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Sample records for quality infant-toddler care

  1. Partnerships for Quality Infant-Toddler Child Care.

    ERIC Educational Resources Information Center

    Fenichel, Emily, Ed.

    2003-01-01

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

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

    ERIC Educational Resources Information Center

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

    2011-01-01

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


  3. Personalizing Care with Infants, Toddlers and Families.

    ERIC Educational Resources Information Center

    Surbeck, Elaine, Ed.; Kelley, Michael F., Ed.

    This publication deals with the present crisis in infant/toddler care. It presents information on infant/toddler development and optimal caregiving paractices, citing recent research on appropriate practices and the impact of poor versus quality care. The book is divided into two sections. In the first section, "Development and Program…

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

    ERIC Educational Resources Information Center

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

    2015-01-01

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

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

    ERIC Educational Resources Information Center

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

    2015-01-01

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


  6. Research on Quality in Infant-Toddler Programs. ERIC Digest.

    ERIC Educational Resources Information Center

    Honig, Alice Sterling

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

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

    ERIC Educational Resources Information Center

    Honig, Alice Sterling

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

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

    ERIC Educational Resources Information Center

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

    2006-01-01

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


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

    ERIC Educational Resources Information Center

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

    2006-01-01

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

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

    ERIC Educational Resources Information Center

    Tietze, Wolfgang; Cryer, Debby

    2004-01-01

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

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

    ERIC Educational Resources Information Center

    Moore, Gary T.

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

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

    ERIC Educational Resources Information Center

    Rentzou, Konstantina

    2014-01-01

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


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

    ERIC Educational Resources Information Center

    Rentzou, Konstantina

    2014-01-01

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

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

    ERIC Educational Resources Information Center

    Honig, Alice Sterling

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


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

    ERIC Educational Resources Information Center

    Signer, Sheila M., Ed.; And Others

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


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

    ERIC Educational Resources Information Center

    Gonzalez-Mena, Janet

    2011-01-01

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

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

    ERIC Educational Resources Information Center

    Gonzalez-Mena, Janet

    2011-01-01

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


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

    ERIC Educational Resources Information Center

    Mortensen, Jennifer A.; Barnett, Melissa A.

    2015-01-01

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


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

    ERIC Educational Resources Information Center

    Mortensen, Jennifer A.; Barnett, Melissa A.

    2015-01-01

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

  20. Infant-Toddler Group Day Care: A Review of Research.

    ERIC Educational Resources Information Center

    Kilmer, Sally

    Research conducted in the United States and Canada on the effects of group care outside of family settings for 20 or more hours per week on a regular basis shows few differences between day care and home reared children on four major variables: attachment, social interactions, cognitive development, and physical health. Of nine studies of…

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

    ERIC Educational Resources Information Center

    Siren-Tiusanen, Helena; Robinson, Helja Antola

    2001-01-01

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

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

    ERIC Educational Resources Information Center

    Ackerman, Debra J.; Barnett, W. Steven

    2009-01-01

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

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

    ERIC Educational Resources Information Center

    Hignett, William F.

    1988-01-01

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

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

    ERIC Educational Resources Information Center

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

    2009-01-01

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

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

    ERIC Educational Resources Information Center

    McMullen, Mary Benson; Apple, Peggy

    2012-01-01

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

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

    ERIC Educational Resources Information Center

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

    2015-01-01

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

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

    ERIC Educational Resources Information Center

    Fenichel, Emily, Ed.

    2003-01-01

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

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

    ERIC Educational Resources Information Center

    Fenichel, Emily, Ed.

    2002-01-01

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

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

    ERIC Educational Resources Information Center

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

    2006-01-01

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

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

    ERIC Educational Resources Information Center

    Rentzou, Konstantina

    2012-01-01

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

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

    ERIC Educational Resources Information Center

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

    2005-01-01

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


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

    ERIC Educational Resources Information Center

    Britt, Donna R.; Gillespie, Linda Groves

    2008-01-01

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

  13. Quality Childcare Top Priority in South Dakota

    ERIC Educational Resources Information Center

    Daniels, Ann Michelle; Wilson, Ann

    2005-01-01

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


  14. Quality Childcare Top Priority in South Dakota

    ERIC Educational Resources Information Center

    Daniels, Ann Michelle; Wilson, Ann

    2005-01-01

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

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

    ERIC Educational Resources Information Center

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

    2016-01-01

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


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

    ERIC Educational Resources Information Center

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

    2016-01-01

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

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

    ERIC Educational Resources Information Center

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

    2009-01-01

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

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

    ERIC Educational Resources Information Center

    Pawl, Jeree, Ed.; And Others

    1989-01-01

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

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

    ERIC Educational Resources Information Center

    Field, Tiffany; And Others

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

  20. Initial Development of the Infant/Toddler Sensory Profile.

    ERIC Educational Resources Information Center

    Dunn, Winnin; Daniels, Debora B.

    2002-01-01

    Parents of 401 infants and toddlers completed the 81-item Infant/Toddler Sensory Profile. Findings suggest that 48 items best characterized sensory processing for children 7-36 months, whereas 36 items appeared relevant for children birth-6 months. Reliability analyses were consistent with clusters identified in Dunn's model of sensory processing…

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

    ERIC Educational Resources Information Center

    Horne, Richard, Ed.

    1990-01-01

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

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

    ERIC Educational Resources Information Center

    Casby, Michael W.

    2003-01-01

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

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

    ERIC Educational Resources Information Center

    Casby, Michael W.

    2003-01-01

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


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

    ERIC Educational Resources Information Center

    Dodd, Christopher J.; Castle, Michael N.

    2006-01-01

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

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

    ERIC Educational Resources Information Center

    Goble, Carla B.; Horm, Diane M.

    2009-01-01

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

  6. Timing of High-Quality Child Care and Cognitive, Language, and Preacademic Development

    PubMed Central

    Li, Weilin; Farkas, George; Duncan, Greg J.; Burchinal, Margaret R.; Vandell, Deborah Lowe

    2014-01-01

    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 care quality during the 2 developmental periods. Findings indicated that cognitive, language, and preacademic skills prior to school entry were highest among children who experienced high-quality care 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-quality care 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-quality infant–toddler care, irrespective of preschool care, was related to better memory skills at the end of the preschool period. PMID:23127299

  7. Quick Quality Check for Infant and Toddler Programs.

    ERIC Educational Resources Information Center

    Knoll, Michelle; O'Brien, Marion

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


  8. Quality in Inclusive and Noninclusive Infant and Toddler Classrooms

    ERIC Educational Resources Information Center

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

    2007-01-01

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

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

    ERIC Educational Resources Information Center

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

    2014-01-01

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

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

    ERIC Educational Resources Information Center

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

    2016-01-01

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

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

    ERIC Educational Resources Information Center

    Moreno, Amanda J.; Klute, Mary M.

    2011-01-01

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

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

    ERIC Educational Resources Information Center

    Moreno, Amanda J.; Klute, Mary M.

    2011-01-01

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


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

    ERIC Educational Resources Information Center

    Gilbert, Jaesook L.

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

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

    ERIC Educational Resources Information Center

    Fenichel, Emily, Ed.

    2002-01-01

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


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

    ERIC Educational Resources Information Center

    Gonzalez-Mena, Janet

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


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

    ERIC Educational Resources Information Center

    Bricker, Diane; Bricker, William

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

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

    ERIC Educational Resources Information Center

    Ebbeck, Marjory; Yim, Hoi Yin Bonnie

    2009-01-01

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

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

    ERIC Educational Resources Information Center

    Sikder, Shukla

    2015-01-01

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


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

    ERIC Educational Resources Information Center

    Prieto, H. Victoria

    2009-01-01

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

  20. Simple Steps: Developmental Activities for Infants, Toddlers, and Two-Year-Olds.

    ERIC Educational Resources Information Center

    Miller, Karen

    This book for caregivers and parents provides over 300 activities based on the developmental needs of infants, toddlers, and 2-year-olds. The book describes key developmental stages to assist caregivers in identifying developmentally appropriate activities. Following an introductory chapter, the book is organized by developmental domains. Each…

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

    ERIC Educational Resources Information Center

    Honig, Alice Sterling

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

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

    ERIC Educational Resources Information Center

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

    2011-01-01

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

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

    ERIC Educational Resources Information Center

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

    2011-01-01

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


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

    Technology Transfer Automated Retrieval System (TEKTRAN)

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

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

    ERIC Educational Resources Information Center

    Ebbeck, Marjory; Yim, Hoi Yin Bonnie

    2009-01-01

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


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

    ERIC Educational Resources Information Center

    DiLauro, Elizabeth; Jones, Lynn; Nelson, Florence

    2007-01-01

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

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

    ERIC Educational Resources Information Center

    Sikder, Shukla

    2015-01-01

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

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

    PubMed Central

    2013-01-01

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

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

    ERIC Educational Resources Information Center

    Mazyck, Aurelia

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

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

    MedlinePLUS

    ... opportunities and partnerships to build more coordinated, effective early childhood systems. WHAT'S NEW Poverty's Effect on Infants and ... Abuse and Neglect Child Care DC: 0-3R Early Childhood Mental Health Early Development Early Language and Literacy ...

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

    ERIC Educational Resources Information Center

    Honig, Alice Sterling

    2004-01-01

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

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

    ERIC Educational Resources Information Center

    Honig, Alice Sterling

    2005-01-01

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


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

    ERIC Educational Resources Information Center

    Fenichel, Emily, Ed.

    1995-01-01

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


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

    ERIC Educational Resources Information Center

    Gonzalez-Mena, Janet

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


  15. Resources within Reason: Resources for Working with Infants, Toddlers, and Young Children Who Are Blind or Visually Impaired.

    ERIC Educational Resources Information Center

    Hatton, Deborah; Catlett, Camille; Winton, Pamela J.; Mitchell, Anna

    2002-01-01

    This article reviews eight resources for working with infants, toddlers, and young children who are blind or visually impaired. Resources include a guide on early intervention with young children with multiple disabilities, a manual on developmental guidelines for infants with visual impairments, a video on early concept development, and Web…

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

    ERIC Educational Resources Information Center

    Morrissey, Anne-Marie

    2014-01-01

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

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

    ERIC Educational Resources Information Center

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

    2013-01-01

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


  18. Comprehensive Training of Personnel and Technical Assistance in Establishment of Home Intervention Program for Families of Infants, Toddlers, and Preschool Aged Children with Hearing Impairment. Final Report.

    ERIC Educational Resources Information Center

    Barringer, Don; Johnson, Dorothy

    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…

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

    ERIC Educational Resources Information Center

    Honig, Alice Sterling

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

  20. Identifying health care quality attributes.

    PubMed

    Ramsaran-Fowdar, Roshnee R

    2005-01-01

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

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

    ERIC Educational Resources Information Center

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

    2001-01-01

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

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

    ERIC Educational Resources Information Center

    Churchill, Robin B.; Pickering, Larry K.

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


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

    ERIC Educational Resources Information Center

    Kendall, Earline D.; Moukaddem, Virginia E.

    1992-01-01

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

  4. Child Care Cost and Quality.

    ERIC Educational Resources Information Center

    Helburn, Suzanne W.; Howes, Carollee

    1996-01-01

    Current knowledge about the cost and quality of full-time child care in centers and family care homes is summarized, with a discussion of parental attention to quality in making child care decisions. Data from two recent national studies suggest that quality is only modestly related to cost. (SLD)

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

    ERIC Educational Resources Information Center

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

    1999-01-01

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


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

    ERIC Educational Resources Information Center

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

    2000-01-01

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

  7. Promising. Quality of care.

    PubMed

    Eleserio, G L

    1998-01-01

    Family planning (FP) and reproductive health (RH) care services need to be of good or better quality in order to attract and retain contraceptive acceptors and users. Nongovernmental organizations (NGOs) provide a large share of overall family planning services in the Philippines, a country with a high degree of unmet need for family planning. There are an estimated 3-4 million women in the Philippines who need contraception, but are currently not using a method due to a variety of reasons, including side effects, health concerns, inconvenience of method use, and difficult access to and availability of methods. One important element to providing high-quality services is to provide clients with complete information on all available methods and friendly counseling to those who have decided to use a certain method. Improving the quality of care (QOC) is a major objective of the NGO track of the Strengthening the Management and Field Implementation of the Family Planning/Reproductive Health Program. Operating since 1994, the UN Population Fund-assisted program is comprised of the NGO track, the Department of Health track, and the Local Government Unit track. The NGO track aims to improve the QOC in 1317 NGO service outlets. Moreover, the NGO track hopes to strengthen the management and implementation of the FP/RH service program, expand the range of RH services provided, and increase community support and cost-sharing for the FP/RH program. An overview is presented of how the QOC program in the NGO track was implemented during the first 2 years of the 4-year project period. PMID:12294070

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

    ERIC Educational Resources Information Center

    Squibb, Betsy

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

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

    ERIC Educational Resources Information Center

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

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

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

    ERIC Educational Resources Information Center

    Collier, Albert M.; Henderson, Frederick W.

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


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

    ERIC Educational Resources Information Center

    Barros, Sílvia; Leal, Teresa B.

    2015-01-01

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

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

    ERIC Educational Resources Information Center

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

    2007-01-01

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

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

    ERIC Educational Resources Information Center

    Fenichel, Emily, Ed.

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

  14. [Quality management in palliative care].

    PubMed

    Cottier, Christoph

    2012-02-01

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

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

    ERIC Educational Resources Information Center

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

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


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

    ERIC Educational Resources Information Center

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

    2012-01-01

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

  17. Providing Accessible Statewide Inservice Training for Practicing Professionals and Paraprofessionals Working with Infants, Toddlers, and Preschoolers Who Are Deaf or Hard of Hearing and Their Families. SKI-HI Distance Education Project, Final Report.

    ERIC Educational Resources Information Center

    Barringer, Donald; Glover, Barbara; Parlin, Mary Ann; Johnson, Dorothy

    This final report discusses the outcomes of a project that developed, demonstrated, evaluated, and disseminated information about a specialized inservice training model to prepare early interventionists, special education teachers, and related service personnel to provide family-centered programming to infants, toddlers, and preschoolers who are…

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

    ERIC Educational Resources Information Center

    Boston Medical Center, MA. Doc4Kids Project.

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

  19. Early Childhood Care, Work, and Family in Japan: Trends in a Society of Smaller Families.

    ERIC Educational Resources Information Center

    Newport, Sally F.

    2001-01-01

    Examined opinions of diverse parents, teachers, and academics regarding Japanese society, its infant/toddler care system, labor force, and family. Found evidence of a difficult transition in the culture of child rearing, including increased caregiver responsibility for child rearing and increased anxiety about parenting among young mothers.…

  20. Perspectives on Home Care Quality

    PubMed Central

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

    1994-01-01

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

  1. Quality of Care: Local Variations.

    ERIC Educational Resources Information Center

    Gariboldi, Antonio; Livraghi, Paola

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


  2. Helping You Choose Quality Behavioral Health Care

    MedlinePLUS

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

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

    ERIC Educational Resources Information Center

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

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

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

    ERIC Educational Resources Information Center

    Goodrich, Samantha; Mudrick, Hannah; Robinson, JoAnn

    2015-01-01

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

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

    ERIC Educational Resources Information Center

    Goodrich, Samantha; Mudrick, Hannah; Robinson, JoAnn

    2015-01-01

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


  6. Measuring quality of maternity care.

    PubMed

    Collins, Katherine J; Draycott, Timothy

    2015-11-01

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

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

    ERIC Educational Resources Information Center

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

    2006-01-01

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


  8. Infants & Toddlers: "Baby Moves"

    ERIC Educational Resources Information Center

    Honig, Alice Sterling

    2007-01-01

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

  9. Quality in rheumatoid arthritis care.

    PubMed

    Mahmood, Sehrash; Lesuis, Nienke; van Tuyl, Lilian H D; van Riel, Piet; Landewé, Robert

    2015-01-01

    While most rheumatology practices are characterized by strong commitment to quality of care and continuous improvement to limit disability and optimize quality of life for patients and their families, the actual step toward improvement is often difficult. This is because there are still barriers to be addressed and facilitators to be captured before a satisfying and cost-effective practice management is installed. Therefore, this review aims to assist practicing rheumatologists with quality improvement of their daily practice, focusing on care for rheumatoid arthritis (RA) patients. First we define 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". Often quality is determined by the interplay between structure, processes, and outcomes of care, which is also reflected in the corresponding indicators to measure quality of care. Next, a brief overview is given of the current treatment strategies used in RA, focusing on the tight control strategy, since this strategy forms the basis of international treatment guidelines. Adherence to tight control strategies leads, also in daily practice, to better outcomes in patients with regard to disease control, functional status, and work productivity. Despite evidence in favor of tight control strategies, adherence in daily practice is often challenging. Therefore, the next part of the review focuses on possible barriers and facilitators of adherence, and potential interventions to improve quality of care. Many different barriers and facilitators are known and targeting these can be effective in changing care, but these effects are rather small to moderate. With regard to RA, few studies have tried to improve care, such as a study aiming to increase the number of disease activity measures done by a combination of education and feedback. Two out of the three studies showed markedly positive effects of their interventions, suggesting that change is possible. Finally, a simple step-by-step plan is described, which could be used by rheumatologists in daily practice wanting to improve their RA patient care. PMID:26697773

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

    ERIC Educational Resources Information Center

    Center for the Study of Social Policy, 2009

    2009-01-01

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

  11. Child Care Subsidy and Quality

    ERIC Educational Resources Information Center

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

    2004-01-01

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


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

    ERIC Educational Resources Information Center

    Brower, Mary R.; Sull, Theresa M.

    2003-01-01

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


  13. Defining Quality Child Care: Multiple Stakeholder Perspectives

    ERIC Educational Resources Information Center

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

    2007-01-01

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

  14. Defining Quality Child Care: Multiple Stakeholder Perspectives

    ERIC Educational Resources Information Center

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

    2007-01-01

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


  15. The cost of quality in health care.

    PubMed

    Overton, D T; Delene, L M

    1992-08-01

    The potential fiscal impact of improved quality on health care providers and organizations is substantial. In this era of dwindling health care resources, proposals that may limit cost increases while improving quality represent true win-win situations. There is a need for a substantial amount of health care research in this fertile area of quality improvement. PMID:1628559

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

    PubMed Central

    Hungerford, Gabriela M.; Garcia, Dainelys

    2015-01-01

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

  17. Quality of Informal Care Is Multidimensional

    PubMed Central

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

    2010-01-01

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

  18. Strategic service quality management for health care.

    PubMed

    Anderson, E A; Zwelling, L A

    1996-01-01

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

  19. Quality of Care: A National Sample.

    ERIC Educational Resources Information Center

    Ferrari, Monica

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

  20. [Quality management in intensive care medicine].

    PubMed

    Martin, J; Braun, J-P

    2013-09-01

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

  1. [Quality management in intensive care medicine].

    PubMed

    Martin, J; Braun, J-P

    2014-02-01

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

  2. Effective Marketing of Quality Child Care.

    ERIC Educational Resources Information Center

    Caldwell, Bettye M.; Boyd, Harper W., Jr.

    1984-01-01

    Identifies negative public and professional attitudes that lie beneath the contemporary negative image of quality child care. Argues that concepts and principles of marketing are appropriate for influencing parents to choose high quality services and helping ensure that supplementary care is of sufficient quality to enhance, not inhibit, the


  3. Child Care Quality and Children's Engagement.

    ERIC Educational Resources Information Center

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

    2001-01-01

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


  4. African Primary Care Research: Quality improvement cycles

    PubMed Central

    Mash, Bob

    2014-01-01

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

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

    ERIC Educational Resources Information Center

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

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

  6. Quality of Pharmaceutical Care in Surgical Patients

    PubMed Central

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

    2014-01-01

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

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

    ERIC Educational Resources Information Center

    Child Trends, 2010

    2010-01-01

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

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

    PubMed

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

    2015-11-01

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

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

    ERIC Educational Resources Information Center

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

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

  10. Improving quality of tuberculosis care in India.

    PubMed

    Pai, Madhukar; Satyanarayana, Srinath; Hopewell, Phil

    2014-01-01

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

  11. Focus on Infants & Toddlers (Ages 0-3): A Quarterly Newsletter for the Education Community, 2000-2001.

    ERIC Educational Resources Information Center

    Barry, Virginia M., Ed.; Cantor, Patricia, Ed.

    2001-01-01

    These four quarterly newsletter issues address various topics of interest to child caregivers. Each issue includes articles on a specific theme, along with regular news or a column by an AECI Executive Board vice president. The Fall 2000 issue focuses on the special features and unique concerns of employer-sponsored child care, with one article…

  12. The quality imperative for palliative care.

    PubMed

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

    2015-02-01

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

  13. The Quality Imperative for Palliative Care

    PubMed Central

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

    2015-01-01

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

  14. Providing high-quality care in primary care settings

    PubMed Central

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

    2014-01-01

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

  15. A Conceptual Framework for Quality of Care

    PubMed Central

    Mosadeghrad, Ali Mohammad

    2012-01-01

    Despite extensive research on defining and measuring health care quality, little attention has been given to different stakeholders’ perspectives of high-quality health care services. The main purpose of this study was to explore the attributes of quality healthcare in the Iranian context. Exploratory in-depth individual and focus group interviews were conducted with key healthcare stakeholders including clients, providers, managers, policy makers, payers, suppliers and accreditation panel members to identify the healthcare service quality attributes and dimensions. Data analysis was carried out by content analysis, with the constant comparative method. Over 100 attributes of quality healthcare service were elicited and grouped into five categories. The dimensions were: efficacy, effectiveness, efficiency, empathy, and environment. Consequently, a comprehensive model of service quality was developed for health care context. The findings of the current study led to a conceptual framework of healthcare quality. This model leads to a better understanding of the different aspects of quality in health care and provides a better basis for defining, measuring and controlling quality of health care services. PMID:23922534

  16. Oregon Child Care Quality Indicators Program: QRS Profile. The Child Care Quality Rating System (QRS) Assessment

    ERIC Educational Resources Information Center

    Child Trends, 2010

    2010-01-01

    This paper presents a profile of Oregon's Child Care Quality Indicators Program prepared as part of the Child Care Quality Rating System (QRS) Assessment Study. The profile consists of several sections and their corresponding descriptions including: (1) Program Information; (2) Rating Details; (3) Quality Indicators for Center-Based Programs; (4)…

  17. [Quality assurance and quality management in intensive care].

