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1

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

ERIC Educational Resources Information Center

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…

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

2011-01-01

2

Quality Infant/Toddler Caregiving: Are There Magic Recipes?  

ERIC Educational Resources Information Center

A survey of research findings on environmental and person variables provides clues as to what is required in a high quality infant-toddler program. One of the most important components of such a program is a loving, responsive caregiver. Research has shown that there are specific adult qualities that nurture the roots of intellectual competence,…

Honig, Alice Sterling

3

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

ERIC Educational Resources Information Center

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,…

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

2006-01-01

4

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

ERIC Educational Resources Information Center

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

Tietze, Wolfgang; Cryer, Debby

2004-01-01

5

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

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…

Honig, Alice Sterling

6

Effects of Transitions to New Child Care Classes on Infant/Toddler Distress and Behavior  

ERIC Educational Resources Information Center

Changes in distress and problem behaviors of 38 infants/toddlers were examined after children transitioned from familiar to new classrooms to look at effects of non-continuity of caregiver. Child's age, classroom quality, teacher sensitivity, and transitioning with a peer were examined as possible mediators. Results suggest that transitions were…

Cryer, Debby; Wagner-Moore, Laura; Burchinal, Margaret; Yazejian, Noreen; Hurwitz, Sarah; Wolery, Mark

2005-01-01

7

Safety and Health Guidelines for Children under Age Three in Group Care [and] Infant/Toddler Programs Minimum Equipment Inventory.  

ERIC Educational Resources Information Center

These booklets offer to infant/toddler group care programs complete guidelines for (1) safety and health and (2) minimum equipment inventory. The introduction to the safety and health guidelines stresses that adults should be alert and prepare the environment to minimize risks. Children then will be able to explore and play freely and safely.…

Child Day Care Association of St. Louis, MO.

8

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

ERIC Educational Resources Information Center

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

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

2012-01-01

9

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

ERIC Educational Resources Information Center

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

Ackerman, Debra J.; Barnett, W. Steven

2009-01-01

10

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

ERIC Educational Resources Information Center

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…

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

11

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

ERIC Educational Resources Information Center

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,"…

Godwin, Annabelle; Schrag, Lorraine

12

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

ERIC Educational Resources Information Center

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

Lally, J. Ronald

2009-01-01

13

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

ERIC Educational Resources Information Center

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…

McMullen, Mary Benson; Apple, Peggy

2012-01-01

14

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

ERIC Educational Resources Information Center

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

Parlakian, Rebecca; Adams, Emily

2010-01-01

15

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

ERIC Educational Resources Information Center

"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…

Fenichel, Emily, Ed.

2002-01-01

16

Towards a Predictive Model of Quality in Canadian Child Care Centers  

ERIC Educational Resources Information Center

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

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

2006-01-01

17

The prediction of process quality from structural features of child care  

Microsoft Academic Search

The purpose of this study was to identify structural characteristics of center child care that are associated with observed child care quality from a large multi-state project. Hierarchical regressions examined the relations between quality of care and selected characteristics of the lead caregiver, classroom, center, and director. Nonprofit and for-profit centers (228 infant\\/toddler and 521 preschool classrooms) were randomly sampled

Debby Cryer

1997-01-01

18

Parents as child care consumers  

Microsoft Academic Search

The child care related values and quality assessments of parents as child care consumers were examined. Seven hundred and twenty-seven parents of infants\\/ toddlers and 2,407 parents of preschoolers responded to questionnaires, providing both importance and quality ratings for aspects of child care. Quality ratings for these same aspects of care were completed by trained data collectors. Parents gave high

Debby Cryer; Margaret Burchinal

1997-01-01

19

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

ERIC Educational Resources Information Center

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…

Goble, Carla B.; Horm, Diane M.

2009-01-01

20

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

ERIC Educational Resources Information Center

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

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

2009-01-01

21

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

ERIC Educational Resources Information Center

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

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

2014-01-01

22

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

ERIC Educational Resources Information Center

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…

Moreno, Amanda J.; Klute, Mary M.

2011-01-01

23

Routines. Infant/Toddler Caregiving: A Guide.  

ERIC Educational Resources Information Center

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…

Gonzalez-Mena, Janet

24

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

ERIC Educational Resources Information Center

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

Honig, Alice Sterling; Wittmer, D. S.

25

Child Care and Early Education Arrangements of Infants, Toddlers, and Preschoolers: 2001. U.S. Department of Education, National Center for Education Statistics. Washington, DC: U.S. Government Printing Office  

Microsoft Academic Search

This report is the latest in a National Center for Education Statistics series on young children’s nonparental care arrangements and educational program participation. It presents the most recent data available for children under the age of six, taken from the 2001 administration of the Early Childhood Program Participation Survey, National Household Education Surveys Program. Variation in participation rates by characteristics

Gail M. Mulligan; DeeAnn Brimhall; Jerry West; Christopher Chapman

2005-01-01

26

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

ERIC Educational Resources Information Center

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…

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

2011-01-01

27

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

ERIC Educational Resources Information Center

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;…

Norton, Yolanda

2006-01-01

28

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

ERIC Educational Resources Information Center

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;…

Norton, Yolanda

2006-01-01

29

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

ERIC Educational Resources Information Center

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)…

DiLauro, Elizabeth; Jones, Lynn; Nelson, Florence

2007-01-01

30

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

ERIC Educational Resources Information Center

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

Stewart, Ruth L.

31

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

PubMed Central

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

2013-01-01

32

Activity Organization to Enrich Infant-Toddler Programs  

ERIC Educational Resources Information Center

Carefully planned room arrangement and equipment selection helps untrained adults participate in providing infants with appropriate developmental experiences. Twenty activity centers are suggested. (CM)

Cataldo, Christine Z.

1978-01-01

33

Children's Programs: Infant, Toddlers and Preschool Gift Cards (Wal-Mart, Smith's, Target, Hair Salons for Haircuts)  

E-print Network

Wish List Children's Programs: Infant, Toddlers and Preschool Gift Cards (Wal-Mart, Smith boys) New socks for kids, 12 mos.-5 years New clothes children 6 mos.-5 years (especially boy clothing and boys pants; seasonally appropriate) New shoes children's size 3-13, unisex (seasonally

New Mexico, University of

34

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

ERIC Educational Resources Information Center

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…

Morrissey, Anne-Marie

2014-01-01

35

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

ERIC Educational Resources Information Center

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…

Honig, Alice Sterling

2005-01-01

36

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

ERIC Educational Resources Information Center

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…

Gonzalez-Mena, Janet

37

Evaluation of an early detection tool for social-emotional and behavioral problems in toddlers: The Brief Infant Toddler Social and Emotional Assessment - A cluster randomized trial  

PubMed Central

Background The prevalence of social-emotional and behavioral problems is estimated to be 8 to 9% among preschool children. Effective early detection tools are needed to promote the provision of adequate care at an early stage. The Brief Infant-Toddler Social and Emotional Assessment (BITSEA) was developed for this purpose. This study evaluates the effectiveness of the BITSEA to enhance social-emotional and behavioral health of preschool children. Methods and Design A cluster randomized controlled trial is set up in youth health care centers in the larger Rotterdam area in the Netherlands, to evaluate the BITSEA. The 31 youth health care centers are randomly allocated to either the control group or the intervention group. The intervention group uses the scores on the BITSEA and cut-off points to evaluate a child's social-emotional and behavioral health and to decide whether or not the child should be referred. The control group provides care as usual, which involves administering a questionnaire that structures the conversation between child health professionals and parents. At a one year follow-up measurement the social-emotional and behavioral health of all children included in the study population will be evaluated. Discussion It is hypothesized that better results will be found, in terms of social-emotional and behavioral health in the intervention group, compared to the control group, due to more adequate early detection, referral and more appropriate and timely care. Trial registration Current Controlled Trials NTR2035 PMID:21702936

2011-01-01

38

Reliability and Validity of the Dutch Version of the Brief Infant-Toddler Social and Emotional Assessment (BITSEA)  

Microsoft Academic Search

BackgroundThe Brief Infant-Toddler Social and Emotional Assessment (BITSEA) is a relatively new and short (42-item) questionnaire that measures psychosocial problems in toddlers and consists of a Problem and a Competence scale. In this study the reliability and validity of the Dutch version of the BITSEA were examined for the whole group and for gender and ethnicity subgroups.MethodsParents of 7140 two-year-old

Ingrid Kruizinga; Wilma Jansen; Carolien L. de Haan; Jan van der Ende; Alice S. Carter; Hein Raat

2012-01-01

39

Screening Accuracy and Clinical Application of the Brief Infant-Toddler Social and Emotional Assessment (BITSEA)  

PubMed Central

Background The Brief Infant-Toddler Social and Emotional Assessment (BITSEA) is a promising questionnaire for the early detection of psychosocial problems in toddlers. The screening accuracy and clinical application were evaluated. Methods In a community sample of 2-year-olds (N?=?2060), screening accuracy of the BITSEA Problem scale was examined regarding a clinical CBCL1.5-5 Total Problem score. For the total population and subgroups by child’s gender and ethnicity Receiver Operating Characteristic (ROC) curves were calculated, and across a range of BITSEA Problem scores, sensitivity, specificity, likelihood ratio’s, diagnostic odds ratio and Youden’s index. Clinical application of the BITSEA was examined by evaluating the relation between the scale scores and the clinical decision of the child health professional. Results The area under the ROC curve (95% confidence interval) of the Problem scale was 0.97(0.95–0.98), there were no significant differences between subgroups. The association between clinical decision and BITSEA Problem score (B?=?2.5) and Competence score (B?=??0.7) was significant (p<0.05). Conclusions The results indicate that the BITSEA Problem scale has good discriminative power to differentiate children with and without psychosocial problems. Referred children had less favourable scores compared to children that were not referred. The BITSEA may be helpful in the early detection of psychosocial problems. PMID:24023626

Kruizinga, Ingrid; Jansen, Wilma; Mieloo, Cathelijne L.; Carter, Alice S.; Raat, Hein

2013-01-01

40

Project Coach Outreach: Transdisciplinary Consultation/Coaching Training for Building Infant/Toddler Teams and Linking To Promote Services in Natural Environments. Final Report.  

ERIC Educational Resources Information Center

This report discusses the activities and outcomes of Project Coach Outreach, a project to encourage the use of best practices in early intervention for infants, toddlers, and preschoolers with disabilities and to increase family-centered service options in Mississippi. Specifically, the project focused on the use of natural environments to include…

Fair, Estella G.; Clay, Connie

41

Extending the Dance: Relationship-Based Approaches to Infant/Toddler Care and Education.  

ERIC Educational Resources Information Center

Describes the value of nonparental adult-child relationships for infants and toddlers and outlines specific steps that American and Italian educators from relationship-oriented programs rely on to expand on children's relationship dances with their parents. Suggests that educators should initially take the initiative to become attuned to the child…

Edwards, Carolyn Pope; Raikes, Helen

2002-01-01

42

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

ERIC Educational Resources Information Center

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…

Honig, Alice Sterling

43

The Zero to Three Child Care Anthology 1984-1992.  

ERIC Educational Resources Information Center

This anthology contains 19 articles selected from the "Zero To Three Bulletin" from 1984 through the spring of 1992 and organized into five sections. The section on relationships in infant/toddler child care includes: "Infants in Day Care: Reflections on Experiences, Expectations, and Relationships," by J. H. Pawl; and "Choosing Child Care for…

Provence, Sally, Ed.; And Others

44

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

ERIC Educational Resources Information Center

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.…

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

2001-01-01

45

Measuring Child Care Quality.  

ERIC Educational Resources Information Center

Child care quality is not a single dimension, but rather a multidimensional characteristic of programs that support the family in its child-rearing role and programs in which children thrive developmentally, socially, cognitively, physically, and emotionally. At the regulatory and accreditation level, approaches to quality focus on group size,…

Fiene, Richard

46

Who's Vulnerable in Infant Child Care Centers?  

ERIC Educational Resources Information Center

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)

Kendall, Earline D.; Moukaddem, Virginia E.

1992-01-01

47

Quality of Cancer Care  

Cancer.gov

Work is underway to make cancer a working model for quality of care research and the translation of this research into practice. This requires addressing how data collection about cancer care can be standardized and made most useful to a variety of audiences including providers, patients and their families, purchasers, payers, researchers, and policymakers. The Applied Research Program has spearheaded several key activities to carry out this initiative.

48

Child Care Cost and Quality  

Microsoft Academic Search

This article summarizes what is known about the cost and quality of full-time child care in centers and family child care homes, and about parents' attention to quality in mak- ing child care choices. It relies primarily upon two recent studies which are among the first to collect detailed information about child care operating costs: the Cost, Quality, and Child

Suzanne W. Helburn; Carollee Howes

49

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

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…

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

50

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

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…

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

51

Service quality in health care.  

PubMed

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

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

1999-02-17

52

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

ERIC Educational Resources Information Center

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

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

53

Infants & Toddlers: "Baby Moves"  

ERIC Educational Resources Information Center

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…

Honig, Alice Sterling

2007-01-01

54

Perspectives on home care quality.  

PubMed

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

Kane, R A; Kane, R L; Illston, L H; Eustis, N N

1994-01-01

55

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 ...

56

Structural Predictors of Child Care Quality in Child Care Homes.  

ERIC Educational Resources Information Center

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…

Burchinal, Margaret; Howes, Carollee; Kontos, Susan

2002-01-01

57

Ten Components of Quality Child Care  

E-print Network

Ten Components of Quality Child Care FACT SHEET The FSU Knight Foundation Quality Child Care Initiative What constitutes quality child care? Research defines ten essential components that produce meaningful outcomes for the young children they serve. Child care programs that endeavor to improve often

McQuade, D. Tyler

58

Defining Quality Child Care: Multiple Stakeholder Perspectives  

ERIC Educational Resources Information Center

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…

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

2007-01-01

59

Service quality in health care setting  

Microsoft Academic Search

Purpose – This paper attempts to explore the concept of service quality in a health care setting. Design\\/methodology\\/approach – This paper probes the definition of service quality from technical and functional aspects for a better understanding on how consumers evaluate the quality of health care. It adopts the conceptual model of service quality frequently used by the most researchers in

Wan Edura Wan Rashid; Hj. Kamaruzaman Jusoff

2009-01-01

60

The effect of care planning on quality of patient care.  

PubMed

Nursing care plans can be seen as a means of ensuring holistic care. This study investigated the view of nurses and support workers on the care plan as a tool to enhance quality care and how their views were reflected in practice. PMID:9873343

Webster, J

1998-11-01

61

"If You Carry Him around All the Time at Home, He Expects One of Us to Carry Him around All Day Here and There Are Only TWO of Us!" Parents', Teachers', and Administrators' Beliefs about the Parent's Role in the Infant/Toddler Center  

ERIC Educational Resources Information Center

Conflicting perspectives on the parent's role in the infant/toddler classroom can play a significant role in early educational settings. A recent ethnographic study of an Early Head Start program in New York City focused on conflict of this nature and raised the following set of questions: What sort of power and privilege should parents be given…

Wilgus, Gay

2005-01-01

62

[Quality management in intensive care medicine].  

PubMed

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

Martin, J; Braun, J-P

2014-02-01

63

Variations in Nursing Care Quality across Hospitals  

PubMed Central

Aims The aim of the study was to describe Registered Nurses’ reports of unmet nursing care needs and examine the variation of nursing care quality across hospitals. Background Large proportions of Registered Nurses have reported leaving necessary care activities undone because they lacked the time to complete the activities. Nursing care left undone can be expected to adversely affect the quality of care. However, little is known about the degree of variation in the quality of nursing care across hospitals. Methods In 2008, a secondary analysis of a 1999 survey of Registered Nurses (N=10,184) was conducted using descriptive and comparative statistics. Data were derived from inpatient staff nurses working in acute care hospital settings (N=168). A hospital-level measure (i.e. unmet nursing care needs) of the quality of nursing care was developed from care needs left undone among all nurses. Results Across hospitals there was a wide range in the proportion of Registered Nurses who reported leaving each nursing care need undone. They reported leaving 2 out of 7 necessary nursing care activities undone during their last shift. After controlling for nurses’ demographic information, we found statistically significant variations in the quality of nursing care across hospitals. Conclusion Differences in nursing care quality across hospitals appear to be closely associated with variations in the quality of care environments. Understanding the determinants of unmet nursing care needs can support policy decisions on systems and human resources management to enhance nurses’ awareness of their care practices and the care environment. PMID:19737326

Lucero, Robert J.; Lake, Eileen T.; Aiken, Linda H.

2009-01-01

64

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

ERIC Educational Resources Information Center

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…

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

65

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

ERIC Educational Resources Information Center

This paper presents a profile of Iowa's Child Care Quality Rating System prepared as part of the Child Care Quality Rating System (QRS) Assessment Study. The profile is divided into the following categories: (1) Program Information; (2) Rating Details; (3) Quality Indicators for Center-Based Programs; (4) Indicators for Family Child Care Programs;…

Child Trends, 2010

2010-01-01

66

Quality of Cancer Care - Applied Research  

Cancer.gov

The purpose of these efforts, substantially supported by the Applied Research Program, is to enhance the state of the science on the quality of cancer care and inform federal and private-sector decision making on care delivery, coverage, regulation, and standard setting. Work is underway to make cancer a working model for quality of care research and the translation of this research into practice.

67

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

PubMed

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

Zeller, Janice M; Lamb, Karen

2011-01-01

68

Life Is Good for Babies: The Pedagogical and Management Decisions Enabling a Teacher to Be Employed in a Rural Infant-Toddler Program  

ERIC Educational Resources Information Center

The Children's Services Regulation 2004 (NSW) makes it possible for children aged between birth and two years to be without a university qualified teacher in a centre-based long day care service. However, research demonstrates important links between caregivers' formal training and the quality of early childhood education. This case study, about a…

Ireland, Lynda

2007-01-01

69

Leadership and the quality of care  

PubMed Central

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

Firth-Cozens, J; Mowbray, D

2001-01-01

70

Providing high-quality care in primary care settings  

PubMed Central

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

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

2014-01-01

71

EULAR efforts to define quality of care.  

PubMed

EULAR is deeply involved in the field of quality of care of musculoskeletal disorders via numerous initiatives. EULAR has promoted initiatives in the different steps involved in improving/facilitating quality of care (e.g. original studies (basic, translational, clinical research studies), meta-analysis/systematic liter-ature research, elaboration and dissemination of recommendations, ...).Moreover, EULAR is promoting educational programs and is lobbying at the European Community level in order to improve the recognition of musculo-skeletal disorders. PMID:18021501

Dougados, M

2007-01-01

72

Empathy and quality of care.  

PubMed Central

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

Mercer, Stewart W; Reynolds, William J

2002-01-01

73

Quality of care in Crohn's disease.  

PubMed

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

Makharia, Govind K

2014-11-15

74

Quality of care in Crohn's disease  

PubMed Central

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.

Makharia, Govind K

2014-01-01

75

Living with diabetes: quality of care and quality of life  

PubMed Central

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

Pera, Pilar Isla

2011-01-01

76

Quality indicators for cardiovascular primary care  

PubMed Central

BACKGROUND: The Canadian Cardiovascular Outcomes Research Team was established in 2001 to improve the quality of cardiovascular care for Canadians. Initially, quality indicators (QIs) for hospital-based care for those with acute myocardial infarctions and congestive heart failure were developed and measured. Qualitative research on the acceptability of those indicators concluded that indicators were needed for ambulatory primary care practice, where the bulk of cardiovascular disease care occurs. OBJECTIVES: To systematically develop QIs for primary care practice for the primary prevention and chronic disease management of ischemic heart disease, hypertension, hyperlipidemia and heart failure. METHODS: A four-stage modified Delphi approach was used and included a literature review of evidence-based practice guidelines and previously developed QIs; the development and circulation of a survey tool with proposed QIs, asking respondents to rate each indicator for validity, necessity to record and feasibility to collect; an in-person meeting of respondents to resolve rating and content discrepancies, and suggest additional QIs; and recirculation of the survey tool for rating of additional QIs. Participants from across Canada included family physicians, primary care nurses, an emergency room family physician and cardiologists. RESULTS: 31 QIs were agreed on, nine of which were for primary prevention and 22 of which were for chronic disease management. CONCLUSIONS: A core set of QIs for ambulatory primary care practice has been developed as a tool for practitioners to evaluate the quality of cardiovascular disease care. While the participants rated the indicators as feasible to collect, the next step will be to conduct field validation. PMID:17440644

Burge, Frederick I; Bower, Kelly; Putnam, Wayne; Cox, Jafna L

2007-01-01

77

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

ERIC Educational Resources Information Center

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;…

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

78

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

ERIC Educational Resources Information Center

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…

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

79

Does quality improvement implementation affect hospital quality of care?  

PubMed

The authors examined how the association between quality improvement (QI) implementation in hospitals and hospital clinical quality is moderated by hospital organizational and environmental context. The authors used Ordinary Least Squares regression analysis of 1,784 community hospitals to model seven quality indicators as a function of four measures of QI implementation and a variety of control variables. They found that forces that are external and internal to the hospital condition the impact of particular QI activities on quality indicators: specifically data use, statistical tool use, and organizational emphasis on Continuous Quality Improvement (CQI). Results supported the proposition that QI implementation is unlikely to improve quality of care in hospital settings without a commensurate fit with the financial, strategic, and market imperatives faced by the hospital. PMID:17650463

Alexander, Jeffrey A; Weiner, Bryan J; Shortell, Stephen M; Baker, Laurence C

2007-01-01

80

Quality of Care in Humanitarian Surgery  

Microsoft Academic Search

Humanitarian surgical programs are set up de novo, within days or hours in emergency or disaster settings. In such circumstances,\\u000a insuring quality of care is extremely challenging. Basic structural inputs such as a safe structure, electricity, clean water,\\u000a a blood bank, sterilization equipment, a post-anesthesia recovery unit, appropriate medications should be established. Currently,\\u000a no specific credentials are needed for surgeons

Kathryn M. ChuMiguel; Miguel Trelles; Nathan P. Ford

2011-01-01

81

Health care quality improvement publication trends.  

PubMed

To analyze the extent of academic interest in quality improvement (QI) initiatives in medical practice, annual publication trends for the most well-known QI methodologies being used in health care settings were analyzed. A total of 10 key medical- and business-oriented library databases were examined: PubMed, Ovid MEDLINE, EMBASE, CINAHL, PsycINFO, ISI Web of Science, Scopus, the Cochrane Central Register of Controlled Trials, ABI/INFORM, and Business Source Complete. A total of 13 057 articles were identified that discuss at least 1 of 10 well-known QI concepts used in health care contexts, 8645 (66.2%) of which were classified as original research. "Total quality management" was the only methodology to demonstrate a significant decline in publication over time. "Continuous quality improvement" was the most common topic of study across all publication years, whereas articles discussing Lean methodology demonstrated the largest growth in publication volume over the past 2 decades. Health care QI publication volume increased substantially beginning in 1991. PMID:24101680

Sun, Gordon H; MacEachern, Mark P; Perla, Rocco J; Gaines, Jean M; Davis, Matthew M; Shrank, William H

2014-01-01

82

Influence of Structural Features on Portuguese Toddler Child Care Quality  

ERIC Educational Resources Information Center

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

Pessanha, Manuela; Aguiar, Cecilia; Bairrao, Joaquim

2007-01-01

83

Creating Champions for Health Care Quality and Safety  

Microsoft Academic Search

Patient safety and quality of care are public concerns that demand personal responsibility at all levels of the health care organization. Senior residents in our graduate medical education program took responsibility for a capstone quality improvement project designed to transform them into champions for health care quality. Residents (n = 26) participated alone or in pairs in a 1-month faculty-mentored

Robert Holland; David Meyers; Christopher Hildebrand; Alan J. Bridges; Mary A. Roach; Bennett Vogelman

2010-01-01

84

Who should care about the cost and quality of medical care? The American Board of Internal  

E-print Network

Who should care about the cost and quality of medical care? The American Board of Internal Medicine of care and reducing health care costs, and how health care professionals can participate in this important work. Choosing Wisely: RATIONING OR COST-CONSCIOUS HEALTH CARE? USF McClaren Conference Room 250

Galles, David

85

Child Care Quality in Different State Policy Contexts  

ERIC Educational Resources Information Center

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…

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

2007-01-01

86

interRAI home care quality indicators  

PubMed Central

Background This paper describe the development of interRAI’s second-generation home care quality indicators (HC-QIs). They are derived from two of interRAI’s widely used community assessments: the Community Health Assessment and the Home Care Assessment. In this work the form in which the quality problem is specified has been refined, the covariate structure updated, and two summary scales introduced. Methods Two data sets were used: at the client and home-care site levels. Client-level data were employed to identify HC-QI covariates. This sample consisted of 335,544 clients from Europe, Canada, and the United States. Program level analyses, where client level data were aggregated at the site level, were also based on the clients from the samples from Europe, Canada, and the United States. There were 1,654 program-based observations – 22% from Europe, 23% from the US, and 55% from Canada. The first task was to identify potential HC-QIs, including both change and prevalence measures. Next, they were reviewed by industry representatives and members of the interRAI network. A two-step process adjustment was followed to identify the most appropriate covariance structure for each HC-QI. Finally, a factor analytic strategy was used to identify HC-QIs that cluster together and thus are candidates for summary scales. Results The set of risk adjusted HC-QIs are multi-dimensional in scope, including measures of function, clinical complexity, social life, distress, and service use. Two factors were identified. The first includes a set of eleven measures that revolve around the absence of decline. This scale talks about functional independence and engagement. The second factor, anchored on nine functional improvement HC-QIs, referenced positively, this scale indicates a return to clinical balance. Conclusions Twenty-three risk-adjusted, HC-QIs are described. Two new summary HC-QI scales, the “Independence Quality Scale” and the “Clinical Balance Quality Scale” are derived. In use at a site, these two scales can provide a macro view of local performance, offering a way for a home care agency to understand its performance. When scales perform less positively, the site then is able to review the HC-QI items that make up the scale, providing a roadmap for areas of greatest concern and in need of targeted interventions. PMID:24245920

2013-01-01

87

ChildCare Quality and Children's Social Development  

Microsoft Academic Search

This study examined the influence on children's social development of variation in the quality of their child-care environments. The sample consisted of 166 children attending representative child-care centers that varied widely in quality. Possible relations associated with age, child-care experience, and family background were controlled using hierarchical multiple regression. Both global estimates of child-care quality and specific program features, such

Deborah Phillips; Kathleen McCartney; Sandra Scarr

1987-01-01

88

Differential Susceptibility to Parenting and Quality Child Care  

ERIC Educational Resources Information Center

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…

Pluess, Michael; Belsky, Jay

2010-01-01

89

38 CFR 51.120 - Quality of care.  

...2014-07-01 2014-07-01 false Quality of care. 51.120 Section 51.120 Pensions...CONTINUED) PER DIEM FOR NURSING HOME CARE OF VETERANS IN STATE HOMES Standards § 51.120 Quality of care. Each resident must receive and...

2014-07-01

90

Relationship of Nursing Home Staffing to Quality of Care  

Microsoft Academic Search

Objective. To compare nursing homes (NHs) that report different staffing statistics on quality of care. Data Sources. Staffing information generated by California NHs on state cost reports and during onsite interviews. Data independently collected by research staff describing quality of care related to 27 care processes. Study Design. Two groups of NHs (n 521) that reported significantly different and stable

John F. Schnelle; Sandra F. Simmons; Charlene Harrington; Mary Cadogan; Emily Garcia; Barbara M. Bates-Jensen

2004-01-01

91

Care Planning, Quality Assurance, and Personnel Management in Long-Term Care Facilities. Final Report.  

ERIC Educational Resources Information Center

Three studies were undertaken to examine topics of care planning, personnel management, and quality assurance in long-term care facilities. The first study examined the formulation and implementation processes of care planning for nursing home residents. The exemplary homes' care planning included the existence of strong care planning leadership,…

Patchner, Michael A.; Balgopal, Pallassana R.

92

Evaluation of the Impact of the Kuwait Diabetes Care Program on the Quality of Diabetes Care  

Microsoft Academic Search

Objectives: To evaluate the impact of the Kuwait Diabetes Care Program on the quality of care provided for diabetic patients in the Primary Health Care setting. Materials and Methods: The Kuwait Diabetes Care Program developed, published and disseminated clinical practice guidelines, conducted training courses, standards for diabetes care, and introduced a monitoring and evaluation system. Four audits (September 1999, October

Afaf Al-Adsani; Jamila Al-Faraj; Fatma Al-Sultan; Mohamed El-Feky; Nouria Al-Mezel; Wafik Saba; Sharifa Aljassar

2008-01-01

93

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

PubMed Central

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

Alonazi, Wadi B; Thomas, Shane A

2014-01-01

94

Child Care in the American South: Poverty, Costs, and Quality  

ERIC Educational Resources Information Center

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…

Collins, Vikki K.

2012-01-01

95

Quality of Diabetes Mellitus Care by Rural Primary Care Physicians  

PubMed Central

Purpose To explore the relationship between degree of rurality and glucose (hemoglobin A1c), blood pressure (BP), and lipid (LDL) control among patients with diabetes. Methods Descriptive study; 1,649 patients in 205 rural practices in the United States. Patients’ residence ZIP codes defined degree of rurality (Rural-Urban Commuting Areas codes). Outcomes were measures of acceptable control (A1c <= 9%, BP < 140/90 mmHg, LDL < 130 mg/dL) and optimal control (A1c < 7%, BP < 130/80 mmHg, LDL < 100 mg/dL). Statistical significance was set at P < .008 (Bonferroni’s correction). Findings Although the proportion of patients with reasonable A1c control worsened by increasing degree of rurality, the differences were not statistically significant (urban 90%, large rural 88%, small rural 85%, isolated rural 83%; P = .10); mean A1c values also increased by degree of rurality, although not statistically significant (urban 7.2 [SD 1.6], large rural 7.3 [SD 1.7], small rural 7.5 [SD1.8], isolated rural 7.5 [SD1.9]; P = .16). We observed no differences between degree of rural and reasonable BP or LDL control (P = .42, P = .23, respectively) or optimal A1c or BP control (P = .52, P = .65, respectively). Optimal and mean LDL values worsened as rurality increased (P = .08, P = .029, respectively). Conclusion In patients with diabetes who seek care in the rural Southern US, we observed no relationship between degree of rurality of patients’ residence and traditional measures of quality of care. Further examination of the trends and explanatory factors for relative worsening of metabolic control by increasing degree of rurality is warranted. PMID:23083082

Tonks, Stephen A.; Makwana, Sohil; Salanitro, Amanda H.; Safford, Monika M.; Houston, Thomas K.; Allison, Jeroan J.; Curry, William; Estrada, Carlos A.

2012-01-01

96

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

PubMed

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

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

2011-01-01

97

Quality-of-care challenges for rural health.  

PubMed

The purpose of this article is to examine the issue of quality of care in rural America and to help others examine this issue in a way that is consistent with the very real challenges faced by rural communities in ensuring the availability of adequate health services. Rural citizens have a right to expect that their local health care meets certain basic standards. Unless rural providers can document that the quality of local health care meets objective external standards, third-party payers might refuse to contract with rural providers, and increasingly sophisticated consumers might leave their communities for basic medical care services. To improve the measurement of health care quality in a rural setting, a number of issues specific to the rural environment must be addressed, including small sample sizes (volume and outcome issues), limited data availability, the ability to define rural health service areas, rural population preferences and the lower priority of formal quality-of-care assessment in shortage areas. Several current health policy initiatives have substantial implications for monitoring and measuring the quality of rural health services. For example, to receive community acceptance and achieve fiscal stability, critical access hospitals (CAHs) must be able to document that the care they provide is at least comparable to that of their predecessor institutions. The expectations for quality assurance activities in CAHs should consider their limited institutional resources and community preferences. As managed care extends from urban areas, there will be an inevitable collision between the ability to provide care and the ability to measure quality. As desirable as it might be to have a national standard for health care quality, this is not an attainable goal. The spectrum and content of rural health care are different from the spectrum and content of care provided in large cities. Accrediting agencies, third-party carriers and health insurance purchasers need to develop rural health care quality standards that are practical, useful and affordable. PMID:10981369

Moscovice, I; Rosenblatt, R

2000-01-01

98

Quality of care: past achievements and future challenges.  

PubMed

The heightened attention currently given to quality of care offers a unique opportunity for major advances. But to make the most of it, the greater energy and resources now available have to build on what is already known about quality of care, rather than largely ignore and therefore rediscover what has been learned in the past about, for example: how quality can be defined and measured, the relation between outcomes and the process of care, and the distinction between quality assessment and determinations of efficacy. If future efforts are rooted in what is known about these and other aspects of quality of care, they can yield substantial insights into how to improve quality, rather than simply how to measure it, and how to do it for more than inpatient hospital care. PMID:2966118

Wyszewianski, L

1988-01-01

99

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

PubMed

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

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

2013-01-01

100

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

PubMed Central

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

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

2009-01-01

101

Assessing Child-Care Quality with a Telephone Interview.  

ERIC Educational Resources Information Center

Examined whether data on child care quality obtained from a telephone interview with the provider could serve as an adequate proxy for data obtained from direct observation of 89 child care homes and 92 centers. Found that a 25-item interview predicted accurately the quality classification of 92 percent of homes and 89 percent of centers.…

Holloway, Susan D.; Kagan, Sharon L.; Fuller, Bruce; Tsou, Lynna; Carroll, Jude

2001-01-01

102

Enhancing the Quality of Child Care: Lessons from Research.  

