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|This publication deals with the present crisis in infant/toddlercare. It presents information on infant/toddler development and optimal caregiving paractices, citing recent research on appropriate practices and the impact of poor versus qualitycare. The book is divided into two sections. In the first section, "Development and Program…
This report describes what has been learned in the first year of a study to examine collaborative community initiatives designed to improve low-income families' access to good-qualityinfant-toddler child care; the report examines the Early Head Start/child care partnerships in detail and identifies emerging themes to consider in more depth as the…
|Concern about the quality of infant-toddlercare 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 Digest introduces some of the many issues related to the quality of infant-toddler…
Discusses ingredients of qualityinfant/toddler caregiving; these include individualized attentive loving, respect for children's tempos and exploration needs, language mastery experiences, activities shared by caregiver and child, nutrition and health care, promotion of babies' altruism, continuity of care and cognitive facilitation. (BB)
|This guide is intended to be used in conjunction with the fourth module of the Program for Infant/Toddler Caregivers (PITC), a four-module video training course for providers of family and center day care. The videos illustrate key concepts and caregiving techniques for a specific area of care, and the guides provide extensive and in-depth…
Describes the growth of Early Head Start (EHS) programs, focusing on one EHS partnership with child care providers in Delaware to serve infants, toddlers, and their families. Includes discussion of partnership strategies that promote quality programming, ways the early care and education coordinator supports child development, strategies for…
Notes that the differences between infant/toddlercare and preschool care have been ignored in all but the best programs and day care homes. Examines child care policies and practices from the perspective of their influence on infant/toddler identity formation, including continuity of care and curricula that are responsive rather than…
|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.
|This paper questions the physical environmental adequacy of the Infant/Toddler Environment Rating Scale (ITERS) developed by Thelma Harms, Debby Cryer, and Richard Clifford at the University of North Carolina, Chapel Hill. ITERS is a 35-item scale designed to assess the quality of center-based infant and toddler care, and one of a family of child…
Infant\\/toddler programs present a challenge to their administrators. The challenge can be successfully met by creative, imaginative, and committed administrators, who ensure the survival of their programs by meeting criteria common to most infant\\/toddler programs. Seven important criteria or characteristics of successful programs which have been developed are discussed here: positive interpersonal relationships; a sound philosophical base; clear delineation of
Beverly Gulley; Billie J. Thomas; Nillofur Zobairi
Describes promising strategies for building community collaborations and partnerships, as well as preliminary themes that may be helpful for programs, communities, and policymakers interested in developing, implementing, and supporting child care partnerships. Focusing on Early Head Start, the authors note that many partnerships have succeeded in expanding access and improving quality, although challenges remain, especially when state licensing requirements differ
Diane Paulsell; Julie Cohen; Ail Stieglitz; Erica Lurie-Hurvitz; Emily Fenichel; Ellen Kisker
|Concern about the quality of infant-toddlercare 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…
|What do preschool teachers know about infant/toddlercare and education? The answer to the question in the title is "Lots!" "if" they are fans of Lilian Katz. The author would not have said that before she sat down to read the new book Lilian wrote with her son Stephen. It's called "Intellectual Emergencies." It starts out with 12 of Lilian's…
\\u000a Increasing numbers of infants\\u000a \\u000a and toddlers\\u000a \\u000a are entering out-of-home care and early education programs. Understanding the specific developmental needs of infants\\u000a \\u000a and toddlers\\u000a \\u000a as they experience the transition from familiar parental care to unfamiliar other care is central to a quality program. Focus\\u000a is on typically developing infants\\u000a \\u000a and toddlers\\u000a \\u000a as well as those with special needs in early intervention
|Analyzed sleep-wake schedules and nap times in multiage infant-toddler groups through three case studies in Finnish day care centers. Found complex interactions among family daily patterns, day care patterns, and young children's sleep disturbances. Identified major differences in day care practices regarding sleep quality related to timing,…
|Discusses three major characteristics that are important for child care professionals: experience, knowledge, and special personal qualities. Among the special personal qualities discussed are those of anticipating and planning, protecting, listening, comforting, and caring for the whole family. (BB)|
|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…
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…
|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…
To address the increasing child care needs of low-income families in the wake of welfare reform, federal and state governments have responded with increased funding for child care and for initiatives to improve quality. Some of these initiatives have been designed specifically to address the unique challenges of infant-toddlercare. This report…
|Emphasizing brain research, this guide is designed to help trainers teach caregivers to provide responsive care to infants/toddlers and to understand why responsive care is important. The training is targeted for anyone in a caregiving role, especially child care providers and home care providers. The guide is organized in three sections. Section…
|"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…
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 Scale (ITERS) and the Early Childhood Environment
Hillel Goelman; Barry Forer; Paul Kershaw; Gillian Doherty; Donna Lero; Annette LaGrange
The purpose of this study was to identify structural characteristics of center child care that are associated with observed child carequality 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
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
In recent years, there has been a significant growth of interest in ensuring that child care provision for children is of\\u000a a high quality. This interest has been stimulated by research evidence according to which good quality child care has a positive\\u000a influence on children’s overall development. The global quality in Greek preschool and infant\\/toddler classrooms was assessed\\u000a with ACEI
The importance of qualitycare for infants, toddlers, and young children continues to be emphasized. The Frank Porter Graham Child Development Center provided data that support the importance of quality childcare. Their longitudinal study showed that infants who received qualitycare were more likely to score higher on IQ, reading, and math tests,…
|The importance of qualitycare for infants, toddlers, and young children continues to be emphasized. The Frank Porter Graham Child Development Center provided data that support the importance of quality childcare. Their longitudinal study showed that infants who received qualitycare were more likely to score higher on IQ, reading, and math…
|Two members of the U.S. Congress share their visions for infants, toddlers, and families. Senator Christopher Dodd (D-CT), Ranking Member of the Subcommittee on Education and Early Childhood Development, Senate Committee on Health, Education, Labor, and Pensions, advocates shifting priorities and resources toward young children and families and…
The effects of high- versus low-quality child care during 2 developmental periods (infant-toddlerhood and preschool) were examined using data from the National Institute of Child Health and Human Development Study of Early Child Care. Propensity score matching was used to account for differences in families who used different combinations of child carequality during the 2 developmental periods. Findings indicated that cognitive, language, and preacademic skills prior to school entry were highest among children who experienced high-qualitycare in both the infant-toddler and preschool periods, somewhat lower among children who experienced high-quality child care during only 1 of these periods, and lowest among children who experienced low-qualitycare during both periods. Irrespective of the care received during infancy-toddlerhood, high-quality preschool care was related to better language and preacademic outcomes at the end of the preschool period; high-qualityinfant-toddlercare, irrespective of preschool care, was related to better memory skills at the end of the preschool period. PMID:23127299
This essay discusses an early intervention program for infants, toddlers and preschoolers at risk of maltreatment that has been implemented by a state child protection agency, the Illinois Department of Children and Family Services. The Therapeutic Family Day Care Project offers quality out-of-home child care to young children at risk and support services to improve the caregiving skills of these
|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…
Background The prevalence of social-emotional and behavioral problems is estimated to be 8 to 9% among preschool children. Effective\\u000a early detection tools are needed to promote the provision of adequate care at an early stage. The Brief Infant-Toddler Social\\u000a and Emotional Assessment (BITSEA) was developed for this purpose. This study evaluates the effectiveness of the BITSEA to\\u000a enhance social-emotional and behavioral
Ingrid Kruizinga; Wilma Jansen; Alice S Carter; Hein Raat
|This final report documents the activities and outcomes of the 3-year outreach project AHEAD (At Home & At Day Care). Over the course of the three years, AHEAD Outreach conducted eight AHEAD Trainers' Training Institutes that provided AHEAD trainers with up-to-date content in the early intervention field, training techniques, hands-on…
This study investigates the construct validity and reliability of the Brief Infant-Toddler Social and Emotional Assessment (BITSEA) in a psychiatric clinical sample of toddlers. The sample consisted of a psychiatric clinical sample (N=112) (male, n=79; female, n=33) of toddlers (12- to 42-months old). Both mothers and fathers completed the BITSEA and mothers completed the Child Behavior Checklist 2/3 (CBCL). Children and their parents were administered a comprehensive psychiatric evaluation. Parents were also given the Autistic Behavior Checklist (AuBC) and the Aberrant Behavior Checklist-Community (ABC). The internal consistency of BITSEA scores was good to excellent for both parents. The BITSEA/Problem (P) scores were significantly correlated with Internalizing, Externalizing and Total Problem scores of the CBCL, all subscores of ABC and total score of AuBC. The BITSEA/Competence (C) scores were significantly inversely correlated with ABC total and AuBC lethargy scores. With respect to a community sample, BITSEA/P scores were significantly higher in the disruptive behavior disorder (DBD) and anxiety/depression (Anx/Dep) groups and BITSEA/C scores were significantly lower in the autism group. These results support the reliability and validity of the BITSEA as a screening tool that may be employed in primary health care services and in psychiatric clinical settings for assessing social-emotional/behavioral problems and delays in competence in infants and toddlers. PMID:20800285
Karabekiroglu, Koray; Briggs-Gowan, Margaret J; Carter, Alice S; Rodopman-Arman, Ayse; Akbas, Seher
The belief that a child has to abandon his home language to learn English implies that the young brain has limited learning capacity. Early childhood teachers need to help families understand that children can learn two languages at the same time. What matters is that the infant/toddler is in an effective language-learning environment, whether it…
This paper is a study of the effectiveness between video and toy reinforcer types to motivate infants\\/toddlers for hearing tests. No significant differences were found between age groups or gender. Toy reinforcers were found to produce on average two more threshold estimates compared to video reinforcers. Variety, color and animation of animals may have contributed to this difference.
|The belief that a child has to abandon his home language to learn English implies that the young brain has limited learning capacity. Early childhood teachers need to help families understand that children can learn two languages at the same time. What matters is that the infant/toddler is in an effective language-learning environment, whether it…
Many children lack adequate exposure to environments that promote emergent literacy. This limits brain stimulation and can have a life-long negative impact on one's knowledge and skills. Salient points relate to the healthy development of literacy, including practical information and applications. Emphasis is placed on strategies for motivating infants, toddlers, and preschoolers as they slowly and steadily build the competences
|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
This study examined potential discontinuity between eligibility policies for children moving from infant/toddler early intervention programs (Part H of Individuals with Disabilities Education Act) to preschool special education programs (Part B). In 14 states, all children eligible under Part H would remain eligible under Part B; in 37 states,…
This study investigates the construct validity and reliability of the Brief Infant–Toddler Social and Emotional Assessment (BITSEA) in a psychiatric clinical sample of toddlers. The sample consisted of a psychiatric clinical sample (N=112) (male, n=79; female, n=33) of toddlers (12- to 42-months old). Both mothers and fathers completed the BITSEA and mothers completed the Child Behavior Checklist 2\\/3 (CBCL). Children
Koray Karabekiroglu; Margaret J. Briggs-Gowan; Alice S. Carter; Ayse Rodopman-Arman; Seher Akbas
Approximately 500,000 teens become mothers every year, and 90% keep their babies. Problems are associated with adolescent parenting, including poor parenting skills and inappropriate infant\\/child feeding practices, which have developmental and health implications for the children. The purpose of this qualitative study was to identify the range of infant\\/toddler feeding practices among 20 pairs of Anglo and Mexican-American adolescent mothers
The TEACH Early Childhood Wisconsin is an initiative to address the crisis in recruitment, compensation, and retention of high-quality early childhood teachers and providers. The plan involves advanced training for infant/toddler caregivers, infant/toddler credential, administrator credential, and scholarships for higher education. Efforts are…
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.
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. M. Gevers Deynoot-Schaub & J. M. A. Riksen-Walraven, 2005). In the present study, results showed a low level of overall process quality for the 2005 sample, measured by the Infant/Toddler Environment Rating Scale-Revised (T. Harms, D. Cryer, & R. M. Clifford, 2003) and the Early Childhood Environment Rating Scale-Revised (T. Harms, R. M. Clifford, & D. Cryer, 1998). The present authors found a significant decline in process quality in comparison with the 1995 and 2001 findings. They concluded that, from an international perspective, the Netherlands has lost its leading position in child-carequality compared with that from 10 years ago. PMID:19069584
Vermeer, Harriet J; Van Ijzendoorn, Marinus H; De Kruif, Renée E L; Fukkink, Ruben G; Tavecchio, Louis W C; Riksen-Walraven, J Marianne; Van Zeijl, Jantien
... development and opportunities for health care providers, early education professionals, parents and ... readiness starts at birth and so should early childhood policy. Read the ZERO TO THREE policy agenda ...
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…
|Evolution has provided babies with wonderful ways to get the loving attention and care that they need from adults. When a baby is distressed, his cry is the most primitive and powerful tool for bringing help. By the time a baby is 2 or 3 months old, his dazzling smile and crooked grin evokes tenderness, smiles, and nurturance from adults who are…
|This newsletter theme issue focuses on providing services to infants with special needs in rural areas. In "Old Threads, New Patterns: Reaching Out to Rural Families," Deborah Harris-Usner discusses bringing infant mental health care and parent-infant psychotherapy to rural New Mexico. In "The People of Kids Place: Creating and Maintaining…
The relationships that children experience with each other during infancy are often a neglected area of study. Most attention has been paid to infants' relationships with adults. However, children are increasingly spending greater amounts of time in group care and with peers at even the early stages of infancy. In these settings, adults are often…
Early identification of autism spectrum disorders (ASDs) is facilitated by the use of standardized screening scales that assess the social emotional behaviors associated with ASD. Authors examined accuracy of Brief Infant-Toddler Social and Emotional Assessment (BITSEA) subscales in detecting Modified Checklist for Autism in Toddlers (M-CHAT) risk…
Gardner, Lauren M.; Murphy, Laura; Campbell, Jonathan M.; Tylavsky, Frances; Palmer, Frederick B.; Graff, J. Carolyn
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
In this study the reliability and validity of the Turkish version of the brief infant–toddler social emotional assessment (BITSEA) were investigated in a community sample. The sample consisted of 462 children (mean age: 24.60±7.93 [12–42] months) who had applied to Turkish health centers for immunization. Both parents completed the BITSEA; mothers completed the child behavior checklist 2\\/3 (CBCL). Internal consistencies
Koray Karabekiroglu; Ayse Rodopman-Arman; Pinar Ay; Mustafa Ozkesen; Seher Akbas; Gokce Nur Tasdemir; Omer Boke; Yildiz Peksen
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
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.
The National Head Start Child Development Institute establishes priorities for continuing to improve the quality and outcomes of child development systems and services for infants, toddlers, preschoolers, and their families in the 21st century. This Imple...
Basic ingredients in health care planning and qualitycare are addressed. Proper planning can assure that adequate manpower facilities are available to insure proper patient care. Thus, one of the most basic ingredients in quality health care is continual...
The purposes of this study were to present a conceptual model for selection into the early childhood profession and to test the model using contemporaneous assessments. A stratified random sample of center-based child care providers in 4 Midwestern states (n=964) participated in a telephone interview, and 223 were also assessed with the Early Childhood Environment Rating Scale—Revised or the Infant–Toddler
Julia C. Torquati; Helen Raikes; Catherine A. Huddleston-Casas
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…
Evaluating health carequality is important for consumers, health care providers, and society. Developing a measure of health care service quality is an important precursor to systems and organizations that value health carequality. SERVQUAL has been proposed as a broad-based measure of service quality that may be applicable to health care settings. Results from a study described in this paper verify SERVQUAL dimensions, but demonstrate additional dimensions that are specific to health care settings. PMID:16318013
This report, the fourth in the National Center for Early Development and Learning's (NCEDL) "Spotlights" series, is based on excerpts from a paper presented during a "Research into Practice in Infant/ToddlerCare" synthesis conference in fall 1997. The report addresses controlling diarrhea in out-of-home child care. The report notes that the rate…
|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.…
In this study the reliability and validity of the Turkish version of the brief infant-toddler social emotional assessment (BITSEA) were investigated in a community sample. The sample consisted of 462 children (mean age: 24.60+/-7.93 [12-42] months) who had applied to Turkish health centers for immunization. Both parents completed the BITSEA; mothers completed the child behavior checklist 2/3 (CBCL). Internal consistencies of the BITSEA-problem (P) and competence (C) scales were good to excellent (Cronbach's alpha=0.82 and 0.72, respectively). Interrater reliability between parents and test-retest reliability were good. BITSEA/P scores were significantly correlated with CBCL internalizing, externalizing and total problem scores (p<0.001). Maternal BITSEA/P cutpoint scores revealed that 30.6% of male toddlers and 28.6% of females were in the subclinical range and 13.1% of males and 17.6% of females were in clinical range. Results reveal that the Turkish version of BITSEA is a reliable, valid and simply applicable instrument for screening social, emotional and behavioral problems among toddlers. Clinical validation of the BITSEA/C and BITSEA/P is warranted. PMID:19411111
|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)|
|Child Care Dallas planned and implemented a project aiming to produce an employer-assisted family day care system which would meet the developmental needs of infants and toddlers, increase the community supply of infant/toddlercare, be affordable for parents and employers, demonstrate effective methods for recruiting and training competent…
|Child Care Dallas planned and implemented a project aiming to produce an employer-assisted family day care system which would meet the developmental needs of infants and toddlers, increase the community supply of infant/toddlercare, be affordable for parents and employers, and demonstrate effective methods for recruiting and training competent…
|This document is comprised of the six 1999 issues of a bimonthly newsletter providing information on young children's health and safety for California's child care professionals. Regular features include a column on infant/toddler concerns, a question-answer column regarding medical and health issues, a nutrition column, and resources for child…
Infrastructure, processes of care and outcome measurements are the cornerstone of qualitycare for pediatric trauma. This review aims to evaluate current evidence on system organization and concentration of pediatric expertise in the delivery of pediatric trauma care. It discusses key quality indicators for all phases of care, from pre-hospital to post-discharge recovery. In particular, it highlights the importance of measuring quality of life and psychosocial recovery for the injured child.
Simpson, Amelia J; Rivara, Frederick P; Pham, Tam N
Background The 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. Methods Parents of 7140 two-year-old children were invited in the study, of which 3170 (44.4%) parents completed the BITSEA. For evaluation of the score distribution, the presence of floor/ceiling effects was determined. The internal consistency (Cronbach's alpha) was evaluated and in subsamples the test-retest, parent-childcare provider interrater reliability and concurrent validity with regard to the Child Behavioral Checklist (CBCL). Discriminative validity was evaluated by comparing scores of parents that worry and parents that do not worry about their child's development. Results The BITSEA showed no floor or ceiling effects. Psychometric properties of the BITSEA Problem and Competence scale were respectively: Cronbach's alphas were 0.76 and 0.63. Test-retest correlations were 0.75 and 0.61. Interrater reliability correlations were 0.30 and 0.17. Concurrent validity was as hypothesised. The BITSEA was able to discriminate between parents that worry about their child and parents that do not worry. The psychometric properties of the BITSEA were comparable across gender and ethnic background. Conclusion The results in this large-scale study of a diverse sample support the reliability and validity of the BITSEA Problem scale. The BITSEA Competence scale needs further study. The performance of the BITSEA appears to be similar in subgroups by gender and ethnic background.
Kruizinga, Ingrid; Jansen, Wilma; de Haan, Carolien L.; van der Ende, Jan; Carter, Alice S.; Raat, Hein
|A search of requests for permission to photocopy articles from past issues of "Zero to Three" identified the seven articles of this collection, all published between 1985 and 1989. They deal with the care of typically developing infants and toddlers as well as with clinical practice with very young children with special health or developmental…
|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 InfantToddler Social-Emotional…
|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.
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 InfantToddler Social-Emotional…
The importance of early developmental and behavioral treatment for children with autism is increasingly recognized. Little is known, however, about early intervention policies that may affect service delivery to these children. The current study describes states' policies for providing early intervention services to children with Autistic Spectrum Disorders under the Individuals with Disabilities Education Act Part C and examines how Part C policies are associated with the proportion of school-age children diagnosed with autism served under IDEA. Results indicate few consistencies among states in policies and practices regarding the identification and care of infants and toddlers with autism. The implications of state variation for policy makers are discussed. PMID:16758329
This multicenter study compared health-related quality of life (HRQOL) and family function of pediatric liver transplant recipients to those of healthy children to determine if this population differed from a healthy population and to distinguish which pretransplant and posttransplant factors impact HRQOL and family function. HRQOL data from 102 patients achieving 2-year survival were collected with the InfantToddlerQuality
Estella M. Alonso; Katie Neighbors; Franca B. Barton; Sue V. McDiarmid; Stephen P. Dunn; George V. Mazariegos; Jeanne M. Landgraf; John C. Bucuvalas
The author, former chief of a medical department and experienced in quality management, describes the development of quality standards by palliative ch, the Swiss Society for Palliative Care. These standards are the basis for explicit quality-criteria. The performance of an institution for palliative care is evaluated against these criteria, during an audit and peer review. Further information is given concerning the label Quality in Palliative Care. The author describes the importance oft the PDCA-cycle as an instrument for permanent improvement. Institutions with little experience in quality management are adviced to start on a smaller scale and use internal audits. Finally the author gives some thoughts as to the limitations of quality management in palliative care. PMID:22334204
Examined opinions of diverse parents, teachers, and academics regarding Japanese society, its infant/toddlercare system, labor force, and family. Found evidence of a difficult transition in the culture of child rearing, including increased caregiver responsibility for child rearing and increased anxiety about parenting among young mothers.…
|The effects of modifying the structural quality components of inclusive classrooms on material engagement among toddlers (18-36 months) with and without disabilities were evaluated. Initially, three classrooms were evaluated using items that addressed structural quality from the Infant/Toddler Environment Rating Scale, the National Association…
DiCarlo, Cynthia F.; Stricklin, Sarintha B.; Reid, Dennis H.
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 infanttoddler…
Edwards, Carolyn Pope; Gandini, Lella; Peon-Casanova, Luis; Danielson, Jim
|Research continues to highlight the relationship between high quality preschool experiences for young children and the educational preparedness of their teachers. As a result, there is an increasing call for enhanced educational preparation for early childhood teachers working in the wide spectrum of programs serving infants, toddlers, and…
Quality is at the top of American consumers' demand list, and consequently American manufacturing companies have been forced to assign priority to the development of high-quality products. To improve the quality of what they offer, many manufacturers use the management philosophy known as total quality management (TQM), and now the service sector is following in their footsteps. The health care industry is a good example of a service industry that can benefit greatly from TQM, and it is the purpose of this article to show how a health care provider can implement TQM and evaluate its effects. PMID:10178544
Practice or Policy: Continuity of care (COC) has many benefits for young children's development but is not the norm in infant\\/toddler classrooms. As a consequence, policymakers might not realize how such an approach might also benefit the professional development of infant and toddler teachers, particularly if they come to the field with little formal training. Although the supports and policies
Practice or Policy: Continuity of care (COC) has many benefits for young children's development but is not the norm in infant/toddler classrooms. As a consequence, policymakers might not realize how such an approach might also benefit the professional development of infant and toddler teachers, particularly if they come to the field with little…
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 ...
|In FY 2009, the Children's Bureau funded the Center for the Study of Social Policy, in partnership with ZERO TO THREE: National Center for Infants, Toddlers, and Families, and the National Alliance of Children's Trust and Prevention Funds, to create a National Quality Improvement Center on Early Childhood (QIC-EC) focused on child maltreatment…
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 InfantToddler Social–Emotional Assessment (BITSEA) in a pilot study in Northern Finland. Parents (N?=?50) evaluated toddler development
Helena Haapsamo; Sanna Kuusikko-Gauffin; Alice S. Carter; Rachel Pollock-Wurman; Hanna Ebeling; Leena Joskitt; Katja Larinen; Hannu Soini; Päivi Pihlaja; Irma Moilanen
Quality assurance is discussed as a health planning objective, and structural and process factors affecting the quality of care are examined. Quality assurance and health planning are explored in relation to the rising cost of health care and the evidence...
The Mediational Intervention for Sensitizing Caregivers (MISC) model is a comprehensive developmental approach to help adults understand their role in child development by enhancing the quality of adult-child interactions. This article describes how the Irving B. Harris Program for Infants, Toddlers and Their Families at Bar-Ilan University…
This study aimed to evaluate diabetes quality measurement efforts, assess their strengths and areas for improvement, and identify gaps not adequately addressed by these measures. We conducted an environmental scan of diabetes quality measures, focusing on metrics included in the National Quality Measures Clearinghouse or promulgated by leading measurement organizations. Key informant interviews were also completed with thought leaders who develop, promote, and use quality measures. The environmental scan identified 146 distinct measures spanning 31 clinical processes or outcomes. This suggests a measurement system that is both redundant and inconsistent, with many different measures assessing the same clinical indicators. Interviewees believe that current diabetes measurement efforts are excessively broad and complex and expressed a need for better harmonization of these measures. Several gaps were also found, including a lack of measures focusing on population health, structural elements of health care, and prevention of diabetes. PMID:19848568
Leas, Brian F; Berman, Bettina; Kash, Kathryn M; Crawford, Albert G; Toner, Richard W; Goldfarb, Neil I; Nash, David B
The three aims of the Hmong Quality Hypertension Care Project (QoHC) were to: (1) define quality of care for hypertension from the perspective of Hmong patients; (2) develop a hypertension quality of care instrument for use with Hmong patients; and (3) pi...
Multiple perspectives regarding the definition of quality child care, and how child carequality 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.