    PubMed

    Notz, K; Dubb, R; Kaltwasser, A; Hermes, C; Pfeffer, S

    2015-11-01

    Treatment success in hospitals, particularly in intensive care units, is directly tied to quality of structure, process, and outcomes. Technological and medical advancements lead to ever more complex treatment situations with highly specialized tasks in intensive care nursing. Quality criteria that can be used to describe and correctly measure those highly complex multiprofessional situations have only been recently developed and put into practice.In this article, it will be shown how quality in multiprofessional teams can be definded and assessed in daily clinical practice. Core aspects are the choice of a nursing theory, quality assurance measures, and quality management. One possible option of quality assurance is the use of standard operating procedures (SOPs). Quality can ultimately only be achieved if professional groups think beyond their boundaries, minimize errors, and establish and live out instructions and SOPs. PMID:26472462

  18. Child Care Subsidy and Program Quality Revisited

    ERIC Educational Resources Information Center

    Antle, Becky F.; Frey, Andy; Barbee, Anita; Frey, Shannon; Grisham-Brown, Jennifer; Cox, Megan

    2008-01-01

    Research Findings: Previous research has documented conflicting results on the relationship between program quality and the percentage of children receiving subsidized child care (subsidy density) in early childhood centers. This research examined the relationship between subsidy density and the quality of infant and preschool classrooms in child…

  19. Quality Child Care: At Whose Expense?

    ERIC Educational Resources Information Center

    Roseman, Marilyn J.

    1999-01-01

    Quality child care is related to the number of adequately prepared practitioners. Unfortunately, workers subsidize the cost of quality by working for substandard wages, few benefits, and little recognition. The need for adequate compensation is the most critical issue facing the profession, and the cost should be shared by all members of society.…

  20. Providing quality end-of-life care.

    PubMed

    Rich, Suzanne

    2005-01-01

    End-of-life care involves not only the care of patients but also the care of those providing care for patients. The routine demands of providing care for patients in end-of-life situations often prevent nurses from working through the grief associated with the death of a patient, resulting in frustration, depression, stress, and eventually, burnout. It is important to recognize that grief and mourning are necessary steps in adjusting to the loss associated with the death of a patient or a loved one. The process of mourning can be likened to the process of healing, with predictable stages or tasks. As nurses providing quality end-of-life care, we can provide an opportunity for a patient's family to begin the process of grieving through appropriate interventions while the patient is still in the hospital or care facility. Recognizing and respecting the appropriateness of individual differences in grief responses creates a means of support for both patients and professionals in healthcare settings. By understanding grief as a predictable, yet individual, response to the loss of a patient or a loved one, we, as nurses, can take care of ourselves while providing quality end-of-life care for our patients. PMID:15855863

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

    ERIC Educational Resources Information Center

    Ireland, Lynda

    2007-01-01

    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…

  2. Quality of trauma care and trauma registries.

    PubMed

    Pino Sánchez, F I; Ballesteros Sanz, M A; Cordero Lorenzana, L; Guerrero López, F

    2015-03-01

    Traumatic disease is a major public health concern. Monitoring the quality of services provided is essential for the maintenance and improvement thereof. Assessing and monitoring the quality of care in trauma patient through quality indicators would allow identifying opportunities for improvement whose implementation would improve outcomes in hospital mortality, functional outcomes and quality of life of survivors. Many quality indicators have been used in this condition, although very few ones have a solid level of scientific evidence to recommend their routine use. The information contained in the trauma registries, spread around the world in recent decades, is essential to know the current health care reality, identify opportunities for improvement and contribute to the clinical and epidemiological research. PMID:25241631

  3. Uncompensated care and quality assurance among rural hospitals.

    PubMed

    Lee, Doohee; Dixon, Chris; Kruszynski, Paul; Coustasse, Alberto

    2010-07-01

    Health care disparities in rural areas remain significant in the U.S. health care industry. Uncompensated care makes health care disparities in rural areas worse, and rural hospitals are unfavorably positioned to compete with urban hospitals in the economic-downturn marketplace. How uncompensated care affects quality care among rural hospitals has been lightly investigated. Given that many rural residents experience difficulty accessing high quality care and given the importance of establishing quality care practice standards in a rural setting, we conducted a systematic literature review to identify some quality-care barriers and opportunities and suggested strategies to strengthen the position of rural hospitals in response to uncompensated care. PMID:20582851

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

    PubMed

    Fullerton, Birgit; Nolte, Ellen; Erler, Antje

    2011-01-01

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

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

    PubMed Central

    Pera, Pilar Isla

    2011-01-01

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

  6. Quality indicators for paediatric palliative care

    PubMed Central

    Charlebois, Janie; Cyr, Claude

    2015-01-01

    OBJECTIVES: To apply quality indicators for paediatric palliative care and evaluate performance in one service provision area. METHODS: After institutional review board approval, medical records were abstracted for well-defined and measurable quality indicators for children with chronic complex conditions (CCCs) between January 2006 and December 2011 (n=50) at a university medical centre. RESULTS: Of the 50 children with a CCC (mean age 64 months, 48% female), 39 (78%) died in hospital, 11 (22%) died at home and 13 (26%) were <1 month of age. In the final month of their life, 10 patients (20%) required an unplanned visit to the emergency department and seven (14%) were admitted. Only four patients (8%) were admitted for >14 days in their final month of life. Goals of care were addressed in a timely manner 60% of the time. An invasive procedure was performed in the final month of life in 27 (44%) patients. Bereavement follow-up was offered to 25 (50%) families. A palliative care consultant was involved with 17 (34%) patients. Palliative care was associated with less frequent invasive procedures in the final month of life and more frequent documentation of the preferred place of death. CONCLUSION: Performance on these particular quality indicators was unsatisfactory across a diverse group of children with CCCs, indicating important opportunities for improvement. Methods used to improve the quality of other aspects of paediatric care, including emphasis on efficient work systems, practical tools and interdisciplinary teamwork, should be used for ensuring delivery of high-quality palliative care. PMID:25914573

  7. Quality of Care in Old Age Institutions

    ERIC Educational Resources Information Center

    Kart, Cary S.; Manard, Barbara B.

    1976-01-01

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

  8. Quality of care and black American patients.

    PubMed Central

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

    1992-01-01

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

  9. Child Care Quality: An Overview for Parents. ERIC Digest.

    ERIC Educational Resources Information Center

    Patten, Peggy; Ricks, Omar Benton

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

  10. [Quality of care in adult resuscitation unit].

    PubMed

    Romero Cabrera, Daniel

    2011-12-01

    Nowadays the quality of care has become a key piece in medical assistance. Apart from doing things correctly we should have an objective knowledge of the opinion of the user That opinion could be known thanks to the analysis of the perceived quality care from the patient. From October to December of 2008 a descriptive, transversal and retrospective research has been developed in a resuscitation unit at a third level hospital of the Community of Madrid. This research has been for all the registrations to the service, through the Servqhos questionnaire. The aims of the research were to evaluate the quality perceived at the resuscitation unit; to know the profile of the patient treated and to identify the possible improvements and problems as well. The patients were anonymous and they presented themselves voluntary 19 of 42 registrations in total answered the questionnaire with a rate of reply of 45%. The average age registered were 57 years old with an average of stay of 11 days. The most prevalent pathologies were neoplasias and polytraumatisms. According to the quality perceived by the unity there has not been any relationship among gender study level, labor activity marital status and previous hospital stay. At the area of information to the patient there have been some deficiencies as well as some discrimination from the attending staff. Noise is valuated negatively by the patients. Further to the professionalism, is valuated positively at all the social classes. The global quality perceived of the unity were very good from the patient. PMID:25551917

  11. Techniques change, but quality care does not.

    PubMed

    Krecko, Lindsey

    2009-01-01

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

  12. Achieving High-Quality Multicultural Geriatric Care.

    PubMed

    2016-02-01

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

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

    ERIC Educational Resources Information Center

    Keenan, Trisha; And Others

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

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

    ERIC Educational Resources Information Center

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

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


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

    PubMed

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

    2016-03-01

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

  16. Influence of Structural Features on Portuguese Toddler Child Care Quality

    ERIC Educational Resources Information Center

    Pessanha, Manuela; Aguiar, Cecilia; Bairrao, Joaquim

    2007-01-01

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

  17. Child Care Quality in Different State Policy Contexts

    ERIC Educational Resources Information Center

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

    2007-01-01

    Using data from the Child Care Supplement to the Fragile Families and Child Wellbeing Study, we test associations between the quality of child care and state child care policies. These data, which include observations of child care and interviews with care providers and mothers for 777 children across 14 states, allow for comparisons across a…

  18. Child Care Quality in Different State Policy Contexts

    ERIC Educational Resources Information Center

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

    2007-01-01

    Using data from the Child Care Supplement to the Fragile Families and Child Wellbeing Study, we test associations between the quality of child care and state child care policies. These data, which include observations of child care and interviews with care providers and mothers for 777 children across 14 states, allow for comparisons across a


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

    PubMed

    Han, M C

    1997-01-01

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

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

    PubMed

    Qin, Hong; Prybutok, Victor; Prybutok, Gayle

    2016-01-01

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

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

    ERIC Educational Resources Information Center

    Ceglowski, Deborah A.; Davis, Elizabeth E.

    2004-01-01

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

  2. Nurse staffing and quality of patient care.

    PubMed Central

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

    2007-01-01

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

  3. Quality Child Care: Quality Care Does Mean Better Child Outcomes. NCEDL Spotlights, No. 2.

    ERIC Educational Resources Information Center

    Clifford, Dick; Peisner-Feinberg, Ellen; Culkin, Mary; Howes, Carollee; Kagan, Sharon Lynn

    This report, the second in the National Center for Early Development & Learning's (NCEDL) "Spotlight" series, is based on a summary of longitudinal results through kindergarten from the "Cost, Quality and Outcomes Study" by NCEDL. The study involved child care centers in four states and was conducted from 1993 to 1996. Researchers followed a group…

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

    ERIC Educational Resources Information Center

    Hagekull, Berit; Bohlin, Gunilla

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

  5. Differential Susceptibility to Parenting and Quality Child Care

    ERIC Educational Resources Information Center

    Pluess, Michael; Belsky, Jay

    2010-01-01

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

  6. 42 CFR 483.25 - Quality of care.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 5 2013-10-01 2013-10-01 false Quality of care. 483.25 Section 483.25 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) STANDARDS AND CERTIFICATION REQUIREMENTS FOR STATES AND LONG TERM CARE FACILITIES Requirements for Long Term Care Facilities § 483.25 Quality of...

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

    ERIC Educational Resources Information Center

    Petrogiannis, Konstantinos

    2002-01-01

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

  8. Program Quality and Licensure in Day Care Centers and Family Day Care Homes.

    ERIC Educational Resources Information Center

    Fiene, Richard; Melnick, Steven A.

    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…

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

    PubMed

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

    2016-03-01

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

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

    PubMed Central

    Alonazi, Wadi B; Thomas, Shane A

    2014-01-01

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

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

    PubMed

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

    2011-07-01

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

  12. [Quality management in intensive care medicine. Indispensable for daily routine].

    PubMed

    Martin, J; Braun, J-P

    2012-05-01

    In areas requiring maximum safety like intensive care units or operating room departments, modern quality management and risk management are essential. Treatment of critically ill patients is associated with high risk and, therefore, demands risk management and quality management. External quality assessment in intensive care medicine has been developed based on a core data set and quality indicators. A peer review procedure has been established. In addition, regional networks of intensive care physicians result in improved local networking. In intensive care medicine, this innovative modular system of quality management and risk management is pursued more consequently than in any other specialty. PMID:22526121

  13. Health Care User Perspectives on Constructing, Contextualizing, and Co-Producing "Quality of Care".

    PubMed

    Baim-Lance, Abigail; Tietz, Daniel; Schlefer, Madeleine; Agins, Bruce

    2016-01-01

    Most of the research on health care user "quality of care" perspectives seeks discrete and measurable indicators to advance quality improvement (QI) goals. This lacks sufficiently grounded query about the meaning of "quality of care" for health users, and how context influences their ideas and experiences. We studied this between 2010 and 2011, repeatedly interviewing and shadowing 45 individuals in three of New York's hospital-based outpatient HIV care settings during routine visits. We found participants using common terminology, but across the cohort meaning varied and employed personal narratives. Participants conveyed the impact of historic and current experiences of stigma and discrimination on limiting access to care, and showed its destabilizing effects on quality constructs. Participants also felt they contributed to their health care settings' delivery of quality care. From our findings, we discuss the applicability and implications of "co-production" to conceptualize health care as jointly delivered by typical "givers" and "receivers" of care. PMID:25670664

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

    ERIC Educational Resources Information Center

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

    2016-01-01

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


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

    PubMed

    Primer, M A

    1995-12-01

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

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

    PubMed

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

    2006-11-01

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

  17. Evaluating the Quality of the Child Care in Finland

    ERIC Educational Resources Information Center

    Hujala, Eeva; Fonsen, Elina; Elo, Janniina

    2012-01-01

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

  18. Evaluating the Quality of the Child Care in Finland

    ERIC Educational Resources Information Center

    Hujala, Eeva; Fonsen, Elina; Elo, Janniina

    2012-01-01

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


  19. Postacute rehabilitation quality of care: toward a shared conceptual framework.

    PubMed

    Jesus, Tiago Silva; Hoenig, Helen

    2015-05-01

    There is substantial interest in mechanisms for measuring, reporting, and improving the quality of health care, including postacute care (PAC) and rehabilitation. Unfortunately, current activities generally are either too narrow or too poorly specified to reflect PAC rehabilitation quality of care. In part, this is caused by a lack of a shared conceptual understanding of what construes quality of care in PAC rehabilitation. This article presents the PAC-rehab quality framework: an evidence-based conceptual framework articulating elements specifically pertaining to PAC rehabilitation quality of care. The widely recognized Donabedian structure, process, and outcomes (SPO) model furnished the underlying structure for the PAC-rehab quality framework, and the International Classification of Functioning, Disability and Health (ICF) framed the functional outcomes. A comprehensive literature review provided the evidence base to specify elements within the SPO model and ICF-derived framework. A set of macrolevel-outcomes (functional performance, quality of life of patient and caregivers, consumers' experience, place of discharge, health care utilization) were defined for PAC rehabilitation and then related to their (1) immediate and intermediate outcomes, (2) underpinning care processes, (3) supportive team functioning and improvement processes, and (4) underlying care structures. The role of environmental factors and centrality of patients in the framework are explicated as well. Finally, we discuss why outcomes may best measure and reflect the quality of PAC rehabilitation. The PAC-rehab quality framework provides a conceptually sound, evidence-based framework appropriate for quality of care activities across the PAC rehabilitation continuum. PMID:25542676

  20. Measurement of Quality to Improve Care in Sleep Medicine

    PubMed Central

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

    2015-01-01

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

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

    PubMed Central

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

    2010-01-01

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

  2. Tennessee Star-Quality Child Care Program: QRS Profile. The Child Care Quality Rating System (QRS) Assessment

    ERIC Educational Resources Information Center

    Child Trends, 2010

    2010-01-01

    This paper presents a profile of Tennessee's Star-Quality Child Care Program prepared as part of the Child Care Quality Rating System (QRS) Assessment Study. The profile consists of several sections and their corresponding descriptions including: (1) Program Information; (2) Rating Details; (3) Quality Indicators for Center-Based Programs; (4)…

  3. Louisiana Quality Start Child Care Rating System: QRS Profile. The Child Care Quality Rating System (QRS) Assessment

    ERIC Educational Resources Information Center

    Child Trends, 2010

    2010-01-01

    This paper presents a profile of Louisiana's Quality Start Child Care Rating System prepared as part of the Child Care Quality Rating System (QRS) Assessment Study. The profile consists of several sections and their corresponding descriptions including: (1) Program Information; (2) Rating Details; (3) Quality Indicators for Center-Based Programs;…

  4. Child Care and Mothers' Mental Health: Is High-Quality Care Associated with Fewer Depressive Symptoms?

    ERIC Educational Resources Information Center

    Gordon, Rachel A.; Usdansky, Margaret L.; Wang, Xue; Gluzman, Anna

    2011-01-01

    Finding high-quality child care may pose financial and logistical challenges and create ongoing emotional strains for some mothers. We use the Study of Early Child Care and Youth Development to ask (a) are child-care settings that mothers select on the basis of their own perceptions of quality rated more highly by independent observers (and more…

  5. Quality of care and the patient: new criteria for evaluation.

    PubMed

    Omachonu, V K

    1990-01-01

    Quality in health care has two critical components: quality in practice and quality in perception. The first involves meeting your own or some other set of standards; the second, meeting your customers' expectations. Neither of these essentials will, by itself, carry a hospital far. This article examines the extent to which customer perception is important in understanding the concept of quality in health care. PMID:2266007

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

    ERIC Educational Resources Information Center

    Blank, Helen

    1993-01-01

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

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

    PubMed

    Grigorovich, Alisa

    2016-03-01

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

  8. Quality of Care in the US Territories

    PubMed Central

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

    2011-01-01

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

  9. Quality end-of-life care: A global perspective

    PubMed Central

    Singer, Peter A; Bowman, Kerry W

    2002-01-01

    Background Quality end-of-life care has emerged as an important concept in industrialized countries. Discussion We argue quality end-of-life care should be seen as a global public health and health systems problem. It is a global problem because 85 % of the 56 million deaths worldwide that occur annually are in developing countries. It is a public health problem because of the number of people it affects, directly and indirectly, in terms of the well being of loved ones, and the large-scale, population based nature of some possible interventions. It is a health systems problem because one of its main features is the need for better information on quality end-of-life care. We examine the context of end-of-life care, including the epidemiology of death and cross-cultural considerations. Although there are examples of success, we could not identify systematic data on capacity for delivering quality end-of-life care in developing countries. We also address a possible objection to improving end-of-life care in developing countries; many deaths are preventable and reduction of avoidable deaths should be the focus of attention. Conclusions We make three recommendations: (1) reinforce the recasting of quality end-of-life care as a global public health and health systems problem; (2) strengthen capacity to deliver quality end-of-life care; and (3) develop improved strategies to acquire information about the quality of end-of-life care. PMID:12139768

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

    ERIC Educational Resources Information Center

    Hagekull, Berit; Bohlin, Gunilla

    1995-01-01

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

  11. Effects of Quality Improvement System for Child Care Centers

    ERIC Educational Resources Information Center

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

    2011-01-01

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

  12. Researcher's and Parents' Perspectives on Quality of Care and Education

    ERIC Educational Resources Information Center

    Rentzou, Konstantina; Sakellariou, Maria

    2013-01-01

    Based on arguments according to which the concept of quality is multifaceted, difficult to be defined and defined differently by various stakeholders, it has been suggested that the quality of care and education be evaluated from different perspectives if one aims to create a global picture of the early childhood education and care programmes. The…

  13. Aspects of Quality in Greek Day Care Centres.

    ERIC Educational Resources Information Center

    Melhuish, Edward C.; Petrogiannis, Konstantinos

    1996-01-01

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

  14. Using Quality Experts from Manufacturing to Transform Primary Care

    ERIC Educational Resources Information Center

    Steiner, Rose M.; Walsworth, David T.

    2010-01-01

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

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

    ERIC Educational Resources Information Center

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

    2007-01-01

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

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

    ERIC Educational Resources Information Center

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

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

  17. Does Children's Behavior Reflect Day Care Classroom Quality?

    ERIC Educational Resources Information Center

    Love, John M.

    Focusing on one aspect of a study examining the child-staff ratio in California state-subsidized day care centers, this paper explores the relationship between indicators of quality and the behavior of children in day care centers. In fall 1990, trained observers spent a week in 122 day care classrooms throughout California. During this time they…

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

    PubMed

    Kazmirski, G

    1998-11-01

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

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

    PubMed Central

    McGlynn, E A; Halfon, N

    1998-01-01

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

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

    PubMed

    Mainz, Jan; Kristensen, Solvejg; Bartels, Paul

    2015-12-01

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

  1. Systems and processes that ensure high quality care.

    PubMed

    Bassett, Sally; Westmore, Kathryn

    2012-10-01

    This is the second in a series of articles examining the components of good corporate governance. It considers how the structures and processes for quality governance can affect an organisation's ability to be assured about the quality of care. Complex information systems and procedures can lead to poor quality care, but sound structures and processes alone are insufficient to ensure good governance, and behavioural factors play a significant part in making sure that staff are enabled to provide good quality care. The next article in this series looks at how the information reporting of an organisation can affect its governance. PMID:23252087

  2. [THE ORGANIZATION OF CONTROLLING QUALITY OF ORTHODONTIC CARE OF POPULATION].

    PubMed

    Chaban, A V; Schepin, V O; Korablev, V N

    2015-01-01

    The article presents originally developed model of quality of orthodontic care of population on the level of subject of the Russian Federation. The model includes the following elements: demand of population in orthodontic care, mission of orthodontic service, regulations of orthodontic service, table of facilities, staff list, standards of evaluation of effectiveness and audit of effectiveness of orthodontic care of population, and standards of quality control. The developed standards of quality control exemplified by typical stomatological polyclinic, demonstrated reserves of further development of quality and accessibility of orthodontic service to population in functioning of medical organization. PMID:26399067

  3. HCFA's health care quality improvement program: the medical informatics challenge.

    PubMed Central

    Grant, J B; Hayes, R P; Pates, R D; Elward, K S; Ballard, D J

    1996-01-01

    The peer-review organizations (PROs) were created by Congress in 1984 to monitor the cost and quality of care received by Medicare beneficiaries. In order to do this, the Health Care Financing Administration (HCFA) contracted with the PROs through a series of contracts referred to as "Scopes of Work." Under the Fourth Scope of Work, the HCFA initiated the Health Care Quality Improvement Program (HCQIP) in 1990, as an application of the principles of continuous quality improvement. Since then, the PROs have participated with health care providers in cooperative projects to improve the quality of primarily inpatient care provided to Medicare beneficiaries. Through HCFA-supplied administrative data and clinical data abstracted from patient records, the PROs have been able to identify opportunities for improvements in patient care. In May 1995, the HCFA proposed a new Fifth Scope of Work, which will shift the focus of HCQIP from inpatient care projects to projects in outpatient and managed care settings. This article describes the HCQIP process, the types of data used by the PROs to conduct cooperative projects with health care providers, and the informatics challenges in improving the quality of care received by Medicare beneficiaries. PMID:8750387

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

    PubMed Central

    Jeon, Sangchoon; Rosenthal, Marjorie S.

