Science.gov

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. 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,…

  5. 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…

  6. 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…

  7. 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…

  8. 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…

  9. Implementation of an Infant/Toddler Inservice Program for Dayhome Staff and Parents.

    ERIC Educational Resources Information Center

    Harmon, Geraldine

    This practicum involved an effort to improve the quality of infant/toddler care and education in a family dayhome setting. An attempt was made to increase the dayhome administrator's and parents' knowledge of infant/toddler development, age appropriate curriculum/material selection and parent/school communication. Direct observation of family…

  10. Playgrounds for Infants, Toddlers, and Preschoolers.

    ERIC Educational Resources Information Center

    Frost, Joe L.; Dempsey, James D.

    This paper offers practical assistance for the development of high quality playgrounds for infants, toddlers, and preschoolers in child care. Discussion of the value of play in child development and the benefits of outdoor play is followed by a consideration of the ways children use playgrounds in exercise, construction, group and dramatic forms…

  11. 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…

  12. 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,…

  13. 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…

  14. Quality Details: A Close-Up Look at Child Care Program Strengths and Weaknesses.

    ERIC Educational Resources Information Center

    Cryer, Debby; Phillipsen, Leslie

    1997-01-01

    Examined quality of infant/toddler and preschool child care centers. Found that although overall program quality was mediocre at best, accredited programs scored better than nonaccredited programs. Preschool classrooms needed improvements in cultural awareness, child privacy, and furnishings for relaxation. For infant/toddler programs,…

  15. Maternal Childrearing Practices with Preschoolers: Relationship to Infant/Toddler Care Patterns.

    ERIC Educational Resources Information Center

    Honig, Alice Sterling; Park, KyungJa

    This study examined parenting styles reported by middle-class families of 105 preschoolers between 3 and 5 years of age who had experienced varying amounts of full-time infant child care. Children had experienced one of the following conditions: (1) full-time nonparental care beginning before 9 months of age; (2) full-time nonparental care…

  16. Educating and Caring for Very Young Children: The Infant/Toddler Curriculum. Early Childhood Education Series.

    ERIC Educational Resources Information Center

    Bergen, Doris; Reid, Rebecca; Torelli, Louis

    Noting an increasing consensus that meeting care and education goals for infants and toddlers is a societal as well as a family responsibility, this book provides an "educare" curriculum for infants and toddlers, emphasizing both education and care perspectives. Part 1 of the book provides basic principles of good infant and toddler curriculum in…

  17. 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…

  18. 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…

  19. 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,"…

  20. 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…

  1. 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…

  2. 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…

  3. 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…

  4. 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.…

  5. Developing Programs for Infants & Toddlers.

    ERIC Educational Resources Information Center

    Frost, Joe L., Comp.

    This collection of conference papers (presented at the 1975 Texas Conference on Infancy sponsored by the Association for Childhood Education International) is directed primarily to caretakers, potential caretakers, and parents of young children. Articles included are: (1) Some Observations on Group Care of Infants; (2) What a State Can Do--For…

  6. 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.)

  7. 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,…

  8. 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…

  9. Infant Toddler Services through Community Collaboration: Oklahoma's Early Childhood Initiatives

    ERIC Educational Resources Information Center

    Goble, Carla B.; Horm, Diane M.

    2009-01-01

    Comprehensive, integrated services for infants, toddlers, and families are essential for optimal child development, and collaboration across systems is increasingly important to maximize limited resources. The authors describe three successful initiatives in Oklahoma that use a collaborative systems approach to providing direct services to young…

  10. Survey of Staff Preparation for Infant/Toddler Development Programs.

    ERIC Educational Resources Information Center

    Gorelick, Molly C.

    The purpose of this study was to survey the agencies and individuals presently conducting infant/toddler development (ITD) programs in the Los Angeles County area to determine whether the agencies were operated by public or private organizations; the educational background of the individuals staffing these programs and the respondents'…

  11. 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,…

  12. 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…

  13. 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…

  14. 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…

  15. Getting Help from Erikson, Piaget, and Vygotsky: Developing Infant-Toddler Curriculum.

    ERIC Educational Resources Information Center

    Gilbert, Jaesook L.

    This paper asserts that infant-toddler teachers, like preschool teachers, need to be cognizant of individual children's developmental levels, chronological ages, and general developmental stages, as well as infant-toddler theories and developmentally appropriate practice for infants and toddlers. In that spirit, the paper describes the purpose and…

  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. 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…

  18. The clinical validity and reliability of the Brief Infant-Toddler Social and Emotional Assessment (BITSEA).

    PubMed

    Karabekiroglu, Koray; Briggs-Gowan, Margaret J; Carter, Alice S; Rodopman-Arman, Ayse; Akbas, Seher

    2010-12-01

    This study investigates the construct validity and reliability of the Brief Infant-Toddler Social and Emotional Assessment (BITSEA) in a psychiatric clinical sample of toddlers. The sample consisted of a psychiatric clinical sample (N=112) (male, n=79; female, n=33) of toddlers (12- to 42-months old). Both mothers and fathers completed the BITSEA and mothers completed the Child Behavior Checklist 2/3 (CBCL). Children and their parents were administered a comprehensive psychiatric evaluation. Parents were also given the Autistic Behavior Checklist (AuBC) and the Aberrant Behavior Checklist-Community (ABC). The internal consistency of BITSEA scores was good to excellent for both parents. The BITSEA/Problem (P) scores were significantly correlated with Internalizing, Externalizing and Total Problem scores of the CBCL, all subscores of ABC and total score of AuBC. The BITSEA/Competence (C) scores were significantly inversely correlated with ABC total and AuBC lethargy scores. With respect to a community sample, BITSEA/P scores were significantly higher in the disruptive behavior disorder (DBD) and anxiety/depression (Anx/Dep) groups and BITSEA/C scores were significantly lower in the autism group. These results support the reliability and validity of the BITSEA as a screening tool that may be employed in primary health care services and in psychiatric clinical settings for assessing social-emotional/behavioral problems and delays in competence in infants and toddlers. PMID:20800285

  19. 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…

  20. 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…

  1. 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...

  2. 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…

  3. Progress of Infants/Toddlers with Severe Disabilities: Perceived and Measured Change

    ERIC Educational Resources Information Center

    Salisbury, Christine L.; Copeland, Christina G.

    2013-01-01

    An exploratory case study was undertaken to examine child and caregiver outcomes in a diverse sample of 21 infants/toddlers with severe disabilities who received services from an urban, Part C program where caregiver-focused intervention was emphasized. Purposive sampling and mixed methods were used to collect data on child developmental change,…

  4. 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…

  5. State Policy Roundup: Progress on Infant-Toddler Issues across the United States

    ERIC Educational Resources Information Center

    Norton, Yolanda

    2006-01-01

    This article summarizes state and community policy activities during the final six months of 2006 and provides updates of the progress to serve infants, toddlers, and their families. The following states are included in the report: (1) Rhode Island; (2) Virginia; (3) New York; (4) Pennsylvania; (5) Nebraska; (6) Ohio; (7) Washington; (8) Arizona;…

  6. 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)…

  7. State Policy Roundup: Progress on Infant-Toddler Issues across the United States

    ERIC Educational Resources Information Center

    Norton, Yolanda

    2006-01-01

    This article summarizes state and community policy activities during the first six months of 2006 and provides updates of the progress to serve infants, toddlers, and their families. The following states are included in the report: (1) Rhode Island; (2) Virginia; (3) New York; (4) Pennsylvania; (5) Nebraska; (6) Ohio; (7) Washington; (8) Arizona;…

  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. Screening for Autism Spectrum Disorders with the Brief Infant-Toddler Social and Emotional Assessment

    PubMed Central

    Kruizinga, Ingrid; Visser, Janne C.; van Batenburg-Eddes, Tamara; Carter, Alice S.; Jansen, Wilma; Raat, Hein

    2014-01-01

    Objective Using parent-completed questionnaires in (preventive) child health care can facilitate the early detection of psychosocial problems and psychopathology, including autism spectrum disorders (ASD). A promising questionnaire for this purpose is the Brief Infant-Toddler Social and Emotional Assessment (BITSEA). The screening accuracy with regard to ASD of the BITSEA Problem and Competence scales and a newly calculated Autism score were evaluated. Method Data, that was collected between April 2010 and April 2011, from a community sample of 2-year-olds (N = 3127), was combined with a sample of preschool children diagnosed with ASD (N = 159). For the total population and for subgroups by child's gender, area under the Receiver Operating Characteristic (ROC) curve was examined, and across a range of BITSEA Problem, Competence and Autism scores, sensitivity, specificity, positive and negative likelihood ratio's, diagnostic odds ratio and Youden's index were reported. Results The area under the ROC curve (95% confidence interval, [95%CI]) of the Problem scale was 0.90(0.87–0.92), of the Competence scale 0.93(0.91–0.95), and of the Autism score 0.95(0.93–0.97). For the total population, the screening accuracy of the Autism score was significantly better, compared to the Problem scale. The screening accuracy of the Competence scale was significantly better for girls (AUC = 0.97; 95%CI = 0.95–0.98) than for boys (AUC = 0.91; 95%CI = 0.88–0.94). Conclusion The results indicate that the BITSEA scales and newly calculated Autism score have good discriminative power to differentiate children with and without ASD. Therefore, the BITSEA may be helpful in the early detection of ASD, which could have beneficial effects on the child's development. PMID:24851868

  10. 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

  11. The Infant & Toddler Handbook: Invitations for Optimum Early Development. Revised.

    ERIC Educational Resources Information Center

    Castle, Kathryn

    Noting that care and teaching can be provided simultaneously by a knowledgeable, responsive, warm and loving parent or child care workers, this infant and toddler handbook provides developmentally sequenced cognitive, social, motor, and language activities, called "invitations," for infants and toddlers from birth to 24 months. Chapter 1,…

  12. 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…

  13. Making the Transition from Preschool to Infant/Toddler Teacher.

    ERIC Educational Resources Information Center

    Keenan, Marjory

    1998-01-01

    Draws on discussions with child care workers to discuss important changes involved in moving from teaching preschoolers to teaching infants and toddlers. Describes differences in (1) relating to children; (2) parent/teacher relationships; (3) group dynamics; (4) curriculum; (5) routines and transitions; (6) coworker relationships; (7) director…

  14. [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…

  15. 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…

  16. 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…

  17. 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…

  18. 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…

  19. 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…

  20. 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…

  1. All About Child Care.

    ERIC Educational Resources Information Center

    Segal, Marilyn, Ed.; Manburg, Abbey, Ed.

    This resource book for child care practitioners has been written for administrators, nursery school teachers and preschool or Head Start teachers who are interested in practical suggestions (1) for setting up classrooms, (2) for developing a curriculum for infants, toddlers and preschool children, (3) for meeting the social-emotional needs of…

  2. 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…

  3. [Quality of health care].

    PubMed

    Medina, J L; De Melo, P C

    2000-01-01

    Quality assurance is a relatively recent concern but already plays a major role in health care management and provision. Quality involves the definition of a comprehensive programme tailored by realistic and effective objectives and norms that include the structured review of procedures (namely clinical audits) and the use of up-to-date protocols. The involvement and motivation of health professionals, together with an adequate internal and external communication strategy, play a key role in the planning and application of these programmes. The use of programmed assessment, based on a solid knowledge of current practice, should have practical implications, optimising procedures in order to improve the quality of care. This commitment towards quality in health care should go far beyond governmental policy and should have clear support from health professionals. PMID:11234496

  4. 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.…

  5. 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…

  6. 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)

  7. 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…

  8. 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…

  9. Defining quality in health care.

    PubMed

    Buck, A S

    1992-05-01

    The difficulty and importance of developing and implementing a definition of quality in health care is discussed. Some current definitions are considered, and a recommended definition of quality health care is presented. PMID:1630660

  10. 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…

  11. 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…

  12. 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…

  13. 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…

  14. 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…

  15. 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…

  16. 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…

  17. A Description of Title IV-A Infant and Toddler Day Care, 1974-1975: Adult-Child Interactions and Care Room Activities. Report No. 7641.

    ERIC Educational Resources Information Center

    Silbermann, David

    This report is concerned with the development and use of the Infant/Toddler Interaction and Activity Profile in 13 day care centers in Philadelphia. The Profile and its development are described and methods of data collection and analysis are explained briefly. Findings are reported in four major areas: (1) basic data characteristics, offering a…

  18. 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…

  19. Care Coordination Practices among Illinois Pediatricians and Early Intervention Service Coordinators

    ERIC Educational Resources Information Center

    Baxter, Marissa

    2015-01-01

    Over the course of the past three decades, largely due to advances in technology, there has been growth in the fields of early intervention (EI) and pediatrics for infants/toddlers with special health care needs (SHCN). This growth has also brought about a change in the relationship between pediatricians and EI service coordinators, creating an…

  20. The Human Rights of Infants and Toddlers: A Comparison of Child-Care Philosophies in Europe, Australia, New Zealand, and the United States

    ERIC Educational Resources Information Center

    Lally, J. Ronald

    2005-01-01

    This essay describes and analyzes economic rationalism, instrumental, and enrichment approaches to early care and education policy in the United States and abroad. The author proposes that differences in infant-toddler care and other services among nations can stem from differences in the way that societies define the basic rights of their…

  1. 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…

  2. 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…

  3. Helping You Choose Quality Behavioral Health Care

    MedlinePlus

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

  4. 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…

  5. 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…

  6. 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

  7. Structural Predictors of Child Care Quality in Child Care Homes.

    ERIC Educational Resources Information Center

    Burchinal, Margaret; Howes, Carollee; Kontos, Susan

    2002-01-01

    Used data from a family child care study and a licensing study to identify dimensions best predicting global day care quality in over 300 child care homes. Found that caregiver training most consistently predicted global quality. Found no reliable association between care quality and child-caregiver ratio or age-weighted group size recommendations…

  8. 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…

  9. 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…

  10. 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…

  11. 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

  12. 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…

  13. Monitoring Quality of Nursing Care

    PubMed Central

    Haussmann, R. K. Dieter; Hegyvary, Sue Thomas; Newman, John F.; Bishop, Annelle C.

    1974-01-01

    The first phase of a cooperative project to develop and pilot-test an improved system for monitoring the quality of nursing care is described. Evaluation criteria from existing methodologies were grouped in a comprehensive framework of nursing objectives and subobjectives, and both the framework and the criteria developed were tested statistically. The master criteria list was placed in a computer file, from which criteria subsets are systematically selected for actual quality monitoring. The methodology has been used in two pilot hospitals; in the second phase of the project, now under way, the system is being implemented in a wider sample of hospitals to further test the validity of the conceptual framework and the reliability of individual criteria. PMID:4414709

  14. 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

  15. Diversity, Child Care Quality, and Developmental Outcomes

    ERIC Educational Resources Information Center

    Burchinal, Margaret R.; Cryer, Debby

    2003-01-01

    It is widely accepted that high quality child care enhances children's cognitive and social development, but some question whether what constitutes quality care depends on the child's ethnic and cultural background. To address this question, secondary analysis of data from the two largest studies of child care experiences in the United States,…

  16. USING THE PARENT-INFANT RELATIONSHIP GLOBAL ASSESSMENT SCALE TO IDENTIFY CAREGIVER-INFANT/TODDLER DYADS WITH ABUSIVE RELATIONSHIP PATTERNS IN SIX EUROPEAN COUNTRIES.

    PubMed

    Hatzinikolaou, Kornilia; Karveli, Vassiliki; Skoubourdi, Aggeliki; Zarokosta, Foteini; Antonucci, Gianluca; Visci, Giovanni; Calheiros, Maria Manuela; MagalhÃes, Eunice; Essau, Cecilia; Allan, Sharon; Pithia, Jayshree; Walji, Fahreen; Ezpeleta, Lourdes; Perez-Robles, Ruth; Fanti, Kostas A; Katsimicha, Evita; Hadjicharambous, Maria-Zoe; Nikolaidis, George; Reddy, Vasudevi

    2016-07-01

    The study examined whether the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood, Revised Edition (DC: 0-3R; ZERO TO THREE, 2005) Parent-Infant Relationship Global Assessment Scale (PIR-GAS) is applicable to six European countries and contributes to the identification of caregiver-infant/toddler dyads with abusive relationship patterns. The sample consisted of 115 dyads with children's ages ranging from 1 to 47 months. Sixty-four dyads were recruited from community settings without known violence problems, and 51 dyads were recruited from clinical settings and already had been identified with violence problems or as being at risk for violence problems. To classify the dyads on the PIR-GAS categories, caregiver-child interactions were video-recorded and coded with observational scales appropriate for child age. To test whether the PIR-GAS allows for reliable identification of dyads with abusive relationship patterns, PIR-GAS ratings were compared with scores on the the International Society for the Prevention of Child Abuse and Neglect's (ISPCAN) Child Abuse Screening Tool-Parental Version (ICAST-P; D.K. Runyan et al., ), a questionnaire measuring abusive parental disciplinary practices. It was found that PIR-GAS ratings differentiated between the general and the clinical sample, and the dyads with abusive patterns of relationship were identified by both the PIR-GAS and the ICAST-P. Interrater reliability for the PIR-GAS ranged from moderate to excellent. The value of a broader use of tools such as the DC: 0-3R to promote early identification of families at risk for infant and toddler abuse and neglect is discussed. PMID:27351372

  17. [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

  18. [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

  19. 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 ...

  20. 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…

  1. Ensuring quality and accountability in managed care.

    PubMed

    Dobalian, A; Rivers, P A

    1998-01-01

    The rapid growth of new forms of managed care in the United States in recent decades has brought with it increasing concerns regarding the quality of care delivered by practitioners in these plans. This article examines the various regulatory demands that are being placed on Managed Care Organizations (MCOs). The authors look at the major determinants that are likely to bring about significant changes in the health care sector for both patients and providers and predict how these shifts will affect the quality of health care services in the near future. They discuss how the quality of health care, rather than the cost of those services, can become and remain the primary factor in the delivery of health care services. Ultimately, they conclude that increased participation by the federal government is required to protect the rights of patients and ensure better quality and accountability for health care services delivered by MCOs. PMID:10345539

  2. 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

  3. 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

  4. Child Care: Use of Standards To Ensure High Quality Care.

    ERIC Educational Resources Information Center

    General Accounting Office, Washington, DC. Health, Education, and Human Services Div.

    Prepared to assist Congress in its deliberations of various child care proposals, this report identifies key child care center standards that are critical in helping to ensure high quality child care. The article also examines the extent to which states incorporate these standards into their own standards, and discusses other important issues that…

  5. Measuring the quality of health care.

    PubMed

    Custer, W

    1995-03-01

    This Issue Brief examines some of the issues involved in defining and measuring the quality of health care and in implementing quality measures. It discusses the importance of measures of health care quality in the evolving health care delivery system, examines some of the conceptual issues involved in defining quality of care, and discusses some of the measures of health care quality and how these measures have been implemented in the health care delivery system. The major impetus for quality assurance programs is cost management: it is an attempt to allocate scarce health care resources efficiently. This requires making choices among alternatives, which may mean that maximizing quality of care for whole populations may not maximize the quality of care for individuals. Quality, in terms of any single good or service, has a number of dimensions. Health care is a complex bundle of services, and each component service within an episode of care affects the other components and the patients differently. Moreover, patients differ in numerous ways, which means that similar symptoms may require different services if care is to be effective. Measuring quality of health care services requires accounting for all of these factors. In attempting to manage health care costs, employers and other private health plans have begun to employ process measures of quality, i.e., evaluating caregivers' activities, the decisions made at each step in an episode of illness, and the appropriateness of the care provided. Process is an important component of quality measures because it focuses directly on the uncertainty in the efficacy of treatment. Given this uncertainty, the logic of medical decision making is an important determinant of quality and cost effectiveness. Examining the process of care involves assembling a panel of physicians who review medical records to determine the appropriateness of the care received. Providers have increasingly found that their medical decision making

  6. 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…

  7. 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;…

  8. Quality in managed care: developments and considerations.

    PubMed

    Spoeri, R K

    1997-01-01

    With the rapid movement of both individuals and groups away from fee-for-service health care into managed care, concerns have been expressed appropriately that the quality of care may be affected adversely. Over the past several years, a number of developments have taken place to respond to these concerns. This quality movement in managed care has not been without some issues and considerations, however. This article first describes the National Committee for Quality Assurance (NCQA) and the prominent role it has played in this movement. Next, quality improvement study design is addressed in the context of assuring quality, controlling costs, and achieving NCQA accreditation. The effect that capitation, as a payment strategy for providers, has on data quality is then described. Fourth, the value of partnering is explored. Finally, the newest version of NCQA's performance measurement template is discussed: the Health Plan Employer Data and Information Set, version 3.0. PMID:10169183

  9. 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

  10. The quality imperative for palliative care.

    PubMed

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

    2015-02-01

    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 U.S. 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 us 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

  11. Assuring quality care: measuring and monitoring the caring process.

    PubMed

    Ammentorp, W; Bock, W; Irrgang, S; Gossett, K

    1988-01-01

    Everyone interested in the quality of the human services agrees that it should be largely determined by the interaction between the client and their caregivers. Unfortunately, this exchange has proven to be very difficult to measure in an accurate and timely manner. The resulting uncertainty has prevented smooth adaptation of the caring process to client needs; it has also made it virtually impossible for managers to devise workable quality control systems. This paper describes the use of miniaturized barcode technology for collection of real-time data at the point of care. With the addition of laptop computers, this technology provides for immediate feedback of information to address quality issues in care planning and management. The data bases produced by this system are sources of documentation for quality assurance as well as a dynamic foundation for quality control. PMID:10291607

  12. 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…

  13. Providing high-quality care in primary care settings

    PubMed Central

    Beaulieu, Marie-Dominique; Geneau, Robert; Grande, Claudio Del; Denis, Jean-Louis; Hudon, Éveline; Haggerty, Jeannie L.; Bonin, Lucie; Duplain, Réjean; 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

  14. 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

  15. Quality of care in sickle cell disease

    PubMed Central

    Evensen, Christian T.; Treadwell, Marsha J.; Keller, San; Levine, Roger; Hassell, Kathryn L.; Werner, Ellen M.; Smith, Wally R.

    2016-01-01

    Abstract Documented deficiencies in adult sickle cell disease (SCD) care include poor access to knowledgeable providers and inadequate treatment in emergency departments (EDs). The aim of this study was to create patient-reported outcome measures of the quality of ambulatory and ED care for adults with SCD. We developed and pilot tested SCD quality of care questions consistent with Consumer Assessments of Healthcare Providers and Systems surveys. We applied psychometric methods to develop scores and evaluate reliability and validity. The participants of this study were adults with SCD (n = 556)—63% aged 18 to 34 years; 64% female; 64% SCD-SS—at 7 US sites. The measure used was Adult Sickle Cell Quality of Life Measurement information system Quality of Care survey. Most participants (90%) reported at least 1 severe pain episode (pain intensity 7.8 ± 2.3, 0–10 scale) in the past year. Most (81%) chose to manage pain at home rather than the ED, citing negative ED experiences (83%). Using factor analysis, we identified Access, Provider Interaction, and ED Care composites with reliable scores (Cronbach α 0.70–0.83) and construct validity (r = 0.32–0.83 correlations with global care ratings). Compared to general adult Consumer Assessments of Healthcare Providers and Systems scores, adults with SCD had worse care, adjusted for age, education, and general health. Results were consistent with other research reflecting deficiencies in ED care for adults with SCD. The Adult Sickle Cell Quality of Life Measurement Quality of Care measure is a useful self-report measure for documenting and tracking disparities in quality of SCD care. PMID:27583862

  16. 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

  17. 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)…

  18. Health care choices: sharing the quality message.

    PubMed

    2001-01-01

    Information on health-care quality (in the form of report cards) is playing an increasingly important role in consumers' health-care decision making. In this brief we discuss how you can help your clients sort through available quality information and how you can prepare a report card using the approach developed by the Foundation for Accountability (FACCT), our guest authors this month. PMID:11859891

  19. Leadership and the quality of care.

    PubMed

    Firth-Cozens, J; Mowbray, D

    2001-12-01

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

  20. 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

  1. Empathy and quality of care.

    PubMed Central

    Mercer, Stewart W; Reynolds, William J

    2002-01-01

    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

  2. [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

  3. Infants, Toddlers and Preschool Transportation.

    ERIC Educational Resources Information Center

    Illinois State Board of Education, Springfield.

