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"Zero to Three" is a single-focus bulletin of the Zero to Three: National Center for Infants, Toddlers, and Families providing insight from multiple disciplines on the development of infants, toddlers, and their families. Noting that some communities are managing to establish and sustain good-qualityinfant-toddlercare and to make it accessible…
A survey of research findings on environmental and person variables provides clues as to what is required in a high qualityinfant-toddler program. One of the most important components of such a program is a loving, responsive caregiver. Research has shown that there are specific adult qualities that nurture the roots of intellectual competence,…
Observed process quality in infant/toddler classrooms was compared in Germany (n = 75) and the USA (n = 219). Process quality was assessed with the Infant/Toddler Environment Rating Scale(ITERS) and parent attitudes about ITERS content with the ITERS Parent Questionnaire (ITERSPQ). The ITERS had comparable reliabilities in the two countries and…
Family centered care (FCC) is an essential component of pediatric nursing. A unit-based FCC Committee was charged with evaluating care on an inpatient infant-toddler unit. The committee adapted the Institute of Family Centered Care survey tools and used them to evaluate parent and staff perceptions of FCC care provided on the unit. The survey tools covered the following areas: environment, nursing care, education, communication, and respect and equality. A convenience sample of 38 parents and 75 staff completed surveys. Families provided significantly more positive responses than the staff did, indicating overall satisfaction with the care received. However, they did identify concerns about educational issues and pain assessment. In contrast, the staff reported more negative perceptions regarding the delivery of FCC, and their primary concern was the unit environment. The FCC Committee used the findings from the survey to first educate the staff and then implement changes to improve the environment and the care delivered. PMID:18196711
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…
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…
Changes in distress and problem behaviors of 38 infants/toddlers were examined after children transitioned from familiar to new classrooms to look at effects of non-continuity of caregiver. Child's age, classroom quality, teacher sensitivity, and transitioning with a peer were examined as possible mediators. Results suggest that transitions were…
This annotated bibliography provides references of practical use to those concerned with infant/toddler caregiving. While many of the works cited concern quality group care for infants and toddlers, some works cited deal specifically with parenting, the parent/child relationship, and activities parents may share with their very young children. In…
Finding affordable, high-quality child care for infants (children up to 12 months old) and toddlers (1- and 2-year-olds) can be difficult. As public support for the education and care of 3- and 4-year-olds has increased, questions have arisen about the extent this has helped or hurt the provision of care for young children. Concerns have been…
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…
The psychometric properties of the Infant-Toddler Environment Rating Scale-Revised Edition (ITERS-R) were examined using 153 classrooms from child-care centers where resources were tied to center performance. An exploratory factor analysis revealed that the scale measures one global aspect of quality. To decrease redundancy, subsets of items were…
Bisceglia, Rossana; Perlman, Michal; Schaack, Diana; Jenkins, Jennifer
Recent research on how infants and toddlers grow and learn has provided new evidence for creating child care practices that support healthy development. The author describes 6 program practices drawn from this research. The article discusses practices that support secure attachments, identity formation, family practices, attention to developmental…
Early childhood programs with infants and toddlers are bustling and alive in ways different from programs that have only preschoolers. Infants and toddlers can make group care environments more caring and family focused spaces, nurturing the well-being of all adults and children participating in the program. The number of infants and toddlers who…
ZERO TO THREE's 2009 parent survey, "Parenting Infants and Toddlers Today," revealed that 25% of all parents surveyed had experienced child care-related hardships as a result of the recent economic downturn. The result is a significant number of children who are experiencing changes in their child care arrangements. Transitions into, and out of,…
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…
The present study is aimed at examining the level of quality and care provided by Greek preschool programmes, from the researcher's and early childhood educators' perspectives and verify whether they evaluate with the same way. Research results indicate that according to the researcher's assessment both preschool and infant\\/toddler classrooms provide care and education of adequate quality, whereas according to early
The present study is aimed at examining the level of quality and care provided by Greek preschool programmes, from the researcher's and early childhood educators' perspectives and verify whether they evaluate with the same way. Research results indicate that according to the researcher's assessment both preschool and infant\\/toddler classrooms provide care and education of adequate quality, whereas according to early
Caregiver-infant interactions in the first years of a child's life provide models and shape patterns of responding that can have consequences throughout the life-span. Research and practice have produced knowledge about the sensitivity of outcomes to characteristics of the infant nurturing situation. Infant caregivers should accept babies' need…
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…
The Caregiver Assessment Scale (CAS) was developed to evaluate caregiver interaction in infant-toddler settings compared to prominent child care guidelines. The CAS covers caregiving skills, enrichment activities, health and safety, and record keeping, and can be used by caregivers, directors, or supervisors. Periodic caregiver assessment is…
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
The State of Florida and its physicians are moving into a wonderful time of opportunity to serve the special needs of infants and toddlers at risk for developmental delays. If we meet our challenge we will no longer judge our success by a viable pregnancy or "graduation" from the nursery. We will begin to expect a community-wide response that prepares a child for education so successful that he or she will graduate prepared to work as a full member of the community. Not all our interventions will succeed at that level, but we have learned that good ones can place almost all our special needs children into the community. Physicians will have a major role in the success of this system of care for handicapped infants, toddlers and their families. PMID:1713256
Objective. - This paper presents the psychometric properties of the French adaptation of the InfantToddler Social and Emotional Assessment (ITSEA), named the Évaluation sociale et émotionnelle de jeunes enfants (ESEJE). Methods. - The French adaptation involved translation and back translation and was administered to 179 parents in pediatric well-baby centers and 115 parents in child care centers. Confirmatory factor
Z. Bracha; F. Perez-Diaz; Y. Perriot; M.-C. Leroux; D. Cohen; P. Reinert; P. Mazeta
Britt and Gillespie make suggestions for teachers' professional New Year's resolutions, including challenging oneself. They include a collection of resources and urge teachers to join NAEYC's Infant/Toddler Professionals Interest Forum. (Contains 27 resources.)
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 purpose of this study conducted in 36 infant-toddler centres ("Kinderkrippen") in the city of Munich in Bavaria/Germany was to explore structural characteristics of early child care and education and their effects on child carequality. Stepwise regressions and variance analysis (Manova) examined the relation between quality of care and…
The first of two articles on play reviews the development of play in typically developing infants, toddlers, and young children, including Piaget's observations on the development of play; developmental play research following Piaget (research by Lunzer, Sinclair, Lezine, Lowe, Rosenblatt, Uzgiris and Hunt, Fenson and others, Watson and Fischer,…
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.
The quality of care in infant and toddler classrooms was compared across inclusive (n=64) and noninclusive classrooms (n=400). Quality was measured using the Infant/Toddler Environment Rating Scale-Revised (ITERS-R). An exploratory and confirmatory factor analysis revealed four distinct dimensions of quality within the ITERS-R. Inclusive…
Hestenes, Linda L.; Cassidy, Deborah J.; Hegde, Archana V.; Lower, Joanna K.
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…
Discusses the importance of cultural sensitivity and specific cultural knowledge when providing care for infants and toddlers. Makes suggestions for responding to cultural differences. Describes dialogue and reflective-thinking strategies for identifying and responding to cultural differences. Asserts that caregivers need diversity training to see…
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 experiences,…
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…
In this paper the refinement and psychometric properties of the Infant-Toddler Social and Emotional Assessment (ITSEA) are described. Results from a sociodemographically diverse birth cohort sample of 1,235 parents of children between the ages of 12 and 36 months are presented. Confirmatory factor analyses supported the hypothesized Internalizing, Externalizing, Regulatory, and Competence do- mains as well as the 17 individual
Alice S. Carter; Margaret J. Briggs-Gowan; Stephanie M. Jones; Todd D. Little
This article summarizes state and community policy activities during the first six months of 2007 and provides updates of the progress to serve infants, toddlers, and their families. The following states are included in the report: (1) Arkansas; (2) California; (3) Indiana; (4) Iowa; (5) Michigan; (6) Minnesota; (7) New York; (8) Ohio; (9)…
This article summarizes state and community policy activities during the first six months of 2006 and provides updates of the progress to serve infants, toddlers, and their families. The following states are included in the report: (1) Rhode Island; (2) Virginia; (3) New York; (4) Pennsylvania; (5) Nebraska; (6) Ohio; (7) Washington; (8) Arizona;…
This article summarizes state and community policy activities during the final six months of 2006 and provides updates of the progress to serve infants, toddlers, and their families. The following states are included in the report: (1) Rhode Island; (2) Virginia; (3) New York; (4) Pennsylvania; (5) Nebraska; (6) Ohio; (7) Washington; (8) Arizona;…
Objective Using parent-completed questionnaires in (preventive) child health care can facilitate the early detection of psychosocial problems and psychopathology, including autism spectrum disorders (ASD). A promising questionnaire for this purpose is the Brief Infant-Toddler Social and Emotional Assessment (BITSEA). The screening accuracy with regard to ASD of the BITSEA Problem and Competence scales and a newly calculated Autism score were evaluated. Method Data, that was collected between April 2010 and April 2011, from a community sample of 2-year-olds (N?=?3127), was combined with a sample of preschool children diagnosed with ASD (N?=?159). For the total population and for subgroups by child's gender, area under the Receiver Operating Characteristic (ROC) curve was examined, and across a range of BITSEA Problem, Competence and Autism scores, sensitivity, specificity, positive and negative likelihood ratio's, diagnostic odds ratio and Youden's index were reported. Results The area under the ROC curve (95% confidence interval, [95%CI]) of the Problem scale was 0.90(0.87–0.92), of the Competence scale 0.93(0.91–0.95), and of the Autism score 0.95(0.93–0.97). For the total population, the screening accuracy of the Autism score was significantly better, compared to the Problem scale. The screening accuracy of the Competence scale was significantly better for girls (AUC?=?0.97; 95%CI?=?0.95–0.98) than for boys (AUC?=?0.91; 95%CI?=?0.88–0.94). Conclusion The results indicate that the BITSEA scales and newly calculated Autism score have good discriminative power to differentiate children with and without ASD. Therefore, the BITSEA may be helpful in the early detection of ASD, which could have beneficial effects on the child's development.
Kruizinga, Ingrid; Visser, Janne C.; van Batenburg-Eddes, Tamara; Carter, Alice S.; Jansen, Wilma; Raat, Hein
A list of equipment and supplies useful in the daytime care of infants and toddlers is presented. This equipment is in use at an all-day care center for 15 infants and 10-12 toddlers. The following types of items are listed: furnishings, linens, toys for motor activities, manipulative toys, crib toys, outdoor play equipment, books, phonograph…
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The SKI-HI program, which provides home-based family support services for infants, toddlers, and preschool children who are deaf or hard of hearing, has been implemented by approximately 250 agencies and annually serves about 4,000 families. Information is provided on the program's rationale, development, family-centered home-based services,…
Written for faculty members, administrators, and trainers in a variety of educational settings, this publication discusses issues and offers recommendations on the preparation of professionals working with infants, toddlers, and their families. Section I identifies four key elements in the training of infant/family practitioners and describes…
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
As part of a longitudinal study, infant/toddler pretend play development and maternal play modelling were investigated in dyadic context. A total of 21 children were videotaped in monthly play sessions with their mothers, from age 8 to 17 months. Child and mother pretend play frequencies and levels were measured using Brown's Pretend Play…
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…
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…
ABSTRACT In this study, we report the translation process, validity, and reliability of the Arabic Infant/Toddler Sensory Profile (IT_SP). A multistep approach was implemented to ensure the accuracy and equivalency of the Arabic and original English IT_SP. Factor analysis indicated that item loadings for over 50% of the items on the Arabic version were identical to the English version; all but three items had logical loadings. Intraclass correlation coefficients (ICC) between scores on the Arabic and English versions reported by parents who were bilingual were >.90 supporting bilingual validity. Alpha coefficients for each section varied from .40 to .74, which was within the range of the English version (.17 to .86), and were thus similar. ICCs between scores for repeated assessments varied from .81 to .99 supporting test-retest reliability. The results support the validity and reliability of the Arabic IT_SP. PMID:23931241
Abu-Dahab, Sana M N; Malkawi, Somaya Hussain; Nadar, Mohammad Shaban; Al Momani, Fidaa; Holm, Margo B
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
The Institute of Medicine (IOM) defines quality of care as "the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge." In 1999, the IOM issued Ensuring Quality Cancer Care, a report that documented significant gaps in the quality of cancer care in the United States.
This final report describes activities and accomplishments of an outreach project of Project SKI-HI, a family-centered, home intervention model designed to provide training to early intervention professionals serving infants, toddlers, and preschoolers with hearing impairments. In the project, an early intervention professional or a parent advisor…
This report discusses the activities and outcomes of Project Coach Outreach, a project to encourage the use of best practices in early intervention for infants, toddlers, and preschoolers with disabilities and to increase family-centered service options in Mississippi. Specifically, the project focused on the use of natural environments to include…
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…
Desired health outcomes include survival and health-related quality of life. For cancer, high qualitycare means delivering the full range of evidence-based interventions that are safe, patient-centered, effective (i.e., likely to provide more benefit than harm), timely, efficient, and equitable. Such care must be provided with technical competence and cultural sensitivity and must foster patient choice based on informed decision making.
This anthology contains 19 articles selected from the "Zero To Three Bulletin" from 1984 through the spring of 1992 and organized into five sections. The section on relationships in infant/toddler child care includes: "Infants in Day Care: Reflections on Experiences, Expectations, and Relationships," by J. H. Pawl; and "Choosing Child Care for…
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.…
Work is underway to make cancer a working model for quality of care research and the translation of this research into practice. This requires addressing how data collection about cancer care can be standardized and made most useful to a variety of audiences including providers, patients and their families, purchasers, payers, researchers, and policymakers. The Applied Research Program has spearheaded several key activities to carry out this initiative.
Developments in and goals of quality of care assessment are noted, with special reference to the nurse practitioner, and a quality of care evaluation model is proposed. The effectiveness of systems for monitoring quality depends primarily on the cooperati...
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)
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…
This document is comprised of the six 2000 issues of a bimonthly newsletter providing information on young children's health and safety for California's child care professionals. Regular features include a column on infant/toddler concerns, a question-answer column regarding medical and health issues, a nutrition column, and resources for child…
The aim of the present study was to explore the parent feeding practice of using food to soothe infant/toddler distress and its relationship to child weight status. Seventy eight families with infants and toddlers (43 males) ranging in age from 3 to 34 months (M=14 mos, SD=9 mos) completed a survey which included questions on their use of food to soothe, questionnaires on parent feeding practices, parenting self-efficacy, child temperament and child's weight and length at the time of their last well-baby visit. Results revealed the use of food to soothe to be a valid construct. In addition, mothers who used food to soothe rated themselves lower in parenting self-efficacy and their children higher in temperamental negativity. Analyses examining weight status as the outcome variable revealed that mothers who reported the use of food to soothe had heavier children, however, this relationship was stronger for children rated as high in temperamental negativity. PMID:21896298
As the quality movement in health care now enters its fourth decade, the language of quality is ubiquitous. Practitioners, organizations, and government agencies alike vociferously testify their commitments to quality and accept numerous forms of governance aimed at improving quality of care. Remarkably, the powerful phrase "quality of care" is rarely defined in the health care literature. Instead it operates as an accepted and assumed goal worth pursuing. The status of evidence-based medicine, for instance, hinges on its ability to improve quality of care, and efforts are made by both proponents and detractors to unpack the contents and outcomes of evidence-based practice while the contents of "quality of care" are presumed to be understood. Because the goals of medicine are far from obvious, this paper investigates the neglected term, "quality of care," in an effort to understand what it is that health care practices are so uncritically assumed to be striving for. Finding lack of consensus on the terminology in the quality literature, I propose that the term operates rhetorically by way of persuasive appeal (and lack of descriptive meaning). Unsatisfied that "quality of care" operates as a mere buzzword in morally contentious debates over resource allocation and duties of care, I implore health care communities to go beyond mere commitments to quality and, instead, to focus attention on the difficult task of specifying what counts as qualitycare within an economically constrained health care system. PMID:22810582
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
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…
This final report describes activities of Project INSITE, a 3-year home intervention program delivering services to infants, toddlers, and preschoolers with deaf blindness or other multidisability sensory impairments. The family centered model features the use of early intervention professionals known as parent advisors who visit homes weekly to…
Utah State Univ., Logan. Dept. of Communicative Disorders.
Repeated calls have recently arisen for increasing the educational level of early childhood teachers in all early care and education settings including classrooms for infants and toddlers. Since the majority of teachers in early child settings do not have a college degree, higher educational expectations could place a strain on early childhood…
A pilot program was designed to provide opportunities for a group of high-risk parents to improve their parenting. Specifically, the program provided a center in which teenage mothers could meet, share child-rearing problems, observe their children being cared for by trained personnel, interact with their children, and have opportunities for…
A critical step toward professionalism of a discipline is the establishment of a credential defining the qualifications for those authorized to work in the field. Such credentials exist in the fields of medicine, education, law and accounting, for example...
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
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…
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
Background: Maternal health improvement is one of the eight goals of the third millennium development, set in 2000. Pregnancy complications are the most important causes of maternal mortality worldwide. Proper and qualified health care access is one the most important factors for reducing maternal and neonatal mortality rates. Objectives: This study aimed to determine quality of peripartum care in Lorestan province in 2013. Materials and Methods: This was a descriptive cross-sectional study, in which quality of peripartum care was assessed among 200 women (sample size was determined according to other studies), referred to Lorestan province public hospitals. Quality assessment according to the WHO was used for the framework of structure, process and outcome. Data was collected by a researcher-made checklist, developed based on the administered instructions by Iran Health Ministry. The checklists were filled by observation. The calculated quality scores were expressed as percentage. SPSS version 18 was used for data analysis. Results: The mean percentages of compatibility with desirable situation were 54%, 57% and 66% in first, second and third stage of labor, respectively. The lowest scores were related to: Leopold maneuvers in the first stage, hand washing in the second stage and pulse control in the third stage of labor. Conclusions: Quality of peripartum care is moderate in Lorestan province, therefore, continuous evaluation of quality of care by administrators and hospital staff is essential to improve this quality and will ultimately result in maternal and neonatal health improvement.
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…
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 article offers a definition of quality medical care. Quality itself is defined not as consisting of the properties of an object but rather as the capacity of these properties to achieve goals. Accordingly, quality medical care is the capacity of the elements of that care to achieve legitimate medical and nonmedical goals. This definition is compared with other current definitions. I offer answers to the questions of how to choose goals, who chooses goals, and what are legitimate goals. Implications of this definition are discussed, particularly with reference to chart review. Because patient values shape goals and because these values are not always assessed and recorded, it is recommended that a formal assessment of patient values become part of the patient's record. PMID:3379723
This study compared the quality of child care programs serving children receiving government subsidies to those not serving such children. Thirty-four classrooms in full day programs serving preschool aged children (19 subsidized, 15 unsubsidized) were observed using the Early Childhood Environment Rating Scales-Revised (ECERS-R). (1) Research…
Jones-Branch, Julie A.; Torquati, Julia C.; Raikes, Helen; Edwards, Carolyn Pope
The quality of care delivered to patients with diabetes has an impact on long-term outcomes. The purpose of this quality improvement project was to examine the effect of a Diabetes Disease Management Program (DDMP) on compliance with recommended process measures of care in primary care practice settings. Certified diabetes nurse educators visited five participating primary care practices biweekly for 1
Janice C. Zgibor; Harsha Rao; Jacqueline Wesche-Thobaben; Nancie Gallagher; Janis McWilliams; Mary T. Korytkowski
The Inpatient Prospective Payment System proposed rule for fiscal 2015 continues the Centers for Medicare & Medicaid Services' move toward basing reimbursement on quality of care, not quantity. The rule also asks for public input on the two-midnight rule and a policy to address short-stay patients. CMS is implementing the Hospital-Acquired Condition Reduction Program, which penalizes hospitals that perform poorly. The agency proposes to add two safety measures to value-based purchasing in the future. PMID:24946382
This survey of 25 day care centers in 5 regions of Italy was designed to determine the characteristics of competent centers and the effects of differing local regulations on the quality of care provided. The Infant and Toddler Environment Rating Scale (ITERS) and a questionnaire were utilized to assess the quality of the day care centers in the…
It is widely accepted that high quality child care enhances children's cognitive and social development, but some question whether what constitutes qualitycare depends on the child's ethnic and cultural background. To address this question, secondary analysis of data from the two largest studies of child care experiences in the United States,…
As the primary providers of round-the-clock bedside care, nurses are well positioned to report on hospital quality of care. Researchers have not examined how nurses’ reports of quality correspond with standard process or outcomes measures of quality. We assess the validity of evaluating hospital quality by aggregating hospital nurses’ responses to a single item that asks them to report on quality of care. We found that a 10% increment in the proportion of nurses reporting excellent quality of care was associated with lower odds of mortality and failure to rescue; greater patient satisfaction; and higher composite process of care scores for acute myocardial infarction, pneumonia, and surgical patients. Nurse reported quality of care is a useful indicator of hospital performance.
The Child Care Facility Schedule (CCFS) represents an effort to develop a measure to assess quality child care. Initially 80 criteria, covering 8 areas considered important for attaining quality, were defined. These were subsequently tested in three different cultural contexts: Athens (Greece), Manila (Philippines), and Ibadan (Nigeria). Reliability studies were conducted in Athens and Ibadan, and a validity study was
Background Surgical patients are at risk for preventable adverse drug events (ADEs) during hospitalization. Usually, preventable ADEs are measured as an outcome parameter of quality of pharmaceutical care. However, process measures such as QIs are more efficient to assess the quality of care and provide more information about potential quality improvements. Objective To assess the quality of pharmaceutical care of medication-related processes in surgical wards with quality indicators, in order to detect targets for quality improvements. Methods For this observational cohort study, quality indicators were composed, validated, tested, and applied on a surgical cohort. Three surgical wards of an academic hospital in the Netherlands (Academic Medical Centre, Amsterdam) participated. Consecutive elective surgical patients with a hospital stay longer than 48 hours were included from April until June 2009. To assess the quality of pharmaceutical care, the set of quality indicators was applied to 252 medical records of surgical patients. Results Thirty-four quality indicators were composed and tested on acceptability and content- and face-validity. The selected 28 candidate quality indicators were tested for feasibility and ‘sensitivity to change’. This resulted in a final set of 27 quality indicators, of which inter-rater agreements were calculated (kappa 0.92 for eligibility, 0.74 for pass-rate). The quality of pharmaceutical care was assessed in 252 surgical patients. Nearly half of the surgical patients passed the quality indicators for pharmaceutical care (overall pass rate 49.8%). Improvements should be predominantly targeted to medication care related processes in surgical patients with gastro-intestinal problems (domain pass rate 29.4%). Conclusions This quality indicator set can be used to measure quality of pharmaceutical care and detect targets for quality improvements. With these results medication safety in surgical patients can be enhanced.
de Boer, Monica; Ramrattan, Maya A.; Boeker, Eveline B.; Kuks, Paul F. M.; Boermeester, Marja A.; Lie-A-Huen, Loraine
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…
This paper presents a profile of Iowa's Child CareQuality Rating System prepared as part of the Child CareQuality Rating System (QRS) Assessment Study. The profile is divided into the following categories: (1) Program Information; (2) Rating Details; (3) Quality Indicators for Center-Based Programs; (4) Indicators for Family Child Care Programs;…
The issue of quality of care involves many different components, including what cancer carequality looks like, which patients are more likely to receive poor qualitycare, and ways to measure healthcare quality.
... problems in order to achieve the best possible outcomes. Quality of care is a cooperative effort that involves patients, doctors, nurses, and other health care professionals, as well as institutions (such as hospitals, nursing homes, mental health centers, and home health care ...
\\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 purpose of these efforts, substantially supported by the Applied Research Program, is to enhance the state of the science on the quality of cancer care and inform federal and private-sector decision making on care delivery, coverage, regulation, and standard setting. Work is underway to make cancer a working model for quality of care research and the translation of this research into practice.
The increasing costs and complexity of technologic advances in diagnosis and treatment have been accompanied by other important issues. They are often moral or ethical in nature; they include the public's desire and determination to have access to these "high-tech" advances; and the quality and equity with which those advances are apportioned and applied must be addressed. Seven criteria that can be applied to technology assessment are identified as is a process for that assessment. Together, these procedures can provide valuable information and assistance to those who make decisions about health benefits coverage--both in the public and the private sectors. PMID:2980910
Abstract Objective To gain a deeper understanding of how primary care (PC) practices belonging to different models manage resources to provide high-qualitycare. Design Multiple-case study embedded in a cross-sectional study of a random sample of 37 practices. Setting Three regions of Quebec. Participants Health care professionals and staff of 5 PC practices. Methods Five cases showing above-average results on quality-of-care indicators were purposefully selected to contrast on region, practice size, and PC model. Data were collected using an organizational questionnaire; the Team Climate Inventory, which was completed by health care professionals and staff; and 33 individual interviews. Detailed case histories were written and thematic analysis was performed. Main findings The core common feature of these practices was their ongoing effort to make trade-offs to deliver services that met their vision of high-qualitycare. These compromises involved the same 3 areas, but to varying degrees depending on clinic characteristics: developing a shared vision of high-qualitycare; aligning resource use with that vision; and balancing professional aspirations and population needs. The leadership of the physician lead was crucial. The external environment was perceived as a source of pressure and dilemmas rather than as a source of support in these matters. Conclusion Irrespective of their models, PC practices’ pursuit of high-qualitycare is based on a vision in which accessibility is a key component, balanced by appropriate management of available resources and of external environment expectations. Current PC reforms often create tensions rather than support PC practices in their pursuit of high-qualitycare.