    2013-01-01

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

  5. Women's and care providers' perspectives of quality prenatal care: a qualitative descriptive study

    PubMed Central

    2012-01-01

    Background Much attention has been given to the adequacy of prenatal care use in promoting healthy outcomes for women and their infants. Adequacy of use takes into account the timing of initiation of prenatal care and the number of visits. However, there is emerging evidence that the quality of prenatal care may be more important than adequacy of use. The purpose of our study was to explore women's and care providers' perspectives of quality prenatal care to inform the development of items for a new instrument, the Quality of Prenatal Care Questionnaire. We report on the derivation of themes resulting from this first step of questionnaire development. Methods A qualitative descriptive approach was used. Semi-structured interviews were conducted with 40 pregnant women and 40 prenatal care providers recruited from five urban centres across Canada. Data were analyzed using inductive open and then pattern coding. The final step of analysis used a deductive approach to assign the emergent themes to broader categories reflective of the study's conceptual framework. Results The three main categories informed by Donabedian's model of quality health care were structure of care, clinical care processes, and interpersonal care processes. Structure of care themes included access, physical setting, and staff and care provider characteristics. Themes under clinical care processes were health promotion and illness prevention, screening and assessment, information sharing, continuity of care, non-medicalization of pregnancy, and women-centredness. Interpersonal care processes themes were respectful attitude, emotional support, approachable interaction style, and taking time. A recurrent theme woven throughout the data reflected the importance of a meaningful relationship between a woman and her prenatal care provider that was characterized by trust. Conclusions While certain aspects of structure of care were identified as being key dimensions of quality prenatal care, clinical and interpersonal care processes emerged as being most essential to quality care. These processes are important as they have a role in mitigating adverse outcomes, promoting involvement of women in their own care, and keeping women engaged in care. The findings suggest key considerations for the planning, delivery, and evaluation of prenatal care. Most notably, care should be woman-centred and embrace shared decision making as an essential element. PMID:22502640

  6. Nutritional intervention and quality of life in palliative care patients.

    PubMed

    Fleming, Mick; Hollins Martin, Caroline J; Martin, Colin R

    Quality of life measures can be used by health professionals to assess effectiveness of nutritional interventions administered to palliative care patients. Stabilizing, maintaining and attempting to increase weight in palliative care patients through the support of oral feeding, and provision of artificial feeding, has been shown to mediate the metabolic and physical wasting effects of the disease process and improve general comfort. A quality of life instrument is a multi-dimensional questionnaire that health professionals can use to measure domains relating to physical, psychological and social aspects of living, and health and disease outcomes. There are three instruments specifically designed to assess quality of life in patients receiving palliative care. These are: The Palliative Care Quality of life Instrument, The Assessment of Quality of Life at the End of Life (AQEL), and The Spitzer Quality of Life Index (SQLI). General use quality of life measures are multifaceted; however, for use with palliative care patients, they have added dimensions of spirituality, existential issues (purpose and meaning of life), family members' perceptions of quality of care, symptom control and family support. Use of quality of life scales provides health professionals and organizations with an ideal measure for planning, targeting and evaluating health interventions. PMID:22068011

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

    PubMed

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

    2016-02-01

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

  8. [Elaboration of health care quality criteria in maxillofacial surgery].

    PubMed

    Kulakov, A A; Butova, V G; Chkadua, T Z

    2015-01-01

    Criteria of quality of care in oral and maxillofacial surgery should reflect not only the quality of the repair functions of chewing, swallowing, breathing, speech, and should take into account the psycho-emotional condition of the patient; satisfaction of its appearance, quality cosmetic fill configuration of the face, tooth defects, smiles; adaptation to implants and dentures; their quality, the conditions and possibilities of their use. The application of the provisions of the international classification of functioning, disability and health in oral and maxillofacial surgery, is a condition that will allow to unify the approaches to the development of quality criteria of this type of medical care. PMID:26145471

  9. Nursing Home Care Quality: Insights from a Bayesian Network Approach

    ERIC Educational Resources Information Center

    Goodson, Justin; Jang, Wooseung; Rantz, Marilyn

    2008-01-01

    Purpose: The purpose of this research is twofold. The first purpose is to utilize a new methodology (Bayesian networks) for aggregating various quality indicators to measure the overall quality of care in nursing homes. The second is to provide new insight into the relationships that exist among various measures of quality and how such measures…

  10. Quality Matters in Early Childhood Education and Care: Slovak Republic

    ERIC Educational Resources Information Center

    Taguma, Miho; Litjens, Ineke; Makowiecki, Kelly

    2012-01-01

    Early childhood education and care (ECEC) is a topic of increased policy interest in the Slovak Republic where improving quality in the ECEC sector is a subject of growing importance. The OECD has identified five effective policy levers to encourage quality in the sector: 1) quality goals and regulations; 2) curriculum and guidelines; 3)


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

    ERIC Educational Resources Information Center

    Barros, Silvia; Aguiar, Cecilia

    2010-01-01

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

  12. Nursing Home Care Quality: Insights from a Bayesian Network Approach

    ERIC Educational Resources Information Center

    Goodson, Justin; Jang, Wooseung; Rantz, Marilyn

    2008-01-01

    Purpose: The purpose of this research is twofold. The first purpose is to utilize a new methodology (Bayesian networks) for aggregating various quality indicators to measure the overall quality of care in nursing homes. The second is to provide new insight into the relationships that exist among various measures of quality and how such measures


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

    ERIC Educational Resources Information Center

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

    2000-01-01

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

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

    PubMed

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

    2008-01-01

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

  15. Multimorbidity and Quality of Preventive Care in Swiss University Primary Care Cohorts

    PubMed Central

    Streit, Sven; da Costa, Bruno R.; Bauer, Douglas C.; Collet, Tinh-Hai; Weiler, Stefan; Zimmerli, Lukas; Frey, Peter; Cornuz, Jacques; Gaspoz, Jean-Michel; Battegay, Edouard; Kerr, Eve; Aujesky, Drahomir; Rodondi, Nicolas

    2014-01-01

    Background Caring for patients with multimorbidity is common for generalists, although such patients are often excluded from clinical trials, and thus such trials lack of generalizability. Data on the association between multimorbidity and preventive care are limited. We aimed to assess whether comorbidity number, severity and type were associated with preventive care among patients receiving care in Swiss University primary care settings. Methods We examined a retrospective cohort composed of a random sample of 1,002 patients aged 50–80 years attending four Swiss university primary care settings. Multimorbidity was defined according to the literature and the Charlson index. We assessed the quality of preventive care and cardiovascular preventive care with RAND’s Quality Assessment Tool indicators. Aggregate scores of quality of provided care were calculated by taking into account the number of eligible patients for each indicator. Results Participants (mean age 63.5 years, 44% women) had a mean of 2.6 (SD 1.9) comorbidities and 67.5% had 2 or more comorbidities. The mean Charlson index was 1.8 (SD 1.9). Overall, participants received 69% of recommended preventive care and 84% of cardiovascular preventive care. Quality of care was not associated with higher numbers of comorbidities, both for preventive care and for cardiovascular preventive care. Results were similar in analyses using the Charlson index and after adjusting for age, gender, occupation, center and number of visits. Some patients may receive less preventive care including those with dementia (47%) and those with schizophrenia (35%). Conclusions In Swiss university primary care settings, two thirds of patients had 2 or more comorbidities. The receipt of preventive and cardiovascular preventive care was not affected by comorbidity count or severity, although patients with certain comorbidities may receive lower levels of preventive care. PMID:24760077

  16. What is the cost of quality for diabetes care?

    PubMed

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

    2014-12-01

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

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

    PubMed

    Weber, Randal S

    2007-12-01

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

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

    PubMed

    Madhok, Rajan

    2002-01-01

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

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

    PubMed Central

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

    2014-01-01

    In 1999, the Institute of Medicine (IOM) published Ensuring Quality Cancer Care, an influential report that described an ideal cancer care system and issued ten recommendations to address pervasive gaps in the understanding and delivery of quality cancer care. Despite generating much fervor, the report’s recommendations—including two recommendations related to quality measurement—remain largely unfulfilled. Amidst continuing concerns regarding increasing costs and questionable quality of care, the IOM charged a new committee with revisiting the 1999 report and with reassessing national cancer care, with a focus on the aging US population. The committee identified high-quality patient-clinician relationships and interactions as central drivers of quality and attributed existing quality gaps, in part, to the nation’s inability to measure and improve cancer care delivery in a systematic way. In 2013, the committee published its findings in Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis, which included two recommendations that emphasize coordinated, patient-centered quality measurement and information technology enhancements: Develop a national quality reporting program for cancer care as part of a learning health care system; and,Develop an ethically sound learning health care information technology system for cancer that enables real-time analysis of data from cancer patients in a variety of care settings. These recommendations underscore the need for independent national oversight, public-private collaboration, and substantial funding to create robust, patient-centered quality measurement and learning enterprises to improve the quality, accessibility, and affordability of cancer care in America. PMID:24839592

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

    ERIC Educational Resources Information Center

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

    2005-01-01

    Purpose: Our objective in this study was to compare the quality of care provided under the Minnesota Senior Health Options (MSHO), a special program designed to serve dually eligible older persons, to care provided to controls who received fee-for-service Medicare and Medicaid managed care. Design and Methods: Two control groups were used; one was


  1. Better Kid Care Program Improves the Quality of Child Care: Results from an Interview Study

    ERIC Educational Resources Information Center

    Ostergren, Carol S.; Riley, David A.; Wehmeier, Jenny M.

    2011-01-01

    More high quality child care is needed in the United States. This article evaluates the Better Kid Care (BKC) program produced by Pennsylvania State University Extension. Child care staff in Wisconsin were interviewed about changes they had made in their early childhood programs following participation in the BKC program. Findings show that 2…

  2. Child-Care Subsidies: Do They Impact the Quality of Care Children Experience?

    ERIC Educational Resources Information Center

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

    2012-01-01

    The federal child-care subsidy program represents one of the government's largest investments in early care and education, but little is known about whether it increases low-income children's access to higher quality child care. This study used newly available nationally representative data on 4-year-old children (N = 750) to investigate whether


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

    ERIC Educational Resources Information Center

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

    2005-01-01

    Purpose: Our objective in this study was to compare the quality of care provided under the Minnesota Senior Health Options (MSHO), a special program designed to serve dually eligible older persons, to care provided to controls who received fee-for-service Medicare and Medicaid managed care. Design and Methods: Two control groups were used; one was…

  4. Child-Care Subsidies: Do They Impact the Quality of Care Children Experience?

    ERIC Educational Resources Information Center

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

    2012-01-01

    The federal child-care subsidy program represents one of the government's largest investments in early care and education, but little is known about whether it increases low-income children's access to higher quality child care. This study used newly available nationally representative data on 4-year-old children (N = 750) to investigate whether…

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

    PubMed Central

    2011-01-01

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

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

    PubMed Central

    Joseph Hotz, V.; Xiao, Mo

    2011-01-01

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

  7. The quality-value proposition in health care.

    PubMed

    Feazell, G Landon; Marren, John P

    2003-01-01

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

  8. Helping You Choose Quality Hospice Care

    MedlinePLUS

    ... Systems Chapter Measurement Measurement Performance Measurement Pioneers in Quality Health Services Research Accountability Measures Annual Report - Improving America's Hospitals Quick Links Core Measure Sets Specifications Manual for ...

  9. Helping You Choose Quality Ambulatory Care

    MedlinePLUS

    ... Systems Chapter Measurement Measurement Performance Measurement Pioneers in Quality Health Services Research Accountability Measures Annual Report - Improving America's Hospitals Quick Links Core Measure Sets Specifications Manual for ...

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

    PubMed

    Fiscella, Kevin; Sanders, Mechelle R

    2016-03-18

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

  11. Nebraska: Early Head Start Initiative

    ERIC Educational Resources Information Center

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

    2012-01-01

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


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

    PubMed Central

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

    2014-01-01

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

  13. [Trust, a support for the quality of care].

    PubMed

    Michon, Florence

    2013-10-01

    Trust in health care is built gradually thanks to the interpersonal skills of the caregivers. There are different types of levers, mainly personal and inter-personal, to be used to develop this trust, which enables nursing staff to deliver high-quality care. PMID:24245036

  14. Economics and quality of care: are they in competition?

    NASA Astrophysics Data System (ADS)

    Simmons, Joan

    1995-10-01

    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 quality care. 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.

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

    PubMed

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

    2015-01-01

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

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

    PubMed

    Roberts, Velma; Perryman, Martha M

    2007-01-01

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

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

    PubMed Central

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

    2015-01-01

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

  18. Women's perceptions of quality and benefits of postpartum care.

    PubMed

    Hunter, M A; Larrabee, J H

    1998-12-01

    Increased competition in the United States has led to increased interest in women's perceptions of their obstetric experience. Family-centered postpartum care (FCPPC) was originated to improve women's perceptions of care quality. This study examined differences in and the hypothesized relationship between quality and beneficence in a group receiving traditional postpartum care (TPPC) and a group receiving FCPPC in a safety-net hospital in West Tennessee. Both groups had high mean quality and beneficence scores; however, the FCPPC group's scores were significantly higher than those of the TPPC group. There was a relationship between quality and beneficence for the combined sample. The findings suggest that nurses should incorporate FCPPC approaches as a means of improving perceived quality and benefits. PMID:9842172

  19. [Quality of life in palliative care--a comparison of hospital and home care].

    PubMed

    Jocham, Hubert R

    2006-06-01

    The aim of palliative care for seriously ill and dying patients suffering from oncological diseases is to obtain or enhance the quality of their lifes. It will become more and more necessary to evaluate and record the efficiency of different kinds of medical care with reliable and validated instruments. Professional home care will gain in importance for various political and economic reasons. The central question asked of palliative care will be how outpatient and inpatient care affects quality of life and if differences can be detected between both kinds of care. A representative group of 121 patients was chosen from a group of 250 terminally ill cancer patients who were either in ambulant or inpatient palliative care (outpatients n = 57, inpatients n = 64). Within the first 24 hours after either admission into the palliative sector of a hospital or first contact with the ambulant "Palliative Home Care Team" at home the patient's quality of life was estimated. After one week another estimation followed. The questionnaire EORTC-QLQ-C30, developed by the European Organisation for Research and Treatment of Cancer and translated into German, was used for this. Both groups of patients were homogeneous in their demographic parameters. In both groups improvements in nearly every dimension of quality of life were achieved between the first and the second assessment. The dimensions of symptom control (pain, fatigue, vomiting, and breathlessness) improved most distinctively in the outpatient care group. The German EORTC-QLQ-C30 turned out to be a reliable evaluation instrument for measuring patients' quality of life in out-patient or inpatient palliative care. Ambulant care always has to be considered as an alternative to inpatient care without leading to any quality deficits. PMID:16826966

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

    ERIC Educational Resources Information Center

    Gilbert, Jaesook Lee; Harte, Helene Arbouet

    2013-01-01

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

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

    PubMed

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

    2007-08-01

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

  2. Mentoring Means Higher Quality Care for Children.

    ERIC Educational Resources Information Center

    Mattern, Valerie; Scott, Barbara

    1999-01-01

    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…

  3. Increasing Quality in Early Care and Learning Environments

    ERIC Educational Resources Information Center

    Fontaine, Nancy S.; Torre, L. Dee; Grafwallner, Rolf; Underhill, Brian

    2006-01-01

    High-quality care is essential to the optimal development of young children. While many children attend childcare away from the home for an average of six hours per day, the environment is not necessarily of the highest quality. An assessment of the indoor and outdoor space, curriculum and activities, teacher and child interactions, materials,…

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

    ERIC Educational Resources Information Center

    Taguma, Miho; Litjens, Ineke; Makowiecki, Kelly

    2013-01-01

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


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

    ERIC Educational Resources Information Center

    Taguma, Miho; Litjens, Ineke; Makowiecki, Kelly

    2013-01-01

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

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

    ERIC Educational Resources Information Center

    Mocan, H. Naci

    1997-01-01

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

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

    ERIC Educational Resources Information Center

    Taguma, Miho; Litjens, Ineke; Makowiecki, Kelly

    2012-01-01

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

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

    ERIC Educational Resources Information Center

    Ridley, Stephanie Maher; McWilliam, R. A.

    2001-01-01

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


  9. Factors Affecting the Quality of Diabetic Care in Primary Care Settings in Oman

    PubMed Central

    Al-Azri, Mohammed; Al-Azri, Hilal; Al-Hashmi, Fatma; Al-Rasbi, Samira; El-Shafie, Kawther; Al-Maniri, Abdullah

    2011-01-01

    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. PMID:21969892

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

    PubMed Central

    Yin, Aitian; Mao, Zongfu; Liu, Xiaoyun

    2015-01-01

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

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

    PubMed

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

    1995-01-01

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

  12. Quality of Life and Supportive Care in Multiple Myeloma

    PubMed Central

    Cömert, Melda; Güne?, Ajda Ersoy; ?ahin, Fahri; Saydam, Güray

    2013-01-01

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

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

    PubMed Central

    van Dam, P.A.; Verkinderen, L.; Hauspy, J.; Vermeulen, P.; Dirix, L.; Huizing, M.; Altintas, S.; Papadimitriou, K.; Peeters, M.; Tjalma, W.

    2013-01-01

    Quality Indicators (QIs) are measures of health care quality that make use of readily available hospital inpatient administrative data. Assessment quality of care can be performed on different levels: national, regional, on a hospital basis or on an individual basis. It can be a mandatory or voluntary system. In all cases development of an adequate database for data extraction, and feedback of the findings is of paramount importance. In the present paper we performed a Medline search on “QIs and breast cancer” and “benchmarking and breast cancer care”, and we have added some data from personal experience. The current data clearly show that the use of QIs for breast cancer care, regular internal and external audit of performance of breast units, and benchmarking are effective to improve quality of care. Adherence to guidelines improves markedly (particularly regarding adjuvant treatment) and there are data emerging showing that this results in a better outcome. As quality assurance benefits patients, it will be a challenge for the medical and hospital community to develop affordable quality control systems, which are not leading to excessive workload. PMID:24753926

  14. Managed Care, Physician Job Satisfaction, and the Quality of Primary Care

    PubMed Central

    Grembowski, David; Paschane, David; Diehr, Paula; Katon, Wayne; Martin, Diane; Patrick, Donald L

    2005-01-01

    OBJECTIVE To determine the associations between managed care, physician job satisfaction, and the quality of primary care, and to determine whether physician job satisfaction is associated with health outcomes among primary care patients with pain and depressive symptoms. DESIGN Prospective cohort study. SETTING Offices of 261 primary physicians in private practice in Seattle. PATIENTS We screened 17,187 patients in waiting rooms, yielding a sample of 1,514 patients with pain only, 575 patients with depressive symptoms only, and 761 patients with pain and depressive symptoms; 2,004 patients completed a 6-month follow-up survey. MEASUREMENTS AND RESULTS For each patient, managed care was measured by the intensity of managed care controls in the patient's primary care office, physician financial incentives, and whether the physician read or used back pain and depression guidelines. Physician job satisfaction at baseline was measured through a 6-item scale. Quality of primary care at follow-up was measured by patient rating of care provided by the primary physician, patient trust and confidence in primary physician, quality-of-care index, and continuity of primary physician. Outcomes were pain interference and bothersomeness, Symptom Checklist for Depression, and restricted activity days. Pain and depression patients of physicians with greater job satisfaction had greater trust and confidence in their primary physicians. Pain patients of more satisfied physicians also were less likely to change physicians in the follow-up period. Depression patients of more satisfied physicians had higher ratings of the care provided by their physicians. These associations remained after controlling statistically for managed care. Physician job satisfaction was not associated with health outcomes. CONCLUSIONS For primary care patients with pain or depressive symptoms, primary physician job satisfaction is associated with some measures of patient-rated quality of care but not health outcomes. PMID:15836532

  15. [Diabetes, psychosocial distress and quality of care].

    PubMed

    Fatati, Giuseppe

    2014-10-01

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

  16. Quality of diabetes care in community health centers.

    PubMed Central

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

    2000-01-01

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

  17. Organizational Cost of Quality Improvement for Depression Care

    PubMed Central

    Liu, Chuan-Fen; Rubenstein, Lisa V; Kirchner, JoAnn E; Fortney, John C; Perkins, Mark W; Ober, Scott K; Pyne, Jeffrey M; Chaney, Edmund F

    2009-01-01

    Objective We documented organizational costs for depression care quality improvement (QI) to develop an evidence-based, Veterans Health Administration (VA) adapted depression care model for primary care practices that performed well for patients, was sustained over time, and could be spread nationally in VA. Data Sources and Study Setting Project records and surveys from three multistate VA administrative regions and seven of their primary care practices. Study Design Descriptive analysis. Data Collection We documented project time commitments and expenses for 86 clinical QI and 42 technical expert support team participants for 4 years from initial contact through care model design, Plan–Do–Study–Act cycles, and achievement of stable workloads in which models functioned as routine care. We assessed time, salary costs, and costs for conference calls, meetings, e-mails, and other activities. Principle Findings Over an average of 27 months, all clinics began referring patients to care managers. Clinical participants spent 1,086 hours at a cost of $84,438. Technical experts spent 2,147 hours costing $197,787. Eighty-five percent of costs derived from initial regional engagement activities and care model design. Conclusions Organizational costs of the QI process for depression care in a large health care system were significant, and should be accounted for when planning for implementation of evidence-based depression care. PMID:19146566

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

    PubMed Central

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

    2015-01-01

    BACKGROUND The quality of cancer care has become a national priority; however, there are few ongoing efforts to assist medical oncology practices in identifying areas for improvement. The Florida Initiative for Quality Cancer Care is a consortium of 11 medical oncology practices that evaluates the quality of cancer care across Florida. Within this practice-based system of self-assessment, we determined adherence to colorectal cancer quality of care indicators (QCIs) in 2006, disseminated results to each practice and reassessed adherence in 2009. The current report focuses on evaluating the direction and magnitude of change in adherence to QCIs for colorectal cancer patients between the 2 assessments. STUDY DESIGN Medical records were reviewed for all colorectal cancer patients seen by a medical oncologist in 2006 (n = 489) and 2009 (n = 511) at 10 participating practices. Thirty-five indicators were evaluated individually and changes in QCI adherence over time and by site were examined. RESULTS Significant improvements were noted from 2006 to 2009, with large gains in surgical/pathological QCIs (eg, documenting rectal radial margin status, lymphovascular invasion, and the review of ?12 lymph nodes) and medical oncology QCIs (documenting planned treatment regimen and providing recommended neoadjuvant regimens). Documentation of perineural invasion and radial margins significantly improved; however, adherence remained low (47% and 71%, respectively). There was significant variability in adherence for some QCIs across institutions at follow-up. CONCLUSIONS The Florida Initiative for Quality Cancer Care practices conducted self-directed quality-improvement efforts during a 3-year interval and overall adherence to QCIs improved. However, adherence remained low for several indicators, suggesting that organized improvement efforts might be needed for QCIs that remained consistently low over time. Findings demonstrate how efforts such as the Florida Initiative for Quality Cancer Care are useful for evaluating and improving the quality of cancer care at a regional level. PMID:24275073

