Developing online accreditation education resources for health care services: An Australian Case Study.

PubMed

Pereira-Salgado, Amanda; Boyd, Leanne; Johnson, Matthew

2017-02-01

In 2013, 'National Safety and Quality Health Service Standards' accreditation became mandatory for most health care services in Australia. Developing and maintaining accreditation education is challenging for health care services, particularly those in regional and rural settings. With accreditation imminent, there was a need to support health care services through the process. A needs analysis identified limited availability of open access online resources for national accreditation education. A standardized set of online accreditation education resources was the agreed solution to assist regional and rural health care services meet compulsory requirements. Education resources were developed over 3 months with project planning, implementation and assessment based on a program logic model. Resource evaluation was undertaken after the first 3 months of resource availability to establish initial usage and stakeholder perceptions. From 1 January 2015 to 31 March 2015, resource usage was 20 272, comprising 12 989 downloads, 3594 course completions and 3689 page views. Focus groups were conducted at two rural and one metropolitan hospital (n = 16), with rural hospitals reporting more benefits. Main user-based recommendations for future resource development were automatic access to customizable versions, ensuring suitability to intended audience, consistency between resource content and assessment tasks and availability of short and long length versions to meet differing users' needs. Further accreditation education resource development should continue to be collaborative, consider longer development timeframes and user-based recommendations. © The Author 2016. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

Innovative approach to improving the care of acute decompensated heart failure.

PubMed

Merhaut, Shawn; Trupp, Robin

2011-06-01

The care of patients presenting to hospitals with acute decompensated heart failure remains a challenging and multifaceted dilemma across the continuum of care. The combination of improved survival rates for and rising incidence of heart failure has created both a clinical and economic burden for hospitals of epidemic proportion. With limited clinical resources, hospitals are expected to provide efficient, comprehensive, and quality care to a population laden with multiple comorbidities and social constraints. Further, this care must be provided in the setting of a volatile economic climate heavily affected by prolonged length of stays, high readmission rates, and changing healthcare policy. Although problems continue to mount, solutions remain scarce. In an effort to help hospitals identify gaps in care, control costs, streamline processes, and ultimately improve outcomes for these patients, the Society of Chest Pain Centers launched Heart Failure Accreditation in July 2009. Rooted in process improvement science, the Society's approach includes utilization of a tiered Accreditation tool to identify best practices, facilitate an internal gap analysis, and generate opportunities for improvement. In contrast to other organizations that require compliance with predetermined specifications, the Society's Heart Failure Accreditation focuses on the overall process including the continuum of care from emergency medical services, emergency department care, inpatient management, transition from hospital to home, and community outreach. As partners in the process, the Society strives to build relationships with facilities and share best practices with the ultimate goal to improve outcomes for heart failure patients.

Advantages and Disadvantages of Health Care Accreditation Mod-els.

PubMed

Tabrizi, Jafar S; Gharibi, Farid; Wilson, Andrew J

2011-01-01

This systematic review seeks to define the general advantages and disadvan-tages of accreditation programs to assist in choosing the most appropriate approach. Systematic search of SID, Ovid Medline & PubMed databases was conducted by the keywords of accreditation, hospital, medical practice, clinic, accreditation models, health care and Persian meanings. From 2379 initial articles, 83 articles met the full inclusion criteria. From initial analysis, 23 attributes were identified which appeared to define advantages and disadvantages of different accreditation approaches and the available systems were compared on these. Six systems were identified in the international literature including the JCAHO from USA, the Canadian program of CCHSA, and the accreditation programs of UK, Australia, New Zealand and France. The main distinguishing attributes among them were: quality improve-ment, patient and staff safety, improving health services integration, public's confi-dence, effectiveness and efficiency of health services, innovation, influence global standards, information management, breadth of activity, history, effective relationship with stakeholders, agreement with AGIL attributes and independence from government. Based on 23 attributes of comprehensive accreditation systems we have defined from a systematic review, the JCAHO accreditation program of USA and then CCHSA of Can-ada offered the most comprehensive systems with the least disadvantages. Other programs such as the ACHS of Australia, ANAES of France, QHNZ of New Zealand and UK accredita-tion programs were fairly comparable according to these criteria. However the decision for any country or health system should be based on an assessment weighing up their specific objec-tives and needs.

EBMT transplant centers with FACT-JACIE accreditation have significantly better compliance with related donor care standards

PubMed Central

Anthias, Chloe; O'Donnell, Paul V; Kiefer, Deidre M; Yared, Jean; Norkin, Maxim; Anderlini, Paolo; Savani, Bipin N; Diaz, Miguel A; Bitan, Menachem; Halter, Joerg P; Logan, Brent R; Switzer, Galen E; Pulsipher, Michael A; Confer, Dennis L; Shaw, Bronwen E

2016-01-01

Previous studies have identified healthcare practices that may place undue pressure on related donors (RDs) of hematopoietic cell products, and an increase in serious adverse events associated with morbidities in this population. As a result, specific requirements to safeguard RD health have been introduced to FACT-JACIE Standards, but the impact of accreditation on RD care has not previously been evaluated. A survey of transplant program directors of EBMT member centers was conducted by the Donor Health and Safety Working Committee of the Center for International Blood and Marrow Transplant Research (CIBMTR) to test the hypothesis that RD care in FACT-JACIE accredited centers is more closely aligned with international consensus donor care recommendations than RD care delivered in centers without accreditation. Responses were received from 39% of 304 centers. Our results show that practice in accredited centers was much closer to recommended standards as compared to non-accredited centers. Specifically, a higher percentage of accredited centers use eligibility criteria to assess RDs (93% versus 78%; P=0.02) and a lower percentage have a single physician simultaneously responsible for a RD and their recipient (14% versus 35%; P=0.008). In contrast, where regulatory standards do not exist, both accredited and non-accredited centers fell short of accepted best practice. These results raise concerns that despite improvements in care, current practice can place undue pressure on donors, and may increase the risk of donation-associated adverse events. We recommend measures to address these issues through enhancement of regulatory standards as well as national initiatives to standardize RD care. PMID:26597079

[Quality of health care, accreditation, and health technology assessment in Croatia: role of agency for quality and accreditation in health].

PubMed

Mittermayer, Renato; Huić, Mirjana; Mestrović, Josipa

2010-12-01

Avedis Donabedian defined the quality of care as the kind of care, which is expected to maximize an inclusive measure of patient welfare, after taking into account the balance of expected gains and losses associated with the process of care in all its segments. According to the World Medical Assembly, physicians and health care institutions have an ethical and professional obligation to strive for continuous quality improvement of services and patient safety with the ultimate goal to improve both individual patient outcomes as well as population health. Health technology assessment (HTA) is a multidisciplinary process that summarizes information about the medical, social, economic and ethical issues related to the use of a health technology in a systematic, transparent, unbiased, robust manner, with the aim to formulate safe and effective health policies that are patient focused and seek to achieve the highest value. The Agency for Quality and Accreditation in Health was established in 2007 as a legal, public, independent, nonprofit institution under the Act on Quality of Health Care. The Agency has three departments: Department of Quality and Education, Department of Accreditation, and Department of Development, Research, and Health Technology Assessment. According to the Act, the Agency should provide the procedure of granting, renewal and cancellation of accreditation of healthcare providers; proposing to the Minister, in cooperation with professional associations, the plan and program for healthcare quality assurance, improvement, promotion and monitoring; proposing the healthcare quality standards as well as the accreditation standards to the Minister; keeping a register of accreditations and providing a database related to accreditation, healthcare quality improvement, and education; providing education in the field of healthcare quality assurance, improvement and promotion; providing the HTA procedure and HTA database, supervising the healthcare insurance

Should we have confidence if a physician is accredited? A Study of the Relative Impacts of Accreditation and Insurance Payments on Quality of Care in the Philippines

PubMed Central

Quimbo, Stella A; Shimkhada, Riti; Woo, Kimberley; Solon, Orville

2008-01-01

It is unclear whether health provider accreditation ensures or promotes quality of care. Using baseline data from the Quality Improvement Demonstration Study (QIDS) in the Philippines we measured the quality of pediatric care provided by private and public doctors working at the district hospital level in the country’s central region. We found that national level accreditation by a national insurance programme influences quality of care. However, our data also show that insurance payments have a similar, strong impact on quality of care. These results suggest that accreditation alone may not be sufficient to promote high quality of care. Further improvements may be achieved with properly monitored and well-designed payment or incentive schemes. PMID:18534734

Where did the acute medical trainees go? A review of the career pathways of acute care common stem acute medical trainees in London.

PubMed

Gowland, Emily; Ball, Karen Le; Bryant, Catherine; Birns, Jonathan

2016-10-01

Acute care common stem acute medicine (ACCS AM) training was designed to develop competent multi-skilled acute physicians to manage patients with multimorbidity from 'door to discharge' in an era of increasing acute hospital admissions. Recent surveys by the Royal College of Physicians have suggested that acute medical specialties are proving less attractive to trainees. However, data on the career pathways taken by trainees completing core acute medical training has been lacking. Using London as a region with a 100% fill rate for its ACCS AM training programme, this study showed only 14% of trainees go on to higher specialty training in acute internal medicine and a further 10% to pursue higher medical specialty training with dual accreditation with internal medicine. 16% of trainees switched from ACCS AM to emergency medicine or anaesthetics during core ACCS training, and intensive care medicine proved to be the most popular career choice for ACCS AM trainees (21%). The ACCS AM training programme therefore does not appear to be providing what it was set out to do and this paper discusses the potential causes and effects. © Royal College of Physicians 2016. All rights reserved.

A hybrid health service accreditation program model incorporating mandated standards and continuous improvement: interview study of multiple stakeholders in Australian health care.

PubMed

Greenfield, David; Hinchcliff, Reece; Hogden, Anne; Mumford, Virginia; Debono, Deborah; Pawsey, Marjorie; Westbrook, Johanna; Braithwaite, Jeffrey

2016-07-01

The study aim was to investigate the understandings and concerns of stakeholders regarding the evolution of health service accreditation programs in Australia. Stakeholder representatives from programs in the primary, acute and aged care sectors participated in semi-structured interviews. Across 2011-12 there were 47 group and individual interviews involving 258 participants. Interviews lasted, on average, 1 h, and were digitally recorded and transcribed. Transcriptions were analysed using textual referencing software. Four significant issues were considered to have directed the evolution of accreditation programs: altering underlying program philosophies; shifting of program content focus and details; different surveying expectations and experiences and the influence of external contextual factors upon accreditation programs. Three accreditation program models were noted by participants: regulatory compliance; continuous quality improvement and a hybrid model, incorporating elements of these two. Respondents noted the compatibility or incommensurability of the first two models. Participation in a program was reportedly experienced as ranging on a survey continuum from "malicious compliance" to "performance audits" to "quality improvement journeys". Wider contextual factors, in particular, political and community expectations, and associated media reporting, were considered significant influences on the operation and evolution of programs. A hybrid accreditation model was noted to have evolved. The hybrid model promotes minimum standards and continuous quality improvement, through examining the structure and processes of organisations and the outcomes of care. The hybrid model appears to be directing organisational and professional attention to enhance their safety cultures. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

Advantages and Disadvantages of Health Care Accreditation Mod­els

PubMed Central

Tabrizi, Jafar S.; Gharibi, Farid; Wilson, Andrew J.

2011-01-01

Background: This systematic review seeks to define the general advantages and disadvan­tages of accreditation programs to assist in choosing the most appropriate approach. Method: Systematic search of SID, Ovid Medline & PubMed databases was conducted by the keywords of accreditation, hospital, medical practice, clinic, accreditation models, health care and Persian meanings. From 2379 initial articles, 83 articles met the full inclusion criteria. From initial analysis, 23 attributes were identified which appeared to define advantages and disadvantages of different accreditation approaches and the available systems were compared on these. Results: Six systems were identified in the international literature including the JCAHO from USA, the Canadian program of CCHSA, and the accreditation programs of UK, Australia, New Zealand and France. The main distinguishing attributes among them were: quality improve­ment, patient and staff safety, improving health services integration, public’s confi­dence, effectiveness and efficiency of health services, innovation, influence global standards, information management, breadth of activity, history, effective relationship with stakeholders, agreement with AGIL attributes and independence from government. Conclusion: Based on 23 attributes of comprehensive accreditation systems we have defined from a systematic review, the JCAHO accreditation program of USA and then CCHSA of Can­ada offered the most comprehensive systems with the least disadvantages. Other programs such as the ACHS of Australia, ANAES of France, QHNZ of New Zealand and UK accredita­tion programs were fairly comparable according to these criteria. However the decision for any country or health system should be based on an assessment weighing up their specific objec­tives and needs. PMID:24688896

Surviving Accreditation: A QIAS Ideas Bank. Accreditation and Beyond Series, Volume I.

ERIC Educational Resources Information Center

Ferry, Jan

This publication provides information on the accreditation process for early childhood education and care providers participating in the Quality Improvement and Accreditation System (QIAS), developed by the National Childcare Accreditation Council of Australia. The publication is divided into sections corresponding to steps in the…

Assuring optimal trauma care: the role of trauma centre accreditation

PubMed Central

Simons, Richard; Kirkpatrick, Andrew

2002-01-01

Optimal care of the injured patient requires the delivery of appropriate, definitive care shortly after injury. Over the last 30 to 40 years, civilian trauma systems and trauma centres have been developed in the United States based on experience gained in military conflicts, particularly in Korea and Vietnam. A similar process is evolving in Canada. National trauma committees in the US and Canada have defined optimal resources to meet the goal of rapid, appropriate care in trauma centres. They have introduced programs (verification or accreditation) to externally audit trauma centre performance based on these guidelines. It is generally accepted that implementing trauma systems results in decreased preventable death and improved survival after trauma. What is less clear is the degree to which each facet of trauma system development contributes to this improvement. The relative importance of national performance guidelines and trauma centre audit as integral steps toward improved outcomes following injury are reviewed. Current Trauma Association of Canada guidelines for trauma centres are presented and the process of trauma centre accreditation is discussed. PMID:12174987

Levers for change: an investigation of how accreditation programmes can promote consumer engagement in healthcare.

PubMed

Hinchcliff, Reece; Greenfield, David; Hogden, Anne; Sarrami-Foroushani, Pooria; Travaglia, Joanne; Braithwaite, Jeffrey

2016-10-01

To examine how consumer engagement (CE) can be promoted through Australian accreditation programmes. A nation-wide qualitative study completed in 2012. All eight Australian States and Territories. Two-hundred and fifty-eight healthcare stakeholders from the acute, primary and aged care sectors. Forty-seven individual and group interviews were undertaken. Questions elicited views on the dimensions and utility of CE promotion by accreditation programmes. Healthcare stakeholders' views on the dimensions and utility of CE promotion by accreditation programmes. Four mechanisms of CE promotion were identified. Two involved requirements for health service organizations to meet CE-related standards related to consumer experience and satisfaction surveys, and consumer participation in organizational governance processes. Two mechanisms for promoting CE through accreditation processes were also identified, concerning consumer participation in the development and revision of standards, and the implementation of accreditation surveys. Accreditation programmes were viewed as important drivers of CE, yet concerns were raised regarding the organizational investments needed to meet programmes' requirements. Accreditation programmes use diverse mechanisms as levers for change to promote CE in healthcare. These mechanisms and their inter-relationships require careful consideration by accreditation agencies and health policymakers to maximize their potential benefits, while maintaining stakeholder engagement in programmes. © The Author 2016. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Beyond accreditation: a multi-track quality-enhancing strategy for primary health care in low- and middle-income countries.

PubMed

Saleh, Shadi S; Alameddine, Mohamad S; Natafgi, Nabil M

2014-01-01

Many define an equitable health care system as one that provides logistical and financial access to "quality" care to the population. Realizing that fact, many low- and middle-income countries started investing in enhancing the quality of care in their health care systems, recently in primary health care. Unfortunately, in many instance, these investments have been exclusively focused on accreditation due to available guidelines and existing accrediting structures. A multi-track quality-enhancing strategy (MTQES) is proposed that includes, in addition to promoting resource-sensitive accreditation, other quality initiatives such as clinical guidelines, performance indicators, benchmarking activities, annual quality-enhancing projects, and annual quality summit/meeting. These complementary approaches are presented to synergistically enhance a continuous quality improvement culture in the primary health care sector, taking into consideration limited resources available, especially in low- and middle-income countries. In addition, an implementation framework depicting MTQES in three-phase interlinked packages is presented; each matches existing resources and quality infrastructure. Health care policymakers and managers need to think about accreditation as a beginning rather than an end to their quest for quality. Improvements in the structure of a health delivery organization or in the processes of care have little value if they do not translate to reduced disparities in access to "quality" care, and not merely access to care.

[Accreditation of medical laboratories].

PubMed

Horváth, Andrea Rita; Ring, Rózsa; Fehér, Miklós; Mikó, Tivadar

2003-07-27

In Hungary, the National Accreditation Body was established by government in 1995 as an independent, non-profit organization, and has exclusive rights to accredit, amongst others, medical laboratories. The National Accreditation Body has two Specialist Advisory Committees in the health care sector. One is the Health Care Specialist Advisory Committee that accredits certifying bodies, which deal with certification of hospitals. The other Specialist Advisory Committee for Medical Laboratories is directly involved in accrediting medical laboratory services of health care institutions. The Specialist Advisory Committee for Medical Laboratories is a multidisciplinary peer review group of experts from all disciplines of in vitro diagnostics, i.e. laboratory medicine, microbiology, histopathology and blood banking. At present, the only published International Standard applicable to laboratories is ISO/IEC 17025:1999. Work has been in progress on the official approval of the new ISO 15189 standard, specific to medical laboratories. Until the official approval of the International Standard ISO 15189, as accreditation standard, the Hungarian National Accreditation Body has decided to progress with accreditation by formulating explanatory notes to the ISO/IEC 17025:1999 document, using ISO/FDIS 15189:2000, the European EC4 criteria and CPA (UK) Ltd accreditation standards as guidelines. This harmonized guideline provides 'explanations' that facilitate the application of ISO/IEC 17025:1999 to medical laboratories, and can be used as a checklist for the verification of compliance during the onsite assessment of the laboratory. The harmonized guideline adapted the process model of ISO 9001:2000 to rearrange the main clauses of ISO/IEC 17025:1999. This rearrangement does not only make the guideline compliant with ISO 9001:2000 but also improves understanding for those working in medical laboratories, and facilitates the training and education of laboratory staff. With the

Short-Term Influence of Revised Provincial Accreditation Standards on Physical Activity, Sedentary Behavior, and Weight Status in Alberta, Canada Child Care Centers

ERIC Educational Resources Information Center

Carson, Valerie; Clark, Dawne; Ogden, Nancy; Harber, Vicki; Kuzik, Nicholas

2015-01-01

In December, 2013, revised Alberta child care accreditation standards were released by the Alberta Government in Canada that included a new standard for physical activity and sedentary behavior in accredited child care settings. The main purpose of this study was to examine the effectiveness of the new accreditation standard in increasing physical…

The Relationship between Using Electronic Health Records and Meeting Accreditation Standards for Client Safety in Residential Aged Care Homes.

PubMed

Jiang, Tao; Yu, Ping

2015-01-01

This study aims to identify the benefits of using electronic health records (EHR) for client safety in residential aged care (RAC) homes. The aged care accreditation reports published between 27 April 2011 and 3 December 2013 were downloaded and analysed. It could be seen from these reports that only 1,031(37.45%) RAC homes in Australia had adopted an EHR system by 2013. 13 RAC homes failed one or more accreditation standards. Only one of these was using an EHR system and this one met the accreditation standards on information systems. Our study provides empirical evidence to suggest that adopting and using EHR can be one of the effective organisational mechanisms to meeting accreditation standards in RAC homes.

Costs and Length of Stay for the Acute Care of Patients with Motor-Complete Spinal Cord Injury Following Cervical Trauma: The Impact of Early Transfer to Specialized Acute SCI Center.

PubMed

Richard-Denis, Andréane; Ehrmann Feldman, Debbie; Thompson, Cynthia; Bourassa-Moreau, Étienne; Mac-Thiong, Jean-Marc

2017-07-01

Acute spinal cord injury (SCI) centers aim to optimize outcome following SCI. However, there is no timeframe to transfer patients from regional to SCI centers in order to promote cost-efficiency of acute care. Our objective was to compare costs and length of stay (LOS) following early and late transfer to the SCI center. A retrospective cohort study involving 116 individuals was conducted. Group 1 (n = 87) was managed in an SCI center promptly after the trauma, whereas group 2 (n = 29) was transferred to the SCI center only after surgery. Direct comparison and multivariate linear regression analyses were used to assess the relationship between costs, LOS, and timing to transfer to the SCI center. Length of stay was significantly longer for group 2 (median, 93.0 days) as compared with group 1 (median, 40.0 days; P < 10), and average costs were also higher (median, Canadian $17,920.0 vs. $10,521.6; P = 0.004) for group 2, despite similar characteristics. Late transfer to the SCI center was the main predictive factor of longer LOS and increased costs. Early admission to the SCI center was associated with shorter LOS and lower costs for patients sustaining tetraplegia. Early referral to an SCI center before surgery could lower the financial burden for the health care system. Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME OBJECTIVES: Upon completion of this article, the reader should be able to: (1) Determine the optimal timing for transfer of individuals with cervical traumatic spinal cord injury (SCI) in order to decrease acute care resource utilization; (2) Determine benefits of a complete perioperative management in a specialized SCI center; and (3) Identify factors that may influence resource utilization for acute care following motor-complete tetraplegia. Advanced ACCREDITATION: The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide

Hospital Performance Trends on National Quality Measures and the Association With Joint Commission Accreditation

PubMed Central

Schmaltz, Stephen P; Williams, Scott C; Chassin, Mark R; Loeb, Jerod M; Wachter, Robert M

2011-01-01

BACKGROUND Evaluations of the impact of hospital accreditation have been previously hampered by the lack of nationally standardized data. One way to assess this impact is to compare accreditation status with other evidence-based measures of quality, such as the process measures now publicly reported by The Joint Commission and the Centers for Medicare and Medicaid Services (CMS). OBJECTIVES To examine the association between Joint Commission accreditation status and both absolute measures of, and trends in, hospital performance on publicly reported quality measures for common diseases. DESIGN, SETTING, AND PATIENTS Performance data for 2004 and 2008 from U.S. acute care and critical access hospitals were obtained using publicly available CMS Hospital Compare data augmented with Joint Commission performance data. MEASUREMENTS Changes in hospital performance between 2004 and 2008, and percent of hospitals with 2008 performance exceeding 90% for 16 measures of quality-of-care and 4 summary scores. RESULTS Hospitals accredited by The Joint Commission tended to have better baseline performance in 2004 than non-accredited hospitals. Accredited hospitals had larger gains over time, and were significantly more likely to have high performance in 2008 on 13 out of 16 standardized clinical performance measures and all summary scores. CONCLUSIONS While Joint Commission-accredited hospitals already outperformed non-accredited hospitals on publicly reported quality measures in the early days of public reporting, these differences became significantly more pronounced over 5 years of observation. Future research should examine whether accreditation actually promotes improved performance or is a marker for other hospital characteristics associated with such performance. Journal of Hospital Medicine 2011;6:458–465. © 2011 Society of Hospital Medicine PMID:21990175

Access to Accredited Cancer Hospitals Within Federal Exchange Plans Under the Affordable Care Act

PubMed Central

Liao, Kai-Ping; Krause, Trudy M.; Giordano, Sharon H.

2017-01-01

Purpose The Affordable Care Act expanded access to health insurance in the United States, but concerns have arisen about access to specialized cancer care within narrow provider networks. To characterize the scope and potential impact of this problem, we assessed rates of inclusion of Commission on Cancer (CoC) –accredited hospitals and National Cancer Institute (NCI) –designated cancer centers within federal exchange networks. Methods We downloaded publicly available machine-readable network data and public use files for individual federal exchange plans from the Centers for Medicare and Medicaid Services for the 2016 enrollment year. We linked this information to National Provider Identifier data, identified a set of distinct provider networks, and assessed the rates of inclusion of CoC-accredited hospitals and NCI-designated centers. We measured variation in these rates according to geography, plan type, and metal level. Results Of 4,058 unique individual plans, network data were available for 3,637 (90%); hospital information was available for 3,531 (87%). Provider lists for these plans reduced into 295 unique networks for analysis. Ninety-five percent of networks included at least one CoC-accredited hospital, but just 41% of networks included NCI-designated centers. States and counties each varied substantially in the proportion of networks listed that included NCI-designated centers (range, 0% to 100%). The proportion of networks that included NCI-designated centers also varied by plan type (range, 31% for health maintenance organizations to 49% for preferred provider organizations; P = .04) but not by metal level. Conclusion A large majority of federal exchange networks contain CoC-accredited hospitals, but most do not contain NCI-designated cancer centers. These results will inform policy regarding access to cancer care, and they reinforce the importance of promoting access to clinical trials and specialized care through community sites. PMID:28068172

75 FR 60640 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-10-01

... Respiratory Care Services; Medicaid Program: Accreditation for Providers of Inpatient Psychiatric Services... Conditions of Participation for Rehabilitation and Respiratory Care Services; Medicaid Program: Accreditation... Participation for Rehabilitation and Respiratory Care Services; Medicaid Program: Accreditation for Providers of...

The effect of certification and accreditation on quality management in 4 clinical services in 73 European hospitals

PubMed Central

Shaw, Charles D.; Groene, Oliver; Botje, Daan; Sunol, Rosa; Kutryba, Basia; Klazinga, Niek; Bruneau, Charles; Hammer, Antje; Wang, Aolin; Arah, Onyebuchi A.; Wagner, Cordula; Klazinga, N; Kringos, DS; Lombarts, K; Plochg, T; Lopez, MA; Secanell, M; Sunol, R; Vallejo, P; Bartels, P; Kristensen, S; Michel, P; Saillour-Glenisson, F; Vlcek, F; Car, M; Jones, S; Klaus, E; Garel, P; Hanslik, K; Saluvan, M; Bruneau, C; Depaigne-Loth, A; Shaw, C; Hammer, A; Ommen, O; Pfaff, H; Groene, O; Botje, D; Wagner, C; Kutaj-Wasikowska, H; Kutryba, B; Escoval, A; Franca, M; Almeman, F; Kus, H; Ozturk, K; Mannion, R; Arah, OA; Chow, A; DerSarkissian, M; Thompson, C; Wang, A; Thompson, A

2014-01-01

Objective To investigate the relationship between ISO 9001 certification, healthcare accreditation and quality management in European hospitals. Design A mixed method multi-level cross-sectional design in seven countries. External teams assessed clinical services on the use of quality management systems, illustrated by four clinical pathways. Setting and Participants Seventy-three acute care hospitals with a total of 291 services managing acute myocardial infarction (AMI), hip fracture, stroke and obstetric deliveries, in Czech Republic, France, Germany, Poland, Portugal, Spain and Turkey. Main Outcome Measure Four composite measures of quality and safety [specialized expertise and responsibility (SER), evidence-based organization of pathways (EBOP), patient safety strategies (PSS) and clinical review (CR)] applied to four pathways. Results Accreditation in isolation showed benefits in AMI and stroke more than in deliveries and hip fracture; the greatest significant association was with CR in stroke. Certification in isolation showed little benefit in AMI but had more positive association with the other conditions; greatest significant association was in PSS with stroke. The combination of accreditation and certification showed least benefit in EBOP, but significant benefits in SER (AMI), in PSS (AMI, hip fracture and stroke) and in CR (AMI and stroke). Conclusions Accreditation and certification are positively associated with clinical leadership, systems for patient safety and clinical review, but not with clinical practice. Both systems promote structures and processes, which support patient safety and clinical organization but have limited effect on the delivery of evidence-based patient care. Further analysis of DUQuE data will explore the association of certification and accreditation with clinical outcomes. PMID:24615598

The effect of certification and accreditation on quality management in 4 clinical services in 73 European hospitals.

PubMed

Shaw, Charles D; Groene, Oliver; Botje, Daan; Sunol, Rosa; Kutryba, Basia; Klazinga, Niek; Bruneau, Charles; Hammer, Antje; Wang, Aolin; Arah, Onyebuchi A; Wagner, Cordula

2014-04-01

To investigate the relationship between ISO 9001 certification, healthcare accreditation and quality management in European hospitals. A mixed method multi-level cross-sectional design in seven countries. External teams assessed clinical services on the use of quality management systems, illustrated by four clinical pathways. Seventy-three acute care hospitals with a total of 291 services managing acute myocardial infarction (AMI), hip fracture, stroke and obstetric deliveries, in Czech Republic, France, Germany, Poland, Portugal, Spain and Turkey. Four composite measures of quality and safety [specialized expertise and responsibility (SER), evidence-based organization of pathways (EBOP), patient safety strategies (PSS) and clinical review (CR)] applied to four pathways. Accreditation in isolation showed benefits in AMI and stroke more than in deliveries and hip fracture; the greatest significant association was with CR in stroke. Certification in isolation showed little benefit in AMI but had more positive association with the other conditions; greatest significant association was in PSS with stroke. The combination of accreditation and certification showed least benefit in EBOP, but significant benefits in SER (AMI), in PSS (AMI, hip fracture and stroke) and in CR (AMI and stroke). Accreditation and certification are positively associated with clinical leadership, systems for patient safety and clinical review, but not with clinical practice. Both systems promote structures and processes, which support patient safety and clinical organization but have limited effect on the delivery of evidence-based patient care. Further analysis of DUQuE data will explore the association of certification and accreditation with clinical outcomes.

Accreditation of ambulatory facilities.

PubMed

Urman, Richard D; Philip, Beverly K

2014-06-01

With the continued growth of ambulatory surgical centers (ASC), the regulation of facilities has evolved to include new standards and requirements on both state and federal levels. Accreditation allows for the assessment of clinical practice, improves accountability, and better ensures quality of care. In some states, ASC may choose to voluntarily apply for accreditation from a recognized organization, but in others it is mandated. Accreditation provides external validation of safe practices, benchmarking performance against other accredited facilities, and demonstrates to patients and payers the facility's commitment to continuous quality improvement. Copyright © 2014 Elsevier Inc. All rights reserved.

Clinical laboratory accreditation in India.

PubMed

Handoo, Anil; Sood, Swaroop Krishan

2012-06-01

Test results from clinical laboratories must ensure accuracy, as these are crucial in several areas of health care. It is necessary that the laboratory implements quality assurance to achieve this goal. The implementation of quality should be audited by independent bodies,referred to as accreditation bodies. Accreditation is a third-party attestation by an authoritative body, which certifies that the applicant laboratory meets quality requirements of accreditation body and has demonstrated its competence to carry out specific tasks. Although in most of the countries,accreditation is mandatory, in India it is voluntary. The quality requirements are described in standards developed by many accreditation organizations. The internationally acceptable standard for clinical laboratories is ISO15189, which is based on ISO/IEC standard 17025. The accreditation body in India is the National Accreditation Board for Testing and Calibration Laboratories, which has signed Mutual Recognition Agreement with the regional cooperation the Asia Pacific Laboratory Accreditation Cooperation and with the apex cooperation the International Laboratory Accreditation Cooperation.

Quality assurance and accreditation.

PubMed

1997-01-01

In 1996, the Joint Commission International (JCI), which is a partnership between the Joint Commission on Accreditation of Healthcare Organizations and Quality Healthcare Resources, Inc., became one of the contractors of the Quality Assurance Project (QAP). JCI recognizes the link between accreditation and quality, and uses a collaborative approach to help a country develop national quality standards that will improve patient care, satisfy patient-centered objectives, and serve the interest of all affected parties. The implementation of good standards provides support for the good performance of professionals, introduces new ideas for improvement, enhances the quality of patient care, reduces costs, increases efficiency, strengthens public confidence, improves management, and enhances the involvement of the medical staff. Such good standards are objective and measurable; achievable with current resources; adaptable to different institutions and cultures; and demonstrate autonomy, flexibility, and creativity. The QAP offers the opportunity to approach accreditation through research efforts, training programs, and regulatory processes. QAP work in the area of accreditation has been targeted for Zambia, where the goal is to provide equal access to cost-effective, quality health care; Jordan, where a consensus process for the development of standards, guidelines, and policies has been initiated; and Ecuador, where JCI has been asked to help plan an approach to the evaluation and monitoring of the health care delivery system.

AAALAC International Standards and Accreditation Process

PubMed Central

Gettayacamin, Montip; Retnam, Leslie

2017-01-01

AAALAC International is a private, nonprofit organization that promotes humane treatment of animals in science through a voluntary international accreditation program. AAALAC International accreditation is recognized around the world as a symbol of high quality animal care and use for research, teaching and testing, as well as promoting animal welfare. Animals owned by the institution that are used for research, teaching and testing are included as part of an accredited program. More than 990 animal care and use institutions in 42 countries around the world (more than 170 programs in 13 countries in the Pacific Rim region) have earned AAALAC International accreditation. The AAALAC International Council on Accreditation evaluates overall performance and all aspects of an animal care and use program, involving an in-depth, multilayered, confidential peer-review process. The evaluators (site visitors) consider compliance with applicable local animal legislation of the host country, institutional policies, and employ a customized approach for evaluating overall program performance using a series of primary standards that include the Guide for the Care and Use of Laboratory Animals, the Guide for the Care and Use of Agricultural Animals in Research and Teaching, or the European Convention for the Protection of Vertebrate Animals Used for Experimental and Other Purposes, Council of Europe (ETS 123), and supplemental Reference Resources, as applicable. PMID:28744349

Acute care clinical pharmacy practice: unit- versus service-based models.

PubMed

Haas, Curtis E; Eckel, Stephen; Arif, Sally; Beringer, Paul M; Blake, Elizabeth W; Lardieri, Allison B; Lobo, Bob L; Mercer, Jessica M; Moye, Pamela; Orlando, Patricia L; Wargo, Kurt

2012-02-01

This commentary from the 2010 Task Force on Acute Care Practice Model of the American College of Clinical Pharmacy was developed to compare and contrast the "unit-based" and "service-based" orientation of the clinical pharmacist within an acute care pharmacy practice model and to offer an informed opinion concerning which should be preferred. The clinical pharmacy practice model must facilitate patient-centered care and therefore must position the pharmacist to be an active member of the interprofessional team focused on providing high-quality pharmaceutical care to the patient. Although both models may have advantages and disadvantages, the most important distinction pertains to the patient care role of the clinical pharmacist. The unit-based pharmacist is often in a position of reacting to an established order or decision and frequently is focused on task-oriented clinical services. By definition, the service-based clinical pharmacist functions as a member of the interprofessional team. As a team member, the pharmacist proactively contributes to the decision-making process and the development of patient-centered care plans. The service-based orientation of the pharmacist is consistent with both the practice vision embraced by ACCP and its definition of clinical pharmacy. The task force strongly recommends that institutions pursue a service-based pharmacy practice model to optimally deploy their clinical pharmacists. Those who elect to adopt this recommendation will face challenges in overcoming several resource, technologic, regulatory, and accreditation barriers. However, such challenges must be confronted if clinical pharmacists are to contribute fully to achieving optimal patient outcomes. © 2012 Pharmacotherapy Publications, Inc.

Patient Protection and Affordable Care Act; standards related to essential health benefits, actuarial value and accreditation. Final rule.

PubMed

2013-02-25

This final rule sets forth standards for health insurance issuers consistent with title I of the Patient Protection and Affordable Care Act, as amended by the Health Care and Education Reconciliation Act of 2010, referred to collectively as the Affordable Care Act. Specifically, this final rule outlines Exchange and issuer standards related to coverage of essential health benefits and actuarial value. This rule also finalizes a timeline for qualified health plans to be accredited in Federally-facilitated Exchanges and amends regulations providing an application process for the recognition of additional accrediting entities for purposes of certification of qualified health plans.

Televisitation: Virtual Transportation of Family to the Bedside in an Acute Care Setting

PubMed Central

Nicholas, Bonnie

2013-01-01

Televisitation is the virtual transportation of a patient’s family to the bedside, regardless of the patient’s location within an acute care setting. This innovation in the Telemedicine Program at Thunder Bay Regional Health Sciences Centre (TBRHSC) in Ontario, Canada, embraces the concept of patient- and family-centered care and has been identified as a leading practice by Accreditation Canada. The need to find creative ways to link patients to their family and friend supports hundreds of miles away was identified more than ten years ago. The important relationship between health outcomes and the psychosocial needs of patients and families has been recognized more recently. TBRHSC’s patient- and family-centered model of care focuses on connecting patients with their families. First Nations renal patients with family in remote communities were some of the earliest users of videoconferencing technology for this purpose. PMID:23596369

Scoping medical tourism and international hospital accreditation growth.