Purpose – The purpose of this paper is to study the appropriateness of applying “manufacturing sector” quality management strategies to residential care homes sector and to analyze its influence on the quality of care. Design\\/methodology\\/approach – Observation and in-depth interviews were conducted with 41 Spanish care home top and middle managers, consultants and employees. Findings – The quality management paradigm
The purpose of this article is to explore the quality assurance methods commonly used in the health care industry. Factors that influence the delivery of quality patient care is explored as well as factors that affect implementation of quality control measures. The importance of quality patient care to the economic success of the health care industry is described. Quality improvement efforts that are utilized by health care institutions are described including: independent performance audits, internal audits, outcomes analysis, consumer reports, industry guidelines, and consumer satisfaction surveys. Highly effective hospital managers exhibit management roles, behaviors, and a range of activities that correlate strongly to institutional commitment to quality and improved patient care outcomes. By reinforcing their involvement in quality improvement efforts, hospital managers were able to enhance their effectiveness in promoting and sustaining qualitycare. PMID:16080413
This article reviews quality of health care initiatives beginning with the quality assessment/quality assurance movement of the 1970s. Conceptually, modern quality of care management is rooted in the intellectual work of Avedis Donabedian who defined quality of care as a combination of structure, process, and outcome. Donabedian's model is presented and some limitations are pointed out. In the late 1980s and 1990s. the health care industry adopted total quality management (TQM). More recently, the pursuit of health carequality has led to substantial performance measurement initiatives such as ORYX by the Joint Commission on Accreditation of Healthcare Organizations and MEDIS by the National Commission of Quality Assurance. The importance of CONQUEST, a freely available performance measurement database developed at the Harvard School of Public Health, is noted and discussed. The article concludes with a list of challenges facing public and private parties interests in health carequality improvement. PMID:15188996
The first phase of a cooperative project to develop and pilot-test an improved system for monitoring the quality of nursing care is described. Evaluation criteria from existing methodologies were grouped in a comprehensive framework of nursing objectives and subobjectives, and both the framework and the criteria developed were tested statistically. The master criteria list was placed in a computer file, from which criteria subsets are systematically selected for actual quality monitoring. The methodology has been used in two pilot hospitals; in the second phase of the project, now under way, the system is being implemented in a wider sample of hospitals to further test the validity of the conceptual framework and the reliability of individual criteria.
Haussmann, R. K. Dieter; Hegyvary, Sue Thomas; Newman, John F.; Bishop, Annelle C.
Quality management has become one of the most important and most debated topics within the service sector. This is especially true for health care, as the controversy rages on how the existing American system should be restructured. Health care reform aimed at reducing costs and ensuring access to all Americans cannot be allowed to jeopardize the quality of care. As such, total quality management (TQM) has become a vital ingredient to strategic planning within the health care domain. At the heart of any such quality improvement effort is the issue of measurement. TQM cannot be effectively utilized as a competitive weapon unless quality can be accurately defined, measured, evaluated, and monitored over time. Through such analysis a hospital can elect how to expend its limited resources toward those quality improvement projects which will impact customer perceptions of service quality the most. Thus, the purpose of this report is to establish a framework by which to approach the issue of quality measurement, delineate the various components of quality that exist in health care, and explore how these elements affect one another. We propose that the issue of quality measurement in health care be approached as an integration of service quality attributes common to other service organizations and technical quality attributes unique to health care. We hope that this research will serve as a first step toward the synthesis of the various quality attributes inherent in the health care domain and encourage other researchers to address the interactions of the various quality attributes. PMID:8763215
Treatment of critical ill patients in the intensive care unit is tantamount to well-designed risk or quality management. Several tools of quality management and quality assurance have been developed in intensive care medicine. In addition to extern quality assurance by benchmarking with regard to the intensive care medicine, peer review procedures have been established for external quality assurance in recent years. In the process of peer review of an intensive care unit (ICU), external physicians and nurses visit the ICU, evaluate on-site proceedings, and discuss with the managing team of the ICU possibilities for optimization. Furthermore, internal quality management in the ICU is possible based on the 10 quality indicators of the German Interdisciplinary Society for Intensive Care Medicine (DIVI, "Deutschen Interdisziplinären Vereinigung für Intensiv- und Notfallmedizin"). Thereby every ICU has numerous possibilities to improve their quality management system. PMID:23846174
|Identifies negative public and professional attitudes that lie beneath the contemporary negative image of quality child care. Argues that concepts and principles of marketing are appropriate for influencing parents to choose high quality services and helping ensure that supplementary care is of sufficient quality to enhance, not inhibit, the…
Identifies negative public and professional attitudes that lie beneath the contemporary negative image of quality child care. Argues that concepts and principles of marketing are appropriate for influencing parents to choose high quality services and helping ensure that supplementary care is of sufficient quality to enhance, not inhibit, the…
The purpose of this paper is to review the methods used to measure quality of stroke care. Relevant articles were searched for on Medline using the following key words: stroke, quality, outcome of care, process of care, structure of care. Articles that examined how to measure the quality of stroke care and that examined difficulties in the measurement of care outcomes, processes, and structures were selected. Selected articles were reviewed to summarise methods used to measure quality of stroke care and the primary outcome measures of the studies were extracted. Conclusions were drawn about the best ways to measure the quality of stroke care. Practical problems in using outcome measures to monitor quality of care include the consequences of case mix and difficulties in risk adjustment. Clinicians may use process measures to understand differences in outcome. Once a process of care has been linked to an outcome measure, this care process should be measured. The national sentinel audit for stroke is an audit tool used to examine the quality of the processes of stroke care.
Quality in health care and ethical principles The last three decades have seen rapid changes in the way United States of America (USA) health care has been delivered, financed and regulated. Four major stakeholders have emerged in the health care debate: patients, providers, payers and public regulatory agencies. These groups do not agree on a definition of quality health care. This paper suggests five ethical principles - autonomy, justice, beneficence, non-maleficence, and prudence - be included in the framework of quality health care. A framework that outlines possible relationships among these ethical attributes and four major stakeholders is presented. PMID:11012797
... Based Decisionmaking Improving Primary Care Practice Resources Quality & Patient Safety Comprehensive Unit-based Safety Program (CUSP) Patient Safety Measure Tools & Resources Pharmacy Health Literacy Center Surveys ...
Information on how warm and responsive care can help shape infants' and toddlers' development and their ability to learn can be reassuring for concerned parents. This guide, in English and Spanish versions, presents quality child care as a partnership between the child caregiver and the parents with the primary goal of benefiting the child. The…
Dodge, Diane Trister; Dombro, Amy Laura; Colker, Laura J.
Everyone brings specific values, beliefs, and assumptions about child rearing and child development to their work with infants and toddlers. Even two teachers who share the same ethnic culture may not share the same beliefs about what is best for young children. Conflicts around these issues can arise with colleagues and families in early care and…
|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…
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…
The study of quality of care in two mid-nineteenth-century day nurseries in North America indicates that quality was associated with saving children's lives within a context of charity-based social welfare. The concern for the health and safety of children led to the entrenchment of a custodial mode of child care. Child care staff developed “coping strategies” that served to modify
Objectives—To identify community nurses' perceptions of qualitycare provision for patients requiring palliative care.Design—Semi-structured interviews were conducted with community nurses working within the district nursing service. An adaptation of Flanagan's critical incident technique was employed to elicit factors associated with high or poor quality palliative care. Interviews were tape recorded and transcribed. Data were analysed using thematic content analysis, recurrent
Lynn Austin; Karen Luker; Ann Caress; Chris Hallett
\\u000a Radical cystectomy is the gold standard treatment for invasive bladder cancer, and requires high standards for both surgical\\u000a skill and ancillary support to achieve consistently good outcomes. As is the case elsewhere in the health care system, increasing\\u000a attention has been paid in recent years to the quality of care delivered before, during, and after surgery. Defining high-quality\\u000a care in
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
Despite extensive research on defining and measuring health carequality, little attention has been given to different stakeholders’ perspectives of high-quality health care services. The main purpose of this study was to explore the attributes of quality healthcare in the Iranian context. Exploratory in-depth individual and focus group interviews were conducted with key healthcare stakeholders including clients, providers, managers, policy makers, payers, suppliers and accreditation panel members to identify the healthcare service quality attributes and dimensions. Data analysis was carried out by content analysis, with the constant comparative method. Over 100 attributes of quality healthcare service were elicited and grouped into five categories. The dimensions were: efficacy, effectiveness, efficiency, empathy, and environment. Consequently, a comprehensive model of service quality was developed for health care context. The findings of the current study led to a conceptual framework of healthcare quality. This model leads to a better understanding of the different aspects of quality in health care and provides a better basis for defining, measuring and controlling quality of health care services.
Children's perceptions of pediatric nursing care have not been systematically taken into account in the development of the quality of care. Usually, parents have evaluated children's care and its quality. The purpose of this study was to examine children's expectations concerning the quality of pediatric nursing care by interviewing 20 preschool and 20 school-aged children in Finland. Twenty of them had insulin-dependent diabetes mellitus (IDDM) and visited the hospital on a regular basis, and 20 were treated on a surgical ward for a short period. Using content analysis, the interviews were coded and categories and subcategories identified. The children's expectations concerning the quality of nursing care were related to the nurse, nursing activities, and environment. They expected the nurses to be humane and reliable, have a good sense of humor, and wear colorful clothes at work. Both the nurses and the parents were expected to take part in nursing activities. The children expected from nurses, in particular, entertainment, educational, caring, and safety activities, while parents were expected to relieve fears and longing and to provide company. The children also emphasized the role of other children as part of good care. The results demonstrate that children are capable of offering valuable insights into the quality of pediatric nursing care. The results open new avenues for strengthening children's perspectives on pediatric nursing. PMID:15371112
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…
The quality of care received by Arab American patients with type 2 diabetes residing in a city with a large migrant Arab population has not been examined. Arab American adults with a self-reported diagnosis of diabetes were identified in a rigorous cross-sectional, population-based epidemiologic study conducted in Dearborn, MI. Quality of diabetes care was determined by assessing adherence to the
Helen D. Berlie; William H. Herman; Morton B. Brown; Adnan Hammad; Linda A. Jaber
In the Netherlands, a quality incentive is expected to ensue from improved collaboration between healthcare professionals. Whether this view is supported by sufficient evidence is, however, questionable. Therefore, the first study included in this thesis is a systematic review of studies on the effects of sharing and delegating diabetes care tasks. It became apparent that sharing and delegating care tasks
This study of 231 regulated family child care providers proposed a theoretical model to explore the effects on quality of: (1) provider level of general education; (2) provider degree of intentionality; (3) provider training and experience in family child care; (4) provider use of support services; and (5) provider work environment. Hierarchical linear regressions confirmed the predictive power of the
Gillian Doherty; Barry Forer; Donna S. Lero; Hillel Goelman; Annette LaGrange
This article examines the relationship between nursing home ownership and the quality of care. It was hypothesized that not-for-profit homes provide less inappropriate care than for-profit homes, and that not-for-profit residents make more functional improvement than for-profit residents. A multiple regression analysis of 3,149 Virginia nursing home residents in 174 homes found that not-for-profit homes provided less inappropriate care than
|Children's earliest experiences set the stage for school success and adult productivity. In the first three years of life, the brain grows at breakneck speed, creating more than a trillion pathways for learning and development. By the age of three, 85 percent of the brain's capacity is in place, creating the ability to speak, learn, and reason.…
Patients who have access to different health care systems, such as Medicare-eligible veterans, may obtain services in either or both health systems. We examined whether quality of diabetes care was associated with care continuity or veterans' usual source of primary care in a retrospective cohort study of 1,867 Medicare-eligible veterans with diabetes in 2001 to 2004. Underprovision of quality of diabetes care was more common than overprovision. In adjusted analyses, veterans who relied only on Medicare fee-for-service (FFS) for primary care were more likely to be underprovided HbA1c testing than veterans who relied only on Veteran Affairs (VA) for primary care. Dual users of VA and Medicare FFS primary care were significantly more likely to be overprovided HbA1c and microalbumin testing than VA-only users. VA and Medicare providers may need to coordinate more effectively to ensure appropriate diabetes care to Medicare-eligible veterans, because VA reliance was a stronger predictor than care continuity. PMID:23868082
Maciejewski, Matthew L; Wang, Virginia; Burgess, James F; Bryson, Chris L; Perkins, Mark; Liu, Chuan-Fen
For nursing home residents, quality of life is largely determined by the quality of the care they receive. Unfortunately, that quality is all too often inadequate. Current regulatory systems have failed in their efforts to assure high-qualitycare. Policy could vitally improve institutional quality of care in three ways: (1) increase efforts to derive a valid and reliable quality of
This paper reports on the use of computer systems in psychiatric care settings in conjunction with the performance of four quality assurance functions (utilization review, patient care audit, individual case review, and medical records review for completeness). Thirty-two centers that treat psychiatric patients and 22 standards setting agencies were surveyed concerning: 1) the general use of computer systems by the facilities surveyed; 2) the computer applications used in conjunction with quality assurance activities by both facilities and agencies, and 3) the computer applications that facility personnel perceived as most useful in the performance of quality assurance activities. Relatively limited use of computer applications was reported in the facilities surveyed, with moderate use reported by the agency personnel who were interviewed. These findings are discussed and recommendations made with regard to the use of computers in conjunction with quality of care review.
Murtaugh, Chris; Siegel, Carole; Fischer, Susan; Alexander, Mary Jane; Craig, Thomas J.
Based on studies carried on for more than ten years, various methods for voluntary quality control of surgical care are proposed. Besides short-term measures (e.g., "strategy of therapy"), a long-term pilot study would permit detection of defects and errors in surgical care through the recording of comparable data. An organization (similar to the Dutch "Concilium chirurgicum") should sponser visitations to various surgical centers. These two, strictly voluntary measures should form the basis for quality control that boots self-esteem of surgeons and does away with the need for state-sponsored measures. PMID:593000
The importance of qualitycare for young children participating in formal care arrangements such as family day care, long day care and occasional care is an important topic for a range of stakeholders including those involved in policy development, care provision, parents, and perhaps most importantly, the children. Qualitycare for young children comprises four main dimensions including Consistency, Appropriateness,
Pay-for-performance initiatives are changing the quality landscape. Gaps exist in quantifying and linking ambulatory carequality indicators to care provided by nurses in ambulatory care. Ambulatory carequality indicators that are sensitive to nursing care, standardized, and tested need to be identified and adopted by ambulatory care nurses, ambulatory care provider organizations, professional organizations, and endorsed by a consensus organization. PMID:18616060
Over the last ten years changes in the legal framework of the German health care system have promoted the development of new health service models to improve chronic care. Recent innovations include the nation-wide introduction of disease management programmes (DMPs), integrated care contracts, community nurse programmes, the introduction of General Practitioner (GP)-centred care contracts, and new opportunities to offer interdisciplinary outpatient care in polyclinics. The aim of this article is to describe the recent developments regarding both the implementation of new health care models by statutory health insurance companies and their evaluation. As part of a European project on the development and validation of disease management evaluation methods (DISMEVAL), we carried out a selective literature search to identify relevant models and evaluation studies. However, on the basis of the currently available evaluation and study results it is difficult to judge whether these developments have actually led to an improvement in the quality of chronic care in Germany. Only for DMPs, evaluation is legally mandatory; its methods are inappropriate, though, for studying the effectiveness of DMPs. Further study results on the effectiveness of DMPs mostly focus on the DMP Diabetes mellitus type II and show consistent improvements regarding process parameters such as regular routine examinations, adherence to treatment guidelines, and quality of life. More research will be needed to determine whether DMPs can also help reduce the incidence of secondary disease and mortality in the long term. PMID:22142877
Clearly, there is a benefit to the group process in helping to establish teamwork. Teamwork and cooperation can assist with promoting effective communication, improving work quality, and building a sense of well-being within the group. With this cooperation, setting goals and looking toward the future can become a reality. Once goals are set, then developing a professional image can begin. Developing a mission statement can be an effective means to help create that professional image. Having the opportunity to develop a mission for a patient care area and articulating it through a mission statement coalesces the values, beliefs, and philosophy of a group of neuroscience staff. The following is the mission statement developed by the neurosciences unit at the University of Wisconsin Hospital and Clinics: We, the staff of UWHC Neuroscience unit embrace a vision of excellence in health care for all. Our mission is to deliver consistent quality patient care, while fostering our own professional growth. As caring healers, teachers and patient advocates in an ever-changing health care environment, we are empowered by the code for nurses. Within our scope of practice, we strive to maintain a balance of basic human respect and dignity for patients and their families in their quest for wellness, adaptation, rehabilitation or comfort care. It is our hope that patients and families will work with the health care team to construct a plan of care that best meets the patient's needs and goals. We are committed to accommodate special communication, religious or cultural needs of patients and their families. Our final acknowledgment is to ourselves, as members of the health care team. We celebrate the dignity of the staff by recognizing each individual as a special person capable of making unique and significant contributions to the unit. PMID:10726245
The implementation of total quality management (TQM) in health care has gone on in parallel with the growth of managed care. What is the interaction between the two? Key issues are the ascendance of cost control over quality in many areas, erosion of employee commitment and loyalty, and a short-run orientation. Associated with this is an emphasis on organizational learning rather than learning by autonomous professionals. Both TQM and managed care acknowledge the dynamic nature of clinical processes and the ability and responsibility of both institutions and clinicians to improve their processes. Both are consistent with efforts to identify and implement best practices. However, these similarities should not mask fundamental differences. Continuous improvement must shift its focus from avoiding unnecessary variation to facilitating rapid organizational learning and institutionalizing mass customization into the delivery of health services. PMID:9327355
The purpose of this research is to examine the relationship between quality of care in nursing homes and their likelihood of closure. We hypothesize that lower-quality facilities will be more likely to close than higher-quality facilities. Using the rates of physical restraint use, urethral catheterization, contractures, pressure ulcers, and psychotropic medication use as quality measures from approximately 12,000 facilities from 1992 to 1998, the author examine cross-sectional and change score relationships between these measures and a nursing home's likelihood of closure. The descriptive analysis shows that 621 nursing homes closed in this time period, and the results for physical restraint use were robust in their positive association with closures in most analyses lending some support for this study's hypothesis. However, overall, the author concludes that nursing facility closures are relatively rare events. And the likelihood of closure, even for poor-quality facilities, is low. PMID:15643031
Managed care profoundly changed medical care in the US, yet the impact of these changes on the quality of care remains unclear. The primary aim of this study was to determine the aspects of managed care that impact evidence-based quality of care markers a...
We assessed measurements of the quality of medical care received in three cohorts of community-dwelling adult patients in the Community Quality Index study, the Assessing Care of Vulnerable Elders study, and the Veterans Health Administration project (7680 patients in total). We analyzed the relationship between the quality of care that patients received, defined as the percentage of quality indicators satisfied
Takahiro Higashi; Neil S. Wenger; John L. Adams; Constance Fung; Martin Roland; Elizabeth A. McGlynn; David Reeves; Steven M. Asch; Eve A. Kerr; Paul G. Shekelle
Management methods for quality of diabetes care need new approaches because of the poor metabolic control of most of these patients. Poor quality of care generally results from poor instruction and training rather than from misbehaviour of both patients and their families. Structure quality of care (who and where?), process quality (how?, which are the goals, what resolution is taken
F. Chiarelli; A. Verrotti; L. di Ricco; M. de Martino; G. Morgese
Humanitarian surgical programs are set up de novo, within days or hours in emergency or disaster settings. In such circumstances, insuring quality of care is extremely challenging. Basic structural inputs such as a safe structure, electricity, clean water, a blood bank, sterilization equipment, a post-anesthesia recovery unit, appropriate medications should be established. Currently, no specific credentials are needed for surgeons to operate in a humanitarian setting; the training of more humanitarian surgeons is desperately needed. Standard perioperative protocols for the humanitarian setting after common procedures such as Cesarean section, burn care, open fractures, and amputations and antibiotic prophylaxis, and post-operative pain management must be developed. Outcome data, especially long-term outcomes, are difficult to collect as patients often do not return for follow-up and may be difficult to trace; standard databases for post-operative infections and mortality rates should be established. Checklists have recently received significant attention as an instrument to support the improvement of surgical quality; knowing which items are most applicable to humanitarian settings remains unknown. In conclusion, the quality of surgical services in humanitarian settings must be regulated. Many other core medical activities of humanitarian organizations such as therapeutic feeding, mass vaccination, and the treatment of infectious diseases, such as tuberculosis and human immunodeficiency virus, are subject to rigorous reporting of quality indicators. There is no reason why surgery should be exempted from quality oversight. The surgical humanitarian community should pull together before the next disaster strikes. PMID:21487849
The analysis of case histories of patients with chlamydial infection has detected some typical errors in management of patients: the absence of topical diagnosis, choice of antibacterial drugs and treatment duration do not satisfy standard recommendations both in uncomplicated and complicated disease. A standard approach to management of patients with Chlamydia infection will help to avoid situations when experts conclude on inadequate quality of medical care delivered by medical professionals. PMID:21815460
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
OBJECTIVE: Despite the significant health impact of gout, there is no consensus on management standards. To guide physician practice, we sought to develop quality of care indicators for gout management.\\u000aMETHODS: A systematic literature review of gout therapy was performed using the Medline database. Two abstractors independently reviewed each of the articles for relevance and satisfaction of minimal inclusion criteria.
Ted R. Mikuls; Catherine H. MacLean; Jason Olivieri; Fausto G. Patino; Jeroan J. Allison; John T. Farrar; Warren B. Bilker; Kenneth G. Saag
The Automated Quality of Care Evaluation Support System (AQCESS) is a microcomputer based, integrated, terminal oriented, interactive, on-line computer system designed to support Patient Administration, Clinical Records and Quality of Care Evaluation func...
The Emergency Care Project, in response to increasing public pressure for development and institution of systems for assessments and assurance of quality of health care, was designed to try to develop an operational system for evaluating the quality of me...
Introduction We aimed (1) to demonstrate the application of national pediatric quality measures derived from claims-based data, for use with Electronic Medical Record (EMR) data, and (2) to determine the extent to which rates differ if specifications were modified to allow for flexibility in measuring receipt of care. Methods We reviewed EMR data for all patients up to 15 years with?1 office visit to a safety net family medicine clinic in 2010 (n=1,544). We assessed rates of appropriate well-child visits (WCVs), immunizations, and body mass index (BMI) documentation, defined strictly by national guidelines versus by guidelines with clinically relevant modifications. Results Among children <3 years, 52.4% attended ?6 WCVs by 15 months; 60.8% had ?6 visits by 2 years. Less than 10% completed 10 vaccination series before their 2nd birthday; with modifications, 36% were up-to-date. Among children aged 3-15 years, 63% had a BMI percentile recorded; 91% had BMI recorded within 36 months of the measurement year. Discussion Applying relevant modifications to national quality measure definitions captured a substantial number of additional services. Strict adherence to measure definitions might miss the true quality of care provided, especially in populations who may have sporadic patterns of care utilization.
... 3-EF Go to Online Store Disparities in Health CareQuality Among Minority Women Selected Findings From the ... race and ethnicity are combined. Return to Contents Health Care Delivery and Systems Information about health care delivery ...
Quality in health care is broad, complex, and not eas ily measured. This essay explores the many dimensions of quality in health care and shows that many under standings of it are narrowly configured to the agendas of the respective participants—providers, patients, and institutions-in today's health care arena. Also, there are many aspects of quality that defy measurement in the
This paper analyzes the effect on medical malpractice litigation of the quality of the medical care provided by the defendant. Our data set includes measures of the quality of the defendant’s medical care. We explore the extent to which information about carequality or negligence is incorporated in three evaluations of the plaintiff’s claim, each based on a different amount
To improve the measurement of the quality of neonatal intensive care for infants with very low birth weights (VLBW)-under 1500 grams-and to study the hospital characteristics associated with high qualitycare. Measuring quality of care for VLBW infants tr...
|Whereas child carequality 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…
Diabetes CareQuality Improvement: A Resource Guide for State Action and its accompanying Workbook were developed by the Agency for Healthcare Research and Quality (AHRQ) as learning tools for all State officials who want to improve the quality of health ...
Diabetes CareQuality Improvement: A Resource Guide for State Action and its accompanying Workbook were developed by the Agency for Healthcare Research and Quality (AHRQ) as learning tools for all State officials who want to improve the quality of health ...
Conditions of older care recipients and their care providers are supposed to affect each other, in light of a dialectical perspective. A possibility is the reciprocal influences between a care recipient's quality of life and his or her care provider's burnout. A study of the possibility surveyed 232 Hong Kong Chinese older care recipients, their professional care providers, and primary
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-carequality and specific program features, such
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 affect the overall quality of nursing home care as measured by the Observable Indicators of Nursing Home CareQuality Instrument. In contrast to many methods used for the same purpose, our method yields both qualitative and quantitative insight into nursing home carequality. Design and Methods We construct several Bayesian networks to study the influences among factors associated with the quality of nursing home care; we compare and measure their accuracy against other predictive models. Results We find the best Bayesian network to perform better than other commonly used methods. We also identify key factors, including number of certified nurse assistant hours, prevalence of bedfast residents, and prevalence of daily physical restraints, that significantly affect the quality of nursing home care. Furthermore, the results of our analysis identify their probabilistic relationships. Implications The findings of this research indicate that nursing home carequality is most accurately represented through a mix of structural, process, and outcome measures of quality. We also observe that the factors affecting the quality of nursing home care collectively determine the overall quality. Hence, focusing on only key factors without addressing other related factors may not substantially improve the quality of nursing home care.
... Patients > Guide to Health CareQuality Guide to Health CareQuality How to Know It When You See ... 120 KB). Plugin Software Help . You Deserve Quality Health Care Getting quality health care can help you stay ...
