented Playground.

    ERIC Educational Resources Information Center

    Stewart, Ruth L.

    A preschool director designed an outdoor playground for 115 infants, toddlers, and preschoolers attending an early childhood center operated by a graduate theological seminary. Based on a review of the relevant literature on different aspects of outdoor play, the design reflected a playground that: (1) integrated outdoor play area with indoor…

  5. Nutrient intakes of US infants, toddlers, and preschoolers meet or exceed dietary reference intakes

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The objective of the study reported here was to assess the usual nutrient intakes of 3,273 US infants, toddlers, and preschoolers, aged 0 to 47 months, who were surveyed in the Feeding Infants and Toddlers Study (FITS) 2008; and to compare data on the usual nutrient intakes for the two waves of FITS...

  6. Social Situation of Development: Parents Perspectives on Infants-Toddlers' Concept Formation in Science

    ERIC Educational Resources Information Center

    Sikder, Shukla

    2015-01-01

    The social situation of development (SSD) specific to each age determines regularly the whole picture of the child's life. Therefore, we need to learn about the whole context surrounding children relevant to their development. The focus of the study is to understand parent's views on infant-toddler's science concept formation in the family…

  7. Annotated Infant/Toddler/Preschooler Research References: Stories Caregivers Need To Know!

    ERIC Educational Resources Information Center

    Honig, Alice Sterling

    This paper annotates research "stories" on the development of infants, toddlers, and preschoolers and is intended to be used by early childhood professionals as a basis for teaching parenting courses and helping families in stressful situations. The references are organized by topic area: (1) child abuse; (2) attachment; (3) fathering; (4) infant

  8. Rethinking Attachment: Fostering Positive Relationships between Infants, Toddlers and Their Primary Caregivers

    ERIC Educational Resources Information Center

    Ebbeck, Marjory; Yim, Hoi Yin Bonnie

    2009-01-01

    This article provides a synthesis of current theory and research in relation to attachment between infants/toddlers and their caregivers. Worldwide statistics show that there are a significant number of women working in the global labour market. In Australia, recent research also found that over 300,000 children aged 0-5 years are currently

  9. Rethinking Attachment: Fostering Positive Relationships between Infants, Toddlers and Their Primary Caregivers

    ERIC Educational Resources Information Center

    Ebbeck, Marjory; Yim, Hoi Yin Bonnie

    2009-01-01

    This article provides a synthesis of current theory and research in relation to attachment between infants/toddlers and their caregivers. Worldwide statistics show that there are a significant number of women working in the global labour market. In Australia, recent research also found that over 300,000 children aged 0-5 years are currently…

  10. Rocking & Rolling: Supporting Infants, Toddlers, and Their Families. One Language, Two Languages, Three Languages . . . More?

    ERIC Educational Resources Information Center

    Prieto, H. Victoria

    2009-01-01

    The belief that a child has to abandon his home language to learn English implies that the young brain has limited learning capacity. Early childhood teachers need to help families understand that children can learn two languages at the same time. What matters is that the infant/toddler is in an effective language-learning environment, whether it…

  11. Infant, Toddler, and Preschool Research and Intervention Project Report--Year III.

    ERIC Educational Resources Information Center

    Bricker, Diane; Bricker, William

    Presented in the third year report of the Infant, Toddler, and Preschool Research and Intervention Project *Nashville, Tennessee) are discussions on theoretical applications, educational services provided for 75 6-month to 6-year-old children and their families, and teacher training procedures; and 12 research summaries. Discussed is the project's

  12. State and Community Policy Roundup: Progress on Infant-Toddler Issues across the United States

    ERIC Educational Resources Information Center

    DiLauro, Elizabeth; Jones, Lynn; Nelson, Florence

    2007-01-01

    This article summarizes state and community policy activities during the first six months of 2007 and provides updates of the progress to serve infants, toddlers, and their families. The following states are included in the report: (1) Arkansas; (2) California; (3) Indiana; (4) Iowa; (5) Michigan; (6) Minnesota; (7) New York; (8) Ohio; (9)…

  13. Quality documentation. Quality care.

    PubMed

    Peters, D A

    1988-10-01

    Providing home care services is becoming a greater challenge as the resources of professional staffing, time, and money become more scarce. However, simultaneously, the need for quality services is increasing as the numbers and needs of people requiring these services increase. Since home care services are essentially "invisible" because they are rendered behind the closed doors of the patient's house, assuring quality becomes dependent on the documentation. This article has presented a framework for organizing care and the documentation of care which provides both a comprehensive assessment and systematic process for uniformly managing that assessment. Us of this framework provides one way to define home health services for both home health personnel and others. Having such a definition focuses everyone's efforts and moves the industry toward quality care and quality documentation. PMID:10290325

  14. Implementing psychiatric day treatment for infants, toddlers, preschoolers and their families: a study from a clinical and organizational perspective

    PubMed Central

    2013-01-01

    Background An increasing number of empirical studies indicate that infants, toddlers and preschoolers may suffer from non-transient mental illnesses featuring developmental psychopathology. A few innovative child psychiatric approaches have been developed to treat infants, toddlers and preschoolers and their families, but have not yet been conceptually presented and discussed in the framework of different healthcare systems. The organizational and clinical experience gained while developing specific approaches may be important across disciplines and guide future developments in psychiatric treatment of infants, toddlers, preschoolers and their families. Results This article introduces the Preschool Family Day Hospital for Infants, Toddlers and Preschoolers and their Families at Münster University Hospital, Germany. This hospital is unique in the German healthcare system with regard to its social-service institution division of labor. Specifically, it uses an intermittent treatment approach and an integrated interactional family psychiatric approach to treat children and their parents as separate patients. This multidisciplinary, developmentally and family-oriented approach includes components of group treatments with children and separate treatments with parents. Specific techniques include video-assisted treatments of the parent–child interaction, psychiatric and psychotherapeutic treatments for parents, and conjoint family therapies that include both parents and siblings. Conclusions The Family Day Hospital for infants, toddlers and preschoolers and their families offers innovative family-oriented treatments for those who suffer from a wide range of severe child psychiatric disorders that cannot be sufficiently treated in outpatient settings. Treatment is based on the need for family-oriented approaches to the early psychiatric treatment of infants, toddlers and preschoolers. Family day hospitals are an innovative approach to preschool child psychiatry that requires further evaluation. PMID:23601961

  15. Suggested Equipment and Supplies for Infant - Toddler Center.

    ERIC Educational Resources Information Center

    Mazyck, Aurelia

    A list of equipment and supplies useful in the daytime care of infants and toddlers is presented. This equipment is in use at an all-day care center for 15 infants and 10-12 toddlers. The following types of items are listed: furnishings, linens, toys for motor activities, manipulative toys, crib toys, outdoor play equipment, books, phonograph…

  16. Screening Accuracy for Risk of Autism Spectrum Disorder Using the Brief Infant-Toddler Social and Emotional Assessment (BITSEA)

    ERIC Educational Resources Information Center

    Gardner, Lauren M.; Murphy, Laura; Campbell, Jonathan M.; Tylavsky, Frances; Palmer, Frederick B.; Graff, J. Carolyn

    2013-01-01

    Early identification of autism spectrum disorders (ASDs) is facilitated by the use of standardized screening scales that assess the social emotional behaviors associated with ASD. Authors examined accuracy of Brief Infant-Toddler Social and Emotional Assessment (BITSEA) subscales in detecting Modified Checklist for Autism in Toddlers (M-CHAT) risk…

  17. Scaffolding, Analysis and Materials: Contributing Factors in an Unexpected Finding of Advanced Infant/Toddler Pretend Play?

    ERIC Educational Resources Information Center

    Morrissey, Anne-Marie

    2014-01-01

    As part of a longitudinal study, infant/toddler pretend play development and maternal play modelling were investigated in dyadic context. A total of 21 children were videotaped in monthly play sessions with their mothers, from age 8 to 17 months. Child and mother pretend play frequencies and levels were measured using Brown's Pretend Play…

  18. [Working with Infants, Toddlers, and Families in Rural Areas.

    ERIC Educational Resources Information Center

    Fenichel, Emily, Ed.

    1995-01-01

    This newsletter theme issue focuses on providing services to infants with special needs in rural areas. In "Old Threads, New Patterns: Reaching Out to Rural Families," Deborah Harris-Usner discusses bringing infant mental health care and parent-infant psychotherapy to rural New Mexico. In "The People of Kids Place: Creating and Maintaining…

  19. Infants & Toddlers: How Babies Use Gestures to Communicate

    ERIC Educational Resources Information Center

    Honig, Alice Sterling

    2004-01-01

    Evolution has provided babies with wonderful ways to get the loving attention and care that they need from adults. When a baby is distressed, his cry is the most primitive and powerful tool for bringing help. By the time a baby is 2 or 3 months old, his dazzling smile and crooked grin evokes tenderness, smiles, and nurturance from adults who are…

  20. Infant/Toddler Caregiving: A Guide to Routines. Second Edition.

    ERIC Educational Resources Information Center

    Gonzalez-Mena, Janet

    Intended for use in conjunction with videos illustrating key concepts and caregiving techniques, this guide focuses on how the daily routines of caring for infants and toddlers can become opportunities for promoting the child's learning and development and for deepening the relationship between child and caregiver. Special attention is given to…

  1. Infants & Toddlers "What's Going On? How to Hold Squriming Babies

    ERIC Educational Resources Information Center

    Honig, Alice Sterling

    2005-01-01

    Using Simple strategies, caregivers can learn to effectively communicate with infants through touch. This article offers suggestions and techniques for calming squirming babies of all types and ages who seem to be unable to find a comfortable position while being held. She begins by suggesting that care givers of very small babies be patient and…

  2. Genetic and Environmental Influences on Socio-Emotional Behavior in Toddlers: An Initial Twin Study of the Infant-Toddler Social and Emotional Assessment

    ERIC Educational Resources Information Center

    Van Hulle, C. A.; Lemery-Chalfant, K.; Goldsmith, H. H.

    2007-01-01

    Background: Relatively little is known about the genetic architecture of childhood behavioral disorders in very young children. Method: In this study, parents completed the Infant-Toddler Social and Emotional Assessment, a questionnaire that assesses symptoms of childhood disorders, as well as socio-emotional competencies, for 822 twin pairs…

  3. Child Care for Infants and Toddlers and During Non-traditional Hours. Child Care Action Campaign. Issue Brief #9.

    ERIC Educational Resources Information Center

    Child Care Action Campaign, New York, NY.

    The Child Care Action Campaign (CCAC) hosted an audioconference on December 8, 1997 to examine strategies to expand and improve family child care to meet the increased need for infant/toddler care and care during non-traditional hours. This issue brief summarizes the audioconference's presentations. Presenters were Julie Rogers, special projects…

  4. Secure Relationships: Nurturing Infant/Toddler Attachment in Early Care Settings.

    ERIC Educational Resources Information Center

    Honig, Alice Sterling

    Noting that research and clinical findings confirm the connection to later emotional well-being of a secure attachment between each infant or young child and a warm, stable adult, this book addresses aspects of attachment important for caregivers of infants and toddlers. The book focuses on those aspects of attachment caregivers need to understand

  5. Identifying health care quality attributes.

    PubMed

    Ramsaran-Fowdar, Roshnee R

    2005-01-01

    Evaluating health care quality is important for consumers, health care providers, and society. Developing a measure of health care service quality is an important precursor to systems and organizations that value health care quality. SERVQUAL has been proposed as a broad-based measure of service quality that may be applicable to health care settings. Results from a study described in this paper verify SERVQUAL dimensions, but demonstrate additional dimensions that are specific to health care settings. PMID:16318013

  6. Child Care Health Connections, 2001: A Health and Safety Newsletter for California Child Care Professionals.

    ERIC Educational Resources Information Center

    Walery, Nancy, Ed.; Evinger, Sara, Ed.; Dailey, Lyn, Ed.; Zamani, Rahman, Ed.; Guralnick, Eva, Ed.

    2001-01-01

    This document is comprised of the six 2001 issues of a bimonthly newsletter providing information on young children's health and safety for California's child care professionals. Regular features include a column on infant/toddler concerns, a question-answer column regarding medical and health issues, and resources for child care providers.

  7. Diarrhea & Child Care: Controlling Diarrhea in Out-of-Home Child Care. NCEDL Spotlights, No. 4.

    ERIC Educational Resources Information Center

    Churchill, Robin B.; Pickering, Larry K.

    This report, the fourth in the National Center for Early Development and Learning's (NCEDL) "Spotlights" series, is based on excerpts from a paper presented during a "Research into Practice in Infant/Toddler Care" synthesis conference in fall 1997. The report addresses controlling diarrhea in out-of-home child care. The report notes that the rate…

  8. Who's Vulnerable in Infant Child Care Centers?

    ERIC Educational Resources Information Center

    Kendall, Earline D.; Moukaddem, Virginia E.

    1992-01-01

    Maintains that infants and toddlers, parents, and child caregivers are vulnerable to a variety of infectious diseases from infant-toddler child care centers. These diseases include infectious diarrhea; rubella; cytomeglovirus; hepatitis A, and haemophilus influenza type B. Suggests ways to prevent the spread of such diseases. (BB)

  9. Child Care Health Connections, 1999: A Health and Safety Newsletter for California Child Care Professionals.

    ERIC Educational Resources Information Center

    Walery, Nancy, Ed.; Evinger, Sara, Ed.; Dailey, Lyn, Ed.; Sherman, Marsha, Ed.; Zamani, Rahman, Ed.

    1999-01-01

    This document is comprised of the six 1999 issues of a bimonthly newsletter providing information on young children's health and safety for California's child care professionals. Regular features include a column on infant/toddler concerns, a question-answer column regarding medical and health issues, a nutrition column, and resources for child…

  10. Child Care Health Connections, 2000: A Health and Safety Newsletter for California Child Care Professionals.

    ERIC Educational Resources Information Center

    Walery, Nancy, Ed.; Evinger, Sara, Ed.; Dailey, Lyn, Ed.; Sherman, Marsha, Ed.; Zamani, Rahman, Ed.

    2000-01-01

    This document is comprised of the six 2000 issues of a bimonthly newsletter providing information on young children's health and safety for California's child care professionals. Regular features include a column on infant/toddler concerns, a question-answer column regarding medical and health issues, a nutrition column, and resources for child…

  11. Character Development: Encouraging Self-Esteem & Self-Discipline in Infants, Toddlers, and Two-Year-Olds.

    ERIC Educational Resources Information Center

    Greenberg, Polly

    With the goal of maintaining settings most conducive to helping each child develop optimally, the essays in this book delve into realistic ways in which child care providers can move from providing inadequate or merely adequate day care to providing high quality center-based or family child care. Most of the 12 essays begin with a question or…

  12. Family Day Care: How to Provide it in Your Home.

    ERIC Educational Resources Information Center

    Squibb, Betsy

    Tips, recommendations, ideas, and background information are offered to providers of family day care. After a brief discussion of licensing and registration and a listing of learning activities for young children at home, additional learning activities and materials are described that are considered appropriate for infants, toddlers, preschool

  13. Respiratory Infections: Respiratory Infections Challenge Child Care Centers. NCEDL Spotlights, No. 5.

    ERIC Educational Resources Information Center

    Collier, Albert M.; Henderson, Frederick W.

    This report, the fifth in the National Center for Early Development & Learning's (NCEDL) "Spotlight" series, is based on excerpts from a paper presented during the "Research into Practice in Infant/Toddler Care" synthesis conference in fall 1997. The report addresses preventing respiratory infections in child care centers. Findings on the subject…

  14. Can I Love This Place? A Staff Guide to Operating Child Care Centers for the Disadvantaged.

    ERIC Educational Resources Information Center

    McKee, Charles J. L., Ed.; Weil, Linn B., Ed.

    This staff guide is directed to individuals or groups who are interested in the establishment and operation of child care centers for disadvantaged children and includes discussions of staff schedules, duties, supplies, health and safety. The first section deals with daily routines and discusses care for infants, toddlers, pre-school and

  15. Service quality in health care.

    PubMed

    Kenagy, J W; Berwick, D M; Shore, M F

    1999-02-17

    Although US health care is described as "the world's largest service industry," the quality of service--that is, the characteristics that shape the experience of care beyond technical competence--is rarely discussed in the medical literature. This article illustrates service quality principles by analyzing a routine encounter in health care from a service quality point of view. This illustration and a review of related literature from both inside and outside health care has led to the following 2 premises: First, if high-quality service had a greater presence in our practices and institutions, it would improve clinical outcomes and patient and physician satisfaction while reducing cost, and it would create competitive advantage for those who are expert in its application. Second, many other industries in the service sector have taken service quality to a high level, their techniques are readily transferable to health care, and physicians caring for patients can learn from them. PMID:10029131

  16. Parents' and Teachers' Perceptions of Quality in Portuguese Childcare Classrooms

    ERIC Educational Resources Information Center

    Barros, Sílvia; Leal, Teresa B.

    2015-01-01

    The main goal of this study was to examine parents' and teachers' perceptions of quality in early childhood education for toddlers in Portugal. A total of 110 parents and 110 teachers participated in the study, rating the importance of specific quality criteria and assessing childcare classrooms, based on the Infant/Toddler Environment Rating…

  17. [Quality management in palliative care].

    PubMed

    Cottier, Christoph

    2012-02-01

    The author, former chief of a medical department and experienced in quality management, describes the development of quality standards by palliative ch, the Swiss Society for Palliative Care. These standards are the basis for explicit quality-criteria. The performance of an institution for palliative care is evaluated against these criteria, during an audit and peer review. Further information is given concerning the label Quality in Palliative Care. The author describes the importance oft the PDCA-cycle as an instrument for permanent improvement. Institutions with little experience in quality management are adviced to start on a smaller scale and use internal audits. Finally the author gives some thoughts as to the limitations of quality management in palliative care. PMID:22334204

  18. R.E.A.D.Y.: Read, Educate and Develop Youth. Reading Plan for Michigan: Parent Information for Infants, Toddlers, and Preschoolers. Learning Begins at Birth. [Kit with Videotape and Audiotape].

    ERIC Educational Resources Information Center

    Michigan Association for the Education of Young Children, East Lansing.

    Noting the important role that parents can play in preparing their child to learn to read, the Read, Educate and Develop Youth (READY) Reading Plan for Michigan provides kits to parents of infants, toddlers, and preschoolers. The kits contain suggestions for age-appropriate activities parents can do with their children to help them learn. In…

  19. A Pilot Longitudinal Follow-Up Study of the Brief Infant Toddler Social-Emotional Assessment (BITSEA) in Northern Finland: Examining Toddlers' Social-Emotional, Behavioural and Communicative Development

    ERIC Educational Resources Information Center

    Haapsamo, Helena; Kuusikko-Gauffin, Sanna; Carter, Alice S.; Pollock-Wurman, Rachel; Ebeling, Hanna; Joskitt, Leena; Larinen, Katja; Soini, Hannu; Pihlaja, Paivi; Moilanen, Irma

    2012-01-01

    Developmental needs should be assessed in early infancy and followed longitudinally to improve identification, prevention and intervention efforts.The objective was to examine the relationship between competencies and areas of need in toddlers' development, and to describe the properties and utility of the Brief Infant Toddler Social-Emotional…

  20. Professional Development Programs for Infant/Toddler Caregivers: Setting the Stage for Lifelong Learning

    ERIC Educational Resources Information Center

    Zwahr, Melissa D.; Davis, Caroline F.; Aviles, Jill; Buss, Kristen H.; Stine, Helen

    2007-01-01

    Increasingly, infants and toddlers in the United States are being cared for outside of the home and/or by extended family (Capizzano & Adams, 2000). This social and demographic change has placed an unprecedented level of responsibility on people other than family--caregivers--to provide a nurturing, stimulating, and safe environment that will meet…

  1. Zero to Three Classics: 7 Articles on Infant/Toddler Development.

    ERIC Educational Resources Information Center

    Fenichel, Emily, Ed.

    A search of requests for permission to photocopy articles from past issues of "Zero to Three" identified the seven articles of this collection, all published between 1985 and 1989. They deal with the care of typically developing infants and toddlers as well as with clinical practice with very young children with special health or developmental…

  2. An Infant/Toddler Program for High Risk Parents and Their Children.

    ERIC Educational Resources Information Center

    Minet, Selma B.

    A pilot program was designed to provide opportunities for a group of high-risk parents to improve their parenting. Specifically, the program provided a center in which teenage mothers could meet, share child-rearing problems, observe their children being cared for by trained personnel, interact with their children, and have opportunities for…

  3. The Gift of Grandparents: Supporting the Next Generation of Infants, Toddlers, and Families

    ERIC Educational Resources Information Center

    Bowman, Barbara; Weissbourd, Bernice

    2010-01-01

    The importance and influence of grandparents in the lives of infants and toddlers is reflected in the results of the recent ZERO TO THREE "Parenting Infants and Toddlers Today" survey. In this article, the authors explore the changing role of grandparents in today's society and how the quality of the relationships between grandparents and their…

  4. Sharing Books with Babies: Promoting Early Literacy in Early Care and Education. [Videotape].

    ERIC Educational Resources Information Center

    Boston Medical Center, MA. Doc4Kids Project.

    Suggesting that very young children spend every waking minute getting ready for kindergarten, this videotape for caregivers and early childhood teachers shows how to support early literacy skill development by sharing stories, relationships, and books with infants, toddlers, and preschoolers in care and education settings. The 25-minute videotape…

  5. Sharing Books with Babies: Promoting Early Literacy in Early Care and Education. [Videotape].

    ERIC Educational Resources Information Center

    Boston Medical Center, MA. Doc4Kids Project.

    Suggesting that very young children spend every waking minute getting ready for kindergarten, this videotape for caregivers and early childhood teachers shows how to support early literacy skill development by sharing stories, relationships, and books with infants, toddlers, and preschoolers in care and education settings. The 25-minute videotape

  6. 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

  7. Perspectives on Home Care Quality

    PubMed Central

    Kane, Rosalie A.; Kane, Robert L.; Illston, Laurel H.; Eustis, Nancy N.

    1994-01-01

    Home care quality assurance (QA) must consider features inherent in home care, including: multiple goals, limited provider control, and unique family roles. Successive panels of stakeholders were asked to rate the importance of selected home care outcomes. Most highly rated outcomes were freedom from exploitation, satisfaction with care, physical safety, affordability, and physical functioning. Panelists preferred outcome indicators to process and structure, and all groups emphasized “enabling” criteria. Themes highlighted included: interpersonal components of care; normalizing life for clientele; balancing quality of life with safety; developing flexible, negotiated care plans; mechanisms for accountability and case management. These themes were formulated differently according to the stakeholders' role. Providers preferred intermediate outcomes, akin to process. PMID:10140158

  8. Quality of Care: Local Variations.

    ERIC Educational Resources Information Center

    Gariboldi, Antonio; Livraghi, Paola

    Conducted in 1991, this study surveyed the quality of day care centers in the province of Pavia, Italy, in order to provide a description of the centers and to trace educational patterns in the infant, young toddler, and toddler sections of the centers. The 32 day care centers located in the province employ a staff of 342 and provide 1,700 places…

  9. Quality in Child Care Centers.

    ERIC Educational Resources Information Center

    ERS Spectrum, 1998

    1998-01-01

    A significant correlation exists between quality child care and outcomes. Quality-related outcomes include cooperative play, sociability, creativity, ability to solve social conflicts, self-control, and language and cognitive development. Legislatures and agencies should strengthen standards; require initial and ongoing staff training; recruit,…

  10. Bambini: Early Care in Education in Pistoia, Italy, A Child-Friendly City. [Videotape].

    ERIC Educational Resources Information Center

    Edwards, Carolyn Pope; Gandini, Lella; Peon-Casanova, Luis; Danielson, Jim

    Noting that Maria Montessori pioneered early childhood education (ECE) reform in Italy, and the surge in innovation in ECE after WWII, this videotape describes the early childhood system in the city of Pistoia, Italy, known for its high-quality and innovative services. The 30-minute video offers footage from 2 of the 9 full-day infant toddler

  11. The Professional Preparation of Early Care and Education Providers: Addressing the Mismatch between Policy and Practice

    ERIC Educational Resources Information Center

    Goble, Carla B.; Moran, James D.; Horm, Diane M.

    2009-01-01

    Research continues to highlight the relationship between high quality preschool experiences for young children and the educational preparedness of their teachers. As a result, there is an increasing call for enhanced educational preparation for early childhood teachers working in the wide spectrum of programs serving infants, toddlers, and…

  12. The Transition from Early Child Care to Preschool: Emerging Toddler Skills and Readiness for Group-Based Learning

    ERIC Educational Resources Information Center

    Goodrich, Samantha; Mudrick, Hannah; Robinson, JoAnn

    2015-01-01

    Research Findings: National policy today is on the brink of defining preschool experiences as essential for children's academic success. Indeed, many children's classroom experience begins as they transition from infant/toddler care to a preschool classroom. This study examined developmentally relevant skill domains among 36-month-olds (effortful…

  13. Increasing Toy Play among Toddlers with and without Disabilities by Modifying the Structural Quality of the Classroom Environment

    ERIC Educational Resources Information Center

    DiCarlo, Cynthia F.; Stricklin, Sarintha B.; Reid, Dennis H.

    2006-01-01

    The effects of modifying the structural quality components of inclusive classrooms on material engagement among toddlers (18-36 months) with and without disabilities were evaluated. Initially, three classrooms were evaluated using items that addressed structural quality from the Infant/Toddler Environment Rating Scale, the National Association for…

  14. Measuring quality of maternity care.

    PubMed

    Collins, Katherine J; Draycott, Timothy

    2015-11-01

    Health-care organisations are required to monitor and measure the quality of their maternity services, but measuring quality is complex, and no universal consensus exists on how best to measure it. Clinical outcomes and process measures that are important to stakeholders should be measured, ideally in standardised sets for benchmarking. Furthermore, a holistic interpretation of quality should also reflect patient experience, ideally integrated with outcome and process measures, into a balanced suite of quality indicators. Dashboards enable reporting of trends in adverse outcomes to stakeholders, staff and patients, and they facilitate targeted quality improvement initiatives. The value of such dashboards is dependent upon high-quality, routinely collected data, subject to robust statistical analysis. Moving forward, we could and should collect a standard, relevant set of quality indicators, from routinely collected data, and present these in a manner that facilitates ongoing quality improvement, both locally and at regional/national levels. PMID:25913563

  15. Productivity and quality patient care.

    PubMed

    Pinette, Shirley L

    2003-01-01

    Because of the need to control rising U.S. health care costs, managers today not only must focus on their staff and patients, but also on the business aspects of radiology, such as increasing productivity. Balancing productivity with quality patient care is not an easy task--it requires changes by the entire radiology team, including managers, technologists and radiologists. After completing this article, the reader should be able to: Discuss why health care costs continue to rise. Define productivity, how it can be measured and why it must be measured in today's health care settings. Recognize how patient satisfaction contributes to a health care organization's bottom line. Understand the health care team's role in simultaneously increasing productivity and patient satisfaction. PMID:12800569

  16. Infants & Toddlers: "Baby Moves"

    ERIC Educational Resources Information Center

    Honig, Alice Sterling

    2007-01-01

    By three to four months of age, most babies placed on their tummies on a safe, warm surface push down with their arms and raise their chests, so that they can turn their heads to look about at the world around them. By five months, babies stretch both feet and hands upward in order to swipe at interesting mobiles placed overhead. At seven to nine…

  17. The Need for the Quality Improvement Center on Early Childhood: Background Research and Evaluation Framework

    ERIC Educational Resources Information Center

    Center for the Study of Social Policy, 2009

    2009-01-01

    In FY 2009, the Children's Bureau funded the Center for the Study of Social Policy, in partnership with ZERO TO THREE: National Center for Infants, Toddlers, and Families, and the National Alliance of Children's Trust and Prevention Funds, to create a National Quality Improvement Center on Early Childhood (QIC-EC) focused on child maltreatment

  18. Child Care Subsidy and Quality

    ERIC Educational Resources Information Center

    Jones-Branch, Julie A.; Torquati, Julia C.; Raikes, Helen; Edwards, Carolyn Pope

    2004-01-01

    This study compared the quality of child care programs serving children receiving government subsidies to those not serving such children. Thirty-four classrooms in full day programs serving preschool aged children (19 subsidized, 15 unsubsidized) were observed using the Early Childhood Environment Rating Scales-Revised (ECERS-R). (1) Research…

  19. Integrating Infant Mental Health into Primary Health Care and Early Childhood Education Settings in Israel: The "Mediational Intervention for Sensitizing Caregivers" Approach

    ERIC Educational Resources Information Center

    Shohet, Cilly; Jaegermann, Nurit

    2012-01-01

    The Mediational Intervention for Sensitizing Caregivers (MISC) model is a comprehensive developmental approach to help adults understand their role in child development by enhancing the quality of adult-child interactions. This article describes how the Irving B. Harris Program for Infants, Toddlers and Their Families at Bar-Ilan University…

  20. Financial Health of Child Care Facilities Affects Quality of Care.

    ERIC Educational Resources Information Center

    Brower, Mary R.; Sull, Theresa M.

    2003-01-01

    Contends that child care facility owners, boards of directors, staff, and parents need to focus on financial management, as poor financial health compromises the quality of care for children. Specifically addresses the issues of: (1) concern for providing high quality child care; (2) the connection between quality and money; and (3) strengthening…

  1. Defining Quality Child Care: Multiple Stakeholder Perspectives

    ERIC Educational Resources Information Center

    Harrist, Amanda W.; Thompson, Stacy D.; Norris, Deborah J.

    2007-01-01

    Multiple perspectives regarding the definition of quality child care, and how child care quality can be improved, were examined using a focus group methodology. Participants were representatives from stakeholder groups in the child care profession, including child care center owners and directors (3 groups), parents (3 groups), child caregivers (3…

  2. Quality assurance in the health care industry.

    PubMed

    Guth, Kim Ann; Kleiner, Brian

    2005-01-01

    The purpose of this article is to explore the quality assurance methods commonly used in the health care industry. Factors that influence the delivery of quality patient care is explored as well as factors that affect implementation of quality control measures. The importance of quality patient care to the economic success of the health care industry is described. Quality improvement efforts that are utilized by health care institutions are described including: independent performance audits, internal audits, outcomes analysis, consumer reports, industry guidelines, and consumer satisfaction surveys. Highly effective hospital managers exhibit management roles, behaviors, and a range of activities that correlate strongly to institutional commitment to quality and improved patient care outcomes. By reinforcing their involvement in quality improvement efforts, hospital managers were able to enhance their effectiveness in promoting and sustaining quality care. PMID:16080413

  3. Psychometric Evaluation of the Brief Infant-Toddler Social and Emotional Assessment (BITSEA) in a Predominately Hispanic, Low-Income Sample

    PubMed Central

    Hungerford, Gabriela M.; Garcia, Dainelys

    2015-01-01

    The goal of the present study was to evaluate the psychometric properties of the Brief Infant-Toddler Social and Emotional Assessment (BITSEA) with 12- to 15-month-old infants from predominately Hispanic, low-income families. Mothers of 144 infants were screened at a pediatric clinic as part of a larger study examining a brief home-based intervention for infants at-risk for behavior problems. Reliability was good for the BITSEA problem scale in all analyses and acceptable for the BITSEA competence scale in most analyses. Discriminative validity was supported by scores on the BITSEA competence scale significantly predicting delayed status on all ASQ-3 subscales. BITSEA problem scale scores significantly predicted scores on the total problems scale of the Child Behavior Checklist, supporting predictive validity. Analyses revealed a main effect of group on BITSEA problem scale scores, providing preliminary support for sensitivity to change for the BITSEA problem scale. Results support the BITSEA as an effective screening tool for use with young infants, Hispanic and Spanish-speaking populations, and low-income families. PMID:26379368

  4. Quality of Informal Care Is Multidimensional

    PubMed Central

    Christie, Juliette; Smith, G. Rush; Williamson, Gail M.; Lance, Charles. E.; Shovali, Tamar E.; Silva, Luciana

    2010-01-01

    Purpose To demonstrate that assessing quality of informal care involves more than merely determining whether care recipient needs for assistance with activities of daily living (ADLs) are satisfied on a routine basis. Potentially harmful behavior (PHB), adequate care, and exemplary care (EC) are conceptually distinct dimensions of quality of care. We investigated the extent to which these three dimensions also are empirically distinguishable. Design 237 care recipients completed the quality of care measures, and their caregivers completed psychosocial measures of depressed affect, life events, cognitive status, and perceived pre-illness relationship quality. Results Confirmatory factor analyses indicated that PHB, adequate care, and EC are empirically distinct factors. Although PHB was moderately related to EC, adequate care was not associated with PHB and was only slightly related to EC. Psychosocial variables were not related to adequate care but were differentially associated with PHB and EC, providing further evidence for the distinction between the measures of quality of care used in this study. Conclusions Assessing quality of informal care is a complex endeavor. ADL assistance can be adequate in the presence of PHB and/or the absence of EC. Declines in EC may signal increases in PHB, independent of adequacy of care. These findings produce a brief, portable, and more comprehensive instrument for assessing quality of informal care. PMID:19469607

  5. Quality assurance in the ambulatory care setting.

    PubMed

    Tyler, R D

    1989-01-01

    One of the most utilitarian developments in the field of quality assurance in health care has been the introduction of industrial concepts of quality management. These concepts, coupled with buyer demand for accountability, are bringing new perspectives to health care quality assurance. These perspectives provide a new view of quality assurance as a major responsibility and strategic opportunity for management; a competitive and marketable commodity; and a method of improving safety, effectiveness, and satisfaction with medical care. PMID:10313405

  6. Strategic service quality management for health care.

    PubMed

    Anderson, E A; Zwelling, L A

    1996-01-01

    Quality management has become one of the most important and most debated topics within the service sector. This is especially true for health care, as the controversy rages on how the existing American system should be restructured. Health care reform aimed at reducing costs and ensuring access to all Americans cannot be allowed to jeopardize the quality of care. As such, total quality management (TQM) has become a vital ingredient to strategic planning within the health care domain. At the heart of any such quality improvement effort is the issue of measurement. TQM cannot be effectively utilized as a competitive weapon unless quality can be accurately defined, measured, evaluated, and monitored over time. Through such analysis a hospital can elect how to expend its limited resources toward those quality improvement projects which will impact customer perceptions of service quality the most. Thus, the purpose of this report is to establish a framework by which to approach the issue of quality measurement, delineate the various components of quality that exist in health care, and explore how these elements affect one another. We propose that the issue of quality measurement in health care be approached as an integration of service quality attributes common to other service organizations and technical quality attributes unique to health care. We hope that this research will serve as a first step toward the synthesis of the various quality attributes inherent in the health care domain and encourage other researchers to address the interactions of the various quality attributes. PMID:8763215

  7. Quality of Care: A National Sample.

    ERIC Educational Resources Information Center

    Ferrari, Monica

    This survey of 25 day care centers in 5 regions of Italy was designed to determine the characteristics of competent centers and the effects of differing local regulations on the quality of care provided. The Infant and Toddler Environment Rating Scale (ITERS) and a questionnaire were utilized to assess the quality of the day care centers in the…

  8. [Quality management in intensive care medicine].

    PubMed

    Martin, J; Braun, J-P

    2014-02-01

    Treatment of critical ill patients in the intensive care unit is tantamount to well-designed risk or quality management. Several tools of quality management and quality assurance have been developed in intensive care medicine. In addition to external quality assurance by benchmarking with regard to the intensive care medicine, peer review procedures have been established for external quality assurance in recent years. In the process of peer review of an intensive care unit (ICU), external physicians and nurses visit the ICU, evaluate on-site proceedings, and discuss with the managing team of the ICU possibilities for optimization. Furthermore, internal quality management in the ICU is possible based on the 10 quality indicators of the German Interdisciplinary Society for Intensive Care Medicine (DIVI, "Deutschen Interdisziplinären Vereinigung für Intensiv- und Notfallmedizin"). Thereby every ICU has numerous possibilities to improve their quality management system. PMID:24493011

  9. [Quality management in intensive care medicine].

    PubMed

    Martin, J; Braun, J-P

    2013-09-01

    Treatment of critical ill patients in the intensive care unit is tantamount to well-designed risk or quality management. Several tools of quality management and quality assurance have been developed in intensive care medicine. In addition to extern quality assurance by benchmarking with regard to the intensive care medicine, peer review procedures have been established for external quality assurance in recent years. In the process of peer review of an intensive care unit (ICU), external physicians and nurses visit the ICU, evaluate on-site proceedings, and discuss with the managing team of the ICU possibilities for optimization. Furthermore, internal quality management in the ICU is possible based on the 10 quality indicators of the German Interdisciplinary Society for Intensive Care Medicine (DIVI, "Deutschen Interdisziplinären Vereinigung für Intensiv- und Notfallmedizin"). Thereby every ICU has numerous possibilities to improve their quality management system. PMID:23846174

  10. Nurse reported quality of care: a measure of hospital quality.

    PubMed

    McHugh, Matthew D; Stimpfel, Amy Witkoski

    2012-12-01

    As the primary providers of round-the-clock bedside care, nurses are well positioned to report on hospital quality of care. Researchers have not examined how nurses' reports of quality correspond with standard process or outcomes measures of quality. We assess the validity of evaluating hospital quality by aggregating hospital nurses' responses to a single item that asks them to report on quality of care. We found that a 10% increment in the proportion of nurses reporting excellent quality of care was associated with lower odds of mortality and failure to rescue; greater patient satisfaction; and higher composite process of care scores for acute myocardial infarction, pneumonia, and surgical patients. Nurse reported quality of care is a useful indicator of hospital performance. PMID:22911102

  11. 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

  12. Helping You Choose Quality Ambulatory Care

    MedlinePlus

    Helping you choose: Quality ambulatory care When you need ambulatory care, you should find out some information to help you choose the best ... the center follows rules for patient safety and quality. Go to Quality Check ® at www. qualitycheck. org ...

  13. Child Care Quality and Children's Engagement.

    ERIC Educational Resources Information Center

    Raspa, Melissa J.; McWilliam, R. A.; Ridley, Stephanie Maher

    2001-01-01

    Examined relationship between child care quality and engagement behavior of toddlers in 17 child care centers. Found that all but one contextual quality measure were associated with unsophisticated engagement. Only global classroom quality was related to sophisticated engagement. The percentage of toddlers engaged in activities was associated with…

  14. 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…

  15. Quality of Care in the Cirrhotic Patient.

    PubMed

    Volk, Michael L; Kanwal, Fasiha

    2016-01-01

    Cirrhosis is a common, complex, chronic condition requiring care by multiple specialists in different locations. Emerging data demonstrates limitations in the quality of care these patients receive-in large part due to the problems with care coordination rather than failures of individual providers. This article will discuss approaches for measuring quality, and provide a step-by-step guide for developing quality improvement programs for this patient population. PMID:27101005

  16. African Primary Care Research: Quality improvement cycles

    PubMed Central

    Mash, Bob

    2014-01-01

    Abstract Improving the quality of clinical care and translating evidence into clinical practice is commonly a focus of primary care research. This article is part of a series on primary care research and outlines an approach to performing a quality improvement cycle as part of a research assignment at a Masters level. The article aims to help researchers design their quality improvement cycle and write their research project proposal. PMID:26245438

  17. Quality of Care in the Cirrhotic Patient

    PubMed Central

    Volk, Michael L; Kanwal, Fasiha

    2016-01-01

    Cirrhosis is a common, complex, chronic condition requiring care by multiple specialists in different locations. Emerging data demonstrates limitations in the quality of care these patients receive—in large part due to the problems with care coordination rather than failures of individual providers. This article will discuss approaches for measuring quality, and provide a step-by-step guide for developing quality improvement programs for this patient population. PMID:27101005

  18. Quality of Pharmaceutical Care in Surgical Patients

    PubMed Central

    de Boer, Monica; Ramrattan, Maya A.; Boeker, Eveline B.; Kuks, Paul F. M.; Boermeester, Marja A.; Lie-A-Huen, Loraine

    2014-01-01

    Background Surgical patients are at risk for preventable adverse drug events (ADEs) during hospitalization. Usually, preventable ADEs are measured as an outcome parameter of quality of pharmaceutical care. However, process measures such as QIs are more efficient to assess the quality of care and provide more information about potential quality improvements. Objective To assess the quality of pharmaceutical care of medication-related processes in surgical wards with quality indicators, in order to detect targets for quality improvements. Methods For this observational cohort study, quality indicators were composed, validated, tested, and applied on a surgical cohort. Three surgical wards of an academic hospital in the Netherlands (Academic Medical Centre, Amsterdam) participated. Consecutive elective surgical patients with a hospital stay longer than 48 hours were included from April until June 2009. To assess the quality of pharmaceutical care, the set of quality indicators was applied to 252 medical records of surgical patients. Results Thirty-four quality indicators were composed and tested on acceptability and content- and face-validity. The selected 28 candidate quality indicators were tested for feasibility and sensitivity to change. This resulted in a final set of 27 quality indicators, of which inter-rater agreements were calculated (kappa 0.92 for eligibility, 0.74 for pass-rate). The quality of pharmaceutical care was assessed in 252 surgical patients. Nearly half of the surgical patients passed the quality indicators for pharmaceutical care (overall pass rate 49.8%). Improvements should be predominantly targeted to medication care related processes in surgical patients with gastro-intestinal problems (domain pass rate 29.4%). Conclusions This quality indicator set can be used to measure quality of pharmaceutical care and detect targets for quality improvements. With these results medication safety in surgical patients can be enhanced. PMID:25006676

  19. 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;…

  20. [Quality assurance concepts in intensive care medicine].