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…
This paper presents a profile of Oregon's Child CareQuality Indicators Program 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)…
Background This study examines quality of cardiometabolic care among veterans receiving care in the Veterans Affairs (VA) health system. We assess whether quality of care disparities by mental disorder status are magnified for individuals living in rural areas. Research Design We identified all patients in a 2005 national Veterans Administration cardiometabolic quality of care chart review. The intersection of this cohort and VA registries, that include patients with and without mental disorder, permitted identification of chart review patients with and without mental disorder. Using residential ZIP code, patients were assigned to rural-urban commuting area codes. We used logistic regression adjusting for age, demographics, comorbidities, and income. Measures We assessed association between rural residence and 9 cardiometabolic carequality indicators including care processes and intermediate outcomes. Results Compared with those without mental disorder, patients with mental disorder were less likely to receive diabetes sensory foot exams (OR: 0.82; 95% CI: 0.72–0.94), retinal exams (OR: 0.82; 95% CI: 0.73–0.93), and renal tests (OR: 0.79; CI: 0.74–0.90). Rural residence was associated with no differences in quality measures. Primary care visit volume was associated with significantly greater likelihood of obtaining diabetic retinal examination and renal testing, but did not explain disparities among patients with mental disorder. Conclusions Mental disorder is associated with lesser attainment of quality cardiometabolic care. In this integrated VA care system, rurality and visit volume did not explain this disparity. Other explanations for disparities must be explored to improve the health and health care of this population.
Morden, Nancy E.; Berke, Ethan M.; Welsh, Deborah E.; McCarthy, John F.; Mackenzie, Todd A.; Kilbourne, Amy M.
Publicity for (and laterly increased economic stringency which makes more likely), failures of care in the NHS engender concern for carequality while its assurance remains the subject of a fragmented and unhelpful literature. A selective attempt is made to examine some underlying principles by posing and answering three questions. What is the quality of care? What basic principles must be followed in defining `standards'? How then may quality be assured? Any definition of care must be multi-faceted and in common use pervaded with the patients' pre-occupation with a search for cures. Nevertheless, it is argued that there are gains in restricting the technical use of the term `care' to those systematic processes of health services and their culture which impinge on the personal experience of patients and which fashion their response. In contemporary society care ought to be designed to restore and enhance the independence, dignity and choice of the patient. Although there is a contrary tendency to abandon problems of care to the professionals, standards for care should be judged ultimately not from the specialised professional but from the viewpoint of lay people whose behaviour in the outside world fashions those norms by which independence, dignity and choice are judged. A number of difficulties in identifying and securing improvements in care are discussed. In particular, it is argued that such is the interdependence of the style of management of an institution and the style of care it provides that enforcement of high qualitycare is likley to be a contradiction in terms. Only trained and sensitive staff can act intuitively and pre-emptively to prevent even incipient deterioration in care. They cannot carefully foster at all times the independence and dignity of their patients unless they are treated in a similar way as professional employees. As an initial step in improving the quality of care a simple start is urged upon implementing an inventory of checks. These are designed to establish the identification and operation of health care policies and practices which give appropriate recognition to the characteristics of care that patients and public expect, coming as they do from a lay rather than professional world. The article concludes with an appropriate inventory of questions to be put to professionals by those laymen who are increasingly imported into health care management through community representation (in CHCs) and staff participation (in joint consultation) and whose interest and concern should be harnessed appropriately.
In September 1998, the Child Care Bureau and the Head Start Bureau of the Administration for Children and Families, U.S. Department of Health and Human Services, sponsored a National Leadership Forum on QualityCare for Infants and Toddlers. State child c...
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
Existing quality models focus on some specific diseases, clinics or clinical areas. Although they contain structure, process, or output type measures, there is no model which measures quality of health care processes comprehensively. In addition, due to the not measured overall process quality, hospitals cannot compare quality of processes internally and externally. To bring a solution to above problems, a new model is developed from software quality measures. We have adopted the ISO/IEC 9126 software quality standard for health care processes. Then, JCIAS (Joint Commission International Accreditation Standards for Hospitals) measurable elements were added to model scope for unifying functional requirements. Assessment (diagnosing) process measurement results are provided in this paper. After the application, it was concluded that the model determines weak and strong aspects of the processes, gives a more detailed picture for the process quality, and provides quantifiable information to hospitals to compare their processes with multiple organizations. PMID:22874345
Providing transportation to children younger than kindergarten age has become more common for public school districts, and school personnel are unsure as to the rules, guidelines, and best practices that apply to the youngest school bus passengers. This document outlines the current Illinois requirements regarding the transportation of very young…
This research sought to develop and test measures of quality of care for vulnerable children through two aims: (1) To validate the PedsQL(trademark) as an outcome measure of quality of healthcare services; (2) To develop and validate a non-categorical mea...
The problem of defining a quality model to be used in the evaluation of the software components of a Health Care System (HCS) is addressed. The model, based on the ISO/IEC 9126 standard, has been interpreted to fit the requirements of some classes of applications representative of Health Care Systems, on the basis of the experience gained both in the field of medical Informatics and assessment of software products. The values resulting from weighing the quality characteristics according to their criticality outline a set of quality profiles that can be used both for evaluation and certification. PMID:10179767
Empathy is a complex multi-dimensional concept that has moral cognitive emotive and behavioural components Clinical empathy involves an ability to: (a) understand the patient's situation, perspective, and feelings (and their attached meanings); (b) to communicate that understanding and check its accuracy; and (c) to act on that understanding with the patient in a helpful (therapeutic) way. Research on the effect of empathy on health outcomes in primary care is lacking, but studies in mental health and in nursing suggest it plays a key role. Empathy can be improved and successfully taught at medical school especially if it is embedded in the students actual experiences with patients. A variety of assessment and feedback techniques have also been used in general medicine psychiatry and nursing. Further work is required to determine if clinical empathy needs to be, and can be, improved in the primary care setting.
This paper explores the historical development of quality measures, examines the dimensions of quality assessment, and compares the application of these dimensions to medical\\/surgical and psychiatric care. The implications for assessing qualitycare in psychiatric settings are discussed.
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
The aim of all diabetes treatment in childhood and adolescence is to counteract the development of complications (acute as well as late), to achieve normal growth and development, and to provide the patients with as good as possible a quality of life. Many studies have confirmed the benefits of intensified medical management regarding the prevalence and/or the progression of diabetic microvascular complications. Intensified medical management means of course much more than intensified insulin substitution; diabetes care includes diet, physical exercise, diabetes education, continuous monitoring, and psychosocial support. To improve the outcome of patients with diabetes mellitus, optimizing structure quality is one of the goals. A number of prerequisites (regarding the social-socioeconomic-health care system) are not yet fulfilled everywhere; structures necessary to provide qualified diabetes care (e.g. pediatric diabetes center, team of experts, outpatient care) are not yet sufficiently available in some areas. According to both the declarations of St. Vincent and of Kos, every effort should be made to enhance structure quality in an attempt to improve the situation and the outcome of our young patients with diabetes. PMID:9676998
Borkenstein, M H; Limbert, C; Reiterer, E; Stalzer, C; Zinggl, E
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 goal of this study was to develop improved measures of the quality of neonatal intensive care for infants with very low birth weights (under 1500 grams) and to study the hospital characteristics associated with high qualitycare.
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.
The objective of the research project was to determine the effects of Hospital Based Managed Care (HBMC) on the cost and quality of hospital care. HBMC is a delivery of care method that involved creating locally derived, multidisciplinary practice guideli...
This project was inspired by a belief that too little attention is paid by the academic structure to its responsibility within the school experience of developing "caring" individuals. The project's goal was to test the idea that "CaringQuality" could be "taught". (Author/RK)
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...
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
Despite Minnesota's reputation for quality child care, recent changes in legislation and the impact of changing needs have raised concerns about the quality of child care available in the state. This paper presents an overview of Minnesota's current child care system including structural indicators of program quality such as licensing standards,…
A study was undertaken to determine the effects of health care cost controls on the quality of care available. The Physician Performance Index (PPI) was utilized as a quality measure of the process of patient care. The index has been used to compare diffe...
M. L. Garg J. L. Mulligan W. A. Gliebe R. R. Parekh
Objective. To compare nursing homes (NHs) that report different staffing statistics on quality of care. Data Sources. Staffing information generated by California NHs on state cost reports and during onsite interviews. Data independently collected by research staff describing quality of care related to 27 care processes. Study Design. Two groups of NHs (n 521) that reported significantly different and stable
John F. Schnelle; Sandra F. Simmons; Charlene Harrington; Mary Cadogan; Emily Garcia; Barbara M. Bates-Jensen
Conducted state-wide in Pennsylvania, this study expands on several research studies of the quality of day care reported by Phillips (1987). Observations and evaluations were made of 149 randomly selected day care centers and family day care homes. The day care and family day care versions of the Child Development Program Evaluation Licensing…
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
High-quality child care has been shown to improve the academic success and life adjustments of children living in poverty. During the past decade, many American states have adopted voluntary Quality Rating and Improvement (QRI) systems in an attempt to increase the level of quality in child care. Using data compiled by the National Association of…
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…
Studies across medical disciplines have shown gaps in the care recommended in evidence based guidelines and the care actually delivered. Quality improvement projects using systematic audit and feedback interventions such as quality measures, will become increasingly important tools to address these gaps in care. These gaps are also apparent in the care of patients with inflammatory bowel disease. Multiple organizations, including the American Gastroenterology Association and the Crohn’s and Colitis Foundation of America, have developed programs designed to implement quality measures to improve the care of inflammatory bowel disease (IBD) patients. Early results show promise of improving quality, but numerous barriers remain. Gastroenterologists need to be aware of these processes to provide the highest care possible to patients with IBD. We review the existing literature on approaches to quality improvement and their potential application and barriers when applied to IBD care.
The purpose of this project is to: (1) analyze the relationship between patients' perspectives of hospital quality of care and key hospital characteristics that may influence patients' experiences of hospital care, including rurality; and (2) assess wheth...
In 2008, the federal government allotted $7 billion in child care subsidies to low-income families through the state-administered Child Care and Development Fund (CCDF), now the government’s largest child care program (US DHHS, 2008). Although subsidies reduce costs for families and facilitate parental employment, it is unclear how they impact the quality of care families purchase. This study investigates the impact of government subsidization on parents’ selection of child carequality using multivariate regression and propensity score matching approaches to account for differential selection into subsidy receipt and care arrangements. Data were drawn from the Child Care Supplement to the Fragile Families and Child Wellbeing Study (CCS-FFCWS), conducted in 2002 and 2003 in 14 of the 20 FFCWS cities when focal children were 3 years old (N = 456). Our results indicate that families who used subsidies chose higher qualitycare than comparable mothers who did not use subsidies, but only because subsidy recipients were more likely to use center-based care. Subgroup analyses revealed that families using subsidies purchased higher-quality home-based care but lower-quality center-based care than comparable non-recipients. Findings suggest that child care subsidies may serve as more than a work support for low-income families by enhancing the quality of nonmaternal care children experience but that this effect is largely attributable to recipients’ using formal child care arrangements (versus kith and kin care) more often than non-recipients.
Ryan, Rebecca M.; Johnson, Anna; Rigby, Elizabeth; Brooks-Gunn, Jeanne
Purpose Because insurers use performance and quality metrics to inform reimbursement, identifying remediable causes of poor-quality cancer care is imperative. We undertook this descriptive cohort study to assess key predictors of women's perceived quality of their breast cancer care and actual guideline-concordant quality of care received. Patients and Methods We surveyed inner-city women with newly diagnosed and surgically treated early-stage breast cancer requiring adjuvant treatment who were enrolled onto a randomized controlled trial (RCT) of patient assistance to reduce disparities in care. We assessed women's perceived quality of care and perceived quality of the process of getting care, such as getting referrals, test results, and treatments; we abstracted records to determine the actual quality of care. Results Of the 374 new patients with early-stage breast cancer enrolled onto the RCT, only a slight majority of women (55%) perceived their quality of care as excellent; 88% actually received good-quality, guideline-concordant care. Excellent perceived quality (P < .001) was significantly associated with patients' perception of the quality of the process of getting care (adjusted relative risk [RR], 1.78; 95% CI, 1.65 to 1.87). Also associated with perceived quality—and mediated by race—were trust in one's physician (adjusted RR, 1.43; 95% CI, 1.16 to 1.64) and perceived racism, which affected black women more than women of other races/ethnicities (black race–adjusted RR for perceived racism, 0.33 [95% CI, 0.10 to 0.87]; black race–adjusted RR for trust, 1.61 [95% CI, 0.97 to 1.90]; c = 0.82 for the model; P < .001). Actual quality of care provided did not affect perceived quality of care received. Conclusion Patients' perceived quality of care differs from their receipt of high-qualitycare. Mutable targets to improve perceived quality of care include the processes of getting care and trusting their physician.
Quality improvement is as central to home health care as to any other field of health care. With the mandated addition in 2000 of Outcome Assessment and Information Set (OASIS) and outcome-based quality improvement (OBQI), Medicare home health agencies entered a new era of documenting, tracking, and systematically improving quality. OBQI is augmented by the Medicare Quality Improvement Organization (QIO) program, which is now entering the ninth in a series of work assignments, with the tenth scope in the planning stages. Evidence has shown that applied quality improvement methods can drive better outcomes using important metrics, such as acute care hospitalization. This article reviews key findings from the past 2 decades of home carequality improvement research and public policy advances, describes specific examples of local and regional programmatic approaches to quality improvement, and forecasts near-future trends in this vital arena of home health care. PMID:19217497
This paper presents a profile of Louisiana's Quality Start Child Care 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;…
This paper presents a profile of Tennessee's Star-Quality Child Care Program 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)…
A study of 198 nursing facilities in Maryland tested the hypotheses that: 1) the presence of more RNs improves the quality of nursing care; and 2) increased numbers of all types of nursing staff improve the quality of nursing care, based on a multidimensional measure of quality of nursing care. Findings indicate that the ratio of RNs to residents is directly related to a measure of resident rights deficiencies. In addition, the ratio of total nursing staff to residents is directly related to a lower overall deficiency index and a higher quality of care score. PMID:8826283
In order to develop a system for assessing the quality of care, the project focused on the relationships among the structure, process and outcome dimensions of quality. Structure and process variables were emphasized because very little work has been done...
It is no longer possible to ignore the issue of quality in health care. Care institutions strive to\\u000aprovide all patients with effective, efficient, safe, timely, patient-centered care. Increased\\u000aattention for quality is also found in discussions regarding use of information and\\u000acommunication technologies (ICTs) in health care processes. In these discussions, ICT is almost\\u000aalways brought into a direct
The purpose of this article is to examine the issue of quality of care in rural America and to help others examine this issue in a way that is consistent with the very real challenges faced by rural communities in ensuring the availability of adequate health services. Rural citizens have a right to expect that their local health care meets certain basic standards. Unless rural providers can document that the quality of local health care meets objective external standards, third-party payers might refuse to contract with rural providers, and increasingly sophisticated consumers might leave their communities for basic medical care services. To improve the measurement of health carequality in a rural setting, a number of issues specific to the rural environment must be addressed, including small sample sizes (volume and outcome issues), limited data availability, the ability to define rural health service areas, rural population preferences and the lower priority of formal quality-of-care assessment in shortage areas. Several current health policy initiatives have substantial implications for monitoring and measuring the quality of rural health services. For example, to receive community acceptance and achieve fiscal stability, critical access hospitals (CAHs) must be able to document that the care they provide is at least comparable to that of their predecessor institutions. The expectations for quality assurance activities in CAHs should consider their limited institutional resources and community preferences. As managed care extends from urban areas, there will be an inevitable collision between the ability to provide care and the ability to measure quality. As desirable as it might be to have a national standard for health carequality, this is not an attainable goal. The spectrum and content of rural health care are different from the spectrum and content of care provided in large cities. Accrediting agencies, third-party carriers and health insurance purchasers need to develop rural health carequality standards that are practical, useful and affordable. PMID:10981369
A study to determine quality of life and care in 20 Long-Term Care (LTC) facilities in the Metro Denver Area revealed care was better than anticipated. Assessments were made on 158 residents regarding problems, functioning level, and appropriateness of level of care based on information from residents, staff, and medical records. (Author)
BackgroundCare 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.ObjectivesThe 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
Marjan Askari; Peter C. Wierenga; Saied Eslami; Stephanie Medlock; Sophia E. de Rooij; Ameen Abu-Hanna
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
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…
The Affordable Care Act seeks to increase access to high-quality, affordable health care for all Americans. To that end, the law requires the Secretary of the Department of Health and Human Services (HHS) to establish a National Strategy for Quality Impro...
Evaluates the quality of the caregiving environment for young infants in day care centers in Athens (Greece) using three global measures: ITERS, PROFILE, and CCFS. Reveals a great similarity among the three measures. Reports a generally low quality for day care, lower than for other countries with similar research. (DSK)
There is wide acknowledgement that quality assurance is desirable in primary health care. Considerable success has been achieved in this field by the Iberian Programme of Training and Implementation of Quality Assurance Activities in Primary Health Care, the basis for which is outlined below. PMID:7794450
Our purpose in this study was to explore the midwives' perception of factors obstructing or facilitating their ability to provide quality perinatal care at a central labor ward in Maputo. In-depth interviews were undertaken with 16 midwives and were analyzed according to grounded theory technique. Barriers to provision of quality perinatal care were identified as follows: (i) the unsupportive environment,
Karen Odberg Pettersson; Eva Johansson; Maria de Fatima M. Pelembe; Clemencia Dgedge; Kyllike Christensson
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…
Examined whether data on child carequality obtained from a telephone interview with the provider could serve as an adequate proxy for data obtained from direct observation of 89 child care homes and 92 centers. Found that a 25-item interview predicted accurately the quality classification of 92 percent of homes and 89 percent of centers.…
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
Introduction: Improving Performance in Practice (IPIP) is an initiative convened by the American Board of Medical Specialties. It investigates the efficacy of coaches in helping primary-care practices improve the care of patients with diabetes and asthma. Most IPIP states use coaches who have a health care background, and are trained in quality…
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 disproportionately high in states that have a disproportionately large social burden and low health care spending overall. These and other vagaries of Medicare spending pose critical challenges to research that depends on Medicare spending to define regional variation in health care. PMID:19056754
Objective Investigate whether high-quality chronic care delivery improved the experiences of patients. Design This study had a longitudinal design. Setting and Participants We surveyed professionals and patients in 17 disease management programs targeting patients with cardiovascular diseases, chronic obstructive pulmonary disease, heart failure, stroke, comorbidity and eating disorders. Main Outcome Measures Patients completed questionnaires including the Patient Assessment of Chronic Illness Care (PACIC) [T1 (2010), 2637/4576 (58%); T2 (2011), 2314/4330 (53%)]. Professionals' Assessment of Chronic Illness Care (ACIC) scores [T1, 150/274 (55%); T2, 225/325 (68%)] were used as a context variable for care delivery. We used two-tailed, paired t-tests to investigate improvements in chronic illness carequality and patients' experiences with chronic care delivery. We employed multilevel analyses to investigate the predictive role of chronic care delivery quality in improving patients' experiences with care delivery. Results Overall, carequality and patients' experiences with chronic illness care delivery significantly improved. PACIC scores improved significantly from 2.89 at T1 to 2.96 at T2 and ACIC-S scores improved significantly from 6.83 at T1 to 7.18 at T2. After adjusting for patients' experiences with care delivery at T1, age, educational level, marital status, gender and mental and physical quality of life, analyses showed that the quality of chronic care delivery at T1 (P < 0.001) and changes in care delivery quality (P < 0.001) predicted patients' experiences with chronic care delivery at T2. Conclusion This research showed that carequality and changes therein predict more positive experiences of patients with various chronic conditions over time.
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
The peer-review organizations (PROs) were created by Congress in 1984 to monitor the cost and quality of care received by Medicare beneficiaries. In order to do this, the Health Care Financing Administration (HCFA) contracted with the PROs through a series of contracts referred to as "Scopes of Work." Under the Fourth Scope of Work, the HCFA initiated the Health CareQuality Improvement Program (HCQIP) in 1990, as an application of the principles of continuous quality improvement. Since then, the PROs have participated with health care providers in cooperative projects to improve the quality of primarily inpatient care provided to Medicare beneficiaries. Through HCFA-supplied administrative data and clinical data abstracted from patient records, the PROs have been able to identify opportunities for improvements in patient care. In May 1995, the HCFA proposed a new Fifth Scope of Work, which will shift the focus of HCQIP from inpatient care projects to projects in outpatient and managed care settings. This article describes the HCQIP process, the types of data used by the PROs to conduct cooperative projects with health care providers, and the informatics challenges in improving the quality of care received by Medicare beneficiaries.
Grant, J B; Hayes, R P; Pates, R D; Elward, K S; Ballard, D J
Because minimum government standards for quality regulate only part of the market failure, they may have unintended effects. We present a general theory of how government regulation of quality of care may affect different market segments, and test the hypotheses for the nursing home market. OBRA 1987 was a sweeping government reform to improve the quality of nursing home care. We study how the effect of OBRA on the quality of nursing home care, measured by resident outcomes, varied with nursing home profitability. Using a semi-parametric method to control for the endogenous effects of regulation, we found that this landmark legislation had a negative effect on the quality of care in less profitable nursing homes, but improved the quality in more profitable nursing homes during the initial period after OBRA. But, this legislation had no statistically significant effect in the later period when the regulation was weakly enforced. PMID:16612571
Kumar, Virender; Norton, Edward C; Encinosa, William E
Wisconsin's Early Childhood Excellence Initiative was a $15 million public policy effort designed in 2000 to increase child carequality for low-income children. An evaluation revealed significant improvement in classroom quality, the quality of caregiver interaction, and caregivers' beliefs about children following a complex multi-faceted…
Roach, Mary A.; Riley, David A.; Adams, Diane; Edie, David
The purpose of this study was to describe the quality of toddler child care classrooms in the district of Porto, in the north of Portugal. One hundred and sixty classrooms for children between 1 and 3 years of age participated in this study. Results suggested the existence of poor average quality and absence of good-quality classrooms. Child-adult…
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…
For a number of years the health care risk management industry has been addressing unplanned and unanticipated adverse events. Organizations that are proactive in their approach to risk and quality management will have big payoffs in clinical quality improvement, service quality improvement, employee satisfaction, and customer satisfaction. PMID:10160154
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)…
This paper aims to clarify the concepts and terminology of clinical research, evaluation, and quality. Clinical research or clinical epidemiology aims to demonstrate the efficacy of medical care. The optimal methodology is a randomized, double-blind trial that allows a causal inference in respect of efficacy. This should be the first stage before generalization of all medical practice. Evaluation of quality of care aims to verify the effectiveness of medical care by comparing practice with references. The optimal methodology is clinical audit that allows fine-tuned diagnosis of the existence of deviant practices. The analysis of causes and correction of the care process are an integral part of the evaluation work. Thus quality assurance and quality management concepts and methods have been developed which tend to ensure solutions for better care and to maintain the level of quality of care to achieve patient satisfaction. Evaluation, clinical research and management quality could in fact be seen as the complementary facets of a comprehensive approach to quality of care. PMID:10070233
Background Caring for patients with multimorbidity is common for generalists, although such patients are often excluded from clinical trials, and thus such trials lack of generalizability. Data on the association between multimorbidity and preventive care are limited. We aimed to assess whether comorbidity number, severity and type were associated with preventive care among patients receiving care in Swiss University primary care settings. Methods We examined a retrospective cohort composed of a random sample of 1,002 patients aged 50–80 years attending four Swiss university primary care settings. Multimorbidity was defined according to the literature and the Charlson index. We assessed the quality of preventive care and cardiovascular preventive care with RAND’s Quality Assessment Tool indicators. Aggregate scores of quality of provided care were calculated by taking into account the number of eligible patients for each indicator. Results Participants (mean age 63.5 years, 44% women) had a mean of 2.6 (SD 1.9) comorbidities and 67.5% had 2 or more comorbidities. The mean Charlson index was 1.8 (SD 1.9). Overall, participants received 69% of recommended preventive care and 84% of cardiovascular preventive care. Quality of care was not associated with higher numbers of comorbidities, both for preventive care and for cardiovascular preventive care. Results were similar in analyses using the Charlson index and after adjusting for age, gender, occupation, center and number of visits. Some patients may receive less preventive care including those with dementia (47%) and those with schizophrenia (35%). Conclusions In Swiss university primary care settings, two thirds of patients had 2 or more comorbidities. The receipt of preventive and cardiovascular preventive care was not affected by comorbidity count or severity, although patients with certain comorbidities may receive lower levels of preventive care.
Streit, Sven; da Costa, Bruno R.; Bauer, Douglas C.; Collet, Tinh-Hai; Weiler, Stefan; Zimmerli, Lukas; Frey, Peter; Cornuz, Jacques; Gaspoz, Jean-Michel; Battegay, Edouard; Kerr, Eve; Aujesky, Drahomir; Rodondi, Nicolas
Although the importance of spiritual care is widely recognized in nursing theory, recent research suggests that it is rarely attended to in nursing practice. One explanation for this contradiction is the conceptual confusion that exists regarding the meaning of spiritual nursing care. To help unravel this confusion, in-depth open-ended interviews were conducted in an oncology care setting with 29 individuals representing the multiple perspectives of nurses, patients, family, and others. Phenomenological analysis of these interviews reveals that spiritual nursing care involves a complexity of social processes, of which developing caring relationships is core. For these social processes to work and for spiritual nursing care to be realized, the nurse must embody four essential human qualities: receptivity, humanity, competency, and positivity. Participants' descriptions of these processes and qualities not only offer clarity and understanding but also capture the diffuse and amorphous nature of spiritual nursing care. PMID:18227195
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
We examine the impact of state child care regulations on the supply and quality of care in child care markets. We exploit panel data on both individual establishments and local markets to control for state, time, and, where possible, establishment-specific fixed effects to mitigate the potential bias due to policy endogeneity. We find that the imposition of regulations reduces the number of center-based child care establishments, especially in lower income markets. However, such regulations increase the quality of services provided, especially in higher income areas. Thus, there are winners and losers from the regulation of child care services.