    Providing transportation to children younger than kindergarten age has become more common for public school districts, and school personnel are unsure as to the rules, guidelines, and best practices that apply to the youngest school bus passengers. This document outlines the current Illinois requirements regarding the transportation of very young…

  4. 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

  5. Determinants of Quality in Diabetes Care Process

    PubMed Central

    Gnavi, Roberto; Picariello, Roberta; la Karaghiosoff, Ludmi; Costa, Giuseppe; Giorda, Carlo

    2009-01-01

    OBJECTIVE To investigate the role of clinical and socioeconomic variables as determinants of adherence to recommended diabetes care guidelines and assess differences in the process of care between diabetologists and general practitioners. RESEARCH DESIGN AND METHODS We identified diabetic residents in Torino, Italy, as of 31 July 2003, using multiple independent data sources. We collected data on several laboratory tests and specialist medical examinations registered during the subsequent 12 months and performed regression analyses to identify associations with quality-of-care indicators based on existing guidelines. RESULTS After 1 year, only 35.8% of patients had undergone a comprehensive assessment. In the multivariate models, factors independently and significantly associated with lower quality of care were age ≥75 years (prevalence rate ratio [PRR] 0.66 [95% CI 0.61–0.70]) and established cardiovascular disease (0.89 [0.86–0.93]). Disease severity (PRR for insulin-treated patients 1.45 [1.38–1.53]) and diabetologist consultation (PRR 3.34 [3.17–3.53]) were positively associated with high quality of care. No clear association emerged between sex and socioeconomic status. These differences were strongly reduced in patients receiving diabetologist care compared with patients receiving general practitioner care only. CONCLUSIONS Despite widespread availability of guidelines and simple screening procedures, a nonnegligible portion of the diabetic population, namely elderly individuals and patients with less severe forms of the disease, are not properly cared for. As practitioners in diabetes centers are more likely to adhere to guidelines than general practitioners, quality in the diabetes care process can be improved by increasing the intensity of disease management programs, with greater participation by general practitioners. PMID:19675196

  6. Quality of care indicators in rectal cancer.

    PubMed

    Demetter, P; Ceelen, W; Danse, E; Haustermans, K; Jouret-Mourin, A; Kartheuser, A; Laurent, S; Mollet, G; Nagy, N; Scalliet, P; Van Cutsem, E; Van Den Eynde, M; Van de Stadt, J; Van Eycken, E; Van Laethem, J L; Vindevoghel, K; Penninckx, F

    2011-09-01

    Quality of health care is a hot topic, especially with regard to cancer. Although rectal cancer is, in many aspects, a model oncologic entity, there seem to be substantial differences in quality of care between countries, hospitals and physicians. PROCARE, a Belgian multidisciplinary national project to improve outcome in all patients with rectum cancer, identified a set of quality of care indicators covering all aspects of the management of rectal cancer. This set should permit national and international benchmarking, i.e. comparing results from individual hospitals or teams with national and international performances with feedback to participating teams. Such comparison could indicate whether further improvement is possible and/or warranted. PMID:22103052

  7. Quality of care compliance plans under PPS.

    PubMed

    Dombi, W A

    2001-03-01

    With the onset of Medicare home health Prospective Payment System (PPS), home care agencies must retool their internal compliance efforts to address the new risk areas. PPS presents a reversal of the incentives that existed under previous Medicare reimbursement principles, significantly reducing the risk of non-compliance and fraud in the financing of services while dramatically increasing non-compliance risks in areas related to quality of care and access to services. PMID:11255744

  8. [The quality of chronic care in Germany].

    PubMed

    Fullerton, Birgit; Nolte, Ellen; Erler, Antje

    2011-01-01

    Over the last ten years changes in the legal framework of the German health care system have promoted the development of new health service models to improve chronic care. Recent innovations include the nation-wide introduction of disease management programmes (DMPs), integrated care contracts, community nurse programmes, the introduction of General Practitioner (GP)-centred care contracts, and new opportunities to offer interdisciplinary outpatient care in polyclinics. The aim of this article is to describe the recent developments regarding both the implementation of new health care models by statutory health insurance companies and their evaluation. As part of a European project on the development and validation of disease management evaluation methods (DISMEVAL), we carried out a selective literature search to identify relevant models and evaluation studies. However, on the basis of the currently available evaluation and study results it is difficult to judge whether these developments have actually led to an improvement in the quality of chronic care in Germany. Only for DMPs, evaluation is legally mandatory; its methods are inappropriate, though, for studying the effectiveness of DMPs. Further study results on the effectiveness of DMPs mostly focus on the DMP Diabetes mellitus type II and show consistent improvements regarding process parameters such as regular routine examinations, adherence to treatment guidelines, and quality of life. More research will be needed to determine whether DMPs can also help reduce the incidence of secondary disease and mortality in the long term. PMID:22142877

  9. Making nursing-sensitive quality indicators real in ambulatory care.

    PubMed

    Swan, Beth Ann

    2008-01-01

    Pay-for-performance initiatives are changing the quality landscape. Gaps exist in quantifying and linking ambulatory care quality indicators to care provided by nurses in ambulatory care. Ambulatory care quality indicators that are sensitive to nursing care, standardized, and tested need to be identified and adopted by ambulatory care nurses, ambulatory care provider organizations, professional organizations, and endorsed by a consensus organization. PMID:18616060

  10. Measuring the quality of care: reforming the health care system.

    PubMed

    Longo, D R; Daugird, A J

    1994-01-01

    Elements of meaningful health care reform must include the ability of patients, providers, and payers to select services offering quality care at an affordable price. To achieve this goal, an appropriate definition of quality needs to be articulated and adopted; data capturing the definition needs to be collected; and appropriate measures need to be selected to analyze that data. Results need to be publically available to assist in making informed choices. The health professions need to fulfill their social contract. And, government needs to ensure that public safety and accountability are maintained and preserved. While the goals and strategies of the different players in the health care arena may be different, there is one thing in common--the needs of citizens must be met through the provision of available, accessible, quality, equitable, and cost-effective health care. These values need to be incorporated into a reform plan. Currently, our ability to comprehensively, consistently, and uniformly perform these tasks is severely limited. While many diverse factors, such as the limitation of financial support and the lack of uniform information systems, contribute to this situation, we believe it is possible through the implementation of a series of recommendations to achieve these goals. This paper outlines the current situation, reviews insights derived from the literature and past and current experiences. Recommendations are made that apply equally to health reform efforts at the state and/or federal levels. PMID:7950482

  11. Quality of care developments. 1993 update.

    PubMed

    Sundwall, D N

    1993-06-01

    This monograph offers an overview of quality of care developments at the federal and state government levels, as well as in the private sector. Although health care reform legislation focuses on access, costs, and delivery systems, initiatives involving the quality of care not only will continue but are included in most of the reform efforts being proposed and those already under way. At the federal level... At the Health Care Financing Administration (HCFA), publication of Medicare mortality data is delayed and the Peer Review Organization (PRO) program is undergoing a major change of emphasis under a "quality improvement initiative." The Clinical Laboratory Improvement Act (CLIA) has taken effect amidst controversy and further rulemaking is expected to correct flaws. The Agency for Health Care Policy and Research (AHCPR) is forging ahead with new practice guidelines while it starts to evaluate their effectiveness. Data on the patient outcomes in organ transplant centers, first published last year, now will be published on a regular basis. The National Practitioner Data Bank continues functioning amidst criticism and varying recommendations for change, from excluding information on small malpractice claims (e.g., less than $30,000) to opening up the data bank to the public (as proposed by Rep. Ron Wyden). Other federal developments include various quality-related reports from the Inspector General of HHS, the General Accounting Office, the Prospective Payment Assessment Commission, and the Physician Payment Review Commission, plus QI initiatives in Veterans Administration hospitals and the CHAMPUS programs. Among the states... Florida has included outcome data reporting and dissemination in its health care reform plan while Illinois struggles with whether physician-specific data will be made public. An innovative effort to test whether practice guidelines can reduce malpractice costs is underway in Maine, while Indiana began an outcome data project. Among

  12. 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

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

    ERIC Educational Resources Information Center

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

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

  14. 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;…

  15. 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…

  16. Quality of congestive heart failure care

    PubMed Central

    Maddocks, Heather; Marshall, J. Neil; Stewart, Moira; Terry, Amanda L.; Cejic, Sonny; Hammond, Jo-Anne; Jordan, John; Chevendra, Vijaya; Denomme, Louisa Bestard; Thind, Amardeep

    2010-01-01

    ABSTRACT OBJECTIVE To study the feasibility of using electronic medical record (EMR) data from the Deliver Primary Healthcare Information (DELPHI) database to measure quality of care for patients with congestive heart failure (CHF) in primary care and to determine the percentage of patients with CHF receiving the recommended care. DESIGN Items listed on the Ontario Ministry of Health and Long-Term Care Heart Failure Patient Care Flow Sheet (CHF flow sheet) were assessed and measured using EMRs of patients diagnosed with CHF between October 1, 2005, and September 30, 2008. SETTING Ten primary health care practices in southwestern Ontario. PARTICIPANTS Four hundred eighty-eight patients who were considered to have CHF because at least 1 of the following was indicated in their EMRs: an International Classification of Diseases billing code for CHF (category 428), an International Classification of Primary Care diagnosis code for heart failure (ie, K77), or “CHF” reported on the problem list. MAIN OUTCOME MEASURES Number of CHF flow sheet items that were measurable using EMR data from the DELPHI database. Percentage of patients with CHF receiving required quality-of-care items since the date of diagnosis. RESULTS The DELPHI database contained information on 60 (65.9%) of the 91 items identified using the CHF flow sheet. The recommended tests and procedures were recorded infrequently: 55.5% of patients with CHF had chest radiographs; 32.6% had electrocardiograms; 32.2% had echocardiograms; 30.5% were prescribed angiotensin-converting enzyme inhibitors; 20.9% were prescribed β-blockers; and 15.8% were prescribed angiotensin II receptor blockers. CONCLUSION Low frequencies of recommended care items for patients with CHF were recorded in the EMR. Physicians explained that CHF care was documented in areas of the EMR that contained patient identifiers, such as the encounter notes, and was therefore not part of the DELPHI database. Extractable information from the EMR

  17. 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…

  18. 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…

  19. Planning quality patient care in today's marketplace.

    PubMed

    Malloch, K

    2000-06-01

    New skills and perspectives are essential for nursing to meet the demands of shrinking resources without co-opting professional standards. Planning patient care in a definitive, value-based framework that ensures a balance among cost, work time, and quality outcomes for the consumer is the new work of nursing. Translating current practice into a value-based model requires an orientation to the content of our care, the context in which it is provided, and the effectiveness of our collaborative skills. PMID:11249282

  20. Measuring the quality of nutritional care.

    PubMed

    Relph, Wendy-Ling

    2015-09-01

    Despite various campaigns and initiatives, and publication of numerous standards, malnutrition in healthcare settings often goes unrecognised and untreated. This negatively affects patients' experiences and outcomes, and has financial implications for the NHS. The British Association for Parenteral and Enteral Nutrition has launched a new online tool that helps trusts measure the quality of the nutritional care they provide. This article describes the tool and explains its structure, how organisations and nurses can access and use it, and the benefits of implementing this resource as a routine part of clinical care. PMID:26309011

  1. 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

  2. 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

  3. Quality Assurance for Social Service Programs: Lessons from Health Care.

    ERIC Educational Resources Information Center

    Coulton, Claudia J.

    1982-01-01

    Suggests that many aspects of quality assurance in health care can be applied to social service agencies. Reviews what has been learned about quality assurance in health care and suggests guidelines for its implementation in social services. (Author/JAC)

  4. 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 ...

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

    ERIC Educational Resources Information Center

    Griffith, Deloris G.

    1986-01-01

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

  6. Electronic Health Records and Quality of Care

    PubMed Central

    Yanamadala, Swati; Morrison, Doug; Curtin, Catherine; McDonald, Kathryn; Hernandez-Boussard, Tina

    2016-01-01

    Abstract Electronic health records (EHRs) were implemented to improve quality of care and patient outcomes. This study assessed the relationship between EHR-adoption and patient outcomes. We performed an observational study using State Inpatient Databases linked to American Hospital Association survey, 2011. Surgical and medical patients from 6 large, diverse states were included. We performed univariate analyses and developed hierarchical regression models relating level of EHR utilization and mortality, readmission rates, and complications. We evaluated the effect of EHR adoption on outcomes in a difference-in-differences analysis, 2008 to 2011. Medical and surgical patients sought care at hospitals reporting no EHR (3.5%), partial EHR (55.2%), and full EHR systems (41.3%). In univariate analyses, patients at hospitals with full EHR had the lowest rates of inpatient mortality, readmissions, and Patient Safety Indicators followed by patients at hospitals with partial EHR and then patients at hospitals with no EHR (P < 0.05). However, these associations were not robust when accounting for other patient and hospital factors, and adoption of an EHR system was not associated with improved patient outcomes (P > 0.05). These results indicate that patients receiving medical and surgical care at hospitals with no EHR system have similar outcomes compared to patients seeking care at hospitals with a full EHR system, after controlling for important confounders. To date, we have not yet seen the promised benefits of EHR systems on patient outcomes in the inpatient setting. EHRs may play a smaller role than expected in patient outcomes and overall quality of care. PMID:27175631

  7. 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…

  8. 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…

  9. 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

  10. [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

  11. New health care law may spell opportunity for quality managers.

    PubMed

    2010-06-01

    New health care law emphasizes quality, safety, and efficiency. Pay-for-performance emphasis requires attention of quality managers. Many quality provisions will not kick in for several years. PMID:20491197

  12. 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

  13. Quality indicators in breast cancer care.

    PubMed

    Del Turco, M Rosselli; Ponti, A; Bick, U; Biganzoli, L; Cserni, G; Cutuli, B; Decker, T; Dietel, M; Gentilini, O; Kuehn, T; Mano, M P; Mantellini, P; Marotti, L; Poortmans, P; Rank, F; Roe, H; Scaffidi, E; van der Hage, J A; Viale, G; Wells, C; Welnicka-Jaskiewicz, M; Wengstöm, Y; Cataliotti, L

    2010-09-01

    To define a set of quality indicators that should be routinely measured and evaluated to confirm that the clinical outcome reaches the requested standards, Eusoma has organised a workshop during which twenty four experts from different disciplines have reviewed the international literature and selected the main process and outcome indicators available for quality assurance of breast cancer care. A review of the literature for evidence-based recommendations have been performed by the steering committee. The experts have identified the quality indicators also taking into account the usability and feasibility. For each of them it has been reported: definition, minimum and target standard, motivation for selection and level of evidence (graded according to AHRO). In overall 17 main quality indicators have been identified, respectively, 7 on diagnosis, 4 on surgery and loco-regional treatment, 2 on systemic treatment and 4 on staging, counselling, follow-up and rehabilitation. Breast Units in Europe are invited to comply with these indicators and monitor them during their periodic audit meetings. PMID:20675120

  14. 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,…

  15. Quality of health care: the responsibility of health care professionals in delivering high quality services.

    PubMed

    Giangrande, A

    1998-11-01

    According to a recent definition, quality of care consists of the degree to which health services increase the likelihood of desired health outcomes and are consistent with current professional knowledge; a definition that introduces both requirements of outcomes and the appropriateness of the process used. Clearly many different figures are interested in quality assessment initiatives in the health care field and these include patients, administrators and doctors each having different perspective. Doctors obviously pay greater attention to technical quality and results, giving greater emphasis to the health of the individual patient, tending to give priority to technical excellence and interaction between patient and doctor. Although the perspective of health care professionals is widely acknowledged to be important and useful, other perspectives on quality have been emphasised in recent years. The most important of these is the recognition that care must be responsive to the preferences and values of the consumers of health care services. In complete harmony with one's own professional commitment, the attention to the perspectives of patients must give physician the chance to identify methods of measuring and verifying quality which take account of the expectations of the many groups with an interest in improving the functioning of the health system. A global approach in the health field is needed the more specialization advances. The quality of medicine lies in its capacity to integrate what science says is appropriate and to be recommended, what can be reconciled with human rights and the self determination of the patient and what can be achieved by optimising available resources. In this complex context, the doctor could take on both the role of the person who decides on the use of resources and the one of social mediator. PMID:9894749

  16. 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

  17. Sustainable development and quality health care.

    PubMed

    1994-01-01

    On the occasion of Development Week in Canada, Dr. Remi Sogunro spoke in February, 1994, about the many achievements of quality primary health care and PLAN's strategy to achieve sustainability. In one generation, under-5 mortality has been cut by a third. Deaths from measles has been reduced from 2.5 million to 1 million a year. Skeletal deformities from polio also have been reduced from 1/2 million to less than 140,000. Despite all this, there is much more to be attained. 35,000 children under 5 die from preventable diseases every day in developing countries. The health community is working hard to address these silent emergencies. PLAN International's primary health care program targets the poor and undeserved populations where diseases are prevalent. The main focus of PLAN's programs are mothers and children who are most vulnerable to disease. Key interventions that PLAN gives priority to are childhood and maternal immunization programs, including pre- and post-natal care for mothers. Other interventions under PLAN's comprehensive primary health care program include: control of diarrheal diseases and acute respiratory infections, growth monitoring, nutrition and control of STDs and HIV/AIDS infection, water and sanitation, family planning information and educational services, and rehabilitation of the handicapped. "Go in search of people, begin with what they know, build on what they have," goes a Chinese proverb. This also summarizes PLAN's guiding principle for achieving sustainable development: the importance of investing in people. PLAN's programs in the field build partnerships and empower communities. PLAN's emphasis on institution-building and capacity-building with local institutions is an important part of organizational strategy to ensure sustained development. PMID:12179549

  18. [Toward a high quality glaucoma care].

    PubMed

    Kashiwagi, Kenji

    2012-03-01

    The following studies were performed to solve current problems in glaucoma care and to pursue quality glaucoma care. Using a scanning peripheral anterior chamber depth analyzer that we developed, we: 1) conducted cross-sectional screening for eyes with angle closure; 2) examined longitudinal changes in anterior chamber depth and occurrence rates of primary angle closure in local senior residents; 3) investigated the significance of the anterior chamber and the angle of eyes with open angle glaucoma; and 4) looked into possible applications of anterior chamber depth and the angle in routine examinations. We investigated the effects of retinal glial cells and optic nerve astrocytes on retinal ganglion cell (RGC) survival and neurite growth using a culture system. We also identified candidate genies of retinal glial cells and optic nerve astrocytes affecting RGC survival and neurite growth using microarray and siRNA systems. SRC, a membrane-associated 60-kDa tyrosine kinase, is reported to be involved in neuron death and neurite growth. We developed two types of gene-targeted mice in which we modified the status of SRC phosphorylation. We compared RGC survival and neurite growth by conducting in vivo and in vitro experiments. Adherence is currently a very important issue in the field of glaucoma. We developed a nm thick and composed of 21.5 chitosan-sodium alginate pairs. IOP reduction and its duration, as well as adverse effects, were investigated. In addition, we established and evaluated a support system for glaucoma care in an effort to promote participation of glaucoma patients in glaucoma care using information and communication technology. This system improved the literacy of glaucoma patients as well as glaucoma medical therapy. At the same time, in order to ably provide glaucoma care given the increase in the number of glaucoma patients and the shortage of glaucoma specialists, a tele-medicine system for ophthalmology was developed, in which ophthalmologists

  19. 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

  20. 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...

  1. 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…

  2. Action Agenda: Quality Care for African American Children.

    ERIC Educational Resources Information Center

    National Black Child Development Inst., Inc., Washington, DC.

    This action agenda focuses on quality child care for the Seattle (Washington) King County area. Poverty rates are high in King County, and quality child care is vital to breaking the cycle of poverty that traps many African-American families. A needs assessment in King County identified many areas for the improvement of child-care services. These…

  3. 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...

  4. 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 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...

  5. 38 CFR 52.120 - Quality of care.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 2 2010-07-01 2010-07-01 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....

  6. 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

  7. 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

  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. 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

  10. 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…

  11. Accountability and quality in managed care: implications for health care practitioners.

    PubMed

    Dobalian, A; Rivers, P A

    1998-01-01

    The development of managed care plans is the most dramatic change in the USA's health care system in recent decades. Despite the widespread growth, society is increasingly concerned with the quality of managed care programs. This article addresses the regulatory pressures that are being placed on managed care organisations and examines what health care practitioners can do to minimize the impact of increased regulation. We look at the major factors that are likely to bring about changes in the health care sector, and predict how these changes will affect the quality of health care that is being delivered in the near future. Addresses how quality can become and remain the primary factor in the delivery of health care services. Finally, concludes that greater involvement by the federal government is necessary to protect consumers' rights, and ensure better quality health care from managed care programs. PMID:10185327

  12. 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…

  13. 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

  14. 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

  15. The Impact of Child Care Subsidy Use on Child Care Quality

    PubMed Central

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

    2010-01-01

    In 2008, the federal government allotted $7 billion in child care subsidies to low-income families through the state-administered Child Care and Development Fund (CCDF), now the government’s largest child care program (US DHHS, 2008). Although subsidies reduce costs for families and facilitate parental employment, it is unclear how they impact the quality of care families purchase. This study investigates the impact of government subsidization on parents’ selection of child care quality using multivariate regression and propensity score matching approaches to account for differential selection into subsidy receipt and care arrangements. Data were drawn from the Child Care Supplement to the Fragile Families and Child Wellbeing Study (CCS-FFCWS), conducted in 2002 and 2003 in 14 of the 20 FFCWS cities when focal children were 3 years old (N = 456). Our results indicate that families who used subsidies chose higher quality care than comparable mothers who did not use subsidies, but only because subsidy recipients were more likely to use center-based care. Subgroup analyses revealed that families using subsidies purchased higher-quality home-based care but lower-quality center-based care than comparable non-recipients. Findings suggest that child care subsidies may serve as more than a work support for low-income families by enhancing the quality of nonmaternal care children experience but that this effect is largely attributable to recipients’ using formal child care arrangements (versus kith and kin care) more often than non-recipients. PMID:21874092

  16. The Impact of Child Care Subsidy Use on Child Care Quality.

    PubMed

    Ryan, Rebecca M; Johnson, Anna; Rigby, Elizabeth; Brooks-Gunn, Jeanne

    2011-01-01

    In 2008, the federal government allotted $7 billion in child care subsidies to low-income families through the state-administered Child Care and Development Fund (CCDF), now the government's largest child care program (US DHHS, 2008). Although subsidies reduce costs for families and facilitate parental employment, it is unclear how they impact the quality of care families purchase. This study investigates the impact of government subsidization on parents' selection of child care quality using multivariate regression and propensity score matching approaches to account for differential selection into subsidy receipt and care arrangements. Data were drawn from the Child Care Supplement to the Fragile Families and Child Wellbeing Study (CCS-FFCWS), conducted in 2002 and 2003 in 14 of the 20 FFCWS cities when focal children were 3 years old (N = 456). Our results indicate that families who used subsidies chose higher quality care than comparable mothers who did not use subsidies, but only because subsidy recipients were more likely to use center-based care. Subgroup analyses revealed that families using subsidies purchased higher-quality home-based care but lower-quality center-based care than comparable non-recipients. Findings suggest that child care subsidies may serve as more than a work support for low-income families by enhancing the quality of nonmaternal care children experience but that this effect is largely attributable to recipients' using formal child care arrangements (versus kith and kin care) more often than non-recipients. PMID:21874092

  17. 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)…

  18. 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;…

  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. 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…

  1. Early Palliative Care Improves Patients' Quality of Life

    MedlinePlus

    ... fullstory_160885.html Early Palliative Care Improves Patients' Quality of Life Also increases chances of having end- ... incurable cancer helps patients cope and improves their quality of life, a new study shows. It also ...

  2. Quality measurement and system change of cancer care delivery.

    PubMed

    Haggstrom, David A; Doebbeling, Bradley N

    2011-12-01

    Cancer care quality measurement and system change may serve as a case example for larger possibilities in the health care system related to other diseases. Cancer care quality gaps and variation exist across both technical and patient-centered cancer quality measures, especially among vulnerable populations. There is a need to develop measures that address the following dimensions of quality and its context: disparities, overuse, patient-centeredness, and uncertainty. Developments that may promote system change in cancer care delivery include changes in the information market, organizational accountability, and consumer empowerment. Information market changes include public cancer care quality reporting, enabled by health information exchange, and incentivized by pay-for-performance. Moving organizational accountability, reimbursement, and quality measurement from individual episodes of care to multiple providers providing coordinated cancer care may address quality gaps associated with the fragmentation of care delivery. Consumer empowerment through new technologies, such as personal health records, may lead to the collection of patient-centered quality measures and promote patient self-management. Across all of these developments, leadership and ongoing research to guide informed system changes will be necessary to transform the cancer care delivery system. PMID:20940654

  3. Improving Child Care Quality and Supply: The Impact of the Child Care and Development Block Grant.

    ERIC Educational Resources Information Center

    Blank, Helen

    1993-01-01

    Surveys how states are investing new federal money in child care quality and supply. Examines several key areas: child care licensing and monitoring; resource and referral services; child care for infants, school-agers, and children with special needs; child care for low-income families; comprehensive and enriched services; provider training;…

  4. 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

  5. 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

  6. Provider workload and quality of care in primary care settings: moderating role of relational climate.

    PubMed

    Mohr, David C; Benzer, Justin K; Young, Gary J

    2013-01-01

    Primary care providers are increasingly under pressure to do more with fewer resources. We examined the effect of workload on patients' experiences of quality of care, measured through approximately 44,000 patient experience surveys in a sample of 222 primary care clinics in the Veterans Health Administration. We tested the extent to which relational climate, a measure of teamwork, moderated the relationship between workload and patient ratings of quality of care. Our outcome measures included patient complaints, time spent with provider, and overall visit quality. Workload was negatively associated with patients' quality of care ratings and relational climate moderated the relation between workload and quality of care ratings. Patients seen in clinics with higher workload and greater relational climate reported better care compared with patients in clinics with higher workload but lower relational climate. Findings highlight the importance of relational climate as an important teamwork factor when managing and developing clinic policies, practices, and procedures in resource-constrained settings. PMID:23222471

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

    PubMed Central

    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

  8. 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…

  9. 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…

  10. Parent-Caregiver Communication and Quality of Care.

    ERIC Educational Resources Information Center

    Ghazvini, Alisa S.; Readdick, Christine, A.

    1994-01-01

    Investigated the relationship between parent-caregiver communication and child care quality in 12 child care centers representing different types of sponsorship. Compared to parents, caregivers rated all forms of parent-caregiver communication as more frequent and as more important. Frequency of parent-caregiver communication and quality of child…

  11. 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

  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. 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.…

  14. Children's Emotional Expression in Child Care Centers Varying in Quality.

    ERIC Educational Resources Information Center

    Hestenes, Linda L.; And Others

    1993-01-01

    Examined the relationships between day-care quality, children's emotional expression, and temperament among 60 3- to 5-year-olds in 26 day-care centers. Found that the appropriateness of the caregiving, but not the appropriateness of activities in the child-care center, significantly predicted the proportion of positive emotional affect in…

  15. 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

  16. How can clinicians measure safety and quality in acute care?

    PubMed

    Pronovost, Peter J; Nolan, Thomas; Zeger, Scott; Miller, Marlene; Rubin, Haya

    2011-03-01

    The demand for high quality care is increasing and warranted. Evidence suggests that the quality of care in hospitals can be improved. The greatest opportunity to improve outcomes for patients over the next quarter century will probably come not from discovering new treatments but from learning how to deliver existing effective therapies. To improve, caregivers need to know what to do, how they are doing, and be able to improve the processes of care. The ability to monitor performance, though challenging in healthcare, is essential to improving quality of care. We present a practical method to assess and learn from routine practice. Methods to evaluate performance from industrial engineering can be broadly applied to efforts to improve the quality of healthcare. One method that may help to provide caregivers frequent feedback is time series data--ie, results are graphically correlated with time. Broad use of these tools might lead to the necessary improvements in quality of care. PMID:23451357

  17. 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

  18. 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

  19. 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

  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. Is health care ready for Six Sigma quality?