ERIC Educational Resources Information Center

Drawing on current research, this paper advocates the optimization and enhancement of quality in group day care. Child development researchers offer many suggestions for improving the quality of child care. Recent research has indicated the importance peers play in children's development. Researchers have also indicated the importance of…

Chambliss, Catherine

103

77 FR 70786 - Request for Information Regarding Health Care Quality for Exchanges  

Federal Register 2010, 2011, 2012, 2013

...Request for Information Regarding Health Care Quality for Exchanges AGENCY...Strategy for Quality Improvement in Health Care (National Quality Strategy) to...efforts to improve the quality of health care in the United States. The...

2012-11-27

104

Effect of the Transformation of the Veterans Affairs Health Care System on the Quality of Care  

Microsoft Academic Search

methods Using data from an ongoing performance-evaluation program in the VA, we evaluated the quality of preventive, acute, and chronic care. We assessed the change in quality-of- care indicators from 1994 (before reengineering) through 2000 and compared the qual- ity of care with that afforded by the Medicare fee-for-service system, using the same in- dicators of quality. results In fiscal

Ashish K. Jha; Jonathan B. Perlin; Kenneth W. Kizer; R. Adams Dudley

2010-01-01

105

Nursing Effort and Quality of Care for Nursing Home Residents  

ERIC Educational Resources Information Center

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

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

2007-01-01

106

Using Quality Experts from Manufacturing to Transform Primary Care  

ERIC Educational Resources Information Center

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

Steiner, Rose M.; Walsworth, David T.

2010-01-01

107

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

ERIC Educational Resources Information Center

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.…

Jackson, Cheryl D.

108

Health-related quality of life in preschool children in five health conditions  

Microsoft Academic Search

Objective  To test the responsiveness of the Infant\\/Toddler Quality of Life Questionnaire (ITQOL) to five health conditions. In addition,\\u000a to evaluate the impact of the child’s age and gender on the ITQOL domain scores.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  Observational study of 494 Dutch preschool-aged children with five clinical conditions and 410 healthy preschool children\\u000a randomly sampled from the general population. The clinical conditions included neurofibromatosis

A. T. Spuijbroek; R. Oostenbrink; J. M. Landgraf; E. Rietveld; A. de Goede-Bolder; E. F. van Beeck; M. van Baar; H. Raat; H. A. Moll

2011-01-01

109

High-quality chronic care delivery improves experiences of chronically ill patients receiving care  

PubMed Central

Objective Investigate whether high-quality chronic care delivery improved the experiences of patients. Design This study had a longitudinal design. Setting and Participants We surveyed professionals and patients in 17 disease management programs targeting patients with cardiovascular diseases, chronic obstructive pulmonary disease, heart failure, stroke, comorbidity and eating disorders. Main Outcome Measures Patients completed questionnaires including the Patient Assessment of Chronic Illness Care (PACIC) [T1 (2010), 2637/4576 (58%); T2 (2011), 2314/4330 (53%)]. Professionals' Assessment of Chronic Illness Care (ACIC) scores [T1, 150/274 (55%); T2, 225/325 (68%)] were used as a context variable for care delivery. We used two-tailed, paired t-tests to investigate improvements in chronic illness care quality and patients' experiences with chronic care delivery. We employed multilevel analyses to investigate the predictive role of chronic care delivery quality in improving patients' experiences with care delivery. Results Overall, care quality and patients' experiences with chronic illness care delivery significantly improved. PACIC scores improved significantly from 2.89 at T1 to 2.96 at T2 and ACIC-S scores improved significantly from 6.83 at T1 to 7.18 at T2. After adjusting for patients' experiences with care delivery at T1, age, educational level, marital status, gender and mental and physical quality of life, analyses showed that the quality of chronic care delivery at T1 (P < 0.001) and changes in care delivery quality (P < 0.001) predicted patients' experiences with chronic care delivery at T2. Conclusion This research showed that care quality and changes therein predict more positive experiences of patients with various chronic conditions over time. PMID:24123243

Cramm, Jane Murray; Nieboer, Anna Petra

2013-01-01

110

Acute care practices relevant to quality end-of-life care: a survey of Pennsylvania hospitals  

Microsoft Academic Search

BackgroundImproving end-of-life care in the hospital is a national priority.PurposeTo explore the prevalence and reasons for implementation of hospital-wide and intensive care unit (ICU) practices relevant to quality care in key end-of-life care domains and to discern major structural determinants of practice implementation.DesignCross-sectional mixed-mode survey of chief nursing officers of Pennsylvania acute care hospitals.ResultsThe response rate was 74% (129 of

C. Y. Lin; R. M. Arnold; J. R. Lave; D. C. Angus; A. E. Barnato

2010-01-01

111

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

Microsoft Academic Search

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

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

2007-01-01

112

Computerised paediatric asthma quality of life questionnaires in routine care  

Microsoft Academic Search

Background: Asthma quality of life questionnaires are not readily incorporated into clinical care. We therefore computerised the Paediatric Asthma Quality of Life Questionnaire (standardised) (PAQLQ(S)) and the Paediatric Asthma Caregivers Quality of Life Questionnaire (PACQLQ), with a colour-coded printed graphical report.Objectives: To (a) assess the feasibility of the electronic questionnaires in clinical care and (b) compare the child’s PAQLQ scores

H Mussaffi; R Omer; D Prais; M Mei-Zahav; T Weiss-Kasirer; Z Botzer; H Blau

2007-01-01

113

Using Quality Information for HealthCare Decisions and Quality Improvement. Cambridge, MA: Mathematica Policy Research  

Microsoft Academic Search

Health care quality measurement and reporting have grown rapidly during the past decade and now enjoy wide support. The CAHPS surveys, funded by the Agency for Healthcare Research and Quality since 1995, have been a key part of the effort to generate scientifically sound measures of consumer perspectives on health care access and quality. This report reviews research on incentives

Tim Lake; Chris Kvam; Marsha Gold

2005-01-01

114

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

ERIC Educational Resources Information Center

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…

Modigliani, Kathy

2011-01-01

115

System Change: Quality Assessment and Improvement for Medicaid Managed Care  

PubMed Central

Rising Medicaid health expenditures have hastened the development of State managed care programs. Methods to monitor and improve health care under Medicaid are changing. Under fee-for-service (FFS), the primary concern was to avoid overutilization. Under managed care, it is to avoid underutilization. Quality enhancement thus moves from addressing inefficiency to addressing insufficiency of care. This article presents a case study of Virginia's redesign of Quality Assessment and Improvement (QA/I) for Medicaid, adapting the guidelines of the Quality Assurance Reform Initiative (QARI) of the Health Care Financing Administration (HCFA). The article concludes that redesigns should emphasize Continuous Quality Improvement (CQI) by all providers and of multi-faceted, population-based data. PMID:10165716

Smith, Wally R; Cotter, J. James; Rossiter, Louis F.

1996-01-01

116

Assessing the Quality of Portuguese Child Care Programs for Toddlers  

ERIC Educational Resources Information Center

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…

Barros, Silvia; Aguiar, Cecilia

2010-01-01

117

The synergy of quality management & risk management in home care.  

PubMed

For a number of years the health care risk management industry has been addressing unplanned and unanticipated adverse events. Organizations that are proactive in their approach to risk and quality management will have big payoffs in clinical quality improvement, service quality improvement, employee satisfaction, and customer satisfaction. PMID:10160154

Rhinehart, E

1996-09-01

118

Nursing Home Care Quality: Insights from a Bayesian Network Approach  

ERIC Educational Resources Information Center

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…

Goodson, Justin; Jang, Wooseung; Rantz, Marilyn

2008-01-01

119

Quality Matters in Early Childhood Education and Care: Slovak Republic  

ERIC Educational Resources Information Center

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)…

Taguma, Miho; Litjens, Ineke; Makowiecki, Kelly

2012-01-01

120

Evaluation of a State Initiative to Improve Child Care Quality  

ERIC Educational Resources Information Center

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…

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

2005-01-01

121

Price and quality transparency: how effective for health care reform?  

PubMed

Many in Minnesota and the United States are promoting price and quality transparency as a means for reforming health care. The assumption is that with such information, consumers and providers would be motivated to change their behavior and this would lead to lower costs and higher-quality care.This article attempts to determine the extent to which publicizing information about the cost and quality of medical care does, in fact, improve quality and lower costs, and thus should be included in any reform strategy. The authors reviewed a number of studies and concluded that there is a general lack of empirical evidence on the effect of price transparency on health care costs and that the evidence on the effectiveness of quality transparency is mixed. PMID:19708312

Nyman, John A; Li, Chia-Hsuan W

2009-07-01

122

What is the cost of quality for diabetes care?  

PubMed

Increasing the quality of care and reducing cost growth are core objectives of numerous private- and public-sector performance improvement initiatives. Using a unique panel data set for a commercially insured population and multivariate regression analysis, this study examines the relationship between medical care spending and diabetes-related quality measures, including provider-initiated processes of care and patient-dependent quality activities. Empirical evidence generated from this analysis of the relationship between a comprehensive set of diabetes quality measures and diabetes-related spending does not lend support for the assumption that high-quality preventive and primary care combined with effective patient self-management can lead to lower costs in the near term. Finally, we find no relationship between adjusted spending and intermediate clinical outcomes (e.g., HbA1c level) measured at the clinic level. PMID:25380606

Abraham, Jean M; Crespin, Daniel J; McCullough, Jeffrey S; Christianson, Jon B

2014-12-01

123

Improving the quality of care for Medicaid patients with chronic diseases: Community Care of North Carolina.  

PubMed

Community Care of North Carolina's provider-driven approach to quality improvement has benefitted tens of thousands of North Carolinians with diabetes, asthma, hypertension, heart failure, and cardiovascular disease, and it has achieved better results than commercial Medicaid managed care nationally. Substantial opportunities remain, however, particularly for patients with complex care needs. PMID:23802479

DuBard, C Annette

2013-01-01

124

The Quality of Care under a Managed-Care Program for Dual Eligibles  

ERIC Educational Resources Information Center

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…

Kane, Robert L.; Homyak, Patricia; Bershadsky, Boris; Lum, Terry; Flood, Shannon; Zhang, Hui

2005-01-01

125

Quality end-of-life care: A global perspective  

Microsoft Academic Search

BACKGROUND: Quality end-of-life care has emerged as an important concept in industrialized countries. DISCUSSION: We argue quality end-of-life care should be seen as a global public health and health systems problem. It is a global problem because 85 % of the 56 million deaths worldwide that occur annually are in developing countries. It is a public health problem because of

Peter A Singer; Kerry W Bowman

2002-01-01

126

The development of quality indicators for community pharmacy care  

Microsoft Academic Search

AimsTo develop a national system of quality indicators for community pharmacy care, reported by community pharmacies.MethodsAfter preliminary validation, an online consensus study was conducted. Pharmacy practice experts (round 1) and practising pharmacists (round 2) were approached. Face-validity scores for risk of harm and quality of care were obtained, as well as data on feasibility and clarity. To field test the

J. de Bie; N. B. Kijlstra; B. J. G. Daemen; M. L. Bouvy

2011-01-01

127

Does Competition Improve Health Care Quality?  

PubMed Central

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

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

2008-01-01

128

Art and the Infant-Toddler Curriculum.  

ERIC Educational Resources Information Center

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…

Lamb, Marilyn

129

Family Perspectives on the Quality of Pediatric Palliative Care  

Microsoft Academic Search

Background: As a prelude to establishing a Pediatric Palliative Care Program, we solicited information from families about their experiences and their suggestions for improving the quality of end-of-life care. Participants were English- and Spanish-speaking family members of de- ceased pediatric patients who received care at Lucile Salter Packard Children's Hospital, Stanford University Medi- cal Center, Palo Alto, Calif. Methods: Sixty-eight

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

2002-01-01

130

OU Medicine Standards of Excellence PROFESSIONALISM -CARING -COMMUNICATION -QUALITY -INNOVATION  

E-print Network

OU Medicine Standards of Excellence PROFESSIONALISM - CARING - COMMUNICATION - QUALITY - INNOVATION We appreciate your interest in OU Medicine and invite you to carefully review our Standards understanding. We are sensitive to the needs of those we serve: · I will always act with compassion, kindness

Oklahoma, University of

131

Health Literacy and Communication Quality in Health Care Organizations  

Microsoft Academic Search

The relationship between limited health literacy and poor health may be due, in part, to poor communication quality within health care delivery organizations. We explored the relationship between health literacy status and receiving patient-centered communication in clinics and hospitals serving communication-vulnerable patient populations. Thirteen health care organizations nationwide distributed a survey to 5929 patients. All patients completed seven items assessing

Matthew K. Wynia; Chandra Y. Osborn

2010-01-01

132

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

PubMed

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

Ndoro, Samuel

133

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

ERIC Educational Resources Information Center

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…

Gilbert, Jaesook Lee; Harte, Helene Arbouet

2013-01-01

134

Quality of care at retail clinics for 3 common conditions.  

PubMed

Objectives Evaluation of quality of care across retail clinics in a geographically diverse population has not been undertaken to date. We sought to evaluate and compare the quality of care for otitis media, pharyngitis, and urinary tract infection received in retail medical clinics in CVS pharmacies ("MinuteClinics" [MCs]), ambulatory care facilities (ACFs), and emergency departments (EDs). Methods We used 14 measures constructed from RAND Corporation's Quality Assurance Tools and guidelines from the American Academy of Pediatrics, the American Academy of Family Physicians, and the Infectious Diseases Society of America. Our cohort was drawn from Aetna medical and prescription claims, 2009-2012. Members were matched on visit date, condition, and propensity score. Generalized estimating equations were used to compare quality across clinic type, overall, and by index condition. Results We matched 75,886 episodes of care, of which 20,153 were eligible for at least 1 quality measure. MCs performed better than EDs and ACFs in 7 measures. In a multivariable model, MCs performed better than ACFs and EDs across all quality measures ([OR 0.42; 95% CI, 0.40-0.45; P < .0001; ACF vs MC] [OR 0.29; 95% CI, 0.27-0.31; P < .0001; ED vs MC]). Results for each condition were significant at P < .0001. Conclusions Quality of care for these conditions based on widely accepted objective measures was superior in MinuteClinics compared with ACFs and EDs. PMID:25365682

Shrank, William H; Krumme, Alexis A; Tong, Angela Y; Spettell, Claire M; Matlin, Olga S; Sussman, Andrew; Brennan, Troyen A; Choudhry, Niteesh K

2014-10-01

135

Quality Matters in Early Childhood Education and Care: Norway 2013  

ERIC Educational Resources Information Center

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…

Taguma, Miho; Litjens, Ineke; Makowiecki, Kelly

2013-01-01

136

Quality Matters in Early Childhood Education and Care: Japan 2012  

ERIC Educational Resources Information Center

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…

Taguma, Miho; Litjens, Ineke; Makowiecki, Kelly

2012-01-01

137

Teacher Structure and Child Care Quality in Preschool Classrooms  

ERIC Educational Resources Information Center

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…

Shim, Jonghee; Hestenes, Linda; Cassidy, Deborah

2004-01-01

138

Race, Managed Care, And The Quality Of Substance Abuse Treatment  

Microsoft Academic Search

The adoption of managed behavioral health care by state Medicaid agencies has the potential to increase the quality of treatment for racial minorities by promoting access to substance abuse treatment and creating more appropriate utilization patterns. This paper examines three indicators of quality for white, Black, and Hispanic Medicaid clients who received substance abuse treatment in Massachusetts between 1992 and

Marilyn C. Daley; Grant A. Ritter; Dominic Hodgkin; Richard H. Beinecke

2005-01-01

139

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

PubMed

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

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

2014-10-01

140

Relationship of Nursing Home Staffing to Quality of Care  

PubMed Central

Objective To compare nursing homes (NHs) that report different staffing statistics on quality of care. Data Sources Staffing information generated by California NHs on state cost reports and during onsite interviews. Data independently collected by research staff describing quality of care related to 27 care processes. Study Design Two groups of NHs (n=21) that reported significantly different and stable staffing data from all data sources were compared on quality of care measures. Data Collection Direct observation, resident and staff interview, and chart abstraction methods. Principal Findings Staff in the highest staffed homes (n=6), according to state cost reports, reported significantly lower resident care loads during onsite interviews across day and evening shifts (7.6 residents per nurse aide [NA]) compared to the remaining homes that reported between 9 to 10 residents per NA (n=15). The highest-staffed homes performed significantly better on 13 of 16 care processes implemented by NAs compared to lower-staffed homes. Conclusion The highest-staffed NHs reported significantly lower resident care loads on all staffing reports and provided better care than all other homes. PMID:15032952

Schnelle, John F; Simmons, Sandra F; Harrington, Charlene; Cadogan, Mary; Garcia, Emily; Bates-Jensen, Barbara M

2004-01-01

141

Benchmarking and audit of breast units improves quality of care  

PubMed Central

?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

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

142

Quality of Hospice Care for Patients with Dementia  

PubMed Central

Background Patients with dementia constitute an increasing proportion of hospice enrollees, yet little is known about the quality of hospice care for this population. Objectives To quantify differences in quality of care measures between hospice patients with and without dementia. Study Design Cross-sectional analysis of data from the 2007 National Home and Hospice Care Survey Participants 4,711 discharges from hospice care Measurements A primary diagnosis of dementia at discharge was defined by ICD-9 codes: 290.0–290.4x, 294.0, 294.1, 294.8, 331.0–331.2, 331.7, and 331.8. Quality of care measures included enrollment into hospice in the last three days of life, receiving tube feeding, depression, receiving antibiotics, lack of advanced directive or do not resuscitate order, ? stage II pressure ulcers, emergent care, lack of continuity of residence and a report of pain at last assessment. Results 450 (9.5%) discharges had a primary diagnosis of dementia. In multivariable analysis, patients with dementia were more likely to receive tube feeding [OR 2.6 (95% CI: 1.4, 4.5)] and to have greater continuity of residence [OR 1.8 (95% CI: 1.1, 3.0)] compared to other hospice patients. They were less likely to have a report of pain at last assessment [OR 0.6 (95% CI: 0.3, 0.9)]. Conclusions The majority of quality of care measures examined in this study did not differ between hospice patients with and without dementia. Use of tube feeding in hospice care and methods of pain assessment and treatment in patients with dementia should be considered as potential quality of care measures. PMID:23710597

Albrecht, Jennifer S.; Gruber-Baldini, Ann L.; Fromme, Erik K.; McGregor, Jessina C.; Lee, David S.H.; Furuno, Jon P.

2014-01-01

143

[Criteria used in the health care quality assurance systems].  

PubMed

The author presents the criteria used in the health care quality assurance systems with special attention paid to the following issues: Quality management system ISO 9000:2000. European Foundation Quality Management. Hospital accreditation. Quality assurance system in occupational health services in Norway "Good OHS". Quality management criteria are regarded as guidelines for functioning of organizations. All presented evaluation systems are based on a common set of criteria, which include: client-patient orientation; advancement of stuff skills; information management; services and management improvement. PMID:14978899

Wdówik, Pawe?

2003-01-01

144

Care-related quality of life in old age  

Microsoft Academic Search

Promoting quality of life is a central theme in recent ageing policies, but what quality of life means in concrete terms for\\u000a people in different stages of old age is rather unclear. This study presents a multi-dimensional model of care-related quality\\u000a of life (crQoL) and, based on analyses of three Finnish cross-sectional datasets from the years 2004–2007, examines the distinctions

Marja Vaarama

2009-01-01

145

Afghanistan's national strategy for improving quality in health care  

PubMed Central

Quality problem or issue When the Ministry of Public Health (MoPH) of the Islamic Republic of Afghanistan began reconstructing the health system in 2003, it faced serious challenges. Decades of war had severely damaged the health infrastructure and the country's ability to deliver health services. Initial assessment A national health resources assessment in 2002 revealed huge structural and resource disparities fundamental to improving health care. For example, only 9% of the population was able to access basic health services, and about 40% of health facilities had no female health providers, severely constraining access of women to health care. Multiple donor programs and the MoPH had some success in improving quality, but questions about sustainability, as well as fragmentation and poor coordination, existed. Plan of action In 2009, MoPH resolved to align and accelerate quality improvement efforts as well as build structural and skill capacity. Implementation The MoPH established a new quality unit within the ministry and undertook a year-long consultative process that drew on international evidence and inputs from all levels of the health system to developed a National Strategy for Improving Quality in Health Care consisting of a strategy implementation framework and a five-year operational plan. Lessons Learned Even in resource-restrained countries, under the most adverse circumstances, quality of health care can be improved at the front-lines and a consensual and coherent national quality strategy developed and implemented. PMID:23485422

Rahimzai, Mirwais; Amiri, Mirwais; Burhani, Nadera Hayat; Leatherman, Sheila; Hiltebeitel, Simon; Rahmanzai, Ahmed Javed

2013-01-01

146

[Diabetes, psychosocial distress and quality of care].  

PubMed

Diabetes is on the rise world wide; according to the latest report from the International Diabetes Federation, the number of people affected by the disease will increase by 55% from 382 in 2013 to almost 600 million in 2033. Individuals living with type 1 or type 2 diabetes are at increased risk for depression and anxiety. Diabetes impacts on physical, emotional, social and financial aspects of life across cultures and countries, yet gaps in care exist around psychosocial and self-management education and support. The DAWN2 study provides a first multinational, multidisciplinary systematic framework for the comparison of unmet needs of people with diabetes and those who care for them in four continents. it is necessary to develop a system of patient-centered care, in which the empowerment of the person is the main instrument, and at the same time target on which to focus. Transforming study results into actions at the national level will represent one of the main activities of the DAWN2 initiative. In Italy, to do so, it is not enough write new documents but new resources are required. PMID:25282349

Fatati, Giuseppe

2014-10-01

147

Quality care and safety know no borders  

PubMed Central

The public, governmental agencies, and payers expect medical professional organisations to develop practice guidelines and technical standards. The American College of Radiology proactively addresses these topics as well as other quality and safety interests including appropriateness criteria and accreditation. The College is also actively involved in development of a national radiology data base to collect data regarding quality and safety metrics in multiple areas. In addition, the College has developed RADPEER™, a simple, cost-effective process that allows peer review to be performed during the routine interpretation of current images. This paper discusses the efforts of the ACR in all of these areas. PMID:21614288

Borgstede, JP; Wilcox, PA

2007-01-01

148

Mississippi Quality Step System: QRS Profile. The Child Care Quality Rating System (QRS)Assessment  

ERIC Educational Resources Information Center

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…

Child Trends, 2010

2010-01-01

149

DOES PROCESS QUALITY PREDICT PRODUCT QUALITY IN HEALTH CARE: A CASE STUDY  

Microsoft Academic Search

1. ABSTRACT The importance of quality in health care has been widely recognized and analyzed in recent years. Medication errors and other errors are beginning to be noticed and addressed. The study explores the fact that process quality leads to product quality. The objective of this study was to do an in depth statistical analysis on patient satisfaction survey data

John Kalblinger; R. Ram

150

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

PubMed Central

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

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

151

Quality of primary health care in Saudi Arabia: a comprehensive review  

Microsoft Academic Search

Objectives. Little is known about the quality of primary care in Saudi Arabia, despite the central role of primary care centers in Saudi health strategy. This study presents an overview of quality of primary care in Saudi Arabia, and identifies factors impeding the achievement of quality, with the aim of determining how the quality of Saudi primary care could be

HANAN AL-AHMADI; MARTIN ROLAND

2005-01-01

152

Purdue University, CALC Symposium September 2012 Does health care quality contribute to disparities?  

E-print Network

Purdue University, CALC Symposium September 2012 Does health care quality contribute to disparities;9/26/20122 Big Ideas. Health care quality is not just a pretty word. Where you live shouldn't limit quality, but it does! Consumer voices are critical for quality care. #12;9/26/20123 Big Idea One In health care

Arnold, Jonathan

153

Perceptions of jordanian head nurses of variables that influence the quality of nursing care.  

PubMed

The purpose of this research was to study the perceptions of head nurses in Jordan about variables that influence the quality of nursing care in a teaching hospital. Head nurses perceived that nurses "usually" provided high quality nursing care. Time was the most important factor that influenced the quality of nursing care. High quality care required adequate staffing levels. PMID:15326998

Mrayyan, Majd T

2004-01-01

154

Quality Improvement Opportunities in Caring for Patients with Nonepileptic Seizures  

PubMed Central

Background. Patients with nonepileptic seizures (NES) are challenging to treat for myriad reasons. Often patients may be misdiagnosed with having epilepsy and then may suffer unintended consequences of treatment side effects with antiepileptic medication. In addition, patients may be maligned by health care providers due to a lack of ownership by both psychiatrists and neurologists and a dearth of dedicated professionals who are able to effectively treat and reduce severity and frequency of symptoms. Aims of Case Report. Many psychiatrists and neurologists are unaware of the extent of the barriers to care faced by patients with NES (PWNES) and the degree of perception of maltreatment or lack of therapeutic alliance at various stages of their care, including medical workup, video-EEG monitoring, and follow-up plans. We present the case of a patient with NES who experienced numerous barriers as well as incoordination to her care despite being offered a breadth of resources and discuss the quality improvement opportunities that may exist to improve care of patients with NES. Conclusion. No known literature has documented the extensive barriers to care of PWNES in parallel to quality improvement opportunities for improving their care. We endeavor to contribute to the overall formulation and development of a clinical care pathway for PWNES. PMID:25295209

Chen, Jasper J.; Thakur, Devendra S.; Bujarski, Krzysztof A.; Jobst, Barbara C.; Kobylarz, Erik J.; Thadani, Vijay M.

2014-01-01

155

Quality of prenatal care questionnaire: instrument development and testing  

PubMed Central

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

2014-01-01

156

[Quality improvement in primary care. Financial incentives related to quality indicators in Europe].  

PubMed

Quality improvement in primary care has been an important issue worldwide for decades. Quality indicators are increasingly used quantitative tools for quality measurement. One of the possible motivational methods for doctors to provide better medical care is the implementation of financial incentives, however, there is no sufficient evidence to support or contradict their effect in quality improvement. Quality indicators and financial incentives are used in the primary care in more and more European countries. The authors provide a brief update on the primary care quality indicator systems of the United Kingdom, Hungary and other European countries, where financial incentives and quality indicators were introduced. There are eight countries where quality indicators linked to financial incentives are used which can influence the finances/salary of family physicians with a bonus of 1-25%. Reliable data are essential for quality indicators, although such data are lacking in primary care of most countries. Further, improvement of indicator systems should be based on broad professional consensus. PMID:23835354

Kolozsvári, László Róbert; Rurik, Imre

2013-07-14

157

Variations in the quality of care at radical prostatectomy  

PubMed Central

Postoperative morbidity and mortality is low following radical prostatectomy (RP), though not inconsequential. Due to the natural history of the disease process, the implications of treatment on long-term oncologic control and functional outcomes are of increased significance. Structures, processes and outcomes are the three main determinants of quality of RP care and provide the framework for this review. Structures affecting quality of care include hospital and surgeon volume, hospital teaching status and patient insurance type. Process determinants of RP care have been poorly studied, by and large, but there is a developing trend toward the performance of randomized trials to assess the merits of evolving RP techniques. Finally, the direct study of RP outcomes has been particularly controversial and includes the development of quality of life measurement tools, combined outcomes measures, and the use of utilities to measure operative success based on individual patient priority. PMID:22496709

Sammon, Jesse; Jhaveri, Jay; Sun, Maxine; Ghani, Khurshid R.; Schmitges, Jan; Jeong, Wooju; Peabody, James O.; Karakiewicz, Pierre I.; Menon, Mani

2012-01-01

158

Assessing the quality of patient handoffs at care transitions  

Microsoft Academic Search

BackgroundEffective handoff practices (ie, mechanisms for transferring information, responsibility and authority) are critical to ensure continuity of care and patient safety.ObjectiveThis study aimed to develop a rating tool (self-rating and external rating) for handoff quality that goes beyond mere information transfer.MethodsThe rating tool was piloted during 126 patient handoffs performed in three different clinical settings in a tertiary care hospital:

Tanja Manser; Simon Foster; Stefan Gisin; Dalit Jaeckel; Wolfgang Ummenhofer

2010-01-01

159

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

PubMed Central

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

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

2013-01-01

160

Initial Steps for Quality Improvement of Obesity Care Across Divisions at a Tertiary Care Pediatric Hospital  

PubMed Central

Background: Pediatric subspecialists can participate in the care of obese children. Objective: To describe steps to help subspecialty providers initiate quality improvement efforts in obesity care. Methods: An anonymous patient data download, provider surveys and interviews assessed subspecialty providers’ identification and perspectives of childhood obesity and gathered information on perceived roles and care strategies. Participating divisions received summary analyses of quantitative and qualitative data and met with study leaders to develop visions for division/service-specific care improvement. Results: Among 13 divisions/services, subspecialists’ perceived role varied by specialty; many expressed the need for cross-collaboration. All survey informants agreed that identification was the first step, and expressed interest in obtaining additional resources to improve care. Conclusions: Subspecialists were interested in improving the quality and coordination of obesity care for patients across our tertiary care setting. Developing quality improvement projects to achieve greater pediatric obesity care goals starts with engagement of providers toward better identifying and managing childhood obesity. PMID:25233013

Chang, Sheila Z.; Beacher, Daniel R.; Kwon, Soyang; McCarville, Megan A.; Binns, Helen J.; Ariza, Adolfo J.

2014-01-01

161

Improving Health Care Quality Reporting: Lessons from the California HealthCare Foundation. Oakland, CA: California HealthCare Foundation  

Microsoft Academic Search

The California HealthCare Foundation has devoted substantial resources to promoting public reporting on the quality of California hospitals, physician groups, and nursing homes. Mathematica conducted an evaluation of the foundation's work from 1998 through 2005, identifying lessons from its experience in fostering quality information and exploring avenues for future foundation involvement in the field. This brief looks at the measurement

Beth Stevens; Tim Lake; Erin Fries Taylor

2007-01-01

162

How grounded theory can improve nursing care quality.  

PubMed

This article presents an overview of the grounded theory research method and demonstrates how nurses can employ specific grounded theories to improve patient care quality. Because grounded theory is derived from real-world experience, it is a particularly appropriate method for nursing research. An overview of the method and language of grounded theory provides a background for nurses as they read grounded theories and apply newly acquired understandings to predictable processes and patterns of behavior. This article presents 2 exemplar grounded theories with suggestions as to how nurses can apply these and other grounded theories to improve the provision of quality nursing care. PMID:17873733

Nathaniel, Alvita K; Andrews, Tom

2007-01-01

163

The business case for health-care quality improvement.  

PubMed

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

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

2013-03-01

164

Primary care perspectives on prostate cancer survivorship: Implications for improving quality of care  

PubMed Central

OBJECTIVES Primary care providers often care for men with prostate cancer due to its prolonged clinical course and an increasing number of survivors. However, their attitudes and care patterns are inadequately studied. In this context, we surveyed primary care providers regarding the scope of their prostate cancer survivorship care. METHODS The 2006 Early Detection and Screening for Prostate Cancer Knowledge, Attitudes and Practice Survey conducted by the Michigan Public Health Institute investigated the beliefs and practice patterns of primary care providers in Michigan. We evaluated responses from 902 primary care providers regarding the timing and content of their prostate cancer survivorship care and relationships with specialty care. RESULTS Two-thirds (67.6%) of providers cared for men during and after prostate cancer treatment. Providers routinely inquired about incontinence, impotence and bowel problems (83.3%), with a few (14.2%) using surveys to measure symptoms. However, only a minority felt ‘very comfortable’ managing the side effects of prostate cancer treatment. Clear plans (76.1%) and details regarding management of treatment complications (65.2%) from treating specialists were suboptimal. Nearly one-half (45.1%) of providers felt it was equally appropriate for them and treating specialists to provide prostate cancer survivorship care. CONCLUSIONS Primary care providers reported that prostate cancer survivorship care is prevalent in their practice, yet few felt very comfortable managing side effects of prostate cancer treatment. To improve quality of care, implementing prostate cancer survivorship care plans across specialties, or transferring primary responsibility to primary care providers through survivorship guidelines, should be considered. PMID:21775171

Skolarus, Ted; Holmes-Rovner, Margaret; Northouse, Laurel; Fagerlin, Angela; Garlinghouse, Carol; Demers, Raymond; Rovner, David; Darwish-Yassine, May; Wei, John

2011-01-01

165

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

PubMed

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

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

2012-05-01

166

Assessing the quality of health care: a consumerist approach.  