Background Leadership and staffing are recognised as important factors for quality of care. This study examines the effects of ward leaders' task- and relationship-oriented leadership styles, staffing levels, ratio of registered nurses and ratio of unlicensed staff on three independent measures of quality of care. Methods A cross-sectional survey of forty nursing home wards throughout Norway was used to collect the data. Five sources of data were utilised: self-report questionnaires to 444 employees, interviews with and questionnaires to 13 nursing home directors and 40 ward managers, telephone interviews with 378 relatives and 900 hours of field observations. Separate multi-level analyses were conducted for quality of care assessed by relatives, staff and field observations respectively. Results Task-oriented leadership style had a significant positive relationship with two of the three quality of care indexes. In contrast, relationship-oriented leadership style was not significantly related to any of the indexes. The lack of significant effect for relationship-oriented leadership style was due to a strong correlation between the two leadership styles (r = 0.78). Staffing levels and ratio of registered nurses were not significantly related to any of the quality of care indexes. The ratio of unlicensed staff, however, showed a significant negative relationship to quality as assessed by relatives and field observations, but not to quality as assessed by staff. Conclusions Leaders in nursing homes should focus on active leadership and particularly task-oriented behaviour like structure, coordination, clarifying of staff roles and monitoring of operations to increase quality of care. Furthermore, nursing homes should minimize use of unlicensed staff and address factors related to high ratios of unlicensed staff, like low staff stability. The study indicates, however, that the relationship between staffing levels, ratio of registered nurses and quality of care is complex. Increasing staffing levels or the ratio of registered nurses alone is not likely sufficient for increasing quality of care.
...the quality and appropriateness of care provided under the plan, including how the State will assure: (a) Access to well-baby care, well-child care, well-adolescent care and childhood and adolescent immunizations. (b) Access to covered...
This position paper describes several aspects of ideal family day care. The importance of a mother substitute and a "home away from home" in which both preschool and school-age children are free to be themselves is emphasized. The key to an optimal relationship between the natural and day care parents is mutual cooperation, friendship and…
Developing and implementing a valid system of-quality assessment is essential for effective functioning of the health care system. Although a number of groups have produced quality assessment tools, these tools typically suffer from a variety of limitatio...
E. A. Kerr E. A. McGlynn E. G. Hamilton J. L. Reifel S. M. Asch
...2013-10-01 2013-10-01 false Benchmarks for quality of care measures. 414...Physician Fee Schedule Â§ 414.1250 Benchmarks for quality of care measures. (a) The benchmark for quality of care measures...
...interpretations on the quality of health care. 480.141 Section 480.141...interpretations on the quality of health care. Subject to the procedures...generalizations on the quality of health care that identify a particular...
The purpose of the report is to quantify the effect on infant mortality and complications of premature birth of delivering in a high-level neonatal intensive care unit (NICU) versus delivering at a local hospital.
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.
There is growing interest today in the design and application of tools for measuring quality of life. However, the rating\\u000a scales applied do not reveal the consequences that Parkinson’s disease has for patients’ relatives. The need for permanent\\u000a care and help to be given to the chronically disabled person leads to a decrease in the life quality of care-givers. The
As increasing numbers of children enter child-care environments that are subsidized by federal and state funds, the demand has risen from policy makers and activists for valid, cost-effective methods of assessing the quality of those environments. In this study we asked whether data on child-carequality obtained from a telephone interview with the provider can serve as an adequate proxy
Susan D Holloway; Sharon L Kagan; Bruce Fuller; Lynna Tsou; Jude Carroll
Lung cancer is the commonest cause of cancer-related death worldwide and poses a significant respiratory disease burden. Little is known about the provision of lung cancer care across Europe. The overall aim of the Task Force was to investigate current practice in lung cancer care across Europe. The Task Force undertook four projects: 1) a narrative literature search on quality management of lung cancer; 2) a survey of national and local infrastructure for lung cancer care in Europe; 3) a benchmarking project on the quality of (inter)national lung cancer guidelines in Europe; and 4) a feasibility study of prospective data collection in a pan-European setting. There is little peer-reviewed literature on quality management in lung cancer care. The survey revealed important differences in the infrastructure of lung cancer care in Europe. The European guidelines that were assessed displayed wide variation in content and scope, as well as methodological quality but at the same time there was relevant duplication. The feasibility study demonstrated that it is, in principle, feasible to collect prospective demographic and clinical data on patients with lung cancer. Legal obligations vary among countries. The European Initiative for Quality Management in Lung Cancer Care has provided the first comprehensive snapshot of lung cancer care in Europe. PMID:24659546
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
The project's goal was to improve the quality of nursing care received by Montana's elderly by enhancing the gerontological knowledge of nursing teams (R.N.s, L.P.N.s, and aides) responsible for elder health care. Program content was organized within the ...
The purpose of the study was to determine if variation among nursing homes in the task design of nursing care jobs was present, and how such variation is related to differences in worker outcomes and differences in carequality indicators. This study fill...
A. Rosen A. Wong D. Tyler D. R. Berlowitz E. Hickey F. Wang G. Brandeis R. Engle V. A. Parker
The research reported here demonstrates the usefulness of a standardized patient assessment system as the basis for developing information on quality of care in the long-term care field. The system is built on a set of descriptors published in Patient Cla...
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.
This paper describes efforts to increase the quality in early care and education through targeted coaching. A collaborative including several community agencies and a university developed a framework of support for early care and education providers, using coaching as its foundational basis, called Coaching to Quality (CTQ). This paper provides a…
The provision of high quality maternity care will make the difference between life and death or lifelong maiming for millions of pregnant women. Barriers preventing access to affordable, appropriate, acceptable and effective services, and lack of facilities providing high quality obstetric care result in about 1600 maternal deaths every day. Education in its broadest sense is required at all levels and sectors of society to enhance policy formulation that will strengthen programme commitment, improve services with a culturally sensitive approach and ensure appropriate delegation of responsibility to health staff at peripheral levels. This paper is the second in series of three which addresses quality of care. The first (Kwast 1998) contains an overview of concepts, assessments, barriers and improvements of quality of care. The third article will describe selected aspects of monitoring and evaluation of quality of care. PMID:9856019
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
Objectives: The quality of services delivered to type 2 diabetic patients in primary health care has an important impact on long-term outcomes. The aim of this study is to explore diabetic patients’ views of factors affecting quality of diabetic services delivered in primary care in Oman, a developing country with a high burden of diabetes. Methods: Semi-structured face to face interviews were conducted with 19 type 2 diabetic patients recruited from four selected primary healthcare centres (PHCs) in Muscat region, the capital city of Oman. A framework approach was used to analyse the qualitative data. Results: Participants identified several factors which could affect the quality of diabetic services provided in PHCs: delays in the follow-up process; lack of continuity of care; diabetes educational materials unavailable in waiting areas; shortage of Omani nurses able to speak the patients’ language; inadequate explanations from the attending primary care physician (PCP); under involvement of dieticians in patient management; delays in provision of laboratory results; inadequate supplies of diabetic medication between appointments, and long waits to see ophthalmologists. Conclusion: Several factors were identified by diabetic patients that may influence the quality of diabetic services provided in the PHC setting in Oman. Health care professionals and decision makers in the Ministry of Health (MOH) and other health care sectors in Oman should consider patients’ views and concerns in order to improve the quality of diabetic care services in primary health care.
The rapid growth of home care brings with it greater risks and liabilities, making quality assurance increasingly more important. Home Health Services Foundation, Inc., a diverse, multi-corporate structure, developed an effective quality assurance program through communication and information sharing. PMID:10109301
There is a growing consensus within the NHS of the importance of obtaining feedback from patients in order to improve the quality of health care; consequently, many patient satisfaction surveys are now undertaken. However, much research is based on provider-held assumptions about service quality. This study focuses on patient satisfaction with coronary bypass surgery, starting with the concerns expressed by
Emilie Roberts; Ralph Leavey; David Allen; Graham Gibbs
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
Evaluating quality in early childhood education and care (ECEC) service internationally is increasingly important. Research to date indicates that it is "high-quality" programmes that boost and sustain children's achievement outcomes over time. There is also growing interest in the accountability of public funds used for ECEC…
The present study examined the relationships between teacher structure, teacher behaviors, and child carequality. Participants included 72 female teachers from 44 preschool classrooms. Both a global measure of quality and a measure of teacher-child interaction were utilized. Results showed that a co-teacher structure was associated with higher…
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
Gout is a growing health problem, affecting approximately 7% of men and 3% of women over the age of 65 years. Although effective therapies for gout management exist, quality in gout care has been too frequently characterized as being "suboptimal." This review examines issues pertinent to quality of care in gouty arthritis with a focus on initial reports examining suboptimal care, subsequent efforts to develop quality of care indicators for gout management, more recently published evidence-based recommendations for gout diagnosis and treatment, and an ongoing international initiative to develop core outcome measures for acute and chronic gout. "If you can not measure it, you can not improve it" - Lord Kelvin. PMID:18021516
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.
Alabama Child Care Resources provides an early-childhood-educator course. A mentoring component was added to transfer learning from course to practical work situations and to provide professional and personal growth for educators. The Specialized Training Achievement Recognition System (STARS) is used as an organized path for professional…
While hospitals have widely adopted quality improvement (QI) initiatives, primary care practices continue to face unique challenges to QI implementation. The purpose of this article is to outline a strategy for promoting QI in primary care practices by introducing specially trained nurses. Two case examples are described, one with a QI nurse external to the practice and one with a nurse internal to the practice. Lessons learned and barriers and facilitators to QI in primary care are presented. Barriers and facilitators are identified in the following categories: practice infrastructure, practice leadership, and practice organizational culture. Implications for primary care practitioners and avenues for future work are discussed. PMID:24978164
Hudson, Shannon M; Hiott, Deanna B; Cole, Jeff; Davis, Robert; Egan, Brent M; Laken, Marilyn A
Multiple myeloma is the second most common haematological malignancy. Novel therapies have led to improvement in survival. Current myeloma management is matching the progress made in improved survival through disease control while optimising quality of life with effective supportive care. Supportive treatment is an essential part of the therapeutic management of myeloma patients because it is directed towards improving the patient’s quality of life and also can improve survival. The aim of this review is to highlight the relationship among life of quality, supportive care, and improvement in survival. Conflict of interest:None declared.
Background Patients with dementia constitute an increasing proportion of hospice enrollees, yet little is known about the quality of hospice care for this population. Objectives To quantify differences in quality of care measures between hospice patients with and without dementia. Study Design Cross-sectional analysis of data from the 2007 National Home and Hospice Care Survey Participants 4,711 discharges from hospice care Measurements A primary diagnosis of dementia at discharge was defined by ICD-9 codes: 290.0–290.4x, 294.0, 294.1, 294.8, 331.0–331.2, 331.7, and 331.8. Quality of care measures included enrollment into hospice in the last three days of life, receiving tube feeding, depression, receiving antibiotics, lack of advanced directive or do not resuscitate order, ? stage II pressure ulcers, emergent care, lack of continuity of residence and a report of pain at last assessment. Results 450 (9.5%) discharges had a primary diagnosis of dementia. In multivariable analysis, patients with dementia were more likely to receive tube feeding [OR 2.6 (95% CI: 1.4, 4.5)] and to have greater continuity of residence [OR 1.8 (95% CI: 1.1, 3.0)] compared to other hospice patients. They were less likely to have a report of pain at last assessment [OR 0.6 (95% CI: 0.3, 0.9)]. Conclusions The majority of quality of care measures examined in this study did not differ between hospice patients with and without dementia. Use of tube feeding in hospice care and methods of pain assessment and treatment in patients with dementia should be considered as potential quality of care measures.
Albrecht, Jennifer S.; Gruber-Baldini, Ann L.; Fromme, Erik K.; McGregor, Jessina C.; Lee, David S.H.; Furuno, Jon P.
A number of sources publish health carequality reports in the United States, but there is limited information about achievable performance in primary care settings. The objective of this article is to report Achievable Benchmarks of Care (ABCs) for 54 quality indicators. Eighty-seven practices participating in a demonstration project in the Practice Partner Research Network (PPRNet), representing 35 US states and 711 969 patients, were included in the analyses. PPRNet practices use a common electronic medical record (Practice Partner, Seattle, Washington). ABCs ranged from 25% to 99%. High ABCs (> or =90%) were achieved for blood pressure screening, lipid screening, and avoiding antibiotics in upper respiratory infection. Some calculated ABCs may be lower than the actual ABCs due to incomplete data recording or abstracting. Primary care practices can achieve high performance across a number of quality indicators, and PPRNet ABCs can serve as benchmarks for primary care practitioners and payers. PMID:18187589
Wessell, Andrea M; Liszka, Heather A; Nietert, Paul J; Jenkins, Ruth G; Nemeth, Lynne S; Ornstein, Steven
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...
Early Learning Guidelines (ELGs) describe expectations about what children should know (understand) and do (competencies and skills) across different domains of learning.1 In 2002, President Bushs Good Start, Grow Smart early learning initiative asked Sta...
Advances in organization and patient management in the intensive care unit (ICU) have led to reductions in the morbidity and mortality suffered by critically ill patients. Two such advances include multidisciplinary teams (MDTs) and the development of clinical protocols. The use of protocols and MDTs does not necessarily guarantee instant improvement in the quality of care, but it does offer
Observed and birthweight-specific neonatal mortality rates have been used for assessing quality of neonatal care, but these are crude and affected by risk characteristics of the population served. Even when neonatal mortality rate is corrected for four risk factors, race, sex, birthweight, and multiple births, (California Data Research Facility, Santa Barbara, CA) it is possible that the corrected neonatal mortality rate is not comparable among institutions because of population differences not corrected for, eg, prenatal care. To analyze whether our high neonatal mortality rate is primarily dependent on population risk or quality of neonatal care, we used contemporaneous data collection by senior physicians and a microcomputer database system to construct indices of quality of care that are based on diagnoses graded according to disease severity. For the 1987/1988 academic year, we found: neonatal intensive care unit nosocomial infection rate, 20%; severe intraventricular hemorrhage per 100 very low birthweight infants (1500 g), 20%; bronchopulmonary dysplasia per 100 cases of severe respiratory distress syndrome, 27%; necrotizing enterocolitis per 100 neonatal intensive care unit discharges, 5%; air leak per 100 cases of severe respiratory distress syndrome, 21%; and neonatal mortality rate per very low birthweight delivery rate, 0.4. We propose that microcomputer, hospital-based analyses will improve comparisons of neonatal intensive care unit quality of care if appropriate indices can be sufficiently well-defined and shared. PMID:2352285
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
Background In the Netherlands, the first formal haemophilia comprehensive care centre was established in 1964, and Dutch haemophilia doctors have been organised since 1972. Although several steps were taken to centralise haemophilia care and maintain quality of care, treatment was still delivered in many hospitals, and formal criteria for haemophilia treatment centres as well as a national haemophilia registry were lacking. Material and methods In collaboration with patients and other stakeholders, Dutch haemophilia doctors have undertaken a formal process to draft new quality standards for the haemophilia treatment centres. First a project group including doctors, nurses, patients and the institute for harmonisation of quality standards undertook a literature study on quality standards and performed explorative visits to several haemophilia treatment centres in the Netherlands. Afterwards concept standards were defined and validated in two treatment centres. Next, the concept standards were evaluated by haemophilia doctors, patients, health insurance representatives and regulators. Finally, the final version of the standards of care was approved by Central body of Experts on quality standards in clinical care and the Dutch Ministry of Health. Results A team of expert auditors have been trained and, together with an independent auditor, will perform audits in haemophilia centres applying for formal certification. Concomitantly, a national registry for haemophilia and allied disorders is being set up. Discussion It is expected that these processes will lead to further concentration and improved quality of haemophilia care in the Netherlands.
The effects of key factors in the nursing practice environment--management style, group cohesion, job stress, organizational job satisfaction, and professional job satisfaction--on staff nurse retention and process aspects of quality of care were examined. Hinshaw and Atwood's (1985) anticipated turnover model was modified and expanded to include relevant antecedent and outcome variables. The four-stage theoretical model was tested using data from 50 nursing units at four acute care hospitals in the southeast. The model explained 49% of the variance in staff nurse retention and 39% of the variance in process aspects of quality of nursing care. Study findings warrant careful consideration in light of recent practice environment changes: experience on the unit and professional job satisfaction were predictors of staff nurse retention; job stress and clinical service were predictors of quality of care. The variable contributing the most to indirect, and in turn, total model effects, was that of management style. These results substantiate the belief that aspects of the practice environment affect staff nurse retention, and most importantly, the quality of care delivered on hospital nursing units. PMID:8773556
Consumers, payers, and policymakers are demanding to know more about the quality of the services they are purchasing or might purchase. The information provided, however, is often driven by data availability rather than by epidemiologic and clinical considerations. In this article, we present an approach for selecting topics for measuring technical quality of care, based on the expected impact on health of improved quality. This approach employs data or estimates on disease burden, efficacy of available treatments, and the current quality of care being provided. We use this model to select measures that could be used to measure the quality of care in health plans, but the proposed framework could also be used to select quality of care measures for other purposes or in other contexts (for example, to select measures for hospitals). Given the limited resources available for quality assessment and the policy consequences of better information on provider quality, priorities for assessment efforts should focus on those areas where better quality translates into improved health.
Siu, A L; McGlynn, E A; Morgenstern, H; Beers, M H; Carlisle, D M; Keeler, E B; Beloff, J; Curtin, K; Leaning, J; Perry, B C
This paper presents a profile of Missouri'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) Indicators for…
This paper presents a profile of Indiana's Paths to Quality 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) Indicators for…
This paper presents a profile of Miami-Dade's Quality Counts 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) Indicators for…
This paper presents a profile of Ohio's Step Up to Quality 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) Indicators for Family…
This paper presents a profile of Illinois' Quality Counts 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) Indicators for Family…
This paper presents a profile of Virginia's Star Quality Initiative 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) Indicators…
This paper presents a profile of Maine's Quality for ME 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) Indicators for Family…
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 paper presents a profile of Palm Beach's Quality Counts 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) Indicators for…
This paper presents a profile of Mississippi's Quality Step 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) Application…
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…
The aim of all diabetes treatment in childhood and adolescence is to counteract the development of complications (acute as well as late), to achieve normal growth and development, and to provide the patients with as good as possible a quality of life. Many studies have confirmed the benefits of intensified medical management regarding the prevalence and\\/or the progression of diabetic
M. H. Borkenstein; Catarina Limbert; Elke Reiterer; Christina Stalzer; E. Zinggl
"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…
Interventions are needed to improve the quality of care for schizophrenia. However, in designing these interventions it would be helpful to understand better which patients are at highest risk for poor-qualitycare and why care for this disorder is often of poor quality. We study the extent to which patient and treatment factors are associated with poor-qualitycare in 224
Objectives. Little is known about the quality of primary care in Saudi Arabia, despite the central role of primary care centers in Saudi health strategy. This study presents an overview of quality of primary care in Saudi Arabia, and identifies factors impeding the achievement of quality, with the aim of determining how the quality of Saudi primary care could be
Background Utilization indices exist to measure quantity of prenatal care, but currently there is no published instrument to assess quality of prenatal care. The purpose of this study was to develop and test a new instrument, the Quality of Prenatal Care Questionnaire (QPCQ). Methods Data for this instrument development study were collected in five Canadian cities. Items for the QPCQ were generated through interviews with 40 pregnant women and 40 health care providers and a review of prenatal care guidelines, followed by assessment of content validity and rating of importance of items. The preliminary 100-item QPCQ was administered to 422 postpartum women to conduct item reduction using exploratory factor analysis. The final 46-item version of the QPCQ was then administered to another 422 postpartum women to establish its construct validity, and internal consistency and test-retest reliability. Results Exploratory factor analysis reduced the QPCQ to 46 items, factored into 6 subscales, which subsequently were validated by confirmatory factor analysis. Construct validity was also demonstrated using a hypothesis testing approach; there was a significant positive association between women’s ratings of the quality of prenatal care and their satisfaction with care (r?=?0.81). Convergent validity was demonstrated by a significant positive correlation (r?=?0.63) between the “Support and Respect” subscale of the QPCQ and the “Respectfulness/Emotional Support” subscale of the Prenatal Interpersonal Processes of Care instrument. The overall QPCQ had acceptable internal consistency reliability (Cronbach’s alpha?=?0.96), as did each of the subscales. The test-retest reliability result (Intra-class correlation coefficient?=?0.88) indicated stability of the instrument on repeat administration approximately one week later. Temporal stability testing confirmed that women’s ratings of their quality of prenatal care did not change as a result of giving birth or between the early postpartum period and 4 to 6 weeks postpartum. Conclusion The QPCQ is a valid and reliable instrument that will be useful in future research as an outcome measure to compare quality of care across geographic regions, populations, and service delivery models, and to assess the relationship between quality of care and maternal and infant health outcomes.
BACKGROUND: In this study, maternal sociodemographic factors are examined in relationship to the quality of prenatal health services US women receive. METHODS: Data from the 1980 National Natality Survey and 1980 Fetal Mortality Survey were used for the analysis. Indicator variables for prenatal carequality are the percentages of prenatal visits at which blood pressure and urine were tested, the performance of hemoglobin or hematocrit tests, and the presence or absence of advice regarding salt restriction and diuretics usage during pregnancy. RESULTS: Distribution of the basic examinations in prenatal care vary according to marital status, parity, education, and residence in a metropolitan or nonmetropolitan county. The advice received concerning salt and diuretics usage was also influenced by sociodemographic variables. CONCLUSIONS: The analyses reveal that prenatal care is not of even minimally acceptable quality for many women.
Postoperative morbidity and mortality is low following radical prostatectomy (RP), though not inconsequential. Due to the natural history of the disease process, the implications of treatment on long-term oncologic control and functional outcomes are of increased significance. Structures, processes and outcomes are the three main determinants of quality of RP care and provide the framework for this review. Structures affecting quality of care include hospital and surgeon volume, hospital teaching status and patient insurance type. Process determinants of RP care have been poorly studied, by and large, but there is a developing trend toward the performance of randomized trials to assess the merits of evolving RP techniques. Finally, the direct study of RP outcomes has been particularly controversial and includes the development of quality of life measurement tools, combined outcomes measures, and the use of utilities to measure operative success based on individual patient priority.
Quality cancer treatment depends upon careful coordination between multiple treatments and treatment providers, the exchange of technical information, and regular communication between all providers and physician disciplines involved in treatment. This article will examine a particular type of organizational structure purported to regularize and streamline the communication between multiple specialists and support services involved in cancer treatment: the multidisciplinary treatment care (MDC) team. We present a targeted review of what is known about various types of MDC team structures and their impact on the quality of treatment care, and we outline a conceptual model of the connections between team context, structure, process, and performance and their subsequent effects on cancer treatment care processes and patient outcomes. Finally, we will discuss future research directions to understand how MDC teams improve patient outcomes and how characteristics of team structure, culture, leadership, and context (organizational setting and local environment) contribute to optimal multidisciplinary cancer care.
Prabhu Das, Irene; Clauser, Steven; Petrelli, Nicholas; Salner, Andrew
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
Background The quality of nursing home care for residents with advanced dementia has been described as suboptimal. One relatively understudied factor is the impact of special care units (SCUs) for dementia for residents at the end-stage of this disease. Objective To examine the association between residence in an SCU and the quality of end-of-life care for nursing home residents with advanced dementia. Research Design This study employed longitudinal data on 323 nursing home residents with advanced dementia living in 22 Boston-area facilities. Using multivariate methods, we analyzed the association between residence in an SCU and measures of quality of end-of-life care including: treatment of pain and dyspnea, prevalence of pressure ulcers, hospitalization, tube feeding, antipsychotic drug use, advance care planning, and health care proxy (HCP) satisfaction with care. Results A total of 43.7% residents were cared for in an SCU. After multivariate adjustment, residents in SCUs were more likely to receive treatment for dyspnea, had fewer hospitalizations, were less likely to be tube fed, and more likely to have a do-not-hospitalize order, compared to non-SCU residents. However, non-SCU residents were more likely to be treated for pain, had fewer pressure ulcers, and less frequent use of antipsychotic drugs than SCU residents. HCPs of SCU residents reported greater satisfaction with care than HCPs of non-SCU residents. Conclusions Residence in an SCU is associated with some, but not all, markers of better quality end-of-life care among nursing home residents with advanced dementia.
Cadigan, Rebecca Orfaly; Grabowski, David C.; Givens, Jane L.; Mitchell, Susan L.
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.