  19. Quality Measures for the Care of Patients with Insomnia

    PubMed Central

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

    2015-01-01

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

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

    PubMed

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

    2007-12-01

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

  1. Quality Measures for the Care of Patients with Narcolepsy

    PubMed Central

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

    2015-01-01

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

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

    PubMed Central

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

    2015-01-01

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

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

    PubMed

    Baker, R

    2000-06-01

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

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

    PubMed Central

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

    1992-01-01

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

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

    PubMed

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

    2015-08-01

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

  6. Indiana Paths to Quality: QRS Profile. The Child Care Quality Rating System (QRS) Assessment

    ERIC Educational Resources Information Center

    Child Trends, 2010

    2010-01-01

    This paper presents a profile of Indiana's Paths to Quality prepared as part of the Child Care Quality Rating System (QRS) Assessment Study. The profile consists of several sections and their corresponding descriptions including: (1) Program Information; (2) Rating Details; (3) Quality Indicators for Center-Based Programs; (4) Indicators for…

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

    ERIC Educational Resources Information Center

    Hsieh, Chang-Ming

    2009-01-01

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

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

    ERIC Educational Resources Information Center

    Hsieh, Chang-Ming

    2009-01-01

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


  9. Illinois Quality Counts: QRS Profile. The Child Care Quality Rating System (QRS) Assessment

    ERIC Educational Resources Information Center

    Child Trends, 2010

    2010-01-01

    This paper presents a profile of Illinois' Quality Counts prepared as part of the Child Care Quality Rating System (QRS) Assessment Study. The profile consists of several sections and their corresponding descriptions including: (1) Program Information; (2) Rating Details; (3) Quality Indicators for Center-Based Programs; (4) Indicators for Family…

  10. Maine Quality for ME: QRS Profile. The Child Care Quality Rating System (QRS) Assessment

    ERIC Educational Resources Information Center

    Child Trends, 2010

    2010-01-01

    This paper presents a profile of Maine's Quality for ME prepared as part of the Child Care Quality Rating System (QRS) Assessment Study. The profile consists of several sections and their corresponding descriptions including: (1) Program Information; (2) Rating Details; (3) Quality Indicators for Center-Based Programs; (4) Indicators for Family…

  11. Palm Beach Quality Counts: QRS Profile. The Child Care Quality Rating System (QRS) Assessment

    ERIC Educational Resources Information Center

    Child Trends, 2010

    2010-01-01

    This paper presents a profile of Palm Beach's Quality Counts prepared as part of the Child Care Quality Rating System (QRS) Assessment Study. The profile consists of several sections and their corresponding descriptions including: (1) Program Information; (2) Rating Details; (3) Quality Indicators for Center-Based Programs; (4) Indicators for…

  12. Miami-Dade Quality Counts: QRS Profile. The Child Care Quality Rating System (QRS) Assessment

    ERIC Educational Resources Information Center

    Child Trends, 2010

    2010-01-01

    This paper presents a profile of Miami-Dade's Quality Counts prepared as part of the Child Care Quality Rating System (QRS) Assessment Study. The profile consists of several sections and their corresponding descriptions including: (1) Program Information; (2) Rating Details; (3) Quality Indicators for Center-Based Programs; (4) Indicators for…

  13. New Hampshire Quality Rating System: QRS Profile. The Child Care Quality Rating System (QRS) Assessment

    ERIC Educational Resources Information Center

    Child Trends, 2010

    2010-01-01

    This paper presents a profile of New Hampshire's Quality Rating System prepared as part of the Child Care Quality Rating System (QRS) Assessment Study. The profile consists of several sections and their corresponding descriptions including: (1) Program Information; (2) Rating Details; (3) Quality Indicators for Center-Based Programs; (4)…

  14. How Can Primary Care Cross the Quality Chasm?

    PubMed Central

    Solberg, Leif I.; Elward, Kurtis S.; Phillips, William R.; Gill, James M.; Swanson, Graham; Main, Deborah S.; Yawn, Barbara P.; Mold, James W.; Phillips, Robert L.

    2009-01-01

    The chasm between knowledge and practice decried by the Institute of Medicine (IOM) is the result of other chasms that have not been addressed. They include the chasm between what we know and what we need to know to improve care; the chasm between those who provide primary care and those who do not fund, study, support, or publish practical primary care studies; and the chasm between research and quality improvement (QI). These chasms are a result of problematic concepts, attitudes, traditions, time frames, and financing approaches among the various participants. If we are to facilitate the production and use of the knowledge needed for primary care to cross IOM’s chasm, major changes are needed. These changes include the following: (1) admission by all primary care professions that we have quality problems that require our unified attention and action; (2) conversion of the paradigm from “translate research into practice” to “optimizing health and health care through research and QI”; (3) development and facilitation of more partnerships among clinicians, researchers, and care delivery leaders for engaged scholarship in both research and QI; (4) modification of the agendas and methods of funders and researchers so they emphasize the problems of patients and patient care and support practical time frames and research designs; and (5) facilitation by funders and journals of the dissemination and implementation of lessons from QI and practical research. PMID:19273872

  15. Quality Improvement Opportunities in Caring for Patients with Nonepileptic Seizures

    PubMed Central

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

    2014-01-01

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

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

    PubMed Central

    2014-01-01

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

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

    PubMed

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

    2016-01-01

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

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

    PubMed Central

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

    2015-01-01

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

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

    PubMed

    Boscarino, Joseph A; Adams, Richard E

    2004-01-01

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

  20. Sociodemographic factors and the quality of prenatal care.

    PubMed Central

    Hansell, M J

    1991-01-01

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

  1. Safe high quality health care: investing in tomorrow's leaders.

    PubMed

    Donaldson, L J

    2001-12-01

    The agenda for health care in developed countries in the 21st century will be dominated by a vision of quality which seeks to address the deep seated problems of the past. The ability to deliver safe, effective, high quality care within organisations with the right cultures, the best systems, and the most highly skilled and motivated work forces will be the key to meeting this challenge. This is an issue which should be a priority for education and training bodies. The need for health services to give priority to developing health professionals equipped to practise in a new way and thrive in new organisational environments requires a rapid response to reshape curricula and training programmes. Developing leadership and management skills will be essential in achieving this transformation in the quality of care delivered to patients. PMID:11700373

  2. 42 CFR 457.495 - State assurance of access to care and procedures to assure quality and appropriateness of care.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 4 2011-10-01 2011-10-01 false State assurance of access to care and procedures to assure quality and appropriateness of care. 457.495 Section 457.495 Public Health CENTERS FOR MEDICARE... State assurance of access to care and procedures to assure quality and appropriateness of care. A...

  3. 42 CFR 457.495 - State assurance of access to care and procedures to assure quality and appropriateness of care.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

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

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

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 4 2014-10-01 2014-10-01 false State assurance of access to care and procedures to assure quality and appropriateness of care. 457.495 Section 457.495 Public Health CENTERS FOR MEDICARE... State assurance of access to care and procedures to assure quality and appropriateness of care. A...

  5. 42 CFR 457.495 - State assurance of access to care and procedures to assure quality and appropriateness of care.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 4 2013-10-01 2013-10-01 false State assurance of access to care and procedures to assure quality and appropriateness of care. 457.495 Section 457.495 Public Health CENTERS FOR MEDICARE... State assurance of access to care and procedures to assure quality and appropriateness of care. A...

  6. 42 CFR 457.495 - State assurance of access to care and procedures to assure quality and appropriateness of care.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 4 2012-10-01 2012-10-01 false State assurance of access to care and procedures to assure quality and appropriateness of care. 457.495 Section 457.495 Public Health CENTERS FOR MEDICARE... State assurance of access to care and procedures to assure quality and appropriateness of care. A...

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

    PubMed Central

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

    2013-01-01

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

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

    PubMed Central

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

    2010-01-01

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

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

    PubMed

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

    2013-03-01

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

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

    PubMed Central

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

    1987-01-01

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

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

    PubMed Central

    Ng, Charis Wei Ling; Ng, Kok Ping

    2013-01-01

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

  12. Internal marketing: creating quality employee experiences in health care organizations.

    PubMed

    Masri, Maysoun Dimachkie; Oetjen, Dawn; Rotarius, Timothy

    2011-01-01

    To cope with the recent challenges within the health care industry, health care managers need to engage in the internal marketing of their various services. Internal marketing has been used as an effective management tool to increase employees' motivation, satisfaction, and productivity (J Mark Commun. 2010;16(5):325-344). Health care managers should understand that an intense focus on internal marketing factors will lead to a quality experience for employees that will ultimately have a positive effect on the patient experiences. PMID:21808171

  13. Infants & Toddlers: Understanding Confusing Expressions of Emotion

    ERIC Educational Resources Information Center

    Honig, Alice Sterling

    2006-01-01

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


  14. Art and the Infant-Toddler Curriculum.

    ERIC Educational Resources Information Center

    Lamb, Marilyn

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

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

    PubMed Central

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

    2015-01-01

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

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

    PubMed Central

    Mummudi, Naveen

    2014-01-01

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

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

    ERIC Educational Resources Information Center

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

    2012-01-01

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

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

    PubMed Central

    2012-01-01

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

  19. Comparing public and private hospital care service quality.

    PubMed

    Camilleri, D; O'Callaghan, M

    1998-01-01

    The study applies the principles behind the SERVQUAL model and uses Donabedian's framework to compare and contrast Malta's public and private hospital care service quality. Through the identification of 16 service quality indicators and the use of a Likert-type scale, two questionnaires were developed. The first questionnaire measured patient pre-admission expectations for public and private hospital service quality (in respect of one another). It also determined the weighted importance given to the different service quality indicators. The second questionnaire measured patient perceptions of provided service quality. Results showed that private hospitals are expected to offer a higher quality service, particularly in the "hotel services", but it was the public sector that was exceeding its patients' expectations by the wider margin. A number of implications for public and private hospital management and policy makers were identified. PMID:10185325

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

    PubMed

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

    2013-01-01

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

  1. Does the nursing process reflect quality care?

    PubMed

    McHugh, M K

    1991-04-01

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

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

    PubMed Central

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

    2011-01-01

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

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

    ERIC Educational Resources Information Center

    Psychological Science, 2002

    2002-01-01

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


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

    ERIC Educational Resources Information Center

    Psychological Science, 2002

    2002-01-01

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

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

    ERIC Educational Resources Information Center

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

    2011-01-01

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

  6. Quality of Institutional Care and Early Childhood Development

    ERIC Educational Resources Information Center

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

    2015-01-01

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

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

    PubMed

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

    2011-06-01

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

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

    PubMed

    Chassin, Mark R

    2013-10-01

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

  9. Quality of Institutional Care and Early Childhood Development

    ERIC Educational Resources Information Center

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

    2015-01-01

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


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

    ERIC Educational Resources Information Center

    Hewes, Dorothy

    1994-01-01

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

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

    PubMed Central

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

    2013-01-01

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

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

    ERIC Educational Resources Information Center

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

    2015-01-01

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


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

    ERIC Educational Resources Information Center

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

    2011-01-01

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


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

    ERIC Educational Resources Information Center

    Fenichel, Emily, Ed.

    2002-01-01

    "Zero to Three" is a single-focus bulletin of the National Center for Infants, Toddlers, and Families providing insight from multiple disciplines on the development of infants, toddlers, and their families. Conceived by the Zero to Three Child Welfare Task Force, this issue focuses on agents of change for infants and toddlers in foster…

  15. Reporting about health care quality: a guide to the galaxy.

    PubMed

    Kanouse, David E; Spranca, Mark; Vaiana, Mary

    2004-07-01

    A review of research on the reporting of health care quality information and related fields in applied social and cognitive science led to identification of seven basic principles that should be followed when planning to report health care quality information to consumers or other audiences: (a) know the audience: who they are, what they care about, and what actions they can take; (b) identify constraints that limit what is feasible; (c) consider barriers and facilitators to achieving objectives; (d) identify specific behaviors to target for change, and prioritize objectives; (e) design a report that specifically incorporates priorities and reflects trade-offs; (f) develop a plan for promotion and dissemination from the beginning; and (g) build in ongoing testing and evaluation to identify successes and areas needing improvement. Case studies provide many examples of unsuccessful reporting efforts that might have succeeded had these guiding principles been followed. PMID:15228776

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

    PubMed

    Harolds, Jay A

    2015-12-01

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

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

    PubMed Central

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

    2016-01-01

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

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

    PubMed

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

    2011-01-01

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

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

    PubMed

    Junoy, J P

    1997-01-01

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

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

    PubMed

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

    2015-12-01

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

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

    PubMed Central

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

    2010-01-01

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

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

    PubMed

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

    2016-04-01

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

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

    PubMed

    Olsen, Ű E; Ndeki, S; Norheim, O F

    2004-10-01

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

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

    ERIC Educational Resources Information Center

    Galinsky, Ellen; Friedman, Dana E.

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

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

    PubMed Central

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

    2009-01-01

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

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

    PubMed

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

    2013-09-01

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

  7. Health care quality and how to achieve it.

    PubMed

    Shine, Kenneth I

    2002-01-01

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

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

    PubMed

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

    2014-10-01

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

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

    PubMed

    Harolds, Jay A

    2016-01-01

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

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

    ERIC Educational Resources Information Center

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

    2008-01-01

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

  11. Managed care and patient ratings of the quality of specialty care among patients with pain or depressive symptoms

    PubMed Central

    Grembowski, David; Paschane, David; Diehr, Paula; Katon, Wayne; Martin, Diane; Patrick, Donald L

    2007-01-01

    Background Managed care efforts to regulate access to specialists and reduce costs may lower quality of care. Few studies have examined whether managed care is associated with patient perceptions of the quality of care provided by physician and non-physician specialists. Aim is to determine whether associations exist between managed care controls and patient ratings of the quality of specialty care among primary care patients with pain and depressive symptoms who received specialty care for those conditions. Methods A prospective cohort study design was conducted in the offices of 261 primary physicians in private practice in Seattle in 1997. Patients (N = 17,187) were screened in waiting rooms, yielding a sample of 1,514 patients with pain only, 575 patients with depressive symptoms only, and 761 patients with pain and depressive symptoms. Patients (n = 1,995) completed a 6-month follow-up survey. Of these, 691 patients received specialty care for pain, and 356 patients saw mental health specialists. For each patient, managed care was measured by the intensity of managed care controls in the patient's health plan and primary care office. Quality of specialty care at follow-up was measured by patient rating of care provided by the specialists. Outcomes were pain interference and bothersomeness, Symptom Checklist for Depression, and restricted activity days. Results The intensity of managed care controls in health plans and primary care offices was generally not associated with patient ratings of the quality of specialty care. However, pain patients in more-managed primary care offices had lower ratings of the quality of specialty care from physician specialists and ancillary providers. Conclusion For primary care patients with pain or depressive symptoms and who see specialists, managed care controls may influence ratings of specialty care for patients with pain but not patients with depressive symptoms. PMID:17306028

  12. COMPETITION AND QUALITY IN HOME HEALTH CARE MARKETS†

    PubMed Central

    JUNG, KYOUNGRAE; POLSKY, DANIEL

    2013-01-01

    SUMMARY Market-based solutions are often proposed to improve health care quality; yet evidence on the role of competition in quality in non-hospital settings is sparse. We examine the relationship between competition and quality in home health care. This market is different from other markets in that service delivery takes place in patients’ homes, which implies low costs of market entry and exit for agencies. We use 6 years of panel data for Medicare beneficiaries during the early 2000s. We identify the competition effect from within-market variation in competition over time. We analyze three quality measures: functional improvements, the number of home health visits, and discharges without hospitalization. We find that the relationship between competition and home health quality is nonlinear and its pattern differs by quality measure. Competition has positive effects on functional improvements and the number of visits in most ranges, but in the most competitive markets, functional outcomes and the number of visits slightly drop. Competition has a negative effect on discharges without hospitalization that is strongest in the most competitive markets. This finding is different from prior research on hospital markets and suggests that market-specific environments should be considered in developing polices to promote competition. PMID:23670849

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

    PubMed Central

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

    2014-01-01

    OBJECTIVE: To examine the 2-year effect of Blue Cross Blue Shield of Massachusetts’ global budget arrangement, the Alternative Quality Contract (AQC), on pediatric quality and spending for children with special health care needs (CSHCN) and non-CSHCN. METHODS: Using a difference-in-differences approach, we compared quality and spending trends for 126?975 unique 0- to 21-year-olds receiving care from AQC groups with 415?331 propensity-matched patients receiving care from non-AQC groups; 23% of enrollees were CSHCN. We compared quality and spending pre (2006–2008) and post (2009–2010) AQC implementation, adjusting analyses for age, gender, health risk score, and secular trends. Pediatric outcome measures included 4 preventive and 2 acute care measures tied to pay-for-performance (P4P), 3 asthma and 2 attention-deficit/hyperactivity disorder quality measures not tied to P4P, and average total annual medical spending. RESULTS: During the first 2 years of the AQC, pediatric care quality tied to P4P increased by +1.8% for CSHCN (P < .001) and +1.2% for non-CSHCN (P < .001) for AQC versus non-AQC groups; quality measures not tied to P4P showed no significant changes. Average total annual medical spending was ?5 times greater for CSHCN than non-CSHCN; there was no significant impact of the AQC on spending trends for children. CONCLUSIONS: During the first 2 years of the contract, the AQC had a small but significant positive effect on pediatric preventive care quality tied to P4P; this effect was greater for CSHCN than non-CSHCN. However, it did not significantly influence (positively or negatively) CSHCN measures not tied to P4P or affect per capita spending for either group. PMID:24366988

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

    ERIC Educational Resources Information Center

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

    2012-01-01

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

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

    ERIC Educational Resources Information Center

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

    2012-01-01

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


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

    PubMed

    Conrad, Douglas A; Perry, Lisa

    2009-01-01

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

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

    ERIC Educational Resources Information Center

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

    2014-01-01

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

  18. Why Good Quality Care Needs Philosophy More Than Compassion

    PubMed Central

    Leget, Carlo

    2015-01-01

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

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

    PubMed Central

    Lane, Mark

    2014-01-01

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

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

    PubMed Central

    2011-01-01

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

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

    PubMed Central

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

    2014-01-01

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

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

    ERIC Educational Resources Information Center

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

    2012-01-01

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


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

    ERIC Educational Resources Information Center

    Hynes, Kathryn; Habasevich-Brooks, Tara

    2008-01-01

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

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

    ERIC Educational Resources Information Center

    Hynes, Kathryn; Habasevich-Brooks, Tara

    2008-01-01

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


  5. Medical Education and Research: The Foundations of Quality Health Care

    PubMed Central

    Mustard, J. F.; Laidlaw, J. C.; Godden, J. O.

    1966-01-01

    In May 1964 the Royal Commission on Health Services declared that “health research is essential to health progress”. However, since that time the means of providing adequate health care have received far less attention than have methods of payment for physicians' services. Because medical education and research is the source from which all other health benefits flow, urgent attention must be paid to the adequate support of teacher-scientists, as set forth in the Woods, Gordon (Gundy) report. It is the numbers and quality of these men and women, more than any other factor, that will determine the shape of medical science and, hence, medical practice in Canada in the future. Expensive as it is, Canadian medicine and Canadian medical scientists must have generous support if medical care in this country is to be of high quality. PMID:5908724

  6. [Hypermedia in medical education: quality of health care].

    PubMed

    Kusec, Sanja; Jaksi?, Zelimir; Vuleti?, Gorka; Kovaci?, Luka; Pavlekovi?, Gordana

    2002-09-01

    The recent technological developments have found its place in medical education as well. Hypermedia has become very popular through the widespread use of the Internet. In its research project, the Department of Educational Technology of the Andrija Stampar School of Public Health studied and applied the educational methods in continuing training of health professionals using hypermedia and taking into account the specificities of medical and health practices. Potentials of hypermedia in medical education are presented within the topic on quality of health care. The result of this project is an interactive educational disk designed for physicians and other health professionals in primary health care faced with the issue of quality. This paper gives an overview of the experience gained during the work on the project and describes the created educational disk with all its specificities observed in the development of the educational hypermedia materials. PMID:19705567

  7. Creating a safer workplace to provide quality care.

    PubMed

    Simmons, J C

    2001-04-01

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

  8. Bioethics for clinicians: 15. Quality end-of-life care

    PubMed Central

    Singer, P A; MacDonald, N

    1998-01-01

    A physician who receives a call from the emergency department to see a patient with heart failure will have a clear framework within which to approach this problem. The thesis of this article is that physicians do not have an analogous conceptual framework for approaching end-of-life care. The authors present and describe a framework for end-of-life care with 3 main elements: control of pain and other symptoms, the use of life-sustaining treatments and support of those who are dying and their families. This 3-part framework can be used by clinicians at the bedside to focus their effort in improving the quality of end-of-life care. PMID:9700330

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

    PubMed

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

    2012-04-01

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

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

    PubMed

    Chassin, Mark R

    2012-01-01

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

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

    PubMed

    Harolds, Jay A

    2016-02-01

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

  12. Quality and equity in early childhood care in Peru

    NASA Astrophysics Data System (ADS)

    Izu, Regina Moromizato

    2007-01-01

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

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

    PubMed

    Thompson, Genevieve N; Chochinov, Harvey Max

    2006-10-01

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

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

    PubMed

    Kraynack, Nathan C; McBride, John T

    2009-10-01

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

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

    PubMed Central

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

    2014-01-01

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

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

    PubMed Central

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

    2006-01-01

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

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

    PubMed

    Herold-Majumdar, A; Behrens, J

    2012-12-01

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

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

    PubMed Central

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

    2001-01-01

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

  19. Improving the quality of care for patients with hypertension in Moshupa District, Botswana: Quality improvement cycle

    PubMed Central

    Kande, Cathy

    2014-01-01

    Abstract Background Although there are no prevalence studies on hypertension in Botswana, this condition is thought to be common and the quality of care to be poor. Aim The aim of this project was to assess and improve the quality of primary care for hypertension. Setting Moshupa clinic and catchment area, Botswana. Methods Quality improvement cycle. Results Two hundred participants were included in the audit. Sixty-eight per cent were women with a mean age of 55 years. In the baseline audit none of the target standards were met. During the re-audit six months later, six out of nine structural target standards, five out of 11 process target standards and one out of two outcome target standards were achieved. Statistically-significant improvement in performance (p < 0.05) was shown in 10 criteria although the target standard was not always met. In the re-audit, the target of achieving blood pressure control (< 140/90) in 70% of patients was achieved. Conclusion The quality of care for hypertension was suboptimal in our setting. Simple interventions were designed and implemented to improve the quality of care. These interventions led to significant improvement in structural and process criteria. A corresponding significant improvement in the control of blood pressure was also seen. PMID:26245397

  20. Improving quality of care through improved audit and feedback

    PubMed Central

    2012-01-01

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

  1. Quality-of-care indicators for infantile spasms.

    PubMed

    Wang, C Jason; Jonas, Rinat; Fu, Chong Min; Ng, Chun Y; Douglass, Laurie

    2013-01-01

    We developed a comprehensive set of quality-of-care indicators for the management of children with infantile spasms in the United States, encompassing evaluation, diagnosis, treatment, and prevention and management of side effects and comorbidities. The indicators were developed using the RAND/UCLA Modified Delphi Method. After a focused review of the literature and guidelines by the study team, an expert panel (nominated by leaders of Child Neurology Society, American Epilepsy Society, and National Institute for Neurologic Disorders) rated the draft indicators anonymously, met face-to-face to discuss each indicator, and rerated the revised indicators on validity, feasibility, and importance. The panel recommended 21 indicators, of which 8 were identified as most likely to have a large positive impact on improving quality of life and/or health outcomes for children with infantile spasms. The proposed indicators can be used to assess and document variations and gaps in quality-of-care and inform future research and quality improvement interventions. PMID:22566712

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

    PubMed Central

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

    2015-01-01

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

  3. Quality of care for OA: the effect of a point-of-care consultation recording template

    PubMed Central

    Jordan, Kelvin P.; Peat, George; Bedson, John; Croft, Peter R.; Hay, Elaine M.; Dziedzic, Krysia S.