    PubMed

    Chassin, M R

    1998-01-01

    Serious, widespread problems exist in the quality of U.S. health care: too many patients are exposed to the risks of unnecessary services; opportunities to use effective care are missed; and preventable errors lead to injuries. Advanced practitioners of industrial quality management, like Motorola and General Electric, have committed themselves to reducing the frequency of defects in their business processes to fewer than 3.4 per million, a strategy known as Six Sigma Quality. In health care, quality problems frequently occur at rates of 20 to 50 percent, or 200,000 to 500,000 per million. In order to approach Six Sigma levels of quality, the health care sector must address the underlying causes of error and make important changes: adopting new educational models; devising strategies to increase consumer awareness; and encouraging public and private investment in quality improvement. PMID:9879303

  2. 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

  3. "Who Says What Is Quality?": Setting Quality Standards for Family Child Care

    ERIC Educational Resources Information Center

    Modigliani, Kathy

    2011-01-01

    This article tells the story of the 4-year consensus-building process to design quality standards for the field of family child care. Working with the National Association for Family Child Care, the Family Child Care Project at Wheelock College was funded to create an accreditation system for home-based child care programs using innovative methods…

  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. Evaluation of a State Initiative to Improve Child Care Quality

    ERIC Educational Resources Information Center

    Roach, Mary A.; Riley, David A.; Adams, Diane; Edie, David

    2005-01-01

    Wisconsin's Early Childhood Excellence Initiative was a $15 million public policy effort designed in 2000 to increase child care quality for low-income children. An evaluation revealed significant improvement in classroom quality, the quality of caregiver interaction, and caregivers' beliefs about children following a complex multi-faceted…

  6. 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…

  7. 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)…

  8. 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…

  9. 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…

  10. 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

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

    PubMed

    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 patient's course causing referrals to occur late in a patient's 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

  12. Federal and state efforts to improve care for infants and toddlers.

    PubMed

    Knitzer, J

    2001-01-01

    Can government help mothers and fathers manage their economic and parenting responsibilities? Should it try? This article examines how federal and state governments currently act as partners with the parents of four million babies who are born each year in the United States. Viewing public policy as a tool that expresses the priorities of society, this article summarizes the leading ways that policy touches the lives of infants and toddlers--from the tax code to mandates for family leave, to cash benefits and subsidies, to funding for direct service programs. Several conclusions emerge from this detailed catalog: Significant federal policies focus on the economics of family life, helping low-income families meet their children's basic physical needs and allowing affluent families to shelter income for their children's benefit. Far less policy attention addresses the challenges that parents face as caregivers trying to ensure that their infants are safe, nurtured, and encouraged each day. Child care, despite its importance for children's development, is seen by policymakers primarily as a service that enables parents to work. Opportunities to promote child development through high-quality care, therefore, go untapped. Some states have creatively combined federal and state resources to provide new services for infants and caregivers, expand successful programs, and build linkages across programs and agencies. The author stresses the importance of maximizing the benefits of current federal policies that reduce the harm of child poverty, and urges policymakers to embed a developmental perspective in new state and federal programs and policies that touch the lives of infants, toddlers, and their families. PMID:11712458

  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. 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…

  15. 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…

  16. Working for Quality Child Care: An Early Childhood Education Text from the Child Care Employee Project.

    ERIC Educational Resources Information Center

    Whitebook, Marcy, Comp.; And Others

    This early childhood education text was designed to help students and child care staff become effective advocates for the improvement of quality, salaries, and working conditions in child care programs. Unit I provides literature on the issues affecting the child care field and focuses on strategies to improve salaries and working conditions.…

  17. 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

  18. Schizophrenia in the Netherlands: Continuity of Care with Better Quality of Care for Less Medical Costs

    PubMed Central

    van der Lee, Arnold; de Haan, Lieuwe; Beekman, Aartjan

    2016-01-01

    Background Patients with schizophrenia need continuous elective medical care which includes psychiatric treatment, antipsychotic medication and somatic health care. The objective of this study is to assess whether continuous elective psychiatric is associated with less health care costs due to less inpatient treatment. Methods Data concerning antipsychotic medication and psychiatric and somatic health care of patients with schizophrenia in the claims data of Agis Health Insurance were collected over 2008–2011 in the Netherlands. Included were 7,392 patients under 70 years of age with schizophrenia in 2008, insured during the whole period. We assessed the relationship between continuous elective psychiatric care and the outcome measures: acute treatment events, psychiatric hospitalization, somatic care and health care costs. Results Continuous elective psychiatric care was accessed by 73% of the patients during the entire three year follow-up period. These patients received mostly outpatient care and accessed more somatic care, at a total cost of €36,485 in three years, than those without continuous care. In the groups accessing fewer or no years of elective care 34%-68% had inpatient care and acute treatment events, while accessing less somatic care at average total costs of medical care from €33,284 to €64,509. Conclusions Continuous elective mental and somatic care for 73% of the patients with schizophrenia showed better quality of care at lower costs. Providing continuous elective care to the remaining patients may improve health while reducing acute illness episodes. PMID:27275609

  19. 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…

  20. 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

  1. Obstacles to employers' pursuit of health care quality.

    PubMed

    Hargraves, J Lee; Trude, Sally

    2002-01-01

    Large employers' roles in improving health care quality are shifting away from value-based purchasing toward direct efforts to improve health care delivery within local markets. Although most large employers adopted the tools required for value-based purchasing, inadequate information on quality has frustrated employers and limited their ability to make choices based on quality. More recent quality initiatives aimed at directly improving local health delivery systems may be limited to specific markets where the largest employers can exert substantial influence. PMID:12224883

  2. 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

  3. 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

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

    PubMed

    Fiscella, Kevin; Sanders, Mechelle R

    2016-01-01

    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

  5. [Nurses' notes, a tool which reflects quality of care].

    PubMed

    Gonfier-Saez, Fabienne

    2011-10-01

    Nurses' notes, a tool which reflects the quality of care. Originally, nurses passed on knowledge and actions verbally. Theorists then developed care models which emerging nursing schools taught their students. Tools for writing down and passing on information were created, refined and adapted to meet the evolutions of society. As the main thread of nursing notes, clinical reasoning guides the implementation of the care given. PMID:22069914

  6. 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

  7. Agents for change: nonphysician medical providers and health care quality.

    PubMed

    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

  8. Effective multidisciplinary working: the key to high-quality care.

    PubMed

    Ndoro, Samuel

    This article explores multidisciplinary team working, inter-disciplinary, trans-disciplinary and effective collaborative practice in order to provide high-quality patient care. It discusses different views on collaboration, some of the issues around cross-discipline and multi-agency working and concerns around promoting 'high-quality' care. It also discusses the importance of evidence-based practice in multidisciplinary teams. Issues around good-quality care, clinical governance and the audit cycle in MDTs are addressed. The article highlights the importance of the 6Cs (care, compassion, competence, communication, courage and commitment) in MDTs if quality care is to be achieved. The article also explores advantages and limitations of multidisciplinary team working, trans-disciplinary working and inter-professional working in developing and delivering high-quality patient-centred care. Further research is needed on how clinical audits can help to improve how MDTs function in order improve the quality of service provided to clients. PMID:25072333

  9. Federal efforts to improve quality of care: the Quality Interagency Coordination Task Force (QuIC).

    PubMed

    Eisenberg, J M; Foster, N E; Meyer, G; Holland, H

    2001-02-01

    FORMATION OF THE QUIC: The Quality Interagency Coordination Task Force (QuIC) was established in 1998 to enable the participating federal agencies to coordinate their activities to study, measure, and improve the quality of care delivered by federal health programs; provide people with information to help them in making more informed choices about their care; and develop the research base and infrastructure needed to improve the health care system, including knowledgeable and empowered workers, well-designed systems of care, and useful information systems. STUDY, MEASURE, AND IMPROVE CARE: The QuIC's initial efforts to improve the care delivered in federal health care programs have focused on diabetes, depression, and the effect of working conditions on quality of care. More recently, patient safety efforts are under way to establish a coordinating center that will enable those who are testing methods of reducing errors to share information across their projects and with experts in error reduction. DEVELOP A RESEARCH BASE AND INFRASTRUCTURE: The QuIC has coordinated efforts in credentialing, information on measures of quality, a taxonomy of quality improvement methods, and errors data collection. PROVIDE INFORMATION TO AMERICANS ABOUT HEALTH CARE QUALITY: The QuIC agencies are developing products that will enhance their ability to communicate with the American people about their health care choices: improved gateways for consumer information available from federal agencies, a glossary of commonly used terms, and guidance for producing report cards on quality of care. MOVING THE QUALITY IMPROVEMENT AGENDA FORWARD: Federal efforts to improve quality of care are moving forward in a more integrated fashion on a wide number of fronts. PMID:11221014

  10. 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

  11. 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…

  12. Quality Control in Child Care Staff Selection

    ERIC Educational Resources Information Center

    Crow, Merwin R.

    1975-01-01

    This paper focuses on the process of staff selection of child care staff at a residential treatment center for children, ages 8-16. Phases of candidate selection, an "open-door" interview procedure, the orientation of hired candidates and the agency's philosophy, procedures and practices are discussed. (GO)

  13. Quality of Care Provided by a Comprehensive Dementia Care Comanagement Program.

    PubMed

    Jennings, Lee A; Tan, Zaldy; Wenger, Neil S; Cook, Erin A; Han, Weijuan; McCreath, Heather E; Serrano, Katherine S; Roth, Carol P; Reuben, David B

    2016-08-01

    Multiple studies have shown that quality of care for dementia in primary care is poor, with physician adherence to dementia quality indicators (QIs) ranging from 18% to 42%. In response, the University of California at Los Angeles (UCLA) Health System created the UCLA Alzheimer's and Dementia Care (ADC) Program, a quality improvement program that uses a comanagement model with nurse practitioner dementia care managers (DCM) working with primary care physicians and community-based organizations to provide comprehensive dementia care. The objective was to measure the quality of dementia care that nurse practitioner DCMs provide using the Assessing Care of Vulnerable Elders (ACOVE-3) and Physician Consortium for Performance Improvement QIs. Participants included 797 community-dwelling adults with dementia referred to the UCLA ADC program over a 2-year period. UCLA is an urban academic medical center with primarily fee-for-service reimbursement. The percentage of recommended care received for 17 dementia QIs was measured. The primary outcome was aggregate quality of care for the UCLA ADC cohort, calculated as the total number of recommended care processes received divided by the total number of eligible quality indicators. Secondary outcomes included aggregate quality of care in three domains of dementia care: assessment and screening (7 QIs), treatment (6 QIs), and counseling (4 QIs). QIs were abstracted from DCM notes over a 3-month period from date of initial assessment. Individuals were eligible for 9,895 QIs, of which 92% were passed. Overall pass rates of DCMs were similar (90-96%). All counseling and assessment QIs had pass rates greater than 80%, with most exceeding 90%. Wider variation in adherence was found among QIs addressing treatments for dementia, which patient-specific criteria triggered, ranging from 27% for discontinuation of medications associated with mental status changes to 86% for discussion about acetylcholinesterase inhibitors. Comprehensive

  14. 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

  15. 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…

  16. Teacher Structure and Child Care Quality in Preschool Classrooms

    ERIC Educational Resources Information Center

    Shim, Jonghee; Hestenes, Linda; Cassidy, Deborah

    2004-01-01

    The present study examined the relationships between teacher structure, teacher behaviors, and child care quality. Participants included 72 female teachers from 44 preschool classrooms. Both a global measure of quality and a measure of teacher-child interaction were utilized. Results showed that a co-teacher structure was associated with higher…

  17. Evidence of improved quality of life with pediatric palliative care.

    PubMed

    O'Quinn, Lucy P; Giambra, Barbara K

    2014-01-01

    Pediatric nurses provide holistic family-centered care for children with life-limiting illnesses while being sensitive to children's growth and developmental needs. To learn how pediatric palliative care programs benefit children and their families, the following clinical question was asked: Among children with a life-limiting illness, does the use of a palliative care program compared with not using a palliative care program improve quality of life for patients and their families? Evidence from two studies found that palliative care services improve quality of life for children with life-limiting illness and their families in the areas of the child's emotional well-being and parental perception of preparation for the child's end of life, resulting in a low grade for the body of evidence. Future research should include high quality studies with larger sample sizes and control groups, and include children's perspectives--from both patients and siblings--to give a more complete picture of how best to improve their quality of life. A reliable tool is needed that includes a spiritual component and sensitive indicators specific to children with a life-limiting illness. Future research using this tool will more fully answer how palliative care services improve children's quality of life. PMID:25929123

  18. 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

  19. Primary Care Quality among Different Health Care Structures in Tibet, China

    PubMed Central

    Yin, Aitian; Mao, Zongfu; Liu, Xiaoyun

    2015-01-01

    Objective. To compare the primary care quality among different health care structures in Tibet, China. Methods. A self-administered questionnaire survey including Primary Care Assessment Tool-Tibetan version was used to obtain data from a total of 1386 patients aged over 18 years in the sampling sites in two prefectures in Tibet. Multivariate analysis was performed to assess the association between health care structures and primary care quality while controlling for sociodemographic and health care characteristics. Results. The services provided by township health centers were more often used by a poor, less educated, and healthy population. Compared with prefecture (77.42) and county hospitals (82.01), township health centers achieved highest total score of primary care quality (86.64). Factors that were positively and significantly associated with higher total assessment scores included not receiving inpatient service in the past year, less frequent health care visits, good self-rated health status, lower education level, and marital status. Conclusions. This study showed that township health centers patients reported better primary care quality than patients visiting prefecture and county hospitals. Government health reforms should pay more attention to THC capacity building in Tibet, especially in the area of human resource development. PMID:25861619

  20. Adult day care: promoting quality of life for the elderly.

    PubMed

    Hunter, S

    1992-02-01

    1. Adult day care allows elderly clients to continue to be a part of their family. The program promotes maintenance of joint mobility, challenges the mind, and allows the client to be a productive part of the community. 2. As director of an adult day care center, it is the RN's responsibility to ensure quality of care for all clients. This includes providing inservice education, establishing quality assurance monitoring, and individualizing care plans for each client. 3. For appropriate placement in day care, the client must be oriented, cooperative, and able to comprehend communication. Physical endurance must allow the client to remain out of bed during the day, and the staff must be able to manage physical handicaps. PMID:1538082

  1. Quality of Life and Supportive Care in Multiple Myeloma

    PubMed Central

    Cömert, Melda; Güneş, Ajda Ersoy; Şahin, Fahri; Saydam, Güray

    2013-01-01

    Multiple myeloma is the second most common haematological malignancy. Novel therapies have led to improvement in survival. Current myeloma management is matching the progress made in improved survival through disease control while optimising quality of life with effective supportive care. Supportive treatment is an essential part of the therapeutic management of myeloma patients because it is directed towards improving the patient’s quality of life and also can improve survival. The aim of this review is to highlight the relationship among life of quality, supportive care, and improvement in survival. Conflict of interest:None declared. PMID:24385802

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

    PubMed

    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

  3. 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

  4. Advance Care Planning and the Quality of End-of-Life Care among Older Adults

    PubMed Central

    Bischoff, Kara E.; Sudore, Rebecca; Miao, Yinghui; Boscardin, W. John; Smith, Alexander K.

    2013-01-01

    Background Advance care planning is increasingly common, but whether it influences end-of-life quality of care remains controversial. Design Medicare data and survey data from the Health and Retirement Study were combined to determine whether advance care planning was associated with quality metrics. Setting The nationally representative Health and Retirement Study. Participants 4394 decedent subjects (mean age 82.6 years at death, 55% women). Measurements Advance care planning was defined as having an advance directive, durable power of attorney or having discussed preferences for end-of-life care with a next-of-kin. Outcomes included previously reported quality metrics observed during the last month of life (rates of hospital admission, in-hospital death, >14 days in the hospital, intensive care unit admission, >1 emergency department visit, hospice admission, and length of hospice ≤3 days). Results Seventy-six percent of subjects engaged in advance care planning. Ninety-two percent of advance directives stated a preference to prioritize comfort. After adjustment, subjects who engaged in advance care planning were less likely to die in a hospital (adjusted RR 0.87, 95% CI 0.80-0.94), more likely to be enrolled in hospice (aRR 1.68, 1.43-1.97), and less likely to receive hospice for ≤3 days before death (aRR 0.88, 0.85-0.91). Having an advance directive, a durable-power-of-attorney or an advance care planning discussion were each independently associated with a significant increase in hospice use (p<0.01 for all). Conclusion Advance care planning was associated with improved quality of care at the end of life, including less in-hospital death and increased use of hospice. Having an advance directive, assigning a durable power of attorney and conducting advance care planning discussions are all important elements of advance care planning. PMID:23350921

  5. Assuring Quality Health Care in the Emergency Department

    PubMed Central

    Letvak, Susan; Rhew, Denise

    2015-01-01

    The provision of quality healthcare is an international mandate. The provision of quality healthcare for mental health patients poses unique challenges. Nowhere is this challenge greater than in the emergency department. The purpose of this manuscript is to describe evidence-based initiatives for improving the quality of care of mental health patients in the emergency department. Specifically, the use of telepsychiatry and reducing provider biases will be presented.

  6. 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

  7. Enhancing family physician capacity to deliver quality palliative home care

    PubMed Central

    Marshall, Denise; Howell, Doris; Brazil, Kevin; Howard, Michelle; Taniguchi, Alan

    2008-01-01

    ABSTRACT PROBLEM BEING ADDRESSED Family physicians face innumerable challenges to delivering quality palliative home care to meet the complex needs of end-of-life patients and their families. OBJECTIVE OF PROGRAM To implement a model of shared care to enhance family physicians’ ability to deliver quality palliative home care, particularly in a community-based setting. PROGRAM DESCRIPTION Family physicians in 3 group practices (N = 21) in Ontario’s Niagara West region collaborated with an interprofessional palliative care team (including a palliative care advanced practice nurse, a palliative medicine physician, a bereavement counselor, a psychosocial-spiritual advisor, and a case manager) in a shared-care partnership to provide comprehensive palliative home care. Key features of the program included systematic and timely identification of end-of-life patients, needs assessments, symptom and psychosocial support interventions, regular communication between team members, and coordinated care guided by outcome-based assessment in the home. In addition, educational initiatives were provided to enhance family physicians’ knowledge and skills. CONCLUSION Because of the program, participants reported improved communication, effective interprofessional collaboration, and the capacity to deliver palliative home care, 24 hours a day, 7 days a week, to end-of-life patients in the community. PMID:19074714

  8. Florida Initiative for Quality Cancer Care: Improvements on Colorectal Cancer Quality of Care Indicators during a 3-Year Interval

    PubMed Central

    Siegel, Erin M; Jacobsen, Paul B; Lee, Ji-Hyun; Malafa, Mokenge; Fulp, William; Fletcher, Michelle; Smith, Jesusa Corazon R; Brown, Richard; Levine, Richard; Cartwright, Thomas; Abesada-Terk, Guillermo; Kim, George; Alemany, Carlos; Faig, Douglas; Sharp, Philip; Markham, Merry-Jennifer; Shibata, David

    2015-01-01

    BACKGROUND The quality of cancer care has become a national priority; however, there are few ongoing efforts to assist medical oncology practices in identifying areas for improvement. The Florida Initiative for Quality Cancer Care is a consortium of 11 medical oncology practices that evaluates the quality of cancer care across Florida. Within this practice-based system of self-assessment, we determined adherence to colorectal cancer quality of care indicators (QCIs) in 2006, disseminated results to each practice and reassessed adherence in 2009. The current report focuses on evaluating the direction and magnitude of change in adherence to QCIs for colorectal cancer patients between the 2 assessments. STUDY DESIGN Medical records were reviewed for all colorectal cancer patients seen by a medical oncologist in 2006 (n = 489) and 2009 (n = 511) at 10 participating practices. Thirty-five indicators were evaluated individually and changes in QCI adherence over time and by site were examined. RESULTS Significant improvements were noted from 2006 to 2009, with large gains in surgical/pathological QCIs (eg, documenting rectal radial margin status, lymphovascular invasion, and the review of ≥12 lymph nodes) and medical oncology QCIs (documenting planned treatment regimen and providing recommended neoadjuvant regimens). Documentation of perineural invasion and radial margins significantly improved; however, adherence remained low (47% and 71%, respectively). There was significant variability in adherence for some QCIs across institutions at follow-up. CONCLUSIONS The Florida Initiative for Quality Cancer Care practices conducted self-directed quality-improvement efforts during a 3-year interval and overall adherence to QCIs improved. However, adherence remained low for several indicators, suggesting that organized improvement efforts might be needed for QCIs that remained consistently low over time. Findings demonstrate how efforts such as the Florida Initiative for

  9. 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

  10. 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

  11. 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

  12. 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

  13. 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

  14. Pregnancy Medical Home Care Pathways Improve Quality of Perinatal Care and Birth Outcomes.

    PubMed

    Berrien, Kate; Ollendorff, Arthur; Menard, M Kathryn

    2015-01-01

    The clinical leadership of the Pregnancy Medical Home (PMH) program develops and disseminates clinical pathways to promote evidence-based practice and to improve quality of care and outcomes. PMH pathways represent the first standardized clinical guidance for obstetric providers statewide across all care settings. PMID:26509523

  15. 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

  16. 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

  17. 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…

  18. 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…

  19. Anesthesia Safe for Infants, Toddlers, Study Says

    MedlinePlus

    ... or federal policy. More Health News on: Anesthesia Child Development Recent Health News Related MedlinePlus Health Topics Anesthesia Child Development About MedlinePlus Site Map FAQs Contact Us Get ...

  20. Anesthesia Safe for Infants, Toddlers, Study Says

    MedlinePlus

    ... Services, or federal policy. More Health News on: Child Development Recent Health News Related MedlinePlus Health Topics Anesthesia Child Development About MedlinePlus Site Map FAQs Contact Us Get ...

  1. Reforming primary care in England--again. Plans for improving the quality of care.

    PubMed

    Baker, R

    2000-06-01

    An extensive programme of health service reform has begun in England. Improvement in the quality of care is a key objective of the reforms, and several initiatives are being introduced in response. These include systems to provide national guidance about appropriate treatment and services, a local system to support quality improvement and arrangements to monitor performance, including a new performance framework, an inspection agency and an annual survey of patients. The local quality improvement system has features of particular interest. These include arrangements for setting objectives for quality improvement, the use of various quality improvement methods tailored to local needs and a new system to provide accountability to both the health service and the public. The introduction of clinical governance and all the other reforms presents primary care practitioners with a major challenge. However, if sufficient time is allowed and adequate resources are made available, the reforms do have the potential to improve health care in England. PMID:10944059

  2. 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…

  3. 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…

  4. 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…

  5. 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…

  6. 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…

  7. 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…

  8. 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)…

  9. 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…

  10. 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…

  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. 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…

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

    PubMed Central

    Siu, A L; McGlynn, E A; Morgenstern, H; Beers, M H; Carlisle, D M; Keeler, E B; Beloff, J; Curtin, K; Leaning, J; Perry, B C

    1992-01-01

    Consumers, payers, and policymakers are demanding to know more about the quality of the services they are purchasing or might purchase. The information provided, however, is often driven by data availability rather than by epidemiologic and clinical considerations. In this article, we present an approach for selecting topics for measuring technical quality of care, based on the expected impact on health of improved quality. This approach employs data or estimates on disease burden, efficacy of available treatments, and the current quality of care being provided. We use this model to select measures that could be used to measure the quality of care in health plans, but the proposed framework could also be used to select quality of care measures for other purposes or in other contexts (for example, to select measures for hospitals). Given the limited resources available for quality assessment and the policy consequences of better information on provider quality, priorities for assessment efforts should focus on those areas where better quality translates into improved health. PMID:1464537

  14. Is the quality of hospital care a function of leadership?

    PubMed

    Harrison, Jeffrey P; Coppola, M Nicholas

    2007-01-01

    Multiple regression analysis was used to evaluate the relationship between hospital quality and independent variables of interest. While past studies have analyzed hospital efficiency to evaluate organizational performance, this study is unique because it evaluates the relationship between quality and efficiency. The study incorporates an independent variable, "efficiency," calculated using a variable returns-to-scale, input-oriented, data envelopment analysis methodology. This article provides an innovative approach to measuring cost and quality as the federal government attempts to realign scarce health care resources to better meet local community needs. Data for 143 hospitals in 2000 were analyzed using multiple regression and data envelopment analysis to evaluate hospital quality. These results have managerial implications related to improving hospital quality as well as enhancing organizational performance. The study has policy implications on the relationship between quality and efficiency and supports current initiatives related to pay-for-performance in the health care industry. This study clearly documents the positive relationship between quality and efficiency, which supports the premise that hospital leadership through the effective allocation of resources and development of high-performance work processes is important to improve quality of care. PMID:17938596

  15. 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

  16. 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

  17. 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

  18. 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

  19. [Health care research to improve the quality of health care provision for older people].