PubMed

Recent investigations show that nontechnical interventions influence patients' ratings of the quality of health care, and that these aspects of the medical encounter are as important to the patient as the technical aspects; perhaps more important. This paper adopts a consumerist approach and measures patients' perceptions of health care quality using a scale adapted from the consumer behavior literature (SERVQUAL). The study measures health care quality as well as five of its individual dimensions. The findings indicate that, for the whole sample, patients' ratings of overall quality as well as the ratings of four of the five dimensions of care are negative. Further analysis indicates that many individual aspects (scale items) are rated negatively by each of two age groups (25-65 and over 65 years old), but the gap between perceptions of the younger group and their expectations is greater than that of the senior group. The two dimensions of "assurance" and "empathy" are found to be the most discriminating dimensions between the two groups. Other analyses indicate that age, annual household income, and work status significantly relate to overall quality rating. Marketing and strategic planning implications of the results are discussed. PMID:10124785

Soliman, A A

1992-01-01

167

Appendix: Health Care Systems The provision of high-quality health care in the United States and globally will challenge  

E-print Network

policy; and 3) Health care treatment. #12;Health Care Operations Clinics, hospitals, hospital networksAppendix: Health Care Systems The provision of high-quality health care in the United States., 2008). * * First two sentences of "Envisioning the Health Care Initiative at Lehigh" The financial

Napier, Terrence

168

Physician incentives to improve quality and the delivery of high quality ambulatory medical care  

PubMed Central

Objective To determine the prevalence of physician incentives for quality and to test the hypothesis that quality of ambulatory medical care is better by physicians with these incentives. Study Design Cross-sectional study using data from the National Ambulatory Medical Care Survey Method We examined the association between physician compensation based on quality, physician compensation based on satisfaction, and public reporting of practice measures and twelve measures of high quality ambulatory care. Results Overall, 20.8% of visits were to physicians whose compensation was partially based on quality, 17.7% of visits were to physicians whose compensation was partially based on patient satisfaction, and 10.0% of visits were to physicians who publicly reported performance measures. Quality of ambulatory care varied: weight reduction counseling occurred in 12.0% of preventative care visits by obese patients whereas urinalysis was not performed in 93.0% of preventative care visits. In multivariable analyses, there were no statistically significant associations between compensation for quality and delivery of any of the 12 measures, nor between compensation for satisfaction and 11 of the 12 measures; the exception was BMI screening in preventative visits (47.8% vs. 56.2%, adjusted p=0.004). There was also no statistically significant association between public reporting and delivery of 11 of 12 measures; the exception was weight reduction counseling for overweight patients (10.0% vs. 25.5%, adjusted p=0.01). Conclusions We found no consistent association between incentives for quality and 12 measures of high quality ambulatory care. PMID:22554038

Bishop, Tara F.; Federman, Alex D.; Ross, Joseph S.

2012-01-01

169

Quality health care for children and the affordable care act: a voltage drop checklist.  

PubMed

The Affordable Care Act (ACA) introduces enormous policy changes to the health care system with several anticipated benefits and a growing number of unanticipated challenges for child and adolescent health. Because the ACA gives each state and their payers substantial autonomy and discretion on implementation, understanding potential effects will require state-by-state monitoring of policies and their impact on children. The "voltage drop" framework is a useful interpretive guide for assessing the impact of insurance market change on the quality of care received. Using this framework we suggest a state-level checklist to examine ACA statewide implementation, assess its impact on health care delivery, and frame policy correctives to improve child health system performance. Although children's health care is a small part of US health care spending, child health provides the foundation for adult health and must be protected in ACA implementation. PMID:25225140

Cheng, Tina L; Wise, Paul H; Halfon, Neal

2014-10-01

170

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

ERIC Educational Resources Information Center

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…

Psychological Science, 2002

2002-01-01

171

What does quality care mean to nurses in rural hospitals?  

PubMed Central

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

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

2013-01-01

172

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

Microsoft Academic Search

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

Therese A Wiegers

2009-01-01

173

Compassion: the missing link in quality of care.  

PubMed

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

van der Cingel, Margreet

2014-09-01

174

Masterassignments eHealth and Quality of Care  

E-print Network

? · Experiments with users · Survey persuasiveness UT/Oulu Uni Finland #12;ePublic Health, social media for health to set up a guideline for the use of social media based on results focus groups · Design ePublic Health1 Masterassignments eHealth and Quality of Care Health Sciences 25 October 2012 Dr Lisette van

Twente, Universiteit

175

Adolescent Substance Abuse Treatment: Organizational Change and Quality of Care  

ERIC Educational Resources Information Center

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…

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

2011-01-01

176

Doctor-patient communication and the quality of care  

Microsoft Academic Search

In this article a comparison is made between three independent sources of assessment of medical consultations. A panel of 12 experienced general practitioners rated 103 consultations with hypertensive patients on the quality of psychosocial care. There was a wide consensus between the judges, resulting in a high reliability score. Two contrasting groups were formed: consultations that were rated high and

Jozien Bensing

1991-01-01

177

Symptom control in palliative care: essential for quality of life  

Microsoft Academic Search

The World Health Organisation (WHO) defines palliative care as an approach that improves the quality of life of patients and their families facing problems associated with life-threatening illness, through the prevention and relief of suffering and the early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual. From this it can be seen that

Debbie Norval; David Cameron

2004-01-01

178

Once Attained, Can Quality Child Care Be Maintained?  

ERIC Educational Resources Information Center

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

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

2006-01-01

179

MFR PAPER 1257 Care and Maintenance of Squid Quality  

E-print Network

MFR PAPER 1257 Care and Maintenance of Squid Quality INTRODUCTION The squid resources in the proper handling of squid at sea and through the processing and dis- tribution stages. Typically, squid for squid is primarily a small-boat fishery, and the catch is sometimes not iced at sea. In southern New

180

Why America Needs High-Quality Early Care and Education  

ERIC Educational Resources Information Center

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

Business Roundtable, 2009

2009-01-01

181

Comparing Clinician Ratings of the Quality of Palliative Care in the Intensive Care Unit  

PubMed Central

Objective There are numerous challenges to successfully integrating palliative care in the ICU. Our primary goal was to describe and compare the quality of palliative care delivered in an ICU as rated by physicians and nurses working in that ICU. Design Multi-site study using self-report questionnaires. Setting Thirteen hospitals throughout the United States. Participants Convenience sample of 188 physicians working in critical care (attending physicians, critical care fellows, resident physicians) and 289 critical care nurses. Measurements Clinicians provided overall ratings of the care delivered by either nurses or physicians in their ICU for each of seven domains of ICU palliative care using a 0–10 scale (0 indicating the worst possible and 10 indicating the best possible care). Analyses included descriptive statistics to characterize measurement characteristics of the 10 items, paired Wilcoxon tests comparing item ratings for the domain of symptom management with all other item ratings, and regression analyses assessing differences in ratings within and between clinical disciplines. We used p<0.001 to denote statistical significance to address multiple comparisons. Main Results The ten items demonstrated good content validity with few missing responses, ceiling or floor effects. Items receiving the lowest ratings assessed spiritual support for families, emotional support for ICU clinicians, and palliative-care education for ICU clinicians. All but two items were rated significantly lower than the item assessing symptom management (p<0.001). Nurses rated nursing care significantly higher (p<0.001) than physicians rated physician care in five domains. In addition, while nurses and physicians gave comparable ratings to palliative care delivered by nurses, nurses’ and physicians’ ratings of physician care were significantly different, with nurse ratings of this care lower than physician ratings on all but one domain. Conclusion Our study supports the content validity of the 10 overall rating items and supports the need for improvement in several aspects of palliative care including spiritual support for families, emotional support for clinicians, and clinician education about palliative care in the ICU. Further, our findings provide some preliminary support for surveying ICU clinicians as one way to assess the quality of palliative care in the ICU. PMID:21283006

Ho, Lawrence A.; Engelberg, Ruth A.; Curtis, J. Randall; Nelson, Judith; Luce, John; Ray, Daniel E.; Levy, Mitchell M.

2011-01-01

182

The economics of health care quality and medical errors.  

PubMed

Hospitals have been looking for ways to improve quality and operational efficiency and cut costs for nearly three decades, using a variety of quality improvement strategies. However, based on recent reports, approximately 200,000 Americans die from preventable medical errors including facility-acquired conditions and millions may experience errors. In 2008, medical errors cost the United States $19.5 billion. About 87 percent or $17 billion were directly associated with additional medical cost, including: ancillary services, prescription drug services, and inpatient and outpatient care, according to a study sponsored by the Society for Actuaries and conducted by Milliman in 2010. Additional costs of $1.4 billion were attributed to increased mortality rates with $1.1 billion or 10 million days of lost productivity from missed work based on short-term disability claims. The authors estimate that the economic impact is much higher, perhaps nearly $1 trillion annually when quality-adjusted life years (QALYs) are applied to those that die. Using the Institute of Medicine's (IOM) estimate of 98,000 deaths due to preventable medical errors annually in its 1998 report, To Err Is Human, and an average of ten lost years of life at $75,000 to $100,000 per year, there is a loss of $73.5 billion to $98 billion in QALYs for those deaths--conservatively. These numbers are much greater than those we cite from studies that explore the direct costs of medical errors. And if the estimate of a recent Health Affairs article is correct-preventable death being ten times the IOM estimate-the cost is $735 billion to $980 billion. Quality care is less expensive care. It is better, more efficient, and by definition, less wasteful. It is the right care, at the right time, every time. It should mean that far fewer patients are harmed or injured. Obviously, quality care is not being delivered consistently throughout U.S. hospitals. Whatever the measure, poor quality is costing payers and society a great deal. However, health care leaders and professionals are focusing on quality and patient safety in ways they never have before because the economics of quality have changed substantially. PMID:23155743

Andel, Charles; Davidow, Stephen L; Hollander, Mark; Moreno, David A

2012-01-01

183

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

PubMed Central

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

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

2005-01-01

184

Peer reviewing critical care: a pragmatic approach to quality management  

PubMed Central

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

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

2010-01-01

185

Complicated deliveries, critical care and quality in emergency obstetric care in Northern Tanzania.  

PubMed

Our objective was to determine the availability and quality of obstetric care to improve resource allocation in northern Tanzania. We surveyed all facilities providing delivery services (n=129) in six districts in northern Tanzania using the UN Guidelines for monitoring emergency obstetric care (EmOC). The three last questions in this audit outline are examined: Are the right women (those with obstetric complications) using emergency obstetric care facilities (Met Need)? Are sufficient quantities of critical services being provided (cesarean section rate (CSR))? Is the quality of the services adequate (case fatality rate (CFR))? Complications are calculated using Plan 3 of the UN Guidelines to assess the value of routine data for EmOC indicator monitoring. Nearly 60% of the expected complicated deliveries in the study population were conducted at EmOC qualified health facilities. 81.2% of the expected complicated deliveries are conducted in any facility (including facilities not qualifying as EmOC facilities). There is an inadequate level of critical services provided (CSR 4.6). Voluntary agencies provide most of these services in rural settings. All indicators show large variations with the setting (urban/rural location, level and ownership of facilities). Finally, there is large variation in the CFR with only one facility meeting the minimum accepted level. Utilization and quality of critical obstetric services at lower levels and in rural districts must be improved. The potential for improving the resource allocation within lower levels of the health care system is discussed. Given the small number of qualified facilities yet relatively high Met Need, we argue that it is neither the mothers' ignorance nor their lack of ability to get to a facility that is the main barrier to receiving quality care when needed, but rather the lack of quality care at the facility. Little can be concluded using the CFR to describe the quality of services provided. PMID:15464791

Olsen, Ø E; Ndeki, S; Norheim, O F

2004-10-01

186

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

PubMed Central

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

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

187

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

PubMed

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

Fumi?, Nera; Marinovi?, Marin; Brajan, Dolores

2014-10-01

188

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

ERIC Educational Resources Information Center

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…

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

2012-01-01

189

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

ERIC Educational Resources Information Center

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…

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

2012-01-01

190

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

PubMed Central

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

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

2013-01-01

191

Conservative spine care: opportunities to improve the quality and value of care.  

PubMed

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

Kosloff, Thomas M; Elton, David; Shulman, Stephanie A; Clarke, Janice L; Skoufalos, Alexis; Solis, Amanda

2013-12-01

192

Quality of care and health-related quality of life of climacteric stage women cared for in family medicine clinics in Mexico  

Microsoft Academic Search

OBJECTIVES: 1) To design and validate indicators to measure the quality of the process of care that climacteric stage women receive in family medicine clinics (FMC). 2) To assess the quality of care that climacteric stage women receive in FMC. 3) To determine the association between quality of care and health-related quality of life (HR-QoL) among climacteric stage women. METHODS:

Svetlana Doubova Dubova; Sergio Flores-Hernández; Leticia Rodriguez-Aguilar; Ricardo Pérez-Cuevas

2010-01-01

193

Quality of neurological care. Balancing cost control and ethics.  

PubMed

As the quality of neurological care becomes a mutual objective of physicians, patients, and health planners, increased demands on cost savings will create conflicts that could threaten the ethical basis of medical practice. Physicians will see increasing ethical conflicts between their fiduciary duties to make treatment decisions in the best interest of their patients and their justice-based duties to conserve societal resources. These conflicts can be best mitigated if physicians maintain their orientation as patient advocates but practice cost-conscious clinical behaviors that consider the cost-effectiveness of tests and treatments and do not squander society's finite resources by ordering medical tests and treatments of zero or marginal utility. Health system planners should resolve their conflicting objectives of quality and cost control by rigorously defining and measuring quality through physician leadership and by implementing cost-control measures that enhance the quality of medical care. Managed care organizations voluntarily should forsake financially successful but blatantly unethical cost-saving schemes, such as gag clauses and end-of-year kickback payments to physicians, because these schemes diminish patients' trust in physicians and degrade the integrity of the patient-physician relationship. State and federal laws should prudently regulate these unethical cost-saving schemes to the same extent as they have for the harmful conflicts in fee-for-service medicine. PMID:9362979

Bernat, J L

1997-11-01

194

Spatial competition for quality in the market for hospital care.  

PubMed

This study analyses the market for secondary health care services when patient choice depends on the quality/distance mix that achieves utility maximization. First, the hospital's equilibrium in a Hotelling spatial competition model under simultaneous quality choices is analyzed to define hospitals' strategic behavior. A first equilibrium outcome is provided, the understanding of which is extremely useful for the policy maker wishing to improve social welfare. Second, patients are assumed to be unable, because of asymmetry of information, to observe the true quality provided. Their decisions reflect the perceived quality, which is affected by bias. Using the mean-variance method, the equilibrium previously found is investigated in a stochastic framework. PMID:15791476

Montefiori, Marcello

2005-06-01

195

Delivering High-Quality and Affordable Care Throughout the Cancer Care Continuum  

PubMed Central

The national cost of cancer care is projected to reach $173 billion by 2020, increasing from $125 billion in 2010. This steep upward cost trajectory has placed enormous an financial burden on patients, their families, and society as a whole and raised major concern about the ability of the health care system to provide and sustain high-quality cancer care. To better understand the cost drivers of cancer care and explore approaches that will mitigate the problem, the National Cancer Policy Forum of the Institute of Medicine held a workshop entitled “Delivering Affordable Cancer Care in the 21st Century” in October 2012. Workshop participants included bioethicists, health economists, primary care physicians, and medical, surgical, and radiation oncologists, from both academic and community settings. All speakers expressed a sense of urgency about the affordability of cancer care resulting from the future demographic trend as well as the high cost of emerging cancer therapies and rapid diffusion of new technologies in the absence to evidence indicating improved outcomes for patients. This article is our summary of presentations at the workshop that highlighted the overuse and underuse of screening, treatments, and technologies throughout the cancer care continuum in oncology practice in the United States. PMID:24127450

Shih, Ya-Chen Tina; Ganz, Patricia A.; Aberle, Denise; Abernethy, Amy; Bekelman, Justin; Brawley, Otis; Goodwin, James S.; Hu, Jim C.; Schrag, Deborah; Temel, Jennifer S.; Schnipper, Lowell

2013-01-01

196

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

PubMed

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

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

2011-10-01

197

Quality Assessment of Child Care Services in Primary Health Care Settings of Central Karnataka (Davangere District)  

PubMed Central

Background: Infectious disease and malnutrition are common in children. Primary health care came into being to decrease the morbidity. Quality assessment is neither clinical research nor technology assessment. It is primarily an administrative device used to monitor performance to determine whether it continues to remain within acceptable bounds. Aims and Objectives: To assess the quality of service in the delivery of child health care in a primary health care setting. To evaluate client satisfaction. To assess utilization of facilities by the community. Materials and Methods: Study Type: Cross-sectional community-based study. Quality assessment was done by taking 30-50%, of the service provider. Client satisfaction was determined with 1 Immunization and child examination-90 clients each. Utilization of services was assessed among 478 households. Statistical Analysis: Proportions, Likert's scale to grade the services and Chi-square. Results: Immunization service: Identification of needed vaccine, preparation and care was average. Vaccination technique, documentation, EPI education, maintenance of cold chain and supplies were excellent. Client satisfaction was good. Growth monitoring: It was excellent except for mother's education andoutreach educational session. Acute respiratory tract infection care: History, physical examination, ARI education were poor. Classification, treatment and referral were excellent. Client satisfaction was good. Diarrheal disease care: History taking was excellent. But examination, classification, treatment, ORT education were poor. Conclusion: Mothers education was not stressed by service providers. Service providers’ knowledge do not go with the quality of service rendered. Physical examination of the child was not good. Except for immunization other services were average. PMID:20606915

Rashmi; Vijaykumar, B

2010-01-01

198

Racial/Ethnic Perspectives on the Quality of Hospice Care  

PubMed Central

Diversity in the US population is increasing, and evaluating the quality of culturally sensitive hospice care is important. A survey design was used to collect data from 743 patients enrolled in hospice or their family members or caregivers. Race/ethnicity was not significantly associated with any of the hospice interventions or outcomes. Patients were less likely to be satisfied with the overall hospice care (OR = 0.23, 95% CI = 0.065-0.796, P = .021) compared to other type of respondents. Satisfaction with emotional support was substantially associated with the increased likelihood of satisfaction with pain management (OR = 3.82, 95% CI = 1.66-8.83, P = .002), satisfaction with other symptom management (OR = 6.17, 95% CI = 2.80-13.64, P < .001), and of overall satisfaction with hospice care (OR = 20.22, 95% CI = 8.64-47.35, P < .001). PMID:22952128

Campbell, Cathy L.; Baernholdt, Marianne; Yan, Guofen; Hinton, Ivora D.; Lewis, Erica

2013-01-01

199

Quality of care: how good is good enough?  

PubMed

Israel has made impressive progress in improving performance on key measures of the quality of health care in the community in recent years. These achievements are all the more notable given Israel's modest overall spending on health care and because they have accrued to virtually the entire population of the country.Health care systems in most developed nations around the world find themselves in a similar position today with respect to health care quality. Despite significantly increased improvement efforts over the past decade, routine safety processes, such as hand hygiene and medication administration, fail routinely at rates of 30% to 50%. People with chronic diseases experience preventable episodes of acute illness that require hospitalization due to medication mix-ups and other failures of outpatient management. Patients continue to be harmed by preventable adverse events, such as surgery on the wrong part of the body and fires in operating theaters. Health care around the world is not nearly as safe as other industries, such as commercial aviation, that have mastered highly effective ways to manage serious hazards.Health care organizations will have to undertake three interrelated changes to get substantially closer to the superlative safety records of other industries: leadership commitment to zero major quality failures, widespread implementation of highly effective process improvement methods, and the adoption of all facets of a culture of safety. Each of these changes represents a major challenge to the way today's health care organizations plan and carry out their daily work. The Israeli health system is in an enviable position to implement these changes. Universal health insurance coverage, the enrolment of the entire population in a small number of health plans, and the widespread use of electronic health records provide advantages available to few other countries.Achieving and sustaining levels of safety comparable to, say, commercial aviation will be a long journey for health care--one we should begin promptly.This is a commentary on http://www.ijhpr.org/content/1/1/3/ PMID:22913581

Chassin, Mark R

2012-01-01

200

Quality and equity in early childhood care in Peru  

NASA Astrophysics Data System (ADS)

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.

Izu, Regina Moromizato

2007-01-01

201

Choosing High-Quality Child Care for a Child with Special Needs  

MedlinePLUS

... PM How do I select a high-quality child care program for my child with special needs? 1. Call your local Child ... the other children and families. Identifying Quality in Child Care Look, listen and ask ? Are families and ...

202

Quality Adjustment for Health Care Spending on Chronic Disease: Evidence from Diabetes Treatment, 1999–2009  

E-print Network

Although US health care expenditures reached 17.6 percent of GDP in 2009, quality measurement in this important service sector remains limited. Studying quality changes associated with 11 years of health care for patients ...

Eggleston, Karen N

203

QUALITY-OF-CARE INDICATORS FOR PELVIC ORGAN PROLAPSE: DEVELOPMENT OF AN INFRASTRUCTURE FOR QUALITY ASSESSMENT  

PubMed Central

Introduction A paucity of data exists addressing the quality of care provided to women with pelvic organ prolapse (POP). We sought to develop a means to measure this quality through the development of quality-of-care indicators (QIs). Methods QIs were modeled after those previously described in the Assessing the Care of Vulnerable Elders (ACOVE) project. The indicators were then presented to a panel of nine experts. Using the RAND Appropriateness Method, we analyzed each indicator’s preliminary rankings. A forum was then held in which each indicator was thoroughly discussed by the panelists as a group, after which panelists individually re-rated the indicators. QIs with median scores of at least seven were considered valid. Results QIs were developed that addressed screening, diagnosis, work-up, and both nonsurgical and surgical management. Areas of controversy included whether screening should be performed to identify prolapse, whether pessary users should undergo a vaginal exam by a health professional every six months versus annually, and whether a colpocleisis should be offered to older women planning to undergo surgery for POP. Fourteen of 21 potential indicators were rated as valid for pelvic organ prolapse (median score ? 7). Conclusion We developed and rated fourteen potential quality indicators for the care of women with POP. Once these QIs are tested for feasibility they can be used on a larger scale to measure and compare the care provided to women with prolapse in different clinical settings. PMID:23644812

Anger, Jennifer T.; Scott, Victoria C.S.; Kiyosaki, Krista; Khan, Aqsa A.; Sevilla, Claudia; Connor, Sarah E.; Roth, Carol P.; Litwin, Mark S.; Wenger, Neil S.; Shekelle, Paul G.

2013-01-01

204

45 CFR 98.51 - Activities to improve the quality of child care.  

Code of Federal Regulations, 2013 CFR

... false Activities to improve the quality of child care. 98.51 Section 98.51 Public Welfare...AND HUMAN SERVICES GENERAL ADMINISTRATION CHILD CARE AND DEVELOPMENT FUND Use of Child Care and Development Funds § 98.51...

2013-10-01

205

45 CFR 98.51 - Activities to improve the quality of child care.  

Code of Federal Regulations, 2010 CFR

... false Activities to improve the quality of child care. 98.51 Section 98.51 Public Welfare...AND HUMAN SERVICES GENERAL ADMINISTRATION CHILD CARE AND DEVELOPMENT FUND Use of Child Care and Development Funds § 98.51...

2010-10-01

206

45 CFR 98.51 - Activities to improve the quality of child care.  

Code of Federal Regulations, 2012 CFR

... false Activities to improve the quality of child care. 98.51 Section 98.51 Public Welfare...AND HUMAN SERVICES GENERAL ADMINISTRATION CHILD CARE AND DEVELOPMENT FUND Use of Child Care and Development Funds § 98.51...

2012-10-01

207

45 CFR 98.51 - Activities to improve the quality of child care.  

Code of Federal Regulations, 2011 CFR

... false Activities to improve the quality of child care. 98.51 Section 98.51 Public Welfare...AND HUMAN SERVICES GENERAL ADMINISTRATION CHILD CARE AND DEVELOPMENT FUND Use of Child Care and Development Funds § 98.51...

2011-10-01

208

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

Microsoft Academic Search

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

Peter Griffiths; Jill Maben; Trevor Murrells

2011-01-01

209

Quality of Care and Patient Outcomes in Critical Access Hospitals  

PubMed Central

Context Critical Access Hospitals (CAHs) play a crucial role in the nation’s rural safety net. Current policy efforts have focused primarily on helping these small, isolated hospitals remain financially viable to ensure access for Americans living in rural areas. However, we know little about the quality of care they provide, or the outcomes their patients achieve. Objective To examine the quality of care and patient outcomes at CAHs, and to understand why patterns of care might differ for CAHs versus non-CAHs. Design Retrospective analysis of national data from Medicare and other sources. Setting U.S. hospitals. Patients Medicare fee-for-service beneficiaries with acute myocardial infarction (AMI), congestive heart failure (CHF), and pneumonia, discharged in 2008–2009. Main Outcome Measures Clinical capabilities, performance on processes of care, and 30-day mortality rates. Results Compared to other hospitals, CAHs were less likely to have intensive care units (30.0% versus 74.4%, p<0.001), cardiac catheterization capabilities (0.5% versus 47.7%, p<0.001), and at least basic electronic health records (4.6% versus 9.9%, p<0.001). CAHs had lower performance on process measures than non-CAHs for all three conditions examined (Hospital Quality Alliance summary score for AMI 91.0% versus 97.8%, for CHF, 80.6% versus 93.5%, and for pneumonia 89.3% versus 93.7%, p<0.001 for each). Patients admitted to a CAH had higher 30-day mortality rates for each condition than those admitted to non-CAHs (for AMI, 23.5% versus 16.2%, Odds Ratio (OR) 1.70 (95% confidence interval 1.61, 1.80), p<0.001; for CHF, 13.4% versus 10.9%, OR 1.28 (1.23, 1.32), p<0.001; and for pneumonia 14.1% versus 12.1%, OR 1.20 (1.16, 1.24) p<0.001). Conclusions Care in CAHs, compared with non-CAHs, is associated with worse processes of care and higher mortality rates. PMID:21730240

Joynt, Karen E.; Harris, Yael; Orav, E. John; Jha, Ashish K.

2012-01-01

210

Paying for efficiency: what price the quality of hospital care?  

PubMed

Economic recession prompts governments and health service ministers to seek increased efficiency in the production of hospital services in order to reconcile increasing demands with scarce resources. As one approach to the problem, the National Health Strategy is recommending pilot schemes, similar to those which have been introduced in both the United Kingdom and the Netherlands, which involve the separation of purchaser from the provider of hospital services. It is argued that such separation, with the introduction of competition between providers of hospital services for contracts placed by publicly funded Area Health Boards, will increase efficiency and accountability in the use of resources. However, this argument ignores the hospital management's ability to keep costs down by altering the quality of hospital care in ways which are difficult to monitor by purchasing agencies. The article considers the effects the introduction of managed competition is likely to have on the quality of hospital services. The outcome is uncertain and competition may improve some dimensions of quality while jeopardizing others. If managed competition is tried in Australia, the opportunity should also be taken to examine its impact on the quality and outcomes of hospital care. PMID:1482723

Shiell, A

1992-09-01

211

Acute care in neurosurgery: quantity, quality, and challenges  

PubMed Central

OBJECTIVE—Part of the daily routine in neurosurgery is the treatment of emergency room admissions, and acute cases from other departments or from outside hospitals. This acute care is not normally included in performance figures or budget management, nor analysed scientifically in respect of quantity and quality of care provided by neurosurgeons.?METHOD—Over a 1 year period, all acute care cases managed by two neurosurgical on call teams in a large northern German city, were recorded prospectively on a day by day basis. A large database of 1819 entries was created and analysed using descriptive statistics.?RESULTS—The minimum incidence of patients requiring neurosurgical acute care was estimated to be 75-115/100 000 inhabitants/year. This corresponds to a mean of about 6/day. Only 30% of patients came directly via the emergency room. The fate of 70% of patients depended initially on the "neurosurgical qualification" of primary care doctors and here deficits existed. Although most intracerebral and subarachnoid haemorrhages were managed with the participation of neurosurgeons, they were not involved in the management of most mild and moderate traumatic brain injuries. Within 1 year the additional workload from acute care amounted to 1000 unplanned admissions, 900 acute imaging procedures, and almost 400 emergency operations.?CONCLUSION—The current policy in public health, which includes cuts in resources, transport facilities, and manpower, is not compatible with the demonstrated extent of acute neurosurgical care. In addition to routine elective work, many extra admissions, evening or night time surgery, and imaging procedures have to be accomplished. An education programme for generalists is required to improve overall patient outcome. These conclusions hold special importance if health authorities wish to not only maintain present standards but aim to improve existing deficits.?? PMID:11459889

Schuhmann, M; Rickels, E; Rosahl, S; Schneekloth, C; Samii, M

2001-01-01

212

The moderate success of quality of care improvement efforts: three observations on the situation  

Microsoft Academic Search

Why is the health care system still unable to achieve a breakthrough in its quality performance? This commentary offers three observations on the problem of the moderate success of quality of care improvement efforts. We based our discussion on theo- retical models from management theory and research. We conclude that health care organizations invest efforts in quality improvement initiatives; however,

TAL KATZ-NAVON; EITAN NAVEH; ZVI STERN

2007-01-01

213

Assessing Structural Indicators of Child Care Quality at the Local Level: Lessons from Four Minnesota Counties  

Microsoft Academic Search

In 1999 Minnesota was ranked as one of ten states that provide quality child care and education, based primarily on licensing requirements. Yet in response to growing concerns about staff turnover and low quality, a partnership of child care resource and referral staff and university researchers conducted an assessment of the quality of child care in four Minnesota counties. The

Deborah A. Ceglowski; Elizabeth E. Davis

2004-01-01

214

Within and beyond the classroom door: assessing quality in child care centers  

Microsoft Academic Search

This study reports data from a multisite study of typical center-based child care and children’s development regarding (a) associations among quality of care defined by structural features, process indicators, and compliance with state regulations, (b) variation in quality based on the stringency of state child care regulations and center compliance, and (c) specific quality indicators that show especially strong links

Deborah Phillips; Debra Mekos; Sandra Scarr; Kathleen McCartney

2000-01-01

215

The quality of care and influence of double health care coverage in Catalonia (Spain)  

PubMed Central

AIMS—To analyse inequalities by social class in children's access to and utilisation of health services in Catalonia (Spain), private health insurance coverage, and certain aspects of the quality of care received.?DESIGN—Cross sectional study using data from the 1994 Catalan Health Interview Survey.?SETTING—Child population of Catalonia.?PARTICIPANTS—A representative sample of non-institutionalised children younger than 15 years (n = 2433).?MAIN OUTCOME MEASURES—Health services utilisation, perceived health, type of health insurance (only National Health System (NHS) or both NHS and private health insurance), and social class.?RESULTS—No inequalities by social class were found for the utilisation of health care services provided by the NHS among children in most need. Double health care coverage does not influence the social pattern of visits. Nevertheless, social inequalities still remain in the use of those health services provided only partially by the NHS (dentist) and when characteristics of the last consultation are taken into account. That is, subjects who paid for a private service waited an average of 14.8 minutes less than those whose visit was paid for by the NHS only.?CONCLUSION—Equitable access and use of medical care services in relation to need, regardless of the type of insurance and social class of their children and families, has been achieved in this region of Spain; differences by social class remain for those services incompletely covered by national health insurance and aspects of the quality of care provided.?? PMID:10952636

Rajmil, L.; Borrell, C.; Starfield, B.; Fernandez, E.; Serra, V.; Schiaffino, A.; Segura, A.

2000-01-01

216

Quality measures for the care of patients with lateral epicondylalgia  

PubMed Central

Background Lateral epicondylalgia (LE) defines a condition of varying degrees of pain near the lateral epicondyle. Studies on the management of LE indicated unexplained variations in the use of pharmacologic, non-pharmacological and surgical treatments. The main aim of this paper was to develop and evaluate clinical quality measures (QMs) or quality indicators, which may be used to assess the quality of the processes of examination, education and treatment of patients with LE. Methods Different QMs were developed by a multidisciplinary group of experts in Quality Management of Health Services during a period of one year. The process was based following a 3-step model: i) review and proportion of existing evidence-based recommendations; ii) review and development of quality measures; iii) pilot testing of feasibility and reliability of the indicators leading to a final consensus by the whole panel. Results Overall, a set of 12 potential indicators related to medical and physical therapy assessment and treatment were developed to measure the performance of LE care. Different systematic reviews and randomized control trials supported each of the indicators judged to be valid during the expert panel process. Application of the new indicator set was found to be feasible; only the measurement of two quality measures had light barriers. Reliability was mostly excellent (Kappa?>?0.8). Conclusions A set of good practice indicators has been built and pilot tested as feasible and reliable. The chosen 3-step standardized evidence-based process ensures maximum clarity, acceptance and sustainability of the developed indicators. PMID:24172311

2013-01-01

217

Factors Affecting Sleep Quality of Patients in Intensive Care Unit  

PubMed Central

Introduction: Sleep disturbance is a frequently overlooked complication of intensive care unit (ICU) stay. Aim: To evaluate sleep quality among patients admitted to ICU and investigate environmental and non-environmental factors that affect sleep quality in ICU. Methods: Over a 22-month period, we consecutively recruited patients who spent ? 2 nights post-endotracheal extubation in ICU and who were orientated to time, place, and person on the day of discharge. Self-reported sleep quality, according to a modified Freedman questionnaire, which provided data on self-reported ICU sleep quality in ICU and environmental factors affecting sleep quality in the ICU, were collected. We also investigated non-environmental factors, such as severity of illness, ICU interventions, and medications that can affect sleep quality. Results: Fifty males and 50 females were recruited with a mean (± SD) age of 65.1 ± 15.2 years. APACHE II score at admission to ICU was 18.1 ± 7.5 with duration of stay 6.7 ± 6.5days. Self-reported sleep quality score at home (1 = worst; 10 = best) was 7.0 ± 2.2; this decreased to 4.0 ± 1.7 during their stay in ICU (p < 0.001). In multivariate analysis with APACHE III as severity of illness (R2 = 0.25), factors [exp(b)(95% CI), p value] which significantly affected sleep in ICU were sex [0.37(0.19-0.72), p < 0.01], age and sex interaction [1.02(1.01-1.03), p < 0.01], bedside phone [0.92(0.87-0.97), p < 0.01], prior quality of sleep at home [1.30(1.05-1.62), p = 0.02], and use of steroids [0.82(0.69-0.98), p = 0.03] during the stay in ICU. Conclusion: Reduced sleep quality is a common problem in ICU with a multifactorial etiology. Citation: Bihari S; McEvoy RD; Kim S; Woodman RJ; Bersten AD. Factors affecting sleep quality of patients in intensive care unit. J Clin Sleep Med 2012;8(3):301-307. PMID:22701388

Bihari, Shailesh; Doug McEvoy, R.; Matheson, Elisha; Kim, Susan; Woodman, Richard J.; Bersten, Andrew D.