    2015-01-01

    Objective. The aims of this study were to determine the feasibility of introducing a computerized template for identifying quality of care during an OA consultation, describe quality of OA care in practices in which the template was introduced and assess the effect of the template on routinely recorded clinician behaviour in those practices. Methods. A computerized template to assist the recording of care in consultations for patients with OA was installed in eight general practices. Eligible patients were those ?45 years of age consulting for clinical OA during a 6 month period. The main outcomes were frequency of template triggering, achievement of quality indicators during the consultation (assessment of pain and function, assessment for first-line analgesics, provision of information, exercise advice, consideration of physiotherapy referral, weight loss advice) and change in routinely recorded clinician behaviour (diagnostic coding, prescribing, referral, use of radiography, weight records) compared with the 12 months prior to template installation. Results. The template was triggered for 1730 patients. Achievement of indicators ranged from 36% (for consideration of physiotherapy referral) to 63% (for pain assessment), with substantial variability between clinicians. There was an increase in prescription of recommended first-line analgesics following the template installation: paracetamol [odds ratio (OR) 1.49 (95% CI 1.22, 1.82) compared with pre-template] and topical NSAIDs [OR 1.95 (95% CI 1.61, 2.35)]. Conclusion. This new template is a feasible tool for capturing data during OA consultations to aid assessment of quality of care. It was associated with significant improvements in recommended care processes. However, strategies are needed to ensure consistent approaches between clinicians. Trial registration. http://www.controlled-trials.com/ISRCTN06984617/mosaics. PMID:25336538

  4. Providers, Children, and Families Experience the Impact of High Quality Care Giving

    ERIC Educational Resources Information Center

    Matsalia, Joan

    2005-01-01

    The National Association for Family Child Care (NAFCC), a non-profit organization dedicated to promoting quality child care, believes that family child care accreditation is the true measure of high-quality family based care. In this article, the author presents the steps made by the NAFCC to accreditation. NAFCC Accreditation is a formal system…

  5. IOM committee calls for complete revamping of health care system to achieve better quality.

    PubMed

    2001-03-01

    The health care system can no longer deliver quality care the way it is currently organized, according to a new report, Crossing the Quality Chasm, released March 1 by the Institute of Medicine's Committee on Quality of Health Care in America. Instead, the committee says that it is time to reinvent the system. PMID:11268795

  6. 42 CFR 488.414 - Action when there is repeated substandard quality of care.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... Action when there is repeated substandard quality of care. (a) General. If a facility has been found to have provided substandard quality of care on the last three consecutive standard surveys, as defined in... substandard quality of care and not on the basis that the substance of the deficiency or the exact tag...

  7. 42 CFR 414.1250 - Benchmarks for quality of care measures.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 3 2014-10-01 2014-10-01 false Benchmarks for quality of care measures. 414.1250... Value-Based Payment Modifier Under the Physician Fee Schedule § 414.1250 Benchmarks for quality of care measures. (a) The benchmark for quality of care measures reported through the PQRS using the...

  8. 42 CFR 414.1250 - Benchmarks for quality of care measures.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 3 2013-10-01 2013-10-01 false Benchmarks for quality of care measures. 414.1250... Value-Based Payment Modifier Under the Physician Fee Schedule § 414.1250 Benchmarks for quality of care measures. (a) The benchmark for quality of care measures reported through the PQRS using the...

  9. 42 CFR 476.160 - General quality of care review procedures.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 4 2013-10-01 2013-10-01 false General quality of care review procedures. 476.160... § 476.160 General quality of care review procedures. (a) Scope of the QIO review. A QIO may conduct a general quality of care review in accordance with section 1154(a)(1)(B) of the Act. (1) A QIO may...

  10. 42 CFR 488.414 - Action when there is repeated substandard quality of care.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... Action when there is repeated substandard quality of care. (a) General. If a facility has been found to have provided substandard quality of care on the last three consecutive standard surveys, as defined in... substandard quality of care and not on the basis that the substance of the deficiency or the exact tag...

  11. The Prediction of Process Quality from Structural Features of Child Care.

    ERIC Educational Resources Information Center

    Phillipsen, Leslie C.; Burchinal, Margaret R.; Howes, Carollee; Cryer, Debby

    1997-01-01

    This study examined the structure of child care classrooms and centers to predict process quality. Costs and quality of early childhood center-based care in four states with varying levels of regulation were analyzed to identify characteristics of the teacher, classroom, director, and center related to child care quality. Findings suggest the need…

  12. Agents of Nursing Home Quality of Care: Ombudsmen and Staff Ratios Revisited.

    ERIC Educational Resources Information Center

    Cherry, Ralph L.

    1991-01-01

    Compared effects of ombudsman programs on quality of nursing home care on random sample of 134 Medicare/Medicaid-certified long-term care facilities in Missouri. Found that presence of ombudsman program was most important factor associated with quality for intermediate-care facilities, and was significantly associated with quality for skilled…

  13. Quality improvement education to improve performance on ulcerative colitis quality measures and care processes aligned with National Quality Strategy priorities.

    PubMed

    Greene, Laurence; Moreo, Kathleen

    2015-01-01

    Studies on inflammatory bowel disease (IBD) have reported suboptimal approaches to patient care. In the United States, the findings have motivated leading gastroenterology organizations to call for initiatives that support clinicians in aligning their practices with quality measures for IBD and priorities of the National Quality Strategy (NQS). We designed and implemented a quality improvement (QI) education program on ulcerative colitis in which patient charts were audited for 30 gastroenterologists before (n = 300 charts) and after (n = 290 charts) they participated in QI-focused educational activities. Charts were audited for nine measures, selected for their alignment with four NQS priorities: making care safer, ensuring patient engagement, promoting communication, and promoting effective treatment practices. Four of the measures, including guideline-directed vaccinations and assessments of disease type and activity, were part of the CMS Physician Quality Reporting System (PQRS). The other five measures involved counseling patients on various topics in ulcerative colitis management, documentation of side effects, assessment of adherence status, and simplification of dosing. The gastroenterologists also completed baseline and post-education surveys designed to assess qualitative outcomes. One of the educational interventions was a private audit feedback session conducted for each gastroenterologist. The sessions were designed to support participants in identifying measures reflecting suboptimal care quality and developing action plans for improvement. In continuous improvement cycles, follow-up interventions included QI tools and educational monographs. Across the nine chart variables, post-education improvements ranged from 0% to 48%, with a mean improvement of 15.9%. Survey findings revealed improvements in self-reported understanding of quality measures and intentions to apply them to practice, and lower rates of perceived significant barriers to high-quality care. The findings indicate the potential for QI education to support gastroenterologists in improving their performance on key measures of care quality for patients with ulcerative colitis. PMID:26732044

  14. Quality improvement education to improve performance on ulcerative colitis quality measures and care processes aligned with National Quality Strategy priorities

    PubMed Central

    Greene, Laurence; Moreo, Kathleen

    2015-01-01

    Studies on inflammatory bowel disease (IBD) have reported suboptimal approaches to patient care. In the United States, the findings have motivated leading gastroenterology organizations to call for initiatives that support clinicians in aligning their practices with quality measures for IBD and priorities of the National Quality Strategy (NQS). We designed and implemented a quality improvement (QI) education program on ulcerative colitis in which patient charts were audited for 30 gastroenterologists before (n = 300 charts) and after (n = 290 charts) they participated in QI-focused educational activities. Charts were audited for nine measures, selected for their alignment with four NQS priorities: making care safer, ensuring patient engagement, promoting communication, and promoting effective treatment practices. Four of the measures, including guideline-directed vaccinations and assessments of disease type and activity, were part of the CMS Physician Quality Reporting System (PQRS). The other five measures involved counseling patients on various topics in ulcerative colitis management, documentation of side effects, assessment of adherence status, and simplification of dosing. The gastroenterologists also completed baseline and post-education surveys designed to assess qualitative outcomes. One of the educational interventions was a private audit feedback session conducted for each gastroenterologist. The sessions were designed to support participants in identifying measures reflecting suboptimal care quality and developing action plans for improvement. In continuous improvement cycles, follow-up interventions included QI tools and educational monographs. Across the nine chart variables, post-education improvements ranged from 0% to 48%, with a mean improvement of 15.9%. Survey findings revealed improvements in self-reported understanding of quality measures and intentions to apply them to practice, and lower rates of perceived significant barriers to high-quality care. The findings indicate the potential for QI education to support gastroenterologists in improving their performance on key measures of care quality for patients with ulcerative colitis.

  15. Effect of quality of care on preventable perinatal mortality.

    PubMed

    Salinas, A M; Coria, I; Reyes, H; Zambrana, M

    1997-04-01

    This study assessed and quantified the effect of quality of care on death preventability, independent of social and biological variables. One hundred and eighty-one avoidable perinatal deaths (cases) were compared to 341 non-avoidable ones (controls). Judgement criteria on death preventability were based predominantly on compliance with explicit hospital medical care standards, determined by peer review. The overall perinatal mortality rate was 24.8 per 1000 births and could be reduced by 35% if all avoidable perinatal deaths were prevented. Sixteen per cent of the deaths presented structural and 31.2% process deficiencies; both predominated among avoidable perinatal deaths (35.4% vs 5.3%, p < 0.000; and 79.3% vs 5.9%, p < 0.000, respectively). Structural deficiencies increased the risk of an avoidable perinatal death eleven-fold (95% confidence interval (CI) 4.1, 26.9; p < 0.001) and process deficiencies eighty-eightfold (95% CI 37.2, 204.5, p < 0.001), after controlling for confounders. The strength of the association between quality of care and preventable perinatal mortality was estimated. PMID:9154495

  16. Emergency Department Crowding and Decreased Quality of Pain Care

    PubMed Central

    Hwang, Ula; Richardson, Lynne; Livote, Elayne; Harris, Ben; Spencer, Natasha; Morrison, R. Sean

    2008-01-01

    Objectives The objective of this study was to evaluate the association of emergency department (ED) crowding factors with the quality of pain care. Methods This was a retrospective observational study of all adult patients (?18 years) with conditions warranting pain care seen at an academic, urban tertiary care ED from July 1 to July 31, 2005, and December 1 to December 31, 2005. Patients were included if they presented with a chief complaint of pain and a final ED diagnosis of a painful condition. Predictor ED crowding variables studied were: 1) census, 2) number of admitted patients waiting for inpatient beds (boarders), and 3) number of boarders divided by ED census (boarding burden). The outcomes of interest were process of pain care measures: documentation of clinician pain assessment, medications ordered, and times of activities (e.g., arrival, assessment, ordering of medications). Results A total of 1,068 patient visits were reviewed. Fewer patients received analgesic medication during periods of high census (>50th percentile) (Parameter estimate = ?0.47 [95% CI = ?0.80 to ?0.07]). There was a direct correlation with total ED census and increased: time to pain assessment (Spearman r = 0.33, p < 0.0001), time to analgesic medication ordering (r = 0.22, p < 0.0001), and time to analgesic medication administration (r = 0.25, p < 0.0001). There were significant delays (>1-hour) for pain assessment and the ordering and administration of analgesic medication during periods of high ED census and number of boarders, but not with boarding burden. Conclusions ED crowding as measured by patient volume negatively impacts patient care. Greater numbers of patients in the ED, whether as total census or number of boarders, were associated with worse pain care. PMID:18945239

  17. Confidential inquiry into quality of care before admission to intensive care

    PubMed Central

    McQuillan, Peter; Pilkington, Sally; Allan, Alison; Taylor, Bruce; Short, Alasdair; Morgan, Giles; Nielsen, Mick; Barrett, David; Smith, Gary

    1998-01-01

    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 PMID:9632403

  18. More Infant and Toddler Experiences.

    ERIC Educational Resources Information Center

    Hast, Fran; Hollyfield, Ann

    Based on experiences gained at the Palo Alto Infant-Toddler Center and the view that quality child care for infants and toddlers depends upon nurturing, long-term connections with their caregivers, other children, and their families, this book presents strategies for interacting with young children that support the developing child as well as the…

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

    ERIC Educational Resources Information Center

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

    2014-01-01

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


  20. Combined quality function deployment and logical framework analysis to improve quality of emergency care in Malta.

    PubMed

    Buttigieg, Sandra Catherine; Dey, Prasanta Kumar; Cassar, Mary Rose

    2016-03-14

    Purpose - The purpose of this paper is to develop an integrated patient-focused analytical framework to improve quality of care in accident and emergency (A & E) unit of a Maltese hospital. Design/methodology/approach - The study adopts a case study approach. First, a thorough literature review has been undertaken to study the various methods of healthcare quality management. Second, a healthcare quality management framework is developed using combined quality function deployment (QFD) and logical framework approach (LFA). Third, the proposed framework is applied to a Maltese hospital to demonstrate its effectiveness. The proposed framework has six steps, commencing with identifying patients' requirements and concluding with implementing improvement projects. All the steps have been undertaken with the involvement of the concerned stakeholders in the A & E unit of the hospital. Findings - The major and related problems being faced by the hospital under study were overcrowding at A & E and shortage of beds, respectively. The combined framework ensures better A & E services and patient flow. QFD identifies and analyses the issues and challenges of A & E and LFA helps develop project plans for healthcare quality improvement. The important outcomes of implementing the proposed quality improvement programme are fewer hospital admissions, faster patient flow, expert triage and shorter waiting times at the A & E unit. Increased emergency consultant cover and faster first significant medical encounter were required to start addressing the problems effectively. Overall, the combined QFD and LFA method is effective to address quality of care in A & E unit. Practical/implications - The proposed framework can be easily integrated within any healthcare unit, as well as within entire healthcare systems, due to its flexible and user-friendly approach. It could be part of Six Sigma and other quality initiatives. Originality/value - Although QFD has been extensively deployed in healthcare setup to improve quality of care, very little has been researched on combining QFD and LFA in order to identify issues, prioritise them, derive improvement measures and implement improvement projects. Additionally, there is no research on QFD application in A & E. This paper bridges these gaps. Moreover, very little has been written on the Maltese health care system. Therefore, this study contributes demonstration of quality of emergency care in Malta. PMID:26959894

  1. Hospital Care for Newborn Babies: Quality Assessment, A Systematic Review

    PubMed Central

    Jabbari, Hossein; Abdollahi Sabet, Somayae; Heidarzadeh, Mohammad

    2015-01-01

    Context: Neonatal mortality rate is declining globally. The aim of the present study is to identify relevant indicators for assessing newborn care in hospitals by a systematic review. Evidence Acquisition: A search on electronic data base and manual searches of personal files for studies on quality indicators of newborn care were carried out. Searching 9 bibliographic databases, we found 85 articles of which 22 exactly related ones were selected and studied. Hand search yielded 1 record were also searched and 2 records were included. Results: A list of 87 structure, process and outcome indicators was formulated from the articles. Also 26 excess measures were identified in gray literature. After removing duplicates, and categorizing in 3 domains, 18 measures were input, 41 process and 34 outcome measures. Conclusions: These 93 indicators provide a framework for assessing how well the hospitals are providing neonatal care. These measures should be discussed in each context expert panels to address nationally applicable indices of neonatal care and may be adapted for local health settings. PMID:26495100

  2. [Supportive care, cognition and quality of life in brain metastases].

    PubMed

    Le Rhun, É; Taillibert, S; Blonski, M; Jouniaux Delbez, N; Delgadillo, D; Taillia, H; Auquier, P; Belin, C; Bonnetain, F; Varin, D; Tallet, A; Taillandier, L

    2015-02-01

    Brain metastases impact on the survival of the patients, but on their quality of life as well. The objective of the management of these patients is then double. Currently, due to medical advances, survivals tend to improve, especially for some tumor subtypes. During the course of the disease, different neurological signs and symptoms can be observed according to the location, the number and the volume of the metastase(s). Patients and caregivers are especially worried about the loss of autonomy and cognitive impairments. A permanent dialogue, during the course of the disease, is mandatory, in order to adapt the management to the objectives determined by the patients and the medical team. These objectives may vary according to the objective response rates of the disease to anticancer therapies, according to the impact of the disease and its management in daily living. Anticancer therapies and supportive care must be appreciated according to their impact on the survival, on the preservation of the functional independence and the quality of life of the patient, on their abilities to preserve the neurological status and delay the apparition of new neurological signs and symptoms, and their adverse events. Supportive care, cognition and quality of life should be regularly evaluated and adapted according to the objectives of the management of brain metastases patients. Different approaches are described in this paper. PMID:25640218

  3. [The "Zurich Quality Model of Nursing Care", based on the "Quality of Health Outcome Model" (QHOM): a new perspective in measuring quality in nursing care].

    PubMed

    Schmid-Büchi, Silvia; Rettke, Horst; Horvath, Eva; Marfurt-Russenberger, Katrin; Schwendimann, René

    2008-10-01

    Ensuring and maintaining a high level of quality in nursing care becomes more and more important as economic pressure is increasing and personnel is being reduced. The nursing executives of four large Swiss hospitals therefore commissioned a group of nursing scientists and nursing experts with the task of developing a trendsetting model to represent, assess, and interpret the quality of nursing care. The "Quality of Health Outcome Model" (QHOM) served as a basis for development. More than 60 nurses from acute care hospitals and specialized clinics assessed a first draft of the model in hearings and by means of questionnaires. The model integrated earlier attempts at quality screening regarding structures, processes and results, complementing these three elements with a fourth: the patients, whose characteristics influence the results of nursing care remarkably. Thus, the former one-dimensional, linear viewpoint was resolved into a dynamic representation of all four elements, illustrating a specific concept of nursing care. Through the multi-dimensionality of the model the complexity of the nursing process is better represented. The model's core consists of eight exemplary indicators of quality, each of which is relevant to nursing and for each of which criteria and assessment tools have been formulated. The model is seen as a basis and reference for the quality development and first opportunities for clinical application have been succesfully employed. The project can serve as a paradigm of networking amongst hospitals and cooperation between nursing scientists and experts, and of the critical significance of such collaboration to the advancement of nursing quality. PMID:18850535

  4. Indicators for Evaluating the Performance and Quality of Care of Ambulatory Care Nurses

    PubMed Central

    Rapin, Joachim; D'Amour, Danielle; Dubois, Carl-Ardy

    2015-01-01

    The quality and safety of nursing care vary from one service to another. We have only very limited information on the quality and safety of nursing care in outpatient settings, an expanding area of practice. Our aim in this study was to make available, from the scientific literature, indicators potentially sensitive to nursing that can be used to evaluate the performance of nursing care in outpatient settings and to integrate those indicators into the theoretical framework of Dubois et al. (2013). We conducted a scoping review in three databases (CINAHL, MEDLINE, and EMBASE) and the bibliographies of selected articles. From a total of 116 articles, we selected 22. The results of our study not only enable that framework to be extended to ambulatory nursing care but also enhance it with the addition of five new indicators. Our work offers nurses and managers in ambulatory nursing units indicators potentially sensitive to nursing that can be used to evaluate performance. For researchers, it presents the current state of knowledge on this construct and a framework with theoretical foundations for future research in ambulatory settings. This work opens an unexplored field for further research. PMID:26380108

  5. Indicators for Evaluating the Performance and Quality of Care of Ambulatory Care Nurses.

    PubMed

    Rapin, Joachim; D'Amour, Danielle; Dubois, Carl-Ardy

    2015-01-01

    The quality and safety of nursing care vary from one service to another. We have only very limited information on the quality and safety of nursing care in outpatient settings, an expanding area of practice. Our aim in this study was to make available, from the scientific literature, indicators potentially sensitive to nursing that can be used to evaluate the performance of nursing care in outpatient settings and to integrate those indicators into the theoretical framework of Dubois et al. (2013). We conducted a scoping review in three databases (CINAHL, MEDLINE, and EMBASE) and the bibliographies of selected articles. From a total of 116 articles, we selected 22. The results of our study not only enable that framework to be extended to ambulatory nursing care but also enhance it with the addition of five new indicators. Our work offers nurses and managers in ambulatory nursing units indicators potentially sensitive to nursing that can be used to evaluate performance. For researchers, it presents the current state of knowledge on this construct and a framework with theoretical foundations for future research in ambulatory settings. This work opens an unexplored field for further research. PMID:26380108

  6. Analysis of early accountable care organizations defines patient, structural, cost, and quality-of-care characteristics.

    PubMed

    Epstein, Arnold M; Jha, Ashish K; Orav, E John; Liebman, Daniel L; Audet, Anne-Marie J; Zezza, Mark A; Guterman, Stuart

    2014-01-01

    Accountable care organizations (ACOs) have attracted interest from many policy makers and clinical leaders because of their potential to improve the quality of care and reduce costs. Federal ACO programs for Medicare beneficiaries are now up and running, but little information is available about the baseline characteristics of early entrants. In this descriptive study we present data on the structural and market characteristics of these early ACOs and compare ACOs' patient populations, costs, and quality with those of their non-ACO counterparts at baseline. We found that ACO patients were more likely than non-ACO patients to be older than age eighty and had higher incomes. ACO patients were less likely than non-ACO patients to be black, covered by Medicaid, or disabled. The cost of care for ACO patients was slightly lower than that for non-ACO patients. Slightly fewer than half of the ACOs had a participating hospital. Hospitals that were in ACOs were more likely than non-ACO hospitals to be large, teaching, and not-for-profit, although there was little difference in their performance on quality metrics. Our findings can be useful in interpreting the early results from the federal ACO programs and in establishing a baseline to assess the programs' development. PMID:24395940

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

    ERIC Educational Resources Information Center

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

    2006-01-01

    The present study was designed to find whether evaluations of maternal competence are linked to mothers' employment status and the quality of maternal care. Participants rated videotaped vignettes, depicting either high-quality or low-quality mother-infant interactions, on various dimensions of care quality. The videotaped mothers were described


  8. 42 CFR 476.170 - General quality of care reconsideration procedures.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 4 2014-10-01 2014-10-01 false General quality of care reconsideration procedures... General quality of care reconsideration procedures. (a) Right to request a reconsideration. Beginning with... AND HUMAN SERVICES (CONTINUED) QUALITY IMPROVEMENT ORGANIZATIONS QUALITY IMPROVEMENT...