Taplin, Stephen H.; Ganz, Patricia; Grunfeld, Eva; Sterba, Katherine
Background Structured quality management is an important aspect for improving patient dental care outcomes, but reliable evidence to validate effects is lacking. We aimed to examine the effectiveness of a quality management program in primary dental care settings in Germany. Methods This was an exploratory study with a before-after-design. 45 dental care practices that had completed the European Practice Assessment (EPA) accreditation scheme twice (intervention group) were selected for the study. The mean interval between the before and after assessment was 36 months. The comparison group comprised of 56 dental practices that had undergone their first assessment simultaneously with follow-up assessment in the intervention group. Aggregated scores for five EPA domains: ‘infrastructure’, ‘information’, ‘finance’, ‘quality and safety’ and ‘people’ were calculated. Results In the intervention group, small non-significant improvements were found in the EPA domains. At follow-up, the intervention group had higher scores on EPA domains as compared with the comparison group (range of differences was 4.2 to 10.8 across domains). These differences were all significant in regression analyses, which controlled for relevant dental practice characteristics. Conclusions Dental care practices that implemented a quality management program had better organizational quality in contrast to a comparison group. This may reflect both improvements in the intervention group and a selection effect of dental practices volunteering for the first round of EPA practice assessment.
Abstract Perinatal morbidity and mortality are key indicators of a nation's health status. These measures of our nation's health are influenced by decisions made in health care facilities and by health care providers. As our health systems and health care for women and infants can be improved, there is an expectation that these measures of health will also improve. State-based perinatal quality collaboratives (PQCs) are networks of perinatal care providers including hospitals, clinicians, and public health professionals working to improve pregnancy outcomes for women and newborns through continuous quality improvement. Members of the collaborative are healthcare facilities, primarily hospitals, which identify processes of care that require improvement and then use the best available methods to effect change and improve outcomes as quickly as possible. The Division of Reproductive Health at the Centers for Disease Control and Prevention is collaborating with state-based PQCs to enhance their ability to improve perinatal care by expanding the range of neonatal and maternal health issues addressed and including higher proportions of participating hospitals in their state PQC. The work of PQCs is cross-cutting and demonstrates how partnerships can act to translate evidence-based science to clinical care. PMID:24655150
Henderson, Zsakeba T; Suchdev, Danielle B; Abe, Karon; Johnston, Emily Osteen; Callaghan, William M
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
The main objective of a hospital-acquired infections control program is to decrease the risk of acquisition and the morbidity and costs associated. The organization of a team with technical and humanistic leadership is essential. Every infection control program must also develop strategies that allow: a) identification of the problems, b) to establish the importance of each one, c) to determine their causes, d) to develop solutions and e) the evaluation of the recommended solutions. The development of technical and humanistic abilities by the leader and the members of the team, and the use of the tools mentioned above have produced the only validate and highly effective program of quality improvement in the hospital. PMID:10608180
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/
Background Improving end-of-life care in the hospital is a national priority. Purpose To explore the prevalence and reasons for implementation of hospital-wide and ICU practices relevant to qualitycare in key end-of-life care domains,and to discern major structural determinants of practice implementation. Design Cross-sectional mixed-mode survey of Chief Nursing Officers of Pennsylvania structural determinants of practice implementation. Results The response rate was 74% (129 of 174). The prevalence of hospital and ICU practices ranged from 95% for a hospital-wide formal code policy to 6% for regularly scheduled family meetings with an attending physician in the ICU. Most practices had less than 50% implementation; most were implemented primarily for quality improvement or to keep up with the standard of care. In a multivariable model including hospital structural characteristics, only hospital size independently predicted the presence of one or more hospital initiatives (ethics consult service, OR 6.13, adjusted p=0.02; private conference room in the ICU for family meetings, OR 4.54, adjusted p<0.001). Conclusions There is low penetration of hospital practices relevant to quality end-of-life care in Pennsylvania acute care hospitals. Our results may serve to inform the development of future benchmark goals. It is critical establish a strong evidence base for the practices most associated with improved end-of-life care outcomes and to develop quality measures for end-of-life care to complement existing hospital quality measures that primarily focus on life extension.
Objective To determine the prevalence of physician incentives for quality and to test the hypothesis that quality of ambulatory medical care is better by physicians with these incentives. Study Design Cross-sectional study using data from the National Ambulatory Medical Care Survey Method We examined the association between physician compensation based on quality, physician compensation based on satisfaction, and public reporting of practice measures and twelve measures of high quality ambulatory care. Results Overall, 20.8% of visits were to physicians whose compensation was partially based on quality, 17.7% of visits were to physicians whose compensation was partially based on patient satisfaction, and 10.0% of visits were to physicians who publicly reported performance measures. Quality of ambulatory care varied: weight reduction counseling occurred in 12.0% of preventative care visits by obese patients whereas urinalysis was not performed in 93.0% of preventative care visits. In multivariable analyses, there were no statistically significant associations between compensation for quality and delivery of any of the 12 measures, nor between compensation for satisfaction and 11 of the 12 measures; the exception was BMI screening in preventative visits (47.8% vs. 56.2%, adjusted p=0.004). There was also no statistically significant association between public reporting and delivery of 11 of 12 measures; the exception was weight reduction counseling for overweight patients (10.0% vs. 25.5%, adjusted p=0.01). Conclusions We found no consistent association between incentives for quality and 12 measures of high quality ambulatory care.
Bishop, Tara F.; Federman, Alex D.; Ross, Joseph S.
Objectives To examine whether high performance on one measure of quality is associated with high performance on others and to develop a data-driven explanatory model of neonatal intensive care unit (NICU) performance. Design We conducted a cross-sectional data analysis of a statewide perinatal care database. Risk-adjusted NICU ranks were computed for each of 8 measures of quality selected based on expert input. Correlations across measures were tested using the Pearson correlation coefficient. Exploratory factor analysis was used to determine whether underlying factors were driving the correlations. Setting Twenty-two regional NICUs in California. Patients In total, 5445 very low-birth-weight infants cared for between January 1, 2004, and December 31, 2007. Main Outcomes Measures Pneumothorax, growth velocity, health care–associated infection, antenatal corticosteroid use, hypothermia during the first hour of life, chronic lung disease, mortality in the NICU, and discharge on any human breast milk. Results The NICUs varied substantially in their clinical performance across measures of quality. Of 28 unit-level correlations only 6 were significant (P < .05). Correlations between pairs of quality measures were strong (? > .5) for 1 pair, moderate (.3 < |?| < .5) for 8 pairs, weak (.1 < |?| < .3) for 5 pairs and negligible (|?| < .1) for 14 pairs. Exploratory factor analysis revealed 4 underlying factors of quality in this sample. Pneumothorax, mortality in the NICU, and antenatal corticosteroid use loaded on factor 1; growth velocity and health care–associated infection loaded on factor 2; chronic lung disease loaded on factor 3; and discharge on any human breast milk loaded on factor 4. Conclusion In this sample, the ability of individual measures of quality to explain overall quality of neonatal intensive care was modest.
Business Roundtable (BRT) and Corporate Voices for Working Families (CVWF) believe federal and state efforts to develop early care and education systems for children birth through age five must be based on a set of guiding Principles that define the components of a successful system and high-quality programs. These Principles draw on current early…
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
In this article a comparison is made between three independent sources of assessment of medical consultations. A panel of 12 experienced general practitioners rated 103 consultations with hypertensive patients on the quality of psychosocial care. There was a wide consensus between the judges, resulting in a high reliability score. Two contrasting groups were formed: consultations that were rated high and
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
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
Research Findings: This study was designed to assess whether investments in child carequality were maintained 3 years after public funding for these centers was significantly reduced. An earlier evaluation documented significant improvements in classroom environments, teachers' sensitivity, and teachers' child-centered beliefs following a…
Generalisability theory is presented as a research method for assessing the quality of health advice. The theory is applied to make a comprehensive assessment of primary health care advice given by community pharmacists. A random sample of pharmacies from all London postal districts were selected and visited for set periods throughout one year. During these visits all consultations on health
Purpose: The purpose of this study was to (1) conduct a systematic review of the literature to identify interventions that improve patient outcomes in the intensive care unit (ICU); (2) evaluate potential measures of quality based on the impact, feasibility, variability, and the strength of evidence to support each measure and to categorize these measures as outcome, process, access, or
Sean M. Berenholtz; Todd Dorman; Koni Ngo; Peter J. Pronovost
The surgical management of clinically localized bladder cancer is challenging, and the quality of care delivered to patients with bladder cancer is a subject of increasing interest. Multiple large studies have examined the association between surgical volume and outcomes after radical cystectomy. These studies generally find lower mortality and complication rates at high-volume centers, though interpretation of the data must
Matthew R. Cooperberg; Michael P. Porter; Badrinath R. Konety
The results of a 1-year project undertaken to place the outcome method for assessing quality of medical care in perspective and to develop disease-specific short-term outcome measures are summarized. The first volume of the full report summarized herein p...
There is growing interest today in the design and application of tools for measuring quality of life. However, the rating scales applied do not reveal the consequences that Parkinson's disease has for patients' relatives. The need for permanent care and help to be given to the chronically disabled person leads to a decrease in the life quality of caregivers. The contribution describes an inventory for evaluating the quality of life of parkinsonian patients' caregivers and analyses some factors determining their social disadaptation. PMID:9617723
Context Overall quality of care and racial disparities in quality are important and related problems in health care, but their relationship has not been well studied. In the Medicare managed care program, broad improvements in quality have been accompanied by reduced racial gaps in processes of care, but substantial disparities in outcomes have persisted. Objectives To assess variations among Medicare
Amal N. Trivedi; Alan M. Zaslavsky; Eric C. Schneider; John Z. Ayanian
The Scottish Government’s social care regulator, the Care Commission, seeks continual improvement in the quality of social care services. Its approach has been to establish a modern risk-based regulatory regime using separate measures of risk and quality. We evaluate this twin approach, firstly, in relation to the literature on predictors of poor service quality in care delivery; and, secondly, by
Gender inequalities in health are a consequence of the basic inequality between men and women in many societies. Despite the importance of socio-economic factors, women's health is also greatly affected by the extent and quality of health services available to them. Both non-governmental women's organizations and feminist health researchers have in recent years identified major gender inequalities in access to services and in the way men and women are treated by the health care system. Firstly, although women are major health care users as well as providers, they are under-represented in decision-making in health care. Secondly, no justice is done in general to existing differences in position and needs of women and men in defining quality of health care, i.e. gender aspects. Among women's organizations, there is general agreement that "gender sensitive health care should be available, accessible, affordable, appropriate and acceptable". In addition, health care for women should be adequate and not depart from a male model of health and illness. In this paper, we pay attention to inappropriate health care for women on the one hand, as illustrated by the increasing medicalization of women's reproductive life [menstruation, menopause, pregnancy and childbirth and (in)fertility]. On the other hand, we discuss gender bias in the management of serious, life-threatening diseases such as cardiovascular disease, lung cancer, and kidney failure, as a form of inadequate care. These examples are followed by a global vision on quality of care from a gender perspective, as formulated by the women's health care movement in the Netherlands and at the Fourth International Conference on Women in Beijing. If anything, the recommendations agreed upon in Beijing will have to ensure the consolidation and enhancement of good quality health care for women around the world. The final discussion, attempts to give some general recommendations for achieving more adequate (gender sensitive) and appropriate (non-medicalizing) health care for women. These recommendations pertain to health and health care research, policy, education, and organization from a women's perspective. PMID:8870135
The delivery of safe high quality patient care is a major issue in clinical settings. However, the implementation of evidence-based practice and educational interventions are not always effective at improving performance. A staff-led behavioral management process was implemented in a large single-site acute (secondary and tertiary) hospital in the North of England for 26 weeks. A quasi-experimental, repeated-measures, within-groups design was used. Measurement focused on qualitycare behaviors (ie, documentation, charting, hand washing). The results demonstrate the efficacy of a staff-led behavioral management approach for improving quality-care practices. Significant behavioral change (F [6, 19] = 5.37, p < 0.01) was observed. Correspondingly, statistically significant (t-test [t] = 3.49, df = 25, p < 0.01) reductions in methicillin-resistant Staphylococcus aureus (MRSA) were obtained. Discussion focuses on implementation issues.
This study examines rural differences in one important indicator of quality for licensed child care settings--the number of children per adult. It also investigates the relationships between cost of child care, child care subsidy receipt, and child carequality for both rural and non-rural areas. We used representative child care survey data…
Many studies have demonstrated gaps in healthcare quality for all medical and surgical specialties including breast surgical care. How to optimally measure and improve quality has generated debate at the local, state, and national level. Attempts to judge medical performance by private companies using non-risk-adjusted administrative databases may not be accurate and may unfairly penalize surgical care. An overview of concepts to measure and improve quality of breast cancer care is presented with specific examples relevant to breast surgeons. Breast surgeons and their professional organizations need to take ownership of quality measure programs because others will surely do so if we do not. Participation in one or more of these programs is beneficial because peer performance comparison allows identification of potential areas for individual or institutional improvement and demonstrates the commitment of breast surgeons to quality improvement. This commitment may gain even greater importance if trends continue toward performance-based physician payment, patient steerage, licensure, and board certification. PMID:21863365
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.
Objective To examine whether low-income parents of children enrolled in the New York State Children's Health Insurance Program (SCHIP) choose managed care plans with better quality of care. Data Sources 2001 New York SCHIP evaluation data; 2001 New York State Managed Care Plan Performance Report; 2000 New York State Managed Care Enrollment Report. Study Design Each market was defined as a county. A final sample of 2,325 new enrollees was analyzed after excluding those in markets with only one SCHIP plan. Plan quality was measured using seven Consumer Assessment of Health Plans Survey (CAHPS) and three Health Plan Employer Data and Information Set (HEDIS) scores. A conditional logit model was applied with plan and individual/family characteristics as covariates. Principle Findings There were 30 plans in the 45 defined markets. The choice probability increased 2.5 percentage points for each unit increase in the average CAHPS score, and the association was significantly larger in children with special health care needs. However, HEDIS did not show any statistically significant association with plan choice. Conclusions Low-income parents do choose managed care plans with higher CAHPS scores for their newly enrolled children, suggesting that overall quality could improve over time because of the dynamics of enrollment.
Liu, Hangsheng; Phelps, Charles E; Veazie, Peter J; Dick, Andrew W; Klein, Jonathan D; Shone, Laura P; Noyes, Katia; Szilagyi, Peter G
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
Objective To examine the reliability of the SF-36 general health questionnaire when used to evaluate the health status of critically ill patients before admission to intensive care and to measure their health-related quality of life prior to admission and its relation to severity of illness and length of stay in the intensive care unit. Methods Prospective cohort study conducted in the intensive care unit of a public teaching hospital. Over three months, communicative and oriented patients were interviewed within the first 72 hours of intensive care unit admission; 91 individuals participated. The APACHE II score was used to assess severity of illness, and the SF-36 questionnaire was used to measure health-related quality of life. Results The reliability of SF-36 was verified in all dimensions using Cronbach's alpha coefficient. In six dimensions of eight domains the value exceeded 0.70. The average SF-36 scores of the health-related quality of life dimensions for the patients before admission to intensive care unit were 57.8 for physical functioning, 32.4 for role-physical, 53.0 for bodily pain, 63.2 for general health, 50.6 for vitality, 56.2 for social functioning, 54.6 for role-emotional and 60.3 for mental health. The correlations between severity of illness and length of stay and the health-related quality of life scores were very low, ranging from -0.152 to 0.175 and -0.158 to 0.152, respectively, which were not statistically significant. Conclusion In the sample studied, the SF-36 demonstrated good reliability when used to measure health-related quality of life in critically ill patients before admission to the intensive care unit. The worst score was role-physical and the best was general health. Health-related quality of life of patients before admission was not correlated with severity of illness or length of stay in the intensive care unit.
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
Abstract Low back pain (LBP) has received considerable attention from researchers and health care systems because of its substantial personal, social, work-related, and economic consequences. A narrative review was conducted summarizing data about the epidemiology, care seeking, and utilization patterns for LBP in the adult US population. Recommendations from a consensus of clinical practice guidelines were compared to findings about the current state of clinical practice for LBP. The impact of the first provider consulted on the quality and value of care was analyzed longitudinally across the continuum of episodes of care. The review concludes with a description of recently published evidence that has demonstrated that favorable health and economic outcomes can be achieved by incorporating evidence-informed decision criteria and guidance about entry into conservative low back care pathways. (Population Health Management 2013;16:390–396)
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…
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…
Diabetes mellitus is a chronic disease with an increasing prevalence. Appropriate treatment of the disease and prevention of chronic complications reduce morbidity and mortality in a cost-effective manner. These actions should be measured through the use of validated indicators for quality of care. The goal of this study was to assess the quality of care in diabetic patients under pharmacologic treatment in a private university hospital. A retrospective study was conducted in adult patients who bought insulin or oral hypoglycemic agents during a 3 month period; demographic and clinical data were obtained for 12 consecutive months following the buying period. The study included 305 adult patients; most were males (60%), with type 2 diabetes (95%), and using oral hipoglycemic agents (86%). Control of blood pressure was registered in 80%, foot exam in 5%, eye exam in 27%, HbA1C blood level in 85%, complete lipid profile in 82%, microalbuminuria in 27% and creatinine clearance in 22% of patients, respectively. Mean values were HbA1C 7.1(+/- 1.6)%, and < or = 7% in 66%, LDL 113 (+/- 33.6) mg/dl and <100 mg/dl in 30%, BP 136-79 mm Hg and < 130-80 mm Hg in 46% of patients, respectively. This study emphasizes the need for quality of care assessment through validated indicators and points out the aspects that should be improved within a health care system. PMID:18051222
Lombraña, María A; Capetta, María E; Ugarte, Alejandro; Correa, Viviana; Giganti, Jorge; Saubidet, Cristian Lopez; Stryjewski, Martin E
Based on experiences gained at the Palo Alto Infant-Toddler Center and the view that quality child care for infants and toddlers depends upon nurturing, long-term connections with their caregivers, other children, and their families, this book presents strategies for interacting with young children that support the developing child as well as the…
There is considerable policy interest in understanding the role of child care in children's development. Yet little research has examined whether individual children experience changes in child carequality across their early years, and less has included children's varying levels of exposure to care in analyses of child care trajectories. Using…
This study evaluated the quality of the maternal and child health care in two different models of Primary Health Care. Interviews were carried out by trained personnel with 1200 families randomly selected. Processes of assistance for maternal and child health care were evaluated by Family Health Strategy Teams and traditional health centers. In the evaluation of child health care, the precocity of the first consultation, the regular assessment of growth and development, the recommendations for accident prevention and prophylactic use of iron supplementation and vitamin A had been statistically associated with the model of the health care. Regarding prenatal health care the results showed statistically significant differences between the two models for breastfeeding counseling, nutritional recommendations and cervical preventive screening using Papanicolaou smear. For women health care out of pregnancy period, the results revealed that counseling for breasts auto-examination, preventive screening using Papanicolaou smear in last year and participation in family planning programs were associated with health Primary Health Care model. All the pointed differences had shown better performance of the Family Health Strategy Teams. PMID:21049154
Caldeira, Antônio Prates; Oliveira, Rafael Morroni de; Rodrigues, Oreston Alves
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
Quality improvement can not focus exclusively on peer review and the scientific evaluation of medical care processes. These essential elements have to be complemented with a focus on individual patient needs and preferences. Only then will hospitals create the competitive advantage needed to survive in an increasingly market-driven hospital industry. Hospital managers can identify these patients' needs by 'living the patient experience' and should then set the hospital's quality objectives according to its target patients and their needs. Excellent quality program design, however, is not sufficient. Successful implementation of a quality improvement program further requires fundamental changes in pivotal jobholders' behavior and mindset and in the supporting organizational design elements. PMID:10114504
The scarcity of rural physicians in India has resulted in non-physician clinicians (NPC) serving at primary health centers (PHC). This study examines the clinical competence of NPCs and physicians serving at PHCs to treat a range of medical conditions. The study is set in Chhattisgarh state, where physicians (medical officers) and NPCs: Rural Medical Assistants (RMA), and Indian system of medicine physicians (AYUSH Medical Officers) serve at PHCs. Where no clinician is available, Paramedics (pharmacists and nurses) usually provide care. In 2009, PHCs in Chhattisgarh were stratified by type of clinical care provider present. From each stratum a representative sample of PHCs was randomly selected. Clinical vignettes were used to measure provider competency in managing diarrhea, pneumonia, malaria, TB, preeclampsia and diabetes. Prescriptions were analyzed. Overall, the quality of medical care was low. Medical Officers and RMAs had similar average competence scores. AYUSH Medical Officers and Paramedicals had significantly lower average scores compared to Medical Officers. Paramedicals had the lowest competence scores. While 61% of Medical Officer and RMA prescriptions were appropriate for treating the health condition, only 51% of the AYUSH Medical Officer and 33% of the prescriptions met this standard. RMAs are as competent as physicians in primary care settings. This supports the use of RMA-type clinicians for primary care in areas where posting Medical Officers is difficult. AYUSH Medical Officers are less competent and need further clinical training. Overall, the quality of medical care at PHCs needs improvement. PMID:23517701
This manual contains guidelines to aid in assessing the quality of care provided to residents in intermediate care facilities for the mentally retarded. Considerations involved in performing independent professional reviews (IPR's) are examined in light o...
Total Quality Management (TQM) is the new management philosophy of the Army health care system. TQM consists of principles and tools which can be applied in this health care setting. TQM represents a tremendous departure from the previous traditional mana...
It is thought that new technologies like computers at the patient's bedside, or point of care technology (PCT) improve nursing productivity, documentation, patient satisfaction and decrease costs. Using the Health Care Technology Assessment (HCTA) framework, (safety, cost, effectiveness, social impact), a descriptive and quasi-experimental study was performed to test the effectiveness and explain the social impact of PCT. A sample of 90 patients from five nursing units in three hospitals were obtained for the study. Half of the patients had computers at their bedside. Data were collected on a hospital pretest/posttest unit and two comparison and experimental units. The main null hypothesis was: There is no difference in the quality of patient care on nursing units with and without PCT. Quality of patient care was measured by patient satisfaction and a nursing care documentation instruments. This hypothesis was rejected. While patients were generally very satisfied with their nursing care on all units, when controlling for time and the presence of the computer, patients who did not have PCT were more satisfied than patients in rooms with PCT. Furthermore, the charts of patients with PCT were less compliant to documentation standards. Conversely, a sub sample of these same patients expressed positive responses to the bedside computer and technologies in their room and this concurred with the current literature. The benefits of the technology were found to outweigh the costs of PCT from the literature review. There was not enough in the literature to draw conclusions about the safety of PCT. In summary, the quality of patient care did not improve with the implementation of PCT in this study.(ABSTRACT TRUNCATED AT 250 WORDS)
Purpose In 1999, the National Cancer Policy Board called attention to the quality of cancer care in the United States and recommended establishing a quality monitoring system with the capability of regularly reporting on the quality of care for patients with cancer. Methods Using data from a patient survey 4 years after diagnosis and review of medical records, we determined
Jennifer L. Malin; Eric C. Schneider; Arnold M. Epstein; John Adams; Ezekiel J. Emanuel; Katherine L. Kahn
The present study examines educational policy documents and programs on early childhood development and education in Peru. The author provides an evaluation of early childhood learning programs and their outcomes in different education centers in Peru. Health, nutrition, development, and participation are identified as key areas of concern. The study concludes with a reference to the importance of monitoring quality and equity in early childhood care.
Objective In myocardial infarction (MI), we studied whether documentation of ischemic symptoms is associated with quality of care and outcomes, and compared patient reports of ischaemic symptoms during interviews with chart documentation Design Observational acute myocardial infarction study from 2003–2004 (Prospective Registry Evaluating Myocardial Infarction: Event and Recovery) Setting 19 diverse US hospitals Patients 2,094 consecutive MI patients (10,911 patients screened; 3,953 patients were eligible and enrolled) with both positive cardiac enzymes and other evidence of infarction (e.g., symptoms, electrocardiographic changes). Transferred patients and those with confounding noncardiac comorbidity were not included (n=1859). Main outcome measures Quality of care indicators and adjusted in-hospital survival Results The records of 10% of all MI patients (217/2094) contained no documented ischaemic symptoms at presentation. Patients without documented symptoms were less likely (p<0.05) to: receive aspirin (89% vs. 96%) or beta-blockers (77% vs. 90%) within 24hr, reperfusion therapy for STEMI (7% vs. 58%) or to survive their hospitalization (adjusted OR=3.2, 95% CI 1.8–5.8). Survivors without documented symptoms were also less likely (p<0.05) to be discharged with aspirin (87% vs. 93%), beta-blockers (81% vs. 91%), ACE/ARB (67% vs. 80%), or smoking cessation counseling (46% vs. 66%). In the subset of 1,356 (65%) interviewed patients, most of those without documented ischaemic symptoms (75%) reported presenting symptoms consistent with ischaemia. Conclusions Failure to document patients’ presenting MI symptoms is associated with poorer quality of care from admission to discharge, and higher in-hospital mortality. Symptom recognition may represent an important opportunity to improve the quality of MI care.
Schelbert, Erik B.; Rumsfeld, John S.; Krumholz, Harlan M.; Canto, John G.; Magid, David J.; Masoudi, Frederick A.; Reid, Kimberly J.; Spertus, John A.