BACKGROUND: Rising health care costs and quality of care concerns require a re-evaluation of various aspects of health care delivery. In order to properly manage costs, payers need to understand how different patient populations contribute to spending trends and where suboptimal quality of care is more prevalent, and, therefore, may drive cost trends. OBJECTIVE: To demonstrate significant opportunities for improvement
Concerns about deficiencies in the quality of care delivered in US hospitals grew during a time period when an increasing number of hospitals were experiencing financial problems. Our study examines a six-year longitudinal database of general acute care hospitals in 11 states to assess the relationship between hospital financial condition and quality of care. We evaluate two measures of financial
|In this study we examine parents' and teachers' perceptions of the early childhood education and care (ECEC) quality in Finland. The study is based on the paradigm of inclusionary quality and the assessment is based on the quality evaluation model. The parents and teachers assess the quality to be good. The strength of the quality was the effect…
The quality of medical care is a potentially important determinant of health outcomes. Nevertheless, it remains an understudied area. The limited research that exists defines quality either on the basis of drug availability or facility characteristics, but little is known about how provider quality affects the provision of health care. Das and Hammer address this gap through a survey in
Based on broad measures of health system quality and performance, states with more total health spending per capita have better-qualitycare. This fact contrasts with a previous finding that states with higher Medicare spending per enrollee have poorer- qualitycare. However, quality results from the total funds available and not from Medicare or any single payer. Moreover, Medicare payments are
Purpose: Consumers and providers demand better indi- cators for quality of care and quality of life at the end of life. This article presents recommendations for advancing the science of measurement at end of life. Design and Methods: The authors reviewed the extant literature and applied the Institute of Medicine's conceptual framework for national health carequality to end-of-life care
Virginia P. Tilden; Susan Tolle; Linda Drach; Susan Hickman
The development of managed care plans is the most dramatic change in the USA’s health care system in recent decades. Despite the widespread growth, society is increasingly concerned with the quality of managed care programs. This article addresses the regulatory pressures that are being placed on managed care organisations, and examines what health care practitioners can do to minimize the
Explores the notion that the introduction of total quality management (TQM) in the public health-care sector indicates a conceptual break with a tradition in which the authority to define and interpret the meaning of medical practice has been located solely within the medical profession. It also serves to shift the focus of medical practice away from its contextual and interactional character towards numerical representations and codification in monetary terms. Further, it is argued that the realization of management ideals in everyday practice is dependent more on the availability of pre-existing technologies and standard procedures than on the ingenuity of particular organizational and institutional actors. These arguments are illustrated with the reutilization for TQM purposes of "local incident reports" in a Swedish hospital organization. PMID:11200301
ABSTRACT: The quality of care received by Medicare beneficiaries varies across areas. We find that states with higher Medicare spending,have lower-qualitycare. This negative rela- tionship may be driven by the use of intensive, costly care that crowds out the use of more effective care. One mechanism,for this trade-off may be the mix of the provider workforce: States with more
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.
Tonks, Stephen A.; Makwana, Sohil; Salanitro, Amanda H.; Safford, Monika M.; Houston, Thomas K.; Allison, Jeroan J.; Curry, William; Estrada, Carlos A.
Health care institutions, when faced with an imperative to cut costs, have targeted labor costs, particularly those associated with the nursing staff. In the absence of any meaningful data relating nursing care with positive patient outcomes, health care ...
Understanding the quality of routine care for adolescent depression constitutes the initial step in designing and implementing improvement strategies. This study assessed depression detection and type and duration of services for adolescents in mental health care settings. Medical record diagnosis and standardized research interview results were compared for youth seeking mental health treatment. The majority of depressed adolescents received care consistent with guidelines and evidence. However, only 51% received appropriate medication; fewer than half received at least 8 sessions of outpatient care or follow-up after hospitalization. Males received significantly fewer components of qualitycare compared with females. Depression diagnoses in routine care may be facilitated by using structured interviews or questionnaires. Quality monitoring and improvement initiatives may also increase rates of care components that are consistent with guidelines and evidence. Methods tested in this study may facilitate the evaluation of quality improvement initiatives for adolescent depression or other mental health disorders. PMID:18216276
Kramer, Teresa L; Miller, Terri L; Phillips, Susan D; Robbins, James M
ABSTRACT. Objective. A measure of pediatric pri- mary carequality that is brief, practical, reliable, and valid would be useful to patients and pediatricians, policymak- ers, and health system leaders. Parents have a unique per- spective from which to report their experiences with their child’s primary care, and these reports may be valid indi- cators of pediatric primary carequality.
Michael Seid; James W. Varni; Laura Olson Bermudez; Mirjana Zivkovic; Maryam Davodi Far; Melissa Nelson; Paul S. Kurtin
We have conducted a retrospective medical record review of a random sample of 580 patients with diabetes from 12 primary health care centres (PHCCs) in Greater Tunis. The aim was to assess the quality of diabetes care in PHCCs and to explore factors associated with quality of care. Data were collected concerning patient characteristics, health centre characteristics and process of
BACKGROUND: Managed care efforts to regulate access to specialists and reduce costs may lower quality of care. Few studies have examined whether managed care is associated with patient perceptions of the quality of care provided by physician and non-physician specialists. Aim is to determine whether associations exist between managed care controls and patient ratings of the quality of specialty care
David Grembowski; David Paschane; Paula Diehr; Wayne Katon; Diane Martin; Donald L Patrick
Objective. To analyse the association between quality of care and technical (productive) efficiency in institutional long-term care wards for the elderly. Setting. One hundred and fourteen public health centre hospitals and residential homes in Finland. Study design. Wards were divided into two categories according to their rank in the quality distribution, considering 41 quality variables separately. The technical efficiency scores
JUHA LAINE; U. HARRIET FINNE-SOVERI; MAGNUS BJÖRKGREN; MIIKA LINNA; ANJA NORO; UNTO HÄKKINEN
...Request for Information Regarding Health CareQuality 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...
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.
Kiguli, Julie; Ekirapa-Kiracho, Elizabeth; Okui, Olico; Mutebi, Aloysius; MacGregor, Hayley; Pariyo, George William
Background Health carequality in the US territories is poorly characterized. We used process measures to compare the performance of hospitals in the US territories and in the US states. Methods Our sample included nonfederal hospitals located in the United States and its territories discharging Medicare fee-for-service (FFS) patients with a principal discharge diagnosis of acute myocardial infarction (AMI), heart failure (HF), or pneumonia (PNE) (July 2005–June 2008). We compared risk-standardized 30-day mortality and readmission rates between territorial and stateside hospitals, adjusting for performance on core process measures and hospital characteristics. Results In 57 territorial hospitals and 4799 stateside hospitals, hospital mean 30-day risk-standardized mortality rates were significantly higher in the US territories (P < .001) for AMI (18.8% vs 16.0%), HF (12.3% vs 10.8%), and PNE (14.9% vs 11.4%). Hospital mean 30-day risk-standardized readmission rates (RSRRs) were also significantly higher in the US territories for AMI (20.6% vs 19.8%; P=.04), and PNE (19.4% vs 18.4%; P=.01) but was not significant for HF (25.5% vs 24.5%; P=.07). The higher risk-standardized mortality rates in the US territories remained statistically significant after adjusting for hospital characteristics and core process measure performance. Hospitals in the US territories had lower performance on all core process measures (P< .05). Conclusions Compared with hospitals in the US states, hospitals in the US territories have significantly higher 30-day mortality rates and lower performance on every core process measure for patients discharged after AMI, HF, and PNE. Eliminating the substantial quality gap in the US territories should be a national priority.
Nunez-Smith, Marcella; Bradley, Elizabeth H.; Herrin, Jeph; Santana, Calie; Curry, Leslie A.; Normand, Sharon-Lise T.; Krumholz, Harlan M.
Investigated the relationship between parent-caregiver communication and child carequality in 12 child care centers representing different types of sponsorship. Compared to parents, caregivers rated all forms of parent-caregiver communication as more frequent and as more important. Frequency of parent-caregiver communication and quality of child…
|This paper presents definitions of child carequality from focus groups conducted to develop a research design to assess the quality of Minnesota's regulated child care system. Eleven individual interviews and 38 focus groups involving 333 people were held in communities throughout Minnesota between 1-11-00 and 6-14-00. The focus groups…
As managed care has grown to dominate the US health care delivery system, questions have been raised about the impact on the quality of care provided to its enrollees. Two important aspects of health carequality are access to care and the appropriateness of care. This analysis evaluated the occurrence of preventable hospitalizations among managed care (MCO) versus fee for
Since the government brought the National Health Insurance program in practice, the number of health care institutes was increasing as well as the medical treatment and medical expense are also running high on. Meanwhile, in Naderism era, health care institutes not merely care medical effect, but also focus on influcening factors of medical quality for earning customers' loyalty. On the
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.
This is the second in a series of articles examining the components of good corporate governance. It considers how the structures and processes for quality governance can affect an organisation's ability to be assured about the quality of care. Complex information systems and procedures can lead to poor qualitycare, but sound structures and processes alone are insufficient to ensure good governance, and behavioural factors play a significant part in making sure that staff are enabled to provide good qualitycare. The next article in this series looks at how the information reporting of an organisation can affect its governance. PMID:23252087
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
background Since 1997, all managed-care plans administered by Medicare have reported on qual- ity-of-care measures from the Health Plan Employer Data and Information Set (HEDIS). Studies of early data found that blacks received care that was of lower quality than that received by whites. In this study, we assessed changes over time in the overall quality of care and in
Amal N. Trivedi; Alan M. Zaslavsky; Eric C. Schneider; John Z. Ayanian
|This background paper discusses the current system of child care finance in Washington State and analyzes options for improvement. It describes prominent characteristics of the early childhood care and education system, findings relating program quality to staff/child ratios and staff educational levels, characteristics of quality, parent…
Because minimum government standards for quality regulate only part of the market failure, they may have unintended effects.\\u000a We present a general theory of how government regulation of quality of care may affect different market segments, and test\\u000a the hypotheses for the nursing home market. OBRA 1987 was a sweeping government reform to improve the quality of nursing home\\u000a care.
Virender Kumar; Edward C. Norton; William E. Encinosa
Ethical care is beginning to be recognised as care that accounts for the views of those at the receiving end of care. However, in the context of palliative and supportive district nursing care, the patients' and their carers' views are seldom heard. This qualitative research study explores these views. Data were collected through semi-structured interviews with 26 patients with palliative and supportive care needs receiving district nursing care, and 13 of their carers. Participants were recruited via community nurses and hospices between September 2010 and October 2011. Post-structural discourse analysis is used to examine how discourses operate on a moral level. One discourse, 'busyness', is argued to preclude a moral form of nursing care. The discourse of friendship is presented to contrast this. Discussion explores Gallagher's 'slow ethics' and challenges the currently accepted ways of measuring to improve quality of care concluding that quality cannot be measured. PMID:23702898
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…
Health-care value purchasing, complex health-care systems, and information technology are the three most important change drivers influencing the interrelated themes of the 4th decennial conference: accountability, quality promotion through infection prevention across the health-care delivery system, and medical informatics. Among the change drivers influencing themes of future conferences may be a societal mandate for health promotion and health-care access for all.
|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)…
|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.…
|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…
The second report from the US Institute of Medicine Crossing the Quality Chasm, highlighted the deficiencies in health carequality in the USA, analyzed the contributory factors, and proposed 13 recommendations for improvements. Clearly, the challenges are enormous. Can anything be learned from the experiences of other countries? This article describes the author's experiences of health carequality improvement efforts in the National Health Service in England and their implications for the USA and for Baylor Health Care System.
Research on differential susceptibility to rearing suggests that infants with difficult temperaments are disproportionately affected by parenting and child carequality, 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 reasonably diverse backgrounds were followed from 1 month to 11 years with repeated observational assessments of parenting and child carequality, as well as teacher report and standardized assessments of children's cognitive-academic and social functioning, to determine whether those with histories of difficult temperament proved more susceptible to early rearing effects at ages 10 and 11. Evidence for such differential susceptibility emerges in the case of both parenting and child carequality and with respect to both cognitive-academic and social functioning. Differential susceptibility to parenting and child carequality extends to late middle childhood. J. Belsky, D. L. Vandell, et al.'s (2007) failure to consider such temperament-moderated rearing effects in their evaluation of long-term child care effects misestimates effects of child carequality on social adjustment. PMID:20210497
Objective To develop homeless-youth-identified process and outcome measures of quality of health care. Data Sources/Study Setting Primary data collection with homeless youth from both street and clinic settings in Seattle, Washington, for calendar year 2002. Study Design The research was a focused ethnography, using key informant and in-depth individual interviews as well as focus groups with a purposeful sample of 47 homeless youth aged 12–23 years. Data Collection/Extraction Methods All interviews and focus groups were tape-recorded, transcribed, and preliminarily coded, with final coding cross-checked and verified with a second researcher. Principal Findings Homeless youth most often stated that cultural and interpersonal aspects of quality of care were important to them. Physical aspects of quality of care reported by the youth were health care sites separate from those for homeless adults, andsites that offered a choice of allopathic and complementary medicine. Outcomes of health care included survival of homelessness, functional and disease-state improvement, and having increased trust and connections with adults and with the wider community. Conclusions Homeless youth identified components of quality of care as well as how quality of care should be measured. Their perspectives will be included in a larger follow-up study to develop quality of care indicators for homeless youth.
|Experience gathered to date confirms that capitation of Medicare does not necessarily decrease quality of health care and may in fact encourage an improvement in health carequality. Incentives inherent in capitated reimbursement are threefold. First, practitioners, by not receiving more payment for more service, are discouraged from providing…
... of you: doctors, physician assistants, nurse practitioners, other nurses and nursing assistants, and other health care professionals all work together to take care of patients, although they have different education, training, and scope of practice (what they are qualified and licensed to do). ...
So when it comes to making major health care decisions--about healthplans, doctors, treatments, hospitals, and long-term care--how can you tell which choices offer quality health care, and which do not. Fortunately, more and more public and private groups...
We examine the impact of state child care regulations on the supply and quality of care in child care markets. We exploit panel data on both individual establishments and local markets to control for state, time, and, where possible, establishment-specific fixed effects to mitigate the potential bias due to policy endogeneity. We find that the imposition of regulations reduces the
We examine the impact of state child care regulations on the supply and quality of care in child care markets. We exploit panel data on both individual establishments and local markets to control for state, time, and, where possible, establishment-specific fixed effects to mitigate the potential bias due to policy endogeneity. We find that the imposition of regulations reduces the
The negative effects of institutionalization caused partially by homogeneity and uniformity of care prompts the exploration of personal and common meanings of nursing home residents. This study is viewed as an initial step in providing qualitycare as defined by the resident. Personal and common meanings embedded in the lived lives of five older women residing in a long-term care
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 drawn from nonenrollees living in the
Robert L. Kane; Patricia Homyak; Boris Bershadsky; Terry Lum; Hui Zhang
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
|The federal child-care subsidy program represents one of the government's largest investments in early care and education, but little is known about whether it increases low-income children's access to higher quality child care. This study used newly available nationally representative data on 4-year-old children (N = 750) to investigate whether…
Johnson, Anna D.; Ryan, Rebecca M.; Brooks-Gunn, Jeanne
|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…
Objectives To investigate factors predicting the quality of care received using a nationally representative dataset from Indonesia. Data Sources The study combines two surveys in 13 provinces: a household survey of 2451 women who delivered a live birth in 1992-1998, and a facility survey that measured quality available from outpatient providers. Study design Multivariate regressions are used to explain the quality of care received. Explanatory variables are high facility quality, maternal education, household wealth, ethnicity, and insurance. Data collection methods Facility quality available is measured by adherence to prenatal protocols using a clinical case scenario. Quality received is measured by maternal reports about routine prenatal services received. Principle findings High facility quality predicts an increase in quality received. Although poor households have access to the same or higher qualitycare compared with the least poor, the poor receive lower levels of quality. In remote regions, quality received rises with increasing levels of maternal education and household wealth. Conclusions Improving health provider knowledge, and increasing household financial resources and information could redress inequalities in quality received among the poor and least educated.
The differences between two hospitals' level of productivity and quality of care were investigated to determine if efficiency in hospital design, and modern technology provide increases in either of these factors. The study consisted of a study of a singl...
This study examines the relationship between hospital reimbursement per discharge and the clinical quality of care received by Medicare patients before and after implementation of the Prospective Payment System (PPS) in 1983/84. The objectives are to eval...
Tracer Objectives Facilitate delivery of quality, comprehensive and safe healthcare to BMEDDAC beneficiaries. Evaluate organizational compliance with national healthcare standards. Staff education and training at point of care; on site peer support. Asses...
BACKGROUND: Assessing the quality of primary care is becoming a priority in national healthcare agendas. Audit and feedback on healthcare quality performance indicators can help improve the quality of care provided. In some instances, fewer numbers of more comprehensive indicators may be preferable. This paper describes the use of the Summary Quality Index (SQUID) in tracking quality of care among
Paul J Nietert; Andrea M Wessell; Ruth G Jenkins; Chris Feifer; Lynne S Nemeth; Steven M Ornstein
Health-care organizations are beginning to apply the principles of total quality management (TQM). Implementing TQM in a health-care laboratory requires incorporating quality improvement (QI) and quality planning (QP) with quality laboratory practices (QLP), quality control (QC), and quality assurance (QA) to provide a complete quality management system. QI and QP can be initiated by developing a strategic plan as a pilot QI project. QI project teams are then introduced to accomplish the highest priority goals. This implementation approach improves strategic planning by using group problem-solving tools and techniques, such as process flow charts, brainstorming, nominal group, fishbone diagrams, consensus decision making, and Pareto analysis. The approach also improves the success of project teams by providing a clear management agenda and a commitment to project-by-project QI. PMID:10113715
Purpose: As palliative care further integrates into cancer care, descriptions of how supportive carequality measures improve patient outcomes are necessary to establish best practices. Methods: We assessed the relationship between conformance to 18 palliative carequality measures and quality of life from data obtained using our novel point-of-care, electronic quality monitoring system, the Quality Data Collection Tool for Palliative Care (QDACT-PC). All patients with cancer from January 2008 through March 2011 seen in the Carolinas Palliative Care Consortium were evaluated for demographic, disease, prognostic, performance status, and measure conformance variables. Using univariate and multivariate regression, we examined the relationship between these variable and high quality of life at the initial specialty palliative care consultation. Results: Our cohort included 459 patients, the majority of whom were over age 65 years (66%) and white (84%). Lung (29.1%) and GI (24.7%) cancers were most common. In univariate analyses, conformance to assessment of comprehensive symptoms, fatigue and constipation assessment, timely management of pain and constipation, and timely emotional well-being assessment were associated with highest levels of quality of life (all Ps < .05). In a multivariate model (C-stat = 0.66), performance status (odds ratio [OR], 5.21; P = .003), estimated life expectancy (OR, 22.6; P = .003), conformance to the measure related to emotional well-being assessment (OR, 1.60; P = .026), and comprehensive screening of symptoms (OR, 1.74, P = .008) remained significant. Conclusion: Oncology care pathways that routinely incorporate supportive care principles, such as comprehensive symptom and emotional well-being assessments, may improve patient outcomes.
Kamal, Arif H.; Bull, Janet; Stinson, Charles S.; Blue, Debra L.; Abernethy, Amy P.
Objectives To study the impact of performance obstacles on intensive care nurses‘ workload, quality and safety of care, and quality of working life (QWL). Performance obstacles are factors that hinder nurses‘ capacity to perform their job and that are closely associated with their immediate work system. Data Sources/Study Setting Data were collected from 265 nurses in 17 intensive care units (ICUs) between February and August 2004 via a structured questionnaire, yielding a response rate of 80 percent. Study Design A cross-sectional study design was used. Data were analyzed by correlation analyses and structural equation modeling. Principal Findings Performance obstacles were found to affect perceived quality and safety of care and QWL of ICU nurses. Workload mediated the impact of performance obstacles with the exception of equipment-related issues on perceived quality and safety of care as well as QWL. Conclusions Performance obstacles in ICUs are a major determinant of nursing workload, perceived quality and safety of care, and QWL. In general, performance obstacles increase nursing workload, which in turn negatively affect perceived quality and safety of care and QWL. Redesigning the ICU work system to reduce performance obstacles may improve nurses‘ work.
Increasing reliance is being placed on electronic medical records to support clinical care and achieve improved quality standards. In order for clinical information systems (CIS) to deliver excellence the data within it needs to be complete, consistent and accurate. This capture of data is critical but forms only part of the procedure in delivering quality health care during the clinician-patient
To support the performance measurement efforts of the Foundation for Accountability (FACCT), the Agency for Health Care Policy and Research (AHCPR) funded a series of scientific papers on topics FACCT had identified as first priorities. The authors review...
What the Army calls organizational effectiveness (OE) other practitioners call organization development. The present study documented what OE interventions are employed in Army health care settings. Organizational effectiveness staff officers (OESOs) work...
A. D. Mangelsdorff P. M. Gilbert J. A. Schlie C. T. Troutman
This was the third Evanston Northwestern Healthcare/Northwestern Universitysponsored conference on outcomes management. The conference was built around two interconnected themes that focused on activities essential for improving cancer care: expanding and...
This study examines the extent, motivation, and performance implications of normal quality improvement (QI) programs in Pennsylvania nursing care facilities. Responses to a 20-item survey sent to facility administrators indicate that continuous quality improvement/total quality management (CQI/TQM) adopters are more motivated by quality of care and human resource concerns in implementing QI, more satisfied with the results of QI efforts, and more aware of a competitive environment than are non-adopters. There are few differences between adopters and non-adopters with respect to organizational characteristics or performance on quality of care measures. Comparison with the results of a study of QI implementation in hospitals reveals some differences in motivation, but similarities in satisfaction with results. PMID:9116533
Increased competition in the United States has led to increased interest in women's perceptions of their obstetric experience. Family-centered postpartum care (FCPPC) was originated to improve women's perceptions of carequality. This study examined differences in and the hypothesized relationship between quality and beneficence in a group receiving traditional postpartum care (TPPC) and a group receiving FCPPC in a safety-net hospital in West Tennessee. Both groups had high mean quality and beneficence scores; however, the FCPPC group's scores were significantly higher than those of the TPPC group. There was a relationship between quality and beneficence for the combined sample. The findings suggest that nurses should incorporate FCPPC approaches as a means of improving perceived quality and benefits. PMID:9842172
I propose that high quality health care -- including innovation and state-of-the-art technology -- can and must co-exist with society's desire to reduce costs. One need not threaten the other. In fact, they should be mutually supportive. In this paper I talk about how we assess value in health care and some of the principles that should inform sound economic decisions about qualitycare. First, I'd like to consider why consumers define quality differently in health care than they do in other markets, and why lower costs and improved quality can -- and must -- move together. I review examples of how we currently use less costly alternatives for delivering care and at the same time maintain or improve our performance in meeting quality health care goals. I discuss how mechanisms in our current system support continued cost and quality improvements. Finally, I'll conclude with thoughts on how we can facilitate this trend with information and continued innovation.
BACKGROUND: Our aim was to assess the contribution of training in data definitions and data extraction guidelines to improving quality of data for use in intensive care scoring systems such as the Acute Physiology and Chronic Health Evaluation (APACHE) II and Simplified Acute Physiology Score (SAPS) II in the Dutch National Intensive Care Evaluation (NICE) registry. METHODS: Before and after
Daniëlle GT Arts; Rob J Bosman; Evert de Jonge; Johannes CA Joore; Nicolette F de Keizer
Many developing countries have adopted the market approach for expanding the supply of child care, but little is known about the economic behavior of independent providers. This paper draws on uniquely rich administrative data on child care centers and their inputs from São Paulo to examine the role of local household income in shaping the entry and quality choices of
Quality improvement (QI) activities can improve health care but must be conducted ethically. The Hastings Center convened leaders and scholars to address ethical requirements for QI and their rela- tionship to regulations protecting human subjects of research. The group defined QI as systematic, data-guided activities designed to bring about immediate improvements in health care delivery in particular settings and concluded
Joanne Lynn; Mary Ann Baily; Melissa Bottrell; Bruce Jennings; Robert J. Levine; Frank Davidoff; David Casarett; Janet Corrigan; Ellen Fox; Matthew K. Wynia; George J. Agich; Margaret O'Kane; Theodore Speroff; Paul Schyve; Paul Batalden; Sean Tunis; Nancy Berlinger; Linda Cronenwett; J. Michael Fitzmaurice; Nancy Neveloff Dubler; Brent James
The Agency for Health Care Policy and Research (AHCPR), a part of the Public Health Service in the U.S. Department of Health and Human Services, is the lead agency charged with supporting research designed to improve the quality of health care, reduce its...
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
Background Care of the elderly is recognized as an increasingly important segment of health care. The Assessing Care Of Vulnerable Elderly (ACOVE) quality indicators (QIs) were developed to assess and improve the care of elderly patients. Objectives The purpose of this review is to summarize studies that assess the quality of care using QIs from or based on ACOVE, in order to evaluate the state of quality of care for the reported conditions. Methods We systematically searched MEDLINE, EMBASE and CINAHL for English-language studies indexed by February 2010. Articles were included if they used any ACOVE QIs, or adaptations thereof, for assessing the quality of care. Included studies were analyzed and relevant information was extracted. We summarized the results of these studies, and when possible generated an overall conclusion about the quality of care as measured by ACOVE for each condition, in various settings, and for each QI. Results Seventeen studies were included with 278 QIs (original, adapted or newly developed). The quality scores showed large variation between and within conditions. Only a few conditions showed a stable pass rate range over multiple studies. Overall, pass rates for dementia (interquartile range (IQR): 11%–35%), depression (IQR: 27%–41%), osteoporosis (IQR: 34%–43%) and osteoarthritis (IQR: 29–41%) were notably low. Medication management and use (range: 81%–90%), hearing loss (77%–79%) and continuity of care (76%–80%) scored higher than other conditions. Out of the 278 QIs, 141 (50%) had mean pass rates below 50% and 121 QIs (44%) had pass rates above 50%. Twenty-three percent of the QIs scored above 75%, and 16% scored below 25%. Conclusions Quality of care per condition varies markedly across studies. Although there has been much effort in improving the care for elderly patients in the last years, the reported quality of care according to the ACOVE indicators is still relatively low.