  9. 42 CFR 476.170 - General quality of care reconsideration procedures.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 4 2013-10-01 2013-10-01 false General quality of care reconsideration procedures...) Qio Review Functions § 476.170 General quality of care reconsideration procedures. (a) Right to... AND HUMAN SERVICES (CONTINUED) QUALITY IMPROVEMENT ORGANIZATIONS UTILIZATION AND QUALITY...

  10. 42 CFR 422.2430 - Activities that improve health care quality.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... technological infrastructure to enhance current quality improving activities or make new quality improvement... 42 Public Health 3 2014-10-01 2014-10-01 false Activities that improve health care quality. 422... Minimum Medical Loss Ratio § 422.2430 Activities that improve health care quality. (a)...

  11. 42 CFR 423.2430 - Activities that improve health care quality.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... technological infrastructure to enhance current quality improving activities or make new quality improvement... 42 Public Health 3 2014-10-01 2014-10-01 false Activities that improve health care quality. 423... Requirements for a Minimum Medical Loss Ratio § 423.2430 Activities that improve health care quality....

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

    ERIC Educational Resources Information Center

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

    2006-01-01

    The present study was designed to find whether evaluations of maternal competence are linked to mothers' employment status and the quality of maternal care. Participants rated videotaped vignettes, depicting either high-quality or low-quality mother-infant interactions, on various dimensions of care quality. The videotaped mothers were described…

  13. Increasing quality through telemedicine in the intensive care unit.

    PubMed

    Kalb, Thomas H

    2015-04-01

    This article explores the hypothesis that a telemedicine intensive care unit (Tele-ICU) platform is uniquely suited to facilitate quality performance improvement (PI). This article addresses some substantial hurdles to overcome that may limit the effectiveness of a Tele-ICU platform to achieve PI objectives. Lastly, this article describes the author's experience with a PI project to improve ventilator management conducted via a Tele-ICU hub interacting with 11 geographically dispersed ICUs. Using this example to illustrate the concepts, the author hopes to shed some light on the successes and lessons learned so as to generate best-practice guidelines for Tele-ICU-directed PI initiatives. PMID:25814453

  14. Cancer care quality measures: diagnosis and treatment of colorectal cancer.

    PubMed Central

    Patwardhan, Meenal B; Samsa, Gregory P; McCrory, Douglas C; Fisher, Deborah A; Mantyh, Christopher R; Morse, Michael A; Prosnitz, Robert G; Cline, Kathryn E; Gray, Rebecca N

    2006-01-01

    OBJECTIVES To identify measures that are currently available to assess the quality of care provided to patients with colorectal cancer (CRC), and to assess the extent to which these measures have been developed and tested. DATA SOURCES Published and unpublished measures identified through a computerized search of English-language citations in MEDLINE (1966-January 2005), the Cochrane Database of Systematic Reviews, and the National Guideline Clearinghouse; through review of reference lists contained in seed articles, all included articles, and relevant review articles; and through searches of the grey literature (institutional or government reports, professional society documents, research papers, and other literature, in print or electronic format, not controlled by commercial publishing interests). Sources for grey literature included professional organization websites and the Internet. REVIEW METHODS Measures were selected by reviewers according to standardized criteria relating to each question, and were then rated according to their importance and usability, scientific acceptability, and extent of testing; each domain was rated from 1 (poor) to 5 (ideal). RESULTS We identified a number of well-developed and well-tested CRC-related quality-of-care measures, both general process-of-care measures (on a broader scale) and technical measures (pertaining to specific details of a procedure). At least some process measures are available for diagnostic imaging, staging, surgical therapy, adjuvant chemotherapy, adjuvant radiation therapy, and colonoscopic surveillance. Various technical measures were identified for quality of colonoscopy (e.g., cecal intubation rate, complications) and staging (adequate lymph node retrieval and evaluation). These technical measures were guideline-based and well developed, but less well tested, and the linkage between them and patient outcomes, although intuitive, was not always explicitly provided. For some elements of the care pathway, such as operative reports and chemotherapy reports, no technical measures were found. CONCLUSIONS Some general process measures have a stronger evidence base than others. Those based on guidelines have the strongest evidence base; those derived from basic first principles supported by some research findings are relatively weaker, but are often sufficient for the task at hand. A consistent source of tension is the distinction between the clinically derived fine-tuning of the definition of a quality measure and the limitations of available data sources (which often do not contain sufficient information to act on such distinctions). Although some excellent technical measures were found, the overall development of technical measures seems less advanced than that of the general process measures. PMID:17764215

  15. Quality of health care in the United States: implications for pediatric inflammatory bowel disease.

    PubMed

    Boyle, Brendan M; Palmer, Lena; Kappelman, Michael D

    2009-09-01

    The Institute of Medicine's publications To Error is Human and Crossing the Quality Chasm publicized the widespread deficits in US health care quality. Emerging studies continue to reveal deficits in the quality of adult and pediatric care, including subspecialty care. In recent years, key stakeholders in the health care system including providers, purchasers, and the public have been applying various quality improvement methods to address these concerns. Lessons learned from these efforts in other pediatric conditions, including asthma, cystic fibrosis, neonatal intensive care, and liver transplantation may be applicable to the care of children with inflammatory bowel disease (IBD).This review is intended to be a primer on the quality of care movement in the United States, with a focus on pediatric IBD. In this article, we review the history, rationale, and methods of quality measurement and improvement, and we discuss the unique challenges in adapting these general strategies to pediatric IBD care. PMID:19633570

  16. Quality of Health Care in the United States: Implications for Pediatric Inflammatory Bowel Disease

    PubMed Central

    Boyle, Brendan M.; Palmer, Lena; Kappelman, Michael D.

    2015-01-01

    The Institute of Medicine’s publications To Error is Human and Crossing the Quality Chasm publicized the widespread deficits in U.S. health care quality. Emerging studies continue to reveal deficits in the quality of adult and pediatric care, including subspecialty care. In recent years, key stakeholders in the health care system including providers, purchasers, and the public have been applying various quality improvement methods to address these concerns. Lessons learned from these efforts in other pediatric conditions, including asthma, cystic fibrosis, neonatal intensive care, and liver transplantation may be applicable to the care of children with inflammatory bowel disease. This review is intended to be a primer on the quality of care movement in the United States, with a focus on pediatric inflammatory bowel disease. In this article, we review the history, rationale, and methods of quality measurement and improvement, and we discuss the unique challenges in adapting these general strategies to pediatric IBD care. PMID:19633570

  17. A Profile Approach to Child Care Quality, Quantity, and Type of Setting: Parent Selection of Infant Child Care Arrangements

    ERIC Educational Resources Information Center

    Sosinsky, Laura Stout; Kim, Se-Kang

    2013-01-01

    Building on prior variable-oriented research which demonstrates the independence of the associations of child care quality, quantity, and type of setting with family factors and child outcomes, the current study identifies four profiles of child care dimensions from the NICHD Study of Early Child Care and Youth Development. Profiles accounted for


  18. A Profile Approach to Child Care Quality, Quantity, and Type of Setting: Parent Selection of Infant Child Care Arrangements

    ERIC Educational Resources Information Center

    Sosinsky, Laura Stout; Kim, Se-Kang

    2013-01-01

    Building on prior variable-oriented research which demonstrates the independence of the associations of child care quality, quantity, and type of setting with family factors and child outcomes, the current study identifies four profiles of child care dimensions from the NICHD Study of Early Child Care and Youth Development. Profiles accounted for…

  19. Effect of an Innovative Medicare Managed Care Program on the Quality of Care for Nursing Home Residents

    ERIC Educational Resources Information Center

    Kane, Robert L.; Flood, Shannon; Bershadsky, Boris; Keckhafer, Gail

    2004-01-01

    Purpose: We sought to assess the quality of care provided by an innovative Medicare+Choice HMO targeted specifically at nursing home residents and employing nurse practitioners to provide additional primary care over and above that provided by physicians. The underlying premise of the Evercare approach is that the additional primary care will…

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

    PubMed Central

    2010-01-01

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

  1. Quality measures for the care of patients with lateral epicondylalgia

    PubMed Central

    2013-01-01

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

  2. Health Care Spending and Quality in Year 1 of the Alternative Quality Contract

    PubMed Central

    Song, Zirui; Safran, Dana Gelb; Landon, Bruce E.; He, Yulei; Ellis, Randall P.; Mechanic, Robert E.; Day, Matthew P.; Chernew, Michael E.

    2012-01-01

    Background In 2009, Blue Cross Blue Shield of Massachusetts (BCBS) implemented a global payment system called the Alternative Quality Contract (AQC). Provider groups in the AQC system assume accountability for spending, similar to accountable care organizations that bear financial risk. Moreover, groups are eligible to receive bonuses for quality. Methods Seven provider organizations began 5-year contracts as part of the AQC system in 2009. We analyzed 2006–2009 claims for 380,142 enrollees whose primary care physicians (PCPs) were in the AQC system (intervention group) and for 1,351,446 enrollees whose PCPs were not in the system (control group). We used a propensity-weighted difference-in-differences approach, adjusting for age, sex, health status, and secular trends to isolate the treatment effect of the AQC in comparisons of spending and quality between the intervention group and the control group. Results Average spending increased for enrollees in both the intervention and control groups in 2009, but the increase was smaller for enrollees in the intervention group — $15.51 (1.9%) less per quarter (P = 0.007). Savings derived largely from shifts in outpatient care toward facilities with lower fees; from lower expenditures for procedures, imaging, and testing; and from a reduction in spending for enrollees with the highest expected spending. The AQC system was associated with an improvement in performance on measures of the quality of the management of chronic conditions in adults (P<0.001) and of pediatric care (P = 0.001), but not of adult preventive care. All AQC groups met 2009 budget targets and earned surpluses. Total BCBS payments to AQC groups, including bonuses for quality, are likely to have exceeded the estimated savings in year 1. Conclusions The AQC system was associated with a modest slowing of spending growth and improved quality of care in 2009. Savings were achieved through changes in referral patterns rather than through changes in utilization. The long-term effect of the AQC system on spending growth depends on future budget targets and providers’ ability to further improve efficiencies in practice. (Funded by the Commonwealth Fund and others.) PMID:21751900

  3. A Multicenter Study of Physician Mindfulness and Health Care Quality

    PubMed Central

    Beach, Mary Catherine; Roter, Debra; Korthuis, P. Todd; Epstein, Ronald M.; Sharp, Victoria; Ratanawongsa, Neda; Cohn, Jonathon; Eggly, Susan; Sankar, Andrea; Moore, Richard D.; Saha, Somnath

    2013-01-01

    PURPOSE Mindfulness (ie, purposeful and nonjudgmental attentiveness to one’s own experience, thoughts, and feelings) is associated with physician well-being. We sought to assess whether clinician self-rated mindfulness is associated with the quality of patient care. METHODS We conducted an observational study of 45 clinicians (34 physicians, 8 nurse practitioners, and 3 physician assistants) caring for patients infected with the human immunodeficiency virus (HIV) who completed the Mindful Attention Awareness Scale and 437 HIV-infected patients at 4 HIV specialty clinic sites across the United States. We measured patient-clinician communication quality with audio-recorded encounters coded using the Roter Interaction Analysis System (RIAS) and patient ratings of care. RESULTS In adjusted analyses comparing clinicians with highest and lowest tertile mindfulness scores, patient visits with high-mindfulness clinicians were more likely to be characterized by a patient-centered pattern of communication (adjusted odds ratio of a patient-centered visit was 4.14; 95% CI, 1.58–10.86), in which both patients and clinicians engaged in more rapport building and discussion of psychosocial issues. Clinicians with high-mindfulness scores also displayed more positive emotional tone with patients (adjusted ? = 1.17; 95% CI, 0.46–1.9). Patients were more likely to give high ratings on clinician communication (adjusted prevalence ratio [APR] = 1.48; 95% CI, 1.17–1.86) and to report high overall satisfaction (APR = 1.45; 95 CI, 1.15–1.84) with high-mindfulness clinicians. There was no association between clinician mindfulness and the amount of conversation about biomedical issues. CONCLUSIONS Clinicians rating themselves as more mindful engage in more patient-centered communication and have more satisfied patients. Interventions should determine whether improving clinician mindfulness can also improve patient health outcomes. PMID:24019273

  4. Nutritional Quality of Meals Compared to Snacks in Child Care

    PubMed Central

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

    2013-01-01

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

  5. Quality in Family Child Care Settings: The Relationship between Provider Educational Experiences and Global Quality Scores in a Statewide Quality Rating and Improvement System

    ERIC Educational Resources Information Center

    Hallam, Rena A.; Bargreen, Kaitlin N.; Ridgley, Robyn

    2013-01-01

    This study is a secondary analysis of a statewide sample of licensed family child care providers in the Tennessee Child Care Evaluation and Report Card Program ("N"?=?1,145) that describes the general quality of family child care programs in the state and examines the relationships between provider education and global quality. Study…

  6. Quality in Family Child Care Settings: The Relationship between Provider Educational Experiences and Global Quality Scores in a Statewide Quality Rating and Improvement System

    ERIC Educational Resources Information Center

    Hallam, Rena A.; Bargreen, Kaitlin N.; Ridgley, Robyn

    2013-01-01

    This study is a secondary analysis of a statewide sample of licensed family child care providers in the Tennessee Child Care Evaluation and Report Card Program ("N"?=?1,145) that describes the general quality of family child care programs in the state and examines the relationships between provider education and global quality. Study


  7. Assessment of the Quality of Delivered Care for Iranian patients with Rheumatoid Arthritis by Using Comprehensive Quality Measurement Model in Health Care (CQMH)

    PubMed Central

    Karimi, Saeed; Safiri, Saeid; Bayat, Mahboubeh; Mottaghi, Payman; Shokri, Azad; Moosazadeh, Mahmood; Fattahi, Hamed

    2015-01-01

    Introduction: Quality of care has become increasingly critical in the evaluation of healthcare and healthcare services. The aim of this study was to assess quality of delivered care among patients with rheumatoid arthritis using a model of Comprehensive Quality Measurement in Health Care (CQMH). Methods: This cross-sectional study was conducted on 172 patients with rheumatoid arthritis (RA) who were received care from private clinics of Isfahan University of medical sciences in 2013. CQMH questionnaires were used for assessing the quality of care. Data were analyzed using SPSS for Windows. Results: The mean scores of Quality Index, Service Quality (SQ), Technical Quality (TQ), and Costumer Quality (CQ) were 72.70, 79.09, 68.54 and 70.25 out of 100, respectively. For CQ only 19.8% of participations staying the course of action even under stress and financial constraints, there is a significant gap between what RA care they received with what was recommended in the guideline for TQ. Scores of service quality was low in majority of aspects especially in "availability of support group" section. Conclusion: Study shows paradoxical findings and expresses that quality scores of service delivery for patients with arthritis rheumatoid from patient's perspective is relatively low. Therefore, for fixing this paradoxical problem, improving the participation of patients and their family and empowering them for self-management and decision should be regarded by health systems. PMID:26744728

  8. Quality of Life in Cancer Patients Receiving Palliative Care

    PubMed Central

    Singh, Divya Pal

    2010-01-01

    Background: The main focus of palliative care services is to improve the patient’s quality of life (QOL), which is defined as the subjective evaluation of life as a whole or the patient’s appraisal and satisfaction with their current level of functioning compared with what they perceive to be possible or ideal. Aims: In this prospective study we attempt to validate the Hindi version of a questionnaire designed by the functional assessment of chronic illness therapy (FACIT) measurement system; to measure the subjective QOL of cancer patients receiving home-based palliative care, determine ease of use of the questionnaire and correlate the QOL of these patients with the objective assessment of their Karnofsky’s performance status and their numerical pain score. Settings and Design: One hundred cancer patients receiving free home-based palliative care in New Delhi, India. Materials and Methods: A multidisciplinary palliative home care team using the Functional Assessment of Cancer Therapy-General (FACT-G©) questionnaire in Hindi. Statistical Analysis Used: Microsoft Excel Correlation. Results: The FACT-G© questionnaire in Hindi is a useful tool in measuring QOL and can be used to monitor the patient’s progress and symptom control during the course of the disease. It is simple to use and does not take too much time to complete. The results are tabulated in English and can be used for comparison purposes globally; the scoring process is very simple. Conclusions: Increasing QOL and KPS showed a positive correlation whereas increasing pain and better QOL show negative correlation, as do better performance status and increasing pain score. PMID:20859470

  9. Burnout and Self-Reported Quality of Care in Community Mental Health

    PubMed Central

    Salyers, Michelle P.; Fukui, Sadaaki; Rollins, Angela L.; Firmin, Ruth; Gearhart, Timothy; Noll, James P.; Williams, Stacy; Davis, C.J.

    2014-01-01

    Staff burnout is widely believed to be problematic in mental healthcare, but few studies have linked burnout directly with quality of care. The purpose of this study was to examine the relationship between burnout and a newly developed scale for quality of care in a sample of community mental health workers (N=113). The Self-Reported Quality of Care scale had three distinct factors (Client-Centered Care, General Work Conscientiousness, and Low Errors), with good internal consistency. Burnout, particularly personal accomplishment, and to a lesser extent depersonalization, were predictive of overall self-reported Quality of Care, over and above background variables. PMID:24659446

  10. 42 CFR 480.141 - Disclosure of QIO interpretations on the quality of health care.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... health care. 480.141 Section 480.141 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT... interpretations on the quality of health care. Subject to the procedures for disclosure and notice of disclosure... generalizations on the quality of health care that identify a particular institution....

  11. 42 CFR 480.141 - Disclosure of QIO interpretations on the quality of health care.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... health care. 480.141 Section 480.141 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT... QIO interpretations on the quality of health care. Subject to the procedures for disclosure and notice... interpretations and generalizations on the quality of health care that identify a particular institution....

  12. 42 CFR 480.141 - Disclosure of QIO interpretations on the quality of health care.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... health care. 480.141 Section 480.141 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT... QIO interpretations on the quality of health care. Subject to the procedures for disclosure and notice... interpretations and generalizations on the quality of health care that identify a particular institution....

  13. 42 CFR 480.141 - Disclosure of QIO interpretations on the quality of health care.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... health care. 480.141 Section 480.141 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT... interpretations on the quality of health care. Subject to the procedures for disclosure and notice of disclosure... generalizations on the quality of health care that identify a particular institution....

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

    ERIC Educational Resources Information Center

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

    2011-01-01

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

  15. Enhancing Early Child Care Quality and Learning for Toddlers at Risk: The Responsive Early Childhood Program

    ERIC Educational Resources Information Center

    Landry, Susan H.; Zucker, Tricia A.; Taylor, Heather B.; Swank, Paul R.; Williams, Jeffrey M.; Assel, Michael; Crawford, April; Huang, Weihua; Clancy-Menchetti, Jeanine; Lonigan, Christopher J.; Phillips, Beth M.; Eisenberg, Nancy; Spinrad, Tracy L.; de Viliers, Jill; de Viliers, Peter; Barnes, Marcia; Starkey, Prentice; Klein, Alice

    2014-01-01

    Despite reports of positive effects of high-quality child care, few experimental studies have examined the process of improving low-quality center-based care for toddler-age children. In this article, we report intervention effects on child care teachers' behaviors and children's social, social-emotional classroom activities (RECC).…

  16. Perceptions of Local Health Care Quality in 7 Rural Communities with Telemedicine

    ERIC Educational Resources Information Center

    Nesbitt, Thomas S.; Marcin, James P.; Daschbach, Martha M.; Cole, Stacey L.

    2005-01-01

    Rural health services are difficult to maintain because of low patient volumes, limited numbers of providers, and unfavorable economies of scale. Rural patients may perceive poor quality in local health care, directly impacting the sustainability of local health care services. This study examines perceptions of local health care quality in 7


  17. Perceptions of Local Health Care Quality in 7 Rural Communities with Telemedicine

    ERIC Educational Resources Information Center

    Nesbitt, Thomas S.; Marcin, James P.; Daschbach, Martha M.; Cole, Stacey L.

    2005-01-01

    Rural health services are difficult to maintain because of low patient volumes, limited numbers of providers, and unfavorable economies of scale. Rural patients may perceive poor quality in local health care, directly impacting the sustainability of local health care services. This study examines perceptions of local health care quality in 7…

  18. Enhancing Early Child Care Quality and Learning for Toddlers at Risk: The Responsive Early Childhood Program

    ERIC Educational Resources Information Center

    Landry, Susan H.; Zucker, Tricia A.; Taylor, Heather B.; Swank, Paul R.; Williams, Jeffrey M.; Assel, Michael; Crawford, April; Huang, Weihua; Clancy-Menchetti, Jeanine; Lonigan, Christopher J.; Phillips, Beth M.; Eisenberg, Nancy; Spinrad, Tracy L.; de Viliers, Jill; de Viliers, Peter; Barnes, Marcia; Starkey, Prentice; Klein, Alice

    2014-01-01

    Despite reports of positive effects of high-quality child care, few experimental studies have examined the process of improving low-quality center-based care for toddler-age children. In this article, we report intervention effects on child care teachers' behaviors and children's social, social-emotional classroom activities (RECC).


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

    ERIC Educational Resources Information Center

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

    2005-01-01

    Nursing home medical-record documentation of daily-care occurrence may be inaccurate, and information is not documented about important quality-of-life domains. The inadequacy of medical record data creates a barrier to improving care quality, because it supports an illusion of care consistent with regulations, which reduces the motivation and…

  20. 45 CFR 98.51 - Activities to improve the quality of child care.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... CHILD CARE AND DEVELOPMENT FUND Use of Child Care and Development Funds § 98.51 Activities to improve the quality of child care. (a) No less than four percent of the aggregate funds expended by the Lead... 45 Public Welfare 1 2014-10-01 2014-10-01 false Activities to improve the quality of child...

  1. 45 CFR 98.51 - Activities to improve the quality of child care.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... CHILD CARE AND DEVELOPMENT FUND Use of Child Care and Development Funds § 98.51 Activities to improve the quality of child care. (a) No less than four percent of the aggregate funds expended by the Lead... 45 Public Welfare 1 2011-10-01 2011-10-01 false Activities to improve the quality of child...