2012-01-01

218

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

PubMed Central

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

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

2011-01-01

219

[Evaluation of care quality in the ICU through a computerized nursing care plan].  

PubMed

The computerized systems that are being implemented for the recording of the Nursing Care Plan may facilitate the performance of continuing follow-up of the care quality. This retrospective descriptive study has been performed in a polyvalent Intensive Care Unit with the following objectives: a) describe the evaluation of the care quality, performed through the computerized record of the Nursing Care Plan; and 2) compare this evaluation with that performed in 1998, when the Nursing Care Plan had not yet been computerized. In the 98 revised computerized Nursing Care Plans, corresponding to the same number of patients with a mean stay of 13.8 days, the following results were obtained. Artificial airway. 74 patients had an endotracheal tube with a mean stay of 5.4 days, 11 patients had a cannula tracheotomy (time period of 45.7 days); no events occurred. Central venous lines: 91 patients were carriers of 163 catheters, the mean presence time was 9.9 days; three with withdrawn due to obstruction, there was one accident withdrawal and two were self-removed. Arterial catheter: the total number of arterial lines, corresponding to 87 patients, was 101 with a mean presence of 6.7 days; 15 obstructions, six accidental withdrawals and four self-removals were recorded. Bladder catheter: 91 patients had a bladder catheter (mean presence 12.9 days); no event occurred. Nasogastric tube: 83 patients were carriers of 98 tubes (63 Salem type and 35 for nutrition), with a mean presence of 10.1 days; five were withdrawn due to obstruction, three accidental withdrawals and 40 self-removed (23 in one patient). Skin integrity: nine patients developed bedsores, eight grade II and two grade III, the mean stay was 26.6 days. No patients had an accidental fall. As study conclusions, it stands out that the preestablished standards for the evaluation of the care were achieved in most and the care quality is maintained in relationship with our 1998 study, remaining within a level considered as good. PMID:15207188

Goñi Viguria, R; García Santolaya, M P; Vázquez Calatayud, M; Margall Coscojuela, M A; Asiaín Erro, M C

2004-01-01

220

Availability and quality of prehospital care on pakistani interurban roads.  

PubMed

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

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

2013-01-01

221

Availability and Quality of Prehospital Care on Pakistani Interurban Roads  

PubMed Central

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

Bhatti, Junaid A.; Waseem, Hunniya; Razzak, Junaid A.; Shiekh, Naeem-ul-lah; Khoso, Ajmal Khan; Salmi, L.-Rachid

2013-01-01

222

Development and testing of a measure designed to assess the quality of care transitions  

Microsoft Academic Search

Background: To improve the quality of care delivered to older persons receiving care across multiple settings, interventions are needed. However, the absence of a patient-centred measure specifically designed to assess this care has constrained innovation. Objective: To develop a rigorously designed and tested measure, the Care Transition Measure (CTM). Setting: A large, integrated managed care organisation in Colorado with approximately

Eric A. Coleman; Jodi D. Smith; Janet C. Frank; Theresa B. Eilertsen; Jill N. Thiare; Andrew M. Kramer

2002-01-01

223

Early Effects of ''Guided Care'' on the Quality of Health Care for Multimorbid Older Persons: A Cluster-Randomized Controlled Trial  

Microsoft Academic Search

Background. The quality of health care for older Americans with multiple chronic conditions is suboptimal. We designed ''Guided Care'' (GC) to enhance quality of care by integrating a registered nurse, intensively trained in chronic care, into primary care practices to work with physicians in providing comprehensive chronic care to 50-60 multimorbid older patients. Methods. We hypothesized that GC would improve

Chad Boult; Lisa Reider; Katherine Frey; Bruce Leff; Cynthia M. Boyd; Jennifer L. Wolff; Stephen Wegener; Jill Marsteller; Lya Karm; Daniel Scharfstein

2008-01-01

224

The quality of ambulatory care in Medicare health maintenance organizations.  

PubMed Central

The quality of ambulatory care received by Medicare recipients who enrolled in health maintenance organizations (HMOs) was compared to the care received by fee-for-service (FFS) Medicare recipients, in a quasi-experimental, non-randomized design. Both samples were drawn from the four major geographic areas in the country, and included two types of HMO practices: staff/group models, and independent practice associations (IPAs). A panel of expert physicians developed criteria for evaluating ambulatory care, and medical record abstractions using these criteria were performed on 1,590 outpatient records: 777 FFS and 813 HMO (441 staff/group, 372 IPA). While individual items of medical histories and physical examinations were performed most often for staff/group HMO patients and least often in FFS patients, odds ratios (OR) for performance in staff/group HMO patients were particularly large for health maintenance items: tonometry (OR = 8.4), mammography (OR = 2.7), pelvic examination (OR = 5.3), rectal examination (OR = 2.9), fecal occult blood test (OR = 3.3). The results suggest that recommended elements of routine and preventive care are more likely to be performed for Medicare enrollees in staff/group HMOs than in FFS settings. PMID:2107765

Retchin, S M; Brown, B

1990-01-01

225

Quality of Care Attributions to Employed Versus Stay-at-Home Mothers  

ERIC Educational Resources Information Center

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…

Shpancer, Noam; Melick, Katherine M.; Sayre, Pamela S.; Spivey, Aria T.

2006-01-01

226

Evaluation of quality in social care: aplus program.  

PubMed

France is not advanced regarding evaluation in social work, despite a law established in January 2002 making evaluation a legal obligation every 5 years. This article presents a software program to help social services evaluate on both individual and group levels. Automatic dashboard results of the program with special emphasis on the main qualities social work would usually present reciprocity and social competence, client ability development, and social care treatment components. The last point is an automatic selection of most efficient treatment components of ability development. PMID:16127122

Dutrénit, Jean-Marc

2005-10-01

227

Brief report: Quality of ambulatory care for women and men in the veterans affairs health care system  

Microsoft Academic Search

BACKGROUND: Gender differences in inpatient quality of care are well known. However, whether men and women receive equivalent ambulatory\\u000a care is less well understood.\\u000a \\u000a \\u000a OBJECTIVE: To study gender differences in quality of care for patients receiving primary care in the Veterans Affairs (VA) Health Care\\u000a System.\\u000a \\u000a \\u000a \\u000a \\u000a DESIGN: Cross-sectional samples of VA enrollees during fiscal years 1999 to 2000.\\u000a \\u000a \\u000a \\u000a \\u000a PARTICIPANTS: Samples

Ashish K. Jha; Jonathan B. Perlin; Michael A. Steinman; John W. Peabody; John Z. Ayanian

2005-01-01

228

Developmentally supportive care in the newborn intensive care unit: early intervention in the community.  

PubMed

The traditional focus of hospital nurses on the medical concerns of infants and toddlers is expanding to encompass the more global view that integrates the developmental level of each infant/toddler into the nursing care plan. Research on early brain development has supported the focus on developmentally supportive care in the NICU. Nursing support of the early relationship between infant and parent that will influence the infant's future development is part of this process. The integration of developmental care concepts including family-centered care that begins on admission to the NICU may continue into the process of discharge and transition to home. The nurse is in an excellent position to support the family in naming their concerns, their strengths, and the hopes and dreams they have for their infant. Nurses in the NICU, home care, community, and public health increasingly focus on a developmental perspective in their work but will be continually challenged to increase their knowledge and understanding of developmental milestones, neurodevelopmental assessment, and their role in collaborating with the wider world of early intervention. This collaboration includes the health care system, the educational system, and the social service system as equal players. For some nurses, this will be a new experience whereby the responsibility for the child is shared among members of an interdisciplinary team that includes the parents. Nurses are key to providing developmentally supportive care and working collaboratively on behalf of the infants and toddlers and their families. PMID:12914307

Bondurant, Patricia Gorra; Brinkman, Kathleen S

2003-06-01

229

Supplemental Nurse Staffing in Hospitals and Quality of Care  

PubMed Central

Objective To promote evidence-based decision making regarding hospital staffing, the authors examined the characteristics of supplemental nurses, as well as the relationship of supplemental staff to nurse outcomes and adverse events. Background The use of supplemental nurses to bolster permanent nursing staff in hospitals is widespread but controversial. Quality concerns have been raised regarding the use of supplemental staff. Methods Data from the 2000 National Sample Survey of Registered Nurses were used to determine whether the qualifications of supplemental nurses working in hospitals differed from permanent staff nurses. Data from Pennsylvania nurse surveys were analyzed to examine whether nurse outcomes and adverse events differed in hospitals with varying proportions of nonpermanent nurses. Results Temporary nurses have qualifications similar to permanent staff nurses. Deficits in patient care environments in hospitals employing more temporary nurses explain the association between poorer quality and temporary nurses. Conclusion Negative perceptions of temporary nurses may be unfounded. PMID:17939464

Aiken, Linda H.; Xue, Ying; Clarke, Sean P.; Sloane, Douglas M.

2010-01-01

230

Neonatal intensive care nursery staff perceive enhanced workplace quality with the single-family room design  

Microsoft Academic Search

Objective:To compare perceived workplace quality in an open-bay neonatal intensive care unit (NICU) and a single-family room (SFR) NICU.Study Design:Prospective non-randomized, non-controlled cohort study.Result:Staff workplace quality perceptions assessed included the following: the quality of being a Sanford Health System employee (NS—not significant), the quality of the NICU physical work environment, the quality of NICU patient care, the job quality in

D C Stevens; C C Helseth; M A Khan; D P Munson; T J Smith

2010-01-01

231

Toward Improving the Quality of Cancer Care: Addressing the Interfaces of Primary & Oncology-Related Subspecialty Care  

Cancer.gov

A number of reports in the last decade, including the classic Institute of Medicine reports on the quality chasm, have identified key elements and deconstructed processes of care that must be addressed to ensure quality of care. This supplement moves beyond that important initial work in distinguishing between the steps in care that are the usual focus of guidelines to focusing on the connections between these steps that have seldom been examined in research or addressed in practice.

232

Quality of care and health-related quality of life of climacteric stage women cared for in family medicine clinics in Mexico  

PubMed Central

Objectives 1) To design and validate indicators to measure the quality of the process of care that climacteric stage women receive in family medicine clinics (FMC). 2) To assess the quality of care that climacteric stage women receive in FMC. 3) To determine the association between quality of care and health-related quality of life (HR-QoL) among climacteric stage women. Methods The study had two phases: I. Design and validation of indicators to measure the quality of care process by using the RAND/UCLA Appropriateness Method. II. Evaluation of the quality of care and its association with HR-QoL through a cross-sectional study conducted in two FMC located in Mexico City that included 410 climacteric stage women. The quality of care was measured by estimating the percentage of recommended care received (PRCR) by climacteric stage women in three process components: health promotion, screening, and treatment. The HR-QoL was measured using the Cervantes scale (0-155). The association between quality of care and HR-QoL was estimated through multiple linear regression analysis. Results The lowest mean of PRCR was for the health promotion component (24.1%) and the highest for the treatment component (86.6%). The mean of HR-QoL was 50.1 points. The regression analysis showed that in the treatment component, for every 10 additional points of the PRCR, the global HR-QoL improved 2.8 points on the Cervantes scale (coefficient -0.28, P < 0.0001). Conclusion The indicators to measure quality of care for climacteric stage women are applicable and feasible in family medicine settings. There is a positive association between the quality of the treatment component and HR-QoL; this would encourage interventions to improve quality of care for climacteric stage women. PMID:20144238

2010-01-01

233

Making the case to improve quality and reduce costs in pediatric health care.  

PubMed

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

Sachdeva, Ramesh C; Jain, Shabnam

2009-08-01

234

Barriers to quality health care for the transgender population.  

PubMed

The transgender community is arguably the most marginalized and underserved population in medicine. A special issue focusing on men's health would be incomplete without mention of this vulnerable population, which includes those transitioning to and from the male gender. Transgender patients face many barriers in their access to healthcare including historical stigmatization, both structural and financial barriers, and even a lack of healthcare provider experience in treating this unique population. Historical stigmatization fosters a reluctance to disclose gender identity, which can have dire consequences for long-term outcomes due to a lack of appropriate medical history including transition-related care. Even if a patient is willing to disclose their gender identity and transition history, structural barriers in current healthcare settings lack the mechanisms necessary to collect and track this information. Moreover, healthcare providers acknowledge that information is lacking regarding the unique needs and long-term outcomes for transgender patients, which contributes to the inability to provide appropriate care. All of these barriers must be recognized and addressed in order to elevate the quality of healthcare delivered to the transgender community to a level commensurate with the general population. Overcoming these barriers will require redefinition of our current system such that the care a patient receives is not exclusively linked to their sex but also considers gender identity. PMID:24560655

Roberts, Tiffany K; Fantz, Corinne R

2014-07-01

235

Nutritional Quality of Meals Compared to Snacks in Child Care  

PubMed Central

Abstract Background Most young children are in child care. Previous studies suggest that children may receive insufficient vegetables, and foods and beverages with added sugars, fats, and sodium in these settings. None have compared the nutritional quality of meals to snacks. Methods Directors from 258 full-day child-care centers in two urban counties of southwestern Ohio were surveyed via telephone in the fall of 2009 about their nutrition practices, and asked to provide a current menu. Lunch and afternoon snack menus were categorized according to average weekly frequency for fruits, vegetables, lean meats, juice (100%), and sweet or salty foods served. Frequencies were compared by meal occasion (lunch vs. snack) using the Fisher exact test. Results Most (60%) directors reported serving 2% milk to children ?3 years; 31% served whole milk. Menu analysis demonstrated the composition of lunches differed from snacks (p<0.0001) in all food categories. A total of 87% centers rarely (<1 time per week) listed nonstarchy vegetables for snacks, but 67% of centers included them at lunch ?3 times per week. Juice (100%) was on snack menus >2 times per week in 37% centers, but in only 1 center as a regular component of lunch. Similarly, 87% centers listed sweet and salty foods at snack ?3 times per week, but rarely at lunch. Conclusions Despite efforts to improve children's diets in child care, meals—and particularly snacks—still lack whole fruits and nonstarchy vegetables and contain added sugars and fats. Snacks represent a missed opportunity to improve the nutritional quality of foods served in childcare. PMID:23635311

Benjamin Neelon, Sara E.; Howald, Angela E.; Wosje, Karen S.

2013-01-01

236

Who's Judging the Quality of Care? Indigenous Maya and the Problem of “Not Being Attended”  

Microsoft Academic Search

In developing countries, lack of trust in the quality of care provided is often cited as a major factor promoting reluctance to seek biomedical help for obstetric emergencies. This article draws on fieldwork among Mayan informants in Sololá, Guatemala, to explore poor perceptions of the quality of care received when seeking obstetric care in the hospital. Using data collected over

Nicole S. Berry

2008-01-01

237

Improving the Quality of Nursing Home Care and Medical-Record Accuracy with Direct Observational Technologies  

ERIC Educational Resources Information Center

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…

Schnelle, John F.; Osterweil, Dan; Simmons, Sandra F.

2005-01-01

238

Quality of Care in Episodes of Common Respiratory Infections in a Disadvantaged Population.  

National Technical Information Service (NTIS)

This study had four principal objectives: to develop valid rules for creating episodes of care from computerized claims data, to develop comprehensive age- and diagnosis-specific profiles of quality of care, to judge the quality of care for several respir...

K. N. Lohr

1980-01-01

239

Money Matters for Early Education: The Relationships among Child Care Quality, Teacher Characteristics, and Subsidy Status  

ERIC Educational Resources Information Center

Child care is the first out-of-home learning opportunity for many children. For low-income children, a high-quality child care placement can provide many of the experiences and skills that help build a foundation for later school success. Among the many measures of child care quality, some closely linked to later success in school are those…

St.Clair-Christman, JeanMarie; Buell, Martha; Gamel-McCormick, Michael

2011-01-01

240

The Cost Efficiency and Clinical Quality of Institutional Long-Term Care for the Elderly  

Microsoft Academic Search

This study applied the stochastic frontier cost function with inefficiency effects to estimate the association between quality of care and cost efficiency in institutional long-term care wards for the elderly in Finland. We used several clinical quality indicators for indicating adverse care processes and outcomes, based on the Resident Assessment Instrument (RAI)\\/Minimum Data Set (MDS). Average cost inefficiency among the

Juha Laine; Miika Linna; Anja Noro; Unto Häkkinen

2005-01-01

241

The Current State of Quality of Care Measurement in the California Department of Corrections and Rehabilitation  

Microsoft Academic Search

The quality of health care in prisons is lacking in many states. In particular, the California Department of Corrections and Rehabilitation (CDCR) is in the midst of an extreme legal remedy to address problems related to access to and quality of care; it now operates under the direction of a federally appointed receiver for medical care. To understand the current

Stephanie S. Teleki; Cheryl L. Damberg; Rebecca Shaw; Liisa Hiatt; Brie Williams; Terry E. Hill; Steven M. Asch

2011-01-01

242

The Evolution of Changes in Primary Care Delivery Underlying the Veterans Health Administration's Quality Transformation  

Microsoft Academic Search

At the heart of the Institute of Medicine's re- port Crossing the Quality Chasm was the need to address the improvement of quality of care through major changes in how health care is organized. 1 The Institute of Medicine's central tenet was that only through significant, sus- tained, and innovative efforts to reorganize the health care system were substantive gains

Elizabeth M. Yano; Barbara F. Simon; Andrew B. Lanto; Lisa V. Rubenstein

2007-01-01

243

The Effects of Quality of Care on Costs: A Conceptual Framework  

PubMed Central

Context The quality of health care and the financial costs affected by receiving care represent two fundamental dimensions for judging health care performance. No existing conceptual framework appears to have described how quality influences costs. Methods We developed the Quality-Cost Framework, drawing from the work of Donabedian, the RAND/UCLA Appropriateness Method, reports by the Institute of Medicine, and other sources. Findings The Quality-Cost Framework describes how health-related quality of care (aspects of quality that influence health status) affects health care and other costs. Structure influences process, which, in turn, affects proximate and ultimate outcomes. Within structure, subdomains include general structural characteristics, circumstance-specific (e.g., disease-specific) structural characteristics, and quality-improvement systems. Process subdomains include appropriateness of care and medical errors. Proximate outcomes consist of disease progression, disease complications, and care complications. Each of the preceding subdomains influences health care costs. For example, quality improvement systems often create costs associated with monitoring and feedback. Providing appropriate care frequently requires additional physician visits and medications. Care complications may result in costly hospitalizations or procedures. Ultimate outcomes include functional status as well as length and quality of life; the economic value of these outcomes can be measured in terms of health utility or health-status-related costs. We illustrate our framework using examples related to glycemic control for type 2 diabetes mellitus or the appropriateness of care for low back pain. Conclusions The Quality-Cost Framework describes the mechanisms by which health-related quality of care affects health care and health status–related costs. Additional work will need to validate the framework by applying it to multiple clinical conditions. Applicability could be assessed by using the framework to classify the measures of quality and cost reported in published studies. Usefulness could be demonstrated by employing the framework to identify design flaws in published cost analyses, such as omitting the costs attributable to a relevant subdomain of quality. PMID:23758513

Nuckols, Teryl K; Escarce, Jose J; Asch, Steven M

2013-01-01

244

Is the quality of care in general medical practice improving? Results of a longitudinal observational study.  

PubMed Central

BACKGROUND: The demand for increased accountability within health care has led to a myriad of government initiatives in the United Kingdom, with the aim of improving care, setting minimum standards, and addressing poor performance. AIM: To assess the quality of care in English general practice in the year 2001 compared with 1998, in terms of access, interpersonal care, and clinical care (chronic disease management, elderly care, and mental health care). DESIGN OF STUDY: Observational study in a purposive sample of general practices in England. SETTING: Twenty-three general practices in England--eight in North Thames, seven in the North West, and eight in the South West. RESULTS: Outcome measures were: quality of chronic disease management (angina, adult asthma and type 2 diabetes from practice questionnaires and medical record review), elderly care and mental health care (from practice questionnaires), access to care, continuity of care and interpersonal care (from practice and patient questionnaires) and costs (mean change in practice budget between 1998 and 2001). There were significant improvements in quality of care in terms of organisational access to services (P = 0.016), practice organisation of chronic disease management (P = 0.039), and the quality of angina care (P = 0.003). There were no significant changes in quality scores for mental health care, elderly care, access and interpersonal care. The mean practice budget rose by 3.4% between 1998 and 2001 (adjusted for inflation). CONCLUSION: These findings provide evidence of improvements in some aspects of the quality of care, achieved at modest cost. This was achieved during a time when the National Health Service was undergoing a series of reforms. However, primary care in England is characterised by variation in care, with significant improvements still possible. PMID:12879830

Campbell, Stephen; Steiner, Andrea; Robison, Judy; Webb, Dale; Raven, Ann; Roland, Martin

2003-01-01

245

42 CFR 425.500 - Measures to assess the quality of care furnished by an ACO.  

Code of Federal Regulations, 2013 CFR

...use in the calculation of the quality performance standard. (3) CMS seeks to improve the quality of care furnished by ACOs...established by CMS. (d) Patient experience of care survey. For performance...right to audit and validate quality data reported by an...

2013-10-01

246

42 CFR 425.500 - Measures to assess the quality of care furnished by an ACO.  

Code of Federal Regulations, 2012 CFR

...use in the calculation of the quality performance standard. (3) CMS seeks to improve the quality of care furnished by ACOs...established by CMS. (d) Patient experience of care survey. For performance...right to audit and validate quality data reported by an...

2012-10-01

247

A Pilot Test of the Effect of Guided Care on the Quality of Primary Care Experiences for Multimorbid Older Adults  

PubMed Central

Objective Improving health care of multimorbid older adults is a critical public health challenge. The objective of this study is to evaluate the effect of a pilot intervention to enhance the quality of primary care experiences for chronically ill older persons (Guided Care). Design Nonrandomized prospective clinical trial. Patients/Participants Older, chronically ill, community-dwelling patients (N?=?150) of 4 General Internists in 1 urban community practice setting who were members of a capitated health plan and identified as being at high risk of heavy use of health services in the coming year by claims-based predictive modeling. Interventions Guided Care, an enhancement to primary care that incorporates the operative principles of chronic care innovations, was delivered by a specially trained, practice-based registered nurse working closely with 2 primary care physicians. Each patient received a geriatric assessment, a comprehensive care plan, evidence-based primary care with proactive follow-up of chronic conditions, coordination of the efforts of health professionals across all health care settings, and facilitated access to community resources. Measurements and Main Results Quality of primary care experiences (physician–patient communication, interpersonal treatment, knowledge of patient, integration of care, and trust in physician) was assessed using the Primary Care Assessment Survey (PCAS) at baseline and 6 months later. At baseline, the patients assigned to receive Guided Care were similar to those assigned to receive usual care in their demographics and disability levels, but they had higher risk scores and were less likely to be married. Thirty-one of the 75 subjects assigned to the Guided Care group received the intervention. At 6 months, intention-to-treat analyses adjusting for age, gender, and risk score suggest that Guided Care may improve the quality of physician–patient communication. In per-protocol analyses, receipt of Guided Care was associated with more favorable change than usual care from baseline to follow-up in all 5 PCAS domains, but only physician–patient communication showed a statistically significant improvement. Conclusions In this pilot study, Guided Care appeared to improve the quality of primary care experiences for high-risk, chronically ill older adults. A larger cluster-randomized controlled trial of Guided Care is underway. PMID:18266045

Shadmi, Efrat; Conwell, Leslie Jackson; Griswold, Michael; Leff, Bruce; Brager, Rosemarie; Sylvia, Martha; Boult, Chad

2008-01-01

248

Research in action: using positive deviance to improve quality of health care  

Microsoft Academic Search

BACKGROUND: Despite decades of efforts to improve quality of health care, poor performance persists in many aspects of care. Less than 1% of the enormous national investment in medical research is focused on improving health care delivery. Furthermore, when effective innovations in clinical care are discovered, uptake of these innovations is often delayed and incomplete. In this paper, we build

Elizabeth H Bradley; Leslie A Curry; Shoba Ramanadhan; Laura Rowe; Ingrid M Nembhard; Harlan M Krumholz

2009-01-01

249

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

E-print Network

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

Ravikumar, B.

250

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

ERIC Educational Resources Information Center

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

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

2004-01-01

251

Towards a standardized method of developing quality indicators for palliative care: protocol of the Quality indicators for Palliative Care (Q-PAC) study  

PubMed Central

Background In recent years, there have been several studies, using a wide variety of methods, aimed at developing quality indicators for palliative care. In this Quality Indicators for Palliative Care study (Q-PAC study) we have applied a scientifically rigorous method to develop a comprehensive and valid quality indicator set which can contribute to a standardized method for use in other countries. Methods and design Firstly, an extensive literature review identified existing international quality indicators and relevant themes for measuring quality in palliative care. Secondly, the most relevant of these were selected by an expert panel. Thirdly, those prioritized by the experts were scored by a second multidisciplinary expert panel for usability and relevance, in keeping with the RAND/UCLA-method, combining evidence with consensus among stakeholders. This panel included carers and policymakers as well as patients and next-of-kin. Fourthly, the draft set was tested and evaluated in practice for usability and feasibility; the indicators were then translated into questionnaires presented to patients, next-of-kin and care providers. To encourage the acceptance and use of the indicators, stakeholders, including national palliative care organizations, were involved throughout the whole project. Conclusion Our indicator development trajectory resulted in a set of quality indicators applicable to all patients in all palliative care settings. The set includes patient and relative perspectives and includes outcome, process and structure indicators. Our method can contribute internationally to a more standardized and rigorous approach to developing quality indicators for palliative care. PMID:23394401

2013-01-01

252

45 CFR 158.150 - Activities that improve health care quality.  

Code of Federal Regulations, 2012 CFR

...nationally recognized health care quality organizations... (i) Improve health outcomes including...under the insurance policy), providers and...communication) to improve health outcomes, including...case management, care coordination,...

2012-10-01

253

45 CFR 158.150 - Activities that improve health care quality.  

Code of Federal Regulations, 2011 CFR

...nationally recognized health care quality organizations... (i) Improve health outcomes including...under the insurance policy), providers and...communication) to improve health outcomes, including...case management, care coordination,...

2011-10-01

254

45 CFR 158.150 - Activities that improve health care quality.  

Code of Federal Regulations, 2013 CFR

...nationally recognized health care quality organizations... (i) Improve health outcomes including...under the insurance policy), providers and...communication) to improve health outcomes, including...case management, care coordination,...

2013-10-01

255

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

PubMed Central

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

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

2011-01-01

256

Grantee Research Highlight: Using Health Systems to Study and Improve the Quality of Cancer Care  

Cancer.gov

The NIH Roadmap and National Cancer Institute strategic plans repeatedly emphasize the importance of involving health care systems in research. Integrated care delivery systems can address key research questions that cannot be answered in other types of settings. Research in this setting can lead to essential insights about the quality of care, including the quality of cancer care and how best to improve patient outcomes.

257

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

PubMed Central

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

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

2006-01-01

258

Barriers to Quality Care for Dying Patients in Rural Communities  

ERIC Educational Resources Information Center

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

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

2006-01-01

259

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

PubMed

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

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

2013-08-01

260

Quality of care in the management of major obstetric haemorrhage.  

PubMed

Substandard care is reported to occur in a large number of cases of major obstetric haemorrhage (MOH). A prospective audit was carried out by a multidisciplinary team at our hospital over a one year period to assess the quality of care (QOC) delivered to women experiencing MOH. MOH was defined according to criteria outlined in the Scottish Audit of Maternal Morbidity (SAMM). 31 cases were identified yielding an incidence of 3.5/1000 deliveries. The predominant causes were uterine atony 11 (35.4%), retained products of conception 6 (19.3%) and placenta praevia/accreta 6 (19.3%). Excellent initial resuscitation and monitoring was noted with a high level of senior staff input. Indicators of QOC compared favourably with the SAMM. Areas for improvement were identified. This pilot study demonstrates the feasibility of detailed prospective data collection in MOH in a busy Dublin obstetric unit with a view to developing a national audit. Standardization of definitions allows for international comparisons. PMID:21675096

Johnson, S N; Khalid, S; Varadkar, S; Fleming, J; Fanning, R; Flynn, C M; Byrne, B

2011-04-01

261

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

PubMed Central

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.

Duan, Xia; Shi, Yan

2014-01-01

262

Measuring quality in diabetes care: an expert-based statistical approach  

E-print Network

We present a methodology for using health insurance claims data to monitor quality of care. The method uses a statistical model trained on the quality ratings of a medical expert. In a pilot study, the expert rated the ...

Bertsimas, Dimitris J.

263

Delivery of maternal health care in Indigenous primary care services: baseline data for an ongoing quality improvement initiative  

Microsoft Academic Search

Background  Australia's Aboriginal and Torres Strait Islander (Indigenous) populations have disproportionately high rates of adverse perinatal\\u000a outcomes relative to other Australians. Poorer access to good quality maternal health care is a key driver of this disparity.\\u000a The aim of this study was to describe patterns of delivery of maternity care and service gaps in primary care services in\\u000a Australian Indigenous communities.

Alice R Rumbold; Ross S Bailie; Damin Si; Michelle C Dowden; Catherine M Kennedy; Rhonda J Cox; Lynette O’Donoghue; Helen E Liddle; Ru K Kwedza; Sandra C Thompson; Hugh P Burke; Alex DH Brown; Tarun Weeramanthri; Christine M Connors

2011-01-01

264

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

PubMed

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

Ishikura, Satoshi

2008-11-01

265

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

PubMed

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

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

2012-08-01

266

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

PubMed Central

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

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

2010-01-01

267

Proximal and distal features of day care quality and children's development  

Microsoft Academic Search

Day care quality assessments can be categorized according to their proxim- ity to children's actual experiences. Distal quality assessments describe experiences potentially available to children, but do not describe actual ex- periences. Distal quality assessments include structural variables, such as ratio, group size, caregiver characteristics, and global quality assessments such as the Early Childhood Environment Rating Scale (ECERS; Harms &

Loraine Dunn

1993-01-01

268

Patient Complexity and Diabetes Quality of Care in Rural Settings  

PubMed Central

Purpose Even though pay-for-performance programs are being rapidly implemented, little is known about how patient complexity affects practice-level performance assessment in rural settings. We sought to determine the association between patient complexity and practice-level performance in the rural United States. Basic procedures Using baseline data from a trial aimed at improving diabetes care, we determined factors associated with a practice’s proportion of patients having controlled diabetes (hemoglobin A1c ?7%): patient socioeconomic factors, clinical factors, difficulty with self-testing of blood glucose, and difficulty with keeping appointments. We used linear regression to adjust the practice-level proportion with A1c controlled for these factors. We compared practice rankings using observed and expected performance and classified practices into hypothetical pay-for-performance categories. Main Findings Rural primary care practices (n = 135) in 11 southeastern states provided information for 1641 patients with diabetes. For practices in the best quartile of observed control, 76.1% of patients had controlled diabetes vs 19.3% of patients in the worst quartile. After controlling for other variables, proportions of diabetes control were 10% lower in those practices whose patients had the greatest difficulty with either self testing or appointment keeping (p < .05 for both). Practice rankings based on observed and expected proportion of A1c control showed only moderate agreement in pay-for-performance categories (? = 0.47; 95% confidence interval, 0.32–0.56; p < .001). Principal Conclusions Basing public reporting and resource allocation on quality assessment that does not account for patient characteristics may further harm this vulnerable group of patients and physicians. PMID:21671526

Salanitro, Amanda H.; Safford, Monika M.; Houston, Thomas K.; Williams, Jessica H.; Ovalle, Fernando; Payne-Foster, Pamela; Allison, Jeroan J.; Estrada, Carlos A.

2011-01-01

269

[ISO System 9000 or evaluation of the quality of medical care].  