Askari, Marjan; Wierenga, Peter C.; Eslami, Saied; Medlock, Stephanie; de Rooij, Sophia E.; Abu-Hanna, Ameen
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…
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…
The purpose of this study is to assess the proposition that adoption of a market orientation leads to improved service quality for service sector organisations. We argue that an organisational culture incorporating customer care as its central tenet and involving efforts to understand the needs of customers through a market orientation enables the organisation to provide quality services that satisfy
Kenneth W. Green Jr.; Subrata Chakrabarty; Dwayne Whitten
Purpose – Organizational culture is a determinant for quality improvement. This paper aims to assess organizational culture in a hospital setting, understand its relationship with perceptions about quality of care and identify areas for improvement. Design\\/methodology\\/approach – The paper is based on a cross-sectional survey in a large clinical department that used two validated questionnaires. The first contained 20 items
Fauziah Rabanni; S. M. Wasim Jafri; Farhat Abbas; Firdous Jahan; Nadir Ali Syed; Gregory Pappas; Syed Iqbal Azam; Mats Brommels; Göran Tomson
|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…
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
Continuity and coordination of care are attributes of medical care that influence its quality. Donabedian describes coordination of care as the process by which the elements and relationships of medical care during any one sequence of care are fitted toge...
Providing quality palliative care is a daunting task profoundly impacted by diminished patient capacity at the end of life. Alzheimer disease (AD) is a disorder that erases our memories and is projected to increase dramatically for decades to come. By the time the patients with AD reach the end stage of the disease, the ability of patients to provide pertinent subjective complaints of pain and discomfort would have vanished. Historical perspectives of palliative care, exploration of the AD process, ethical issues, and crucial clinical considerations are provided to improve the understanding of disease progression and quality of care for patients with end-stage AD. PMID:22811214
Quality of care improvement has become a priority for decision-makers. Important variations in the quality and cost of care are being documented often without evidence of improved outcomes. Therapeutic advances are not consistently applied to practice despite efforts from professional organisations to create guidelines. The quality movement emerged following increasing evidence that the creation and measurement of quality indicators can improve quality of care and health outcomes. Quality indicators can measure healthcare system performance across providers, system levels and regions. In rheumatology, early efforts to develop quality measures have focused on examining all aspects of care while more recent efforts have focused on disease course monitoring. The American College Rheumatology has recently endorsed seven quality indicators for rheumatoid arthritis (RA) that are evidence based and measurable for use in routine rheumatology practices. This review provides an overview on quality indicators in rheumatology with a focus on RA, and discusses the application of quality measures into routine rheumatology practices to improve quality of care for RA. PMID:23253925
Context? The paper refers to the increased competition between health care providers and the need for patient-centred services in Greece. Using service quality methodology, this paper investigates service quality perceptions of patients in Greek public primary health centres. Objective? To test the internal consistency and applicability of SERVQUAL in primary health care centres in Greece. Strategy? SERVQUAL was used to examine whether patients have different expectations from health care providers and whether different groups of patients may consider some dimensions of care more important than others. Results? The analysis showed that there were gaps in all dimensions measured by SERVQUAL. The largest gap was detected in empathy. Further analysis showed that there were also differences depending on gender, age and education levels. A separate analysis of expectations and perceptions revealed that this gap was because of differences in patients' perceptions rather than expectations. Discussion and conclusions? This paper raises a number of issues that concern the applicability of SERVQUAL in health care services and could enhance current discussions about SERVQUAL improvement. Quality of health care needs to be redefined by encompassing multiple dimensions. Beyond a simple expectations-perceptions gap, people may hold different understandings of health care that, in turn, influence their perception of the quality of services. PMID:22296402
Hospitalized patients with inflammatory bowel disease (IBD) are at high risk for morbidity, mortality, and health care utilization costs. While the literature on trends in hospitalization rates for this disease is conflicting, there does appear to be significant variation in the delivery of care to this complex group, which may be a marker of suboptimal quality of care. There is a need for improvement in identifying patients at risk for hospitalization in an effort to reduce admissions. Moreover, appropriate screening for a number of hospital acquired complications such as venous thromboembolism and Clostridium difficile infection is suboptimal. This review discusses areas of inpatient care for IBD patients that are in need of improvement and outlines a number of potential quality improvement initiatives such as pay-for-performance models, quality improvement frameworks, and healthcare information technology.
This paper reviews the genesis of managed care and the reasons for its rapid growth. The effects of the differing incentives of traditional and managed-care plans on quality of care are described. There is an urgent need for federal, state and local health departments to monitor and regulate the quantity and quality of health care provided by all types of insurance plans. The elements of such a program are outlined, and the need for adequate funding as well as political and technical leadership is emphasized. This should become a major priority issue for the public health movement in the United States. PMID:9581426
Quality of life of nursing home residents is a critical consideration in international health care policies and health care decisions. Yet, there is little relevant research to support decisions about client-tailored and effective nursing care for this population. Because of the permanency of their stay, the care received affects the quality of daily life. This study investigated the quality of
Chantal C. M. Holtkamp; Ada Kerkstra; Miel W. Ribbe; Cretien van Campen; Marcel E. Ooms
|This paper presents a profile of New Hampshire's Quality Rating System prepared as part of the Child CareQuality 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)…
|This study explores the relationship between health, quality of care of geriatric case management and quality of life for the purpose of furthering the understanding of the relationship between quality of life and geriatric case management. Using survey data from a group of frail older adults, this study assesses the relative merit of two…
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.
|Notes that the majority of brain development occurs in the first three years of life. States that infant and toddler interactions are beneficial to both ages, provided contact occurs in a safe environment. Discusses how infants and toddlers learn from each other through play, even if they are nonverbal, and further benefit from insights and…
ABSTRACT PROBLEM BEING ADDRESSED Family physicians face innumerable challenges to delivering quality palliative home care to meet the complex needs of end-of-life patients and their families. OBJECTIVE OF PROGRAM To implement a model of shared care to enhance family physicians’ ability to deliver quality palliative home care, particularly in a community-based setting. PROGRAM DESCRIPTION Family physicians in 3 group practices (N = 21) in Ontario’s Niagara West region collaborated with an interprofessional palliative care team (including a palliative care advanced practice nurse, a palliative medicine physician, a bereavement counselor, a psychosocial-spiritual advisor, and a case manager) in a shared-care partnership to provide comprehensive palliative home care. Key features of the program included systematic and timely identification of end-of-life patients, needs assessments, symptom and psychosocial support interventions, regular communication between team members, and coordinated care guided by outcome-based assessment in the home. In addition, educational initiatives were provided to enhance family physicians’ knowledge and skills. CONCLUSION Because of the program, participants reported improved communication, effective interprofessional collaboration, and the capacity to deliver palliative home care, 24 hours a day, 7 days a week, to end-of-life patients in the community.
Marshall, Denise; Howell, Doris; Brazil, Kevin; Howard, Michelle; Taniguchi, Alan
Objective We documented organizational costs for depression carequality improvement (QI) to develop an evidence-based, Veterans Health Administration (VA) adapted depression care model for primary care practices that performed well for patients, was sustained over time, and could be spread nationally in VA. Data Sources and Study Setting Project records and surveys from three multistate VA administrative regions and seven of their primary care practices. Study Design Descriptive analysis. Data Collection We documented project time commitments and expenses for 86 clinical QI and 42 technical expert support team participants for 4 years from initial contact through care model design, Plan–Do–Study–Act cycles, and achievement of stable workloads in which models functioned as routine care. We assessed time, salary costs, and costs for conference calls, meetings, e-mails, and other activities. Principle Findings Over an average of 27 months, all clinics began referring patients to care managers. Clinical participants spent 1,086 hours at a cost of $84,438. Technical experts spent 2,147 hours costing $197,787. Eighty-five percent of costs derived from initial regional engagement activities and care model design. Conclusions Organizational costs of the QI process for depression care in a large health care system were significant, and should be accounted for when planning for implementation of evidence-based depression care.
Liu, Chuan-Fen; Rubenstein, Lisa V; Kirchner, JoAnn E; Fortney, John C; Perkins, Mark W; Ober, Scott K; Pyne, Jeffrey M; Chaney, Edmund F
The purpose of this paper was to determine the criteria that reflect the quality of care provided by long-term care institutions. Research was conducted using a two-step procedure that first utilized the SERVQUAL model with Fuzzy Delphi Method to establish the proper criteria by which service quality could be measured. A total of 200 questionnaires were mailed to expert respondents, of which 89 were returned and 77 deemed valid for use in this study. We then applied the Multi-Criteria Decision Making Process to determine the degree of importance of each criterion to long-term care institution service quality planning work. Secondly, 200 questionnaires were distributed and 74 valid responses were returned. Based on the 5 SERVQUAL model constructs, this study found 17 of the 28 criteria, to be pertinent to nursing carequality, with those in the Responsiveness and Empathy domains being the ones most critical. PMID:18080970
In 1989, the Department of Veterans Affairs (VA) identified six primarily psychiatric hospitals in which 38 patient deaths may have occurred due to likely quality-of-care problems in the medical treatment these individuals received. Before this, in 1988, ...
The VA Office of Inspector General (OIG), Office of Healthcare Inspections conducted an inspection to determine the validity of alleged poor quality of resident care on the community living center (CLC) 3. An anonymous complainant alleged that residents o...
Background: No primary practice care model has been shown to be superior in achieving high-quality primary care. We aimed to identify the organizational characteristics of primary care practices that provide high-quality primary care. Methods: We performed a cross-sectional observational study involving a stratified random sample of 37 primary care practices from 3 regions of Quebec. We recruited 1457 patients who had 1 of 2 chronic care conditions or 1 of 6 episodic care conditions. The main outcome was the overall technical quality score. We measured organizational characteristics by use of a validated questionnaire and the Team Climate Inventory. Statistical analyses were based on multilevel regression modelling. Results: The following characteristics were strongly associated with overall technical quality of care score: physician remuneration method (27.0; 95% confidence interval [CI] 19.0–35.0), extent of sharing of administrative resources (7.6; 95% CI 0.8–14.4), presence of allied health professionals (15.3; 95% CI 5.4–25.2) and/or specialist physicians (19.6; 95% CI 8.3–30.9), the presence of mechanisms for maintaining or evaluating competence (7.7; 95% CI 3.0–12.4) and average organizational access to the practice (4.9; 95% CI 2.6–7.2). The number of physicians (1.2; 95% CI 0.6–1.8) and the average Team Climate Inventory score (1.3; 95% CI 0.1–2.5) were modestly associated with high-qualitycare. Interpretation: We identified a common set of organizational characteristics associated with high-quality primary care. Many of these characteristics are amenable to change through practice-level organizational changes.
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 carequality 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
Objective: To improve quality of dementia care in a Kaiser Permanente service area through rigorous dissemination of prac- tice guidelines and social worker support for physicians and patients. Study Design: Pre-post design with practice behavior change assessed by medical record review, and provider and caregiver sat- isfaction with care assessed by surveys. Methods: A diagnostic guideline and later a management
Debra L. Cherry; Barbara G. Vickrey; Lenore Schwankovsky; Elizabeth Heck; Michelle Plauché; Ralph Yep
Research into the value of music therapy in pediatric palliative care (PPC) has identified quality of life as one area of improvement for families caring for a child in the terminal stages of a life-threatening illness. This small-scale investigation collected data in a multisite, international study including Minnesota, USA, and Melbourne, Australia. An exploratory mixed method design used the qualitative
Kathryn J. Lindenfelser; Cherry Hense; Katrina McFerran
Purpose – Although “satisfaction” is not easy to define, excellence in health care is impossible without professional\\/patient satisfaction, so this paper aims to report on a pilot study designed in order to evaluate the degree of nursing staff satisfaction with the implementation of measures to improve quality of care. Design\\/methodology\\/approach – The project consisted of several phases: writing protocols of
Esther Uña Cidón; Fernando Cuadrillero Martín; Milagros Hijas Villaizán; Francisco López Lara
Attempts to improve patient care, its increasing cost and the aggressive malpractice environment have highlighted the need for standards of professional accountability. However, current measures of quality of care have mostly been met with skepticism by the medical community. These measures have been criticized for their uncertain validity and for focussing on secondary aspects of service that measure what is
This study reports on a skills-enhancement training series for direct care workers providing personal assistance under a waiver for Medicaid home care services. Designed to increase professionalism, the training was part of a federally funded state-level initiative to promote change in the community-based long-term-care system. A linear improvement in the ratings of training quality was documented, with the module on
Constance L. Coogle; Rita Jablonski; Jason A. Rachel; Iris A. Parham
\\u000a While some of the changes in life that accompany increasing age may promote higher quality of life, the increased prevalence\\u000a of disease and other negative life events presumably operate in the opposite direction. Among the most salient negative life\\u000a events in later life is the development of physical or mental disability sufficiently severe to justify moving from an independent\\u000a life
OBJECTIVE: To examine the impact of managed care on children's access, satisfaction, use, and quality of care using nationally representative household survey data. DATA SOURCE: The 1996 Medical Expenditure Panel Survey (MEPS). STUDY DESIGN: Bivariate and multivariate analyses are used to detect independent effects of managed care on access, satisfaction, utilization, and quality of pediatric health services. DATA COLLECTION/EXTRACTION METHODS: Data were obtained from rounds 1, 2, and 3 of the 1996 MEPS. MEPS collects data on health care use, insurance, access, and satisfaction, along with basic demographic and health status information for a representative sample of the U. S. civilian, noninstitutionalized population. Our sample consists of 5,995 children between the ages of 0 and 17. FINDINGS: Among the 18 outcome indicators examined, the bivariate analysis revealed only three statistically significant differences between children enrolled in managed care and children in traditional health plans: children enrolled in managed care were more likely to receive physician services, more likely to have access to office-based care during evening or weekend hours, and less likely to report being very satisfied with overall quality of care. However, after controlling for confounding factors, none of these differences remained statistically significant. CONCLUSIONS: Our findings suggest that there are no statistically significant differences in self-reported outcomes for children enrolled in managed care and traditional health plans. This conclusion is provisional, however, because of limitations in the data set.
Newacheck, P W; Hung, Y Y; Marchi, K S; Hughes, D C; Pitter, C; Stoddard, J J
This article draws on findings from a recent Cochrane systematic review of midwife-led care and discusses its contribution to the safety and quality of women's care in the domains of safety, effectiveness, woman-centeredness, and efficiency. According to the Cochrane review, women who received models of midwife-led care were nearly eight times more likely to be attended at birth by a known midwife, were 21% less likely to experience fetal loss before 24 weeks' gestation, 19% less likely to have regional analgesia, 14% less likely to have instrumental birth, 18% less likely to have an episiotomy, and significantly more likely to have a spontaneous vaginal birth, initiate breastfeeding, and feel in control. In addition to normalizing and humanizing birth, the contribution of midwife-led care to the quality and safety of health care is substantial. The implications are that policymakers who wish to improve the quality and safety of maternal and infant care, particularly around normalizing and humanizing birth, should consider midwife-led models of care and how financing of midwife-led services can support this. Suggestions for future research include exploring why fetal loss is reduced under 24 weeks' gestation in midwife-led models of care, and ensuring that the effectiveness of midwife-led models of care on mothers' and infants' health and well-being are assessed in the longer postpartum period. PMID:20434086
Sandall, Jane; Devane, Declan; Soltani, Hora; Hatem, Marie; Gates, Simon
Background Food and nutritional carequality must be assessed and scored, so as to improve health institution efficacy. This study aimed to detect and compare actions related to food and nutritional carequality in public and private hospitals. Methods Investigation of the Hospital Food and Nutrition Service (HFNS) of 37 hospitals by means of structured interviews assessing two quality control corpora, namely nutritional carequality (NCQ) and hospital food service quality (FSQ). HFNS was also evaluated with respect to human resources per hospital bed and per produced meal. Results Comparison between public and private institutions revealed that there was a statistically significant difference between the number of hospital beds per HFNS staff member (p?=?0.02) and per dietitian (p?0.01). The mean compliance with NCQ criteria in public and private institutions was 51.8% and 41.6%, respectively. The percentage of public and private health institutions in conformity with FSQ criteria was 42.4% and 49.1%, respectively. Most of the actions comprising each corpus, NCQ and FSQ, varied considerably between the two types of institution. NCQ was positively influenced by hospital type (general) and presence of a clinical dietitian. FSQ was affected by institution size: large and medium-sized hospitals were significantly better than small ones. Conclusions Food and nutritional care in hospital is still incipient, and actions concerning both nutritional care and food service take place on an irregular basis. It is clear that the design of food and nutritional care in hospital indicators is mandatory, and that guidelines for the development of actions as well as qualification and assessment of nutritional care are urgent.
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
The MobiQual programme aims to improve the quality of care through the use of pedagogical tools focused on public health issues. Developed by the French society of geriatrics and gerontology, and initially aimed at institutions, in 2009 the programme was opened up to those who provide home care. The "Pain, Well Treatment, Home" tool was the first to be specifically aimed at this sector PMID:23785976
Quality in health care requires access, appropriate and acceptable treatment plans, responsible patient follow through, a workforce of sufficient numbers and qualification and agreement on health carequality indicators. The purpose of this article is to describe APN workforce and dose effects on quality, reflected in patient outcomes and health care costs with current quality indicators. Stakeholders measure “quality indicators”
Dorothy Brooten; JoAnne M. Youngblut; Joyce Kutcher; Charles Bobo
In this article the author presents the theoretical concepts of quality of life, labor satisfaction, and service professions. Then describes the politic-institution characteristics of the actual national context in which the professionals that work in the Health field, developed their daily work. Presents a proposal of indicators, specially constructed by the author to analyze the labor context, that are being used in different research projects she developed since the beginning on XXI century. Finally presents the necessity of generate project that considers protagonist points of view and allow the construct of diagnosis of the situation, that generate public policies to answer the problem. PMID:20038992
This study investigates how environmental threats may adversely affect internal resources (slacks) and how hospitals' slack level may mediate the adverse effect of environmental threats on quality. Two testable hypotheses are (1) The environmental threat and level of organizational slack in hospitals are inversely related; and (2) Hospitals' slack level and quality of care are positively related. Both hypotheses are
Background Racial\\/ethnic minorities are more likely to report receipt of lower quality of health care; however, the mediators of such\\u000a patient reports are not known.\\u000a \\u000a \\u000a \\u000a \\u000a Objectives To determine (1) whether racial disparities in perceptions of quality of health care are mediated by perceptions of being\\u000a discriminated against while receiving medical care and (2) whether this association is further mediated by patient sociodemographic
The opinion of 357 patients about satisfaction with the quality of medical care in the multidisciplinary clinic before and after the introduction improve model organizational development of the medical institution for the improvement of the institution using the technique of two-dimensional analysis of "importance - satisfactions" are studied. Established that all the components of health care is important for patients and retain its relevance. Patient satisfaction as the major components of health care (organization diagnostic and treatment process, information support of patients), and the quality of the assistance provided in general significantly increased after the introduction improve model organizational development, which demonstrates of its effectiveness. PMID:23786026
Total quality management (TQM) is the newest in a long line of magic formulas which have been touted as saviors for American industry and medicine. The author discusses the basic concepts of TQM and notes that much of it resembles philosophical beliefs long held by the medical community. TQM does offer many opportunities to refine old concepts and further those goals of qualitycare to which health care providers have always aspired. If, however, it becomes simply another codified bureaucracy, then a great deal of time and money will be invested for very little gain. PMID:1749501
Collaborative networks of intensive care units can help promote a quality-improvement agenda across an entire system or region. Proposed advantages include targeting a greater number of patients, sharing of resources, and common measurement systems for audit and feedback or benchmarking. This review focuses on elements that are essential for the success and sustainability of these collaborative networks, using as examples networks in Michigan and Ontario. More research is needed to understand the mechanisms through which collaborative networks lead to improved care delivery and to demonstrate their cost-effectiveness in comparison with other approaches to system-level quality improvement. PMID:23182529
Prior efforts to effectively and efficiently audit quality of ambulatory care based on comprehensive process criteria have been limited largely by the complexity and cost of data abstraction and management. Over the years, several demonstration projects have generated large sets of process criteria and mapping systems for evaluating quality of care, but these paper-based approaches have been impractical to implement on a routine basis. Recognizing that portable microcomputers could solve many of the technical problems in abstracting data from medical records, we built upon previously described criteria and developed a microcomputer-based abstracting system that facilitates reliable and cost-effective data abstraction.
McCoy, J. Michael; Dunn, Earl V.; Borgiel, Alexander E.
...calculation of the quality performance standard...seeks to improve the quality of care furnished by ACOs...established by CMS. (d) Patient experience of care survey. For performance...audit and validate quality data reported by...
|States have placed high priority on developing early care and education systems that include early learning guidelines, curriculum, program guidelines or standards, and early childhood educator competencies. To explore how professional development and quality improvement initiatives are being integrated into emerging infant-toddlercare systems,…
Mangione, Peter L.; Lally, J. Ronald; Poole, Janet L.; Tuesta, Alicia; Paxton, Arlene R.
Our goal was to measure the quality of care provided in the Pediatric Intensive Care Unit (PICU) during Therapeutic Apheresis (TA). We described the care as a step by step process. We designed a flow chart to carefully document each step of the process. We then defined each step with a unique clinical indictor (CI) that represented the exact task we felt provided qualitycare. These CIs were studied and modified for 1 year. We measured our performance in this process by the number of times we accomplished the CI vs. the total number of CIs that were to be performed. The degree of compliance, with these clinical indicators, was analyzed and used as a metric for quality by calculating how close the process is running exactly as planned or "in control." The Apheresis Process was in control (compliance) for 47% of the indicators, as measured in the aggregate for the first observational year. We then applied the theory of Total Quality Management (TQM) through our Design, Measure, Analyze, Improve, and Control (DMAIC) model. We were able to improve the process and bring it into control by increasing the compliance to > 99.74%, in the aggregate, for the third and fourth quarter of the second year. We have implemented TQM to increase compliance, thus control, of a highly complex and multidisciplinary Pediatric Intensive Care therapy. We have shown a reproducible and scalable measure of quality for a complex clinical process in the PICU, without additional capital expenditure. PMID:22095668
Sussmane, Jeffrey B; Torbati, Dan; Gitlow, Howard S
Objective: To establish the need for a chronic disease management strategy for major depressive disorder (MDD), discuss the challenges involved in implementing guideline-level treatment for MDD, and provide examples of successful implementation of collaborative care programs. Data Sources: A systematic literature search of MEDLINE and the US National Library of Medicine was performed. Study Selection: We reviewed clinical studies evaluating the effectiveness of collaborative care interventions for the treatment of depression in the primary care setting using the keywords collaborative care, depression, and MDD. This review includes 45 articles relevant to MDD and collaborative care published through May 2010 and excludes all non–English-language articles. Results: Collaborative care interventions include a greater role for nonmedical specialists and a supervising psychiatrist with the major goal of improving quality of depression care in primary care systems. Collaborative care programs restructure clinical practice to include a patient care strategy with specific goals and an implementation plan, support for self-management training, sustained patient follow-up, and decision support for medication changes. Key components associated with the most effective collaborative care programs were improvement in antidepressant adherence, use of depression case managers, and regular case load supervision by a psychiatrist. Across studies, primary care patients randomized to collaborative care interventions experienced enhanced treatment outcomes compared with those randomized to usual care, with overall outcome differences approaching 30%. Conclusions: Collaborative care interventions may help to achieve successful, guideline-level treatment outcomes for primary care patients with MDD. Potential benefits of collaborative care strategies include reduced financial burden of illness, increased treatment adherence, and long-term improvement in depression symptoms and functional outcomes.