PubMed

Woodhead, Anthony

2013-01-01

Uwe Reinhardt stated that medical tourism can do to the US healthcare system what the Japanese automotive industry did to American carmakers after Japanese products developed a value for money and reliability reputation. Unlike cars, however, healthcare can seldom be test-driven. Quality is difficult to assess after an intervention (posteriori), therefore, it is frequently evaluated via accreditation before an intervention (a priori). This article aims to scope the growth in international accreditation and its relationship to medical tourism markets. Using self-reported data from Accreditation Canada, Joint Commission International (JCI) and Australian Council on Healthcare Standards (ACHS), this article examines how quickly international accreditation is increasing, where it is occurring and what providers have been accredited. Since January 2000, over 350 international hospitals have been accredited; the JCI's total nearly tripling between 2007-2011. Joint Commission International staff have conducted most international accreditation (over 90 per cent). Analysing which countries and regions where the most international accreditation has occurred indicates where the most active medical tourism markets are. However, providers will not solely be providing care for medical tourists. Accreditation will not mean that mistakes will never happen, but that accredited providers are more willing to learn from them, to varying degrees. If a provider has been accredited by a large international accreditor then patients should gain some reassurance that the care they receive is likely to be a good standard. The author questions whether commercializing international accreditation will improve quality, arguing that research is necessary to assess the accreditation of these growing markets.

Communication Between Acute Care Hospitals and Skilled Nursing Facilities During Care Transitions: A Retrospective Chart Review.

PubMed

Jusela, Cheryl; Struble, Laura; Gallagher, Nancy Ambrose; Redman, Richard W; Ziemba, Rosemary A

2017-03-01

HOW TO OBTAIN CONTACT HOURS BY READING THIS ARTICLE INSTRUCTIONS 1.3 contact hours will be awarded by Villanova University College of Nursing upon successful completion of this activity. A contact hour is a unit of measurement that denotes 60 minutes of an organized learning activity. This is a learner-based activity. Villanova University College of Nursing does not require submission of your answers to the quiz. A contact hour certificate will be awarded once you register, pay the registration fee, and complete the evaluation form online at http://goo.gl/gMfXaf. To obtain contact hours you must: 1. Read the article, "Communication Between Acute Care Hospitals and Skilled Nursing Facilities During Care Transitions: A Retrospective Chart Review" found on pages 19-28, carefully noting any tables and other illustrative materials that are included to enhance your knowledge and understanding of the content. Be sure to keep track of the amount of time (number of minutes) you spend reading the article and completing the quiz. 2. Read and answer each question on the quiz. After completing all of the questions, compare your answers to those provided within this issue. If you have incorrect answers, return to the article for further study. 3. Go to the Villanova website listed above to register for contact hour credit. You will be asked to provide your name; contact information; and a VISA, MasterCard, or Discover card number for payment of the $20.00 fee. Once you complete the online evaluation, a certificate will be automatically generated. This activity is valid for continuing education credit until February 29, 2020. CONTACT HOURS This activity is co-provided by Villanova University College of Nursing and SLACK Incorporated. Villanova University College of Nursing is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation. ACTIVITY OBJECTIVES 1. Discuss problematic barriers during care transitions

Enclosed versus open nursing stations in adult acute care psychiatric settings: does the design affect the therapeutic milieu?

PubMed

Southard, Kelly; Jarrell, Ashley; Shattell, Mona M; McCoy, Thomas P; Bartlett, Robin; Judge, Christine A

2012-05-01

Specific efforts by hospital accreditation organizations encourage renovation of nursing stations, so nurses can better see, attend, and care for their patients. The purpose of this study was to examine the effect of nursing station design on the therapeutic milieu in an adult acute care psychiatric unit. A repeated cross-sectional, pretest-posttest design was used. Data were collected from a convenience sample of 81 patients and 25 nursing staff members who completed the Ward Atmosphere Scale. Pretest data were collected when the unit had an enclosed nursing station, and posttest data were collected after renovations to the unit created an open nursing station. No statistically significant differences were found in patient or staff perceptions of the therapeutic milieu. No increase in aggression toward staff was found, given patients' ease of access to the nursing station. More research is needed about the impact of unit design in acute care psychiatric settings. Copyright 2012, SLACK Incorporated.

Intersocietal Accreditation Commission Accreditation Status of Outpatient Cerebrovascular Testing Facilities Among Medicare Beneficiaries: The VALUE Study.

PubMed

Brown, Scott C; Wang, Kefeng; Dong, Chuanhui; Farrell, Mary Beth; Heller, Gary V; Gornik, Heather L; Hutchisson, Marge; Needleman, Laurence; Benenati, James F; Jaff, Michael R; Meier, George H; Perese, Susana; Bendick, Phillip; Hamburg, Naomi M; Lohr, Joann M; LaPerna, Lucy; Leers, Steven A; Lilly, Michael P; Tegeler, Charles; Katanick, Sandra L; Alexandrov, Andrei V; Siddiqui, Adnan H; Rundek, Tatjana

2016-09-01

Accreditation of cerebrovascular ultrasound laboratories by the Intersocietal Accreditation Commission (IAC) and equivalent organizations is supported by the Joint Commission certification of stroke centers. Limited information exists on the accreditation status and geographic distribution of cerebrovascular testing facilities in the United States. Our study objectives were to identify the proportion of IAC-accredited outpatient cerebrovascular testing facilities used by Medicare beneficiaries, describe their geographic distribution, and identify variations in cerebrovascular testing procedure types and volumes by accreditation status. As part of the VALUE (Vascular Accreditation, Location, and Utilization Evaluation) Study, we examined the proportion of IAC-accredited facilities that conducted cerebrovascular testing in a 5% Centers for Medicare and Medicaid Services random Outpatient Limited Data Set in 2011 and investigated their geographic distribution using geocoding. Among 7327 outpatient facilities billing Medicare for cerebrovascular testing, only 22% (1640) were IAC accredited. The proportion of IAC-accredited cerebrovascular testing facilities varied by region (χ(2)[3] = 177.1; P < .0001), with 29%, 15%, 13%, and 10% located in the Northeast, South, Midwest, and West, respectively. However, of the total number of cerebrovascular outpatient procedures conducted in 2011 (38,555), 40% (15,410) were conducted in IAC-accredited facilities. Most cerebrovascular testing procedures were carotid duplex, with 40% of them conducted in IAC-accredited facilities. The proportion of facilities conducting outpatient cerebrovascular testing accredited by the IAC is low and varies by region. The growing number of certified stroke centers should be accompanied by more accredited outpatient vascular testing facilities, which could potentially improve the quality of stroke care.

77 FR 37680 - Medicare and Medicaid Programs; Application From the Accreditation Association for Ambulatory...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-06-22

...] Medicare and Medicaid Programs; Application From the Accreditation Association for Ambulatory Health Care... of an application from the Accreditation Association for Ambulatory Health Care for continued... by CMS. The Accreditation Association for Ambulatory Health Care (AAAHC) current term of approval for...

National Accreditation and Its Role in Early Education: An Analysis of Florida's Gold Seal Quality Child-Care Program and Licensing Standards

ERIC Educational Resources Information Center

Winterbottom, Christian; Jones, Ithel

2014-01-01

This article reports on the first Florida statewide assessment of the Gold Seal Quality Care program, accreditation, and the relationship with licensing violations. This study analyzed the differences between the Department of Children and Families Gold Seal-Accredited facilities and nonaccredited facilities by comparing the facilities and the…

A National Perspective on Exploring Correlates of Accreditation in Children's Mental Health Care.

PubMed

Lee, Madeline Y

2017-07-01

This study is the first to explore national accreditation rates and the relationship between accreditation status and organizational characteristics and quality indicators in children's mental health. Data from the Substance Abuse and Mental Health Services Administration's (SAMHSA's) National Survey of Mental Health Treatment Facilities (NSMHTF) were used from 8,247 facilities that serve children and/or adolescents. Nearly 60% (n=4,925) of the facilities were accredited by the Council on Accreditation (COA), the Commission on Accreditation of Rehabilitation Facilities (CARF), or The Joint Commission (TJC). Chi-square analyses were conducted to explore relationships. Compared to non-accredited facilities, more accredited facilities reported greater number of admissions, acceptance of government funding and client funds, and implementation of several quality indicators. Policies with incentives for accreditation could influence accreditation rates, and accreditation could influence quality indicators. These results set the foundation for future research about the drivers of the accreditation phenomenon and its impact on children's mental health outcomes.

Hospital accreditation: staff experiences and perceptions.

PubMed

Bogh, Søren Bie; Blom, Ane; Raben, Ditte Caroline; Braithwaite, Jeffrey; Thude, Bettina; Hollnagel, Erik; Plessen, Christian von

2018-06-11

Purpose The purpose of this paper is to understand how staff at various levels perceive and understand hospital accreditation generally and in relation to quality improvement (QI) specifically. Design/methodology/approach In a newly accredited Danish hospital, the authors conducted semi-structured interviews to capture broad ranging experiences. Medical doctors, nurses, a quality coordinator and a quality department employee participated. Interviews were audio recorded and subjected to framework analysis. Findings Staff reported that The Danish Healthcare Quality Programme affected management priorities: office time and working on documentation, which reduced time with patients and on improvement activities. Organisational structures were improved during preparation for accreditation. Staff perceived that the hospital was better prepared for new QI initiatives after accreditation; staff found disease specific requirements unnecessary. Other areas benefited from accreditation. Interviewees expected that organisational changes, owing to accreditation, would be sustained and that the QI focus would continue. Practical implications Accreditation is a critical and complete hospital review, including areas that often are neglected. Accreditation dominates hospital agendas during preparation and surveyor visits, potentially reducing patient care and other QI initiatives. Improvements are less likely to occur in areas that other QI initiatives addressed. Yet, accreditation creates organisational foundations for future QI initiatives. Originality/value The authors study contributes new insights into how hospital staff at different organisational levels perceive and understand accreditation.

Patient dissatisfaction with acute stroke care.

PubMed

Asplund, Kjell; Jonsson, Fredrik; Eriksson, Marie; Stegmayr, Birgitta; Appelros, Peter; Norrving, Bo; Terént, Andreas; Asberg, Kerstin Hulter

2009-12-01

Riks-Stroke, the Swedish Stroke Register, was used to explore patient characteristics and stroke services as determinants of patient dissatisfaction with acute in-hospital care. All 79 hospitals in Sweden admitting acute stroke patients participate in Riks-Stroke. During 2001 to 2007, 104,876 patients (87% of survivors) responded to a follow-up questionnaire 3 months after acute stroke; this included questions on satisfaction with various aspects of stroke care. The majority (>90%) were satisfied with acute in-hospital stroke care. Dissatisfaction was closely associated with outcome at 3 months. Patient who were dependent regarding activities of daily living, felt depressed, or had poor self-perceived general health were more likely to be dissatisfied. Dissatisfaction with global acute stroke care was linked to dissatisfaction with other aspects of care, including rehabilitation and support by community services. Patients treated in stroke units were less often dissatisfied than patients in general wards, as were patients who had been treated in a small hospital (vs medium or large hospitals) and patient who had participated in discharge planning. In multivariate analyses, the strongest predictor of dissatisfaction with acute care was poor outcome (dependency regarding activities of daily living, depressed mood, poor self-perceived health). Dissatisfaction with in-hospital acute stroke care is part of a more extensive complex comprising poor functional outcome, depressive mood, poor self-perceived general health, and dissatisfaction not only with acute care but also with health care and social services at large. Several aspects of stroke care organization are associated with a lower risk of dissatisfaction.

77 FR 70783 - Medicare and Medicaid Programs; Approval of the Accreditation Association for Ambulatory Health...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-11-27

...] Medicare and Medicaid Programs; Approval of the Accreditation Association for Ambulatory Health Care (AAAHC... announces our decision to approve the Accreditation Association for Ambulatory Health Care (AAAHC) for... Ambulatory Health Care's (AAAHC) current term of approval for their ASC accreditation program expires on...

Patient safety principles in family medicine residency accreditation standards and curriculum objectives

PubMed Central

Kassam, Aliya; Sharma, Nishan; Harvie, Margot; O’Beirne, Maeve; Topps, Maureen

2016-01-01

Abstract Objective To conduct a thematic analysis of the College of Family Physicians of Canada’s (CFPC’s) Red Book accreditation standards and the Triple C Competency-based Curriculum objectives with respect to patient safety principles. Design Thematic content analysis of the CFPC’s Red Book accreditation standards and the Triple C curriculum. Setting Canada. Main outcome measures Coding frequency of the patient safety principles (ie, patient engagement; respectful, transparent relationships; complex systems; a just and trusting culture; responsibility and accountability for actions; and continuous learning and improvement) found in the analyzed CFPC documents. Results Within the analyzed CFPC documents, the most commonly found patient safety principle was patient engagement (n = 51 coding references); the least commonly found patient safety principles were a just and trusting culture (n = 5 coding references) and complex systems (n = 5 coding references). Other patient safety principles that were uncommon included responsibility and accountability for actions (n = 7 coding references) and continuous learning and improvement (n = 12 coding references). Conclusion Explicit inclusion of patient safety content such as the use of patient safety principles is needed for residency training programs across Canada to ensure the full spectrum of care is addressed, from community-based care to acute hospital-based care. This will ensure a patient safety culture can be cultivated from residency and sustained into primary care practice. PMID:27965349

Quality Assurance in Breast Health Care and Requirement for Accreditation in Specialized Units.

PubMed

Güler, Sertaç Ata; Güllüoğlu, Bahadır M

2014-07-01

Breast health is a subject of increasing importance. The statistical increase in the frequency of breast cancer and the consequent increase in death rate increase the importance of quality of services to be provided for breast health. For these reasons, the minimum standards and optimum quality metrics of breast care provided to the community are determined. The quality parameters for breast care service include the results, the structure and the operation of services. Within this group, the results of breast health services are determined according to clinical results, patient satisfaction and financial condition. The structure of quality services should include interdisciplinary meetings, written standards for specific procedures and the existence of standardized reporting systems. Establishing breast centers that adopt integrated multidisciplinary working principles and their cost-effective maintenance are important in terms of operation of breast health services. The importance of using a "reviewing/auditing" procedure that checks if all of these functions existing in the health system are carried out at the desired level and an "accreditation" system indicating that the working breast units/centers provide minimum quality adequacy in all aspects, is undeniable. Currently, the accreditation system for breast centers is being used in the European Union and the United States for the last 5-10 years. This system is thought to provide standardization in breast care services, and is accepted as one of the important factors that resulted in reduction in mortality associated with breast cancer.

Highlighting Health: A Discussion of Health Practices and Accreditation. Accreditation and Beyond Series, Volume I.

ERIC Educational Resources Information Center

Bell, Claire

Research indicates children in group care have increased risk of infectious illnesses compared to those cared for at home. The health practices of child care center staff, children, and parents will influence the incidence of illness. The issues discussed in the book relate to some of the indicators of selected health accreditation principles in…

The effects of massage therapy on pain management in the acute care setting.

PubMed

Adams, Rose; White, Barb; Beckett, Cynthia

2010-03-17

Pain management remains a critical issue for hospitals and is receiving the attention of hospital accreditation organizations. The acute care setting of the hospital provides an excellent opportunity for the integration of massage therapy for pain management into the team-centered approach of patient care. This preliminary study evaluated the effect of the use of massage therapy on inpatient pain levels in the acute care setting. The study was conducted at Flagstaff Medical Center in Flagstaff, Arizona-a nonprofit community hospital serving a large rural area of northern Arizona. A convenience sample was used to identify research participants. Pain levels before and after massage therapy were recorded using a 0 - 10 visual analog scale. Quantitative and qualitative methods were used for analysis of this descriptive study. Hospital inpatients (n = 53) from medical, surgical, and obstetrics units participated in the current research by each receiving one or more massage therapy sessions averaging 30 minutes each. The number of sessions received depended on the length of the hospital stay. Before massage, the mean pain level recorded by the patients was 5.18 [standard deviation (SD): 2.01]. After massage, the mean pain level was 2.33 (SD: 2.10). The observed reduction in pain was statistically significant: paired samples t(52) = 12.43, r = .67, d = 1.38, p < .001. Qualitative data illustrated improvement in all areas, with the most significant areas of impact reported being overall pain level, emotional well-being, relaxation, and ability to sleep. This study shows that integration of massage therapy into the acute care setting creates overall positive results in the patient's ability to deal with the challenging physical and psychological aspects of their health condition. The study demonstrated not only significant reduction in pain levels, but also the interrelatedness of pain, relaxation, sleep, emotions, recovery, and finally, the healing process.

Quality in health care and globalization of health services: accreditation and regulatory oversight of medical tourism companies.

PubMed

Turner, Leigh G

2011-02-01

Patients are crossing national borders in search of affordable and timely health care. Many medical tourism companies are now involved in organizing cross-border health services. Despite the rapid expansion of the medical tourism industry, few standards exist to ensure that these businesses organize high-quality, competent international health care. Addressing the regulatory vacuum, 10 standards are proposed as a framework for regulating the medical tourism industry. Medical tourism companies should have to undergo accreditation review. Care should be arranged only at accredited international health-care facilities. Standards should be established to ensure that clients of medical tourism companies make informed choices. Continuity of care needs to become an integral feature of cross-border care. Restrictions should be placed on the use of waiver of liability forms by medical tourism companies. Medical tourism companies must ensure that they conform to relevant legislation governing privacy and confidentiality of patient information. Restrictions must be placed on the types of health services marketed by medical tourism companies. Representatives of medical tourism agencies should have to undergo training and certification. Medical travel insurance and medical complications insurance should be included in the health-care plans of patients traveling for care. To protect clients from financial losses, medical tourism companies should be mandated to contribute to compensation funds. Establishing high standards for the operation of medical tourism companies should reduce risks facing patients when they travel abroad for health care.

Safety climate and attitude toward medication error reporting after hospital accreditation in South Korea.

PubMed

Lee, Eunjoo

2016-09-01

This study compared registered nurses' perceptions of safety climate and attitude toward medication error reporting before and after completing a hospital accreditation program. Medication errors are the most prevalent adverse events threatening patient safety; reducing underreporting of medication errors significantly improves patient safety. Safety climate in hospitals may affect medication error reporting. This study employed a longitudinal, descriptive design. Data were collected using questionnaires. A tertiary acute hospital in South Korea undergoing a hospital accreditation program. Nurses, pre- and post-accreditation (217 and 373); response rate: 58% and 87%, respectively. Hospital accreditation program. Perceived safety climate and attitude toward medication error reporting. The level of safety climate and attitude toward medication error reporting increased significantly following accreditation; however, measures of institutional leadership and management did not improve significantly. Participants' perception of safety climate was positively correlated with their attitude toward medication error reporting; this correlation strengthened following completion of the program. Improving hospitals' safety climate increased nurses' medication error reporting; interventions that help hospital administration and managers to provide more supportive leadership may facilitate safety climate improvement. Hospitals and their units should develop more friendly and intimate working environments that remove nurses' fear of penalties. Administration and managers should support nurses who report their own errors. © The Author 2016. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Is the hospital decision to seek accreditation an effective one?

PubMed

Grepperud, Sverre

2015-01-01

The rapid expansion in the number of accredited hospitals justifies inquiry into the motives of hospitals in seeking accreditation and its social effectiveness. This paper presents a simple decision-theoretic framework where cost reductions and improved quality of care represent the endpoint benefits from accreditation. We argue that hospital accreditation, although acting as a market-signaling device, might be a socially inefficient institution. First, there is at present no convincing evidence for accreditation causing output quality improvements. Second, hospitals could seek accreditation, even though doing so is socially inefficient, because of moral hazard, consumer misperceptions, and nonprofit motivations. Finally, hospitals that seek accreditation need not themselves believe in output quality improvements from accreditation. Consequently, while awaiting additional evidence on accreditation, policy makers and third-party payers should exercise caution in encouraging such programs. Copyright © 2014 John Wiley & Sons, Ltd.

States Moving from Accreditation to Accountability. Accreditation: State School Accreditation Policies

ERIC Educational Resources Information Center

Wixom, Micah Ann

2014-01-01

Accreditation policies vary widely among the states. Since Education Commission of the States last reviewed public school accreditation policies in 1998, a number of states have seen their legislatures take a stronger role in accountability--resulting in a move from state-administered accreditation systems to outcomes-focused state accountability…

Strategic opportunities in the oversight of the U.S. hospital accreditation system.

PubMed

Moffett, Maurice L; Morgan, Robert O; Ashton, Carol M

2005-12-01

Hospital accreditation and state certification are the means that the Centers for Medicare & Medicaid Services (CMS) employs to meet quality of care requirements for medical care reimbursement. Hospitals can choose to use either a national accrediting agency or a state certification inspection in order to receive Medicare payments. Approximately, 80% of hospitals choose the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). The purpose of this paper is to analyze and discuss improvements on the structure of the accreditation process in a Principal-Agent-Supervisor framework with a special emphasis on the oversight by the principal (CMS) of the supervisor (JCAHO).

Lessons from Ten Years of TEAC's Accrediting Activity

ERIC Educational Resources Information Center

Murray, Frank B.

2010-01-01

Founded in 1997, the Teacher Education Accreditation Council (TEAC) designed a system that balances three sources of evidence in a single accreditation system: (1) that the program's graduates are qualified, competent, and caring beginning teachers; (2) that the program faculty investigates the factors that improve program quality; and (3) that…

Acute care research: is it ethical?

PubMed

Iserson, K V; Mahowald, M B

1992-07-01

Research in acute care is a troubling area for Institutional Review Board (IRB) approval and informed consent. Confusion about ethical and legal requirements has hampered research efforts and subsequent patient benefits. Acute care patients are the relatively few critical care patients who have suffered unexpected events that carry a high probability of mortality or severe morbidity unless immediate medical intervention is provided. We argue that acute care research is justified if the usual ethical requirements for research are modified to reflect the uniqueness of the situation. Our recommendations are to: a) use an explicit definition of acute care as distinct from other modes of critical care; b) eliminate the requirement for informed consent (as it is usually understood); and c) require stringent IRB oversight, regarding the unique ethical problems raised by this area of research. We further suggest that IRB oversight includes review of the protocol by a panel of individuals who represent possible enrollees in the proposed study.

Do written mandatory accreditation standards for residential care positively model learning organizations? Textual and critical discourse analysis.

PubMed

Bell, Erica; Robinson, Andrew; See, Catherine

2013-11-01

Unprecedented global population ageing accompanied by increasing complexity of aged care present major challenges of quality in aged care. In the business literature, Senge's theory of adaptive learning organisations offers a model of organisational quality. However, while accreditation of national standards is an increasing mechanism for achieving quality in aged care, there are anecdotal concerns it creates a 'minimum standards compliance mentality' and no evidence about whether it reinforces learning organisations. The research question was 'Do mandatory national accreditation standards for residential aged care, as they are written, positively model learning organisations?'. Automatic text analysis was combined with critical discourse analysis to analyse the presence of learning concepts from Senge's learning organisation theory in an exhaustive sample of national accreditation standards from 7 countries. The two stages of analysis were: (1) quantitative mapping of the presence of learning organisation concepts in standards using Bayesian-based textual analytics software and (2) qualitative critical discourse analysis to further examine how the language of standards so identified may be modelling learning organisation concepts. The learning concepts 'training', 'development', 'knowledge', and 'systems' are present with relative frequencies of 19%, 11%, 10%, and 10% respectively in the 1944 instances, in paragraph-sized text blocks, considered. Concepts such as 'team', 'integration', 'learning', 'change' and 'innovation' occur with 7%, 6%, 5%, 5%, and 1% relative frequencies respectively. Learning concepts tend to co-occur with negative rather than positive sentiment language in the 3176 instances in text blocks containing sentiment language. Critical discourse analysis suggested that standards generally use the language of organisational change and learning in limited ways that appear to model 'learning averse' communities of practice and organisational

The Apollo Accreditation Program: A web-based Joint Commission International standards compliance management tool.

PubMed

Dewan, Shaveta; Sibal, Anupam; Uberoi, R S; Kaur, Ishneet; Nayak, Yogamaya; Kar, Sujoy; Loria, Gaurav; Yatheesh, G; Balaji, V

2014-01-01

Creating and implementing processes to deliver quality care in compliance with accreditation standards is a challenging task but even more daunting is sustaining these processes and systems. There is need for frequent monitoring of the gap between the expected level of care and the level of care actually delivered so as to achieve consistent level of care. The Apollo Accreditation Program (AAP) was implemented as a web-based single measurable dashboard to display, measure and compare compliance levels for established standards of care in JCI accredited hospitals every quarter and resulted in an overall 15.5% improvement in compliance levels over one year.

A comprehensive education plan: the key to a successful Joint Commission on Accreditation of Healthcare Organizations survey.

PubMed

Thurber, Raymond; Read, Linda Eklof

2008-01-01

This article describes how education specialists from a 359-bed acute care hospital in the Northeast developed and implemented a comprehensive educational plan to prepare all staff members on the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) tracer methodology and upcoming triennial survey. This methodology can be utilized by staff development educators in any setting to not only prepare staff members for a successful JCAHO survey but also to meet or exceed JCAHO standards in one's everyday job.

Medical students' perceptions of international accreditation.

PubMed

Ibrahim, Halah; Abdel-Razig, Sawsan; Nair, Satish C

2015-10-11

This study aimed to explore the perceptions of medical students in a developing medical education system towards international accreditation. Applicants to an Internal Medicine residency program in an academic medical center in the United Arab Emirates (UAE) accredited by the Accreditation Council for Graduate Medical Education-International (ACGME-I) were surveyed between May and June 2014. The authors analysed responses using inductive qualitative thematic analysis to identify emergent themes. Seventy-eight of 96 applicants (81%) completed the survey. The vast majority of respondents 74 (95%) reported that ACGME-I accreditation was an important factor in selecting a residency program. Five major themes were identified, namely improving the quality of education, increasing opportunities, meeting high international standards, improving program structure, and improving patient care. Seven (10%) of respondents felt they would be in a position to pursue fellowship training or future employment in the United States upon graduation from an ACGME-I program. UAE trainees have an overwhelmingly positive perception of international accreditation, with an emphasis on improving the quality of training provided. Misperceptions, however, exist about potential opportunities available to graduates of ACGME-I programs. As more countries adopt the standards of the ACGME-I or other international accrediting bodies, it is important to recognize and foster trainee "buy-in" of educational reform initiatives.

Understanding the bereavement care roles of nurses within acute care: a systematic review.

PubMed

Raymond, Anita; Lee, Susan F; Bloomer, Melissa J

2017-07-01

To investigate nurses' roles and responsibilities in providing bereavement care during the care of dying patients within acute care hospitals. Bereavement within acute care hospitals is often sudden, unexpected and managed by nurses who may have limited access to experts. Nurses' roles and experience in the provision of bereavement care can have a significant influence on the subsequent bereavement process for families. Identifying the roles and responsibilities, nurses have in bereavement care will enhance bereavement supports within acute care environments. Mixed-methods systematic review. The review was conducted using the databases Cumulative Index Nursing and Allied Health Literature Plus, Embase, Ovid MEDLINE, PsychINFO, CareSearch and Google Scholar. Included studies published between 2006-2015, identified nurse participants, and the studies were conducted in acute care hospitals. Seven studies met the inclusion criteria, and the research results were extracted and subjected to thematic synthesis. Nurses' role in bereavement care included patient-centred care, family-centred care, advocacy and professional development. Concerns about bereavement roles included competing clinical workload demands, limitations of physical environments in acute care hospitals and the need for further education in bereavement care. Further research is needed to enable more detailed clarification of the roles nurse undertake in bereavement care in acute care hospitals. There is also a need to evaluate the effectiveness of these nursing roles and how these provisions impact on the bereavement process of patients and families. The care provided by acute care nurses to patients and families during end-of-life care is crucial to bereavement. The bereavement roles nurses undertake are not well understood with limited evidence of how these roles are measured. Further education in bereavement care is needed for acute care nurses. © 2016 John Wiley & Sons Ltd.

Smartphone Use by Nurses in Acute Care Settings.

PubMed

Flynn, Greir Ander Huck; Polivka, Barbara; Behr, Jodi Herron

2018-03-01

The use of smartphones in acute care settings remains controversial due to security concerns and personal use. The purposes of this study were to determine (1) the current rates of personal smartphone use by nurses in acute care settings, (2) nurses' preferences regarding the use of smartphone functionality at work, and (3) nurse perceptions of the benefits and drawbacks of smartphone use at work. An online survey of nurses from six acute care facilities within one healthcare system assessed the use of personal smartphones in acute care settings and perceptions of the benefits and drawbacks of smartphone use at work. Participants (N = 735) were primarily point-of-care nurses older than 31 years. Most participants (98%) used a smartphone in the acute care setting. Respondents perceived the most common useful and beneficial smartphone functions in acute care settings as allowing them to access information on medications, procedures, and diseases. Participants older than 50 years were less likely to use a smartphone in acute care settings and to agree with the benefits of smartphones. There is a critical need for recognition that smartphones are used by point-of-care nurses for a variety of functions and that realistic policies for smartphone use are needed to enhance patient care and minimize distractions.

Effectiveness of Acute Geriatric Unit Care Using Acute Care for Elders Components: A Systematic Review and Meta-Analysis

PubMed Central

Fox, Mary T; Persaud, Malini; Maimets, Ilo; O'Brien, Kelly; Brooks, Dina; Tregunno, Deborah; Schraa, Ellen

2012-01-01

Objectives To compare the effectiveness of acute geriatric unit care, based on all or part of the Acute Care for Elders (ACE) model and introduced in the acute phase of illness or injury, with that of usual care. Design Systematic review and meta-analysis of 13 randomized controlled and quasi-experimental trials with parallel comparison groups retrieved from multiple sources. Setting Acute care geriatric and nongeriatric hospital units. Participants Acutely ill or injured adults (N = 6,839) with an average age of 81. Interventions Acute geriatric unit care characterized by one or more ACE components: patient-centered care, frequent medical review, early rehabilitation, early discharge planning, prepared environment. Measurements Falls, pressure ulcers, delirium, functional decline at discharge from baseline 2-week prehospital and hospital admission statuses, length of hospital stay, discharge destination (home or nursing home), mortality, costs, and hospital readmissions. Results Acute geriatric unit care was associated with fewer falls (risk ratio (RR) = 0.51, 95% confidence interval (CI) = 0.29–0.88), less delirium (RR = 0.73, 95% CI = 0.61–0.88), less functional decline at discharge from baseline 2-week prehospital admission status (RR = 0.87, 95% CI = 0.78–0.97), shorter length of hospital stay (weighted mean difference (WMD) = −0.61, 95% CI = −1.16 to −0.05), fewer discharges to a nursing home (RR = 0.82, 95% CI = 0.68–0.99), lower costs (WMD = −$245.80, 95% CI = −$446.23 to −$45.38), and more discharges to home (RR = 1.05, 95% CI = 1.01–1.10). A nonsignificant trend toward fewer pressure ulcers was observed. No differences were found in functional decline between baseline hospital admission status and discharge, mortality, or hospital readmissions. Conclusion Acute geriatric unit care, based on all or part of the ACE model and introduced during the acute phase of older adults' illness or injury, improves patient- and system

76 FR 52548 - National Veterinary Accreditation Program; Currently Accredited Veterinarians Performing...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-23

.... APHIS-2006-0093] RIN 0579-AC04 National Veterinary Accreditation Program; Currently Accredited... accredited in the National Veterinary Accreditation Program (NVAP) may continue to perform accredited duties..., 2011. FOR FURTHER INFORMATION CONTACT: Dr. Todd Behre, National Veterinary Accreditation Program, VS...

Pitfalls of implementing acute care surgery.

PubMed

Kaplan, Lewis J; Frankel, Heidi; Davis, Kimberly A; Barie, Philip S

2007-05-01

Incorporating emergency general surgery into the current practice of the trauma and critical care surgeon carries sweeping implications for future practice and training. Herein, we examine the known benefits of the practice of emergency general surgery, contrast it with the emerging paradigm of acute care surgery, and examine pitfalls already encountered in integration of emergency general surgery into a traditional trauma/critical care surgery service. A MEDLINE literature search was supplemented with local experience and national presentations at major meetings to provide data for this review. Considerations including faculty complement, service structure, resident staffing, physician extenders, the decreased role of community hospitals in providing trauma and emergency general surgery care, and the effects on an elective operative schedule are inadequately explored at present. There are no firm recommendations as to how to incorporate emergency general surgery into a trauma/critical care practice that will satisfy both academic and community practice paradigms. The near future seems likely to embrace the expanded training and clinical care program termed acute care surgery. A host of essential elements have yet to be examined to undertake a critical analysis of the applicability, advisability, and appropriate structure of both emergency general surgery and acute care surgery in the United States. Proceeding along this pathway may be fraught with training, education, and implementation pitfalls that are ideally addressed before deploying acute care surgery as a national standard.

Medical students’ perceptions of international accreditation

PubMed Central

Abdel-Razig, Sawsan; Nair, Satish C

2015-01-01

Objectives This study aimed to explore the perceptions of medical students in a developing medical education system towards international accreditation. Methods Applicants to an Internal Medicine residency program in an academic medical center in the United Arab Emirates (UAE) accredited by the Accreditation Council for Graduate Medical Education-International (ACGME-I) were surveyed between May and June 2014. The authors analysed responses using inductive qualitative thematic analysis to identify emergent themes. Results Seventy-eight of 96 applicants (81%) completed the survey. The vast majority of respondents 74 (95%) reported that ACGME-I accreditation was an important factor in selecting a residency program. Five major themes were identified, namely improving the quality of education, increasing opportunities, meeting high international standards, improving program structure, and improving patient care. Seven (10%) of respondents felt they would be in a position to pursue fellowship training or future employment in the United States upon graduation from an ACGME-I program. Conclusions UAE trainees have an overwhelmingly positive perception of international accreditation, with an emphasis on improving the quality of training provided. Misperceptions, however, exist about potential opportunities available to graduates of ACGME-I programs. As more countries adopt the standards of the ACGME-I or other international accrediting bodies, it is important to recognize and foster trainee “buy-in” of educational reform initiatives. PMID:26454402

The Effects of Massage Therapy on Pain Management in the Acute Care Setting

PubMed Central

Adams, Rose; White, Barb; Beckett, Cynthia

2010-01-01

Background Pain management remains a critical issue for hospitals and is receiving the attention of hospital accreditation organizations. The acute care setting of the hospital provides an excellent opportunity for the integration of massage therapy for pain management into the team-centered approach of patient care. Purpose and Setting This preliminary study evaluated the effect of the use of massage therapy on inpatient pain levels in the acute care setting. The study was conducted at Flagstaff Medical Center in Flagstaff, Arizona—a nonprofit community hospital serving a large rural area of northern Arizona. Method A convenience sample was used to identify research participants. Pain levels before and after massage therapy were recorded using a 0 – 10 visual analog scale. Quantitative and qualitative methods were used for analysis of this descriptive study. Participants Hospital inpatients (n = 53) from medical, surgical, and obstetrics units participated in the current research by each receiving one or more massage therapy sessions averaging 30 minutes each. The number of sessions received depended on the length of the hospital stay. Result Before massage, the mean pain level recorded by the patients was 5.18 [standard deviation (SD): 2.01]. After massage, the mean pain level was 2.33 (SD: 2.10). The observed reduction in pain was statistically significant: paired samples t52 = 12.43, r = .67, d = 1.38, p < .001. Qualitative data illustrated improvement in all areas, with the most significant areas of impact reported being overall pain level, emotional well-being, relaxation, and ability to sleep. Conclusions This study shows that integration of massage therapy into the acute care setting creates overall positive results in the patient’s ability to deal with the challenging physical and psychological aspects of their health condition. The study demonstrated not only significant reduction in pain levels, but also the interrelatedness of pain, relaxation

Quality indicators to compare accredited independent pharmacies and accredited chain pharmacies in Thailand.