PubMed

Evaluation of the quality of medical care began in Mexico in 1956. This was done by reviewing the clinical files of patients. In 1984, Donabedian introduced the Theory of Systems that evaluates structure, process and results, adopted as a base in the IMSS to develop the System of Integral Evaluation and Continuous Improvement of the Quality of the Medical Care, through the identification and solution of the problems that affect quality in medical care as well as the improvements of the inefficient processes or those with low quality. The Joint Commission on Accreditation of Health Care, European Foundation for Quality Management (ETQM) and International Society for Quality in Health Care (ISQua) use a similar methodology in its evaluations. The ISO System (International Organization for Standardization) was created in 1947 to assure and to certify the quality of the production processes and to guarantee the quality of the products that were fabricated. In health institutions the ISO system is useful to certify the structure and organization, and it indicates that they are under conditions to assure the quality of medical care, but it does not guarantee that this must happen. On the other hand, faults in structure and organization may result in poor quality of care. We conclude that both systems are complementary, rather than exclusionary. PMID:18492443

Aguirre-Gas, Héctor Gerardo

2008-01-01

270

National Quality Measures for Child Mental Health Care: Background, Progress, and Next Steps  

PubMed Central

OBJECTIVE: To review recent health policies related to measuring child health care quality, the selection processes of national child health quality measures, the nationally recommended quality measures for child mental health care and their evidence strength, the progress made toward developing new measures, and early lessons learned from these national efforts. METHODS: Methods used included description of the selection process of child health care quality measures from 2 independent national initiatives, the recommended quality measures for child mental health care, and the strength of scientific evidence supporting them. RESULTS: Of the child health quality measures recommended or endorsed during these national initiatives, only 9 unique measures were related to child mental health. CONCLUSIONS: The development of new child mental health quality measures poses methodologic challenges that will require a paradigm shift to align research with its accelerated pace. PMID:23457148

Murphy, J. Michael; Scholle, Sarah Hudson; Hoagwood, Kimberly Eaton; Sachdeva, Ramesh C.; Mangione-Smith, Rita; Woods, Donna; Kamin, Hayley S.; Jellinek, Michael

2013-01-01

271

Short and long term improvements in quality of chronic care delivery predict program sustainability.  

PubMed

Empirical evidence on sustainability of programs that improve the quality of care delivery over time is lacking. Therefore, this study aims to identify the predictive role of short and long term improvements in quality of chronic care delivery on program sustainability. In this longitudinal study, professionals [2010 (T0): n=218, 55% response rate; 2011 (T1): n=300, 68% response rate; 2012 (T2): n=265, 63% response rate] from 22 Dutch disease-management programs completed surveys assessing quality of care and program sustainability. Our study findings indicated that quality of chronic care delivery improved significantly in the first 2 years after implementation of the disease-management programs. At T1, overall quality, self-management support, delivery system design, and integration of chronic care components, as well as health care delivery and clinical information systems and decision support, had improved. At T2, overall quality again improved significantly, as did community linkages, delivery system design, clinical information systems, decision support and integration of chronic care components, and self-management support. Multilevel regression analysis revealed that quality of chronic care delivery at T0 (p<0.001) and quality changes in the first (p<0.001) and second (p<0.01) years predicted program sustainability. In conclusion this study showed that disease-management programs based on the chronic care model improved the quality of chronic care delivery over time and that short and long term changes in the quality of chronic care delivery predicted the sustainability of the projects. PMID:24560235

Cramm, Jane Murray; Nieboer, Anna Petra

2014-01-01

272

Primary care perspectives on prostate cancer survivorship: Implications for improving quality of care  

Microsoft Academic Search

ObjectivesPrimary care providers often care for men with prostate cancer due to its prolonged clinical course and an increasing number of survivors. However, their attitudes and care patterns are inadequately studied. In this context, we surveyed primary care providers regarding the scope of their prostate cancer survivorship care.

Ted A. Skolarus; Margaret Holmes-Rovner; Laurel L. Northouse; Angela Fagerlin; Carol Garlinghouse; Raymond Y. Demers; David R. Rovner; May Darwish-Yassine; John T. Wei

273

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

ERIC Educational Resources Information Center

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…

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

2012-01-01

274

The Impact of Medical Interpreter Services on the Quality of Health Care: A Systematic Review  

Microsoft Academic Search

Twenty-one million Americans are limited in English proficiency (LEP), but little is known about the effect of medical interpreter services on health care quality. A systematic literature review was conducted on the impact of interpreter services on quality of care. Five database searches yielded 2,640 citations and a final database of 36 articles, after applying exclusion criteria. Multiple studies document

Glenn Flores

2005-01-01

275

Multimorbidity and quality of life in primary care: a systematic review  

Microsoft Academic Search

BACKGROUND: Many patients with several concurrent medical conditions (multimorbidity) are seen in the primary care setting. A thorough understanding of outcomes associated with multimorbidity would benefit primary care workers of all disciplines. The purpose of this systematic review was to clarify the relationship between the presence of multimorbidity and the quality of life (QOL) or health-related quality of life (HRQOL)

Martin Fortin; Lise Lapointe; Catherine Hudon; Alain Vanasse; Antoine L Ntetu; Danielle Maltais

2004-01-01

276

Does Investor Ownership of Nursing Homes Compromise the Quality of Care?  

Microsoft Academic Search

For the 1.6 million Americans who reside in nursing homes, the quality of care largely de- termines the quality of life. Most patients in acute-care hospitals will return to their homes and families, regaining command of their sleep schedules, food choices, hygiene, and mobility. They can generally change physicians and hospitals if dissatisfied. But most nursing home patients cannot go

Charlene Harrington; Steffie Woolhandler; Joseph Mullan; Helen Carrillo; David U. Himmelstein

2001-01-01

277

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

ERIC Educational Resources Information Center

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…

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

2004-01-01

278

Enhancing the Quality of Care in Residential and Nursing Homes: More than Just a Professional Responsibility  

Microsoft Academic Search

This article highlights a range of issues considered essential to improving the quality of care received by older people in residential and nursing home settings. It is argued that improving such care represents a societal as well as a professional responsibility and that remedial action is needed at a number of levels. Five ‘routes’ to achieving quality are outlined, and

Mike Nolan

1999-01-01

279

Mothers' perspectives on qualities of care in their relationships with health care professionals: the influence of relational and communicative competencies.  

PubMed

Research suggests that parents of seriously ill children place significant value on the relational context of their children's health care. This psychological phenomenological study explored mothers' perspectives on qualities that they found to be either helpful or unhelpful to their experiences of caregiving. Relational and communicative competencies were identified as most influential in mothers' assessments of provider care. Practitioners experienced in end-of-life care were viewed as highly supportive by the mothers in the study. Training for professionals in principles of palliative and end-of-life care is recommended for those who work with these children and families. PMID:19042889

Konrad, Shelley Cohen

2008-01-01

280

How can we improve the quality of health care in Japan?  

Microsoft Academic Search

The World Health Report 2000 placed Japan first for overall health system attainment: a surprising development considering that, aside from discussing excessive expenditure, health care professionals and the Health Ministry have paid little attention recently to the quality of health care. Japan's free access policy and the universal health care system have actually fostered a very relaxed attitude toward evaluation.

Masahiro Hirose; Yuichi Imanaka; Tatsuro Ishizaki; Edward Evans

2003-01-01

281

Child Care in Poor Communities: Early Learning Effects of Type, Quality, and Stability  

ERIC Educational Resources Information Center

Young children in poor communities are spending more hours in nonparental care because of policy reforms and expansion of early childhood programs. Studies show positive effects of high-quality center-based care on children's cognitive growth. Yet, little is known about the effects of center care typically available in poor communities or the…

Loeb, Susanna; Fuller, Bruce; Kagan, Sharon Lynn; Carrol, Bidemi

2004-01-01

282

HIC 2001 Realising Quality Health Care * Paper reviewed according to DETYA standard 1999  

E-print Network

HIC 2001 Realising Quality Health Care * Paper reviewed according to DETYA standard 1999 Austin, D , et al. ISBN 0 9585370 8 9 Understanding community health care: Implications for technology design case study of a community health care setting. The intention of this study was to better understand

Fitzpatrick, Geraldine

283

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

ERIC Educational Resources Information Center

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…

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

2008-01-01

284

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

ERIC Educational Resources Information Center

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…

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

285

Quality Indicators for End-of-Life Care in Vulnerable Elders  

Microsoft Academic Search

are for vulnerable elders, many of whom may be near the end of life, has come under increasing scrutiny in the past decade. Studies demonstrate inade- quate quality of care with regard to symptom control, matching of care with patient preferences, and optimal resource use at the end of life (1). Several expert panels have concluded that end-of-life care requires

Neil S. Wenger; Kenneth Rosenfeld

2001-01-01

286

A Study Identifying the Components of a Quality Child Care Center.  

ERIC Educational Resources Information Center

Specific characteristics of a quality day care center are identified through a survey of parents, teachers, and directors utilizing or working in day care centers. The introduction to this descriptive research study offers background information on the history of the child care movement in America and a review of related research projects. A…

Panetta, Sandra J.

287

Caring for Animals. Animal Well-Being, Quality Assurance, Show Ring Ethics. Discussion Guide.  

ERIC Educational Resources Information Center

This discussion guide was developed for use in conjunction with the "Caring for Animals" videotape. It includes information for teachers to use in facilitating class discussions about animal care and well-being. The guide covers the following: (1) goals and objectives; (2) animal well-being; (3) animal health; (4) care for animals; (5) quality

Kleilein, Ann McGovern; Nickles, Sherry; Smith, David R.

288

Quality of the Literacy Environment in Day Care and Children's Development  

Microsoft Academic Search

Although traditional assessments of day care environments have been linked to children's development, understanding of the specific characteristics of the environment that enhance language, literacy, and cognitive development is sketchy. The purpose of this study was to explore the lenvironment for iteracy in day care centers, its relationship with traditional measures of day care quality and its influence on children's

Loraine Dunn; Sara Ann Beach; Susan Kontos

1994-01-01

289

ONE APPLICATION, ONE ONLINE PAYMENT UW-Madison's campus child care system offers high quality early  

E-print Network

ONE APPLICATION, ONE ONLINE PAYMENT UW-Madison's campus child care system offers high quality early family information and needs as you see fit. We recommend that you visit http://occfr.wisc.edu/child_care CHILDREN'S CENTERS! Office of Child Care and Family Resources | 611 Eagle Heights, Madison, WI | phone 608

Wisconsin at Madison, University of

290

Quality of Ambulatory Care in Medicare Advantage HMOs and Traditional Medicare  

PubMed Central

To compare quality of care nationally between Medicare Advantage health maintenance organizations (HMOs) and traditional Medicare and determine how various types of Medicare HMOs differed in quality from traditional Medicare, we assessed performance measures of the quality of ambulatory care from the among beneficiaries matched by demographic characteristics within local areas during 2003-2009. HMO enrollees were consistently more likely than traditional Medicare beneficiaries to receive appropriate breast cancer screening, diabetes care, and cholesterol testing for cardiovascular disease. Personal physicians were rated less highly in HMOs than traditional Medicare in 2003, but more highly in 2009. Not-for-profit, larger, and older HMOs performed consistently more favorably on clinical measures and ratings of care than for-profit, smaller, and newer HMOs. The effects on ambulatory quality of care of more integrated delivery systems in Medicare HMOs may outweigh the potential incentives to restrict care under capitated payments. PMID:23836738

Ayanian, John Z.; Landon, Bruce E.; Saunders, Robert C.; Pawlson, L. Greg; Newhouse, Joseph P.

2013-01-01

291

Quality of care in maternal health : childbirth practices of public and private skilled birth attendants and a quality improvement system in Cambodia .  

E-print Network

??High-quality midwifery services, including access to skilled birth attendants (SBAs) and high quality emergency obstetric and neonatal care are essential for reducing maternal mortality worldwide.… (more)

Ith, Ponndara

2013-01-01

292

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

PubMed Central

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

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

2010-01-01

293

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

ERIC Educational Resources Information Center

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.…

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

294

Do Sociodemographic Characteristics of Pregnant Women Determine their Perception of Antenatal Care Quality?  

Microsoft Academic Search

Objectives To explore sociodemographic determinants of perceived quality of antenatal care (ANC) at the primary care level. Methods A survey of 452 randomly selected pregnant women accessing antenatal care at the primary healthcare facilities in Sagamu\\u000a Local Government Area (LGA) of Ogun State, southwest Nigeria. The relationships between 13 sociodemographic characteristics\\u000a of women and their overall perception of the quality

Olufemi T. Oladapo; Modinat O. Osiberu

2009-01-01

295

The Meaning of Quality in Kinship Foster Care: Caregiver, Child, and Worker Perspectives  

E-print Network

F O S T E R CARE The Meaning of Quality in Kinship Foster Care: Caregiver, Child, and Worker Perspectives Robert Chipman, Susan J, Wells, St Michelle A. Johnson Abstract Though principles, guidelines, and procedures for assessing the quality... requirements for nonkinship foster care while highlighting important safety considerations in evaluating kinship families, such as the ability o f the relative to protect the child from the parent (see Table 1) . The CWLA standards also provide flexibility...

Chipman, Robert; Wells, Susan J.; Johnson, Michelle A.

2002-01-01

296

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

PubMed

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

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

2001-01-01

297

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

PubMed

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 newborn care systems can benefit from using the quality framework in planning workforce development and resource allocation. PMID:24965816

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

298

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

PubMed

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

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

2010-12-01

299

QUALITY OF MATERNITY CARE IN RURAL TEXAS (MEXICAN-AMERICAN)  

Microsoft Academic Search

The purpose of the study was to describe regionalized systems of perinatal care serving predominantly low income Mexican-American women in rural underserved areas of Texas. The study focused upon ambulatory care; however, it provided a vehicle for examination of the health care system. The questions posed at the onset of the study included: (1) How well do regional organizations with

DONNA MARIE LEBLANC

1983-01-01

300

Formal selection of measures for a composite index of NICU quality of care: Baby-MONITOR  

Microsoft Academic Search

Objective:To systematically rate measures of care quality for very low birth weight infants for inclusion into Baby-MONITOR, a composite indicator of quality.Study Design:Modified Delphi expert panelist process including electronic surveys and telephone conferences. Panelists considered 28 standard neonatal intensive care unit (NICU) quality measures and rated each on a 9-point scale taking into account pre-defined measure characteristics. In addition, panelists

J Profit; J B Gould; J A F Zupancic; A R Stark; K M Wall; M A Kowalkowski; M Mei; K Pietz; E J Thomas; L A Petersen

2011-01-01

301

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

PubMed Central

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

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

2013-01-01

302

Child Care in Poor Communities: Early Learning Effects of Type, Quality, and Stability  

Microsoft Academic Search

Young children in poor communities are spending more hours in nonparental care because of policy reforms and expansion of early childhood programs. Studies show positive effects of high-quality center-based care on children's cognitive growth. Yet, little is known about the effects of center care typically available in poor communities or the effects of home-based care. Using a sample of children

Susanna Loeb; Bruce Fuller; Sharon Lynn Kagan; Bidemi Carrol

2004-01-01

303

Delivery System Integration and Health Care Spending and Quality for Medicare Beneficiaries  

PubMed Central

Background The Medicare accountable care organization (ACO) programs rely on delivery system integration and provider risk sharing to lower spending while improving quality of care. Methods Using 2009 Medicare claims and linked American Medical Association Group Practice data, we assigned 4.29 million beneficiaries to provider groups based on primary care use. We categorized group size according to eligibility thresholds for the Shared Savings (?5,000 assigned beneficiaries) and Pioneer (?15,000) ACO programs and distinguished hospital-based from independent groups. We compared spending and quality of care between larger and smaller provider groups and examined how size-related differences varied by 2 factors considered central to ACO performance: group primary care orientation (measured by the primary care share of large groups’ specialty mix) and provider risk sharing (measured by county health maintenance organization penetration and its relationship to financial risk accepted by different group types for managed care patients). Spending and quality of care measures included total medical spending, spending by type of service, 5 process measures of quality, and 30-day readmissions, all adjusted for sociodemographic and clinical characteristics. Results Compared with smaller groups, larger hospital-based groups had higher total per-beneficiary spending in 2009 (mean difference: +$849), higher 30-day readmission rates (+1.3% percentage points), and similar performance on 4 of 5 process measures of quality. In contrast, larger independent physician groups performed better than smaller groups on all process measures and exhibited significantly lower per-beneficiary spending in counties where risk sharing by these groups was more common (?$426). Among all groups sufficiently large to participate in ACO programs, a strong primary care orientation was associated with lower spending, fewer readmissions, and better quality of diabetes care. Conclusions Spending was lower and quality of care better for Medicare beneficiaries served by larger independent physician groups with strong primary care orientations in environments where providers accepted greater risk. PMID:23780467

McWilliams, J. Michael; Chernew, Michael E.; Zaslavsky, Alan M.; Hamed, Pasha; Landon, Bruce E.

2013-01-01

304

The impact of a maternal and child health care program on the quality of prenatal care  

Microsoft Academic Search

A typical maternal and child health care program was implemented in an American Indian reservation community, and its impact on the effectiveness of prenatal care was assessed. Evaluation included examination from both the provider perspective (care provided to program users) and the population perspective (care received by a sample of all prenatal patients in the community), as well as examination

Paul A. Nutting; Judy E. Barrick; Susan C. Logue

1979-01-01

305

Nursing care quality and adverse events in US hospitals  

PubMed Central

Aim To examine the association between nurses' reports of unmet nursing care needs and their reports of patients' receipt of the wrong medication or dose, nosocomial infections and patient falls with injury in hospitals. Background Because nursing activities are often difficult to measure, and data are typically not collected by health care organisations, there are few studies that have addressed the association between nursing activities and patient outcomes. Design Secondary analysis of cross-sectional data collected in 1999 from 10,184 staff nurses and 168 acute care hospitals in the US. Methods Multivariate linear regression models estimated the effect of unmet nursing care needs on adverse events given the influence of patient factors and the care environment. Results The proportion of necessary nursing care left undone ranged from 26% for preparing patients and families for discharge to as high as 74% for developing or updating nursing care plans. A majority of nurses reported that patients received the wrong medication or dose, acquired nosocomial infections, or had a fall with injury infrequently. However, nurses who reported that these adverse events occurred frequently varied considerably [i.e. medication errors (15%), patient falls with injury (20%), nosocomial infection (31%)]. After adjusting for patient factors and the care environment, there remained a significant association between unmet nursing care needs and each adverse event. Conclusion The findings suggest that attention to optimising patient care delivery could result in a reduction in the occurrence of adverse events in hospitals. Relevance to clinical practice The occurrence of adverse events may be mitigated when nurses complete care activities that require them to spend time with their patients. Hospitals should engage staff nurses in the creation of policies that influence human resources management to enhance their awareness of the care environment and patient care delivery. PMID:20659198

Lucero, Robert J; Lake, Eileen T; Aiken, Linda H

2010-01-01

306

Enhancing the quality of care in the intensive care unit: a systems engineering approach.  

PubMed

This article presents an overview of systems engineering and describes common core principles found in systems engineering methodologies. The Patient Care Program Acute Care Initiative collaboration between the Armstrong Institute of the Johns Hopkins School of Medicine and the Gordon and Betty Moore Foundation, which will use systems engineering to reduce patient harm in the intensive care unit, is introduced. Specific examples of applying a systems engineering approach to the Patient Care Program Acute Care Initiative are presented. PMID:23182531

Tropello, Steven P; Ravitz, Alan D; Romig, Mark; Pronovost, Peter J; Sapirstein, Adam

2013-01-01

307

The evolution of quality in the US health care industry: an old wine in a new bottle  

Microsoft Academic Search

Explores the evolution of the quality issue within the health care industry and also the significance of quality in the health industry along with the historical origins of quality management. Reviews applications of total quality management in the health care industry along with implementation issues. Concludes that a fundamental understanding of the process of total quality management is an absolute

Patrick Asubonteng; Karl J. McCleary; George Munchus

1996-01-01

308

Monitoring and Improving Quality of Care with Interactive Exploration of Temporal Patterns in Electronic Health Records  

E-print Network

was helpful to: 1) quickly identify unknown data quality issues, 2) speed up the finding of patients illustrate the potential impact on patient safety, quality assurance and process improvement. #12 for their use in patient care, clinical research, quality assurance, and alarm specification. For example

Golbeck, Jennifer

309

Coverage and Quality of Antenatal Care Provided at Primary Health Care Facilities in the ‘Punjab’ Province of ‘Pakistan’  

PubMed Central

Background Antenatal care is a very important component of maternal health services. It provides the opportunity to learn about risks associated with pregnancy and guides to plan the place of deliveries thereby preventing maternal and infant morbidity and mortality. In ‘Pakistan’ antenatal services to rural population are being provided through a network of primary health care facilities designated as 'Basic Health Units and Rural Health Centers. Pakistan is a developing country, consisting of four provinces and federally administered areas. Each province is administratively subdivided in to ‘Divisions’ and ‘Districts’. By population ‘Punjab’ is the largest province of Pakistan having 36 districts. This study was conducted to assess the coverage and quality antenatal care in the primary health care facilities in ‘Punjab’ province of ‘Pakistan’. Methods Quantitative and Qualitative methods were used to collect data. Using multistage sampling technique nine out of thirty six districts were selected and 19 primary health care facilities of public sector (seventeen Basic Health Units and two Rural Health Centers were randomly selected from each district. Focus group discussions and in-depth interviews were conducted with clients, providers and health managers. Results The overall enrollment for antenatal checkup was 55.9% and drop out was 32.9% in subsequent visits. The quality of services regarding assessment, treatment and counseling was extremely poor. The reasons for low coverage and quality were the distant location of facilities, deficiency of facility resources, indifferent attitude and non availability of the staff. Moreover, lack of client awareness about importance of antenatal care and self empowerment for decision making to seek care were also responsible for low coverage. Conclusion The coverage and quality of the antenatal care services in ‘Punjab’ are extremely compromised. Only half of the expected pregnancies are enrolled and out of those 1/3 drop out in follow-up visits. PMID:25409502

Majrooh, Muhammad Ashraf; Hasnain, Seema; Akram, Javaid; Siddiqui, Arif; Memon, Zahid Ali

2014-01-01

310

Risk adjustment methods for Home Care Quality Indicators (HCQIs) based on the minimum data set for home care  

PubMed Central

Background There has been increasing interest in enhancing accountability in health care. As such, several methods have been developed to compare the quality of home care services. These comparisons can be problematic if client populations vary across providers and no adjustment is made to account for these differences. The current paper explores the effects of risk adjustment for a set of home care quality indicators (HCQIs) based on the Minimum Data Set for Home Care (MDS-HC). Methods A total of 22 home care providers in Ontario and the Winnipeg Regional Health Authority (WRHA) in Manitoba, Canada, gathered data on their clients using the MDS-HC. These assessment data were used to generate HCQIs for each agency and for the two regions. Three types of risk adjustment methods were contrasted: a) client covariates only; b) client covariates plus an "Agency Intake Profile" (AIP) to adjust for ascertainment and selection bias by the agency; and c) client covariates plus the intake Case Mix Index (CMI). Results The mean age and gender distribution in the two populations was very similar. Across the 19 risk-adjusted HCQIs, Ontario CCACs had a significantly higher AIP adjustment value for eight HCQIs, indicating a greater propensity to trigger on these quality issues on admission. On average, Ontario had unadjusted rates that were 0.3% higher than the WRHA. Following risk adjustment with the AIP covariate, Ontario rates were, on average, 1.5% lower than the WRHA. In the WRHA, individual agencies were likely to experience a decline in their standing, whereby they were more likely to be ranked among the worst performers following risk adjustment. The opposite was true for sites in Ontario. Conclusions Risk adjustment is essential when comparing quality of care across providers when home care agencies provide services to populations with different characteristics. While such adjustment had a relatively small effect for the two regions, it did substantially affect the ranking of many individual home care providers. PMID:15656901

Dalby, Dawn M; Hirdes, John P; Fries, Brant E

2005-01-01

311

Quality Care in Transverse Myelitis: A Responsive Protocol  

Microsoft Academic Search

This study was conducted to aid in the development of a multidisciplinary care center for patients with transverse myelitis. We surveyed the parents of 20 children diagnosed with transverse myelitis between the ages of 0.5 and 21 years to understand their experiences in navigating the health care system. We analyzed acute care events and long-term follow-up in relation to patient

Carrilin C. Trecker; Dana E. Kozubal; Megan Quigg; Edward Hammond; Chitra Krishnan; Peter A. Sim; Adam I. Kaplin

2009-01-01

312

Is Patient-Perceived Severity of a Geriatric Condition Related to Better Quality of Care?  

PubMed Central

Background Care for falls and urinary incontinence (UI) among older patients is inadequate. One possible explanation is that physicians provide less recommended care to patients who are not as concerned about their falls and UI. Objective To test whether patient-reported severity for two geriatric conditions, falls and UI, is associated with quality of care. Research Design Prospective cohort study of elders with falls and/or fear of falling (n=384) and UI (n=163). Subjects Participants in the Assessing Care of Vulnerable Elders-2 Study (2002–3), which evaluated an intervention to improve the care for falls and UI among older (age ?75) ambulatory care patients with falls/fear of falling or UI. Measures Falls Efficacy Scale (FES) and the Incontinence Quality of Life (IQOL) surveys measured at baseline, quality of care measured by a 13-month medical record abstraction. Results There was a small difference in falls quality scores across the range of FES, with greater patient-perceived falls severity associated with better odds of passing falls quality indicators (OR 1.11 (95% CI 1.02–1.21) per 10-point increment in FES). Greater patient-perceived UI severity (IQOL score) was not associated with better quality of UI care. Conclusions Although older persons with greater patient-perceived falls severity receive modestly better quality of care, those with more distressing incontinence do not. For both conditions, however, even the most symptomatic patients received less than half of recommended care. Low patient-perceived severity of condition is not the basis of poor care for falls and UI. PMID:21079526

Min, Lillian C.; Reuben, David B.; Keeler, Emmett; Ganz, David A.; Fung, Constance H.; Shekelle, Paul; Roth, Carol P.; Wenger, Neil S.

2013-01-01

313

Social Media and Rating Sites as Tools to Understanding Quality of Care: A Scoping Review  

PubMed Central

Background Insight into the quality of health care is important for any stakeholder including patients, professionals, and governments. In light of a patient-centered approach, it is essential to assess the quality of health care from a patient’s perspective, which is commonly done with surveys or focus groups. Unfortunately, these “traditional” methods have significant limitations that include social desirability bias, a time lag between experience and measurement, and difficulty reaching large groups of people. Information on social media could be of value to overcoming these limitations, since these new media are easy to use and are used by the majority of the population. Furthermore, an increasing number of people share health care experiences online or rate the quality of their health care provider on physician rating sites. The question is whether this information is relevant to determining or predicting the quality of health care. Objective The goal of our research was to systematically analyze the relation between information shared on social media and quality of care. Methods We performed a scoping review with the following goals: (1) to map the literature on the association between social media and quality of care, (2) to identify different mechanisms of this relationship, and (3) to determine a more detailed agenda for this relatively new research area. A recognized scoping review methodology was used. We developed a search strategy based on four themes: social media, patient experience, quality, and health care. Four online scientific databases were searched, articles were screened, and data extracted. Results related to the research question were described and categorized according to type of social media. Furthermore, national and international stakeholders were consulted throughout the study, to discuss and interpret results. Results Twenty-nine articles were included, of which 21 were concerned with health care rating sites. Several studies indicate a relationship between information on social media and quality of health care. However, some drawbacks exist, especially regarding the use of rating sites. For example, since rating is anonymous, rating values are not risk adjusted and therefore vulnerable to fraud. Also, ratings are often based on only a few reviews and are predominantly positive. Furthermore, people providing feedback on health care via social media are presumably not always representative for the patient population. Conclusions Social media and particularly rating sites are an interesting new source of information about quality of care from the patient’s perspective. This new source should be used to complement traditional methods, since measuring quality of care via social media has other, but not less serious, limitations. Future research should explore whether social media are suitable in practice for patients, health insurers, and governments to help them judge the quality performance of professionals and organizations. PMID:24566844

Van de Belt, Tom H; Engelen, Lucien JLPG; Schoonhoven, Lisette; Kool, Rudolf B

2014-01-01

314

A Pilot Test of the Effect of Guided Care on the Quality of Primary Care Experiences for Multimorbid Older Adults  

Microsoft Academic Search

Objective  Improving health care of multimorbid older adults is a critical public health challenge. The objective of this study is to\\u000a evaluate the effect of a pilot intervention to enhance the quality of primary care experiences for chronically ill older persons\\u000a (Guided Care).\\u000a \\u000a \\u000a \\u000a Design  Nonrandomized prospective clinical trial.\\u000a \\u000a \\u000a \\u000a Patients\\/Participants  Older, chronically ill, community-dwelling patients (N?=?150) of 4 General Internists in 1 urban community

Cynthia M. Boyd; Efrat Shadmi; Leslie Jackson Conwell; Michael Griswold; Bruce Leff; Rosemarie Brager; Martha Sylvia; Chad Boult

2008-01-01

315

Quality of Care for Decompensated Heart Failure: Comparable Performance between Academic Hospitalists and Non-hospitalists  

Microsoft Academic Search

Background  Hospitalists improve efficiency, but little information exists regarding whether they impact quality of care.\\u000a \\u000a \\u000a \\u000a Objective  To determine hospitalists’ effect on the quality of acute congestive heart failure care.\\u000a \\u000a \\u000a \\u000a Design and Participants  Using data from the Multicenter Hospitalist Study, we retrospectively evaluated quality of care in patients admitted with\\u000a congestive heart failure who were assigned to hospitalists (n?=?120) or non-hospitalists (n?=?252) among six

Eduard E. Vasilevskis; David Meltzer; Jeffrey Schnipper; Peter Kaboli; Tosha Wetterneck; David Gonzales; Vineet Arora; James Zhang; Andrew D. Auerbach

2008-01-01

316

Value-based health care, Part 2. The physician imperative: define, measure, and improve health care quality.  

PubMed

Health care is the only major industry that lacks agreed-upon metrics to objectively define the quality of its products and services. The fundamental deficiency has led to the use of price as the de facto metric for patient contracting. Provider selection defaults to price because quality is assumed to be equal across all physicians and hospitals. This assumption is erroneous and now obsolete. Health care quality can be accurately measured using sophisticated illness modeling techniques that objectively risk-adjust patients level data. Providers' clinical data can be correlated with patient self-assessed outcomes for all episodes of inpatient and outpatient care. Physicians and their hospitals currently managing financial risks and those positioning themselves for these opportunities find such tools and techniques to be invaluable. Credible information creates a power shift away from price-based contracting to a true competitive marketplace that rewards quality of care. Purchasers and patients seek providers who objectively demonstrate their value on both quality and price. Part I of this article appeared in the January/February issue of The Physician Executive. PMID:10180974

Mohlenbrock, W C

1998-01-01

317

Comparative analysis of quality assurance in health care delivery and higher medical education  

PubMed Central

Quality assurance (QA) in higher medical education involves the development, sustenance, improvement, and evaluation of the standard of training of medical professionals. In health care delivery, QA focuses on guaranteeing and maintaining a high standard of the service provided in different health care systems. When the service delivered by the care provider is in accordance with what the recipients of health care expect, then quality in health care is considered to be present. There are several factors in higher medical education and health care that are responsible for the emergence of QA. These include externally imposed obligations requiring demonstration of public accountability and responsibility from educational institutions, as well as the need for activity-specific information by policy makers as an aid for important decision-making within educational institutions. In health care delivery on the other hand, the emergence of QA is linked to the need for containing rising health care costs in the face of limited resources and to guaranteeing high quality patient care in a changing health care environment where the power relationship between doctors and patients is shifting towards patients. Although medical education can be regarded as a distinct entity in the health care industry, it still remains an inherent part of the health care delivery system. As a result, different strategies aimed at guaranteeing and assuring high standards of health care and education in many countries tend to overlap. This paper reflects on whether quality assurance in health care delivery and medical education should be seen as separate entities. PMID:23762010

Busari, Jamiu O

2012-01-01

318

Comparative analysis of quality assurance in health care delivery and higher medical education.  

PubMed

Quality assurance (QA) in higher medical education involves the development, sustenance, improvement, and evaluation of the standard of training of medical professionals. In health care delivery, QA focuses on guaranteeing and maintaining a high standard of the service provided in different health care systems. When the service delivered by the care provider is in accordance with what the recipients of health care expect, then quality in health care is considered to be present. There are several factors in higher medical education and health care that are responsible for the emergence of QA. These include externally imposed obligations requiring demonstration of public accountability and responsibility from educational institutions, as well as the need for activity-specific information by policy makers as an aid for important decision-making within educational institutions. In health care delivery on the other hand, the emergence of QA is linked to the need for containing rising health care costs in the face of limited resources and to guaranteeing high quality patient care in a changing health care environment where the power relationship between doctors and patients is shifting towards patients. Although medical education can be regarded as a distinct entity in the health care industry, it still remains an inherent part of the health care delivery system. As a result, different strategies aimed at guaranteeing and assuring high standards of health care and education in many countries tend to overlap. This paper reflects on whether quality assurance in health care delivery and medical education should be seen as separate entities. PMID:23762010

Busari, Jamiu O

2012-01-01

319

Communicating for Quality in School Age Care Services  

ERIC Educational Resources Information Center

School Age Care (SAC) services have existed in Australia for over 100 years but they have tended to take a back seat when compared with provision for school-aged children and those under school age using early childhood education and care (ECEC) services. Many SAC services are housed in shared premises and many children attending preparatory or…

Cartmel, Jennifer; Grieshaber, Susan

2014-01-01

320

Predicting Desire for Institutional Placement among Racially Diverse Dementia Family Caregivers: The Role of Quality of Care  

ERIC Educational Resources Information Center

Purpose: Literature on institutionalization of patients with dementia has not considered the role of caregivers' quality of care, which encompasses caregivers' exemplary care (EC) behaviors and caregivers' potentially harmful behaviors (PHBs) toward care recipients. This study sought to understand the role of quality of care in mediating between…

Sun, Fei; Durkin, Daniel W.; Hilgeman, Michelle M.; Harris, Grant; Gaugler, Joseph E.; Wardian, Jana; Allen, Rebecca S.; Burgio, Louis D.