    PubMed

    Kuhlmey, A

    2011-08-01

    This article addresses the contribution that health care research can make to facilitating appropriate health care provision for older adults. First, the major risks in this age group are described. These include multiple illnesses, the increasing need for nursing care with age, but also the growing numbers of older adults with psychological disorders, primarily dementia. The second section of the article presents a critical assessment of the current health care situation in light of the risks identified. On this basis, the third section specifies the areas of health care research that can contribute to improving the quality of the health care provision for this population. The article is based on a presentation made by the author at the 2010 Berlin Talks on Social Medicine: "The New Old--Health Care Research for a Changed Society." PMID:21800238

  20. 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

  1. 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

  2. Gauging food and nutritional care quality in hospitals

    PubMed Central

    2012-01-01

    Background Food and nutritional care quality must be assessed and scored, so as to improve health institution efficacy. This study aimed to detect and compare actions related to food and nutritional care quality in public and private hospitals. Methods Investigation of the Hospital Food and Nutrition Service (HFNS) of 37 hospitals by means of structured interviews assessing two quality control corpora, namely nutritional care quality (NCQ) and hospital food service quality (FSQ). HFNS was also evaluated with respect to human resources per hospital bed and per produced meal. Results Comparison between public and private institutions revealed that there was a statistically significant difference between the number of hospital beds per HFNS staff member (p = 0.02) and per dietitian (p < 0.01). The mean compliance with NCQ criteria in public and private institutions was 51.8% and 41.6%, respectively. The percentage of public and private health institutions in conformity with FSQ criteria was 42.4% and 49.1%, respectively. Most of the actions comprising each corpus, NCQ and FSQ, varied considerably between the two types of institution. NCQ was positively influenced by hospital type (general) and presence of a clinical dietitian. FSQ was affected by institution size: large and medium-sized hospitals were significantly better than small ones. Conclusions Food and nutritional care in hospital is still incipient, and actions concerning both nutritional care and food service take place on an irregular basis. It is clear that the design of food and nutritional care in hospital indicators is mandatory, and that guidelines for the development of actions as well as qualification and assessment of nutritional care are urgent. PMID:22954229

  3. 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

  4. 42 CFR 457.495 - State assurance of access to care and procedures to assure quality and appropriateness of care.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false State assurance of access to care and procedures to assure quality and appropriateness of care. 457.495 Section 457.495 Public Health CENTERS FOR MEDICARE... State assurance of access to care and procedures to assure quality and appropriateness of care. A...

  5. 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

  6. 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

  7. Agents of Change in Foster Care for Infants and Toddlers.

    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. Conceived by the Zero to Three Child Welfare Task Force, this issue focuses on agents of change for infants and toddlers in foster…

  8. 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

  9. 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

  10. 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

  11. The management of health care service quality. A physician perspective

    PubMed Central

    Bobocea, L; Gheorghe, IR; Spiridon, St; Gheorghe, CM; Purcarea, VL

    2016-01-01

    Applying marketing in health care services is presently an essential element for every manager or policy maker. In order to be successful, a health care organization has to identify an accurate measurement scale for defining service quality due to competitive pressure and cost values. The most widely employed scale in the services sector is SERVQUAL scale. In spite of being successfully adopted in fields such as brokerage and banking, experts concluded that the SERVQUAL scale should be modified depending on the specific context. Moreover, the SERVQUAL scale focused on the consumer’s perspective regarding service quality. While service quality was measured with the help of SERVQUAL scale, other experts identified a structure-process-outcome design, which, they thought, would be more suitable for health care services. This approach highlights a different perspective on investigating the service quality, namely, the physician’s perspective. Further, we believe that the Seven Prong Model for Improving Service Quality has been adopted in order to effectively measure the health care service in a Romanian context from a physician’s perspective. PMID:27453745

  12. The management of health care service quality. A physician perspective.

    PubMed

    Bobocea, L; Gheorghe, I R; Spiridon, St; Gheorghe, C M; Purcarea, V L

    2016-01-01

    Applying marketing in health care services is presently an essential element for every manager or policy maker. In order to be successful, a health care organization has to identify an accurate measurement scale for defining service quality due to competitive pressure and cost values. The most widely employed scale in the services sector is SERVQUAL scale. In spite of being successfully adopted in fields such as brokerage and banking, experts concluded that the SERVQUAL scale should be modified depending on the specific context. Moreover, the SERVQUAL scale focused on the consumer's perspective regarding service quality. While service quality was measured with the help of SERVQUAL scale, other experts identified a structure-process-outcome design, which, they thought, would be more suitable for health care services. This approach highlights a different perspective on investigating the service quality, namely, the physician's perspective. Further, we believe that the Seven Prong Model for Improving Service Quality has been adopted in order to effectively measure the health care service in a Romanian context from a physician's perspective. PMID:27453745

  13. 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 patient’s course causing referrals to occur late in a patient’s 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

  14. 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

  15. 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,…

  16. Compendium of Quality Rating Systems and Evaluations: The Child Care Quality Rating System (QRS) Assessment

    ERIC Educational Resources Information Center

    Tout, Kathryn; Starr, Rebecca; Soli, Margaret; Moodie, Shannon; Kirby, Gretchen; Boller, Kimberly

    2010-01-01

    Quality Rating Systems (QRS) are currently operating, under development, or being piloted in over 25 states or local areas. As the QRS model becomes integrated into the landscape of child care and education service delivery, policy, and the decisions parents make about child care across the United States, there is an increasing need for…

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

    PubMed Central

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

    2013-01-01

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

  18. Ensuring Quality Cancer Care: A Follow-Up Review of the Institute of Medicine’s Ten Recommendations for Improving the Quality of Cancer Care in America

    PubMed Central

    Spinks, Tracy; Albright, Heidi W.; Feeley, Thomas W.; Walters, Ron; Burke, Thomas W.; Aloia, Thomas; Bruera, Eduardo; Buzdar, Aman; Foxhall, Lewis; Hui, David; Summers, Barbara; Rodriguez, Alma; DuBois, Raymond; Shine, Kenneth I.

    2011-01-01

    Responding to growing concerns regarding the safety, quality, and efficacy of cancer care in the United States, the Institute of Medicine (IOM) of the National Academy of Sciences commissioned a comprehensive review of cancer care delivery in the US healthcare system in the late 1990s. The National Cancer Policy Board (NCPB), a twenty-member board with broad representation, performed this review. In its review, the NCPB focused on the state of cancer care delivery at that time, its shortcomings, and ways to measure and improve the quality of cancer care. The NCPB described an ideal cancer care system, where patients would have equitable access to coordinated, guideline-based care and novel therapies throughout the course of their disease. In 1999, the IOM published the results of this review in its influential report, Ensuring Quality Cancer Care. This report outlined ten recommendations, which, when implemented, would: 1) improve the quality of cancer care; 2) increase our understanding of quality cancer care; and, 3) reduce or eliminate access barriers to quality cancer care. Despite the fervor generated by this report, there are lingering doubts regarding the safety and quality of cancer care in the United States today. Increased awareness of medical errors and barriers to quality care, coupled with escalating healthcare costs, has prompted national efforts to reform the healthcare system. These efforts by healthcare providers and policymakers should bridge the gap between the ideal state described in Ensuring Quality Cancer Care and the current state of cancer care in the United States. PMID:22045610

  19. Patient involvement in education for enhanced quality of care.

    PubMed

    Le Var, R M H

    2002-12-01

    Government policies in the UK are promoting health care practitioners working in partnership with patients and clients as an important constituent of quality in health care delivery. However, for practitioners to work in this way requires experience of such partnerships in the educational preparation. The involvement of patients and clients (i.e. service users) and their carers in the curriculum has been encouraged and supported in England since the early 1990s. From 1998, the comprehensive involvement in all phases of programme provision has been a requirement, ensuring that service users have a real 'voice' in influencing the direction of programmes. Examples of good practice are provided, demonstrating a range of approaches in the different stages of the educational process. Issues to be considered for successful implementation are included. Benefits to education and patient/client care are identified on the basis of literature and recent experience. They are strongly associated with enhanced quality of care. The article argues for a need to continue to broaden implementation for the major benefits of influencing the attitudes and approaches of students, and empowering users, with the end result of enhancing the quality of care. A strategic approach is needed to make user involvement an effective and workable reality. The need for systematic evaluation of the outcomes and for publications is highlighted. The principle of service user involvement in educational preparation is deemed to be equally relevant in other countries. PMID:12492943

  20. Compassion: the missing link in quality of care.

    PubMed

    van der Cingel, Margreet

    2014-09-01

    This article discusses the impact of selected findings from a PhD-study that focuses on compassion as a guiding principle for contemporary nursing education and practice. The study, of which the literature review and empirical findings have already been published, looked at compassion as perceived within the relationship of nurses and older persons with a chronic disease. The patient group was chosen because daily life for them is characterized by long-term dependency on care. The literature review resulted in a theoretical framework of compassion that also explores other closely related concepts such as suffering and empathy. The empirical part of the study, in which 61 in-depth interviews and 6 group interviews with patients and nurses took place, showed that compassion is a mirroring process in response to grief. Compassion consists of seven dimensions such as attentiveness and presence, in which saliency, so as to anticipate patients' needs, is of major importance. Compassion is perceived by participants as an indispensable aspect of care, which helps to reveal relevant information in order to establish appropriate outcomes of care. This article focuses on the aspects of the PhD-study in which an analysis of compassion in the context of both modern as well as the history of nursing took place. Currently evidence based practice is regarded as the standard for good quality care. Nevertheless there is an on-going debate about what constitutes good quality care. Within this debate two opposing views are apparent. One view defines good care as care supported by the best scientific evidence. The other view states that good care takes place within the nurse-patient relationship in which the nurse performs professional care based on intuitive knowing. It is suggested that compassion is the (missing) link between these views. PMID:24856582

  1. 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…

  2. 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

  3. 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…

  4. 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…

  5. 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)

  6. 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…

  7. 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…

  8. Improving the quality of health care: what's taking so long?

    PubMed

    Chassin, Mark R

    2013-10-01

    Nearly fourteen years ago the Institute of Medicine's report, To Err Is Human: Building a Safer Health System, triggered a national movement to improve patient safety. Despite the substantial and concentrated efforts that followed, quality and safety problems in health care continue to routinely result in harm to patients. Desired progress will not be achieved unless substantial changes are made to the way in which quality improvement is conducted. Alongside important efforts to eliminate preventable complications of care, there must also be an effort to seriously address the widespread overuse of health services. That overuse, which places patients at risk of harm and wastes resources at the same time, has been almost entirely left out of recent quality improvement endeavors. Newer and much more effective strategies and tools are needed to address the complex quality challenges confronting health care. Tools such as Lean, Six Sigma, and change management are proving highly effective in tackling problems as difficult as hand-off communication failures and patient falls. Finally, the organizational culture of most American hospitals and other health care organizations must change. To create a culture of safety, leaders must eliminate intimidating behaviors that suppress the reporting of errors and unsafe conditions. Leaders must also hold everyone accountable for adherence to safe practices. PMID:24101066

  9. 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

  10. Recognizing Differences in Hospital Quality Performance for Pediatric Inpatient Care

    PubMed Central

    Zaslavsky, Alan M.; Toomey, Sara L.; Chien, Alyna T.; Jang, Jisun; Bryant, Maria C.; Klein, David J.; Kaplan, William J.; Schuster, Mark A.

    2015-01-01

    BACKGROUND: Hospital quality-of-care measures are publicly reported to inform consumer choice and stimulate quality improvement. The number of hospitals and states with enough pediatric hospital discharges to detect worse-than-average inpatient care remains unknown. METHODS: This study was a retrospective analysis of hospital discharges for children aged 0 to 17 years from 3974 hospitals in 44 states in the 2009 Kids’ Inpatient Database. For 11 measures of all-condition or condition-specific quality, we assessed the number of hospitals and states that met a “power standard” of 80% power for a 5% level significance test to detect when care is 20% worse than average over a 3-year period. For this assessment, we approximated volume as 3 times actual 2009 admission volumes. RESULTS: For all-condition quality, 1380 hospitals (87% of all pediatric discharges) and all states met the power standard for the family experience-of-care measure; 1958 hospitals (95% of discharges) and all states met the standard for adverse drug events. For condition-specific quality measures of asthma, birth, and mental health, 203 to 482 hospitals (52%–90% of condition-specific discharges) met the power standard and 40 to 44 states met the standard. One hospital and 16 states met the standard for sickle cell disease. No hospital and ≤27 states met the standard for the remaining measures studied (appendectomy, cerebrospinal fluid shunt surgery, gastroenteritis, heart surgery, and seizure). CONCLUSIONS: Most children are admitted to hospitals in which all-condition measures of quality have adequate power to show modest differences in performance from average, but most condition-specific measures do not. Policies regarding incentives for pediatric inpatient quality should take these findings into account. PMID:26169435

  11. 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

  12. 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

  13. Changing personnel behavior to promote quality care practices in an intensive care unit

    PubMed Central

    Cooper, Dominic; Farmery, Keith; Johnson, Martin; Harper, Christine; Clarke, Fiona L; Holton, Phillip; Wilson, Susan; Rayson, Paul; Bence, Hugh

    2005-01-01

    The delivery of safe high quality patient care is a major issue in clinical settings. However, the implementation of evidence-based practice and educational interventions are not always effective at improving performance. A staff-led behavioral management process was implemented in a large single-site acute (secondary and tertiary) hospital in the North of England for 26 weeks. A quasi-experimental, repeated-measures, within-groups design was used. Measurement focused on quality care behaviors (ie, documentation, charting, hand washing). The results demonstrate the efficacy of a staff-led behavioral management approach for improving quality-care practices. Significant behavioral change (F [6, 19] = 5.37, p < 0.01) was observed. Correspondingly, statistically significant (t-test [t] = 3.49, df = 25, p < 0.01) reductions in methicillin-resistant Staphylococcus aureus (MRSA) were obtained. Discussion focuses on implementation issues. PMID:18360574

  14. 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

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

    PubMed Central

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

    2015-01-01

    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

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

    PubMed Central

    Braun, Jan-Peter; Bause, Hanswerner; Bloos, Frank; Geldner, Götz; Kastrup, Marc; Kuhlen, Ralf; Markewitz, Andreas; Martin, Jörg; 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

  17. Quality of Care for Transcatheter Aortic Valve Implantation: Development of Canadian Cardiovascular Society Quality Indicators.

    PubMed

    Asgar, Anita W; Lauck, Sandra; Ko, Dennis; Alqoofi, Faisal; Cohen, Eric; Forsey, Anne; Lambert, Laurie J; Oakes, Garth H; Pelletier, Marc; Webb, John G

    2016-08-01

    Transcatheter aortic valve implantation (TAVI) is a relatively new procedure to treat aortic stenosis in patients at high surgical risk, and it is becoming increasingly available in Canada. Variation exists in the clinical care, program coordination, evaluation, and funding across provinces and centres. As a part of the Canadian Cardiovascular Society (CCS) quality initiative, the TAVI Quality Indicator (QI) Working Group was established in 2014 to develop a set of indicators to measure quality of care for Canadians undergoing TAVI for aortic stenosis. The TAVI QI Working Group is composed of expert clinical and government agency representatives. The group developed consensus agreements for the selection of the first iteration of measurable structure, process, and outcome indicators reflective of the quality of care for patients undergoing TAVI. The objectives of the project are to develop quality indicators with the eventual goal of standardizing TAVI quality reports across Canada and to support local and national quality assurance, as well as engage multiple stakeholders to build a national strategy for the evaluation of quality of care. PMID:26948037

  18. 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…

  19. 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

  20. 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

  1. Quality assurance in the health care system in The Netherlands.

    PubMed

    Reerink, E

    1987-03-01

    Thirteen years of activities in the field of quality assurance in the health care field in The Netherlands bring to life the many ups and some downs in this intriguing endeavour. Back in 1974, quality assurance was in the minds of few individuals and in the hands of nobody. This has changed dramatically: not only are there now functioning programmes carried out by knowledgeable and dedicated health care providers, there is legislation that suits the convenience of quality assurance, and a firm delineation of responsibilities. At the same time there is flexibility which enables the various actors to interpret their roles according to their capabilities and tastes. The various contributions in this issue are part of this national development. PMID:3566639

  2. 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.…

  3. The Primary Care Respiratory Society-UK Quality Award: development and piloting of quality standards for primary care respiratory medicine.

    PubMed

    Gruffydd-Jones, Kevin; Small, Iain; Fletcher, Monica; Bryant, Tricia

    2013-09-01

    In an attempt to improve the standards of primary respiratory care in the UK, the Primary Care Respiratory Society-UK (PCRS-UK), in conjunction with other leading respiratory-interested health professional and patient groups, has devised a General Practice Quality Award for Respiratory Medicine. The Award is divided into three modules separated into a total of seven clinical standards (in parentheses): 'Clinical' (prevention, early and accurate diagnosis, acute care, chronic care); 'Organisational' (equipment); and 'The Practice Team' (practice learning needs, educational strategy). Assessment is by submission of a written portfolio of 37 pieces of evidence including audit, reflective learning, patient feedback, and significant event analyses. The Award was piloted in five respiratory-interested practices across the UK. The practices reported improvements in practice organisation, practice teamwork, improved process measures such as improvement in quality of spirometry, and improved patient access to patient services. All practices in the UK are being invited to apply for the Award in 2013. It is hoped that it will provide a framework and stimulus for provision of high-quality primary respiratory care, not only in the UK, but also some aspects of the Award may be applicable on a wider international scale. PMID:23974675

  4. 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

  5. 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…

  6. [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

  7. 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

  8. 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…

  9. Homebound older adults: Prevalence, characteristics, health care utilization and quality of care.

    PubMed

    Musich, Shirley; Wang, Shaohung S; Hawkins, Kevin; Yeh, Charlotte S

    2015-01-01

    The purpose of this study was to estimate prevalence rates of homebound older adults, their characteristics and the impact of homebound status on health care utilization, expenditures and quality of medical care measures. Surveys were sent to new enrollees (n = 25,725) in AARP(®) Medicare Supplement plans (insured through UnitedHealthcare) to screen for serious chronic conditions, ambulatory disabilities and eligibility for care coordination programs. Health care utilization and expenditures were determined from paid claims. Member-level quality measures considered compliance with medication adherence and care patterns. Among survey respondents, 19.6% were classified as being homebound. The strongest predictors of being homebound included serious memory loss, being older, having more chronic conditions, taking more prescription medications and having multiple hospitalizations. Homebound had significantly higher health care utilization and expenditures. Homebound were more likely to be noncompliant with medication adherence and care pattern rules. Ongoing screening and subsequent interventions for new enrollees classified as homebound may be warranted. PMID:26254815

  10. The Equity and Quality (EQual) Health-Care Project: A Connecticut Health Foundation initiative with Qualidigm.

    PubMed

    Van Hoof, Thomas J; Mahier, Stephen E; Barr, Judith K; Krause, Elizabeth M S; Kelvey-Albert, Michele; Curry, Maureen; Meehan, Thomas P

    2010-05-01

    In response to the growing incidence and prevalence of diabetes, quality and disparity of care concerns, and the increasing diversity of the US and Connecticut's populations, the Connecticut Health Foundation funded Qualidigm to implement the Equity and Quality (EQual) Health-Care Project. Now in its second full year, the EQualHealth-CareProject is helping eight primary-care practices in Connecticut improve the equity and quality of diabetes care through technology, education, and quality improvement. PMID:20509420

  11. 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 (2006–2008) and post (2009–2010) 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

  12. 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

  13. Process Dimensions of Child Care Quality and Academic Achievement: An Instrumental Variables Analysis

    ERIC Educational Resources Information Center

    Auger, Anamarie; Farkas, George; Duncan, Greg; Burchinal, Peg; Vandell, Deborah Lowe

    2012-01-01

    Child care quality is usually measured along two dimensions--structural and process. In this paper the authors focus on process quality--the quality of child care center instructional practices and teacher interactions with students. They use an instrumental variables technique to estimate the effect of child care center process quality on…

  14. 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…

  15. 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

  16. 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

  17. Quality and Value in an Evolving Health Care Landscape.

    PubMed

    Kamal, Robin N

    2016-07-01

    Demonstrating and improving value of care continues to be increasingly important in hand surgery. To prepare for emerging models that transition payment from volume to value, hand surgeons will benefit from a clear understanding of quality, cost, and value. National organizations and both public and private payers increasingly advocate for patient-reported outcome measures for pay for reporting and pay for performance initiatives. These are intended to incentivize providers and health systems to improve patient-centered care while minimizing costs. Appreciating the limitations to using patient-reported outcomes in hand surgery can ensure hand surgery is appropriately assessed in novel payment models. PMID:27374791

  18. 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

  19. 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

  20. 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

  1. 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

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

    PubMed

    Jacobalis, S

    1989-01-01

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

  3. Quality of care and racial health disparities: a strategic overview.

    PubMed

    Chassin, Mark R; Anderson, Rebecca M

    2008-01-01

    Substantial racial and ethnic disparities in health and health care exist in the United States. The Department of Health Policy at the Mount Sinai School of Medicine has developed a strategy for reducing those disparities that builds upon its quality improvement experience. This article discusses the utility of applying quality improvement principles to the development of interventions to eliminate underuse of effective treatments and reduce the disparities that may arise from this quality problem. We present a conceptual model of racial disparities in health and our underuse hypothesis. Parallels between our disparities research strategy and six sigma quality improvement methods are described. Finally, the article provides an example of how we have been able to successfully implement proven-effective health improvement programs in the Harlem community even after grant funding has ended. PMID:18306237

  4. 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…

  5. Quality care for the seriously mentally ill: a dream deferred.

    PubMed

    Trotter, C M

    1996-09-01

    This is a study of a system in change-a public mental hospital, isolated by the strong Koolau mountains and neglected by its citizens. At the end of 1990, the federal Department of Justice jolted the people of Hawaii into recognizing the poor quality of care provided to their family members at the Hawaii State Hospital (HSH). This model of a recruitment and retention project was developed to address education, professional development, and recruitment needs of nursing staff at HSH to improve quality of care. The interventions were based on a dynamic model of collaboration between a public state hospital and a university school of nursing in the creation of a learning community. The components of the project provide for nursing staff to continue their formal university education, services of advanced practice nurses, and continuing education classes for nursing staff. PMID:9069831

  6. 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

  7. Creating a safer workplace to provide quality care.

    PubMed

    Simmons, J C

    2001-04-01

    In recent years, increasing interest has been placed on how health care workers can be trained and equipped to better protect them from possible workplace accidents and injuries while improving the care they deliver. Better workplace safety also means better customer and employee satisfaction, improved workforce retention and recruitment, and cost savings. Workplace safety is constantly evolving and addresses a whole host of issues ranging from needles and sharps injuries to moving patients to human factor analyses. This issue takes a cross-sectional look at how hospitals and health systems are addressing problem areas--and sharing information and best practices--to strengthen their quality of care at the workplace level. PMID:11330227

  8. 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

  9. 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.

  10. 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

  11. Case-volume, quality of care, and care efficiency in coronary artery bypass surgery

    PubMed Central

    Auerbach, Andrew D.; Hilton, Joan F.; Maselli, Judith; Pekow, Penelope S.; Rothberg, Michael B.; Lindenauer, Peter K.

    2016-01-01

    Background How case volume and quality of care relate to hospital costs or length of stay are important questions as we seek to improve the value of healthcare. Methods Observational study of patients 18 or older who underwent coronary artery bypass grafting surgery in a network of US hospitals. Case volumes were estimated using our dataset. Quality was assessed by whether recommended medications and services were not received in ideal patients, as well as the overall number of measures missed. We used multivariable hierarchical models to estimate the effects of case volume and quality on hospital cost and length of stay. Results The majority of hospitals (51%) and physicians (78%) were lowest volume providers and only 18% of patients received all quality of care measures. Median length of stay was 7 days (interquartile range [IQR] 6 to 11 days), and median costs were $25140 (IQR $19677, $33121). In analyses adjusted for patient and site characteristics, lowest volume hospitals had 19.8% higher costs (95% CI 3.9% to 38% higher); adjusting for care quality did not eliminate differences in costs. Low surgeon volume was also associated with higher costs, though less strongly (3.1% higher costs, 95% CI 0.6% to 5.6% higher). Individual quality measures had inconsistent associations with costs or length of stay, but patients who had no quality measures missed had much lower length of stay and costs than those who missed even one. Conclusions Avoiding lowest volume hospitals and maximizing quality are separate approaches to improving healthcare efficiency through reducing costs of coronary bypass surgery. PMID:20660837

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

    PubMed Central

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

    2014-01-01

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

  13. 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…

  14. 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

  15. Patients' experiences with quality of hospital care: the Consumer Quality Index Cataract Questionnaire

    PubMed Central

    Stubbe, JH; Brouwer, W; Delnoij, DMJ

    2007-01-01

    Background Patients' feedback is of great importance in health care policy decisions. The Consumer Quality Index Cataract Questionnaire (CQI Cataract) was used to measure patients' experiences with quality of care after a cataract operation. This study aims to evaluate the reliability and the dimensional structure of this questionnaire and assesses its ability to measure differences between hospitals in patients' experiences with quality of care. Methods Survey data of 4,635 respondents were available. An exploratory factor analysis was performed to evaluate the construct validity of the questionnaire and item-correlations and inter-factor correlations were calculated. Secondly, Cronbach's alpha coefficients were calculated to assess the internal consistency of the scales. Thirdly, to evaluate the ability of the questionnaire to discriminate between hospitals, multilevel analyses were performed with patients hierarchically nested within hospitals. Results Exploratory factor analysis resulted in 14 quality of care items subdivided over three factors (i.e. communication with ophthalmologist, communication with nurses, and communication about medication). Cronbach's alpha coefficients of 0.89, 0.76 and 0.79 indicated good internal consistency. Multilevel analyses showed that the questionnaire was able to measure differences in patients' experiences with hospital care regarding communication with ophthalmologist and communication about medication. In addition, there was variation between hospitals regarding ophthalmologist ratings, hospital ratings and one dichotomous information item. Conclusion These findings suggest that the CQI Cataract is a reliable and valid instrument. This instrument can be used to measure patients' experiences with three domains of hospital care after a cataract operation and is able to assess differences in evaluated care between hospitals. PMID:17877840

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

    PubMed Central

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

    2014-01-01

    Background Thirty-day readmissions post medical or surgical discharge have been analyzed extensively. Studies have shown that complex interactions of multiple factors are responsible for these hospitalizations. Methods A retrospective analysis was conducted using the Surveillance, Epidemiology and End Results (SEER) Medicare database of newly diagnosed elderly glioblastoma multiforme (GBM) patients who underwent surgical resection between 1991 and 2007. Hospitals were classified into high- or low-readmission rate cohorts using a risk-adjusted methodology. Bivariate comparisons of outcomes were conducted. Multivariate analysis evaluated differences in quality of care according to hospital readmission rates. Results A total of 1,273 patients underwent surgery in 338 hospitals; 523 patients were treated in 228 high-readmission hospitals and 750 in 110 low-readmission hospitals. Patient characteristics for high-versus low-readmission hospitals were compared. In a confounder-adjusted model, patients treated in high- versus low-readmission hospitals had similar outcomes. The hazard of mortality for patients treated at high- compared to low-readmission hospitals was 1.06 (95% CI, 0.095%–1.19%). While overall complications were comparable between high- and low-readmission hospitals (16.3% vs 14.3%; P = .33), more postoperative pulmonary embolism/deep vein thrombosis complications were documented in patients treated at high-readmission hospitals (7.5% vs 4.1%; P = .01). Adverse events and levels of resection achieved during surgery were comparable at high- and low-readmission hospitals. Conclusions For patients undergoing GBM resection, quality of care provided by hospitals with the highest adjusted readmission rates was similar to the care delivered by hospitals with the lowest rates. These findings provide evidence against the preconceived notion that 30-day readmissions can be used as a metric for quality of surgical and postsurgical care. PMID:26034614

  17. Quality of Care Delivered Before versus After A Quality Improvement Intervention for Acute Geriatric Trauma

    PubMed Central

    Min, Lillian; Cryer, Henry; Chan, Chiao-Li; Roth, Carol; Tillou, Areti

    2014-01-01

    Background Older trauma injury patients had improved recovery after we implemented routine geriatric consultation for patients ≥ age 65 at a level-1 academic trauma center. The intervention aimed to improve quality of geriatric care. However, the specific care processes that improved are unknown. Study Design Prospective observation comparing medical care after (December 2007-November 2009) versus before (December 2006-November 2007) implementation of the geriatric consult-based intervention. To measure quality-of-care (QOC) we used 33 previously-validated care-process quality indicators (QIs) from the Assessing the Care of Vulnerable Elders (ACOVE) study, measured by review of medical records for 76 Geriatric Consult [GC] versus 71 control group patients. As pre-specified subgroup analyses, we aggregated QIs by type: geriatric (e.g., delirium screening) versus non-geriatric condition-based care (e.g., thrombosis prophylaxis) and compared QI scores by type of care. Last, we aggregated QI scores into overall, geriatric, and non-geriatric QOC scores for each patient (# QIs passed/# QIs eligible), and compared patient-level QOC for the GC versus control group, adjusting for age, gender, ethnicity, comorbidity, and injury severity. Results 63% of the GC versus 11% of the control group patients received a geriatric consultation. We evaluated 2505 QIs overall (1664 geriatric-type and 841 non-geriatric QIs). In general, fewer geriatric-type QIs were passed than non-geriatric QIs (71% vs 81%, p<.001). We provided better overall-QOC to the GC (77%) than control group patients (73%, p<.05). However, the difference was not statistically significant after multivariable adjustment (p=.08). We improved geriatric-QOC for the GC (74%) compared to the control group (68%, p<.01), a difference that was significant after multivariable adjustment (p=.01). Conclusion Geriatricians and surgeons can collaboratively improve geriatric QOC for older trauma patients. PMID:25840534

  18. 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

  19. Quality Nursing Care for Hospitalized Patients with Advanced Illness: Concept Development

    PubMed Central

    Izumi, Shigeko; Baggs, Judith G.; Knafl, Kathleen A.