Introduction Health care reimbursement is increasingly based on quality. Little is known about how clinic-level patient characteristics affect quality performance, particularly in community health centers (CHCs). Methods Using electronic health record data for 4,019 diabetic patients from 23 CHC primary care clinics in the OCHIN practice-based research network, we calculated correlations between a clinic’s patient panel characteristics and delivery rates of diabetes preventive services in 2007. Using regression models, we estimated the proportion of clinic variability in clinics’ preventive services rates associated with the variability in the clinics’ patient panel characteristics. We also explored whether clinics’ performance rates were affected by how patient panel denominators were defined. Results Clinic rates of glycosylated hemoglobin testing, influenza immunizations, and lipid screening were positively associated with the percentage of patients with continuous health insurance coverage, and negatively associated with the percentage uninsured. Microalbumin screening rates were positively associated with the percentage of racial minorities in a clinic’s panel. Associations remained consistent with different panel denominators. Conclusions Clinic variability in delivery rates of preventive services correlates with differences in clinics’ patient panel characteristics, particularly the percentage of patients with continuous insurance coverage. Quality scores that do not account for these differences could create disincentives to diabetes care for vulnerable patients.
Bailey, Steffani; O'Malley, Jean P.; Gold, Rachel; Heintzman, John; Likumahuwa, Sonja; DeVoe, Jennifer E.
Introduction A paucity of data exists addressing the quality of care provided to women with pelvic organ prolapse (POP). We sought to develop a means to measure this quality through the development of quality-of-care indicators (QIs). Methods QIs were modeled after those previously described in the Assessing the Care of Vulnerable Elders (ACOVE) project. The indicators were then presented to a panel of nine experts. Using the RAND Appropriateness Method, we analyzed each indicator’s preliminary rankings. A forum was then held in which each indicator was thoroughly discussed by the panelists as a group, after which panelists individually re-rated the indicators. QIs with median scores of at least seven were considered valid. Results QIs were developed that addressed screening, diagnosis, work-up, and both nonsurgical and surgical management. Areas of controversy included whether screening should be performed to identify prolapse, whether pessary users should undergo a vaginal exam by a health professional every six months versus annually, and whether a colpocleisis should be offered to older women planning to undergo surgery for POP. Fourteen of 21 potential indicators were rated as valid for pelvic organ prolapse (median score ? 7). Conclusion We developed and rated fourteen potential quality indicators for the care of women with POP. Once these QIs are tested for feasibility they can be used on a larger scale to measure and compare the care provided to women with prolapse in different clinical settings.
Anger, Jennifer T.; Scott, Victoria C.S.; Kiyosaki, Krista; Khan, Aqsa A.; Sevilla, Claudia; Connor, Sarah E.; Roth, Carol P.; Litwin, Mark S.; Wenger, Neil S.; Shekelle, Paul G.
Background Asthma quality of life questionnaires are not readily incorporated into clinical care. We therefore computerised the Paediatric Asthma Quality of Life Questionnaire (standardised) (PAQLQ(S)) and the Paediatric Asthma Caregivers Quality of Life Questionnaire (PACQLQ), with a colour?coded printed graphical report. Objectives To (a) assess the feasibility of the electronic questionnaires in clinical care and (b) compare the child's PAQLQ scores with the parent's score, physician's clinical score and spirometry. Methods Children with asthma were given a clinical severity score of 1–4 (increasing severity) and then completed the PAQLQ(S) electronically (scores 1–7 for increasing quality of life in emotional, symptoms and activity limitation domains) followed by spirometry and physician review. Parents completed the PACQLQ. Inclusion criteria required fluent Hebrew and reliable performance of spirometry. Children with additional chronic diseases were excluded. Results 147 children with asthma aged 7–17?years completed PAQLQs and 115 accompanying parents completed PACQLQs, taking 8.3 (4.3–15) and 4.4 (1.5–12.7) min, respectively (mean (range)). Graphical reports enabled physicians to address quality of life during even brief visits. Children's (PAQLQ) and parents' (PACQLQ) total scores correlated (r?=?0.61, p<0.001), although the children's median emotional score of 6.3 was higher than their parents' 5.7 (p<0.001), whereas median activity limitation score was lower than their parents': 5.0 and 6.8, respectively (p<0.001). No correlation was found with physician's clinical score or spirometry. Conclusions Electronic PAQLQs are easy to use, providing additional insight to spirometry and physician's assessment, in routine asthma care. Future studies must assess impact on asthma management.
Mussaffi*, H; Omer*, R; Prais, D; Mei-Zahav, M; Weiss-Kasirer, T; Botzer, Z; Blau, H
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.
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.
Background The Department of Veterans Affairs (VA) has led the industry in measuring facility performance as a critical element in improving quality of care, investing substantial resources to develop and maintain valid and cost-effective measures. The External Peer Review Program (EPRP) of the VA is the official data source for monitoring facility performance, used to prioritize the quality areas needing most attention. Facility performance measurement has significantly improved preventive and chronic care, as well as overall quality; however, much variability still exists in levels of performance across measures and facilities. Audit and feedback (A&F), an important component of effective performance measurement, can help reduce this variability and improve overall performance. Previous research suggests that VA Medical Centers (VAMCs) with high EPRP performance scores tend to use EPRP data as a feedback source. However, the manner in which EPRP data are used as a feedback source by individual providers as well as service line, facility, and network leadership is not well understood. An in-depth understanding of mental models, strategies, and specific feedback process characteristics adopted by high-performing facilities is thus urgently needed. This research compares how leaders of high, low, and moderately performing VAMCs use clinical performance data from the EPRP as a feedback tool to maintain and improve quality of care. Methods We will conduct a qualitative, grounded theory analysis of up to 64 interviews using a novel method of sampling primary care, facility, and Veterans Integrated Service Network (VISN) leadership at high-, moderate-, and low-performing facilities. We will analyze interviews for evidence of cross-facility differences in perceptions of performance data usefulness and strategies for disseminating performance data evaluating performance, with particular attention to timeliness, individualization, and punitiveness of feedback delivery. Discussion Most research examining feedback to improve provider and facility performance lacks a detailed understanding of the elements of effective feedback. This research will highlight the elements most commonly used at high-performing facilities and identify additional features of their successful feedback strategies not previously identified. Armed with this information, practices can implement more effective A&F interventions to improve quality of care.
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
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
The quality of nursing care as perceived by hospitalized patients with advanced illness has not been examined. A concept of quality nursing care for this population was developed by integrating the literature on constructs defining quality nursing care with empirical findings from interviews of 16 patients with advanced illness. Quality nursing care was characterized as competence and personal caring supported by professionalism and delivered with an appropriate demeanor. Although the attributes of competence, caring, professionalism, and demeanor were identified as common components of qualitycare across various patient populations, the caring domain increased in importance when patients with advanced illness perceived themselves as vulnerable. Assessment of quality nursing care for patients with advanced illness needs to include measures of patient perceptions of vulnerability.
Izumi, Shigeko; Baggs, Judith G.; Knafl, Kathleen A.
Background Lateral epicondylalgia (LE) defines a condition of varying degrees of pain near the lateral epicondyle. Studies on the management of LE indicated unexplained variations in the use of pharmacologic, non-pharmacological and surgical treatments. The main aim of this paper was to develop and evaluate clinical quality measures (QMs) or quality indicators, which may be used to assess the quality of the processes of examination, education and treatment of patients with LE. Methods Different QMs were developed by a multidisciplinary group of experts in Quality Management of Health Services during a period of one year. The process was based following a 3-step model: i) review and proportion of existing evidence-based recommendations; ii) review and development of quality measures; iii) pilot testing of feasibility and reliability of the indicators leading to a final consensus by the whole panel. Results Overall, a set of 12 potential indicators related to medical and physical therapy assessment and treatment were developed to measure the performance of LE care. Different systematic reviews and randomized control trials supported each of the indicators judged to be valid during the expert panel process. Application of the new indicator set was found to be feasible; only the measurement of two quality measures had light barriers. Reliability was mostly excellent (Kappa?>?0.8). Conclusions A set of good practice indicators has been built and pilot tested as feasible and reliable. The chosen 3-step standardized evidence-based process ensures maximum clarity, acceptance and sustainability of the developed indicators.
This study examines perspectives of a broad group of nursing home employees, regulators, advocates, and professional associations to describe progress made since the 1990 implementation of the Nursing Home Reform legislation (OBRA '87) and to determine whether the legislation is perceived as affecting positive change for nursing home residents. Interviews were conducted with 59 residents and 132 professional and non-professional staff in six states. Important quality of care issues of resident rights, resident dignity, restraint use, resident assessment, as well as perspectives of residents themselves are explored. In general, OBRA '87 is viewed as positive, with all groups of respondents indicating that residents have benefited from it. They identify the focus on resident rights as the most important accomplishment. Empowerment of residents through involvement in care decisions is noted by many as an important achievement. Many conclude that quality of care has improved and restraint use has decreased. The MDS is a useful tool from the standpoint of nursing home staff and regulators. This appraisal sharply contrasts their opinions about the Preadmission Screening and Resident Review (PASARR) screening tool. We believe that PASARR should be reexamined and that changes should be made in the process and/or implementation of the tool. PMID:8954382
BACKGROUND: Structured care is proposed as a lever for improving care for patients with chronic conditions. The purpose of this study was to explore the associations of structured care characteristics, derived from the Chronic Care Model, with health-related quality of life (HRQOL) and optimal clinical management in chronic heart failure (CHF) patients in primary care, as well as the association
Marije Bosch; Trudy van der Weijden; Richard Grol; Henk Schers; Reinier Akkermans; Louis Niessen; Michel Wensing
Objective: To examine the prevalence, nature, causes, and consequences of suboptimal care before admission to intensive care units, and to suggest possible solutions. Design: Prospective confidential inquiry on the basis of structured interviews and questionnaires. Setting: A large district general hospital and a teaching hospital. Subjects: A cohort of 100 consecutive adult emergency admissions, 50 in each centre. Main outcome measures: Opinions of two external assessors on quality of care especially recognition, investigation, monitoring, and management of abnormalities of airway, breathing, and circulation, and oxygen therapy and monitoring. Results: Assessors agreed that 20 patients were well managed (group 1) and 54 patients received suboptimal care (group 2). Assessors disagreed on quality of management of 26 patients (group 3). The casemix and severity of illness, defined by the acute physiology and chronic health evaluation (APACHE II) score, were similar between centres and the three groups. In groups 1, 2, and 3 intensive care mortalities were 5 (25%), 26 (48%), and 6 (23%) respectively (P=0.04) (group 1 versus group 2, P=0.07). Hospital mortalities were 7 (35%), 30 (56%), and 8 (31%) (P=0.07) and standardised hospital mortality ratios (95% confidence intervals) were 1.23 (0.49 to 2.54), 1.4 (0.94 to 2.0), and 1.26 (0.54 to 2.48) respectively. Admission to intensive care was considered late in 37 (69%) patients in group 2. Overall, a minimum of 4.5% and a maximum of 41% of admissions were considered potentially avoidable. Suboptimal care contributed to morbidity or mortality in most instances. The main causes of suboptimal care were failure of organisation, lack of knowledge, failure to appreciate clinical urgency, lack of supervision, and failure to seek advice. Conclusions: The management of airway, breathing, and circulation, and oxygen therapy and monitoring in severely ill patients before admission to intensive care units may frequently be suboptimal. Major consequences may include increased morbidity and mortality and requirement for intensive care. Possible solutions include improved teaching, establishment of medical emergency teams, and widespread debate on the structure and process of acute care. Key messages Suboptimal management of oxygen therapy, airway, breathing, circulation, and monitoring before admission to intensive care occurred in over half of a consecutive cohort of acute adult emergency patients. This may be associated with increased morbidity, mortality, and avoidable admissions to intensive care At least 39% of acute adult emergency patients were admitted to intensive care late in the clinical course of the illness Major causes of suboptimal care included failure of organisation, lack of knowledge, failure to appreciate clinical urgency, lack of supervision, and failure to seek advice A medical emergency team may be useful in responding pre-emptively to the clinical signs of life threatening dysfunction of airway, breathing, and circulation, rather than relying on a cardiac arrest team The structure and process of acute care and their importance require major re-evaluation and debate
Objectives To explore views on high quality diabetes care based on an analysis of existing diversity in diabetes care programmes and related quality indicators. Methods A review of systematic reviews was performed. Four databases (MEDLINE database of the National Library of Medicine, COCHRANE database of Systematic Reviews, the Cumulative Index to Nursing and Allied Health Database-CINAHL and Pre-Cinahl) were searched for English review articles published between November 1989 and December 2006. Methodological quality of the articles was assessed. A standardized extraction form was used to assess features of diabetes care programmes and diabetes quality indicators with special reference to those aspects that hinder the conceptualization of high quality diabetes care. Based on these findings the relationship between diversity in diabetes care programmes and the conceptualization of high quality diabetes care was further explored. Results Twenty-one systematic reviews met the inclusion criteria representing a total of 185 diabetes care programmes. Six elements were identified to produce a picture of diversity in diabetes care programmes and hinder their standardization: 1) the variety and relative absence of conceptual backgrounds in diabetes care programmes, 2) confusion over what is considered a constituent of a diabetes care program and components of the implementation strategy, 3) large variety in type of diabetes care programmes, settings and related goals, 4) a large number and variety in interventions and quality indicators used, 5) no conclusive evidence on effectiveness, 6) no systematic results on costs. Conclusions There is large diversity in diabetes care programmes and related quality indicators. From this review and our analysis on the mutual relationship between diversity in diabetes care programmes and the conceptualization of high quality diabetes care, we conclude that no single conceptual framework used to date provides a comprehensive overview of attributes of high quality diabetes care linked to quality indicators at the structure, process and outcome level. There is a need for a concerted action to develop a standardized framework on high quality diabetes care that is complemented by a practical tool to provide guidance to the design, implementation and evaluation of diabetes care programmes.
Borgermans, Liesbeth A.D.; Goderis, Geert; Ouwens, Marielle; Wens, Johan; Heyrman, Jan; Grol, Richard P.T. M.
Interurban road crashes often result in severe Road Traffic Injuries (RTIs). Prehospital emergency care on interurban roads was rarely evaluated in the low- and middle-income countries. The study highlighted the availability and quality of prehospital care facilities on interurban roads in Pakistan, a low-income country. The study setting was a 592-km-long National highway in the province of Sindh, Pakistan. Using the questionnaires adapted from the World Health Organization prehospital care guidelines [Sasser et al., 2005], managers and ambulance staff at the stations along highways were interviewed regarding the process of care, supplies in ambulances, and their experience of trauma care. Ambulance stations were either managed by the police or the Edhi Foundation (EF), a philanthropic organization. All highway stations were managed by the EF; the median distance between highway stations was 38 km (Interquartile Range [IQR]=27-46). We visited 14 stations, ten on the highway section, and four in cities, including two managed by the police. Most highway stations (n=13) received one RTI call per day. Half of stations (n=5) were inside highway towns, usually near primary or secondary-level healthcare facilities. Travel time to the nearest tertiary healthcare facility ranged from 31 to 70 minutes (median=48 minutes; IQR=30-60). Other shortcomings noted for stations were not triaging RTI cases (86%), informing hospitals (64%), or recording response times (57%). All ambulances (n=12) had stretchers, but only 58% had oxygen cylinders. The median schooling of ambulance staff (n=13) was 8 years (IQR=3-10), and the median paramedic training was 3 days (IQR=2-3). Observed shortcomings in prehospital care could be improved by public-private partnerships focusing on paramedic training, making available essential medical supplies, and linking ambulance stations with designated healthcare facilities for appropriate RTI triage. PMID:24406963
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)
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.
To monitor the progress of the improvement of diabetes care several methods are available such as clinical databases, epidemiological studies, and mortality and morbidity statistics. Developments in information technology have made clinical databases such as the DiabCare System a method of high potential because of high generalisability and the potential participation of many clinicians. Epidemiological studies utilize standardized methods to assess disease outcomes and to quantify risk factors. For example, the EURODIAB IDDM Complications Study indicated that life-style factors may have a direct influence on the risk of complications: 21% of 272 patients aged 15-19 years were smokers, rising to above 30% in those aged 20 and above (n = 1,193). This was associated with poor glycemic control in all age groups. Mortality and mortality statistics have the problem of under-ascertainment but they still provide evidence for substantial excess rates in young IDDM subjects with wide regional variations. Thus, for analysing the outcomes of improvements in the quality of care all available information sources have to be utilized, taking care to assess their accuracy and generalisibility. PMID:9677002
The current study sought to define best practice for timeliness for a breast cancer program at each diagnostic step. The study was a retrospective review of patients newly diagnosed with invasive breast cancer who were enrolled in the breast cancer database from 2009-2011. A convenience sampling methodology was used for patient selection, and descriptive statistics for various time intervals were calculated for identified data points from abnormal imaging to surgery. No evidence-based practice standards exist for access to breast cancer care. Practice guidelines that include benchmarks for quality measures and an established process to measure patient outcomes would promote high-qualitycare. An understanding of how practice sites function also would help healthcare providers identify and develop resources to improve patient outcomes. In the current study, the advanced practice nurse (APN) in the practice setting was identified as a key point person in facilitating patients' timely access to healthcare services. The physician and APN practice model was instrumental in influencing the process. The results of the current study provided clinical data to identify benchmarks that a breast oncology practice can use to monitor timeliness as a quality indicator. PMID:24476729
The aim was to describe and compare nursing assistants', enrolled nurses' and registered nurses' perceptions of quality of care, working conditions, competence and personal health in older peoples' care. Altogether 70 nursing assistants, 163 enrolled nurses and 198 registered nurses completed a questionnaire comprising Quality from the Patient's Perspective modified for caregivers, Creative Climate Questionnaire, Stress of Conscience Questionnaire, items on education and competence and Health Index. The caregivers reported higher perceived reality of quality of care in medical-technical competence and physical-technical conditions than in identity-oriented approach and socio-cultural atmosphere. In subjective importance, the highest rating was assessed in one of the physical-technical items. The organisational climate was for three of the dimensions rather close/reached the value for a creative climate, for seven dimensions close to a stagnant climate. In perceived stress of conscience, there were low values. Nursing assistants had lower values than enrolled nurses and registered nurses. The caregivers reported highest values regarding previous education making them feel safe at work and lowest value on the item about education increasing the ability for a scientific attitude. Registered nurses could use knowledge in practice and to a higher degree than nursing assistants/enrolled nurses reported a need to gain knowledge, but the latter more often received education during working hours. The health index among caregivers was high, but registered nurses scored lower on emotional well-being than nursing assistants/enrolled nurses. The caregivers' different perceptions of quality of care and work climate need further attention. Although stress of conscience was low, it is important to acknowledge what affected the caregivers work in a negative way. Attention should be paid to the greater need for competence development among registered nurses during working hours. PMID:23088213
Ensuring and maintaining a high level of quality in nursing care becomes more and more important as economic pressure is increasing and personnel is being reduced. The nursing executives of four large Swiss hospitals therefore commissioned a group of nursing scientists and nursing experts with the task of developing a trendsetting model to represent, assess, and interpret the quality of nursing care. The "Quality of Health Outcome Model" (QHOM) served as a basis for development. More than 60 nurses from acute care hospitals and specialized clinics assessed a first draft of the model in hearings and by means of questionnaires. The model integrated earlier attempts at quality screening regarding structures, processes and results, complementing these three elements with a fourth: the patients, whose characteristics influence the results of nursing care remarkably. Thus, the former one-dimensional, linear viewpoint was resolved into a dynamic representation of all four elements, illustrating a specific concept of nursing care. Through the multi-dimensionality of the model the complexity of the nursing process is better represented. The model's core consists of eight exemplary indicators of quality, each of which is relevant to nursing and for each of which criteria and assessment tools have been formulated. The model is seen as a basis and reference for the quality development and first opportunities for clinical application have been succesfully employed. The project can serve as a paradigm of networking amongst hospitals and cooperation between nursing scientists and experts, and of the critical significance of such collaboration to the advancement of nursing quality. PMID:18850535
Schmid-Büchi, Silvia; Rettke, Horst; Horvath, Eva; Marfurt-Russenberger, Katrin; Schwendimann, René
Explored how research can be useful for improving day-carequality. Studied relationship of pedagogic content and parent policy to day-care center aims, finding a strong relationship between special goals and quality standards. Suggested that improvement requires context-bound theories and a stronger theoretical framework for working with groups…
Quality Rating and Improvement Systems (QRIS) for early care and education and school age care programs are designed to collect information about quality and to use that information to produce program-level ratings, which are the foundation of a QRIS. The...
Recent years have seen the introduction of for- malised accreditation processes in both commu- nity and residential aged care, but these only partially address quality assessment within this sector. Residential aged care in Australia does not yet have a standardised system of resident assessment related to clinical, rather than admin- istrative, outcomes. This paper describes the development of a quality
Mary Courtney; Maria T O'Reilly; Helen Edwards; Stacey Hassall
...2013-10-01 2013-10-01 false General quality of care reconsideration procedures. 476...HEALTH AND HUMAN SERVICES (CONTINUED) QUALITY IMPROVEMENT ORGANIZATIONS UTILIZATION AND QUALITY CONTROL REVIEW Review...
As health care systems seek to provide patient-centered care as a cornerstone of quality, how to measure this aspect of quality has become a concern. Previous development of quality indicators for treating individual chronic disease has rarely included patient perspectives on quality of care. Using epilepsy as an exemplar, the authors sought to develop an approach to measuring patient-centered quality of care. They conducted six focus groups with adults with epilepsy. Using qualitative methods, the authors initially identified 10 patient-generated quality indicators, 5 of which were subsequently rated, along with literature-based quality indicators, by an expert panel using a modified RAND appropriateness methodology. The authors discuss similarities and differences in aspects of care patients and providers value as essential for good quality. The process presented in this article may serve as a model for incorporating patient perceptions of quality into the future development of quality indicators for chronic diseases. PMID:19074307
Bokhour, Barbara G; Pugh, Mary Jo; Rao, Jaya K; Avetisyan, Ruzan; Berlowitz, Dan R; Kazis, Lewis E
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
Background Improving the healthcare for patients with depression is a priority health policy across the world. Roughly, two major problems can be identified in daily practice: (1) the content of care is often not completely consistent with recommendations in guidelines and (2) the organization of care is not always integrated and delivered by multidisciplinary teams. Aim To describe the content and preliminary results of a quality improvement project in primary care, aiming at improving the uptake of clinical depression guidelines in daily practice as well as the collaboration between different mental health professionals. Method A Depression Breakthrough Collaborative was initiated from December 2006 until March 2008. The activities included the development and implementation of a stepped care depression model, a care pathway with two levels of treatment intensity: a first step treatment level for patients with non-severe depression (brief or mild depressive symptoms) and a second step level for patients with severe depression. Twelve months data were measured by the teams in terms of one outcome and several process indicators. Qualitative data were gathered by the national project team with a semi-structured questionnaire amongst the local team coordinators. Results Thirteen multidisciplinary teams participated in the project. In total 101 health professionals were involved, and 536 patients were diagnosed. Overall 356 patients (66%) were considered non-severely depressed and 180 (34%) patients showed severe symptoms. The mean percentage of non-severe patients treated according to the stepped care model was 78%, and 57% for the severely depressed patient group. The proportion of non-severely depressed patients receiving a first step treatment according to the stepped care model, improved during the project, this was not the case for the severely depressed patients. The teams were able to monitor depression symptoms to a reasonable extent during a period of 6 months. Within 3 months, 28% of monitored patients had recovered, meaning a Beck Depression Inventory (BDI) score of 10 and lower, and another 27% recovered between 3 and 6 months. Conclusions and discussion A stepped care approach seems acceptable and feasible in primary care, introducing different levels of care for different patient groups. Future implementation projects should pay special attention to the quality of care for severely depressed patients. Although the Depression Breakthrough Collaborative introduced new treatment concepts in primary and specialty care, the change capacity of the method remains unclear. Thorough data gathering is needed to judge the real value of these intensive improvement projects.
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.
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.
This study is a secondary analysis of a statewide sample of licensed family child care providers in the Tennessee Child Care Evaluation and Report Card Program ("N"?=?1,145) that describes the general quality of family child care programs in the state and examines the relationships between provider education and global quality. Study…
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
Since 1991, the US Government has funded medical and support services for people living with HIV and AIDS (PLWHA) through the Ryan White HIV/AIDS Program. The Ryan White Program supports networks of care which include medical care providers and support services for PLWHA in 51 Eligible Metropolitan Areas (EMAs). In the 2000 reauthorization of the Ryan White Program, quality management programs were required for all sites receiving funding. To facilitate quality management and improvement activities in EMAs, we developed a set of surveys to measure characteristics of care networks and the quality, accessibility, and coordination of services from the perspective of case management and medical providers, administrators and consumers. The surveys measured quality management and support activities of the entire network, as well as reported quality of services at individual care sites. They were administered in 42 EMAs from a total of 43 who had not participated in earlier pilot testing and were located in the continental US. The care networks were rated highly on access, quality, and coordination between case management and primary care providers. However, there were frequently differences in ratings of quality and barriers by type of respondent (consumer representatives, Grantees, and providers). There were also substantial variations across EMAs in network characteristics, perceived effectiveness, performance measurement, and quality improvement activities. The results indicate that the Ryan White Program has been successful in some areas of developing networks of care, but additional support is needed to strengthen the comprehensiveness and coordination of care. Additional work also is needed to better define and measure the essential characteristics of coordinated and integrated networks of care and assess whether those characteristics are related to access and quality of care and services. PMID:19484615
Hirschhorn, Lisa R; Landers, Stewart; McInnes, D Keith; Malitz, Faye; Ding, Lin; Joyce, Rebecca; Cleary, Paul D
Background We examined the quality of adult epilepsy care using the Quality Indicators in Epilepsy Treatment (QUIET) measure, and variations in quality based on the source of epilepsy care. Methods We identified 311 individuals with epilepsy diagnosis between 2004 and 2007 in a tertiary medical center in New England. We abstracted medical charts to identify the extent to which participants received quality indicator (QI) concordant care for individual QI's and the proportion of recommended care processes completed for different aspects of epilepsy care over a two year period. Finally, we compared the proportion of recommended care processes completed for those receiving care only in primary care, neurology clinics, or care shared between primary care and neurology providers. Results The mean proportion of concordant care by indicator was 55.6 (standard deviation = 31.5). Of the 1985 possible care processes, 877 (44.2%) were performed; care specific to women had the lowest concordance (37% vs. 42% [first seizure evaluation], 44% [initial epilepsy treatment], 45% [chronic care]). Individuals receiving shared care had more aspects of QI concordant care performed than did those receiving neurology care for initial treatment (53% vs. 43%; X2 = 9.0; p = 0.01) and chronic epilepsy care (55% vs. 42%; X2 = 30.2; p < 0.001). Conclusions Similar to most other chronic diseases, less than half of recommended care processes were performed. Further investigation is needed to understand whether a shared-care model enhances quality of care, and if so, how it leads to improvements in quality.