2013-01-01

321

Environmental Quality of Life in Long-Term Care  

Microsoft Academic Search

A study of frail elderly persons in Jerusalem compared environmental quality of life among 66 institution dwellers and 64 community-based residents (n = 130). The effort employed a unique composite measure of the quality of housing, social, service and personal environments. Multivariate analysis found no effect of respondents' background attributes on their environmental quality of life. A positive effect of

Howard Litwin

2001-01-01

322

Health care reform: will quality remodeling affect obstetrician-gynecologists in addition to patients?  

PubMed

The Patient Protection and Affordable Care Act is a federal statute that attempts to address many fundamental problems with the current health care system including the uninsured, rising health care costs, and quality care. Quality metrics have been in development for years (by private and governmental sectors), and momentum is growing. The purpose of this commentary is to explore quality changes in the way practicing obstetricians and gynecologists will be held accountable for quality service. Two new options being explored for health care, both focusing on improving quality and physician metrics, include value-based purchasing and accountable-care organizations. Both will likely consist of universal clinical algorithms and cost monitoring as measures. For obstetrics this will probably include physician's rates of cesarean deliveries and elective inductions. For gynecology this may comprise of indications for hysterectomy with documented failed medical management, minor surgical management, or both medical and minor surgical management. It is anticipated patients will no longer be able to request obstetric testing, pregnancy induction, or hysterectomy. It is imperative we, as obstetrician-gynecologists, are involved in health care reform that inevitably involves the care of women. The expectation is that the American Congress of Obstetricians and Gynecologists (ACOG) will further develop evidenced-based opinions and guidelines, as medical communities embrace ACOG documents and reference these in hospital policies and peer review. PMID:21508757

von Gruenigen, Vivian E; Deveny, T Clifford

2011-05-01

323

Social support, self-care, and quality of life in cancer patients receiving radiotherapy in Thailand  

SciTech Connect

The purpose of the study was two-fold: (1) to examine the relationships among self-care, social support, and quality of life in adult cancer patients receiving radiotherapy while the selected basic conditioning factors of age, marital and socio-economic status, living arrangement, stage and site of cancer were statistically controlled; and (2) to test a theoretical model which postulated that (a) quality of life was predicted jointly by the selected basic conditioning factors, social support and self-care, and (b) self-care was predicted jointly by the selected basic conditioning factors and social support. A convenience sample of 112 adult cervical and head/neck cancer patients receiving radiotherapy was obtained from radiotherapy outpatient clinic in three hospitals located in Bangkok, Thailand. Results of the study indicated positive relationships among self-care, social support, and quality of life. Socio-economic status, site of cancer, and self-care were significant predictors for reported quality of life. Social support appeared to be a significant predictor of quality of life indirectly through self-care. Socio-economic status and social support were also significant predictors of self-care, whereas, stage and site of cancer seemed to predict self-care indirectly through social support.

Hanucharurnkul, S.

1988-01-01

324

The Child Care HOME Inventories: Assessing the Quality of Family Child Care Homes.  

ERIC Educational Resources Information Center

Evaluated versions of the HOME Inventory for use in assessing family child care homes. Found that psychometric properties of child care versions of HOME were similar to those of the original HOME for the family environment. Child care HOME scores were strongly related to observational measures of caregiver behavior and to measures of physical and…

Bradley, Robert H.; Caldwell, Bettye M.; Corwyn, Robert F.

2003-01-01

325

Quality along the Continuum: A Health Facility Assessment of Intrapartum and Postnatal Care in Ghana  

PubMed Central

Objective To evaluate quality of routine and emergency intrapartum and postnatal care using a health facility assessment, and to estimate “effective coverage” of skilled attendance in Brong Ahafo, Ghana. Methods We conducted an assessment of all 86 health facilities in seven districts in Brong Ahafo. Using performance of key signal functions and the availability of relevant drugs, equipment and trained health professionals, we created composite quality categories in four dimensions: routine delivery care, emergency obstetric care (EmOC), emergency newborn care (EmNC) and non-medical quality. Linking the health facility assessment to surveillance data we estimated “effective coverage” of skilled attendance as the proportion of births in facilities of high quality. Findings Delivery care was offered in 64/86 facilities; only 3-13% fulfilled our requirements for the highest quality category in any dimension. Quality was lowest in the emergency care dimensions, with 63% and 58% of facilities categorized as “low” or “substandard” for EmOC and EmNC, respectively. This implies performing less than four EmOC or three EmNC signal functions, and/or employing less than two skilled health professionals, and/or that no health professionals were present during our visit. Routine delivery care was “low” or “substandard” in 39% of facilities, meaning 25/64 facilities performed less than six routine signal functions and/or had less than two skilled health professionals and/or less than one midwife. While 68% of births were in health facilities, only 18% were in facilities with “high” or “highest” quality in all dimensions. Conclusion Our comprehensive facility assessment showed that quality of routine and emergency intrapartum and postnatal care was generally low in the study region. While coverage with facility delivery was 68%, we estimated “effective coverage” of skilled attendance at 18%, thus revealing a large “quality gap.” Effective coverage could be a meaningful indicator of progress towards reducing maternal and newborn mortality. PMID:24312265

Nesbitt, Robin C.; Lohela, Terhi J.; Manu, Alexander; Vesel, Linda; Okyere, Eunice; Edmond, Karen; Owusu-Agyei, Seth; Kirkwood, Betty R.; Gabrysch, Sabine

2013-01-01

326

First, do no harm: less training ? quality care.  

PubMed

In an attempt to transform the health care system in the United States to improve upon the inadequacies and deficiencies of our current model, the Robert Wood Johnson Foundation and the Institute of Medicine created a collaborative partnership to spell out what aspects of our health care system need to be remodeled. They envisioned that "interprofessional collaboration and coordination would be the 'norm,'"(1) because no discipline functions in isolation of others, certainly not in our intensive care units. In this spirit of interdisciplinary collaboration, the American College of Chest Physicians (ACCP) and the American Association of Critical-Care Nurses (AACN)-physician and nursing societies, respectively, with combined memberships totaling more than 110 000 practicing critical care practitioners-have spoken with one voice in the editorial that follows about how and how not to address the shortage of critical care physicians. Because our critical care nurses work side by side with our intensivists, shouldn't they have a say in how intensivists are trained? The ACCP and AACN think so, and we agree. Richard S. Irwin, MD, Master FCCP Editor in Chief, CHEST. PMID:22721978

Baumann, Michael H; Simpson, Steven Q; Stahl, Mary; Raoof, Suhail; Marciniuk, Darcy D; Gutterman, David D

2012-07-01

327

Organizational determinants of high-quality routine diabetes care.  

PubMed

Abstract Objective. Randomized trials showed that changes in healthcare organization improved diabetes care. This study aimed to identify which organizational determinants were associated with patient outcomes in routine diabetes care. Design. Observational study, in which multilevel regression analyses were applied to examine the impact of 12 organizational determinants on diabetes care as separate measures and as a composite score. Setting. Primary care practices in the Netherlands. Subjects. 11,751 patients with diabetes in 354 practices. Main outcome measures. Patients' recorded glycated hemoglobin (HbA1c), systolic blood pressure, and serum cholesterol levels. Results. A higher score on the composite measure of organizational determinants was associated with better control of systolic blood pressure (p = 0.017). No effects on HbA1C or cholesterol levels were found. Exploration of specific organizational factors found significant impact of use of an electronic patient registry on HbA1c (OR = 1.80, 95% CI 1.12-2.88), availability of patient leaflets on systolic blood pressure control (OR = 2.59, 95% CI 1.06-6.35), and number of hours' nurse education on cholesterol control (OR = 2.51, 95% CI 1.02-6.15). Conclusion. In routine primary care, it was found that favorable healthcare organization was associated with a number of intermediate outcomes in diabetes care. This finding lends support to the findings of trials on organizational changes in diabetes care. Notably, the composite measure of organizational determinants had most impact. PMID:25264939

van Doorn-Klomberg, Arna L; Braspenning, Jozé C C; Wolters, René J; Bouma, Margriet; de Grauw, Wim J C; Wensing, Michel

2014-09-01

328

Improving the quality of health care for chronic conditions  

PubMed Central

?? Chronic conditions are increasingly the primary concern of healthcare systems throughout the world. In response to this challenge, the World Health Organization has joined with the MacColl Institute for Healthcare Innovation to adapt the Chronic Care Model (CCM) from a global perspective. The resultant effort is the Innovative Care for Chronic Conditions (ICCC) framework which expands community and policy aspects of improving health care for chronic conditions and includes components at the micro (patient and family), meso (healthcare organisation and community), and macro (policy) levels. The framework provides a flexible but comprehensive base on which to build or redesign health systems in accordance with local resources and demands. PMID:15289634

Epping-Jordan, J; Pruitt, S; Bengoa, R; Wagner, E

2004-01-01

329

Framework for assessing quality of care for inflammatory bowel disease in Sweden  

PubMed Central

AIM: To create and apply a framework for quality assessment and improvement in care for inflammatory bowel disease (IBD) patients. METHODS A framework for quality assessment and improvement was created for IBD based on two generally acknowledged quality models. The model of Donabedian (Df) offers a logistical and productive perspective and the Clinical Value Compass (CVC) model adds a management and service perspective. The framework creates a pedagogical tool to understand the balance between the dimensions of clinical care (CVC) and the components of clinical outcome (Df). The merged models create a framework of the care process dimensions as a whole, reflecting important parts of the IBD care delivery system in a local setting. Clinical and organizational quality measures were adopted from clinical experience and the literature and were integrated into the framework. Data were collected at the yearly check-up for 481 IBD patients during 2008. The application of the quality assessment framework was tested and evaluated in a local clinical IBD care setting in Jönköping County, Sweden. RESULTS: The main outcome was the presentation of how locally-selected clinical quality measures, integrated into two complementary models to develop a framework, could be instrumental in assessing the quality of care delivered to patients with IBD. The selected quality measures of the framework noted less anemia in the population than previously reported, provided information about hospitalization rates and the few surgical procedures reported, and noted good access to the clinic. CONCLUSION: The applied local quality framework was feasible and useful for assessing the quality of care delivered to IBD patients in a local setting. PMID:22416183

Rejler, Martin; Tholstrup, Jorgen; Elg, Mattias; Spangeus, Anna; Gare, Boel Andersson

2012-01-01

330

How has hospital consolidation affected the price and quality of hospital care?  

PubMed

During the 1990s, the hospital industry was transformed by mergers and acquisitions. This synthesis looks at why this rapid consolidation occurred and what impact it had on the price and quality for patients, and the cost of care for hospitals. Key findings include: Managed care was not a main driver of consolidation, but fear of managed care may have played a part. Other factors, including technological advances that reduced inpatient demand, and an antitrust environment that was receptive to consolidation contributed to consolidation. Research suggests hospital prices increased by 5 percent or more as a result of consolidation. When two hospitals merge, not only does the surviving hospital raise prices but so do its competitors. Evidence of the impact of consolidation on quality of care is limited and mixed, but the strongest studies show a reduction in quality. Hospital consolidation does modestly reduce the cost to hospitals of providing care. PMID:22051574

Vogt, William B; Town, Robert; Williams, Claudia H

2006-02-01

331

Effect of a primary-care-based epilepsy specialist nurse service on quality of care from the patients' perspective: quasi-experimental evaluation  

Microsoft Academic Search

Initiatives to improve epilepsy care have emphasized the role of specialist nurses. Formal evaluation of these initiatives are scarce. Further evaluative studies are required to ascertain the optimal means of providing epilepsy care. This study aimed to assess the effect of a primary-care-based epilepsy specialist nurse service on patients' reported health status, perceived quality of life, health care use, attitudes

N. Mills; M. O. Bachmann; I. Harvey; I. Hine; M. McGowan

1999-01-01

332

Patients providing the answers: narrowing the gap in data quality for emergency care  

E-print Network

Objective The authors examined the validity of documentation produced during paediatric emergency care to determine if a patient-driven health information technology called ParentLink produced higher-quality data than ...

Porter, Stephen Calder

333

Quality of care and drug surveillance : a data-driven perspective  

E-print Network

In this thesis, we describe the use of medical insurance claims data in three important areas of medicine. First, we develop expert- trained statistical models of quality of care based on variables derived from insurance ...

Czerwinski, David (David E.)

2008-01-01

334

Association Between Rural Residence and the Use, Type, and Quality of Depression Care.  

National Technical Information Service (NTIS)

This brief assesses the association between rurality and the use, type (pharmacotherapy versus psychotherapy), and quality of care among individuals in the Medical Expenditure Panel Survey with self-reported depression.

F. Dong, J. C. Fortney, J. S. Harman, S. Xu

2009-01-01

335

Developing and Testing Asthma Quality of Care Measures. Abstract, Executive Summary and Final Report.  

National Technical Information Service (NTIS)

Suboptimal treatment contributes significantly to increased asthma morbidity, especially among economically disadvantaged inner-city residents. The purpose of the project was to develop a system to evaluate the quality of acute asthma care. The project's ...

Y. M. Coyle

2001-01-01

336

Quality of Care for Patients With Traction in Shahid Beheshti Hospital in 2012  

PubMed Central

Background With increasing incidence of traumatic fractures, the use of orthopedic intervention such as traction has increased. Inappropriate traction care may cause substantial morbidity and delay the patient rehabilitation. Objectives This study was conducted to evaluate the quality of care for patients with traction in the orthopedic unit of Kashan's Shahid Beheshti Hospital, Kashan, Iran. Patients and Methods This observational study was conducted on 100 patients with traumatic fractures of hip and femur bones who were admitted to Kashan Shahid-Beheshti Hospital during the first 6 months of 2012, and for whom skeletal or skin traction was performed. Data were collected using a checklist including questions about the personal characteristics and 23 items related to care for patients with tractions. These items were in three domains including caring while establishing traction, recording care and patient’s education. Descriptive statistics were calculated and data were analyzed using the independent sample t-test and Pearson correlation coefficient. Results The mean age of patients was 51.16 ± 23.28 years and 66% of them were male. In total, 47% of the patients were treated by skin traction and 53% by skeletal traction. The overall mean score of quality of care was 10.20 ± 2.64. Quality of establishing traction was good in 55% of patients, but the quality of care was poor in the domains of recording care (88%) and patient education (96%). Total mean of quality of care was significantly different between male and female patients (P < 0.02). Conclusions The quality of care of patients with traction was not optimal. Therefore it is necessary to improve measures in this area. PMID:24396800

Adib Hajbaghery, Mohsen; Moradi, Tayebeh

2013-01-01

337

Change What? Identifying Quality Improvement Targets by Investigating Usual Mental Health Care  

PubMed Central

Efforts to improve community-based children’s mental health care should be based on valid information about effective practices and current routine practices. Emerging research on routine care practices and outcomes has identified discrepancies between evidence-based practices and “usual care.” These discrepancies highlight potentially potent quality improvement interventions. This article reviews existing research on routine or “usual care” practice, identifies strengths and weaknesses in routine psychotherapeutic care, as well as gaps in knowledge, and proposes quality improvement recommendations based on existing data to improve the effectiveness of children’s mental health care. The two broad recommendations for bridging the research-practice gap are to implement valid, feasible measurement feedback systems and clinician training in common elements of evidence-based practice. PMID:20177769

Bickman, Leonard; Chorpita, Bruce F.

2010-01-01

338

Quality systems in health care: a situational approach.  

PubMed

Many views on quality management in professional service firms derived from ideas of industrial quality management. It seems that in the area of professional services these ideas are taken over without much criticism. For instance, the ideas on quality control and quality assurance generally are heavily based on the ISO 9000 standards. In The Netherlands the PACE-standards have been deduced from the ISO 9000 standards for application in hospitals. In this paper it has been argued that in many cases a more situational approach will be preferable. A global framework for a quality system in a professional service firm has been presented. This framework has been compared with the restrictions for quality systems in hospitals, following from the PACE-standards. PMID:10185318

van der Bij, J D; Vollmar, T; Weggeman, M C

1998-01-01

339

Medicaid reimbursement and the quality of nursing home care  

Microsoft Academic Search

An influential series of papers have found that an increase in Medicaid reimbursement decreases the level of nursing home quality in the presence of certificate-of-need (CON) and construction moratorium regulations. Using more recent national data, an outcome-oriented measure of quality, and an alternative methodology, this study finds a positive, albeit small, effect of reimbursement on quality. Although this paper does

David C. Grabowski

2001-01-01

340

Rationing health care resources. Is the quality-adjusted life-year a helpful guide?  

PubMed Central

The quality-adjusted life-year, an economic tool for allocating health care resources, lets researchers compare the cost-effectiveness of different therapies for virtually any disease. It purports to describe quantity of life, with an adjustment for quality of life, as a function of financial cost. Its goal is to maximize health care efficiency, but its methodology does not adequately meet the needs of older patients. Images p124-a p124-b PMID:8312748

Warren, J. M.

1994-01-01

341

Two measures of the quality of group care for infants and toddlers  

Microsoft Academic Search

Two sets of quality measures of group care were used to assess their predictive power for two sets of measures of the development\\u000a of infant and toddlers in group day care. One of the quality measures we investigated was the Early Childhood Environment\\u000a Rating Scale (ECERS). We replicated the findings of Scarr, Eisenberg, & Dealer-Deckard (1994) which were that the

Emanuel Kuno Beller; Marita Stahnke; Petra Butz; Walter Stahl; Holger Wessels

1996-01-01

342

Self-care self-efficacy, quality of life, and depression after stroke  

Microsoft Academic Search

Robinson-Smith G, Johnston MV, Allen J. Self-care self-efficacy, quality of life, and depression after stroke. Arch Phys Med Rehabil 2000;81:460-4. Objective: To determine the relationship of self-care self-efficacy to functional independence, quality of life, and depression after stroke. Methods: Longitudinal, descriptive correlational design. Setting: Inpatient rehabilitation facility at 1 month after stroke and home at 6 months after stroke. Participants:

Gale Robinson-Smith; Mark V Johnston; Judith Allen

2000-01-01

343

Using GIS to Profile HealthCare Costs of VA Quality-Enhancement Research Initiative Diseases  

Microsoft Academic Search

The Health Services Research and Development (HSR&D) Service at the Department of Veterans Affairs (VA) Health Care System launched a Quality Enhancement Research Initiative (QUERI) in 1998. This study estimated health-care costs of nine diseases under the QUERI project and analyzed geographic differences in health-care costs and utilization across 22 VA Integrated Service Networks (VISNs), using a geographic information system

Wei Yu; Diane Cowper; Magdalena Berger; Mark Kuebeler; Joe Kubal; Larry Manheim

2004-01-01

344

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

Microsoft Academic Search

Objective: To examine the effects of nurse staffing and organizational support for nursing care on nurses' dissatisfaction with their jobs, nurse burnout, and nurse reports of quality of patient care in an international sample of hospitals. Design: Multisite cross-sectional survey Setting: Adult acute-care hospitals in the U.S. (Pennsylvania), Canada (Ontario and British Columbia), England and Scotland. Study Participants: 10319 nurses

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

2002-01-01

345

Grantee Research Highlight: Taking Account of the Patient's Perspective when Examining the Quality of Cancer Care  

Cancer.gov

Optimizing patient experiences with care is especially important in cancer because cancer care is often complex and involves communication with and coordination across providers of multiple specialties and across multiple institutional settings. Unsatisfactory interactions with the health care system pose an additional burden on patients when they are already ill and vulnerable. More importantly, less-than-optimal patient experiences can have a significant negative impact on patients’ health-related quality of life.

346

Managing the quality effort in a health care setting: an application.  

PubMed

Recent marketplace realities and trends have forced health care institutions to adopt strategic orientations that stress a customer focus. Central to such strategic orientations is the effective utilization of service quality practices and philosophies. Toward that end, this research offers health care institutions an affordable methodology. A real-life application of the rapid assessment methodology (RAM) in a health care operational setting is presented. Finally, a framework to guide the implementation of the RAM methodology is outlined and explored. PMID:10047978

Yasin, M M; Czuchry, A J; Jennings, D L; York, C

1999-01-01

347

Enhancing Home-Based Child Care Quality Through Video-Feedback Intervention: A Randomized Controlled Trial  

Microsoft Academic Search

In the present randomized controlled trial, the effectiveness of video-feedback intervention to promote positive parenting–child care (VIPP-CC) was tested in home-based child care. Forty-eight caregivers were randomly assigned either to the intervention group or to the control group. Global child care quality improved in the intervention group but not in the control group. The program did not change observed caregiver

Marleen G. Groeneveld; Harriet J. Vermeer; Marinus H. van IJzendoorn; Mariëlle Linting

2011-01-01

348

School-Based Health Centers: Improving Access and Quality of Care for Low-Income Adolescents  

Microsoft Academic Search

OBJECTIVES. We sought to compare visit rates, emergency care use, and markers of quality of care between adolescents who use school-based health centers and those who use other community centers within a safety-net health care system for low-income and uninsured patients. PATIENTS AND METHODS. In this retrospective cohort study we used Denver Health electronic medical chart data, the Denver Health

Mandy A. Allison; Lori A. Crane; Brenda L. Beaty; Arthur J. Davidson; Paul Melinkovich; Allison Kempe

2008-01-01

349

Between evidence-based practice and total quality management: the implementation of cost-effective care  

Microsoft Academic Search

There is an increasing number of studies showing that patients often do not receive necessary care or receive care that is not needed, inefficient or even damaging. There is no lack of ideas and approaches on how to improve practice. In the last decades we have seen the rise of fascinating models for quality improvement, for instance Evidence Based Medicine,

RICHARD GROL

2000-01-01

350

Child Care Quality: Centers and Home Settings that Serve Poor Families  

ERIC Educational Resources Information Center

The effects of center-based care on early development, outside of carefully controlled demonstration programs, appear to be positive yet often modest for children from low-income families. But little is known about variation in the quality of centers and preschools found among low-income neighborhoods. Evidence also remains scarce on the observed…

Fuller, B.; Kagan, S.L.; Loeb, S.; Chang, Y.W.

2004-01-01

351

Quality of antenatal care in rural Tanzania: counselling on pregnancy danger signs  

Microsoft Academic Search

BACKGROUND: The high rate of antenatal care attendance in sub-Saharan Africa, should facilitate provision of information on signs of potential pregnancy complications. The aim of this study was to assess quality of antenatal care with respect to providers' counselling of pregnancy danger signs in Rufiji district, Tanzania. METHODS: A cross-sectional study was conducted in 18 primary health facilities. Thirty two

Andrea B Pembe; Anders Carlstedt; David P Urassa; Gunilla Lindmark; Lennarth Nyström; Elisabeth Darj

2010-01-01

352

Child-Care Provider Survey Reveals Cost Constrains Quality. Research Brief. Volume 96, Number 5  

ERIC Educational Resources Information Center

A survey of 414 child care providers in southeastern Wisconsin reveals that cost as well as low wages and lack of benefits for workers can constrain providers from pursuing improvements to child-care quality. Of survey respondents, approximately half of whom are home-based and half center-based, 13% have at least three of five structural factors…

Public Policy Forum, 2008

2008-01-01

353

The impact of horizontal mergers and acquisitions on cost and quality in health care.  

PubMed

Mergers and acquisitions among HMOs, hospitals and other health care providers can be disconcerting to benefits staff and employees, but they can be successfully managed. They may offer an employer the opportunity to improve the quality of care provided and to do so at reduced costs. PMID:10153603

Taylor, M J; Porper, R W; Manji, S

1995-12-01

354

Quality of Care for Acute Myocardial Infarction in Rural and Urban US Hospitals  

ERIC Educational Resources Information Center

Context: Acute myocardial infarction (AMI) is a common and important cause of admission to US rural hospitals, as transport of patients with AMI to urban settings can result in unacceptable delays in care. Purpose: To examine the quality of care for patients with AMI in rural hospitals with differing degrees of remoteness from urban centers.…

Baldwin, Laura-Mae; MacLehose, Richard F.; Hart, L. Gary; Beaver, Shelli K.; Every,Nathan; Chan,Leighton

2004-01-01

355

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

Microsoft Academic Search

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

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

2001-01-01

356

Connecting Child Care Quality to Child Outcomes: Drawing Policy Lessons from Nonexperimental Data  

ERIC Educational Resources Information Center

Effective early childhood intervention and child care policies should be based on an understanding of the effects of child care quality and type on child well-being. This article describes methods for securing unbiased estimates of these effects from nonexperimental data. It focuses on longitudinal studies like the one developed by the National…

Duncan, Greg J.; Gibson-Davis, Christina M.

2006-01-01

357

The Quality of Care for Depressive and Anxiety Disorders in the United States  

Microsoft Academic Search

Background: Depressive and anxiety disorders are preva- lent and cause substantial morbidity. While effective treat- ments exist, little is known about the quality of care for these disorders nationally. We estimated the rate of ap- propriate treatment among the US population with these disorders, and the effect of insurance, provider type, and individual characteristics on receipt of appropriate care. Methods:

Alexander S. Young; Ruth Klap; Cathy D. Sherbourne; Kenneth B. Wells

2001-01-01

358

Predictors of Global Quality in Family Child Care Homes: Structural and Belief Characteristics  

ERIC Educational Resources Information Center

Research Findings: With a substantial number of young children receiving care in family child care settings, an examination of the characteristics, both structural and attitudinal, that predict program quality is warranted. The current study examines gaps in the research by examining both structural characteristics and provider beliefs that…

Hughes-Belding, Kere; Hegland, Susan; Stein, Amanda; Sideris, John; Bryant, Donna

2012-01-01

359

Quality of life in the five years after intensive care: a cohort study  

PubMed Central

Introduction Data on quality of life beyond 2 years after intensive care discharge are limited and we aimed to explore this area further. Our objective was to quantify quality of life and health utilities in the 5 years after intensive care discharge. Methods A prospective longitudinal cohort study in a University Hospital in the UK. Quality of life was assessed from the period before ICU admission until 5 years and quality adjusted life years calculated. Results 300 level 3 intensive care patients of median age 60.5 years and median length of stay 6.7 days, were recruited. Physical quality of life fell to 3 months (P = 0.003), rose back to pre-morbid levels at 12 months then fell again from 2.5 to 5 years after intensive care (P = 0.002). Mean physical scores were below the population norm at all time points but the mean mental scores after 6 months were similar to those population norms. The utility value measured using the EuroQOL-5D quality of life assessment tool (EQ-5D) at 5 years was 0.677. During the five years after intensive care unit, the cumulative quality adjusted life years were significantly lower than that expected for the general population (P < 0.001). Conclusions Intensive care unit admission is associated with a high mortality, a poor physical quality of life and a low quality adjusted life years gained compared to the general population for 5 years after discharge. In this group, critical illness associated with ICU admission should be treated as a life time diagnosis with associated excess mortality, morbidity and the requirement for ongoing health care support. PMID:20089197

2010-01-01

360

AHRQ prevention quality indicators to assess the quality of primary care of local providers: a pilot study from Italy  

PubMed Central

Background: Outside the USA, Agency for Healthcare Research and Quality (AHRQ) prevention quality indicators (PQIs) have been used to compare the quality of primary care services only at a national or regional level. However, in several national health systems, primary care is not directly managed by the regions but is in charge of smaller territorial entities. We evaluated whether PQIs might be used to compare the performance of local providers such as Italian local health authorities (LHAs) and health districts. Methods: We analysed the hospital discharge abstracts of 44 LHAs (and 11 health districts) of five Italian regions (including ?18 million residents) in 2008–10. Age-standardized PQI rates were computed following AHRQ specifications. Potential predictors were investigated using multilevel modelling. Results: We analysed 11 470 722 hospitalizations. The overall rates of preventable hospitalizations (composite PQI 90) were 1012, 889 and 988 (×100 000 inhabitants) in 2008, 2009 and 2010, respectively. Composite PQIs were able to differentiate LHAs and health districts and showed small variation in the performance ranking over years. Conclusion: Although further research is required, our findings support the use of composite PQIs to evaluate the performance of relatively small primary health care providers (50 000–60 000 enrollees) in countries with universal health care coverage. Achieving high precision may be crucial for a structured quality assessment system to align hospitalization rate indicators with measures of other contexts of care (cost, clinical management, satisfaction/experience) that are typically computed at a local level. PMID:24367065

Flacco, Maria Elena; De Vito, Corrado; Arca, Silvia; Carle, Flavia; Capasso, Lorenzo; Marzuillo, Carolina; Muraglia, Angelo; Samani, Fabio; Villari, Paolo

2014-01-01

361

Aspirations for quality health care in Uganda: How do we get there?  

PubMed Central

Background Despite significant investments and reforms, health care remains poor for many in Africa. To design an intervention to improve access and quality of health care at health facilities in eastern Uganda, we aimed to understand local priorities for qualities in health care, and factors that enable or prevent these qualities from being enacted. Methods In 2009 to 2010, we carried out 69 in-depth interviews and 6 focus group discussions with 65 health workers at 17 health facilities, and 10 focus group discussions with 113 community members in Tororo District, Uganda. Results Health-care workers and seekers valued technical, interpersonal and resource qualities in their aspirations for health care. However, such qualities were frequently not enacted, and our analysis suggests that meeting aspirations required social and financial resources to negotiate various power structures. Conclusions We argue that achieving aspirations for qualities valued in health care will require a genuine reorientation of focus by health workers and their managers toward patients, through renewed respect and support for these providers as professionals. PMID:23521859

2013-01-01

362

Issues of quality and consumer rights in the health care market.  

PubMed

This Issue Brief describes how the structure of the health care market has changed in the recent years. It outlines the growth in managed care and the changes in the types of managed care plans available. In addition, it discusses the issue of quality in the health care market. It also includes an overview of the legislative topics and issues relating to quality and consumer rights that policymakers are currently considering. Growth in national health expenditures, the medical care price index, and employer health care costs has slowed significantly since 1990. This decreased growth has coincided with substantial increases in managed care plan enrollment. The percentage of employees enrolled in managed care plans increased from 48 percent to 85 percent from 1992 to 1997. Quality is a multidimensional concept. Although individuals may agree on its components, they may disagree on the relative importance of these components. Therefore, disagreement exists not only on how to measure quality but also on how it is defined. Consequently, policy decisions need to be based on an evaluation of a particular law's effect as opposed to its stated goal or intent. This distinction is important because a law that addresses access or consumer rights does not necessarily address the quality of care a consumer receives. Ultimately, whether an individual believes that a law truly addresses quality will depend in a large part on his or her subjective opinion of what quality entails. To date, comparison of the quality of managed care plans with that of fee-for-service plans has not produced results that uniformly differentiate between these two plan types in either a positive or a negative way. In addition, it is important to note that the current debate on the quality of care provided in the health care market is not new to the present managed care era. The regulations and mandates discussed in this report would not guarantee increased quality in the health care market, unless quality is defined as easier access for those with health insurance. However, if quality is defined as the success of the outcomes of health services provided, the effect of these regulations on quality is in need of further research. Yet, the regulations would have some impact on the costs of health benefits and insurance. This impact has been estimated to be relatively small to substantial, depending on the interpretation of the mandates and assumptions derived from that interpretation. Regardless of the magnitude of the estimated increases, some research has shown that these regulations could have serious implications for the likelihood of small businesses offering health benefits. While these health plan regulations effect on quality depends on one's definition of quality, costs would increase regardless of the definition one uses. Consequently, these regulations would come at a price. Thus, legislators must decide between: (a) imposing regulation that would increase access and consumer "rights" for those with insurance but would be of questionable value to the quality of outcomes, and (b) allowing existing market forces to improve quality through experimentation and competitive forces. PMID:10177730

Copeland, C

1998-04-01

363

Beyond Quality in Early Childhood Education and Care: Postmodern Perspectives.  

ERIC Educational Resources Information Center

Working with postmodern ideas, this book questions the search to define and measure quality in the early childhood field and its tendency to reduce philosophical issues of value to purely technical and managerial issues of expert knowledge and measurement. The book argues that there are ways other than the "discourse of quality" for understanding…

Dahlberg, Gunilla; Moss, Peter; Pence, Alan

364

[Effects of a computer-assisted system for nursing care documentation on quality and quantity of nursing care documentation].  

PubMed

The University Hospital in Heidelberg has been gathering experience with the computer based nursing documentationsystem PIK since 1998. Its introduction on four pilotwards was systematically evaluated in an intervention study, gaining data to acceptance issues as well as to the quality of nursing documentation, as the nursing process is often not documented in an appropriate manner. Data to quantity and quality of nursing documentation before and after the intervention was gathered by means of a quality checklist, which was developed on the basis of an intensive literature review. To measure a difference in the quality of nursing documentation 20 documents from each of the four wards were assessed at the three assigned points of time by two nursing experts. The assessors stated a significant improvement in documentation quality due to the increase in formal completeness when documenting the nursing process. The content of the documentation as well as the individualization of the nursing care plan still need to be improved. PMID:12838723

Mahler, Cornelia; Ammenwerth, Elske; Tautz, Angelika; Wagner, Andreas; Eichstädter, Ronald; Hoppe, Bettina

2003-06-01

365

[Challenges and barriers in the promotion of quality in health care services].  