PubMed

Arkaravichien, Wiwat; Wongpratat, Apichaya; Lertsinudom, Sunee

2016-08-01

Background Quality indicators determine the quality of actual practice in reference to standard criteria. The Community Pharmacy Association (Thailand), with technical support from the International Pharmaceutical Federation, developed a tool for quality assessment and quality improvement at community pharmacies. This tool has passed validity and reliability tests, but has not yet had feasibility testing. Objective (1) To test whether this quality tool could be used in routine settings. (2) To compare quality scores between accredited independent and accredited chain pharmacies. Setting Accredited independent pharmacies and accredited chain pharmacies in the north eastern region of Thailand. Methods A cross sectional study was conducted in 34 accredited independent pharmacies and accredited chain pharmacies. Quality scores were assessed by observation and by interviewing the responsible pharmacists. Data were collected and analyzed by independent t-test and Mann-Whitney U test as appropriate. Results were plotted by histogram and spider chart. Main outcome measure Domain's assessable scores, possible maximum scores, mean and median of measured scores. Results Domain's assessable scores were close to domain's possible maximum scores. This meant that most indicators could be assessed in most pharmacies. The spider chart revealed that measured scores in the personnel, drug inventory and stocking, and patient satisfaction and health promotion domains of chain pharmacies were significantly higher than those of independent pharmacies (p < 0.05). There was no statistical difference between independent pharmacies and chain pharmacies in the premise and facility or dispensing and patient care domains. Conclusion Quality indicators developed by the Community Pharmacy Association (Thailand) could be used to assess quality of practice in pharmacies in routine settings. It is revealed that the quality scores of chain pharmacies were higher than those of independent pharmacies.

The Costs of Pursuing Accreditation for Methadone Treatment Sites: Results from a National Study

ERIC Educational Resources Information Center

Zarkin, Gary A.; Dunlap, Laura J.; Homsi, Ghada

2006-01-01

The use of accreditation has been widespread among medical care providers, but accreditation is relatively new to the drug abuse treatment field. This study presents estimates of the costs of pursuing accreditation for methadone treatment sites. Data are from 102 methadone treatment sites that underwent accreditation as part of the Center for…

Bundling Post-Acute Care Services into MS-DRG Payments

PubMed Central

Vertrees, James C.; Averill, Richard F.; Eisenhandler, Jon; Quain, Anthony; Switalski, James

2013-01-01

Objective A bundled hospital payment system that encompasses both acute and post-acute care has been proposed as a means of creating financial incentives in the Medicare fee-for-service system to foster care coordination and to improve the current disorganized system of post care. The objective of this study was to evaluate the statistical stability of alternative designs of a hospital payment system that includes post-acute care services to determine the feasibility of using a combined hospital and post-acute care bundle as a unit of payment. Methods The Medicare Severity-Diagnosis Related Groups (MS-DRGs) were subdivided into clinical subclasses that measured a patient's chronic illness burden to test whether a patient's chronic illness burden had a substantial impact on post-acute care expenditures. Using Medicare data the statistical performance of the MS-DRGs with and without the chronic illness subclasses was evaluated across a wide range of post-acute care windows and combinations of post-acute care service bundles using both submitted charges and Medicare payments. Results The statistical performance of the MS-DRGs as measured by R2 was consistently better when the chronic illness subclasses are included indicating that MS-DRGs by themselves are an inadequate unit of payment for post-acute care payment bundles. In general, R2 values increased as the post-acute care window length increased and decreased as more services were added to the post-acute care bundle. Discussion The study results suggest that it is feasible to develop a payment system that incorporates significant post-acute care services into the MS-DRG inpatient payment bundle. This expansion of the basic DRG payment approach can provide a strong financial incentive for providers to better coordinate care potentially leading to improved efficiency and outcome quality. PMID:24753970

The Accreditation Council for Graduate Medical Education resident duty hour new standards: history, changes, and impact on staffing of intensive care units.

PubMed

Pastores, Stephen M; O'Connor, Michael F; Kleinpell, Ruth M; Napolitano, Lena; Ward, Nicholas; Bailey, Heatherlee; Mollenkopf, Fred P; Coopersmith, Craig M

2011-11-01

The Accreditation Council for Graduate Medical Education recently released new standards for supervision and duty hours for residency programs. These new standards, which will affect over 100,000 residents, take effect in July 2011. In response to these new guidelines, the Society of Critical Care Medicine convened a task force to develop a white paper on the impact of changes in resident duty hours on the critical care workforce and staffing of intensive care units. A multidisciplinary group of professionals with expertise in critical care education and clinical practice. Relevant medical literature was accessed through a systematic MEDLINE search and by requesting references from all task force members. Material published by the Accreditation Council for Graduate Medical Education and other specialty organizations was also reviewed. Collaboratively and iteratively, the task force corresponded by electronic mail and held several conference calls to finalize this report. The new rules mandate that all first-year residents work no more than 16 hrs continuously, preserving the 80-hr limit on the resident workweek and 10-hr period between duty periods. More senior trainees may work a maximum of 24 hrs continuously, with an additional 4 hrs permitted for handoffs. Strategic napping is strongly suggested for trainees working longer shifts. Compliance with the new Accreditation Council for Graduate Medical Education duty-hour standards will compel workflow restructuring in intensive care units, which depend on residents to provide a substantial portion of care. Potential solutions include expanded utilization of nurse practitioners and physician assistants, telemedicine, offering critical care training positions to emergency medicine residents, and partnerships with hospitalists. Additional research will be necessary to evaluate the impact of the new standards on patient safety, continuity of care, resident learning, and staffing in the intensive care unit.

NCI Updates Tobacco Policies Following Re-accreditation | Poster

Cancer.gov

This year, NCI was re-accredited as one of nearly 200 CEO Cancer Gold Standard employers across the United States. According to its website, “the CEO Cancer Gold Standard provides a framework for employers to have a healthier workplace by focusing on cancer risk reduction, early detection, and access to clinical trials and high-quality care.” As part of this re-accreditation,

Determining level of care appropriateness in the patient journey from acute care to rehabilitation

PubMed Central

2011-01-01

Background The selection of patients for rehabilitation, and the timing of transfer from acute care, are important clinical decisions that impact on care quality and patient flow. This paper reports utilization review data on inpatients in acute care with stroke, hip fracture or elective joint replacement, and other inpatients referred for rehabilitation. It examines reasons why acute level of care criteria are not met and explores differences in decision making between acute care and rehabilitation teams around patient appropriateness and readiness for transfer. Methods Cohort study of patients in a large acute referral hospital in Australia followed with the InterQual utilization review tool, modified to also include reasons why utilization criteria are not met. Additional data on team decision making about appropriateness for rehabilitation, and readiness for transfer, were collected on a subset of patients. Results There were 696 episodes of care (7189 bed days). Days meeting acute level of care criteria were 56% (stroke, hip fracture and joint replacement patients) and 33% (other patients, from the time of referral). Most inappropriate days in acute care were due to delays in processes/scheduling (45%) or being more appropriate for rehabilitation or lower level of care (30%). On the subset of patients, the acute care team and the utilization review tool deemed patients ready for rehabilitation transfer earlier than the rehabilitation team (means of 1.4, 1.3 and 4.0 days from the date of referral, respectively). From when deemed medically stable for transfer by the acute care team, 28% of patients became unstable. From when deemed stable by the rehabilitation team or utilization review, 9% and 11%, respectively, became unstable. Conclusions A high proportion of patient days did not meet acute level of care criteria, due predominantly to inefficiencies in care processes, or to patients being more appropriate for an alternative level of care, including

75 FR 59605 - National Veterinary Accreditation Program; Currently Accredited Veterinarians Performing...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-09-28

.... APHIS-2006-0093] RIN 0579-AC04 National Veterinary Accreditation Program; Currently Accredited... Veterinary Accreditation Program (NVAP) may continue to perform accredited duties and to elect to continue to..., National Veterinary Accreditation Program, VS, APHIS, 4700 River Road Unit 200, Riverdale, MD 20737; (301...

A systematic review of advance practice providers in acute care: options for a new model in a burn intensive care unit.

PubMed

Edkins, Renee E; Cairns, Bruce A; Hultman, C Scott

2014-03-01

Accreditation Council for Graduate Medical Education mandated work-hour restrictions have negatively impacted many areas of clinical care, including management of burn patients, who require intensive monitoring, resuscitation, and procedural interventions. As surgery residents become less available to meet service needs, new models integrating advanced practice providers (APPs) into the burn team must emerge. We performed a systematic review of APPs in critical care questioning, how best to use all providers to solve these workforce challenges? We performed a systematic review of PubMed, CINAHL, Ovid, and Google Scholar, from 2002 to 2012, using the key words: nurse practitioner, physician assistant, critical care, and burn care. After applying inclusion/exclusion criteria, 18 relevant articles were selected for review. In addition, throughput and financial models were developed to examine provider staffing patterns. Advanced practice providers in critical care settings function in various models, both with and without residents, reporting to either an intensivist or an attending physician. When APPs participated, patient outcomes were similar or improved compared across provider models. Several studies reported considerable cost-savings due to decrease length of stay, decreased ventilator days, and fewer urinary tract infections when nurse practitioners were included in the provider mix. Restrictions in resident work-hours and changing health care environments require that new provider models be created for acute burn care. This article reviews current utilization of APPs in critical care units and proposes a new provider model for burn centers.

A prospective, multi-method, multi-disciplinary, multi-level, collaborative, social-organisational design for researching health sector accreditation [LP0560737

PubMed Central

Braithwaite, Jeffrey; Westbrook, Johanna; Pawsey, Marjorie; Greenfield, David; Naylor, Justine; Iedema, Rick; Runciman, Bill; Redman, Sally; Jorm, Christine; Robinson, Maureen; Nathan, Sally; Gibberd, Robert

2006-01-01

Background Accreditation has become ubiquitous across the international health care landscape. Award of full accreditation status in health care is viewed, as it is in other sectors, as a valid indicator of high quality organisational performance. However, few studies have empirically demonstrated this assertion. The value of accreditation, therefore, remains uncertain, and this persists as a central legitimacy problem for accreditation providers, policymakers and researchers. The question arises as to how best to research the validity, impact and value of accreditation processes in health care. Most health care organisations participate in some sort of accreditation process and thus it is not possible to study its merits using a randomised controlled strategy. Further, tools and processes for accreditation and organisational performance are multifaceted. Methods/design To understand the relationship between them a multi-method research approach is required which incorporates both quantitative and qualitative data. The generic nature of accreditation standard development and inspection within different sectors enhances the extent to which the findings of in-depth study of accreditation process in one industry can be generalised to other industries. This paper presents a research design which comprises a prospective, multi-method, multi-level, multi-disciplinary approach to assess the validity, impact and value of accreditation. Discussion The accreditation program which assesses over 1,000 health services in Australia is used as an exemplar for testing this design. The paper proposes this design as a framework suitable for application to future international research into accreditation. Our aim is to stimulate debate on the role of accreditation and how to research it. PMID:16968552

A Conceptual Model for Episodes of Acute, Unscheduled Care.

PubMed

Pines, Jesse M; Lotrecchiano, Gaetano R; Zocchi, Mark S; Lazar, Danielle; Leedekerken, Jacob B; Margolis, Gregg S; Carr, Brendan G

2016-10-01

We engaged in a 1-year process to develop a conceptual model representing an episode of acute, unscheduled care. Acute, unscheduled care includes acute illnesses (eg, nausea and vomiting), injuries, or exacerbations of chronic conditions (eg, worsening dyspnea in congestive heart failure) and is delivered in emergency departments, urgent care centers, and physicians' offices, as well as through telemedicine. We began with a literature search to define an acute episode of care and to identify existing conceptual models used in health care. In accordance with this information, we then drafted a preliminary conceptual model and collected stakeholder feedback, using online focus groups and concept mapping. Two technical expert panels reviewed the draft model, examined the stakeholder feedback, and discussed ways the model could be improved. After integrating the experts' comments, we solicited public comment on the model and made final revisions. The final conceptual model includes social and individual determinants of health that influence the incidence of acute illness and injury, factors that affect care-seeking decisions, specific delivery settings where acute care is provided, and outcomes and costs associated with the acute care system. We end with recommendations for how researchers, policymakers, payers, patients, and providers can use the model to identify and prioritize ways to improve acute care delivery. Copyright © 2016 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

Women's Health Fellowships: Examining the Potential Benefits and Harms of Accreditation.

PubMed

Carnes, Molly; Vogelman, Bennett

2015-05-01

This commentary responds to the assertions by Foreman et al. that credentialing of women's health (WH) fellows by the American Board of Medical Subspecialties and accreditation of current and future WH fellowships by the Accreditation Council for Graduate Medical Education would improve the health and healthcare of women by increasing the number of primary care providers competent to meet a growing clinical need. They speculate that such accreditation would raise the status of WH fellowships, increase the number of applicants, and result in more academic leaders in WH. They assert that curricular deficiencies in WH exist in physician training and that WH fellowships are the preferred means of training physicians to care for midlife women. We review the evidence to support or refute these claims and conclude that accrediting WH fellowships would not have the forecasted outcomes and would jeopardize the success of current WH fellowships.

Women's Health Fellowships: Examining the Potential Benefits and Harms of Accreditation

PubMed Central

Vogelman, Bennett

2015-01-01

Abstract This commentary responds to the assertions by Foreman et al. that credentialing of women's health (WH) fellows by the American Board of Medical Subspecialties and accreditation of current and future WH fellowships by the Accreditation Council for Graduate Medical Education would improve the health and healthcare of women by increasing the number of primary care providers competent to meet a growing clinical need. They speculate that such accreditation would raise the status of WH fellowships, increase the number of applicants, and result in more academic leaders in WH. They assert that curricular deficiencies in WH exist in physician training and that WH fellowships are the preferred means of training physicians to care for midlife women. We review the evidence to support or refute these claims and conclude that accrediting WH fellowships would not have the forecasted outcomes and would jeopardize the success of current WH fellowships. PMID:25919589

[Laboratory accreditation and proficiency testing].

PubMed

Kuwa, Katsuhiko

2003-05-01

ISO/TC 212 covering clinical laboratory testing and in vitro diagnostic test systems will issue the international standard for medical laboratory quality and competence requirements, ISO 15189. This standard is based on the ISO/IEC 17025, general requirements for competence of testing and calibration laboratories and ISO 9001, quality management systems-requirements. Clinical laboratory services are essential to patient care and therefore should be available to meet the needs of all patients and clinical personnel responsible for human health care. If a laboratory seeks accreditation, it should select an accreditation body that operates according to this international standard and in a manner which takes into account the particular requirements of clinical laboratories. Proficiency testing should be available to evaluate the calibration laboratories and reference measurement laboratories in clinical medicine. Reference measurement procedures should be of precise and the analytical principle of measurement applied should ensure reliability. We should be prepared to establish a quality management system and proficiency testing in clinical laboratories.

Sharing Accreditation.

ERIC Educational Resources Information Center

Horrocks, Norman

1984-01-01

Reports on conference convened by Association for Library and Information Science Education for discussion of library school accreditation by 17 library-related associations and agencies. Highlights include accreditation models, accrediting information science, records management, special librarians, certification for archivists, M.L.S. in…

Medicare's bundling pilot: including post-acute care services.

PubMed

Dummit, Laura A

2011-03-28

Fee-for-service Medicare, in which a separate payment is made for each service, rewards health care providers for delivering more services, but not necessarily coordinating those services over time or across settings. To help address these concerns, the Patient Protection and Affordable Care Act of 2010 requires Medicare to experiment with making a bundled payment for a hospitalization plus post-acute care, that is, the recuperative or rehabilitative care following a hospital discharge. This bundled payment approach is intended to promote more efficient care across the acute/post-acute episode because the entity that receives the payment has financial incentives to keep episode costs below the payment. Although the entity is expected to control costs through improved care coordination and efficiency, it could stint on care or avoid expensive patients instead. This issue brief focuses on the unique challenges posed by the inclusion of post-acute care services in a payment bundle and special considerations in implementing and evaluating the episode payment approach.

Acute care teaching in the undergraduate nursing curriculum.

PubMed

McGaughey, Jennifer

2009-01-01

To incorporate basic aspects of acute care into the undergraduate nursing programme by providing an opportunity for the development of knowledge and skills in the early recognition and assessment of deteriorating patients on general hospital wards. Acute care initiatives implemented in the hospital setting to improve the identification and management of 'at risk' patients have focused on the provision of education for trained or qualified staff. However, to ensure student nurses are 'fit to practice' at the point of registration, it has been recommended that acute care theory and skills are incorporated into the undergraduate nursing curriculum. PRACTICE DEVELOPMENT INITIATIVE: An 'Integrated Nursing Care' module was incorporated into year 3 of the undergraduate nursing programme to introduce students to acute care theory and practice. Module content focuses on the early detection and management of acute deterioration in patients with respiratory, cardiac, neurological or renal insufficiencies. We used a competency-based framework to ensure the application of theory to practice through the use of group seminars. High-fidelity patient-simulated clinical scenarios were a key feature. The United Kingdom Resuscitation Council Intermediate Life Support course is also an important component of the module. Incorporating the Integrated Nursing Care module into the undergraduate nursing curriculum provides pre-registration students the opportunity to develop their knowledge and skills in acute care. The provision of undergraduate education in care of the acutely ill patient in hospital is essential to improve nurses' competence and confidence in assessing and managing deteriorating patients in general wards at the point of registration.

Effect of accreditation on the quality of chronic disease management: a comparative observational study.

PubMed

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

2014-11-04

Practice accreditation is widely used to assess and improve quality of healthcare providers. Little is known about its effectiveness, particularly in primary care. In this study we examined the effect of accreditation on quality of care regarding diabetes, chronic obstructive pulmonary disease (COPD) and cardiovascular disease (CVD). A comparative observational study with two cohorts was performed. We included 138 Dutch family practices that participated in the national accreditation program for primary care. A first cohort of 69 practices was measured at start and completion of a 3-year accreditation program. A second cohort of 69 practices was included and measured simultaneously with the final measurement of the first cohort. In separate multilevel regression analyses, we compared both within-group changes in the first cohort and between-groups differences at follow-up (first cohort) and start (second cohort). Outcome measures consisted of 24 systematically developed indicators of quality of care in targeted chronic diseases. In the within-group comparison, we found improvements on 6 indicators related to diabetes (feet examination, cholesterol measurement, lipid lowering medication prescription) and COPD (spirometry performance, stop smoking advice). In the between-groups comparison we found that first cohort practices performed better on 4 indicators related to diabetes (cholesterol outcome) and CVD (blood pressure outcome, smoke status registration, glucose measurement). Improvements of the quality of primary care for patients with chronic diseases were found, but few could be attributed to the accreditation program. Further development of accreditation is needed to enhance its effectiveness on chronic disease management.

Patterns and predictors of local health department accreditation in Missouri

PubMed Central

Mayer, Jeffrey; Elliott, Michael; Brownson, Ross C.; Abdulloeva, Safina; Wojciehowski, Kathleen

2016-01-01

Context Accreditation of local health departments has been identified as a crucial strategy for strengthening the public health infrastructure. Rural local health departments face many challenges including lower levels of staffing and funding than LHDs serving metropolitan or urban areas; simultaneously their populations experience health disparities related to risky health behaviors, health outcomes, and access to medical care. Through accreditation, rural local health departments can become better equipped to meet the needs of their communities. Objective To better understand the needs of communities by assessing barriers and incentives to state-level accreditation in Missouri from the rural local health department (RHLD) perspective. Design Qualitative analysis of semi-structured key informant interviews with Missouri LHDs serving rural communities. Participants Eleven administrators of RLHDs, seven from accredited and four from unaccredited departments were interviewed. Population size served ranged from 6,400 to 52,000 for accredited RLHDs and 7,200 to 73,000 for unaccredited RLHDs. Results Unaccredited RLHDs identified more barriers to accreditation than accredited RLHDs. Time was a major barrier to seeking accreditation. Unaccredited RLHDs overall did not see accreditation as a priority for their agency and failed to the see value of accreditation. Accredited RLHDs listed significantly more incentives then their unaccredited counterparts. Unaccredited RLHDs identified accountability, becoming more effective and efficient, staff development, and eventual funding as incentives to accreditation. Conclusions There is a need for better documentation of measurable benefits in order for a RLHD to pursue voluntary accreditation. Those who pursue are likely to see benefits after the fact, but those who do not, do not see the immediate and direct benefits of voluntary accreditation. The findings from this study of state-level accreditation in Missouri provides insight

The Condition of Accreditation: U.S. Accreditation in 2011

ERIC Educational Resources Information Center

Council for Higher Education Accreditation, 2012

2012-01-01

Institutions are accredited by three types of accreditors: national faith-related organizations that accredit religiously affiliated and doctrinally based institutions that are primarily degree-granting and nonprofit; national career-related organizations that accredit mainly for-profit career-based degree-granting and non-degree-granting…

21 CFR 900.13 - Revocation of accreditation and revocation of accreditation body approval.

Code of Federal Regulations, 2011 CFR

2011-04-01

... accreditation body approval. 900.13 Section 900.13 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF... Certification § 900.13 Revocation of accreditation and revocation of accreditation body approval. (a) FDA action following revocation of accreditation. If a facility's accreditation is revoked by an accreditation body...

Cardiovascular genomics: implications for acute and critical care nurses.

PubMed

Quinn Griffin, Mary T; Klein, Deborah; Winkelman, Chris

2013-01-01

As genomic health care becomes commonplace, nurses will be asked to provide genomic care in all health care settings including acute care and critical care. Three common cardiac conditions are reviewed, Marfan syndrome, bicuspid aortic valve, and hypertrophic cardiomyopathy, to provide acute care and critical care nurses with an overview of these pathologies through the lens of genomics and relevant case studies. This information will help critical care nursing leaders become familiar with genetics related to common cardiac conditions and prepare acute care and critical care nurses for a new phase in patient diagnostics, with greater emphasis on early diagnosis and recognition of conditions before sudden cardiac death.

Update: A Review of Women's Health Fellowships, Their Role in Interdisciplinary Health Care, and the Need for Accreditation

PubMed Central

Foreman, Heather; Weber, Lauren

2015-01-01

Abstract While Women's Health (WH) Fellowships have been in existence since 1990, knowledge of their existence seems limited. Specialized training in WH is crucial to educate leaders who can appropriately integrate this multidisciplinary field into academic centers, especially as the demand for providers confident in the areas of contraception, perimenopause/menopause, hormone therapy, osteoporosis, hypoactive sexual desire disorder, medical management of abnormal uterine bleeding, office based care of stress/urge incontinence, and gender-based medicine are increasing popular and highly sought after. WH fellowship programs would benefit from accreditation from the American Board of Medical Subspecialties and from the American College of Graduate Medical Education, as this may allow for greater recruitment, selection, and training of future leaders in WH. This article provides a current review of what WH trained physicians can offer patients, and also highlights the added value that accreditation would offer the field. Ultimately, accrediting WH fellowships will improve women's health medical education by creating specialists that can serve as academic leaders to help infuse gender specific education in primary residencies, as well as serve as consultants and leaders, and promote visibility and prestige of the field. PMID:25884348

Update: A Review of Women's Health Fellowships, Their Role in Interdisciplinary Health Care, and the Need for Accreditation.

PubMed

Foreman, Heather; Weber, Lauren; Thacker, Holly L

2015-05-01

While Women's Health (WH) Fellowships have been in existence since 1990, knowledge of their existence seems limited. Specialized training in WH is crucial to educate leaders who can appropriately integrate this multidisciplinary field into academic centers, especially as the demand for providers confident in the areas of contraception, perimenopause/menopause, hormone therapy, osteoporosis, hypoactive sexual desire disorder, medical management of abnormal uterine bleeding, office based care of stress/urge incontinence, and gender-based medicine are increasing popular and highly sought after. WH fellowship programs would benefit from accreditation from the American Board of Medical Subspecialties and from the American College of Graduate Medical Education, as this may allow for greater recruitment, selection, and training of future leaders in WH. This article provides a current review of what WH trained physicians can offer patients, and also highlights the added value that accreditation would offer the field. Ultimately, accrediting WH fellowships will improve women's health medical education by creating specialists that can serve as academic leaders to help infuse gender specific education in primary residencies, as well as serve as consultants and leaders, and promote visibility and prestige of the field.

Patients with acute abdominal pain describe their experiences of fundamental care across the acute care episode: a multi-stage qualitative case study.

PubMed

Jangland, Eva; Kitson, Alison; Muntlin Athlin, Åsa

2016-04-01

To explore how patients with acute abdominal pain describe their experiences of fundamental care across the acute care episode. Acute abdominal pain is one of the most common conditions to present in the acute care setting. Little is known about how patients' fundamental care needs are managed from presentation to post discharge. A multi-stage qualitative case study using the Fundamentals of Care framework as the overarching theoretical and explanatory mechanism. Repeated reflective interviews were conducted with five adult patients over a 6-month period in 2013 at a university hospital in Sweden. The interviews (n = 14) were analysed using directed content analysis. Patients' experiences across the acute care episode are presented as five patient narratives and synthesized into five descriptions of the entire hospital journey. The patients talked about the fundamentals of care and had vivid accounts of what they meant to them. The experiences of each of the patients were influenced by the extent to which they felt engaged with the health professionals. The ability to engage or build a rapport was identified as a central component across the fundamental care elements, but it varied in visibility. Consistent pain management, comfort, timely and accurate information, choice and dignity and relationships were identified as essential fundamental care needs of patients experiencing acute abdominal pain regardless of setting, diagnosis, or demographic variables. These were variously achieved and the patients' narratives raised areas for improvement in several areas. © 2016 John Wiley & Sons Ltd.

Factors affecting implementation of accreditation programmes and the impact of the accreditation process on quality improvement in hospitals: a SWOT analysis.

PubMed

Ng, G K B; Leung, G K K; Johnston, J M; Cowling, B J

2013-10-01

The objectives of this review were to identify factors that influence implementation of hospital accreditation programmes and to assess the impact of the accreditation process on quality improvement in public hospitals. Two electronic databases, Medline (OvidSP) and PubMed, were systematically searched. "Public hospital", "hospital accreditation", and "quality improvement" were used as the search terms. A total of 348 citations were initially identified. After critical appraisal and study selection, 26 articles were included in the review. The data were extracted and analysed using a SWOT (strengths, weaknesses, opportunities, threats) analysis. Increased staff engagement and communication, multidisciplinary team building, positive changes in organisational culture, and enhanced leadership and staff awareness of continuous quality improvement were identified as strengths. Weaknesses included organisational resistance to change, increased staff workload, lack of awareness about continuous quality improvement, insufficient staff training and support for continuous quality improvement, lack of applicable accreditation standards for local use, and lack of performance outcome measures. Opportunities included identification of improvement areas, enhanced patient safety, additional funding, public recognition, and market advantage. Threats included opportunistic behaviours, funding cuts, lack of incentives for participation, and a regulatory approach to mandatory participation. By relating the findings to the operational issues of accreditation, this review discussed the implications for successful implementation and how accreditation may drive quality improvement. These findings have implications for various stakeholders (government, the public, patients and health care providers), when it comes to embarking on accreditation exercises.

Quality geriatric care as perceived by nurses in long-term and acute care settings.

PubMed

Barba, Beth Ellen; Hu, Jie; Efird, Jimmy

2012-03-01

This study focused on differences in nurses' satisfaction with the quality of care of older people and with organisational characteristics and work environment in acute care and long-term care settings. Numerous studies have explored links between nurses' satisfaction with care and work environments on the one hand and a variety of physical, behavioural and psychological reactions of nurses on the other. One key to keeping nurses in the workplace is a better understanding of nurses' satisfaction with the quality of care they provide. Descriptive design. The self-selected sample included 298 registered nurses and licensed practical nurses who provide care to minority, underserved and disadvantaged older populations in 89 long-term care and <100 bed hospitals in 38 rural counties and eight metropolitan areas in a Southern state. All completed the Agency Geriatric Nursing Care survey, which consisted of a 13-item scale measuring nurses' satisfaction with the quality of geriatric care in their practice settings and an 11-item scale examining obstacles to providing quality geriatric care. Demographic variables were compared with chi-square. Independent t-tests were used to examine differences between nurses in long-term care and acute care settings. Significant differences were found in level of satisfaction and perceived obstacles to providing quality care to older adults between participants from acute and long-term care. Participants in long-term care had greater satisfaction with the quality of geriatric care than those in acute facilities. Nurses in long-term care were more satisfied that care was evidence-based; specialised to individual needs of older adults; promoted autonomy and independence of elders; and was continuous across settings. Participants in acute facilities perceived more obstacles to providing quality geriatric care than nurses in long-term care facilities. Modification of hospital geriatric practice environments and leadership commitment to

Acute care hospitals' accountability to provincial funders.

PubMed

Kromm, Seija K; Ross Baker, G; Wodchis, Walter P; Deber, Raisa B

2014-09-01

Ontario's acute care hospitals are subject to a number of tools, including legislation and performance measurement for fiscal accountability and accountability for quality. Examination of accountability documents used in Ontario at the government, regional and acute care hospital levels reveals three trends: (a) the number of performance measures being used in the acute care hospital sector has increased significantly; (b) the focus of the health system has expanded from accountability for funding and service volumes to include accountability for quality and patient safety; and (c) the accountability requirements are misaligned at the different levels. These trends may affect the success of the accountability approach currently being used. Copyright © 2014 Longwoods Publishing.

The pathology milestones and the next accreditation system.

PubMed

Naritoku, Wesley Y; Alexander, C Bruce; Bennett, Betsy D; Black-Schaffer, W Stephen; Brissette, Mark D; Grimes, Margaret M; Hoffman, Robert D; Hunt, Jennifer L; Iezzoni, Julia C; Johnson, Rebecca; Kozel, Jessica; Mendoza, Ricardo M; Post, Miriam D; Powell, Suzanne Z; Procop, Gary W; Steinberg, Jacob J; Thorsen, Linda M; Nestler, Steven P

2014-03-01

In the late 1990s, the Accreditation Council for Graduate Medical Education developed the Outcomes Project and the 6 general competencies with the intent to improve the outcome of graduate medical education in the United States. The competencies were used as the basis for developing learning goals and objectives and tools to evaluate residents' performance. By the mid-2000s the stakeholders in resident education and the general public felt that the Outcomes Project had fallen short of expectations. To develop a new evaluation method to track trainee progress throughout residency using benchmarks called milestones. A change in leadership at the Accreditation Council for Graduate Medical Education brought a new vision for the accreditation of training programs and a radically different approach to the evaluation of residents. The Pathology Milestones Working Group reviewed examples of developing milestones in other specialties, the literature, and the Accreditation Council for Graduate Medical Education program requirements for pathology to develop pathology milestones. The pathology milestones are a set of objective descriptors for measuring progress in the development of competency in patient care, procedural skill sets, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism, and systems-based practice. The milestones provide a national standard for evaluation that will be used for the assessment of all residents in Accreditation Council for Graduate Medical Education-accredited pathology training programs.

[Staff accreditation in parenteral nutrition production in hospital pharmacy].

PubMed

Vrignaud, S; Le Pêcheur, V; Jouan, G; Valy, S; Clerc, M-A

2016-09-01

This work aims to provide staff accreditation methodology to harmonize and secure practices for parenteral nutrition bags preparation. The methodology used in the present study is inspired from project management and quality approach. Existing training supports were used to produce accreditation procedure and evaluation supports. We first defined abilities levels, from level 1, corresponding to accredited learning agent to level 3, corresponding to expert accredited agent. Elements assessed for accreditation are: clothing assessment either by practices audit or by microbiologic test, test bags preparation and handling assessment, bag production to assess aseptic filling for both manual or automatized method, practices audit, number of days of production, and non-conformity following. At Angers Hospital, in 2014, production staff is composed of 12 agents. Staff accreditation reveals that 2 agents achieve level 3, 8 agents achieve level 2 and 2 agents are level 1. We noted that non-conformity decreased as accreditation took place from 81 in 2009 to 0 in 2014. To date, there is no incident due to parenteral bag produced by Angers hospital for neonatal resuscitation children. Such a consistent study is essential to insure a secured nutrition parenteral production. This also provides a satisfying quality care for patients. Copyright © 2016 Académie Nationale de Pharmacie. Published by Elsevier Masson SAS. All rights reserved.

Effects of Payment Changes on Trends in Post-Acute Care

PubMed Central

Buntin, Melinda Beeuwkes; Colla, Carrie Hoverman; Escarce, José J

2009-01-01

Objective To test how the implementation of new Medicare post-acute payment systems affected the use of inpatient rehabilitation facilities (IRFs), skilled nursing facilities (SNFs), and home health agencies. Data Sources Medicare acute hospital, IRF, and SNF claims; provider of services file; enrollment file; and Area Resource File data. Study Design We used multinomial logit models to measure realized access to post-acute care and to predict how access to alternative sites of care changed in response to prospective payment systems. Data Extraction Methods A file was constructed linking data for elderly Medicare patients discharged from acute care facilities between 1996 and 2003 with a diagnosis of hip fracture, stroke, or lower extremity joint replacement. Principal Findings Although the effects of the payment systems on the use of post-acute care varied, most reduced the use of the site of care they directly affected and boosted the use of alternative sites of care. Payment system changes do not appear to have differentially affected the severely ill. Conclusions Payment system incentives play a significant role in determining where Medicare beneficiaries receive their post-acute care. Changing these incentives results in shifting of patients between post-acute sites. PMID:19490159

Effects of payment changes on trends in post-acute care.

PubMed

Buntin, Melinda Beeuwkes; Colla, Carrie Hoverman; Escarce, José J

2009-08-01

To test how the implementation of new Medicare post-acute payment systems affected the use of inpatient rehabilitation facilities (IRFs), skilled nursing facilities (SNFs), and home health agencies. Medicare acute hospital, IRF, and SNF claims; provider of services file; enrollment file; and Area Resource File data. We used multinomial logit models to measure realized access to post-acute care and to predict how access to alternative sites of care changed in response to prospective payment systems. A file was constructed linking data for elderly Medicare patients discharged from acute care facilities between 1996 and 2003 with a diagnosis of hip fracture, stroke, or lower extremity joint replacement. Although the effects of the payment systems on the use of post-acute care varied, most reduced the use of the site of care they directly affected and boosted the use of alternative sites of care. Payment system changes do not appear to have differentially affected the severely ill. Payment system incentives play a significant role in determining where Medicare beneficiaries receive their post-acute care. Changing these incentives results in shifting of patients between post-acute sites.

The impact of an acute care surgery team on general surgery residency.

PubMed

Hatch, Quinton; McVay, Derek; Johnson, Eric K; Maykel, Justin A; Champagne, Bradley J; Steele, Scott R

2014-11-01

Acute care surgical teams (ACSTs) have limited data in residency. We sought to determine the impact of an ACST on the depth and breadth of general surgery resident training. One year prior to and after implementation of an ACST, Accreditation Council for Graduate Medical Education case logs spanning multiple postgraduate year levels were compared for numbers, case types, and complexity. We identified 6,009 cases, including 2,783 after ACST implementation. ACSTs accounted for 752 cases (27%), with 39.2% performed laparoscopically. ACST cases included biliary (19.4%), skin/soft tissue (10%), hernia (9.8%), and appendix (6.5%). Second-year residents performed a lower percentage of laparoscopic cases after the creation of the ACST (20.4% vs 26.3%; P = .003), while chief residents performed a higher percentage (42.1 vs 37.4; P = .04). Case numbers and complexity following ACST development were unchanged within all year groups (P > .1). ACST in a residency program does not sacrifice resident case complexity, diversity, or volume. Published by Elsevier Inc.

Accreditation and Educational Quality: Are Students in Accredited Programs More Academically Engaged?

ERIC Educational Resources Information Center

Cole, James S.; Cole, Shu T.

2008-01-01

There has been a great deal of debate regarding the value of program accreditation. Two research questions guided this study: 1) are students enrolled in accredited parks, recreation, and leisure programs more academically engaged than students enrolled in non-accredited programs, and 2) do students enrolled in accredited parks, recreation, and…

Sense and nonsense in the process of accreditation of a pathology laboratory.