The study applies the principles behind the SERVQUAL model and uses Donabedian's framework to compare and contrast Malta's public and private hospital care service quality. Through the identification of 16 service quality indicators and the use of a Likert-type scale, two questionnaires were developed. The first questionnaire measured patient pre-admission expectations for public and private hospital service quality (in respect of one another). It also determined the weighted importance given to the different service quality indicators. The second questionnaire measured patient perceptions of provided service quality. Results showed that private hospitals are expected to offer a higher quality service, particularly in the "hotel services", but it was the public sector that was exceeding its patients' expectations by the wider margin. A number of implications for public and private hospital management and policy makers were identified. PMID:10185325
Stroke, the second leading cause of death throughout the world, has a major impact on society. This article provides a summary of quality improvement initiatives, including those relating to hospitals, the system of care delivery infrastructure, and legislative efforts in the United States and in various countries outside of the United States. Through quality improvement initiatives, it is projected that stroke outcomes may improve and the economic burden of stroke may be reduced. PMID:19026908
Objective. To evaluate HIV quality of care using a symptom-based, patient-centered framework. Methods. An expert panel developed 13 quality indicators for three common symptoms: cough with fever and\\/or shortness of breath; severe or persistent diarrhea; and signiWcant weight loss. A nationally representative probability sample of HIV-infected adults was interviewed between 1996 and 1997. Participants were asked about the presence and
STEVEN M. ASCH; ALLEN M. FREMONT; BARBARA J. TURNER; ALLEN GIFFORD; J. ALLEN; W. M. CHRISTOPHER MATHEWS; SAMUEL A. BOZZETTE; MARTIN F. SHAPIRO
Our aim is to describe the clients'perception related to to the admission in the Intensive Care. We have developed a descriptive study based on a qualitative approach in the intensive care in a university hospital in RJ, from May, 2003 to May, 2004. Thirty-two clients participated in this study just after hospital discharge. Data collection was possible through a questionaire. We consider that the clients showed some kind of satisfaction related to nursing intensive care, and the problem that really annoys them is the physical and ambiental stressors. The study shows questions that need a continuous discussion considering the stress, once it is a part of the activities and the atmosphere of intensive care and it also detaches the relavence of a work using indicatives of subjective quality in the intensive care. PMID:17051891
de Souza, Sônia Regina Oliveira e Silva; da Silva, Cláudia Aparecida; de Mello, Ursula Magliano; Ferreira, Carolina Neris
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 carequality 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
"Zero to Three" is a single-focus bulletin of the National Center for Infants, Toddlers, and Families providing insight from multiple disciplines on the development of infants, toddlers, and their families. Conceived by the Zero to Three Child Welfare Task Force, this issue focuses on agents of change for infants and toddlers in foster…
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 carequality. 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/
Goals We aimed to evaluate the palliative carequality for terminal cancer patients as a reference for prospective service improvements.\\u000a \\u000a \\u000a \\u000a Patients and methods A prospective study was conducted to analyze the quality audit data collected from 1,476 samples in one medical center’s palliative\\u000a care unit. Lai’s modified version of the support team assessment schedule was utilized for 2-year data collection, applying\\u000a 17
The relationship between limited health literacy and poor health may be due 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 5,929 patients. All patients completed seven items assessing patient-centered communication. One third also completed three items assessing health literacy. The majority of patients had self-reported health literacy challenges, reporting problems learning about their medical condition because of difficulty understanding written information (53%), a lack of confidence in completing medical forms by themselves (61%), and needing someone to help them read hospital/clinic materials (57%). Logistic regression models showed that, after adjustment for patient demographic characteristics and health care organization type, patients with limited health literacy were 28–79% less likely than those with adequate health literacy to report their health care organization “always” provides patient-centered communication across seven communication items. Using a scaled composite of these items, limited health literacy remained associated with lower reported communication quality. These results suggest that improving communication quality in health care organizations might help to address the challenges facing patients with limited health literacy. They also highlight that efforts to address the needs of patients with limited health literacy should be sensitive to the range of communication challenges confronting these patients and their caregivers.
The purpose of this study was to measure the efficiency of simple searches in retrieving controlled evidence about specific primary health carequality improvement interventions and their effects. Searches were conducted to retrieve evidence on seven interventions and seven effect variables. Specific words and the closest Medical Subject Headings (MeSH) recommended by professional librarians were used to search the MEDLINE
E. Andrew Balas; Marcia G. Stockham; Joyce A. Mitchell; Mary Ellen Sievert; Bernard G. Ewigman; Suzanne Austin Boren
|The efficiency of public day care centers in Sweden was studied by collecting data on inputs and services for about 200 centers and analyzing the information by data envelopment analysis. Results show large differences in efficiencies among centers, but these differences have few systematic relations to quality. (SLD)|
This paper suggests that different cultural communities may hold different definitions of “quality” in Early Childhood Education and Care (ECEC) conforming with their respective, culturally valued educational goals and culturally based beliefs regarding practices that facilitate their attainment. Despite the negative implication of stereotyping socio-cultural communities as “individualist” or “collectivist” (Triandis, 1995), the conceptualisation of cultural variations in educational goals
In this model, insurance offering a choice of hospitals is valued because consumers are uncertain which hospital they will prefer ex post. A competitive insurance market facilitates tacit price collusion between hospitals; high margins induce hospitals to compete for customers through overinvestment in quality. Incentives may exist to lock in market share via managed-care plans with less choice and lower
This chapter aims to describe the origin and current status of quality assurance (QA) in health care and to provide a background of similar developments in other industries, which have provided a major impetus for QA initiatives in health care. The interest in quality and safety in the health care sector has rapidly risen over the past decade. Without important lessons learnt from other industries, the interest and obtained improvements would have been far less fast. Knowledge on basic principles and challenges faced by other industries like the airline, car, and nuclear energy industry, that drove quality improvement projects, is of major relevance to understand the evolutions taking place in health care. To fully appreciate the QA movement, and design or implement quality improvement projects, its basic principles need to be understood. This chapter aims to give insights in basic principles underlying QA, and to discuss historical lessons that have been learnt from other industries. Furthermore, it discusses how to implement and assure a sustainable QA program. PMID:21764002
de Jonge, Vincent; Sint Nicolaas, Jerome; van Leerdam, Monique E; Kuipers, Ernst J
Nearly fourteen years ago the Institute of Medicine's report, To Err Is Human: Building a Safer Health System, triggered a national movement to improve patient safety. Despite the substantial and concentrated efforts that followed, quality and safety problems in health care continue to routinely result in harm to patients. Desired progress will not be achieved unless substantial changes are made to the way in which quality improvement is conducted. Alongside important efforts to eliminate preventable complications of care, there must also be an effort to seriously address the widespread overuse of health services. That overuse, which places patients at risk of harm and wastes resources at the same time, has been almost entirely left out of recent quality improvement endeavors. Newer and much more effective strategies and tools are needed to address the complex quality challenges confronting health care. Tools such as Lean, Six Sigma, and change management are proving highly effective in tackling problems as difficult as hand-off communication failures and patient falls. Finally, the organizational culture of most American hospitals and other health care organizations must change. To create a culture of safety, leaders must eliminate intimidating behaviors that suppress the reporting of errors and unsafe conditions. Leaders must also hold everyone accountable for adherence to safe practices. PMID:24101066
One result of a policy in the UK of providing support for older people to remain in their own homes has been an increase in frailty in the residents of care homes, many of whom suffer from dementia. The importance of enabling these residents to enjoy a good quality of life is recognized. Results from two research projects show that
Abdominal aortic aneurysm (AAA) repair is a complex surgical procedure and is commonly performed in a variety of practice settings across the United States. The quality of surgical care is neither ideal nor uniform across medical centers with documented variation in both utilization and outcomes. Recent data document that screening, though effective in reducing AAA-related deaths, may have only small
|Discusses the concept of Total Quality Management (TQM), developed by W. Edward Deming and Joseph Juran in 1940s, and its applications for child care centers. Discusses how TQM focuses on customer satisfaction, measuring performance, benchmarking, employee empowerment, and continuous training. Includes a list of suggested readings on TQM. (MDM)|
Defines and describes different types of audits and areas of patient care which lend themselves to a quality of performance review. Describes an audit application at a hospital-based crisis intervention center and the corrective action taken on the basis of the findings. (Author)
Purpose of the Study: In this article, I examine the asso- ciation between turnover of nursing home administrators and five important quality of care outcomes. Design and Methods: The data came from a survey of 420 nurs- ing facilities and the 1999 On-line Survey, Certification, and Reporting System. Using multivariate logistic regres- sion analyses, I looked at the effects of
|Substance abuse treatment agencies serving youth face unique barriers to providing qualitycare. 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…
The staff of the American Psychiatric Assocition (APA), the American Psychiatric Institute for Research and Education (APIRE), and a national panel of experts in bipolar disorder and practice guideline development have collaborated to generate a set of quality of care indicators for the pharmacologic and psychosocial treatment of bipolar disorder. The indicators were derived from APA’s evidence-based Practice Guideline for
Farifteh Firoozmand Duffy; William Narrow; Joyce C. West; Laura J. Fochtmann; David A. Kahn; Trisha Suppes; John M. Oldham; John S. McIntyre; Ronald W. Manderscheid; Paul Sirovatka; Darrel Regier
|Research Findings: This study investigated parents' experiences using Child Care and Development Fund and other state-dispersed child care subsidies, reasons for choosing their current child care program, and perceptions of the quality of child care received from their current program. A telephone survey of 659 parents receiving child care…
Research Findings: This study investigated parents’ experiences using Child Care and Development Fund and other state-dispersed child care subsidies, reasons for choosing their current child care program, and perceptions of the quality of child care received from their current program. A telephone survey of 659 parents receiving child care subsidies in 4 states showed that parents gave generally positive ratings
Helen Raikes; Julia Torquati; Cixin Wang; Brinn Shjegstad
There is a vast array of technical data that is continuously generated within the intensive care unit environment. In addition to physiological monitors, there is information being captured by the ventilator, intravenous infusion pumps, medication dispensing units, and even the patient's bed. The ability to retrieve and synchronize data is essential for both clinical documentation and real-time problem solving for individual patients and the intensive care unit population as a whole. Technical advances that permit the integration of all relevant data into a singular display or "dashboard" may improve staff efficiency, accelerate decisions, streamline workflow processes, and reduce oversights and errors in clinical practice. Critical care nurses must coordinate all aspects of care for one or more patients. Clinical data are constantly being retrieved, documented, analyzed, and communicated to others, all within the daily routine of nursing care. In addition, many bedside monitors and devices have alarms systems that must be evaluated throughout the workday, and actions taken on the basis of the patient's condition and other data. It is obvious that the complexity within such care processes presents many potential opportunities for overlooking important details. The capability to systematically and logically link physiological monitors and other selected data sets into a cohesive dashboard system holds tremendous promise for improving carequality, patient safety, and clinical outcomes in the intensive care unit. PMID:17063102
This study evaluated the effectiveness of implementation of common assessment tools, collaborative care plans, and symptom management guidelines for cancer patients as a strategy to improve the quality, coordination, and integration of palliative care service across organizations and health care sectors. A pre-post design to measure the impact on symptom management, caregiver burden and satisfaction with care delivery, and service utilization was used. Two cohorts of eligible patients and caregivers completed Edmonton Symptom Assessment Scales, Caregiver Reaction Assessment and FAMCARE Scales and chart audits were conducted. Administrative data from each participating site were examined for utilization trends. Audits of 53 charts preimplementation and 63 postimplementation showed an increase in documentation of pain from 24.5% to 74.6% (P<0.001) of charts. Administrative data showed a decrease in the percentage of patients with at least one emergency room visit from 94.3% to 84.8% (P<0.001), in the percentage of patients with at least one admission to the acute care hospital (P<0.001), and deaths in acute care 43.1%-35.7% (P=0.133). There was minimal change in the intensity of symptoms (P=0.591), and no change in the burden on the caregiver (P=0.086) or caregiver satisfaction with care (P=0.942). This study showed that implementation of common assessment tools, collaborative care plans, and symptom management guidelines across health sectors can result in some increased documentation of symptoms and efficiencies in care. Future projects should consider imbedding a continuous quality improvement methodology and longer timelines into their projects to improve outcomes. PMID:18358693
Background Follow-up is critically important for stroke survivors with diabetes, yet there is limited research about the quality of diabetes care that these patients receive. We investigated performance on diabetes quality of care indicators for stroke survivors overall and by race. Methods Claims data was extracted for 1,460 Medicare beneficiaries with preexisting diabetes who survived hospitalization for acute ischemic stroke in 2000. Adjusted probabilities of receiving HbA1c, LDL and dilated eye exams were estimated using logistic regression. Results 53% had a dilated eye exam, 60% received an LDL check, 73% percent had their HbA1c checked at least once and only 51% received two or more HbA1c checks. In the unadjusted results, blacks were significantly less likely than whites to receive these tests. Conclusions Care of stroke survivors, particularly blacks, shows gaps according to guidelines.
Pandhi, Nancy; Smith, Maureen A.; Kind, Amy J.H.; Frytak, Jennifer R.; Finch, Michael D.
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. Qualitycare 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, qualitycare 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
Background: Providing quality of care in family planning services is an important task for care providers so as to increase service utilization and coverage; however, little is known about the existing quality of care in such services. Objective: To assess quality of care in family planning services in Jimma Zone, southwest Ethiopia. Methods: A cross-sectional survey was conducted from January
Internal quality assurance is natural for hospital physicians. External quality control is undertaken in cooperation with medical societies and sponsors-partly on voluntary basis. Despite considerable efforts in optimizing treatment procedures by classification of injuries and tumor stages, algorithms and tightly scheduled practical medical training, further control mechanisms are demanded; the economic drive is evident. In parallel to the introduction of quality control for services with a case-based flat rate, an interstructural result quality is desired. Hospital certification procedures are no longer utopian. The physician's duty for continuing medical education, which is set down in the professional code, has to be proven. The development of guidelines by scientific societies may help but is in need of a corrective. The medical chambers may play a particular role in this connection. Even if mechanisms of quality assurance differ, it is in the patient's interest that there must be no difference between ambulant and hospital care. PMID:9221208
The aim of this cross-sectional study was to evaluate quality of life in chronic patients treated at primary care services associated with the Catholic University of Pelotas, Rio Grande do Sul State, Brazil. Quality of life was assessed by WHOQOL-Bref, and data on chronic diseases were obtained from patients' medical records and categorized as cardiovascular diseases, respiratory diseases, endocrine diseases, mental illness, and other musculoskeletal diseases. A total of 920 subjects were interviewed. Low self-rated quality of life was associated with female gender, older age, low socioeconomic status, single conjugal status, and chronic disease. In all domains of quality of life, mean levels were lower in patients with diseases of the nervous system, except in the environmental domains, which were lower in patients with mental illness. The results corroborate that quality of life in patients with chronic diseases is a priority for public health policies. PMID:24068223
Azevedo, Ana Lucia Soares de; Silva, Ricardo Azevedo da; Tomasi, Elaine; Quevedo, Luciana de Ávila
In the rush to produce balanced scorecards and outcomes measures, managed care organizations must recognize the need to better assess the clinical competencies of their contracted skilled nursing facilities. Health plan quality management staffs, although composed of gifted professionals, generally do not have sufficient skilled nursing facility (SNF)-related experience or knowledge to support evaluation and qualification of these providers. The successfully implemented Altman-Conrad (A-C) SNF quality management process objectively measures and monitors managed care contracted services provided by SNFs. The A-C process requires a health plan's quality management/utilization management staff to engage in a team-based educational endeavor. This effort is designed to generate measurable outcomes specific to the health plan's needs. The proven benefits of the process include improved member services, greater member satisfaction, more productive days for SNFs, more effective discharges, and the generation of a win-win relationship between the health plan and its contract providers. PMID:10185717
This article assesses whether there are methodological problems with child outcome measures that may contribute to the small associations between child carequality and child outcomes found in the literature. Outcome measures used in 65 studies of child carequality published between 1979 and December 2005 were examined, taking the previous review by Vandell and Wolfe (2000) as the starting point. Serious methodological problems were not pervasive for child outcome measures. However, methodological concerns were most prevalent among measures of socioemotional development. Furthermore, psychometric information on outcome measures was often missing from published reports, and health outcomes and approaches to learning were infrequently studied. Future research should address alignment issues between aspects of quality and the specific child outcomes chosen for study. PMID:16966677
This article asks whether financial incentives can improve the quality of health care. A conceptual framework drawn from microeconomics, agency theory, behavioral economics, and cognitive psychology motivates a set of propositions about incentive effects on clinical quality. These propositions are evaluated through a synthesis of extant peer-reviewed empirical evidence. Comprehensive financial incentives--balancing rewards and penalties; blending structure, process, and outcome measures; emphasizing continuous, absolute performance standards; tailoring the size of incremental rewards to increasing marginal costs of quality improvement; and assuring certainty, frequency, and sustainability of incentive payoffs--offer the prospect of significantly enhancing quality beyond the modest impacts of prevailing pay-for-performance (P4P) programs. Such organizational innovations as the primary care medical home and accountable health care organizations are expected to catalyze more powerful quality incentive models: risk- and quality-adjusted capitation, episode of care payments, and enhanced fee-for-service payments for quality dimensions (e.g., prevention) most amenable to piece-rate delivery. PMID:19296779
This study explored the association between perceptions of health carequality and quality of life in patients with advanced metastatic cancer and their informal caregivers (n=39). Patients' and caregivers' perceptions of health carequality, mental health, health-related quality of life, symptoms, and burden were measured. The key findings included the following: 1) patients' mental health and depression scores correlated with
David A. Fleming; Vanessa B. Sheppard; Patricia A. Mangan; Kathryn L. Taylor; Michelle Tallarico; Inez Adams; Jane Ingham
This article addresses conceptual and practical issues in the assessment of pediatric health carequality, outlines a conceptual model for measuring quality, and describes on-going research to validate an outcome measure of health carequality for vulnerable children. Pediatric quality measurement is distinct from that for adults due to development, dependence, differential epidemiology, demographic factors, and differences between the child
BACKGROUND: Quality of care from the perspective of users is increasingly used in evaluating health care performance. Going beyond satisfaction studies, quality of care from the users' perspective is conceptualised in two dimensions: the importance users attach to aspects of care and their actual experience with these aspects. It is well established that health care systems differ in performance. The
Peter P. Groenewegen; Jan J. Kerssens; Herman J. Sixma; Ingrid van der Eijk; Wienke G. W. Boerma
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
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.
Presents some examples of the implications derived from imposing the objective of maximizing social welfare, subject to limited resources, on ethical care patients management in respect of quality performance of health services. Conventional knowledge of health economics points out that critically ill patients are responsible for increased use of technological resources and that they receive a high proportion of health care resources. Attempts to answer, from the point of view of microeconomics, the question: how do we measure comparative efficiency in the management of intensive care units? Analyses this question through data from an international empirical study using micro-economic measures of productive efficiency in public services (data envelopment analysis). Results show a 28.8 per cent level of technical inefficiency processing data from 25 intensive care units in the USA. PMID:10169231
|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…
|Child carequality 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…
In an attempt to improve the standards of primary respiratory care in the UK, the Primary Care Respiratory Society-UK (PCRS-UK), in conjunction with other leading respiratory-interested health professional and patient groups, has devised a General Practice Quality Award for Respiratory Medicine. The Award is divided into three modules separated into a total of seven clinical standards (in parentheses): 'Clinical' (prevention, early and accurate diagnosis, acute care, chronic care); 'Organisational' (equipment); and 'The Practice Team' (practice learning needs, educational strategy). Assessment is by submission of a written portfolio of 37 pieces of evidence including audit, reflective learning, patient feedback, and significant event analyses. The Award was piloted in five respiratory-interested practices across the UK. The practices reported improvements in practice organisation, practice teamwork, improved process measures such as improvement in quality of spirometry, and improved patient access to patient services. All practices in the UK are being invited to apply for the Award in 2013. It is hoped that it will provide a framework and stimulus for provision of high-quality primary respiratory care, not only in the UK, but also some aspects of the Award may be applicable on a wider international scale. PMID:23974675
The negative effects of institutionalization caused partially by homogeneity and uniformity of care prompts the exploration of personal and common meanings of nursing home residents. This study is viewed as an initial step in providing qualitycare as defined by the resident. Personal and common meanings embedded in the lived lives of five older women residing in a long-term care facility are interpreted using a seven-stage Heideggerian hermeneutical phenomenological approach. An unstructured modified life review format is used to interview each participant on three separate occasions. Three constitutive patterns emerge: dwelling in remembering, living relatedly, and being after loss. These patterns endure across the life span of each woman and continue to endure after admission to the facility. The revelation of common and personal meanings provide new possibilities for the transformation of nursing practice to ensure qualitycare from the perspective of what is considered meaningful to each resident. PMID:9146196
Health information technology (HIT) is expected to transform the delivery of health care in the United States, but implementation and adoption vary widely across settings, specialties, and geographies. Significant barriers to high-level adoption persist despite federal incentives to hospitals and health-care providers. This article will review the current status and future impact of HIT in the specialty of urology, with emphasis on the intersection of HIT and quality measurement. PMID:23881730
HIV patients are at increased risk for depression. However, a comprehensive set of quality of care indicators for depression in the context of HIV does not exist. We report the results of a recent expert panel convened to develop a comprehensive set of HIV depression quality indicators. We systematically reviewed the depression and HIV depression literature to provide the evidence for the quality indicators. The HIV depression quality indicators were divided into six chapters: general, bereavement, substance abuse, viral hepatitis, cognitive impairment and drug interactions. A modified Delphi expert panel method was used to evaluate the validity and feasibility of the candidate quality indicators. The expert panel included HIV physicians, psychiatrists and a pharmacist, all with experience with HIV depression. The in-person eleven-member panel rated 80 candidate HIV-depression quality indicators. Indicators were evaluated using main and sensitivity analysis criteria for validity and feasibility. Seventy-four percent (59/80) of the quality indicators met a priori main analysis criteria for validity and feasibility and 61% met sensitivity analysis criteria. Approved indicators that are more specific to HIV depression include: depression screening frequency; depression screening and treatment in the context of hepatitis C; optimizing depression and HIV treatment in the context of cognitive impairment; and starting antidepressants at lower doses but advancing to doses typical for the general population. Most adverse medication interaction indicators did not meet main analysis validity criteria. The quality indicators identified in this study provide a useful tool for measuring and informing the quality of HIV-depression care. PMID:18825515
Pyne, Jeffrey M; Asch, Steven M; Lincourt, Katherine; Kilbourne, Amy M; Bowman, Candice; Atkinson, Hamp; Gifford, Allen
Responding to growing concerns regarding the safety, quality, and efficacy of cancer care in the United States, the Institute of Medicine (IOM) of the National Academy of Sciences commissioned a comprehensive review of cancer care delivery in the US health care system in the late 1990s. The National Cancer Policy Board (NCPB), a 20-member board with broad representation, performed this review. In its review, the NCPB focused on the state of cancer care delivery at that time, its shortcomings, and ways to measure and improve the quality of cancer care. The NCPB described an ideal cancer care system in which patients would have equitable access to coordinated, guideline-based care and novel therapies throughout the course of their disease. In 1999, the IOM published the results of this review in its influential report, Ensuring Quality Cancer Care. The report outlined 10 recommendations, which, when implemented, would: 1) improve the quality of cancer care, 2) increase the current understanding of quality cancer care, and 3) reduce or eliminate access barriers to quality cancer care. Despite the fervor generated by this report, there are lingering doubts regarding the safety and quality of cancer care in the United States today. Increased awareness of medical errors and barriers to qualitycare, coupled with escalating health care costs, has prompted national efforts to reform the health care system. These efforts by health care providers and policymakers should bridge the gap between the ideal state described in Ensuring Quality Cancer Care and the current state of cancer care in the United States. PMID:22045610
Purpose Although the American health care system is the most expensive in the world, it delivers inconsistent (and sometimes poor)\\u000a quality of care. Recent health care legislation contains several delivery system reforms that will attempt to address these\\u000a issues. We review these programs and discuss the implications for practicing urologists.\\u000a \\u000a \\u000a \\u000a \\u000a Methods We evaluated the medical, legal, and public policy literature (both print
Christopher P. Filson; John M. Hollingsworth; Ted A. Skolarus; J. Quentin Clemens; Brent K. Hollenbeck
OBJECTIVE: To determine the associations between managed care, physician job satisfaction, and the quality of primary care, and to determine\\u000a whether physician job satisfaction is associated with health outcomes among primary care patients with pain and depressive\\u000a symptoms.\\u000a \\u000a \\u000a DESIGN: Prospective cohort study.\\u000a \\u000a \\u000a \\u000a \\u000a SETTING: Offices of 261 primary physicians in private practice in Seattle.\\u000a \\u000a \\u000a \\u000a \\u000a PATIENTS: We screened 17,187 patients in waiting
David Grembowski; David Paschane; Paula Diehr; Wayne Katon; Diane Martin; Donald L. Patrick
Pressing ethical issues, such as the appropriateness of resuscitation and decision making for incompetent patients, frequently arise in conjunction with long term care. Institutional ethics committees can help long term care facility personnel and patients address ethical concerns. Interfacility ethics study groups can be organized to meet the needs of facilities with limited resources. Compliance with ethical policies (eg, regarding decisions to withhold or withdraw life-prolonging treatment, artificial nutrition and hydration, and use of chemical and physical restraints) can be monitored as part of a facility's quality assurance program. PMID:3134635
With the growth of Facebook, public health researchers are exploring the platform's uses in health care. However, little research has examined the relationship between Facebook and traditional hospital quality measures. The authors conducted an exploratory quantitative analysis of hospitals' Facebook pages to assess whether Facebook "Likes" were associated with hospital quality and patient satisfaction. The 30-day mortality rates and patient recommendation rates were used to quantify hospital quality and patient satisfaction; these variables were correlated with Facebook data for 40 hospitals near New York, NY. The results showed that Facebook "Likes" have a strong negative association with 30-day mortality rates and are positively associated with patient recommendation. These exploratory findings suggest that the number of Facebook "Likes" for a hospital may serve as an indicator of hospital quality and patient satisfaction. These findings have implications for researchers and hospitals looking for a quick and widely available measure of these traditional indicators. PMID:23378059
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
There is a widespread belief that high-quality early care and education can improve children's school readiness. However, debate continues about the essential elements of a high-quality experience, about whether quality means the same things across different types of care settings, about how to measure quality, and about the level of quality that might make a meaningful difference in outcomes for
There is a widespread belief that high-quality early care and education can improve children's school readiness. However, debate continues about the essential elements of a high-quality experience, about whether quality means the same things across different types of care settings, about how to measure quality, and about the level of quality that…
All federally qualified HMOs must develop and implement quality assurance programs for monitoring the quality of care, the quality of services, and the costs of inpatient and ambulatory care. Such quality assurance programs are diverse and vary in administrative structure, criteria, review procedures, feedback, and decision making. This paper describes a computerized quality assurance reporting system operating in an HMO
In May 1964 the Royal Commission on Health Services declared that “health research is essential to health progress”. However, since that time the means of providing adequate health care have received far less attention than have methods of payment for physicians' services. Because medical education and research is the source from which all other health benefits flow, urgent attention must be paid to the adequate support of teacher-scientists, as set forth in the Woods, Gordon (Gundy) report. It is the numbers and quality of these men and women, more than any other factor, that will determine the shape of medical science and, hence, medical practice in Canada in the future. Expensive as it is, Canadian medicine and Canadian medical scientists must have generous support if medical care in this country is to be of high quality.