  2. Quality and Safety in Health Care, Part I: Five Pioneers in Quality.

    PubMed

    Harolds, Jay

    2015-08-01

    Five pioneers had a huge impact on the quality movement in health care in the United States. Ernest Codman contributed in many ways, including his focus on outcome analysis. Avidis Donabedian is known for his focus on the 3 domains of structure, process, and outcome in health care. Walter Shewhart is known especially for the control chart and early work on what W. Edwards Deming made into the PDSA cycle. Deming is also known for other contributions, including his 14 points of management, correcting system problems rather than blaming the workers, and his System of Profound Knowledge. Juran is known for the Pareto principle and his emphasis on customer satisfaction and addressing the human, not just statistical side, of quality improvement. PMID:26147460

  3. Music therapy in pediatric palliative care: family-centered care to enhance quality of life.

    PubMed

    Lindenfelser, Kathryn J; Hense, Cherry; McFerran, Katrina

    2012-05-01

    Research into the value of music therapy in pediatric palliative care (PPC) has identified quality of life as one area of improvement for families caring for a child in the terminal stages of a life-threatening illness. This small-scale investigation collected data in a multisite, international study including Minnesota, USA, and Melbourne, Australia. An exploratory mixed method design used the qualitative data collected through interviews with parents to interpret results from the PedsQL Family Impact Module of overall parental quality of life. Parents described music therapy as resulting in physical improvements of their child by providing comfort and stimulation. They also valued the positive experiences shared by the family in music therapy sessions that were strength oriented and family centered. This highlighted the physical and communication scales within the PedsQL Family Impact Module, where minimal improvements were achieved in contrast to some strong results suggesting diminished quality of life in cognitive and daily activity domains. Despite the significant challenges faced by parents during this difficult time, parents described many positive experiences in music therapy, and the overall score for half of the parents in the study did not diminish. The value of music therapy as a service that addresses the family-centered agenda of PPC is endorsed by this study. PMID:22144660

  4. Improving the quality of eye care with tele-ophthalmology: shared-care glaucoma screening.

    PubMed

    de Mul, Marleen; de Bont, Antoinette A; Reus, Nicolaas J; Lemij, Hans G; Berg, Marc

    2004-01-01

    We evaluated a shared-care tele-ophthalmology service initiated by the Rotterdam Eye Hospital and 10 optometrists working in retail optician stores. The optometrists screened their clients with a nerve fibre analyser and the resulting images were then further assessed by trained technicians at the hospital. We analysed data from 1729 patients and measured several indicators of the quality of the work as well as its efficiency and effectiveness. The quality of the images was at least satisfactory in most cases (89%), and the agreement between the optometrists and the hospital about normal or suspect test results was high (81%). Only 27% of the patients were called for additional testing at the hospital department and 11% consulted an ophthalmologist. Eighty new cases of glaucoma were detected. The combination of task redesign and telemedicine accounted for the success of the screening service. Task redesign was needed to transfer screening from the hospital to primary care in a safe and responsible way. Telemedicine was crucial for assuring quality, facilitating information exchange and for coordination. PMID:15603630

  5. Gaps in quality of diabetes care in internal medicine residency clinics suggest the need for better ambulatory care training.

    PubMed

    Lynn, Lorna; Hess, Brian J; Weng, Weifeng; Lipner, Rebecca S; Holmboe, Eric S

    2012-01-01

    To ensure that medical residents will be prepared to deliver consistently high-quality care, they should be trained in settings that provide such care. Residents in internal medicine, particularly, need to learn good care habits in order to meet the needs of patients with diabetes and other common chronic and high-impact illnesses. To assess the strength of such training, we compared the quality of medical care provided in sixty-seven US internal medicine residency ambulatory clinics with the quality of care provided by 703 practicing general internists. We found significant quality gaps in process, intermediate outcome, and patient-experience measures. These inadequacies in ambulatory training for internal medicine residents must be addressed by policy makers and educators-for example, by accelerating the movement toward new residency curricula that emphasize competency-based training. PMID:22232105

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

    PubMed Central

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

    2013-01-01

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

  7. Fighting violence against health workers: a way to improve quality of care?

    PubMed

    Gignon, Maxime; Verheye, Jean-Charles; Manaouil, CĂ©cile; Ammirati, Christine; Turban-Castel, Emmanuelle; Ganry, Olivier

    2014-06-01

    Violence against health care workers impairs the quality of care. In one university medical center in France, 46% of the health care workers were physically assaulted at some point in the previous 12 months and 79% were verbally insulted. This article describes a participatory approach that was used to ensure health care workers take an active role in designing and implementing anti-violence measures. In each unit, a working group of health care professionals and managers developed an action plan for reducing violence-generating practices. This proactive approach is a powerful tool for motivating health care professionals to improve quality of care. PMID:24971816

  8. Agreement and disagreement on health care quality concepts among academic health professionals: the Saudi case.

    PubMed

    Mahrous, Mohamed Saad

    2014-01-01

    A systematic and rigorous implementation of quality improvement processes is likely to improve the well-being of staff members and heighten their job satisfaction. Assessing professionals' perceptions of health care quality should lead to the betterment of health care services. In Saudi Arabia, no previous studies examine how university health professionals view health care quality concepts. A cross-sectional analytical study employing a self-administered questionnaire with 43 statements assessing quality perceptions of academic health care professionals was used. Despite the agreement of health professionals on numerous quality concepts addressed in this study, there was insufficient agreement on 10 core quality concepts, 3 of which were the following: "quality focuses on customers" (50%), "quality is tangible and therefore measurable" (29.3%), and "quality is data-driven" (62%). Hence, providing health professionals with relevant training likely will generate a better understanding of quality concepts and optimize their performance. PMID:23897553

  9. Relationship Between Patients' Perceptions of Care Quality and Health Care Errors in 11 Countries: A Secondary Data Analysis

    PubMed Central

    Slack, Marion; Malone, Daniel C.; MacKinnon, Neil J.; Warholak, Terri L.

    2016-01-01

    Patients may be the most reliable reporters of some aspects of the health care process; their perspectives should be considered when pursuing changes to improve patient safety. The authors evaluated the association between patients' perceived health care quality and self-reported medical, medication, and laboratory errors in a multinational sample. The analysis was conducted using the 2010 Commonwealth Fund International Health Policy Survey, a multinational consumer survey conducted in 11 countries. Quality of care was measured by a multifaceted construct developed using Rasch techniques. After adjusting for potentially important confounding variables, an increase in respondents' perceptions of care coordination decreased the odds of self-reporting medical errors, medication errors, and laboratory errors (P < .001). As health care stakeholders continue to search for initiatives that improve care experiences and outcomes, this study's results emphasize the importance of guaranteeing integrated care. PMID:26783863

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

    ERIC Educational Resources Information Center

    Headrick, Linda A.; And Others

    1992-01-01

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

  11. The Nonprofit Advantage: Producing Quality in Thick and Thin Child Care Markets

    ERIC Educational Resources Information Center

    Cleveland, Gordon; Krashinsky, Michael

    2009-01-01

    Nonprofit child care centers are frequently observed to produce child care which is, on average, of higher quality than care provided in commercial child care centers. In part, this nonprofit advantage is due to different input choices made by nonprofit centers--lower child--staff ratios, better-educated staff and directors, higher rates of…

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

    ERIC Educational Resources Information Center

    Meyers, Marcia K.

    1993-01-01

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

  13. Quality of Care for Myocardial Infarction in Rural and Urban Hospitals

    ERIC Educational Resources Information Center

    Baldwin, Laura-Mae; Chan, Leighton; Andrilla, C. Holly A.; Huff, Edwin D.; Hart, L. Gary

    2010-01-01

    Background: In the mid-1990s, significant gaps existed in the quality of acute myocardial infarction (AMI) care between rural and urban hospitals. Since then, overall AMI care quality has improved. This study uses more recent data to determine whether rural-urban AMI quality gaps have persisted. Methods: Using inpatient records data for 34,776…

  14. 45 CFR 158.150 - Activities that improve health care quality.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... quality reporting and related documentation in non-electronic form for activities to prevent hospital... 45 Public Welfare 1 2012-10-01 2012-10-01 false Activities that improve health care quality. 158... Reporting § 158.150 Activities that improve health care quality. (a) General requirements. The...

  15. 45 CFR 158.150 - Activities that improve health care quality.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... quality reporting and related documentation in non-electronic form for activities to prevent hospital... 45 Public Welfare 1 2013-10-01 2013-10-01 false Activities that improve health care quality. 158... Reporting § 158.150 Activities that improve health care quality. (a) General requirements. The...

  16. Quality of Care for Myocardial Infarction in Rural and Urban Hospitals

    ERIC Educational Resources Information Center

    Baldwin, Laura-Mae; Chan, Leighton; Andrilla, C. Holly A.; Huff, Edwin D.; Hart, L. Gary

    2010-01-01

    Background: In the mid-1990s, significant gaps existed in the quality of acute myocardial infarction (AMI) care between rural and urban hospitals. Since then, overall AMI care quality has improved. This study uses more recent data to determine whether rural-urban AMI quality gaps have persisted. Methods: Using inpatient records data for 34,776


  17. West Virginia Essential Elements of Quality for Early Care and Education Programs.

    ERIC Educational Resources Information Center

    West Virginia Governor's Cabinet on Children and Families, Charleston.

    Based on the belief that all children have a right to quality care and education, early childhood best practices, and trained staff/providers, this guide details quality standards for early care and education programs in West Virginia, developed through the Early Education Quality Improvement Project (EQUIP). The standards are voluntary and not…

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

    PubMed

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

    2015-09-01

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

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

    PubMed Central

    2013-01-01

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

  20. Quality of care in reproductive health programmes: monitoring and evaluation of quality improvement.

    PubMed

    Kwast, B E

    1998-12-01

    As 200 million women become pregnant every year, at least 30 million will develop life-threatening complications requiring emergency treatment at any level of society where they live. But it is a basic human right that pregnancy be made safe for all women as complications are mostly unpredictable. This requires reproductive health programmes which are responsive to women's and their families' needs and expectations on the one hand and enhancement of community participation, high quality obstetric services, and both provider collaboration and satisfaction on the other. Monitoring and evaluation of these facets need to be an integral part of any safe motherhood programme, not only to assess progress, but also to use this information for subsequent planning and implementation cycles of national programmes. Lessons learned from ten years' implementation of Safe Motherhood programmes indicate that process and outcome indicators are more feasible for short-term evaluation purposes than impact indicators, such as maternal mortality reduction. The former are described in this paper with relevant country examples. This is the third, and last, article in a series on quality of care in reproductive health programmes. The first (Kwast 1998a) contains an overview of concepts, assessments, barriers and improvements of quality of care. The second (Kwast 1998b) addresses education issues for quality improvement. PMID:10076314

  1. The ABC's of Quality Child Care: Parent Handbook.

    ERIC Educational Resources Information Center

    Oklahoma State Dept. of Human Services, Oklahoma City. Office of Child Care.

    This booklet for Oklahoma parents provides guidelines for selecting a child care setting that best suits the child, the family, and the work situation. It delineates 13 steps in choosing a child care arrangement and lists child care options such as centers, family day care homes, and in-home care arrangements. The role of state licensing is…

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

    ERIC Educational Resources Information Center

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

    2006-01-01

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

  3. Managing risk, clinical error, and quality of care.

    PubMed

    Milne, J Kenneth

    2002-09-01

    Clinical risk presents enormous challenges for the health profession and governments. Despite excellent national and regional programs focused on the management of obstetrical conditions and prevention of newborn injury, an environment of clinical error persists; according to Canadian Medical Protective Association data, each year 6% of Canadian obstetricians face a legal challenge, with most cases also involving nurses and hospitals. Principles and lessons learned from risk management developed in high reliability organizations (HROs), such as air traffic controllers and nuclear power plants, can be applied to risk management in perinatal/obstetrical units. In 2002, the Society of Obstetricians and Gynaecologists of Canada will launch an obstetrical risk management program called "Managing Obstetrical Risk Efficiently" (MORE), integrating labour and delivery clinical core content with HRO principles and reflective learning and practice modification tools designed to help all obstetrical caregivers build and maintain confidence and competency, improve patient safety and quality of care, and reduce clinical error and adverse events. PMID:12360367

  4. Development of a quality ranking model for home health care providers.

    PubMed

    Gressel, Justin W

    2013-01-01

    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

  5. Quality and quantity of infertility care in Bangladesh.

    PubMed

    Fatima, P; Ishrat, S; Rahman, D; Banu, J; Deeba, F; Begum, N; Anwary, S A; Hossain, H B

    2015-01-01

    Infertility is an important health issue which has been neglected in the developing countries. First test-tube babies (triplet) in Bangladesh were born on 30th May, 2001. Although there is no tertiary level infertility center in the public sector, several private centers have come up with the facilities. The objective of the study was to find i) the quality and quantity of infertility care in Bangladesh and ii) the cause of infertility in the attending patients iii) the treatment seeking behaviors iv) and the reasons for not taking treatment among the attending patients. There are now 10 tertiary level Infertility centers in Bangladesh. The information was collected in a preformed datasheet about the facilities and the profile of the patients and the treatment seeking behavior of the attending patients. Out of the ten centers two centers refused to respond and did not disclose their data. Around 16700 new patients are enrolled in a year in the responsive clinics. Five percent (5%) of the patients underwent ART, 7% of the patients gave only one visit, 84% of the patients completed their evaluation, 76% of the patients took treatment. Causes of infertility in the patients taking treatment were male factor in 36.4%, bilateral tubal block in 20.2%, PCOS and anovulation in 31.7%, endometriosis in 19.6%, unexplained in 10.95, combined in 3.5%, ovarian failure in 1.4%, testicular failure in 0.33%, congenital anomaly in 0.3%. The main reason for not taking treatment was financial constrainment. The quality and quantity of infertility care is dependent on the available resources and on the use of the resources by the patients. In developing countries the resources are merging and confined to specified areas which cannot meet the demand of their population. The study gives us the idea of the need and the demand of the services in the country. PMID:25725670

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

    PubMed Central

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

    2011-01-01

    Context: Racial and ethnic disparities in the quality of health care are well documented in the U.S. health care system. Reducing these disparities requires action by health care organizations. Collecting accurate data from patients about their race and ethnicity is an essential first step for health care organizations to take such action, but these data are not systematically collected and used for quality improvement purposes in the United States. This study explores the challenges encountered by health care organizations that attempted to collect and use these data to reduce disparities. Methods: Purposive sampling was used to identify eight health care organizations that collected race and ethnicity data to measure and reduce disparities in the quality and outcomes of health care. Staff, including senior managers and data analysts, were interviewed at each site, using a semi-structured interview format about the following themes: the challenges of collecting and collating accurate data from patients, how organizations defined a disparity and analyzed data, and the impact and uses of their findings. Findings: To collect accurate self-reported data on race and ethnicity from patients, most organizations had upgraded or modified their IT systems to capture data and trained staff to collect and input these data from patients. By stratifying nationally validated indicators of quality for hospitals and ambulatory care by race and ethnicity, most organizations had then used these data to identify disparities in the quality of care. In this process, organizations were taking different approaches to defining and measuring disparities. Through these various methods, all organizations had found some disparities, and some had invested in interventions designed to address them, such as extra staff, extended hours, or services in new locations. Conclusion: If policymakers wish to hold health care organizations accountable for disparities in the quality of the care they 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. PMID:21676022

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

    PubMed

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

    2013-01-01

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

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

    PubMed

    Mayberry, Robert M; Nicewander, David A; Qin, Huanying; Ballard, David J

    2008-01-01

    The health care quality chasm is better described as a gulf for certain segments of the population, such as racial and ethnic minority groups, given the gap between actual care received and ideal or best care quality. The landmark Institute of Medicine report Crossing the Quality Chasm: A New Health System for the 21st Century challenges all health care organizations to pursue six major aims of health care improvement: safety, timeliness, effectiveness, efficiency, equity, and patient-centeredness. "Equity" aims to ensure that quality care is available to all and that the quality of care provided does not differ by race, ethnicity, or other personal characteristics unrelated to a patient's reason for seeking care. Baylor Health Care System is in the unique position of being able to examine the current state of equity in a typical health care delivery system and to lead the way in health equity research. Its organizational vision, "culture of quality," and involved leadership bode well for achieving equitable best care. However, inequities in access, use, and outcomes of health care must be scrutinized; the moral, ethical, and economic issues they raise and the critical injustice they create must be remedied if this goal is to be achieved. Eliminating any observed inequities in health care must be synergistically integrated with quality improvement. Quality performance indicators currently collected and evaluated indicate that Baylor Health Care System often performs better than the national average. However, there are significant variations in care by age, gender, race/ethnicity, and socioeconomic status that indicate the many remaining challenges in achieving "best care" for all. PMID:19181022

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

    PubMed

    Mayberry, Robert M; Nicewander, David A; Qin, Huanying; Ballard, David J

    2006-04-01

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

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

    Cancer.gov

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

  11. 45 CFR 98.51 - Activities to improve the quality of child care.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 45 Public Welfare 1 2013-10-01 2013-10-01 false Activities to improve the quality of child care. 98.51 Section 98.51 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION CHILD CARE AND DEVELOPMENT FUND Use of Child Care and Development Funds § 98.51 Activities to improve the quality of child care. (a) No less than...

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

    PubMed

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

    2015-01-01

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

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

    PubMed Central

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

    2015-01-01

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

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

    PubMed

    Le Rouge, Cynthia; De Leo, Gianluca

    2008-01-01

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

  15. [Quality evaluation of primary care service performance. What are the problems with the recent Hungarian primary care indicators?].

    PubMed

    KolozsvĂĄri, LĂĄszlĂł RĂłbert; Rurik, Imre

    2016-02-28

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

  16. Does value-based purchasing enhance quality of care and patient outcomes in the ICU?

    PubMed

    O'Brien, James M; Kumar, Anupam; Metersky, Mark L

    2013-01-01

    As health care expenditures increase, payers, including the Centers for Medicare and Medicaid Services, are moving away from reimbursement based on types and volume of services to an emphasis on quality of provided care, an approach called value-based purchasing (VBP). Because it is tied to reimbursement, VBP creates economic motivation to measure and improve care. VBP is proceeding without high-level evidence supporting its effectiveness in improving health care quality. Rising health care costs, however, make VBP an attractive approach for curtailing costs and emphasizing improved quality, and VBP is likely to become a more prevalent mechanism of reimbursement for providers and facilities. PMID:23182530

  17. Serious Mental Illness and Nursing Home Quality of Care

    PubMed Central

    Rahman, Momotazur; Grabowski, David C; Intrator, Orna; Cai, Shubing; Mor, Vincent

    2013-01-01

    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, policy makers 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. PMID:23278400

  18. Patient-reported quality of care and pain severity in cancer

    PubMed Central

    Martinez, Kathryn A.; Snyder, Claire F.; Malin, Jennifer L.; Dy, Sydney M.

    2015-01-01

    Objective Despite treatment availability, many cancer patients experience severe pain. Although patient assessments of care are increasingly employed to evaluate quality of care, little is known about its association with cancer symptom burden. The objective of our study was to examine the association between patient-reported quality of care and pain severity in a nationally representative cohort of cancer patients. Method Quality of care was measured in three domains: physician communication, care coordination/responsiveness, and nursing care. Quality scores were dichotomized as optimal versus nonoptimal. Pain was measured on a scale of 0 (least) to 100 (worst). We utilized multivariable linear regression to examine the association between patient-reported quality of care and pain severity. Results The analytic sample included 2,746 individuals. Fifty and 54% of patients, respectively, rated physician communication and care coordination/responsiveness as nonoptimal; 28% rated nursing care as nonoptimal. In adjusted models, rating physician communication as nonoptimal (versus optimal) was associated with a 1.8-point higher pain severity (p = 0.018), and rating care coordination/responsiveness as nonoptimal was associated with a 2.2-point higher pain severity (p = 0.006). Significance of results Patient-reported quality of care was significantly associated with pain severity, although the differences were small. Interventions targeting physician communication and care coordination/responsiveness may result in improved pain control for some patients. PMID:24967597

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

    PubMed

    Marcus, M; Spolsky, V

    1998-02-01

    This is a survey of various concepts of quality of care in the health care field and their application to periodontics. Definitions of quality care, measuring and improving quality, third party payment and quality of care, and the role of periodontists in managing quality are presented. The definitions of quality care include the following dimensions: access, appropriateness, technical quality, and the art of care. Examples of each of these dimensions are presented, and their implications for quality assessment are discussed. Emphasis is placed on appropriateness of care and the strengths and weaknesses of mechanisms for deriving evidence-based decision making. The use of randomized clinical trials (RCT), employing expert opinion such as consensus panels, and meta-analysis are discussed as they apply to appropriateness of periodontal treatment. Work in the area of technical quality of care (i.e., the third dimension of quality care) has resulted in the development of quality assurance guidelines. Examples of guidelines and practice parameters such as those developed by the U.S. Food and Drug Administration and by various dental specialties are presented. The fourth dimension of quality deals with the art of care. It focuses on the patient's participation in the process of care and the input of the provider in this interaction. The description of outcomes of care includes the concept of measuring clinical outcomes of treatment as well as efforts to measure the health and well-being of a patient. It deals with quality of life measures. Patient satisfaction is another outcome that is presented. Examples of these aspects of quality measurement are discussed. These concepts and measures are presented within the context of a quality assurance program. The steps used to assess and assure quality are outlined. Examples of provider and patient profiles are presented, along with a discussion on how they are used in a quality assurance system. Lastly, the role of the periodontist in quality of care is presented, emphasizing the efforts that have already been made as well as the leadership role that the periodontist has in influencing the profession of dentistry. The advent of managed care and its implications for the quality of periodontal treatment and patient management are discussed using situations obtained from dental plans. PMID:9526923

  20. Thalassaemia in children: from quality of care to quality of life.

    PubMed

    Amid, Ali; Saliba, Antoine N; Taher, Ali T; Klaassen, Robert J

    2015-11-01

    Over the past few decades, there has been a remarkable improvement in the survival of patients with thalassaemia in developed countries. Availability of safe blood transfusions, effective and accessible iron chelating medications, the introduction of new and non-invasive methods of tissue iron assessment and other advances in multidisciplinary care of thalassaemia patients have all contributed to better outcomes. This, however, may not be true for patients who are born in countries where the resources are limited. Unfortunately, transfusion-transmitted infections are still major concerns in these countries where paradoxically thalassaemia is most common. Moreover, oral iron chelators and MRI for monitoring of iron status may not be widely accessible or affordable, which may result in poor compliance and suboptimal iron chelation. All of these limitations will lead to reduced survival and increased thalassaemia-related complications and subsequently will affect the patient's quality of life. In countries with limited resources, together with improvement of clinical care, strategies to control the disease burden, such as public education, screening programmes and appropriate counselling, should be put in place. Much can be done to improve the situation by developing partnerships between developed countries and those with limited resources. Future research should also particularly focus on patient's quality of life as an important outcome of care. PMID:26289062

  1. The patient as the pivot point for quality in health care delivery.

    PubMed

    Lengnick-Hall, C A

    1995-01-01

    Health care enterprises make comprehensive and durable changes in people. This human-centered purpose defines the fundamental nature of quality in health care settings. Traditional perspectives of quality and familiar views of customer satisfaction are inadequate to manage the complex relationships between the health care delivery firm and its patients. Patients play four roles in health care systems that must be reflected when defining and measuring quality in these settings: patient as supplier, patient as product, patient as participant, and patient as recipient. This article presents a conceptual model of quality that incorporates these diverse patient roles. The strategic and managerial implications of the model are also discussed. PMID:10140872

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

    PubMed Central

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

    2006-01-01

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

  3. Cost, Utilization, and Quality of Care: An Evaluation of Illinois’ Medicaid Primary Care Case Management Program

    PubMed Central

    Phillips, Robert L.; Han, Meiying; Petterson, Stephen M.; Makaroff, Laura A.; Liaw, Winston R.