    2011-01-01

    The quality of nursing care as perceived by hospitalized patients with advanced illness has not been examined. A concept of quality nursing care for this population was developed by integrating the literature on constructs defining quality nursing care with empirical findings from interviews of 16 patients with advanced illness. Quality nursing care was characterized as competence and personal caring supported by professionalism and delivered with an appropriate demeanor. Although the attributes of competence, caring, professionalism, and demeanor were identified as common components of quality care across various patient populations, the caring domain increased in importance when patients with advanced illness perceived themselves as vulnerable. Assessment of quality nursing care for patients with advanced illness needs to include measures of patient perceptions of vulnerability. PMID:20572095

  20. 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…

  1. 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

  2. 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

  3. 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

  4. eHealth and quality in health care: implementation time.

    PubMed

    Ossebaard, Hans C; Van Gemert-Pijnen, Lisette

    2016-06-01

    The use of information and communication technologies in health and health care could improve healthcare quality in many ways. Today's evidence base demonstrates the (cost-)effectiveness of online education, self-management support and tele-monitoring in several domains of health and care. While new results gradually provide more evidence for eHealth's impact on quality issues, now is the time to come to grips with implementation issues. Documented drawbacks such as low acceptance, low adoption or low adherence need our attention today to make the most of eHealth' potential. Improvement science is beginning to deliver the tools to address these persistent behavioural and cultural issues. The ceHRes Roadmap, for instance, is a plural and pragmatic approach that includes users' needs. It is now imperative to improve our implementation strategies in order to scale up eHealth technologies. This will accelerate the much needed transformation of our healthcare systems and sustain access, affordability and quality for all in the near future. PMID:27029590

  5. [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

  6. [Influence of registries on the quality of care].

    PubMed

    Stengel, D; Dreinhöfer, K; Kostuj, T

    2016-06-01

    Registries are a topic of lively debate amongst all stakeholders in healthcare, politics and economics. In general, registries are national or international (prospective) databases documenting the current state of diagnostic, therapeutic and long-term outcome variables of subjects with a distinct condition or health problem. The access to and handling of registry information is subject to strict legal, methodological and ethical principles and regulations before these data can be scientifically utilized and reentered into the routine daily practice. Because of the representativeness and reality of data, registries are widely regarded as the backbone of health systems and budgets.Currently there is only indirect evidence that registries influence outcomes and the quality of care. Recent statistical techniques may allow quasi-experimental modelling of observational information. In orthopedic and trauma surgery, current and upcoming registries should be wisely utilized to develop and evaluate innovations and to make informed decisions relevant to care. PMID:27164976

  7. 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

  8. The Quality Assurance Project: introducing quality improvement to primary health care in less developed countries.

    PubMed

    Nicholas, D D; Heiby, J R; Hatzell, T A

    1991-01-01

    Persistently excessive morbidity and mortality rates in less developed countries (LDCs) served by primary health care systems suggest that the quality of services is inadequate. The PRICOR project, sponsored by the United States Agency for International Development, has designed and implemented methods for quality assessment and problem solving in LDC health systems. After developing comprehensive lists of essential activities and tasks, similar to practice parameters, for seven child survival interventions, PRICOR supported comprehensive quality assessment studies in twelve LDC countries. The studies, yielding over 6000 observations of health worker-client encounters, indicated highly prevalent, serious program deficiencies in areas including diagnosis, treatment, patient education and supervision. To facilitate corrective action, PRICOR assisted managers in conducting operations research to resolve priority problems revealed by the assessments. The recently initiated Quality Assurance Project is building on PRICOR techniques in designing and implementing sustainable continuous quality improvement programs for LDC health systems. PMID:1782383

  9. 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

  10. 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…

  11. Preparation of patients for anaesthesia - achieving quality care.

    PubMed

    Lau, L; Jan, G; Chan, T F

    2002-04-01

    Implementation of anaesthesia begins with a preoperative assessment of the surgical patient and development of an anaesthetic plan. Preparation of the patient includes the preoperative assessment, review of preoperative tests, optimisation of medical conditions, adequate preoperative fasting, appropriate premedication, and the explanation of anaesthetic risk to patients. The goals of preoperative preparation are to reduce the morbidity of surgery, to increase the quality while decreasing the cost of perioperative care, and to return the patient to desirable functioning as quickly as possible. A knowledgeable anaesthesiologist is the 'final clinical gatekeeper', who coordinates perioperative management and ensures that the patient is in the optimal state for anaesthesia and surgery. PMID:11937664

  12. Quality in Child Day Care Centres: How to Promote It? A Study of Six Day-Care Centres.

    ERIC Educational Resources Information Center

    Singer, Elly; Miltenburg, Ruth

    1994-01-01

    Explored how research can be useful for improving day-care quality. Studied relationship of pedagogic content and parent policy to day-care center aims, finding a strong relationship between special goals and quality standards. Suggested that improvement requires context-bound theories and a stronger theoretical framework for working with groups…

  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. 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…

  15. Introducing quality management into primary health care services in Uganda.

    PubMed Central

    Omaswa, F.; Burnham, G.; Baingana, G.; Mwebesa, H.; Morrow, R.

    1997-01-01

    In 1994, a national quality assurance programme was established in Uganda to strengthen district-level management of primary health care services. Within 18 months both objective and subjective improvements in the quality of services had been observed. In the examples documented here, there was a major reduction in maternal mortality among pregnant women referred to Jinja District Hospital, a reduction in waiting times and increased patient satisfaction at Masaka District Hospital, and a marked reduction in reported cases of measles in Arua District. Beyond these quantitative improvements, increased morale of district health team members, improved satisfaction among patients, and greater involvement of local government in the decisions of district health committees have been observed. At the central level, the increased coordination of activities has led to new guidelines for financial management and the procurement of supplies. District quality management workshops followed up by regular support visits from the Ministry of Health headquarters have led to a greater understanding by central staff of the issues faced at the district level. The quality assurance programme has also fostered improved coordination among national disease-control programmes. Difficulties encountered at the central level have included delays in carrying out district support visits and the failure to provide appropriate support. At the district level, some health teams tackled problems over which they had little control or which were overly complex; others lacked the management capacity for problem solving. PMID:9185368

  16. Quality Assurance and Quality Control in Point-of-Care Testing.

    PubMed

    Newman, Ashleigh W; Behling-Kelly, Erica

    2016-03-01

    With advancements in the standard of care in veterinary medicine and instrument technology, performing in-house laboratory work on a variety of point-of-care instruments, ranging from glucometers to benchtop chemistry analyzers, has become increasingly commonplace. However, the ability of an instrument to perform a test does not guarantee that those results are accurate. Ensuring that your in-clinic laboratory is providing reliable data requires a comprehensive plan that encompasses both common sense practices aimed at preventing errors at each stage of the testing process, as well as standard operating procedures to validate and monitor analyzer performance. These 2 arms of the plan are known as quality assurance and quality control. Although these concepts are typically out of the comfort zone for veterinarians, just as the thought of business management may deter some veterinarians from practice ownership, it is not beyond the capabilities of veterinarians to learn, understand, and incorporate them into their practice. The objectives of this article are to convey the importance of quality assurance and quality control, walk you through the American Society for Veterinary Clinical Pathology guidelines on this topic, and provide direction to additional resources for further education on this topic, all with the focus on point-of-care testing in the in-clinic laboratory. PMID:27451043

  17. Assessing methods for measurement of clinical outcomes and quality of care in primary care practices

    PubMed Central

    2012-01-01

    Purpose To evaluate the appropriateness of potential data sources for the population of performance indicators for primary care (PC) practices. Methods This project was a cross sectional study of 7 multidisciplinary primary care teams in Ontario, Canada. Practices were recruited and 5-7 physicians per practice agreed to participate in the study. Patients of participating physicians (20-30) were recruited sequentially as they presented to attend a visit. Data collection included patient, provider and practice surveys, chart abstraction and linkage to administrative data sets. Matched pairs analysis was used to examine the differences in the observed results for each indicator obtained using multiple data sources. Results Seven teams, 41 physicians, 94 associated staff and 998 patients were recruited. The survey response rate was 81% for patients, 93% for physicians and 83% for associated staff. Chart audits were successfully completed on all but 1 patient and linkage to administrative data was successful for all subjects. There were significant differences noted between the data collection methods for many measures. No single method of data collection was best for all outcomes. For most measures of technical quality of care chart audit was the most accurate method of data collection. Patient surveys were more accurate for immunizations, chronic disease advice/information dispensed, some general health promotion items and possibly for medication use. Administrative data appears useful for indicators including chronic disease diagnosis and osteoporosis/ breast screening. Conclusions Multiple data collection methods are required for a comprehensive assessment of performance in primary care practices. The choice of which methods are best for any one particular study or quality improvement initiative requires careful consideration of the biases that each method might introduce into the results. In this study, both patients and providers were willing to participate in and

  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. 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

  1. Quality care for community-based FP / MCH.

    PubMed

    1995-02-01

    The Regional Workshop on Quality Care for Community-based FP/MCH in Asia was organized by the Family Planning Association of Nepal (FPAN) in cooperation with JOICFP and held in Kathmandu, Nepal, December 4-9. Representatives of counterpart organizations in Bangladesh, Laos, Nepal, and the Philippines implementing the UNFPA-supported Sustainable Community-based FP/MCH Project with Special Focus on Women were included among the forty participants. Representatives of China and Vietnam as well as resource persons from Mexico and Japan also attended the event. The workshop was held with the goal of providing participants with effective strategies for promoting quality care for community-based FP/MCH activities based upon the Nepalese experience. The event also provided the opportunity for participants to share experiences, develop strategies for project sustainability, and identify strategies and action plans suitable for their particular country situations. In field trips to Panchkhal, Sunsari, and Morang where the project is being implemented in 26 villages, participants noted the strong community involvement and village leader support. They were also impressed by the communities' awareness of services provided under the project. FPAN has succeeded despite geographical and cultural difficulties in promoting fee-based services toward project sustainability. By paying nominal fees, villagers also enjoy access to drugs and services which may not have been available through the government free of charge. Participants at the end of the workshop recommended the identification of specific indicators and systems for monitoring services and activities, training and orientation at all levels to improve the skills and attitudes of health care workers, the development of potential income-generating activities, the provision of essential FP/MCH equipment, and the equal involvement of men and women at the policy and implementation levels. PMID:12288392

  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. 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

  4. 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

  5. Effects of Work Environment on Quality of Care in ICUs: A Multisite Survey in China.

    PubMed

    Liu, Jiali; You, Liming; Zheng, Jing; Ross, Amy Miner; Liu, Ke

    2016-01-01

    This study estimated the effects of the work environment on the quality of care in intensive care units (ICUs). Nurses in ICUs with good work environments or high nurse staffing were significantly less likely to report poor or fair quality of care (odds ratio [OR] = 0.37-0.47), rationing of nursing care (OR = 0.38-0.76), and health care-associated infections (OR = 0.28-0.68). Favorable ICU work environments and adequate nurse staffing can predict better quality of care. PMID:26796973

  6. Medical guidelines, physician density, and quality of care: evidence from German SHARE data.

    PubMed

    Jürges, Hendrik; Pohl, Vincent

    2012-10-01

    We use German SHARE data to study the relationship between district general practitioner density and the quality of preventive care provided to older adults. We measure physician quality of care as the degree of adherence to medical guidelines (for the management of risk factors for cardiovascular disease and the prevention of falls) as reported by patients. Contrary to theoretical expectations, we find only weak and insignificant effects of physician density on quality of care. Our results shed doubt on the notion that increasing physician supply will increase the quality of care provided in Germany's present health care system. PMID:22203268

  7. 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

  8. 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

  9. 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).…

  10. 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...

  11. 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...

  12. 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...

  13. 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...

  14. 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...

  15. 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…

  16. 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…

  17. 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....

  18. 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

  19. 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

  20. 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

  1. 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

  2. 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…

  3. Child Care in JOBS Employment and Training Program: What Difference Does Quality Make?

    ERIC Educational Resources Information Center

    Meyers, Marcia K.

    1993-01-01

    Examined data from Job Opportunities and Basic Skills program. Found that participants increased their use of substitute child care and of licensed day-care homes/centers, after beginning job readiness activities. Child care was found to be highly variable in terms of convenience and program quality. Problems with child care increased…

  4. Teaching Medical Students about Quality and Cost of Care at Case Western Reserve University.

    ERIC Educational Resources Information Center

    Headrick, Linda A.; And Others

    1992-01-01

    At Case Western University (Ohio), medical students critically analyze the quality and cost of asthma care in the community by studying patients in primary care practices. Each writes a case report, listing all medical charges and comparing them with guidelines for asthma care. Several recommendations for improved care have emerged. (MSE)

  5. 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…

  6. National Statement on Quality Child Care (Enonce de principe national sur la qualite dans les services de garde).

    ERIC Educational Resources Information Center

    Canadian Child Care Federation, Ottawa (Ontario).

    The Canadian Child Day Care Federation's National Statement on Quality Child Care suggests separate principles of quality care for center-based and family-based child care. The principles of quality center-based care are divided into seven areas, each with a statement of general philosophy. The philosophical principles are then defined in more…

  7. Task shifting in the provision of home and social care in Ontario, Canada: implications for quality of care.

    PubMed

    Denton, Margaret; Brookman, Catherine; Zeytinoglu, Isik; Plenderleith, Jennifer; Barken, Rachel

    2015-09-01

    Growing healthcare costs have caused home-care providers to look for more efficient use of healthcare resources. Task shifting is suggested as a strategy to reduce the costs of delivering home-care services. Task shifting refers to the delegation or transfer of tasks from regulated healthcare professionals to home-care workers (HCWs). The purpose of this paper is to explore the impacts of task shifting on the quality of care provided to older adults from the perspectives of home healthcare workers. This qualitative study was completed in collaboration with a large home and community care organisation in Ontario, Canada, in 2010-2011. Using a purposive sampling strategy, semi-structured telephone interviews were conducted with 46 home healthcare workers including HCWs, home-care worker supervisors, nurses and therapists. Study participants reported that the most common skills transferred or delegated to HCWs were transfers, simple wound care, exercises, catheterisation, colostomies, compression stockings, G-tube feeding and continence care. A thematic analysis of the data revealed mixed opinions on the impacts of task shifting on the quality of care. HCWs and their supervisors, more often than nurses and therapists, felt that task shifting improved the quality of care through the provision of more consistent care; the development of trust-based relationships with clients; and because task shifting reduced the number of care providers entering the client's home. Nurses followed by therapists, as well as some supervisors and HCWs, expressed concerns that task shifting might compromise the quality of care because HCWs lacked the knowledge, training and education necessary for more complex tasks, and that scheduling problems might leave clients with inconsistent care once tasks are delegated or transferred. Policy implications for regulating bodies, employers, unions and educators are discussed. PMID:25471361

  8. Involving patients to improve service quality in primary care.

    PubMed

    Stevenson, Keith; Sinfield, Paul; Ion, Vince; Merry, Marilyn

    2004-01-01

    A sample of 92 UK patients volunteered to take part in focus groups to discuss what elements of local primary care provision were important to them. Issues raised were prioritised by the patients and then fashioned into 18 quality indicators which nine local practices were invited to assess themselves against. At the assessment meeting three months later over 40 changes in service provision were noted in the nine participating practices. A patient questionnaire carried out in each practice, however, indicated a tendency for practices to overestimate the services they felt they provided. Patients rated the experience of generating standards as very worthwhile and enjoyed being asked. Further research needs to be carried out to assess the effectiveness of this methodology in different settings. PMID:15481696

  9. The quality of maternity care services as experienced by women in the Netherlands

    PubMed Central

    Wiegers, Therese A

    2009-01-01

    Background Maternity care is all care in relation to pregnancy, childbirth and the postpartum period. In the Netherlands maternity care is provided by midwives and general practitioners (GPs) in primary care and midwives and gynecologists in secondary care. To be able to interpret women's experience with the quality of maternity care, it is necessary to take into account their 'care path', that is: their route through the care system. In the Netherlands a new tool is being developed to evaluate the quality of care from the perspective of clients. The tool is called: 'Consumer Quality Index' or CQI and is, within a standardized and systematic framework, tailored to specific health care issues. Within the framework of developing a CQI Maternity Care, data were gathered about the care women in the Netherlands received during pregnancy, childbirth, and the postpartum period. In this paper the quality of maternity care in the Netherlands is presented, as experienced by women at different stages of their care path. Methods A sample of 1,248 pregnant clients of four insurance companies, with their due date in early April 2007, received a postal survey in the third trimester of pregnancy (response 793). Responders to the first questionnaire received a second questionnaire twelve weeks later, on average four weeks after delivery (response 632). Based on care provider and place of birth the 'care path' of the women is described. With factor analysis and reliability analysis five composite measures indicating the quality of treatment by the care provider at different stages of the care path have been constructed. Overall ratings relate to eight different aspects of care, varying from antenatal care by a midwife or GP to care related to neonatal screening. Results 41.5 percent of respondents remained in primary care throughout pregnancy, labor, birth and the postpartum period, receiving care from a midwife or general practitioner, 31.3% of respondents gave birth at home. The

  10. Aides' Involvement in Decision-Making and the Quality of Care in Institutional Settings

    ERIC Educational Resources Information Center

    Raynes, Norma V.; And Others

    1977-01-01

    The degree of participation in decision making by direct care staff aides, and its effect on the quality of care for mentally handicapped persons, was assessed among 125 staff of 3 state institutions averaging 1080 patients. (BB)

  11. [The availability and quality of the ambulatory polyclinic care].

    PubMed

    Guseva, N K; Sokolov, V A; Sokolova, I A; Doiutova, M V

    2013-01-01

    The article deals with the results of the study of complex of medical demographic and social economic indicators of Nizhny Novgorod oblast during 1989-2010. The results are as follows. The policlinics' net reduced by 2.25 times, including by 10.6 times in rural area and by 12.6 times of ambulatories of community hospitals. The indicators of physicians' supply of oblast population decreased too especially in urban area. The annual number of visits to physicians per capita decreased by 1.36 times. The number of calls of out-patients to physicians of emergency medical care increased by 1.5 times. The morbidity with temporarily disability and primary registration as a disabled person decreased by 1.45 times, including able-bodied citizen by 1.54 times. In Nizhny Novgorod oblast, the rate of decrease of indicators of primary disability during 2006-2009 overpassed the corresponding federal indicators by 1.45 times. The population mortality increased by 1.43 times. The accessibility and quality of ambulatory polyclinic care significantly impacts on the levels of mortality and social security of population and can be used as an indicator of social risks in the region. PMID:23808035

  12. How Health Care Organizations Are Using Data on Patients' Race and Ethnicity to Improve Quality of Care

    PubMed Central

    Thorlby, Ruth; Jorgensen, Selena; Siegel, Bruce; Ayanian, John Z

    2011-01-01

    Context: Racial and ethnic disparities in the quality of health care are well documented in the U.S. health care system. Reducing these disparities requires action by health care organizations. Collecting accurate data from patients about their race and ethnicity is an essential first step for health care organizations to take such action, but these data are not systematically collected and used for quality improvement purposes in the United States. This study explores the challenges encountered by health care organizations that attempted to collect and use these data to reduce disparities. Methods: Purposive sampling was used to identify eight health care organizations that collected race and ethnicity data to measure and reduce disparities in the quality and outcomes of health care. Staff, including senior managers and data analysts, were interviewed at each site, using a semi-structured interview format about the following themes: the challenges of collecting and collating accurate data from patients, how organizations defined a disparity and analyzed data, and the impact and uses of their findings. Findings: To collect accurate self-reported data on race and ethnicity from patients, most organizations had upgraded or modified their IT systems to capture data and trained staff to collect and input these data from patients. By stratifying nationally validated indicators of quality for hospitals and ambulatory care by race and ethnicity, most organizations had then used these data to identify disparities in the quality of care. In this process, organizations were taking different approaches to defining and measuring disparities. Through these various methods, all organizations had found some disparities, and some had invested in interventions designed to address them, such as extra staff, extended hours, or services in new locations. Conclusion: If policymakers wish to hold health care organizations accountable for disparities in the quality of the care they

  13. Improving care quality and preventing maltreatment in institutional care - a feasibility study with caregivers.

    PubMed

    Hermenau, Katharin; Kaltenbach, Elisa; Mkinga, Getrude; Hecker, Tobias

    2015-01-01

    Institutionalized children in low-income countries often face maltreatment and inadequate caregiving. In addition to prior traumatization and other childhood adversities in the family of origin, abuse and neglect in institutional care are linked to various mental health problems. By providing a manualized training workshop for caregivers, we aimed at improving care quality and preventing maltreatment in institutional care. In Study 1, 29 participating caregivers rated feasibility and efficacy of the training immediately before, directly after, and 3 months following the training workshop. The results showed high demand, good feasibility, high motivation, and acceptance of caregivers. They reported improvements in caregiver-child relationships, as well as in the children's behavior. Study 2 assessed exposure to maltreatment and the mental health of 28 orphans living in one institution in which all caregivers had been trained. The children were interviewed 20 months before, 1 month before, and 3 months after the training. Children reported a decrease in physical maltreatment and assessments showed a decrease in mental health problems. Our approach seems feasible under challenging circumstances and provides first hints for its efficacy. These promising findings call for further studies testing the efficacy and sustainability of this maltreatment prevention approach. PMID:26236248

  14. Improving care quality and preventing maltreatment in institutional care – a feasibility study with caregivers

    PubMed Central

    Hermenau, Katharin; Kaltenbach, Elisa; Mkinga, Getrude; Hecker, Tobias

    2015-01-01

    Institutionalized children in low-income countries often face maltreatment and inadequate caregiving. In addition to prior traumatization and other childhood adversities in the family of origin, abuse and neglect in institutional care are linked to various mental health problems. By providing a manualized training workshop for caregivers, we aimed at improving care quality and preventing maltreatment in institutional care. In Study 1, 29 participating caregivers rated feasibility and efficacy of the training immediately before, directly after, and 3 months following the training workshop. The results showed high demand, good feasibility, high motivation, and acceptance of caregivers. They reported improvements in caregiver–child relationships, as well as in the children’s behavior. Study 2 assessed exposure to maltreatment and the mental health of 28 orphans living in one institution in which all caregivers had been trained. The children were interviewed 20 months before, 1 month before, and 3 months after the training. Children reported a decrease in physical maltreatment and assessments showed a decrease in mental health problems. Our approach seems feasible under challenging circumstances and provides first hints for its efficacy. These promising findings call for further studies testing the efficacy and sustainability of this maltreatment prevention approach. PMID:26236248