OBJECTIVE Diabetic women are at increased risk for adverse pregnancy outcomes that can be improved by preconception care. Our goal was to evaluate the quality of medical care in diabetic women who undergo fertility treatment and compare it with the quality of medical care in diabetic women with spontaneous pregnancies. RESEARCH DESIGN AND METHODS This retrospective study on reproductive-age women undergoing fertility treatment in Clalit Health Services (CHS) used data on fertility treatments, prescription fillings, HbA1c levels, and demographics extracted from CHS computerized systems. The control group comprised women with spontaneous pregnancy. Three quality measures in the periconception period were evaluated: folic acid prescription fillings, evaluation and level of HbA1c, and use of potentially hazardous drugs. RESULTS There were 230 fertility treatment cycles in 83 diabetic women, and 30 diabetic women had spontaneous pregnancy. Women in the fertility group were older and had fewer children. There were no significant differences in marital status or ethnicity. Regular folic acid use, HbA1c recording, and the percentage of women with HbA1c <7% was similar between women in fertility treatment and those with spontaneous pregnancy (23.9, 57.8, and 31.3% vs. 20.0, 73.3, and 40.0%, respectively). Several women in both groups continued the use of potentially hazardous medication. CONCLUSIONS The periconception medical care of diabetic women who undergo fertility treatment is suboptimal and no better than that of diabetic women with spontaneous pregnancies. More intensive and targeted counseling regarding the importance of folic acid and glycemic control is needed to optimize periconception care of these diabetic patients.
A national trial of a methodology for monitoring quality of nursing care was conducted in 19 hospitals of differing sizes and characteristics. The relationship between the quality of nursing care provided in these hospitals and a number of organizational ...
... PM How do I select a high-quality child care program for my child with special needs? 1. ... the other children and families. Identifying Quality in Child Care Look, listen and ask ? Are families and children ...
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
BACKGROUND: The management of patients with head and neck cancer is complex, and implementation of an integrated care program might improve the quality of care. METHODS: A prospective before-after study was performed in 1 clinic for head and neck oncology on 311 adults with head and neck cancer to evaluate an integrated care program. RESULTS: Scores on the integrated care
Mariëlle M. M. T. J. Ouwens; Rosella R. P. M. G. Hermens; Marlies M. E. J. L. Hulscher; Matthias A. W. Merkx; Frank J. A. van den Hoogen; Richard P. Grol; Hub C. H. Wollersheim; Henri A. M. Marres
A literature review was undertaken to explore both published and unpublished quality improvement studies, projects, and initiatives that strove to develop more efficient systems to support an infrastructure for nursing home quality of care. The review included a search of all available, full-text published literature from 1997 to 2007 available from PubMed, CINAHL, and MEDLINE. The methods used by the researchers were varied, and this article identified several primary findings: the use of a specific, measurable mission or goal statement; the use of multidepartmental and multidisciplinary involvement; the need for further education and resource materials; the use of a reward/incentive program; the need for internal and external stakeholders to be identified along with a project champion; and the process of feedback and outcome measurement. This article summarizes the findings from the review and offers key recommendations that are supported for improving quality of care and sustaining quality gains. PMID:20077965
Within hospitals, a plan for quality improvement consists of numerous steps to be taken by an inclusive management team, implicating all of the actors involved. The establishment of an instrument panel of indicators is the outcome of such a participatory process. The existence of best practice referentials allows for the construction of a coherent plan to improve the quality of care. A query of the francophone bibliographic databases reveals very few publications from internal audits on the relevance of care. Nevertheless, external audits demonstrate the significance of evaluation of the quality of care in psychiatric hospitals. The authors are therefore surprised to note the existing hiatus between the wealth of references and their lack of being used in the publications of the professionals concerned. The analysis of the relevance of the medical decision is not widely accepted. Clinical practice is still considered as an art form even though it has become a technique which now calls on the collective experience of peers. PMID:12891818
Background Health information exchange is a national priority, but there is limited evidence of its effectiveness. Objective We sought to determine the effect of health information exchange on ambulatory quality. Methods We conducted a retrospective cohort study over two years of 138 primary care physicians in small group practices in the Hudson Valley region of New York State. All physicians had access to an electronic portal, through which they could view clinical data (such as laboratory and radiology test results) for their patients over time, regardless of the ordering physician. We considered 15 quality measures that were being used by the community for a pay-for-performance program, as well as the subset of 8 measures expected to be affected by the portal. We adjusted for 11 physician characteristics (including health carequality at baseline). Results Nearly half (43%) of the physicians were portal users. Non-users performed at or above the regional benchmark on 48% of the measures at baseline and 49% of the measures at followup (p = 0.58). Users performed at or above the regional benchmark on 57% of the measures at baseline and 64% at follow-up (p<0.001). Use of the portal was independently associated with higher quality of care at follow-up for those measures expected to be affected by the portal (p = 0.01), but not for those not expected to be affected by the portal (p = 0.12). Conclusions Use of an electronic portal for viewing clinical data was associated with modest improvements in ambulatory quality.
Kern, L.M.; Barron, Y.; Dhopeshwarkar, R.V.; Kaushal, R.
Traditionally, standards are used to define the level of care that a patient can expect to receive in a given institution or on a given nursing unit. These standards are the foundation of quality assurance programs. Unfortunately, with the increased emphasis on monitoring care, many standards are being written after the quality assurance activities have been developed and are in place. Often, standards are placed neatly in a book that is dusted off and brought out when the Joint Commission for Accreditation of Healthcare Organizations representative (JCAHO) visits. The nursing staff at the unit level has no real knowledge or understanding of the standards. This may result in a nonfunctioning quality assurance program. PMID:1995020
To assess the effects of an Integrated Care System (ICS) on parent-reported quality of care and satisfaction for Children with Special Health Care Needs (CSHCN). In 2006 Florida reformed its Medicaid program in Broward and Duval counties. Children's Medical Services Network (CMSN) chose to participate in the reform and developed an ICS for CSHCN. The ICS ushered in several changes such as more prior approval requirements and closing of the provider network. Telephone surveys were conducted with CMSN parents whose children reside in the reform counties and parents whose children reside outside of the reform counties in 2006 and 2007 (n = 1,727). Results from multivariate quasi-experimental models show that one component of parent-report quality of care, customer service, increased. Following implementation of the ICS, customer service increased by 0.22 points. After implementation of the ICS, parent-reported quality and satisfaction were generally unaffected. Although significant increases were not seen in the majority of the quality and satisfaction domains, it is nonetheless encouraging that parents did not report negative experiences with the ICS. It is important to present these interim findings so that progress can be monitored and decision-makers can begin to consider if the program should be expanded statewide. PMID:21509433
Knapp, Caprice; Madden, Vanessa; Sloyer, Phyllis; Shenkman, Elizabeth
We developed a comprehensive set of quality-of-care indicators for the management of children with infantile spasms in the United States, encompassing evaluation, diagnosis, treatment, and prevention and management of side effects and comorbidities. The indicators were developed using the RAND/UCLA Modified Delphi Method. After a focused review of the literature and guidelines by the study team, an expert panel (nominated by leaders of Child Neurology Society, American Epilepsy Society, and National Institute for Neurologic Disorders) rated the draft indicators anonymously, met face-to-face to discuss each indicator, and rerated the revised indicators on validity, feasibility, and importance. The panel recommended 21 indicators, of which 8 were identified as most likely to have a large positive impact on improving quality of life and/or health outcomes for children with infantile spasms. The proposed indicators can be used to assess and document variations and gaps in quality-of-care and inform future research and quality improvement interventions. PMID:22566712
Wang, C Jason; Jonas, Rinat; Fu, Chong Min; Ng, Chun Y; Douglass, Laurie
Objectives: The majority of persons with dementia live in the community where most of their care is provided by family members. We aimed to expand our limited knowledge about the styles of high-qualitycare, such as person-centered care, and poor-qualitycare adopted by these informal caregivers and the characteristics of those who provide better care. Method: We conducted a mail survey of 148 family caregivers. Caregiving styles were measured with items from existing scales that had not been analyzed together before. Factor analysis of these items was used to identify styles of caregiving, and structural equation modeling was used to identify their relationships with caregiver and care-recipient characteristics. Results: Three high quality-of-care factors (personalized, respectful, and compensatory) and three poor quality-of-care factors (punitive, controlling, and withdrawing) were found. The personality traits of agreeableness, openness, conscientiousness, and neuroticism were related to higher quality of care, and the trait of extraversion was related to poorer quality of care. Wishful coping - an avoidance/escape strategy - was linked to poorer quality of care. Conclusion: We discovered new dimensions of quality of care, some consistent with person-centered care and some antithetical to this model, and we identified for the first time caregiver personality traits and coping strategies associated with better quality of care. These results may be useful in targeting caregiver interventions to benefit both caregivers and care recipients. PMID:24171485
The Health CareQuality Improvement Program (HCQIP), administered by the Health Care Financing Administration and implemented through Utilization and Quality Control Peer Review Organizations (PROs), is a new approach to monitoring the health care received by Medicare beneficiaries. The HCQIP shifts the focus of the PRO program from regulatory quality management to quality improvement principles. Through a series of cooperative projects, each focusing on a specific medical condition or procedure, PROs will conduct pattern analysis and share information about these analyses with health care organizations for the purpose of stimulating internal quality improvement efforts. As a fundamental shift in the way PROs have conducted quality-related activities, the HCQIP presents PROs with numerous challenges. This paper provides insight into one of their most significant challenges, the development of a model for constructive, nonevaluative feedback. Successful HCQIP feedback efforts may serve as models for quality management programs that will accompany national health care reform. PMID:10141395
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
Compared effects of ombudsman programs on quality of nursing home care on random sample of 134 Medicare/Medicaid-certified long-term care facilities in Missouri. Found that presence of ombudsman program was most important factor associated with quality for intermediate-care facilities, and was significantly associated with quality for skilled…
ABSTRACT: Health carequality falls far short of its potential nationally. Because care is de- livered locally, improvement strategies should be tailored to community needs. This analy- sis from the Community,Quality Index (CQI) study reports on a comprehensive,examination of how effectively care is delivered in twelve metropolitan areas. We find room for improve- ment in quality overall and in dimensions
E. A. Kerr; E. A. McGlynn; J. Adams; J. Keesey; S. M. Asch
This report from the 1995 Child Care Action Campaign national audioconference examines approaches to building support among child care providers, legislators, and parents for investments in good quality child care in light of welfare reform. The report summarizes recent findings that children in good quality child care had a more developed…
The National Association for Family Child Care (NAFCC), a non-profit organization dedicated to promoting quality child care, believes that family child care accreditation is the true measure of high-quality family based care. In this article, the author presents the steps made by the NAFCC to accreditation. NAFCC Accreditation is a formal system…
Purpose – Quality of health care is the degree of the most optimal degree of health outcomes by delivery of effective, efficient and cost-benefit professional health services to people and communities. As nurses are the largest groups among health care professionals and are legally liable and morally responsible for their care, thus their perspective on quality of nursing care is
Mansoureh Z. Tafreshi; Mehrnoosh Pazargadi; Zhila Abed Saeedi
OBJECTIVE: To assess user expectations and degree of client satisfaction and quality of health care provided in rural Bangladesh. METHODS: A total of 1913 persons chosen by systematic random sampling were successfully interviewed immediately after having received care in government health facilities. FINDINGS: The most powerful predictor for client satisfaction with the government services was provider behaviour, especially respect and politeness. For patients this aspect was much more important than the technical competence of the provider. Furthermore, a reduction in waiting time (on average to 30 min) was more important to clients than a prolongation of the quite short (from a medical standpoint) consultation time (on average 2 min, 22 sec), with 75% of clients being satisfied. Waiting time, which was about double at outreach services than that at fixed services, was the only element with which users of outreach services were dissatisfied. CONCLUSIONS: This study underscores that client satisfaction is determined by the cultural background of the people. It shows the dilemma that, though optimally care should be capable of meeting both medical and psychosocial needs, in reality care that meets all medical needs may fail to meet the client's emotional or social needs. Conversely, care that meets psychosocial needs may leave the clients medically at risk. It seems important that developing countries promoting client-oriented health services should carry out more in-depth research on the determinants of client satisfaction in the respective culture.
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.
Bihari, Shailesh; Doug McEvoy, R.; Matheson, Elisha; Kim, Susan; Woodman, Richard J.; Bersten, Andrew D.
Understanding patients' and family members' perspectives on the relative importance of elements of end-of-life (EOL) care and their satisfaction with those elements will help prioritize quality improvement initiatives. We administered a face-to-face questionnaire containing a selection of 28 elements of care to eligible inpatients with advanced lung, heart, or liver disease, or metastatic cancer, and available family caregivers (FCGs) in five tertiary care hospitals across Canada. 440 of 569 (78%) eligible patients and 160 of 176 (91%) FCGs participated. No respondent reported complete satisfaction with all elements of care. The average satisfaction score was 4.6 on a 26 point scale. Medical patients reported lower levels of satisfaction than cancer patients. Elements rated as "extremely important" and anything other than "completely satisfied" most frequently by respondents related to discharge planning, availability of home health services, symptom relief, not being a burden, physician trust, and communication. In conclusion, most patients and their family members in our survey were not completely satisfied with EOL care. Improvement initiatives to target key elements identified by patients and FCGs have the potential to improve satisfaction with EOL care across care settings. PMID:16334968
Background Since 2000, Israel has had a national program for ongoing monitoring of the quality of the primary care services provided by the country's four competing non-profit health plans. Previous research has demonstrated that quality of care has improved substantially since the program's inception and that the program enjoys wide support among health plan managers. However, prior to this study there were anecdotal and journalistic reports of opposition to the program among primary care physicians engaged in direct service delivery; these raised serious questions about the extent of support among physicians nationally. Goals To assess how Israeli primary care physicians experience and rate health plan efforts to track and improve the quality of care. Method The study population consisted of primary care physicians employed by the health plans who have responsibility for the quality of care of a panel of adult patients. The study team randomly sampled 250 primary-care physicians from each of the four health plans. Of the 1,000 physicians sampled, 884 met the study criteria. Every physician could choose whether to participate in the survey by mail, e-mail, or telephone. The anonymous questionnaire was completed by 605 physicians – 69% of those eligible. The data were weighted to reflect differences in sampling and response rates across health plans. Main findings The vast majority of respondents (87%) felt that the monitoring of quality was important and two-thirds (66%) felt that the feedback and subsequent remedial interventions improved medical care to a great extent. Almost three-quarters (71%) supported continuation of the program in an unqualified manner. The physicians with the most positive attitudes to the program were over age 44, independent contract physicians, and either board-certified in internal medicine or without any board-certification (i.e., residents or general practitioners). At the same time, support for the program was widespread even among physicians who are young, board-certified in family medicine, and salaried. Many physicians also reported that various problems had emerged to a great or very great extent: a heavier workload (65%), over-competitiveness (60%), excessive managerial pressure (48%), and distraction from other clinical issues (35%). In addition, there was some criticism of the quality of the measures themselves. Respondents also identified approaches to addressing these problems. Conclusions The findings provide perspective on the anecdotal reports of physician opposition to the monitoring program; they may well accurately reflect the views of the small number of physicians directly involved, but they do not reflect the views of primary care physicians as a whole, who are generally quite supportive of the program. At the same time, the study confirms the existence of several perceived problems. Some of these problems, such as excess managerial pressure, can probably best be addressed by the health plans themselves; while others, such as the need to refine the quality indicators, are probably best addressed at the national level. Cooperation between primary care physicians and health plan managers, which has been an essential component of the program's success thus far, can also play an important role in addressing the problems identified.
Background Our aim was to assess the contribution of training in data definitions and data extraction guidelines to improving quality of data for use in intensive care scoring systems such as the Acute Physiology and Chronic Health Evaluation (APACHE) II and Simplified Acute Physiology Score (SAPS) II in the Dutch National Intensive Care Evaluation (NICE) registry. Methods Before and after attending a central training programme, a training group of 31 intensive care physicians from Dutch hospitals who were newly participating in the NICE registry extracted data from three sample patient records. The 5-hour training programme provided participants with guidelines for data extraction and strict data definitions. A control group of 10 intensive care physicians, who were trained according the to train-the-trainer principle at least 6 months before the study, extracted the data twice, without specific training in between. Results In the training group the mean percentage of accurate data increased significantly after training for all NICE variables (+7%, 95% confidence interval 5%–10%), for APACHE II variables (+6%, 95% confidence interval 4%–9%) and for SAPS II variables (+4%, 95% confidence interval 1%–6%). The percentage data error due to nonadherence to data definitions decreased by 3.5% after training. Deviations from 'gold standard' SAPS II scores and predicted mortalities decreased significantly after training. Data accuracy in the control group did not change between the two data extractions and was equal to post-training data accuracy in the training group. Conclusion Training in data definitions and data extraction guidelines is an effective way to improve quality of intensive care scoring data.
Arts, Danielle GT; Bosman, Rob J; de Jonge, Evert; Joore, Johannes CA; de Keizer, Nicolette F
Health care professionals working in HIV\\/AIDS are dedicated to providing qualitycare for their clients. They also need to care for themselves. This study examines why burnout occurs and how it may be prevented in the care of clients with HIV\\/AIDS. The sample of Australian HIV\\/AIDS health care professionals (n = 84). consisted of 54 nurses, 16 doctors and 14
|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 carequality. The videotaped mothers were described…
Shpancer, Noam; Melick, Katherine M.; Sayre, Pamela S.; Spivey, Aria T.
Extensive research into quality of care in different countries yields no conclu- sive findings that one system is better or worse than others. Quality does not necessarily vary with financing mechanisms; even countries with single-payer systems have variations in quality. Quality is not directly related to the amount spent on health care, since the high- est-spending country (the United States)
Modern medicine is complex and delivered by interdependent teams. Conscious redesign of the way in which these teams interact can contribute to improving the quality of care by reducing practice variation. This requires techniques that are different to those used for individual patient care. In this paper, we describe some of these quality improvement (QI) techniques. The first section deals with the identification of practice variation as the starting point of a systematic QI endeavour. This involves collecting data in multiple centres on a set of quality indicators as well as on case-mix variables that are thought to affect those indicators. Reporting the collected indicator data in longitudinal run charts supports teams in monitoring the effect of their QI effort. After identifying the opportunities for improvement, the second section discusses how to reduce practice variation. This includes selecting the 'package' of clinical actions to implement, identifying subsidiary actions to achieve the improvement aim, designing the implementation strategy and ways to incentivise QI. PMID:23472488
BACKGROUND: Few individuals with depression treated in the primary care setting receive care consistent with clinical treatment guidelines. Interventions based on the chronic care model (CCM) have been promoted to address barriers and improve the quality of care. A current understanding of barriers to depression care and an awareness of whether physicians believe interventions effectively address those barriers is needed
Rachel Mosher Henke; Ann F Chou; Johann C Chanin; Amanda B Zides; Sarah Hudson Scholle
Currently barriers exist in delivering quality health care. This study aimed to investigate such barriers in the eight rural district hospitals of the West Coast Winelands Region, three type A and five type B hospitals. A quantitative descriptive design was applied which included the total population of nursing staff (n = 340) working at the time of data collection. A self-administered questionnaire was distributed with a response rate of 82%.Reliability of the instrument was verified using the Cronbach alpha coefficient and a pilot study. The validity, specifically construct and content validity, were assured by means of an extensive literature review, pilot study and use of experts. Ethics approval was obtained from the relevant stakeholders.Results showed that 272 participants (97%) disagreed that provision of staff was adequate, with staff above 40 years of age more likely to disagree (p = <0.01). A statistically significant association was shown between availability of doctors and staff not being able to cope with emergencies (p = <0.01). Most participants (n =212; 76%) indicated that they were not receiving continuing education, with the registered nurses more likely to disagree (?² test, p = 0.02). Participants in both hospital types A (n = 131; 82%) and B (n = 108; 91%) also disagreed that provision of equipment and consumables was adequate.The research showed that inadequacies relating to human resources, professional development, consumables and equipment influenced the quality of patient care. Urgent attention should be given to the problems identified to ensure quality of patient care in rural hospitals. PMID:23327761
Objectives. To study how medical professionals perceived recent organizational changes and financial cut-backs in terms of organizational and health carequality. Design. A cross-sectional questionnaire survey. Setting. County council of Stockholm. Participants. A random sample (n=936; 70% response rate) of physicians and nurses employed by the county council of Stockholm. Main outcome measures. Staff perception of how recent changes impacted
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.
Aiken, Linda H.; Xue, Ying; Clarke, Sean P.; Sloane, Douglas M.
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.
Purpose: We sought to assess the quality of care provided by an innovative MedicareþChoice HMO targeted specifically at nursing home residents and employing nurse practitioners to provide additional primary care over and above that provided by physicians. The underlying premise of the Evercare approach is that the additional primary care will reduce the rate of untoward events and reduce the
Robert L. Kane; Shannon Flood; Boris Bershadsky; Gail Keckhafer
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
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.
A retrospective study was conducted at a Nigerian tertiary hospital to assess the quality of emergency care provided to women managed for a ruptured uterus over an 11-year period. There were 76 cases of ruptured uterus and 4,770 deliveries (1.6%) during the period. Ten women died from a ruptured uterus, giving a case fatality rate of 13.2%. The mean admission-assessment interval by a senior clinician was 48.4 min. The mean decision-laparotomy interval was 6.9 h. Deviations from management protocol were noted in 66 women (86.8%) and underlying reasons were classified as patient-orientated (59.2%), medical personnel (13.2%) and administrative (22.4%) problems. Among women who died, there were more administrative problems, intraoperative and total blood losses were significantly more and preoperative haematocrit was significantly less compared with survivors. The poor quality of care for ruptured uterus in this centre is attributable to patients' financial limitations, which is compounded by administrative problems, particularly those regarding inefficient blood transfusion services. This study demonstrates the urgent need for implementation of a national health insurance scheme at this centre and reiterates the feasibility of employing detailed enquiry of peripartal circumstances to identify specific problems underlying major causes of maternal morbidity and mortality. PMID:20373929
The Hospital for Sick Children (SickKids) is situated in one of the most diverse cities in the world. This is reflected in the patient population it serves. In 2009, the hospital embarked on a quality improvement initiative to address the existing evidence base on health disparities and to enhance health equity through cultural competence programming. The goal was to achieve optimal health outcomes for all patients and families, with a particular focus on new immigrant and other vulnerable populations. Evaluation results indicate changes in clinical practice as a result of this initiative and increased patient satisfaction with regard to staff members' level of cultural sensitivity. This article provides an overview of this hospital-wide initiative, as well as the evaluation methods and outcomes. Based on a needs assessment, we developed an institutionally meaningful curriculum with SickKids' values of family-centred care, patient safety and service excellence embedded in the program. Educational sessions were delivered to clinical and non-clinical hospital staff, focusing on health disparities, the case for culturally competent care and practical tools for healthcare practitioners. Organizational change strategies, including the use of champions as change agents and role models, were used to embed cultural competence as integral to family-centred care at SickKids. PMID:22008574
Karmali, Karima; Grobovsky, Linda; Levy, Jennifer; Keatings, Margaret
PURPOSE Mindfulness (ie, purposeful and nonjudgmental attentiveness to one's own experience, thoughts, and feelings) is associated with physician well-being. We sought to assess whether clinician self-rated mindfulness is associated with the quality of patient care. METHODS We conducted an observational study of 45 clinicians (34 physicians, 8 nurse practitioners, and 3 physician assistants) caring for patients infected with the human immunodeficiency virus (HIV) who completed the Mindful Attention Awareness Scale and 437 HIV-infected patients at 4 HIV specialty clinic sites across the United States. We measured patient-clinician communication quality with audio-recorded encounters coded using the Roter Interaction Analysis System (RIAS) and patient ratings of care. RESULTS In adjusted analyses comparing clinicians with highest and lowest tertile mindfulness scores, patient visits with high-mindfulness clinicians were more likely to be characterized by a patient-centered pattern of communication (adjusted odds ratio of a patient-centered visit was 4.14; 95% CI, 1.58-10.86), in which both patients and clinicians engaged in more rapport building and discussion of psychosocial issues. Clinicians with high-mindfulness scores also displayed more positive emotional tone with patients (adjusted ? = 1.17; 95% CI, 0.46-1.9). Patients were more likely to give high ratings on clinician communication (adjusted prevalence ratio [APR] = 1.48; 95% CI, 1.17-1.86) and to report high overall satisfaction (APR = 1.45; 95 CI, 1.15-1.84) with high-mindfulness clinicians. There was no association between clinician mindfulness and the amount of conversation about biomedical issues. CONCLUSIONS Clinicians rating themselves as more mindful engage in more patient-centered communication and have more satisfied patients. Interventions should determine whether improving clinician mindfulness can also improve patient health outcomes. PMID:24019273
Beach, Mary Catherine; Roter, Debra; Korthuis, P Todd; Epstein, Ronald M; Sharp, Victoria; Ratanawongsa, Neda; Cohn, Jonathon; Eggly, Susan; Sankar, Andrea; Moore, Richard D; Saha, Somnath
Purpose: There are few empirical studies relating components of long-term care to quality of life for residents with dementia. This study relates elements of dementia care in residential care\\/assisted living (RC\\/ AL) facilities and nursing homes to resident quality of life and considers the guidance this information provides for practice and policy. Design and Methods: We used a variety of
Sheryl Zimmerman; Philip D. Sloane; Christianna S. Williams; Peter S. Reed; John S. Preisser; J. Kevin Eckert; Malaz Boustani; Debra Dobbs
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
Improving the Quality of Health Care for Mental and Substance-Use Conditions represents the intersection of two key developments now taking place in health care. One is the increasing attention to improving the quality of health care in ways that take acc...