This short report explores the quality of the care process for children with intellectual disabilities. A Delphi procedure was used to identify a set of indicators for the quality of the care process reflecting the perspectives of the care providers, the parents and the experts. The sample consisted of 59 individuals involved in different ways in…
Swennenhuis, Petra; Vermeer, Adri; Rispens, Jan; Teunissen, Joop; Wensing, Michel
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
This report brings together two issues: quality of care measurement and health care for the disadvantaged. The main question that is asked is whether an improvement in the quality of health care delivered to the disadvantaged will contribute to equalizing their health status. A review of the literature points to the following four conclusions: (1)…
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
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.
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
Abstract Background Most young children are in child care. Previous studies suggest that children may receive insufficient vegetables, and foods and beverages with added sugars, fats, and sodium in these settings. None have compared the nutritional quality of meals to snacks. Methods Directors from 258 full-day child-care centers in two urban counties of southwestern Ohio were surveyed via telephone in the fall of 2009 about their nutrition practices, and asked to provide a current menu. Lunch and afternoon snack menus were categorized according to average weekly frequency for fruits, vegetables, lean meats, juice (100%), and sweet or salty foods served. Frequencies were compared by meal occasion (lunch vs. snack) using the Fisher exact test. Results Most (60%) directors reported serving 2% milk to children ?3 years; 31% served whole milk. Menu analysis demonstrated the composition of lunches differed from snacks (p<0.0001) in all food categories. A total of 87% centers rarely (<1 time per week) listed nonstarchy vegetables for snacks, but 67% of centers included them at lunch ?3 times per week. Juice (100%) was on snack menus >2 times per week in 37% centers, but in only 1 center as a regular component of lunch. Similarly, 87% centers listed sweet and salty foods at snack ?3 times per week, but rarely at lunch. Conclusions Despite efforts to improve children's diets in child care, meals—and particularly snacks—still lack whole fruits and nonstarchy vegetables and contain added sugars and fats. Snacks represent a missed opportunity to improve the nutritional quality of foods served in childcare.
Benjamin Neelon, Sara E.; Howald, Angela E.; Wosje, Karen S.
As part of the Department of Health initiative - £30 million funding for children's palliative care in 2010/11, Children's Hospices UK successfully submitted a proposal with Help the Hospices relating to CareQuality Commission (CQC) registration and compliance with the statutory Essential Standards of Quality and Safety. The project ran between December 2010 and March 2011 developing guidance and best practice examples for hospice services in England. The project assisted children's and adult hospice services by providing information to:? Inform future development and planning of services to ensure best practice ? Identify current services and gaps in current compliance ? Work with our partner 'Help the Hospices' to share project outputs and support the transition agenda between children's and adult services. The project required a mixed methodology to ensure effective delivery of the project objectives. Methodologies employed included an online questionnaire, stakeholder visits and interviews, delivery of three educational workshops, academic review of compliance techniques and partnership working with stakeholders to complete exemplar compliance assessments. The project enabled a number of outputs and analysis and these were shared with member organisations via the extranet services of both Children's Hospices UK and Help the Hospices. Outputs included:? Establishment of information relating to registered activities across hospice services ? Provision of educational workshops led by the CQC in relation to compliance, inspection and the Judgement Framework ? The development of a 'Compliance Toolkit' providing information and advice relating to meeting the Essential Standards including exemplar compliance assessments ? Partnership with 'Help the Hospices' to further improve transition for life limited young people by understanding the population of children and young people with palliative care needs who will be moving to adult services. The presentation will focus on some of the learning from this joint venture and consider next steps. PMID:24653238
Ruthven, Tracy; Blackburn, Maddie; Ellis, Jonathan
Context The quality of health care and the financial costs affected by receiving care represent two fundamental dimensions for judging health care performance. No existing conceptual framework appears to have described how quality influences costs. Methods We developed the Quality-Cost Framework, drawing from the work of Donabedian, the RAND/UCLA Appropriateness Method, reports by the Institute of Medicine, and other sources. Findings The Quality-Cost Framework describes how health-related quality of care (aspects of quality that influence health status) affects health care and other costs. Structure influences process, which, in turn, affects proximate and ultimate outcomes. Within structure, subdomains include general structural characteristics, circumstance-specific (e.g., disease-specific) structural characteristics, and quality-improvement systems. Process subdomains include appropriateness of care and medical errors. Proximate outcomes consist of disease progression, disease complications, and care complications. Each of the preceding subdomains influences health care costs. For example, quality improvement systems often create costs associated with monitoring and feedback. Providing appropriate care frequently requires additional physician visits and medications. Care complications may result in costly hospitalizations or procedures. Ultimate outcomes include functional status as well as length and quality of life; the economic value of these outcomes can be measured in terms of health utility or health-status-related costs. We illustrate our framework using examples related to glycemic control for type 2 diabetes mellitus or the appropriateness of care for low back pain. Conclusions The Quality-Cost Framework describes the mechanisms by which health-related quality of care affects health care and health status–related costs. Additional work will need to validate the framework by applying it to multiple clinical conditions. Applicability could be assessed by using the framework to classify the measures of quality and cost reported in published studies. Usefulness could be demonstrated by employing the framework to identify design flaws in published cost analyses, such as omitting the costs attributable to a relevant subdomain of quality.
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
A systematic and rigorous implementation of quality improvement processes is likely to improve the well-being of staff members and heighten their job satisfaction. Assessing professionals' perceptions of health carequality should lead to the betterment of health care services. In Saudi Arabia, no previous studies examine how university health professionals view health carequality concepts. A cross-sectional analytical study employing a self-administered questionnaire with 43 statements assessing quality perceptions of academic health care professionals was used. Despite the agreement of health professionals on numerous quality concepts addressed in this study, there was insufficient agreement on 10 core quality concepts, 3 of which were the following: "quality focuses on customers" (50%), "quality is tangible and therefore measurable" (29.3%), and "quality is data-driven" (62%). Hence, providing health professionals with relevant training likely will generate a better understanding of quality concepts and optimize their performance. PMID:23897553
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…
Obtaining meaningful information from statistically valid and reliable measures of the quality of care for disease-specific care provided in small rural hospitals is limited by small numbers of cases and different definitive care capacities. An alternative approach may be to aggregate and analyze patient services that reflect more generalized care…
Wakefield, Douglas S.; Ward, Marcia; Miller, Thomas; Ohsfeldt, Robert; Jaana, Mirou; Lei, Yang; Tracy, Roger; Schneider, John
Considerable research has addressed quality of life and quality of care; however, it has not addressed adequately the experiences of patients and their families at the end of life. Health care may have a greater effect on quality of life during the dying process than it normally does. Building on research and expert review, a conceptual framework is presented that
Anita L Stewart; Joan Teno; Donald L Patrick; Joanne Lynn
...2013-10-01 false Measures to assess the quality of care furnished by an ACO. 425... MEDICARE SHARED SAVINGS PROGRAM Quality Performance Standards and Reporting Â§ 425.500 Measures to assess the quality of care furnished by an ACO....
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: We examined the quality of adult epilepsy care using the Quality Indicators in Epilepsy Treatment (QUIET) measure, and variations in quality based on the source of epilepsy care. METHODS: We identified 311 individuals with epilepsy diagnosis between 2004 and 2007 in a tertiary medical center in New England. We abstracted medical charts to identify the extent to which participants
Mary Jo Pugh; Dan R Berlowitz; Jaya K Rao; Gabriel Shapiro; Ruzan Avetisyan; Amresh Hanchate; Kelli Jarrett; Jeffrey Tabares; Lewis E Kazis
Pre-hospital critical care is considered to be a complex intervention with a weak evidence base. In quality improvement literature, the value equation has been used to depict the inevitable relationship between resources expenditure and quality. Increased value of pre-hospital critical care involves moving a system from quality assurance to quality improvement. Agreed quality indicators can be integrated in existing quality improvement and complex intervention methodology. A QI system for pre-hospital critical care includes leadership involvement, multi-disciplinary buy-in, data collection infrastructure and long-term commitment. Further, integrating process control with governance systems allows evidence-based change of practice and publishing of results.
This research aims to increase transparency and simplify consumer decision-making regarding the selection of a home health care provider. Currently, quality information on home health care providers is fragmented and difficult to interpret. In this study, a quality-ranking model is developed by selecting multidimensional quality indicators across multiple sources and respective weights using expert judgment. Given the weights and providers' performance on each quality indicator, a composite score is calculated that summarizes a home health care provider's overall quality level. This quality information empowers consumers to narrow their search and select the best-performing, most efficient providers. PMID:23924223
Context: Racial and ethnic disparities in the quality of health care are well documented in the U.S. health care system. Reducing these disparities requires action by health care organizations. Collecting accurate data from patients about their race and ethnicity is an essential first step for health care organizations to take such action, but these data are not systematically collected and used for quality improvement purposes in the United States. This study explores the challenges encountered by health care organizations that attempted to collect and use these data to reduce disparities. Methods: Purposive sampling was used to identify eight health care organizations that collected race and ethnicity data to measure and reduce disparities in the quality and outcomes of health care. Staff, including senior managers and data analysts, were interviewed at each site, using a semi-structured interview format about the following themes: the challenges of collecting and collating accurate data from patients, how organizations defined a disparity and analyzed data, and the impact and uses of their findings. Findings: To collect accurate self-reported data on race and ethnicity from patients, most organizations had upgraded or modified their IT systems to capture data and trained staff to collect and input these data from patients. By stratifying nationally validated indicators of quality for hospitals and ambulatory care by race and ethnicity, most organizations had then used these data to identify disparities in the quality of care. In this process, organizations were taking different approaches to defining and measuring disparities. Through these various methods, all organizations had found some disparities, and some had invested in interventions designed to address them, such as extra staff, extended hours, or services in new locations. Conclusion: If policymakers wish to hold health care organizations accountable for disparities in the quality of the care they deliver, common standards will be needed for organizations’ data measurement, analysis, and use to guide systematic analysis and robust investment in potential solutions to reduce and eliminate disparities.
Thorlby, Ruth; Jorgensen, Selena; Siegel, Bruce; Ayanian, John Z
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.
The NIH Roadmap and National Cancer Institute strategic plans repeatedly emphasize the importance of involving health care systems in research. Integrated care delivery systems can address key research questions that cannot be answered in other types of settings. Research in this setting can lead to essential insights about the quality of care, including the quality of cancer care and how best to improve patient outcomes.
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
Efforts to translate efficacious interventions into long-term care practice have had limited success due to the lack of consideration of key translational intervention components. A multi-faceted intervention was implemented in two veteran affairs facilities to improve feeding assistance care. There were three study phases: baseline, intervention, and follow-up. During each phase, trained research staff conducted standardized observations of 12 meals/participant to assess feeding assistance carequality. The staff received three initial training sessions followed by six consecutive weeks of feedback sessions wherein the observation-based care process measures were shared with the staff. There were significant, but modest, improvements in mealtime feeding assistance care processes, and most of the improvements were maintained during follow-up. A multi-faceted intervention resulted in significant, but modest, improvements in mealtime feeding assistance carequality. Organizational (staff schedules, communication) and environmental (dining location) barriers were identified that interfered with improvement efforts. PMID:24073169
Simmons, Sandra F; Durkin, Daniel W; Shotwell, Matthew S; Erwin, Scott; Schnelle, John F
Objective To estimate the effect of a nursing home’s share of residents with a serious mental illness (SMI) on the quality of care. Data Sources Secondary nursing home-level data over the period 2000 through 2008 obtained from the Minimum Data Set, OSCAR, and Medicare claims. Study Design We employ an instrumental variables approach to address the potential endogeneity of the share of SMI residents in nursing homes in a model including nursing home and year fixed effects. Principal Findings An increase in the share of SMI nursing home residents positively affected the hospitalization rate among non-SMI residents and negatively affected staffing skill mix and level. We did not observe a statistically significant effect on inspection-based health deficiencies or the hospitalization rate for SMI residents. Conclusions Across the majority of indicators, a greater SMI share resulted in lower nursing home quality. Given the increased prevalence of nursing home residents with SMI, policymakers and providers will need to adjust practices in the context of this new patient population. Reforms may include more stringent preadmission screening, new regulations, reimbursement changes, and increased reporting and oversight.
Grabowski, David C.; Intrator, Orna; Cai, Shubing; Mor, Vincent
Quality assurance (QA) in higher medical education involves the development, sustenance, improvement, and evaluation of the standard of training of medical professionals. In health care delivery, QA focuses on guaranteeing and maintaining a high standard of the service provided in different health care systems. When the service delivered by the care provider is in accordance with what the recipients of health care expect, then quality in health care is considered to be present. There are several factors in higher medical education and health care that are responsible for the emergence of QA. These include externally imposed obligations requiring demonstration of public accountability and responsibility from educational institutions, as well as the need for activity-specific information by policy makers as an aid for important decision-making within educational institutions. In health care delivery on the other hand, the emergence of QA is linked to the need for containing rising health care costs in the face of limited resources and to guaranteeing high quality patient care in a changing health care environment where the power relationship between doctors and patients is shifting towards patients. Although medical education can be regarded as a distinct entity in the health care industry, it still remains an inherent part of the health care delivery system. As a result, different strategies aimed at guaranteeing and assuring high standards of health care and education in many countries tend to overlap. This paper reflects on whether quality assurance in health care delivery and medical education should be seen as separate entities.
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
This is an exploratory study examining consumers perceptions of the quality-of-indicators which are appearing in health care report cards. This study utilizes focus groups and surveys to explore consumer understanding of quality information. Content analy...
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 objective of this study was to investigate the relation between older patients' assessments of the quality of their primary care and measures of good clinical practice on the basis of data from administrative and clinical records.
Mala Rao; Aileen Clarke; Colin Sanderson; Richard Hammersley
The U.S. health care system serves a diverse population, often resulting in significant disparities in delivery and quality of care. Nevertheless, most quality improvement efforts fail to systematically assess diversity and associated disparities. This article describes application of the multimethod assessment process (MAP) for understanding disparities in relation to diversity, cultural competence, and quality improvement in clinical practice. MAP is an innovative quality improvement methodology that integrates quantitative and qualitative techniques and produces a system level understanding of organizations to guide quality improvement interventions. A demonstration project in a primary care practice illustrates the utility of MAP for assessing diversity. PMID:12938252
Kairys, Jo Ann; Orzano, John; Gregory, Patrice; Stroebel, Christine; DiCicco-Bloom, Barbara; Roemheld-Hamm, Beatrix; Kobylarz, Fred A; Scott, John G; Coppola, Lisa; Crabtree, Benjamin F
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.
The process of radiotherapy (RT) is complex and involves understanding of the principles of medical physics, radiobiology, radiation safety, dosimetry, radiation treatment planning, simulation and interaction of radiation with other treatment modalities. Each step in the integrated process of RT needs quality control and quality assurance (QA) to prevent errors and to give high confidence that patients will receive the prescribed treatment correctly. Recent advances in RT, including intensity-modulated and image-guided RT, focus on the need for a systematic RTQA program that balances patient safety and quality with available resources. It is necessary to develop more formal error mitigation and process analysis methods, such as failure mode and effect analysis, to focus available QA resources optimally on process components. External audit programs are also effective. The International Atomic Energy Agency has operated both an on-site and off-site postal dosimetry audit to improve practice and to assure the dose from RT equipment. Several countries have adopted a similar approach for national clinical auditing. In addition, clinical trial QA has a significant role in enhancing the quality of care. The Advanced Technology Consortium has pioneered the development of an infrastructure and QA method for advanced technology clinical trials, including credentialing and individual case review. These activities have an impact not only on the treatment received by patients enrolled in clinical trials, but also on the quality of treatment administered to all patients treated in each institution, and have been adopted globally; by the USA, Europe and Japan also. PMID:18952706
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.
This study identified training needs for Pennsylvania child care providers and assessed the impact of training, classroom/caregiver dynamics, and staff characteristics on child carequality. Participating were 29 family child care providers, 30 group homes, and 60 child care centers, stratified by type of site and geographic region. Quality of…
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
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 &
Purpose Even though pay-for-performance programs are being rapidly implemented, little is known about how patient complexity affects practice-level performance assessment in rural settings. We sought to determine the association between patient complexity and practice-level performance in the rural United States. Basic procedures Using baseline data from a trial aimed at improving diabetes care, we determined factors associated with a practice’s proportion of patients having controlled diabetes (hemoglobin A1c ?7%): patient socioeconomic factors, clinical factors, difficulty with self-testing of blood glucose, and difficulty with keeping appointments. We used linear regression to adjust the practice-level proportion with A1c controlled for these factors. We compared practice rankings using observed and expected performance and classified practices into hypothetical pay-for-performance categories. Main Findings Rural primary care practices (n = 135) in 11 southeastern states provided information for 1641 patients with diabetes. For practices in the best quartile of observed control, 76.1% of patients had controlled diabetes vs 19.3% of patients in the worst quartile. After controlling for other variables, proportions of diabetes control were 10% lower in those practices whose patients had the greatest difficulty with either self testing or appointment keeping (p < .05 for both). Practice rankings based on observed and expected proportion of A1c control showed only moderate agreement in pay-for-performance categories (? = 0.47; 95% confidence interval, 0.32–0.56; p < .001). Principal Conclusions Basing public reporting and resource allocation on quality assessment that does not account for patient characteristics may further harm this vulnerable group of patients and physicians.
Salanitro, Amanda H.; Safford, Monika M.; Houston, Thomas K.; Williams, Jessica H.; Ovalle, Fernando; Payne-Foster, Pamela; Allison, Jeroan J.; Estrada, Carlos A.
OBJECTIVE: To review recent health policies related to measuring child health carequality, the selection processes of national child health quality measures, the nationally recommended quality measures for child mental health care and their evidence strength, the progress made toward developing new measures, and early lessons learned from these national efforts. METHODS: Methods used included description of the selection process of child health carequality measures from 2 independent national initiatives, the recommended quality measures for child mental health care, and the strength of scientific evidence supporting them. RESULTS: Of the child health quality measures recommended or endorsed during these national initiatives, only 9 unique measures were related to child mental health. CONCLUSIONS: The development of new child mental health quality measures poses methodologic challenges that will require a paradigm shift to align research with its accelerated pace.
Murphy, J. Michael; Scholle, Sarah Hudson; Hoagwood, Kimberly Eaton; Sachdeva, Ramesh C.; Mangione-Smith, Rita; Woods, Donna; Kamin, Hayley S.; Jellinek, Michael
Empirical evidence on sustainability of programs that improve the quality of care delivery over time is lacking. Therefore, this study aims to identify the predictive role of short and long term improvements in quality of chronic care delivery on program sustainability. In this longitudinal study, professionals [2010 (T0): n=218, 55% response rate; 2011 (T1): n=300, 68% response rate; 2012 (T2): n=265, 63% response rate] from 22 Dutch disease-management programs completed surveys assessing quality of care and program sustainability. Our study findings indicated that quality of chronic care delivery improved significantly in the first 2 years after implementation of the disease-management programs. At T1, overall quality, self-management support, delivery system design, and integration of chronic care components, as well as health care delivery and clinical information systems and decision support, had improved. At T2, overall quality again improved significantly, as did community linkages, delivery system design, clinical information systems, decision support and integration of chronic care components, and self-management support. Multilevel regression analysis revealed that quality of chronic care delivery at T0 (p<0.001) and quality changes in the first (p<0.001) and second (p<0.01) years predicted program sustainability. In conclusion this study showed that disease-management programs based on the chronic care model improved the quality of chronic care delivery over time and that short and long term changes in the quality of chronic care delivery predicted the sustainability of the projects. PMID:24560235
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
Research suggests that parents of seriously ill children place significant value on the relational context of their children's health care. This psychological phenomenological study explored mothers' perspectives on qualities that they found to be either helpful or unhelpful to their experiences of caregiving. Relational and communicative competencies were identified as most influential in mothers' assessments of provider care. Practitioners experienced in end-of-life care were viewed as highly supportive by the mothers in the study. Training for professionals in principles of palliative and end-of-life care is recommended for those who work with these children and families. PMID:19042889
Background: Hospital performance reports based on administrative data should distinguish differences in quality of care between hospitals from case mix related variation and random error effects. A study was undertaken to determine which of 12 diagnosis-outcome indicators measured across all hospitals in one state had significant risk adjusted systematic (or special cause) variation (SV) suggesting differences in quality of care.
The author explores the extent to which infants and toddlers are regularly in the care of nonparental relatives, friends, and neighbors and notes the limited research on the quality of care provided by family, friends, and neighbors. (Note: This article is an excerpt from "Who's Watching the Babies?: Improving the Quality of Family, Friend, and…
This study examined the relationship between quality of mental health care provided by community mental health centers (CMHCs) and the poverty and racial mix of neighborhoods. Indicators of quality of care were constructed by examining service mix and prescription patterns for adult patients with schizophrenia during fiscal year 1996. CMHCs in high income, Caucasian areas were found to have higher
...2013-10-01 2013-10-01 false Attribution for quality of care and cost measures. 414.1240 Section 414.1240...Fee Schedule Â§ 414.1240 Attribution for quality of care and cost measures. Beneficiaries are attributed to...
Patients with advanced cancer often do not receive high-quality pain and symptom management or support with coordination of care, communication, and decision making. Implementing quality indicators that are reflective of the scope of care, feasible to implement, and supported by evidence might help to identify areas and settings most in need of improvement. However, recent reviews and policy initiatives identified
Hsien Seow; Claire F. Snyder; Richard A. Mularski; Lisa R. Shugarman; Jean S. Kutner; Karl A. Lorenz; Albert W. Wu; Sydney M. Dy
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
Although US health care expenditures reached 17.6 percent of GDP in 2009, quality measurement in this important service sector remains limited. Studying quality changes associated with 11 years of health care for patients with diabetes, we find that the value of reduced mortality and avoided treatment spending, net of the increase in annual spending, was $9,094 for the average patient.
Karen N. Eggleston; Nilay D. Shah; Steven A. Smith; Ernst R. Berndt; Joseph P. Newhouse
Twenty-one million Americans are limited in English proficiency (LEP), but little is known about the effect of medical interpreter services on health carequality. A systematic literature review was conducted on the impact of interpreter services on quality of care. Five database searches yielded 2,640 citations and a final database of 36 articles, after applying exclusion criteria. Multiple studies document
BACKGROUND: South Africa is currently focusing strongly on human resource development. The purpose of this study was to describe and compare the quality of nursing service and care in three health districts in the KwaZulu Natal Province. To identify deficiencies which could be addressed by education and training, it might be useful to measure the quality of care given by
To explore the question of what constitutes quality in a health care encounter from a patientâ€™s perspective, Mathematica conducted focus groups with African Americans, Latinos, Asian Indians, and whites. Participants were asked to define quality in the context of a visit to a primary care physician, and to describe their ideal visit and the characteristics of an excellent physician. Although
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
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.
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. PMID:12389764
Summary The health reform legislation recently discussed by Congress would develop an infrastructure for the ongoing generation and dissemination of information on the comparative effectiveness of different health care treatments. The specifics of these proposals have not yet been fully defined, even as the concept of comparative effectiveness raises concerns for many health care stakeholders. The quality of health care
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…
In 1991, Zimbabwe embarked on a structural adjustment programme. In the health sector, collection of fees was enforced and fees were later increased. Utilisation subsequently declined. This paper examines the perceptions of both government nurses and health care consumers regarding the impact of adjustment on overall quality of care, including nurse professionalism, the nurse-client relationship and patient satisfaction with care.