PubMed

Long-Mira, Elodie; Washetine, Kevin; Hofman, Paul

2016-01-01

The aim of accreditation of a pathology laboratory is to control and optimize, in a permanent manner, good professional practice in clinical and molecular pathology, as defined by internationally established standards. Accreditation of a pathology laboratory is a key element in fine in increasing recognition of the quality of the analyses performed by a laboratory and in improving the care it provides to patients. One of the accreditation standards applied to clinical chemistry and pathology laboratories in the European Union is the ISO 15189 norm. Continued functioning of a pathology laboratory might in time be determined by whether or not it has succeeded the accreditation process. Necessary requirements for accreditation, according to the ISO 15189 norm, include an operational quality management system and continuous control of the methods used for diagnostic purposes. Given these goals, one would expect that all pathologists would agree on the positive effects of accreditation. Yet, some of the requirements stipulated in the accreditation standards, coming from the bodies that accredit pathology laboratories, and certain normative issues are perceived as arduous and sometimes not adapted to or even useless in daily pathology practice. The aim of this review is to elaborate why it is necessary to obtain accreditation but also why certain requirements for accreditation might be experienced as inappropriate.

A Comparison of the Audit and Accreditation Tools Used By The Health Care Financing Administration, The Texas Department of Insurance, and The National Committee on Quality Assurance: The Cost of Multi-Agency Oversight on Medicare+Choice Plans in Texas

DTIC Science & Technology

2001-04-12

Comparison of Oversight Models in Managed Care 1 Running Head: Comparison of Oversight Models in Managed Care A Comparison of the Audit and...TITLE AND SUBTITLE A Comparison of the Audit and Accreditation Tools Used By The Health Care Financing Administration, The Texas Department of...Comparison of Oversight Models in Managed Care 5 A Comparison of the Audit and Accreditation Tools Used By The Health Care Financing

Accreditation Fact Sheet.

ERIC Educational Resources Information Center

National Association of Private, Nontraditional Schools and Colleges, Grand Junction, CO.

Questions and answers concerning accreditation of postsecondary institutions are presented, along with a list of personal/organizational sources and bibliographical sources of information. Information is provided on the following: accreditation and its origin, the Council on Postsecondary Accreditation, the U.S. Department of Education, the…

Implementing a resident acute care surgery service: Improving resident education and patient care.

PubMed

Kantor, Olga; Schneider, Andrew B; Rojnica, Marko; Benjamin, Andrew J; Schindler, Nancy; Posner, Mitchell C; Matthews, Jeffrey B; Roggin, Kevin K

2017-03-01

To simulate the duties and responsibilities of an attending surgeon and allow senior residents more intraoperative and perioperative autonomy, our program created a new resident acute care surgery consult service. We structured resident acute care surgery as a new admitting and inpatient consult service managed by chief and senior residents with attending supervision. When appropriate, the chief resident served as a teaching assistant in the operation. Outcomes were recorded prospectively and reviewed at weekly quality improvement conferences. The following information was collected: (1) teaching assistant case logs for senior residents preimplentation (n = 10) and postimplementation (n = 5) of the resident acute care surgery service; (2) data on the proportion of each case performed independently by residents; (3) resident evaluations of the resident acute care surgery versus other general operative services; (4) consult time for the first 12 months of the service (June 2014 to June 2015). During the first year after implementation, the number of total teaching assistant cases logged among graduating chief residents increased from a mean of 13.4 ± 13.0 (range 4-44) for preresident acute care surgery residents to 30.8 ± 8.8 (range 27-36) for postresident acute care surgery residents (P < .01). Of 323 operative cases, the residents performed an average of 82% of the case independently. There was a significant increase in the satisfaction with the variety of cases (mean 5.08 vs 4.52, P < .01 on a 6-point Likert scale) and complexity of cases (mean 5.35 vs 4.94, P < .01) on service evaluations of resident acute care surgery (n = 27) in comparison with other general operative services (n = 127). In addition, creation of a 1-team consult service resulted in a more streamlined consult process with average consult time of 22 minutes for operative consults and 25 minutes for nonoperative consults (range 5-90 minutes). The implementation of a

Antibiotic treatment of acute respiratory infections in acute care settings.

PubMed

Gonzales, Ralph; Camargo, Carlos A; MacKenzie, Thomas; Kersey, Ayanna S; Maselli, Judith; Levin, Sara K; McCulloch, Charles E; Metlay, Joshua P

2006-03-01

To examine the patterns of antibiotic use for acute respiratory tract infections (ARIs) in acute care settings. Chart reviews were performed retrospectively on a random sample of adult ARI visits to seven Veterans Affairs (VA) and seven non-VA emergency departments (EDs) for the period of November 2003 to February 2004. Visits were limited to those discharged to home and those with primary diagnoses of antibiotic-responsive (pneumonia, acute exacerbation of chronic bronchitis, pharyngitis, sinusitis) and antibiotic-nonresponsive conditions (acute bronchitis, nonspecific upper respiratory tract infection [URI]). Results are expressed as adjusted odds ratios with 95% confidence intervals. Of 2,270 ARI visits, 62% were for antibiotic-nonresponsive diagnoses. Seventy-two percent of acute bronchitis and 38% of URI visits were treated with antibiotics (p < 0.001). Stratified analyses show that antibiotic prescription rates were similar among attending-only and housestaff-associated visits for antibiotic-responsive diagnoses (p = 0.11), and acute bronchitis (76% vs. 59%; p = 0.31). However, the antibiotic prescription rate for URIs was greater for attending-only visits compared with housestaff-associated visits (48% vs. 15%; p = 0.01). Antibiotic prescription rates for total ARIs varied between sites, ranging from 42% to 89%. Patient age, gender, race and ethnicity, smoking status, comorbidities, and clinical setting (VA vs. non-VA) were not independently associated with antibiotic prescribing. Acute care settings are important targets for reducing inappropriate antibiotic prescribing. The mechanisms accounting for lower antibiotic prescription rates observed with housestaff-associated visits merit further study.

Components of laboratory accreditation.

PubMed

Royal, P D

1995-12-01

Accreditation or certification is a recognition given to an operation or product that has been evaluated against a standard; be it regulatory or voluntary. The purpose of accreditation is to provide the consumer with a level of confidence in the quality of operation (process) and the product of an organization. Environmental Protection Agency/OCM has proposed the development of an accreditation program under National Environmental Laboratory Accreditation Program for Good Laboratory Practice (GLP) laboratories as a supplement to the current program. This proposal was the result of the Inspector General Office reports that identified weaknesses in the current operation. Several accreditation programs can be evaluated and common components identified when proposing a structure for accrediting a GLP system. An understanding of these components is useful in building that structure. Internationally accepted accreditation programs provide a template for building a U.S. GLP accreditation program. This presentation will discuss the traditional structure of accreditation as presented in the Organization of Economic Cooperative Development/GLP program, ISO-9000 Accreditation and ISO/IEC Guide 25 Standard, and the Canadian Association for Environmental Analytical Laboratories, which has a biological component. Most accreditation programs are managed by a recognized third party, either privately or with government oversight. Common components often include a formal review of required credentials to evaluate organizational structure, a site visit to evaluate the facility, and a performance evaluation to assess technical competence. Laboratory performance is measured against written standards and scored. A formal report is then sent to the laboratory indicating accreditation status. Usually, there is a scheduled reevaluation built into the program. Fee structures vary considerably and will need to be examined closely when building a GLP program.

[A Delphi Method Survey of the Core Competences of Post-Acute-Care Nurses in Caring for Acute Stroke Patients].

PubMed

Chi, Shu-Ching; Yeh, Lily; Lu, Meei-Shiow; Lin, Pei-Yu

2015-12-01

Post-acute care (PAC) service is becoming increasingly important in Taiwan as a core focus of government policies that are designed to ensure continuity of care. In order to improve PAC nursing education and quality of care, the present study applies a modified Delphi method to identify the core competences of nurses who provide PAC services to acute stroke patients. We surveyed 18 experts in post-acute care and long-term care anonymously using a 29-question questionnaire in order to identify the essential professional skills that are required to perform PAC effectively. The results of this survey indicate that the core competences of PAC may be divided into two categories: Case Management and Care Management. Case Management includes Direct Care, Communication, Health Care Education, Nursing Consulting, and Family Assessment & Health Care. Care Management includes Interdisciplinary Teamwork, Patient Care Management, and Resource Integration. The importance and practicality of each item was evaluated using a 7-point Likert scale. The experts required 2 rounds to reach a consensus about the importance and 3 rounds to determine the practicality of PAC core competences. This process highlighted the differing points of view that are held by professionals in the realms of nursing, medicine, and national health policy. The PAC in-job training program in its current form inadequately cul-tivates core competence in Care Management. The results of the present study may be used to inform the development of PAC nurse orientation training programs and continuing education courses.

Accreditation and quality approach in operating theatre departments: the French approach.

PubMed

Soudée, M

2005-01-01

Since 1996, French health establishments are subjected to a process of evaluating the quality of care, called "accreditation". This process was controlled by ANAES, which, after January 1st, 2005 became the Haute Autorité de Santé (HAS). The accreditation is characterized by a dual process of self-assessment and external audit, leading to four levels of accreditation. In spite of requiring a time-consuming methodology, this approach provides an important means of consolidating the development of the quality approach and re-stimulating the compliance of establishments with standards of safety and vigilance. The professional teams of many French operating theatre departments have been able to use the regulatory and restricting framework of accreditation to organize quality approaches specific to the operative system, supported by the organizational structures of the department such as the operating suite committee, departmental boards and the steering group. Based on quality guidelines including a commitment from the manager and operating suite committee, as well as a quality flow chart and a quality system, these teams describe the main procedures for running the operating theatre. They also organize the follow-up of incidents and undesirable events, along with the risks and points to watch. Audits of the operative system are planned on a regular basis. The second version of the accreditation process considerably reinforces the assessment of professional practices by evaluating the relevance, the risks and the methods of managing care for pathologies. It will make it possible to implement assessments of the health care provided by operating theatre departments and will reinforce the importance of search for quality.

Pediatric thermal injury: acute care and reconstruction update.

PubMed

Armour, Alexis D; Billmire, David A

2009-07-01

The acute and reconstructive care of each pediatric burn patient presents unique challenges to the plastic surgeon and the burn care team. : The purpose of this review article is to highlight the interdependence between the acute and reconstructive needs of pediatric burn patients as it pertains to each anatomical site. Relevant principles of acute pediatric burn care and burn reconstruction are outlined, based on the authors' experience and review of the literature. The need for late reconstruction in pediatric burn survivors is significantly influenced by the acute surgical and rehabilitative treatments. With their vulnerability to airway swelling, hypothermia, pulmonary edema, and ischemia-reperfusion injury, pediatric patients with large burns require precise, life-saving treatment in the acute phase. Decision-making in pediatric burn reconstruction must take into account the patient's future growth, maturity, and often lack of suitable donor sites. Appropriately selected reconstructive techniques are essential to optimize function, appearance, and quality of life in pediatric burn survivors.

Post-acute care and vertical integration after the Patient Protection and Affordable Care Act.

PubMed

Shay, Patrick D; Mick, Stephen S

2013-01-01

The anticipated changes resulting from the passage of the Patient Protection and Affordable Care Act-including the proposed adoption of bundled payment systems and the promotion of accountable care organizations-have generated considerable controversy as U.S. healthcare industry observers debate whether such changes will motivate vertical integration activity. Using examples of accountable care organizations and bundled payment systems in the American post-acute healthcare sector, this article applies economic and sociological perspectives from organization theory to predict that as acute care organizations vary in the degree to which they experience environmental uncertainty, asset specificity, and network embeddedness, their motivation to integrate post-acute care services will also vary, resulting in a spectrum of integrative behavior.

Understanding the Role of Accredited Drug Dispensing Outlets in Tanzania's Health System.

PubMed

Embrey, Martha; Vialle-Valentin, Catherine; Dillip, Angel; Kihiyo, Bernard; Mbwasi, Romuald; Semali, Innocent A; Chalker, John C; Liana, Jafary; Lieber, Rachel; Johnson, Keith; Rutta, Edmund; Kimatta, Suleiman; Shekalaghe, Elizabeth; Valimba, Richard; Ross-Degnan, Dennis

2016-01-01

People in many low-income countries access medicines from retail drug shops. In Tanzania, a public-private partnership launched in 2003 used an accreditation approach to improve access to quality medicines and pharmaceutical services in underserved areas. The government scaled up the accredited drug dispensing outlet (ADDO) program nationally, with over 9,000 shops now accredited. This study assessed the relationships between community members and their sources of health care and medicines, particularly antimicrobials, with a specific focus on the role ADDOs play in the health care system. Using mixed methods, we collected data in four regions. We surveyed 1,185 households and audited 96 ADDOs and 84 public/nongovernmental health facilities using a list of 17 tracer drugs. To determine practices in health facilities, we interviewed 1,365 exiting patients. To assess dispensing practices, mystery shoppers visited 306 ADDOs presenting one of three scenarios (102 each) about a child's respiratory symptoms. Of 614 household members with a recent acute illness, 73% sought outside care-30% at a public facility and 31% at an ADDO. However, people bought medicines more often at ADDOs no matter who recommended the treatment; of the 581 medicines that people had received, 49% came from an ADDO. Although health facilities and ADDOs had similar availability of antimicrobials, ADDOs had more pediatric formulations available (p<0.001). The common perception was that drugs from ADDOs are more expensive, but the difference in the median cost to treat pneumonia was relatively minimal (US$0.26 in a public facility and US$0.30 in an ADDO). Over 20% of households said they had someone with a chronic condition, with 93% taking medication, but ADDOs are allowed to sell very few chronic care-related medicines. ADDO dispensers are trained to refer complicated cases to a health facility, and notably, 99% of mystery shoppers presenting a pneumonia scenario received an antimicrobial (54%), a

A Threat to Accreditation: Defamation Judgment against an Accreditation Team Member.

ERIC Educational Resources Information Center

Flygare, Thomas J.

1980-01-01

Delaware Law School founder Alfred Avins successfully sued accreditation team member James White for defamation as a result of comments made in 1974 and 1975. An appeals brief claims Avins was a "public figure," that he consented to accreditation, and that the accreditation process deserves court protection against such suits. (PGD)

Key stakeholder perceptions regarding acute care psychiatry in distressed publicly funded mental health care markets.

PubMed

Frueh, B Christopher; Grubaugh, Anouk L; Lo Sasso, Anthony T; Jones, Walter J; Oldham, John M; Lindrooth, Richard C

2012-01-01

The role of acute care inpatient psychiatry, public and private, has changed dramatically since the 1960s, especially as recent market forces affecting the private sector have had ripple effects on publicly funded mental health care. Key stakeholders' experiences, perceptions, and opinions regarding the role of acute care psychiatry in distressed markets of publicly funded mental health care were examined. A qualitative research study was conducted using semi-structured thematic interviews with 52 senior mental health system administrators, clinical directors and managers, and nonclinical policy specialists. Participants were selected from markets in six regions of the United States that experienced recent significant closures of acute care psychiatric beds. Qualitative data analyses yielded findings that clustered around three sets of higher order themes: structure of care, service delivery barriers, and outcomes. Structure of care suggests that acute care psychiatry is seen as part of a continuum of services; service delivery barriers inhibit effective delivery of services and are perceived to include economic, regulatory, and political factors; outcomes include fragmentation of mental health care services across the continuum, the shift of mental health care to the criminal justice system, and market-specific issues affecting mental health care. Findings delineate key stakeholders' perceptions regarding the role acute care psychiatry plays in the continuum of care for publicly funded mental health and suggest that public mental health care is inefficacious. Results carry implications for policy makers regarding strategies/policies to improve optimal utilization of scarce resources for mental health care, including greater focus on psychotherapy.

Key stakeholder perceptions regarding acute care psychiatry in distressed publicly funded mental health care markets

PubMed Central

Frueh, B. Christopher; Grubaugh, Anouk L.; Lo Sasso, Anthony T.; Jones, Walter J.; Oldham, John M.; Lindrooth, Richard C.

2017-01-01

The role of acute care inpatient psychiatry, public and private, has changed dramatically since the 1960s, especially as recent market forces affecting the private sector have had ripple effects on publicly funded mental health care. Key stakeholders’ experiences, perceptions, and opinions regarding the role of acute care psychiatry in distressed markets of publicly funded mental health care were examined. A qualitative research study was conducted using semi-structured thematic interviews with 52 senior mental health system administrators, clinical directors and managers, and nonclinical policy specialists. Participants were selected from markets in six regions of the United States that experienced recent significant closures of acute care psychiatric beds. Qualitative data analyses yielded findings that clustered around three sets of higher order themes: structure of care, service delivery barriers, and outcomes. Structure of care suggests that acute care psychiatry is seen as part of a continuum of services; service delivery barriers inhibit effective delivery of services and are perceived to include economic, regulatory, and political factors; outcomes include fragmentation of mental health care services across the continuum, the shift of mental health care to the criminal justice system, and market-specific issues affecting mental health care. Findings delineate key stakeholders’ perceptions regarding the role acute care psychiatry plays in the continuum of care for publicly funded mental health and suggest that public mental health care is inefficacious. Results carry implications for policy makers regarding strategies/policies to improve optimal utilization of scarce resources for mental health care, including greater focus on psychotherapy. PMID:22409204

Acute care surgery: impact on practice and economics of elective surgeons.

PubMed

Miller, Preston R; Wildman, Elizabeth A; Chang, Michael C; Meredith, J Wayne

2012-04-01

The creation of an acute care surgery service provides a rich operative experience for acute care surgeons. Elective surgeons typically have concerns about whether their practice volume will be restored with elective cases. Acute care surgery has financial implications for both groups. The aim of this project is to examine the impact in terms of work relative value units (wRVUs), collections, and cases in both groups with creation of an acute care surgery service at our institution. Work RVUs, collections, and case volume were examined from departmental records for 2 groups before and after acute care surgery service creation. The service began on September 1, 2008. Before this time, emergency surgical consults went to the general surgeon on call. After this date, all emergency consults were seen by acute care surgeons. The number of operations performed by the acute care surgery group increased significantly when the mean of the 2 years after institution of acute care surgery were compared with the mean of the 2 years preceding the service creation (1,639 vs 790/year; p = 0.007). There was no change in total operations done by the elective surgery group (2,763 vs 2,496/year: p = 0.13). Elective caseload, however, did increase by 23% in the elective surgery group. In the acute care surgery group, wRVUs increased by 140% and elective surgery group wRVUs decreased by 8%. Collections increased in both groups (acute care surgery 129%, elective surgery 7%) and the combined collections of the groups increased by $2,138,00 in the year after service creation. Acute care surgery service creation took emergency business from the elective surgery group, but this was almost immediately replaced with elective cases. This resulted in higher collections for both groups and a resultant significant increase in collections in aggregate. Copyright © 2012 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

ACEHSA accreditation safeguards the public interest.

PubMed

Sundre, Steven M

2004-01-01

Daily, we are reminded that the public's investment in attaining quality health and medical care is among the most important priorities of our nation's citizens. Central to realizing that attainment is the level of professional competence of those charged with managing the nation's health resources. The not-for-profit Accrediting Commission on Education for Health Services Administration is the sole national organization governing the standards by which future health managers, administrators, and executives are educated and trained in accredited graduate programs. The impact of the ACEHSA is growing as health and medical leaders, government and regulatory policy-makers, insurance executives, special interest groups, and, of course, members of the public increasingly realize that top-flight healthcare delivery requires excellence in the management of health resources.

Health service accreditation: report of a pilot programme for community hospitals.

PubMed Central

Shaw, C. D.; Collins, C. D.

1995-01-01

Voluntary accreditation in the United Kingdom is being used by health care providers to improve and market their services and by commissioners to define and monitor service contracts. In a three year pilot scheme in the south west of England, 43 out of 57 eligible community hospitals volunteered to be surveyed; 37 of them were ultimately accredited for up to two years by the hospital accreditation programme. The main causes for non-accreditation related to safety, clinical records, and medical organisation. Follow up visits in 10 hospitals showed that, overall, 69% of recommendations were implemented. An independent survey of participating hospitals showed the perceived benefits to include team building, review of operational policies, improvement of data systems, and the generation of local prestige. Purchasers are increasingly influenced by accreditation status but are mostly unwilling to finance the process directly. None the less, the concept may become an important factor moderating the quality of service in the new NHS. PMID:7711585

Competencies for public health and interprofessional education in accreditation standards of complementary and alternative medicine disciplines.

PubMed

Brett, Jennifer; Brimhall, Joseph; Healey, Dale; Pfeifer, Joseph; Prenguber, Marcia

2013-01-01

This review examines the educational accreditation standards of four licensed complementary and alternative medicine (CAM) disciplines (naturopathic medicine, chiropractic health care, acupuncture and oriental medicine, and massage therapy), and identifies public health and other competencies found in those standards that contribute to cooperation and collaboration among the health care professions. These competencies may form a foundation for interprofessional education. The agencies that accredit the educational programs for each of these disciplines are individually recognized by the United States Department (Secretary) of Education. Patients and the public are served when healthcare practitioners collaborate and cooperate. This is facilitated when those practitioners possess competencies that provide them the knowledge and skills to work with practitioners from other fields and disciplines. Educational accreditation standards provide a framework for the delivery of these competencies. Requiring these competencies through accreditation standards ensures that practitioners are trained to optimally function in integrative clinical care settings. © 2013 Elsevier Inc. All rights reserved.

Research performance of AACSB accredited institutions in Taiwan: before versus after accreditation.

PubMed

Ke, Shih-Wen; Lin, Wei-Chao; Tsai, Chih-Fong

2016-01-01

More and more universities are receiving accreditation from the Association to Advance Collegiate Schools of Business (AACSB), which is an international association for promoting quality teaching and learning at business schools. To be accredited, the schools are required to meet a number of standards ensuring that certain levels of teaching quality and students' learning are met. However, there are a variety of points of view espoused in the literature regarding the relationship between research and teaching, some studies have demonstrated that research and teaching these are complementary elements of learning, but others disagree with these findings. Unlike past such studies, we focus on analyzing the research performance of accredited schools during the period prior to and after receiving accreditation. The objective is to answer the question as to whether performance has been improved by comparing the same school's performance before and after accreditation. In this study, four AACSB accredited universities in Taiwan are analyzed, including one teaching oriented and three research oriented universities. Research performance is evaluated by comparing seven citation statistics, the number of papers published, number of citations, average number of citations per paper, average citations per year, h-index (annual), h-index, and g-index. The analysis results show that business schools demonstrated enhanced research performance after AACSB accreditation, but in most accredited schools the proportion of faculty members not actively doing research is larger than active ones. This study shows that the AACSB accreditation has a positive impact on research performance. The findings can be used as a reference for current non-accredited schools whose research goals are to improve their research productivity and quality.

Accreditation's Legal Landscape

ERIC Educational Resources Information Center

Graca, Thomas J.

2009-01-01

Like most issues in higher education, the accreditation paradigm in the United States is defined in large measure by the legal and political climate in which the academy finds itself. In the case of accreditation in particular, the legal substrate is of particular importance given the central role of accreditation in a college's ability to receive…

The Accreditation Canada Program: A Complementary Tool to Promote Accountability in Canadian Healthcare

PubMed Central

Mitchell, Jonathan I.; Nicklin, Wendy; Macdonald, Bernadette

2014-01-01

Across Canada and internationally, the public and governments at all levels have increasing expectations for quality of care, value for healthcare dollars and accountability. Within this reality, there is increasing recognition of the value of accreditation as a barometer of quality and as a tool to assess and improve accountability and efficiency in healthcare delivery. In this commentary, we show how three key attributes of the Accreditation Canada Qmentum accreditation program – measurement, scalability and currency – promote accountability in healthcare. PMID:25305398

Hospital-based, acute care after ambulatory surgery center discharge.

PubMed

Fox, Justin P; Vashi, Anita A; Ross, Joseph S; Gross, Cary P

2014-05-01

As a measure of quality, ambulatory surgery centers have begun reporting rates of hospital transfer at discharge. This process, however, may underestimate the acute care needs of patients after care. We conducted this study to determine rates and evaluate variation in hospital transfer and hospital-based, acute care within 7 days among patients discharged from ambulatory surgery centers. Using data from the Healthcare Cost and Utilization Project, we identified adult patients who underwent a medical or operative procedure between July 2008 and September 2009 at ambulatory surgery centers in California, Florida, and Nebraska. The primary outcomes were hospital transfer at the time of discharge and hospital-based, acute care (emergency department visits or hospital admissions) within 7-days expressed as the rate per 1,000 discharges. At the ambulatory surgery center level, rates were adjusted for age, sex, and procedure-mix. We studied 3,821,670 patients treated at 1,295 ambulatory surgery centers. At discharge, the hospital transfer rate was 1.1 per 1,000 discharges (95% confidence interval 1.1-1.1). Among patients discharged home, the hospital-based, acute care rate was 31.8 per 1,000 discharges (95% confidence interval 31.6-32.0). Across ambulatory surgery centers, there was little variation in adjusted hospital transfer rates (median = 1.0/1,000 discharges [25th-75th percentile = 1.0-2.0]), whereas substantial variation existed in adjusted, hospital-based, acute care rates (28.0/1,000 [21.0-39.0]). Among adult patients undergoing ambulatory care at surgery centers, hospital transfer at time of discharge from the ambulatory care center is a rare event. In contrast, the rate of need for hospital-based, acute care in the first week afterwards is nearly 30-fold greater, varies across centers, and may be a more meaningful measure for discriminating quality. Published by Mosby, Inc.

Acute Complex Care Model: An organizational approach for the medical care of hospitalized acute complex patients.

PubMed

Pietrantonio, Filomena; Orlandini, Francesco; Moriconi, Luca; La Regina, Micaela

2015-12-01

Chronic diseases are the major cause of death (59%) and disability worldwide, representing 46% of global disease burden. According to the Future Hospital Commission of the Royal College of Physicians, Medical Division (MD) will be responsible for all hospital medical services, from emergency to specialist wards. The Hospital Acute Care Hub will bring together the clinical areas of the MD that focus on the management of acute medical patients. The Chronic Care Model (CCM) places the patient at the center of the care system enhancing the community's social and health support, pathways and structures to keep chronic, frail, poly-pathological people at home or out of the hospital. The management of such patients in the hospital still needs to be solved. Hereby, we propose an innovative model for the management of the hospital's acute complex patients, which is the hospital counterpart of the CCM. The target population are acutely ill complex and poly-pathological patients (AICPPs), admitted to hospital and requiring high technology resources. The mission is to improve the management of medical admissions through pre-defined intra-hospital tracks and a global, multidisciplinary, patient-centered approach. The ACCM leader is an internal medicine specialist (IMS) who summarizes health problems, establishes priorities, and restores health balance in AICPPs. The epidemiological transition leading to a progressive increase in "chronically unstable" and complex patients needing frequent hospital treatment, inevitably enhances the role of hospital IMS in the coordination and delivery of care. ACCM represents a practical response to this epochal change of roles. Copyright © 2015 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

Return to the Primary Acute Care Service Among Patients With Multiple Myeloma on an Acute Inpatient Rehabilitation Unit.

PubMed

Fu, Jack B; Lee, Jay; Shin, Ben C; Silver, Julie K; Smith, Dennis W; Shah, Jatin J; Bruera, Eduardo

2017-06-01

Pancytopenia, immunosuppression, and other factors may place patients with multiple myeloma at risk for medical complications. These patients often require inpatient rehabilitation. No previous studies have looked at risk factors for return to the primary acute care service of this patient population. To determine the percentage of and factors associated with return to the primary acute care service of multiple myeloma rehabilitation inpatients. Retrospective review. Acute inpatient rehabilitation unit within a National Cancer Institute Comprehensive Cancer Center. All patients with multiple myeloma admitted to the inpatient rehabilitation unit between March 1, 2004, and February 28, 2015. Return to the primary acute care service was analyzed with demographic information, multiple myeloma characteristics, medications, laboratory values, and hospital admission characteristics. One hundred forty-three inpatient rehabilitation admissions were found during the study period. After we removed multiple admissions of the same patients and planned transfers to the primary acute care service, 122 admissions were analyzed. Thirty-two (26%) patients transferred back to the primary acute care service for unplanned reasons. Multivariate analysis revealed male gender and thrombocytopenia as significantly associated with return to the primary acute care service. The median survival of patients who transferred back to the inpatient primary acute care service was 180 days versus 550 days for those who did not (P < .001). Because of their medical fragility, clinicians caring for rehabilitation inpatients with multiple myeloma should maintain close contact with the primary oncology service. Factors associated with an increased risk of transfer back to the primary acute care service include male gender and thrombocytopenia. IV. Copyright © 2017 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

NAEYC Accreditation: The First Decade of NAEYC Accreditation: Growth and Impact on the Field.

ERIC Educational Resources Information Center

Bredekamp, Sue; Glowacki, Stephanie

1996-01-01

Describes development of NAEYC accreditation and offers a description of the process. Highlights the effects of accreditation and discusses its future. Notes that accreditation provides opportunities and motivation for valuable professional development, and that quality control is the greatest challenge faced by accreditation efforts. Notes…

78 FR 77470 - Health Insurance Exchanges; Approval of an Application by the Accreditation Association for...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-12-23

... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services [CMS-9953-FN] Health Insurance Exchanges; Approval of an Application by the Accreditation Association for Ambulatory...\\ Health Insurance Exchanges; Application by the Accreditation Association for Ambulatory Health Care To Be...

The Influence of Accreditation on the Sustainability of Organizations with the Brazilian Accreditation Methodology

PubMed Central

de Paiva, Anderson Paulo

2018-01-01

This research evaluates the influence of the Brazilian accreditation methodology on the sustainability of the organizations. Critical factors for implementing accreditation were also examined, including measuring the relationships established between these factors in the organization sustainability. The present study was developed based on the survey methodology applied in the organizations accredited by ONA (National Accreditation Organization); 288 responses were received from the top level managers. The analysis of quantitative data of the measurement models was made with factorial analysis from principal components. The final model was evaluated from the confirmatory factorial analysis and structural equation modeling techniques. The results from the research are vital for the definition of factors that interfere in the accreditation processes, providing a better understanding for accredited organizations and for Brazilian accreditation. PMID:29599939

Acute care nurses' perceptions of spirituality and spiritual care: an exploratory study in Singapore.

PubMed

Chew, Brendan Wk; Tiew, Lay Hwa; Creedy, Debra K

2016-09-01

To investigate acute care nurses' perceptions of spirituality and spiritual care and relationships with nurses' personal and professional characteristics. Spirituality and spiritual care are often neglected or absent in daily nursing practice. Nurses' perceptions of spirituality can be influenced by personal, professional and social factors and affect the provision of spiritual care. A cross-sectional, exploratory, nonexperimental design was used. All nursing staff (n = 1008) from a large acute care hospital in Singapore were invited to participate. Participants completed a demographic form and the Spiritual Care-Giving Scale. Completed surveys were received from 767 staff yielding a response rate of 76%. Descriptive statistics and General Linear Modelling were used to analyse data. Acute care nurses reported positive perceptions of spirituality and spiritual care. Religion, area of clinical practice and view of self as spiritual were associated with nurses' reported perspectives of spirituality and spiritual care. Nurses working in this acute care hospital in Singapore reported positive perceptions of spirituality and spiritual care. Respondents tended to equate religion with spirituality and were often unclear about what constituted spiritual care. They reported a sense of readiness to apply an interprofessional approach to spiritual care. However, positive perceptions of spirituality may not necessarily translate into practice. Spiritual care can improve health outcomes. Nurses' understanding of spirituality is essential for best practice. Interprofessional collaboration with clinicians, administrators, educators, chaplains, clergy and spiritual leaders can contribute to the development of practice guidelines and foster spiritual care by nurses. Further research is needed on the practical applications of spiritual care in nursing. © 2016 John Wiley & Sons Ltd.

Engineering Accreditation in China: The Progress and Development of China's Engineering Accreditation

ERIC Educational Resources Information Center

Jiaju, Bi

2009-01-01

Among engineering degree programs at the bachelor's level in China, civil engineering was the first one accredited in accordance with a professional programmatic accreditation system comparable to that of international practice. Launched in 1994, the accreditation of civil engineering aimed high and toward international standards and featured the…

Why Become Pharmacy Compounding Accreditation Board Accredited?

PubMed

Dillon, L Rad

2016-01-01

The Pharmacy Compounding Accreditation Board's goal is to assist pharmacies to obtain formal recognition of their status as a high-quality and fully compliant provider of pharmaceuticals and patient services. This article provides a brief outline of the application process, the survey preparation, points of information about the actual survey, and suggestions on how to remain in compliance with Pharmacy Compounding Accreditation Board's standards. Copyright© by International Journal of Pharmaceutical Compounding, Inc.

Is gerontology ready for accreditation?

PubMed

Haley, William E; Ferraro, Kenneth F; Montgomery, Rhonda J V

2012-01-01

The authors review widely accepted criteria for program accreditation and compare gerontology with well-established accredited fields including clinical psychology and social work. At present gerontology lacks many necessary elements for credible professional accreditation, including defined scope of practice, applied curriculum, faculty with applied professional credentials, and resources necessary to support professional credentialing review. Accreditation with weak requirements will be dismissed as "vanity" accreditation, and strict requirements will be impossible for many resource-poor programs to achieve, putting unaccredited programs at increased risk for elimination. Accreditation may be appropriate in the future, but it should be limited to professional or applied gerontology, perhaps for programs conferring bachelor's or master's degrees. Options other than accreditation to enhance professional skills and employability of gerontology graduates are discussed.

Accreditation of specialized asthma units for adults in Spain: an applicable experience for the management of difficult-to-control asthma

PubMed Central

Cisneros, Carolina; Díaz-Campos, Rocío Magdalena; Marina, Núria; Melero, Carlos; Padilla, Alicia; Pascual, Silvia; Pinedo, Celia; Trisán, Andrea

2017-01-01

This paper, developed by consensus of staff physicians of accredited asthma units for the management of severe asthma, presents information on the process and requirements for already-existing asthma units to achieve official accreditation by the Spanish Society of Pneumology and Thoracic Surgery (SEPAR). Three levels of specialized asthma care have been established based on available resources, which include specialized units for highly complex asthma, specialized asthma units, and basic asthma units. Regardless of the level of accreditation obtained, the distinction of “excellence” could be granted when more requirements in the areas of provision of care, technical and human resources, training in asthma, and teaching and research activities were met at each level. The Spanish experience in the process of accreditation of specialized asthma units, particularly for the care of patients with difficult-to-control asthma, may be applicable to other health care settings. PMID:28533690

The impact of national accreditation reform on survey reliability: a 2-year investigation of survey coordinators' perspectives.

PubMed

Greenfield, David; Hogden, Anne; Hinchcliff, Reece; Mumford, Virginia; Pawsey, Marjorie; Debono, Deborah; Westbrook, Johanna I; Braithwaite, Jeffrey

2016-10-01

Accrediting health care organizations against standards is a recognized safety and quality intervention. The credibility of an accreditation programme relies on surveying reliability. We investigated accreditation survey coordinators' perceptions of reliability issues and their continued relevancy, during a period of national accreditation reform. In 2013 and 2014, questionnaire surveys were developed using survey coordinators' feedback of their experiences and concerns regarding the accreditation process. Each year, a purpose-designed questionnaire survey was administered during the accrediting agency survey coordinator training days. Participants reported that survey reliability was informed by five categories of issues: the management of the accreditation process, including standards and health care organizational issues; surveyor workforce management; survey coordinator role; survey team; and individual surveyors. A new accreditation system and programme did not alter the factors reported to shape survey reliability. However, across the reform period, there was a noted change within each category of the specific issues that were of concern. Furthermore, consensus between coordinators that existed in 2013 appears to have diminished in 2014. Across all categories, in 2014 there was greater diversity of opinion than in 2013. The known challenges to the reliability of an accreditation programme retained their potency and relevancy during a period of reform. The diversity of opinion identified across the coordinator workforce could potentially place the credibility and reliability of the new scheme at risk. The study highlights that reliability of an accreditation scheme is an ongoing achievement, not a one-off attainment. © 2016 John Wiley & Sons, Ltd.

NCI Updates Tobacco Policies Following Re-accreditation | Poster

Cancer.gov

This year, NCI was re-accredited as one of nearly 200 CEO Cancer Gold Standard employers across the United States. According to its website, “the CEO Cancer Gold Standard provides a framework for employers to have a healthier workplace by focusing on cancer risk reduction, early detection, and access to clinical trials and high-quality care.” As part of this re-accreditation, NCI has updated its Tobacco-Free Policy. Part of this policy includes posting signs around campus reminding visitors and staff that NCI’s campus is tobacco-free. Therefore, the use of all tobacco products is prohibited. This includes cigarettes, cigars, pipes, e-cigarettes, and smokeless tobacco.