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 carequality, because it supports an illusion of care consistent with regulations, which reduces the motivation and…
Schnelle, John F.; Osterweil, Dan; Simmons, Sandra F.
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
One of the most challenging aspects of health care improvement and reform is ensuring that individuals, particularly those who are vulnerable and low income, have access to care. Just as challenging is the imperative to ensure that the care accessed is of the highest quality possible. The Institute of Medicine (IOM) report, Crossing the Quality Chasm, identified the primary goal
Background: Various groups have called for a national sys- tem to monitor the quality of cancer care. The validity of cancer registry data for quality of cancer care has not been well studied. We investigated the validity of such informa- tion in the California Cancer Registry. Methods: We com- pared registry data associated with care with data ab- stracted from
Jennifer L. Malin; Katherine L. Kahn; John Adams; Lorna Kwan; Marianne Laouri; Patricia A. Ganz
Rural health services are difficult to maintain because of low patient volumes, limited numbers of providers, and unfavorable economies of scale. Rural patients may perceive poor quality in local health care, directly impacting the sustainability of local health care services. This study examines perceptions of local health carequality in 7…
Nesbitt, Thomas S.; Marcin, James P.; Daschbach, Martha M.; Cole, Stacey L.
Purpose To evaluate the appropriateness of potential data sources for the population of performance indicators for primary care (PC) practices. Methods This project was a cross sectional study of 7 multidisciplinary primary care teams in Ontario, Canada. Practices were recruited and 5-7 physicians per practice agreed to participate in the study. Patients of participating physicians (20-30) were recruited sequentially as they presented to attend a visit. Data collection included patient, provider and practice surveys, chart abstraction and linkage to administrative data sets. Matched pairs analysis was used to examine the differences in the observed results for each indicator obtained using multiple data sources. Results Seven teams, 41 physicians, 94 associated staff and 998 patients were recruited. The survey response rate was 81% for patients, 93% for physicians and 83% for associated staff. Chart audits were successfully completed on all but 1 patient and linkage to administrative data was successful for all subjects. There were significant differences noted between the data collection methods for many measures. No single method of data collection was best for all outcomes. For most measures of technical quality of care chart audit was the most accurate method of data collection. Patient surveys were more accurate for immunizations, chronic disease advice/information dispensed, some general health promotion items and possibly for medication use. Administrative data appears useful for indicators including chronic disease diagnosis and osteoporosis/ breast screening. Conclusions Multiple data collection methods are required for a comprehensive assessment of performance in primary care practices. The choice of which methods are best for any one particular study or quality improvement initiative requires careful consideration of the biases that each method might introduce into the results. In this study, both patients and providers were willing to participate in and consent to, the collection and linkage of information from multiple sources that would be required for such assessments.
Technology has made great strides in healthcare, but has been slow in reaching a Senior's home or residence. At 35 million and growing, the Senior population is making it known that home is where they want to stay. Technology advancements in devices, communications, and wireless capability are now making possible the delivery of customized telehealth solutions to provide Seniors with "enabled independence," allowing them to confidently "age in place" at home or residence for much longer, with improved health outcomes and quality of life. Combined with traditional ambulatory care services, integrating telehealth technology services now allows delivery of "virtual assisted living" services at home that can more efficiently meet Senior health requirements, and can simplify other aspects of a Senior's life that can play a role in extending time at home. To be successful, an integrated service must be able to usefully address a range of activities of daily living-instrumental activities of daily living, and enhanced activities of daily living-requirements. Already proven in other areas such as radiology, intensive care units, prisons, and rural communities, companies are working to develop practical telehealth service offerings designed for the home or residence. These services must be (a) packaged to meet individual Senior needs and (b) reviewed and revised regularly to match changes in Senior requirements over time. A core element of this service is the use of regular "virtual visits" between healthcare professionals and a Senior at home or residence, which have been shown to both increase efficiency and Senior health outcomes. Another important element is centralizing key data from the telehealth technology into a single database to improve information delivered to a Senior's doctor, family, and other ambulatory care providers. North Shore eCare and other companies are conducting extensive market tests and pilot efforts to make sure service offerings meet Senior needs, and can be delivered cost-effectively. PMID:15968214
Prince, Thomas R; Croghan, John E; Sheridan, Phillip H; Weatherly, Jonathan D
Most empirical studies of the determinants of the quality of nursing home care find a strong relationship between poor quality and a high percentage of Medicaid patients in the nursing home. These findings are often interpreted as evidence that the reimbursement rates paid for Medicaid patients are constraining nursing homes from providing higher qualitycare. Alternatively, this relationship can be
|Background: In the mid-1990s, significant gaps existed in the quality of acute myocardial infarction (AMI) care between rural and urban hospitals. Since then, overall AMI carequality has improved. This study uses more recent data to determine whether rural-urban AMI quality gaps have persisted. Methods: Using inpatient records data for 34,776…
Baldwin, Laura-Mae; Chan, Leighton; Andrilla, C. Holly A.; Huff, Edwin D.; Hart, L. Gary
Background: In the mid-1990s, significant gaps existed in the quality of acute myocardial infarction (AMI) care between rural and urban hospitals. Since then, overall AMI carequality has improved. This study uses more recent data to determine whether rural-urban AMI quality gaps have persisted. Methods: Using inpatient records data for 34,776…
Baldwin, Laura-Mae; Chan, Leighton; Andrilla, C. Holly A.; Huff, Edwin D.; Hart, L. Gary
Based on the belief that all children have a right to qualitycare and education, early childhood best practices, and trained staff/providers, this guide details quality standards for early care and education programs in West Virginia, developed through the Early Education Quality Improvement Project (EQUIP). The standards are voluntary and not…
West Virginia Governor's Cabinet on Children and Families, Charleston.
Objective: ‘Quality of life’ is an important but poorly defined outcome in health and health care research. We sought to identify stroke professionals' definitions of quality of life and views of the purpose of its assessment.Design: Using issues identified during in-depth interviews with stroke care professionals, we designed a postal survey questionnaire. Participants were asked to define quality of life,
C. McKevitt; J. Redfern; V. La-Placa; C. D. A. Wolfe
This research addresses the origins and motivations that drive long-term-care regulations and enforcement. It outlines the historical development of the US long-term-care system and describes regulations that focus on improving quality of care. Current long-term-care regulations are inadequate and ineffective because of fragmentation and inconsistencies that have resulted in conflicts of interest, inequitable services, underfunded care, low reimbursement, cumbersome and duplicative processes, and inadequate training and compensation for providers. Reforms such as establishing higher standards and modifying enforcement procedures are necessary to bring about increased quality of care for long-term-care consumers. PMID:22534968
To ensure that medical residents will be prepared to deliver consistently high-qualitycare, they should be trained in settings that provide such care. Residents in internal medicine, particularly, need to learn good care habits in order to meet the needs of patients with diabetes and other common chronic and high-impact illnesses. To assess the strength of such training, we compared the quality of medical care provided in sixty-seven US internal medicine residency ambulatory clinics with the quality of care provided by 703 practicing general internists. We found significant quality gaps in process, intermediate outcome, and patient-experience measures. These inadequacies in ambulatory training for internal medicine residents must be addressed by policy makers and educators-for example, by accelerating the movement toward new residency curricula that emphasize competency-based training. PMID:22232105
Lynn, Lorna; Hess, Brian J; Weng, Weifeng; Lipner, Rebecca S; Holmboe, Eric S
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
BACKGROUND: Reports of higher qualitycare by higher-volume secondary care providers have fuelled a shift of services from smaller provider units to larger hospitals and units. In the United Kingdom, most patients are managed in primary care. Hence if larger practices provide better quality of care; this would have important implications for the future organization of primary care services. We
Sonia Saxena; Josip Car; Darren Eldred; Michael Soljak; Azeem Majeed
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.
This paper argues that continuous training for child care staff is an important element in improving quality of day care provision. Evidence from the day care field, the school effectiveness literature and adult education is cited. Theories of education and learning are used to examine the design of effective approaches to training for day care providers. More specifically, Kolb's model
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
Nonprofit child care centers are frequently observed to produce child care which is, on average, of higher quality than care provided in commercial child care centers. In part, this nonprofit advantage is due to different input choices made by nonprofit centers--lower child--staff ratios, better-educated staff and directors, higher rates of…
Objective: Depression is commonly seen, but infrequently adequately treated, in primary care clinics. Improving access to depression care in primary care clinics has improved outcomes in clinical trials; however, these interventions are largely unstudied in clinical settings. This study examined the effectiveness of a quality improvement project improving access to mental healthcare in a large primary care clinic.Methods: A before–after
Bradley V Watts; Brian Shiner; Andrew Pomerantz; Patricia Stender
Background While the Osteoporosis Canada 2002 Canadian guidelines provided evidence based strategies in preventing, diagnosing, and managing this condition, publication and distribution of guidelines have not, in and of themselves, been shown to alter physicians clinical approaches. We hypothesize that primary care physicians enrolled in the Quality Circle project would change their patient management of osteoporosis in terms of awareness of osteoporosis risk factors and bone mineral density testing in accordance with the guidelines. Methods The project consisted of five Quality Circle phases that included: 1) Training & Baseline Data Collection, 2) First Educational Intervention & First Follow-Up Data Collection 3) First Strategy Implementation Session, 4) Final Educational Intervention & Final Follow-up Data Collection, and 5) Final Strategy Implementation Session. A total of 340 circle members formed 34 quality circles and participated in the study. The generalized estimating equations approach was used to model physician awareness of risk factors for osteoporosis and appropriate utilization of bone mineral density testing pre and post educational intervention (first year of the study). Odds ratios (OR) and 95% confidence intervals (95% CI) were calculated. Results After the 1st year of the study, physicians' certainty of their patients' risk factor status increased. Certainty varied from an OR of 1.4 (95% CI: 1.1, 1.8) for prior vertebral fracture status to 6.3 (95% CI: 2.3, 17.9) for prior hip fracture status. Furthermore, bone mineral density testing increased in high risk as compared with low risk patients (OR: 1.4; 95% CI: 1.2, 1.7). Conclusion Quality Circle methodology was successful in increasing both physicians' awareness of osteoporosis risk factors and appropriate bone mineral density testing in accordance with the 2002 Canadian guidelines.
Managed care organizations (MCOs) are responsible for ensuring that persons enrolled in their plans receive quality health care. In addition, MCOs publicly funded through the Medicare and Medicaid programs are required by State and Federal governments to ...
The purpose of the review was to determine the validity of allegations regarding quality of care at the Louis A. Johnson VA Medical Center, Clarksburg, West Virginia. We concluded that there were deficiencies in this patient's care that warranted consider...
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
Chronic lung disease (CLD) is one of the most common long-term complications in very preterm infants. Bronchopulmonary dysplasia (BPD) is the most common cause of CLD in infancy. Modern neonatal respiratory care has witnessed the emergence of a new BPD that exhibits decreased fibrosis and emphysema, but also decreased alveolar septation, and microvascular development. CLD encompasses the classic and the new BPD, and recognizes that lung injury can occur in term infants who need aggressive ventilatory support and who develop lung injury as a result, and that CLD is a multisystem disease. Controversy exists on whether quality improvement (QI) methods that implement multiple interventions will be effective in limiting pathology with multiple causes. Caution in generalization of QI findings is encouraged. QI methods toward improvement in CLD or any other outcome should be considered as a tool for implementing evidence and studying the effects of change in complex adaptive systems. PMID:20363459
We explore and compare the importance of various quality dimensions for health care and e-commerce web sites. The results show that the importance of various quality attributes for all except four of ten quality dimensions studied differ between health care and e-commerce web sites. These results can help health care managers to improve and/or to guide the design of their web sites. PMID:18998907
This is a survey of various concepts of quality of care in the health care field and their application to periodontics. Definitions of qualitycare, measuring and improving quality, third party payment and quality of care, and the role of periodontists in managing quality are presented. The definitions of qualitycare include the following dimensions: access, appropriateness, technical quality, and the art of care. Examples of each of these dimensions are presented, and their implications for quality assessment are discussed. Emphasis is placed on appropriateness of care and the strengths and weaknesses of mechanisms for deriving evidence-based decision making. The use of randomized clinical trials (RCT), employing expert opinion such as consensus panels, and meta-analysis are discussed as they apply to appropriateness of periodontal treatment. Work in the area of technical quality of care (i.e., the third dimension of qualitycare) has resulted in the development of quality assurance guidelines. Examples of guidelines and practice parameters such as those developed by the U.S. Food and Drug Administration and by various dental specialties are presented. The fourth dimension of quality deals with the art of care. It focuses on the patient's participation in the process of care and the input of the provider in this interaction. The description of outcomes of care includes the concept of measuring clinical outcomes of treatment as well as efforts to measure the health and well-being of a patient. It deals with quality of life measures. Patient satisfaction is another outcome that is presented. Examples of these aspects of quality measurement are discussed. These concepts and measures are presented within the context of a quality assurance program. The steps used to assess and assure quality are outlined. Examples of provider and patient profiles are presented, along with a discussion on how they are used in a quality assurance system. Lastly, the role of the periodontist in quality of care is presented, emphasizing the efforts that have already been made as well as the leadership role that the periodontist has in influencing the profession of dentistry. The advent of managed care and its implications for the quality of periodontal treatment and patient management are discussed using situations obtained from dental plans. PMID:9526923
The article deals with the results of the study of complex of medical demographic and social economic indicators of Nizhny Novgorod oblast during 1989-2010. The results are as follows. The policlinics' net reduced by 2.25 times, including by 10.6 times in rural area and by 12.6 times of ambulatories of community hospitals. The indicators of physicians' supply of oblast population decreased too especially in urban area. The annual number of visits to physicians per capita decreased by 1.36 times. The number of calls of out-patients to physicians of emergency medical care increased by 1.5 times. The morbidity with temporarily disability and primary registration as a disabled person decreased by 1.45 times, including able-bodied citizen by 1.54 times. In Nizhny Novgorod oblast, the rate of decrease of indicators of primary disability during 2006-2009 overpassed the corresponding federal indicators by 1.45 times. The population mortality increased by 1.43 times. The accessibility and quality of ambulatory polyclinic care significantly impacts on the levels of mortality and social security of population and can be used as an indicator of social risks in the region. PMID:23808035
Guseva, N K; Sokolov, V A; Sokolova, I A; Doiutova, M V
|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.
Objectives: Measurement of outcomes is increasingly employed as an indicator of the quality of clinical care. The most commonly measured outcome in many clinical studies, especially in oncology, still remains the overall survival rate. Sultan Qaboos University Hospital (SQUH), Oman, is striving for excellence through quality management. In seeking continual improvement, quality measurement exercises have been initiated throughout the Hospital. We present the overall survival rate of four of the ten most common cancers diagnosed in Oman. Methods: The cancers included non-Hodgkin’s lymphoma (NHL), Hodgkin’s lymphoma (HL), breast cancer, and stomach cancer. The studies were all retrospective and had been conducted previously. For present purposes, only the overall survival was compared with studies both from the region, and with bench-mark studies. Results: For NHL, with a median follow-up of 8 months, the 2-year overall survival rate was 64%; 90% for low risk, 55% for intermediate risk, and 15% for high risk groups. For HL, the 5-year overall survival rate was 64%; 76% for low risk and 42% for high risk. For breast cancer, the 5-year survival rate was 67%; percentages were 88%, 75% and 59% for Groups I, II, and III respectively. For gastric cancer, the 5-year survival rate was 16.5 %; 24% for the non-metastatic group. Conclusion: The outcome of patients with early stages and fewer adverse prognostic factors is comparable to what has been reported in the international literature; however, the outcome is inferior for patients presenting with advanced stage disease and several adverse prognostic factors.
Burney, Ikram A; Al Moundhri, Mansour S; Rizvi, Azhar J; Ganguly, Shyam S; Al Abri, Rashid; Ashrafi, Rafi A
The purpose of the report is to assess the relationship between managed care organizations (MCOs) organizational features on children with special health care needs' (CSHCN): (1) use of health care services and (2) families' experiences with their childre...
B. Vogel D. Schatz E. Shenkman J. Nackashi J. Sherman L. Tian
Objectives To investigate predictors for specific dimensions of service quality perceived by hospital employees in long-term care hospitals. Methods Data collected from a survey of 298 hospital employees in 18 long-term care hospitals were analysed. Multivariate ordinary least squares regression analysis with hospital fixed effects was used to determine the predictors of service quality using respondents’ and organizational characteristics. Results The most significant predictors of employee-perceived service quality were job satisfaction and degree of consent on national evaluation criteria. National evaluation results on long-term care hospitals and work environment also had positive effects on service quality. Conclusion The findings of the study show that organizational characteristics are significant determinants of service quality in long-term care hospitals. Assessment of the extent to which hospitals address factors related to employeeperceived quality of services could be the first step in quality improvement activities. Results have implications for efforts to improve service quality in longterm care hospitals and designing more comprehensive national evaluation criteria.
Assessed child carequality based on reports of 170 center directors in three California counties. Responses indicated that most centers in lower-income and working-class communities displayed at least moderate quality levels along structural measures. About 1 in 6 failed to meet recommended quality standards. Center quality was not consistently…
Day carequality 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 &
|While child carequality has been examined in numerous studies, the definition of quality and specifically, the concepts of structural and process quality, have not been adequately explored. In this qualitative analysis of the constructs of process and structural quality, a content analysis of the Early Childhood Environment Rating Scale-Revised…
Cassidy, Deborah J.; Hestenes, Linda L.; Hansen, Joanna K.; Hegde, Archana; Shim, Jonghee; Hestenes, Steve
Because of the high proportion of nursing home residents with a mental illness other than dementia, the quality of mental health care in nursing homes is a major clinical and policy issue. The authors apply Donabedian's framework for assessing quality of care based on the triad of structure, process, and outcome-based measures in reviewing the literature on the quality of mental health care in nursing homes. Quality measures used within the literature include mental health consultations and hospitalizations, inappropriate use of medications, and mental health survey deficiencies. Factors related to the resident's welfare (nurse staffing), provider norms (locality), and financial factors (payer mix) were associated with the quality of mental health care. Although future research is necessary, the extant literature suggests that persons with mental illness are frequently admitted to nursing homes and their care is often of poor quality and related to a series of resident and facility factors.
Grabowski, David C.; Aschbrenner, Kelly A.; Rome, Vincent F.; Bartels, Stephen J.
|Considered impact of physical environment on work-related stress and quality of care in day care center integrating demented people and other frail elderly. Examined positive and negative differences before and after move to new facility. Discusses implications for facility design and other program characteristics. (Author/CM)|
Objectives: To investigate the concept of clinical governance being advocated by primary care groups/trusts (PCG/Ts), approaches being used to implement clinical governance, and potential barriers to its successful implementation in primary care. Design: Qualitative case studies using semi-structured interviews and documentation review. Setting: Twelve purposively sampled PCG/Ts in England. Participants: Fifty senior staff including chief executives, clinical governance leads, mental health leads, and lay board members. Main outcome measures: Participants' perceptions of the role of clinical governance in PCG/Ts. Results: PCG/Ts recognise that the successful implementation of clinical governance in general practice will require cultural as well as organisational changes, and the support of practices. They are focusing their energies on supporting practices and getting them involved in quality improvement activities. These activities include, but move beyond, conventional approaches to quality assessment (audit, incentives) to incorporate approaches which emphasise corporate and shared learning. PCG/Ts are also engaged in setting up systems for monitoring quality and for dealing with poor performance. Barriers include structural barriers (weak contractual levers to influence general practices), resource barriers (perceived lack of staff or money), and cultural barriers (suspicion by practice staff or problems overcoming the perceived blame culture associated with quality assessment). Conclusion: PCG/Ts are focusing on setting up systems for implementing clinical governance which seek to emphasise developmental and supportive approaches which will engage health professionals. Progress is intentionally incremental but formidable challenges lie ahead, not least reconciling the dual role of supporting practices while monitoring (and dealing with poor) performance.
Campbell, S; Sheaff, R; Sibbald, B; Marshall, M; Pickard, S; Gask, L; Halliwell, S; Rogers, A; Roland, M
The 12th Commonwealth Fund\\/Modern Healthcare Health Care Opinion Leaders Survey found that increased transparency in the quality and price of health care is important, according to a diverse group of experts. More than 80 percent of health care opinion leaders called for transparency on prescription drug prices and medical loss ratios (i.e., the share of premium dollars that private insurance
Objective: To investigate practical and methodological problems in assessing the quality of care of multiple conditions in general practice. Setting: Sixteen general practices from two socioeconomically diverse regions in the UK. Method: Quality of care was assessed in 100 randomly selected patient records in each practice using an established set of quality indicators covering 23 conditions commonly seen in primary care. Inter-rater reliability assessment was carried out for five of the conditions. Results: Conducting simultaneous quality assessment across multiple conditions is highly resource intensive. Poor data quality and the low prevalence of some items of care defined by the indicators are significant problems. Scores for individual indicators require very large samples for reliable assessment. Quality scores are more reliable when reported at a higher unit of analysis. This is particularly true for indicators and conditions with low prevalence where data may need to be aggregated to the level of groups of conditions or organisational providers. There is no single ideal way of aggregating quality scores. Conclusion: The study identified some of the practical and methodological difficulties in assessing quality of care across multiple conditions. For improved quality assessment, advances in information technology and improvements in data quality are required for more efficient and reliable data extraction from medical records, together with the development of methods for combining scores across indicators, conditions, and practices. However, electronic data extraction methods will still be based on the assumption that the care recorded reflects the care provided.
Kirk, S; Campbell, S; Kennell-Webb, S; Reeves, D; Roland, M; Marshall, M
For critically ill patients and their loved ones, high-quality health care includes the provision of excellent palliative care. To achieve this goal, the healthcare system needs to identify, mea- sure, and report specific targets for quality palliative care for critically ill or injured patients. Our objective was to use a con- sensus process to develop a preliminary set of quality
Richard A. Mularski; J. Randall Curtis; J. Andrew Billings; Robert Burt; Ira Byock; Cathy Fuhrman; Anne C. Mosenthal; Justine Medina; Daniel E. Ray; Gordon D. Rubenfeld; Lawrence J. Schneiderman; Patsy D. Treece; Robert D. Truog; Mitchell M. Levy
Background Physician job satisfaction is reportedly associated with interpersonal quality of care, such as patient satisfaction, but its association with technical quality of care, as determined by whether patients are offered recommended services, is unknown. Objective We explored whether the job satisfaction of hospital-employed physicians in Japan is associated with the technical quality of care, with an emphasis on process qualities as measured by quality indicators. Design Cross-sectional study linking data from physician surveys with data abstracted from outpatient charts. Participants A total of 53 physicians working at 13 hospitals in Japan participated. Medical records covering 568 patients were reviewed. Measurements Disease-specific indicators related to the care of patients with hypertension, type 2 diabetes, and asthma, as well as disease-independent measures of the process of care were abstracted. We analyzed the association between the quality of care score for individual physicians, which is defined as the percentage of quality indicators satisfied among the total for which their patients were eligible, and physician job satisfaction, which was measured by a validated scale. Results No statistically significant association between physician job satisfaction and quality of care was observed. A 1-standard deviation (SD) increment in the physician job satisfaction scale was associated with an increase of only 0.3% for overall quality (P?=?0.85), ?3.0% for hypertension (P?=?0.22), 2.5% for type 2 diabetes (P?=?0.44), 8.0% for asthma (P?=?0.21), and ?0.4% for cross-cutting care (P?=?0.76). Conclusion Contrary to the positive association reported between physician job satisfaction and high quality of interpersonal care, no association was seen between physician job satisfaction and the technical quality of care.
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
The purpose of this study was to evaluate the impact of quality of care on costs in nursing homes. The sample consisted of 749 nursing homes in 5 states in 1996. Nursing home cost functionswere estimated using weighted 2-stage least-squares regression analysis. Costs are measured as the facility's total patient care costs. Two outcome measures are used as quality indicators:
|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
Underutilization of medical facilities in African countries is widely believed to be a result of consumer disappointments with quality of care. This paper uses data from a randomized household survey, enriched with exogenous information on health facility attributes, to examine more deeply the quality factor in health care demand in rural Kenya. We find that broad availability of drugs in
The On-Time Quality Improvement Program is a practical approach to quality improvement (QI) in long-term care, embedding QI strategies and best practices into health information technology (HIT). The On-Time QI for Long-Term Care Program (On-Time) was dev...
Kihlstrom (2005) has recently called attention to the need for prospective longitudinal studies of dissociation. The present study assesses quality of early care and childhood trauma as predictors of dissociation in a sample of 56 low-income young adults followed from infancy to age 19. Dissociation was assessed with the Dissociative Experiences Scale; quality of early care was assessed by observer
Demands on workload and work efficiency have increased because of ongoing global changes in health care organizations. Assessing and evaluating effects of changes on organizational and individual well-being require valid and reliable methods. Questionnaires from 3 large health care studies were used to develop instruments for work quality and health. Variable fields of work quality, health and well-being, and modifying
Quality assessment and assurance activities in the intensive care unit are complex processes that begin with the definition of the scope of services delivered in the unit with further identification of the impor tant aspects of care. There is also a need to establish indicators of quality, gather data, and finally to or ganize the data into useful information. There
...the quality of child care. 98.51 Section 98.51 Public Welfare DEPARTMENT OF...Care and Development Funds Â§ 98.51 Activities to improve the quality...training and technical assistance in areas appropriate to the provision...