Mary Travis Bassett; Leon Bijlmakers; David M. Sanders
The effects of resident behavior and resident characteristics on the quantity and quality of care 452 residents with severe mental retardation received from 416 direct-care staff was examined. Results found certain resident characteristics, and behavior did influence specific aspects of the care they received, especially ambulance, communication,…
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
are for vulnerable elders, many of whom may be near the end of life, has come under increasing scrutiny in the past decade. Studies demonstrate inade- quate quality of care with regard to symptom control, matching of care with patient preferences, and optimal resource use at the end of life (1). Several expert panels have concluded that end-of-life care requires
Falls are one of the most common adverse events in hospitals and fall management remains a major challenge in the medical carequality. Falls in patients are associated with major health complications that can result in health decline and increased medical care cost. To deliver medical care in time, reliable location-aware fall detection is needed. In this paper, we propose
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…
First Children's Finance is a national nonprofit organization located in Minneapolis, Minnesota, whose work strives to break the cycle of poverty, starting with those who care for and educate the nation's youngest citizens--child care businesses. First Children's Finance asks the question: How do Americans talk about providing quality child care…
In developing countries, lack of trust in the quality of care provided is often cited as a major factor promoting reluctance to seek biomedical help for obstetric emergencies. This article draws on fieldwork among Mayan informants in Sololá, Guatemala, to explore poor perceptions of the quality of care received when seeking obstetric care in the hospital. Using data collected over two years, I set out to understand why interviewees repeatedly complain that hospital staff "do not attend to you." I maintain that the powerlessness of patients to influence the treatment they receive further reduces their trust in the quality of care delivered, ultimately negatively impacting the decision to seek obstetric care. Finally, I argue for the importance of recognizing the influence of the wider historical and social context in creating the dynamics of this interaction. The implications of this research in defining the quality of care and skilled attendance within the quest to make pregnancy safer are discussed. PMID:18464128
Transforming Care at the Bedside program was developed as a way to improve care on medical-surgical units, patients' and family members' experience of care, and teamwork among care team members and to increase satisfaction and retention of nurses. Average turnover rates for this program's RNs decreased to about 3%, a 58% reduction in rate. The time RNs spent in direct patient care increased 10% compared to the control unit, and value-added care also increased from 10% to 15% over baseline. Patient and staff satisfaction improved. PMID:20628315
We explored the relationship between nurse burnout and ratings of quality of care in 53,846 nurses from six countries. In this secondary analysis, we used data from the International Hospital Outcomes Study; data were collected from1998 to 2005. The Maslach Burnout Inventory and a single-item reflecting nurse-rated quality of care were used inmultiple logistic regression modeling to investigate the association between nurse burnout and nurse-rated quality of care. Across countries, higher levels of burnout were associated with lower ratings of the quality of care independent of nurses’ ratings of practice environments. These findings suggest that reducing nurse burnout may be an effective strategy for improving nurse-rated quality of care in hospitals.
During this past half century, there has been remarkable increase in the role of forensic pathologists and medical examiners in the determination of cause and manner of deaths in health care facilities and investigations of quality of patient care. Autopsy data are an essential part of this quality assurance (QA) program in patient care, especially in trauma centers' QA programs. Forensic pathologists participate in evaluating appropriateness of patient care where death occurs during or following therapeutic and diagnostic procedures. Continuous quality improvement programs now extend into data sharing in child and elder abuse, monitoring of defective medical devices and consumer products which contributed to deaths. In recent years, forensic pathologists are increasingly requested directly by family members to conduct private autopsies to provide independent opinions as to quality of patient care. Thus forensic pathologists are contributing expertise to an ever widening circle of influence in prevention of unnecessary deaths with quality assurance programs and peer review processes. PMID:16229389
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
In home care nursing work is redesigned by differentiated practice (= skill mix) and specialization. The aim of this redesign is efficient use of staff, and maintenance or improvement of quality of care. In this article the effects of differentiated practice and specialization are studied in respect of quality of care. The perspective of the client was taken as the starting point. Quality of care was defined as the discrepancy between clients' expectations and perceptions of several aspects of care. The effects of work redesign were determined on the basis of a comparison between an experimental (n = 103) and a control group (n = 108). Data-analysis showed hardly any differences. Possible explanations are the premature status of the projects and the fact that clients are usually (very) satisfied. The margin in which differences between the experimental and the control group should occur is therefore very small. However, by means of this approach a detailed picture can be obtained of the subjective standard clients use to judge the quality of care. PMID:9376931
Jansen, P G; Kerkstra, A; van der Zee, J; Huijer Abu-Saad, H; Abrahamse, H
This paper deals with quality assurance in health care and its relation to quality assurance in trade and industry. We present the service quality model--a model of quality from marketing research--and discuss how it can be applied to health care. Traditional quality assurance appears to have serious flaws. It lacks a general theory of the sources of hazards in the complex process of patient care and tends to stagnate, for no real improvement takes place. Departing from this criticism, modern quality assurance in health care is marked by: defining quality in a preferential sense as "fitness for use"; the use of theories and models of trade and industry (process-control); an emphasis on analyzing the process, instead of merely inspecting it; use of the Deming problem solving technique (plan, do, check, act); improvement of the process of care by altering perceptions of parties involved. We present an experience of application and utilization of this method in the University Hospital Maastricht, The Netherlands. The successful application of this model requires a favorable corporate culture and motivation of the health care workers. This model provides a useful framework to uplift the traditional approach to quality assurance in health care. PMID:8322109
The effects of resident behaviors and resident characteristics on the quantity and quality of care they receive from direct-care staff was examined. Four hundred and fifty-two residents with severe and profound mental retardation and 416 direct care staff members were involved. Naturalistic observations were conducted on direct-care staff behavior, that is, staff-resident initiatives, staff affection, staff communicative behavior, on resident
Daniel Seys; Pieter Duker; Wineke Salemink; Jolanda Franken-Wijnhoven
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
PURPOSE Efforts to better understand the impact of clinic member relationships on carequality in primary care clinics have been limited by the absence of a validated instrument to assess these relationships. The purpose of this study was to develop and validate a scale assessing relationships within primary care clinics. METHODS The Work Relationships Scale (WRS) was developed and administered as part of a survey of learning and relationships among 17 Department of Veterans Affairs (VA) primary care clinics. A Rasch partial-credit model and principal components analysis were used to evaluate item performance, select the final items for inclusion, and establish unidimensionality for the WRS. The WRS was then validated against semistructured clinic member interviews and VA Survey of Healthcare Experiences of Patients (SHEP) data. RESULTS Four hundred fifty-seven clinicians and staff completed the clinic survey, and 247 participated in semistructured interviews. WRS scores were significantly associated with clinic-level reporting for 2 SHEP variables: overall rating of personal doctor/nurse (r2 =0.43, P <.01) and overall rating of health care (r2= 0.25, P <.05). Interview data describing relationship characteristics were consistent with variability in WRS scores across low-scoring and high-scoring clinics. CONCLUSIONS The WRS shows promising validity as a measure assessing the quality of relationships in primary care settings; moreover, primary care clinics with lower WRS scores received poorer patient quality ratings for both individual clinicians and overall health care. Relationships play an important role in shaping care delivery and should be assessed as part of efforts to improve patient care within primary care settings.
Finley, Erin P.; Pugh, Jacqueline A.; Lanham, Holly Jordan; Leykum, Luci K.; Cornell, John; Veerapaneni, Poornachand; Parchman, Michael L.
Background Recently, there has been considerable effort to promote the use of health information technology (HIT) in order to improve health carequality. However, relatively little is known about the extent to which HIT implementation is associated with hospital patient carequality. We undertook this study to determine the association of various HITs with: hospital quality improvement (QI) practices and strategies; adherence to process of care measures; risk-adjusted inpatient mortality; patient satisfaction; and assessment of patient carequality by hospital quality managers and front-line clinicians. Methods We conducted surveys of quality managers and front-line clinicians (physicians and nurses) in 470 short-term, general hospitals to obtain data on hospitals’ extent of HIT implementation, QI practices and strategies, assessments of quality performance, commitment to quality, and sufficiency of resources for QI. Of the 470 hospitals, 401 submitted complete data necessary for analysis. We also developed measures of hospital performance from several publicly data available sources: Hospital Compare adherence to process of care measures; Medicare Provider Analysis and Review (MEDPAR) file; and Hospital Consumer Assessment of Healthcare Providers and Systems HCAHPS® survey. We used Poisson regression analysis to examine the association between HIT implementation and QI practices and strategies, and general linear models to examine the relationship between HIT implementation and hospital performance measures. Results Controlling for potential confounders, we found that hospitals with high levels of HIT implementation engaged in a statistically significant greater number of QI practices and strategies, and had significantly better performance on mortality rates, patient satisfaction measures, and assessments of patient carequality by hospital quality managers; there was weaker evidence of higher assessments of patient carequality by front-line clinicians. Conclusions Hospital implementation of HIT was positively associated with activities intended to improve patient carequality and with higher performance on four of six performance measures.
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 The Medicare accountable care organization (ACO) programs rely on delivery system integration and provider risk sharing to lower spending while improving quality of care. Methods Using 2009 Medicare claims and linked American Medical Association Group Practice data, we assigned 4.29 million beneficiaries to provider groups based on primary care use. We categorized group size according to eligibility thresholds for the Shared Savings (?5,000 assigned beneficiaries) and Pioneer (?15,000) ACO programs and distinguished hospital-based from independent groups. We compared spending and quality of care between larger and smaller provider groups and examined how size-related differences varied by 2 factors considered central to ACO performance: group primary care orientation (measured by the primary care share of large groups’ specialty mix) and provider risk sharing (measured by county health maintenance organization penetration and its relationship to financial risk accepted by different group types for managed care patients). Spending and quality of care measures included total medical spending, spending by type of service, 5 process measures of quality, and 30-day readmissions, all adjusted for sociodemographic and clinical characteristics. Results Compared with smaller groups, larger hospital-based groups had higher total per-beneficiary spending in 2009 (mean difference: +$849), higher 30-day readmission rates (+1.3% percentage points), and similar performance on 4 of 5 process measures of quality. In contrast, larger independent physician groups performed better than smaller groups on all process measures and exhibited significantly lower per-beneficiary spending in counties where risk sharing by these groups was more common (?$426). Among all groups sufficiently large to participate in ACO programs, a strong primary care orientation was associated with lower spending, fewer readmissions, and better quality of diabetes care. Conclusions Spending was lower and quality of care better for Medicare beneficiaries served by larger independent physician groups with strong primary care orientations in environments where providers accepted greater risk.
McWilliams, J. Michael; Chernew, Michael E.; Zaslavsky, Alan M.; Hamed, Pasha; Landon, Bruce E.
End-of-life care can be broadly defined as health care provided to persons who are very ill, have a prognosis that is likely to worsen, and most likely will die in the near term from their illness. End-of-life care may be in the form of acute care provide...
A. K. Sarata E. D. Williams J. Mulvey K. J. Colello K. R. Thomas
As a result of the generally low quality of child care in the United States and the increased emphasis on accountability in education policy, quality rating systems (QRSs) are proliferating in the child-care arena. QRSs assess child-care providers on multiple dimensions of quality and integrate these assessments into an easily understood summary…
Zellman, Gail L.; Perlman, Michal; Le, Vi-Nhuan; Setodji, Claude Messan
Background Approximately 1.7 million Americans are diagnosed with cancer annually. There is an increasing demand for high-quality cancer care; however, what constitutes qualitycare is not well defined. There remains a gap in our knowledge regarding the current perceptions of what defines qualitycare. Objective To review the current understanding and perspectives of key stakeholders regarding quality cancer care for adult patients with cancer who are receiving chemotherapy-based treatment regimens. Methods This systematic qualitative literature review involved a search of MEDLINE and PubMed databases for articles that were published between January 2009 and May 2013 using a predefined search strategy with specific Medical Subject Headings terms encompassing 3 core concepts—cancer, chemotherapy, and quality of healthcare. Articles were eligible to be included if they focused on adult cancers, discussed quality indicators of cancer care or quality of care in the article's body, discussed treating cancer with chemotherapy, were conducted in the United States and with US respondents, and reported data about cancer quality that were obtained directly from stakeholders (eg, patients, caregivers, providers, payers, other healthcare professionals). Thematic analyses were conducted to assess the perspectives and the intersection of qualitycare issues from each stakeholder group that was identified, including patients, providers, and thought leaders. Results The search strategy identified 542 articles that were reviewed for eligibility. Of these articles, 15 were eligible for inclusion in the study and reported perspectives from a total of 4934 participants. Patients with cancer, as well as providers, noted information needs, psychosocial support, responsibility for care, and coordination of care as important aspects of qualitycare. Providers also reported the importance of equity in cancer care and reimbursement concerns, whereas patients with cancer considered the timeliness of care an important factor. The perspectives of thought leaders focused on barriers to and facilitators of qualitycare. Conclusion Thematic elements related to cancer quality were relatively consistent between patients and providers; no additional information was found regarding payer perspectives. The perspectives of these groups are important to consider as quality initiatives are being developed.
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
Purpose Despite considerable potential for improving health carequality, adoption of new technologies, such as electronic medical records (EMRs), requires prudence, to ensure that such tools are designed, implemented, and used meaningfully to facilitate patient-centered communication and care processes, and better health outcomes. The association between patients’ perceptions of health care provider use of EMRs and health carequality ratings was assessed. Method Data from two iterations of the Health Information National Trends Survey, fielded in 2011 and 2012, were pooled for these analyses. The data were collected via mailed questionnaire, using a nationally representative listing of home addresses as the sampling frame (n=7,390). All data were weighted to provide representative estimates of quality of care ratings and physician use of EMR, in the adult US population. Descriptive statistics, t-tests, and multivariable linear regression analyses were conducted. Results EMR use was reported significantly more frequently by females, younger age groups, non-Hispanic whites, and those with higher education, higher incomes, health insurance, and a usual source of health care. Respondents who reported physician use of EMRs had significantly higher ratings of carequality (Beta=4.83, standard error [SE]=1.7, P<0.01), controlling for sociodemographic characteristics, usual source of health care, and health insurance status. Conclusion Nationally representative data suggest that patients’ perceptions of EMR use are associated with their perceptions of the quality of the health care they receive.
Finney Rutten, Lila J; Vieux, Sana N; St Sauver, Jennifer L; Arora, Neeraj K; Moser, Richard P; Beckjord, Ellen Burke; Hesse, Bradford W
The purpose of this article is to review the literature and update analyses pertaining to the aggressiveness of cancer care near the end of life. Specifically, we will discuss trends and factors responsible for chemotherapy overuse very near death and underutilization of hospice services. Whether the concept of overly aggressive treatment represents a quality-of-care issue that is acceptable to all involved stakeholders is an open question.
Earle, Craig C.; Landrum, Mary Beth; Souza, Jeffrey M.; Neville, Bridget A.; Weeks, Jane C.; Ayanian, John Z.
Many clinicians remain unsure of the relevance of measuring quality of life to their clinical practice. In health economics quality of life measures have become the standard means of assessing the results of health care interventions and, more controversially, the means of prioritising funding; but they have many other applications. This article--the first of three on measuring quality of life--reviews
R. Fitzpatrick; A. Fletcher; S. Gore; D. Jones; D. Spiegelhalter; D. Cox
This study assesses the quality of services in the therapeutic foster care programs used by one county in the Midwest. Using a consultative quality assurance review methodology, evaluators examined 67 randomly sampled cases across seven agencies to assess the service quality issues experienced by children. Following interviews with staff, foster parents, and children, and a review of case records, reviewers
Thomas W. Pavkov; Richard W. Hug; Ira S. Lourie; Sesen Negash
This paper explores some of the findings of a study focussing on constructions of family day care from the perspectives of caregivers/educators and coordinators as they engaged in a quality review process using a recently developed resource--The Quality Journey/He haerenga whai hua (2000). The paper positions quality review as a part of a…
We examine the association between hospital community orientation and quality-of-care measures, which include process measures for patients admitted for acute myocardial infarction, heart failure, and pneumonia as well as measures of patient experience. The community orientation measure is obtained from the 2009 American Hospital Association's Annual Survey Database. Information on hospital quality of care and patient experience comes from 2009 Hospital Quality Alliance data and results from the 2009 Hospital Consumer Assessment of Healthcare Providers and Systems (Medicare.gov, 2009). To evaluate the relationship between community orientation and measures of quality and patient experience, we used multivariate linear regressions. Organizational and market control variables included bed size, ownership, teaching status, safety net status, number of nurses per patient day, multihospital system status, network status, extent of reliance on managed care, market competition, and location within an Aligning Forces for Quality community (these communities have multistakeholder alliances and focus on improving quality of care at the community level). After controlling for organizational factors, we found that hospitals with a stronger commitment to community orientation perform better on process measures for all three conditions, and they report higher patient experience of care scores for one measure, than do those demonstrating weaker commitment. Hospital commitment to community orientation is significantly related to the provision of high-qualitycare and to one measure of patient experience of care. PMID:24396948
Background Care for falls and urinary incontinence (UI) among older patients is inadequate. One possible explanation is that physicians provide less recommended care to patients who are not as concerned about their falls and UI. Objective To test whether patient-reported severity for two geriatric conditions, falls and UI, is associated with quality of care. Research Design Prospective cohort study of elders with falls and/or fear of falling (n=384) and UI (n=163). Subjects Participants in the Assessing Care of Vulnerable Elders-2 Study (2002–3), which evaluated an intervention to improve the care for falls and UI among older (age ?75) ambulatory care patients with falls/fear of falling or UI. Measures Falls Efficacy Scale (FES) and the Incontinence Quality of Life (IQOL) surveys measured at baseline, quality of care measured by a 13-month medical record abstraction. Results There was a small difference in falls quality scores across the range of FES, with greater patient-perceived falls severity associated with better odds of passing falls quality indicators (OR 1.11 (95% CI 1.02–1.21) per 10-point increment in FES). Greater patient-perceived UI severity (IQOL score) was not associated with better quality of UI care. Conclusions Although older persons with greater patient-perceived falls severity receive modestly better quality of care, those with more distressing incontinence do not. For both conditions, however, even the most symptomatic patients received less than half of recommended care. Low patient-perceived severity of condition is not the basis of poor care for falls and UI.
Min, Lillian C.; Reuben, David B.; Keeler, Emmett; Ganz, David A.; Fung, Constance H.; Shekelle, Paul; Roth, Carol P.; Wenger, Neil S.
Information systems are increasingly important for measuring and improving health carequality. A number of integrated health care delivery systems use advanced information systems and integrated decision support to carry out quality assurance activities, but none as large as the Veterans Health Administration (VHA). The VHA's Quality Enhancement Research Initiative (QUERI) is a large-scale, multidisciplinary quality improvement initiative designed to ensure excellence in all areas where VHA provides health care services, including inpatient, outpatient, and long-term care settings. In this paper, we describe the role of information systems in the VHA QUERI process, highlight the major information systems critical to this quality improvement process, and discuss issues associated with the use of these systems.
Hynes, Denise M.; Perrin, Ruth A.; Rappaport, Steven; Stevens, Joanne M.; Demakis, John G.
Background Quality of care in general practice may be affected by the team climate perceived by its health and non-health professionals. Better team working is thought to lead to higher effectiveness and quality of care. However, there is limited evidence available on what affects team functioning and its relationship with quality of care in general practice. This study aimed to explore individual and practice factors that were associated with team climate, and to explore the relationship between team climate and quality of care. Methods Cross sectional survey of a convenience sample of 14 general practices and their staff in South Tyneside in the northeast of England. Team climate was measured using the short version of Team Climate Inventory (TCI) questionnaire. Practice characteristics were collected during a structured interview with practice managers. Quality was measured using the practice Quality and Outcome Framework (QOF) scores. Results General Practitioners (GP) had a higher team climate scores compared to other professionals. Individual's gender and tenure, and number of GPs in the practice were significantly predictors of a higher team climate. There was no significant correlation between mean practice team climate scores (or subscales) with QOF scores. Conclusion The absence of a relationship between a measure of team climate and quality of care in this exploratory study may be due to a number of methodological problems. Further research is required to explore how to best measure team functioning and its relationship with quality of care.
A system of quality assurance for a surgical intensive care unit is described. A System Outcome Score (SOS) is devised incorporating only easily obtained objective components that reflect the likelihood of death. Through the use of a derived Outcome Index (OI) the actual mortality rate is compared with the predicted mortality as a method of monitoring the quality of care delivered. Subroutines exist to identify errors in data entry, to detect malicious interference in patient care, to add non-scoring components for the purposes of clinical studies and to facilitate retrieval of a concise summary of the major events during the stay of every patient admitted to the intensive care unit.
Objective To examine the relationship of availability and quality of a usual source of care (USC) to medical expenditures overall and\\u000a for various types of health care services for children with special health care needs (CSHCN), as a group and by four diagnostic\\u000a subgroups (asthma, non-asthmatic physical conditions, mental retardation, other mental illnesses).\\u000a \\u000a \\u000a \\u000a Methods Generalized linear models were used to estimate the
Chia-Ling Liu; Alan M. Zaslavsky; Michael L. Ganz; James Perrin; Steven Gortmaker; Marie C. McCormick
Context Electronic health records (EHRs) are increasingly used by U.S. outpatient physicians. EHRs could improve clinical care via clinical decision support (CDS), electronic guideline-based reminders and alerts. Objective Using nationally representative data, we assessed the relationship of EHR and CDS use to ambulatory carequality, hypothesizing that higher quality of care would be associated with EHRs and CDS. Design Retrospective, cross-sectional analysis of physician survey data on patient visits. Setting Ambulatory care physician practices in non-federal offices and hospitals. Participants National estimates were based on 190,314 patient visits from the 2005–07 National Ambulatory Medical Care Survey and 2005–06 National Hospital Ambulatory Medical Care Survey. Main Outcome Measures We used a previously developed set of 20 visit-based quality indicators to assess the provision of guideline recommended care with a focus on appropriate pharmacotherapy and preventive counseling. Results EHRs were connected with 28% of an estimated 1.0 billion annual U.S. patient visits. CDS was present in 57% of the visits where an EHR was used (16% of all visits). Use of EHR and CDS varied with provider and patient characteristics, including significantly increased use in the West and in multi-physician settings compared with solo practices. For 19 of 20 quality indicators, visits associated with EHRs had similar quality compared with visits conducted without EHR. Higher quality was noted only for diet counseling in high risk adults (p=0.002). Among the EHR visits, 19 of the 20 quality indicators showed no significant difference in quality between visits with and without CDS. CDS was associated with significantly better performance for only one indicator, lack of routine ECG ordering in low risk patients (p=0.001). Conclusions Our finding of no consistent association between EHR and CDS use and better quality raises concern about the ability of EHR, in isolation, to fundamentally alter outpatient carequality.
Quality assurance (QA) in higher medical education involves the development, sustenance, improvement, and evaluation of the standard of training of medical professionals. In health care delivery, QA focuses on guaranteeing and maintaining a high standard of the service provided in different health care systems. When the service delivered by the care provider is in accordance with what the recipients of health care expect, then quality in health care is considered to be present. There are several factors in higher medical education and health care that are responsible for the emergence of QA. These include externally imposed obligations requiring demonstration of public accountability and responsibility from educational institutions, as well as the need for activity-specific information by policy makers as an aid for important decision-making within educational institutions. In health care delivery on the other hand, the emergence of QA is linked to the need for containing rising health care costs in the face of limited resources and to guaranteeing high quality patient care in a changing health care environment where the power relationship between doctors and patients is shifting towards patients. Although medical education can be regarded as a distinct entity in the health care industry, it still remains an inherent part of the health care delivery system. As a result, different strategies aimed at guaranteeing and assuring high standards of health care and education in many countries tend to overlap. This paper reflects on whether quality assurance in health care delivery and medical education should be seen as separate entities. PMID:23762010
This study applied the stochastic frontier cost function with inefficiency effects to estimate the association between quality of care and cost efficiency in institutional long-term care wards for the elderly in Finland. We used several clinical quality indicators for indicating adverse care processes and outcomes, based on the Resident Assessment Instrument (RAI)/Minimum Data Set (MDS). Average cost inefficiency among the wards was 22%. We found an association between the clinical quality indicators and cost inefficiency. Higher prevalence of pressure ulcers was associated with higher costs, whereas the higher prevalence of use of depressants and hypnotics increased inefficiency. PMID:15952611
Laine, Juha; Linna, Miika; Noro, Anja; Häkkinen, Unto
The objective of this study was to assess the role of provider coordination on nurse manager and physician perceptions of carequality, while controlling for organizational factors. Findings indicated that nurse-nurse coordination was positively associated with nurse manager perceptions of carequality; neither physician-physician nor physician-nurse coordination was associated with physician perceptions. Organizational factors associated with positive perceptions of carequality included facility support of education for nurses and physicians, and the use of multidisciplinary rounding. PMID:24509244
McIntosh, Nathalie; Burgess, James F; Meterko, Mark; Restuccia, Joseph D; Alt-White, Anna C; Kaboli, Peter; Charns, Martin
A recent study of family child care documented that a significant number of providers were giving inadequate care. As a result, this study sought to: (1) identify public and private initiatives to enhance the quality of family child care and determine how the initiatives are financed; (2) describe the federal role in supporting quality…
General Accounting Office, Washington, DC. Health, Education, and Human Services Div.
Purpose: Literature on institutionalization of patients with dementia has not considered the role of caregivers' quality of care, which encompasses caregivers' exemplary care (EC) behaviors and caregivers' potentially harmful behaviors (PHBs) toward care recipients. This study sought to understand the role of quality of care in mediating between…
Sun, Fei; Durkin, Daniel W.; Hilgeman, Michelle M.; Harris, Grant; Gaugler, Joseph E.; Wardian, Jana; Allen, Rebecca S.; Burgio, Louis D.
This article provides information for consumers regarding standards for the use of tech nology in the home health care pediatric program. The authors describe studies and the experience of one state agency. They provide questions and arguments that can be uti lized by hospital discharge planners, case managers, home health care service providers, and families.
In the United States today, more than 40 cents of every health care dollar is spent on people who are 65 or older. Older adults suffer from a multitude of conditions and are especially susceptible to the effects of poor care, yet we know relatively little...