Implementation of the integrated palliative care outcome scale in acute care settings - a feasibility study.

PubMed

Lind, Susanne; Sandberg, J; Brytting, T; Fürst, C J; Wallin, L

2018-01-21

Although hospitals have been described as inadequate place for end-of-life care, many deaths still occur in hospital settings. Although patient-reported outcome measures have shown positive effects for patients in need of palliative care, little is known about how to implement them. We aimed to explore the feasibility of a pilot version of an implementation strategy for the Integrated Palliative care Outcome Scale (IPOS) in acute care settings. A strategy, including information, training, and facilitation to support the use of IPOS, was developed and carried out at three acute care units. For an even broader understanding of the strategy, it was also tested at a palliative care unit. A process evaluation was conducted including collecting quantitative data and performing interviews with healthcare professionals. Result Factors related to the design and performance of the strategy and the context contributed to the results. The prevalence of completed IPOS in the patient's records varied from 6% to 44% in the acute care settings. At the palliative care unit, the prevalence in the inpatient unit was 53% and the specialized home care team 35%. The qualitative results showed opposing perspectives concerning the training provided: Related to everyday work at the acute care units and Nothing in it for us at the palliative care unit. In the acute care settings, A need for an improved culture regarding palliative care was identified. A context characterized by A constantly increasing workload, a feeling of Constantly on-going changes, and a feeling of Change fatigue were found at all units. Furthermore, the internal facilitators and the nurse managers' involvement in the implementation differed between the units. Significance of the results The feasibility of the strategy in our study is considered to be questionable and the components need to be further explored to enhance the impact of the strategy and thereby improve the use of IPOS.

Utilization of Post-Acute Care following Distal Radius Fracture among Medicare Beneficiaries

PubMed Central

Zhong, Lin; Mahmoudi, Elham; Giladi, Aviram M.; Shauver, Melissa; Chung, Kevin C.; Waljee, Jennifer F.

2016-01-01

Purpose To examine the utilization and cost of post-acute care following isolated distal radius fractures (DRF) among Medicare beneficiaries. Methods We examined utilization of post-acute care among Medicare beneficiaries who experienced an isolated DRF (n=38,479) during 2007 using 100% Medicare claims data. We analyzed the effect of patient factors on hospital admission following DRF and the receipt of post-acute care delivered by skilled nursing facilities (SNFs), inpatient rehabilitation facilities (IRFs), home healthcare agencies (HHAs), and outpatient OT/PT for the recovery of DRF. Results In this cohort of isolated DRF patients, 1,694 (4.4%) were admitted to hospitals following DRF, and 20% received post-acute care. Women and patients with more comorbid conditions were more likely to require hospital admission. The utilization of post-acute care was higher among women, patients who resided in urban areas, and patients of higher socioeconomic status. The average cost per patient of post-acute care services from IRFs and SNFs ($15,888/patient) was significantly higher than the average cost other aspects of DRF care and accounted for 69% of the total DRF-related expenditure among patients who received inpatient rehabilitation. Conclusions Sociodemographic factors, including sex, socioeconomic status, and age, were significantly correlated with the use of post-acute care following isolated DRFs, and post-acute care accounted for a substantial proportion of the total expenditures related to these common injuries among the elderly. Identifying patients who will derive the greatest benefit from post-acute care can inform strategies to improve the cost-efficiency of rehabilitation and optimize scarce healthcare resources. Level of evidence Therapeutic, III PMID:26527599

The Future of Accreditation

ERIC Educational Resources Information Center

Eaton, Judith S.

2012-01-01

Accreditation, the primary means of assuring and improving academic quality in U.S. higher education, has endured for more than 100 years. While accommodating many changes in higher education and society, accreditation's fundamental values and practices have remained essentially intact, affirming their sturdiness. Accreditation is a form of…

CDC/NACCHO Accreditation Support Initiative: advancing readiness for local and tribal health department accreditation.

PubMed

Monteiro, Erinn; Fisher, Jessica Solomon; Daub, Teresa; Zamperetti, Michelle Chuk

2014-01-01

Health departments have various unique needs that must be addressed in preparing for national accreditation. These needs require time and resources, shortages that many health departments face. The Accreditation Support Initiative's goal was to test the assumption that even small amounts of dedicated funding can help health departments make important progress in their readiness to apply for and achieve accreditation. Participating sites' scopes of work were unique to the needs of each site and based on the proposed activities outlined in their applications. Deliverables and various sources of data were collected from sites throughout the project period (December 2011-May 2012). Awardees included 1 tribal and 12 local health departments, as well as 5 organizations supporting the readiness of local and tribal health departments. Sites dedicated their funding toward staff time, accreditation fees, completion of documentation, and other accreditation readiness needs and produced a number of deliverables and example documents. All sites indicated that they made accreditation readiness gains that would not have occurred without this funding. Preliminary evaluation data from the first year of the Accreditation Support Initiative indicate that flexible funding arrangements may be an effective way to increase health departments' accreditation readiness.

Rural Implications of Medicare's Post-Acute-Care Transfer Payment Policy

ERIC Educational Resources Information Center

Schoenman, Julie A.; Mueller, Curt D.

2005-01-01

Under the Medicare post-acute-care (PAC) transfer policy, acute-care hospitals are reimbursed under a per-diem formula whenever beneficiaries are discharged from selected diagnosis-related groups (DRGs) to a skilled nursing facility, home health care, or a prospective payment system (PPS)-excluded facility. Total per-diem payments are below the…

Colocating an accredited practising dietitian to an adult community mental health service: An exploratory study.

PubMed

Furness, Trentham; Wallace, Elizabeth; McElhinney, Jo; McKenna, Brian; Cuzzillo, Celeste; Foster, Kim

2018-04-27

For people with severe mental illness, accredited practising dietitians may assist with a nutrition care plan that considers the medical, psychiatric, psychological, social, spiritual, and pharmacological aspects of their care. However, consumers' access to care has been limited by difficulties attending appointments and suboptimal interface between nutritional and mental health services. Therefore, the objectives of this exploratory study were to describe access to, and key stakeholder perspectives of, the accredited practising dietitian role colocated in a community mental health service. A total of 16 key stakeholders participated in one-to-one interviews. Two main themes with subthemes were derived from analysis of interviews: (i) 'building empowerment and collaboration' and included the subthemes, (a) nutrition awareness and education and (b) healthy lifestyle changes, and (ii) 'overcoming challenges to optimal nutrition and effective health care'. In addition, improved access to the role was demonstrated with 124 (79%) consumers attending at least one appointment with an accredited practising dietitian. A total of 15 (12%) consumers attended more than 10 appointments during their outpatient admission to the community mental health service. Colocating an accredited practising dietitian was perceived to build empowerment and collaboration, and overcome challenges to optimal nutrition and effective health care for consumers, carers, and clinicians. The colocation of a dietitian can empower consumers' to make health-informed decisions and support their willingness to engage with physical healthcare provision when it is prioritized alongside mental healthcare provision. © 2018 Australian College of Mental Health Nurses Inc.

[Implementation of a palliative care concept in a geriatric acute care hospital].

PubMed

Hagg-Grün, U; Lukas, A; Sommer, B-N; Klaiber, H-R; Nikolaus, T

2010-12-01

To integrate palliative care patients into an acute geriatric ward requires extensive and continuous education and preparation of all participating professionals. It can be a lengthy process to integrate palliative care concepts despite cooperation of the hospital administration. The group of patients to be integrated differs from the patients of regular geriatric wards because of a higher percentage of relatively young oncologic patients and they differ from a regular palliative ward because about 50% are non-oncologic patients, while the average age is much higher than in normal palliative care. It is possible to integrate specialized palliative care into a regular geriatric ward. Patients admitted without palliative intention will benefit the most from ward-integrated palliative care if the treatment aim turns this way. Ward-integrated palliative care can be an integral part of treating geriatric patients in addition to acute geriatric medicine, rehabilitation, and prevention. It can also provide caretakers and patients with the benefits from continuity of treatment and care.

Acute care nurse practitioners in trauma care: results of a role survey and implications for the future of health care delivery.

PubMed

Noffsinger, Dana L

2014-01-01

The role of acute care nurse practitioners (ACNPs) in trauma care has evolved over time. A survey was performed with the aim of describing the role across the United States. There were 68 respondents who depicted the typical trauma ACNP as being a 42-year-old woman who works full-time at a level I American College of Surgeons verified trauma center. Trauma ACNPs typically practice with 80% of their time for clinical care and are based on a trauma and acute care surgery service. They are acute care certified and hold several advanced certifications to supplement their nursing license.

Accredited Birth Centers

MedlinePlus

... 83702 208-343-2079 Accredited Since June 2013 Tree of Life Birth & Gynecology Deland In-Process 125 ... 32720 386-279-0145 In-Process of Accreditation Tree of Life Birth & Gynecology Orlando In-Process 1010 ...

Improving performance management for delivering appropriate care for patients no longer needing acute hospital care.

PubMed

Penney, Christine; Henry, Effie

2008-01-01

The public, providers and policy-makers are interested in a service continuum where care is provided in the appropriate place. Alternate level of care is used to define patients who no longer need acute care but remain in an acute care bed. Our aims were to determine how subacute care and convalescent care should be defined in British Columbia (BC); how these care levels should be aligned with existing legislation to provide more consistent service standards to patients and what reporting requirements were needed for system planning and performance management. A literature review was conducted to understand the international trends in performance management, care delivery models and change management. A Canada-wide survey was carried out to determine the directions of other provinces on the defined issues and a BC survey provided a current state analysis of programming within the five regional health authorities (HAs). A provincial policy framework for subacute and convalescent care has been developed to begin to address the concerns raised and provide a base for performance measurement. The policy has been approved and disseminated to BC HAs for implementation. An implementation plan has been developed and implementation activities have been integrated into the work of existing provincial committees. Evaluation will occur through performance measurement. The benefits anticipated include: clear policy guidance for programme development; improved comparability of performance information for system monitoring, planning and integrity of the national acute care Discharge Abstracting Database; improved efficiency in acute care bed use; and improved equity of access, insurability and quality for patients requiring subacute and convalescent care. While a national reporting system exists for acute care in Canada, this project raises questions about the implications for this system, given the shifting definition of acute care as other care levels emerge. Questions are also

Provider-to-Provider Communication during Transitions of Care from Outpatient to Acute Care: A Systematic Review.

PubMed

Luu, Ngoc-Phuong; Pitts, Samantha; Petty, Brent; Sawyer, Melinda D; Dennison-Himmelfarb, Cheryl; Boonyasai, Romsai Tony; Maruthur, Nisa M

2016-04-01

Most research on transitions of care has focused on the transition from acute to outpatient care. Little is known about the transition from outpatient to acute care. We conducted a systematic review of the literature on the transition from outpatient to acute care, focusing on provider-to-provider communication and its impact on quality of care. We searched the MEDLINE, CINAHL, Scopus, EMBASE, and Cochrane databases for English-language articles describing direct communication between outpatient providers and acute care providers around patients presenting to the emergency department or admitted to the hospital. We conducted double, independent review of titles, abstracts, and full text articles. Conflicts were resolved by consensus. Included articles were abstracted using standardized forms. We maintained search results via Refworks (ProQuest, Bethesda, MD). Risk of bias was assessed using a modified version of the Downs' and Black's tool. Of 4009 citations, twenty articles evaluated direct provider-to-provider communication around the outpatient to acute care transition. Most studies were cross-sectional (65%), conducted in the US (55%), and studied communication between primary care and inpatient providers (62%). Of three studies reporting on the association between communication and 30-day readmissions, none found a significant association; of these studies, only one reported a measure of association (adjusted OR for communication vs. no communication, 1.08; 95% CI 0.92-1.26). The literature on provider-to-provider communication at the transition from outpatient to acute care is sparse and heterogeneous. Given the known importance of communication for other transitions of care, future studies are needed on provider-to-provider communication during this transition. Studies evaluating ideal methods for communication to reduce medical errors, utilization, and optimize patient satisfaction at this transition are especially needed.

[Detection of palliative care needs in an acute care hospital unit. Pilot study].

PubMed

Rodríguez-Calero, Miguel Ángel; Julià-Mora, Joana María; Prieto-Alomar, Araceli

2016-01-01

Previous to wider prevalence studies, we designed the present pilot study to assess concordance and time invested in patient evaluations using a palliative care needs assessment tool. We also sought to estimate the prevalence of palliative care needs in an acute care hospital unit. A cross-sectional study was carried out, 4 researchers (2 doctors and 2 nurses) independently assessed all inpatients in an acute care hospital unit in Manacor Hospital, Mallorca (Spain), using the validated tool NECPAL CCOMS-ICO©, measuring time invested in every case. Another researcher revised clinical recordings to analise the sample profile. Every researcher assessed 29 patients, 15 men and 14 women, mean age 74,03 ± 10.25 years. 4-observer concordance was moderate (Kappa 0,5043), tuning out to be higher between nurses. Mean time per patient evaluation was 1.9 to 7.72 minutes, depending on researcher. Prevalence of palliative care needs was 23,28%. Moderate concordance lean us towards multidisciplinary shared assessments as a method for future research. Avarage of time invested in evaluations was less than 8 minutes, no previous publications were identified regarding this variable. More than 20% of inpatients of the acute care unit were in need of palliative care. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.

Directory of Accredited Private Home Study Schools, 1971.

ERIC Educational Resources Information Center

National Home Study Council, Washington, DC.

This directory of accredited private home study schools lists 152 schools which have met the following standards set by the National Home Study Council: competent faculty; educationally sound and up-to-date courses; careful screening of students for admission; satisfactory educational services; demonstration of ample student success and…

Directory of Accredited Private Home Study Schools, 1970.

ERIC Educational Resources Information Center

National Home Study Council, Washington, DC.

This directory of accredited private home study schools lists 137 schools which have met the following standards set by the National Home Study Council: competent faculty; educationally sound and up-to-date courses; careful screening of students for admission; satisfactory educational services; demonstration of ample student success and…

Use of chest sonography in acute-care radiology☆

PubMed Central

De Luca, C.; Valentino, M.; Rimondi, M.R.; Branchini, M.; Baleni, M. Casadio; Barozzi, L.

2008-01-01

Diagnosis of acute lung disease is a daily challenge for radiologists working in acute-care areas. It is generally based on the results of chest radiography performed under technically unfavorable conditions. Computed tomography (CT) is undoubtedly more accurate in these cases, but it cannot always be performed on critically ill patients who need continuous care. The use of thoracic ultrasonography (US) has recently been proposed for the study of acute lung disease. It can be carried out rapidly at the bedside and does not require any particularly sophisticated equipment. This report analyzes our experience with chest sonography as a supplement to chest radiography in an Emergency Radiology Unit. We performed chest sonography – as an adjunct to chest radiography – on 168 patients with acute chest pathology. Static and dynamic US signs were analyzed in light of radiographic findings and, when possible, CT. The use of chest US improved the authors' ability to provide confident diagnoses of acute disease of the chest and lungs. PMID:23397048

[Changing of the patient safety culture in the pilot institutes of the Hungarian accreditation program].

PubMed

Lám, Judit; Merész, Gergő; Bakacsi, Gyula; Belicza, Éva; Surján, Cecília; Takács, Erika

2016-10-01

The accreditation system for health care providers was developed in Hungary aiming to increase safety, efficiency, and efficacy of care and optimise its organisational operation. The aim of this study was to assess changes of organisational culture in pilot institutes of the accreditation program. 7 volunteer pilot institutes using an internationally validated questionnaire were included. The impact study was performed in 2 rounds: the first before the introduction of the accreditation program, and the second a year later, when the standards were already known. Data were analysed using descriptive statistics and logistic regression models. Statistically significant (p<0.05) positive changes were detected in hospitals in three dimensions: organisational learning - continuous improvement, communication openness, teamwork within the unit while in outpatient clinics: overall perceptions of patient safety, and patient safety within the unit. Organisational culture in the observed institutes needs improvement, but positive changes already point to a safer care. Orv. Hetil., 2016, 157(42), 1667-1673.

Building Care Bridges between Acute and Long-Term Care with Nursing Diagnosis.

ERIC Educational Resources Information Center

Taylor, Carol A.

The increasing age of the American population and the current emphasis on cost containment in health care make the 1980s an ideal time for building bridges to span the health care needs of elderly persons in acute care and long-term care. While hospitals often discharge patients to nursing homes as an intermediate step between hospitalization and…

Understanding the impact of accreditation on quality in healthcare: A grounded theory approach.

PubMed

Desveaux, L; Mitchell, J I; Shaw, J; Ivers, N M

2017-11-01

To explore how organizations respond to and interact with the accreditation process and the actual and potential mechanisms through which accreditation may influence quality. Qualitative grounded theory study. Organizations who had participated in Accreditation Canada's Qmentum program during January 2014-June 2016. Individuals who had coordinated the accreditation process or were involved in managing or promoting quality. The accreditation process is largely viewed as a quality assurance process, which often feeds in to quality improvement activities if the feedback aligns with organizational priorities. Three key stages are required for accreditation to impact quality: coherence, organizational buy-in and organizational action. These stages map to constructs outlined in Normalization Process Theory. Coherence is established when an organization and its staff perceive that accreditation aligns with the organization's beliefs, context and model of service delivery. Organizational buy-in is established when there is both a conceptual champion and an operational champion, and is influenced by both internal and external contextual factors. Quality improvement action occurs when organizations take purposeful action in response to observations, feedback or self-reflection resulting from the accreditation process. The accreditation process has the potential to influence quality through a series of three mechanisms: coherence, organizational buy-in and collective quality improvement action. Internal and external contextual factors, including individual characteristics, influence an organization's experience of accreditation. © The Author 2017. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

Surgical rescue: The next pillar of acute care surgery.

PubMed

Kutcher, Matthew E; Sperry, Jason L; Rosengart, Matthew R; Mohan, Deepika; Hoffman, Marcus K; Neal, Matthew D; Alarcon, Louis H; Watson, Gregory A; Puyana, Juan Carlos; Bauzá, Graciela M; Schuchert, Vaishali D; Fombona, Anisleidy; Zhou, Tianhua; Zolin, Samuel J; Becher, Robert D; Billiar, Timothy R; Forsythe, Raquel M; Zuckerbraun, Brian S; Peitzman, Andrew B

2017-02-01

The evolving field of acute care surgery (ACS) traditionally includes trauma, emergency general surgery, and critical care. However, the critical role of ACS in the rescue of patients with a surgical complication has not been explored. We here describe the role of "surgical rescue" in the practice of ACS. A prospective, electronic medical record-based ACS registry spanning January 2013 to May 2014 at a large urban academic medical center was screened by ICD-9 codes for acute surgical complications of an operative or interventional procedure. Long-term outcomes were derived from the Social Security Death Index. Of 2,410 ACS patients, 320 (13%) required "surgical rescue": most commonly, from wound complications (32%), uncontrolled sepsis (19%), and acute obstruction (15%). The majority of complications (85%) were related to an operation; 15% were related to interventional procedures. The most common rescue interventions required were bowel resection (23%), wound debridement (18%), and source control of infection (17%); 63% of patients required operative intervention, and 22% required surgical critical care. Thirty-six percent of complications occurred in ACS primary patients ("local"), whereas 38% were referred from another surgical service ("institutional") and 26% referred from another institution ("regional"). Hospital length of stay was longer, and in-hospital and 1-year mortalities were higher in rescue patients compared with those without a complication. Outcomes were equivalent between "local" and "institutional" patients, but hospital length of stay and discharge to home were significantly worse in "institutional" referrals. We here describe the distinct role of the acute care surgeon in the surgical management of complications; this is an additional pillar of ACS. In this vital role, the acute care surgeon provides crucial support to other providers as well as direct patient care in the "surgical rescue" of surgical and procedural complications

Non Profit and For-Profit Higher Education Accreditation. Council for Higher Education Accreditation. Fact Sheet #7

ERIC Educational Resources Information Center

Council for Higher Education Accreditation, 2012

2012-01-01

This fact sheet presents data provided to the Council for Higher Education Accreditation (CHEA) by accrediting organizations for accrediting activity during 2010-2011. It includes both Title IV and Non-Title IV institutions. Data are presented in the following categories: (1) Accrediting Organizations; (2) Fourteen Major For-Profit Higher…

Creating learning momentum through overt teaching interactions during real acute care episodes.

PubMed

Piquette, Dominique; Moulton, Carol-Anne; LeBlanc, Vicki R

2015-10-01

Clinical supervisors fulfill a dual responsibility towards patient care and learning during clinical activities. Assuming such roles in today's clinical environments may be challenging. Acute care environments present unique learning opportunities for medical trainees, as well as specific challenges. The goal of this paper was to better understand the specific contexts in which overt teaching interactions occurred in acute care environments. We conducted a naturalistic observational study based on constructivist grounded theory methodology. Using participant observation, we collected data on the teaching interactions occurring between clinical supervisors and medical trainees during 74 acute care episodes in the critical care unit of two academic centers, in Toronto, Canada. Three themes contributed to a better understanding of the conditions in which overt teaching interactions among trainees and clinical supervisors occurred during acute care episodes: seizing emergent learning opportunities, coming up against challenging conditions, and creating learning momentum. Our findings illustrate how overt learning opportunities emerged from certain clinical situations and how clinical supervisors and trainees could purposefully modify unfavorable learning conditions. None of the acute care episodes encountered in the critical care environment represented ideal conditions for learning. Yet, clinical supervisors and trainees succeeded in engaging in overt teaching interactions during many episodes. The educational value of these overt teaching interactions should be further explored, as well as the impact of interventions aimed at increasing their use in acute care environments.

Obtaining accreditation by the pharmacy compounding accreditation board, part 2: developing essential standard operating procedures.

PubMed

Cabaleiro, Joe

2007-01-01

A key component of qualifying for accreditation with the Pharmacy Compounding Accreditation Board is having a set of comprehensive standard operating procedures that are being used by the pharmacy staff. The three criteria in standard operating procedures for which the Pharmacy Compounding Accreditation Board looks are: (1)written standard operating procedures; (2)standard operating procedures that reflect what the organization actualy does; and (3) whether the written standard operating procedures are implemented. Following specified steps in the preparation of standard operating procedures will result in procedures that meet Pharmacy Compounding Accreditation Board Requirements, thereby placing pharmacies one step closer to qualifying for accreditation.

Medicare's post-acute care payment: a review of the issues and policy proposals.

PubMed

Linehan, Kathryn

2012-12-07

Medicare spending on post-acute care provided by skilled nursing facility providers, home health providers, inpatient rehabilitation facility providers, and long-term care hospitals has grown rapidly in the past several years. The Medicare Payment Advisory Commission and others have noted several long-standing problems with the payment systems for post-acute care and have suggested refinements to Medicare's post-acute care payment systems that are intended to encourage the delivery of appropriate care in the right setting for a patient's condition. The Patient Protection and Affordable Care Act of 2010 contained several provisions that affect the Medicare program's post-acute care payment systems and also includes broader payment reforms, such as bundled payment models. This issue brief describes Medicare's payment systems for post-acute care providers, evidence of problems that have been identified with the payment systems, and policies that have been proposed or enacted to remedy those problems.

Design characteristics of acute care units in china.

PubMed

Lu, Yi; Wang, Yijia

2014-01-01

To describe the current state of design characteristics of acute care units in China's public hospitals and compare these with characteristics with acute care units in the United States. The healthcare construction industry in China is one of the fastest growing sectors in China and, arguably, in the world. Understanding the physical design of acute care units in China is of great importance because it will influence a large population. Descriptive study was performed of unit configuration, size, patient visibility, distance to nursing station and supplies, and lighting conditions in 25 units in 19 public hospitals built after 2003. Data and information were collected based on spatial and visibility analysis. The study identified major design characteristics of the recently built (from 2003 onward) acute care units in China, comparing them, where appropriate, with those in U.S. It found there are three dominant types of unit layout: single-corridor (52%), triangular (36%), and double-corridor (12%). The number of private rooms is very low (11%), compared with two- or three-bed rooms. Centralized nursing stations are the only type of nurses' working area. China also has a large unit size in terms of number of patient beds. The average number of patient beds in a unit is 40.6 in China (versus 32.9 in U.S.). The care units in China have longer walking distance from nursing station to patient bedside. The percentage of beds visible from a nursing station is lower in China than in the U.S. The access to natural light and direct sunlight in patient rooms is greater in China compared with those in U.S.-100% of patient rooms in China have natural lighting. A majority of them face south or southeast and thus receiving direct sunlight (91.4%). Because of the differences in economies and building codes, there are dramatic differences between the spatial characteristics of acute care units in China and the United States. © 2014 Vendome Group, LLC.

Casemix classification payment for sub-acute and non-acute inpatient care, Thailand.

PubMed

Khiaocharoen, Orathai; Pannarunothai, Supasit; Zungsontiporn, Chairoj; Riewpaiboon, Wachara

2010-07-01

There is a need to develop other casemix classifications, apart from DRG for sub-acute and non-acute inpatient care payment mechanism in Thailand. To develop a casemix classification for sub-acute and non-acute inpatient service. The study began with developing a classification system, analyzing cost, assigning payment weights, and ended with testing the validity of this new casemix system. Coefficient of variation, reduction in variance, linear regression, and split-half cross-validation were employed. The casemix for sub-acute and non-acute inpatient services contained 98 groups. Two percent of them had a coefficient of variation of the cost of higher than 1.5. The reduction in variance of cost after the classification was 32%. Two classification variables (physical function and the rehabilitation impairment categories) were key determinants of the cost (adjusted R2 = 0.749, p = .001). Validity results of split-half cross-validation of sub-acute and non-acute inpatient service were high. The present study indicated that the casemix for sub-acute and non-acute inpatient services closely predicted the hospital resource use and should be further developed for payment of the inpatients sub-acute and non-acute phase.

Clinical Psychology Training: Accreditation and Beyond.

PubMed

Levenson, Robert W

2017-05-08

Beginning with efforts in the late 1940s to ensure that clinical psychologists were adequately trained to meet the mental health needs of the veterans of World War II, the accreditation of clinical psychologists has largely been the province of the Commission on Accreditation of the American Psychological Association. However, in 2008 the Psychological Clinical Science Accreditation System began accrediting doctoral programs that adhere to the clinical science training model. This review discusses the goals of accreditation and the history of the accreditation of graduate programs in clinical psychology, and provides an overview of the evaluation procedures used by these two systems. Accreditation is viewed against the backdrop of the slow rate of progress in reducing the burden of mental illness and the changes in clinical psychology training that might help improve this situation. The review concludes with a set of five recommendations for improving accreditation.

9 CFR 439.53 - Revocation of accreditation.

Code of Federal Regulations, 2010 CFR

2010-01-01

... ACCREDITATION OF NON-FEDERAL CHEMISTRY LABORATORIES § 439.53 Revocation of accreditation. The accreditation of a laboratory will be revoked for the following reasons: (a) An accredited laboratory that is accredited to.... If the accredited laboratory fails to meet any of the criteria set forth in §§ 439.20(d) and 439.20(h...

Handbook of Accreditation. Second Edition.

ERIC Educational Resources Information Center

North Central Association of Colleges and Schools, Chicago, IL. Commission on Institutions of Higher Education.

This handbook contains accreditation information from the North Central Association of Colleges and Schools Commission on Institutions of Higher Education, including general institutional requirements, criteria for accreditation, and policies on educational change. Chapters include: (1) "Introduction to Voluntary Accreditation and the…

Development and Implementation of a Quality Improvement Process for Echocardiographic Laboratory Accreditation.

PubMed

Gilliland, Yvonne E; Lavie, Carl J; Ahmad, Homaa; Bernal, Jose A; Cash, Michael E; Dinshaw, Homeyar; Milani, Richard V; Shah, Sangeeta; Bienvenu, Lisa; White, Christopher J

2016-03-01

We describe our process for quality improvement (QI) for a 3-year accreditation cycle in echocardiography by the Intersocietal Accreditation Commission (IAC) for a large group practice. Echocardiographic laboratory accreditation by the IAC was introduced in 1996, which is not required but could impact reimbursement. To ensure high-quality patient care and community recognition as a facility committed to providing high-quality echocardiographic services, we applied for IAC accreditation in 2010. Currently, there is little published data regarding the IAC process to meet echocardiography standards. We describe our approach for developing a multicampus QI process for echocardiographic laboratory accreditation during the 3-year cycle of accreditation by the IAC. We developed a quarterly review assessing (1) the variability of the interpretations, (2) the quality of the examinations, (3) a correlation of echocardiographic studies with other imaging modalities, (4) the timely completion of reports, (5) procedure volume, (6) maintenance of Continuing Medical Education credits by faculty, and (7) meeting Appropriate Use Criteria. We developed and implemented a multicampus process for QI during the 3-year accreditation cycle by the IAC for Echocardiography. We documented both the process and the achievement of those metrics by the Echocardiography Laboratories at the Ochsner Medical Institutions. We found the QI process using IAC standards to be a continuous educational experience for our Echocardiography Laboratory physicians and staff. We offer our process as an example and guide for other echocardiography laboratories who wish to apply for such accreditation or reaccreditation. © 2016, Wiley Periodicals, Inc.

Quality Assurance in Breast Health Care and Requirement for Accreditation in Specialized Units

PubMed Central

Güler, Sertaç Ata; Güllüoğlu, Bahadır M.

2014-01-01

Breast health is a subject of increasing importance. The statistical increase in the frequency of breast cancer and the consequent increase in death rate increase the importance of quality of services to be provided for breast health. For these reasons, the minimum standards and optimum quality metrics of breast care provided to the community are determined. The quality parameters for breast care service include the results, the structure and the operation of services. Within this group, the results of breast health services are determined according to clinical results, patient satisfaction and financial condition. The structure of quality services should include interdisciplinary meetings, written standards for specific procedures and the existence of standardized reporting systems. Establishing breast centers that adopt integrated multidisciplinary working principles and their cost-effective maintenance are important in terms of operation of breast health services. The importance of using a “reviewing/auditing” procedure that checks if all of these functions existing in the health system are carried out at the desired level and an “accreditation” system indicating that the working breast units/centers provide minimum quality adequacy in all aspects, is undeniable. Currently, the accreditation system for breast centers is being used in the European Union and the United States for the last 5–10 years. This system is thought to provide standardization in breast care services, and is accepted as one of the important factors that resulted in reduction in mortality associated with breast cancer. PMID:28331658

Post–Acute Care Use and Hospital Readmission after Sepsis

PubMed Central

Jones, Tiffanie K.; Fuchs, Barry D.; Small, Dylan S.; Halpern, Scott D.; Hanish, Asaf; Umscheid, Craig A.; Baillie, Charles A.; Kerlin, Meeta Prasad; Gaieski, David F.

2015-01-01

Rationale: The epidemiology of post–acute care use and hospital readmission after sepsis remains largely unknown. Objectives: To examine the rate of post–acute care use and hospital readmission after sepsis and to examine risk factors and outcomes for hospital readmissions after sepsis. Methods: In an observational cohort study conducted in an academic health care system (2010–2012), we compared post–acute care use at discharge and hospital readmission after 3,620 sepsis hospitalizations with 108,958 nonsepsis hospitalizations. We used three validated, claims-based approaches to identify sepsis and severe sepsis. Measurements and Main Results: Post–acute care use at discharge was more likely after sepsis, driven by skilled care facility placement (35.4% after sepsis vs. 15.8%; P < 0.001), with the highest rate observed after severe sepsis. Readmission rates at 7, 30, and 90 days were higher postsepsis (P < 0.001). Compared with nonsepsis hospitalizations (15.6% readmitted within 30 d), the increased readmission risk was present regardless of sepsis severity (27.3% after sepsis and 26.0–26.2% after severe sepsis). After controlling for presepsis characteristics, the readmission risk was found to be 1.51 times greater (95% CI, 1.38–1.66) than nonsepsis hospitalizations. Readmissions after sepsis were more likely to result in death or transition to hospice care (6.1% vs. 13.3% after sepsis; P < 0.001). Independent risk factors associated with 30-day readmissions after sepsis hospitalizations included age, malignancy diagnosis, hospitalizations in the year prior to the index hospitalization, nonelective index admission type, one or more procedures during the index hospitalization, and low hemoglobin and high red cell distribution width at discharge. Conclusions: Post–acute care use and hospital readmissions were common after sepsis. The increased readmission risk after sepsis was observed regardless of sepsis severity and was associated with

Accreditation of Developmental Disabilities Programs.

ERIC Educational Resources Information Center

Hemp, Richard; Braddock, David

1988-01-01

Data gathered from 296 agency accreditation surveys, conducted by the Accreditation Council on Services for People with Developmental Disabilities, were analyzed, focusing on ownership, services provided, size of residential units, critical standards, characteristics of individuals served, and accreditation outcome. Redundancies between private…

[Evaluation auditing of the quality of health care in accreditation of health facilities].

PubMed

Paim, Chennyfer da Rosa Paino; Zucchi, Paola

2011-01-01

This article shows how many health insurance companies operating in the Greater São Paulo have been performing auditing of the quality of their health care services, professionals, and which criteria are being employed to do so. Because of the legislation decreeing that health insurance companies have legal co-responsibility for the health care services and National Health Agency control the health services National Health Agency, auditing evaluations have been implemented since then. The survey was based on electronic forms e-mailed to all health insurance companies operating in the Greater São Paulo. The sample consisted of 125 health insurance companies; 29 confirmed that had monitoring and evaluation processes; 26 performed auditing of their services regularly; from those, 20 used some type of form or protocol for technical visits; all evaluation physical and administrative structure and 22 included functional structure. Regarding the professionals audited 21 were nurses, 13 administrative assistants; 04 managers and 02 doctors. Regarding criteria for accreditation the following were highlighted: region analysis (96%), localization (88.88%) and cost (36%). We conclude that this type of auditing evaluation is rather innovative and is being gradually implemented by the health insurance companies, but is not a systematic process.

End-of-Life Care in an Acute Care Hospital: Linking Policy and Practice

ERIC Educational Resources Information Center

Sorensen, Ros; Iedema, Rick

2011-01-01

The care of people who die in hospitals is often suboptimal. Involving patients in decisions about their care is seen as one way to improve care outcomes. Federal and state government policymakers in Australia are promoting shared decision making in acute care hospitals as a means to improve the quality of end-of-life care. If policy is to be…

Quality of Electronic Nursing Records: The Impact of Educational Interventions During a Hospital Accreditation Process.

PubMed

Nomura, Aline Tsuma Gaedke; Pruinelli, Lisiane; da Silva, Marcos Barragan; Lucena, Amália de Fátima; Almeida, Miriam de Abreu

2018-03-01

Hospital accreditation is a strategy for the pursuit of quality of care and safety for patients and professionals. Targeted educational interventions could help support this process. This study aimed to evaluate the quality of electronic nursing records during the hospital accreditation process. A retrospective study comparing 112 nursing records during the hospital accreditation process was conducted. Educational interventions were implemented, and records were evaluated preintervention and postintervention. Mann-Whitney and χ tests were used for data analysis. Results showed that there was a significant improvement in the nursing documentation quality postintervention. When comparing records preintervention and postintervention, results showed a statistically significant difference (P < .001) between the two periods. The comparison between items showed that most scores were significant. Findings indicated that educational interventions performed by nurses led to a positive change that improved nursing documentation and, consequently, better care practices.

PAs and NPs in an emergency room-linked acute care clinic.

PubMed

Currey, C J

1984-12-01

The use of hospital emergency rooms for nonurgent care during evenings hours often strains medical resources and may affect the quality of emergency care. One facility's effective use of an after-hours acute care clinic staffed by PAs and NPs to divert nonurgent problems away from its emergency room is outlined. PAs and NPs work during peak demand hours (evenings and weekends) under the supervision of an emergency room physician, and receive supplementary support from other emergency room personnel. Incoming patients are referred to the emergency room or acute care clinic, depending on the nature of their problems. Acute care clinic patients are then treated by the PA or NP and either released or referred to an emergency room physician, if their conditions warrant additional treatment. As a result, use of the acute care clinic has greatly reduced the amount of non-urgent medical treatment in the emergency room and has provided other advantages to both patients and staff as well. These advantages and the encouraging statistics following six months of the clinic's operation are discussed.