    2014-01-01

    PURPOSE In 2006, Illinois established Illinois Health Connect (IHC), a primary care case management program for Medicaid that offered enhanced fee-for-service, capitation payments, performance incentives, and practice support. Illinois also implemented a complementary disease management program, Your Healthcare Plus (YHP). This external evaluation explored outcomes associated with these programs. METHODS We analyzed Medicaid claims and enrollment data from 2004 to 2010, covering both pre- and post-implementation. The base year was 2006, and 2006–2010 eligibility criteria were applied to 2004–2005 data to allow comparison. We studied costs and utilization trends, overall and by service and setting. We studied quality by incorporating Healthcare Effectiveness Data and Information Set (HEDIS) measures and IHC performance payment criteria. RESULTS Illinois Medicaid expanded considerably between 2006 (2,095,699 full-year equivalents) and 2010 (2,692,123). Annual savings were 6.5% for IHC and 8.6% for YHP by the fourth year, with cumulative Medicaid savings of $1.46 billion. Per-beneficiary annual costs fell in Illinois over this period compared to those in states with similar Medicaid programs. Quality improved for nearly all metrics under IHC, and most prevention measures more than doubled in frequency. Medicaid inpatient costs fell by 30.3%, and outpatient costs rose by 24.9% to 45.7% across programs. Avoidable hospitalizations fell by 16.8% for YHP, and bed-days fell by 15.6% for IHC. Emergency department visits declined by 5% by 2010. CONCLUSIONS The Illinois Medicaid IHC and YHP programs were associated with substantial savings, reductions in inpatient and emergency care, and improvements in quality measures. This experience is not typical of other states implementing some, but not all, of these same policies. Although specific features of the Illinois reforms may have accounted for its better outcomes, the limited evaluation design calls for caution in making causal inferences. PMID:25354404

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

    MedlinePLUS

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

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

    PubMed Central

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

    2015-01-01

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

  6. Relations among Child Care Quality, Teacher Behavior, Children's Play Activities, Emotional Security, and Cognitive Activity in Child Care.

    ERIC Educational Resources Information Center

    Howes, Carollee; Smith, Ellen W.

    1995-01-01

    Examined the relationship between variation in 840 children's cognitive activities and child-care quality, interaction with teachers, and children's play activities and attachment security with their child-care teachers. In 7 of the 8 subsamples, 15 to 30% of the variability in cognitive activities could be predicted from positive social…

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

    ERIC Educational Resources Information Center

    Lemay, Lise; Bigras, Nathalie; Bouchard, Caroline

    2015-01-01

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

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

    ERIC Educational Resources Information Center

    Lemay, Lise; Bigras, Nathalie; Bouchard, Caroline

    2015-01-01

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


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

    PubMed Central

    Duan, Xia; Shi, Yan

    2014-01-01

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

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

    PubMed

    Ishikura, Satoshi

    2008-11-01

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

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

    ERIC Educational Resources Information Center

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

    2006-01-01

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


  12. Quality of care in inflammatory bowel disease: a review and discussion.

    PubMed

    Kappelman, Michael D; Palmer, Lena; Boyle, Brendan M; Rubin, David T

    2010-01-01

    The Institute of Medicine's publications To Err Is Human and Crossing the Quality Chasm publicized the widespread deficits in U.S. health care quality. Emerging studies continue to reveal deficits in the quality of adult and pediatric care, including subspecialty care. The inflammatory bowel diseases (IBD) Crohn's disease and ulcerative colitis require diligent, long-term management and attention to their impact on intestinal and extraintestinal organ systems. Although the quality of IBD care has not been prospectively or comprehensively evaluated in the United States, several small studies have demonstrated significant variation in care. As variation may indicate underuse, overuse, or misuse of medical services, such variation suggests a clear need for translating evidence-based practices into the actual practice and follow-up provided for patients. This article reviews the history, rationale, and methods of quality measurement and improvement and identifies the unique challenges in adapting these general strategies to the care of the inflammatory bowel diseases. PMID:19572335

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

    PubMed Central

    Kim, Jinkyung; Han, Woosok

    2012-01-01

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

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

    PubMed Central

    Colebourn, Claire L

    2015-01-01

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

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

    PubMed Central

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

    2016-01-01

    Objectives The study examines the meaning of good-quality social care for people with Parkinson's disease and their carers. It identifies, from their perspective, the impact of good-quality social care on health and well-being. Design Qualitative case study methodology, interview and framework analysis techniques were used. Setting: community locations in the north and midlands of England. Participants Data were collected from 43 participants including individual interviews with people with Parkinson's disease (n=4), formal and informal social care providers (n=13), 2 focus groups, 1 with people with Parkinson's disease and their carers (n=17), and 1 with professionals (n=8), plus a telephone interview with a former commissioner. Findings Good-quality social care, delivered in a timely fashion, was reported to have a positive impact on health. Furthermore, there is an indication that good-quality social care can prevent untoward events, such as infections, symptom deterioration and deterioration in mental health. The concept of the ‘Impact Gap’ developed from the findings, illustrates how the costs of care may be reduced by delivering good-quality social care. Control, choice and maintaining independence emerged as indicators of good-quality social care, irrespective of clinical condition. Participants identified characteristics indicative of good-quality social care specific to Parkinson's disease, including understanding Parkinson's disease, appropriate administration of medication, timing of care and reassessment. ‘Parkinson's aware’ social care was seen to generate psychological, physical and social benefits that were inter-related. Conclusions The findings indicate how maximising quality in social care delivery for people with Parkinson's disease can impact on health and well-being. Long-term or short-term benefits may result in prevented events and reductions in health and social care resource. Health professionals can be instrumental in early detection of and signposting to social care. PMID:26883233

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

    PubMed Central

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

    2011-01-01

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

  17. Survey using incognito standardized patients shows poor quality care in China's rural clinics.

    PubMed

    Sylvia, Sean; Shi, Yaojiang; Xue, Hao; Tian, Xin; Wang, Huan; Liu, Qingmei; Medina, Alexis; Rozelle, Scott

    2015-04-01

    Over the past decade, China has implemented reforms designed to expand access to health care in rural areas. Little objective evidence exists, however, on the quality of that care. This study reports results from a standardized patient study designed to assess the quality of care delivered by village clinicians in rural China. To measure quality, we recruited individuals from the local community to serve as undercover patients and trained them to present consistent symptoms of two common illnesses (dysentery and angina). Based on 82 covert interactions between the standardized patients and local clinicians, we find that the quality of care is low as measured by adherence to clinical checklists and the rates of correct diagnoses and treatments. Further analysis suggests that quality is most strongly correlated with provider qualifications. Our results highlight the need for policy action to address the low quality of care delivered by grassroots providers. PMID:24653216

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

    PubMed Central

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

    2010-01-01

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

  19. Do hospitals without physicians on the board deliver lower quality of care?

    PubMed

    Bai, Ge; Krishnan, Ranjani

    2015-01-01

    This study examines whether hospitals without physician participation on their boards of directors deliver lower quality of care. Using data from California nonprofit hospitals from 2004 to 2008, the authors document that the absence of physicians on the board is associated with a decrease of 3 to 5 percentage points in 3 of 4 measures of care quality. This result was obtained using regression analysis, which controls for various hospital characteristics. The authors also identify factors that influence quality of care in hospitals. Specifically, hospital size, church affiliation, urban location, and system affiliation are positively associated with quality of care; proportion of Medicaid patient revenue and poverty level of the county in which the hospital is located are negatively associated with quality of care. These results highlight the importance of physician participation in hospital governance and indicate areas for hospitals and policy makers to focus on to enhance medical quality management. PMID:24413657

  20. Can psychiatry cross the quality chasm? Improving the quality of health care for mental and substance use conditions.

    PubMed

    Pincus, Harold Alan; Page, Ann E K; Druss, Benjamin; Appelbaum, Paul S; Gottlieb, Gary; England, Mary Jane

    2007-05-01

    In 2001, a seminal Institute of Medicine report, Crossing the Quality Chasm: A New Health System for the 21st Century, put forth a comprehensive strategy for improving the quality of U.S. health care. This strategy attained considerable traction within the overall U.S. health care system and subsequent attention in the mental health community as well. A new Institute of Medicine report, Improving the Quality of Health Care for Mental and Substance Use Conditions, examines the quality chasm strategy in light of the distinctive features of mental and substance use health care, including concerns about patient decision-making abilities and coercion into care, a less developed quality measurement and improvement infrastructure, lagging use of information technology and participation in the development of the National Health Information Infrastructure, greater separations in care delivery accompanied by more restrictions on sharing clinical information, a larger number of provider types licensed to diagnose and treat, more solo practice, and a differently structured marketplace. This article summarizes the Institute of Medicine's analysis of these issues and recommendations for improving mental and substance use health care and discusses the implications for psychiatric practice and related advocacy efforts of psychiatrists, psychiatric organizations, and other leaders in mental and substance use health care. PMID:17475728

  1. Quality of Type II Diabetes Care in Primary Health Care Centers in Kuwait: Employment of a Diabetes Quality Indicator Set (DQIS).

    PubMed

    Badawi, Dalia; Saleh, Shadi; Natafgi, Nabil; Mourad, Yara; Behbehani, Kazem

    2015-01-01

    Diabetes Mellitus is one of the major public health challenges, affecting more than 347 million adults worldwide. The impact of diabetes necessitates assessing the quality of care received by people with diabetes, especially in countries with a significant diabetes burden such as Kuwait. This paper aimed at piloting an approach for measuring Type II diabetes care performance through the use of a diabetes quality indicator set (DQIS) in primary health care. The DQIS for Kuwait was adapted from that developed by the National Diabetes Quality Improvement Alliance and the International Diabetes Federation. Five key care domains/measures were employed: (1) Blood glucose level measurement, (2) Cholesterol level measurement, (3) Blood pressure measurement, (4) Kidney function testing and (5) Smoking status check. The sample included the four major primary health care centers with the highest case load in Kuwait City, 4,241 patients in 2012 and 3,211 in 2010. Findings revealed the applicability and utility of employing performance indicators for diabetes care in Kuwait. Furthermore, findings revealed that many of the primary health care centers have achieved noteworthy improvement in diabetes care between 2010 and 2012, with the exception of smoking status check. The DQIS can help policymakers identify performance gaps and investigate key system roadblocks related to diabetes care in Kuwait. PMID:26176691

  2. Quality of Type II Diabetes Care in Primary Health Care Centers in Kuwait: Employment of a Diabetes Quality Indicator Set (DQIS)

    PubMed Central

    Badawi, Dalia; Saleh, Shadi; Natafgi, Nabil; Mourad, Yara; Behbehani, Kazem

    2015-01-01

    Diabetes Mellitus is one of the major public health challenges, affecting more than 347 million adults worldwide. The impact of diabetes necessitates assessing the quality of care received by people with diabetes, especially in countries with a significant diabetes burden such as Kuwait. This paper aimed at piloting an approach for measuring Type II diabetes care performance through the use of a diabetes quality indicator set (DQIS) in primary health care. The DQIS for Kuwait was adapted from that developed by the National Diabetes Quality Improvement Alliance and the International Diabetes Federation. Five key care domains/measures were employed: (1) Blood glucose level measurement, (2) Cholesterol level measurement, (3) Blood pressure measurement, (4) Kidney function testing and (5) Smoking status check. The sample included the four major primary health care centers with the highest case load in Kuwait City, 4,241 patients in 2012 and 3,211 in 2010. Findings revealed the applicability and utility of employing performance indicators for diabetes care in Kuwait. Furthermore, findings revealed that many of the primary health care centers have achieved noteworthy improvement in diabetes care between 2010 and 2012, with the exception of smoking status check. The DQIS can help policymakers identify performance gaps and investigate key system roadblocks related to diabetes care in Kuwait. PMID:26176691

  3. 42 CFR 425.500 - Measures to assess the quality of care furnished by an ACO.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM (CONTINUED) MEDICARE SHARED SAVINGS PROGRAM Quality Performance Standards and Reporting § 425.500 Measures to assess the quality of care furnished by an ACO. (a) General. CMS establishes quality performance measures to assess the quality of...

  4. 42 CFR 425.500 - Measures to assess the quality of care furnished by an ACO.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM (CONTINUED) MEDICARE SHARED SAVINGS PROGRAM Quality Performance Standards and Reporting § 425.500 Measures to assess the quality of care furnished by an ACO. (a) General. CMS establishes quality performance measures to assess the quality of...

  5. 42 CFR 425.500 - Measures to assess the quality of care furnished by an ACO.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM (CONTINUED) MEDICARE SHARED SAVINGS PROGRAM Quality Performance Standards and Reporting § 425.500 Measures to assess the quality of care furnished by an ACO. (a) General. CMS establishes quality performance measures to assess the quality of...

  6. Developing a Patient Care Co-ordination Centre in Trafford, England: lessons from the International Foundation for Integrated Care (IFIC)/Advancing Quality Alliance integrated care fellowship experience

    PubMed Central

    Gregory, Michael

    2015-01-01

    The NHS and Social Care in England are facing one of the biggest financial challenges for a generation. Commissioners and providers need to work on collaborative schemes to manage the increasing demand on health and social care within a period of financial constraint. Different forms of care co-ordination have been developed at different levels across the world. In the north-west of England, the Trafford health and social care economy have been working through a competitive dialogue process with industry to develop an innovative and dynamic solution to deliver seamless co-ordination for all patients and service users. The strategy is to develop a new Patient Care Co-ordination Centre, which will be responsible for the delivery of co-ordinated, quality care. The Patient Care Co-ordination Centre will work at clinical, service, functional and community levels across multiple providers covering risk stratification, preventative, elective and unscheduled care. I am the clinical lead for the Patient Care Co-ordination Centre and during my year as an Advancing Quality Alliance Integrated Care Fellow, I have had the opportunity to study examples of care coordination from UK and international sites. The learning from these visits has been assimilated into the design process of the Patient Care Co-ordination Centre. PMID:26034468

  7. Developing a Patient Care Co-ordination Centre in Trafford, England: lessons from the International Foundation for Integrated Care (IFIC)/Advancing Quality Alliance integrated care fellowship experience.

    PubMed

    Gregory, Michael

    2015-01-01

    The NHS and Social Care in England are facing one of the biggest financial challenges for a generation. Commissioners and providers need to work on collaborative schemes to manage the increasing demand on health and social care within a period of financial constraint. Different forms of care co-ordination have been developed at different levels across the world. In the north-west of England, the Trafford health and social care economy have been working through a competitive dialogue process with industry to develop an innovative and dynamic solution to deliver seamless co-ordination for all patients and service users. The strategy is to develop a new Patient Care Co-ordination Centre, which will be responsible for the delivery of co-ordinated, quality care. The Patient Care Co-ordination Centre will work at clinical, service, functional and community levels across multiple providers covering risk stratification, preventative, elective and unscheduled care. I am the clinical lead for the Patient Care Co-ordination Centre and during my year as an Advancing Quality Alliance Integrated Care Fellow, I have had the opportunity to study examples of care coordination from UK and international sites. The learning from these visits has been assimilated into the design process of the Patient Care Co-ordination Centre. PMID:26034468

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

    ERIC Educational Resources Information Center

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

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

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

    PubMed

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

    2015-09-01

    Acute care of children remains a challenge due to a shortage of pediatric surgeons, particularly in rural areas. In our institutional norm, all cases in patients age six and older are managed by dedicated general surgeons. The provision of care to these children by these surgeons alleviates the impact of such shortages. We conducted a five-year retrospective analysis of all acute care pediatric surgical cases performed in patients aged 6 to 17 years by a dedicated group of adult general surgeons in a rural tertiary care hospital. Demographics, procedure, complications, outcomes, length of stay, and time of consultation/operation were obtained via chart review. Elective, trauma related, or procedures performed by a pediatric surgeon were excluded. Descriptive statistics are reported. A total of 397 cases were performed by six dedicated general surgeons during the study period. Mean age was 11.5 ± 3.1 years. In all, 100 (25.2%) were transferred from outlying facilities and 52.6 per cent of consultations/operations occurred at night (7P-7A), of which 33.2 per cent occurred during late night hours (11P-7A). On weekends, 34.0 per cent occurred. Appendectomy was the most commonly performed operation (n = 357,89.9%), of which 311 were laparoscopic (87.1%). Others included incision/drainage (4.5%), laparoscopic cholecystectomy (2.0%), bowel resection (1.5%), incarcerated hernia (0.5%), small bowel obstruction (0.5%), intra-abdominal abscess drainage (0.3%), resection of intussusception (0.3%), Graham patch (0.3%), and resection omental torsion (0.3%). Median length of stay was two days. Complications occurred in 23 patients (5.8%), of which 22(5.5%) were the result of the disease process. These results parallel those published by pediatric surgeons in this age group and for the diagnoses treated. Models integrating dedicated general surgeons into pediatric call rotations can be designed such that quality of pediatric care is maintained while providing relief to an overburdened pediatric surgical workforce. PMID:26350660

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

    PubMed Central

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

    2013-01-01

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

  11. Family Impacts among Children with Autism Spectrum Disorder: The Role of Health Care Quality

    PubMed Central

    Zuckerman, Katharine E.; Lindly, Olivia J.; Bethell, Christina D.; Kuhlthau, Karen

    2014-01-01

    Objectives To compare health care quality and family employment and financial impacts among children with special health care needs (CSHCN) with autism spectrum disorder (CSHCN+ASD), CSHCN with functional limitations (CSHCN+FL), and CSHCN lacking these conditions (other CSHCN). To test whether high health care quality was associated with reduced family impacts among CSHCN+ASD. Methods Data from the 2009-2010 National Survey of CSHCN were used to compare 3025 CSHCN+ASD, 6505 CSHCN+FL, and 28 296 other CSHCN. Weighted multivariate logistic regression analyses examined six age-relevant, federally-defined health care quality indicators and five family financial and employment impact indicators. Two composite measures were additionally used: (1) receipt of care that met all age-relevant quality indicators; and (2) had ? two of the five adverse family impacts. Results Across all health care quality indicators CSHCN+ASD fared poorly, with only 7.4% meeting all age-relevant indicators. CSHCN+ASD had worse health care quality than other CSHCN, including CSHCN+FL. CSHCN+ASD also had high rates of adverse family impact, with over half experiencing two or more adverse impacts. Rates of adverse family impact were higher in CSHCN+ASD than other CSHCN, including CSHCN+FL. Among CSHCN+ASD, those whose health care that met federal quality standards were less likely to have multiple adverse family impacts than CSHCN+ASD whose health care did not meet federal quality standards. Conclusions CSHCN+ASD are more prone to experience poor health care quality and family impacts than other CSHCN, even CSHCN+FL. Receipt of care meeting federal quality standards may potentially lessen adverse family impacts for CSHCN+ASD. PMID:24976352

  12. 42 CFR 423.2430 - Activities that improve health care quality.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... services under the plan or coverage. (ii) To prevent hospital readmissions through a comprehensive program... 42 Public Health 3 2013-10-01 2013-10-01 false Activities that improve health care quality. 423... Requirements for a Minimum Medical Loss Ratio § 423.2430 Activities that improve health care quality....

  13. 42 CFR 422.2430 - Activities that improve health care quality.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... services under the plan or coverage. (ii) To prevent hospital readmissions through a comprehensive program... 42 Public Health 3 2013-10-01 2013-10-01 false Activities that improve health care quality. 422... Minimum Medical Loss Ratio § 422.2430 Activities that improve health care quality. (a)...

  14. Vermont STep Ahead Recognition System: QRS Profile. The Child Care Quality Rating System (QRS) Assessment

    ERIC Educational Resources Information Center

    Child Trends, 2010

    2010-01-01

    This paper presents a profile of Vermont's STep Ahead Recognition System (STARS) prepared as part of the Child Care Quality Rating System (QRS) Assessment Study. The profile consists of several sections and their corresponding descriptions including: (1) Program Information; (2) Rating Details; (3) Quality Indicators for All Child Care Programs;…

  15. 42 CFR 414.1240 - Attribution for quality of care and cost measures.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 3 2014-10-01 2014-10-01 false Attribution for quality of care and cost measures. 414.1240 Section 414.1240 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH... quality of care and cost measures. (a) Beneficiaries are attributed to groups of physicians subject to...

  16. 42 CFR 414.1240 - Attribution for quality of care and cost measures.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 3 2013-10-01 2013-10-01 false Attribution for quality of care and cost measures. 414.1240 Section 414.1240 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH... quality of care and cost measures. Beneficiaries are attributed to groups of physicians subject to...

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

    ERIC Educational Resources Information Center

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

    2012-01-01

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


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

    ERIC Educational Resources Information Center

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

    2012-01-01

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

  19. Physicians’ Perceptions About the Quality of Primary Health Care Services in Transitional Albania

    PubMed Central

    Kellici, Neritan; Dibra, Arvin; Mihani, Joana; Kellici, Suela; Burazeri, Genc

    2015-01-01

    Aim: To date, the available information regarding the quality of primary health care services in Albania is scarce. The aim of our study was to assess the quality of primary health care services in Albania based on physicians’ perceptions towards the quality of the services provided to the general population. Methods: A cross-sectional study was conducted in January-March 2013 including a representative sample of 132 physicians (59 men aged 41.3±6.9 years and 73 women aged 43.7±4.8 years; overall response rate: 132/150=88%) providing primary health care services in several polyclinics (health centers) of Tirana, the Albanian capital city. A structured self-administered and anonymous questionnaire was applied including physicians’ perceptions regarding different dimensions of the quality of primary health care. Binary logistic regression was used to assess the association of self-perceived quality of health care services with baseline characteristics of physicians. Results: Self-perceived adequate quality of health care services was positively related to the age of physicians, their working experience, female gender, a lower population served, and specialization in family medicine. Conclusion: Our findings provide useful evidence on the self-perceived quality of health services from primary health care physicians’ perspective in transitional Albania. Health authorities in Albania should implement suitable instruments to measure the quality of health care services at all levels. PMID:26005264

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

    ERIC Educational Resources Information Center

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

    2004-01-01

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