Purpose – Quality improvement of reproductive health care has been announced as one of five global strategies to accelerate progress toward reproductive health goals. The World Health Organization emphasises the evaluation of structure, procedure and outcome of health services to improve quality of care. This study aims to assess the quality of provided care in labour and delivery units in
Masoumeh Simbar; Farideh Ghafari; Shahnaz Tork Zahrani; Hamid Alavi Majd
Publicly reporting information stimulates providers’ efforts to improve the quality of health care. The availability of mandated, uniform clinical data in all nursing homes and home health agencies has facilitated the public reporting of comparative quality data. This article reviews the conceptual and technical challenges of applying information about the quality of long-term care providers and the evidence for the impact of information-based quality improvement. Quality “tools” have been used despite questions about the validity of the measures and their use in selecting providers or offering them bonus payments. Although the industry now realizes the importance of quality, research still is needed on how consumers use this information to select providers and monitor their performance and whether these efforts actually improve the outcomes of care.
Age-related hearing loss (ARHL), known as presbycusis, is characterized by progressive deterioration of auditory sensitivity, loss of the auditory sensory cells, and central processing functions associated with the aging process. ARHL is the third most prevalent chronic condition in older Americans, after hypertension and arthritis, and is a leading cause of adult hearing handicaps in the United States. The prevalence of ARHL is expected to rise for the next several decades with the increasing aging Baby Boomer population. Nevertheless, ARHL remains an often undetected, underestimated and neglected condition in the geriatric population due to a slow development process of the disease. If left untreated, the impact of ARHL on patients, significant others, and the society as a whole would be significant. The purpose of this review is to raise the awareness of ARHL, to update our current understanding of ARHL with a focus on age-related deficits in auditory and cognitive processing of speech, and to explore strategies of prevention, identification, amplification, and aural rehabilitation. The ultimate goal is to improve the quality of hearing health care and the overall quality of life of the Baby Boomer generation. PMID:22383543
Objective: To examine whether clinical severity is greater among children receiving attention-deficit/hyperactivity disorder (ADHD) care in primary care compared with those in specialty mental health clinics, and to examine how care processes and clinical outcomes vary by sector across three 6-month time intervals. Method: This was a longitudinal…
Zima, Bonnie T.; Bussing, Regina; Tang, Lingqi; Zhang, Lily; Ettner, Susan; Belin, Thomas R.; Wells, Kenneth B.
In 2008, the federal government allotted $7 billion in child care subsidies to low-income families through the state-administered Child Care and Development Fund (CCDF), now the government's largest child care program (US DHHS, 2008). Although subsidies reduce costs for families and facilitate parental employment, it is unclear how they impact the…
Ryan, Rebecca M.; Johnson, Anna; Rigby, Elizabeth; Brooks-Gunn, Jeanne
This paper compares the cost and quality incentive effects of cost reimbursement and prospective payment systems in the health industry. When a provider cannot refuse patients who require high treatment costs or discriminate patients by qualities, optimally designed prospective payments can implement the efficient quality and cost reduction efforts, but cost reimbursement cannot induce any cost incentive. When the provider
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 patients and primary care practices that use an electronic medical record (EMR). All practices are part of the Practice Partner Research Network, representing over 100 ambulatory care practices throughout the United States. Methods The SQUID is comprised of 36 process and outcome measures, all of which are obtained from the EMR. This paper describes algorithms for the SQUID calculations, various statistical properties, and use of the SQUID within the context of a multi-practice quality improvement (QI) project. Results At any given time point, the patient-level SQUID reflects the proportion of recommended care received, while the practice-level SQUID reflects the average proportion of recommended care received by that practice's patients. Using quarterly reports, practice- and patient-level SQUIDs are provided routinely to practices within the network. The SQUID is responsive, exhibiting highly significant (p < 0.0001) increases during a major QI initiative, and its internal consistency is excellent (Cronbach's alpha = 0.93). Feedback from physicians has been extremely positive, providing a high degree of face validity. Conclusion The SQUID algorithm is feasible and straightforward, and provides a useful QI tool. Its statistical properties and clear interpretation make it appealing to providers, health plans, and researchers.
Nietert, Paul J; Wessell, Andrea M; Jenkins, Ruth G; Feifer, Chris; Nemeth, Lynne S; Ornstein, Steven M
Objective To evaluate quality of routine and emergency intrapartum and postnatal care using a health facility assessment, and to estimate “effective coverage” of skilled attendance in Brong Ahafo, Ghana. Methods We conducted an assessment of all 86 health facilities in seven districts in Brong Ahafo. Using performance of key signal functions and the availability of relevant drugs, equipment and trained health professionals, we created composite quality categories in four dimensions: routine delivery care, emergency obstetric care (EmOC), emergency newborn care (EmNC) and non-medical quality. Linking the health facility assessment to surveillance data we estimated “effective coverage” of skilled attendance as the proportion of births in facilities of high quality. Findings Delivery care was offered in 64/86 facilities; only 3-13% fulfilled our requirements for the highest quality category in any dimension. Quality was lowest in the emergency care dimensions, with 63% and 58% of facilities categorized as “low” or “substandard” for EmOC and EmNC, respectively. This implies performing less than four EmOC or three EmNC signal functions, and/or employing less than two skilled health professionals, and/or that no health professionals were present during our visit. Routine delivery care was “low” or “substandard” in 39% of facilities, meaning 25/64 facilities performed less than six routine signal functions and/or had less than two skilled health professionals and/or less than one midwife. While 68% of births were in health facilities, only 18% were in facilities with “high” or “highest” quality in all dimensions. Conclusion Our comprehensive facility assessment showed that quality of routine and emergency intrapartum and postnatal care was generally low in the study region. While coverage with facility delivery was 68%, we estimated “effective coverage” of skilled attendance at 18%, thus revealing a large “quality gap.” Effective coverage could be a meaningful indicator of progress towards reducing maternal and newborn mortality.
A plethora of research links professional nurses' qualifications to patient outcomes. Also, research has shown that reports by nurses on the quality of care correspond with process or outcome measures of quality in a hospital. New to the debate is whether professional nurses' qualifications impact on their perceptions of patient safety and quality of care. This research aims to investigate professional nurses' perceptions of patient safety and quality of care in South Africa, and the relationship between these perceptions and professional nurses' qualifications. A cross-sectional survey of 1117 professional nurses from medical and surgical units of 55 private and 7 public hospitals was conducted. Significant problems with regard to nurse-perceived patient safety and quality of care were identified, while adverse incidents in patients and professional nurses were underreported. Qualifications had no correlation with perceptions of patient safety and quality of care, although perceptions may serve as a valid indicator of patient outcomes. Creating an organizational culture that is committed to patient safety and encourages the sharing of adverse incidents will contribute to patient safety and quality of care in hospitals. PMID:24102916
Blignaut, Alwiena J; Coetzee, Siedine K; Klopper, Hester C
The 20th century has seen dramatic improvements in quality, efficiency, and productivity of the industrial, manufacturing, and selected service sectors through the redesign of the management and production processes. Moreover, the health care sector, plagued by overuse, underuse, and misuse of care remained a laggard in adopting needed changes to improve quality, effectiveness, and delivery. The change agent may have been the 2001 report by the Institute of Medicine, which shocked the collective conscience of the industry with the revelation of the alarming statistics of death owing to preventable medical errors. A variety of methodologies have since been adopted by the health care sector with mixed successes. However, scant attention has been given to the historical significance of Florence Nightingale pioneering quality management in nursing care over a century ago with her use of statistics to influence health care decisions, to enhance qualitycare delivery, and to improve facility design. This article addresses the abstract concept of quality, its illusive nature, and multidimensionality from different perspectives in health utilization and delivery. It presents a survey of the various quality management theories and models and their variance, which have attracted the attention of the health sectors as potential saviors of the beleaguered health industry afflicted by the quality crisis. PMID:24267627
Drawing on interviewsummaries from 52 in-depth interviews with SocialHMOmembers, coded for quality-of-life themes, we explore how home-and community-based services affect quality of life, autonomy, and control. We identify areas where services positively influence quality of life, including promoting functional independence and preventing further functional decline, and we raise questions about important quality-of-life related care that has been outside the Social
Several reports have described the poor quality of care delivered to psychotic patients. However, the context in which care was delivered, including the structure, organization, and performance of the health care system, as a possible determinant of quality of care has received less attention. In this study we explored the relationship between conformance with guidelines and structural and organizational characteristics in 2 departments of Mental Health in Italy. Dosing of antipsychotic drugs in the maintenance phase was investigated in 125 patients. Higher than recommended doses could be explained by the high patient caseload per psychiatrist, leading to insufficient contacts with patients and their families and to excessive reliance upon drug treatment. The analysis of structural and organizational determinants of care at the local level may help to explain insufficient quality and to plan suitable interventions. PMID:19077861
Objectives The ability to assess quality of care is a necessary component of continuous quality improvement. The assessment typically is accomplished by determination of compliance with a defined set of quality measures (QMs). The objective of this effort was to establish a set of QM for the assessment of the process of care in JIA. Methods A 12 member working group (WG) composed of representatives from the ACR, AAP, ABP, and ARHP was assembled to guide the project. Delphi questionnaires were sent to 237 health professionals involved in the care of children with juvenile idiopathic arthritis (JIA). A total of 471 items in 27 domains were identified. The WG met via four live e-meetings during which results from the Delphi’s were distilled to a reduced draft set. Each WG member selected a proposed QM to investigate and present evidence from the literature as to its attributes and appropriateness for inclusion into the set. Nominal group technique was used to come to consensus on a proposed set of QMs. Results The proposed set contains 12 QMs within four health care domains. Each QM consists of a statement of (i) the assessment to be completed, (ii) when the first assessment should be completed and a suggested frequency of assessment during follow-up, (iii) recommendations of appropriate tools or methods of assessment, and (iv) initial performance goals. Conclusions Implementation of the proposed QM set will improve the process of care, facilitate continuous QI, and eventuate in improved health outcomes of children with JIA.
Lovell, Daniel J.; Passo, Murray H.; Beukelman, Timothy; Bowyer, Suzanne L.; Gottlieb, Beth S.; Henrickson, Michael; Ilowite, Norman T.; Kimura, Yukiko; DeWitt, Esi Morgan; Segerman, Jill; Stein, Leonard D.; Taylor, Janalee; Vehe, Richard K.; Giannini, Edward H.
Background In diabetes care, knowledge about what is achievable in primary and secondary care is important. There is a need for an objective method to assess the quality of care in different settings. A quality-of-care summary score has been developed based on process and outcome measures. An adapted version of this score was used to evaluate diabetes management in different settings. Aim To evaluate the quality of diabetes management in primary and secondary care in a defined geographic region in the Netherlands, using a quality score. Design of study Cross-sectional study. Setting Thirty general practices in the Netherlands. Method A study of 2042 patients with type 2 diabetes (1640 primary care and 402 secondary care) was conducted. Quality of diabetes management was assessed by a score of process and outcome indicators (range 0–40). Clustering at practice level and differences in patient characteristics (case mix) were taken into account. Results At the outpatient clinic, patients were younger (mean age 64.1 years, standard deviation (SD) = 12.5 years, versus mean age 67.1 years, SD = 11.7, P<0.001), had more diabetes-related complications (macrovascular: 39.7% versus 24.3%, P<0.001; and microvascular: 25.9% versus 7.3%, P<0.001), and lower quality-of-life scores (EuroQol-5D: mean = 0.60, SD = 0.29, versus mean = 0.80, SD = 0.21, P<0.001). After adjusting for case mix and clustering, there was a weak association between the setting of treatment and haemoglobin A1c (primary care: mean 7.1%, SD = 1.1, versus secondary care: mean 7.6%, SD = 1.2, P<0.016), and between setting and systolic blood pressure (primary: mean 145.7 mmHg, SD = 19.2, versus secondary care: 147.77 mmHg, SD 21.0, P<0.035). Quality-of-care summary scores in primary and secondary care differed significantly, with a higher score in primary care (mean 19.6, SD = 8.5 versus, mean 18.1, SD = 8.7, P<0.01). However, after adjusting for case mix and clustering, this difference lost significance. Conclusion GPs and internists are treating different categories of patients with type 2 diabetes. However, overall quality of diabetes management in primary and secondary care is equal. There is much room for improvement. Future guidelines may differentiate between different categories of patients.
van Bruggen, Rykel; Gorter, Kees; Stolk, Ronald; Zuithoff, Peter; Verhoeven, Rob; Rutten, Guy
This national invitational conference - Improving Quality of Health Care for Children: An Agenda for Research - was called to identify the key research issues and questions that must be addressed to achieve a delivery system that will ensure the continuou...
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 functions within a military medical treatment facility. 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 functions within a military medical treatment facility. System...
At the request of Congressman Peter Roskam's office, the VA Office of Inspector General (OIG), Office of Healthcare Inspections conducted an inspection and oversight review to determine the validity of allegations regarding the quality of care received by...
The VA Office of Inspector General (OIG), Office of Healthcare Inspections conducted an inspection to assess the merit of allegations made by a complainant concerning a patient's quality of care and communication between facility staff and the patient's f...
The intent of this study was to examine the feasibility of a tracking mechanism and patient survey as a means of directly and indirectly assessing specific administrative functions in the health care delivery process. Keywords: TQM; Management; Quality; H...
The usefulness of hospital charges for instructing medical students on the quality and cost of medical care provided by physicians in general internal medicine and family practice specialists is examined. Hospital cost data were obtained during 1972 and 1...
M. L. Garg J. L. Mulligan M. J. McNamara J. K. Skipper R. R. Parekh
When planning a study measuring the effects of a neurodevelopmental treatment (NDT), we were confronted with the methodological problem that while measuring the effects of NDT, a rival hypothesis is that the decision to implement the NDT might be related to the quality of nursing care. Therefore, we measured the quality of nursing care as a possible confounding variable in relation to this outcome study. The quality of nursing care was measured on 12 wards participating in the experimental and control groups of the outcome study. Data were collected from 125 patients and 71 nurses and patients' records. The findings showed no significant differences in the quality of nursing care between the 2 groups of wards (P = .49). This method may be useful to other researchers conducting outcome research and who are confronted with a similar methodological problem. PMID:17873736
Hafsteinsdóttir, Thóra B; Kruitwagen, Cas; Strijker, Karin; van der Weide, Lies; Grypdonck, Maria H F
This exploratory study focused on the interactional dimensions of kith and kin care, and involved childcare providers living in low-income urban communities in Los Angeles (80% African American; 20% Latina). The focus of the present study was to examine: 1) The range and variability of each index of quality--providers' professional development…
Recommendations for action based on survey data, review and analysis of the literature, and personal experience are presented in this report from the Montgomery County (Maryland) Commission on Child Care. The report notes the community's concerns regarding the need for high quality early childhood programs and cites the linkages between wages,…
Montgomery County Commission on Child Care, Rockville, MD.
The VA Office of Inspector General Office of Healthcare Inspections conducted a review at the request of Congressman Jo Bonner to assess allegations concerning a patient's quality of care as well as address problems with services at the VA Gulf Coast Vete...
Background With increasing incidence of traumatic fractures, the use of orthopedic intervention such as traction has increased. Inappropriate traction care may cause substantial morbidity and delay the patient rehabilitation. Objectives This study was conducted to evaluate the quality of care for patients with traction in the orthopedic unit of Kashan's Shahid Beheshti Hospital, Kashan, Iran. Patients and Methods This observational study was conducted on 100 patients with traumatic fractures of hip and femur bones who were admitted to Kashan Shahid-Beheshti Hospital during the first 6 months of 2012, and for whom skeletal or skin traction was performed. Data were collected using a checklist including questions about the personal characteristics and 23 items related to care for patients with tractions. These items were in three domains including caring while establishing traction, recording care and patient’s education. Descriptive statistics were calculated and data were analyzed using the independent sample t-test and Pearson correlation coefficient. Results The mean age of patients was 51.16 ± 23.28 years and 66% of them were male. In total, 47% of the patients were treated by skin traction and 53% by skeletal traction. The overall mean score of quality of care was 10.20 ± 2.64. Quality of establishing traction was good in 55% of patients, but the quality of care was poor in the domains of recording care (88%) and patient education (96%). Total mean of quality of care was significantly different between male and female patients (P < 0.02). Conclusions The quality of care of patients with traction was not optimal. Therefore it is necessary to improve measures in this area.
Efforts to improve community-based children’s mental health care should be based on valid information about effective practices and current routine practices. Emerging research on routine care practices and outcomes has identified discrepancies between evidence-based practices and “usual care.” These discrepancies highlight potentially potent quality improvement interventions. This article reviews existing research on routine or “usual care” practice, identifies strengths and weaknesses in routine psychotherapeutic care, as well as gaps in knowledge, and proposes quality improvement recommendations based on existing data to improve the effectiveness of children’s mental health care. The two broad recommendations for bridging the research-practice gap are to implement valid, feasible measurement feedback systems and clinician training in common elements of evidence-based practice.
Quality of care measures are increasingly important to health plans, purchasers, physicians, and patients. Appropriate measures can be used to assess quality and evaluate improvement and are necessary components of pay-for-performance programs. Despite the broad scope of activity in the development of quality measures, migraine headache has received little attention. Given the enormous costs associated with migraine, especially in terms of lost productivity and preventable health care utilization, health plans could gain from a structured approach to measuring the quality of migraine care their beneficiaries receive. A potential migraine quality measurement set was developed through a review of migraine care literature and guidelines, interviews with leaders in migraine care, health care purchasing, and managed care, and the assembly of an advisory board. The board discussed candidate measures and established consensus on a testable measurement set. Twenty measures were developed, focused primarily on diagnosis and utilization. Areas of utilization include physician visits, emergency department visits, hospitalizations, and imaging. Use of both acute and preventive medications is included. More complex aspects of migraine care are also addressed, including triptan overuse, the relationship between acute and preventive medications, and follow-up after emergency department visits. The measures are currently being tested in health plans to assess their feasibility and value. A compelling case can be made for the development of migraine-specific quality measures for health plans. This effort to develop and test a starter set of measures should lead to new and innovative efforts to assess and improve quality of care for migraineurs. PMID:18942925
Leas, Brian F; Gagne, Joshua J; Goldfarb, Neil I; Rupnow, Marcia F T; Silberstein, Stephen
Community-based health insurance (CBHI) may be a mechanism for improving the quality of health care available to people outside the formal sector in developing countries. The purpose of this paper is: (1) to identify problems associated with the quality of hysterectomy care accessed by members of SEWA, an Indian CBHI scheme; and (2) to discuss mechanisms that might be put in place by SEWA, and CBHI schemes more generally, to optimize quality of health care. Data on the structure and process of hysterectomy care were collected primarily through review of 63 insurance claims and semi-structured interviews with 12 providers. Quality of hysterectomy care accessed by SEWA's members varies tremendously, from potentially dangerous to excellent. Seemingly dangerous aspects of structure include: operating theatres without separate hand-washing facilities or proper lighting; and the absence of qualified nursing staff. Dangerous aspects of process include: performing hysterectomy on demand; removing both ovaries without consulting or notifying the patient; and failing to send the excised organs for histopathology, even when symptoms and signs are suggestive of disease. Women pay substantial amounts of money even for care of poor, and potentially dangerous, quality. In order to improve the quality of hospital care accessed by its members, a CBHI scheme can: (1) gather data on the costs and complications for each provider, and investigate cases where these are excessive; (2) use incentives to encourage providers to make efficient and equitable resource allocation decisions; (3) select, and contract with, providers who provide a high standard of care or who agree to certain conditions; and (4) inform and advise doctors and the insured about the costs and benefits of different interventions. In the case of SEWA, it is most feasible to identify a limited number of hospitals providing better-qualitycare and contract directly with them. PMID:11739364
The study was prompted by controversy over changes in nursing home certification procedures, proposed by the Health Care Financing Administration (HCRA) in 1982. When the committee commenced its work it agreed that a serious look at many factors bearing o...
For more than two decades, polls have shown that Americans are dissatisfied with their current health care system. However, the public's views on how to change the current system are more conflicted than often suggested by individual poll results. At the same time, Americans are both dissatisfied with the current health care system and relatively satisfied with their own health care arrangements. As a result of the conflict between these views and the public's distrust of government, there often is a wide gap between the public's support for a set of principles concerning what needs to be done about the overall problems facing the nation's health care system and their support for specific policies designed to achieve those goals.
Blendon, Robert J; Brodie, Mollyann; Benson, John M; Altman, Drew E; Buhr, Tami
To evaluate the effectiveness of palliative day care in improving pain, symptom control, and quality of life (QOL), 120 consecutive new referrals to five specialist palliative day care centers were recruited into a prospective comparative study. Fifty-three comparison patients were identified as those patients receiving usual palliative care services (home care, inpatient care), but did not attend day care. Patients were assessed at 3 interviews (baseline, 6-8 weeks, and 12-15 weeks) using measures of health-related quality of life: McGill Quality of Life Questionnaire (MQOL) and Palliative Care Outcome Scale (POS). There were two main analyses: 1) patient demographic data were analyzed using chi-square (chi(2)), and 2) QOL data were compared, based on distribution of scores, using the Mann-Whitney test (MQOL and POS), and Wilcoxon Signed Rank for within group differences (POS data only); P < 0.05 was taken as significant. The patients were representative of those attending palliative day care in the UK. At baseline, the day care group were (non-significantly) worse than the comparison group in the MQOL support domain (P = 0.065). The comparison group had marginally more severe pain at baseline (P = 0.053) and more severe symptoms at second assessment (P = 0.025). Both patient groups maintained overall health-related quality of life during the three months of the study. Palliative day care was not found to improve overall health-related quality of life. The limitations of the QOL measures in identifying the effects (patient outcomes) of palliative day care and the differences between the two patient groups (age, employment, unequal sample sizes) were limitations of the study and indicate the need for further research in this area. PMID:12614955
Goodwin, Danielle M; Higginson, Irene J; Myers, Kathy; Douglas, Hannah-Rose; Normand, Charles E
The quality-adjusted life-year, an economic tool for allocating health care resources, lets researchers compare the cost-effectiveness of different therapies for virtually any disease. It purports to describe quantity of life, with an adjustment for quality of life, as a function of financial cost. Its goal is to maximize health care efficiency, but its methodology does not adequately meet the needs of older patients. Images p124-a p124-b
Abstract Background: The Carolinas Center for Medical Excellence launched the PEACE project in 2006, under contract with the Centers for Medicare & Medicaid Services (CMS), to identify, develop, and pilot test quality measures for hospice and palliative care programs. Objectives: The project collected pilot data to test the usability and feasibility of potential quality measures and data collection processes for hospice and palliative care programs. Settings/subjects: Twenty-two hospices participating in a national Quality Improvement Collaborative (QIC) submitted data from 367 chart reviews for pain care and 45 chart reviews for nausea care. Fourteen additional hospices completed a one-time data submission of 126 chart reviews on 60 potential patient-level quality measures across eight domains of care and an organizational assessment evaluating structure and processes of care. Design: Usability was assessed by examining the range, variability and size of the populations targeted by each quality measure. Feasibility was assessed during the second pilot study by surveying data abstractors about the abstraction process and examining the rates of missing data. The impact of data collection processes was assessed by comparing results obtained using different processes. Results: Measures shown to be both usable and feasible included: screening for physical symptoms on admission and documentation of treatment preferences. Methods of data collection and measure construction appear to influence observed rates of quality of care. Conclusions: We successfully identified quality measures with potential for use in hospices and palliative care programs. Future research is needed to understand whether these measures are sensitive to quality improvement interventions. PMID:24921162
Schenck, Anna P; Rokoske, Franziska S; Durham, Danielle; Cagle, John G; Hanson, Laura C
Teaching RN-to-baccalaureate nursing students to incorporate patient-centered care and quality concepts into the practice environment presents challenges and opportunities for nurse educators. The authors describe development, deployment, and evaluation of an RN-to-baccalaureate hybrid course focused on patient-centered care and quality improvement. Course teaching strategies and evaluation of student learning and the efficacy of using a hybrid instructional design are discussed. PMID:21670632
Robinson-Smith G, Johnston MV, Allen J. Self-care self-efficacy, quality of life, and depression after stroke. Arch Phys Med Rehabil 2000;81:460-4. Objective: To determine the relationship of self-care self-efficacy to functional independence, quality of life, and depression after stroke. Methods: Longitudinal, descriptive correlational design. Setting: Inpatient rehabilitation facility at 1 month after stroke and home at 6 months after stroke. Participants:
Gale Robinson-Smith; Mark V Johnston; Judith Allen
Background The extent to which patient experiences with hospital care are related to other measures of hospital quality and safety is unknown. Methods We examined the relationship between Hospital Consumer Assessment of Healthcare Providers and Systems scores and technical measures of quality and safety using service-line specific data in 927 hospitals. We used data from the Hospital Quality Alliance to assess technical performance in medical and surgical processes of care and calculated Patient Safety Indicators to measure medical and surgical complication rates. Results The overall rating of the hospital and willingness to recommend the hospital had strong relationships with technical performance in all medical conditions and surgical care (correlation coefficients ranging from 0.15 to 0.63; p<.05 for all). Better patient experiences for each measure domain were associated with lower decubitus ulcer rates (correlations ?0.17 to ?0.35; p<.05 for all), and for at least some domains with each of the other assessed complications, such as infections due to medical care. Conclusions Patient experiences of care were related to measures of technical quality of care, supporting their validity as summary measures of hospital quality. Further study may elucidate implications of these relationships for improving hospital care.
Isaac, Thomas; Zaslavsky, Alan M; Cleary, Paul D; Landon, Bruce E
The Health Services Research and Development (HSR&D) Service at the Department of Veterans Affairs (VA) Health Care System launched a Quality Enhancement Research Initiative (QUERI) in 1998. This study estimated health-care costs of nine diseases under the QUERI project and analyzed geographic differences in health-care costs and utilization across 22 VA Integrated Service Networks (VISNs), using a geographic information system