Echocardiography practice, training and accreditation in the intensive care: document for the World Interactive Network Focused on Critical Ultrasound (WINFOCUS)

PubMed Central

Price, Susanna; Via, Gabriele; Sloth, Erik; Guarracino, Fabio; Breitkreutz, Raoul; Catena, Emanuele; Talmor, Daniel

2008-01-01

Echocardiography is increasingly used in the management of the critically ill patient as a non-invasive diagnostic and monitoring tool. Whilst in few countries specialized national training schemes for intensive care unit (ICU) echocardiography have been developed, specific guidelines for ICU physicians wishing to incorporate echocardiography into their clinical practice are lacking. Further, existing echocardiography accreditation does not reflect the requirements of the ICU practitioner. The WINFOCUS (World Interactive Network Focused On Critical UltraSound) ECHO-ICU Group drew up a document aimed at providing guidance to individual physicians, trainers and the relevant societies of the requirements for the development of skills in echocardiography in the ICU setting. The document is based on recommendations published by the Royal College of Radiologists, British Society of Echocardiography, European Association of Echocardiography and American Society of Echocardiography, together with international input from established practitioners of ICU echocardiography. The recommendations contained in this document are concerned with theoretical basis of ultrasonography, the practical aspects of building an ICU-based echocardiography service as well as the key components of standard adult TTE and TEE studies to be performed on the ICU. Specific issues regarding echocardiography in different ICU clinical scenarios are then described. Obtaining competence in ICU echocardiography may be achieved in different ways – either through completion of an appropriate fellowship/training scheme, or, where not available, via a staged approach designed to train the practitioner to a level at which they can achieve accreditation. Here, peri-resuscitation focused echocardiography represents the entry level – obtainable through established courses followed by mentored practice. Next, a competence-based modular training programme is proposed: theoretical elements delivered through

[Regional ophthalmological cluster as a resource basis for the process and the procedure of specialist accreditation].

PubMed

Chukhraev, A M; Khodzhaev, N S; Malyugin, B E; Doga, A V; Zabolotniy, A G

Since 2016, phased introduction of specialist accreditation has been launched. Many issues like how training at regional accreditation centers (RACs) should be organized - for applicants applying for primary specialized accreditation as residents in ophthalmology (2018) or periodic accreditation as practicing ophthalmologists (2021) - are yet debatable. to provide organizational and educational resources for arranging accreditation of ophthalmologists at the background of improving the quality of medical care in a federal subject of the Russian Federation. The study object was the process and the procedure of accreditation, the study subject - the system of specialist accreditation. bibliographical, analytical, and expert. Methodological basis for tasks solving: mobilization of an independent organizational structure, that is, the regional ophthalmological scientific-educational cluster (ROSEC). Three complex problems have been defined that require solution. 1. Discrepancies between accreditation procedures depending on the type of accreditation. The absence of practical skills assessment within the periodical accreditation procedure and low availability of innovative simulation systems impede the achievement of the declared goals of accreditation. 2. The absence of a clear order and criteria for portfolio assessment as well as a legal format of its formation during non-interrupted medical education (NIME) demands active management. 3. There is still a lack of appropriate organizational, educational, material technical, and personnel support of the accreditation system. The proposed organizational and methodological approaches are aimed at solving issues of accreditation support, proper functioning of RACs, and improving the quality and regional availability of NIME. Systematic approach effectively solves the problem of resource support of accreditation. ROSEC should be regarded as the provision basis for complex of all stages of ophthalmologist accreditation and

42 CFR 8.4 - Accreditation body responsibilities.

Code of Federal Regulations, 2010 CFR

2010-10-01

...) Accreditation surveys and for cause inspections. (1) Accreditation bodies shall conduct routine accreditation surveys for initial, renewal, and continued accreditation of each OTP at least every 3 years. (2... survey of the OTP by the accreditation body otherwise demonstrates one or more deficiencies in the OTP...

42 CFR 8.4 - Accreditation body responsibilities.

Code of Federal Regulations, 2011 CFR

2011-10-01

...) Accreditation surveys and for cause inspections. (1) Accreditation bodies shall conduct routine accreditation surveys for initial, renewal, and continued accreditation of each OTP at least every 3 years. (2... survey of the OTP by the accreditation body otherwise demonstrates one or more deficiencies in the OTP...

7 CFR 983.1 - Accredited laboratory.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 8 2011-01-01 2011-01-01 false Accredited laboratory. 983.1 Section 983.1 Agriculture..., ARIZONA, AND NEW MEXICO Definitions § 983.1 Accredited laboratory. An accredited laboratory is a laboratory that has been approved or accredited by the U.S. Department of Agriculture. [74 FR 56539, Nov. 2...

42 CFR 8.13 - Revocation of accreditation and accreditation body approval.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 1 2010-10-01 2010-10-01 false Revocation of accreditation and accreditation body approval. 8.13 Section 8.13 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL PROVISIONS CERTIFICATION OF OPIOID TREATMENT PROGRAMS Certification and Treatment Standards § 8.13...

42 CFR 8.13 - Revocation of accreditation and accreditation body approval.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 1 2013-10-01 2013-10-01 false Revocation of accreditation and accreditation body approval. 8.13 Section 8.13 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL PROVISIONS CERTIFICATION OF OPIOID TREATMENT PROGRAMS Certification and Treatment Standards § 8.13...

42 CFR 8.13 - Revocation of accreditation and accreditation body approval.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 1 2012-10-01 2012-10-01 false Revocation of accreditation and accreditation body approval. 8.13 Section 8.13 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL PROVISIONS CERTIFICATION OF OPIOID TREATMENT PROGRAMS Certification and Treatment Standards § 8.13...

42 CFR 8.13 - Revocation of accreditation and accreditation body approval.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 1 2011-10-01 2011-10-01 false Revocation of accreditation and accreditation body approval. 8.13 Section 8.13 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL PROVISIONS CERTIFICATION OF OPIOID TREATMENT PROGRAMS Certification and Treatment Standards § 8.13...

42 CFR 8.13 - Revocation of accreditation and accreditation body approval.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 1 2014-10-01 2014-10-01 false Revocation of accreditation and accreditation body approval. 8.13 Section 8.13 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL PROVISIONS CERTIFICATION OF OPIOID TREATMENT PROGRAMS Certification and Treatment Standards § 8.13...

Guide to Accreditation, 2011-2012

ERIC Educational Resources Information Center

Teacher Education Accreditation Council, 2011

2011-01-01

The Teacher Education Accreditation Council (TEAC) "Guide to Accreditation" includes a full description of TEAC's principles and standards, the accreditation process and audit, and detailed instruction on writing the "Brief." This revision includes expanded information on (1) preparing an "Inquiry Brief Proposal" and the audit of the "Inquiry…

The costs and service implications of substituting intermediate care for acute hospital care.

PubMed

Mayhew, Leslie; Lawrence, David

2006-05-01

Intermediate care is part of a package of initiatives introduced by the UK Government mainly to relieve pressure on acute hospital beds and reduce delayed discharge (bed blocking). Intermediate care involves caring for patients in a range of settings, such as in the home or community or in nursing and residential homes. This paper considers the scope of intermediate care and its role in relation to acute hospital services. In particular, it develops a framework that can be used to inform decisions about the most cost-effective care pathways for given clinical situations, and also for wider planning purposes. It does this by providing a model for evaluating the costs of intermediate care services provided by different agencies and techniques for calibrating the model locally. It finds that consistent application of the techniques over a period of time, coupled with sound planning and accounting, should result in savings to the health economy.

Interprofessional communication failures in acute care chains: How can we identify the causes?

PubMed

van Leijen-Zeelenberg, Janneke E; van Raak, Arno J A; Duimel-Peeters, Inge G P; Kroese, Mariëlle E A L; Brink, Peter R G; Vrijhoef, Hubertus J M

2015-01-01

Although communication failures between professionals in acute care delivery occur, explanations for these failures remain unclear. We aim to gain a deeper understanding of interprofessional communication failures by assessing two different explanations for them. A multiple case study containing six cases (i.e. acute care chains) was carried out in which semi-structured interviews, physical artifacts and archival records were used for data collection. Data were entered into matrices and the pattern-matching technique was used to examine the two complementary propositions. Based on the level of standardization and integration present in the acute care chains, the six acute care chains could be divided into two categories of care processes, with the care chains equally distributed among the categories. Failures in communication occurred in both groups. Communication routines were embedded within organizations and descriptions of communication routines in the entire acute care chain could not be found. Based on the results, failures in communication could not exclusively be explained by literature on process typology. Literature on organizational routines was useful to explain the occurrence of communication failures in the acute care chains. Organizational routines can be seen as repetitive action patterns and play an important role in organizations, as most processes are carried out by means of routines. The results of this study imply that it is useful to further explore the role of organizational routines on interprofessional communication in acute care chains to develop a solution for failures in handover practices.

21 CFR 900.13 - Revocation of accreditation and revocation of accreditation body approval.

Code of Federal Regulations, 2012 CFR

2012-04-01

... agency may take whatever other action or combination of actions will best protect the public health... human health or because the accreditation body fraudulently accredited facilities, that the certificates...

ISO 15189 accreditation: Requirements for quality and competence of medical laboratories, experience of a laboratory I.

PubMed

Guzel, Omer; Guner, Ebru Ilhan

2009-03-01

Medical laboratories are the key partners in patient safety. Laboratory results influence 70% of medical diagnoses. Quality of laboratory service is the major factor which directly affects the quality of health care. The clinical laboratory as a whole has to provide the best patient care promoting excellence. International Standard ISO 15189, based upon ISO 17025 and ISO 9001 standards, provides requirements for competence and quality of medical laboratories. Accredited medical laboratories enhance credibility and competency of their testing services. Our group of laboratories, one of the leading institutions in the area, had previous experience with ISO 9001 and ISO 17025 Accreditation at non-medical sections. We started to prepared for ISO 15189 Accreditation at the beginning of 2006 and were certified in March, 2007. We spent more than a year to prepare for accreditation. Accreditation scopes of our laboratory were as follows: clinical chemistry, hematology, immunology, allergology, microbiology, parasitology, molecular biology of infection serology and transfusion medicine. The total number of accredited tests is 531. We participate in five different PT programs. Inter Laboratory Comparison (ILC) protocols are performed with reputable laboratories. 82 different PT Program modules, 277 cycles per year for 451 tests and 72 ILC program organizations for remaining tests have been performed. Our laboratory also organizes a PT program for flow cytometry. 22 laboratories participate in this program, 2 cycles per year. Our laboratory has had its own custom made WEB based LIS system since 2001. We serve more than 500 customers on a real time basis. Our quality management system is also documented and processed electronically, Document Management System (DMS), via our intranet. Preparatory phase for accreditation, data management, external quality control programs, personnel related issues before, during and after accreditation process are presented. Every laboratory has

Implementation of quality management systems and progress towards accreditation of National Tuberculosis Reference Laboratories in Africa

PubMed Central

de Dieu Iragena, Jean; Kao, Kekeletso; Erni, Donatelle; Mekonen, Teferi

2017-01-01

Background Laboratory services are essential at all stages of the tuberculosis care cascade, from diagnosis and drug resistance testing to monitoring response to treatment. Enabling access to quality services is a challenge in low-resource settings. Implementation of a strong quality management system (QMS) and laboratory accreditation are key to improving patient care. Objectives The study objective was to determine the status of QMS implementation and progress towards accreditation of National Tuberculosis Reference Laboratories (NTRLs) in the African Region. Method An online questionnaire was administered to NTRL managers in 47 World Health Organization Regional Office for Africa member states in the region, between February and April 2015, regarding the knowledge of QMS tools and progress toward implementation to inform strategies for tuberculosis diagnostic services strengthening in the region. Results A total of 21 laboratories (43.0%) had received SLMTA/TB-SLMTA training, of which 10 had also used the Global Laboratory Initiative accreditation tool. However, only 36.7% of NTRLs had received a laboratory audit, a first step in quality improvement. Most NTRLs participated in acid-fast bacilli microscopy external quality assurance (95.8%), although external quality assurance for other techniques was lower (60.4% for first-line drug susceptibility testing, 25.0% for second-line drug susceptibility testing, and 22.9% for molecular testing). Barriers to accreditation included lack of training and accreditation programmes. Only 28.6% of NTRLs had developed strategic plans and budgets which included accreditation. Conclusion Good foundations are in place on the continent from which to scale up accreditation efforts. Laboratory audits should be conducted as a first step in developing quality improvement action plans. Political commitment and strong leadership are needed to drive accreditation efforts; advocacy will require clear evidence of patient impact and cost

Association of Cost Sharing With Mental Health Care Use, Involuntary Commitment, and Acute Care.

PubMed

Ravesteijn, Bastian; Schachar, Eli B; Beekman, Aartjan T F; Janssen, Richard T J M; Jeurissen, Patrick P T

2017-09-01

A higher out-of-pocket price for mental health care may lead not only to cost savings but also to negative downstream consequences. To examine the association of higher patient cost sharing with mental health care use and downstream effects, such as involuntary commitment and acute mental health care use. This difference-in-differences study compared changes in mental health care use by adults, who experienced an increase in cost sharing, with changes in youths, who did not experience the increase and thus formed a control group. The study examined all 2 780 558 treatment records opened from January 1, 2010, through December 31, 2012, by 110 organizations that provide specialist mental health care in the Netherlands. Data analysis was performed from January 18, 2016, to May 9, 2017. On January 1, 2012, the Dutch national government increased the out-of-pocket price of mental health services for adults by up to €200 (US$226) per year for outpatient treatment and €150 (US$169) per month for inpatient treatment. The number of treatment records opened each day in regular specialist mental health care, involuntary commitment, and acute mental health care, and annual specialist mental health care spending. This study included 1 448 541 treatment records opened from 2010 to 2012 (mean [SD] age, 41.4 [16.7] years; 712 999 men and 735 542 women). The number of regular mental health care records opened for adults decreased abruptly and persistently by 13.4% (95% CI, -16.0% to -10.8%; P < .001) per day when cost sharing was increased in 2012. The decrease was substantial and significant for severe and mild disorders and larger in low-income than in high-income neighborhoods. Simultaneously, in 2012, daily record openings increased for involuntary commitment by 96.8% (95% CI, 87.7%-105.9%; P < .001) and for acute mental health care by 25.1% (95% CI, 20.8%-29.4%; P < .001). In contrast to our findings for adults, the use of regular care among youths

Improving patients' and staff's experiences of acute care.

PubMed

Chaplin, Rob; Crawshaw, Jacob; Hood, Chloe

2015-03-01

The aim of this audit was to assess the effect of the Quality Mark programme on the quality of acute care received by older patients by comparing the experiences of staff and older adults before and after the programme. Data from 31 wards in 12 acute hospitals were collected over two stages. Patients and staff completed questionnaires on the perceived quality of care on the ward. Patients rated improved experiences of nutrition, staff availability and dignity. Staff received an increase in training and reported better access to support, increased time and skill to deliver care and improved morale, leadership and teamwork. Problems remained with ward comfort and mealtimes. Overall, results indicated an improvement in ratings of care quality in most domains during Quality Mark data collection. Further audits need to explore ways of improving ward comfort and mealtime experience.

Accreditation Council for Graduate Medical Education accreditation and influence on perceptions of pediatric otolaryngology fellowship training experience.

PubMed

Bedwell, Joshua R; Choi, Sukgi; Chan, Kenny; Preciado, Diego

2013-09-01

The American Society of Pediatric Otolaryngology (ASPO) has set a goal of universal accreditation of fellowship programs by the Accreditation Council for Graduate Medical Education (ACGME) by 2014. This study offers data comparing trainee experience at accredited vs nonaccredited programs. To evaluate perceptions of pediatric otolaryngology fellowship training experience and to elucidate differences between those who trained in ACGME-accredited fellowships vs those who did not. Web-based survey sent to all members of ASPO, as well as recent fellowship graduate ASPO-eligible physicians. Responses were obtained in an anonymous fashion. The study population comprised 136 ASPO members who recently graduated from pediatric otolaryngology fellowship programs (36 from ACGME-accredited fellowships and 100 from nonaccredited programs). Difference in perceived fellowship experience between graduates of accredited vs nonaccredited programs, specifically, differences in service vs education perceptions. Overall, a majority (64%) of respondents agreed that standardizing the pediatric fellowship curriculum through ACGME accreditation is a worthwhile goal. Those who attended ACGME-accredited fellowships were more likely to favor accreditation vs non-ACGME graduates (83% vs 58%; P = .006). Graduates of ACGME-accredited programs were also more likely to agree that their fellowship provided adequate preparation for a career in academic medicine (100% vs 89%; P = .04), protected time for research (94% vs 60%; P < .001), vacation and academic time (94% vs 78%; P = .03), and opportunities to formally evaluate their superiors (72% vs 32%; P < .001). Non-ACGME graduates reported higher primary call frequency (0.8 days per week vs 0.2 days per week; P = .01), and attending physician participation in rounds (71% vs 53%; P = .05). Most respondents were in agreement with universal ACGME accreditation. Those having trained in accredited programs cite increased

The delivery of clinical preventive services: acute care intervention.

PubMed

Hahn, D L

1999-10-01

. Evidence-based clinical preventive services are underutilized. We explored the major factors associated with delivery of these services in a large physician-owned community-based group practice that provided care for both fee-for-service (FFS) and health maintenance organization (HMO) patient populations. We performed a cross-sectional audit of the computerized billing data of all adult outpatients seen at least once by any primary care provider in 1995 (N = 75,621). Delivery of preventive services was stratified by age, sex, visit frequency, insurance status (FFS or HMO), and visit type (acute care only or scheduled preventive visit). Insurance status and visit type were the strongest predictors of clinical preventive service delivery. Patients with FFS coverage received 6% to 13% (absolute difference) fewer of these services than HMO patients. Acute-care-only patients received 9% to 45% fewer services than patients who scheduled preventive visits. The combination of these factors was associated with profound differences. Having insurance to pay for preventive services is an important factor in the delivery of such care. Encouraging all patients to schedule preventive visits has been suggested as a strategy for increasing delivery, but that is not practical in this setting. Assessing the need for preventive services and offering them during acute care visits has equal potential for increasing delivery.

Tracking Success: Outputs Versus Outcomes-A Comparison of Accredited and Non-Accredited Public Health Agencies' Community Health Improvement Plan objectives.

PubMed

Perrault, Evan K; Inderstrodt-Stephens, Jill; Hintz, Elizabeth A

2018-06-01

With funding for public health initiatives declining, creating measurable objectives that are focused on tracking and changing population outcomes (i.e., knowledge, attitudes, or behaviors), instead of those that are focused on health agencies' own outputs (e.g., promoting services, developing communication messages) have seen a renewed focus. This study analyzed 4094 objectives from the Community Health Improvement Plans (CHIPs) of 280 local PHAB-accredited and non-accredited public health agencies across the United States. Results revealed that accredited agencies were no more successful at creating outcomes-focused objectives (35% of those coded) compared to non-accredited agencies (33% of those coded; Z = 1.35, p = .18). The majority of objectives were focused on outputs (accredited: 61.2%; non-accredited: 63.3%; Z = 0.72, p = .47). Outcomes-focused objectives primarily sought to change behaviors (accredited: 85.43%; non-accredited: 80.6%), followed by changes in knowledge (accredited: 9.75%; non-accredited: 10.8%) and attitudes (accredited: 1.6%; non-accredited: 5.1%). Non-accredited agencies had more double-barreled objectives (49.9%) compared to accredited agencies (32%; Z = 11.43, p < .001). The authors recommend that accreditation procedures place a renewed focus on ensuring that public health agencies strive to achieve outcomes. It is also advocated that public health agencies work with interdisciplinary teams of Health Communicators who can help them develop procedures to effectively and efficiently measure outcomes of knowledge and attitudes that are influential drivers of behavioral changes.

Finding consensus on frailty assessment in acute care through Delphi method

PubMed Central

2016-01-01

Objective We seek to address gaps in knowledge and agreement around optimal frailty assessment in the acute medical care setting. Frailty is a common term describing older persons who are at increased risk of developing multimorbidity, disability, institutionalisation and death. Consensus has not been reached on the practical implementation of this concept to assess clinically and manage older persons in the acute care setting. Design Modified Delphi, via electronic questionnaire. Questions included ranking items that best recognise frailty, optimal timing, location and contextual elements of a successful tool. Intraclass correlation coefficients for overall levels of agreement, with consensus and stability tested by 2-way ANOVA with absolute agreement and Fisher's exact test. Participants A panel of national experts (academics, front-line clinicians and specialist charities) were invited to electronic correspondence. Results Variables reflecting accumulated deficit and high resource usage were perceived by participants as the most useful indicators of frailty in the acute care setting. The Acute Medical Unit and Care of the older Persons Ward were perceived as optimum settings for frailty assessment. ‘Clinically meaningful and relevant’, ‘simple (easy to use)’ and ‘accessible by multidisciplinary team’ were perceived as characteristics of a successful frailty assessment tool in the acute care setting. No agreement was reached on optimal timing, number of variables and organisational structures. Conclusions This study is a first step in developing consensus for a clinically relevant frailty assessment model for the acute care setting, providing content validation and illuminating contextual requirements. Testing on clinical data sets is a research priority. PMID:27742633

Promoting patient-centred fundamental care in acute healthcare systems.

PubMed

Feo, Rebecca; Kitson, Alison

2016-05-01

Meeting patients' fundamental care needs is essential for optimal safety and recovery and positive experiences within any healthcare setting. There is growing international evidence, however, that these fundamentals are often poorly executed in acute care settings, resulting in patient safety threats, poorer and costly care outcomes, and dehumanising experiences for patients and families. Whilst care standards and policy initiatives are attempting to address these issues, their impact has been limited. This discussion paper explores, through a series of propositions, why fundamental care can be overlooked in sophisticated, high technology acute care settings. We argue that the central problem lies in the invisibility and subsequent devaluing of fundamental care. Such care is perceived to involve simple tasks that require little skill to execute and have minimal impact on patient outcomes. The propositions explore the potential origins of this prevailing perception, focusing upon the impact of the biomedical model, the consequences of managerial approaches that drive healthcare cultures, and the devaluing of fundamental care by nurses themselves. These multiple sources of invisibility and devaluing surrounding fundamental care have rendered the concept underdeveloped and misunderstood both conceptually and theoretically. Likewise, there remains minimal role clarification around who should be responsible for and deliver such care, and a dearth of empirical evidence and evidence-based metrics. In explicating these propositions, we argue that key to transforming the delivery of acute healthcare is a substantial shift in the conceptualisation of fundamental care. The propositions present a cogent argument that counters the prevailing perception that fundamental care is basic and does not require systematic investigation. We conclude by calling for the explicit valuing and embedding of fundamental care in healthcare education, research, practice and policy. Without this

22 CFR 96.103 - Oversight by accrediting entities.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 22 Foreign Relations 1 2011-04-01 2011-04-01 false Oversight by accrediting entities. 96.103... Relating to Temporary Accreditation § 96.103 Oversight by accrediting entities. (a) The accrediting entity... agency's application for full accreditation when it is filed. The accrediting entity must also...

22 CFR 96.103 - Oversight by accrediting entities.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Oversight by accrediting entities. 96.103... Relating to Temporary Accreditation § 96.103 Oversight by accrediting entities. (a) The accrediting entity... agency's application for full accreditation when it is filed. The accrediting entity must also...

NCI Central Review Board Receives Accreditation

Cancer.gov

The Association for the Accreditation of Human Research Protection Programs has awarded the NCI Central Institutional Review Board full accreditation. AAHRPP awards accreditation to organizations demonstrating the highest ethical standards in clinical res

Editor's Choice - Acute Cardiovascular Care Association Position Paper on Intensive Cardiovascular Care Units: An update on their definition, structure, organisation and function.

PubMed

Bonnefoy-Cudraz, Eric; Bueno, Hector; Casella, Gianni; De Maria, Elia; Fitzsimons, Donna; Halvorsen, Sigrun; Hassager, Christian; Iakobishvili, Zaza; Magdy, Ahmed; Marandi, Toomas; Mimoso, Jorge; Parkhomenko, Alexander; Price, Susana; Rokyta, Richard; Roubille, Francois; Serpytis, Pranas; Shimony, Avi; Stepinska, Janina; Tint, Diana; Trendafilova, Elina; Tubaro, Marco; Vrints, Christiaan; Walker, David; Zahger, Doron; Zima, Endre; Zukermann, Robert; Lettino, Maddalena

2018-02-01

Acute cardiovascular care has progressed considerably since the last position paper was published 10 years ago. It is now a well-defined, complex field with demanding multidisciplinary teamworking. The Acute Cardiovascular Care Association has provided this update of the 2005 position paper on acute cardiovascular care organisation, using a multinational working group. The patient population has changed, and intensive cardiovascular care units now manage a large range of conditions from those simply requiring specialised monitoring, to critical cardiovascular diseases with associated multi-organ failure. To describe better intensive cardiovascular care units case mix, acuity of care has been divided into three levels, and then defining intensive cardiovascular care unit functional organisation. For each level of intensive cardiovascular care unit, this document presents the aims of the units, the recommended management structure, the optimal number of staff, the need for specially trained cardiologists and cardiovascular nurses, the desired equipment and architecture, and the interaction with other departments in the hospital and other intensive cardiovascular care units in the region/area. This update emphasises cardiologist training, referring to the recently updated Acute Cardiovascular Care Association core curriculum on acute cardiovascular care. The training of nurses in acute cardiovascular care is additionally addressed. Intensive cardiovascular care unit expertise is not limited to within the unit's geographical boundaries, extending to different specialties and subspecialties of cardiology and other specialties in order to optimally manage the wide scope of acute cardiovascular conditions in frequently highly complex patients. This position paper therefore addresses the need for the inclusion of acute cardiac care and intensive cardiovascular care units within a hospital network, linking university medical centres, large community hospitals, and smaller

Use of alternative and complementary therapies in labor and delivery care: a cross-sectional study of midwives' training in Catalan hospitals accredited as centers for normal birth.

PubMed

Muñoz-Sellés, Ester; Vallès-Segalés, Antoni; Goberna-Tricas, Josefina

2013-11-15

The use of complementary and alternative medicine (CAM) and complementary and alternative therapies (CAT) during pregnancy is increasing. Scientific evidence for CAM and CAT in the field of obstetrics mainly covers pain relief in labor. Midwives are responsible for labor and delivery care: hence, their knowledge of CAM and CAT is important. The aims of this study are to describe the professional profile of midwives who provide care for natural childbirth in Catalan hospitals accredited as centers for normal birth, to assess midwives' level of training in CAT and their use of these therapies, and to identify specific resources for CAT in labor wards. A descriptive, cross-sectional, quantitative method was used to assess the level of training and use of CAT by midwives working at 28 hospitals in Catalonia, Spain, accredited as public normal birth centers. Just under a third of midwives (30.4%) trained in CAT after completion of basic training. They trained in an average of 5.97 therapies (SD 3.56). The number of CAT in which the midwives were trained correlated negatively with age (r = - 0.284; p < 0.001) and with their time working at the hospital in years (r = - 0.136; p = 0.036). Midwives trained in CAT considered that the following therapies were useful or very useful for pain relief during labor and delivery: relaxation techniques (64.3%), hydrotherapy (84.8%) and the application of compresses to the perineum (75.9%). The availability of resources for providing CAT during normal birth care varied widely from center to center. Age may influence attitudes towards training. It is important to increase the number of midwives trained in CAM for pain relief during childbirth, in order to promote the use of CAT and ensure efficiency and safety. CAT resources at accredited hospitals providing normal childbirth care should also be standardized.

22 CFR 96.21 - Choosing an accrediting entity.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Choosing an accrediting entity. 96.21 Section... Accreditation and Approval § 96.21 Choosing an accrediting entity. (a) An agency that seeks to become accredited must apply to an accrediting entity that is designated to provide accreditation services and that has...

22 CFR 96.21 - Choosing an accrediting entity.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 22 Foreign Relations 1 2011-04-01 2011-04-01 false Choosing an accrediting entity. 96.21 Section... Accreditation and Approval § 96.21 Choosing an accrediting entity. (a) An agency that seeks to become accredited must apply to an accrediting entity that is designated to provide accreditation services and that has...

Latent Growth Modeling of nursing care dependency of acute neurological inpatients.

PubMed

Piredda, M; Ghezzi, V; De Marinis, M G; Palese, A

2015-01-01

Longitudinal three-time point study, addressing how neurological adult patient care dependency varies from the admission time to the 3rd day of acute hospitalization. Nursing care dependency was measured with the Care Dependency Scale (CDS) and a Latent Growth Modeling approach was used to analyse the CDS trend in 124 neurosurgical and stroke inpatients. Care dependence followed a decreasing linear trend. Results can help nurse-managers planning an appropriate amount of nursing care for acute neurological patients during their initial stage of hospitalization. Further studies are needed aimed at investigating the determinants of nursing care dependence during the entire in-hospital stay.

Standardizing communication from acute care providers to primary care providers on critically ill adults.

PubMed

Ellis, Kerri A; Connolly, Ann; Hosseinnezhad, Alireza; Lilly, Craig M

2015-11-01

To increase the frequency of communication of patient information between acute and primary care providers. A secondary objective was to determine whether higher rates of communication were associated with lower rates of hospital readmission 30 days after discharge. A validated instrument was used for telephone surveys before and after an intervention designed to increase the frequency of communication among acute care and primary care providers. The communication intervention was implemented in 3 adult intensive care units from 2 campuses of an academic medical center. The frequency of communication among acute care and primary care providers, the perceived usefulness of the intervention, and its association with 30-day readmission rates were assessed for 202 adult intensive care episodes before and 100 episodes after a communication intervention. The frequency of documented communication increased significantly (5/202 or 2% before to 72/100 or 72% after the intervention; P < .001) and the communication was considered useful by every participating primary care provider. Rates of rehospitalization at 30 days were lower for the intervention group than the preintervention group, but the difference was not statistically significant (41/202 or 23% vs 16/88 or 18% of discharged patients; P = .45; power 0.112 at P = .05). The frequency of communication episodes that provide value can be increased through standardized processes. The key aspects of this effective intervention were setting the expectation that communication should occur, documenting when communication has occurred, and reviewing that documentation during multiprofessional rounds. ©2015 American Association of Critical-Care Nurses.

Accreditation Outcome Scores: Teacher Attitudes toward the Accreditation Process and Professional Development

ERIC Educational Resources Information Center

Ulmer, Phillip Gregory

2015-01-01

Accreditation is an essential component in the history of education in the United States and is a central catalyst for quality education, continuous improvement, and positive growth in student achievement. Although previous researchers identified teachers as an essential component in meeting accreditation outcomes, additional information was…

The Relative Importance of Post-Acute Care and Readmissions for Post-Discharge Spending.

PubMed

Huckfeldt, Peter J; Mehrotra, Ateev; Hussey, Peter S

2016-10-01

To understand what patterns of health care use are associated with higher post-hospitalization spending. Medicare hospital, skilled nursing, inpatient rehabilitation, and home health agency claims, and Medicare enrollment data from 2007 and 2008. For 10 common inpatient conditions, we calculated variation across hospitals in price-standardized and case mix-adjusted Medicare spending in the 30 days following hospital discharge. We estimated the fraction of spending differences between low- and high-spending hospitals attributable to readmissions versus post-acute care, and within post-acute care between inpatient rehabilitation facility (IRF) versus skilled nursing facility (SNF) use. For each service, we distinguished between differences in probability of use and spending conditional on use. We identified index hospital claims and examined hospital and post-acute care occurring within a 30-day period following hospital discharge. For each Medicare Severity Diagnosis-Related Group (MS-DRG) at each hospital, we calculated average price-standardized Medicare payments for readmissions, SNFs, IRFs, and post-acute care overall (also including home health agencies and long-term care hospitals). There was extensive variation across hospitals in Medicare spending in the 30 days following hospital discharge. For example, the interquartile range across hospitals ranged from $1,245 for chronic obstructive pulmonary disease to over $4,000 for myocardial infarction MS-DRGs. The proportion of differences attributable to readmissions versus post-acute care differed across conditions. For myocardial infarction, 74 to 93 percent of the variation was due to readmissions. For hip and femur procedures and joint replacement, 72 to 92 percent of the variation was due to differences in post-acute care spending. There was also variation in the relative importance of the type of post-acute spending. For hip and femur procedures, joint replacement, and stroke, whether patients received IRF

Tracer methodology: an appropriate tool for assessing compliance with accreditation standards?

PubMed

Bouchard, Chantal; Jean, Olivier

2017-10-01

Tracer methodology has been used by Accreditation Canada since 2008 to collect evidence on the quality and safety of care and services, and to assess compliance with accreditation standards. Given the importance of this methodology in the accreditation program, the objective of this study is to assess the quality of the methodology and identify its strengths and weaknesses. A mixed quantitative and qualitative approach was adopted to evaluate consistency, appropriateness, effectiveness and stakeholder synergy in applying the methodology. An online questionnaire was sent to 468 Accreditation Canada surveyors. According to surveyors' perceptions, tracer methodology is an effective tool for collecting useful, credible and reliable information to assess compliance with Qmentum program standards and priority processes. The results show good coherence between methodology components (appropriateness of the priority processes evaluated, activities to evaluate a tracer, etc.). The main weaknesses are the time constraints faced by surveyors and management's lack of cooperation during the evaluation of tracers. The inadequate amount of time allowed for the methodology to be applied properly raises questions about the quality of the information obtained. This study paves the way for a future, more in-depth exploration of the identified weaknesses to help the accreditation organization make more targeted improvements to the methodology. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

Pediatric stroke: clinical characteristics, acute care utilization patterns, and mortality.

PubMed

Statler, Kimberly D; Dong, Li; Nielsen, Denise M; Bratton, Susan L

2011-04-01

Acute care utilization patterns are not well described but may help inform care coordination and treatment for pediatric stroke. The Kids Inpatient Database was queried to describe demographics and clinical characteristics of children with stroke, compare acute care utilization for hemorrhagic vs. ischemic stroke and Children's vs. non-Children's Hospitals, and identify factors associated with aggressive care and in-hospital mortality. Using a retrospective cohort of children hospitalized with stroke, demographics, predisposing conditions, and intensive (mechanical ventilation, advanced monitoring, and blood product administration) or aggressive (pharmacological therapy and/or invasive interventions) care were compared by stroke and hospital types. Factors associated with aggressive care or in-hospital mortality were explored using logistic regression. Hemorrhagic stroke comprised 43% of stroke discharges, was more common in younger children, and carried greater mortality. Ischemic stroke was more common in older children and more frequently associated with a predisposing condition. Rates of intensive and aggressive care were low (30% and 15%), similar by stroke type, and greater at Children's Hospitals. Older age, hemorrhagic stroke, predisposing condition, and treatment at a Children's Hospital were associated with aggressive care. Hemorrhagic stroke and aggressive care were associated with in-hospital mortality. Acute care utilization is similar by stroke type but both intensive and aggressive care are more common at Children's Hospitals. Mortality remains relatively high after pediatric stroke. Widespread implementation of treatment guidelines improved outcomes in adult stroke. Adoption of recently published treatment recommendations for pediatric stroke may help standardize care and improve outcomes.

Accreditation Status and Geographic Location of Outpatient Echocardiographic Testing Facilities Among Medicare Beneficiaries: The VALUE-ECHO Study.

PubMed

Brown, Scott C; Wang, Kefeng; Dong, Chuanhui; Yi, Li; Marinovic Gutierrez, Carolina; Di Tullio, Marco R; Farrell, Mary Beth; Burgess, Pamela; Gornik, Heather L; Hamburg, Naomi M; Needleman, Laurence; Orsinelli, David; Robison, Susana; Rundek, Tatjana

2018-02-01

and interpretation protocols from a single accrediting body is important to facilitate optimal cardiovascular care. © 2017 by the American Institute of Ultrasound in Medicine.

77 FR 19290 - Medicare and Medicaid Programs; Renewal of Deeming Authority of the Accreditation Association for...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-03-30

... Ambulatory Health Care, Inc. for Medicare Advantage Health Maintenance Organizations and Local Preferred... Accreditation Association for Ambulatory Health Care, Inc. (AAAHC) for Health Maintenance Organizations and....165(b). AOs that apply for MA deeming authority are generally recognized by the health care industry...