    PubMed

    Brinkmann, A; Braun, J P; Riessen, R; Dubb, R; Kaltwasser, A; Bingold, T M

    2015-11-01

    Intensive care medicine (ICM) is characterized by a high degree of complexity and requires intense communication and collaboration on interdisciplinary and multiprofessional levels. In order to achieve good quality of care in this environment and to prevent errors, a proactive quality and error management as well as a structured quality assurance system are essential. Since the early 1990s, German intensive care societies have developed concepts for quality management and assurance in ICM. In 2006, intensive care networks were founded in different states to support the implementation of evidence-based knowledge into clinical routine and to improve medical outcome, efficacy, and efficiency in ICM. Current instruments and concepts of quality assurance in German ICM include core intensive care data from the data registry DIVI REVERSI, quality indicators, peer review in intensive care, IQM peer review, and various certification processes. The first version of German ICM quality indicators was published in 2010 by an interdisciplinary and interprofessional expert commission. Key figures, indicators, and national benchmarks are intended to describe the quality of structures, processes, and outcomes in intensive care. Many of the quality assurance tools have proved to be useful in clinical practice, but nationwide implementation still can be improved. PMID:26497132

  1. Improving quality of tuberculosis care in India.

    PubMed

    Pai, Madhukar; Satyanarayana, Srinath; Hopewell, Phil

    2014-01-01

    In India, the quality of care that tuberculosis (TB) patients receive varies considerably and is often not in accordance with the national and international standards. In this article, we provide an overview of the third (latest) edition of the International Standards of Tuberculosis Care (ISTC). These standards are supported by the existing World Health Organization guidelines and policy statements pertaining to TB care and have been endorsed by a number of international organizations. We call upon all health care providers in the country to practice TB care that is consistent with these standards, as well as the upcoming Standards for TB Care in India (STCI). PMID:24640340

  2. A Parent's Guide to Infant/Toddler Programs = Guia para los padres sobre los programas de cuidado infantil de 0-3 anos.

    ERIC Educational Resources Information Center

    Dodge, Diane Trister; Dombro, Amy Laura; Colker, Laura J.

    Information on how warm and responsive care can help shape infants' and toddlers' development and their ability to learn can be reassuring for concerned parents. This guide, in English and Spanish versions, presents quality child care as a partnership between the child caregiver and the parents with the primary goal of benefiting the child. The…

  3. A Parent's Guide to Infant/Toddler Programs = Guia para los padres sobre los programas de cuidado infantil de 0-3 anos.

    ERIC Educational Resources Information Center

    Dodge, Diane Trister; Dombro, Amy Laura; Colker, Laura J.

    Information on how warm and responsive care can help shape infants' and toddlers' development and their ability to learn can be reassuring for concerned parents. This guide, in English and Spanish versions, presents quality child care as a partnership between the child caregiver and the parents with the primary goal of benefiting the child. The

  4. Mindfulness meditation to improve care quality and quality of life in long-term care settings.

    PubMed

    Zeller, Janice M; Lamb, Karen

    2011-01-01

    Quality of long-term care has been the focus of 2 recent Institute of Medicine reports: "Improving the Quality of Long-Term Care"(1) and "Improving the Quality of Care in Nursing Homes."(2) Although there has been some improvement in care quality since regulatory reforms were enacted in 1987,(3) poor care persists.(4) Certified nursing assistants (CNAs) are challenged in the provision of optimal care by chronic stress in the workplace, leading to absenteeism, reduced job satisfaction, and increased turnover.(5-7) Mindfulness training, which cultivates a practice of being present in the moment, recognizing stressful situations when they arise, and responding to stress in an adaptive manner,(8) holds promise as a simple, inexpensive approach to reduce CNA stress and improve quality of care and quality of life for residents in long-term care settings. Formal and informal mindfulness practices can readily be incorporated into CNA educational programs. PMID:21239085

  5. The Quality Imperative for Palliative Care

    PubMed Central

    Kamal, Arif H.; Hanson, Laura C.; Casarett, David J.; Dy, Sydney M.; Pantilat, Steven Z.; Lupu, Dale; Abernethy, Amy P.

    2015-01-01

    Palliative medicine must prioritize the routine assessment of the quality of clinical care we provide. This includes regular assessment, analysis, and reporting of data on quality. Assessment of quality informs opportunities for improvement and demonstrates to our peers and ourselves the value of our efforts. In fact, continuous messaging of the value of palliative care services is needed to sustain our discipline; this requires regularly evaluating the quality of our care. As the reimbursement mechanisms for health care in the United States shift from fee-for-service to fee-for-value models, palliative care will be expected to report robust data on quality of care. We must move beyond demonstrating to our constituents (including patients and referrers), “here is what we do,” and increase the focus on “this is how well we do it” and “let’s see how we can do it better.” It is incumbent on palliative care professionals to lead these efforts. This involves developing standardized methods to collect data without adding additional burden, comparing and sharing our experiences to promote discipline-wide quality assessment and improvement initiatives, and demonstrating our intentions for quality improvement on the clinical frontline. PMID:25057987

  6. 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…

  7. Providing high-quality care in primary care settings

    PubMed Central

    Beaulieu, Marie-Dominique; Geneau, Robert; Grande, Claudio Del; Denis, Jean-Louis; Hudon, veline; Haggerty, Jeannie L.; Bonin, Lucie; Duplain, Rjean; Goudreau, Johanne; Hogg, William

    2014-01-01

    Abstract Objective To gain a deeper understanding of how primary care (PC) practices belonging to different models manage resources to provide high-quality care. Design Multiple-case study embedded in a cross-sectional study of a random sample of 37 practices. Setting Three regions of Quebec. Participants Health care professionals and staff of 5 PC practices. Methods Five cases showing above-average results on quality-of-care indicators were purposefully selected to contrast on region, practice size, and PC model. Data were collected using an organizational questionnaire; the Team Climate Inventory, which was completed by health care professionals and staff; and 33 individual interviews. Detailed case histories were written and thematic analysis was performed. Main findings The core common feature of these practices was their ongoing effort to make trade-offs to deliver services that met their vision of high-quality care. These compromises involved the same 3 areas, but to varying degrees depending on clinic characteristics: developing a shared vision of high-quality care; aligning resource use with that vision; and balancing professional aspirations and population needs. The leadership of the physician lead was crucial. The external environment was perceived as a source of pressure and dilemmas rather than as a source of support in these matters. Conclusion Irrespective of their models, PC practices pursuit of high-quality care is based on a vision in which accessibility is a key component, balanced by appropriate management of available resources and of external environment expectations. Current PC reforms often create tensions rather than support PC practices in their pursuit of high-quality care. PMID:24829023

  8. A conceptual framework for quality of care.

    PubMed

    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

  9. 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

  10. [Quality of health care and its evaluation].

    PubMed

    Tsubo, T

    1997-10-01

    The focus on quality improvement of health care has been emerging in last decade, due to rapidly increasing competition, cost containment by governmental and private health financing corporations (including health insurance), and high costs structure of health care providing institutions. Accordingly, necessity of evaluation on results of care/outcome (discharge and discontinuation) of care has been drawn prompt attention of decision makers and administrators in health care institutions. However, since, original motive of quality care has been generated from the aspect of care providers' oriented (in US: Market and costs oriented, in Europe: Legislation oriented) bases and directions, in terms of cost performance, downsizing operation, improvement of competing capability and creating new profit making opportunity, evaluation approach, prioritization, itemization, setting goal, and standards were forced to set as forth to meet the providers' objective, in stead of patient's benefit and maximization of patient's satisfaction. Therefore, effective evaluation structure of quality balance management in operation must be built and consisted of four major 1)-4) cores to maintain patient oriented quality and optimal level of quality obligation to community. 1) In process 2) In Services 3) In Inhabitant Benefits 4) In Producing Assured Results. Through the efforts, it is proposed to urge "Evaluation Effectiveness Initiative (EEI) by Japan's leadership" to achieve sustainable safety and effective quality in balance of process through whole operations. PMID:9423195

  11. Leadership: improving the quality of patient care.

    PubMed

    Clegg, A

    The satisfaction staff achieve from their work is in part determined by the style of management they work under. This article analyses the impact of a proactive leadership style on team performance and the quality of patient care. PMID:11973895

  12. 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)…

  13. Predictors of Quality in Family Child Care

    ERIC Educational Resources Information Center

    Doherty, Gillian; Forer, Barry; Lero, Donna S.; Goelman, Hillel; LaGrange, Annette

    2006-01-01

    This study of 231 regulated family child care providers proposed a theoretical model to explore the effects on quality of: (1) provider level of general education; (2) provider degree of intentionality; (3) provider training and experience in family child care; (4) provider use of support services; and (5) provider work environment. Hierarchical…

  14. Quality management in Irish health care.

    PubMed

    Ennis, K; Harrington, D

    1999-01-01

    This paper reports on the findings from a quantitative research study of quality management in the Irish health-care sector. The study findings suggest that quality management is what hospitals require to become more cost-effective and efficient. The research also shows that the culture of health-care institutions must change to one where employees experience pride in their work and where all are involved and committed to continuous quality improvement. It is recommended that a shift is required from the traditional management structures to a more participative approach. Furthermore, all managers whether from a clinical or an administration background must understand one another's role in the organisation. Finally, for quality to succeed in the health-care sector, strong committed leadership is required to overcome tensions in quality implementation. PMID:10724566

  15. Hospital governance and the quality of care.

    PubMed

    Jha, Ashish; Epstein, Arnold

    2010-01-01

    Hospitals' boards may influence the quality of care that hospitals provide, but their engagement in quality-related issues is largely unknown. We surveyed a nationally representative sample of board chairs of 1,000 U.S. hospitals to understand their expertise, perspectives, and activities in clinical quality. We found that fewer than half of the boards rated quality of care as one of their two top priorities, and only a minority reported receiving training in quality. The large differences in board activities between high-performing and low-performing hospitals we found suggest that governing boards may be an important target for intervention for policymakers hoping to improve care in U.S. hospitals. PMID:19897509

  16. The Practical Guide to Quality Child Care.

    ERIC Educational Resources Information Center

    Schiller, Pam; Dyke, Patricia Carter

    This guide is a comprehensive manual for administrators who manage child care facilities. The guide provides practical help with the ultimate goal of improving the quality of programs for young children and helping directors and teachers be more effective in their work. The chapters are: (1) "Qualities and Characteristics of an Effective…

  17. 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…

  18. [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

  19. Empathy and quality of care.

    PubMed

    Mercer, Stewart W; Reynolds, William J

    2002-10-01

    Empathy is a complex multi-dimensional concept that has moral cognitive emotive and behavioural components Clinical empathy involves an ability to: (a) understand the patient's situation, perspective, and feelings (and their attached meanings); (b) to communicate that understanding and check its accuracy; and (c) to act on that understanding with the patient in a helpful (therapeutic) way. Research on the effect of empathy on health outcomes in primary care is lacking, but studies in mental health and in nursing suggest it plays a key role. Empathy can be improved and successfully taught at medical school especially if it is embedded in the students actual experiences with patients. A variety of assessment and feedback techniques have also been used in general medicine psychiatry and nursing. Further work is required to determine if clinical empathy needs to be, and can be, improved in the primary care setting. PMID:12389763

  20. 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

  1. Infant & Toddler Programs: The Workforce

    ERIC Educational Resources Information Center

    Child Care, Inc., 2006

    2006-01-01

    Children's earliest experiences set the stage for school success and adult productivity. In the first three years of life, the brain grows at breakneck speed, creating more than a trillion pathways for learning and development. By the age of three, 85 percent of the brain's capacity is in place, creating the ability to speak, learn, and reason.…

  2. Living with diabetes: quality of care and quality of life

    PubMed Central

    Pera, Pilar Isla

    2011-01-01

    Background: The aim of this research was to characterize the experience of living with diabetes mellitus (DM) and identify patients’ opinions of the quality of care received and the results of interventions. Methods: A descriptive, exploratory evaluation study using qualitative methodology was performed. Participants consisted of 40 adult patients diagnosed with DM and followed up in a public hospital in Barcelona, Spain. A semistructured interview and a focus group were used and a thematic content analysis was performed. Results: Patients described DM as a disease that is difficult to control and that provokes lifestyle changes requiring effort and sacrifice. Insulin treatment increased the perception of disease severity. The most frequent and dreaded complication was hypoglycemia. The main problems perceived by patients affecting the quality of care were related to a disease-centered medical approach, lack of information, limited participation in decision-making, and the administrative and bureaucratic problems of the health care system. Conclusion: The bureaucratic circuits of the health care system impair patients’ quality of life and perceived quality of care. Health professionals should foster patient participation in decision-making. However, this requires not only training and appropriate attitudes, but also adequate staffing and materials. PMID:21423590

  3. Managing health care variability to achieve quality care.

    PubMed

    Simmons, J C

    2001-05-01

    While much has been written about variation and health care, one area that has received little attention is variation within hospitals related to the operations management--which can lead to wasted money and human resources. Two Boston researchers who have been studying this area say that addressing these variations--and using techniques found in other major industries across the country--could give hospitals a new tool in addressing patient safety issues, nursing shortages, cost containment, and overall better quality of care. PMID:11400326

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

    ERIC Educational Resources Information Center

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

    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 child care center quality and: center characteristics; teaching staff wages and working conditions;…

  5. Quality of Care in Old Age Institutions

    ERIC Educational Resources Information Center

    Kart, Cary S.; Manard, Barbara B.

    1976-01-01

    This paper looks at the complexity of the "quality-of-care" issue and discusses five characteristics which investigators have suggested for identifying a good old age institution (OAI): ownership, size of facility, socioeconomic status of facility, social integration, and "professionalism" of staff. (Author)

  6. Enhancing Program Quality and Care through Supervision

    ERIC Educational Resources Information Center

    Olsen, Heather; Kowalski, Christopher L.

    2010-01-01

    In this age of accountability, afterschool programs are increasingly held responsible for providing youth with quality care and education. Afterschool programs play a critical role in helping youth develop their intrapersonal and interpersonal skills, often by engaging them in activities in which they interact with their peers. Such activities…

  7. Quality of care and black American patients.

    PubMed Central

    Weddington, W. H.; Gabel, L. L.; Peet, G. M.; Stewart, S. O.

    1992-01-01

    Even with major advancements in medical knowledge and significant improvements in health sciences technology, evidence still exists that blacks do not enjoy as full a measure of health as do other racial and ethnic groups. To attempt a better understanding of this situation, literature was reviewed to consider relationships between being black and issues related to quality of health care. It was determined that these relationships have not been studied to any great extent, either in quantity or quality. When such studies have been undertaken, they have been limited to mostly qualitative designs, and appropriate controls for confounding variables have been minimal. The psychiatric literature reports most of the studies with very few studies found in the literature of other specialties. A conceptual model is presented regarding race-related research. It is argued that a first step might be to study whether the quality of care differs when the physician and the patient are members of different racial groups compared with when the physician and patient are members of the same racial group. In all race-related research, it is necessary to carefully consider specific variables that may confound results, eg, diagnostic errors, age, sex, socioeconomic status, level of education, geographic locale, and method of payment for health-care services. PMID:1629920

  8. Quality in point-of-care testing.

    PubMed

    Nichols, James H

    2003-09-01

    Point-of-care testing (POCT) is an increasingly popular means of providing laboratory testing at or near to the site of patient care. POCT provides rapid results and has the potential to improve patient outcome from earlier treatment. However, a faster result is not necessarily an equivalent result to traditional, core laboratory testing. Preanalytic, analytic and postanalytic factors can influence the quality of POCT and lead to misinterpretation. Concerns over the quality of POCT have resulted in a hierarchy of laboratory regulations in the USA and POCT guidelines are appearing in a number of countries worldwide. Quality POCT must control every aspect of the test and testing process that can affect the ultimate result. Laboratory quality regulations are very similar to industrial quality requirements and POCT can be viewed like any manufacturing business where the product being produced is the test result. Use of industrial management techniques, such as failure mode and effects analysis, can be applied to POCT to isolate and reduce the sources of testing error. Data management is fundamental to quality. Analyzing POCT data can show quality trends before they affect the result. Newer POCT devices have computerized data capture and storage functions that can collect the key information at the time the test is performed and later transmit that data to a POCT data manager or hospital information system. Recent standards, such as the National Committee for Clinical Laboratory Standards POCT1-A, provide a connectivity standard to allow different POCT devices to share a common interface and data manager system, reducing the cost of implementing and maintaining POCT. Guaranteeing POCT quality is resource-intensive and as healthcare budgets get tighter and staffing shortages grow, patient outcome must be weighed against available resources to determine optimum testing strategies. Use of the POCT literature can help establish an evidence-based justification to support POCT. PMID:14510177

  9. Quality of care in humanitarian surgery.

    PubMed

    Chu, Kathryn M; Trelles, Miguel; Ford, Nathan P

    2011-06-01

    Humanitarian surgical programs are set up de novo, within days or hours in emergency or disaster settings. In such circumstances, insuring quality of care is extremely challenging. Basic structural inputs such as a safe structure, electricity, clean water, a blood bank, sterilization equipment, a post-anesthesia recovery unit, appropriate medications should be established. Currently, no specific credentials are needed for surgeons to operate in a humanitarian setting; the training of more humanitarian surgeons is desperately needed. Standard perioperative protocols for the humanitarian setting after common procedures such as Cesarean section, burn care, open fractures, and amputations and antibiotic prophylaxis, and post-operative pain management must be developed. Outcome data, especially long-term outcomes, are difficult to collect as patients often do not return for follow-up and may be difficult to trace; standard databases for post-operative infections and mortality rates should be established. Checklists have recently received significant attention as an instrument to support the improvement of surgical quality; knowing which items are most applicable to humanitarian settings remains unknown. In conclusion, the quality of surgical services in humanitarian settings must be regulated. Many other core medical activities of humanitarian organizations such as therapeutic feeding, mass vaccination, and the treatment of infectious diseases, such as tuberculosis and human immunodeficiency virus, are subject to rigorous reporting of quality indicators. There is no reason why surgery should be exempted from quality oversight. The surgical humanitarian community should pull together before the next disaster strikes. PMID:21487849

  10. Techniques change, but quality care does not.

    PubMed

    Krecko, Lindsey

    2009-01-01

    The technical tools and complexity of cases for young practitioners are not the same as those used by their predecessors, but the aim is the same: quality ethical care at the highest level. The challenges of building the ethical practice today include building trust in a world where patients have access to media depictions of a society of greed, the temptations of over-treatment, and a need for an evidence base to one's practice. PMID:20415128

  11. Achieving High-Quality Multicultural Geriatric Care.

    PubMed

    2016-02-01

    As the ethnic diversity of the U.S. population increases, there is a growing awareness of healthcare disparities and the need to address them. This position statement that the American Geriatrics Society (AGS) Ethnogeriatrics Committee developed outlines healthcare disparities in the United States and the minimum quality indicators that healthcare organizations and healthcare providers should adopt to ensure that all older adults receive care that is culturally appropriate and takes into account level of health literacy. PMID:26804356

  12. Washington's Infant Toddler Early Intervention Program Study: Enrollment of Washington Children with Disabilities and Special Health Care Needs in Washington State Public Programs on December 1, 1995.

    ERIC Educational Resources Information Center

    Keenan, Trisha; And Others

    This document presents tables, graphs, and narrative text providing information on the number and characteristics of infants and toddlers, under the age of 3, with disabilities and special health problems who were enrolled in Washington State's infant and toddler early intervention program in 1995. Major findings of the report include the

  13. Washington's Infant Toddler Early Intervention Program Study: Enrollment of Washington Children with Disabilities and Special Health Care Needs in Washington State Public Programs on December 1, 1997.

    ERIC Educational Resources Information Center

    Lyons, Dorothy; Keenan, Trisha; Cawthon, Laurie; Felming, Jan; Dickey, Rita; Loerch, Sandy; Shureen, Anne

    This report presents information on infants and toddlers (ages birth to three) with delaying or disabling conditions, who were enrolled in Washington State public services on December 1, 1997, under the Individuals with Disabilities Education Act, Part H. Major findings included: (1) there was a total enrollment of 5,007 infants and toddlers (2.1…

  14. 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 ...

  15. Quality care as ethical care: a poststructural analysis of palliative and supportive district nursing care.

    PubMed

    Nagington, Maurice; Walshe, Catherine; Luker, Karen A

    2016-03-01

    Quality of care is a prominent discourse in modern health-care and has previously been conceptualised in terms of ethics. In addition, the role of knowledge has been suggested as being particularly influential with regard to the nurse-patient-carer relationship. However, to date, no analyses have examined how knowledge (as an ethical concept) impinges on quality of care. Qualitative semi-structured interviews were conducted with 26 patients with palliative and supportive care needs receiving district nursing care and thirteen of their lay carers. Poststructural discourse analysis techniques were utilised to take an ethical perspective on the current way in which quality of care is assessed and produced in health-care. It is argued that if quality of care is to be achieved, patients and carers need to be able to redistribute and redevelop the knowledge of their services in a collaborative way that goes beyond the current ways of working. Theoretical works and extant research are then used to produce tentative suggestions about how this may be achieved. PMID:26189362

  16. Diversity, Child Care Quality and Developmental Outcomes. FPG Snapshot, #21

    ERIC Educational Resources Information Center

    FPG Child Development Institute, University of North Carolina, 2004

    2004-01-01

    It is widely accepted that high quality child care enhances children's cognitive and social development, but some people question if what constitutes quality care depends on the child's ethnic and cultural background. To examine this issue, secondary analysis of the two largest U.S. studies of child care--the Cost, Quality, and Outcomes Study and…

  17. 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

  18. 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

  19. 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…

  20. New horizon in quality care--Asian perspective.

    PubMed

    Han, M C

    1997-01-01

    The current status and directions for changes of issues related to quality care in health services in Asian countries--Malaysia, China, Singapore, Japan and Korea are overviewed. In countries with public sector dominated health care systems such as Malaysia. China and Singapore, governmental leadership in quality care is prominent along with legislative backup. Japan and Korea have private sector dominated health care systems and quality care activities are mainly carried out by non-governmental organisations. Hospital accreditation programs are in the developing stages in most countries, although China and Korea started in 1980. Most Asian countries are at the initial stages in quality care activities and focus has been placed on education and training. Asian countries are not exempted from efforts to enhance quality care activities and a new horizon in quality health care is emerging. PMID:10174544

  1. [Quality of coding in acute inpatient care].

    PubMed

    Stausberg, J

    2007-08-01

    Routine data in the electronic patient record are frequently used for secondary purposes. Core elements of the electronic patient record are diagnoses and procedures, coded with the mandatory classifications. Despite the important role of routine data for reimbursement, quality management and health care statistics, there is currently no systematic analysis of coding quality in Germany. Respective concepts and investigations share the difficulty to decide what's right and what's wrong, being at the end of the long process of medical decision making. Therefore, a relevant amount of disagreement has to be accepted. In case of the principal diagnosis, this could be the fact in half of the patients. Plausibility of coding looks much better. After optimization time in hospitals, regular and complete coding can be expected. Whether coding matches reality, as a prerequisite for further use of the data in medicine and health politics, should be investigated in controlled trials in the future. PMID:17676418

  2. Quantitative comparison of measurements of urgent care service quality.

    PubMed

    Qin, Hong; Prybutok, Victor; Prybutok, Gayle

    2016-01-01

    Service quality and patient satisfaction are essential to health care organization success. Parasuraman, Zeithaml, and Berry introduced SERVQUAL, a prominent service quality measure not yet applied to urgent care. We develop an instrument to measure perceived service quality and identify the determinants of patient satisfaction/ behavioral intentions. We examine the relationships among perceived service quality, patient satisfaction and behavioral intentions, and demonstrate that urgent care service quality is not equivalent using measures of perceptions only, differences of expectations minus perceptions, ratio of perceptions to expectations, and the log of the ratio. Perceptions provide the best measure of urgent care service quality. PMID:26950539

  3. Where Child Care is above Average? Licensing, Legislation, and Indicators of Quality of Care in Minnesota

    ERIC Educational Resources Information Center

    Ceglowski, Deborah A.; Davis, Elizabeth E.

    2004-01-01

    Despite Minnesota's reputation for quality child care, recent changes in legislation and the impact of changing needs have raised concerns about the quality of child care available in the state. This paper presents an overview of Minnesota's current child care system including structural indicators of program quality such as licensing standards,…

  4. Nurse staffing and quality of patient care.

    PubMed Central

    Kane, Robert L; Shamliyan, Tatyana; Mueller, Christine; Duval, Sue; Wilt, T J

    2007-01-01

    OBJECTIVES To assess how nurse to patient ratios and nurse work hours were associated with patient outcomes in acute care hospitals, factors that influence nurse staffing policies, and nurse staffing strategies that improved patient outcomes. DATA SOURCES MEDLINE (PubMed), CINAHL, Cochrane Databases, EBSCO research database, BioMed Central, Federal reports, National Database of Nursing Quality Indicators, National Center for Workforce Analysis, American Nurses Association, American Academy of Nurse Practitioners, and Digital Dissertations. REVIEW METHODS In the absence of randomized controlled trials, observational studies were reviewed to examine the relationship between nurse staffing and outcomes. Meta-analysis tested the consistency of the association between nurse staffing and patient outcomes; classes of patient and hospital characteristics were analyzed separately. RESULTS Higher registered nurse staffing was associated with less hospital-related mortality, failure to rescue, cardiac arrest, hospital acquired pneumonia, and other adverse events. The effect of increased registered nurse staffing on patients safety was strong and consistent in intensive care units and in surgical patients. Greater registered nurse hours spent on direct patient care were associated with decreased risk of hospital-related death and shorter lengths of stay. Limited evidence suggests that the higher proportion of registered nurses with BSN degrees was associated with lower mortality and failure to rescue. More overtime hours were associated with an increase in hospital related mortality, nosocomial infections, shock, and bloodstream infections. No studies directly examined the factors that influence nurse staffing policy. Few studies addressed the role of agency staff. No studies evaluated the role of internationally educated nurse staffing policies. CONCLUSIONS Increased nursing staffing in hospitals was associated with lower hospital-related mortality, failure to rescue, and other patient outcomes, but the association is not necessarily causal. The effect size varied with the nurse staffing measure, the reduction in relative risk was greater and more consistent across the studies, corresponding to an increased registered nurse to patient ratio but not hours and skill mix. Estimates of the size of the nursing effect must be tempered by provider characteristics including hospital commitment to high quality care not considered in most of the studies. Greater nurse staffing was associated with better outcomes in intensive care units and in surgical patients. PMID:17764206

  5. Evaluating health care quality: the moderating role of outcomes.

    PubMed

    Lytle, R S; Mokwa, M P

    1992-03-01

    An integrative model of health care quality is presented. "Health care quality" is defined as provider conformance to patient requirements at three benefit levels: core, intangible, and tangible. The model is operationalized and tested in a clinical setting, a large center for fertility studies with more than 5000 patients. Health care "process variables" such as physician and patient interactions were not as important in patients' evaluations of health care quality when successful outcomes occurred (pregnancy). However, when patients experienced unsuccessful outcomes (no pregnancy), health care "process variables" were important and had a significant influence on patient perceptions of health care quality. Hence, service outcomes can significantly affect the measurement and interpretation of health care quality. Implications for health care management and research are discussed. PMID:10116754

  6. 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

  7. Differential Susceptibility to Parenting and Quality Child Care

    ERIC Educational Resources Information Center

    Pluess, Michael; Belsky, Jay

    2010-01-01

    Research on differential susceptibility to rearing suggests that infants with difficult temperaments are disproportionately affected by parenting and child care quality, but a major U.S. child care study raises questions as to whether quality of care influences social adjustment. One thousand three hundred sixty-four American children from…

  8. Quality of Care and Problem Behaviors in Early Childhood.

    ERIC Educational Resources Information Center

    Hagekull, Berit; Bohlin, Gunilla

    This longitudinal study examined the relationship of care quality in children's homes and external day care settings to children's emotional expressions and to problem and competence behaviors. Subjects were 123 children (63 males, 60 females) mostly from middle-class Swedish families. When children were 29 months old, data about quality of care

  9. Greek Day Care Centres' Quality, Caregivers' Behaviour and Children's Development.

    ERIC Educational Resources Information Center

    Petrogiannis, Konstantinos

    2002-01-01

    Examined the relationship between preschool children's development and the quality of child care, group size, adult-child ratio, caregiving style, and caregiver child interactions in child care centers in Athens, Greece. Found that development could be predicted by the overall quality of the child care center, with smaller effect from group size.…

  10. 42 CFR 483.25 - Quality of care.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 5 2013-10-01 2013-10-01 false Quality of care. 483.25 Section 483.25 Public... Care Facilities § 483.25 Quality of care. Each resident must receive and the facility must provide the... prevent urinary tract infections and to restore as much normal bladder function as possible. (e) Range...

  11. 38 CFR 52.120 - Quality of care.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 2 2012-07-01 2012-07-01 false Quality of care. 52.120... FOR ADULT DAY HEALTH CARE OF VETERANS IN STATE HOMES Standards § 52.120 Quality of care. Each... sentinel event is an adverse event that results in the loss of life or limb or permanent loss of...

  12. 42 CFR 483.25 - Quality of care.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 5 2011-10-01 2011-10-01 false Quality of care. 483.25 Section 483.25 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) STANDARDS AND CERTIFICATION REQUIREMENTS FOR STATES AND LONG TERM CARE FACILITIES Requirements for Long Term Care Facilities § 483.25 Quality of...

  13. 38 CFR 52.120 - Quality of care.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 2 2011-07-01 2011-07-01 false Quality of care. 52.120... FOR ADULT DAY HEALTH CARE OF VETERANS IN STATE HOMES Standards § 52.120 Quality of care. Each... sentinel event is an adverse event that results in the loss of life or limb or permanent loss of...

  14. 42 CFR 483.25 - Quality of care.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 5 2014-10-01 2014-10-01 false Quality of care. 483.25 Section 483.25 Public... Care Facilities § 483.25 Quality of care. Each resident must receive and the facility must provide the... prevent urinary tract infections and to restore as much normal bladder function as possible. (e) Range...

  15. 38 CFR 51.120 - Quality of care.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 2 2013-07-01 2013-07-01 false Quality of care. 51.120 Section 51.120 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS (CONTINUED) PER DIEM FOR NURSING HOME CARE OF VETERANS IN STATE HOMES Standards § 51.120 Quality of care. Each resident must receive and the facility management...

  16. 42 CFR 483.25 - Quality of care.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 5 2010-10-01 2010-10-01 false Quality of care. 483.25 Section 483.25 Public... Care Facilities § 483.25 Quality of care. Each resident must receive and the facility must provide the... prevent urinary tract infections and to restore as much normal bladder function as possible. (e) Range...

  17. 38 CFR 52.120 - Quality of care.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 2 2014-07-01 2014-07-01 false Quality of care. 52.120... FOR ADULT DAY HEALTH CARE OF VETERANS IN STATE HOMES Standards § 52.120 Quality of care. Each... sentinel event is an adverse event that results in the loss of life or limb or permanent loss of...

  18. 38 CFR 52.120 - Quality of care.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 2 2013-07-01 2013-07-01 false Quality of care. 52.120 Section 52.120 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS (CONTINUED) PER DIEM FOR ADULT DAY HEALTH CARE OF VETERANS IN STATE HOMES Standards § 52.120 Quality of care. Each participant must receive, and the...

  19. 38 CFR 51.120 - Quality of care.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 2 2011-07-01 2011-07-01 false Quality of care. 51.120... FOR NURSING HOME CARE OF VETERANS IN STATE HOMES Standards § 51.120 Quality of care. Each resident... an adverse event that results in the loss of life or limb or permanent loss of function. (2)...

  20. 38 CFR 51.120 - Quality of care.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 2 2012-07-01 2012-07-01 false Quality of care. 51.120... FOR NURSING HOME CARE OF VETERANS IN STATE HOMES Standards § 51.120 Quality of care. Each resident... an adverse event that results in the loss of life or limb or permanent loss of function. (2)...

  1. 38 CFR 51.120 - Quality of care.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 2 2014-07-01 2014-07-01 false Quality of care. 51.120... FOR NURSING HOME CARE OF VETERANS IN STATE HOMES Standards § 51.120 Quality of care. Each resident... an adverse event that results in the loss of life or limb or permanent loss of function. (2)...

  2. 42 CFR 483.25 - Quality of care.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 5 2012-10-01 2012-10-01 false Quality of care. 483.25 Section 483.25 Public... Care Facilities § 483.25 Quality of care. Each resident must receive and the facility must provide the... prevent urinary tract infections and to restore as much normal bladder function as possible. (e) Range...

  3. In Quality We Trust; but Quality of Life or Quality of Care?

    PubMed

    Chen, Shan Shan; Unruh, Mark; Williams, Mark

    2016-03-01

    The ESRD program provides medical care to a diverse and medically complex patient population. The care for the ESRD patient population has become increasingly benchmarked with process of care measures. These measures include dialysis adequacy, anemia, nutrition, and vascular access outcomes. These process-related dialysis measures may not improve the care of the individual patient as care relates to the individual's goals and values. There is also evidence that these process measures may not be causally related to quality of life, hospitalization, and survival. The adoption of patient-reported outcomes may shift the balance toward more patient-centered care. However, the extent to which mandated measures of health-related quality of life and patient satisfaction result in improved outcomes remains unclear. PMID:26860436

  4. Quality of Care and Quality of Life: Convergence or Divergence?

    PubMed Central

    Alonazi, Wadi B; Thomas, Shane A

    2014-01-01

    The aim of this study was to explore the impact of quality of care (QoC) on patients’ quality of life (QoL). In a cross-sectional study, two domains of QoC and the World Health Organization Quality of Life-Bref questionnaire were combined to collect data from 1,059 pre-discharge patients in four accredited hospitals (ACCHs) and four non-accredited hospitals (NACCHs) in Saudi Arabia. Health and well-being are often restricted to the characterization of sensory qualities in certain settings such as unrestricted access to healthcare, effective treatment, and social welfare. The patients admitted to tertiary health care facilities are generally able to present themselves with a holistic approach as to how they experience the impact of health policy. The statistical results indicated that patients reported a very limited correlation between QoC and QoL in both settings. The model established a positive, but ultimately weak and insignificant, association between QoC (access and effective treatment) and QoL (r = 0.349, P = 0.000; r = 0.161, P = 0.000, respectively). Even though the two settings are theoretically different in terms of being able to conceptualize, adopt, and implement QoC, the outcomes from both settings demonstrated insignificant relationships with QoL as the results were quite similar. Though modern medicine has substantially improved QoL around the world, this paper proposes that health accreditation has a very limited impact on improving QoL. This paper raises awareness of this topic with multiple healthcare professionals who are interested in correlating QoC and QoL. Hopefully, it will stimulate further research from other professional groups that have new and different perspectives. Addressing a transitional health care system that is in the process of endorsing accreditation, investigating the experience of tertiary cases, and analyzing deviated data may limit the generalization of this study. Global interest in applying public health policy underlines the impact of such process on patients’ outcomes. As QoC accreditation does not automatically produce improved QoL outcomes, the proposed study encourages further investigation of the value of health accreditation on personal and social well-being. PMID:25114568

  5. Quality of care for gastrointestinal conditions: a primer for gastroenterologists.

    PubMed

    Kappelman, Michael D; Dorn, Spencer D; Peterson, Erica; Runge, Thomas; Allen, John I

    2011-07-01

    The Institute of Medicine's publications To Err Is Human and Crossing the Quality Chasm publicized the widespread deficits in health-care quality. The quality of care for digestive diseases has not been evaluated comprehensively, although emerging literature suggests that the gap between recommended care and actual practice may be quite substantial. This paper reviews the history of, the rationale behind, and current work related to quality of care and quality improvement in the area of digestive diseases, with particular attention to colonoscopy, inflammatory bowel diseases, gastroesophageal reflux disease, chronic hepatitis C virus infection, and liver transplantation. PMID:21731014

  6. Quality specifications and standard-setting for stoma care patients.

    PubMed

    Primer, M A

    1995-12-01

    Quality specifications can be used as an information resource by purchasers of health care. The nature of service provision and nursing care can be positively influenced by the formalisation of standards and quality specifications. Auditing is essential in the ongoing evaluation of a quality system. PMID:8552696

  7. Measuring the Multifaceted Nature of Infant and Toddler Care Quality

    ERIC Educational Resources Information Center

    Mangione, Peter L.; Kriener-Althen, Kerry; Marcella, Jennifer

    2016-01-01

    Research Findings: The quality of group care infants and toddlers experience relates to their concurrent and later development. Recent quality improvement initiatives point to the need for ecologically valid measures that assess the multifaceted nature of child care quality. In this article, we present the psychometric properties of an infant and…

  8. 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…

  9. The AAWC conceptual framework of quality systems for wound care.

    PubMed

    Paine, Timothy G; Milne, Catherine T; Barr, Jane Ellen; Cordrey, Renee; Dieter, Susan; Harwood, Judith; Sawyer, Allen; Trepanier, Kimberly; Woelfel, Stephanie

    2006-11-01

    When the Association for Advanced Wound Care Quality of Care Task Force members determined there was no unanimously accepted definition of quality as it relates to wound care, they: 1) identified relevant components of quality wound care, and 2) created a framework of quality wound care indicators to enable the creation or assessment of wound care delivery systems. The framework is an innovative conceptual model that serves as a basis for the Association strategies to facilitate high quality wound care for patients/clients across the continuum of care and recognizes the role of the supporting systems necessary to provide wound care services. It uses the Institute of Medicine's Crossing the Quality Chasm: A New Health System for the 21st Century to define quality systems for wound care and includes safety and effectiveness coupled with the delivery of timely, efficient, equitable, collaborative, patient-centered care. This framework can be utilized during clinical, managerial, or regulatory review of wound care service delivery. PMID:17146119

  10. Evaluating the Quality of the Child Care in Finland

    ERIC Educational Resources Information Center

    Hujala, Eeva; Fonsen, Elina; Elo, Janniina

    2012-01-01

    In this study we examine parents' and teachers' perceptions of the early childhood education and care (ECEC) quality in Finland. The study is based on the paradigm of inclusionary quality and the assessment is based on the quality evaluation model. The parents and teachers assess the quality to be good. The strength of the quality was the effect

  11. Evaluating the Quality of the Child Care in Finland

    ERIC Educational Resources Information Center

    Hujala, Eeva; Fonsen, Elina; Elo, Janniina

    2012-01-01

    In this study we examine parents' and teachers' perceptions of the early childhood education and care (ECEC) quality in Finland. The study is based on the paradigm of inclusionary quality and the assessment is based on the quality evaluation model. The parents and teachers assess the quality to be good. The strength of the quality was the effect…

  12. 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

  13. Measurement of Quality to Improve Care in Sleep Medicine

    PubMed Central

    Morgenthaler, Timothy I.; Aronsky, Amy J.; Carden, Kelly A.; Chervin, Ronald D.; Thomas, Sherene M.; Watson, Nathaniel F.