  15. Translating improved quality of care into an improved quality of life for patients with inflammatory bowel disease.

    PubMed

    Siegel, Corey A; Allen, John I; Melmed, Gil Y

    2013-08-01

    The term quality of care has been interpreted in different ways in medicine. Skeptics of the quality movement insist that checkboxes and government and payer oversight will not lead to better patient outcomes. Supporters refer to areas in medicine in which quality improvement efforts have led to improved survival, such as in cystic fibrosis and cardiovascular disease. For quality improvement to be effective, the process demands rigorous documentation, analysis, feedback, and behavioral change. This requires valid metrics and mechanisms to provide dynamic point-of-care (or close to point of care) feedback in a manner that drives improvement. For inflammatory bowel disease, work has been performed in Europe and the United States to develop a framework for how practitioners can improve quality of care. Improve Care Now has created a sophisticated quality improvement program for pediatric patients with inflammatory bowel disease. The American Gastroenterology Association has worked within the National Quality Strategy framework to develop quality measures for patients with inflammatory bowel disease that have been incorporated into Federal programs that are moving Medicare reimbursement from a volume-based to a value-based structure. The Crohn's and Colitis Foundation of America is initiating a quality intervention program that can be implemented in community and academic practices to stimulate continual improvement processes for patients with inflammatory bowel disease. All of this work is intended to make quality improvement programs both feasible and useful, with the ultimate goal of improving quality of life for our patients. PMID:23747710

  16. End-user perspectives on e-commerce and health care web site quality.

    PubMed

    Le Rouge, Cynthia; De Leo, Gianluca

    2008-01-01

    We explore and compare the importance of various quality dimensions for health care and e-commerce web sites. The results show that the importance of various quality attributes for all except four of ten quality dimensions studied differ between health care and e-commerce web sites. These results can help health care managers to improve and/or to guide the design of their web sites. PMID:18998907

  17. Quality Improvement in Critical Care: Selection and Development of Quality Indicators.

    PubMed

    Chrusch, Carla A; Martin, Claudio M; Project, The Quality Improvement In Critical Care

    2016-01-01

    Background. Caring for critically ill patients is complex and resource intensive. An approach to monitor and compare the function of different intensive care units (ICUs) is needed to optimize outcomes for patients and the health system as a whole. Objective. To develop and implement quality indicators for comparing ICU characteristics and performance within and between ICUs and regions over time. Methods. Canadian jurisdictions with established ICU clinical databases were invited to participate in an iterative series of face-to-face meetings, teleconferences, and web conferences. Eighteen adult intensive care units across 14 hospitals and 5 provinces participated in the process. Results. Six domains of ICU function were identified: safe, timely, efficient, effective, patient/family satisfaction, and staff work life. Detailed operational definitions were developed for 22 quality indicators. The feasibility was demonstrated with the collection of 3.5 years of data. Statistical process control charts and graphs of composite measures were used for data display and comparisons. Medical and nursing leaders as well as administrators found the system to be an improvement over prior methods. Conclusions. Our process resulted in the selection and development of 22 indicators representing 6 domains of ICU function. We have demonstrated the feasibility of such a reporting system. This type of reporting system will demonstrate variation between units and jurisdictions to help identify and prioritize improvement efforts. PMID:27493476

  18. Quality Improvement in Critical Care: Selection and Development of Quality Indicators

    PubMed Central

    Martin, Claudio M.; Project, The Quality Improvement in Critical Care

    2016-01-01

    Background. Caring for critically ill patients is complex and resource intensive. An approach to monitor and compare the function of different intensive care units (ICUs) is needed to optimize outcomes for patients and the health system as a whole. Objective. To develop and implement quality indicators for comparing ICU characteristics and performance within and between ICUs and regions over time. Methods. Canadian jurisdictions with established ICU clinical databases were invited to participate in an iterative series of face-to-face meetings, teleconferences, and web conferences. Eighteen adult intensive care units across 14 hospitals and 5 provinces participated in the process. Results. Six domains of ICU function were identified: safe, timely, efficient, effective, patient/family satisfaction, and staff work life. Detailed operational definitions were developed for 22 quality indicators. The feasibility was demonstrated with the collection of 3.5 years of data. Statistical process control charts and graphs of composite measures were used for data display and comparisons. Medical and nursing leaders as well as administrators found the system to be an improvement over prior methods. Conclusions. Our process resulted in the selection and development of 22 indicators representing 6 domains of ICU function. We have demonstrated the feasibility of such a reporting system. This type of reporting system will demonstrate variation between units and jurisdictions to help identify and prioritize improvement efforts. PMID:27493476

  19. Concepts of quality and the provision of periodontal care: a survey.

    PubMed

    Marcus, M; Spolsky, V

    1998-02-01

    This is a survey of various concepts of quality of care in the health care field and their application to periodontics. Definitions of quality care, measuring and improving quality, third party payment and quality of care, and the role of periodontists in managing quality are presented. The definitions of quality care include the following dimensions: access, appropriateness, technical quality, and the art of care. Examples of each of these dimensions are presented, and their implications for quality assessment are discussed. Emphasis is placed on appropriateness of care and the strengths and weaknesses of mechanisms for deriving evidence-based decision making. The use of randomized clinical trials (RCT), employing expert opinion such as consensus panels, and meta-analysis are discussed as they apply to appropriateness of periodontal treatment. Work in the area of technical quality of care (i.e., the third dimension of quality care) has resulted in the development of quality assurance guidelines. Examples of guidelines and practice parameters such as those developed by the U.S. Food and Drug Administration and by various dental specialties are presented. The fourth dimension of quality deals with the art of care. It focuses on the patient's participation in the process of care and the input of the provider in this interaction. The description of outcomes of care includes the concept of measuring clinical outcomes of treatment as well as efforts to measure the health and well-being of a patient. It deals with quality of life measures. Patient satisfaction is another outcome that is presented. Examples of these aspects of quality measurement are discussed. These concepts and measures are presented within the context of a quality assurance program. The steps used to assess and assure quality are outlined. Examples of provider and patient profiles are presented, along with a discussion on how they are used in a quality assurance system. Lastly, the role of the

  20. Outcome as a Measure of Quality of Care in Oncology

    PubMed Central

    Burney, Ikram A; Al Moundhri, Mansour S; Rizvi, Azhar J; Ganguly, Shyam S; Al Abri, Rashid; Ashrafi, Rafi A

    2008-01-01

    Objectives: Measurement of outcomes is increasingly employed as an indicator of the quality of clinical care. The most commonly measured outcome in many clinical studies, especially in oncology, still remains the overall survival rate. Sultan Qaboos University Hospital (SQUH), Oman, is striving for excellence through quality management. In seeking continual improvement, quality measurement exercises have been initiated throughout the Hospital. We present the overall survival rate of four of the ten most common cancers diagnosed in Oman. Methods: The cancers included non-Hodgkin’s lymphoma (NHL), Hodgkin’s lymphoma (HL), breast cancer, and stomach cancer. The studies were all retrospective and had been conducted previously. For present purposes, only the overall survival was compared with studies both from the region, and with bench-mark studies. Results: For NHL, with a median follow-up of 8 months, the 2-year overall survival rate was 64%; 90% for low risk, 55% for intermediate risk, and 15% for high risk groups. For HL, the 5-year overall survival rate was 64%; 76% for low risk and 42% for high risk. For breast cancer, the 5-year survival rate was 67%; percentages were 88%, 75% and 59% for Groups I, II, and III respectively. For gastric cancer, the 5-year survival rate was 16.5 %; 24% for the non-metastatic group. Conclusion: The outcome of patients with early stages and fewer adverse prognostic factors is comparable to what has been reported in the international literature; however, the outcome is inferior for patients presenting with advanced stage disease and several adverse prognostic factors. PMID:21654954

  1. Timely Access to Quality Health Care Among Georgia Children Ages 4 to 17 Years

    PubMed Central

    Ogbuanu, Chinelo; Goodman, David A.; Kahn, Katherine; Long, Cherie; Noggle, Brendan; Bagchi, Suparna; Barradas, Danielle; Castrucci, Brian

    2015-01-01

    We examined factors associated with children's access to quality health care, a major concern in Georgia, identified through the 2010 Title V Needs Assessment. Data from the 2007 National Survey of Children's Health were merged with the 2008 Area Resource File and Health Resources and Services Administration medically under-served area variable, and restricted to Georgia children ages 4–17 years (N = 1,397). The study outcome, access to quality health care was derived from access to care (timely utilization of preventive medical care in the previous 12 months) and quality of care (compassionate/culturally effective/family-centered care). Andersen's behavioral model of health services utilization guided independent variable selection. Analyses included Chi-square tests and multinomial logit regressions. In our study population, 32.8 % reported access to higher quality care, 24.8 % reported access to moderate quality care, 22.8 % reported access to lower quality care, and 19.6 % reported having no access. Factors positively associated with having access to higher/moderate versus lower quality care include having a usual source of care (USC) (adjusted odds ratio, AOR:3.27; 95 % confidence interval, 95 % CI 1.15–9.26), and special health care needs (AOR:2.68; 95 % CI 1.42–5.05). Lower odds of access to higher/moderate versus lower quality care were observed for non-Hispanic Black (AOR:0.31; 95 % CI 0.18–0.53) and Hispanic (AOR:0.20; 95 % CI 0.08–0.50) children compared with non-Hispanic White children and for children with all other forms of insurance coverage compared with children with continuous-adequate-private insurance. Ensuring that children have continuous, adequate insurance coverage and a USC may positively affect their access to quality health care in Georgia. PMID:23054451

  2. Improving quality and reducing inequities: a challenge in achieving best care

    PubMed Central

    Nicewander, David A.; Qin, Huanying; Ballard, David J.

    2006-01-01

    The health care quality chasm is better described as a gulf for certain segments of the population, such as racial and ethnic minority groups, given the gap between actual care received and ideal or best care quality. The landmark Institute of Medicine report Crossing the Quality Chasm: A New Health System for the 21st Century challenges all health care organizations to pursue six major aims of health care improvement: safety, timeliness, effectiveness, efficiency, equity, and patient-centeredness. “Equity” aims to ensure that quality care is available to all and that the quality of care provided does not differ by race, ethnicity, or other personal characteristics unrelated to a patient's reason for seeking care. Baylor Health Care System is in the unique position of being able to examine the current state of equity in a typical health care delivery system and to lead the way in health equity research. Its organizational vision, “culture of quality,” and involved leadership bode well for achieving equitable best care. However, inequities in access, use, and outcomes of health care must be scrutinized; the moral, ethical, and economic issues they raise and the critical injustice they create must be remedied if this goal is to be achieved. Eliminating any observed inequities in health care must be synergistically integrated with quality improvement. Quality performance indicators currently collected and evaluated indicate that Baylor Health Care System often performs better than the national average. However, there are significant variations in care by age, gender, race/ethnicity, and socioeconomic status that indicate the many remaining challenges in achieving “best care” for all. PMID:16609733

  3. Palliative Care: Increasing the quality of life for patients and families… | NIH MedlinePlus the Magazine

    MedlinePlus

    ... this page please turn JavaScript on. Feature: Palliative Care Palliative Care: Increasing the quality of life for patients and ... Past Issues / Spring 2014 Table of Contents Palliative Care: Conversations Matter™ for Sick Children "Palliative Care: Conversations ...

  4. Effects of Primary Care Team Social Networks on Quality of Care and Costs for Patients With Cardiovascular Disease

    PubMed Central

    Mundt, Marlon P.; Gilchrist, Valerie J.; Fleming, Michael F.; Zakletskaia, Larissa I.; Tuan, Wen-Jan; Beasley, John W.

    2015-01-01

    PURPOSE Cardiovascular disease is the leading cause of mortality and morbidity in the United States. Primary care teams can be best suited to improve quality of care and lower costs for patients with cardiovascular disease. This study evaluates the associations between primary care team communication, interaction, and coordination (ie, social networks); quality of care; and costs for patients with cardiovascular disease. METHODS Using a sociometric survey, 155 health professionals from 31 teams at 6 primary care clinics identified with whom they interact daily about patient care. Social network analysis calculated variables of density and centralization representing team interaction structures. Three-level hierarchical modeling evaluated the link between team network density, centralization, and number of patients with a diagnosis of cardiovascular disease for controlled blood pressure and cholesterol, counts of urgent care visits, emergency department visits, hospital days, and medical care costs in the previous 12 months. RESULTS Teams with dense interactions among all team members were associated with fewer hospital days (rate ratio [RR] = 0.62; 95% CI, 0.50–0.77) and lower medical care costs (−$556; 95% CI, −$781 to −$331) for patients with cardiovascular disease. Conversely, teams with interactions revolving around a few central individuals were associated with increased hospital days (RR = 1.45; 95% CI, 1.09–1.94) and greater costs ($506; 95% CI, $202–$810). Team-shared vision about goals and expectations mediated the relationship between social network structures and patient quality of care outcomes. CONCLUSIONS Primary care teams that are more interconnected and less centralized and that have a shared team vision are better positioned to deliver high-quality cardiovascular disease care at a lower cost. PMID:25755035

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

    PubMed Central

    Duan, Xia; Shi, Yan

    2014-01-01

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

  6. Quality assurance of radiotherapy in cancer treatment: toward improvement of patient safety and quality of care.

    PubMed

    Ishikura, Satoshi

    2008-11-01

    The process of radiotherapy (RT) is complex and involves understanding of the principles of medical physics, radiobiology, radiation safety, dosimetry, radiation treatment planning, simulation and interaction of radiation with other treatment modalities. Each step in the integrated process of RT needs quality control and quality assurance (QA) to prevent errors and to give high confidence that patients will receive the prescribed treatment correctly. Recent advances in RT, including intensity-modulated and image-guided RT, focus on the need for a systematic RTQA program that balances patient safety and quality with available resources. It is necessary to develop more formal error mitigation and process analysis methods, such as failure mode and effect analysis, to focus available QA resources optimally on process components. External audit programs are also effective. The International Atomic Energy Agency has operated both an on-site and off-site postal dosimetry audit to improve practice and to assure the dose from RT equipment. Several countries have adopted a similar approach for national clinical auditing. In addition, clinical trial QA has a significant role in enhancing the quality of care. The Advanced Technology Consortium has pioneered the development of an infrastructure and QA method for advanced technology clinical trials, including credentialing and individual case review. These activities have an impact not only on the treatment received by patients enrolled in clinical trials, but also on the quality of treatment administered to all patients treated in each institution, and have been adopted globally; by the USA, Europe and Japan also. PMID:18952706

  7. Quebec's Child Care Services: What Are the Mechanisms Influencing Children's Behaviors across Quantity, Type, and Quality of Care Experienced?

    ERIC Educational Resources Information Center

    Lemay, Lise; Bigras, Nathalie; Bouchard, Caroline

    2015-01-01

    The objective of this study was to examine how quantity, type, and quality of care interact in predicting externalizing and internalizing behaviors of 36-month-old children attending Quebec's educational child care from their first years of life. To do so, the authors examined two hypothesized models: (1) a mediation model where quantity, type,…

  8. Nursing home staffing and training recommendations for promoting older adults' quality of care and life: Part 1. Deficits in the quality of care due to understaffing and undertraining.

    PubMed

    Maas, Meridean L; Specht, Janet P; Buckwalter, Kathleen C; Gittler, Josephine; Bechen, Kate

    2008-04-01

    Caught between the inability or unwillingness of nursing home corporations and owners to redistribute revenue and the reluctance of federal and state agencies to increase payments to nursing homes, the nation's most vulnerable older adults are not receiving the care they deserve. Widespread recognition of substandard care and quality of life of older adults in nursing homes has existed for decades. In addition, there is substantial evidence that poor quality of care is related to inadequate numbers and training of nursing staff. Still, policy makers and nursing home owners have failed to take needed action. In the first article of this two-part series, major deficits in the care of older adult nursing home residents are reviewed, and research documenting the relationship between nursing home staffing and the quality of care and life of residents is summarized. PMID:20078025

  9. Barriers to Quality Care for Dying Patients in Rural Communities

    ERIC Educational Resources Information Center

    Van Vorst, Rebecca F.; Crane, Lori A.; Barton, Phoebe Lindsey; Kutner, Jean S.; Kallail, K. James; Westfall, John M.

    2006-01-01

    Context: Barriers to providing optimal palliative care in rural communities are not well understood. Purpose: To identify health care personnel's perceptions of the care provided to dying patients in rural Kansas and Colorado and to identify barriers to providing optimal care. Methods: An anonymous self-administered survey was sent to health care…

  10. Chronic care model strategies in the United States and Germany deliver patient-centered, high-quality diabetes care.

    PubMed

    Stock, Stephanie; Pitcavage, James M; Simic, Dusan; Altin, Sibel; Graf, Christian; Feng, Wen; Graf, Thomas R

    2014-09-01

    Improving the quality of care for chronic diseases is an important issue for most health care systems in industrialized nations. One widely adopted approach is the Chronic Care Model (CCM), which was first developed in the late 1990s. In this article we present the results from two large surveys in the United States and Germany that report patients' experiences in different models of patient-centered diabetes care, compared to the experiences of patients who received routine diabetes care in the same systems. The study populations were enrolled in either Geisinger Health System in Pennsylvania or Barmer, a German sickness fund that provides medical insurance nationwide. Our findings suggest that patients with type 2 diabetes who were enrolled in the care models that exhibited key features of the CCM were more likely to receive care that was patient-centered, high quality, and collaborative, compared to patients who received routine care. This study demonstrates that quality improvement can be realized through the application of the Chronic Care Model, regardless of the setting or distinct characteristics of the program. PMID:25201658

  11. Assuring the quality of health care for older persons. An expert panel's priorities.

    PubMed

    Fink, A; Siu, A L; Brook, R H; Park, R E; Solomon, D H

    1987-10-01

    To select topics for quality assurance activities focusing on older patients, we convened a 14-member panel of physicians and experts in quality assurance. In two rounds of ratings, panelists rated 42 medical conditions (eg, pneumonia) in terms of their effects on patient outcomes, the availability of beneficial interventions, and the health benefits from improving current quality. They rated 27 health services (eg, adult day-care) on similar dimensions. The feasibility of doing quality assurance work on each condition and service also was rated. Using the ratings, the conditions selected for quality assurance work were congestive heart failure, hypertension, pneumonia, breast cancer, adverse effects of drugs, incontinence, and depression. Health care services selected were hospital discharge planning, acute inpatient care for the frail elderly, long-term-care facilities (intermediate-care facilities and skilled nursing facilities), home health care services, and case management. PMID:3656600

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

    PubMed

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

    2012-08-01

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

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

    PubMed Central

    Kim, Jinkyung; Han, Woosok

    2012-01-01

    Objectives To investigate predictors for specific dimensions of service quality perceived by hospital employees in long-term care hospitals. Methods Data collected from a survey of 298 hospital employees in 18 long-term care hospitals were analysed. Multivariate ordinary least squares regression analysis with hospital fixed effects was used to determine the predictors of service quality using respondents’ and organizational characteristics. Results The most significant predictors of employee-perceived service quality were job satisfaction and degree of consent on national evaluation criteria. National evaluation results on long-term care hospitals and work environment also had positive effects on service quality. Conclusion The findings of the study show that organizational characteristics are significant determinants of service quality in long-term care hospitals. Assessment of the extent to which hospitals address factors related to employeeperceived quality of services could be the first step in quality improvement activities. Results have implications for efforts to improve service quality in longterm care hospitals and designing more comprehensive national evaluation criteria. PMID:24159497

  14. Assessing diversity and quality in primary care through the multimethod assessment process (MAP).

    PubMed

    Kairys, Jo Ann; Orzano, John; Gregory, Patrice; Stroebel, Christine; DiCicco-Bloom, Barbara; Roemheld-Hamm, Beatrix; Kobylarz, Fred A; Scott, John G; Coppola, Lisa; Crabtree, Benjamin F

    2002-01-01

    The U.S. health care system serves a diverse population, often resulting in significant disparities in delivery and quality of care. Nevertheless, most quality improvement efforts fail to systematically assess diversity and associated disparities. This article describes application of the multimethod assessment process (MAP) for understanding disparities in relation to diversity, cultural competence, and quality improvement in clinical practice. MAP is an innovative quality improvement methodology that integrates quantitative and qualitative techniques and produces a system level understanding of organizations to guide quality improvement interventions. A demonstration project in a primary care practice illustrates the utility of MAP for assessing diversity. PMID:12938252

  15. Measuring and monitoring quality in satellite echo services within critical care: an exploration of best practice.

    PubMed

    Thomas, Toby C; Colebourn, Claire L

    2015-06-01

    The subspecialty of critical care echocardiography is a rapidly developing area of cardiac imaging. The United Kingdom Committee for Critical Care Echocardiography was set up in 2009 to examine the remit of echocardiography in critical care, and a successful collaboration between the British Society of Echocardiography (BSE) and the Intensive Care Society has resulted in the establishment of two new critical care accreditation processes: Focused Intensive Care Echocardiography and Advanced Critical Care Echocardiography. These accreditation processes are currently driving the development of satellite echo services within critical care departments throughout the UK. Individual practitioner - and more recently, departmental - accreditation have become well-established processes advocated by the BSE. Practitioner accreditation promotes accountability, and departmental accreditation standardises the environment in which practitioners operate. The accreditation of individual echocardiographers has been embraced by the critical care fraternity; we propose that departmental accreditation for critical care echo services be viewed in the same way. Identifying quality indicators for satellite echocardiography services within critical care areas is therefore the focus of the present quality exploration: our aim is to propose a set of parameters against which satellite critical care echo services can be benchmarked. In publishing our suggestions, we hope to stimulate debate in light of the rapid evolution of critical care echocardiography as a subspecialty practice. We suggest that our proposed parameters could be used to maintain satellite critical care service standards and to help identify departments capable of delivering high-quality services and training in critical care echocardiography. PMID:26693334

  16. Measuring and monitoring quality in satellite echo services within critical care: an exploration of best practice

    PubMed Central

    Colebourn, Claire L

    2015-01-01

    The subspecialty of critical care echocardiography is a rapidly developing area of cardiac imaging. The United Kingdom Committee for Critical Care Echocardiography was set up in 2009 to examine the remit of echocardiography in critical care, and a successful collaboration between the British Society of Echocardiography (BSE) and the Intensive Care Society has resulted in the establishment of two new critical care accreditation processes: Focused Intensive Care Echocardiography and Advanced Critical Care Echocardiography. These accreditation processes are currently driving the development of satellite echo services within critical care departments throughout the UK. Individual practitioner – and more recently, departmental – accreditation have become well-established processes advocated by the BSE. Practitioner accreditation promotes accountability, and departmental accreditation standardises the environment in which practitioners operate. The accreditation of individual echocardiographers has been embraced by the critical care fraternity; we propose that departmental accreditation for critical care echo services be viewed in the same way. Identifying quality indicators for satellite echocardiography services within critical care areas is therefore the focus of the present quality exploration: our aim is to propose a set of parameters against which satellite critical care echo services can be benchmarked. In publishing our suggestions, we hope to stimulate debate in light of the rapid evolution of critical care echocardiography as a subspecialty practice. We suggest that our proposed parameters could be used to maintain satellite critical care service standards and to help identify departments capable of delivering high-quality services and training in critical care echocardiography. PMID:26693334

  17. Good-quality social care for people with Parkinson’s disease: a qualitative study

    PubMed Central

    Kennedy, Fiona; Stocks, Amanda-Jayne; McDonnell, Ann; Ramaswamy, Bhanu; Wood, Brendan; Whitfield, Malcolm

    2016-01-01

    Objectives The study examines the meaning of good-quality social care for people with Parkinson's disease and their carers. It identifies, from their perspective, the impact of good-quality social care on health and well-being. Design Qualitative case study methodology, interview and framework analysis techniques were used. Setting: community locations in the north and midlands of England. Participants Data were collected from 43 participants including individual interviews with people with Parkinson's disease (n=4), formal and informal social care providers (n=13), 2 focus groups, 1 with people with Parkinson's disease and their carers (n=17), and 1 with professionals (n=8), plus a telephone interview with a former commissioner. Findings Good-quality social care, delivered in a timely fashion, was reported to have a positive impact on health. Furthermore, there is an indication that good-quality social care can prevent untoward events, such as infections, symptom deterioration and deterioration in mental health. The concept of the ‘Impact Gap’ developed from the findings, illustrates how the costs of care may be reduced by delivering good-quality social care. Control, choice and maintaining independence emerged as indicators of good-quality social care, irrespective of clinical condition. Participants identified characteristics indicative of good-quality social care specific to Parkinson's disease, including understanding Parkinson's disease, appropriate administration of medication, timing of care and reassessment. ‘Parkinson's aware’ social care was seen to generate psychological, physical and social benefits that were inter-related. Conclusions The findings indicate how maximising quality in social care delivery for people with Parkinson's disease can impact on health and well-being. Long-term or short-term benefits may result in prevented events and reductions in health and social care resource. Health professionals can be instrumental in early

  18. A Review and Characterization of the Various Perceptions of Quality Cancer Care

    PubMed Central

    Colosia, Ann D; Peltz, Gerson; Pohl, Gerhardt; Liu, Esther; Copley-Merriman, Kati; Khan, Shahnaz; Kaye, James A

    2011-01-01

    BACKGROUND It is important to maintain high-quality cancer care while reducing spending. This requires an understanding of how stakeholders define “quality.” The objective of this literature review was to understand the perceptions patients, physicians, and managed care professionals have about quality cancer care, especially chemotherapy. METHODS A computerized literature search was conducted for articles concerning quality cancer care in patients who received chemotherapy. Among >1100 identified sources, 25 presented interviews/survey results from stakeholders. RESULTS Patients defined quality cancer care as being treated well by providers, having multiple treatment options, and being part of the decision-making process. Waiting to see providers, having problems with referrals, going to different locations for treatment, experiencing billing inaccuracies, and navigating managed care reimbursement negatively affected patients' quality-of-care perceptions. Providers perceived quality cancer care as making decisions based on the risks-benefits of specific chemotherapy regimens and patients' health status rather than costs. Providers objected to spending substantial time interacting with payers instead of delivering care to patients. Payers must control the costs of cancer care but do not want an adversarial relationship with providers and patients. Payers' methods of managing cancer more efficiently involved working with providers to develop assessment and decision-assist tools. CONCLUSIONS Delivering quality cancer care is increasingly difficult because of the shortage of oncologists and rising costs of chemotherapy agents, radiation therapy, and imaging tests. The definition of quality cancer care differed among stakeholders, and healthcare reform must reflect these various needs to maintain and improve quality while controlling costs. Cancer 2011. © 2010 American Cancer Society PMID:20939015

  19. Disparities in Health Care Quality Indicators among US Children with Special Health Care Needs According to Household Language Use

    PubMed Central

    Yu, Stella; Lin, Sue; Strickland, Bonnie

    2015-01-01

    Background: Lower health care utilization and less favorable health outcomes have been demonstrated in children from Non-English Primary Language households (NEPL) in previous studies. This study examines prevalence of health care quality indicators among US children with special health care needs (CSHCN) and their association with household language use. Methods: We used data from the 2009-2010 National Survey of Children with Special Health Care Needs, restricted to an analytic sample of 40,242 children. Logistic regression models were used to examine the effects of primary household language on the attainment of the 6 health care quality indicators for CSHCN. Results: Compared to CSHCN from English primary language households (EPL), CSHCN from NEPL households had 31% higher odds of not feeling like partners in health care decision-making. They had 67% higher odds of lacking care through a medical home and 42% higher odds of reporting inadequate health insurance. NEPL children had 32% higher odds of not receiving early and continuous screening for special health care needs. NEPL youths had 69% higher odds of not receiving services for transition to adulthood. Minority race/ethnicity, lower income and families other than two biological parents all conferred additional risks to not attaining quality indicators. Publicly insured or uninsured CSHCN were also at higher risk. Conclusions and Global Health Implications: Our study provides compelling evidence that significant disparities exist for CSHCN by primary household language status across all health care quality indicators. Establishment of effective surveillance systems and targeting of outreach programs in both developed and developing countries may lead to improved understanding of health care needs and quality of services and reduction of health disparities for this underserved population.