Association of Cost Sharing With Mental Health Care Use, Involuntary Commitment, and Acute Care

PubMed Central

Schachar, Eli B.; Beekman, Aartjan T. F.; Janssen, Richard T. J. M.; Jeurissen, Patrick P. T.

2017-01-01

Importance A higher out-of-pocket price for mental health care may lead not only to cost savings but also to negative downstream consequences. Objective To examine the association of higher patient cost sharing with mental health care use and downstream effects, such as involuntary commitment and acute mental health care use. Design, Setting, and Participants This difference-in-differences study compared changes in mental health care use by adults, who experienced an increase in cost sharing, with changes in youths, who did not experience the increase and thus formed a control group. The study examined all 2 780 558 treatment records opened from January 1, 2010, through December 31, 2012, by 110 organizations that provide specialist mental health care in the Netherlands. Data analysis was performed from January 18, 2016, to May 9, 2017. Exposures On January 1, 2012, the Dutch national government increased the out-of-pocket price of mental health services for adults by up to €200 (US$226) per year for outpatient treatment and €150 (US$169) per month for inpatient treatment. Main Outcomes and Measures The number of treatment records opened each day in regular specialist mental health care, involuntary commitment, and acute mental health care, and annual specialist mental health care spending. Results This study included 1 448 541 treatment records opened from 2010 to 2012 (mean [SD] age, 41.4 [16.7] years; 712 999 men and 735 542 women). The number of regular mental health care records opened for adults decreased abruptly and persistently by 13.4% (95% CI, −16.0% to −10.8%; P < .001) per day when cost sharing was increased in 2012. The decrease was substantial and significant for severe and mild disorders and larger in low-income than in high-income neighborhoods. Simultaneously, in 2012, daily record openings increased for involuntary commitment by 96.8% (95% CI, 87.7%-105.9%; P < .001) and for acute mental health care by 25.1% (95% CI, 20

22 CFR 96.99 - Converting an application for temporary accreditation to an application for full accreditation.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Converting an application for temporary accreditation to an application for full accreditation. 96.99 Section 96.99 Foreign Relations DEPARTMENT OF... INTERCOUNTRY ADOPTION ACT OF 2000 (IAA) Procedures and Standards Relating to Temporary Accreditation § 96.99...

7 CFR 205.506 - Granting accreditation.

Code of Federal Regulations, 2010 CFR

2010-01-01

..., Inspections, Marketing Practices), DEPARTMENT OF AGRICULTURE (CONTINUED) ORGANIC FOODS PRODUCTION ACT PROVISIONS NATIONAL ORGANIC PROGRAM Accreditation of Certifying Agents § 205.506 Granting accreditation. (a... accreditation as provided in § 205.510(c), the certifying agent voluntarily ceases its certification activities...

Developing a customised approach for strengthening tuberculosis laboratory quality management systems toward accreditation

PubMed Central

Trollip, Andre; Erni, Donatelle; Kao, Kekeletso

2017-01-01

Background Quality-assured tuberculosis laboratory services are critical to achieve global and national goals for tuberculosis prevention and care. Implementation of a quality management system (QMS) in laboratories leads to improved quality of diagnostic tests and better patient care. The Strengthening Laboratory Management Toward Accreditation (SLMTA) programme has led to measurable improvements in the QMS of clinical laboratories. However, progress in tuberculosis laboratories has been slower, which may be attributed to the need for a structured tuberculosis-specific approach to implementing QMS. We describe the development and early implementation of the Strengthening Tuberculosis Laboratory Management Toward Accreditation (TB SLMTA) programme. Development The TB SLMTA curriculum was developed by customizing the SLMTA curriculum to include specific tools, job aids and supplementary materials specific to the tuberculosis laboratory. The TB SLMTA Harmonized Checklist was developed from the World Health Organisation Regional Office for Africa Stepwise Laboratory Quality Improvement Process Towards Accreditation checklist, and incorporated tuberculosis-specific requirements from the Global Laboratory Initiative Stepwise Process Towards Tuberculosis Laboratory Accreditation online tool. Implementation Four regional training-of-trainers workshops have been conducted since 2013. The TB SLMTA programme has been rolled out in 37 tuberculosis laboratories in 10 countries using the Workshop approach in 32 laboratories in five countries and the Facility-based approach in five tuberculosis laboratories in five countries. Conclusion Lessons learnt from early implementation of TB SLMTA suggest that a structured training and mentoring programme can build a foundation towards further quality improvement in tuberculosis laboratories. Structured mentoring, and institutionalisation of QMS into country programmes, is needed to support tuberculosis laboratories to achieve

Utilization of acute care among patients with ESRD discharged home from skilled nursing facilities.

PubMed

Hall, Rasheeda K; Toles, Mark; Massing, Mark; Jackson, Eric; Peacock-Hinton, Sharon; O'Hare, Ann M; Colón-Emeric, Cathleen

2015-03-06

Older adults with ESRD often receive care in skilled nursing facilities (SNFs) after an acute hospitalization; however, little is known about acute care use after SNF discharge to home. This study used Medicare claims for North and South Carolina to identify patients with ESRD who were discharged home from a SNF between January 1, 2010 and August 31, 2011. Nursing Home Compare data were used to ascertain SNF characteristics. The primary outcome was time from SNF discharge to first acute care use (hospitalization or emergency department visit) within 30 days. Cox proportional hazards models were used to identify patient and facility characteristics associated with the outcome. Among 1223 patients with ESRD discharged home from a SNF after an acute hospitalization, 531 (43%) had at least one rehospitalization or emergency department visit within 30 days. The median time to first acute care use was 37 days. Characteristics associated with a shorter time to acute care use were black race (hazard ratio [HR], 1.25; 95% confidence interval [95% CI], 1.04 to 1.51), dual Medicare-Medicaid coverage (HR, 1.24; 95% CI, 1.03 to 1.50), higher Charlson comorbidity score (HR, 1.07; 95% CI, 1.01 to 1.12), number of hospitalizations during the 90 days before SNF admission (HR, 1.12; 95% CI, 1.03 to 1.22), and index hospital discharge diagnoses of cellulitis, abscess, and/or skin ulcer (HR, 2.59; 95% CI, 1.36 to 4.45). Home health use after SNF discharge was associated with a lower rate of acute care use (HR, 0.72; 95% CI, 0.59 to 0.87). There were no statistically significant associations between SNF characteristics and time to first acute care use. Almost one in every two older adults with ESRD discharged home after a post-acute SNF stay used acute care services within 30 days of discharge. Strategies to reduce acute care utilization in these patients are needed. Copyright © 2015 by the American Society of Nephrology.

Accreditation versus Certification: Which?

ERIC Educational Resources Information Center

Totten, Herman L.

1989-01-01

Describes and compares the process used for accreditation of postsecondary programs of education for librarianship, and the existing programs and justification for certification of individual librarians. An argument for the advantages of institutional accreditation over individual certification is presented. (13 references) (CLB)

Proposed Accreditation Standards for Degree-Granting Correspondence Programs Offered by Accredited Institutions.

ERIC Educational Resources Information Center

McGraw-Hill Continuing Education Center, Washington, DC.

A study on proposed accreditation standards grew out of a need to (1) stimulate the growth of quality correspondence degree programs; and (2) provide a policy for accreditation of correspondence degree programs so that graduates would be encouraged to pursue advanced degree programs offered elsewhere by educational institutions. The study focused…

Examination of the Use of Healing Touch by Registered Nurses in the Acute Care Setting.

PubMed

Anderson, Joel G; Friesen, Mary Ann; Swengros, Diane; Herbst, Anna; Mangione, Lucrezia

2017-03-01

Acute care nursing is currently undergoing unprecedented change, with health systems becoming more open to nonpharmacological approaches to patient care. Healing Touch (HT) may be a valuable intervention for acute care patients. Research has shown that HT helps both the patient and the caregiver; however, no study to date has examined the impact that the education of nurses in and their use of HT have on daily care delivery in the acute care setting. The purpose of the current qualitative study was to examine the use of HT by registered nurses in the acute care setting during their delivery of patient care, as well as the impact of education in and use of HT on the nurses themselves. Five themes were identified: (1) use of HT techniques, processes, and sequence; (2) outcomes related to HT; (3) integration of HT into acute care nursing practice; (4) perceptions of HT, from skepticism to openness; and (5) transformation through HT. Education in HT and delivery of this modality by nurses in the acute care setting provide nurses with a transformative tool to improve patient outcomes.

76 FR 51475 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-18

... Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment... Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective...-related costs of acute care hospitals to implement changes arising from our continuing experience with...

78 FR 50495 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-19

... Prospective Payment Systems for Acute Care Hospitals and the Long Term Care; Hospital Prospective Payment... Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective... prospective payment systems (IPPS) for operating and capital-related costs of acute care hospitals to...

75 FR 50041 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-16

... Prospective Payment Systems for Acute Care Hospitals and the Long Term Care Hospital Prospective Payment... Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment... inpatient prospective payment systems (IPPS) for operating and capital-related costs of acute care hospitals...

Guide to Accreditation, 2012. [December 2011 Revision

ERIC Educational Resources Information Center

Teacher Education Accreditation Council, 2012

2012-01-01

The Teacher Education Accreditation Council's (TEAC's) "Guide to Accreditation" is primarily for the faculty, staff, and administrators of TEAC member programs. It is designed for use in preparing for both initial and continuing accreditation. Program personnel should understand and accept all the components of the TEAC accreditation process…

Acute Care Utilization by Patients After Graduation of Their Resident Primary Care Physicians.

PubMed

Solomon, Sonja R; Gooding, Holly C; Reyes Nieva, Harry; Linder, Jeffrey A

2015-11-01

The disruption in provider continuity caused by medical resident graduation may result in adverse patient outcomes. Our aim was to investigate whether resident graduation was associated with increased acute care utilization by residents' primary care patients. This was a retrospective cohort study of patients cared for by junior and senior residents finishing the academic year in 2010, 2011 and 2012. We compared rates of clinic visits, emergency department (ED) visits, and hospitalizations between transitioning patients whose residents were graduating and non-transitioning patients whose residents were not graduating. Our study population comprised 90 residents, 4018 unique patients, and 5988 resident-patient dyads that transitioned (n = 3136) or did not transition (n = 2852). For transitioning patients, the clinic visit rate per 100 patients in the 4 months before and after graduation was 129 and 102, respectively; for non-transitioning patients, the clinic visit rate was 119 and 94, respectively (difference-in-differences, +2 per 100 patients; p = 0.12). For transitioning patients, the ED visit rate per 100 patients before and after graduation was 29 and 26, respectively; for non-transitioning patients, the ED visit rate was 28 and 25, respectively (difference-in-differences, 0; p = 0.49). For transitioning patients, the hospitalization rate per 100 patients before and after graduation was 14 and 13, respectively; for non-transitioning patients, the hospitalization rate was 15 and 12, respectively (difference-in-differences, -2; p = 0.20). In multivariable modeling there was no increased risk for transitioning patients for clinic visits (adjusted rate ratio [aRR], 1.03; 95 % confidence interval [CI], 0.97 to 1.10), ED visits (aRR, 1.05; 95 % CI, 0.92 to 1.20), or hospitalizations (aRR, 1.04; 95 % CI, 0.83 to 1.31). Acute care utilization by residents' patients did not increase or decrease after graduation. Acute care utilization was high

St George Acute Care Team: the local variant of crisis resolution model of care.

PubMed

Cupina, Denise D; Wand, Anne P F; Phelan, Emma; Atkin, Rona

2016-10-01

The objective of this study was to describe functioning and clinical activities of the St George Acute Care Team and how it compares to the typical crisis resolution model of care. Descriptive data including demographics, sources of referral, type of clinical intervention, length of stay, diagnoses and outcomes were collected from records of all patients who were discharged from the team during a 10 week period. There were 677 referrals. The team's functions consisted of post-discharge follow-up (31%), triage and intake (30%), case management support (23%) and acute community based assessment and treatment (16%). The average length of stay was 5 days. The majority of patients were diagnosed with a mood (23%) or a psychotic (25%) disorder. Points of contrast to other reported crisis resolution teams include shorter length of stay, relatively less focus on direct clinical assessment and more telephone follow-up and triage. St George Acute Care Team provides a variety of clinical activities. The focus has shifted away from the original model of crisis resolution care to meet local and governmental requirements. © The Royal Australian and New Zealand College of Psychiatrists 2016.

9 CFR 439.50 - Refusal of accreditation.

Code of Federal Regulations, 2010 CFR

2010-01-01

... ACCREDITATION OF NON-FEDERAL CHEMISTRY LABORATORIES § 439.50 Refusal of accreditation. Upon a determination by the Administrator, a laboratory will be refused accreditation for the following reasons: (a) A laboratory will be refused accreditation for failure to meet the requirements of § 439.5 or § 439.10 of this...

Distinctions among Accreditation Agencies for Business Programs

ERIC Educational Resources Information Center

Corcoran, Charles P.

2007-01-01

Over the past twenty years, business accreditation has become a growth industry. In 1988, some eleven percent of business programs were accredited by an accrediting body devoted solely to business program accreditation. Today, over forty-two percent boast of such external validation of their programs. Although the three principal accrediting…

42 CFR 414.68 - Imaging accreditation.

Code of Federal Regulations, 2011 CFR

2011-10-01

... of the organization's data management and analysis system for its surveys and accreditation decisions... organizations. (iv) Notify CMS, in writing, at least 30 calendar days in advance of the effective date of any... to designate and approve independent accreditation organizations for purposes of accrediting...

42 CFR 414.68 - Imaging accreditation.

Code of Federal Regulations, 2010 CFR

2010-10-01

... of the organization's data management and analysis system for its surveys and accreditation decisions... organizations. (iv) Notify CMS, in writing, at least 30 calendar days in advance of the effective date of any... to designate and approve independent accreditation organizations for purposes of accrediting...

The impact of accreditation of primary healthcare centers: successes, challenges and policy implications as perceived by healthcare providers and directors in Lebanon

PubMed Central

2014-01-01

Background In 2009, the Lebanese Ministry of Public Health (MOPH) launched the Primary Healthcare (PHC) accreditation program to improve quality across the continuum of care. The MOPH, with the support of Accreditation Canada, conducted the accreditation survey in 25 PHC centers in 2012. This paper aims to gain a better understanding of the impact of accreditation on quality of care as perceived by PHC staff members and directors; how accreditation affected staff and patient satisfaction; key enablers, challenges and strategies to improve implementation of accreditation in PHC. Methods The study was conducted in 25 PHC centers using a cross-sectional mixed methods approach; all staff members were surveyed using a self-administered questionnaire whereas semi-structured interviews were conducted with directors. Results The scales measuring Management and Leadership had the highest mean score followed by Accreditation Impact, Human Resource Utilization, and Customer Satisfaction. Regression analysis showed that Strategic Quality Planning, Customer Satisfaction and Staff Involvement were associated with a perception of higher Quality Results. Directors emphasized the benefits of accreditation with regards to documentation, reinforcement of quality standards, strengthened relationships between PHC centers and multiple stakeholders and improved staff and patient satisfaction. Challenges encountered included limited financial resources, poor infrastructure, and staff shortages. Conclusions To better respond to population health needs, accreditation is an important first step towards improving the quality of PHC delivery arrangement system. While there is a need to expand the implementation of accreditation to cover all PHC centers in Lebanon, considerations should be given to strengthening their financial arrangements as well. PMID:24568632

Insurance and Quality of Care for Adults with Acute Asthma

PubMed Central

Ferris, Timothy G; Blumenthal, David; Woodruff, Prescott G; Clark, Sunday; Camargo, Carlos A

2002-01-01

OBJECTIVE The relationship between health care insurance and quality of medical care remains incompletely studied. We sought to determine whether type of patient insurance is related to quality of care and subsequent outcomes for patients who arrive in the emergency department (ED) for acute asthma. DESIGN Using prospectively collected data from the Multicenter Airway Research Collaboration, we compared measures of quality of pre-ED care, acute severity, and short-term outcomes across 4 insurance categories: managed care, indemnity, Medicaid, and uninsured. SETTING AND PARTICIPANTS Emergency departments at 57 academic medical centers enrolled 1,019 adults with acute asthma. RESULTS Patients with managed care ranked first and uninsured patients ranked last on all 7 unadjusted quality measures. After controlling for covariates, uninsured patients had significantly lower quality of care than indemnity patients for 5 of 7 measures and had lower initial peak expiratory flow rates than indemnity insured patients. Patients with managed care insurance were more likely than indemnity-insured patients to identify a primary care physician and report using inhaled steroids in the month prior to arrival in the ED. Patients with Medicaid insurance were more likely than indemnity-insured patients to use the ED as their usual source of care for problems with asthma. We found no differences in patient outcomes among the insurance categories we studied. CONCLUSIONS Uninsured patients had consistently poorer quality of care and than insured patients. Despite differences in indicators of quality of care between types of insurance, we found no differences in short-term patient outcomes by type of insurance. PMID:12472926

IS 2010 and ABET Accreditation: An Analysis of ABET-Accredited Information Systems Programs

ERIC Educational Resources Information Center

Saulnier, Bruce; White, Bruce

2011-01-01

Many strong forces are converging on information systems academic departments. Among these forces are quality considerations, accreditation, curriculum models, declining/steady student enrollments, and keeping current with respect to emerging technologies and trends. ABET, formerly the Accrediting Board for Engineering and Technology, is at…

Urban Telemedicine Enables Equity in Access to Acute Illness Care.

PubMed

Ronis, Sarah D; McConnochie, Kenneth M; Wang, Hongyue; Wood, Nancy E

2017-02-01

Children with care for acute illness available through the Health-e-Access telemedicine model at childcare and schools were previously found to have 22% less emergency department (ED) use than counterparts without this service, but they also had 24% greater acute care use overall. We assessed the hypothesis that increased utilization reflected improved access among impoverished inner-city children to a level experienced by more affluent suburban children. This observational study compared utilization among children without and with telemedicine access, beginning in 1993, ending in 2007, and based on 84,287 child-months of billing claims-based observation. Health-e-Access Telemedicine was initiated in stepwise manner over 187 study-months among 74 access sites (childcare, schools, community centers), beginning in month 105. Children dwelled in inner city, rest-of-city Rochester, NY, or in surrounding suburbs. Rate of total acute care visits (office, ED, telemedicine) was measured as visits per 100 child-years. Observed utilization rates were adjusted in multivariate analysis for age, sex, insurance type, and season of year. When both suburban and inner-city children lacked telemedicine access, overall acute illness visits were 75% greater among suburban than inner-city children (suburban:inner-city rate ratio 1.75, p < 0.0001). After telemedicine became available to inner-city children, their overall acute visits approximated those of suburban children (suburban:inner-city rate ratio 0.80, p = 0.07), whereas acute visits among suburban children remained at least (worst-case comparison) 56% greater than inner-city children without telemedicine (rate ratio 1.56, p < 0.0001). At baseline, overall acute illness utilization of suburban children exceeded that of inner-city children. Overall utilization for inner-city children increased with telemedicine to that of suburban children at baseline. Without telemedicine, however, inner-city use remained

Patient Nonadherence to Guideline-Recommended Care in Acute Low Back Pain.

PubMed

Bier, Jasper D; Kamper, Steven J; Verhagen, Arianne P; Maher, Christopher G; Williams, Christopher M

2017-12-01

To describe the magnitude of patient-reported nonadherence with guideline-recommended care for acute low back pain. Secondary analysis of data from participants enrolled in the Paracetamol for Acute Low Back Pain study trial, a randomized controlled trial evaluating the effectiveness of paracetamol for acute low back pain. Primary care, general practitioner. Data from participants with acute low back pain (N=1643). Guideline-recommended care, including reassurance, simple analgesia, and the advice to stay active and avoid bed rest. Also, advice against additional treatments and referral for imaging. Proportion of nonadherence with guideline-recommended care. Nonadherence was defined as (1) failure to consume the advised paracetamol dose, or (2) receipt of additional health care, tests, or medication during the trial treatment period (4wk). Multivariable logistic regression analysis was performed to determine the factors associated with nonadherence. In the first week of treatment, 39.7% of participants were classified as nonadherent. Over the 4-week treatment period, 70.0% were nonadherent, and 57.5% did not complete the advised paracetamol regimen. Higher perceived risk of persistent pain, lower level of disability, and not claiming workers' compensation were associated with nonadherence, with odds ratios ranging from .46 to 1.05. Adherence to guideline-recommended care for acute low back pain was poor. Most participants do not complete the advised paracetamol regimen. Higher perceived risk of persistence of complaints, lower baseline disability, and participants not claiming workers' compensation were independently associated with nonadherence. Copyright © 2017 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Trends in Accreditation Council for Graduate Medical Education Accreditation for Subspecialty Fellowship Training in Plastic Surgery.

PubMed

Silvestre, Jason; Serletti, Joseph M; Chang, Benjamin

2018-05-01

The purposes of this study were to (1) determine the proportion of plastic surgery residents pursuing subspecialty training relative to other surgical specialties, and (2) analyze trends in Accreditation Council for Graduate Medical Education accreditation of plastic surgery subspecialty fellowship programs. The American Medical Association provided data on career intentions of surgical chief residents graduating from 2014 to 2016. The percentage of residents pursuing fellowship training was compared by specialty. Trends in the proportion of accredited fellowship programs in craniofacial surgery, hand surgery, and microsurgery were analyzed. The percentage of accredited programs was compared between subspecialties with added-certification options (hand surgery) and subspecialties without added-certification options (craniofacial surgery and microsurgery). Most integrated and independent plastic surgery residents pursued fellowship training (61.8 percent versus 49.6 percent; p = 0.014). Differences existed by specialty from a high in orthopedic surgery (90.8 percent) to a low in colon and rectal surgery (3.2 percent). From 2005 to 2015, the percentage of accredited craniofacial fellowship programs increased, but was not significant (from 27.8 percent to 33.3 percent; p = 0.386). For hand surgery, the proportion of accredited programs that were plastic surgery (p = 0.755) and orthopedic surgery (p = 0.253) was stable, whereas general surgery decreased (p = 0.010). Subspecialty areas with added-certification options had more accredited fellowships than those without (100 percent versus 19.2 percent; p < 0.001). There has been slow adoption of accreditation among plastic surgery subspecialty fellowships, but added-certification options appear to be highly correlated.

A systems engineering approach to AIS accreditation

DOE Office of Scientific and Technical Information (OSTI.GOV)

Harris, L.M.; Hunteman, W.J.

1994-04-01

The systems engineering model provides the vehicle for communication between the developer and the customer by presenting system facts and demonstrating the system in an organized form. The same model provides implementors with views of the system`s function and capability. The authors contend that the process of obtaining accreditation for a classified Automated Information System (AIS) adheres to the typical systems engineering model. The accreditation process is modeled as a ``roadmap`` with the customer represented by the Designed Accrediting Authority. The ``roadmap`` model reduces the amount of accreditation knowledge required of an AIS developer and maximizes the effectiveness of participationmore » in the accreditation process by making the understanding of accreditation a natural consequence of applying the model. This paper identifies ten ``destinations`` on the ``road`` to accreditation. The significance of each ``destination`` is explained, as are the potential consequences of its exclusion. The ``roadmap,`` which has been applied to a range of information systems throughout the DOE community, establishes a paradigm for the certification and accreditation of classified AISs.« less

Cardiac acute care nurse practitioner and 30-day readmission.

PubMed

David, Daniel; Britting, Lorraine; Dalton, Joanne

2015-01-01

The utilization outcomes of nurse practitioners (NPs) in the acute care setting have not been widely studied. The purpose of this study was to determine the impact on utilization outcomes of NPs on medical teams who take care of patients admitted to a cardiovascular intensive care unit. A retrospective 2-group comparative design was used to evaluate the outcomes of 185 patients with ST- or non ST-segment elevation myocardial infarction or heart failure who were admitted to a cardiovascular intensive care unit in an urban medical center. Patients received care from a medical team that included a cardiac acute care NP (n = 109) or medical team alone (n = 76). Patient history, cardiac assessment, medical interventions, discharge disposition, discharge time, and 3 utilization outcomes (ie, length of stay, 30-day readmission, and time of discharge) were compared between the 2 treatment groups. Logistic regression was used to identify predictors of 30-day readmission. Patients receiving care from a medical team that included an NP were rehospitalized approximately 50% less often compared with those receiving care from a medical team without an NP. Thirty-day hospital readmission (P = .011) and 30-day return rates to the emergency department (P = .021) were significantly lower in the intervention group. Significant predictors for rehospitalization included diagnosis of heart failure versus myocardial infarction (odds ratio [OR], 3.153, P = 0.005), treatment by a medical team without NP involvement (OR, 2.905, P = 0.008), and history of diabetes (OR, 2.310, P = 0.032). The addition of a cardiac acute care NP to medical teams caring for myocardial infarction and heart failure patients had a positive impact on 30-day emergency department return and hospital readmission rates.

38 CFR 21.4253 - Accredited courses.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 2 2013-07-01 2013-07-01 false Accredited courses. 21...) VOCATIONAL REHABILITATION AND EDUCATION Administration of Educational Assistance Programs Courses § 21.4253 Accredited courses. (a) General. A course may be approved as an accredited course if it meets one of the...

38 CFR 21.4253 - Accredited courses.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 2 2014-07-01 2014-07-01 false Accredited courses. 21...) VOCATIONAL REHABILITATION AND EDUCATION Administration of Educational Assistance Programs Courses § 21.4253 Accredited courses. (a) General. A course may be approved as an accredited course if it meets one of the...

38 CFR 21.4253 - Accredited courses.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 2 2012-07-01 2012-07-01 false Accredited courses. 21...) VOCATIONAL REHABILITATION AND EDUCATION Administration of Educational Assistance Programs Courses § 21.4253 Accredited courses. (a) General. A course may be approved as an accredited course if it meets one of the...

Accreditation for Armed Forces Educational Institutions.

ERIC Educational Resources Information Center

Tarquine, Robert Blaine

The report established the need for educational accreditation and consolidates the various means of achieving accreditation that are available to the Armed Forces, into one accessible reference. The scope of each accrediting method is presented in detail, allowing educational officials to evaluate the methods in respect to their individual…

Meeting ACGME Standards Under a Unified Accreditation System: Challenges for Osteopathic Graduate Medical Education Programs.

PubMed

Cummings, Mark

2017-07-01

In 2014, the American Osteopathic Association (AOA) and the American Association of Colleges of Osteopathic Medicine signed a memorandum of understanding (MOU) with the Accreditation Council for Graduate Medical Education (ACGME) to create a unified accreditation system for graduate medical education (GME) under the ACGME. The AOA will cease to accredit GME programs on June 30, 2020. By then, AOA-accredited programs need to apply for and achieve ACGME initial accreditation. The terms of the MOU also made it advantageous for some formerly nonteaching hospitals to establish AOA programs, chiefly in primary care, as a step toward future ACGME accreditation.In transitioning AOA programs to the ACGME system, hospitals with osteopathic GME can expect to encounter challenges related to major differences between AOA and ACGME standards. The minimum numbers of residents for ACGME programs in most specialties are greater than those for AOA programs, which will require hospitals that may already be at their federal caps to add additional residency positions. ACGME standards are also more faculty- and staff-intensive and require additional infrastructure, necessitating additional financial investments. In addition, greater curricular specificity in ACGME standards will generate new educational and financial challenges.To address these challenges, hospitals may need to reallocate resources and positions among their current AOA programs, reducing the number of programs (and specialties) they sponsor. It is expected that a number of established and new AOA programs will choose not to pursue ACGME accreditation or will fail to qualify for ACGME initial accreditation.

Orthopaedic traumatology: fundamental principles and current controversies for the acute care surgeon

PubMed Central

Pharaon, Shad K; Schoch, Shawn; Marchand, Lucas; Mirza, Amer

2018-01-01

Multiply injured patients with fractures are co-managed by acute care surgeons and orthopaedic surgeons. In most centers, orthopaedic surgeons definitively manage fractures, but preliminary management, including washouts, splinting, reductions, and external fixations, may be performed by selected acute care surgeons. The acute care surgeon should have a working knowledge of orthopaedic terminology to communicate with colleagues effectively. They should have an understanding of the composition of bone, periosteum, and cartilage, and their reaction when there is an injury. Fractures are usually fixed urgently, but some multiply injured patients are better served with a damage control strategy. Extremity compartment syndrome should be suspected in all critically injured patients with or without fractures and a low threshold for compartment pressure measurements or empiric fasciotomy maintained. Acute care surgeons performing rib fracture fixation and other chest wall injury reconstructions should follow the principles of open fracture reduction and stabilization. PMID:29766123

Orthopaedic traumatology: fundamental principles and current controversies for the acute care surgeon.

PubMed

Pharaon, Shad K; Schoch, Shawn; Marchand, Lucas; Mirza, Amer; Mayberry, John

2018-01-01

Multiply injured patients with fractures are co-managed by acute care surgeons and orthopaedic surgeons. In most centers, orthopaedic surgeons definitively manage fractures, but preliminary management, including washouts, splinting, reductions, and external fixations, may be performed by selected acute care surgeons. The acute care surgeon should have a working knowledge of orthopaedic terminology to communicate with colleagues effectively. They should have an understanding of the composition of bone, periosteum, and cartilage, and their reaction when there is an injury. Fractures are usually fixed urgently, but some multiply injured patients are better served with a damage control strategy. Extremity compartment syndrome should be suspected in all critically injured patients with or without fractures and a low threshold for compartment pressure measurements or empiric fasciotomy maintained. Acute care surgeons performing rib fracture fixation and other chest wall injury reconstructions should follow the principles of open fracture reduction and stabilization.

The Federal Regulation of Accrediting. Draft.

ERIC Educational Resources Information Center

Orlans, Harold

The meaning of accreditation and how it has evolved is discussed, and the relationship between accrediting agencies and the federal government is examined. Accrediting agencies derive from the federal government the power to designate which school shall be eligible for federal student assistance programs and/or a national recognition and stimulus…

Trivializing Teacher Education: The Accreditation Squeeze

ERIC Educational Resources Information Center

Johnson, Dale D.; Johnson, Bonnie; Farenga, Stephen J.; Ness, Daniel

2005-01-01

This book presents a critical analysis of the National Council for Accreditation of Teacher Education (NCATE). This accreditation organization has been in existence for 50 years and claims to accredit approximately 700 teacher education programs that prepare two-thirds of the nation's teachers. There is no convincing research, however, that…

[Accreditation of forensic laboratories].

PubMed

Sołtyszewski, Ireneusz

2010-01-01

According to the framework decision of the European Union Council, genetic laboratories which perform tests for the benefit of the law enforcement agencies and the administration of justice are required to obtain a certificate of accreditation testifying to compliance with the PN EN ISO/IEC 17025:2005 standard. The certificate is the official confirmation of the competence to perform research, an acknowledgement of credibility, impartiality and professional independence. It is also the proof of establishment, implementation and maintenance of an appropriate management system. The article presents the legal basis for accreditation, the procedure of obtaining the certificate of accreditation and selected elements of the management system.

Components of nurse innovation: a model from acute care hospitals.

PubMed

Neidlinger, S H; Drews, N; Hukari, D; Bartleson, B J; Abbott, F K; Harper, R; Lyon, J

1992-12-01

Components that promote nurse innovation in acute care hospitals are explicated in the Acute Care Nursing Innovation Model. Grounded in nursing care delivery systems and excellent management-organizations perspectives, nurse executives and 30 nurse "intrapreneurs" from 10 innovative hospitals spanning the United States shared their experiences and insights through semistructured, tape-recorded telephone interviews. Guided by interpretive interactionist strategies, the essential components, characteristics, and interrelationships are conceptualized and described so that others may be successful in their innovative endeavors. Successful innovation is dependent on the fit between and among the components; the better the fit, the more likely the innovation will succeed.

Guide to Accreditation, 2010

ERIC Educational Resources Information Center

Teacher Education Accreditation Council, 2010

2010-01-01

The Teacher Education Accreditation Council (TEAC), founded in 1997, is dedicated to improving academic degree and certificate programs for professional educators--those who teach and lead in schools, pre-K through grade 12, and to assuring the public of their quality. TEAC accredits undergraduate and graduate programs, including alternate route…

Accreditation of Distance Learning

ERIC Educational Resources Information Center

Demirel, Ergün

2016-01-01

The higher education institutes aspire to gain reputation of quality having accreditation from internationally recognized awarding bodies. The accreditation leads and provides quality assurance for education. Although distance learning becomes a significant part of the education system in the 21st century, there is still a common opinion that the…

A Handbook of Accreditation.

ERIC Educational Resources Information Center

North Central Association of Colleges and Schools, Chicago, IL. Commission on Institutions of Higher Education.

An overview is presented of the accreditation process of the Commission on Institutions of Higher Education, along with a brief history of how that process has evolved. The handbook is divided into the following chapters: (1) introduction (meaning and purposes of accreditation, the evaluation of the Commission's evaluative principles, and the…

Issues experienced while administering care to patients with dementia in acute care hospitals: A study based on focus group interviews

PubMed Central

Fukuda, Risa; Shimizu, Yasuko

2015-01-01

Objective Dementia is a major public health problem. More and more patients with dementia are being admitted to acute care hospitals for treatment of comorbidities. Issues associated with care of patients with dementia in acute care hospitals have not been adequately clarified. This study aimed to explore the challenges nurses face in providing care to patients with dementia in acute care hospitals in Japan. Methods This was a qualitative study using focus group interviews (FGIs). The setting was six acute hospitals with surgical and medical wards in the western region of Japan. Participants were nurses in surgical and internal medicine wards, excluding intensive care units. Nurses with less than 3 years working experience, those without experience in dementia patient care in their currently assigned ward, and head nurses were excluded from participation. FGIs were used to collect data from February to December 2008. Interviews were scheduled for 1–1.5 h. The qualitative synthesis method was used for data analysis. Results In total, 50 nurses with an average experience of 9.8 years participated. Eight focus groups were formed. Issues in administering care to patients with dementia at acute care hospitals were divided into seven groups. Three of these groups, that is, problematic patient behaviors, recurrent problem, and problems affecting many people equally, interact to result in a burdensome cycle. This cycle is exacerbated by lack of nursing experience and lack of organization in hospitals. In coping with this cycle, the nurses develop protection plans for themselves and for the hospital. Conclusions The two main issues experienced by nurses while administering care to patients with dementia in acute care hospitals were as follows: (a) the various problems and difficulties faced by nurses were interactive and caused a burdensome cycle, and (b) nurses do their best to adapt to these conditions despite feeling conflicted. PMID:25716983

21 CFR 900.13 - Revocation of accreditation and revocation of accreditation body approval.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Revocation of accreditation and revocation of accreditation body approval. 900.13 Section 900.13 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MAMMOGRAPHY QUALITY STANDARDS ACT MAMMOGRAPHY Quality Standards and...

Professional Accreditation for International Continuing Education.

ERIC Educational Resources Information Center

Edelson, Paul Jay

It is reasonable to argue that the members of a profession are the only ones who can directly address issues of accreditation. In the context of accreditation for international continuing education, it may be argued that professional organizations in continuing education cannot function as accrediting bodies except in the sense that they determine…

Safe patient handling perceptions and practices: a survey of acute care physical therapists.

PubMed

Olkowski, Brian F; Stolfi, Angela M

2014-05-01

Acute care physical therapists are at risk for developing work-related musculoskeletal disorders (WMSDs) due to manual patient handling. Safe patient handling (SPH) reduces WMSDs caused by manual handling. The purpose of this study was to describe the patient handling practices of acute care physical therapists and their perceptions regarding SPH. Additionally, this study determined whether an SPH program influences the patient handling practices and perceptions regarding SPH of acute care physical therapists. Subscribers to the electronic discussion board of American Physical Therapy Association's Acute Care Section were invited to complete a survey questionnaire. The majority of respondents used SPH equipment and practices (91.1%), were confident using SPH equipment and practices (93.8%), agreed that evidence supports the use of SPH equipment and practices (87.0%), and reported the use of SPH equipment and practices is feasible (92.2%). Respondents at a facility with an SPH program were more likely to use SPH equipment and practices, have received training in the use of SPH equipment and practices, agree that the use of SPH equipment and practices is feasible, and feel confident using SPH equipment and practices. The study might not reflect the perceptions and practices of the population of acute care physical therapists. Acute care physical therapists are trained to use SPH equipment and practices, use SPH equipment and practices, and have positive perceptions regarding SPH. Acute care physical therapists in a facility with an SPH program are more likely to use SPH equipment and practices, receive training in SPH equipment and practices, and have positive perceptions regarding SPH. Quasi-regulatory organizations should incorporate SPH programs into their evaluative standards.