    2015-01-01

    The Board of Directors of the American Academy of Sleep Medicine (AASM) commissioned a Task Force to develop quality measures as part of its strategic plan to promote high quality patient-centered care. Among many potential dimensions of quality, the AASM requested Workgroups to develop outcome and process measures to aid in evaluating the quality of care of five common sleep disorders: restless legs syndrome, insomnia, narcolepsy, obstructive sleep apnea in adults, and obstructive sleep apnea in children. This paper describes the rationale, background, general methods development, and considerations in implementation for these sleep disorder quality measures. The Workgroup papers are published in this issue under the following titles: Quality Measures for the Care of Adult Patients with Restless Legs Syndrome, Quality Measures for the Care of Patients with Insomnia, Quality Measures for the Care of Patients with Narcolepsy, Quality Measures for the Care of Adult Patients with Obstructive Sleep Apnea, and Quality Measures for the Care of Pediatric Patients with Obstructive Sleep Apnea. Citation: Morgenthaler TI, Aronsky AJ, Carden KA, Chervin RD, Thomas SM, Watson NF. Measurement of quality to improve care in sleep medicine. J Clin Sleep Med 2015;11(3):279–291. PMID:25700883

  14. The critical incident technique and nursing care quality research.

    PubMed

    Kemppainen, J K

    2000-11-01

    The critical incident technique, is a highly flexible qualitative research method used in solving practical problems. Although this research method has been extensively used in the service industry to evaluate consumers' expectations and perceptions, applications to the study of health care quality are just beginning. This article describes critical incident methodology, reviews previous applications of the technique to the study of health care quality and provides illustrations from research. This practical research methodology offers the following important advantages to those interested in designing studies of care quality: identifying patients' experiences in health care settings, exploring dimensions of nurse-patient interactions and identifying patients' responses to illness and health care treatment. PMID:11115012

  15. Tennessee Star-Quality Child Care 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 Tennessee's Star-Quality Child Care 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)…

  16. Louisiana Quality Start Child Care 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 Louisiana's Quality Start Child Care Rating System 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;…

  17. How health policy influences quality of care in pediatrics.

    PubMed

    Simpson, Lisa A; Fairbrother, Gerry

    2009-08-01

    The primary focus of child health policy for the last twenty years has been on improving health care coverage and access. More recently, the focus has shifted to include not only coverage, but also the quality of the care received. This article describes some "voltage drops" in health care that impede delivery of high quality health care. The growing emphasis on quality is reflected in provisions of the new Child Health Program Reauthorization Act of 2009 (CHIPRA) legislation. In addition to providing funding for health coverage for over four million more children, it also includes the most significant federal investment in pediatric quality to date. PMID:19660643

  18. 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…

  19. Assessing Quality Day-Care: The WHO Child Care Facility Schedule.

    ERIC Educational Resources Information Center

    Dragonas, Thalia; And Others

    Focusing on how the definition and assessment of quality day care are culturally specific, this paper reviews the development and validity of the Child Care Facility Schedule (CCFS), a procedure for assessing quality in child care settings in many countries. This project was initiated by the Division of Mental Health of the World Health…

  20. A Multidisciplinary Approach to Assessing the Quality of Care in Long-Term Care Facilities

    ERIC Educational Resources Information Center

    Kahn, Kenneth A.; And Others

    1977-01-01

    A study to determine quality of life and care in 20 Long-Term Care (LTC) facilities in the Metro Denver Area revealed care was better than anticipated. Assessments were made on 158 residents regarding problems, functioning level, and appropriateness of level of care based on information from residents, staff, and medical records. (Author)

  1. Quality of Care in the US Territories

    PubMed Central

    Nunez-Smith, Marcella; Bradley, Elizabeth H.; Herrin, Jeph; Santana, Calie; Curry, Leslie A.; Normand, Sharon-Lise T.; Krumholz, Harlan M.

    2011-01-01

    Background Health care quality in the US territories is poorly characterized. We used process measures to compare the performance of hospitals in the US territories and in the US states. Methods Our sample included nonfederal hospitals located in the United States and its territories discharging Medicare fee-for-service (FFS) patients with a principal discharge diagnosis of acute myocardial infarction (AMI), heart failure (HF), or pneumonia (PNE) (July 2005–June 2008). We compared risk-standardized 30-day mortality and readmission rates between territorial and stateside hospitals, adjusting for performance on core process measures and hospital characteristics. Results In 57 territorial hospitals and 4799 stateside hospitals, hospital mean 30-day risk-standardized mortality rates were significantly higher in the US territories (P < .001) for AMI (18.8% vs 16.0%), HF (12.3% vs 10.8%), and PNE (14.9% vs 11.4%). Hospital mean 30-day risk-standardized readmission rates (RSRRs) were also significantly higher in the US territories for AMI (20.6% vs 19.8%; P=.04), and PNE (19.4% vs 18.4%; P=.01) but was not significant for HF (25.5% vs 24.5%; P=.07). The higher risk-standardized mortality rates in the US territories remained statistically significant after adjusting for hospital characteristics and core process measure performance. Hospitals in the US territories had lower performance on all core process measures (P< .05). Conclusions Compared with hospitals in the US states, hospitals in the US territories have significantly higher 30-day mortality rates and lower performance on every core process measure for patients discharged after AMI, HF, and PNE. Eliminating the substantial quality gap in the US territories should be a national priority. PMID:21709184

  2. The meaning of quality of care in home care settings: older lesbian and bisexual women's perspectives.

    PubMed

    Grigorovich, Alisa

    2016-03-01

    Research suggests that the experience of being a lesbian or bisexual woman influences women's interactions with health care providers, and their perception of the quality of care. Limited research to date, however, has examined how ageing and sexuality mediates women's experiences of quality, when accessing health care in the community. To fill a gap in the literature, this study investigated older lesbian and bisexual women's perspectives on the meaning of quality of care in the context of receiving home care services. This was a qualitative single case study. Sixteen participants, aged 55-72 from Ontario, Canada, participated in semi-structured interviews between 2011 and 2012. The interviews were recorded and transcribed. The interview data were analysed using iterative thematic analysis and guided by a feminist ethic of care perspective. Participants described quality of care in ways that were in line with a feminist ethic of care; that is, they wanted care providers to be responsive and attentive to their needs, to involve them in the caring process and to demonstrate respect and caring. Participants also indicated that providers' comfort with, and knowledge of, sexual diversity was important for enabling quality of care. These findings deepen our understanding of how to support quality of care for this population through changes to provider education and training, and health policy. PMID:25919504

  3. Increasing access to quality health care for the poor: Community perceptions on quality care in Uganda.

    PubMed

    Kiguli, Julie; Ekirapa-Kiracho, Elizabeth; Okui, Olico; Mutebi, Aloysius; Macgregor, Hayley; Pariyo, George William

    2009-01-01

    This paper examines the community's perspectives and perceptions on quality of health care delivery in two Uganda districts. The paper addresses community concerns on service quality. It focuses on the poor because they are a vulnerable group and often bear a huge burden of disease. Community views were solicited and obtained using eight focus group discussions, six in-depth and 12 key informant interviews. User perceptions and definitions of the quality of health services depended on a number of variables related to technical competence, accessibility to services, interpersonal relations and presence of adequate drugs, supplies, staff, and facility amenities. Results indicate that service delivery to the poor in the general population is perceived to be of low quality. The factors that were mentioned as affecting the quality of services delivered were inadequate trained health workers, shortage of essential drugs, poor attitude of the health workers, and long distances to health facilities. This paper argues that there should be an improvement in the quality of health services with particular attention being paid to the poor. Despite wide focus on improvement of the existing infrastructure and donor funding, there is still low satisfaction with health services and poor perceived accessibility. PMID:19936148

  4. Aspects of Quality in Greek Day Care Centres.

    ERIC Educational Resources Information Center

    Melhuish, Edward C.; Petrogiannis, Konstantinos

    1996-01-01

    Evaluates the quality of the caregiving environment for young infants in day care centers in Athens (Greece) using three global measures: ITERS, PROFILE, and CCFS. Reveals a great similarity among the three measures. Reports a generally low quality for day care, lower than for other countries with similar research. (DSK)

  5. Effects of Quality Improvement System for Child Care Centers

    ERIC Educational Resources Information Center

    Ma, Xin; Shen, Jianping; Kavanaugh, Amy; Lu, Xuejin; Brandi, Karen; Goodman, Jeff; Till, Lance; Watson, Grace

    2011-01-01

    Using multiple years of data collected from about 100 child care centers in Palm Beach County, Florida, the authors studied whether the Quality Improvement System (QIS) made a significant impact on quality of child care centers. Based on a pre- and postresearch design spanning a period of 13 months, QIS appeared to be effective in improving…

  6. Child Outcome Measures in the Study of Child Care Quality

    ERIC Educational Resources Information Center

    Zaslow, Martha; Halle, Tamara; Martin, Laurie; Cabrera, Natasha; Calkins, Julia; Pitzer, Lindsay; Margie, Nancy Geyelin

    2006-01-01

    This article assesses whether there are methodological problems with child outcome measures that may contribute to the small associations between child care quality and child outcomes found in the literature. Outcome measures used in 65 studies of child care quality published between 1979 and December 2005 were examined, taking the previous review…

  7. Day Care Quality, Family and Child Characteristics and Socioemotional Development.

    ERIC Educational Resources Information Center

    Hagekull, Berit; Bohlin, Gunilla

    1995-01-01

    Investigated effects of day-care quality--in interaction with child and family characteristics--on socioemotional development at 29 months and again at 4 years. Results showed a main effect of day-care quality on expressions of positive emotions. Interactive effects were demonstrated for several of the other indicators of socioemotional

  8. Primary care groups in the United Kingdom: quality and accountability.

    PubMed

    Bindman, A B; Weiner, J P; Majeed, A

    2001-01-01

    With the introduction of primary care groups (PCGs), the British National Health Service has attempted to integrate delivery, finance, and quality improvement into a locally directed care system with a strong sense of community accountability. PCGs will eventually hold the budgets for primary care, specialist, hospital, and community-based services and have the flexibility to reapportion these budgets. Through clinical governance, PCGs are attempting to coordinate education, guidelines, audit and feedback, and other quality improvement approaches around health problems that are relevant to their patient panels and local communities. PCGs offer other nations attempting to improve the quality and accountability of health care an innovative approach that merits consideration. PMID:11585160

  9. Nursing Effort and Quality of Care for Nursing Home Residents

    ERIC Educational Resources Information Center

    Arling, Greg; Kane, Robert L.; Mueller, Christine; Bershadsky, Julie; Degenholtz, Howard B.

    2007-01-01

    Purpose: The purpose of this study was to determine the relationship between nursing home staffing level, care received by individual residents, and resident quality-related care processes and functional outcomes. Design and Methods: Nurses recorded resident care time for 5,314 residents on 156 units in 105 facilities in four states (Colorado,

  10. Nursing Effort and Quality of Care for Nursing Home Residents

    ERIC Educational Resources Information Center

    Arling, Greg; Kane, Robert L.; Mueller, Christine; Bershadsky, Julie; Degenholtz, Howard B.

    2007-01-01

    Purpose: The purpose of this study was to determine the relationship between nursing home staffing level, care received by individual residents, and resident quality-related care processes and functional outcomes. Design and Methods: Nurses recorded resident care time for 5,314 residents on 156 units in 105 facilities in four states (Colorado,…

  11. The Bottom Line: Quality/Consumer-Oriented Child Care.

    ERIC Educational Resources Information Center

    Jackson, Cheryl D.

    Arguing that the provision of child care services is consistent with the role of the community college, this paper provides an overview of the current demand for and delivery of child care services and briefly discusses ways in which community colleges can assist in the development and provision of consumer-oriented, high-quality child care.…

  12. Money, Accreditation, and Child Care Center Quality. Working Paper Series.

    ERIC Educational Resources Information Center

    Gormley, William T., Jr.; Lucas, Jessica K.

    In recent years, several states have offered financial incentives to encourage child care centers and homes to become accredited by a reputable national organization to improve child care quality. This report examines whether it is good policy to offer higher reimbursement rates to accredited child care facilities and assesses the relative merits…

  13. Child Care in Corporate America: Quality Indicators and Model Programs.

    ERIC Educational Resources Information Center

    Catalyst, New York, NY.

    A study examined issues of quality in corporate-sponsored child care centers for children up to the age of 6. The study used a combination of methods, including a literature review, telephone interviews with corporations sponsoring child care centers, and visits to 12 corporate-sponsored child care centers. The findings came under the four…

  14. Marketing quality and value to the managed care market.

    PubMed

    Kazmirski, G

    1998-11-01

    Quantifying quality and marketing care delivery have been long-term challenges in the health care market. Insurers, employers, other purchasers of care, and providers face a constant challenge in positioning their organizations in a proactive, competitive niche. Tools that measure patient's self-reported perception of health care needs and expectations have increased the ability to quantify quality of care delivery. When integrated with case management and disease management strategies, outcomes reporting and variance analysis tracking can be packaged to position a provider in a competitive niche. PMID:10338715

  15. Overview of issues in improving quality of care for children.

    PubMed Central

    McGlynn, E A; Halfon, N

    1998-01-01

    OBJECTIVE: To provide a framework for a research agenda-setting conference on quality of care for children. DATA SOURCES/STUDY SETTING: Literature review. CONCLUSIONS: Research on quality of care for children has lagged behind its counterpart for adults. Defining key issues and questions in seven topic areas-the health of children; the efficacy and effectiveness of health services for children; assessing quality of care; improving quality of care within health services delivery systems; assessing and improving quality at the community level; getting financial incentives right; and disseminating information about the results of research investigations-will facilitate the development of an effective research strategy. Ultimately, enhanced information in these areas will lead to improvements in the processes and outcomes of care for children. PMID:9776946

  16. Quality improvement and accountability in the Danish health care system.

    PubMed

    Mainz, Jan; Kristensen, Solvejg; Bartels, Paul

    2015-12-01

    Denmark has unique opportunities for quality measurement and benchmarking since Denmark has well-developed health registries and unique patient identifier that allow all registries to include patient-level data and combine data into sophisticated quality performance monitoring. Over decades, Denmark has developed and implemented national quality and patient safety initiatives in the healthcare system in terms of national clinical guidelines, performance and outcome measurement integrated in clinical databases for important diseases and clinical conditions, measurement of patient experiences, reporting of adverse events, national handling of patient complaints, national accreditation and public disclosure of all data on the quality of care. Over the years, Denmark has worked up a progressive and transparent just culture in quality management; the different actors at the different levels of the healthcare system are mutually attentive and responsive in a coordinated effort for quality of the healthcare services. At national, regional, local and hospital level, it is mandatory to participate in the quality initiatives and to use data and results for quality management, quality improvement, transparency in health care and accountability. To further develop the Danish governance model, it is important to expand the model to the primary care sector. Furthermore, a national quality health programme 2015-18 recently launched by the government supports a new development in health care focusing upon delivering high-quality health care-high quality is defined by results of value to the patients. PMID:26443814

  17. 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

  18. 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

  19. Health and Safety of Child Care Centers: An Analysis of Licensing Specialists’ Reports of Routine, Unannounced Inspections

    PubMed Central

    Jeon, Sangchoon; Rosenthal, Marjorie S.

    2013-01-01

    Objectives. We assessed the prevalence of regulatory noncompliance of licensed child care centers and identified factors associated with improved compliance. Methods. We analyzed 676 routine, unannounced reports of child care centers collected by the Connecticut Department of Public Health licensing specialists over a 2-year time period, included characteristics of centers, and created categories of regulations. Results. The sample included 41% of licensed child care centers. Of the 13 categories of regulations in the analyses, 7 categories (outdoor safety, indoor safety, indoor health, child and staff documentation, emergency preparedness, infant-toddler indoor health, and infant-toddler indoor safety) had regulations with center noncompliance greater than 10%. Playground hazard-free was the regulation with the highest frequency (48.4%) of noncompliance. Compliance with the regulation for 20 hours of continuing education per year for child care providers was the characteristic most frequently associated with regulations compliance. Conclusions. Efforts to support continuing education of child care providers are essential to improve and sustain healthy and safe early-care and education programs. Analyses of state child care licensing inspection reports provide valuable data and findings for strategic planning efforts. PMID:23948016

  20. Issues in Measuring and Improving Health Care Quality

    PubMed Central

    Friedman, Maria A.

    1995-01-01

    This issue of the Health Care Financing Review focuses on issues and advances in measuring and improving the quality of care, particularly for Medicare and Medicaid beneficiaries. Discussions of quality-related topics are especially timely, given the growing and widespread interest in improving quality in the organization, financing, and delivery of health care services. This article has several purposes. The first is to provide a brief description of some of the causes underlying the growth of the health care quality movement; the second is to provide a contextual framework for discussion of some of the overarching themes that emerge in this issue. These themes include examining conceptual issues, developing quality measures for specific sites and populations, and creating or adapting data sets for quality-measurement purposes. PMID:10151882

  1. The legal framework for health care quality assurance in Germany.

    PubMed

    Sauerland, Dirk

    2009-01-01

    Like most industrialized countries, Germany's health care system is facing two major challenges. The first is to find a sustainable financing system for increasing health care expenditures. The second is to ensure - and improve - the quality of care provided. This article describes the status quo in quality assurance in Germany and analyses the changes introduced into the SHI (Statutory Health Insurance) system with the Modernization Act of 2004. First, a theoretical framework for quality assurance that is consistent with the logic of the German social market economy is outlined. The analysis then describes new actors and their duties in the field of quality assurance, highlighting improvements in regulation and the regulatory instruments applied. Although the strategy for quality assurance is still dominated by regulation and corporatist bodies, the latest reform acts of 2004 and 2007 focus on more and better information about the quality of services provided - an important prerequisite for more competitive elements in the German health care system. PMID:19099618

  2. Access to Quality Early Childhood Care and Education. Background Paper for the Quality Child Care Think Tank. Draft.

    ERIC Educational Resources Information Center

    Brandon, Richard N.; Smith, Diana

    This background paper discusses the current system of child care finance in Washington State and analyzes options for improvement. It describes prominent characteristics of the early childhood care and education system, findings relating program quality to staff/child ratios and staff educational levels, characteristics of quality, parent…

  3. Quality Care and Patient Safety in the Pediatric Emergency Department.

    PubMed

    Rosen, Johanna R; Suresh, Srinivasan; Saladino, Richard A

    2016-04-01

    Over the past 15 years, with alarming and illustrative reports released from the Institute of Medicine, quality improvement and patient safety have come to the forefront of medical care. This article reviews quality improvement frameworks and methodology and the use of evidence-based guidelines for pediatric emergency medicine. Top performance measures in pediatric emergency care are described, with examples of ongoing process and quality improvement work in our pediatric emergency department. PMID:27017034

  4. Methodological Research Priorities in Palliative Care and Hospice Quality Measurement.

    PubMed

    Dy, Sydney Morss; Herr, Keela; Bernacki, Rachelle E; Kamal, Arif H; Walling, Anne M; Ersek, Mary; Norton, Sally A

    2016-02-01

    Quality measurement is a critical tool for improving palliative care and hospice, but significant research is needed to improve the application of quality indicators. We defined methodological priorities for advancing the science of quality measurement in this field based on discussions of the Technical Advisory Panel of the Measuring What Matters consensus project of the American Academy of Hospice and Palliative Medicine and Hospice and Palliative Nurses Association and a subsequent strategy meeting to better clarify research challenges, priorities, and quality measurement implementation strategies. In this article, we describe three key priorities: 1) defining the denominator(s) (or the population of interest) for palliative care quality indicators, 2) developing methods to measure quality from different data sources, and 3) conducting research to advance the development of patient/family-reported indicators. We then apply these concepts to the key quality domain of advance care planning and address relevance to implementation of indicators in improving care. Developing the science of quality measurement in these key areas of palliative care and hospice will facilitate improved quality measurement across all populations with serious illness and care for patients and families. PMID:26596877

  5. 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)…

  6. Assessing the Quality of Portuguese Child Care Programs for Toddlers

    ERIC Educational Resources Information Center

    Barros, Silvia; Aguiar, Cecilia

    2010-01-01

    The purpose of this study was to describe the quality of toddler child care classrooms in the district of Porto, in the north of Portugal. One hundred and sixty classrooms for children between 1 and 3 years of age participated in this study. Results suggested the existence of poor average quality and absence of good-quality classrooms. Child-adult…

  7. 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

  8. Observed Engagement as an Indicator of Child Care Program Quality.

    ERIC Educational Resources Information Center

    Ridley, Stephanie Maher; McWilliam, R. A.; Oates, Christie S.

    2000-01-01

    Observed engagement of children in 17 child care environments as a way to assess program quality. Found that children in centers that met only minimal licensing requirements had lower levels of engagement than other children, and that center quality was related to quality of experience. (LBT)

  9. 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…

  10. Cancer Quality Alliance: Blueprint for a better cancer care system.

    PubMed

    Rose, Christopher; Stovall, Ellen; Ganz, Patricia A; Desch, Christopher; Hewitt, Maria

    2008-01-01

    The Cancer Quality Alliance (CQA), a national alliance advocating for improvements in the quality of cancer care in America, presents a set of 5 case studies that depict a vision of quality cancer care and a "Blueprint" for actions to realize this vision. The CQA Blueprint case studies feature patients with soft tissue sarcoma, breast cancer, rectal cancer, and Hodgkin disease and focus on key phases in the cancer care trajectory: detection, diagnosis, treatment, post-treatment/survivorship, and end of life. Each case study begins with a patient summary, follows with a worst- and a best-case scenario, and concludes with a discussion section identifying "what went right" in the best case and "what went wrong" in the worst case. Steps to be taken by key stakeholders, for example, health care providers, insurers/payers, policy makers, and patients and families, are then outlined. By juxtaposing a worst- and best-case scenario, the cancer care case studies elucidate the origins of complex health care problems and clarify the actions needed to overcome them. The CQA will make the case studies available for use as teaching tools to give health care providers and patients themselves descriptions of how the health care system should work to achieve the ultimate benefit for an individual living with, through, and beyond a diagnosis of cancer. The CQA adopted the definition of quality health care of the Institute of Medicine, and the analysis of care provided in the discussion section of each case study is framed using 6 quality improvement aims identified in the Institute of Medicine's report, Crossing the Quality Chasm: A New Health System for the 21st Century. Health care quality may be judged according to its safety, effectiveness, patient-centeredness, timeliness, efficiency, and equity. PMID:18768677

  11. Crossing the quality chasm: lessons from health care quality improvement efforts in England

    PubMed Central

    2002-01-01

    The second report from the US Institute of Medicine Crossing the Quality Chasm, highlighted the deficiencies in health care quality in the USA, analyzed the contributory factors, and proposed 13 recommendations for improvements. Clearly, the challenges are enormous. Can anything be learned from the experiences of other countries? This article describes the author's experiences of health care quality improvement efforts in the National Health Service in England and their implications for the USA and for Baylor Health Care System. PMID:16333409

  12. Crossing the quality chasm: lessons from health care quality improvement efforts in England.

    PubMed

    Madhok, Rajan

    2002-01-01

    The second report from the US Institute of Medicine Crossing the Quality Chasm, highlighted the deficiencies in health care quality in the USA, analyzed the contributory factors, and proposed 13 recommendations for improvements. Clearly, the challenges are enormous. Can anything be learned from the experiences of other countries? This article describes the author's experiences of health care quality improvement efforts in the National Health Service in England and their implications for the USA and for Baylor Health Care System. PMID:16333409

  13. Delivering High-Quality Cancer Care: The Critical Role of Quality Measurement

    PubMed Central

    Spinks, Tracy; Ganz, Patricia A.; Sledge, George W.; Levit, Laura; Hayman, James A.; Eberlein, Timothy J.; Feeley, Thomas W.

    2014-01-01

    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

  14. What Is Quality Family Day Care?

    ERIC Educational Resources Information Center

    Hasegawa, Pam, Comp.

    This position paper describes several aspects of ideal family day care. The importance of a mother substitute and a "home away from home" in which both preschool and school-age children are free to be themselves is emphasized. The key to an optimal relationship between the natural and day care parents is mutual cooperation, friendship and…

  15. 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

  16. Improving the quality of head and neck cancer care.

    PubMed

    Weber, Randal S

    2007-12-01

    The 2001 report by the Institute of Medicine (IOM) titled Crossing the Quality Chasm: A New Health System for the 21st Century highlighted the gap that exists between what we know to be effective, beneficial care and the care that is often delivered to an individual patient.(1) In the report, the IOM stated, "Between the health care we have and the care we could have lies not just a gap, but a chasm."(1)((p1)) The report, signifying a national initiative to improve the quality of care in the United States, articulated the following 6 aims for a new health care system: (1) to increase the safety of health care by avoiding injuries to patients through care intended to help them; (2) to provide effective services based on scientific knowledge and to avoid services of no proven benefit; (3) to deliver individualized treatment respectful of and responsive to the patient's preferences, needs, and values; (4) to deliver timely care by reducing wait times and harmful delays; (5) to increase efficiency by not wasting equipment, supplies, ideas, and energy; and (6) to deliver care that is equitable and does not vary by personal characteristics, patient sex, ethnicity, geography, and social economic status. The IOM also recognized a need to optimize quality cancer care in the United States. PMID:18086958

  17. Assuring the Quality of In-Home Care: The "Other" Challenge for Long-Term Care.

    ERIC Educational Resources Information Center

    Applebaum, Robert; Phillips, Paul

    1990-01-01

    Discusses critical factors complicating efforts to assure quality of in-home care for people with chronic disabilities: client and provider characteristics, fiscal restraints, inadequate regulation, lack of quality assurance methods, and lack of coherent social policy for long-term care. Identifies three areas of policy to be addressed if efforts…

  18. Leadership, staffing and quality of care in nursing homes

    PubMed Central

    2011-01-01

    Background Leadership and staffing are recognised as important factors for quality of care. This study examines the effects of ward leaders' task- and relationship-oriented leadership styles, staffing levels, ratio of registered nurses and ratio of unlicensed staff on three independent measures of quality of care. Methods A cross-sectional survey of forty nursing home wards throughout Norway was used to collect the data. Five sources of data were utilised: self-report questionnaires to 444 employees, interviews with and questionnaires to 13 nursing home directors and 40 ward managers, telephone interviews with 378 relatives and 900 hours of field observations. Separate multi-level analyses were conducted for quality of care assessed by relatives, staff and field observations respectively. Results Task-oriented leadership style had a significant positive relationship with two of the three quality of care indexes. In contrast, relationship-oriented leadership style was not significantly related to any of the indexes. The lack of significant effect for relationship-oriented leadership style was due to a strong correlation between the two leadership styles (r = 0.78). Staffing levels and ratio of registered nurses were not significantly related to any of the quality of care indexes. The ratio of unlicensed staff, however, showed a significant negative relationship to quality as assessed by relatives and field observations, but not to quality as assessed by staff. Conclusions Leaders in nursing homes should focus on active leadership and particularly task-oriented behaviour like structure, coordination, clarifying of staff roles and monitoring of operations to increase quality of care. Furthermore, nursing homes should minimize use of unlicensed staff and address factors related to high ratios of unlicensed staff, like low staff stability. The study indicates, however, that the relationship between staffing levels, ratio of registered nurses and quality of care is complex. Increasing staffing levels or the ratio of registered nurses alone is not likely sufficient for increasing quality of care. PMID:22123029

  19. 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

  20. 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…

  1. 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

  2. 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…

  3. The Impact of Regulations on the Supply and Quality of Care in Child Care Markets

    PubMed Central

    Joseph Hotz, V.; Xiao, Mo

    2011-01-01

    We examine the impact of state child care regulations on the supply and quality of care in child care markets. We exploit panel data on both individual establishments and local markets to control for state, time, and, where possible, establishment-specific fixed effects to mitigate the potential bias due to policy endogeneity. We find that the imposition of regulations reduces the number of center-based child care establishments, especially in lower income markets. However, such regulations increase the quality of services provided, especially in higher income areas. Thus, there are winners and losers from the regulation of child care services. PMID:24991060

  4. Measuring Racial Disparities in the Quality of Ambulatory Diabetes Care

    PubMed Central

    Bynum, Julie P. W.; Fisher, Elliott S.; Song, Yunjie; Skinner, Jonathan; Chandra, Amitabh

    2010-01-01

    Background Improving the health of minority patients who have diabetes depends in part on improving quality and reducing disparities in ambulatory care. It has been difficult to measure these components at the level of actionable units. Objective To measure ambulatory care quality and racial disparities in diabetes care across groups of physicians who care for populations of ambulatory diabetes patients. Research Design Prospective cohort analysis using administrative data. Subjects Using fee-for-service Medicare claims data from 2003 to 2005, we link patients to their principal ambulatory care physician. The patients are then linked to the hospital where their physicians work or have their patients admitted, creating physician-hospital networks. Measures Proportion of recommended diabetes testing received by black and nonblack diabetes patients. Results Blacks received 70% of recommended care compared with nonblacks who received 76.9% (P < 0.001). However, for black and nonblack patients, variation in the quality of care exceeds the racial gap in treatment. The network-specific performance rates for blacks and nonblacks were highly correlated (r = 0.67, P < 0.001), but 47% of blacks, versus 31% of nonblacks, received care from the third of networks with lowest quality. Physician-hospital networks with higher overall quality, or patients with higher socioeconomic status, were no less likely to exhibit black-white disparities. Conclusions It is possible to measure, benchmark, and monitor the quality of minority care at the level of networks responsible for ambulatory care. Consequently, it should be easier to provide patients with information on network performance and to design policies that improve the quality of minority-serving providers. PMID:21063231

  5. The nurse retention, quality of care and patient satisfaction chain.

    PubMed

    Newman, K; Maylor, U; Chansarkar, B

    2001-01-01

    This paper proposes an integrated approach to examining and dealing with the complex issue of nurse recruitment, retention, healthcare quality and patient satisfaction. The paper depicts and describes a generic conceptual framework or chain derived from a review of the literature on nurse recruitment and retention, service quality and human resource management. The chain is made up of the following components: NHS and Trust conditions and environment (internal quality)--service capability--nurse satisfaction--nurse retention--quality of patient care--patient satisfaction. The value of the chain is derived from its synthesis and display of the prime constituents or drivers of nurse satisfaction, quality of patient care and satisfaction. From this holistic picture it is possible for both national and local initiatives to be integrated in a mutually reinforcing way in order to achieve improvements in nurse recruitment, retention, quality of care and patient satisfaction. PMID:11436752

  6. Racial/Ethnic Discrimination in Health Care: Impact on Perceived Quality of Care

    PubMed Central

    Ngo-Metzger, Quyen; De Alba, Israel

    2010-01-01

    Background Racial/ethnic minorities are more likely to report receipt of lower quality of health care; however, the mediators of such patient reports are not known. Objectives To determine (1) whether racial disparities in perceptions of quality of health care are mediated by perceptions of being discriminated against while receiving medical care and (2) whether this association is further mediated by patient sociodemographic characteristics, access to care, and patient satisfaction across racial/ethnic groups. Research Design A cross-sectional analysis of a population-based sample of California adults responding to the 2003 California Health Interview Survey. Multivariable logistic regression was used to examine the relationship between perceived discrimination and perceived quality of health care after adjusting for patient characteristics and reports of access to care. Main Results A total of 36,831 respondents were included. African Americans (68.7%) and Asian/Pacific Islanders (64.5%) were less likely than non-Hispanic whites (72.8%) and Hispanics (74.9%) to rate their health care quality highly. African Americans (13.1%) and Hispanics (13.4%) were the most likely to report discrimination, followed by Asian/Pacific Islanders (7.3%) and non-Hispanic whites (2.6%). Racial/ethnic discrimination in health care was negatively associated with ratings of health care quality within each racial/ethnic group, even after adjusting for sociodemographic variables and other indicators of access and satisfaction. Feeling discriminated against fully accounted for the difference in low ratings of quality care between African Americans and whites, but not for other racial/ethnic minorities. Conclusions Patient perceptions of discrimination may play an important, yet variable role in ratings of health care quality across racial/ethnic minority groups. Health care institutions should consider how to address this patient concern as a part of routine quality improvement. PMID:20146022

  7. Does Competition Improve Health Care Quality?

    PubMed Central

    Scanlon, Dennis P; Swaminathan, Shailender; Lee, Woolton; Chernew, Michael

    2008-01-01

    Objective To identify the effect of competition on health maintenance organizations' (HMOs) quality measures. Study Design Longitudinal analysis of a 5-year panel of the Healthcare Effectiveness Data and Information Set (HEDIS) and Consumer Assessment of Health Plans Survey® (CAHPS) data (calendar years 1998–2002). All plans submitting data to the National Committee for Quality Assurance (NCQA) were included regardless of their decision to allow NCQA to disclose their results publicly. Data Sources NCQA, Interstudy, the Area Resource File, and the Bureau of Labor Statistics. Methods Fixed-effects models were estimated that relate HMO competition to HMO quality controlling for an unmeasured, time-invariant plan, and market traits. Results are compared with estimates from models reliant on cross-sectional variation. Principal Findings Estimates suggest that plan quality does not improve with increased levels of HMO competition (as measured by either the Herfindahl index or the number of HMOs). Similarly, increased HMO penetration is generally not associated with improved quality. Cross-sectional models tend to suggest an inverse relationship between competition and quality. Conclusions The strategies that promote competition among HMOs in the current market setting may not lead to improved HMO quality. It is possible that price competition dominates, with purchasers and consumers preferring lower premiums at the expense of improved quality, as measured by HEDIS and CAHPS. It is also possible that the fragmentation associated with competition hinders quality improvement. PMID:18793214

  8. Strategies that promote high quality care in Indonesia

    PubMed Central

    Gertler, Paul J.

    2009-01-01

    Objectives To investigate factors predicting the quality of care received using a nationally representative dataset from Indonesia. Data Sources The study combines two surveys in 13 provinces: a household survey of 2451 women who delivered a live birth in 1992-1998, and a facility survey that measured quality available from outpatient providers. Study design Multivariate regressions are used to explain the quality of care received. Explanatory variables are high facility quality, maternal education, household wealth, ethnicity, and insurance. Data collection methods Facility quality available is measured by adherence to prenatal protocols using a clinical case scenario. Quality received is measured by maternal reports about routine prenatal services received. Principle findings High facility quality predicts an increase in quality received. Although poor households have access to the same or higher quality care compared with the least poor, the poor receive lower levels of quality. In remote regions, quality received rises with increasing levels of maternal education and household wealth. Conclusions Improving health provider knowledge, and increasing household financial resources and information could redress inequalities in quality received among the poor and least educated. PMID:18501988

  9. The quality-value proposition in health care.

    PubMed

    Feazell, G Landon; Marren, John P

    2003-01-01

    Powerful forces are converging in US health care to finally cause recognition of the inherently logical relationship between quality and money. The forces, or marketplace "drivers," which are converging to compel recognition of the relationship between cost and quality are: (1) the increasing costs of care; (2) the recurrence of another medical malpractice crisis; and (3) the recognition inside and outside of health care that quality is inconsistent and unacceptable. It is apparent that hospital administrators, financial officers, board members, and medical staff leadership do not routinely do two things: (1) relate quality to finance; and (2) appreciate the intra-hospital structural problems that impede quality attainment. This article discusses these factors and offers a positive method for re-structuring quality efforts and focusing the hospital and its medical staff on quality. The simple but compelling thesis of the authors is that health care must immediately engage in the transformation to making quality of medical care the fundamental business strategy of the organization. PMID:14977035

  10. Nebraska: Early Head Start Initiative

    ERIC Educational Resources Information Center

    Center for Law and Social Policy, Inc. (CLASP), 2012

    2012-01-01

    Since 1999, Nebraska's Early Head Start Infant/Toddler Quality Initiative has supported Early Head Start (EHS) and community child care partnerships to improve the quality and professionalism of infant and toddler care. EHS programs apply to receive funding to establish partnerships with center-based or home-based child care.The initiative has…

  11. Racial and Ethnic Disparities in the Quality of Health Care.

    PubMed

    Fiscella, Kevin; Sanders, Mechelle R

    2016-03-18

    The annual National Healthcare Quality and Disparities Reports document widespread and persistent racial and ethnic disparities. These disparities result from complex interactions between patient factors related to social disadvantage, clinicians, and organizational and health care system factors. Separate and unequal systems of health care between states, between health care systems, and between clinicians constrain the resources that are available to meet the needs of disadvantaged groups, contribute to unequal outcomes, and reinforce implicit bias. Recent data suggest slow progress in many areas but have documented a few notable successes in eliminating these disparities. To eliminate these disparities, continued progress will require a collective national will to ensure health care equity through expanded health insurance coverage, support for primary care, and public accountability based on progress toward defined, time-limited objectives using evidence-based, sufficiently resourced, multilevel quality improvement strategies that engage patients, clinicians, health care organizations, and communities. PMID:26789384

  12. Impact of Performance Obstacles on Intensive Care Nurses‘ Workload, Perceived Quality and Safety of Care, and Quality of Working Life

    PubMed Central

    Gurses, Ayse P; Carayon, Pascale; Wall, Melanie

    2009-01-01

    Objectives To study the impact of performance obstacles on intensive care nurses‘ workload, quality and safety of care, and quality of working life (QWL). Performance obstacles are factors that hinder nurses‘ capacity to perform their job and that are closely associated with their immediate work system. Data Sources/Study Setting Data were collected from 265 nurses in 17 intensive care units (ICUs) between February and August 2004 via a structured questionnaire, yielding a response rate of 80 percent. Study Design A cross-sectional study design was used. Data were analyzed by correlation analyses and structural equation modeling. Principal Findings Performance obstacles were found to affect perceived quality and safety of care and QWL of ICU nurses. Workload mediated the impact of performance obstacles with the exception of equipment-related issues on perceived quality and safety of care as well as QWL. Conclusions Performance obstacles in ICUs are a major determinant of nursing workload, perceived quality and safety of care, and QWL. In general, performance obstacles increase nursing workload, which in turn negatively affect perceived quality and safety of care and QWL. Redesigning the ICU work system to reduce performance obstacles may improve nurses‘ work. PMID:19207589

  13. Improving Higher Education: Total Quality Care.

    ERIC Educational Resources Information Center

    Barnett, Ronald

    This book presents two dominant and rival conceptions of quality in higher education. One is based on the expression of the tacit conceptions of value and propriety in the academic community. It is the character and quality of the continuing interactions of higher education's members that are at issue rather than any endpoint or definitive…

  14. Patient reported outcomes as indicators of pediatric health care quality.

    PubMed

    Bevans, Katherine B; Moon, JeanHee; Carle, Adam C; Mara, Constance A; Lai, Jin-Shei; DiMarco, Lindsay; Muller, Nicole; Woods, Donna

    2014-01-01

    Health care reform has increased demand for pediatric health care quality evaluations, particularly those that assess the impact of care on patient and population health outcomes. Many of today's most common childhood conditions are characterized by symptoms, behaviors, and functional limitations that are best assessed as patient reported outcomes (PROs). Although they remain greatly underutilized, PROs have the potential to improve pediatric health care quality assessment at the point of care and through system-level performance evaluations. The functions, benefits, and challenges of these PRO applications are described and illustrated in case examples. Although challenges remain, numerous methodological and technical innovations facilitate the use of PROs as health care quality metrics. These include advances in PRO measure development methodologies, the integration of PRO measures into electronic health records, and developing consensus among providers that PROs provide valuable information that can be used to enhance patient care. Although additional work is needed to address remaining methodological challenges, pediatric PROs are increasingly recognized as valuable indicators of health care quality in the clinical environment and as measures of organization- and provider-level performance. PMID:25169465

  15. Determining the quality of IMCI pneumonia care in Malawian children

    PubMed Central

    Bjornstad, Erica; Preidis, Geoffrey A.; Lufesi, Norman; Olson, Dan; Kamthunzi, Portia; Hosseinipour, Mina C.; McCollum, Eric D.