...the quality of child care. 98.51 Section 98.51 Public Welfare DEPARTMENT OF...Care and Development Funds Â§ 98.51 Activities to improve the quality...training and technical assistance in areas appropriate to the provision...
Objective. More than half of Medicaid enrollees are now in managed care. Scant information exists about which policies of practice sites improve quality of care in managed Medicaid. Children with asthma are a sentinel group for Medicaid quality moni- toring because they are at elevated risk for adverse out- comes. The objective of this study was to identify prac- tice-site
Tracy A. Lieu; Jonathan A. Finkelstein; Paula Lozano; Angela M. Capra; Felicia W. Chi; Nancy Jensvold; Charles P. Quesenberry; Harold J. Farber
Purpose – Despite 77 per cent antenatal care coverage and 90 per cent skilled attendant at delivery, adjusted maternal mortality in Iran is 76 per 100,000 births. Low quality of maternal health services is one cause of maternal morbidity and mortality. However, few and limited studies have been devoted to the quality of postpartum care in Iran. This study aims
M. Simbar; Z. Alizadeh Dibazari; J. Abed Saeidi; H. Alavi Majd
Purpose – To develop a framework for evaluating the quality of Portuguese health care organisations based on the relationship between customers and providers, to define key variables related to the quality of health care services based on a review of the available literature, and to establish a conceptual framework in order to test the framework and variables empirically. Design\\/methodology\\/approach –
The purpose of this project was to develop and test methodologies for (1) reliably documenting the quality of care provided by an individual or within an institution and (2) validly comparing the quality of care provided by several individuals or within s...
BACKGROUND: Reduction of maternal mortality ratio by two-thirds by 2015 is an international development goal with unrestricted access to high quality emergency obstetric care services promoted towards the attainment of that goal. The objective of this qualitative study was to assess the availability and quality of emergency obstetric care services in Gambia's main referral hospital. METHODS: From weekend admissions a
Research has revealed significant variation in both the quality of clinical care and the health status of populations. We conducted a study to determine if variations in the quality of clinical care can be quantitatively linked to variations in health status, at the patient and the population level. This study, conducted at health facilities in four municipalities in Macedonia, collected
John W. Peabody; Robert J. Nordyke; Fimka Tozija; Jeff Luck; Jorge A. Muñoz; Anne Sunderland; Karen DeSalvo; Ninez Ponce; Charles McCulloch
Background: Studies show that subspecialists can pro- vide better qualitycare than primary care physicians when working within their subspecialty for patients with some medical conditions. However, many subspecialists care for patients outside of their chosen subspecialty. The present study compared the quality of care provided by subspe- cialists practicing outside of their specialty, general inter- nists, and subspecialists practicing
Scott R. Weingarten; Lynne Lloyd; Chiun-Fang Chiou; Glenn D. Braunstein
This power considers the process of implementing clinical governance in primary care and its impact on quality improvement. It discuss how clinical governance is being implemented both at the level of Primary Care Organisations and general practices, and the challenges to implementing clinical governance. It also suggests a model for promoting the factors that will help clinical governance improve quality of care. The experience of implementing clinical governance is broadly positive to date. However, the government needs to match its commitment to a ten-year programme of change with realistic timetables to secure the cultural and organisational changes needed to improve quality of care.
Intensive care units (ICUs) are an essential and unique component of modern medicine. The number of critically ill individuals, complexity of illness, and cost of care continue to increase with time. In order to meet future demands, maintain quality, and minimize medical errors, intensivists will need to look beyond traditional medical practice, seeking lessons on quality assurance from industry and aviation. Intensivists will be challenged to keep pace with rapidly advancing information technology and its diverse roles in ICU care delivery. Modern ICU quality improvement initiatives include ensuring evidence-based best practice, participation in multicenter ICU collaborations, employing state-of-the-art information technology, providing point-of-care diagnostic testing, and efficient organization of ICU care delivery. This article demonstrates that each of these initiatives has the potential to revolutionize the quality of future ICU care in the United States. PMID:22328598
Delirium, or acute confusional state, which often results from hospital-related complications or inadequate hospital care for older patients, can serve as a marker of the quality of hospital care. By reviewing five pathways that can lead to a greater incidence of delirium--iatrogenesis, failure to recognize delirium in its early stages, attitudes toward the care of the elderly, the rapid pace and technological focus of health care, and the reduction in skilled nursing staff--we identify how future trends and cost-containment practices may exacerbate the problem. Examining delirium also provides an opportunity to improve the quality of hospital care for older persons. Interventions to reduce delirium would need to occur at the local and national levels. Local strategies would include routine cognitive assessment and the creation of systems to enhance geriatric care, such as incentives to change practice patterns, geriatric expertise, case management, and clinical pathways. National strategies might include providing education for physicians and nurses to improve the recognition of delirium and the awareness of its clinical implications, improving quality monitoring systems for delirium, and creating environments to facilitate the provision of high-quality geriatric care. PMID:10335730
In order to improve quality (of therapy), one has to know, evaluate and make transparent, one's own daily processes. This process of reflection can be supported by the presentation of key data or indicators, in which the real as-is state can be represented. Quality indicators are required in order to depict the as-is state.Quality indicators reflect adherence to specific quality measures. Continuing registration of an indicator is useless once it becomes irrelevant or adherence is 100%. In the field of intensive care medicine, studies of quality indicators have been performed in some countries. Quality indicators relevant for medical quality and outcome in critically ill patients have been identified by following standardized approaches.Different German societies of intensive care medicine have finally agreed on 10 core quality indicators that will be valid for two years and are currently recommended in German intensive care units (ICUs). PMID:21063472
In order to improve quality (of therapy), one has to know, evaluate and make transparent, one’s own daily processes. This process of reflection can be supported by the presentation of key data or indicators, in which the real as-is state can be represented. Quality indicators are required in order to depict the as-is state. Quality indicators reflect adherence to specific quality measures. Continuing registration of an indicator is useless once it becomes irrelevant or adherence is 100%. In the field of intensive care medicine, studies of quality indicators have been performed in some countries. Quality indicators relevant for medical quality and outcome in critically ill patients have been identified by following standardized approaches. Different German societies of intensive care medicine have finally agreed on 10 core quality indicators that will be valid for two years and are currently recommended in German intensive care units (ICUs).
Describes a questionnaire sent to 11 of the 66 nursing homes in the Brighton Health Authority to compare the quality of care provided. These homes care for 242 patients (representing 13 per cent of the 1,728 places in Brighton nursing homes). Questions dealt with residential environment, occupational health, care and control of medicines, clerical services, procedures for prevention and control
|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.
Patient satisfaction is an important measure of service quality in health care systems. Patients' perceptions about health care systems seem to have been largely ignored by health care managers in developing countries. The aim of this study is to develop a reliable and valid instrument to measure patient satisfaction in Turkey. A questionnaire was developed and a total of 1100
|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…
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
S. N. Weingart; J. Zhu; L. Chiappetta; S. O. Stuver; E. C. Schneider; A. M. Epstein; J. A. David-Kasdan; C. L. Annas; F. J. Fowler Jr; J. S. Weissman
Background: Electronic health records (EHRs) have been proposed as a sustainable solution for improving the quality of medical care. We assessed the association betweenEHRuse,asimplemented,andthequalityofam- bulatory care in a nationally representative survey. Methods: We performed a retrospective, cross- sectional analysis of visits in the 2003 and 2004 Na- tional Ambulatory Medical Care Survey. We examined EHR use throughout the United States
Jeffrey A. Linder; Jun Ma; David W. Bates; Blackford Middleton; Randall S. Stafford
Little research has been carried out on the inclusion of children with special needs in child care. The purpose of this study was to determine what variables predict the inclusion of children with disabilities in centers and home care. Logistic regression was used to examine the association of several indicators of quality child care and…
Essa, Eva L.; Bennett, Patrick R.; Burnham, Melissa M.; Martin, Sally S.; Bingham, Ann; Allred, Keith
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 carequality and its influence on children's
|Background: Because of an increase in life expectancy and de-institutionalisation, many adults with intellectual disability (ID) live with and are cared for by their parents throughout their adult lives. Because of caring demands, the quality of life (QOL) of parents may be affected. The study explored the impact of caring for an adult with ID on…
Objective. To evaluate the quality of pe- diatric primary care, including preventive services, be- fore and after the introduction of an electronic medical record (EMR) developed for use in an urban pediatric primary care center. Methods. A pre-postintervention analysis was used in the study. The intervention was a pediatric EMR. Routine health care maintenance visits for children <5 years old
William G. Adams; Adriana M. Mann; Howard Bauchner
|A cross-country comparison of children's cortisol levels at child care was performed in relation to their cortisol levels at home and the quality and quantity of child care they received. Participants were toddlers visiting child care centers in Spanish Basque Country (N = 60) and the Netherlands (N = 25) with substantial variation in structural…
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
Background Primary care services are often the main healthcare service for people with dementia; as such, good-qualitycare at this level is important. Aim To measure the quality of care provided to people with dementia in general practice using routinely collected data, and to explore associated patient and practice factors. Design and setting Observational, cross-sectional review of medical records from general practices (n = 52) in five primary care trusts. Method A total of 994 people with dementia were identified from dementia registers. An unweighted quality-of-care score was constructed using information collected in the annual dementia review, together with pharmacological management of cognitive and non-cognitive symptoms. Multilevel modelling was carried out to identify factors associated with quality-of-care scores. Results In total, 599 out of 745 (80%) patients with dementia had received an annual dementia review; however, a social care review or discussion with carers was evident in just 305 (51%) and 367 (61%) of those 599 cases, respectively. Despite high prevalence of vascular disease, over a quarter (n = 259, 26%) of all patients with dementia were prescribed antipsychotics; only 57% (n = 148) of these had undergone medication review in the previous 6 months. Those with vascular dementia who were registered with single-handed practices received poorer quality of care than those registered with practices that had more than one GP. Conclusion Although the number of people with dementia with a record of an annual dementia review is high, the quality of these reviews is suboptimal. The quality score developed in this study could be used as one source of data to identify weaknesses in practice activity that need to be corrected, and so would be of value to commissioners and regulators, as well as practices themselves.
ObjectivesTo determine which of the two methods of case note review provide the most useful and reliable information for reviewing quality of care.DesignRetrospective, multiple reviews of 692 case notes were undertaken using both holistic (implicit) and criterion-based (explicit) review methods. Quality measures were evidence-based review criteria and a quality of care rating scale.SettingNine randomly selected acute hospitals in England.ParticipantsSixteen doctors,
A. Hutchinson; J. E. Coster; K. L. Cooper; A. McIntosh; S. J. Walters; P. A. Bath; M. Pearson; K. Rantell; M. J. Campbell; J. Nicholl; P. Irwin
Background We assessed the quality of life of ICU survivors using SF-36 at 4 months after ICU discharge and investigated any correlation of PCS and MCS with age, illness severity and hospital or ICU length of stay. We examined the relationship between these variables, persisting physical and psychological symptoms and the perceived benefit of individual patients of follow-up. Findings For one year, adult patients admitted for multiple organ or advanced respiratory support for greater than 48 hours to a 16-bedded teaching hospital general intensive care unit were identified. Those surviving to discharge were sent a questionnaire at 4 months following ICU discharge assessing quality of life and persisting symptoms. Demographic, length of stay and illness severity data were recorded. Higher or lower scores were divided at the median value. A two-tailed Students t-test assuming equal variances was used for normally-distributed data and Mann-Whitney tests for non-parametric data. 87 of 175 questionnaires were returned (50%), but only 65 had sufficient data giving a final response rate of 37%. Elderly patients had increased MCS as compared with younger patients. The PCS was inversely related to hospital LOS. There was a significant correlation between the presence of psychological and physical symptoms and desire for follow-up. Conclusion Younger age and prolonged hospital stay are associated with lower mental or physical quality of life and may be targets for rehabilitation. Patients with persisting symptoms at 4 months view follow-up as beneficial and a simple screening questionnaire may identify those likely to attend outpatient services.
Baldwin, Fiona J; Hinge, Denise; Dorsett, Joanna; Boyd, Owen F
... sicker, poorer, and have no alternative insurance Primary Care Primary care patients who see physician assistants and ... healthier than other homeless individuals Elderly/Long-Term Care Aging causes changes in the brain's white matter, ...
Nonprofit child care centers are frequently observed to produce child care which is, on average, of higher quality than care provided in commercial child care centers. In part, this nonprofit advantage is due to different input choices made by nonprofit centers-lower child-staff ratios, better-educated staff and directors, higher rates of professional development for staff. Nonprofit centers may have an additional
Efforts to improve community-based children’s mental health care should be based on valid information about effective practices\\u000a and current routine practices. Emerging research on routine care practices and outcomes has identified discrepancies between\\u000a evidence-based practices and “usual care.” These discrepancies highlight potentially potent quality improvement interventions.\\u000a This article reviews existing research on routine or “usual care” practice, identifies strengths and
Ann F. Garland; Leonard Bickman; Bruce F. Chorpita
In managing treatment for persons with mental illness, the primary care physician (PCP) needs to communicate with mental health (MH) professionals in various settings over time to provide appropriate management and continuity of care. However, effective communication between PCPs and MH specialists is often poor. The present study reviewed evidence on the quality of information transfer between PCPs and specialist MH providers for referral requests and after inpatient discharge. Twenty-three audit studies were identified that assessed the quality of content and nine that assessed strategies to improve quality. Results indicated that rates of item reporting were variable. Within the limited evidence on interventions to improve quality, use of structured forms showed positive results. Follow-up work can identify a minimum set of items to include in information transfers, along with item definitions and structures for holding this information. Then, methodologies for measuring data quality, including electronically generated performance metrics, can be developed. PMID:22855384
This report of the Quality 2000 Initiative documents the quality crisis in early care and education in the United States, discussing the reasons for this crisis and suggesting a plan for improvement. Part 1 of the report: describes the mediocre quality of care cited in the Cost, Quality, and Child Outcomes Study, the erosion of quality since 1980,…
Background Child and adolescent mental health problems are common in primary healthcare settings. However, few parents of children with mental health problems express concerns about these problems during consultations. Based on parental views, we aimed to create quality of care measures for child and adolescent mental health in primary care and develop consensus about the importance of these quality standards within primary care. Methods Quality Standards were developed using an iterative approach involving four phases: 1) 34 parents with concerns about their child’s emotional health or behaviour were recruited from a range of community settings including primary care practices to participate in focus group discussions, followed by validation groups or interviews. 2) Preliminary Quality Standards were generated that fully represented the parents’ experiences and were refined following feedback from an expert parent nominal group. 3) 55 experts, including parents and representatives from voluntary organisations, across five panels participated in a modified two-stage Delphi study to develop consensus on the importance of the Quality Standards. The panels comprised general practitioners, other community-based professionals, child and adolescent psychiatrists, other child and adolescent mental health professionals and public health and policy specialists. 4) The final set of Quality Standards was piloted with 52 parents in primary care. Results In the Delphi process, all five panels agreed that 10 of 31 Quality Standards were important. Although four panels rated 25–27 statements as important, the general practitioner panel rated 12 as important. The final 10 Quality Standards reflected healthcare domains involving access, confidentiality for young people, practitioner knowledge, communication, continuity of care, and referral to other services. Parents in primary care agreed that all 10 statements were important. Conclusions It is feasible to develop a set of Quality Standards to assess mental healthcare provision for children and adolescents seen within primary healthcare services. Primary care practitioners should be aware of parental perspectives about quality of care as these may influence help-seeking behaviours.
We investigate a health care market with uncertainty in a mixed duopoly, where a partially privatized public hospital competes against a private hospital in terms of quality choice. We use a simple Hotelling-type spatial competition model by incorporating mean-variance analysis and the framework of partial privatization. We show how the variance in the quality perceived by patients affects the true quality of medical care provided by hospitals. In addition, we show that a case exists in which the quality of the partially privatized hospital becomes higher than that of the private hospital when the patient's preference for quality is relatively high. PMID:18712422
Quantifying quality is supposed to unite health policy, health plans, and health care consumers in a circuit of constant improvement. In practice, significant gulfs separate how policymakers, health plan administrators, and consumers write and talk about quality. Drawing on policy literature, ethnography inside a managed care organization, and interviews with health plan members, this article examines a quality improvement program at a health plan in Puerto Rico. The findings challenge the assumption underwriting neoliberal health policy that quality measurement leads to quality improvement. PMID:20694893
Since 2001, approximately 500 children with inborn errors of metabolism (IBEM) have been identified through the Minnesota newborn screening program. The vast majority of them receive specialty care at the Pediatric Metabolism Clinic or the Phenylketonuria (PKU) Clinic at the University of Minnesota. In order to determine provider satisfaction with the quality of services at those clinics, we surveyed primary care physicians, certified nurse practitioners and a certified physician assistant, collectively referred to in this article as primary care providers, who referred patients with IBEM to one of the clinics. Our objective was to evaluate the quality of metabolic team specialty services for children with IBEM; identify strategies to ensure coordinated and comprehensive care for children with IBEM; improve metabolic specialty care and connection to services for children with IBEM and their families; and gather data to inform newborn screening programming through the Minnesota Department of Health. Responses revealed a high level of overall satisfaction with the referral processes, 2) the quality of verbal communications and written reports, 3) feedback to the primary care team and 4) the management plans for addressing the needs of children with IBEM within the primary care setting. Improvement in communication about emergency planning for children with IBEM is clinics as a result of the survey findings. PMID:23193706
Anderson, Carolyn Stady; Bentler, Kristi; Vanderburg, Nancy; Berry, Susan A
Given the ongoing concerns about the quality of care in nursing homes, a theoretical framework to guide a systems approach to quality is important. Existing frameworks either do not model causality, or do so in a linear fashion in which the actual linkages between components of quality may not be well specified. Through a review of frameworks for nursing home
Background. Many developed countries are beginning to see the public reporting of comparative information about the quality of health care as an important way of improving accountability, stimulating quality improvement and empowering members of the public. The production and dissemination of quality reports is particularly high on the policy agenda in the US and the UK, and there is now
MARTIN N. MARSHALL; PATRICK S. ROMANO; HUW T. O. DAVIES
The electronic health record (EHR) is seen by many as an ideal vehicle for measuring quality of health care and monitoring ongoing provider performance. It is anticipated that the availability of EHR-extracted data will allow quality assessment without the expensive and time-consuming process of medical record abstraction. A review of the data requirements for the indicators in the Quality Assessment
Carol P. Roth; Yee-Wei Lim; Joshua M. Pevnick; Steven M. Asch; Elizabeth A. McGlynn
Introduction: Patient views on quality of care are of paramount importance with respect to the implementation of quality assurance (QA) and improvement (QI) programmes. However, the relevance of patient satisfaction studies is often questioned because of conceptual and methodological problems. Here, it is our belief that a different strategy is necessary. Objective: To develop a conceptual framework for measuring quality
Herman J. Sixma; Jan J. Kerssens; Cretien van Campen; Loe Peters
BACKGROUND: Primary care office spirometry can improve access to testing and concordance between clinical practice and asthma guidelines. Compliance with test quality standards is essential to implementation. OBJECTIVE: To evaluate the quality of spirometry performed onsite in a regional primary care asthma program (RAP) by health care professionals with limited training. METHODS: Asthma educators were trained to perform spirometry during two 2 h workshops and supervised during up to six patient encounters. Quality was analyzed using American Thoracic Society (ATS) 1994 and ATS/European Respiratory Society (ERS) 2003 (ATS/ERS) standards. These results were compared with two regional reference sites: a primary care group practice (Family Medical Centre [FMC], Windsor, Ontario) and a teaching hospital pulmonary function laboratory (London Health Sciences Centre [LHSC], London, Ontario). RESULTS: A total of 12,815 flow-volume loops (FVL) were evaluated: RAP – 1606 FVL in 472 patient sessions; reference sites – FMC 4013 FVL in 573 sessions; and LHSC – 7196 in 1151 sessions. RAP: There were three acceptable FVL in 392 of 472 (83%) sessions, two reproducible FVL according to ATS criteria in 428 of 469 (91%) sessions, and 395 of 469 (84%) according to ATS/ERS criteria. All quality criteria – minimum of three acceptable and two reproducible FVL according to ATS criteria in 361 of 472 (77%) sessions and according to ATS/ERS criteria in 337 of 472 (71%) sessions. RAP met ATS criteria more often than the FMC (388 of 573 [68%]); however, less often than LHSC (1050 of 1151 [91%]; P<0.001). CONCLUSIONS: Health care providers with limited training and experience operating within a simple quality program achieved ATS/ERS quality spirometry in the majority of sessions in a primary care setting. The quality performance approached pulmonary function laboratory standards.
Licskai, Christopher J; Sands, Todd W; Paolatto, Lisa; Nicoletti, Ivan; Ferrone, Madonna
While quality of care is a major concern in the western world, not many studies investigate this topic in low-income countries. Even less is known about the quality of care in humanitarian aid settings, where additional challenges from natural or manmade disasters contribute to additional challenges. This study tried to address this gap by introducing a new approach to systematically measure quality of care in a project of Médecins Sans Frontières (MSF) in Agok area, between South Sudan and Sudan. Our objective was to obtain a valid snapshot of quality of care for a MSF project in three weeks that has the potential to serve as a baseline for quality improvement strategies. The evaluation followed a cross-sectional study design to assess structural, process and outcome quality according to Donabedian's criteria of quality of care. A bundle of well-established methods for collection of quantitative and qualitative data was used to assess the project by following a triangulated mixed-methods approach. Mean structural quality scored 73% of expected performance level and mean process quality 59%. The overall mortality rate for the hospital was 3.6%. On average, less complicated cases got a better level of care than patients who were seriously ill. Significant motivational issues were discovered in staff interviews potentially affecting quality of care. The tool appeared to be quick, feasible and effective in judging quality of care in the selected project. To tap the whole potential of the approach a re-evaluation should be carried out to assess the effectiveness of implemented improvement strategies in Agok. To confirm the usefulness of the approach, more studies are needed covering the variety of different humanitarian aid settings.
While quality of care is a major concern in the western world, not many studies investigate this topic in low-income countries. Even less is known about the quality of care in humanitarian aid settings, where additional challenges from natural or manmade disasters contribute to additional challenges. This study tried to address this gap by introducing a new approach to systematically measure quality of care in a project of Médecins Sans Frontières (MSF) in Agok area, between South Sudan and Sudan. Our objective was to obtain a valid snapshot of quality of care for a MSF project in three weeks that has the potential to serve as a baseline for quality improvement strategies. The evaluation followed a cross-sectional study design to assess structural, process and outcome quality according to Donabedian's criteria of quality of care. A bundle of well-established methods for collection of quantitative and qualitative data was used to assess the project by following a triangulated mixed-methods approach. Mean structural quality scored 73% of expected performance level and mean process quality 59%. The overall mortality rate for the hospital was 3.6%. On average, less complicated cases got a better level of care than patients who were seriously ill. Significant motivational issues were discovered in staff interviews potentially affecting quality of care. The tool appeared to be quick, feasible and effective in judging quality of care in the selected project. To tap the whole potential of the approach a re-evaluation should be carried out to assess the effectiveness of implemented improvement strategies in Agok. To confirm the usefulness of the approach, more studies are needed covering the variety of different humanitarian aid settings. PMID:23683715
A concrete and useful way to create an action plan for improving the quality of maternity care in the United States is to start with a view of the desired result, a common definition and a shared vision for a high-quality, high-value maternity care system. In this paper, we present a long-term vision for the future of maternity care in the United States. We present overarching values and principles and specific attributes of a high-performing maternity care system. We put forth the "2020 Vision for a High-Quality, High-Value Maternity Care System" to serve as a positive starting place for a fruitful collaborative process to develop specific action steps for broad-based maternity care system improvement. PMID:20123185
Objectives. We sought to compare quality of diabetes care by insurance type in federally funded community health centers. Method. We categorized 2018 diabetes patients, randomly selected from 27 community health centers in 17 states in 2002, into 6 mutually exclusive insurance groups. We used multivariate logistic regression analyses to compare quality of diabetes care according to 6 National Committee for Quality Assurance Health Plan Employer Data and Information Set diabetes processes of care and outcome measures. Results. Thirty-three percent of patients had no health insurance, 24% had Medicare only, 15% had Medicaid only, 7% had both Medicare and Medicaid, 14% had private insurance, and 7% had another insurance type. Those without insurance were the least likely to meet the quality-of-care measures; those with Medicaid had a quality of care similar to those with no insurance. Conclusions. Research is needed to identify the major mediators of differences in quality of care by insurance status among safety-net providers such as community health centers. Such research is needed for policy interventions at Medicaid benefit design and as an incentive to improve quality of care.
Huang, Elbert S.; Drum, Melinda L.; Kirchhoff, Anne C.; Schlichting, Jennifer A.; Schaefer, Cynthia T.; Heuer, Loretta J.; Chin, Marshall H.
BackgroundPrevious studies have demonstrated that women hospitalized for heart failure receive poorer quality of care and have worse outcomes than men. However, these studies were based upon selected patient populations and lacked quality of care measures.
Saif S. Rathore; JoAnne Micale Foody; Yongfei Wang; Jeph Herrin; Frederick A. Masoudi; Edward P. Havranek; Diana L. Ordin; Harlan M. Krumholz
This study was an endeavor to develop a system to collect and display useful information on the quality of ambulatory care by which hospital staff could make intelligent decisions in the management of the Ambulatory CareQuality Assurance Program.