  20. Quality of Mental Health Care for Nursing Home Residents: A Literature Review

    PubMed Central

    Grabowski, David C.; Aschbrenner, Kelly A.; Rome, Vincent F.; Bartels, Stephen J.

    2010-01-01

    Because of the high proportion of nursing home residents with a mental illness other than dementia, the quality of mental health care in nursing homes is a major clinical and policy issue. The authors apply Donabedian's framework for assessing quality of care based on the triad of structure, process, and outcome-based measures in reviewing the literature on the quality of mental health care in nursing homes. Quality measures used within the literature include mental health consultations and hospitalizations, inappropriate use of medications, and mental health survey deficiencies. Factors related to the resident's welfare (nurse staffing), provider norms (locality), and financial factors (payer mix) were associated with the quality of mental health care. Although future research is necessary, the extant literature suggests that persons with mental illness are frequently admitted to nursing homes and their care is often of poor quality and related to a series of resident and facility factors. PMID:20223943

  1. A cross-national comparison of the quality of clinical care using vignettes.

    PubMed

    Peabody, John W; Liu, Anli

    2007-09-01

    In studies comparing clinical practice to evidence-based standards, researchers have found that quality of care is inconsistently provided to different segments of the population in both developing and developed countries. To test the hypothesis that quality of care varies widely within different countries, we conducted a prospectively designed evaluation of quality for three common clinical conditions: diarrhoea, tuberculosis and prenatal care. Five countries participated in the study: China, the Philippines, Mexico, El Salvador and India. Within each country, physicians were randomly selected from tertiary care hospitals, district level hospitals, and public and private outpatient clinics. A total of 488 previously validated case vignettes were administered to 300 participating physicians. Vignettes were scored according to evidence and expert based quality criteria. We used a random effects model to estimate the associations between quality scores by case, physician characteristics, study site, and country. We found that average quality of care was low (61.0%), but there exists a wide variation in overall quality (30-93%). While there was little difference in average quality scores between countries (60.2 to 62.6%), variation within countries was broad. The wide variation was consistent across facility type, medical condition and domain of care. We also found that younger, female, tertiary care and specialist physicians performed better than their counterparts. We conclude that some physicians provide exceptional care even in the setting of limited resources. Furthermore, poor quality can be addressed by health policy planners by directing remediation toward the lowest performers. PMID:17660225

  2. 42 CFR 476.160 - General quality of care review procedures.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 4 2014-10-01 2014-10-01 false General quality of care review procedures. 476.160 Section 476.160 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) QUALITY IMPROVEMENT ORGANIZATIONS QUALITY IMPROVEMENT ORGANIZATION REVIEW Review Responsibilities of Quality...

  3. Revisiting the Two Faces of Child Care Quality: Structure and Process

    ERIC Educational Resources Information Center

    Cassidy, Deborah J.; Hestenes, Linda L.; Hansen, Joanna K.; Hegde, Archana; Shim, Jonghee; Hestenes, Steve

    2005-01-01

    While child care quality has been examined in numerous studies, the definition of quality and specifically, the concepts of structural and process quality, have not been adequately explored. In this qualitative analysis of the constructs of process and structural quality, a content analysis of the Early Childhood Environment Rating Scale-Revised…

  4. Rapid cycle change projects improve quality of care.

    PubMed

    Valente, Sharon

    2011-01-01

    Transforming Care at the Bedside program was developed as a way to improve care on medical-surgical units, patients' and family members' experience of care, and teamwork among care team members and to increase satisfaction and retention of nurses. Average turnover rates for this program's RNs decreased to about 3%, a 58% reduction in rate. The time RNs spent in direct patient care increased 10% compared to the control unit, and value-added care also increased from 10% to 15% over baseline. Patient and staff satisfaction improved. PMID:20628315

  5. The Integration of Adult Acute Care Surgeons into Pediatric Surgical Care Models Supplements the Workforce without Compromising Quality of Care.

    PubMed

    Judhan, Rudy J; Silhy, Raquel; Statler, Kristen; Khan, Mija; Dyer, Benjamin; Thompson, Stephanie; Richmond, Bryan

    2015-09-01

    Acute care of children remains a challenge due to a shortage of pediatric surgeons, particularly in rural areas. In our institutional norm, all cases in patients age six and older are managed by dedicated general surgeons. The provision of care to these children by these surgeons alleviates the impact of such shortages. We conducted a five-year retrospective analysis of all acute care pediatric surgical cases performed in patients aged 6 to 17 years by a dedicated group of adult general surgeons in a rural tertiary care hospital. Demographics, procedure, complications, outcomes, length of stay, and time of consultation/operation were obtained via chart review. Elective, trauma related, or procedures performed by a pediatric surgeon were excluded. Descriptive statistics are reported. A total of 397 cases were performed by six dedicated general surgeons during the study period. Mean age was 11.5 ± 3.1 years. In all, 100 (25.2%) were transferred from outlying facilities and 52.6 per cent of consultations/operations occurred at night (7P-7A), of which 33.2 per cent occurred during late night hours (11P-7A). On weekends, 34.0 per cent occurred. Appendectomy was the most commonly performed operation (n = 357,89.9%), of which 311 were laparoscopic (87.1%). Others included incision/drainage (4.5%), laparoscopic cholecystectomy (2.0%), bowel resection (1.5%), incarcerated hernia (0.5%), small bowel obstruction (0.5%), intra-abdominal abscess drainage (0.3%), resection of intussusception (0.3%), Graham patch (0.3%), and resection omental torsion (0.3%). Median length of stay was two days. Complications occurred in 23 patients (5.8%), of which 22(5.5%) were the result of the disease process. These results parallel those published by pediatric surgeons in this age group and for the diagnoses treated. Models integrating dedicated general surgeons into pediatric call rotations can be designed such that quality of pediatric care is maintained while providing relief to an

  6. Investing in Our Children's Future: The Path to Quality Child Care through the Pennsylvania Child Care/Early Childhood Development Training System.

    ERIC Educational Resources Information Center

    Iutcovich, Joyce; Fiene, Richard; Johnson, James; Koppel, Ross; Langan, Francine

    This study identified training needs for Pennsylvania child care providers and assessed the impact of training, classroom/caregiver dynamics, and staff characteristics on child care quality. Participating were 29 family child care providers, 30 group homes, and 60 child care centers, stratified by type of site and geographic region. Quality of…

  7. [Evaluation of the quality of performance of general practitioners. What is the problem with primary care quality indicators in Hungary?].

    PubMed

    Kolozsvári, László Róbert; Rurik, Imre

    2016-02-28

    The Hungarian primary care quality indicator system has been introduced in 2009, and has been continuously developed since then. The system offers extra financing for family physicians who are achieving the expected levels of indicators. There are currently 16 indicators for adult and mixed practices and 8 indicators are used in paediatric care. Authors analysed the influencing factors of the indicators other than those related to the performance of family physicians. Expectations and compliance of patients, quality of outpatient (ambulatory) care services, insufficient flow of information, inadequate primary care softwares which need to be updated could be considered as the most important factors. The level of financial motivations should also be significantly increased besides changes in the reporting system. It is recommended, that decision makers in health policy and financing have to declare clearly their expectations, and professional bodies should find the proper solution. These indicators could contribute properly to the improvement of the quality of primary care services in Hungary. PMID:26895800

  8. Practical Issues in Palliative and Quality-of-Life Care

    PubMed Central

    Hennessy, John E.; Lown, Beth A.; Landzaat, Lindy; Porter-Williamson, Karin

    2013-01-01

    Although palliative care is not new to health care or to oncology, oncologists still struggle to maximize the value of this type of care across the entire care continuum and across the patient's trajectory of illness. When we don't use what may be the best tools for the job, at the right times in the care path, we miss opportunities to optimize patient and family coping, to limit suffering, and to ensure that our care plans are patient centered. In this article, we look at how we define palliative care and how the tools of palliative medicine can be used to enhance patient care in the outpatient oncology practice setting. PMID:23814513

  9. A Nursing Interaction Approach to Consumer Internet Training on Quality Health Care

    ERIC Educational Resources Information Center

    Lesley, Marsha L.; Oermann, Marilyn H.; Vander Wal, Jillon S.

    2004-01-01

    This study examined the effectiveness of using the Internet to teach consumers about quality health care, compared consumer definitions of quality health care prior to and following completion of the Internet experience, and compared ratings of learning, satisfaction and value of the Internet instruction between consumers who completed the…

  10. Implementing the patient circle. Call on patients to help improve perceptions of health care quality.

    PubMed

    Ostasiewski, P; Fugate, D L

    1994-01-01

    Adapting the quality-circle concept to a health care setting helped one hospital solve a problem and boosted its image among patients. The "patient circle" technique is one step health care providers can take toward delivering "total customer value," a quality perception that can mean the difference between surviving and thriving in the future. PMID:10154633

  11. Factors Associated with the Utilization and Quality of Prenatal Care in Western Rural Regions of China

    ERIC Educational Resources Information Center

    Dongxu, Wang; Yuhui, Shi; Stewart, Donald; Chun, Chang; Chaoyang, Li

    2012-01-01

    Purpose: The paper seeks to identify key features of prenatal care utilization and quality in western regions of China and to determine the factors affecting the quality of prenatal care. Design/methodology/approach: A descriptive, cross-sectional study was conducted. The instrument for the study was a 10-stem respondent-administered, structured…

  12. Vermont STep Ahead Recognition 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 Vermont's STep Ahead Recognition System (STARS) 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 All Child Care Programs;…

  13. Quality Health Care for People with Developmental Disabilities: A Guide for Parents and Other Caregivers.

    ERIC Educational Resources Information Center

    Pfaffinger, Kathleen M.; Nelson, Richard P.

    Starting with the premise that all people have a right to quality health care, this guide emphasizes that assisting people with developmental disabilities to obtain health care and maintain healthy life styles will enhance the quality of their lives at home and in the community. The guide consists of four sections. A section on obtaining care…

  14. Physician Job Satisfaction and Quality of Care Among Hospital Employed Physicians in Japan

    PubMed Central

    Bito, Seiji; Matsumura, Shinji; Hayashino, Yasuaki; Fukuhara, Shunichi

    2009-01-01

    Background Physician job satisfaction is reportedly associated with interpersonal quality of care, such as patient satisfaction, but its association with technical quality of care, as determined by whether patients are offered recommended services, is unknown. Objective We explored whether the job satisfaction of hospital-employed physicians in Japan is associated with the technical quality of care, with an emphasis on process qualities as measured by quality indicators. Design Cross-sectional study linking data from physician surveys with data abstracted from outpatient charts. Participants A total of 53 physicians working at 13 hospitals in Japan participated. Medical records covering 568 patients were reviewed. Measurements Disease-specific indicators related to the care of patients with hypertension, type 2 diabetes, and asthma, as well as disease-independent measures of the process of care were abstracted. We analyzed the association between the quality of care score for individual physicians, which is defined as the percentage of quality indicators satisfied among the total for which their patients were eligible, and physician job satisfaction, which was measured by a validated scale. Results No statistically significant association between physician job satisfaction and quality of care was observed. A 1-standard deviation (SD) increment in the physician job satisfaction scale was associated with an increase of only 0.3% for overall quality (P = 0.85), −3.0% for hypertension (P = 0.22), 2.5% for type 2 diabetes (P = 0.44), 8.0% for asthma (P = 0.21), and −0.4% for cross-cutting care (P = 0.76). Conclusion Contrary to the positive association reported between physician job satisfaction and high quality of interpersonal care, no association was seen between physician job satisfaction and the technical quality of care. PMID:19130149

  15. Interview with a quality leader: Joel T. Allison on healthcare technology and quality care. Interview by Marie St. Rose.

    PubMed

    Allison, Joel T

    2009-01-01

    Managing the delivery of healthcare in a turbulent environment is challenging. In this article, Joel T. Allison shares his knowledge, experiences, and best practices on healthcare technology and quality care. PMID:19753802

  16. Determinants of Quality of Life in Primary Care Patients with Diabetes: Implications for Social Workers

    ERIC Educational Resources Information Center

    Ayalon, Liat; Gross, Revital; Tabenkin, Hava; Porath, Avi; Heymann, Anthony; Porter, Boaz

    2008-01-01

    Using a cross-sectional design of 400 primary care patients with diabetes, the authors evaluated demographics, health status, subjective health and mental health, health behaviors, health beliefs, knowledge of diabetes treatment, satisfaction with medical care, and quality of medical care as potential predictors of QoL and QoL in the hypothetical…

  17. Parents Pleased With Child Care Options and Quality. Research Brief, Volume 96, Number 4

    ERIC Educational Resources Information Center

    Public Policy Forum, 2008

    2008-01-01

    A recent survey of 430 parents in southeastern Wisconsin finds the majority are satisfied with the quality of their child care arrangements and their options for child care. Most say they would not change anything about their child care arrangement if they had the chance, and nearly two-thirds report a willingness to pay more for their current…

  18. Child Care: States Face Difficulties Enforcing Standards and Promoting Quality. Report to Congressional Requesters.

    ERIC Educational Resources Information Center

    General Accounting Office, Washington, DC. Div. of Human Resources.

    This report discusses efforts to ensure and promote quality child care through enforcement of state standards and other activities. The Child Care and Development Block Grant Act of 1990 authorized the dispersing of funds to states for child care services through the United States Department of Health and Human Services (HHS). These funds are used…

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

    ERIC Educational Resources Information Center

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

    2004-01-01

    Obtaining meaningful information from statistically valid and reliable measures of the quality of care for disease-specific care provided in small rural hospitals is limited by small numbers of cases and different definitive care capacities. An alternative approach may be to aggregate and analyze patient services that reflect more generalized care…

  20. Parental Child Care Selection Criteria and Program Quality in Metropolitan and Nonmetropolitan Communities.

    ERIC Educational Resources Information Center

    Ispa, Jean M.; Thornburg, Kathy R.; Venter-Barkley, Janet

    1998-01-01

    A study of 127 families and 50 child care facilities in 17 Missouri communities found that criteria for selecting child care were similar for metropolitan and nonmetropolitan parents; parents were more concerned with quality child care and caregiver "warmth" than with practical considerations; but ratings on caregiver warmth did not predict…

  1. Handbook on Quality Child Care for Young Children: Settings Standards and Resources.

    ERIC Educational Resources Information Center

    Baglin, Carol Ann, Ed.; Bender, Michael, Ed.

    Intended primarily for professionals teaching early childhood and infant intervention courses, this handbook presents an overview of child care as both a support to families and an economic necessity, meeting changing and dynamic needs. Child care settings and types of care are discussed, along with quality indicators, licensing, and provider…

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

    PubMed

    Predavec, Sanja; Sogorić, Selma; Jurković, Drazen

    2010-12-01

    Emergency medical services (EMS) in the Republic of Croatia are currently organized as part of the existing health care system and delivered in the form of pre-hospital and hospital EMS. The pre-hospital EMS are delivered by standalone EMS Centers, EMS units set up in community health centers, and by general practitioners working in shifts and on call in remote and scarcely populated areas. In hospitals, each ward usually has its own emergency reception area, and only in a couple of cases there is an integrated emergency admission unit for the entire hospital. The current EMS structure does not meet the basic requirements that would make an EMS system optimal, i.e. equal quality, equal access, effectiveness and appropriate equipment. The EMS Restructuring Project is part of the Croatian health care system reform and is addressed by the National Health Development Strategy 2006-2011. As part of restructuring efforts, the Croatian National Institute of Emergency Medicine, 21 County Institutes of Emergency Medicine and county-level call centers are going to be set up. In addition, the project will introduce the following: integrated emergency admission areas at hospitals; telemedicine as part of emergency medicine; emergency medicine specialty for physicians and additional specialized training for nurses/technicians; separation of emergency and non-emergency transport; standards for vehicles and equipment and guidelines/protocols/algorithms for care. The Croatian National Institute of Emergency Medicine is an umbrella EMS organization. It shapes the EMS in Croatia and proposes, plans, monitors and analyzes EMS actions in Croatia. In addition, it submits a proposal of the Emergency Medicine Network to the minister, sets standards for EMS transport, and coordinates, guides and supervises the work of County Institutes of Emergency Medicine. County Institutes organize and deliver pre-hospital EMS in their counties. Integrated hospital emergency admission units represent a

  3. Creating a Patient-Centered Health Care Delivery System: A Systematic Review of Health Care Quality From the Patient Perspective.

    PubMed

    Mohammed, Khaled; Nolan, Margaret B; Rajjo, Tamim; Shah, Nilay D; Prokop, Larry J; Varkey, Prathibha; Murad, Mohammad H

    2016-01-01

    Patient experience is one of key domains of value-based purchasing that can serve as a measure of quality and be used to improve the delivery of health services. The aims of this study are to explore patient perceptions of quality of health care and to understand how perceptions may differ by settings and condition. A systematic review of multiple databases was conducted for studies targeting patient perceptions of quality of care. Two reviewers screened and extracted data independently. Data synthesis was performed following a meta-narrative approach. A total of 36 studies were included that identified 10 quality dimensions perceived by patients: communication, access, shared decision making, provider knowledge and skills, physical environment, patient education, electronic medical record, pain control, discharge process, and preventive services. These dimensions can be used in planning and evaluating health care delivery. Future research should evaluate the effect of interventions targeting patient experience on patient outcomes. PMID:25082873

  4. Improving quality and safety of hospital care: a reappraisal and an agenda for clinically relevant reform.

    PubMed

    Scott, I A; Poole, P J; Jayathissa, S

    2008-01-01

    Improving quality and safety of hospital care is now firmly on the health-care agenda. Various agencies within different levels of government are pursuing initiatives targeting hospitals and health professionals that aim to identify, quantify and lessen medical error and suboptimal care. Although not denying the value of such 'top-down' initiatives, more attention may be needed towards 'bottom-up' reform led by practising physicians. This article discusses factors integral to delivery of safe, high-quality care grouped under six themes: clinical workforce, teamwork, patient participation in care decisions, indications for health-care interventions, clinical governance and information systems. Following this discussion, a 20-point action plan is proposed as an agenda for future reform capable of being led by physicians, together with some cautionary notes about relying too heavily on information technology, use of non-clinical quality personnel and quantitative evaluative approaches as primary strategies in improving quality. PMID:18190414

  5. Using Quality Experts from Manufacturing to Transform Primary Care

    ERIC Educational Resources Information Center

    Steiner, Rose M.; Walsworth, David T.

    2010-01-01

    Introduction: Improving Performance in Practice (IPIP) is an initiative convened by the American Board of Medical Specialties. It investigates the efficacy of coaches in helping primary-care practices improve the care of patients with diabetes and asthma. Most IPIP states use coaches who have a health care background, and are trained in quality…

  6. 38 CFR 51.120 - Quality of care.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ...) Tracheostomy care; (5) Tracheal suctioning; (6) Respiratory care; (7) Foot care; and (8) Prostheses. (m... unnecessary drug is any drug when used: (i) In excessive dose (including duplicate drug therapy); or (ii) For... antipsychotic drugs are not given these drugs unless antipsychotic drug therapy is necessary to treat a...

  7. 38 CFR 51.120 - Quality of care.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ...) Tracheostomy care; (5) Tracheal suctioning; (6) Respiratory care; (7) Foot care; and (8) Prostheses. (m... unnecessary drug is any drug when used: (i) In excessive dose (including duplicate drug therapy); or (ii) For... antipsychotic drugs are not given these drugs unless antipsychotic drug therapy is necessary to treat a...

  8. 38 CFR 51.120 - Quality of care.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ...) Tracheostomy care; (5) Tracheal suctioning; (6) Respiratory care; (7) Foot care; and (8) Prostheses. (m... unnecessary drug is any drug when used: (i) In excessive dose (including duplicate drug therapy); or (ii) For... antipsychotic drugs are not given these drugs unless antipsychotic drug therapy is necessary to treat a...

  9. 42 CFR 483.25 - Quality of care.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ..., or ileostomy care; (4) Tracheostomy care; (5) Tracheal suctioning; (6) Respiratory care; (7) Foot... duplicate drug therapy); or (ii) For excessive duration; or (iii) Without adequate monitoring; or (iv...) Residents who have not used antipsychotic drugs are not given these drugs unless antipsychotic drug...

  10. 38 CFR 51.120 - Quality of care.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ...) Tracheostomy care; (5) Tracheal suctioning; (6) Respiratory care; (7) Foot care; and (8) Prostheses. (m... unnecessary drug is any drug when used: (i) In excessive dose (including duplicate drug therapy); or (ii) For... antipsychotic drugs are not given these drugs unless antipsychotic drug therapy is necessary to treat a...

  11. 42 CFR 483.25 - Quality of care.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ..., or ileostomy care; (4) Tracheostomy care; (5) Tracheal suctioning; (6) Respiratory care; (7) Foot... duplicate drug therapy); or (ii) For excessive duration; or (iii) Without adequate monitoring; or (iv...) Residents who have not used antipsychotic drugs are not given these drugs unless antipsychotic drug...

  12. 42 CFR 483.25 - Quality of care.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ..., or ileostomy care; (4) Tracheostomy care; (5) Tracheal suctioning; (6) Respiratory care; (7) Foot... duplicate drug therapy); or (ii) For excessive duration; or (iii) Without adequate monitoring; or (iv...) Residents who have not used antipsychotic drugs are not given these drugs unless antipsychotic drug...

  13. 38 CFR 51.120 - Quality of care.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ...) Tracheostomy care; (5) Tracheal suctioning; (6) Respiratory care; (7) Foot care; and (8) Prostheses. (m... unnecessary drug is any drug when used: (i) In excessive dose (including duplicate drug therapy); or (ii) For... antipsychotic drugs are not given these drugs unless antipsychotic drug therapy is necessary to treat a...

  14. 42 CFR 483.25 - Quality of care.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ..., or ileostomy care; (4) Tracheostomy care; (5) Tracheal suctioning; (6) Respiratory care; (7) Foot... duplicate drug therapy); or (ii) For excessive duration; or (iii) Without adequate monitoring; or (iv...) Residents who have not used antipsychotic drugs are not given these drugs unless antipsychotic drug...

  15. [Telemedicine: Improving the quality of care for critical patients from the pre-hospital phase to the intensive care unit].

    PubMed

    Murias, G; Sales, B; García-Esquirol, O; Blanch, L

    2010-01-01

    The Health System is in crisis and critical care (from transport systems to the ICU) cannot escape from that. Lack of integration between ambulances and reference Hospitals, a deep shortage of critical care specialists and assigned economical resources that increase less than critical care demand are the cornerstones of the problem. Moreover, the analysis of the situation anticipated that the problem will be worse in the future. "Closed" ICUs in which critical care specialists direct patient care outperform "open" ones in which primary admitting physicians direct patient care in consultation with critical care specialists. However, the current paradigm in which a critical care specialist is close to the patient is in the edge of the trouble so, only a new paradigm could help to increase the number of patients under intensivist care. Current information technology and networking capabilities should be fully exploited to improve both the extent and quality of intensivist coverage. Far to be a replacement of the existing model Telemedicine might be a complimentary tool. In fact, to centralize medical data into servers has many additional advantages that could even improve the way in which critical care physicians take care of their patients under the traditional system. PMID:19811855

  16. Midwifery and quality care: findings from a new evidence-informed framework for maternal and newborn care.

    PubMed

    Renfrew, Mary J; McFadden, Alison; Bastos, Maria Helena; Campbell, James; Channon, Andrew Amos; Cheung, Ngai Fen; Silva, Deborah Rachel Audebert Delage; Downe, Soo; Kennedy, Holly Powell; Malata, Address; McCormick, Felicia; Wick, Laura; Declercq, Eugene

    2014-09-20

    In this first paper in a series of four papers on midwifery, we aimed to examine, comprehensively and systematically, the contribution midwifery can make to the quality of care of women and infants globally, and the role of midwives and others in providing midwifery care. Drawing on international definitions and current practice, we mapped the scope of midwifery. We then developed a framework for quality maternal and newborn care using a mixed-methods approach including synthesis of findings from systematic reviews of women's views and experiences, effective practices, and maternal and newborn care providers. The framework differentiates between what care is provided and how and by whom it is provided, and describes the care and services that childbearing women and newborn infants need in all settings. We identified more than 50 short-term, medium-term, and long-term outcomes that could be improved by care within the scope of midwifery; reduced maternal and neonatal mortality and morbidity, reduced stillbirth and preterm birth, decreased number of unnecessary interventions, and improved psychosocial and public health outcomes. Midwifery was associated with more efficient use of resources and improved outcomes when provided by midwives who were educated, trained, licensed, and regulated. Our findings support a system-level shift from maternal and newborn care focused on identification and treatment of pathology for the minority to skilled care for all. This change includes preventive and supportive care that works to strengthen women's capabilities in the context of respectful relationships, is tailored to their needs, focuses on promotion of normal reproductive processes, and in which first-line management of complications and accessible emergency treatment are provided when needed. Midwifery is pivotal to this approach, which requires effective interdisciplinary teamwork and integration across facility and community settings. Future planning for maternal and

  17. Nurse Burnout and Quality of Care: Cross-National Investigation in Six Countries

    PubMed Central

    Clarke, Sean P.; Finlayson, Mary; Aiken, Linda H.