    2014-01-01

    Background Although pneumonia is the leading cause of child mortality worldwide, little is known about the quality of routine pneumonia care in high burden settings like Malawi that utilize World Health Organization’s Integrated Management of Childhood Illnesses (IMCI) guidelines. Due to severe human resource constraints, the majority of clinical care in Malawi is delivered by non-physician clinicians called Clinical Officers (COs). Aim To assess the quality of child pneumonia care delivered by Malawian COs in routine care conditions. Methods At an outpatient district-level clinic in Lilongwe, Malawi, 10 COs caring for 695 children who presented with fever, cough, or difficulty breathing were compared to IMCI pneumonia diagnostic and treatment guidelines. Results Fewer than 1% of patients received an evaluation by COs that included all 16 elements of the history and physical examination. The respiratory rate was only determined in 16.1% of patients presenting with cough or difficulty breathing. Of the 274 children with IMCI-defined pneumonia, COs correctly diagnosed 30%, and administered correct pneumonia care in less than 25%. COs failed to hospitalize 40.8% of children with severe or very severe pneumonia. Conclusions IMCI pneumonia care quality at this Malawian government clinic is alarmingly low. Along with reassessing current pneumonia training and supervision approaches, novel quality improvement interventions are necessary to improve care. PMID:24091151

  16. The impact of financial incentives on quality of health care.

    PubMed

    Dudley, R A; Miller, R H; Korenbrot, T Y; Luft, H S

    1998-01-01

    Purchasers of health care could offer financial incentives to plans or providers in order to increase quality. Unfortunately, the current health care market, in which quality is rarely measured and there is no risk adjustment, actively discourages both plans and providers from maximizing quality, resulting in a poor overall level of quality, both in fee-for-service arrangements and health maintenance organizations. Health plans and providers will not focus on quality until mechanisms to correct for risk differences among enrollees can be developed. Although such risk adjustment will be the most important stimulus for quality, it should also be linked to improvements in information systems and agreement on a minimum benefits package, quality reporting standards, and financial solvency requirements. PMID:9879306

  17. Agents for Change: Nonphysician Medical Providers and Health Care Quality

    PubMed Central

    Boucher, Nathan A; McMillen, Marvin A; Gould, James S

    2015-01-01

    Quality medical care is a clinical and public health imperative, but defining quality and achieving improved, measureable outcomes are extremely complex challenges. Adherence to best practice invariably improves outcomes. Nonphysician medical providers (NPMPs), such as physician assistants and advanced practice nurses (eg, nurse practitioners, advanced practice registered nurses, certified registered nurse anesthetists, and certified nurse midwives), may be the first caregivers to encounter the patient and can act as agents for change for an organization’s quality-improvement mandate. NPMPs are well positioned to both initiate and ensure optimal adherence to best practices and care processes from the moment of initial contact because they have robust clinical training and are integral to trainee/staff education and the timely delivery of care. The health care quality aspects that the practicing NPMP can affect are objective, appreciative, and perceptive. As bedside practitioners and participants in the administrative and team process, NPMPs can fine-tune care delivery, avoiding the problem areas defined by the Institute of Medicine: misuse, overuse, and underuse of care. This commentary explores how NPMPs can affect quality by 1) supporting best practices through the promotion of guidelines and protocols, and 2) playing active, if not leadership, roles in patient engagement and organizational quality-improvement efforts. PMID:25663213

  18. Creating a culture for health care quality and safety.

    PubMed

    Roberts, Velma; Perryman, Martha M

    2007-01-01

    Approximately 67% of hospital quality indicators require some type of laboratory testing to monitor compliance. Unfortunately, in many hospitals, laboratory data information systems remain an untapped resource in eliminating medical errors and improving patient safety. Using case scenarios, this article demonstrates potential consequences for patient safety and quality of care when information sharing between medical technologists and nurses is not a part of a hospital's culture. The outcome for this patient could have been avoided if a more inclusive health care quality and safety culture existed. Creating a culture for health care quality and safety requires consensus building by clinical and administrative leaders. Consensus building occurs by managing relationships among and between a team of independent, autonomous physicians, nurses, allied health professionals, and health care administrators. These relationships are built on mutual respect and effective communication. Creating a quality culture is a challenging but necessary prerequisite for eliminating medical errors and ensuring patient safety. Physician leaders promoting and advancing cultural change in clinical care from one of exclusive decision making authority to a culture that is based on shared decision making are a necessary first step. Shared decision making requires mutual respect, trust, confidentiality, responsiveness, empathy, effective listening, and communication among all clinical team members. Physician and administrative leaders with a focus on patient safety and a willingness to change will ensure a culture of health care quality and safety. PMID:17464230

  19. Developing a residential care facility version of the observable indicators of Nursing Home Care Quality Instrument.

    PubMed

    Aud, Myra A; Rantz, Marilyn J; Zwygart-Stauffacher, Mary; Manion, Pam

    2004-01-01

    The last decade has seen a substantial growth in the development of residential care facilities (assisted living facilities). Evaluation of the quality of care in this service delivery sector has been hampered by the lack of a consensus definition of quality and the lack of reliable instruments to measure quality. Founded on extensive research on nursing home care quality, a field test of the Residential Care Facility Version of the Observable Indicators of Nursing Home Care Quality Instrument was conducted in 35 residential care facilities in Missouri. Content validity of the 34 items was rated by 4 expert raters as 3.4 on a 4-point scale of relevance. Test-retest was 0.94, interrater reliability was 0.73, and internal consistency was 0.90 for the total scale, indicating excellent results for initial field-testing. A focus group confirmed the 5 dimensions of quality of care measured by the instrument as important in residential care settings. PMID:14717148

  20. Coaching to Quality: Increasing Quality in Early Care and Education Programmes through Community-University Partnership

    ERIC Educational Resources Information Center

    Gilbert, Jaesook Lee; Harte, Helene Arbouet

    2013-01-01

    This paper describes efforts to increase the quality in early care and education through targeted coaching. A collaborative including several community agencies and a university developed a framework of support for early care and education providers, using coaching as its foundational basis, called Coaching to Quality (CTQ). This paper provides a…

  1. Does Satisfaction Reflect the Technical Quality of Mental Health Care?

    PubMed Central

    Edlund, Mark J; Young, Alexander S; Kung, Fuan Yue; Sherbourne, Cathy D; Wells, Kenneth B

    2003-01-01

    Objective To analyze the relationship between satisfaction and technical quality of care for common mental disorders. Data Source A nationally representative telephone survey of 9,585 individuals conducted in 1997–1998. Study Design Using multinomial logistic regression techniques we investigated the association between a five-level measure of satisfaction with the mental health care available for personal or emotional problems and two quality indicators. The first measure, appropriate technical quality, was defined as use of either appropriate counseling or psychotropic medications during the prior year for a probable depressive or anxiety disorder. The second, active treatment, indicated whether the respondent had received treatment for a psychiatric disorder in the past year. Covariates included measures of physical and mental health and sociodemographic indicators. Principal Findings Appropriate technical quality of care was significantly associated with higher levels of satisfaction. The strength of the association was moderate. Conclusions Satisfaction is associated with technical quality of care. However, profiling quality of care with satisfaction will likely require large samples and case-mix adjustment, which may be more difficult for plans or provider groups to implement than measuring technical indicators. More importantly, satisfaction is not the same as technical quality, and our results suggest that at this time they cannot be made to approach each other closely enough to eliminate either. PMID:12785565

  2. The ReACH Collaborative--improving quality home care.

    PubMed

    Boyce, Patricia Simino; Pace, Karen B; Lauder, Bonnie; Solomon, Debra A

    2007-08-01

    Research on quality of care has shown that vigorous leadership, clear goals, and compatible incentive systems are critical factors in influencing successful change (Institute of Medicine, 2001). Quality improvement is a complex process, and clinical quality improvement applications are more likely to be effective in organizations that are ready for change and have strong leaders, who are committed to creating and reinforcing a work environment that supports quality goals (Shortell, 1998). Key leadership roles include providing clear and sustained direction, articulating a coherent set of values and incentives to guide group and individual activities, aligning and integrating improvement efforts into organizational priorities, obtaining or freeing up resources to implement improvement activities, and creating a culture of "continuous improvement" that encourages and rewards the pursuit and achievement of shared quality aims (Institute of Medicine, 2001, 70-71). In summary, home health care is a significant and growing sector of the health care system that provides care to millions of vulnerable patients. There seems little doubt that home health agencies want to focus on quality of care issues and provide optimal care to home-based patients. Furthermore, there is a growing awareness of the value for adapting innovative, effective models for improving the culture of home care practice. This awareness stems from the notion that some agencies see quality improvement activities as a way for them to distinguish themselves not only to regulators and customers, but also to meet the cultural and transformational needs to remain viable in a constantly evolving and competitive health care industry. PMID:17966307

  3. Shared Care Contributions to Self-Care and Quality of Life in Chronic Cardiac Patients.

    PubMed

    Sebern, Margaret; Brown, Roger; Flatley-Brennan, Patricia

    2016-07-01

    Shared care is an interpersonal interaction system composed of communication, decision making, and reciprocity; it is used by patients and family caregivers (care dyads) to exchange social support. This study's purpose was to describe the contributions of shared care to outcomes for individuals with cardiac disease. A secondary data analysis was used to answer the following questions. What is the association between elements of shared care and patient outcomes? Do dyad perceptions of shared care differentially contribute to patient outcomes? Participants in this study were 93 individuals with a cardiac disease and 93 family caregivers. Composite index structured equation modeling was the analytic tool. Caregiver communication and reciprocity were related to patient mental quality of life. Patient communication and reciprocity were related to their own mental and physical quality of life and self-care confidence. Findings from this study contribute a better understanding of how care dyads are integral to patient outcomes. PMID:26864996

  4. Quality of care in reproductive health programmes: education for quality improvement.

    PubMed

    Kwast, B E

    1998-09-01

    The provision of high quality maternity care will make the difference between life and death or lifelong maiming for millions of pregnant women. Barriers preventing access to affordable, appropriate, acceptable and effective services, and lack of facilities providing high quality obstetric care result in about 1600 maternal deaths every day. Education in its broadest sense is required at all levels and sectors of society to enhance policy formulation that will strengthen programme commitment, improve services with a culturally sensitive approach and ensure appropriate delegation of responsibility to health staff at peripheral levels. This paper is the second in series of three which addresses quality of care. The first (Kwast 1998) contains an overview of concepts, assessments, barriers and improvements of quality of care. The third article will describe selected aspects of monitoring and evaluation of quality of care. PMID:9856019

  5. Assessing Quality in Early Childhood Education and Care

    ERIC Educational Resources Information Center

    Ishimine, Karin; Tayler, Collette

    2014-01-01

    Evaluating quality in early childhood education and care (ECEC) service internationally is increasingly important. Research to date indicates that it is "high-quality" programmes that boost and sustain children's achievement outcomes over time. There is also growing interest in the accountability of public funds used for ECEC…

  6. Quality Matters in Early Childhood Education and Care: Norway 2013

    ERIC Educational Resources Information Center

    Taguma, Miho; Litjens, Ineke; Makowiecki, Kelly

    2013-01-01

    Early childhood education and care (ECEC) can bring a wide range of benefits--for children, parents and society at large. However, these benefits are conditional on "quality". Expanding access to services without attention to quality will not deliver good outcomes for children or long-term productivity benefits for society. This series of country

  7. Quality Matters in Early Childhood Education and Care: Norway 2013

    ERIC Educational Resources Information Center

    Taguma, Miho; Litjens, Ineke; Makowiecki, Kelly

    2013-01-01

    Early childhood education and care (ECEC) can bring a wide range of benefits--for children, parents and society at large. However, these benefits are conditional on "quality". Expanding access to services without attention to quality will not deliver good outcomes for children or long-term productivity benefits for society. This series of country…

  8. Quality Matters in Early Childhood Education and Care: Japan 2012

    ERIC Educational Resources Information Center

    Taguma, Miho; Litjens, Ineke; Makowiecki, Kelly

    2012-01-01

    Early childhood education and care (ECEC) can bring a wide range of benefits--for children, parents and society at large. However, these benefits are conditional on "quality". Expanding access to services without attention to quality will not deliver good outcomes for children or long-term productivity benefits for society. This series of country…

  9. Cost Functions, Efficiency, and Quality in Day Care Centers.

    ERIC Educational Resources Information Center

    Mocan, H. Naci

    1997-01-01

    Data collected in visits to 50 for-profit and 50 nonprofit day care centers showed no quality differences and little efficiency difference between the two sectors. Cost of increasing quality from mediocre to good was 12-16 cents per child-hour. (SK)

  10. Putting the Child Back into Child Care Quality Assessment.

    ERIC Educational Resources Information Center

    Ridley, Stephanie Maher; McWilliam, R. A.

    2001-01-01

    Focuses on children's daily experiences as an important component of assessing the quality of child care programs. Discusses the importance of individual and group engagement to better understand the quality classroom environments and keep track of improvements over time. Presents the Engagement Check II as a measure of group engagement and…

  11. Effects of stress management program on the quality of nursing care and intensive care unit nurses

    PubMed Central

    Pahlavanzadeh, Saied; Asgari, Zohreh; Alimohammadi, Nasrollah

    2016-01-01

    Background: High level of stress in intensive care unit nurses affects the quality of their nursing care. Therefore, this study aimed to determine the effects of a stress management program on the quality of nursing care of intensive care unit nurses. Materials and Methods: This study is a randomized clinical trial that was conducted on 65 nurses. The samples were selected by stratified sampling of the nurses working in intensive care units 1, 2, 3 in Al-Zahra Hospital in Isfahan, Iran and were randomly assigned to two groups. The intervention group underwent an intervention, including 10 sessions of stress management that was held twice a week. In the control group, placebo sessions were held simultaneously. Data were gathered by demographic checklist and Quality Patient Care Scale before, immediately after, and 1 month after the intervention in both groups. Then, the data were analyzed by Student's t-test, Mann–Whitney, Chi-square, Fisher's exact test, and analysis of variance (ANOVA) through SPSS software version 18. Results: Mean scores of overall and dimensions of quality of care in the intervention group were significantly higher immediately after and 1 month after the intervention, compared to pre-intervention (P < 0.001). The results showed that the quality of care in the intervention group was significantly higher immediately after and 1 month after the intervention, compared to the control group (P < 0.001). Conclusions: As stress management is an effective method to improve the quality of care, the staffs are recommended to consider it in improvement of the quality of nursing care. PMID:27186196

  12. Quality of care in family planning services in Morocco.

    PubMed

    Brown, L; Tyane, M; Bertrand, J; Lauro, D; Abou-ouakil, M; deMaria, L

    1995-01-01

    This study was conducted to heighten awareness of quality of care as a programmatic issue in the Moroccan governmental family planning program and to test modified Situation Analysis instruments for measuring quality of care. Data were collected from 50 service-delivery points in five provinces to measure six elements of quality in accordance with the Bruce/Jain framework. A procedure for calculating quality-indicator scores is presented. Although facilities varied by province and within provinces, most had the equipment and supplies needed to deliver services; service personnel were trained and regularly supervised; the service-delivery points scored well on mechanisms to ensure continuity of use. Notable shortcomings included a dearth of materials for counseling and a widespread unavailability of the Ovrette pill. This study raises issues regarding the complexity of measuring quality, the ownership of results, and the appropriateness of a centralized study of quality in a decentralized program. PMID:7570765

  13. Leadership and quality of working life in home health care.

    PubMed

    Smith, H L; Hood, J N; Piland, N F

    1994-01-01

    Home health care has undergone startling changes in the past decade and, in the process, become a strategically important ingredient of health care delivery. However, the question remains whether home health care organizations can deliver the benefits anticipated for integrated care delivery systems. The answer to this question depends to a great extent on whether home health care organizations build vibrant, visionary leadership capable of transforming organizations and motivating staff to deliver high quality and low cost services. This paper examines a case study of transformational leadership as it relates to the quality of working life for nurses, homemakers, and staff. The findings indicate that leader behaviour is strongly associated with homemakers', and to a lesser extent staff members', job satisfaction, job involvement, and propensity to remain with the organization. These job attitudes have been shown to be related to higher job performance. The implications for leadership in home health agencies are discussed. PMID:10134028

  14. How to Diagnose Solutions to a Quality of Care Problem.

    PubMed

    Harel, Ziv; Silver, Samuel A; McQuillan, Rory F; Weizman, Adam V; Thomas, Alison; Chertow, Glenn M; Nesrallah, Gihad; Chan, Christopher T; Bell, Chaim M

    2016-05-01

    To change a particular quality of care outcome within a system, quality improvement initiatives must first understand the causes contributing to the outcome. After the causes of a particular outcome are known, changes can be made to address these causes and change the outcome. Using the example of home dialysis (home hemodialysis and peritoneal dialysis), this article within this Moving Points feature on quality improvement will provide health care professionals with the tools necessary to analyze the steps contributing to certain outcomes in health care quality and develop ideas that will ultimately lead to their resolution. The tools used to identify the main contributors to a quality of care outcome will be described, including cause and effect diagrams, Pareto analysis, and process mapping. We will also review common change concepts and brainstorming activities to identify effective change ideas. These methods will be applied to our home dialysis quality improvement project, providing a practical example that other kidney health care professionals can replicate at their local centers. PMID:27016495

  15. Measuring consumer satisfaction to improve quality of care.

    PubMed

    McMillan, J R

    1987-03-01

    Patients' satisfaction affects their decisions regarding health care, so most care providers ultimately implement a program to measure satisfaction. Consumers' expectations influence whether, how soon, and how often they seek care, which provider they choose, and how satisfied they are. For consumers to seek care, they must have high expectations about care quality. Consumers' satisfaction is based on their perception of the treatment and not the quality of the treatment per se. Since health care quality is difficult for patients to assess, providers can present tangible evidence, such as facility design, that patients can use as surrogate measures of care quality. Providers deliver care at several levels, ranging from below standard to ideal. Satisfaction after treatment depends on what level the patient expected, so this must be measured before treatment. Satisfaction scores may be falsely high, since most patients do not wish to give negative answers, or falsely low, since some patients are dissatisfied with life in general. Thus it is helpful to compare the study's results with those in the literature. To gauge satisfaction, researchers have measured repeat usage; behavioral intentions and preferences; beliefs, attitudes, and expectations; or satisfaction and dissatisfaction directly. Some researchers have used measures of overall satisfaction, but these are inadequate because patients express varying levels of satisfaction with different attributes of care. Therefore a research plan should incorporate overall and individual attribute satisfaction scores plus composite measures created algebraically. Focusing on a specific health care episode helps determine which types of provider behavior are related to the satisfaction stated. Measurements should be made in the office before and directly after treatment to compare satisfaction with expectations. PMID:10280976

  16. Quality of diabetes care in community health centers.

    PubMed Central

    Chin, M H; Auerbach, S B; Cook, S; Harrison, J F; Koppert, J; Jin, L; Thiel, F; Karrison, T G; Harrand, A G; Schaefer, C T; Takashima, H T; Egbert, N; Chiu, S C; McNabb, W L

    2000-01-01

    OBJECTIVES: This study assessed the quality of diabetes care in community health centers. METHODS: In 55 midwestern community health centers, we reviewed the charts of 2865 diabetic adults for American Diabetes Association measures of quality. RESULTS: On average, 70% of the patients in each community health center had measurements of glycosylated hemoglobin, 26% had dilated eye examinations, 66% had diet intervention, and 51% received foot care. The average glycosylated hemoglobin value per community health center was 8.6%. Practice guidelines were independently associated with higher quality of care. CONCLUSIONS: Rates of adherence to process measures of quality were relatively low among community health centers, compared with the targets established by the American Diabetes Association. PMID:10705866

  17. Can patients reliably identify safe, high quality care?

    PubMed Central

    Tevis, Sarah E.; Schmocker, Ryan K.; Kennedy, Gregory D.

    2015-01-01

    The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey is a publicly reported tool that measures patient satisfaction. As both patients and Centers for Medicare & Medicaid Services (CMS) reimbursement rely on survey results as a metric of quality of care, we reviewed the current literature to determine if patient satisfaction correlates with quality, safety, or patient outcomes. We found varying associations between safety culture, process of care measure compliance, and patient outcomes with patient satisfaction on the HCAHPS survey. Some studies found inverse relationships between quality and safety metrics and patient satisfaction. The measure that most reliably correlated with high patient satisfaction was low readmission rate. Future studies using patient specific data are needed to better identify which factors most influence patient satisfaction and to determine if patient satisfaction is a marker of safer and better quality care. Furthermore, the HCAHPS survey should continue to undergo evaluations to assure it generates predictable results. PMID:26413179

  18. Quality Measures for the Care of Patients with Insomnia

    PubMed Central

    Edinger, Jack D.; Buysse, Daniel J.; Deriy, Ludmila; Germain, Anne; Lewin, Daniel S.; Ong, Jason C.; Morgenthaler, Timothy I.

    2015-01-01

    The American Academy of Sleep Medicine (AASM) commissioned five Workgroups to develop quality measures to optimize management and care for patients with common sleep disorders including insomnia. Following the AASM process for quality measure development, this document describes measurement methods for two desirable outcomes of therapy, improving sleep quality or satisfaction, and improving daytime function, and for four processes important to achieving these goals. To achieve the outcome of improving sleep quality or satisfaction, pre- and post-treatment assessment of sleep quality or satisfaction and providing an evidence-based treatment are recommended. To realize the outcome of improving daytime functioning, pre- and post-treatment assessment of daytime functioning, provision of an evidence-based treatment, and assessment of treatment-related side effects are recommended. All insomnia measures described in this report were developed by the Insomnia Quality Measures Workgroup and approved by the AASM Quality Measures Task Force and the AASM Board of Directors. The AASM recommends the use of these measures as part of quality improvement programs that will enhance the ability to improve care for patients with insomnia. Citation: Edinger JD, Buysse DJ, Deriy L, Germain A, Lewin DS, Ong JC, Morgenthaler TI. Quality measures for the care of patients with insomnia. J Clin Sleep Med 2015;11(3):311–334. PMID:25700881

  19. Quality Measures for the Care of Patients with Narcolepsy

    PubMed Central

    Krahn, Lois E.; Hershner, Shelley; Loeding, Lauren D.; Maski, Kiran P.; Rifkin, Daniel I.; Selim, Bernardo; Watson, Nathaniel F.

    2015-01-01

    The American Academy of Sleep Medicine (AASM) commissioned a Workgroup to develop quality measures for the care of patients with narcolepsy. Following a comprehensive literature search, 306 publications were found addressing quality care or measures. Strength of association was graded between proposed process measures and desired outcomes. Following the AASM process for quality measure development, we identified three outcomes (including one outcome measure) and seven process measures. The first desired outcome was to reduce excessive daytime sleepiness by employing two process measures: quantifying sleepiness and initiating treatment. The second outcome was to improve the accuracy of diagnosis by employing the two process measures: completing both a comprehensive sleep history and an objective sleep assessment. The third outcome was to reduce adverse events through three steps: ensuring treatment follow-up, documenting medical comorbidities, and documenting safety measures counseling. All narcolepsy measures described in this report were developed by the Narcolepsy Quality Measures Work-group and approved by the AASM Quality Measures Task Force and the AASM Board of Directors. The AASM recommends the use of these measures as part of quality improvement programs that will enhance the ability to improve care for patients with narcolepsy. Citation: Krahn LE, Hershner S, Loeding LD, Maski KP, Rifkin DI, Selim B, Watson NF. Quality measures for the care of patients with narcolepsy. J Clin Sleep Med 2015;11(3):335–355. PMID:25700880

  20. How student nurses can influence care quality.

    PubMed

    Banks, Suzanne; May, Ruth; Boath, Elizabeth; Tilford, Sarah; Johnston, Charlotte

    With support from NHS England, NHS Improving Quality and universities, student nurses have run conferences across the country on pressure ulcer prevention. The success of the events suggests that, as emerging nurse leaders, students recognise they have a key role in educating, motivating and galvanising their peers around a shared purpose. PMID:27089752

  1. Research into care quality criteria for long-term care institutions.

    PubMed

    Wang, Wen-Liang; Chang, Hong-Jer; Liu, An-Chi; Chen, Yu-Wen

    2007-12-01

    The purpose of this paper was to determine the criteria that reflect the quality of care provided by long-term care institutions. Research was conducted using a two-step procedure that first utilized the SERVQUAL model with Fuzzy Delphi Method to establish the proper criteria by which service quality could be measured. A total of 200 questionnaires were mailed to expert respondents, of which 89 were returned and 77 deemed valid for use in this study. We then applied the Multi-Criteria Decision Making Process to determine the degree of importance of each criterion to long-term care institution service quality planning work. Secondly, 200 questionnaires were distributed and 74 valid responses were returned. Based on the 5 SERVQUAL model constructs, this study found 17 of the 28 criteria, to be pertinent to nursing care quality, with those in the Responsiveness and Empathy domains being the ones most critical. PMID:18080970

  2. Quality and Safety in Health Care, Part II: Three Early Reports on Quality.

    PubMed

    Harolds, Jay A

    2015-09-01

    The 1990 Institute of Medicine report Medicare: A Strategy for Quality Assurance offered a definition of quality in health care and recommendations on how to achieve it. The forces for change would include different activities by the federal government, informed consumers, professionalism, and private initiatives. Eight years later, the National Roundtable report Statement on Quality of Care indicated that there were major problems of underuse, overuse, and misuse of health care services. In the same year, the President's Advisory Commission report Quality First: Better Health Care for All Americans discussed major problems with health care and proposed many initiatives to correct them, and also recommended a Bill of Rights and Responsibilities for the patients. PMID:26244402

  3. Health System Quality Improvement: Impact of Prompt Nutrition Care on Patient Outcomes and Health Care Costs.

    PubMed

    Meehan, Anita; Loose, Claire; Bell, Jvawnna; Partridge, Jamie; Nelson, Jeffrey; Goates, Scott

    2016-01-01

    Among hospitalized patients, malnutrition is prevalent yet often overlooked and undertreated. We implemented a quality improvement program that positioned early nutritional care into the nursing workflow. Nurses screened for malnutrition risk at patient admission and then immediately ordered oral nutritional supplements for those at risk. Supplements were given as regular medications, guided and monitored by medication administration records. Post-quality improvement program, pressure ulcer incidence, length of stay, 30-day readmissions, and costs of care were reduced. PMID:26910129

  4. Quality of tuberculosis care in India: a systematic review

    PubMed Central

    Satyanarayana, S.; Subbaraman, R.; Shete, P.; Gore, G.; Das, J.; Cattamanchi, A.; Mayer, K.; Menzies, D.; Harries, A. D.; Hopewell, P.; Pai, M.

    2015-01-01

    SUMMARY BACKGROUND While Indian studies have assessed care providers’ knowledge and practices, there is no systematic review on the quality of tuberculosis (TB) care. METHODS We searched multiple sources to identify studies (2000–2014) on providers’ knowledge and practices. We used the International Standards for TB Care to benchmark quality of care. RESULTS Of the 47 studies included, 35 were questionnaire surveys and 12 used chart abstraction. None assessed actual practice using standardised patients. Heterogeneity in the findings precluded meta-analysis. Of 22 studies evaluating provider knowledge about using sputum smears for diagnosis, 10 found that less than half of providers had correct knowledge; 3 of 4 studies assessing self-reported practices by providers found that less than a quarter reported ordering smears for patients with chest symptoms. In 11 of 14 studies that assessed treatment, less than one third of providers knew the standard regimen for drug-susceptible TB. Adherence to standards in practice was generally lower than correct knowledge of those standards. Eleven studies with both public and private providers found higher levels of appropriate knowledge/practice in the public sector. CONCLUSIONS Available evidence suggests suboptimal quality of TB care, particularly in the private sector. Improvement of quality of care should be a priority for India. PMID:26056098

  5. Mozambican midwives' views on barriers to quality perinatal care.

    PubMed

    Pettersson, Karen Odberg; Johansson, Eva; Pelembe, Maria de Fatima M; Dgedge, Clemencia; Christensson, Kyllike

    2006-02-01

    Our purpose in this study was to explore the midwives' perception of factors obstructing or facilitating their ability to provide quality perinatal care at a central labor ward in Maputo. In-depth interviews were undertaken with 16 midwives and were analyzed according to grounded theory technique. Barriers to provision of quality perinatal care were identified as follows: (i) the unsupportive environment, (ii) nonempowering and limited interaction with women in labor, (iii) a sense of professional inadequacy and inferiority, and (iv) nonappliance of best caring practices. A model based on the midwives' reflections on barriers to quality perinatal care and responses to these were developed. Actions aimed at overcoming the barriers were improvising and identifying areas in need of change. Identified evading actions were holding others accountable and yielding to dysfunction and structural control. In order to improve perinatal care, the midwives need to see themselves as change agents and not as victims of external and internal causal relationships over which they have no influence. It is moreover essential that the midwives chose actions aiming at overcoming barriers to quality perinatal care instead of choosing evading actions, which might jeopardize the health of the unborn and newborn infant. We suggest that local as well as national education programs need to correspond with existing reality, even if they provide knowledge that surpasses the present possibilities in practice. Quality of intrapartum and the immediate newborn care requires a supportive environment, however, which in the context of this study presented such serious obstacles that they need to be addressed on the national level. Structural and administrative changes are difficult to target as these depend on national organization of maternal health care (MHC) services and national health expenditures. PMID:16484159

  6. New Hampshire 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 New Hampshire's Quality Rating System 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. Mississippi Quality Step 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 Mississippi's Quality Step System 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) Application…

  8. Illinois Quality Counts: 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 Illinois' Quality Counts 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) Indicators for Family…

  9. Health, Quality of Care and Quality of Life: A Case of Frail Older Adults

    ERIC Educational Resources Information Center

    Hsieh, Chang-Ming

    2009-01-01

    This study explores the relationship between health, quality of care of geriatric case management and quality of life for the purpose of furthering the understanding of the relationship between quality of life and geriatric case management. Using survey data from a group of frail older adults, this study assesses the relative merit of two…

  10. Health, Quality of Care and Quality of Life: A Case of Frail Older Adults

    ERIC Educational Resources Information Center

    Hsieh, Chang-Ming

    2009-01-01

    This study explores the relationship between health, quality of care of geriatric case management and quality of life for the purpose of furthering the understanding of the relationship between quality of life and geriatric case management. Using survey data from a group of frail older adults, this study assesses the relative merit of two

  11. Miami-Dade Quality Counts: 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 Miami-Dade's Quality Counts 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) Indicators for…

  12. Palm Beach Quality Counts: 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 Palm Beach's Quality Counts 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) Indicators for…

  13. Maine Quality for ME: 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 Maine's Quality for ME 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) Indicators for Family…

  14. Indiana Paths to Quality: 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 Indiana's Paths to Quality 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) Indicators for…

  15. Virginia Star Quality Initiative: 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 Virginia's Star Quality Initiative 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) Indicators…

  16. Missouri 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 Missouri's Quality Rating System 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) Indicators for…

  17. Ohio Step Up to Quality: 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 Ohio's Step Up to Quality 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) Indicators for Family…

  18. Defining quality of care indicators for neonatal intensive care units independent of maternal risk factors.

    PubMed

    Ekelem, I; Taeusch, H W

    1990-05-01

    Observed and birthweight-specific neonatal mortality rates have been used for assessing quality of neonatal care, but these are crude and affected by risk characteristics of the population served. Even when neonatal mortality rate is corrected for four risk factors, race, sex, birthweight, and multiple births, (California Data Research Facility, Santa Barbara, CA) it is possible that the corrected neonatal mortality rate is not comparable among institutions because of population differences not corrected for, eg, prenatal care. To analyze whether our high neonatal mortality rate is primarily dependent on population risk or quality of neonatal care, we used contemporaneous data collection by senior physicians and a microcomputer database system to construct indices of quality of care that are based on diagnoses graded according to disease severity. For the 1987/1988 academic year, we found: neonatal intensive care unit nosocomial infection rate, 20%; severe intraventricular hemorrhage per 100 very low birthweight infants (1500 g), 20%; bronchopulmonary dysplasia per 100 cases of severe respiratory distress syndrome, 27%; necrotizing enterocolitis per 100 neonatal intensive care unit discharges, 5%; air leak per 100 cases of severe respiratory distress syndrome, 21%; and neonatal mortality rate per very low birthweight delivery rate, 0.4. We propose that microcomputer, hospital-based analyses will improve comparisons of neonatal intensive care unit quality of care if appropriate indices can be sufficiently well-defined and shared. PMID:2352285

  19. Health care and the quality of life: a review.

    PubMed

    Holmes, C A

    1989-10-01

    The increasing requirement for evaluation of health care, either for purposes of quality assurance or deciding resource distribution issues, has brought into question a number of ideas concerning the aims of the health care enterprise. This article suggests that the ultimate aim is to improve the quality of life, and examines the feasibility of adopting this as an evaluation criterion. Difficulties concerning the concept and definition of the quality of life are outlined, and a plea made for the adoption of the broadest possible therapeutic aims. Social indicators and subjective evaluations are considered in turn as measures of the quality of life, and their inadequacies and strengths exposed. Relationships between the measures are discussed, and their uses outlined. It is finally suggested that nurses should participate in the formulation of quality of life concepts and evaluations which reflect the values which underpin their own practice. PMID:2681314

  20. Board oversight of patient care quality in community health systems.

    PubMed

    Prybil, Lawrence D; Peterson, Richard; Brezinski, Paul; Zamba, Gideon; Roach, William; Fillmore, Ammon

    2010-01-01

    In hospitals and health systems, ensuring that standards for the quality of patient care are established and continuous improvement processes are in place are among the board's most fundamental responsibilities. A recent survey has examined governance oversight of patient care quality at 123 nonprofit community health systems and compared their practices with current benchmarks of good governance. The findings show that 88% of the boards have established standing committees on patient quality and safety, nearly all chief executive officers' performance expectations now include targets related to patient quality and safety, and 96% of the boards regularly receive formal written reports regarding their organizations' performance in relation to quality measures and standards. However, there continue to be gaps between present reality and current benchmarks of good governance in several areas. These gaps are somewhat greater for independent systems than for those affiliated with a larger parent organization. PMID:20042764

  1. Review of Medicare, Medicaid, and Commercial Quality of Care Measures: Considerations for Assessing Accountable Care Organizations.

    PubMed

    Kessell, Eric; Pegany, Vishaal; Keolanui, Beth; Fulton, Brent D; Scheffler, Richard M; Shortell, Stephen M

    2015-08-01

    Accountable care organizations (ACOs) have proliferated under the Affordable Care Act (ACA). If ACOs are to improve health care quality and lower costs, quality measures will be increasingly important in determining if provider consolidations associated with the development of ACOs are achieving their intended purpose. This article assesses quality measurement across public and private sectors. We reviewed available quality measures for a subset of programs in six organizations and assessed the number and domain of measures (structure, process, outcomes, and patient experience). Two-thirds of all quality measures were categorized as process measures. Outcome measures made up nearly 20 percent of measures. Patient experience and structure measures made up approximately 8 percent and 7 percent, respectively. We propose further improvements to quality measurement initiatives. For example, programs that reward providers should consider reward size and distribution within the organization. Quality improvement initiatives should consider what encourages provider buy-in and participation and the effects on populations with disproportionate health care needs. As the focus of quality initiatives may change from year to year, measures should be periodically revisited to ensure continued improvement and sustainability. Finally, we suggest quality measures that regulators could use prior to ACO formation or in the year or two following formation. PMID:26124294

  2. Does a quality management system improve quality in primary care practices in Switzerland? A longitudinal study

    PubMed Central

    Goetz, Katja; Hess, Sigrid; Jossen, Marianne; Huber, Felix; Rosemann, Thomas; Brodowski, Marc; Künzi, Beat; Szecsenyi, Joachim

    2015-01-01

    Objectives To examine the effectiveness of the quality management programme—European Practice Assessment—in primary care in Switzerland. Design Longitudinal study with three points of measurement. Setting Primary care practices in Switzerland. Participants In total, 45 of 91 primary care practices completed European Practice Assessment three times. Outcomes The interval between each assessment was around 36 months. A variance analyses for repeated measurements were performed for all 129 quality indicators from the domains: ‘infrastructure’, ‘information’, ‘finance’, and ‘quality and safety’ to examine changes over time. Results Significant improvements were found in three of four domains: ‘quality and safety’ (F=22.81, p<0.01), ‘information’ (F=27.901, p<0.01) and ‘finance’ (F=4.073, p<0.02). The 129 quality indicators showed a significant improvement within the three points of measurement (F=33.864, p<0.01). Conclusions The European Practice Assessment for primary care practices thus provides a functioning quality management programme, focusing on the sustainable improvement of structural and organisational aspects to promote high quality of primary care. The implementation of a quality management system which also includes a continuous improvement process would give added value to provide good care. PMID:25900466

  3. Accountability for quality of care: Monitoring all aspects of quality across a framework adapted for action.

    PubMed

    Hulton, Louise; Matthews, Zoë; Bandali, Sarah; Izge, Abubakar; Daroda, Ramatu; Stones, William

    2016-01-01

    Quality of care is essential to maternal and newborn survival. The multidimensional nature of quality of care means that frameworks are useful for capturing it. The present paper proposes an adaptation to a widely used quality of care framework for maternity services. The framework subdivides quality into two inter-related dimensions-provision and experience of care-but suggests adaptations to reflect changes in the concept of quality over the past 15years. The application of the updated framework is presented in a case study, which uses it to measure and inform quality improvements in northern Nigeria across the reproductive, maternal, newborn, and child health continuum of care. Data from 231 sampled basic and comprehensive emergency obstetric and newborn care (BEmONC and CEmONC) facilities in six northern Nigerian states showed that only 35%-47% of facilities met minimum quality standards in infrastructure. Standards for human resources performed better with 49%-73% reaching minimum standards. A framework like this could form the basis for a certification scheme. Certification offers a practical and concrete opportunity to drive quality standards up and reward good performance. It also offers a mechanism to strengthen accountability. PMID:26723043

  4. 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

  5. Quality of prenatal care questionnaire: instrument development and testing

    PubMed Central

    2014-01-01

    Background Utilization indices exist to measure quantity of prenatal care, but currently there is no published instrument to assess quality of prenatal care. The purpose of this study was to develop and test a new instrument, the Quality of Prenatal Care Questionnaire (QPCQ). Methods Data for this instrument development study were collected in five Canadian cities. Items for the QPCQ were generated through interviews with 40 pregnant women and 40 health care providers and a review of prenatal care guidelines, followed by assessment of content validity and rating of importance of items. The preliminary 100-item QPCQ was administered to 422 postpartum women to conduct item reduction using exploratory factor analysis. The final 46-item version of the QPCQ was then administered to another 422 postpartum women to establish its construct validity, and internal consistency and test-retest reliability. Results Exploratory factor analysis reduced the QPCQ to 46 items, factored into 6 subscales, which subsequently were validated by confirmatory factor analysis. Construct validity was also demonstrated using a hypothesis testing approach; there was a significant positive association between women’s ratings of the quality of prenatal care and their satisfaction with care (r = 0.81). Convergent validity was demonstrated by a significant positive correlation (r = 0.63) between the “Support and Respect” subscale of the QPCQ and the “Respectfulness/Emotional Support” subscale of the Prenatal Interpersonal Processes of Care instrument. The overall QPCQ had acceptable internal consistency reliability (Cronbach’s alpha = 0.96), as did each of the subscales. The test-retest reliability result (Intra-class correlation coefficient = 0.88) indicated stability of the instrument on repeat administration approximately one week later. Temporal stability testing confirmed that women’s ratings of their quality of prenatal care did not change as a result of giving birth or between the early postpartum period and 4 to 6 weeks postpartum. Conclusion The QPCQ is a valid and reliable instrument that will be useful in future research as an outcome measure to compare quality of care across geographic regions, populations, and service delivery models, and to assess the relationship between quality of care and maternal and infant health outcomes. PMID:24894497

  6. Quality and cost-effective management of mental health care.

    PubMed

    Burton, W N; Hoy, D A; Bonin, R L; Gladstone, L

    1989-04-01

    Corporations have reduced their mental health care benefits by limits on coverage for such services. We report on a comprehensive mental health care program, including prevention and early intervention, hospital utilization review, and consulting psychiatrist, which has improved the quality and has significantly reduced inpatient insurance psychiatric hospitalization costs. Mental health service coverage was actually enhanced. Inpatient psychiatric hospitalization costs 12 months before and after the implementation of a concurrent psychiatric hospital utilization review program were reviewed for a major corporation. Total hospital days and average length of stay decreased by 43% whereas total inpatient psychiatric hospital charges decreased by $309,518. Total inpatient days decreased by 1045. Quality and cost-effective comprehensive psychiatric health care services can be offered by major corporations providing that such benefits are carefully designed and managed. PMID:2715844

  7. Improving Quality of Depression Care Using Organized Systems of Care: A Review of the Literature

    PubMed Central

    Guico-Pabia, Christine J.