PubMed

The promotion of quality and safety in health care faces many challenges and barriers including lack of cooperation by physicians. Complexity and uncertainty in measuring quality raise methodological difficulties. Lack of sufficient awareness about these limitations, also among those who measure quality, contributes to physicians lack of interest, suspicion and mistrust. Strategic issues associated with quality assessment in the Israeli health care system derive from lack of regulation and evasiveness about the accountability of executives and governing bodies regarding the quality of the services provided to patients in hospitals and clinics. Some of these challenges relate to the intrusion of market forces into the world of medicine without needed adaptations, so that reimbursement is often conveniently linked to the quantity of services and not to their quality. Efficiency, which characterizes competitive markets, is not easily translated in the clinical world where empathy, listening skills, and capability of explaining are critical physician attributes. This clinical world values giving beyond monetary compensation, and cooperation between institutions--rather than competition--all crucial for the continuity of patient's care. The interface between economics and health care calls for creative thinking, with a novel definition for the social value of medical and nursing care according to their quality and not their quantity. PMID:22519258

Brezis, Mayer; Cohen, Matan J; Frankel, Meir; Chinitz, David

2012-03-01

366

Using Web sites on quality health care for teaching consumers in public libraries.  

PubMed

More and more consumers are searching the Internet for health information. Health Web sites vary in quality, though, and not all consumers are aware of the need to evaluate the information they find on the Web. Nurses and other health providers involved in patient education can evaluate Web sites and suggest quality sites for patients to use. This article describes a project we implemented in 2 public libraries to educate consumers about quality health care and patient safety using Web sites that we had evaluated earlier. Participants (n = 103) completed resources on health care quality, questions patients should ask about their diagnoses and treatment options, changes in Medicare and Medicare options or ways to make their health benefits work for them, and tips to help prevent medical errors. Most consumers were highly satisfied with the Web sites and the information they learned on quality care from these resources. Many participants did not have Internet access at home or work and instead used the library to search the Web. Information about the Web sites used in this project and other sites on quality care can be made available in libraries and community settings and as part of patient education resources in hospitals. The Web provides easy access for consumers to information about patient safety initiatives and health care quality in general. PMID:16027597

Oermann, Marilyn H; Lesley, Marsha L; VanderWal, Jillon S

2005-01-01

367

International standard of quality in the pediatric intensive care unit: a model for pediatric intensive care units in South America.  

PubMed

Investments in critical care in South America have been postponed so that more pressing primary care needs may be funded. Poor underlying health, a lack of organized health care delivery systems, a lack of critical care beds, and regional epidemics, however, result in patients being admitted to pediatric intensive care units (ICUs) late in their illnesses. Pediatric ICU mortality rates are approximately 20%. Hospital problems include insufficient interdepartmental coordination, lack of care protocols, too few pediatric intensivists, inferior quality equipment, and a lack of qualified technicians. Pediatric nurses are poorly paid, have no special pediatric ICU training, and receive no special professional recognition. The few trained ICU nurses are often assigned administrative roles, while pediatric ICUs often employ auxiliary nurses who have the equivalent of 1 high school year of nurse's training. South America needs a model of pediatric intensive care which is different from that implemented in the US. In this model, resources must be optimized, difficulties minimized, and continuous and stable growth permitted until the state of the art is reached. ICUs must improve relationships and coordinate services interregionally, especially with emergency medical care systems, and they should be located in large medical centers. Intermediate care areas could also be developed to smooth the transition out of the pediatric ICU. Intensivists with appropriate training and certification should direct patient care, perform administrative tasks, and train residents on a full-time basis. Further, pediatric ICU nurses should be specially trained and participate in administration, while auxiliary nurses should be better trained to help ease the nursing shortage. Finally, equipment must be upgraded, but invasive, advanced hemodynamic monitoring is presently not a priority. PMID:8365264

Garcia, P C

1993-09-01

368

Evaluating the Quality of Colorectal Cancer Care in the State of Florida: Results From the Florida Initiative for Quality Cancer Care  

PubMed Central

Purpose: The Florida Initiative for Quality Cancer Care (FIQCC) was established to evaluate the quality of cancer care at the regional level across the state of Florida. This study assessed adherence to validated quality indicators in colorectal cancer (CRC) and the variability in adherence by practice site, volume, and patient age. Methods: The FIQCC is a consortium of 11 medical oncology practices in Florida. Medical record reviews were conducted for 507 patients diagnosed with CRC and seen as new medical oncology patients in 2006. Thirty-five indicators were evaluated individually and categorized across clinical domains and components of care. Results: The mean adherence for 19 of 35 individual indicators was > 85%. Pathology reports were compliant on reporting depth of tumor invasion (96%; range, 86% to 100%), grade (93%; range, 72% to 100%), and status of proximal and distal surgical resection margins (97%; range. 86% to 100%); however, documentation of lymphovascular and perineural invasion did not meet adherence standards (76%; range, 53% to 100% and 39%; range, 5% to 83%, respectively). Among patients with nonmetastatic rectal cancer, documentation of the status of surgical radial margins was consistently low across sites (42%; range, 0% to 100%; P = .19). Documentation of planned treatment regimens for adjuvant chemotherapy was noted in only 58% of eligible patients. Conclusion: In this large regional initiative, we found high levels of adherence to more than half of the established quality indicators. Although the quality of care delivered within FIQCC practices seems to be high, several components of care were identified that warrant further scrutiny on both a systemic level and at individual centers. PMID:23180990

Siegel, Erin M.; Jacobsen, Paul B.; Malafa, Mokenge; Fulp, William; Fletcher, Michelle; Lee, Ji-Hyun; 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

2012-01-01

369

Managing the relationship between quality and cost-effective burn care.  

PubMed

In the modern era of fiscal prudence, managing the relationship between quality health care and cost reduction is a complex and challenging task for policy makers and health care providers. Health economics is an applied field that aids in assessing the feasibility of incorporating new interventions in a certain field. Applying these tools when allocating funds for burn care is even more complicated due to the lack of clinical data regarding the cost effectiveness of different aspects in burn care. Herein we review the existing literature and summarize different approaches for achieving cost effective health care in general and in burn care specifically. Special considerations to funds allocation in burn care are also discussed. PMID:21130580

Stavrou, Demetris; Weissman, Oren; Winkler, Eyal; Millet, Eran; Nardini, Gil; Tessone, Ariel; Zmora, Niv; Mushin, Oren Paul; Haik, Joseph

2011-05-01

370

The quality caring nursing model: a journey to selection and implementation.  

PubMed

A nursing model selection team was created to evaluate the theoretical framework of the professional practice model for the department of nursing. The team's mission was to assess whether the present nursing model was congruent with the culture of contemporary practice of nursing within the organization. After a year of in-depth readings, meetings, and communications with other hospitals, the committee adopted the Quality Caring Model(©) (QCM) developed by Joanne Duffy, RN, PhD. The implementation team used focus groups, Web-based tutorials, and interactive media as educational tools. Quality caring advocates (unit-based direct care nurses) were selected to assist with the sustainability of the QCM(©). PMID:22024041

Edmundson, Elizabeth

2012-08-01

371

Coverage, quality of and barriers to postnatal care in rural Hebei, China: a mixed method study  

PubMed Central

Background Postnatal care is an important link in the continuum of care for maternal and child health. However, coverage and quality of postnatal care are poor in low- and middle-income countries. In 2009, the Chinese government set a policy providing free postnatal care services to all mothers and their newborns in China. Our study aimed at exploring coverage, quality of care, reasons for not receiving and barriers to providing postnatal care after introduction of this new policy. Methods We carried out a mixed method study in Zhao County, Hebei Province, China from July to August 2011. To quantify the coverage, quality of care and reasons for not using postnatal care, we conducted a household survey with 1601 caregivers of children younger than two years of age. We also conducted semi-structured interviews with 24 township maternal and child healthcare workers to evaluate their views on workload, in-service training and barriers to postnatal home visits. Results Of 1442 (90% of surveyed caregivers) women who completed the postnatal care survey module, 8% received a timely postnatal home visit (within one week after delivery) and 24% of women received postnatal care within 42 days after delivery. Among women who received postnatal care, 37% received counseling or guidance on infant feeding and 32% on cord care. 24% of women reported that the service provider checked jaundice of their newborns and 18% were consulted on danger signs and thermal care of their newborns. Of 991 mothers who did not seek postnatal care within 42 days after birth, 65% of them said that they did not knew about postnatal care and 24% of them thought it was unnecessary. Qualitative findings revealed that staff shortages and inconvenient transportation limited maternal and child healthcare workers in reaching out to women at home. In addition, maternal and child healthcare workers said that in-service training was inadequate and more training on postnatal care, hands-on practice, and supervision were needed. Conclusions Coverage and quality of postnatal care were low in rural Hebei Province and far below the targets set by Chinese government. We identified barriers both from the supply and demand side. PMID:24438644

2014-01-01

372

Maintaining Quality Care during a Nursing Shortage Using Licensed Practical Nurses in Acute Care  

Microsoft Academic Search

Implications of an aging registered nurse workforce, coupled with an inadequate supply of new nurses, presented a unique challenge for the nurse executive in an acute care hospital. This article presents one possible solution: reintroduction of licensed practical nurses to the patient care setting. It describes a pilot project initiated to answer the following question: Is there a change in

Patricia A. Kenney

373

Readiness to Implement a National Quality Framework: Evidence from Irish Early Childhood Care and Education Centres  

ERIC Educational Resources Information Center

This study examined the factors associated with childcare staff members' readiness to implement quality standards in early childhood settings in Ireland. To coincide with a new government policy that provides every three-year-old child with access to a free preschool year, a framework designed to improve the quality of early childhood care and…

Doyle, Orla; Logue, Caitriona; McNamara, Kelly A.

2011-01-01

374

A Portable Action Lab for Creating Quality Student Projects for Health Care Careers.  

ERIC Educational Resources Information Center

This document is intended to introduce health occupations educators to the principles of the portable action lab and help them use those principles to create quality learning projects for students preparing for careers in health care. Section 1 outlines the concepts and frameworks of quality project-based learning, which is based on the following…

Alongi, Anthony; Arora, Sonia; Hogan, Christopher; Steinberg, Adria; Vickers, Margaret

375

Providing Outcomes Information to Nursing Homes: Can It Improve Quality of Care?  

ERIC Educational Resources Information Center

Purpose: This study examined whether providing outcomes information to 120 nursing homes facilitated improvements in quality over a 12-month period, as compared with 1,171 facilities not receiving this information. The outcomes information provided consisted of a report mailed to administrators that examined six measures of care quality. These…

Castle, Nicholas G.

2003-01-01

376

The True Cost of Quality in Early Care and Education Programs  

ERIC Educational Resources Information Center

Questions on the gap between the price parents pay and the "true cost" of quality care were the catalyst for the True Cost of Quality (TCOQ) project launched in the spring of 2001 by the City of Seattle's Northwest Finance Circle. The mission of the Northwest Finance Circle, a community collaboration, was to improve and expand the financing of…

Young, Billie

2005-01-01

377

The effect of Medicaid reimbursement on quality of care in nursing homes  

Microsoft Academic Search

This study uses a nationally representative sample of nursing homes and nursing home residents to examine the effect of Medicaid reimbursement on quality of care. The analysis shows that both reimbursement approach and level affect nursing home quality, as measured by case-mix adjusted staff to resident ratios. The analysis also shows that staffing ratios have a significant impact on resident

Joel W. Cohen; William D. Spector

1996-01-01

378

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

Microsoft Academic Search

This paper will present some of the findings of a qualitative study that utilised grounded theory to discover nurses perceptions of quality and factors that affect quality nursing care provided to Percutaneous Transluminal Coronary Angioplasty (PTCA) patients in a large Queensland Metropolitan Hospital. The study used focus group interviews, participant observation, in-depth interviews and published literature to gather data. Fifteen

Sonja Cleary; Sansnee Jirojwong; Sandra Walker

379

Hearing Parents' and Carers' Voices: Experiences of Accessing Quality Long Day Care in Northern Regional Australia  

ERIC Educational Resources Information Center

This article explores parents' and carers' experiences of accessing quality long day care in northern regional Australia. The data was gathered in 2009, after the collapse of ABC Developmental Learning Centres (herein referred to as ABC Learning) and before the implementation of the "National Quality Framework," and provides a snapshot of…

Harris, Nonie; Tinning, Beth

2012-01-01

380

Women's Reflections on Choosing Quality Long Day Care in a Regional Community  

ERIC Educational Resources Information Center

This article qualitatively explores women's experiences of choosing quality long day care in a regional community. The study complements recent quantitative research on the quality implications of increased for-profit childcare provision. It also adds to our understanding of current childcare policy by focusing on the experiences of women in a…

Harris, Nonie

2008-01-01

381

A model of service quality perceptions and health care consumer behavior.  

PubMed

Analysis of covariance structures (LISREL) was used to examine the influence of consumer held perceptions of service quality on consumer satisfaction and intentions to return. Results indicate that service quality is a significant predictor of consumer satisfaction which, in turn, predicts intention to return. Health care marketing implications are discussed. PMID:10116639

O'Connor, S J; Shewchuk, R M; Bowers, M R

1991-01-01

382

The Minimum Data Set Prevalence of Restraint Quality Indicator: Does It Reflect Differences in Care?  

ERIC Educational Resources Information Center

Purpose: This study investigated whether the use of restraining devices and related measures of care quality are different in nursing homes that score in the upper and lower quartiles on the Minimum Data Set (MDS) "prevalence of restraint" quality indicator, which assesses daily use of restraining devices when residents are out of bed. Design and…

Schnelle, John F.; Bates-Jensen, Barbara M.; Levy-Storms, Lene; Grbic, Valena; Yoshii, June; Cadogan, Mary; Simmons, Sandra F.

2004-01-01

383

Special Care Units and Traditional Care in Dementia: Relationship with Behavior, Cognition, Functional Status and Quality of Life - A Review  

PubMed Central

Background Special care facilities for patients with dementia gain increasing attention. However, an overview of studies examining the differences between care facilities with respect to their effects on behavior, cognition, functional status and quality of life is lacking. Results Our literature search resulted in 32 studies published until October 2012. Overall, patients with dementia who lived at special care units (SCUs) showed a significantly more challenging behavior, more agitation/aggression, more depression and anxiety, more cases of global cognitive impairment and a better psychosocial functioning. There was a tendency towards a better functional status in specialized care facilities, and a better quality of life was found in favor of the SCU group compared to the traditional nursing home (n-SCU) group. Longitudinal studies showed an increased number of neuropsychiatric cases, more patients displaying deteriorating behavior and resistance to care as well as less decline in activities of daily living (ADL) in the SCU group compared to the n-SCU group. Patients in small-scale, homelike SCUs showed more agitation and less ADL decline compared to SCU patients. Conclusion This review shows that the patient characteristics in SCU and n-SCU settings and, to a minor extent, in SCU and small-scale, homelike SCU settings are different. Over time, there are differences between n-SCU, SCU and small-scale, homelike SCU facilities for some variables. PMID:24403908

Kok, Jeroen S.; Berg, Ina J.; Scherder, Erik J.A.

2013-01-01

384

The Australian Palliative Care Outcomes Collaboration (PCOC)--measuring the quality and outcomes of palliative care on a routine basis.  

PubMed

Australia is leading the way in establishing a national system (the Palliative Care Outcomes Collaboration - PCOC) to measure the outcomes and quality of specialist palliative care services and to benchmark services across the country. This article reports on analysis of data collected routinely at point-of-care on 5939 patients treated by the first fifty one services that voluntarily joined PCOC. By March 2009, 111 services have agreed to join PCOC, representing more than 70% of services and more than 80% of specialist palliative care patients nationally. All states and territories are involved in this unique process that has involved extensive consultation and infrastructure and close collaboration between health services and researchers. The challenges of dealing with wide variation in outcomes and practice and the progress achieved to date are described. PCOC is aiming to improve understanding of the reasons for variations in clinical outcomes between specialist palliative care patients and differences in service outcomes as a critical step in an ongoing process to improve both service quality and patient outcomes. PMID:20497731

Eagar, Kathy; Watters, Prue; Currow, David C; Aoun, Samar M; Yates, Patsy

2010-05-01

385

Identifying resident care areas for a quality improvement intervention in long-term care: a collaborative approach  

PubMed Central

Background In Canada, healthcare aides (also referred to as nurse aides, personal support workers, nursing assistants) are unregulated personnel who provide 70-80% of direct care to residents living in nursing homes. Although they are an integral part of the care team their contributions to the resident care planning process are not always acknowledged in the organization. The purpose of the Safer Care for Older Persons [in residential] Environments (SCOPE) project was to evaluate the feasibility of engaging front line staff (primarily healthcare aides) to use quality improvement methods to integrate best practices into resident care. This paper describes the process used by teams participating in the SCOPE project to select clinical improvement areas. Methods The study employed a collaborative approach to identify clinical areas and through consensus, teams selected one of three areas. To select the clinical areas we recruited two nursing homes not involved in the SCOPE project and sampled healthcare providers and decision-makers within them. A vote counting method was used to determine the top five ranked clinical areas for improvement. Results Responses received from stakeholder groups included gerontology experts, decision-makers, registered nurses, managers, and healthcare aides. The top ranked areas from highest to lowest were pain/discomfort management, behaviour management, depression, skin integrity, and assistance with eating. Conclusions Involving staff in selecting areas that they perceive as needing improvement may facilitate staff engagement in the quality improvement process. PMID:23009173

2012-01-01

386

Quality of Health Care PH/ISyE 703  

E-print Network

for the participation grade is the amount and quality of effort put forth by each student to provide thoughtful and constructive commentary. · 100 points per module: Your grade on a mini-paper. For each module, you will choose

Sheridan, Jennifer

387

Easing the Separation Process for Infants, Toddlers, and Families  

ERIC Educational Resources Information Center

Attachment and separation are the stuff of which life is made. The bonds between family and child promote resilience, self-regulation, and a positive sense of self. In this article, the author focuses her discussion on the importance of attachment to children's development. She has cited some theories that can help her explain further. For…

Balaban, Nancy

2006-01-01

388

Using Toys to Support Infant-Toddler Learning and Development  

ERIC Educational Resources Information Center

Choosing toys and activities that are suitable for infants and toddlers can challenge even the most experienced teacher. By being mindful of the basic principles of child development and the role of play, teachers can intentionally select toys to meet young children's unique needs and interests, supporting learning. It is also important to be…

Guyton, Gabriel

2011-01-01

389

Innovations: The Comprehensive Infant & Toddler Curriculum. Trainer's Guide.  

ERIC Educational Resources Information Center

This guide is designed for training teachers in the use of the "Innovations" curricula for infants and for toddlers. The "Innovations" program is based on the view that curricula for young children should involve thinking and planning for everything that can contribute to child development as well as the teacher's relationship with the child and…

Miller, Linda G.; Albrecht, Kay

390

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

MedlinePLUS

... Resources Play Promoting Social-Emotional Development Reflective Practice & Program Development Safe Babies Court Teams: Building Strong Families and ... Safe Babies Court Teams Project Training and Professional Development Zero To Three Journal Digital ... go to www.zerotothree.org/reprints nonprofit software

391

Demographic Predictors of Media Use Among Infants, Toddlers, and Preschoolers  

Microsoft Academic Search

A great deal of research during the past four decades has explored the effects of media use on children, but remarkably little work has explored the factors that determine how much time a child spends interacting with various media. This article does so with a focus on very young children, ages 6 months to 6 years, and on demographic predictors

Sowmya Anand; Jon A. Krosnick

2005-01-01

392

Infants & Toddlers: Development--The Power of Touch  

ERIC Educational Resources Information Center

When a baby is born, parents check for fingers and toes, and over the next few weeks remain alert to whether the baby can see and hear. When babies nurse well, parents are assured that the sense of taste and smell are fine. But what about touch? This crucial sense for babies is often overlooked. In this article, the author discusses how to ensure…

Honig, Alice Sterling

2005-01-01

393

NCS Dietary Assessment Literature Review - Chapter 3: Infants & Toddlers Group  

Cancer.gov

Test weighing validation studies in breastfed infants have focused on modifications of procedures to reduce the maternal burden and disruptions of feeding. Results of three studies (31;81;82) examining whether breast milk intake could be estimated from the product of test 43 weights for one or two feeds in a 24-hour period found the highest correlations between intakes estimated with 24-hour test weighing and estimates calculated from two consecutive test weights in the mid 24-hour period.

394

Hospitalized patients' participation and its impact on quality of care and patient safety  

PubMed Central

Objective To understand the extent to which hospitalized patients participate in their care, and the association of patient participation with quality of care and patient safety. Design Random sample telephone survey and medical record review. Setting US acute care hospitals in 2003. Participants A total of 2025 recently hospitalized adults. Main Outcome Measures Hospitalized patients reported participation in their own care, assessments of overall quality of care and the presence of adverse events (AEs) in telephone interviews. Physician reviewers rated the severity and preventability of AEs identified by interview and chart review among 788 surveyed patients who also consented to medical record review. Results Of the 2025 patients surveyed, 99.9% of patients reported positive responses to at least one of seven measures of participation. High participation (use of >4 activities) was strongly associated with patients’ favorable ratings of the hospital quality of care (adjusted OR: 5.46, 95% CI: 4.15–7.19). Among the 788 patients with both patient survey and chart review data, there was an inverse relationship between participation and adverse events. In multivariable logistic regression analyses, patients with high participation were half as likely to have at least one adverse event during the admission (adjusted OR = 0.49, 0.31–0.78). Conclusions Most hospitalized patients participated in some aspects of their care. Participation was strongly associated with favorable judgments about hospital quality and reduced the risk of experiencing an adverse event. PMID:21307118

Weingart, Saul N.; Zhu, Junya; Chiappetta, Laurel; Stuver, Sherri O.; Schneider, Eric C.; Epstein, Arnold M.; David-Kasdan, Jo Ann; Annas, Catherine L.; Fowler, Floyd J.; Weissman, Joel S.

2011-01-01

395

Reforming Cardiovascular Care in the United States towards High-Quality Care at Lower Cost with Examples from Model Programs in the State of Michigan.  

PubMed

Despite its status as a world leader in treatment innovation and medical education, a quality chasm exists in American health care. Care fragmentation and poor coordination contribute to expensive care with highly variable quality in the United States. The rising costs of health care since 1990 have had a huge impact on individuals, families, businesses, the federal and state governments, and the national budget deficit. The passage of the Affordable Care Act represents a large shift in how health care is financed and delivered in the United States. The objective of this review is to describe some of the economic and social forces driving health care reform, provide an overview of the Patient Protection and Affordable Care Act (ACA), and review model cardiovascular quality improvement programs underway in the state of Michigan. As health care reorganization occurs at the federal level, local and regional efforts can serve as models to accelerate improvement toward achieving better population health and better care at lower cost. Model programs in Michigan have achieved this goal in cardiovascular care through the systematic application of evidence-based care, the utilization of regional quality improvement collaboratives, community-based childhood wellness promotion, and medical device-based competitive bidding strategies. These efforts are examples of the direction cardiovascular care delivery will need to move in this era of the Affordable Care Act. PMID:25120917

Alyeshmerni, Daniel; Froehlich, James B; Lewin, Jack; Eagle, Kim A

2014-07-01

396

Neighborhood Characteristics, and Child Care Type and Quality  

ERIC Educational Resources Information Center

Research Findings: Using data from the Project on Human Development in Chicago Neighborhoods, this article relates neighborhood characteristics to the type of child care used in families with toddlers and preschoolers (N = 1,121; representative of children in Chicago in 1996-1998). Neighborhood structural disadvantage was assessed via U.S. Census…

Burchinal, Margaret; Nelson, Lauren; Carlson, Mary; Brooks-Gunn, Jeanne

2008-01-01

397

Quality Matters in Early Childhood Education and Care: Finland  

ERIC Educational Resources Information Center

Early childhood education and care (ECEC) has become a policy priority in many countries. A growing body of research recognises that it provides a wide range of benefits, including social and economic benefits, better child well-being and learning outcomes as a foundation for lifelong learning, more equitable outcomes and reduction of poverty, and…

Taguma, Miho; Litjens, Ineke; Makowiecki, Kelly

2012-01-01

398

Factors affecting the quality of antenatal care provided to remote dwelling Aboriginal women in northern Australia.  

PubMed

Objective: there is a significant gap in pregnancy and birth outcomes for Australian Aboriginal and Torres Strait Islander women compared with other Australian women. The provision of appropriate and high quality antenatal care is one way of reducing these disparities. The aim of this study was to assess adherence to antenatal guidelines by clinicians and identify factors affecting the quality of antenatal care delivery to remote dwelling Aboriginal women. Setting and design: a mixed method study drew data from 27 semi-structured interviews with clinicians and a retrospective cohort study of Aboriginal women from two remote communities in Northern Australia, who gave birth from 2004-2006 (n=412). Medical records from remote health centres and the regional hospital were audited. Measurements and findings: the majority of women attended antenatal care and adherence to some routine antenatal screening guidelines was high. There was poor adherence to local guidelines for follow-up of highly prevalent problems including anaemia, smoking, urinary tract infections and sexually transmitted infections. Multiple factors influenced the quality of antenatal care. Key conclusions and implications for practice: the resourcing and organisation of health services and the beliefs, attitudes and practices of clinicians were the major factors affecting the quality of care. There is an urgent need to address the identified issues in order to achieve equity in women's access to high quality antenatal care with the aim of closing the gap in maternal and neonatal health outcomes. PMID:23809580

Bar-Zeev, Sarah; Barclay, Lesley; Kruske, Sue; Kildea, Sue

2014-03-01

399

Primary care quality improvement from a practice facilitator's perspective  

PubMed Central

Background Practice facilitation has proven to be effective at improving care delivery. Practice facilitators are healthcare professionals who work with and support other healthcare providers. To the best of our knowledge, very few studies have explored the perspective of facilitators. The objective of this study was to gain insight into the barriers that facilitators face during the facilitation process and to identify approaches used to overcome these barriers to help practices move towards positive change. Methods We conducted semi-structured interviews with four practice facilitators who worked with 84 primary care practices in Eastern Ontario, Canada over a period of five years (2007–2012). The transcripts were analyzed independently by three members of the research team using an open coding technique. A qualitative data analysis using immersion/crystallization technique was applied to interpret the interview transcripts. Results Common barriers identified by the facilitators included accessibility to the practice (e.g., difficulty scheduling meetings, short meetings), organizational behaviour (team organization, team conflicts, etc.), challenges with practice engagement (e.g., lack of interest, lack of trust), resistance to change, and competing priorities. To help practices move towards positive change the facilitators had to tailor their approach, integrate themselves, be persistent with practices, and exhibit flexibility. Conclusions The consensus on redesigning and transforming primary care in North America and around the world is rapidly growing. Practice facilitation has been pivotal in materializing the transformation in the way primary care practices deliver care. This study provides an exclusive insight into facilitator approaches which will assist the design and implementation of small- and large-scale facilitation interventions. PMID:24490746

2014-01-01

400

Parents' Perceptions of Pediatric Primary Care Quality: Effects of Race/Ethnicity, Language, and Access  

PubMed Central

Objective To examine the effects of race/ethnicity, language, and potential access on parents' reports of pediatric primary care experiences. Data Sources/Study Setting Primary survey data were collected (67 percent response rate) from 3,406 parents of students in kindergarten through sixth grade in a large urban school district in California during the 1999–2000 school year. Data Collection The data were collected by mail, telephone, and in person. Surveys were administered in English, Spanish, Vietnamese, and Tagalog. Study Design Data were analyzed using multiple regression models. The dependent variable was parents' reports of primary care quality, assessed via the previously validated Parents' Perceptions of Primary Care measure (P3C). The independent variables were race/ethnicity, language, and potential access to care (insurance status, presence of a regular provider of care), controlling for child age, gender, and chronic health condition status, and mother's education. Principal Findings Parents' reports of primary care quality varied according to race/ethnicity, with Asian and Latino parents reporting lower P3C scores than African Americans and whites. In multivariate analyses, both language and potential access exerted strong independent effects on primary care quality, reducing the effect of race/ethnicity such that the coefficient for Latinos was no longer significant, and the coefficient for Asians was much smaller, though still statistically significant. Conclusions To reduce racial/ethnic disparities in primary care, attention should be paid both to policies aimed at improving potential access and to providing linguistically appropriate services. PMID:12968814

Seid, Michael; Stevens, Gregory D; Varni, James W

2003-01-01

401

Quantitative quality assurance in a community hospital pediatric intensive care unit.  

PubMed Central

Unbiased, objective evaluations of quality of care are preferred over subjective evaluations. We observed 681 admissions to a pediatric intensive care unit of a community hospital from 1989 through 1990 for outcomes and physiologic profiles of the patients on the admission day using the Pediatric Risk of Mortality score to assess severity of illness. Mortality adjusted for severity of illness was compared with that predicted from a pediatric intensive care unit of a tertiary medical center: 32.6 deaths were predicted based on the physiologic profiles, and 23 occurred. The number of outcomes and their distribution according to mortality risk indicated close agreement between observed and predicted results. Thus, a quality-assurance technique developed in tertiary care centers can be used to indicate a comparable level of care in a community hospital. PMID:1441464

Frank, B S; Pollack, M M

1992-01-01

402

Quality of maternal and neonatal care in Central Asia and Europe-lessons learnt.  

PubMed

In the World Health Organization (WHO) European region despite official high coverage of essential interventions for maternal and neonatal care, there are still significant gaps in the delivery of effective interventions. Since 2001, WHO designed and implemented the Making Pregnancy Safer programme, which includes hands-on training courses in effective perinatal care for maternity teams, development of clinical guidelines, maternal mortality and morbidity case reviews, and assessments of quality of care. This has contributed to enhancing capacity at country level to improve organisation and provision of care. This paper describes the programme's components, challenges, achievements and results. PMID:25236627

Bacci, A

2014-09-01

403

The relationship between quality of care and financial performance in nursing homes.  

PubMed

Changes in the reimbursement structure of the Medicaid and Medicare programs have caused nursing homes to face severe revenue restraints. In the hopes of alleviating the effect of payment cutbacks on their financial performance, nursing homes have been instituting quality improvement initiatives. The goal of this study was to examine the relationships of quality of care with revenues, private-pay market share, and costs in the nursing home industry, and how these dynamics interplay to affect financial performance. This goal was achieved by using secondary data consisting of: (1) the Minimum Data Set Plus (MDS+); (2) the Health Care Information Analyst (HCIA) nursing home data set; and (3) the On-line Survey Certification of Automated Records (OSCAR) data set. Structural equation modeling (SEM) using maximum likelihood estimation was used to examine the total, direct, and indirect effects of the variables. Findings indicate that nursing homes that produce high quality care are able to achieve lower resident costs and in the process, report better financial performance than those facilities producing lower quality care. On the other hand, quality of care provided was not significantly associated with the revenues or private-pay market share of the nursing home. Overall, the total effects of quality to financial performance were positive (.055). PMID:12635994

Weech-Maldonado, Robert; Neff, Gerald; Mor, Vince

2003-01-01

404

Nursing practice environment, quality of care, and morale of hospital nurses in Japan.  

PubMed

The purpose of this study was to describe Japanese hospital nurses' perceptions of the nursing practice environment and examine its association with nurse-reported ability to provide quality nursing care, quality of patient care, and ward morale. A cross-sectional survey design was used including 223 nurses working in 12 acute inpatient wards in a large Japanese teaching hospital. Nurses rated their work environment favorably overall using the Japanese version of the Practice Environment Scale of the Nursing Work Index. Subscale scores indicated high perceptions of physician relations and quality of nursing management, but lower scores for staffing and resources. Ward nurse managers generally rated the practice environment more positively than staff nurses except for staffing and resources. Regression analyses found the practice environment was a significant predictor of quality of patient care and ward morale, whereas perceived ability to provide quality nursing care was most strongly associated with years of clinical experience. These findings support interventions to improve the nursing practice environment, particularly staffing and resource adequacy, to enhance quality of care and ward morale in Japan. PMID:23855754

Anzai, Eriko; Douglas, Clint; Bonner, Ann

2014-06-01

405

Paths to Partnership: Veterans Health Administration's Journey in Pilot Testing Breast Cancer Care Quality Measures.  