    2010-01-01

    We explored the relationship between nurse burnout and ratings of quality of care in 53,846 nurses from six countries. In this secondary analysis, we used data from the International Hospital Outcomes Study; data were collected from1998 to 2005. The Maslach Burnout Inventory and a single-item reflecting nurse-rated quality of care were used inmultiple logistic regression modeling to investigate the association between nurse burnout and nurse-rated quality of care. Across countries, higher levels of burnout were associated with lower ratings of the quality of care independent of nurses’ ratings of practice environments. These findings suggest that reducing nurse burnout may be an effective strategy for improving nurse-rated quality of care in hospitals. PMID:20645421

  18. Challenges and Opportunities in Delivering High-Quality Cancer Care: A 2016 Update.

    PubMed

    Ganz, Patricia A; Hassett, Michael J; Miller, David C

    2016-01-01

    Herein, both the rationale and scope of current initiatives aimed at improving the quality of cancer care delivery in the United States are described. First, we discuss a recent report from the Institute of Medicine that issued a strong call for both the development of quality measures in oncology and implementation of a learning health care system in which data and experience from clinical practice can inform continuous improvements in cancer care. Second, we review the multiple, diverse initiatives that are underway to identify, test, and validate quality measures for the entire spectrum of cancer care. Finally, we discuss regional quality improvement collaboratives as one successful approach to creating a cycle of quality measurement, identification of best practices, and implementation of changes in practice patterns that ultimately yield improved care and outcomes for patients with cancer. PMID:27249735

  19. Child Care in the Netherlands: Trends in Quality over the Years 1995-2005

    ERIC Educational Resources Information Center

    Vermeer, Harriet J.; van Ijzendoorn, Marinus H.; de Kruif, Renee E. L.; Fukkink, Ruben G.; Tavecchio, Louis W. C.; Riksen-Walraven, J. Marianne; van Zeijl, Jantien

    2008-01-01

    The authors assessed the quality of child care in a representative national sample of 42 child-care centers in the Netherlands and compared it with the quality of care that researchers have found using similar samples in 1995 (M. H. van IJzendoorn, L. W. C. Tavecchio, G. J. J. M. Stams, M. J. E. Verhoeven, & E. J. Reiling, 1998) and 2001 (M. J. J.…

  20. Patients' perceptions of service quality dimensions: an empirical examination of health care in New Zealand.

    PubMed

    Clemes, M D; Ozanne, L K; Laurensen, W L

    2001-01-01

    The 1984 liberalization of the New Zealand economy has resulted in a health care sector that has become very competitive (Zwier and Clarke, 1999). The private sector is now able to supply health care services and, as a result, a greater value is being placed on patient satisfaction (Zwier and Clarke, 1999). However, despite the increasing focus on customer satisfaction, research into health care patients' perceptions of the dimensions of service quality is scarce. This can be problematic, as quality of care is an essential issue in the strategic marketing of health care services (Turner and Pol, 1995). This study takes a step towards addressing this deficiency by identifying patients' perceptions of the dimensions of service quality in health care. The findings of this study are based on the empirical analysis of a sample of 389 respondents interviewed by telephone. The findings indicate that the service quality dimensions identified in this health care specific study differ in number and dimensional structure from the widely adopted service quality dimensions first identified by Parasuraman, Berry and Zeithaml (1988): reliability, responsiveness, assurance, empathy and tangibles. The service quality dimensions identified in this study were: reliability, tangibles, assurance, empathy, food, access, outcome, admission, discharge and responsiveness. In addition, health care patients perceive the service quality dimensions relating to the core product in health care delivery (for example, outcome and reliability) as more important than the service quality dimensions relating to the peripheral product in health care delivery (for example, food, access and tangibles). Finally, the results of this study suggest that patients with different geographic, demographic, and behavioristic characteristics have different needs and wants during health care delivery and therefore perceive different service quality dimensions as important. PMID:11727291

  1. La calidad del cuidado infantil: Un resumen para padres (Child Care Quality: An Overview for Parents). ERIC Digest.

    ERIC Educational Resources Information Center

    Patten, Peggy; Ricks, Omar Benton

    Many parents want to know how important the quality of care is to children's social, emotional, and academic development. This Digest synthesizes some major recent research on child care quality. First, the Digest explains what features contribute to quality of care. The Digest also explains the differences between studies of how quality is…

  2. Internal quality control in point-of-care testing: where's the evidence?

    PubMed

    Holt, Helen; Freedman, Danielle B

    2016-03-01

    ISO 22870 standards require protocols for performance of internal quality control for all point-of-care testing devices and training of users in its theory and practice. However, the unique setting of point-of-care testing (i.e. processes conducted by non-scientific users) means that laboratory internal quality control programmes do not easily translate to point-of-care testing. In addition, while the evidence base for internal quality control within the laboratory has been increasing, the equivalent literature surrounding point-of-care testing is very limited. This has led to wide variation in what is considered acceptable practice for internal quality control at the point of care. Indeed, it has been demonstrated that internal quality control is an area of deficiency in point-of-care testing. Internal quality control protocols used at point-of-care testing should be defined based on risk management. The protocol will therefore be dependent on analyser complexity and availability of inbuilt system checks, the risk associated with release of an incorrect patient result as well as frequency of use. The emphasis should be on designing an effective internal quality control protocol as opposed to the inherent tendency of introducing high-frequency quality control. Typically a simple pass or fail criterion is used for internal quality control in point-of-care testing based on whether internal quality control results fall within assigned ranges. While simply taught, such criteria can require broad internal quality control ranges to decrease the probability of false rejection (also reducing the probability of error detection). Customized internal quality control ranges, two-tier acceptance systems and assay-specific internal quality control can be used to improve error detection rates. PMID:26486440

  3. Relationship Quality and Patient-Assessed Quality of Care in VA Primary Care Clinics: Development and Validation of the Work Relationships Scale

    PubMed Central

    Finley, Erin P.; Pugh, Jacqueline A.; Lanham, Holly Jordan; Leykum, Luci K.; Cornell, John; Veerapaneni, Poornachand; Parchman, Michael L.

    2013-01-01

    PURPOSE Efforts to better understand the impact of clinic member relationships on care quality in primary care clinics have been limited by the absence of a validated instrument to assess these relationships. The purpose of this study was to develop and validate a scale assessing relationships within primary care clinics. METHODS The Work Relationships Scale (WRS) was developed and administered as part of a survey of learning and relationships among 17 Department of Veterans Affairs (VA) primary care clinics. A Rasch partial-credit model and principal components analysis were used to evaluate item performance, select the final items for inclusion, and establish unidimensionality for the WRS. The WRS was then validated against semistructured clinic member interviews and VA Survey of Healthcare Experiences of Patients (SHEP) data. RESULTS Four hundred fifty-seven clinicians and staff completed the clinic survey, and 247 participated in semistructured interviews. WRS scores were significantly associated with clinic-level reporting for 2 SHEP variables: overall rating of personal doctor/nurse (r2 =0.43, P <.01) and overall rating of health care (r2= 0.25, P <.05). Interview data describing relationship characteristics were consistent with variability in WRS scores across low-scoring and high-scoring clinics. CONCLUSIONS The WRS shows promising validity as a measure assessing the quality of relationships in primary care settings; moreover, primary care clinics with lower WRS scores received poorer patient quality ratings for both individual clinicians and overall health care. Relationships play an important role in shaping care delivery and should be assessed as part of efforts to improve patient care within primary care settings. PMID:24218378

  4. Quality of Medical Care for Persons with Serious Mental Illness: A Comprehensive Review

    PubMed Central

    McGinty, EE; Baller, J; Azrin, ST; Juliano-Bult, D; Daumit, GL

    2015-01-01

    Objectives Prior studies suggest variation in the quality of medical care for somatic conditions such as cardiovascular disease and diabetes provided to persons with SMI, but to date no comprehensive review of the literature has been conducted. The goals of this review were to summarize the prior research on quality of medical care for the United States population with SMI; identify potential sources of variation in quality of care; and identify priorities for future research. Methods Peer-reviewed studies were identified by searching four major research databases and subsequent reference searches of retrieved articles. All studies assessing quality of care for cardiovascular disease, diabetes, dyslipidemia, and HIV/AIDs among persons with schizophrenia and bipolar disorder published between January 2000 and December 2013 were included. Quality indicators and information about the study population and setting were abstracted by two trained reviewers. Results Quality of medical care in the population with SMI varied by study population, time period, and setting. Rates of guideline-concordant care tended to be higher among veterans and lower among Medicaid beneficiaries. In many study samples with SMI, rates of guideline adherence were considerably lower than estimated rates for the general US population. Conclusions Future research should identify and address modifiable provider, insurer, and delivery system factors that contribute to poor quality of medical care among persons with SMI and consider how to best use quality performance measures as part of the larger strategy to improve health for this group. PMID:25936686

  5. [Self-responsibility as a component of quality-oriented care-reflections on further development of nursing care insurance].

    PubMed

    Gohde, J

    2005-08-01

    Further development of nursing care insurance must consider both ethical aspects and scarcity of resources. An economy that serves human life has two principal targets: safeguarding the basis of existence and extension of the fulfillment of life. From an ethical perspective welfare and personal responsibility have to be equilibrated by promoting individuality and self-responsibility and maintaining relatives' willingness to become a caregiver. Discussing the role of prevention and rehabilitation in nursing care it is argued that the legally committed primacy of prevention and rehabilitation over care has still not been put into practise due to unresolved problems at the interface of health insurance and nursing care insurance as well as at the interface of inpatient and outpatient providers. Moreover, it seems necessary to strengthen prevention and rehabilitation in the context of care. A comprehensive understanding of individual demands for help, support, and care requires a revision of the common definition of need for care in terms of activities of daily living which neglects particularly psycho-social needs. Case management is a suitable approach to provide adequate and coordinated support as a prerequisite for quality of life in people in need for care. Overcoming compartmentalization of inpatient and outpatient sectors and crosslinking of services are described as essential challenges for future provision of nursing care insurance. Intensification of counseling and advice for patients and relatives, extension and diversification of local providers, upgrading of ambulant services, daily care and short-term care, diversification of nursing homes and other housing arrangements, further development of hospices and palliative care, and acceptance of institutions for the elderly as indispensable components of the future care system are discussed as specific tasks in the further development of nursing care insurance. PMID:16133754

  6. [SOROKA UNIVERSITY MEDICAL CENTER: THE ROAD TO LEADERSHIP IN QUALITY OF MEDICAL CARE, SERVICE AND RESEARCH].

    PubMed

    Davidson, Ehud; Sheiner, Eyal

    2016-02-01

    Soroka University Medical Center is a tertiary hospital, and the sole medical center in the Negev, the southern part of Israel. Soroka has invested in quality, service and research. The region has developed joint programs in order to advance the quality of medical care whilst optimizing the utilization of available resources. In this editorial we describe the path to leadership in quality of medical care, service and research. PMID:27215117

  7. Assessing the Validity of the Qualistar Early Learning Quality Rating and Improvement System as a Tool for Improving Child-Care Quality

    ERIC Educational Resources Information Center

    Zellman, Gail L.; Perlman, Michal; Le, Vi-Nhuan; Setodji, Claude Messan

    2008-01-01

    As a result of the generally low quality of child care in the United States and the increased emphasis on accountability in education policy, quality rating systems (QRSs) are proliferating in the child-care arena. QRSs assess child-care providers on multiple dimensions of quality and integrate these assessments into an easily understood summary…

  8. What is important in evaluating health care quality? An international comparison of user views

    PubMed Central

    Groenewegen, Peter P; Kerssens, Jan J; Sixma, Herman J; van der Eijk, Ingrid; Boerma, Wienke GW

    2005-01-01

    Background Quality of care from the perspective of users is increasingly used in evaluating health care performance. Going beyond satisfaction studies, quality of care from the users' perspective is conceptualised in two dimensions: the importance users attach to aspects of care and their actual experience with these aspects. It is well established that health care systems differ in performance. The question in this article is whether there are also differences in what people in different health care systems view as important aspects of health care quality. The aim is to describe and explain international differences in the importance that health care users attach to different aspects of health care. Methods Data were used from different studies that all used a version of the QUOTE-questionnaire that measures user views of health care quality in two dimensions: the importance that users attach to aspects of care and their actual experience. Data from 12 European countries and 5133 individuals were used. They were analysed using multi-level analysis. Results Although most of the variations in importance people attach to aspects of health care is located at the individual level, there are also differences between countries. The ranking of aspects shows similarities. 'My GP should always take me seriously' was in nearly all countries ranked first, while an item about waiting time in the GP's office was always ranked lowest. Conclusion Differences between countries in how health care users value different aspects of care are difficult to explain. Further theorising should take into account that importance and performance ratings are positively related, that people compare their experiences with those of others, and that general and instrumental values might be related through the institutions of the health care system. PMID:15723701

  9. [Quality of life and supportive care in head and neck cancers].

    PubMed

    Babin, Emmanuel; Heutte, Natacha; Grandazzi, Guillaume; Prévost, Virginie; Robard, Laetitia

    2014-05-01

    The quality of life of patients treated for head and neck cancers and their carers is part of the current concerns of health care teams. Assessment tools were created and helped to highlight the severe physical effects (pain, mucositis…) and chronic (mutilation, post-radiation complications…) related to the disease or to different treatments but also to consider the psychosocial impact of this disease. Improving the quality of life through a thoughtful and comprehensive support that must be associated with somatic care, mental health care, rehabilitation and inclusion of social difficulties and suffering relatives. Supportive care shall ensure a good quality of life for patients treated and their families but also reduce the physical effects associated with the disease and treatment. They rely on coordination of care including the cancer networks established in the cancer plan to ensure comprehensive and continuous care for these patients. PMID:24886902

  10. Quality of care in psychosis and bipolar disorder from the service user perspective.

    PubMed

    Skelly, Niamh; Schnittger, Rebecca I; Butterly, Lisa; Frorath, Charlotte; Morgan, Craig; McLoughlin, Declan M; Fearon, Paul

    2013-12-01

    According to the recovery model of mental health care, service development should incorporate the expert knowledge of service users. To date, there has been limited research into conceptualizations of mental health care quality among services users diagnosed with bipolar disorder or psychosis. To investigate service user perspectives on quality of care, we conducted six focus groups (N = 29) with inpatients and outpatients of an independent Irish mental health service. We undertook an inductive thematic analysis of the data. Participants identified proactive staff, meaningful and warm staff-patient interactions, and safety and sociability in the inpatient environment as components of good quality mental health care. Participants also discussed how the implementation of best practice guidelines does not necessarily improve quality of care from the service user perspective. This and similar qualitative research should be used to inform service development and the creation of evaluation instruments compatible with the recovery model. PMID:24163347

  11. The impact of competition on quality and prices in the English care homes market

    PubMed Central

    Forder, Julien; Allan, Stephen

    2014-01-01

    This study assesses the impact of competition on quality and price in the English care/nursing homes market. Considering the key institutional features, we use a theoretical model to assess the conditions under which further competition could increase or reduce quality. A dataset comprising the population of 10,000 care homes was used. We constructed distance/travel-time weighted competition measures. Instrumental variable estimations, used to account for the endogeneity of competition, showed quality and price were reduced by greater competition. Further analyses suggested that the negative quality effect worked through the effect on price – higher competition reduces revenue which pushes down quality. PMID:24487075

  12. Too complicated for the field? Measuring quality of care in humanitarian aid settings

    PubMed Central

    Kersten, Roland; Bosse, Götz; Dörner, Frank; Slavuckij, Andrej; Fernandez, Gustavo; Marx, Michael

    2013-01-01

    While quality of care is a major concern in the western world, not many studies investigate this topic in low-income countries. Even less is known about the quality of care in humanitarian aid settings, where additional challenges from natural or manmade disasters contribute to additional challenges. This study tried to address this gap by introducing a new approach to systematically measure quality of care in a project of Médecins Sans Frontières (MSF) in Agok area, between South Sudan and Sudan. Our objective was to obtain a valid snapshot of quality of care for a MSF project in three weeks that has the potential to serve as a baseline for quality improvement strategies. The evaluation followed a cross-sectional study design to assess structural, process and outcome quality according to Donabedian's criteria of quality of care. A bundle of well-established methods for collection of quantitative and qualitative data was used to assess the project by following a triangulated mixed-methods approach. Mean structural quality scored 73% of expected performance level and mean process quality 59%. The overall mortality rate for the hospital was 3.6%. On average, less complicated cases got a better level of care than patients who were seriously ill. Significant motivational issues were discovered in staff interviews potentially affecting quality of care. The tool appeared to be quick, feasible and effective in judging quality of care in the selected project. To tap the whole potential of the approach a re-evaluation should be carried out to assess the effectiveness of implemented improvement strategies in Agok. To confirm the usefulness of the approach, more studies are needed covering the variety of different humanitarian aid settings. PMID:23683715

  13. Quality Measures for Palliative Care in Patients With Cancer: A Systematic Review

    PubMed Central

    Kamal, Arif H.; Gradison, Margaret; Maguire, Jennifer M.; Taylor, Donald; Abernethy, Amy P.

    2014-01-01

    Purpose: Quality assessment is a critical component of determining the value of medical services, including palliative care. Characterization of the current portfolio of measures that assess the quality of palliative care delivered in oncology is necessary to identify gaps and inform future measure development. Methods: We performed a systematic review of MEDLINE/PubMed and the gray literature for quality measures relevant to palliative care. Measures were categorized into National Quality Forum domains and reviewed for methodology of development and content. Measures were additionally analyzed to draw summative conclusions on scope and span. Results: Two hundred eighty-four quality measures within 13 measure sets were identified. The most common domains for measure content were Physical Aspects of Care (35%) and Structure and Processes of Care (22%). Of symptom-related measures, pain (36%) and dyspnea (26%) were the most commonly addressed. Spiritual (4%) and Cultural (1%) Aspects of Care were least represented domains. Generally, measures addressed processes of care, did not delineate benchmarks for success, and often did not specify intended interventions to address unmet needs. This was most evident regarding issues of psychosocial and spiritual assessment and management. Conclusion: Within a large cohort of quality measures for palliative, care is often a focus on physical manifestations of disease and adverse effects of therapy; relatively little attention is given to the other aspects of suffering commonly observed among patients with advanced cancer, including psychological, social, and spiritual distress. PMID:24917264

  14. Enablers and barriers for implementing high-quality hypertension care in a rural primary care setting in Nigeria: perspectives of primary care staff and health insurance managers

    PubMed Central

    Odusola, Aina O.; Stronks, Karien; Hendriks, Marleen E.; Schultsz, Constance; Akande, Tanimola; Osibogun, Akin; van Weert, Henk; Haafkens, Joke A.

    2016-01-01

    Background Hypertension is a highly prevalent risk factor for cardiovascular diseases in sub-Saharan Africa (SSA) that can be modified through timely and long-term treatment in primary care. Objective We explored perspectives of primary care staff and health insurance managers on enablers and barriers for implementing high-quality hypertension care, in the context of a community-based health insurance programme in rural Nigeria. Design Qualitative study using semi-structured individual interviews with primary care staff (n = 11) and health insurance managers (n=4). Data were analysed using standard qualitative techniques. Results Both stakeholder groups perceived health insurance as an important facilitator for implementing high-quality hypertension care because it covered costs of care for patients and provided essential resources and incentives to clinics: guidelines, staff training, medications, and diagnostic equipment. Perceived inhibitors included the following: high staff workload; administrative challenges at facilities; discordance between healthcare provider and insurer on how health insurance and provider payment methods work; and insufficient fit between some guideline recommendations and tools for patient education and characteristics/needs of the local patient population. Perceived strategies to address inhibitors included the following: task-shifting; adequate provider payment benchmarking; good provider–insurer relationships; automated administration systems; and tailoring guidelines/patient education. Conclusions By providing insights into perspectives of primary care providers and health insurance managers, this study offers information on potential strategies for implementing high-quality hypertension care for insured patients in SSA. PMID:26880152

  15. Organization of Nursing and Quality of Care for Veterans at the End of Life

    PubMed Central

    Kutney-Lee, Ann; Brennan, Caitlin W.; Meterko, Mark; Ersek, Mary

    2015-01-01

    Context The Veterans Health Administration (VA) has improved the quality of end-of-life (EOL) care over the past several years. Several structural and process variables are associated with better outcomes. Little is known, however, about the relationship between the organization of nursing care and EOL outcomes. Objectives To examine the association between the organization of nursing care, including the nurse work environment and nurse staffing levels, and quality of EOL care in VA acute care facilities. Methods Secondary analysis of linked data from the Bereaved Family Survey (BFS), electronic medical record, administrative data, and the VA Nursing Outcomes Database. The sample included 4908 veterans who died in one of 116 VA acute care facilities nationally between October 2010 and September 2011. Unadjusted and adjusted generalized estimating equations were used to examine associations between nursing and BFS outcomes. Results BFS respondents were 17% more likely to give an excellent overall rating of the quality of EOL care received by the veteran in facilities with better nurse work environments (P ≤ 0.05). The nurse work environment also was a significant predictor of providers listening to concerns and providing desired treatments. Nurse staffing was significantly associated with an excellent overall rating, alerting of the family before death, attention to personal care needs, and the provision of emotional support after the patient’s death. Conclusion Improvement of the nurse work environment and nurse staffing in VA acute care facilities may result in enhanced quality of care received by hospitalized veterans at the EOL. PMID:25116912

  16. Improving quality of care and reducing unnecessary hospital admissions: a literature review.

    PubMed

    Means, Tracy

    2016-06-01

    As the UK population lives to older ages, with more complex health and social care needs, there comes a time when going to live in a care home might be essential for a frail, older person. Residents and their families expect high-quality care in return for the costs of their placements, but often find this is not the case ( Help the Aged, 2006 ). In order to improve quality in care homes, the Lincolnshire Community Health Services NHS Trust are piloting a care home support team. The new service aims to provide education and training to an unpredictable workforce, with the addition of regular ward rounds in care homes to ensure more proactive care for residents, in order to reduce unnecessary hospital admissions and improve the quality of care offered. This article looks at the literature relating to education and training for staff in care homes to support this service. It also aims to use the reviewed articles to identify specific training and education needed to improve quality of care for residents and reduce avoidable hospital admissions. PMID:27270196

  17. Setting Standards at the Forefront of Delivery System Reform: Aligning Care Coordination Quality Measures for Multiple Chronic Conditions

    PubMed Central

    DuGoff, Eva H.; Dy, Sydney; Giovannetti, Erin R.; Leff, Bruce; Boyd, Cynthia M.

    2015-01-01

    The primary study objective is to assess how three major health reform care coordination initiatives (Accountable Care Organizations, Independence at Home, and Community-based Care Transitions) measure concepts critical to care coordination for people with multiple chronic conditions. We find that there are major differences in quality measurement across these three large and politically important programs. Quality measures currently used or proposed for these new health reform-related programs addressing care coordination primarily capture continuity of care. Other key areas of care coordination, such as care transitions, patient-centeredness, and cross-cutting care across multiple conditions are infrequently addressed. The lack of a comprehensive and consistent measure set for care coordination will pose challenges for health care providers and policymakers who seek, respectively, to provide and reward well-coordinated care. In addition, this heterogeneity in measuring care coordination quality will generate new information, but will inhibit comparisons between these care coordination programs. PMID:24004040

  18. Measurement of Perceived and Technical Quality of Care for Depression in Racially and Ethnically Diverse Groups.

    PubMed

    Leff, H Stephen; Chow, Clifton; Wieman, Dow A; Ostrow, Laysha; Cortés, Dharma E; Harris, Treniece

    2016-08-01

    Measurement of patient satisfaction is now considered essential for providing patient centered care and is an important tool for addressing health care disparities. However, little is known about how ethnically and racially diverse (ERD) groups differ in how they perceive quality, and widely used instruments for measuring perceived quality give little attention to cultural elements of care. This study examined the relationship between the culturally determined beliefs and expectations of four ERD groups (African Americans, Latinos, Portuguese-speakers, and Haitians, total N = 160) and the technical quality of treatment for depression provided in four "culturally-specific" primary care clinics. Using data from the Experiences of Care and Health Outcomes survey, chart reviews and focus groups, the study addressed a set of questions related to the psychometric properties of perceived care measures and the technical quality of care. The groups differed in preferred cultural elements except all preferred inclusion of religion. They did not differ in overall perceived quality. Technical quality was higher for Portuguese and Haitians than for African Americans and Latinos. Implications of group differences for measuring quality are discussed. PMID:26748509

  19. Quality of Child Care Using the Environment Rating Scales: A Meta-Analysis of International Studies

    ERIC Educational Resources Information Center

    Vermeer, Harriet J.; van IJzendoorn, Marinus H.; Cárcamo, Rodrigo A.; Harrison, Linda J.

    2016-01-01

    The current study provides a systematic examination of child care quality around the globe, using the Environment Rating Scales (ERS). Additional goals of this study are to examine associations between ERS process quality and structural features (group size, caregiver-child ratio) that underpin quality and between ERS and more proximal aspects of…

  20. Thin Blue Lines and Red Crosses: Signposts to Quality in Family Day Care?

    ERIC Educational Resources Information Center

    White, Jayne

    2005-01-01

    This paper explores some of the findings of a study focussing on constructions of family day care from the perspectives of caregivers/educators and coordinators as they engaged in a quality review process using a recently developed resource--The Quality Journey/He haerenga whai hua (2000). The paper positions quality review as a part of a…