    2011-01-01

    Objective: To establish the need for a chronic disease management strategy for major depressive disorder (MDD), discuss the challenges involved in implementing guideline-level treatment for MDD, and provide examples of successful implementation of collaborative care programs. Data Sources: A systematic literature search of MEDLINE and the US National Library of Medicine was performed. Study Selection: We reviewed clinical studies evaluating the effectiveness of collaborative care interventions for the treatment of depression in the primary care setting using the keywords collaborative care, depression, and MDD. This review includes 45 articles relevant to MDD and collaborative care published through May 2010 and excludes all non–English-language articles. Results: Collaborative care interventions include a greater role for nonmedical specialists and a supervising psychiatrist with the major goal of improving quality of depression care in primary care systems. Collaborative care programs restructure clinical practice to include a patient care strategy with specific goals and an implementation plan, support for self-management training, sustained patient follow-up, and decision support for medication changes. Key components associated with the most effective collaborative care programs were improvement in antidepressant adherence, use of depression case managers, and regular case load supervision by a psychiatrist. Across studies, primary care patients randomized to collaborative care interventions experienced enhanced treatment outcomes compared with those randomized to usual care, with overall outcome differences approaching 30%. Conclusions: Collaborative care interventions may help to achieve successful, guideline-level treatment outcomes for primary care patients with MDD. Potential benefits of collaborative care strategies include reduced financial burden of illness, increased treatment adherence, and long-term improvement in depression symptoms and functional outcomes. PMID:21731829

  8. Public perceptions of quality care and provider profiling in New York: implications for improving quality care and public health.

    PubMed

    Boscarino, Joseph A; Adams, Richard E

    2004-01-01

    Despite a growing emphasis on providing health care consumers with more information about quality care, useful and valid provider-specific information often has not been available to the public or has been underutilized. To assess this issue in New York State, random telephone surveys were conducted in September 2002 and March 2003, respectively, of 1,001 and 500 English- or Spanish-speaking persons, 18 years or older. Results indicated that 33% of New Yorkers were very concerned about the quality of care, with African Americans being particularly concerned. Less than half of the respondents recalled hearing or seeing information about health care quality in the past year and less than 20% actually used this information in medical decision making. African Americans were the least likely to recall receiving or being exposed to quality-related information, whereas women and more educated adults were the most likely to report being exposed. Furthermore, New Yorkers received quality information from multiple sources, with about 20% saying that they obtained information about physician and hospital quality from media (eg, newspaper) and nonmedia (eg, recommendation by family member) sources. Evaluations of different kinds of information suggested that some types (eg, whether or not a doctor is board certified) carried more weight in health care decision making than other types (eg, government ratings). Unexpectedly, those who used information to make health care decisions were more likely to have reported experiencing a medical error in the household. Finally, in the 6-month follow-up survey, concerns about the quality of care in the state remained about the same, while fears of terrorism decreased and preparations for future terrorist attacks increased. In the survey, few major differences were found in results based on payer status (eg, private insurance versus Medicaid/no insurance). These findings have implications for both the private and public health care sectors. Specifically, they suggest that greater access to and use of provider-specific health care information by the public is a viable way to improve quality, particularly if health care professionals support the public use of these data. PMID:15253520

  9. A quality measurement framework for managed care organizations.

    PubMed

    Zhou, Q; Mickey, D; Lancaster, D R; Epstein, D

    2001-01-01

    This article presents a framework for a quality measurement system and its corresponding principles for quality improvement within a managed care environment. The quality measurement system comprises four modes: quality assessment, comparison, improvement, and system evaluation. If these modes are to be effective, the measurement system must incorporate the following five principles: (a) maintain and continually improve the data systems, (b) develop and utilize sound methodology and valid indicators, (c) build a competent measurement team, (d) develop effective strategies for implementation, and (e) protect member confidentiality. This model is helpful in the ongoing development and testing of new measurement systems. PMID:11257799

  10. Sociodemographic factors and the quality of prenatal care.

    PubMed Central

    Hansell, M J

    1991-01-01

    BACKGROUND: In this study, maternal sociodemographic factors are examined in relationship to the quality of prenatal health services US women receive. METHODS: Data from the 1980 National Natality Survey and 1980 Fetal Mortality Survey were used for the analysis. Indicator variables for prenatal care quality are the percentages of prenatal visits at which blood pressure and urine were tested, the performance of hemoglobin or hematocrit tests, and the presence or absence of advice regarding salt restriction and diuretics usage during pregnancy. RESULTS: Distribution of the basic examinations in prenatal care vary according to marital status, parity, education, and residence in a metropolitan or nonmetropolitan county. The advice received concerning salt and diuretics usage was also influenced by sociodemographic variables. CONCLUSIONS: The analyses reveal that prenatal care is not of even minimally acceptable quality for many women. PMID:1953875

  11. Quality of life for chronic psychiatric illnesses and home care

    PubMed Central

    Molu, Nesibe Gunay; Ozkan, Birgul; Icel, Sema

    2016-01-01

    Nowadays, mental illnesses are gradually increasing and so does chronic psychiatric patients. As a result of this increase, chronic psychiatric disorders lead the burden of patients and their families. To reduce the burden of mental illnesses on individuals and their families, treatment and care are given including psychosocial, physiological and medical support and social services. To begin with, home care enables both the patient and his or her family to stay at their own houses and not to be bothered with residents or long-term, institutional-based nursing homes. In addition, the home care providers deliver services to the patient’s at their own house. The other advantages of taking care at home is that it eases financial issues in terms of reducing the cost, reduces the patient’s symptoms and improve the individual’s quality of life (QoL). In addition to these, home care also minimizes the burden on outpatient services and provides help for the patient and the family in order to solve their problems and give support. Home care services help patients to get their freedom back and enhance the quality of their lives. Thus, it is necessary to procure and implement these services and supply both the patient and his or her family a high-quality life. Sources of data/ study selection: Literature review was done by using the keywords “home care, patient with chronic mental illness, quality of life, home care nursing” from the sources including PsychINFO, PsychARTICLES, MEDLINE, PubMED, EBSCOHOST and The COCHRANE LIBRARY in the time period of 2005- 2015. PMID:27182272

  12. Measuring the quality of therapeutic apheresis care in the pediatric intensive care unit.

    PubMed

    Sussmane, Jeffrey B; Torbati, Dan; Gitlow, Howard S

    2012-01-01

    Our goal was to measure the quality of care provided in the Pediatric Intensive Care Unit (PICU) during Therapeutic Apheresis (TA). We described the care as a step by step process. We designed a flow chart to carefully document each step of the process. We then defined each step with a unique clinical indictor (CI) that represented the exact task we felt provided quality care. These CIs were studied and modified for 1 year. We measured our performance in this process by the number of times we accomplished the CI vs. the total number of CIs that were to be performed. The degree of compliance, with these clinical indicators, was analyzed and used as a metric for quality by calculating how close the process is running exactly as planned or "in control." The Apheresis Process was in control (compliance) for 47% of the indicators, as measured in the aggregate for the first observational year. We then applied the theory of Total Quality Management (TQM) through our Design, Measure, Analyze, Improve, and Control (DMAIC) model. We were able to improve the process and bring it into control by increasing the compliance to > 99.74%, in the aggregate, for the third and fourth quarter of the second year. We have implemented TQM to increase compliance, thus control, of a highly complex and multidisciplinary Pediatric Intensive Care therapy. We have shown a reproducible and scalable measure of quality for a complex clinical process in the PICU, without additional capital expenditure. PMID:22095668

  13. Does Child Care Quality Mediate Associations Between Type of Care and Development?

    PubMed Central

    Abner, Kristin S.; Gordon, Rachel A.; Kaestner, Robert; Korenman, Sanders

    2013-01-01

    Studies document that, on average, children cared for in centers, as compared to homes, have higher cognitive test scores but worse socioemotional and health outcomes. The authors assessed whether the quality of care received explains these associations. They considered multiple domains of child development—cognitive, socioemotional, and health—and examined whether mediation is greater when quality measures are better aligned with outcome domains. Using the Early Childhood Longitudinal Study Birth Cohort, they found that children in centers have better cognitive skills and behavioral regulation than children in homes, but worse social competence and generally equivalent health (N = 1,550). They found little evidence that quality of child care, as measured by standard instruments (e.g., the Early Childhood Environment Rating Scale—Revised), accounts for associations between type of care and child developmental outcomes. PMID:24068846

  14. A Portable Computer System for Auditing Quality of Ambulatory Care

    PubMed Central

    McCoy, J. Michael; Dunn, Earl V.; Borgiel, Alexander E.

    1987-01-01

    Prior efforts to effectively and efficiently audit quality of ambulatory care based on comprehensive process criteria have been limited largely by the complexity and cost of data abstraction and management. Over the years, several demonstration projects have generated large sets of process criteria and mapping systems for evaluating quality of care, but these paper-based approaches have been impractical to implement on a routine basis. Recognizing that portable microcomputers could solve many of the technical problems in abstracting data from medical records, we built upon previously described criteria and developed a microcomputer-based abstracting system that facilitates reliable and cost-effective data abstraction.

  15. The business case for health-care quality improvement.

    PubMed

    Swensen, Stephen J; Dilling, James A; Mc Carty, Patrick M; Bolton, Jeffrey W; Harper, Charles M

    2013-03-01

    The business case for health-care quality improvement is presented. We contend that investment in process improvement is aligned with patients' interests, the organization's reputation, and the engagement of their workforce. Four groups benefit directly from quality improvement: patients, providers, insurers, and employers. There is ample opportunity, even in today's predominantly pay-for-volume (that is, evolving toward value-based purchasing) insurance system, for providers to deliver care that is in the best interest of the patient while improving their financial performance. PMID:23429226

  16. The Organization of Multidisciplinary Care Teams: Modeling Internal and External Influences on Cancer Care Quality

    PubMed Central

    Prabhu Das, Irene; Clauser, Steven; Petrelli, Nicholas; Salner, Andrew

    2010-01-01

    Quality cancer treatment depends upon careful coordination between multiple treatments and treatment providers, the exchange of technical information, and regular communication between all providers and physician disciplines involved in treatment. This article will examine a particular type of organizational structure purported to regularize and streamline the communication between multiple specialists and support services involved in cancer treatment: the multidisciplinary treatment care (MDC) team. We present a targeted review of what is known about various types of MDC team structures and their impact on the quality of treatment care, and we outline a conceptual model of the connections between team context, structure, process, and performance and their subsequent effects on cancer treatment care processes and patient outcomes. Finally, we will discuss future research directions to understand how MDC teams improve patient outcomes and how characteristics of team structure, culture, leadership, and context (organizational setting and local environment) contribute to optimal multidisciplinary cancer care. PMID:20386055

  17. Quality in occupational health care: management's view.

    PubMed

    Callahan, E W

    1994-04-01

    Total Quality Management (TQM) is a continual improvement process that requires common sense, education and training, and the ability to communicate and work as part of a team. TQM can improve all aspects of a business, including health, safety, and environmental functions. Physicians and nonphysician managers can use TQM to identify and respond to customer needs and improve the efficiency and effectiveness of programs. Examples of TQM to improve medical programs have included (1) an Audit Program that assesses medical programs and provides specific measurements ("metrics") of medical programs, and (2) a team that developed an Alternative Return-to-Work Program, which now assists in early rehabilitation of injured employees. In addition to expecting its physicians to be knowledgeable, fair, and objective, management expects them to use and understand TQM principles. PMID:8014711

  18. Multilevel factors affecting quality: examples from the cancer care continuum.

    PubMed

    Zapka, Jane; Taplin, Stephen H; Ganz, Patricia; Grunfeld, Eva; Sterba, Katherine

    2012-05-01

    The complex environmental context must be considered as we move forward to improve cancer care and, ultimately, patient and population outcomes. The cancer care continuum represents several care types, each of which includes multiple technical and communication steps and interfaces among patients, providers, and organizations. We use two case scenarios to 1) illustrate the variability, diversity, and interaction of factors from multiple levels that affect care quality and 2) discuss research implications and provide hypothetical examples of multilevel interventions. Each scenario includes a targeted literature review to illustrate contextual influences upon care and sets the stage for theory-informed interventions. The screening case highlights access issues in older women, and the survivorship case illustrates the multiple transition challenges faced by patients, families, and organizations. Example interventions show the potential gains of implementing intervention strategies that work synergistically at multiple levels. While research examining multilevel intervention is a priority, it presents numerous study design, measurement, and analytic challenges. PMID:22623591

  19. Multilevel Factors Affecting Quality: Examples From the Cancer Care Continuum

    PubMed Central

    Taplin, Stephen H.; Ganz, Patricia; Grunfeld, Eva; Sterba, Katherine

    2012-01-01

    The complex environmental context must be considered as we move forward to improve cancer care and, ultimately, patient and population outcomes. The cancer care continuum represents several care types, each of which includes multiple technical and communication steps and interfaces among patients, providers, and organizations. We use two case scenarios to 1) illustrate the variability, diversity, and interaction of factors from multiple levels that affect care quality and 2) discuss research implications and provide hypothetical examples of multilevel interventions. Each scenario includes a targeted literature review to illustrate contextual influences upon care and sets the stage for theory-informed interventions. The screening case highlights access issues in older women, and the survivorship case illustrates the multiple transition challenges faced by patients, families, and organizations. Example interventions show the potential gains of implementing intervention strategies that work synergistically at multiple levels. While research examining multilevel intervention is a priority, it presents numerous study design, measurement, and analytic challenges. PMID:22623591

  20. Does practice size matter? Review of effects on quality of care in primary care

    PubMed Central

    Ng, Charis Wei Ling; Ng, Kok Ping

    2013-01-01

    Background There is a trend towards consolidating smaller primary care practices into larger practices worldwide. However, the effects of practice size on quality of care remain unclear. Aim This review aims to systematically appraise the effects of practice size on the quality of care in primary care. Design and setting A systematic review and narrative synthesis of studies examining the relationship between practice size and quality of care in primary care. Method Quantitative studies that focused on primary care practices or practitioners were identified through PubMed, CINAHL, Embase, Cochrane Library, CRD databases, ProQuest dissertations and theses, conference proceedings, and MedNar databases, as well as the reference lists of included studies. Independent variables were team or list size; outcome variables were measures of clinical processes, clinical outcomes, or patient-reported outcomes. A narrative synthesis of the results was conducted. Results The database search yielded 371 articles, of which 34 underwent quality assessment, and 17 articles (13 cross-sectional studies) were included. Ten studies examined the association of practice size and clinical processes, but only five found associations of larger practices with selected process measures such as higher specialist referral rates, better adherence to guidelines, higher mammography rates, and better monitoring of haemoglobin A1c. There were mixed results for cytology and pneumococcal coverage. Only one of two studies on clinical outcomes found an effect of larger practices on lower random haemoglobin A1 value. Of the three studies on patient-reported outcomes, smaller practices were consistently found to be associated with satisfaction with access, but evidence was inconsistent for other patient-reported outcomes evaluated. Conclusion There is limited evidence to support an association between practice size and quality of care in primary care. PMID:23998840

  1. Palliative care in COPD: an unmet area for quality improvement

    PubMed Central

    Vermylen, Julia H; Szmuilowicz, Eytan; Kalhan, Ravi

    2015-01-01

    COPD is a leading cause of morbidity and mortality worldwide. Patients suffer from refractory breathlessness, unrecognized anxiety and depression, and decreased quality of life. Palliative care improves symptom management, patient reported health-related quality of life, cost savings, and mortality though the majority of patients with COPD die without access to palliative care. There are many barriers to providing palliative care to patients with COPD including the difficulty in prognosticating a patients course causing referrals to occur late in a patients disease. Additionally, physicians avoid conversations about advance care planning due to unique communication barriers present with patients with COPD. Lastly, many health systems are not set up to provide trained palliative care physicians to patients with chronic disease including COPD. This review analyzes the above challenges, the available data regarding palliative care applied to the COPD population, and proposes an alternative approach to address the unmet needs of patients with COPD with proactive primary palliative care. PMID:26345486

  2. Quality assurance: standards of care and ethical practice

    PubMed Central

    Vear, Herbert J

    1991-01-01

    In the past, standards of care in chiropractic were based upon the bias, empiricism and little if any scientific work by the author. This was due, in part, to history which fostered the belief that all that was needed was anecdotal testimony and in part to the isolation of chiropractic colleges from main stream science. Today, standards are being based upon the scientific evaluation of the clinical procedures used and formulated by consensus of experts within the profession. The chiropractic profession has the duty to create standards of practice that will advance its clinical practice, protect the patient, ensure its contribution to health care and promote research into the assessment of outcomes and effectiveness. Although such steps are being actively pursued, significant discrepancies exist between the 60 statutes regulating chiropractic practice. Absence of consensus not only in the scope of practice but also in lexicon, adds confusion within and outside the profession. In addition, the profession is facing the same difficult task as the other health care professions, the need to develop quality assurance parameters for standards of care, quality of care and outcome of care measurements. Each of the parameters must be rational, defensible and modifiable as advances in science and technology become available. It is the responsibility of each chiropractor to maintain the appropriate level of professional skills to ensure that the patient receives the best care possible.

  3. Art and the Infant-Toddler Curriculum.

    ERIC Educational Resources Information Center

    Lamb, Marilyn

    Stages in the development of art expression in infants and toddlers are briefly described and illustrated in this paper. Following this overview, suggestions are made about ways to introduce infants and toddlers to various developmentally appropriate media and how to support the artistic efforts of very young children. Materials recommended…

  4. Infants & Toddlers: Understanding Confusing Expressions of Emotion

    ERIC Educational Resources Information Center

    Honig, Alice Sterling

    2006-01-01

    In this article, the author responds to a teacher's question on a baby's behavior who keeps banging on his high chair and laughs uncontrollably. The author states that young children pay close attention to adult's emotional responses. Their lives depend on knowing the best ways to get positive or at least neutral responses from grown-ups in charge…

  5. The new world of health care quality and measurement.

    PubMed

    Brooks, Jo Ann

    2014-07-01

    This column is designed to provide a nursing perspective on the new hospital quality measurements. Future articles will cover the various quality indicators hospitals face and the role of the nurse in meeting mandated benchmarks. Reader responses to this column are welcome and will help to make it more useful to nurses in meeting the challenges posed by health care reform and changing Medicare reimbursement programs. PMID:25742357

  6. Palliative care and quality of life in neuro-oncology

    PubMed Central

    Mummudi, Naveen

    2014-01-01

    Health-related quality of life has become an important end point in modern day clinical practice in patients with primary or secondary brain tumors. Patients have unique symptoms and problems from diagnosis till death, which require interventions that are multidisciplinary in nature. Here, we review and summarize the various key issues in palliative care, quality of life and end of life in patients with brain tumors, with the focus on primary gliomas. PMID:25165570

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

    PubMed Central

    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

  8. Parent Experiences with State Child Care Subsidy Systems and Their Perceptions of Choice and Quality in Care Selected

    ERIC Educational Resources Information Center

    Raikes, Helen; Torquati, Julia; Wang, Cixin; Shjegstad, Brinn

    2012-01-01

    Research Findings: This study investigated parents' experiences using Child Care and Development Fund and other state-dispersed child care subsidies, reasons for choosing their current child care program, and perceptions of the quality of child care received from their current program. A telephone survey of 659 parents receiving child care

  9. Does the nursing process reflect quality care?

    PubMed

    McHugh, M K

    1991-04-01

    The nursing process is a very linear method that does not require that the nurse use knowledge gathered over the years; instead it requires an objective assessment of data accessible to the senses. Although this method should assure uniform practice, it will not assure quality practice. Some authors liken it to the scientific method. It is not. The scientific method begins with a perceived problem which is defined as facts, events, or situations that lack explanation or that are incongruent with accepted beliefs, expectations, or preconceptions. Without expectations, and beliefs, life holds no surprises and no problems. Only with years of accumulated experiences can expert nurses quickly determine the problems and "the solutions to problems using experience-based holistic recognition of similarity which produces deep situational understanding." This understanding and the solutions to problems may be and should be different for each nurse. This is not so when nurses use the nursing process. All phenomena are abstracted from the personal; they are context free. The Dreyfus Model of Skill Acquisition, related to nursing by Benner, explains this kind of practice as Novice. The Expert, on the other hand, "knows what to do based on mature and practiced understanding. Experts solve problems using know-how, the sort of ability we all use all the time as we go about our everyday tasks." They know problems without analyzing them; they sense them. Benner states, "If experts are made to attend to the particulars or to a formal model or rule, then performance actually deteriorates."(ABSTRACT TRUNCATED AT 250 WORDS) PMID:2045436

  10. Health-related quality of life and quality of care in specialized medicare-managed care plans.

    PubMed

    Grace, Susan C; Elliott, Marc N; Giordano, Laura A; Burroughs, James N; Malinoff, Rochelle L

    2013-01-01

    Special needs plans (SNPs) were created under the Medicare Modernization Act of 2003 to focus on Medicare beneficiaries who required more coordination of care than most beneficiaries served through the Medicare Advantage program. This research indicates that beneficiaries in 3 types of SNPs show evidence of worse health-related quality of life. Special needs plans demonstrated worse plan performance on the HEDIS osteoporosis testing in older women measure compared with non-SNP Medicare Advantage beneficiaries, but better plan performance on the HEDIS fall risk management measure. Future research should consider broader measures of plan performance, quality of care, and cost. PMID:23222014

  11. Clinical dashboards: impact on workflow, care quality, and patient safety.

    PubMed

    Egan, Marie

    2006-01-01

    There is a vast array of technical data that is continuously generated within the intensive care unit environment. In addition to physiological monitors, there is information being captured by the ventilator, intravenous infusion pumps, medication dispensing units, and even the patient's bed. The ability to retrieve and synchronize data is essential for both clinical documentation and real-time problem solving for individual patients and the intensive care unit population as a whole. Technical advances that permit the integration of all relevant data into a singular display or "dashboard" may improve staff efficiency, accelerate decisions, streamline workflow processes, and reduce oversights and errors in clinical practice. Critical care nurses must coordinate all aspects of care for one or more patients. Clinical data are constantly being retrieved, documented, analyzed, and communicated to others, all within the daily routine of nursing care. In addition, many bedside monitors and devices have alarms systems that must be evaluated throughout the workday, and actions taken on the basis of the patient's condition and other data. It is obvious that the complexity within such care processes presents many potential opportunities for overlooking important details. The capability to systematically and logically link physiological monitors and other selected data sets into a cohesive dashboard system holds tremendous promise for improving care quality, patient safety, and clinical outcomes in the intensive care unit. PMID:17063102

  12. Child-Care Structure?Process?Outcome: Direct and Indirect Effects of Child-Care Quality on Young Children's Development.

    ERIC Educational Resources Information Center

    Psychological Science, 2002

    2002-01-01

    Used NICHD Study of Early Child Care data to test paths from child care quality through process indicators to child outcomes. Found that maternal caregiving quality was strongest predictor of cognitive and social competence. Nonmaternal caregiving quality related to cognitive and social competence. Nonmaternal caregiving quality mediated…

  13. Technology Diffusion and Prostate Cancer Quality of Care

    PubMed Central

    Schroeck, Florian R.; Kaufman, Samuel R.; Jacobs, Bruce L.; Skolarus, Ted A.; Zhang, Yun; Hollenbeck, Brent K.

    2014-01-01

    Objective To evaluate the association of technological capacity with prostate cancer quality of care. Technological capacity was conceptualized as a market’s ability to provide prostate cancer treatment with new technology, including robotic prostatectomy and intensity-modulated radiotherapy (IMRT). Methods In this retrospective cohort study, we used data from the Surveillance Epidemiology and End Results (SEER) – Medicare linked database from 2004–2009 to identify men with newly diagnosed prostate cancer (n=46,274). We measured technological capacity as the number of providers performing robotic prostatectomy or IMRT per population in a healthcare market. We used multilevel logistic regression to assess the association of technological capacity with receiving quality care according to a set of nationally endorsed quality measures, while adjusting for patient and market characteristics. Results Overall, our findings were mixed with only subtle differences in quality of care when comparing high-tech to low-tech markets. High robotic prostatectomy capacity was associated with better adherence to some quality measures, such as avoiding unnecessary bone scans (79.8% vs. 73.0%, p=0.003) and having follow-up with urologists (67.7% vs. 62.6%, p=0.023). However, for most measures, neither high robotic prostatectomy nor high IMRT capacity were associated with significant increases in adherence rates. In fact, for one measure (treatment by a high-volume provider), high IMRT capacity was associated with lower performance (23.4% vs. 28.5%, p<0.001). Conclusion Our findings suggest that new technology is not clearly associated with higher quality of care. To improve quality, more specific efforts will be needed. PMID:25443905

  14. Adolescent substance abuse treatment: Organizational change and quality of care

    PubMed Central

    Rieckmann, Traci; Fussell, Holly; Doyle, Kevin; Ford, Jay; Riley, Katherine; Henderson, Stuart

    2013-01-01

    Substance abuse treatment agencies serving youth face unique barriers to providing quality care. Interviews with 17 adolescent programs found that family engagement, community involvement, and gender and diversity issues impacted treatment delivery. Programs report organizational change efforts with implications for future process improvement initiatives. PMID:23750096

  15. Overview of the quality assurance movement in health care.

    PubMed

    de Jonge, Vincent; Sint Nicolaas, Jerome; van Leerdam, Monique E; Kuipers, Ernst J

    2011-06-01

    This chapter aims to describe the origin and current status of quality assurance (QA) in health care and to provide a background of similar developments in other industries, which have provided a major impetus for QA initiatives in health care. The interest in quality and safety in the health care sector has rapidly risen over the past decade. Without important lessons learnt from other industries, the interest and obtained improvements would have been far less fast. Knowledge on basic principles and challenges faced by other industries like the airline, car, and nuclear energy industry, that drove quality improvement projects, is of major relevance to understand the evolutions taking place in health care. To fully appreciate the QA movement, and design or implement quality improvement projects, its basic principles need to be understood. This chapter aims to give insights in basic principles underlying QA, and to discuss historical lessons that have been learnt from other industries. Furthermore, it discusses how to implement and assure a sustainable QA program. PMID:21764002

  16. Once Attained, Can Quality Child Care Be Maintained?

    ERIC Educational Resources Information Center

    Roach, Mary A.; Kim, YaeBin; Riley, David A.

    2006-01-01

    Research Findings: This study was designed to assess whether investments in child care quality were maintained 3 years after public funding for these centers was significantly reduced. An earlier evaluation documented significant improvements in classroom environments, teachers' sensitivity, and teachers' child-centered beliefs following a…

  17. Enhancing Child Care Quality by Director Training and Collegial Mentoring

    ERIC Educational Resources Information Center

    Doherty, Gillian; Ferguson, Tammy McCormick; Ressler, Glory; Lomotey, Jonathan

    2015-01-01

    Although considerable evidence confirms that a director with good leadership and administrative skills is vital for developing and sustaining a high quality child care program, many directors assume the role with little management experience or training. This paper reports on a training program in Canada that combined a formal curriculum to…

  18. Adolescent Substance Abuse Treatment: Organizational Change and Quality of Care

    ERIC Educational Resources Information Center

    Rieckmann, Traci; Fussell, Holly; Doyle, Kevin; Ford, Jay; Riley, Katherine J.; Henderson, Stuart

    2011-01-01

    Substance abuse treatment agencies serving youth face unique barriers to providing quality care. Interviews with 17 adolescent programs found that family engagement, community involvement, and gender and diversity issues affected treatment delivery. Programs report organizational change efforts with implications for future process improvement…

  19. TQ What?: Applying Total Quality Management to Child Care.

    ERIC Educational Resources Information Center

    Hewes, Dorothy

    1994-01-01

    Discusses the concept of Total Quality Management (TQM), developed by W. Edward Deming and Joseph Juran in 1940s, and its applications for child care centers. Discusses how TQM focuses on customer satisfaction, measuring performance, benchmarking, employee empowerment, and continuous training. Includes a list of suggested readings on TQM. (MDM)

  20. Quality of Institutional Care and Early Childhood Development

    ERIC Educational Resources Information Center

    Oliveira, Paula Salgado; Fearon, R. M. Pasco; Belsky, Jay; Fachada, Inês; Soares, Isabel

    2015-01-01

    Institutional rearing adversely affects children's development, but the extent to which specific characteristics of the institutional context and the quality of care provided contribute to problematic development remains unclear. In this study, 72 preschoolers institutionalised for at least 6 months were evaluated by their caregiver using the…

  1. Why America Needs High-Quality Early Care and Education

    ERIC Educational Resources Information Center

    Business Roundtable, 2009

    2009-01-01

    Business Roundtable (BRT) and Corporate Voices for Working Families (CVWF) believe federal and state efforts to develop early care and education systems for children birth through age five must be based on a set of guiding Principles that define the components of a successful system and high-quality programs. These Principles draw on current early…

  2. Building Choice and Quality into Your Managed Care Plan.

    ERIC Educational Resources Information Center

    Rinaldi, Stephen J.

    1997-01-01

    The challenge of containing health-care costs continues despite a break from cost increases. Most experts would advise school employees to replace existing health plans with a triple-choice HMO plan using $10 copayments. Armed with quality data and a choice-based plan design, school business officials can improve their chances for long-term cost…

  3. Quality and safety in health care, part V: introduction to crossing the quality chasm.

    PubMed

    Harolds, Jay A

    2015-12-01

    The Institute of Medicine report Crossing the Quality Chasm: A New Health System for the 21st Century focused on quality issues generally in health care, not only on mistakes. It made numerous recommendations for improving health care, including 6 aims and 10 rules to guide policy makers. This was intended to help redesign health care. However, the authors of the report did not attempt to provide all the answers because they realized that innovation was important and that they could not foresee all the sociopolitical forces and technological and research breakthroughs in the future. PMID:26402122

  4. Comparative Quality Indicators for Hospital Choice: Do General Practitioners Care?

    PubMed Central

    Ferrua, Marie; Sicotte, Claude; Lalloué, Benoît; Minvielle, Etienne

    2016-01-01

    Context The strategy of publicly reporting quality indicators is being widely promoted through public policies as a way to make health care delivery more efficient. Objective To assess general practitioners’ (GPs) use of the comparative hospital quality indicators made available by public services and the media, as well as GPs’ perceptions of their qualities and usefulness. Method A telephone survey of a random sample representing all self-employed GPs in private practice in France. Results A large majority (84.1%–88.5%) of respondents (n = 503; response rate of 56%) reported that they never used public comparative indicators, available in the mass media or on government and non-government Internet sites, to influence their patients’ hospital choices. The vast majority of GPs rely mostly on traditional sources of information when choosing a hospital. At the same time, this study highlights favourable opinions shared by a large proportion of GPs regarding several aspects of hospital quality indicators, such as their good qualities and usefulness for other purposes. In sum, the results show that GPs make very limited use of hospital quality indicators based on a consumer choice paradigm but, at the same time, see them as useful in ways corresponding more to the usual professional paradigms, including as a means to improve quality of care. PMID:26840429

  5. Parental Perceptions of Child Care Quality in Centre-Based and Home-Based Settings: Associations with External Quality Ratings

    ERIC Educational Resources Information Center

    Lehrer, Joanne S.; Lemay, Lise; Bigras, Nathalie

    2015-01-01

    The current study examined how parental perceptions of child care quality were related to external quality ratings and considered how parental perceptions of quality varied according to child care context (home-based or centre-based settings). Parents of 179 4-year-old children who attended child care centres (n = 141) and home-based settings…

  6. Integrating Resources and Strategies into an Emerging System of Professional Development: The Case of PITC in California

    ERIC Educational Resources Information Center

    Mangione, Peter L.; Lally, J. Ronald; Poole, Janet L.; Tuesta, Alicia; Paxton, Arlene R.

    2011-01-01

    States have placed high priority on developing early care and education systems that include early learning guidelines, curriculum, program guidelines or standards, and early childhood educator competencies. To explore how professional development and quality improvement initiatives are being integrated into emerging infant-toddler care systems,…

  7. Peer reviewing critical care: a pragmatic approach to quality management

    PubMed Central

    Braun, Jan-Peter; Bause, Hanswerner; Bloos, Frank; Geldner, Gtz; Kastrup, Marc; Kuhlen, Ralf; Markewitz, Andreas; Martin, Jrg; Mende, Hendrik; Quintel, Michael; Steinmeier-Bauer, Klaus; Waydhas, Christian; Spies, Claudia

    2010-01-01

    Critical care medicine frequently involves decisions and measures that may result in significant consequences for patients. In particular, mistakes may directly or indirectly derive from daily routine processes. In addition, consequences may result from the broader pharmaceutical and technological treatment options, which frequently involve multidimensional aspects. The increasing complexity of pharmaceutical and technological properties must be monitored and taken into account. Besides the presence of various disciplines involved, the provision of 24-hour care requires multiple handovers of significant information each day. Immediate expert action that is well coordinated is just as important as a professional handling of medicine's limitations. Intensivists are increasingly facing professional quality management within the ICU (Intensive Care Unit). This article depicts a practical and effective approach to this complex topic and describes external evaluation of critical care according to peer reviewing processes, which have been successfully implemented in Germany and are likely to gain in significance. PMID:21063473

  8. Quality of emergency rooms and urgent care services: user satisfaction.

    PubMed

    Lima, Cássio de Almeida; Santos, Bruna Tatiane Prates Dos; Andrade, Dina Luciana Batista; Barbosa, Francielle Alves; Costa, Fernanda Marques da; Carneiro, Jair Almeida

    2015-12-01

    Objective To evaluate the quality of emergency rooms and urgent care services according to the satisfaction of their users. Methods A cross-sectional descriptive study with a quantitative approach. The sample comprised 136 users and was drawn at random. Data collection took place between October and November 2012 using a structured questionnaire. Results Participants were mostly male (64.7%) aged less than 30 years (55.8%), and the predominant level of education was high school (54.4%). Among the items evaluated, those that were statistically associated with levels of satisfaction with care were waiting time, confidence in the service, model of care, and the reason for seeking care related to acute complaints, cleanliness, and comfortable environment. Conclusion Accessibility, hospitality, and infrastructure were considered more relevant factors for patient satisfaction than the cure itself. PMID:26313440

  9. Measuring technical efficiency of output quality in intensive care units.

    PubMed

    Junoy, J P

    1997-01-01

    Presents some examples of the implications derived from imposing the objective of maximizing social welfare, subject to limited resources, on ethical care patients management in respect of quality performance of health services. Conventional knowledge of health economics points out that critically ill patients are responsible for increased use of technological resources and that they receive a high proportion of health care resources. Attempts to answer, from the point of view of microeconomics, the question: how do we measure comparative efficiency in the management of intensive care units? Analyses this question through data from an international empirical study using micro-economic measures of productive efficiency in public services (data envelopment analysis). Results show a 28.8 per cent level of technical inefficiency processing data from 25 intensive care units in the USA. PMID:10169231

  10. Fundamental elements of the quality of care: a simple framework.

    PubMed

    Bruce, J

    1990-01-01

    This article argues for attention to a neglected dimension of family planning services--their quality. A framework for assessing quality from the client's perspective is offered, consisting of six parts (choice of methods, information given to clients, technical competence, interpersonal relations, follow-up and continuity mechanisms, and the appropriate constellation of services). The literature is reviewed regarding evidence that improvements in these various dimensions of care result in gains at the individual level; an even scarcer body of literature is reviewed for evidence of gains at the level of program efficiency and impact. A concluding section discusses how to make practical use of the framework and distinguishes three vantage points from which to view quality: the structure of the program, the service-giving process itself, and the outcome of care, particularly with respect to individual knowledge, behavior, and satisfaction with services. PMID:2191476

  11. Improving Quality of Emergency Care Through Integration of Mental Health.

    PubMed

    Okafor, Martha; Wrenn, Glenda; Ede, Victor; Wilson, Nana; Custer, William; Risby, Emile; Claeys, Michael; Shelp, Frank E; Atallah, Hany; Mattox, Gail; Satcher, David

    2016-04-01

    The goal of this study was to better integrate emergency medical and psychiatric care at a large urban public hospital, identify impact on quality improvement metrics, and reduce healthcare cost. A psychiatric fast track service was implemented as a quality improvement initiative. Data on disposition from the emergency department from January 2011 to May 2012 for patients impacted by the pilot were analyzed. 4329 patients from January 2011 to August 2011 (pre-intervention) were compared with 4867 patients from September 2011 to May 2012 (intervention). There was a trend of decline on overall quality metrics of time to triage and time from disposition to discharge. The trend analysis of the psychiatric length of stay and use of restraints showed significant reductions. Integrated emergency care models are evidence-based approach to ensuring that patients with mental health needs receive proper and efficient treatment. Results suggest that this may also improve overall emergency department's throughput. PMID:26711094

  12. Quality of care for 2 common pediatric conditions treated by convenient care providers.

    PubMed

    Jacoby, Richard; Crawford, Albert G; Chaudhari, Paresh; Goldfarb, Neil I

    2011-01-01

    Rates of adherence to 2 quality measures, modeled after Heathcare Effectiveness Data and Information Set (HEDIS) measures, were evaluated in a pediatric population in a convenient care (retail medicine) clinic setting. The measures were appropriate testing for children with pharyngitis and appropriate treatment for children with upper-respiratory infection (URI). The convenient care clinic (CCC) achieved a ranking above the HEDIS 90th percentile for the pharyngitis measure and approximately midway between the 50th and 90th percentiles for the URI measure for the 2007 reporting period. This represents the third major study reporting quality of care for pharyngitis in a CCC setting and the first study for URIs. Other aspects of quality--namely access, follow-up, and equity--are also reported on for the population in question. PMID:20861514

  13. A Study of Day Care Costs: Their Impact on Day Care Center Quality.

    ERIC Educational Resources Information Center

    REAP Associates, Washington, DC.

    This study analyzes the effects of costs on day care center quality for a total of 13 high cost ($40-50 per week for each child) and low cost ($20-30 per week) day care centers in three New York counties. A mail survey questionnaire (included in Appendix) was used to gather data on program operations, core services, and budget expenditures.…

  14. Quality and Safety in Health Care, Part VI: More on Crossing the Quality Chasm.

    PubMed

    Harolds, Jay A

    2016-01-01

    One of the most important aspects of the Institute of Medicine (IOM) Crossing the Quality Chasm. A New Health System for the 21st Century report (Chasm report) was that 6 major aims for US health care were set forth. In addition, the report indicated that health care in the United States care should be redesigned in accordance with 10 enumerated rules. There were other recommendations as well, to try to bridge the huge gap between the health care many people in the United States receive and what they should receive. PMID:26447385

  15. Investing in Quality Child Care: A Report for AT&T.

    ERIC Educational Resources Information Center

    Galinsky, Ellen; Friedman, Dana E.