PubMed

Prioritizing personalized, proactive, patient-driven health care is among the Veterans Health Administration's (VHA's) transformational initiatives. As one of the largest integrated healthcare systems, the VHA sets standards for performance measures and outcomes achieved in quality of care. Evidence-based practice (EBP) is a hallmark in oncology nursing care. EBP can be linked to positive outcomes and improving quality that can be influenced directly by nursing interventions. VHA oncology nurses had the opportunity to partner with the Oncology Nursing Society (ONS), ONS Foundation, and the Joint Commission in the multiyear development of a comprehensive approach to quality cancer care. Building on a platform of existing measures and refining measurement sets culminated in testing evidence-based, nursing-sensitive quality measures for reliability through the ONS Foundation-supported Breast Cancer Care (BCC) Quality Measures Set. The BCC Measures afforded the VHA to have its many sites collectively assess documentation of the symptoms of patients with breast cancer, the use of colony-stimulating factors, and education about neutropenia precautions provided. Parallel paths of the groups, seeking evidence-based measures, led to the perfect partnership in the VHA's journey in pilot testing the BCC Measures in veterans with breast cancer. This generated further quality assessments and continuous improvement projects for spread and sustainability throughout the VHA. PMID:25252994

Hogg, Lori Hoffman

2014-10-01

406

Impacts of pay for performance on the quality of primary care  

PubMed Central

Increasingly, financial incentives are being used in health care as a result of increasing demand for health care coupled with fiscal pressures. Financial incentive schemes are one approach by which the system may incentivize providers of health care to improve productivity and/or adapt to better quality provision. Pay for performance (P4P) is an example of a financial incentive which seeks to link providers’ payments to some measure of performance. This paper provides a discussion of the theoretical underpinnings of P4P, gives an overview of the health P4P evidence base, and provide a detailed case study of a particularly large scheme from the English National Health Service. Lessons are then drawn from the evidence base. Overall, we find that the evidence for the effectiveness of P4P for improving quality of care in primary care is mixed. This is to some extent due to the fact that the P4P schemes used in primary care are also mixed. There are many different schemes that incentivize different aspects of care in different ways and in different settings, making evaluation problematic. The Quality and Outcomes Framework in the United Kingdom is the largest example of P4P in primary care. Evidence suggests incentivized quality initially improved following the introduction of the Quality and Outcomes Framework, but this was short-lived. If P4P in primary care is to have a long-term future, the question about scheme effectiveness (perhaps incorporating the identification and assessment of potential risk factors) needs to be answered robustly. This would require that new schemes be designed from the onset to support their evaluation: control and treatment groups, coupled with before and after data. PMID:25061341

Allen, T; Mason, T; Whittaker, W

2014-01-01

407

NCI Community Cancer Centers Program - Resources - Quality of Care and Survivorship Issues  

Cancer.gov

The American Society of Clinical Oncology's Quality Oncology Practice Initiative (QOPI) is an oncologist-led, practice-based quality improvement initiative. Its goal is to promote excellence in cancer care by helping practices create a culture of self-examination and improvement. QOPI includes a set of quality measures, a specified chart selection strategy, a secure system for data entry, automated data analysis and reporting, and a network of resources for improvement. Currently, more than 250 oncology practices are registered for QOPI.

408

Quality of intrapartum care at Mulago national referral hospital, Uganda: clients' perspective  

PubMed Central

Background Quality of intrapartum care is an important intervention towards increasing clients’ utilization of skilled attendance at birth and accelerating improvements in newborn’s and maternal survival and wellbeing. Ensuring quality of care is one of the key challenges facing maternal and neonatal services in Uganda. The study assessed quality of intrapartum care services in the general labor ward of the Mulago national referral and teaching hospital in Uganda from clients’ perspective. Methods A cross sectional study was conducted using face to face interviews at discharge with 384 systematically selected clients, who delivered in general labor ward at Mulago hospital during May, 2012. Data analysis was done using STATA Version (10) software. Means and median general index scores for quality of intrapartum care services were calculated. Linear regression models were used to determine factors associated with quality of care. Results Overall, quality of intrapartum care mean index score was 49.4 (standard deviation (sd) 15.46, and the median (interquartile range (IQR)) was 49.1 (37.5–58.9). Median index scores (IQR) per selected quality of care indicators were; dignity and respect 75 (50–87.5); relief of pain and suffering 71.4 (42.8-85.7); information 42.1 (31.6-55.3); privacy and confidentiality 33.3 (1–66.7); and involvement in decision making 16.7 (1–33.3). On average, higher educational level (college/university) (?: 6.81, 95% CI: 0.85-15.46) and rural residence of clients (?: 5.67, 95% CI: 0.95-10.3) were statistically associated with higher quality scores. Conclusion This study has revealed that quality of intrapartum care services from clients’ perspective was low. Improvements should be focused on involving clients in decision making, provision of information about their conditions and care, and provision of privacy and confidentiality. There is also need to improve the number and availability of health care providers in the labor ward. PMID:23941203

2013-01-01

409

The current state of quality of care measurement in the California Department of Corrections and Rehabilitation.  

PubMed

The quality of health care in prisons is lacking in many states. In particular, the California Department of Corrections and Rehabilitation (CDCR) is in the midst of an extreme legal remedy to address problems related to access to and quality of care; it now operates under the direction of a federally appointed receiver for medical care. To understand the current state of access and quality measurement and to assess strengths and weaknesses of current activities, the RAND Corporation conducted a series of interviews and site visits in the CDCR and related offices as well as document reviews (December 2008 to February 2009). Findings supported RAND's larger project goals to identify measures for use in a sustainable quality measurement system. PMID:21525115

Teleki, Stephanie S; Damberg, Cheryl L; Shaw, Rebecca; Hiatt, Liisa; Williams, Brie; Hill, Terry E; Asch, Steven M

2011-04-01

410

Research in action: using positive deviance to improve quality of health care  

PubMed Central

Background Despite decades of efforts to improve quality of health care, poor performance persists in many aspects of care. Less than 1% of the enormous national investment in medical research is focused on improving health care delivery. Furthermore, when effective innovations in clinical care are discovered, uptake of these innovations is often delayed and incomplete. In this paper, we build on the established principle of 'positive deviance' to propose an approach to identifying practices that improve health care quality. Methods We synthesize existing literature on positive deviance, describe major alternative approaches, propose benefits and limitations of a positive deviance approach for research directed toward improving quality of health care, and describe an application of this approach in improving hospital care for patients with acute myocardial infarction. Results The positive deviance approach, as adapted for use in health care, presumes that the knowledge about 'what works' is available in existing organizations that demonstrate consistently exceptional performance. Steps in this approach: identify 'positive deviants,' i.e., organizations that consistently demonstrate exceptionally high performance in the area of interest (e.g., proper medication use, timeliness of care); study the organizations in-depth using qualitative methods to generate hypotheses about practices that allow organizations to achieve top performance; test hypotheses statistically in larger, representative samples of organizations; and work in partnership with key stakeholders, including potential adopters, to disseminate the evidence about newly characterized best practices. The approach is particularly appropriate in situations where organizations can be ranked reliably based on valid performance measures, where there is substantial natural variation in performance within an industry, when openness about practices to achieve exceptional performance exists, and where there is an engaged constituency to promote uptake of discovered practices. Conclusion The identification and examination of health care organizations that demonstrate positive deviance provides an opportunity to characterize and disseminate strategies for improving quality. PMID:19426507

Bradley, Elizabeth H; Curry, Leslie A; Ramanadhan, Shoba; Rowe, Laura; Nembhard, Ingrid M; Krumholz, Harlan M

2009-01-01

411

[Cross-sectoral quality assurance in ambulatory care].  

PubMed

Overcoming rigid sectoral segmentation in healthcare has also become a health policy target in quality assurance. With the Act to Enhance Competition in Statutory Health Insurance (GKV-WSG) coming into effect, quality assurance measures are to be designed in a cross-sectoral fashion for in- and outpatient sectors equally. An independent institution is currently mandated to develop specific quality indicators for eleven indications. For three of these operating tests have already been commissioned by the Federal Joint Committee. This article depicts the major results of a feasibility study, including a compliance cost estimate, for the aforementioned indications of cross-sectoral quality assurance (cQA). In conclusion, a number of both practical and conceptual basic challenges are still to be resolved prior to the full implementation of cQA, such as a sufficient specification to activate documentation requirements and an inspection system capable of separating actual quality problems from documentary deficits. So far, a comprehensive cost-utility analysis of cQA has not been provided, in particular with comparison to existing QA systems. In order to optimise cost and utility of cQA an evidence-based approach is required for both the extension of cQA areas and for QA provisions. PMID:24290666

Albrecht, Martin; Loos, Stefan; Otten, Marcus

2013-01-01

412

HIV care providers emphasize the importance of the Ryan White Program for access to and quality of care.  

PubMed

With the implementation of the Affordable Care Act (ACA) under way, some policy makers have questioned the continued relevance of the Ryan White HIV/AIDS Program as a safety net for people living with HIV/AIDS. We surveyed HIV care providers to understand the role of the Ryan White Program and to identify concerns regarding the ACA implementation. We also addressed whether the program is still relevant after ACA implementation and, if so, what elements should be retained. We found that providers consider the Ryan White Program to be critical in facilitating high-quality care for people living with HIV/AIDS. Most of the providers highlighted the program's support for providing medical and nonmedical case management as especially valuable and important to the entire continuum of care and for all patient subpopulations. Whether care is supplied by the Ryan White Program, Medicaid, or other means, our findings suggest that case management services will remain critical in treating HIV/AIDS as the health care landscape continues to evolve. PMID:24590936

Sood, Neeraj; Juday, Timothy; Vanderpuye-Orgle, Jacqueline; Rosenblatt, Lisa; Romley, John A; Peneva, Desi; Goldman, Dana P

2014-03-01

413

Lessons Learned from Testing the Quality Cost Model of Advanced Practice Nursing (APN) Transitional Care  

PubMed Central

Purpose To describe the development, testing, modification, and results of the Quality Cost Model of Advanced Practice Nurses (APNs) Transitional Care on patient outcomes and health care costs in the United States over 22 years, and to delineate what has been learned for nursing education, practice, and further research. Organizing Construct The Quality Cost Model of APN Transitional Care. Methods Review of published results of seven randomized clinical trials with very low birth-weight (VLBW) infants; women with unplanned cesarean births, high risk pregnancies, and hysterectomy surgery; elders with cardiac medical and surgical diagnoses and common diagnostic related groups (DRGs); and women with high risk pregnancies in which half of physician prenatal care was substituted with APN care. Ongoing work with the model is linking the process of APN care with the outcomes and costs of care. Findings APN intervention has consistently resulted in improved patient outcomes and reduced health care costs across groups. Groups with APN providers were rehospitalized for less time at less cost, reflecting early detection and intervention. Optimal number and timing of postdischarge home visits and telephone contacts by the APNs and patterns of rehospitalizations and acute care visits varied by group. Conclusions To keep people well over time, APNs must have depth of knowledge and excellent clinical and interpersonal skills that are the hallmark of specialist practice, an in-depth understanding of systems and how to work within them, and sufficient patient contact to effect positive outcomes at low cost. PMID:12501741

Brooten, Dorothy; Naylor, Mary D.; York, Ruth; Brown, Linda P.; Munro, Barbara Hazard; Hollingsworth, Andrea O.; Cohen, Susan M.; Finkler, Steven; Deatrick, Janet; Youngblut, JoAnne M.

2013-01-01

414

Neonatal nurse practitioners provide quality, cost-effective care.  

PubMed

Loretta Ford, the pioneer of nurse practitioners, was the recipient of the Crystal Trailblazer Award from the American College of Nurse Practitioners in February 2003. In her acceptance speech, the stated that "in some ways, the profession had expanded beyond my wildest dreams," but cautioned against the medicalization of the NP role: "The profession is rooted in nursing ... and we enhance, advance, and influence through nursing." She added: "Medical and nursing interdependency sets the stage for the highest level of care. No one profession can deliver comprehensive health care themselves." NNPs, functioning collaboratively with neonatologists as part of a multidisciplinary team, illustrate the truth of Ford's words. They have clearly and unequivocally made significant strides during the past 20 years. Their achievements and contributions have been many but their potential has yet to be reached. PMID:14508891

Geiss, Donna M; Cavaliere, Terri A

2003-09-01

415

The quality of care delivered to Parkinson's disease patients in the U.S. Pacific Northwest Veterans Health System  

Microsoft Academic Search

BACKGROUND: Parkinson's disease (PD) is the second most common chronic neurological disorder of the elderly. Despite the fact that a comprehensive review of general health care in the United States showed that the quality of care delivered to patients usually falls below professional standards, there is limited data on the quality of care for patients with PD. METHODS: Using the

Kari Swarztrauber; Eric Graf; Eric Cheng

2006-01-01

416

A new implicit review instrument for measuring quality of care delivered to pediatric patients in the emergency department  

Microsoft Academic Search

BACKGROUND: There are few outcomes experienced by children receiving care in the Emergency Department (ED) that are amenable to measuring for the purposes of assessing of quality of care. The purpose of this study was to develop, test, and validate a new implicit review instrument that measures quality of care delivered to children in EDs. METHODS: We developed a 7-point

Madan Dharmar; James P Marcin; Nathan Kuppermann; Emily R Andrada; Stacey Cole; Danielle J Harvey; Patrick S Romano

2007-01-01

417

Culture and Caregiving: Goals, Expectations, & Conflict.  

ERIC Educational Resources Information Center

"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 goals, expectations, and conflict in the relationship between culture and child caregiving and other care services.…

Fenichel, Emily, Ed.

2003-01-01

418

Measuring Process of Arthritis Care. A Proposed Set of Quality Measures for the Process of Care in Juvenile Idiopathic Arthritis  

PubMed Central

Objectives The ability to assess quality of care is a necessary component of continuous quality improvement. The assessment typically is accomplished by determination of compliance with a defined set of quality measures (QMs). The objective of this effort was to establish a set of QM for the assessment of the process of care in JIA. Methods A 12 member working group (WG) composed of representatives from the ACR, AAP, ABP, and ARHP was assembled to guide the project. Delphi questionnaires were sent to 237 health professionals involved in the care of children with juvenile idiopathic arthritis (JIA). A total of 471 items in 27 domains were identified. The WG met via four live e-meetings during which results from the Delphi’s were distilled to a reduced draft set. Each WG member selected a proposed QM to investigate and present evidence from the literature as to its attributes and appropriateness for inclusion into the set. Nominal group technique was used to come to consensus on a proposed set of QMs. Results The proposed set contains 12 QMs within four health care domains. Each QM consists of a statement of (i) the assessment to be completed, (ii) when the first assessment should be completed and a suggested frequency of assessment during follow-up, (iii) recommendations of appropriate tools or methods of assessment, and (iv) initial performance goals. Conclusions Implementation of the proposed QM set will improve the process of care, facilitate continuous QI, and eventuate in improved health outcomes of children with JIA. PMID:20842714

Lovell, Daniel J.; Passo, Murray H.; Beukelman, Timothy; Bowyer, Suzanne L.; Gottlieb, Beth S.; Henrickson, Michael; Ilowite, Norman T.; Kimura, Yukiko; DeWitt, Esi Morgan; Segerman, Jill; Stein, Leonard D.; Taylor, Janalee; Vehe, Richard K.; Giannini, Edward H.

2010-01-01

419

Centre-Based Child Care Quality in Urban Australia  

ERIC Educational Resources Information Center

This study investigates the quality of childcare centres in urban Australian communities designated according to different bands of Centre Location Demographics (CLD). Childcare centres were assessed using the Early Childhood Environment Rating Scale- Revised Edition (ECERS-R) and the Early Childhood Environment Rating Scale-Extension (ECERS-E).…

Ishimine, Karin; Wilson, Rachel

2009-01-01

420

Prescribing Quality Patellofemoral Rehabilitation Before Advocating Operative Care  

Microsoft Academic Search

In this article we discuss causes of patellofe- moral dysfunction (Table 1), the treatment algo- rithm of nonsurgical therapy modalities, and what constitutes a quality rehabilitation protocol for a patient with patellofemoral dysfunction. We also discuss how to avoid patellofemoral problems after surgery of the knee joint. Patellofe- moral pain is one of the most prevalent knee problems, affecting nearly

Anil Bhave; Erin Baker

421

Patient views on quality care in general practice: Literature review  

Microsoft Academic Search

The present paper examines research on patient satisfaction and the factors which influence patient attitudes regarding quality in general practice. Although data are used from U.S. and other sources, conclusions are drawn with a specific focus on a U.K. general practice context. This is a research area with a growing literature, much of it based on unsystematic research. The purpose

J. Rees Lewis

1994-01-01

422

Improving the Quality of Maternal and Neonatal Care: the Role of Standard Based Participatory Assessments  

PubMed Central

Background Gaps in quality of care are seriously affecting maternal and neonatal health globally but reports of successful quality improvement cycles implemented at large scale are scanty. We report the results of a nation-wide program to improve quality of maternal and neonatal hospital care in a lower-middle income country focusing on the role played by standard-based participatory assessments. Methods Improvements in the quality of maternal and neonatal care following an action-oriented participatory assessment of 19 areas covering the whole continuum from admission to discharge were measured after an average period of 10 months in four busy referral maternity hospitals in Uzbekistan. Information was collected by a multidisciplinary national team with international supervision through visit to hospital services, examination of medical records, direct observation of cases and interviews with staff and mothers. Scores (range 0 to 3) attributed to over 400 items and combined in average scores for each area were compared with the baseline assessment. Results Between the first and the second assessment, all four hospitals improved their overall score by an average 0.7 points out of 3 (range 0.4 to 1), i.e. by 22%. The improvements occurred in all main areas of care and were greater in the care of normal labor and delivery (+0.9), monitoring, infection control and mother and baby friendly care (+0.8) the role of the participatory action-oriented approach in determining the observed changes was estimated crucial in 6 out of 19 areas and contributory in other 8. Ongoing implementation of referral system and new classification of neonatal deaths impede the improved process of care to be reflected in current statistics. Conclusions Important improvements in the quality of hospital care provided to mothers and newborn babies can be achieved through a standard-based action-oriented and participatory assessment and reassessment process. PMID:24167616

Tamburlini, Giorgio; Yadgarova, Klara; Kamilov, Asamidin; Bacci, Alberta

2013-01-01

423

Missing Elements Revisited: Information Engineering for Managing Quality of Care for Patients with Diabetes  

PubMed Central

Introduction Advances in information technology offer new avenues for assembling data about diet and care regimens of diabetes patients “in the field.” This creates a challenge for their doctors and the diabetes care community—how to organize and use new data to produce better long-term outcomes for diabetes patients. Methods iAbetics approaches the challenge as a quality management problem, drawing on total quality concepts, which in turn are grounded in application of the scientific method. We frame the diabetes patient's quality-of-care problem as an ongoing scientific investigation aimed at quantifying and predicting relationships between specific care-management actions and their outcomes for individual patients in their ordinary course of life. Results Framing diabetes quality-of-care management as a scientific investigation leads to a seven-step model termed “adaptive empirical iteration.” Adaptive empirical iteration is a deliberate process to perfect the patient's choices, decisions, and actions in routine situations that make up most day-to-day life and to systematically adapt across differences in individual patients and/or changes in their physiology, diet, or environment. The architecture incorporates care-protocol management and version control, structured formats for data collection using mobile smart phones, statistical analysis on secure Web sites, tools for comparing alternative protocols, choice architecture technology to improve patient decisions, and information sharing for doctor review. Conclusions Adaptive empirical iteration is a foundation for information architecture designed to systematically improve quality-of-care provided to diabetes patients who act as their own day-to-day care provider under supervision and with support from their doctor. The approach defines “must-have” capabilities for systems using new information technology to improve long-term outcomes for diabetes patients. PMID:20920451

Connor, Matthew J; Connor, Michael J

2010-01-01

424

Improving cancer patient care: development of a generic cancer consumer quality index questionnaire for cancer patients  

PubMed Central

Background To develop a Consumer Quality Index (CQI) Cancer Care questionnaire for measuring experiences with hospital care of patients with different types of cancer. Methods We derived quality aspects from focus group discussions, existing questionnaires and literature. We developed an experience questionnaire and sent it to 1,498 Dutch cancer patients. Another questionnaire measuring the importance of the quality aspects was sent to 600 cancer patients. Data were psychometrically analysed. Results The response to the experience questionnaire was 50 percent. Psychometric analysis revealed 12 reliable scales. Patients rated rapid and adequate referral, rapid start of the treatment after diagnosis, enough information and confidence in the healthcare professionals as most important themes. Hospitals received high scores for skills and cooperation of healthcare professionals and a patient-centered approach by doctors; and low scores for psychosocial guidance and information at completion of the treatment. Conclusions The CQI Cancer Care questionnaire is a valuable tool for the evaluation of the quality of cancer care from the patient’s perspective. Large scale implementation is necessary to determine the discriminatory powers of the questionnaire and may enable healthcare providers to improve the quality of cancer care. Preliminary results indicate that hospitals could improve their psychosocial guidance and information provision. PMID:23617741

2013-01-01

425

Evaluation of a Quality Improvement Collaborative in Asthma Care: Does it Improve Processes and Outcomes of Care?  

PubMed Central

PURPOSE We wanted to examine whether a collaborative to improve asthma care influences process and outcomes of care in asthmatic adults. METHOD We undertook a preintervention-postintervention evaluation of 185 patients in 6 intervention clinics and 3 matched control sites that participated in the Institute for Healthcare Improvement Breakthrough Series (BTS) Collaborative for asthma care. The intervention consisted of 3, 2-day educational sessions for teams dispatched by participating sites, which were followed by 3 action periods during the course of a year. RESULTS Overall process of asthma care improved significantly in the intervention compared with the control group (change of 10% vs 1%, P = .003). Patients in the intervention group were more likely to attend educational sessions (20% vs 5%, P = .03). Having a written action plan, setting goals, monitoring peak flow rates, and using long-term asthma medications increased between 2% and 19% (not significant), but asthma-related knowledge was unchanged for the 2 groups. Patients in the BTS Collaborative were significantly more likely to be satisfied with clinician and lay educator communication (62% vs 39%, P = .02). Health-related quality of life, asthma-specific quality of life, number of bed days caused by asthma-related illness, and acute care service use were not significantly different between the 2 groups. CONCLUSIONS The intervention was associated with improved process-of-care measures that have been linked with better outcomes. Patients benefited through increased satisfaction with communication. Follow-up of patients who participated in the intervention may have been too brief to be able to detect significant improvement in health-related outcomes. PMID:15928222

Schonlau, Matthias; Mangione-Smith, Rita; Chan, Kitty S.; Keesey, Joan; Rosen, Mayde; Louis, Thomas A.; Wu, Shin-Yi; Keeler, Emmett

2005-01-01

426

The Strengthening Families Initiative and Child Care Quality Improvement: How Strengthening Families Influenced Change in Child Care Programs in One State  

ERIC Educational Resources Information Center

Research Findings: This study investigated how the Strengthening Families through Early Care and Education initiative in Illinois (SFI) influenced change in 4 child care programs. Findings indicate that SFI influenced quality improvements through 4 primary pathways: (a) Learning Networks, (b) the quality of training, (c) the engagement of program…

Douglass, Anne; Klerman, Lorraine

2012-01-01

427

Psychosocial work conditions and quality of life among primary health care employees: a cross sectional study  

PubMed Central

Background Workers in Primary Health Care are often exposed to stressful conditions at work. This study investigated the association between adverse psychosocial work conditions and poor quality of life among Primary Health Care workers. Methods This cross-sectional study included all 797 Primary Health Care workers of a medium-sized city, Brazil: doctors, nurses, nursing technicians and nursing assistants, dentists, oral health technicians, and auxiliary oral hygienists, and community health workers. Data were collected by interviews. Quality of life was assessed using the WHOQOL-BREF; general quality of life, as well as the physical, psychological, social and environmental domains were considered, with scores from 0 to 100. Higher scores indicate a better quality of life. Poor quality of life was defined by the lowest quartiles of the WHOQOL score distributions for each of the domains. Adverse psychosocial work conditions were investigated by the Effort-Reward Imbalance model. Associations were verified using multiple logistic regression. Results Poor quality of life was observed in 117 (15.4%) workers. Workers with imbalanced effort-reward (high effort/low reward) had an increased probability of general poor quality of life (OR?=?1.91; 1.07–3.42), and in the physical (OR?=?1.62; 1.02–2.66), and environmental (OR?=?2.39; 1.37–4.16) domains; those with low effort/low reward demonstrated a greater probability of poor quality of life in the social domain (OR?=?1.82; 1.00–3.30). Workers with overcommitment at work had an increased likelihood of poor quality of life in the physical (OR?=?1.55, 1.06–2.26) and environmental (OR?=?1.69; 1.08–2.65) domains. These associations were independent of individual characteristics, job characteristics, lifestyle, perception of general health, or psychological and biological functions. Conclusions There is an association between adverse psychosocial work conditions and poor quality of life among Primary Health Care workers. PMID:24884707

2014-01-01

428

Putting the spotlight on health literacy to improve quality care.  

PubMed

A recent survey from the American Medical Association Foundation found that the issue of health literacy is just a blip on many physicians' radar screens. However, this problem is beginning to receive greater attention because of its magnitude: An estimated 90 million adult Americans face challenges in understanding basic, common instructions given to them by their physicians. Related to low health literacy is the potential impact on patient outcomes, which could mean additional healthcare costs of up to $73 billion annually. This issue of The Quality Letter for Healthcare Leaders looks at how health literacy is defined and what can be done to improve communication among providers and patients from all walks of life to promote quality healthcare. PMID:12918286

2003-07-01

429

Practical approaches for health care: Indoor air quality management  

SciTech Connect

The management of indoor air quality (IAQ) is of interest to building occupants, managers, owners, and regulators alike. Whether by poor design, improper attention, inadequate maintenance or the intent to save energy, many buildings today have significantly degraded IAQ levels. Acceptable IAQ is defined by the American Society of Heating, Refrigerating, and Air Conditioning Engineers (ASHRAE) in Standard 62-1989 {open_quotes}Ventilation for Acceptable Indoor Air Quality{close_quotes} as {open_quotes}air in which there are no known contaminants at harmful concentrations as determined by cognizant authorities and with which a substantial majority (80 percent or more) of the people exposed do not express dissatisfaction.{close_quotes} ASHRAE`s definition not only addresses the chemical compounds that may be present in the air, but it also recognizes a need to address both physiological and psychosocial comfort. The second step is to conduct a performance review of the HVAC systems based on equipment design specifications and guidelines for acceptable IAQ. And the third step is to identify potential chemical, physical and biological sources that are known to contribute to adverse air quality. Upon completion of these three steps, you will able to identify the more significant contributors to IAQ problems and establish applications for prevention and mitigation.

Turk, A.R.; Poulakos, E.M.

1996-05-01

430

Counseling in Primary Care Improves Depression and Quality of Life  

PubMed Central

Introduction: To measure the effectiveness on Quality of Life of adjunctive cognitive behavioral counseling in the setting of General Practitioners (GPs) along with the treatment as usual (TAU;) for the treatment of depression. Methods: Six month-controlled trial of patients who were referred to randomly assigned GPs (four for experimental group of patients and ten for the control) was done. Experimental sample had 34 patients with DSM-IV diagnosis of Depression (Depressed Episode, Dysthymia, or Adjustment Disorder with Depressed Mood) receiving the TAU supplemented with counseling. Control group had 30 patients with diagnosis of Depression receiving only the TAU. Results: The Beck Depression Inventory (BDI) score improved in both groups. Patients in the experimental group showed greater improvement compared to the control group at T2. The World Health Organization Quality OF Life Questionnaire (WHOQOL) score also improved in the experimental group but not in the control group. The improvement in the experimental group was statistically significant in terms of both BDI and WHOQOL scores. Conclusions: Adding counseling to TAU in general medical practice settings is more effective in controlling the symptoms of depression and improving the quality of life as measured over a period of six months, than TAU alone. These results while encouraging, also calls for a larger study involving a largersample size and a longer period of time. PMID:23173011

Carta, MG; Petretto, D; Adamo, S; Bhat, KM; Lecca, ME; Mura, G; Carta, V; Angermeyer, M; Moro, MF

2012-01-01

431

Healthcare Inspection: Alleged Radiology and Cardiology Quality of Care Issues Malcom Randall VA Medical Center Gainesville, Florida.  

National Technical Information Service (NTIS)

The purpose of this review was to determine the validity of allegations regarding timeliness of care, quality of care and staff certification at the Malcom Randall VA Medical Center Gainesville, FL. The complaint alleged: Biopsies in the radiology departm...

2010-01-01

432

Medicare Part B reimbursement and the perceived quality of physician care.  

PubMed

The maximum amount physicians can charge Medicare patients for Part B services depends on Medicare reimbursement rates and on federal and state restrictions regarding balance billing. This study evaluates whether Part B payment rates, state restrictions on balance billing beyond the federal limit, and physician balance billing influence how beneficiaries rate the quality of their doctor's care. Using nationally representative data from the 2001 to 2003 Medicare Current Beneficiary Survey, this paper finds strong evidence that Medicare reimbursement rates, and state balance billing restrictions influence a wide range of perceived care quality measures. Lower Medicare reimbursement and restrictions on physicians' ability to balance bill significantly reduce the perceived quality of care under Part B. PMID:19960245

Brunt, Christopher S; Jensen, Gail A

2010-06-01

433

[Evaluation of the quality of primary health care in Sopot after privatization].  

PubMed

One of the main aims of health system reform was to increase the quality of service and patients' satisfaction. The deepest changes were in the primary care sector. Besides the changes in financing the services, we can observe here the process of privatisation of primary care clinics. We have evaluated the quality of services of four private primary care clinics in the town of Sopot. We received 571 questionnaires from the patients. The average patient was 50 years old, finished high school and complained of mild health problems. Most of patients were satisfied of given services by physicians and nurses. In most categories they gave 85 to 95% good and very good marks for specific quality aspects. One of the main complains was information received, both in the registration board and from the physician. Most of patients were also delighted by medical outcome of treatment, because only 18% gave their mark as satisfactory and worse. PMID:15002239

Jedrzejczyk, Tadeusz; Zarzeczna-Baran, Marzena; Popowski, Piotr

2002-01-01

434

National healthcare information system in Croatian primary care: the foundation for improvement of quality and efficiency in patient care.  

PubMed

In order to improve the quality of patient care, while at the same time keeping up with the pace of increased needs of the population for healthcare services that directly impacts on the cost of care delivery processes, the Republic of Croatia, under the leadership of the Ministry of Health and Social Welfare, has formed a strategy and campaign for national public healthcare system reform. The strategy is very comprehensive and addresses all niches of care delivery processes; it is founded on the enterprise information systems that will aim to support end-to-end business processes in the healthcare domain. Two major requirements are in focus: (1) to provide efficient healthcare-related data management in support of decision-making processes; (2) to support a continuous process of healthcare resource spending optimisation. The first project is the Integrated Healthcare Information System (IHCIS) on the primary care level; this encompasses the integration of all primary point-of-care facilities and subjects with the Croatian Institute for Health Insurance and Croatian National Institute of Public Health. In years to come, IHCIS will serve as the main integration platform for connecting all other stakeholders and levels of health care (that is, hospitals, pharmacies, laboratories) into a single enterprise healthcare network. This article gives an overview of Croatian public healthcare system strategy aims and goals, and focuses on properties and characteristics of the primary care project implementation that started in 2003; it achieved a major milestone in early 2007 - the official grand opening of the project with 350 GPs already fully connected to the integrated healthcare information infrastructure based on the IHCIS solution. PMID:18005567

Gvozdanovi?, Darko; Koncar, Miroslav; Kojundzi?, Vinko; Jezidzi?, Hrvoje

2007-01-01

435

Research Initiatives | CanCORS: Research Gaps Identified in Cancer Care Quality and Outcomes  

Cancer.gov

CanCORS has prospectively studied the quality of care and health outcomes of approximately 5,000 lung cancer patients and approximately 5,000 colorectal cancer patients. The study design, which blends patient, provider, and caregiver surveys with detailed clinical data from medical records, provides a rich and comprehensive data resource, allowing the investigators to examine care processes and outcomes during initial treatment as well as long-term survivorship in greater detail than previously possible.

436

Quality of life in terminal care—with special reference to age, gender and marital status  

Microsoft Academic Search

Objectives  This study was conducted to explore symptoms, other quality of life (QoL) aspects and impact of age, gender, marital status, cancer diagnosis and time of survival in patients with advanced cancer admitted to palliative care.Patients and methods  A cross-sectional study of 278 cancer patients completing the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 at referral to palliative care.Main

C. Lundh Hagelin; Åke Seiger; C. J. Fürst

2006-01-01

437

Children's Books in Child Care Classrooms: Quality, Accessibility, and Reasons for Teachers' Choices  

Microsoft Academic Search

The importance of child care classrooms as contexts for early literacy development makes it critical to investigate the child care teacher's role in selecting, reading, and making accessible high-quality children's books, and in providing a variety of reading opportunities. The present study was designed to obtain exploratory descriptive information about this neglected topic. Twenty-one teachers of 4-year-old children from a

Sandra Stone; Sandra Twardosz

2001-01-01

438

Canadian experiences in telehealth: equalizing access to quality care.  

PubMed

The Canadian Conference "TExpo'98: Interactive Health" focused on four telehealth themes: community needs, Canadian experiences, industry perspectives, and access/security/interoperability issues. Health and socioeconomic needs have been the driving force behind telehealth initiatives; telelearning is one of the major Canadian initiatives. To encourage Canadian telehealth initiatives, the federal government is building a national health infrastructure. One element in this framework is concerned with empowering the public, strengthening health care services, and ensuring accountability. Technological advancements and innovative partnerships among health communities, government, users, professional bodies, and industry are critical to continued growth. Key issues including access, evaluation, implementation, privacy, confidentiality, security, and interoperability are of universal concern to participants. Research that examines the benefits and costs of telehealth is needed. PMID:11110641

Jennett, P A; Person, V L; Watson, M; Watanabe, M

2000-01-01

439

The Criminal Prosecutor's Roles in Assuring Quality of Care in Long Term Care Settings  

Microsoft Academic Search

In 1990, allegations of the wounding and deaths of nursing home residents due to malnutrition, dehydration, and decubitus ulceration were made by Philadelphi