    More than 50 child care experts were asked (1) What aspects of child care are most likely to ensure high quality? (2) What are the current barriers to achieving quality in child care? and (3) What corporate or labor initiative would make the greatest difference in improving the quality of child care services? Recommendations generated from the…

  16. Health care quality and how to achieve it.

    PubMed

    Shine, Kenneth I

    2002-01-01

    Studies conducted by the Institute of Medicine have demonstrated a serious gap between what the American health care system provides and its full potential. This results from a substantial amount of overuse, underuse, and misuse of health care. An Institute of Medicine (IOM) publication focusing attention on medical errors--To Err is Human: Building a Safer Healthcare System--galvanized the public and private sector as well as the professions to strive for building a safer health care system. In its report, Crossing the Quality Chasm: A New Health System for the 21st Century, the IOM's committee visualized a series of aims and rules for the health care system that would propel it successfully into the 21st century. Multidisciplinary professional teams should provide care for an increasing portion of the population (now about 40%) who have one or more chronic illnesses. Since 20 conditions account for 80% of America's health care costs, the author recommends that a special focus be placed upon 15 of these conditions to systematically improve the quality of care over the next five years. Information technology offers important opportunities to improve patient safety and contribute to better and continuous improvement of quality. The elimination of written clinical notes by the year 2010 is an achievable objective. These developments require medical educators and health professionals to move from a 20th-century paradigm of the physician who was in solo practice, held autonomy as a central value, prided himself or herself upon continuous learning and the acquisition of new knowledge, and laid claim to infallibility when confronting patients and colleagues. The 21st-century paradigm is that of physicians who understand teamwork and systems of care in which they can provide leadership. Group practice, both virtual and real, will allow the support of information systems, the collection of evidence about care, and efforts for continuous quality improvement. Fallibility should be replaced by an approach to multidisciplinary problem solving, and the acquisition of knowledge must be associated with the commitment and understanding of the need for change. PMID:11788332

  17. [Continuous nursing education to improve the quality of health care].

    PubMed

    Fumić, Nera; Marinović, Marin; Brajan, Dolores

    2014-10-01

    Health care and today's medical and technical achievements and approved standards of treatment provide comprehensive quality, safety and traceability of medical procedures respecting the principles of health protection. Continuous education improves the quality of nursing health care and increases the effectiveness of patient care, consequently maintaining and enhancing patient safety. Patient health problems impose the need of appropriate, planned and timely nursing care and treatment. In providing quality nursing care, attention is focused on the patient and his/her needs in order to maintain and increase their safety, satisfaction, independence and recovery or peaceful death, so the health and nursing practices must be systematized, planned and based on knowledge and experience. Health and nursing care of patients at risk of developing acute and chronic wounds or already suffering from some form of this imply preventive measures that are provided through patient education, motivation, monitoring, early recognition of risk factors and causes, and reducing or removing them through the prescribed necessary medical treatment which is safe depending on the patient health status. Except for preventive measures, nursing care of patients who already suffer from some form of acute or chronic wounds is focused on the care and treatment of damaged tissue by providing appropriate and timely diagnosis, timely and proper evaluation of the wound and patient general status, knowledge and understanding of the wide range of local, oral and parenteral therapy and treatment, aiming to increase patient safety by preventing progression of the patient general condition and local wound status and reducing the possibility of developing infection or other complications of the underlying disease. In the overall patient management, through nursing process, medical interventions are implemented and aimed to maintain and optimize health status, prevent complications of existing diseases and conditions, provide appropriate wound treatment, increase satisfaction, reduce pain, increase mobility, reduce and eliminate aggravating factors, and achieve a satisfactory functional and aesthetic outcome. Many scientific researches and knowledge about the pathophysiological processes of wound formation and healing are currently available. Modern achievements can accelerate independence, reduce pain and encourage faster wound healing, thus it is important to continuously develop awareness, knowledge and experience, along with the treatment to achieve, maintain and enhance the quality of health care and patient safety. PMID:25326985

  18. Managed Care Quality of Care and Plan Choice in New York SCHIP

    PubMed Central

    Liu, Hangsheng; Phelps, Charles E; Veazie, Peter J; Dick, Andrew W; Klein, Jonathan D; Shone, Laura P; Noyes, Katia; Szilagyi, Peter G

    2009-01-01

    Objective To examine whether low-income parents of children enrolled in the New York State Children's Health Insurance Program (SCHIP) choose managed care plans with better quality of care. Data Sources 2001 New York SCHIP evaluation data; 2001 New York State Managed Care Plan Performance Report; 2000 New York State Managed Care Enrollment Report. Study Design Each market was defined as a county. A final sample of 2,325 new enrollees was analyzed after excluding those in markets with only one SCHIP plan. Plan quality was measured using seven Consumer Assessment of Health Plans Survey (CAHPS) and three Health Plan Employer Data and Information Set (HEDIS) scores. A conditional logit model was applied with plan and individual/family characteristics as covariates. Principle Findings There were 30 plans in the 45 defined markets. The choice probability increased 2.5 percentage points for each unit increase in the average CAHPS score, and the association was significantly larger in children with special health care needs. However, HEDIS did not show any statistically significant association with plan choice. Conclusions Low-income parents do choose managed care plans with higher CAHPS scores for their newly enrolled children, suggesting that overall quality could improve over time because of the dynamics of enrollment. PMID:19208091

  19. Differences in Child Care Quality in Rural and Non-Rural Areas

    ERIC Educational Resources Information Center

    Maher, Erin J.; Frestedt, Becki; Grace, Cathy

    2008-01-01

    This study examines rural differences in one important indicator of quality for licensed child care settings--the number of children per adult. It also investigates the relationships between cost of child care, child care subsidy receipt, and child care quality for both rural and non-rural areas. We used representative child care survey data…

  20. Foreign Medical Graduates and their Effects on the Quality of Medical Care in the United States.

    ERIC Educational Resources Information Center

    Williams, Kathleen N.; Brook, Robert H.

    The purpose of the study was to examine existing information on the level of quality of medical care delivered by foreign medical graduates (FMGs), as part of a broader consideration of policies relating to FMGs and health care delivery in the United States. Quality of care is considered to comprise both technical care and the "art of care." FMGs…

  1. The effects of hospital competition on inpatient quality of care.

    PubMed

    Mutter, Ryan L; Wong, Herbert S; Goldfarb, Marsha G

    2008-01-01

    Existing empirical studies have produced inconclusive, and sometimes contradictory, findings on the effects of hospital competition on inpatient quality of care. These inconsistencies may be due to the use of different methodologies, hospital competition measures, and hospital quality measures. This paper applies the Quality Indicator software from the Agency for Healthcare Research and Quality to the 1997 Healthcare Cost and Utilization Project State Inpatient Databases to create three versions (i.e., observed, risk-adjusted, and "smoothed") of 38 distinct measures of inpatient quality. The relationship between 12 different hospital competition measures and these quality measures are assessed, using ordinary least squares, two-step efficient generalized method of moments, and negative binomial regression techniques. We find that across estimation strategies, hospital competition has an impact on a number of hospital quality measures. However, the effect is not unidirectional: some indicators show improvements in hospital quality with greater levels of competition, some show decreases in hospital quality, and others are unaffected. We provide hypotheses based on emerging areas of research that could explain these findings, but inconsistencies remain. PMID:19069009

  2. Conservative Spine Care: Opportunities to Improve the Quality and Value of Care

    PubMed Central

    Elton, David; Shulman, Stephanie A.; Clarke, Janice L.; Skoufalos, Alexis; Solis, Amanda

    2013-01-01

    Abstract Low back pain (LBP) has received considerable attention from researchers and health care systems because of its substantial personal, social, work-related, and economic consequences. A narrative review was conducted summarizing data about the epidemiology, care seeking, and utilization patterns for LBP in the adult US population. Recommendations from a consensus of clinical practice guidelines were compared to findings about the current state of clinical practice for LBP. The impact of the first provider consulted on the quality and value of care was analyzed longitudinally across the continuum of episodes of care. The review concludes with a description of recently published evidence that has demonstrated that favorable health and economic outcomes can be achieved by incorporating evidence-informed decision criteria and guidance about entry into conservative low back care pathways. (Population Health Management 2013;16:390–396) PMID:23965043

  3. Two-Year Impact of the Alternative Quality Contract on Pediatric Health Care Quality and Spending

    PubMed Central

    Song, Zirui; Chernew, Michael E.; Landon, Bruce E.; McNeil, Barbara J.; Safran, Dana G.; Schuster, Mark A.

    2014-01-01

    OBJECTIVE: To examine the 2-year effect of Blue Cross Blue Shield of Massachusetts global budget arrangement, the Alternative Quality Contract (AQC), on pediatric quality and spending for children with special health care needs (CSHCN) and non-CSHCN. METHODS: Using a difference-in-differences approach, we compared quality and spending trends for 126?975 unique 0- to 21-year-olds receiving care from AQC groups with 415?331 propensity-matched patients receiving care from non-AQC groups; 23% of enrollees were CSHCN. We compared quality and spending pre (20062008) and post (20092010) AQC implementation, adjusting analyses for age, gender, health risk score, and secular trends. Pediatric outcome measures included 4 preventive and 2 acute care measures tied to pay-for-performance (P4P), 3 asthma and 2 attention-deficit/hyperactivity disorder quality measures not tied to P4P, and average total annual medical spending. RESULTS: During the first 2 years of the AQC, pediatric care quality tied to P4P increased by +1.8% for CSHCN (P < .001) and +1.2% for non-CSHCN (P < .001) for AQC versus non-AQC groups; quality measures not tied to P4P showed no significant changes. Average total annual medical spending was ?5 times greater for CSHCN than non-CSHCN; there was no significant impact of the AQC on spending trends for children. CONCLUSIONS: During the first 2 years of the contract, the AQC had a small but significant positive effect on pediatric preventive care quality tied to P4P; this effect was greater for CSHCN than non-CSHCN. However, it did not significantly influence (positively or negatively) CSHCN measures not tied to P4P or affect per capita spending for either group. PMID:24366988

  4. Evaluation of Delaware Stars for Early Success: Year 1 Report. Research Report

    ERIC Educational Resources Information Center

    Schwartz, Heather L.; Karoly, Lynn A.; Le, Vi-Nhuan; Tamargo, Jennifer; Setodji, Claude Messan

    2014-01-01

    Delaware was in the first group of states to receive a federal grant in 2012 to improve early care and education services and increase the number of infants, toddlers, and preschool-age children in high-quality programs. One component of the state's grant is a rigorous validation process for Delaware Stars for Early Success, a voluntary quality

  5. Quality-based financial incentives in health care: can we improve quality by paying for it?

    PubMed

    Conrad, Douglas A; Perry, Lisa

    2009-01-01

    This article asks whether financial incentives can improve the quality of health care. A conceptual framework drawn from microeconomics, agency theory, behavioral economics, and cognitive psychology motivates a set of propositions about incentive effects on clinical quality. These propositions are evaluated through a synthesis of extant peer-reviewed empirical evidence. Comprehensive financial incentives--balancing rewards and penalties; blending structure, process, and outcome measures; emphasizing continuous, absolute performance standards; tailoring the size of incremental rewards to increasing marginal costs of quality improvement; and assuring certainty, frequency, and sustainability of incentive payoffs--offer the prospect of significantly enhancing quality beyond the modest impacts of prevailing pay-for-performance (P4P) programs. Such organizational innovations as the primary care medical home and accountable health care organizations are expected to catalyze more powerful quality incentive models: risk- and quality-adjusted capitation, episode of care payments, and enhanced fee-for-service payments for quality dimensions (e.g., prevention) most amenable to piece-rate delivery. PMID:19296779

  6. Competition and quality in home health care markets.

    PubMed

    Jung, Kyoungrae; Polsky, Daniel

    2014-03-01

    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

  7. 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

  8. A Count for Quality: Child Care Center Directors on Rating and Improvement Systems

    ERIC Educational Resources Information Center

    Schulman, Karen; Matthews, Hannah; Blank, Helen; Ewen, Danielle

    2012-01-01

    Quality Rating and Improvement Systems (QRIS)--a strategy to improve families' access to high-quality child care--assess the quality of child care programs, offer incentives and assistance to programs to improve their ratings, and give information to parents about the quality of child care. These systems are operating in a growing number of…

  9. Acute Myocardial Infarction Quality of Care: The Strong Heart Study

    PubMed Central

    Best, Lyle G.; Butt, Amir; Conroy, Britt; Devereux, Richard B.; Galloway, James M.; Jolly, Stacey; Lee, Elisa T.; Silverman, Angela; Yeh, Jeun-Liang; Welty, Thomas K.; Kedan, Ilan

    2014-01-01

    Objectives Evaluate the quality of care provided patients with acute myocardial infarction and compare with similar national and regional data. Design Case series. Setting The Strong Heart Study has extensive population-based data related to cardiovascular events among American Indians living in three rural regions of the United States. Participants Acute myocardial infarction cases (72) occurring between 1/1/2001 and 12/31/2006 were identified from a cohort of 4549 participants. Outcome measures The proportion of cases that were provided standard quality of care therapy, as defined by the Healthcare Financing Administration and other national organizations. Results The provision of quality services, such as administration of aspirin on admission and at discharge, reperfusion therapy within 24 hours, prescription of beta blocker medication at discharge, and smoking cessation counseling were found to be 94%, 91%, 92%, 86% and 71%, respectively. The unadjusted, 30 day mortality rate was 17%. Conclusion Despite considerable challenges posed by geographic isolation and small facilities, process measures of the quality of acute myocardial infarction care for participants in this American Indian cohort were comparable to that reported for Medicare beneficiaries nationally and within the resident states of this cohort. PMID:21942161

  10. 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

  11. Quality measures for supportive cancer care: the Cancer Quality-ASSIST Project.

    PubMed

    Lorenz, Karl A; Dy, Sydney M; Naeim, Arash; Walling, Anne M; Sanati, Homayoon; Smith, Patricia; Shanman, Roberta; Roth, Carol P; Asch, Steven M

    2009-06-01

    Patients and physicians often cite symptom control as one of their most important goals in cancer care. Despite this, a previous systematic review found few tools for evaluating the quality of supportive cancer management. We developed a comprehensive set of quality indicators for evaluating pain and nonpain symptom management as well as care planning needs in cancer patients. Based on the prevalence and quality-of-life data, clinician-researchers prioritized pain, psychosocial distress, dyspnea, nausea and vomiting, fatigue and anorexia, treatment-associated toxicities, and information and care planning for quality-indicator development. Using search terms and selection criteria, we identified English-language documents from Medline (1997-2007) and Internet-based searches. Based on this evidence, clinician-reviewers proposed process quality indicators. We then used the VA Health Services Research and Development (VA HSR & D) appropriateness methods to compile the ratings of a multidisciplinary, international expert panel of the validity and feasibility of each indicator. The panel judged 92 out of 133 (69%) proposed quality indicators valid and feasible (15 out of 23 pain, 5 out of 6 depression, 8 out of 11 dyspnea, 15 out of 19 nausea and vomiting, 13 out of 26 fatigue and anorexia, 23 out of 32 other treatment-associated toxicities, and 13 out of 16 information and care planning). Of the final indicators, 67 are potentially useful for inpatient and 81 for outpatient evaluation, and 26 address screening, 12 diagnostic evaluation, 20 management, and 21 follow-up. These quality indicators provide evidence-explicit tools for measuring processes critical to ensuring high-quality supportive cancer care. Research is needed to characterize adherence to recommended practices and to evaluate the use of these measures in quality improvement efforts. PMID:19359135

  12. Total quality management as a health care corporate strategy.

    PubMed

    Johnson, J A; Omachonu, V K

    1995-01-01

    Total quality management (TQM) must become a part of corporate strategy if it is to become a way of life in health care. TQM should be understood in the context of a cultural transformation. The greatest challenge for top management is to create an organization in which every employee, department and function is linked inextricably to the organization's mission and vision. One of the key benefits of TQM is the use of teams to work on and achieve organizational objectives. Health care managers must understand motivation in order to carry the workforce with them to attain those objectives. PMID:10165402

  13. Why Good Quality Care Needs Philosophy More Than Compassion

    PubMed Central

    Leget, Carlo

    2015-01-01

    Although Marianna Fotaki’s Editorial is helpful and challenging by looking at both the professional and institutional requirements for reinstalling compassion in order to aim for good quality healthcare, the causes that hinder this development remain unexamined. In this commentary, 3 causes are discussed; the boundary between the moral and the political; Neoliberalism; and the underdevelopment of reflection on the nature of care. A plea is made for more philosophical reflection on the nature of care and its implications in healthcare education. PMID:26673178

  14. Licensure Portability: Assuring Access To Quality Care In Physical Therapy

    PubMed Central

    Lane, Mark

    2014-01-01

    The concurrent circumstances of an increasingly mobile workforce, disparities in access to healthcare, and the ability to deliver care through technology (e.g., telehealth) present the need and the opportunity for practice across state borders. Over the past four years, the Federation of State Boards of Physical Therapy (FSBPT) has explored professional licensure models that will allow cross border practice. This paper reviews FSBPT’s exploratory process and describes some of the advantages of an interstate compact. It concludes that if agreement among state licensing boards can be achieved, a compact could serve as a viable means to increase patient access to quality physical therapy care. PMID:25945219

  15. Practice size, financial sharing and quality of care

    PubMed Central

    2013-01-01

    Background Although we are observing a general move towards larger primary care practices, surprisingly little is known about the influence of key components of practice organization on primary care. We aimed to determine the relationships between practice size, and revenue sharing agreements, and quality of care. Methods As part of a large cross sectional study, group practices were randomly selected from different primary care service delivery models in Ontario. Patient surveys and chart reviews were used to assess quality of care. Multilevel regressions controlled for patient, provider and practice characteristics. Results Positive statistically significant associations were found between the logarithm of group size and access, comprehensiveness, and disease prevention. Negative significant associations were found between logarithm group size and continuity. No differences were found for chronic disease management and health promotion. Practices that shared revenues were found to deliver superior health promotion compared to those who did not. Interacting group size with the presence of a revenue-sharing arrangement had a negative impact on health promotion. Conclusions Despite the limitations of our study, our findings have provided preliminary evidence of the tradeoffs inherent with increasing practice size. Larger group size is associated with better access and comprehensiveness but worse continuity of care. Revenue sharing in group practices was associated with higher health promotion compared to sharing only common costs. Further work is required to better inform policy makers and practitioners as to whether the pattern revealed in larger practices mitigates any of the previously reported benefits of continuity of primary care. We found few benefits of revenue sharing – even then the effect of revenue sharing on health promotion seemed diminished in larger practices. PMID:24165413

  16. Primary care quality indicators for children: measuring quality in UK general practice

    PubMed Central

    Gill, Peter J; O’Neill, Braden; Rose, Peter; Mant, David; Harnden, Anthony

    2014-01-01

    Background Child health care is an important part of the UK general practice workload; in 2009 children aged <15 years accounted for 10.9% of consultations. However, only 1.2% of the UK’s Quality and Outcomes Framework pay-for-performance incentive points relate specifically to children. Aim To improve the quality of care provided for children and adolescents by defining a set of quality indicators that reflect evidence-based national guidelines and are feasible to audit using routine computerised clinical records. Design and setting Multi-step consensus methodology in UK general practice. Method Four-step development process: selection of priority issues (applying nominal group methodology), systematic review of National Institute for Health and Care Excellence (NICE) and Scottish Intercollegiate Guidelines Network (SIGN) clinical guidelines, translation of guideline recommendations into quality indicators, and assessment of their validity and implementation feasibility (applying consensus methodology used in selecting QOF indicators). Results Of the 296 national guidelines published, 48 were potentially relevant to children in primary care, but only 123 of 1863 recommendations (6.6%) met selection criteria for translation into 56 potential quality indicators. A further 13 potential indicators were articulated after review of existing quality indicators and standards. Assessment of the validity and feasibility of implementation of these 69 candidate indicators by a clinical expert group identified 35 with median scores 8 on a 9-point Likert scale. However, only seven of the 35 achieved a GRADE rating >1 (were based on more than expert opinion). Conclusion Producing valid primary care quality indicators for children is feasible but difficult. These indicators require piloting before wide adoption but have the potential to raise the standard of primary care for all children. PMID:25452539

  17. Implementing a quality improvement programme in palliative care in care homes: a qualitative study

    PubMed Central

    2011-01-01

    Background An increasing number of older people reach the end of life in care homes. The aim of this study is to explore the perceived benefits of, and barriers to, implementation of the Gold Standards Framework for Care Homes (GSFCH), a quality improvement programme in palliative care. Methods Nine care homes involved in the GSFCH took part. We conducted semi-structured interviews with nine care home managers, eight nurses, nine care assistants, eleven residents and seven of their family members. We used the Framework approach to qualitative analysis. The analysis was deductive based on the key tasks of the GSFCH, the 7Cs: communication, coordination, control of symptoms, continuity, continued learning, carer support, and care of the dying. This enabled us to consider benefits of, and barriers to, individual components of the programme, as well as of the programme as a whole. Results Perceived benefits of the GSFCH included: improved symptom control and team communication; finding helpful external support and expertise; increasing staff confidence; fostering residents' choice; and boosting the reputation of the home. Perceived barriers included: increased paperwork; lack of knowledge and understanding of end of life care; costs; and gaining the cooperation of GPs. Many of the tools and tasks in the GSFCH focus on improving communication. Participants described effective communication within the homes, and with external providers such as general practitioners and specialists in palliative care. However, many had experienced problems with general practitioners. Although staff described the benefits of supportive care registers, coding predicted stage of illness and advance care planning, which included improved communication, some felt the need for more experience of using these, and there were concerns about discussing death. Conclusions Most of the barriers described by participants are relevant to other interventions to improve end of life care in care homes. There is a need to investigate the impact of quality improvement programmes in care homes, such as the GSFCH, on a wider range of outcomes for residents and their families, and to monitor the sustainability of any resulting improvements. It is also important to explore the impact of the different components of these complex interventions. PMID:21658253

  18. Do patients "like" good care? measuring hospital quality via Facebook.

    PubMed

    Timian, Alex; Rupcic, Sonia; Kachnowski, Stan; Luisi, Paloma

    2013-01-01

    With the growth of Facebook, public health researchers are exploring the platform's uses in health care. However, little research has examined the relationship between Facebook and traditional hospital quality measures. The authors conducted an exploratory quantitative analysis of hospitals' Facebook pages to assess whether Facebook "Likes" were associated with hospital quality and patient satisfaction. The 30-day mortality rates and patient recommendation rates were used to quantify hospital quality and patient satisfaction; these variables were correlated with Facebook data for 40 hospitals near New York, NY. The results showed that Facebook "Likes" have a strong negative association with 30-day mortality rates and are positively associated with patient recommendation. These exploratory findings suggest that the number of Facebook "Likes" for a hospital may serve as an indicator of hospital quality and patient satisfaction. These findings have implications for researchers and hospitals looking for a quick and widely available measure of these traditional indicators. PMID:23378059

  19. Working for Quality Child Care: Good Child Care Jobs Equals Good Care for Children.

    ERIC Educational Resources Information Center

    Bellm, Dan; Haack, Peggy

    Although child caregivers make a major contribution to children's development and to the health and well-being of their communities, they remain underpaid and undervalued. Written for entry-level and experienced child care teachers and providers, this book presents information on the child care occupation and includes tools to help teachers and…

  20. Parent Experiences with State Child Care Subsidy Systems and Their Perceptions of Choice and Quality in Care Selected

    ERIC Educational Resources Information Center

    Raikes, Helen; Torquati, Julia; Wang, Cixin; Shjegstad, Brinn

    2012-01-01

    Research Findings: This study investigated parents' experiences using Child Care and Development Fund and other state-dispersed child care subsidies, reasons for choosing their current child care program, and perceptions of the quality of child care received from their current program. A telephone survey of 659 parents receiving child care…

  1. The Ups and Downs of Child Care: Variations in Child Care Quality and Exposure across the Early Years

    ERIC Educational Resources Information Center

    Hynes, Kathryn; Habasevich-Brooks, Tara

    2008-01-01

    There is considerable policy interest in understanding the role of child care in children's development. Yet little research has examined whether individual children experience changes in child care quality across their early years, and less has included children's varying levels of exposure to care in analyses of child care trajectories. Using…

  2. Staffing Subsidies and the Quality of Care in Nursing Homes

    PubMed Central

    Foster, Andrew D.; Lee, Yong Suk

    2015-01-01

    Concerns about the quality of state-financed nursing home care has led to the wide-scale adoption by states of pass-through subsidies, in which Medicaid reimbursement rates are directly tied to staffing expenditure. We examine the effects of Medicaid pass-through on nursing home staffing and quality of care by adapting a two-step FGLS method that addresses clustering and state-level temporal autocorrelation. We find that pass-through subsidies increases staffing by about 1% on average and 2.7% in nursing homes with a low share of Medicaid patients. Furthermore, pass-through subsidies reduce the incidences of pressure ulcer worsening by about 0.9%. PMID:25814437

  3. [Without reciprocal recognition there is not quality of care].

    PubMed

    Calvo Rigual, Fernando; Costa Alcaraz, Ana M; García-Conde Brú, Javier; Megía Sanz, María Jesús

    2011-10-01

    Understanding the classic doctor-patient relationship has entered a crisis in medicine today. Communication difficulties, underestimation of empathy, or bringing economic criteria are leading to care styles that facilitate the objectification of patients, contempt for doctors, and indifference of both to collective measures of health. Basic principles of this relationship such as quality, justice, patient autonomy and beneficence may appear weak content. We intend to apply the concept of "reciprocal recognition" from philosophy to "recharge" content different aspects of the clinical relationship: a look "inside", dealing with the identity of the protagonists seek to promote it by using reciprocal recognition of both patient and the professional. In one aspect "external", focusing on the quality of care, a key objective of the clinical relationship. With reciprocal recognition, issues of justice and equity are reinforced through public health, building an identity of citizens with rights. PMID:22212833

  4. Quality and Safety in Health Care, Part VII: Lower Costs and Higher Quality.

    PubMed

    Harolds, Jay A

    2016-02-01

    The Institute of Medicine report entitled The Health Care Imperative: Lowering Costs and Improving Outcomes discussed numerous ways to decrease costs in the health care system without decreasing quality. The use of evidence-based medicine, eliminating wasteful spending such as needlessly high administrative costs, having more preventive services, having a better reimbursement system that emphasized quality, developing a less fragmented and more efficient medical delivery system, having more transparency for patients on the outcomes of different providers, having greater health care literacy for patients, and eliminating fraud were some of the recommendations. The total savings from eliminating unnecessary health care costs was estimated to be over 3 quarters of a trillion dollars each year. PMID:26545019

  5. Quality and equity in early childhood care in Peru

    NASA Astrophysics Data System (ADS)

    Izu, Regina Moromizato

    2007-01-01

    The present study examines educational policy documents and programs on early childhood development and education in Peru. The author provides an evaluation of early childhood learning programs and their outcomes in different education centers in Peru. Health, nutrition, development, and participation are identified as key areas of concern. The study concludes with a reference to the importance of monitoring quality and equity in early childhood care.

  6. Effects of an Integrated Care System on quality of care and satisfaction for children with special health care needs.

    PubMed

    Knapp, Caprice; Madden, Vanessa; Sloyer, Phyllis; Shenkman, Elizabeth

    2012-04-01

    To assess the effects of an Integrated Care System (ICS) on parent-reported quality of care and satisfaction for Children with Special Health Care Needs (CSHCN). In 2006 Florida reformed its Medicaid program in Broward and Duval counties. Children's Medical Services Network (CMSN) chose to participate in the reform and developed an ICS for CSHCN. The ICS ushered in several changes such as more prior approval requirements and closing of the provider network. Telephone surveys were conducted with CMSN parents whose children reside in the reform counties and parents whose children reside outside of the reform counties in 2006 and 2007 (n = 1,727). Results from multivariate quasi-experimental models show that one component of parent-report quality of care, customer service, increased. Following implementation of the ICS, customer service increased by 0.22 points. After implementation of the ICS, parent-reported quality and satisfaction were generally unaffected. Although significant increases were not seen in the majority of the quality and satisfaction domains, it is nonetheless encouraging that parents did not report negative experiences with the ICS. It is important to present these interim findings so that progress can be monitored and decision-makers can begin to consider if the program should be expanded statewide. PMID:21509433

  7. Methodological challenges in measuring quality care at the end of life in the long-term care environment.

    PubMed

    Thompson, Genevieve N; Chochinov, Harvey Max

    2006-10-01

    Understanding what constitutes quality end-of-life care from the perspective of the patient, their family, and health care professionals has been a priority for many researchers in the past few decades. Literature in this area has helped describe many of the barriers to measuring the quality of care in various environments, such as the hospital, hospice, and home. However, much of the work to date in defining the domains of quality care at the end of life has not been conducted within the long-term care environment. This environment is expected to provide care to an increasing number of dying persons with the concurrent aging of the population in many Western countries and demand for more formal services. In this review, the methodological issues involved in measuring quality care at the end of life are examined, with specific attention given to the challenges encountered in the long-term care environment. PMID:17000355

  8. Improving care at cystic fibrosis centers through quality improvement.

    PubMed

    Kraynack, Nathan C; McBride, John T

    2009-10-01

    Quality improvement (QI) using a clinical microsystems approach provides cystic fibrosis (CF) centers the opportunity to make a significant positive impact on the health of their patients. The availability of center-specific outcomes data and the support of the Cystic Fibrosis Foundation are important advantages for these quality improvement efforts. This article illustrates how the clinical microsystems methodology can improve care delivery and outcomes by describing the gradual application of quality improvement principles over the past 5 years by the CF team at the Lewis Walker Cystic Fibrosis Center at Akron Children's Hospital in Akron, Ohio. Using the example of a project to improve the pulmonary function of the pediatric patients at our center as a framework, we describe the QI process from the initial team-building phase, through the assessment of care processes, standardization of care, and developing a culture of continuous improvement. We outline how enthusiastic commitment from physician leadership, clinical managers and central administration, the availability of coaches, and an appreciation of the importance of measurement, patient involvement, communication, and standardization are critical components for successful process improvement. PMID:19760542

  9. [Quality of life in the focus of quality audits in long-term care].

    PubMed

    Herold-Majumdar, A; Behrens, J

    2012-12-01

    Quality of life - an important outcome factor of long-term care - development and psychometric testing of an audit instrument, the Quality of Life Index, (QoL index"), to assess the consideration for individual quality of life aspects during the care process in long-term care settings is evaluated ?-? even for clients with limited communication skills.A stratified random sample of n=209 residents was drawn out of the population of N=1 128 residents of 8 nursing homes and their individual QoL-aspects were assessed with SEIQoL-DW or in difficult communication situations with "LQ-Index-Informationssammlung". The LQ-Index's new items were validated via a parallel testing with the reference instrument SEIQoL-DW, the split half-reliability, the interrater reliability (Kappa) and a structured expert review according to the cognitive interview technique.All 209 participants were assessed via LQ-Index. The SEIQoL-Interview was completed and estimated valid by 18 (8.61%) residents. The psychometric testing results and the expert review indicate high feasibility, good reliability, validity and objectivity of the instrument "LQ-Index".As a result of this study a feasible and valid instrument is now available to assess the consideration for individual quality of life aspects during the care process in long-term care settings - even for clients with limited communication skills. PMID:22322335

  10. 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

  11. Cancer care quality measures: symptoms and end-of-life care.

    PubMed Central

    Lorenz, Karl; Lynn, Joanne; Dy, Sydney; Hughes, Ronda; Mularski, Richard A; Shugarman, Lisa R; Wilkinson, Anne M

    2006-01-01

    OBJECTIVES To systematically identify quality measures and the evidence for them-to support quality assessment and improvement in the palliative care of patients with cancer in the areas of pain, dyspnea, depression, and advance care planning (ACP), and to identify important gaps in related research. DATA SOURCES MEDLINE, CINAHL, and PsycINFO in English 1995-2005. We also conducted an extensive Internet search of professional organizations seeking guidelines and other grey literature (i.e., not published in peer-reviewed journals) using similar terms and attempted to contact all measure developers. REVIEW METHODS We searched using terms for each domain for patients (adults and children) with a cancer diagnosis throughout the continuum of care (e.g., diagnosis to death). Pain and depression searches were limited to cancer, but we searched broadly for dyspnea and ACP, because the evidence base for dyspnea is more limited and experts advised that ACP measures would be generalizable to cancer. Measures were included if they expressed a normative relationship to quality and included a measurable numerator and denominator. Citations and articles were each reviewed/abstracted by two of six palliative care researcher/clinicians who described populations, testing, and attributes for each measure. RESULTS The literature search identified 5,187 titles, of which 4,650 were excluded at abstract review. Of 537 articles, only 25 contained measures: 21 on ACP, 4 on depression, 2 on dyspnea, and 12 on pain. Ten relevant measure sets were identified: ACOVE, QA Tools, Cancer Care Ontario, Cancer Care Nova Scotia, Dana-Farber, Georgia Cancer Coalition, University Health Consortium, NHPCO, VHA, and ASCO. We identified a total of 40 operationalized and 19 non-operationalized measures. The most measures were available for pain (12) and ACP (21), compared with only 4 for depression and 2 for dyspnea. Few of the measures were published, and few had been specifically tested in a cancer population. CONCLUSIONS A large number of measures are available for addressing palliative cancer care, but testing them in relevant populations is urgently needed. No measures or indicators were available to evaluate the quality of supportive pediatric cancer care. Basic research is urgently needed to address measurement in populations with impaired self-report. Funding field testing of highest quality measures should be an urgent patient and family-centered priority to meet the needs of patients with cancer. PMID:17764216

  12. National infection prevention and control programmes: Endorsing quality of care.

    PubMed

    Stempliuk, Valeska; Ramon-Pardo, Pilar; Holder, Reynaldo

    2014-01-01

    Core components Health care-associated infections (HAIs) are a major cause of morbidity and mortality. In addition to pain and suffering, HAIs increase the cost of health care and generates indirect costs from loss of productivity for patients and society as a whole. Since 2005, the Pan American Health Organization has provided support to countries for the assessment of their capacities in infection prevention and control (IPC). More than 130 hospitals in 18 countries were found to have poor IPC programmes. However, in the midst of many competing health priorities, IPC programmes are not high on the agenda of ministries of health, and the sustainability of national programmes is not viewed as a key point in making health care systems more consistent and trustworthy. Comprehensive IPC programmes will enable countries to reduce the mobility, mortality and cost of HAIs and improve quality of care. This paper addresses the relevance of national infection prevention and control (NIPC) programmes in promoting, supporting and reinforcing IPC interventions at the level of hospitals. A strong commitment from national health authorities in support of national IPC programmes is crucial to obtaining a steady decrease of HAIs, lowering health costs due to HAIs and ensuring safer care. PMID:26502483

  13. Client satisfaction and quality of health care in rural Bangladesh.

    PubMed Central

    Mendoza Aldana, J.; Piechulek, H.; al-Sabir, A.

    2001-01-01

    OBJECTIVE: To assess user expectations and degree of client satisfaction and quality of health care provided in rural Bangladesh. METHODS: A total of 1913 persons chosen by systematic random sampling were successfully interviewed immediately after having received care in government health facilities. FINDINGS: The most powerful predictor for client satisfaction with the government services was provider behaviour, especially respect and politeness. For patients this aspect was much more important than the technical competence of the provider. Furthermore, a reduction in waiting time (on average to 30 min) was more important to clients than a prolongation of the quite short (from a medical standpoint) consultation time (on average 2 min, 22 sec), with 75% of clients being satisfied. Waiting time, which was about double at outreach services than that at fixed services, was the only element with which users of outreach services were dissatisfied. CONCLUSIONS: This study underscores that client satisfaction is determined by the cultural background of the people. It shows the dilemma that, though optimally care should be capable of meeting both medical and psychosocial needs, in reality care that meets all medical needs may fail to meet the client's emotional or social needs. Conversely, care that meets psychosocial needs may leave the clients medically at risk. It seems important that developing countries promoting client-oriented health services should carry out more in-depth research on the determinants of client satisfaction in the respective culture. PMID:11436472

  14. Best practices in implementing and sustaining quality of care. A review of the quality improvement literature.

    PubMed

    Compas, Carol; Hopkins, Kimberly A; Townsley, Elaine

    2008-07-01

    A literature review was undertaken to explore both published and unpublished quality improvement studies, projects, and initiatives that strove to develop more efficient systems to support an infrastructure for nursing home quality of care. The review included a search of all available, full-text published literature from 1997 to 2007 available from PubMed, CINAHL, and MEDLINE. The methods used by the researchers were varied, and this article identified several primary findings: the use of a specific, measurable mission or goal statement; the use of multidepartmental and multidisciplinary involvement; the need for further education and resource materials; the use of a reward/incentive program; the need for internal and external stakeholders to be identified along with a project champion; and the process of feedback and outcome measurement. This article summarizes the findings from the review and offers key recommendations that are supported for improving quality of care and sustaining quality gains. PMID:20077965

  15. Improving quality of care through improved audit and feedback

    PubMed Central

    2012-01-01

    Background The Department of Veterans Affairs (VA) has led the industry in measuring facility performance as a critical element in improving quality of care, investing substantial resources to develop and maintain valid and cost-effective measures. The External Peer Review Program (EPRP) of the VA is the official data source for monitoring facility performance, used to prioritize the quality areas needing most attention. Facility performance measurement has significantly improved preventive and chronic care, as well as overall quality; however, much variability still exists in levels of performance across measures and facilities. Audit and feedback (A&F), an important component of effective performance measurement, can help reduce this variability and improve overall performance. Previous research suggests that VA Medical Centers (VAMCs) with high EPRP performance scores tend to use EPRP data as a feedback source. However, the manner in which EPRP data are used as a feedback source by individual providers as well as service line, facility, and network leadership is not well understood. An in-depth understanding of mental models, strategies, and specific feedback process characteristics adopted by high-performing facilities is thus urgently needed. This research compares how leaders of high, low, and moderately performing VAMCs use clinical performance data from the EPRP as a feedback tool to maintain and improve quality of care. Methods We will conduct a qualitative, grounded theory analysis of up to 64 interviews using a novel method of sampling primary care, facility, and Veterans Integrated Service Network (VISN) leadership at high-, moderate-, and low-performing facilities. We will analyze interviews for evidence of cross-facility differences in perceptions of performance data usefulness and strategies for disseminating performance data evaluating performance, with particular attention to timeliness, individualization, and punitiveness of feedback delivery. Discussion Most research examining feedback to improve provider and facility performance lacks a detailed understanding of the elements of effective feedback. This research will highlight the elements most commonly used at high-performing facilities and identify additional features of their successful feedback strategies not previously identified. Armed with this information, practices can implement more effective A&F interventions to improve quality of care. PMID:22607640

  16. Quality of Palliative Care for Patients With Advanced Cancer in a Community Consortium

    PubMed Central

    Kamal, Arif H.; Nipp, Ryan D.; Bull, Janet H.; Stinson, Charles S.; Lowery, Ashlei W.; Nicolla, Jonathan M.; Abernethy, Amy P.

    2015-01-01

    Background Measuring quality of care delivery is essential to palliative care program growth and sustainability. We formed the Carolinas Consortium for Palliative Care and collected a quality data registry to monitor our practice and inform quality improvement efforts. Measures We analyzed all palliative care consultations in patients with cancer in our quality registry from March 2008 through October 2011 using 18 palliative care quality measures. Descriptive metric adherence was calculated after analyzing the relevant population for measurement. Intervention We used a paper-based, prospective method to monitor adherence for quality measures in a community-based palliative care consortium. Outcomes We demonstrate that measures evaluating process assessment (range 63-100%), as opposed to interventions (range 3-17%), are better documented. Conclusions/Lessons Learned Analyzing data on quality is feasible and valuable in community-based palliative care. Overall, processes to collect data on quality using non-technology methods may underestimate true adherence to quality measures. PMID:25220048

  17. Monitoring quality in Israeli primary care: The primary care physicians' perspective

    PubMed Central

    2012-01-01

    Background Since 2000, Israel has had a national program for ongoing monitoring of the quality of the primary care services provided by the country's four competing non-profit health plans. Previous research has demonstrated that quality of care has improved substantially since the program's inception and that the program enjoys wide support among health plan managers. However, prior to this study there were anecdotal and journalistic reports of opposition to the program among primary care physicians engaged in direct service delivery; these raised serious questions about the extent of support among physicians nationally. Goals To assess how Israeli primary care physicians experience and rate health plan efforts to track and improve the quality of care. Method The study population consisted of primary care physicians employed by the health plans who have responsibility for the quality of care of a panel of adult patients. The study team randomly sampled 250 primary-care physicians from each of the four health plans. Of the 1,000 physicians sampled, 884 met the study criteria. Every physician could choose whether to participate in the survey by mail, e-mail, or telephone. The anonymous questionnaire was completed by 605 physicians – 69% of those eligible. The data were weighted to reflect differences in sampling and response rates across health plans. Main findings The vast majority of respondents (87%) felt that the monitoring of quality was important and two-thirds (66%) felt that the feedback and subsequent remedial interventions improved medical care to a great extent. Almost three-quarters (71%) supported continuation of the program in an unqualified manner. The physicians with the most positive attitudes to the program were over age 44, independent contract physicians, and either board-certified in internal medicine or without any board-certification (i.e., residents or general practitioners). At the same time, support for the program was widespread even among physicians who are young, board-certified in family medicine, and salaried. Many physicians also reported that various problems had emerged to a great or very great extent: a heavier workload (65%), over-competitiveness (60%), excessive managerial pressure (48%), and distraction from other clinical issues (35%). In addition, there was some criticism of the quality of the measures themselves. Respondents also identified approaches to addressing these problems. Conclusions The findings provide perspective on the anecdotal reports of physician opposition to the monitoring program; they may well accurately reflect the views of the small number of physicians directly involved, but they do not reflect the views of primary care physicians as a whole, who are generally quite supportive of the program. At the same time, the study confirms the existence of several perceived problems. Some of these problems, such as excess managerial pressure, can probably best be addressed by the health plans themselves; while others, such as the need to refine the quality indicators, are probably best addressed at the national level. Cooperation between primary care physicians and health plan managers, which has been an essential component of the program's success thus far, can also play an important role in addressing the problems identified. PMID:22913311

  18. Organizational control of hospital infrastructure determines the quality of care.

    PubMed

    Grujic, S D; O'Sullivan, D D; Wehrmacher, W H

    1989-02-01

    Hospital personnel and their performance underlie all hospital facilities and patient services (the hospital infrastructure). Hence, quality patient care is not exclusively in the domain of the medical staff and must be regarded as a comprehensive responsibility of the hospital. Hospitals must establish behavioral quality systems and teach employees not only how to do their job well to meet technical quality standards, but also how to fulfill patient expectations. Critical and life threatening problems are thereon prevented or minimized, and protection of physicians and hospitals from litigation improves as a result. Governing boards must provide a role model and demand excellence of everyone, in order to improve the performance of the hospital infrastructure. PMID:2535568

  19. Quality improvement education to improve performance on ulcerative colitis quality measures and care processes aligned with National Quality Strategy priorities

    PubMed Central

    Greene, Laurence; Moreo, Kathleen

    2015-01-01

    Studies on inflammatory bowel disease (IBD) have reported suboptimal approaches to patient care. In the United States, the findings have motivated leading gastroenterology organizations to call for initiatives that support clinicians in aligning their practices with quality measures for IBD and priorities of the National Quality Strategy (NQS). We designed and implemented a quality improvement (QI) education program on ulcerative colitis in which patient charts were audited for 30 gastroenterologists before (n = 300 charts) and after (n = 290 charts) they participated in QI-focused educational activities. Charts were audited for nine measures, selected for their alignment with four NQS priorities: making care safer, ensuring patient engagement, promoting communication, and promoting effective treatment practices. Four of the measures, including guideline-directed vaccinations and assessments of disease type and activity, were part of the CMS Physician Quality Reporting System (PQRS). The other five measures involved counseling patients on various topics in ulcerative colitis management, documentation of side effects, assessment of adherence status, and simplification of dosing. The gastroenterologists also completed baseline and post-education surveys designed to assess qualitative outcomes. One of the educational interventions was a private audit feedback session conducted for each gastroenterologist. The sessions were designed to support participants in identifying measures reflecting suboptimal care quality and developing action plans for improvement. In continuous improvement cycles, follow-up interventions included QI tools and educational monographs. Across the nine chart variables, post-education improvements ranged from 0% to 48%, with a mean improvement of 15.9%. Survey findings revealed improvements in self-reported understanding of quality measures and intentions to apply them to practice, and lower rates of perceived significant barriers to high-quality care. The findings indicate the potential for QI education to support gastroenterologists in improving their performance on key measures of care quality for patients with ulcerative colitis. PMID:26732044

  20. Quality improvement education to improve performance on ulcerative colitis quality measures and care processes aligned with National Quality Strategy priorities.

    PubMed

    Greene, Laurence; Moreo, Kathleen

    2015-01-01

    Studies on inflammatory bowel disease (IBD) have reported suboptimal approaches to patient care. In the United States, the findings have motivated leading gastroenterology organizations to call for initiatives that support clinicians in aligning their practices with quality measures for IBD and priorities of the National Quality Strategy (NQS). We designed and implemented a quality improvement (QI) education program on ulcerative colitis in which patient charts were audited for 30 gastroenterologists before (n = 300 charts) and after (n = 290 charts) they participated in QI-focused educational activities. Charts were audited for nine measures, selected for their alignment with four NQS priorities: making care safer, ensuring patient engagement, promoting communication, and promoting effective treatment practices. Four of the measures, including guideline-directed vaccinations and assessments of disease type and activity, were part of the CMS Physician Quality Reporting System (PQRS). The other five measures involved counseling patients on various topics in ulcerative colitis management, documentation of side effects, assessment of adherence status, and simplification of dosing. The gastroenterologists also completed baseline and post-education surveys designed to assess qualitative outcomes. One of the educational interventions was a private audit feedback session conducted for each gastroenterologist. The sessions were designed to support participants in identifying measures reflecting suboptimal care quality and developing action plans for improvement. In continuous improvement cycles, follow-up interventions included QI tools and educational monographs. Across the nine chart variables, post-education improvements ranged from 0% to 48%, with a mean improvement of 15.9%. Survey findings revealed improvements in self-reported understanding of quality measures and intentions to apply them to practice, and lower rates of perceived significant barriers to high-quality care. The findings indicate the potential for QI education to support gastroenterologists in improving their performance on key measures of care quality for patients with ulcerative colitis. PMID:26732044

  1. Agents of Nursing Home Quality of Care: Ombudsmen and Staff Ratios Revisited.

    ERIC Educational Resources Information Center

    Cherry, Ralph L.

    1991-01-01

    Compared effects of ombudsman programs on quality of nursing home care on random sample of 134 Medicare/Medicaid-certified long-term care facilities in Missouri. Found that presence of ombudsman program was most important factor associated with quality for intermediate-care facilities, and was significantly associated with quality for skilled

  2. IOM committee calls for complete revamping of health care system to achieve better quality.

    PubMed

    2001-03-01

    The health care system can no longer deliver quality care the way it is currently organized, according to a new report, Crossing the Quality Chasm, released March 1 by the Institute of Medicine's Committee on Quality of Health Care in America. Instead, the committee says that it is time to reinvent the system. PMID:11268795

  3. State health agencies and quality improvement in perinatal care.

    PubMed

    Johnson, K A; Little, G A

    1999-01-01

    The origin of the federal-state partnership in Maternal and Child Health (MCH) can be traced from the Children's Bureau grants of 1912, through the Sheppard-Towner Act, to the creation of Title V and other programs of today that mandate planning, accountability, and systems development. In the past decade with the transformation of the health care system and the emergence of managed care, there has been a resurgence of interest in public, professional, and governmental interest in quality measurement and accountability. Regional perinatal systems have been implemented in all states with varying levels of involvement by state health agencies and the public sector. This historical framework discusses two primary themes: the decades of evolution in the federal-state partnership, and the emergence in the last three decades of perinatal regional system policy, and suggests that the structure of the federal-state partnership has encouraged state variation. A survey of state MCH programs was undertaken to clarify their operational and perceived role in promoting quality improvement in perinatal care. Data and information from the survey, along with five illustrative state case studies, demonstrate great variation in how individual state agencies function. State efforts in quality improvement, a process to make things better, have four arenas of activity: policy development and implementation, definition and measurement of quality, data collection and analysis, and communication to affect change. Few state health agencies (through their MCH programs and perinatal staff) are taking action in all four arenas. This analysis concludes that there are improvements MCH programs could implement without significant expansion in their authority or resources and points out that there is an opportunity for states to be more proactive as they have the legal authority and responsibility for assuring MCH outcomes. PMID:9917467

  4. More Infant and Toddler Experiences.

    ERIC Educational Resources Information Center

    Hast, Fran; Hollyfield, Ann

    Based on experiences gained at the Palo Alto Infant-Toddler Center and the view that quality child care for infants and toddlers depends upon nurturing, long-term connections with their caregivers, other children, and their families, this book presents strategies for interacting with young children that support the developing child as well as the…

  5. Evaluation of Delaware Stars for Early Success: Year 1 Report. Research Report

    ERIC Educational Resources Information Center

    Schwartz, Heather L.; Karoly, Lynn A.; Le, Vi-Nhuan; Tamargo, Jennifer; Setodji, Claude Messan

    2014-01-01

    Delaware was in the first group of states to receive a federal grant in 2012 to improve early care and education services and increase the number of infants, toddlers, and preschool-age children in high-quality programs. One component of the state's grant is a rigorous validation process for Delaware Stars for Early Success, a voluntary quality…

  6. Emergency Department Crowding and Decreased Quality of Pain Care

    PubMed Central

    Hwang, Ula; Richardson, Lynne; Livote, Elayne; Harris, Ben; Spencer, Natasha; Morrison, R. Sean

    2008-01-01

    Objectives The objective of this study was to evaluate the association of emergency department (ED) crowding factors with the quality of pain care. Methods This was a retrospective observational study of all adult patients (?18 years) with conditions warranting pain care seen at an academic, urban tertiary care ED from July 1 to July 31, 2005, and December 1 to December 31, 2005. Patients were included if they presented with a chief complaint of pain and a final ED diagnosis of a painful condition. Predictor ED crowding variables studied were: 1) census, 2) number of admitted patients waiting for inpatient beds (boarders), and 3) number of boarders divided by ED census (boarding burden). The outcomes of interest were process of pain care measures: documentation of clinician pain assessment, medications ordered, and times of activities (e.g., arrival, assessment, ordering of medications). Results A total of 1,068 patient visits were reviewed. Fewer patients received analgesic medication during periods of high census (>50th percentile) (Parameter estimate = ?0.47 [95% CI = ?0.80 to ?0.07]). There was a direct correlation with total ED census and increased: time to pain assessment (Spearman r = 0.33, p < 0.0001), time to analgesic medication ordering (r = 0.22, p < 0.0001), and time to analgesic medication administration (r = 0.25, p < 0.0001). There were significant delays (>1-hour) for pain assessment and the ordering and administration of analgesic medication during periods of high ED census and number of boarders, but not with boarding burden. Conclusions ED crowding as measured by patient volume negatively impacts patient care. Greater numbers of patients in the ED, whether as total census or number of boarders, were associated with worse pain care. PMID:18945239

  7. Availability and Quality of Prehospital Care on Pakistani Interurban Roads

    PubMed Central

    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

  8. Combined quality function deployment and logical framework analysis to improve quality of emergency care in Malta.

    PubMed

    Buttigieg, Sandra Catherine; Dey, Prasanta Kumar; Cassar, Mary Rose

    2016-03-14

    Purpose - The purpose of this paper is to develop an integrated patient-focused analytical framework to improve quality of care in accident and emergency (A & E) unit of a Maltese hospital. Design/methodology/approach - The study adopts a case study approach. First, a thorough literature review has been undertaken to study the various methods of healthcare quality management. Second, a healthcare quality management framework is developed using combined quality function deployment (QFD) and logical framework approach (LFA). Third, the proposed framework is applied to a Maltese hospital to demonstrate its effectiveness. The proposed framework has six steps, commencing with identifying patients' requirements and concluding with implementing improvement projects. All the steps have been undertaken with the involvement of the concerned stakeholders in the A & E unit of the hospital. Findings - The major and related problems being faced by the hospital under study were overcrowding at A & E and shortage of beds, respectively. The combined framework ensures better A & E services and patient flow. QFD identifies and analyses the issues and challenges of A & E and LFA helps develop project plans for healthcare quality improvement. The important outcomes of implementing the proposed quality improvement programme are fewer hospital admissions, faster patient flow, expert triage and shorter waiting times at the A & E unit. Increased emergency consultant cover and faster first significant medical encounter were required to start addressing the problems effectively. Overall, the combined QFD and LFA method is effective to address quality of care in A & E unit. Practical/implications - The proposed framework can be easily integrated within any healthcare unit, as well as within entire healthcare systems, due to its flexible and user-friendly approach. It could be part of Six Sigma and other quality initiatives. Originality/value - Although QFD has been extensively deployed in healthcare setup to improve quality of care, very little has been researched on combining QFD and LFA in order to identify issues, prioritise them, derive improvement measures and implement improvement projects. Additionally, there is no research on QFD application in A & E. This paper bridges these gaps. Moreover, very little has been written on the Maltese health care system. Therefore, this study contributes demonstration of quality of emergency care in Malta. PMID:26959894

  9. Making a Quality Child Care Choice: Finding and Keeping Quality Child Care Can Be Challenging. Where Do You Start? = Choisir des services de garde de qualite: Trouver et garder des services de garde de qualite peut etre difficile. Du commencer?

    ERIC Educational Resources Information Center

    Canadian Child Care Federation, Ottawa (Ontario).

    This booklet offers Canadian parents guidance on finding high-quality child care. The booklet begins by defining quality child care, indicating that child care should support a child's emotional, social, intellectual well-being and that child caregivers are the key to quality child care. The characteristics of quality child care settings are also…

  10. Working for Quality Child Care: Good Child Care Jobs Equals Good Care for Children. Trainer's Guide.

    ERIC Educational Resources Information Center

    Bellm, Dan; Haack, Peggy

    Noting that the education and training of most early childhood practitioners lack information on child care as an adult work environment, this guide is designed to assist trainers in providing practitioners information about working with the array of adults they encounter on the job, the serious challenges and instabilities in the field, and the…

  11. 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

  12. [Quality concept in health care. Methodology for its measurement].

    PubMed

    Morera Guitart, J

    2003-12-01

    It is increasingly necessary that the neurologists achieve basic knowledgement in clinical management and medical care quality. We will review the concepts of medical care quality (MCQ). Of the definitions checked, we want to emphasize the following aspects. a) application of current scientific knowledge; b) interpersonal relationship; c) environment where the assistance is dispensed; d) results in health; e) cost of assistance; f) risks for the patient and g) patient satisfaction. For the analysis of the MCQ we could distinguish several components: scientific-technical component, efficacy, effectiveness, efficiency, accessibility, continuity, equity, appropriateness, and satisfaction of the patient and of the professional. One of the main objectives to measure the MCQ is to improve the assistance itself. For its measurement we can employ diverse methods depending on our objective: to improve the process, to do Benchmarking, to know the satisfaction of the patients or to guarantee the quality of the medical attention. The most used tools for this measurement are: establishment of criteria-indicator-standard for quality, elaboration of satisfaction questionnaires, interviews to key informant, analysis of complaints and claims of patients and professionals, and clinical audits. The role of the neurologist in the achievement of a high quality neurological attention if fundamental. Therefore, it is necessary some specific formation on: scientific and technical matter, communicative abilities, teamworking, management and organisation of tasks and pharmaco-economic evaluation, and a cultural change that involves every professional on the co-responsibility of the continuous improvement of the processes and of the results of his work, advancing gradually towards the excellence of medical assistance. PMID:15206329

  13. Hospital Care for Newborn Babies: Quality Assessment, A Systematic Review

    PubMed Central

    Jabbari, Hossein; Abdollahi Sabet, Somayae; Heidarzadeh, Mohammad

    2015-01-01

    Context: Neonatal mortality rate is declining globally. The aim of the present study is to identify relevant indicators for assessing newborn care in hospitals by a systematic review. Evidence Acquisition: A search on electronic data base and manual searches of personal files for studies on quality indicators of newborn care were carried out. Searching 9 bibliographic databases, we found 85 articles of which 22 exactly related ones were selected and studied. Hand search yielded 1 record were also searched and 2 records were included. Results: A list of 87 structure, process and outcome indicators was formulated from the articles. Also 26 excess measures were identified in gray literature. After removing duplicates, and categorizing in 3 domains, 18 measures were input, 41 process and 34 outcome measures. Conclusions: These 93 indicators provide a framework for assessing how well the hospitals are providing neonatal care. These measures should be discussed in each context expert panels to address nationally applicable indices of neonatal care and may be adapted for local health settings. PMID:26495100

  14. [Supportive care, cognition and quality of life in brain metastases].

    PubMed

    Le Rhun, É; Taillibert, S; Blonski, M; Jouniaux Delbez, N; Delgadillo, D; Taillia, H; Auquier, P; Belin, C; Bonnetain, F; Varin, D; Tallet, A; Taillandier, L

    2015-02-01

    Brain metastases impact on the survival of the patients, but on their quality of life as well. The objective of the management of these patients is then double. Currently, due to medical advances, survivals tend to improve, especially for some tumor subtypes. During the course of the disease, different neurological signs and symptoms can be observed according to the location, the number and the volume of the metastase(s). Patients and caregivers are especially worried about the loss of autonomy and cognitive impairments. A permanent dialogue, during the course of the disease, is mandatory, in order to adapt the management to the objectives determined by the patients and the medical team. These objectives may vary according to the objective response rates of the disease to anticancer therapies, according to the impact of the disease and its management in daily living. Anticancer therapies and supportive care must be appreciated according to their impact on the survival, on the preservation of the functional independence and the quality of life of the patient, on their abilities to preserve the neurological status and delay the apparition of new neurological signs and symptoms, and their adverse events. Supportive care, cognition and quality of life should be regularly evaluated and adapted according to the objectives of the management of brain metastases patients. Different approaches are described in this paper. PMID:25640218

  15. [Nurses deliver quality care in the community nurses deliver quality care in the community].

    PubMed

    Huang, Yu-Chu; Lin, Chouh-Jiaun

    2009-08-01

    In Taiwan, responsibility for administering healthcare services is being gradually moved out of hospitals and into the community. As such, nurses are increasingly required to address new problems and meet the specific healthcare needs of important subgroups such as Taiwan's growing elderly population and young adult immigrants. Because policies have lagged behind such developments, nurses are expected to provide leadership in addressing these new challenges. Their status within the medical system, however, continues to reflect earlier, more 'traditional' stereotypes and gives inadequate credit for current responsibilities, which include providing long term healthcare and public health nursing, in addition to homecare responsibilities. In the face of these challenges, Taiwan community nurses have continued to develop new ways to provide care and demonstrated innovation, commitment and flexibility in their roles. If nurses are to continue to take a leading role in developing community healthcare services, they require professional recognition as well as appropriate policy support from regulatory and local government authorities. PMID:19634095

  16. [The "Zurich Quality Model of Nursing Care", based on the "Quality of Health Outcome Model" (QHOM): a new perspective in measuring quality in nursing care].

    PubMed

    Schmid-Büchi, Silvia; Rettke, Horst; Horvath, Eva; Marfurt-Russenberger, Katrin; Schwendimann, René

    2008-10-01

    Ensuring and maintaining a high level of quality in nursing care becomes more and more important as economic pressure is increasing and personnel is being reduced. The nursing executives of four large Swiss hospitals therefore commissioned a group of nursing scientists and nursing experts with the task of developing a trendsetting model to represent, assess, and interpret the quality of nursing care. The "Quality of Health Outcome Model" (QHOM) served as a basis for development. More than 60 nurses from acute care hospitals and specialized clinics assessed a first draft of the model in hearings and by means of questionnaires. The model integrated earlier attempts at quality screening regarding structures, processes and results, complementing these three elements with a fourth: the patients, whose characteristics influence the results of nursing care remarkably. Thus, the former one-dimensional, linear viewpoint was resolved into a dynamic representation of all four elements, illustrating a specific concept of nursing care. Through the multi-dimensionality of the model the complexity of the nursing process is better represented. The model's core consists of eight exemplary indicators of quality, each of which is relevant to nursing and for each of which criteria and assessment tools have been formulated. The model is seen as a basis and reference for the quality development and first opportunities for clinical application have been succesfully employed. The project can serve as a paradigm of networking amongst hospitals and cooperation between nursing scientists and experts, and of the critical significance of such collaboration to the advancement of nursing quality. PMID:18850535

  17. Shared Care: A Quality Improvement Initiative to Optimize Primary Care Management of Constipation

    PubMed Central

    Vernacchio, Louis; Trudell, Emily; Antonelli, Richard; Nurko, Samuel; Leichtner, Alan M.; Lightdale, Jenifer R.

    2015-01-01

    BACKGROUND: Pediatric constipation is commonly managed in the primary care setting, where there is much variability in management and specialty referral use. Shared Care is a collaborative quality improvement initiative between Boston Children’s Hospital and the Pediatric Physician’s Organization at Children’s (PPOC), through which subspecialists provide primary care providers with education, decision-support tools, pre-referral management recommendations, and access to advice. We investigated whether Shared Care reduces referrals and improves adherence to established clinical guidelines. METHODS: We reviewed the primary care management of patients 1 to 18 years old seen by a Boston Children’s Hospital gastroenterologist and diagnosed with constipation who were referred from PPOC practices in the 6 months before and after implementation of Shared Care. Charts were assessed for patient factors and key components of management. We also tracked referral rates for all PPOC patients for 29 months before implementation and 19 months after implementation. RESULTS: Fewer active patients in the sample were referred after implementation (61/27 365 [0.22%] vs 90/27 792 [0.36%], P = .003). The duration of pre-referral management increased, and the rate of fecal impaction decreased after implementation. No differences were observed in documentation of key management recommendations. Analysis of medical claims showed no statistically significant change in referrals. CONCLUSIONS: A multifaceted initiative to support primary care management of constipation can alter clinical care, but changes in referral behavior and pre-referral management may be difficult to detect and sustain. Future efforts may benefit from novel approaches to provider engagement and systems integration. PMID:25896837

  18. Collaborative Care Management Reduces Disparities in Dementia Care Quality for Caregivers with Less Education

    PubMed Central

    Brown, Arleen F.; Vassar, Stefanie D.; Connor, Karen I.; Vickrey, Barbara G.

    2013-01-01

    BACKGROUND Lower educational attainment among informal caregivers’ may be associated with poorer outcomes for patients with dementia. OBJECTIVE To examine educational gradients in dementia care and whether the effect of a dementia collaborative care management intervention varied by the educational attainment of the informal caregiver. DESIGN Analysis of data from a cluster-randomized controlled trial. SETTING Eighteen clinics across 3 healthcare organizations in Southern California. PARTICIPANTS Dyads of Medicare recipients, ages 65 years and older with a diagnosis of dementia, and an eligible caregiver. INTERVENTION Collaborative care management for dementia. MEASUREMENTS 1) Caregiver educational attainment, 2) adherence to four dimensions of guideline-recommended processes of dementia care: Assessment, Treatment, Education/Support, and Safety pre- and post-intervention, and 3) the adjusted intervention effect (IE) for each dimension stratified by caregiver education. Each IE was estimated by subtracting the difference between pre- and post-intervention scores for the usual care participants from the difference in the intervention participants. RESULTS At baseline, caregivers with lower educational attainment had lower guideline-recommended processes of dementia care for the Treatment and Education dimensions than those with more education. However, less educated caregivers had significantly more improvement after the intervention on the Assessment, Treatment, and Safety dimensions. The IEs for those who had not graduated from high school compared to college graduates were 44.4 vs. 29.5 for the Assessment dimension (P<0.001), 36.9 vs. 15.7 for the Treatment dimension (P<0.001), and 52.7 vs. 40.9 for the Safety Dimension (P<0.001). CONCLUSIONS Collaborative care management was associated with reductions in disparities in dementia care quality among caregivers with lower educational attainment relative to more educated caregivers. PMID:23320655

  19. Regulation, Subsidy Receipt and Provider Characteristics: What Predicts Quality in Child Care Homes?

    ERIC Educational Resources Information Center

    Raikes, H.A.; Raikes, H.H.; Wilcox, B.

    2005-01-01

    Far less is known about predictors of quality for family child care homes than for child care centers. The current study of 120 randomly-selected family child care providers in four Midwestern states examined distal, state policy-level variables (family child care regulations and the concentration of children cared for who received public child…

  20. Diversity in diabetes care programmes and views on high quality diabetes care: are we in need of a standardized framework?

    PubMed Central

    Borgermans, Liesbeth A.D.; Goderis, Geert; Ouwens, Marielle; Wens, Johan; Heyrman, Jan; Grol, Richard P.T. M.

    2008-01-01

    Objectives To explore views on high quality diabetes care based on an analysis of existing diversity in diabetes care programmes and related quality indicators. Methods A review of systematic reviews was performed. Four databases (MEDLINE database of the National Library of Medicine, COCHRANE database of Systematic Reviews, the Cumulative Index to Nursing and Allied Health Database-CINAHL and Pre-Cinahl) were searched for English review articles published between November 1989 and December 2006. Methodological quality of the articles was assessed. A standardized extraction form was used to assess features of diabetes care programmes and diabetes quality indicators with special reference to those aspects that hinder the conceptualization of high quality diabetes care. Based on these findings the relationship between diversity in diabetes care programmes and the conceptualization of high quality diabetes care was further explored. Results Twenty-one systematic reviews met the inclusion criteria representing a total of 185 diabetes care programmes. Six elements were identified to produce a picture of diversity in diabetes care programmes and hinder their standardization: 1) the variety and relative absence of conceptual backgrounds in diabetes care programmes, 2) confusion over what is considered a constituent of a diabetes care program and components of the implementation strategy, 3) large variety in type of diabetes care programmes, settings and related goals, 4) a large number and variety in interventions and quality indicators used, 5) no conclusive evidence on effectiveness, 6) no systematic results on costs. Conclusions There is large diversity in diabetes care programmes and related quality indicators. From this review and our analysis on the mutual relationship between diversity in diabetes care programmes and the conceptualization of high quality diabetes care, we conclude that no single conceptual framework used to date provides a comprehensive overview of attributes of high quality diabetes care linked to quality indicators at the structure, process and outcome level. There is a need for a concerted action to develop a standardized framework on high quality diabetes care that is complemented by a practical tool to provide guidance to the design, implementation and evaluation of diabetes care programmes. PMID:18493592

  1. Caregivers in older peoples' care: perception of quality of care, working conditions, competence and personal health.

    PubMed

    From, Ingrid; Nordström, Gun; Wilde-Larsson, Bodil; Johansson, Inger

    2013-09-01

    The aim was to describe and compare nursing assistants', enrolled nurses' and registered nurses' perceptions of quality of care, working conditions, competence and personal health in older peoples' care. Altogether 70 nursing assistants, 163 enrolled nurses and 198 registered nurses completed a questionnaire comprising Quality from the Patient's Perspective modified for caregivers, Creative Climate Questionnaire, Stress of Conscience Questionnaire, items on education and competence and Health Index. The caregivers reported higher perceived reality of quality of care in medical-technical competence and physical-technical conditions than in identity-oriented approach and socio-cultural atmosphere. In subjective importance, the highest rating was assessed in one of the physical-technical items. The organisational climate was for three of the dimensions rather close/reached the value for a creative climate, for seven dimensions close to a stagnant climate. In perceived stress of conscience, there were low values. Nursing assistants had lower values than enrolled nurses and registered nurses. The caregivers reported highest values regarding previous education making them feel safe at work and lowest value on the item about education increasing the ability for a scientific attitude. Registered nurses could use knowledge in practice and to a higher degree than nursing assistants/enrolled nurses reported a need to gain knowledge, but the latter more often received education during working hours. The health index among caregivers was high, but registered nurses scored lower on emotional well-being than nursing assistants/enrolled nurses. The caregivers' different perceptions of quality of care and work climate need further attention. Although stress of conscience was low, it is important to acknowledge what affected the caregivers work in a negative way. Attention should be paid to the greater need for competence development among registered nurses during working hours. PMID:23088213

  2. Understanding quality patient care and the role of the practicing nurse.

    PubMed

    Owens, Laura D; Koch, Robert W

    2015-03-01

    Nurses play a vital role in improving the safety and quality of patient care. The authors provide the front-line nurse providers with an overview of critical concepts related to quality management of patient care. A historical approach provides the reader with an overview of the trajectory or the quality in health care movement. Furthermore, the article provides the nurse with a basic understanding of national and international organizations that focus on quality patient care. A brief introduction of measures of quality care is presented as well as implications for nursing practice. PMID:25680485

  3. Indicators for Evaluating the Performance and Quality of Care of Ambulatory Care Nurses

    PubMed Central

    Rapin, Joachim; D'Amour, Danielle; Dubois, Carl-Ardy

    2015-01-01

    The quality and safety of nursing care vary from one service to another. We have only very limited information on the quality and safety of nursing care in outpatient settings, an expanding area of practice. Our aim in this study was to make available, from the scientific literature, indicators potentially sensitive to nursing that can be used to evaluate the performance of nursing care in outpatient settings and to integrate those indicators into the theoretical framework of Dubois et al. (2013). We conducted a scoping review in three databases (CINAHL, MEDLINE, and EMBASE) and the bibliographies of selected articles. From a total of 116 articles, we selected 22. The results of our study not only enable that framework to be extended to ambulatory nursing care but also enhance it with the addition of five new indicators. Our work offers nurses and managers in ambulatory nursing units indicators potentially sensitive to nursing that can be used to evaluate performance. For researchers, it presents the current state of knowledge on this construct and a framework with theoretical foundations for future research in ambulatory settings. This work opens an unexplored field for further research. PMID:26380108

  4. Quality of Care Attributions to Employed Versus Stay-at-Home Mothers

    ERIC Educational Resources Information Center

    Shpancer, Noam; Melick, Katherine M.; Sayre, Pamela S.; Spivey, Aria T.

    2006-01-01

    The present study was designed to find whether evaluations of maternal competence are linked to mothers' employment status and the quality of maternal care. Participants rated videotaped vignettes, depicting either high-quality or low-quality mother-infant interactions, on various dimensions of care quality. The videotaped mothers were described…

  5. Quality improvement in depression care in the Netherlands: the Depression Breakthrough Collaborative. A quality improvement report

    PubMed Central

    Franx, Gerdien; Meeuwissen, Jolanda A.C; Sinnema, Henny; Spijker, Jan; Huyser, Jochanan; Wensing, Michel; de Lange, Jacomine

    2009-01-01

    Background Improving the healthcare for patients with depression is a priority health policy across the world. Roughly, two major problems can be identified in daily practice: (1) the content of care is often not completely consistent with recommendations in guidelines and (2) the organization of care is not always integrated and delivered by multidisciplinary teams. Aim To describe the content and preliminary results of a quality improvement project in primary care, aiming at improving the uptake of clinical depression guidelines in daily practice as well as the collaboration between different mental health professionals. Method A Depression Breakthrough Collaborative was initiated from December 2006 until March 2008. The activities included the development and implementation of a stepped care depression model, a care pathway with two levels of treatment intensity: a first step treatment level for patients with non-severe depression (brief or mild depressive symptoms) and a second step level for patients with severe depression. Twelve months data were measured by the teams in terms of one outcome and several process indicators. Qualitative data were gathered by the national project team with a semi-structured questionnaire amongst the local team coordinators. Results Thirteen multidisciplinary teams participated in the project. In total 101 health professionals were involved, and 536 patients were diagnosed. Overall 356 patients (66%) were considered non-severely depressed and 180 (34%) patients showed severe symptoms. The mean percentage of non-severe patients treated according to the stepped care model was 78%, and 57% for the severely depressed patient group. The proportion of non-severely depressed patients receiving a first step treatment according to the stepped care model, improved during the project, this was not the case for the severely depressed patients. The teams were able to monitor depression symptoms to a reasonable extent during a period of 6 months. Within 3 months, 28% of monitored patients had recovered, meaning a Beck Depression Inventory (BDI) score of 10 and lower, and another 27% recovered between 3 and 6 months. Conclusions and discussion A stepped care approach seems acceptable and feasible in primary care, introducing different levels of care for different patient groups. Future implementation projects should pay special attention to the quality of care for severely depressed patients. Although the Depression Breakthrough Collaborative introduced new treatment concepts in primary and specialty care, the change capacity of the method remains unclear. Thorough data gathering is needed to judge the real value of these intensive improvement projects. PMID:19590610

  6. Cancer care quality measures: diagnosis and treatment of colorectal cancer.

    PubMed Central

    Patwardhan, Meenal B; Samsa, Gregory P; McCrory, Douglas C; Fisher, Deborah A; Mantyh, Christopher R; Morse, Michael A; Prosnitz, Robert G; Cline, Kathryn E; Gray, Rebecca N

    2006-01-01

    OBJECTIVES To identify measures that are currently available to assess the quality of care provided to patients with colorectal cancer (CRC), and to assess the extent to which these measures have been developed and tested. DATA SOURCES Published and unpublished measures identified through a computerized search of English-language citations in MEDLINE (1966-January 2005), the Cochrane Database of Systematic Reviews, and the National Guideline Clearinghouse; through review of reference lists contained in seed articles, all included articles, and relevant review articles; and through searches of the grey literature (institutional or government reports, professional society documents, research papers, and other literature, in print or electronic format, not controlled by commercial publishing interests). Sources for grey literature included professional organization websites and the Internet. REVIEW METHODS Measures were selected by reviewers according to standardized criteria relating to each question, and were then rated according to their importance and usability, scientific acceptability, and extent of testing; each domain was rated from 1 (poor) to 5 (ideal). RESULTS We identified a number of well-developed and well-tested CRC-related quality-of-care measures, both general process-of-care measures (on a broader scale) and technical measures (pertaining to specific details of a procedure). At least some process measures are available for diagnostic imaging, staging, surgical therapy, adjuvant chemotherapy, adjuvant radiation therapy, and colonoscopic surveillance. Various technical measures were identified for quality of colonoscopy (e.g., cecal intubation rate, complications) and staging (adequate lymph node retrieval and evaluation). These technical measures were guideline-based and well developed, but less well tested, and the linkage between them and patient outcomes, although intuitive, was not always explicitly provided. For some elements of the care pathway, such as operative reports and chemotherapy reports, no technical measures were found. CONCLUSIONS Some general process measures have a stronger evidence base than others. Those based on guidelines have the strongest evidence base; those derived from basic first principles supported by some research findings are relatively weaker, but are often sufficient for the task at hand. A consistent source of tension is the distinction between the clinically derived fine-tuning of the definition of a quality measure and the limitations of available data sources (which often do not contain sufficient information to act on such distinctions). Although some excellent technical measures were found, the overall development of technical measures seems less advanced than that of the general process measures. PMID:17764215

  7. Patient-Reported Quality of Supportive Care Among Patients With Colorectal Cancer in the Veterans Affairs Health Care System

    PubMed Central

    van Ryn, Michelle; Phelan, Sean M.; Arora, Neeraj K.; Haggstrom, David A.; Jackson, George L.; Zafar, S. Yousuf; Griffin, Joan M.; Zullig, Leah L.; Provenzale, Dawn; Yeazel, Mark W.; Jindal, Rahul M.; Clauser, Steven B.

    2014-01-01

    Purpose High-quality supportive care is an essential component of comprehensive cancer care. We implemented a patient-centered quality of cancer care survey to examine and identify predictors of quality of supportive care for bowel problems, pain, fatigue, depression, and other symptoms among 1,109 patients with colorectal cancer. Patients and Methods Patients with new diagnosis of colorectal cancer at any Veterans Health Administration medical center nationwide in 2008 were ascertained through the Veterans Affairs Central Cancer Registry and sent questionnaires assessing a variety of aspects of patient-centered cancer care. We received questionnaires from 63% of eligible patients (N = 1,109). Descriptive analyses characterizing patient experiences with supportive care and binary logistic regression models were used to examine predictors of receipt of help wanted for each of the five symptom categories. Results There were significant gaps in patient-centered quality of supportive care, beginning with symptom assessment. In multivariable modeling, the impact of clinical factors and patient race on odds of receiving wanted help varied by symptom. Coordination of care quality predicted receipt of wanted help for all symptoms, independent of patient demographic or clinical characteristics. Conclusion This study revealed substantial gaps in patient-centered quality of care, difficult to characterize through quality measurement relying on medical record review alone. It established the feasibility of collecting patient-reported quality measures. Improving quality measurement of supportive care and implementing patient-reported outcomes in quality-measurement systems are high priorities for improving the processes and outcomes of care for patients with cancer. PMID:24493712

  8. Quality of health care in the United States: implications for pediatric inflammatory bowel disease.

    PubMed

    Boyle, Brendan M; Palmer, Lena; Kappelman, Michael D

    2009-09-01

    The Institute of Medicine's publications To Error is Human and Crossing the Quality Chasm publicized the widespread deficits in US health care quality. Emerging studies continue to reveal deficits in the quality of adult and pediatric care, including subspecialty care. In recent years, key stakeholders in the health care system including providers, purchasers, and the public have been applying various quality improvement methods to address these concerns. Lessons learned from these efforts in other pediatric conditions, including asthma, cystic fibrosis, neonatal intensive care, and liver transplantation may be applicable to the care of children with inflammatory bowel disease (IBD).This review is intended to be a primer on the quality of care movement in the United States, with a focus on pediatric IBD. In this article, we review the history, rationale, and methods of quality measurement and improvement, and we discuss the unique challenges in adapting these general strategies to pediatric IBD care. PMID:19633570

  9. Pediatric recertification and quality of care: the role of the American Board of Pediatrics in improving children's health care.

    PubMed

    Miles, Paul V

    2007-11-01

    American health care is in the middle of a second revolution in quality as profound as the Flexner revolution occurring almost 100 years ago. Although systems issues are the basis for most of the concern, physician quality and professional development are also pertinent. Specialty board certification and maintenance of certification are key drivers of professional development and improvement of care. PMID:17950317

  10. Medicare: Reviews of Quality of Care at Participating Hospitals. Report to the Administrator, Health Care Financing Administration.

    ERIC Educational Resources Information Center

    General Accounting Office, Washington, DC. Div. of Human Resources.

    This report concerns the Health Care Financing Administration's (HCFA) contracting with Utilization and Quality Control Peer Review Organizations (PROs) as a means of monitoring the medical necessity and quality of in-hospital care provided to Medicare beneficiaries. Findings from a HCFA survey of PROs in California, Florida, and Georgia are used…

  11. Effect of an Innovative Medicare Managed Care Program on the Quality of Care for Nursing Home Residents

    ERIC Educational Resources Information Center

    Kane, Robert L.; Flood, Shannon; Bershadsky, Boris; Keckhafer, Gail

    2004-01-01

    Purpose: We sought to assess the quality of care provided by an innovative Medicare+Choice HMO targeted specifically at nursing home residents and employing nurse practitioners to provide additional primary care over and above that provided by physicians. The underlying premise of the Evercare approach is that the additional primary care will

  12. A Profile Approach to Child Care Quality, Quantity, and Type of Setting: Parent Selection of Infant Child Care Arrangements

    ERIC Educational Resources Information Center

    Sosinsky, Laura Stout; Kim, Se-Kang

    2013-01-01

    Building on prior variable-oriented research which demonstrates the independence of the associations of child care quality, quantity, and type of setting with family factors and child outcomes, the current study identifies four profiles of child care dimensions from the NICHD Study of Early Child Care and Youth Development. Profiles accounted for…

  13. A Profile Approach to Child Care Quality, Quantity, and Type of Setting: Parent Selection of Infant Child Care Arrangements

    ERIC Educational Resources Information Center

    Sosinsky, Laura Stout; Kim, Se-Kang

    2013-01-01

    Building on prior variable-oriented research which demonstrates the independence of the associations of child care quality, quantity, and type of setting with family factors and child outcomes, the current study identifies four profiles of child care dimensions from the NICHD Study of Early Child Care and Youth Development. Profiles accounted for

  14. Quality measures for the care of patients with lateral epicondylalgia

    PubMed Central

    2013-01-01

    Background Lateral epicondylalgia (LE) defines a condition of varying degrees of pain near the lateral epicondyle. Studies on the management of LE indicated unexplained variations in the use of pharmacologic, non-pharmacological and surgical treatments. The main aim of this paper was to develop and evaluate clinical quality measures (QMs) or quality indicators, which may be used to assess the quality of the processes of examination, education and treatment of patients with LE. Methods Different QMs were developed by a multidisciplinary group of experts in Quality Management of Health Services during a period of one year. The process was based following a 3-step model: i) review and proportion of existing evidence-based recommendations; ii) review and development of quality measures; iii) pilot testing of feasibility and reliability of the indicators leading to a final consensus by the whole panel. Results Overall, a set of 12 potential indicators related to medical and physical therapy assessment and treatment were developed to measure the performance of LE care. Different systematic reviews and randomized control trials supported each of the indicators judged to be valid during the expert panel process. Application of the new indicator set was found to be feasible; only the measurement of two quality measures had light barriers. Reliability was mostly excellent (Kappa > 0.8). Conclusions A set of good practice indicators has been built and pilot tested as feasible and reliable. The chosen 3-step standardized evidence-based process ensures maximum clarity, acceptance and sustainability of the developed indicators. PMID:24172311

  15. [The price of quality: health care expenditures and quality of life].

    PubMed

    Vleugels, A M

    1995-01-01

    In an era where the substitution of health policy by budgetary arguments is imminent, this paper aims to offer some elements in the discussion on the relationship between health care expenditures and their effect on quality of life for individuals and society. Historical developments, present differences in medical consumption and in outcome, the growing interest in alternative medicine, the use of new medical technologies and observations on the expenditures for pharmaceuticals show that this relationship is not self-evident and that generalizations must be avoided. The observations lead to an argument of more efficiency in the use of health care resources. PMID:8571665

  16. Quality of care and health-related quality of life of climacteric stage women cared for in family medicine clinics in Mexico

    PubMed Central

    2010-01-01

    Objectives 1) To design and validate indicators to measure the quality of the process of care that climacteric stage women receive in family medicine clinics (FMC). 2) To assess the quality of care that climacteric stage women receive in FMC. 3) To determine the association between quality of care and health-related quality of life (HR-QoL) among climacteric stage women. Methods The study had two phases: I. Design and validation of indicators to measure the quality of care process by using the RAND/UCLA Appropriateness Method. II. Evaluation of the quality of care and its association with HR-QoL through a cross-sectional study conducted in two FMC located in Mexico City that included 410 climacteric stage women. The quality of care was measured by estimating the percentage of recommended care received (PRCR) by climacteric stage women in three process components: health promotion, screening, and treatment. The HR-QoL was measured using the Cervantes scale (0-155). The association between quality of care and HR-QoL was estimated through multiple linear regression analysis. Results The lowest mean of PRCR was for the health promotion component (24.1%) and the highest for the treatment component (86.6%). The mean of HR-QoL was 50.1 points. The regression analysis showed that in the treatment component, for every 10 additional points of the PRCR, the global HR-QoL improved 2.8 points on the Cervantes scale (coefficient -0.28, P < 0.0001). Conclusion The indicators to measure quality of care for climacteric stage women are applicable and feasible in family medicine settings. There is a positive association between the quality of the treatment component and HR-QoL; this would encourage interventions to improve quality of care for climacteric stage women. PMID:20144238

  17. Health Care Spending and Quality in Year 1 of the Alternative Quality Contract

    PubMed Central

    Song, Zirui; Safran, Dana Gelb; Landon, Bruce E.; He, Yulei; Ellis, Randall P.; Mechanic, Robert E.; Day, Matthew P.; Chernew, Michael E.

    2012-01-01

    Background In 2009, Blue Cross Blue Shield of Massachusetts (BCBS) implemented a global payment system called the Alternative Quality Contract (AQC). Provider groups in the AQC system assume accountability for spending, similar to accountable care organizations that bear financial risk. Moreover, groups are eligible to receive bonuses for quality. Methods Seven provider organizations began 5-year contracts as part of the AQC system in 2009. We analyzed 20062009 claims for 380,142 enrollees whose primary care physicians (PCPs) were in the AQC system (intervention group) and for 1,351,446 enrollees whose PCPs were not in the system (control group). We used a propensity-weighted difference-in-differences approach, adjusting for age, sex, health status, and secular trends to isolate the treatment effect of the AQC in comparisons of spending and quality between the intervention group and the control group. Results Average spending increased for enrollees in both the intervention and control groups in 2009, but the increase was smaller for enrollees in the intervention group $15.51 (1.9%) less per quarter (P = 0.007). Savings derived largely from shifts in outpatient care toward facilities with lower fees; from lower expenditures for procedures, imaging, and testing; and from a reduction in spending for enrollees with the highest expected spending. The AQC system was associated with an improvement in performance on measures of the quality of the management of chronic conditions in adults (P<0.001) and of pediatric care (P = 0.001), but not of adult preventive care. All AQC groups met 2009 budget targets and earned surpluses. Total BCBS payments to AQC groups, including bonuses for quality, are likely to have exceeded the estimated savings in year 1. Conclusions The AQC system was associated with a modest slowing of spending growth and improved quality of care in 2009. Savings were achieved through changes in referral patterns rather than through changes in utilization. The long-term effect of the AQC system on spending growth depends on future budget targets and providers ability to further improve efficiencies in practice. (Funded by the Commonwealth Fund and others.) PMID:21751900

  18. Quality of advance care planning policy and practice in residential aged care facilities in Australia

    PubMed Central

    Silvester, William; Fullam, Rachael S; Parslow, Ruth A; Lewis, Virginia J; Sjanta, Rebekah; Jackson, Lynne; White, Vanessa; Gilchrist, Jane

    2013-01-01

    Objectives To assess existing advance care planning (ACP) practices in residential aged care facilities (RACFs) in Victoria, Australia before a systematic intervention; to assess RACF staff experience, understanding of and attitudes towards ACP. Design Surveys of participating organisations concerning ACP-related policies and procedures, review of existing ACP-related documentation, and pre-intervention survey of RACF staff covering their role, experiences and attitudes towards ACP-related procedures. Setting 19 selected RACFs in Victoria. Participants 12 aged care organisations (representing 19 RACFs) who provided existing ACP-related documentation for review, 12 RACFs who completed an organisational survey and 45 staff (from 19 RACFs) who completed a pre-intervention survey of knowledge, attitudes and behaviour. Results Findings suggested that some ACP-related practices were already occurring in RACFs; however, these activities were inconsistent and variable in quality. Six of the 12 responding RACFs had written policies and procedures for ACP; however, none of the ACP-related documents submitted covered all information required to meet ACP best practice. Surveyed staff had limited experience of ACP, and discrepancies between self reported comfort, and levels of knowledge and confidence to undertake ACP-related activities, indicated a need for training and ongoing organisational support. Conclusions Surveyed organisations â policies and procedures related to ACP were limited and the quality of existing documentation was poor. RACF staff had relatively limited experience in developing advance care plans with facility residents, although attitudes were positive. A systematic approach to the implementation of ACP in residential aged care settings is required to ensure best practice is implemented and sustained. PMID:24644755

  19. Appreciative Inquiry for Quality Improvement in Primary Care Practices

    PubMed Central

    Ruhe, Mary C.; Bobiak, Sarah N.; Litaker, David; Carter, Caroline A.; Wu, Laura; Schroeder, Casey; Zyzanski, Stephen; Weyer, Sharon M.; Werner, James J.; Fry, Ronald E.; Stange, Kurt C.

    2014-01-01

    Purpose To test the effect of an Appreciative Inquiry (AI) quality improvement strategy, on clinical quality management and practice development outcomes. AI enables discovery of shared motivations, envisioning a transformed future, and learning around implementation of a change process. Methods Thirty diverse primary care practices were randomly assigned to receive an AI-based intervention focused on a practice-chosen topic and on improving preventive service delivery (PSD) rates. Medical record review assessed change in PSD rates. Ethnographic fieldnotes and observational checklist analysis used editing and immersion/crystallization methods to identify factors affecting intervention implementation and practice development outcomes. Results PSD rates did not change. Field note analysis suggested that the intervention elicited core motivations, facilitated development of a shared vision, defined change objectives and fostered respectful interactions. Practices most likely to implement the intervention or develop new practice capacities exhibited one or more of the following: support from key leader(s), a sense of urgency for change, a mission focused on serving patients, health care system and practice flexibility, and a history of constructive practice change. Conclusions An AI approach and enabling practice conditions can lead to intervention implementation and practice development by connecting individual and practice strengths and motivations to the change objective. PMID:21192206

  20. Issues of therapeutic communication relevant for improving quality of care

    PubMed Central

    Popa-Velea, O; Purcărea, VL

    2014-01-01

    Communication issues are extensively considered a topic of high interest for improving the efficacy of the therapeutic act. This article aimed to overview several issues of therapeutic communication relevant for improving quality of care. A number of 15 bibliographic resources on these topics published in peer-reviewed journals between 1975 and 2010, and indexed in PubMed, ProQuest and EBSCO databases were examined, to seek for evidence regarding these data. Results highlight a number of communication problems commonly reported in the literature, such as the lack of physician communicational skills or their deterioration, the persistence of an asymmetric therapeutic communicational model, communication obstacles brought by the disease itself or by several variables pertaining to the patient, including specific demographic and psychological contexts. Equally, literature reports ways of improving therapeutic communication, such as optimizing the clinical interview, better time management techniques or assertiveness. Integration of communication training in the bio-psycho-social model of care and monitoring parameters like adherence and quality of life as tools reflecting also a good therapeutic communication can be valuable future approaches of obtaining better results in this area.

  1. The ethics of using quality improvement methods in health care.

    PubMed

    Lynn, Joanne; Baily, Mary Ann; Bottrell, Melissa; Jennings, Bruce; Levine, Robert J; Davidoff, Frank; Casarett, David; Corrigan, Janet; Fox, Ellen; Wynia, Matthew K; Agich, George J; O'Kane, Margaret; Speroff, Theodore; Schyve, Paul; Batalden, Paul; Tunis, Sean; Berlinger, Nancy; Cronenwett, Linda; Fitzmaurice, J Michael; Dubler, Nancy Neveloff; James, Brent

    2007-05-01

    Quality improvement (QI) activities can improve health care but must be conducted ethically. The Hastings Center convened leaders and scholars to address ethical requirements for QI and their relationship to regulations protecting human subjects of research. The group defined QI as systematic, data-guided activities designed to bring about immediate improvements in health care delivery in particular settings and concluded that QI is an intrinsic part of normal health care operations. Both clinicians and patients have an ethical responsibility to participate in QI, provided that it complies with specified ethical requirements. Most QI activities are not human subjects research and should not undergo review by an institutional review board; rather, appropriately calibrated supervision of QI activities should be part of professional supervision of clinical practice. The group formulated a framework that would use key characteristics of a project and its context to categorize it as QI, human subjects research, or both, with the potential of a customized institutional review board process for the overlap category. The group recommended a period of innovation and evaluation to refine the framework for ethical conduct of QI and to integrate that framework into clinical practice. PMID:17438310

  2. Quality in Family Child Care Settings: The Relationship between Provider Educational Experiences and Global Quality Scores in a Statewide Quality Rating and Improvement System

    ERIC Educational Resources Information Center

    Hallam, Rena A.; Bargreen, Kaitlin N.; Ridgley, Robyn

    2013-01-01

    This study is a secondary analysis of a statewide sample of licensed family child care providers in the Tennessee Child Care Evaluation and Report Card Program ("N"?=?1,145) that describes the general quality of family child care programs in the state and examines the relationships between provider education and global quality. Study

  3. Quality in Family Child Care Settings: The Relationship between Provider Educational Experiences and Global Quality Scores in a Statewide Quality Rating and Improvement System

    ERIC Educational Resources Information Center

    Hallam, Rena A.; Bargreen, Kaitlin N.; Ridgley, Robyn

    2013-01-01

    This study is a secondary analysis of a statewide sample of licensed family child care providers in the Tennessee Child Care Evaluation and Report Card Program ("N"?=?1,145) that describes the general quality of family child care programs in the state and examines the relationships between provider education and global quality. Study…

  4. Making the case to improve quality and reduce costs in pediatric health care.

    PubMed

    Sachdeva, Ramesh C; Jain, Shabnam

    2009-08-01

    This article makes a case for the urgent need to improve health care quality and reduce costs. It provides an overview of the importance of the quality movement and the definition of quality, including the concept of clinical and operational quality. Some national drivers for quality improvement as well as drivers of escalating health care costs are discussed, along with the urgency of reducing health care costs. The link between quality and cost is reviewed using the concept of value in health care, which combines quality and cost in the same equation. The article ends with a discussion of future directions of the quality movement, including emerging concepts, such as risk-adjustment, shared responsibility for quality, measuring quality at the individual provider level, and evolving legal implications of the quality movement, as well as the concept of a shared savings model. PMID:19660624

  5. Nutritional Quality of Meals Compared to Snacks in Child Care

    PubMed Central

    Benjamin Neelon, Sara E.; Howald, Angela E.; Wosje, Karen S.

    2013-01-01

    Abstract Background Most young children are in child care. Previous studies suggest that children may receive insufficient vegetables, and foods and beverages with added sugars, fats, and sodium in these settings. None have compared the nutritional quality of meals to snacks. Methods Directors from 258 full-day child-care centers in two urban counties of southwestern Ohio were surveyed via telephone in the fall of 2009 about their nutrition practices, and asked to provide a current menu. Lunch and afternoon snack menus were categorized according to average weekly frequency for fruits, vegetables, lean meats, juice (100%), and sweet or salty foods served. Frequencies were compared by meal occasion (lunch vs. snack) using the Fisher exact test. Results Most (60%) directors reported serving 2% milk to children ≥3 years; 31% served whole milk. Menu analysis demonstrated the composition of lunches differed from snacks (p<0.0001) in all food categories. A total of 87% centers rarely (<1 time per week) listed nonstarchy vegetables for snacks, but 67% of centers included them at lunch ≥3 times per week. Juice (100%) was on snack menus >2 times per week in 37% centers, but in only 1 center as a regular component of lunch. Similarly, 87% centers listed sweet and salty foods at snack ≥3 times per week, but rarely at lunch. Conclusions Despite efforts to improve children's diets in child care, meals—and particularly snacks—still lack whole fruits and nonstarchy vegetables and contain added sugars and fats. Snacks represent a missed opportunity to improve the nutritional quality of foods served in childcare. PMID:23635311

  6. A Multicenter Study of Physician Mindfulness and Health Care Quality

    PubMed Central

    Beach, Mary Catherine; Roter, Debra; Korthuis, P. Todd; Epstein, Ronald M.; Sharp, Victoria; Ratanawongsa, Neda; Cohn, Jonathon; Eggly, Susan; Sankar, Andrea; Moore, Richard D.; Saha, Somnath

    2013-01-01

    PURPOSE Mindfulness (ie, purposeful and nonjudgmental attentiveness to one’s own experience, thoughts, and feelings) is associated with physician well-being. We sought to assess whether clinician self-rated mindfulness is associated with the quality of patient care. METHODS We conducted an observational study of 45 clinicians (34 physicians, 8 nurse practitioners, and 3 physician assistants) caring for patients infected with the human immunodeficiency virus (HIV) who completed the Mindful Attention Awareness Scale and 437 HIV-infected patients at 4 HIV specialty clinic sites across the United States. We measured patient-clinician communication quality with audio-recorded encounters coded using the Roter Interaction Analysis System (RIAS) and patient ratings of care. RESULTS In adjusted analyses comparing clinicians with highest and lowest tertile mindfulness scores, patient visits with high-mindfulness clinicians were more likely to be characterized by a patient-centered pattern of communication (adjusted odds ratio of a patient-centered visit was 4.14; 95% CI, 1.58–10.86), in which both patients and clinicians engaged in more rapport building and discussion of psychosocial issues. Clinicians with high-mindfulness scores also displayed more positive emotional tone with patients (adjusted β = 1.17; 95% CI, 0.46–1.9). Patients were more likely to give high ratings on clinician communication (adjusted prevalence ratio [APR] = 1.48; 95% CI, 1.17–1.86) and to report high overall satisfaction (APR = 1.45; 95 CI, 1.15–1.84) with high-mindfulness clinicians. There was no association between clinician mindfulness and the amount of conversation about biomedical issues. CONCLUSIONS Clinicians rating themselves as more mindful engage in more patient-centered communication and have more satisfied patients. Interventions should determine whether improving clinician mindfulness can also improve patient health outcomes. PMID:24019273

  7. Assessment of the Quality of Delivered Care for Iranian patients with Rheumatoid Arthritis by Using Comprehensive Quality Measurement Model in Health Care (CQMH)

    PubMed Central

    Karimi, Saeed; Safiri, Saeid; Bayat, Mahboubeh; Mottaghi, Payman; Shokri, Azad; Moosazadeh, Mahmood; Fattahi, Hamed

    2015-01-01

    Introduction: Quality of care has become increasingly critical in the evaluation of healthcare and healthcare services. The aim of this study was to assess quality of delivered care among patients with rheumatoid arthritis using a model of Comprehensive Quality Measurement in Health Care (CQMH). Methods: This cross-sectional study was conducted on 172 patients with rheumatoid arthritis (RA) who were received care from private clinics of Isfahan University of medical sciences in 2013. CQMH questionnaires were used for assessing the quality of care. Data were analyzed using SPSS for Windows. Results: The mean scores of Quality Index, Service Quality (SQ), Technical Quality (TQ), and Costumer Quality (CQ) were 72.70, 79.09, 68.54 and 70.25 out of 100, respectively. For CQ only 19.8% of participations staying the course of action even under stress and financial constraints, there is a significant gap between what RA care they received with what was recommended in the guideline for TQ. Scores of service quality was low in majority of aspects especially in "availability of support group" section. Conclusion: Study shows paradoxical findings and expresses that quality scores of service delivery for patients with arthritis rheumatoid from patient's perspective is relatively low. Therefore, for fixing this paradoxical problem, improving the participation of patients and their family and empowering them for self-management and decision should be regarded by health systems. PMID:26744728

  8. The quality performance matrix: New York State's model for targeting quality improvement in managed care plans.

    PubMed

    Roohan, Patrick J; Gesten, Foster; Pasley, Beverly; Schettine, Anne M

    2002-01-01

    This article describes a methodology developed by the New York State Department of Health to analyze health plan performance data using two benchmarks: comparison to peers and comparison to historic results. It explains how that analysis is used to target quality improvement. Through this process the department effectively partners with health plans to foster improvement by identifying problems and barriers, encouraging health plans to set performance goals, and then working with health plans to design action plans to address the barriers. This model can be replicated for use by other states or other entities charged with monitoring quality improvement in managed care. PMID:11799829

  9. Quality of Life in Cancer Patients Receiving Palliative Care

    PubMed Central

    Singh, Divya Pal

    2010-01-01

    Background: The main focus of palliative care services is to improve the patient’s quality of life (QOL), which is defined as the subjective evaluation of life as a whole or the patient’s appraisal and satisfaction with their current level of functioning compared with what they perceive to be possible or ideal. Aims: In this prospective study we attempt to validate the Hindi version of a questionnaire designed by the functional assessment of chronic illness therapy (FACIT) measurement system; to measure the subjective QOL of cancer patients receiving home-based palliative care, determine ease of use of the questionnaire and correlate the QOL of these patients with the objective assessment of their Karnofsky’s performance status and their numerical pain score. Settings and Design: One hundred cancer patients receiving free home-based palliative care in New Delhi, India. Materials and Methods: A multidisciplinary palliative home care team using the Functional Assessment of Cancer Therapy-General (FACT-G©) questionnaire in Hindi. Statistical Analysis Used: Microsoft Excel Correlation. Results: The FACT-G© questionnaire in Hindi is a useful tool in measuring QOL and can be used to monitor the patient’s progress and symptom control during the course of the disease. It is simple to use and does not take too much time to complete. The results are tabulated in English and can be used for comparison purposes globally; the scoring process is very simple. Conclusions: Increasing QOL and KPS showed a positive correlation whereas increasing pain and better QOL show negative correlation, as do better performance status and increasing pain score. PMID:20859470

  10. Quality and Safety in Health Care, Part I: Five Pioneers in Quality.

    PubMed

    Harolds, Jay

    2015-08-01

    Five pioneers had a huge impact on the quality movement in health care in the United States. Ernest Codman contributed in many ways, including his focus on outcome analysis. Avidis Donabedian is known for his focus on the 3 domains of structure, process, and outcome in health care. Walter Shewhart is known especially for the control chart and early work on what W. Edwards Deming made into the PDSA cycle. Deming is also known for other contributions, including his 14 points of management, correcting system problems rather than blaming the workers, and his System of Profound Knowledge. Juran is known for the Pareto principle and his emphasis on customer satisfaction and addressing the human, not just statistical side, of quality improvement. PMID:26147460

  11. Burnout and Self-Reported Quality of Care in Community Mental Health

    PubMed Central

    Salyers, Michelle P.; Fukui, Sadaaki; Rollins, Angela L.; Firmin, Ruth; Gearhart, Timothy; Noll, James P.; Williams, Stacy; Davis, C.J.

    2014-01-01

    Staff burnout is widely believed to be problematic in mental healthcare, but few studies have linked burnout directly with quality of care. The purpose of this study was to examine the relationship between burnout and a newly developed scale for quality of care in a sample of community mental health workers (N=113). The Self-Reported Quality of Care scale had three distinct factors (Client-Centered Care, General Work Conscientiousness, and Low Errors), with good internal consistency. Burnout, particularly personal accomplishment, and to a lesser extent depersonalization, were predictive of overall self-reported Quality of Care, over and above background variables. PMID:24659446

  12. Improving the Quality of Nursing Home Care and Medical-Record Accuracy with Direct Observational Technologies

    ERIC Educational Resources Information Center

    Schnelle, John F.; Osterweil, Dan; Simmons, Sandra F.

    2005-01-01

    Nursing home medical-record documentation of daily-care occurrence may be inaccurate, and information is not documented about important quality-of-life domains. The inadequacy of medical record data creates a barrier to improving care quality, because it supports an illusion of care consistent with regulations, which reduces the motivation and

  13. 77 FR 70786 - Request for Information Regarding Health Care Quality for Exchanges

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-11-27

    ... HUMAN SERVICES Centers for Medicare & Medicaid Services Request for Information Regarding Health Care... Improvement in Health Care (National Quality Strategy) to create national aims and priorities that would guide local, state, and national efforts to improve the quality of health care in the United States....

  14. Improving the Quality of Nursing Home Care and Medical-Record Accuracy with Direct Observational Technologies

    ERIC Educational Resources Information Center

    Schnelle, John F.; Osterweil, Dan; Simmons, Sandra F.

    2005-01-01

    Nursing home medical-record documentation of daily-care occurrence may be inaccurate, and information is not documented about important quality-of-life domains. The inadequacy of medical record data creates a barrier to improving care quality, because it supports an illusion of care consistent with regulations, which reduces the motivation and…

  15. Enhancing Early Child Care Quality and Learning for Toddlers at Risk: The Responsive Early Childhood Program

    ERIC Educational Resources Information Center

    Landry, Susan H.; Zucker, Tricia A.; Taylor, Heather B.; Swank, Paul R.; Williams, Jeffrey M.; Assel, Michael; Crawford, April; Huang, Weihua; Clancy-Menchetti, Jeanine; Lonigan, Christopher J.; Phillips, Beth M.; Eisenberg, Nancy; Spinrad, Tracy L.; de Viliers, Jill; de Viliers, Peter; Barnes, Marcia; Starkey, Prentice; Klein, Alice

    2014-01-01

    Despite reports of positive effects of high-quality child care, few experimental studies have examined the process of improving low-quality center-based care for toddler-age children. In this article, we report intervention effects on child care teachers' behaviors and children's social, social-emotional classroom activities (RECC).…

  16. 45 CFR 98.51 - Activities to improve the quality of child care.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... CHILD CARE AND DEVELOPMENT FUND Use of Child Care and Development Funds § 98.51 Activities to improve the quality of child care. (a) No less than four percent of the aggregate funds expended by the Lead... 45 Public Welfare 1 2014-10-01 2014-10-01 false Activities to improve the quality of child...

  17. 45 CFR 98.51 - Activities to improve the quality of child care.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... CHILD CARE AND DEVELOPMENT FUND Use of Child Care and Development Funds § 98.51 Activities to improve the quality of child care. (a) No less than four percent of the aggregate funds expended by the Lead... 45 Public Welfare 1 2012-10-01 2012-10-01 false Activities to improve the quality of child...

  18. 45 CFR 98.51 - Activities to improve the quality of child care.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... CHILD CARE AND DEVELOPMENT FUND Use of Child Care and Development Funds § 98.51 Activities to improve the quality of child care. (a) No less than four percent of the aggregate funds expended by the Lead... 45 Public Welfare 1 2013-10-01 2013-10-01 false Activities to improve the quality of child...

  19. 45 CFR 98.51 - Activities to improve the quality of child care.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... CHILD CARE AND DEVELOPMENT FUND Use of Child Care and Development Funds § 98.51 Activities to improve the quality of child care. (a) No less than four percent of the aggregate funds expended by the Lead... 45 Public Welfare 1 2010-10-01 2010-10-01 false Activities to improve the quality of child...

  20. 45 CFR 98.51 - Activities to improve the quality of child care.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... CHILD CARE AND DEVELOPMENT FUND Use of Child Care and Development Funds § 98.51 Activities to improve the quality of child care. (a) No less than four percent of the aggregate funds expended by the Lead... 45 Public Welfare 1 2011-10-01 2011-10-01 false Activities to improve the quality of child...

  1. Enhancing Early Child Care Quality and Learning for Toddlers at Risk: The Responsive Early Childhood Program

    ERIC Educational Resources Information Center

    Landry, Susan H.; Zucker, Tricia A.; Taylor, Heather B.; Swank, Paul R.; Williams, Jeffrey M.; Assel, Michael; Crawford, April; Huang, Weihua; Clancy-Menchetti, Jeanine; Lonigan, Christopher J.; Phillips, Beth M.; Eisenberg, Nancy; Spinrad, Tracy L.; de Viliers, Jill; de Viliers, Peter; Barnes, Marcia; Starkey, Prentice; Klein, Alice

    2014-01-01

    Despite reports of positive effects of high-quality child care, few experimental studies have examined the process of improving low-quality center-based care for toddler-age children. In this article, we report intervention effects on child care teachers' behaviors and children's social, social-emotional classroom activities (RECC).

  2. Perceptions of Local Health Care Quality in 7 Rural Communities with Telemedicine

    ERIC Educational Resources Information Center

    Nesbitt, Thomas S.; Marcin, James P.; Daschbach, Martha M.; Cole, Stacey L.

    2005-01-01

    Rural health services are difficult to maintain because of low patient volumes, limited numbers of providers, and unfavorable economies of scale. Rural patients may perceive poor quality in local health care, directly impacting the sustainability of local health care services. This study examines perceptions of local health care quality in 7…

  3. Money Matters for Early Education: The Relationships among Child Care Quality, Teacher Characteristics, and Subsidy Status

    ERIC Educational Resources Information Center

    St.Clair-Christman, JeanMarie; Buell, Martha; Gamel-McCormick, Michael

    2011-01-01

    Child care is the first out-of-home learning opportunity for many children. For low-income children, a high-quality child care placement can provide many of the experiences and skills that help build a foundation for later school success. Among the many measures of child care quality, some closely linked to later success in school are those…

  4. 42 CFR 480.141 - Disclosure of QIO interpretations on the quality of health care.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... health care. 480.141 Section 480.141 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT... interpretations on the quality of health care. Subject to the procedures for disclosure and notice of disclosure... generalizations on the quality of health care that identify a particular institution....

  5. 42 CFR 480.141 - Disclosure of QIO interpretations on the quality of health care.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... health care. 480.141 Section 480.141 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT... interpretations on the quality of health care. Subject to the procedures for disclosure and notice of disclosure... generalizations on the quality of health care that identify a particular institution....

  6. 42 CFR 480.141 - Disclosure of QIO interpretations on the quality of health care.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... health care. 480.141 Section 480.141 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT... interpretations on the quality of health care. Subject to the procedures for disclosure and notice of disclosure... generalizations on the quality of health care that identify a particular institution....

  7. 42 CFR 480.141 - Disclosure of QIO interpretations on the quality of health care.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... health care. 480.141 Section 480.141 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT... QIO interpretations on the quality of health care. Subject to the procedures for disclosure and notice... interpretations and generalizations on the quality of health care that identify a particular institution....

  8. Music therapy in pediatric palliative care: family-centered care to enhance quality of life.

    PubMed

    Lindenfelser, Kathryn J; Hense, Cherry; McFerran, Katrina

    2012-05-01

    Research into the value of music therapy in pediatric palliative care (PPC) has identified quality of life as one area of improvement for families caring for a child in the terminal stages of a life-threatening illness. This small-scale investigation collected data in a multisite, international study including Minnesota, USA, and Melbourne, Australia. An exploratory mixed method design used the qualitative data collected through interviews with parents to interpret results from the PedsQL Family Impact Module of overall parental quality of life. Parents described music therapy as resulting in physical improvements of their child by providing comfort and stimulation. They also valued the positive experiences shared by the family in music therapy sessions that were strength oriented and family centered. This highlighted the physical and communication scales within the PedsQL Family Impact Module, where minimal improvements were achieved in contrast to some strong results suggesting diminished quality of life in cognitive and daily activity domains. Despite the significant challenges faced by parents during this difficult time, parents described many positive experiences in music therapy, and the overall score for half of the parents in the study did not diminish. The value of music therapy as a service that addresses the family-centered agenda of PPC is endorsed by this study. PMID:22144660

  9. Gaps in quality of diabetes care in internal medicine residency clinics suggest the need for better ambulatory care training.

    PubMed

    Lynn, Lorna; Hess, Brian J; Weng, Weifeng; Lipner, Rebecca S; Holmboe, Eric S

    2012-01-01

    To ensure that medical residents will be prepared to deliver consistently high-quality care, they should be trained in settings that provide such care. Residents in internal medicine, particularly, need to learn good care habits in order to meet the needs of patients with diabetes and other common chronic and high-impact illnesses. To assess the strength of such training, we compared the quality of medical care provided in sixty-seven US internal medicine residency ambulatory clinics with the quality of care provided by 703 practicing general internists. We found significant quality gaps in process, intermediate outcome, and patient-experience measures. These inadequacies in ambulatory training for internal medicine residents must be addressed by policy makers and educators-for example, by accelerating the movement toward new residency curricula that emphasize competency-based training. PMID:22232105

  10. The Effects of Quality of Care on Costs: A Conceptual Framework

    PubMed Central

    Nuckols, Teryl K; Escarce, José J; Asch, Steven M

    2013-01-01

    Context The quality of health care and the financial costs affected by receiving care represent two fundamental dimensions for judging health care performance. No existing conceptual framework appears to have described how quality influences costs. Methods We developed the Quality-Cost Framework, drawing from the work of Donabedian, the RAND/UCLA Appropriateness Method, reports by the Institute of Medicine, and other sources. Findings The Quality-Cost Framework describes how health-related quality of care (aspects of quality that influence health status) affects health care and other costs. Structure influences process, which, in turn, affects proximate and ultimate outcomes. Within structure, subdomains include general structural characteristics, circumstance-specific (e.g., disease-specific) structural characteristics, and quality-improvement systems. Process subdomains include appropriateness of care and medical errors. Proximate outcomes consist of disease progression, disease complications, and care complications. Each of the preceding subdomains influences health care costs. For example, quality improvement systems often create costs associated with monitoring and feedback. Providing appropriate care frequently requires additional physician visits and medications. Care complications may result in costly hospitalizations or procedures. Ultimate outcomes include functional status as well as length and quality of life; the economic value of these outcomes can be measured in terms of health utility or health-status-related costs. We illustrate our framework using examples related to glycemic control for type 2 diabetes mellitus or the appropriateness of care for low back pain. Conclusions The Quality-Cost Framework describes the mechanisms by which health-related quality of care affects health care and health status–related costs. Additional work will need to validate the framework by applying it to multiple clinical conditions. Applicability could be assessed by using the framework to classify the measures of quality and cost reported in published studies. Usefulness could be demonstrated by employing the framework to identify design flaws in published cost analyses, such as omitting the costs attributable to a relevant subdomain of quality. PMID:23758513

  11. Fighting violence against health workers: a way to improve quality of care?

    PubMed

    Gignon, Maxime; Verheye, Jean-Charles; Manaouil, Cécile; Ammirati, Christine; Turban-Castel, Emmanuelle; Ganry, Olivier

    2014-06-01

    Violence against health care workers impairs the quality of care. In one university medical center in France, 46% of the health care workers were physically assaulted at some point in the previous 12 months and 79% were verbally insulted. This article describes a participatory approach that was used to ensure health care workers take an active role in designing and implementing anti-violence measures. In each unit, a working group of health care professionals and managers developed an action plan for reducing violence-generating practices. This proactive approach is a powerful tool for motivating health care professionals to improve quality of care. PMID:24971816

  12. Agreement and disagreement on health care quality concepts among academic health professionals: the Saudi case.

    PubMed

    Mahrous, Mohamed Saad

    2014-01-01

    A systematic and rigorous implementation of quality improvement processes is likely to improve the well-being of staff members and heighten their job satisfaction. Assessing professionals' perceptions of health care quality should lead to the betterment of health care services. In Saudi Arabia, no previous studies examine how university health professionals view health care quality concepts. A cross-sectional analytical study employing a self-administered questionnaire with 43 statements assessing quality perceptions of academic health care professionals was used. Despite the agreement of health professionals on numerous quality concepts addressed in this study, there was insufficient agreement on 10 core quality concepts, 3 of which were the following: "quality focuses on customers" (50%), "quality is tangible and therefore measurable" (29.3%), and "quality is data-driven" (62%). Hence, providing health professionals with relevant training likely will generate a better understanding of quality concepts and optimize their performance. PMID:23897553

  13. Relationship Between Patients' Perceptions of Care Quality and Health Care Errors in 11 Countries: A Secondary Data Analysis

    PubMed Central

    Slack, Marion; Malone, Daniel C.; MacKinnon, Neil J.; Warholak, Terri L.

    2016-01-01

    Patients may be the most reliable reporters of some aspects of the health care process; their perspectives should be considered when pursuing changes to improve patient safety. The authors evaluated the association between patients' perceived health care quality and self-reported medical, medication, and laboratory errors in a multinational sample. The analysis was conducted using the 2010 Commonwealth Fund International Health Policy Survey, a multinational consumer survey conducted in 11 countries. Quality of care was measured by a multifaceted construct developed using Rasch techniques. After adjusting for potentially important confounding variables, an increase in respondents' perceptions of care coordination decreased the odds of self-reporting medical errors, medication errors, and laboratory errors (P < .001). As health care stakeholders continue to search for initiatives that improve care experiences and outcomes, this study's results emphasize the importance of guaranteeing integrated care. PMID:26783863

  14. Relationship Between Patients' Perceptions of Care Quality and Health Care Errors in 11 Countries: A Secondary Data Analysis.

    PubMed

    Hincapie, Ana L; Slack, Marion; Malone, Daniel C; MacKinnon, Neil J; Warholak, Terri L

    2016-01-01

    Patients may be the most reliable reporters of some aspects of the health care process; their perspectives should be considered when pursuing changes to improve patient safety. The authors evaluated the association between patients' perceived health care quality and self-reported medical, medication, and laboratory errors in a multinational sample. The analysis was conducted using the 2010 Commonwealth Fund International Health Policy Survey, a multinational consumer survey conducted in 11 countries. Quality of care was measured by a multifaceted construct developed using Rasch techniques. After adjusting for potentially important confounding variables, an increase in respondents' perceptions of care coordination decreased the odds of self-reporting medical errors, medication errors, and laboratory errors (P < .001). As health care stakeholders continue to search for initiatives that improve care experiences and outcomes, this study's results emphasize the importance of guaranteeing integrated care. PMID:26783863

  15. Continuity of Caregiver for Infants and Toddlers in Center-based Child Care: Report on a Survey of Center Practices.

    ERIC Educational Resources Information Center

    Cryer, Debby; Hurwitz, Sarah; Wolery, Mark

    2000-01-01

    Explored practices around transitioning infants/toddlers to new classes. Responses to mail survey indicated that relatively few programs provided caregiver continuity. Most programs considered attainment of developmental milestones, age, and available space when making transition decisions for infants/toddlers. Most centers used a few practices to…

  16. Caring for patients in a malpractice crisis: physician satisfaction and quality of care.

    PubMed

    Mello, Michelle M; Studdert, David M; DesRoches, Catherine M; Peugh, Jordon; Zapert, Kinga; Brennan, Troyen A; Sage, William M

    2004-01-01

    The rhetoric of malpractice reform is at fever pitch, but political advocacy does not necessarily reflect grassroots opinion. To determine whether the ongoing liability crisis has greatly reduced physicians' professional satisfaction, we surveyed specialist physicians in Pennsylvania. We found widespread discontent among physicians practicing in high-liability environments, which seems to be compounded by other financial and administrative pressures. Opinion alone should not determine public policy, but physicians' perceptions matter for two reasons. First, perceptions influence behavior with respect to practice environment and clinical decision making. Second, perceptions influence the physician-patient relationship and the interpersonal quality of care. PMID:15318566

  17. The Nonprofit Advantage: Producing Quality in Thick and Thin Child Care Markets

    ERIC Educational Resources Information Center

    Cleveland, Gordon; Krashinsky, Michael

    2009-01-01

    Nonprofit child care centers are frequently observed to produce child care which is, on average, of higher quality than care provided in commercial child care centers. In part, this nonprofit advantage is due to different input choices made by nonprofit centers--lower child--staff ratios, better-educated staff and directors, higher rates of…

  18. Strategies To Improve Quality in Subsidized Child Care. CCAC Issue Brief #8.

    ERIC Educational Resources Information Center

    Child Care Action Campaign Issue Brief, 1997

    1997-01-01

    Recent state efforts reflect a growing commitment to building state child care systems, but increasing child care capacity while simultaneously designing and expanding good quality, new child care systems remains a challenge. On November 17, 1997, the Child Care Action Campaign (CCAC) conducted an audioconference that focused on how Wisconsin,…

  19. Quality of Care for Myocardial Infarction in Rural and Urban Hospitals

    ERIC Educational Resources Information Center

    Baldwin, Laura-Mae; Chan, Leighton; Andrilla, C. Holly A.; Huff, Edwin D.; Hart, L. Gary

    2010-01-01

    Background: In the mid-1990s, significant gaps existed in the quality of acute myocardial infarction (AMI) care between rural and urban hospitals. Since then, overall AMI care quality has improved. This study uses more recent data to determine whether rural-urban AMI quality gaps have persisted. Methods: Using inpatient records data for 34,776…

  20. Quality of Care for Myocardial Infarction in Rural and Urban Hospitals

    ERIC Educational Resources Information Center

    Baldwin, Laura-Mae; Chan, Leighton; Andrilla, C. Holly A.; Huff, Edwin D.; Hart, L. Gary

    2010-01-01

    Background: In the mid-1990s, significant gaps existed in the quality of acute myocardial infarction (AMI) care between rural and urban hospitals. Since then, overall AMI care quality has improved. This study uses more recent data to determine whether rural-urban AMI quality gaps have persisted. Methods: Using inpatient records data for 34,776