9 CFR 439.53 - Revocation of accreditation.

Code of Federal Regulations, 2014 CFR

2014-01-01

... ACCREDITATION OF NON-FEDERAL CHEMISTRY LABORATORIES § 439.53 Revocation of accreditation. The accreditation of a... has: (1) Altered any official sample or analytical finding; or (2) Substituted any analytical result...

9 CFR 439.53 - Revocation of accreditation.

Code of Federal Regulations, 2012 CFR

2012-01-01

... ACCREDITATION OF NON-FEDERAL CHEMISTRY LABORATORIES § 439.53 Revocation of accreditation. The accreditation of a... has: (1) Altered any official sample or analytical finding; or (2) Substituted any analytical result...

9 CFR 439.53 - Revocation of accreditation.

Code of Federal Regulations, 2013 CFR

2013-01-01

... ACCREDITATION OF NON-FEDERAL CHEMISTRY LABORATORIES § 439.53 Revocation of accreditation. The accreditation of a... has: (1) Altered any official sample or analytical finding; or (2) Substituted any analytical result...

9 CFR 439.53 - Revocation of accreditation.

Code of Federal Regulations, 2011 CFR

2011-01-01

... ACCREDITATION OF NON-FEDERAL CHEMISTRY LABORATORIES § 439.53 Revocation of accreditation. The accreditation of a... has: (1) Altered any official sample or analytical finding; or (2) Substituted any analytical result...

The US emergency care system: meeting everyday acute care needs while being ready for disasters.

PubMed

Lurie, Nicole; Margolis, Gregg S; Rising, Kristin L

2013-12-01

The emergency care system is an essential part of the US health care system. In addition to providing acute resuscitation and life- and limb-saving care, the emergency care system provides considerable support to physicians outside the emergency department and serves as an important safety-net provider. In times of disaster, the emergency care system must be able to surge rapidly to accommodate a massive influx of patients, sometimes with little or no notice. Extreme daily demands on the system can promote innovations and adaptations that are invaluable in responding to disasters. However, excessive and inappropriate utilization is wasteful and can diminish "surge capacity" when it is most needed. Certain features of the US health care system have imposed strains on the emergency care system. We explore policy issues related to moving toward an emergency care system that can more effectively meet both individuals' needs for acute care and the broader needs of the community in times of disaster. Strategies for the redesign of the emergency care system must include the active engagement of both patients and the community and a close look at how to align incentives to reward quality and efficiency throughout the health care system.

Challenges that nurses face in caring for morbidly obese patients in the acute care setting.

PubMed

Drake, Daniel; Dutton, Kathy; Engelke, Martha; McAuliffe, Maura; Rose, Mary Ann

2005-01-01

Despite increasing numbers of morbidly obese patients admitted to acute care facilities for surgery or treatment of nonsurgical conditions, there is little evidence of the problems nurses face in providing care to these patients. Anecdotal evidence suggests that the care of these patients is more demanding than the care of nonobese patients. The objective of this study was to describe nurses' perceptions of the challenges that they face when caring for morbidly obese patients. Focus groups of nurses from a tertiary care facility were convened. A trained facilitator posed questions to the group concerning various aspects of care for morbidly obese patients. Comments of respondents were categorized using NVIVO software. Nurses reported concerns about the increased staffing needs required for care of these patients and the particular challenges of the physical care. Concerns also included the availability, placement, and use of specialized equipment. Room size and the absence of some equipment were also problematic. Finally, nurses perceived safety issues, both for themselves and their patients. Morbidly obese patients in the acute care setting require specialized nursing care in terms of techniques, levels of staffing required, and the use of specialized equipment.

Delivering quality care: what can emergency gynaecology learn from acute obstetrics?

PubMed

Bika, O H; Edozien, L C

2014-08-01

Emergency obstetric care in the UK has been systematically developed over the years to high quality standards. More recently, advances have been made in the organisation and delivery of care for women presenting with acute gynaecological problems, but a lot remains to be done, and emergency gynaecology has a lot to learn from the evolution of its sister special interest area: acute obstetric care. This paper highlights areas such as consultant presence, risk management, patient flow pathways, out-of-hours care, clinical guidelines and protocols, education and training and facilities, where lessons from obstetrics are transferrable to emergency gynaecology.

Quality indicators for acute myocardial infarction: A position paper of the Acute Cardiovascular Care Association.

PubMed

Schiele, Francois; Gale, Chris P; Bonnefoy, Eric; Capuano, Frederic; Claeys, Marc J; Danchin, Nicolas; Fox, Keith Aa; Huber, Kurt; Iakobishvili, Zaza; Lettino, Maddalena; Quinn, Tom; Rubini Gimenez, Maria; Bøtker, Hans E; Swahn, Eva; Timmis, Adam; Tubaro, Marco; Vrints, Christiaan; Walker, David; Zahger, Doron; Zeymer, Uwe; Bueno, Hector

2017-02-01

Evaluation of quality of care is an integral part of modern healthcare, and has become an indispensable tool for health authorities, the public, the press and patients. However, measuring quality of care is difficult, because it is a multifactorial and multidimensional concept that cannot be estimated solely on the basis of patients' clinical outcomes. Thus, measuring the process of care through quality indicators (QIs) has become a widely used practice in this context. Other professional societies have published QIs for the evaluation of quality of care in the context of acute myocardial infarction (AMI), but no such indicators exist in Europe. In this context, the European Society of Cardiology (ESC) Acute Cardiovascular Care Association (ACCA) has reflected on the measurement of quality of care in the context of AMI (ST segment elevation myocardial infarction (STEMI) and non-ST segment elevation myocardial infarction (NSTEMI)) and created a set of QIs, with a view to developing programmes to improve quality of care for the management of AMI across Europe. We present here the list of QIs defined by the ACCA, with explanations of the methodology used, scientific justification and reasons for the choice for each measure.

A College President's Defense of Accreditation

ERIC Educational Resources Information Center

Oden, Robert A.

2009-01-01

Accreditation may be the sole opportunity for all parts of an institution to inquire together and in depth about the totality of their mission. In this chapter, the author seeks to frame the accreditation process well and defend the process with vigor and confidence. Before moving on to discuss a quite different perspective on accreditation, the…

Acute Respiratory Failure in Renal Transplant Recipients: A Single Intensive Care Unit Experience.

PubMed

Ulas, Aydin; Kaplan, Serife; Zeyneloglu, Pinar; Torgay, Adnan; Pirat, Arash; Haberal, Mehmet

2015-11-01

Frequency of pulmonary complications after renal transplant has been reported to range from 3% to 17%. The objective of this study was to evaluate renal transplant recipients admitted to an intensive care unit to identify incidence and cause of acute respiratory failure in the postoperative period and compare clinical features and outcomes between those with and without acute respiratory failure. We retrospectively screened the data of 540 consecutive adult renal transplant recipients who received their grafts at a single transplant center and included those patients admitted to an intensive care unit during this period for this study. Acute respiratory failure was defined as severe dyspnea, respiratory distress, decreased oxygen saturation, hypoxemia or hypercapnia on room air, or requirement of noninvasive or invasive mechanical ventilation. Among the 540 adult renal transplant recipients, 55 (10.7%) were admitted to an intensive care unit, including 26 (47.3%) admitted for acute respiratory failure. Median time from transplant to intensive care unit admission was 10 months (range, 0-67 mo). The leading causes of acute respiratory failure were bacterial pneumonia (56%) and cardiogenic pulmonary edema (44%). Mean partial pressure of arterial oxygen to fractional inspired oxygen ratio was 174 ± 59, invasive mechanical ventilation was used in 13 patients (50%), and noninvasive mechanical ventilation was used in 8 patients (31%). The overall mortality was 16.4%. Acute respiratory failure was the reason for intensive care unit admission in almost half of our renal transplant recipients. Main causes of acute respiratory failure were bacterial pneumonia and cardiogenic pulmonary edema. Mortality of patients admitted for acute respiratory failure was similar to those without acute respiratory failure.

The experience of accreditation of the Reggio Emilia Research Hospital with the OECI model.

PubMed

Mazzini, Elisa; Cerullo, Loredana; Mazzi, Giorgio; Costantini, Massimo

2015-01-01

The research hospital Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) of Reggio Emilia has a unique organization that involves a recently recognized IRCCS in oncology within a preexisting general hospital. The IRCCS of Reggio Emilia joined the "Tailored Accreditation Model for Comprehensive Cancer Centers: Validation through the Applicability of the Experimental OECI-based Model to the Network of Cancer IRCCS of the Alliance Against Cancer" and applied the accreditation & designation (A&D) Organisation of European Cancer Institutes (OECI) model in 2013. Before that accreditation, it had never been accredited according to international accreditation systems concerning cancer. By December 2015, the IRCCS of Reggio Emilia completed the first steps of the A&D OECI process (self-assessment period, peer review visit, implementation of the improvement plan). In December 2014, OECI confirmed the accreditation of our IRCCS and its designation as a Clinical Cancer Center and proposed a revisit at 2 years for upgrading the designation to Comprehensive Cancer Center (CCC). On the whole, the results given by adhesion to the A&D-OECI project are numerous and positive, under different points of view, formal (European accreditation and designation as a Clinical Cancer Center with possible upgrade to CCC) and substantial (involvement of professionals, attention to ongoing improvement, work on the sectors mainly of interest). The balance between the advantages and disadvantages linked to this accreditation model was positive. Following our experience, we conclude that the model was useful also for our kind of IRCCS, with its features useful for investigating all the sectors of the patient care pathway and research and necessity to stimulate change.

Associations between preoperative physical therapy and post-acute care utilization patterns and cost in total joint replacement.

PubMed

Snow, Richard; Granata, Jaymes; Ruhil, Anirudh V S; Vogel, Karen; McShane, Michael; Wasielewski, Ray

2014-10-01

Health-care costs following acute hospital care have been identified as a major contributor to regional variation in Medicare spending. This study investigated the associations of preoperative physical therapy and post-acute care resource use and its effect on the total cost of care during primary hip or knee arthroplasty. Historical claims data were analyzed using the Centers for Medicare & Medicaid Services Limited Data Set files for Diagnosis Related Group 470. Analysis included descriptive statistics of patient demographic characteristics, comorbidities, procedures, and post-acute care utilization patterns, which included skilled nursing facility, home health agency, or inpatient rehabilitation facility, during the ninety-day period after a surgical hospitalization. To evaluate the associations, we used bivariate and multivariate techniques focused on post-acute care use and total episode-of-care costs. The Limited Data Set provided 4733 index hip or knee replacement cases for analysis within the thirty-nine-county Medicare hospital referral cluster. Post-acute care utilization was a significant variable in the total cost of care for the ninety-day episode. Overall, 77.0% of patients used post-acute care services after surgery. Post-acute care utilization decreased if preoperative physical therapy was used, with only 54.2% of the preoperative physical therapy cohort using post-acute care services. However, 79.7% of the non-preoperative physical therapy cohort used post-acute care services. After adjusting for demographic characteristics and comorbidities, the use of preoperative physical therapy was associated with a significant 29% reduction in post-acute care use, including an $871 reduction of episode payment driven largely by a reduction in payments for skilled nursing facility ($1093), home health agency ($527), and inpatient rehabilitation ($172). The use of preoperative physical therapy was associated with a 29% decrease in the use of any post-acute care

Voluntary Industry Distributor Accreditation Program

DOT National Transportation Integrated Search

1996-09-05

This advisory circular (AC) describes a system for the voluntary accreditation of civil aircraft parts distributors on the basis of voluntary industry oversight and provides information that may be used for developing accreditation programs. The Fede...

Studying Physician-Patient Communication in the Acute Care Setting: The Hospitalist Rapport Study

PubMed Central

Anderson, Wendy G.; Winters, Kathryn; Arnold, Robert M.; Puntillo, Kathleen A.; White, Douglas B.; Auerbach, Andrew D.

2010-01-01

Objective To assess the feasibility of studying physician-patient communication in the acute care setting. Methods We recruited hospitalist physicians and patients from two hospitals within a university system and audio-recorded their first encounter. Recruitment, data collection, and challenges encountered were tracked. Results Thirty-two physicians consented (rate 91%). Between August 2008 and March 2009, 441 patients were referred, 210 (48%) were screened, and 119 (66% of 179 eligible) consented. We audio-recorded encounters of 80 patients with 27 physicians. Physicians’ primary concern about participation was interference with their workflow. Addressing their concerns and building the protocol around their schedules facilitated participation. Challenges unique to the acute care setting were: 1) extremely limited time for patient identification, screening, and enrollment during which patients were ill and busy with clinical care activities, and 2) little advance knowledge of when physician-patient encounters would occur. Employing a full-time study coordinator mitigated these challenges. Conclusion Physician concerns for participating in communication studies are similar in ambulatory and acute care settings. The acute care setting presents novel challenges for patient recruitment and data collection. Practice Implications These methods should be used to study provider-patient communication in acute care settings. Future work should test strategies to increase patient enrollment. PMID:20444569

[Accreditation of clinical laboratories based on ISO standards].

PubMed

Kawai, Tadashi

2004-11-01

International Organization for Standardization (ISO) have published two international standards (IS) to be used for accreditation of clinical laboratories; ISO/IEC 17025:1999 and ISO 15189:2003. Any laboratory accreditation body must satisfy the requirements stated in ISO/IEC Guide 58. In order to maintain the quality of the laboratory accreditation bodies worldwide, the International Laboratory Accreditation Cooperation (ILAC) has established the mutual recognition arrangement (MRA). In Japan, the International Accreditation Japan (IAJapan) and the Japan Accreditation Board for Conformity Assessment (JAB) are the members of the ILAC/MRA group. In 2003, the Japanese Committee for Clinical Laboratory Standards (JCCLS) and the JAB have established the Development Committee of Clinical Laboratory Accreditation Program (CLAP), in order to establish the CLAP, probably starting in 2005.

Paediatric emergency and acute care in resource poor settings.

PubMed

Duke, Trevor; Cheema, Baljit

2016-02-01

Acute care of seriously ill children is a global public health issue, and there is much scope for improving quality of care in hospitals at all levels in many developing countries. We describe the current state of paediatric emergency and acute care in the least developed regions of low and middle income countries and identify gaps and requirements for improving quality. Approaches are needed which span the continuum of care: from triage and emergency treatment, the diagnostic process, identification of co-morbidities, treatment, monitoring and supportive care, discharge planning and follow-up. Improvements require support and training for health workers and quality processes. Effective training is that which is ongoing, combining good technical training in under-graduate courses and continuing professional development. Quality processes combine evidence-based guidelines, essential medicines, appropriate technology, appropriate financing of services, standards and assessment tools and training resources. While initial emergency treatment is based on common clinical syndromes, early differentiation is required for specific treatment, and this can usually be carried out clinically without expensive tests. While global strategies are important, it is what happens locally that makes a difference and is too often neglected. In rural areas in the poorest countries in the world, public doctors and nurses who provide emergency and acute care for children are revered by their communities and demonstrate daily that much can be carried out with little. © 2016 The Authors. Journal of Paediatrics and Child Health © 2016 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

Fluid accumulation during acute kidney injury in the intensive care unit.

PubMed

Berthelsen, R E; Perner, A; Jensen, A K; Jensen, J-U; Bestle, M H

2018-07-01

Fluid therapy is a ubiquitous intervention in patients admitted to the intensive care unit, but positive fluid balance may be associated with poor outcomes and particular in patients with acute kidney injury. Studies describing this have defined fluid overload either at specific time points or considered patients with a positive mean daily fluid balance as fluid overloaded. We wished to detail this further and performed joint model analyses of the association between daily fluid balance and outcome represented by mortality and renal recovery in patients admitted with acute kidney injury. We did a retrospective cohort study of patients admitted to the intensive care unit with acute kidney injury during a 2-year observation period. We used serum creatinine measurements to identify patients with acute kidney injury and collected sequential daily fluid balance during the first 5 days of admission to the intensive care unit. We used joint modelling techniques to correlate the development of fluid overload with survival and renal recovery adjusted for age, gender and disease severity. The cohort contained 863 patients with acute kidney injury of whom 460 (53%) and 254 (29%) developed 5% and 10% fluid overload, respectively. We found that both 5% and 10% fluid overload was correlated with reduced survival and renal recovery. Joint model analyses of fluid accumulation in patients admitted to the intensive care unit with acute kidney injury confirm that even a modest degree of fluid overload (5%) may be negatively associated with both survival and renal recovery. © 2018 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

Use of alternative and complementary therapies in labor and delivery care: a cross-sectional study of midwives’ training in Catalan hospitals accredited as centers for normal birth

PubMed Central

2013-01-01

Background The use of complementary and alternative medicine (CAM) and complementary and alternative therapies (CAT) during pregnancy is increasing. Scientific evidence for CAM and CAT in the field of obstetrics mainly covers pain relief in labor. Midwives are responsible for labor and delivery care: hence, their knowledge of CAM and CAT is important. The aims of this study are to describe the professional profile of midwives who provide care for natural childbirth in Catalan hospitals accredited as centers for normal birth, to assess midwives’ level of training in CAT and their use of these therapies, and to identify specific resources for CAT in labor wards. Methods A descriptive, cross-sectional, quantitative method was used to assess the level of training and use of CAT by midwives working at 28 hospitals in Catalonia, Spain, accredited as public normal birth centers. Results Just under a third of midwives (30.4%) trained in CAT after completion of basic training. They trained in an average of 5.97 therapies (SD 3.56). The number of CAT in which the midwives were trained correlated negatively with age (r = - 0.284; p < 0.001) and with their time working at the hospital in years (r = - 0.136; p = 0.036). Midwives trained in CAT considered that the following therapies were useful or very useful for pain relief during labor and delivery: relaxation techniques (64.3%), hydrotherapy (84.8%) and the application of compresses to the perineum (75.9%). The availability of resources for providing CAT during normal birth care varied widely from center to center. Conclusions Age may influence attitudes towards training. It is important to increase the number of midwives trained in CAM for pain relief during childbirth, in order to promote the use of CAT and ensure efficiency and safety. CAT resources at accredited hospitals providing normal childbirth care should also be standardized. PMID:24238197

Issues concerning the on-going care of patients with comorbidities in acute care and post-discharge in Australia: a literature review.

PubMed

Williams, Allison; Botti, Mari

2002-10-01

Advances in medical science and improved lifestyles have reduced mortality rates in Australia and most western countries. This has resulted in an ageing population with a concomitant growth in the number of people who are living with chronic illnesses. Indeed a significant number of younger people experience more than one chronic illness. Large numbers of these may require repeated admissions to hospital for acute or episodic care that is superimposed upon the needs of their chronic conditions. To explore the issues that circumscribe the complexities of caring for people with concurrent chronic illnesses, or comorbidities, in the acute care setting and postdischarge. A literature review to examine the issues that impact upon the provision of comprehensive care to patients with comorbidities in the acute care setting and postdischarge. Few studies have investigated this subject. From an Australian perspective, it is evident that the structure of the current health care environment has made it difficult to meet the needs of patients with comorbidities in the acute care setting and postdischarge. This is of major concern for nurses attempting to provide comprehensive care to an increasingly prevalent group of chronically ill people. Further research is necessary to explore how episodic care is integrated into the on-going management of patients with comorbidities and how nurse clinicians can better use an episode of acute illness as an opportunity to review their overall management.

Regional variation in acute stroke care organisation.

PubMed

Muñoz Venturelli, Paula; Robinson, Thompson; Lavados, Pablo M; Olavarría, Verónica V; Arima, Hisatomi; Billot, Laurent; Hackett, Maree L; Lim, Joyce Y; Middleton, Sandy; Pontes-Neto, Octavio; Peng, Bin; Cui, Liying; Song, Lily; Mead, Gillian; Watkins, Caroline; Lin, Ruey-Tay; Lee, Tsong-Hai; Pandian, Jeyaraj; de Silva, H Asita; Anderson, Craig S

2016-12-15

Few studies have assessed regional variation in the organisation of stroke services, particularly health care resourcing, presence of protocols and discharge planning. Our aim was to compare stroke care organisation within middle- (MIC) and high-income country (HIC) hospitals participating in the Head Position in Stroke Trial (HeadPoST). HeadPoST is an on-going international multicenter crossover cluster-randomized trial of 'sitting-up' versus 'lying-flat' head positioning in acute stroke. As part of the start-up phase, one stroke care organisation questionnaire was completed at each hospital. The World Bank gross national income per capita criteria were used for classification. 94 hospitals from 9 countries completed the questionnaire, 51 corresponding to MIC and 43 to HIC. Most participating hospitals had a dedicated stroke care unit/ward, with access to diagnostic services and expert stroke physicians, and offering intravenous thrombolysis. There was no difference for the presence of a dedicated multidisciplinary stroke team, although greater access to a broad spectrum of rehabilitation therapists in HIC compared to MIC hospitals was observed. Significantly more patients arrived within a 4-h window of symptoms onset in HIC hospitals (41 vs. 13%; P<0.001), and a significantly higher proportion of acute ischemic stroke patients received intravenous thrombolysis (10 vs. 5%; P=0.002) compared to MIC hospitals. Although all hospitals provided advanced care for people with stroke, differences were found in stroke care organisation and treatment. Future multilevel analyses aims to determine the influence of specific organisational factors on patient outcomes. Copyright © 2016 Elsevier B.V. All rights reserved.

An analysis of clinical outcomes and costs of a long term acute care hospital.

PubMed

Votto, John J; Scalise, Paul J; Barton, Randall W; Vogel, Cristine A

2011-01-01

Compare clinical outcomes and costs in a study group of long-term acute care hospital (LTCH) patients with a control group of LTCH-eligible patients in an acute care hospital. LTCHs were created to provide post-acute care services not available at other post-acute settings. This is based on the premise that these patients would otherwise have stayed at acute care hospitals as high-cost outliers. The LTCH hospital is intended to deliver care to patients more efficiently, however, there are little documented clinical and financial data regarding the comparative clinical outcomes and costs for patients. Retrospective medical and billing record review of patients from the following groups: (1) LTCH study comprising patients admitted directly from an acute care hospital to the study LTCH and discharged from the LTCH from September 2004 through August 2006; (2) a control group of LTCH-eligible, medically complex patients treated and discharged from an acute care hospital in FY 2002. The control group was selected from approximately 500 patients who had at least one of the ten most common principle diagnosis DRGs of the study LTCH with >30-day length of stay at the referring hospital and met NALTH admitting guidelines. Discharge disposition is an important outcome measure of the quality of care of medically complex patients. The in-hospital mortality rate trended lower and home discharge was 3 times higher for the LTCH study group than for the control group. As a possible result, SNF discharge of LTCH patients was approximately half that of the control group. Both mean patient cost per day and mean total cost per patient were significantly higher in the control group than in the LTCH study group. The patients in the LTCH study group had both better clinical outcomes and lower cost of care than the control group.

Family Adversity and Resilience Measures in Pediatric Acute Care Settings.

PubMed

O'Malley, Donna M; Randell, Kimberly A; Dowd, M Denise

2016-01-01

Adverse childhood experiences (ACEs) impact health across the life course. The purpose of this study was to identify caregiver ACEs, current adversity, and resilience in families seeking care in pediatric acute care settings. Study aims included identifying demographic characteristics, current adversities, and resilience measures associated with caregiver ACEs ≥4. A cross-sectional survey study design was used and a convenience sample (n = 470) recruited at emergency and urgent care settings of a large Midwest pediatric hospital system. Measures were self-reported. The original 10-item ACEs questionnaire measured caregiver past adversity. Current adversity was measured using the 10-item IHELP. The six-item Brief Resiliency Scale measured resilience, and WHO-5 Well-Being Index was used to measure depressive affect. Compared to participants with ACEs score of 0-3 participants with ACEs ≥4 were more likely to have multiple current adversities, increased risk of depression, and lower resilience. Caregivers using pediatric acute care settings carry a high burden of ACEs and current adversities. Caregiver ACEs are associated with current child experiences of adversity. Caregivers socioeconomic status and education level may not be an accurate indicator of a family's risks or needs. Pediatric acute care settings offer opportunities to access, intervene, and prevent childhood adversity. © 2016 Wiley Periodicals, Inc.

Implementation of national palliative care guidelines in Swedish acute care hospitals: A qualitative content analysis of stakeholders' perceptions.

PubMed

Lind, S; Wallin, L; Brytting, T; Fürst, C J; Sandberg, J

2017-11-01

In high-income countries a large proportion of all deaths occur in hospitals. A common way to translate knowledge into clinical practice is developing guidelines for different levels of health care organisations. During 2012, national clinical guidelines for palliative care were published in Sweden. Later, guidance for palliative care was issued by the National Board of Health and Welfare. The aim of this study was two-fold: to investigate perceptions regarding these guidelines and identify obstacles and opportunities for implementation of them in acute care hospitals. Interviews were conducted with local politicians, chief medical officers and health professionals at acute care hospitals. The Consolidated Framework for Implementation Research was used in a directed content analysis approach. The results showed little knowledge of the two documents at all levels of the health care organisation. Palliative care was primarily described as end of life care and only few of the participants talked about the opportunity to integrate palliative care early in a disease trajectory. The environment and culture at hospitals, characterised by quick decisions and actions, were perceived as obstacles to implementation. Health professionals' expressed need for palliative care training is an opportunity for implementation of clinical guidelines. There is a need for further implementation of palliative care in hospitals. One option for further research is to evaluate implementation strategies tailored to acute care. Copyright © 2017 Elsevier B.V. All rights reserved.

COAMFTE accreditation and California MFT licensing exam success.

PubMed

Caldwell, Benjamin E; Kunker, Shelly A; Brown, Stephen W; Saiki, Dustin Y

2011-10-01

Professional accreditation of graduate programs in marital and family therapy (MFT) is intended to ensure the strength of the education students receive. However, there is great difficulty in assessing the real-world impact of accreditation on students. Only one measure is applied consistently to graduates of all MFT programs, regardless of accreditation status: licensure examinations. Within California, COAMFTE-accredited, regionally (WASC) accredited, and state-approved programs all may offer degrees qualifying for licensure. Exam data from 2004, 2005, and 2006 (n = 5,646 examinees on the Written Clinical Vignette exam and n = 3,408 first-time examinees on the Standard Written Exam) were reviewed to determine the differences in exam success among graduates of programs at varying levels of accreditation. Students from COAMFTE-accredited programs were more successful on both California exams than were students from other WASC-accredited or state-approved universities. There were no significant differences between (non-COAMFTE) WASC-accredited universities and state-approved programs. Differences could be related to selection effects, if COAMFTE programs initially accept students of higher quality. Implications for therapist education and training are discussed. © 2011 American Association for Marriage and Family Therapy.

42 CFR 8.4 - Accreditation body responsibilities.

Code of Federal Regulations, 2014 CFR

2014-10-01

... CERTIFICATION OF OPIOID TREATMENT PROGRAMS Accreditation § 8.4 Accreditation body responsibilities. (a... discovers information that suggests that an OTP is not meeting Federal opioid treatment standards, or if... substantially fails to meet the Federal opioid treatment standards. (ii) Accreditation bodies shall notify...

42 CFR 8.4 - Accreditation body responsibilities.

Code of Federal Regulations, 2012 CFR

2012-10-01

... CERTIFICATION OF OPIOID TREATMENT PROGRAMS Accreditation § 8.4 Accreditation body responsibilities. (a... discovers information that suggests that an OTP is not meeting Federal opioid treatment standards, or if... substantially fails to meet the Federal opioid treatment standards. (ii) Accreditation bodies shall notify...

42 CFR 8.4 - Accreditation body responsibilities.

Code of Federal Regulations, 2013 CFR

2013-10-01

... CERTIFICATION OF OPIOID TREATMENT PROGRAMS Accreditation § 8.4 Accreditation body responsibilities. (a... discovers information that suggests that an OTP is not meeting Federal opioid treatment standards, or if... substantially fails to meet the Federal opioid treatment standards. (ii) Accreditation bodies shall notify...

Referral Regions for Time-Sensitive Acute Care Conditions in the United States.

PubMed

Wallace, David J; Mohan, Deepika; Angus, Derek C; Driessen, Julia R; Seymour, Christopher M; Yealy, Donald M; Roberts, Mark M; Kurland, Kristen S; Kahn, Jeremy M

2018-03-24

Regional, coordinated care for time-sensitive and high-risk medical conditions is a priority in the United States. A necessary precursor to coordinated regional care is regions that are actionable from clinical and policy standpoints. The Dartmouth Atlas of Health Care, the major health care referral construct in the United States, uses regions that cross state and county boundaries, limiting fiscal or political ownership by key governmental stakeholders in positions to create incentive and regulate regional care coordination. Our objective is to develop and evaluate referral regions that define care patterns for patients with acute myocardial infraction, acute stroke, or trauma, yet also preserve essential political boundaries. We developed a novel set of acute care referral regions using Medicare data in the United States from 2011. For acute myocardial infraction, acute stroke, or trauma, we iteratively aggregated counties according to patient home location and treating hospital address, using a spatial algorithm. We evaluated referral political boundary preservation and spatial accuracy for each set of referral regions. The new set of referral regions, the Pittsburgh Atlas, had 326 distinct regions. These referral regions did not cross any county or state borders, whereas 43.1% and 98.1% of all Dartmouth Atlas hospital referral regions crossed county and state borders. The Pittsburgh Atlas was comparable to the Dartmouth Atlas in measures of spatial accuracy and identified larger at-risk populations for all 3 conditions. A novel and straightforward spatial algorithm generated referral regions that were politically actionable and accountable for time-sensitive medical emergencies. Copyright © 2018 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

Accreditation of residency training in the US.

PubMed Central

Armbruster, J. S.

1996-01-01

In the US, accreditation and certification of residency training are functions of separate public sector agencies. Accrediting decisions are made directly by 26 Residency Review Committees, which represent the primary medical specialties and function under the authority of the Accreditation Council for Graduate Medical Education. The accrediting bodies may consider only educational issues and are prohibited by the government from controlling physician supply. Only the programme, not the institution in which it is conducted, is accredited. The US residency is a structured educational programme that is expected to provide comparable experience to all enrolled residents. Length of training may vary from two to six years depending on the specialty. Additional training may be obtained in subspecialty programmes, which are subsets of the primary specialty residencies and are also reviewed for accreditation. These have increased in significant number in recent years as subspecialisation has proliferated in the US. PMID:8935597

The Experience of Witnessing Patients' Trauma and Suffering among Acute Care Nurses

ERIC Educational Resources Information Center

Walsh, Mary E.; Buchanan, Marla J.

2011-01-01

A large body of research provides evidence of workplace injuries to those in the nursing profession. Research on workplace stress and burnout among medical professionals is also well known; however, the profession of acute care nursing has not been examined with regards to work-related stress. This qualitative study focused on acute care nurses'…

78 FR 27485 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-10

... Prospective Payment Systems for Acute Care Hospitals and the Long Term Care Hospital Prospective Payment... [CMS-1599-P] RIN 0938-AR53 Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute... capital-related costs of acute care hospitals to implement changes arising from our continuing experience...

Acute hospital dementia care: results from a national audit.

PubMed

Timmons, Suzanne; O'Shea, Emma; O'Neill, Desmond; Gallagher, Paul; de Siún, Anna; McArdle, Denise; Gibbons, Patricia; Kennelly, Sean

2016-05-31

Admission to an acute hospital can be distressing and disorientating for a person with dementia, and is associated with decline in cognitive and functional ability. The objective of this audit was to assess the quality of dementia care in acute hospitals in the Republic of Ireland. Across all 35 acute public hospitals, data was collected on care from admission through discharge using a retrospective chart review (n = 660), hospital organisation interview with senior management (n = 35), and ward level organisation interview with ward managers (n = 76). Inclusion criteria included a diagnosis of dementia, and a length of stay greater than 5 days. Most patients received physical assessments, including mobility (89 %), continence (84 %) and pressure sore risk (87 %); however assessment of pain (75 %), and particularly functioning (36 %) was poor. Assessment for cognition (43 %) and delirium (30 %) was inadequate. Most wards have access at least 5 days per week to Liaison Psychiatry (93 %), Geriatric Medicine (84 %), Occupational Therapy (79 %), Speech & Language (81 %), Physiotherapy (99 %), and Palliative Care (89 %) Access to Psychology (9 %), Social Work (53 %), and Continence services (34 %) is limited. Dementia awareness training is provided on induction in only 2 hospitals, and almost half of hospitals did not offer dementia training to doctors (45 %) or nurses (48 %) in the previous 12 months. Staff cover could not be provided on 62 % of wards for attending dementia training. Most wards (84 %) had no dementia champion to guide best practice in care. Discharge planning was not initiated within 24 h of admission in 72 % of cases, less than 40 % had a single plan for discharge recorded, and 33 % of carers received no needs assessment prior to discharge. Length of stay was significantly greater for new discharges to residential care (p < .001). Dementia care relating to assessment, access to certain specialist services

[Professional formation and its accreditation in medicine. A paradigm to sustain public confidence].

PubMed

Rosselot, Eduardo; Norero, Colomba; Hanne, Christel; Mateluna, Ester

2002-05-01

Sustaining quality control of learning programs for health professions has become a central issue in university systems, under the pressure of an unexpected merging of new medical schools in Chile, during the last decade, and the massive arrival of other Latin American physicians. Accreditation of institutions and programs represents valid safeguards used in most countries where professional training processes take place. Due guarantee of its quality is required to assure proper health care to people. The authors provide specific arguments to support systematic evaluation and accreditation processes, as those introduced in our country to fulfill the requirements of a high level medical practice.

22 CFR 96.8 - Fees charged by accrediting entities.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Fees charged by accrediting entities. 96.8... Duties of Accrediting Entities § 96.8 Fees charged by accrediting entities. (a) An accrediting entity may... fees approved by the Secretary. Before approving a schedule of fees proposed by an accrediting entity...

Antibiotic use among older adults on an acute care general surgery service

PubMed Central

Pollmann, André S.; Bailey, Jon G.; Davis, Philip J.B.; Johnson, Paul M.

2017-01-01

Background Antibiotics play an important role in the treatment of many surgical diseases that affect older adults, and the potential for inappropriate use of these drugs is high. Our objective was to describe antibiotic use among older adults admitted to an acute care surgery service at a tertiary care teaching hospital. Methods Detailed data regarding diagnosis, comorbidities, surgery and antibiotic use were retrospectively collected for patients 70 years and older admitted to an acute care surgery service. We evaluated antibiotic use (perioperative prophylaxis and treatment) for appropriateness based on published guidelines. Results During the study period 453 patients were admitted to the acute care surgery service, and 229 underwent surgery. The most common diagnoses were small bowel obstruction (27.2%) and acute cholecystitis (11.0%). In total 251 nonelective abdominal operations were performed, and perioperative antibiotic prophylaxis was appropriate in 49.5% of cases. The most common prophylaxis errors were incorrect timing (15.5%) and incorrect dose (12.4%). Overall 206 patients received treatment with antibiotics for their underlying disease process, and 44.2% received appropriate first-line drug therapy. The most common therapeutic errors were administration of second- or third-line antibiotics without indication (37.9%) and use of antibiotics when not indicated (12.1%). There was considerable variation in the duration of treatment for patients with the same diagnoses. Conclusion Inappropriate antibiotic use was common among older patients admitted to an acute care surgery service. Quality improvement initiatives are needed to ensure patients receive optimal care in this complex hospital environment. PMID:28930045

Readmission Patterns Over 90-Day Episodes of Care Among Medicare Fee-for-Service Beneficiaries Discharged to Post-acute Care.

PubMed

Middleton, Addie; Kuo, Yong-Fang; Graham, James E; Karmarkar, Amol; Lin, Yu-Li; Goodwin, James S; Haas, Allen; Ottenbacher, Kenneth J

2018-04-21

Examine readmission patterns over 90-day episodes of care in persons discharged from hospitals to post-acute settings. Retrospective cohort study. Acute care hospitals. Medicare fee-for-service enrollees (N = 686,877) discharged from hospitals to post-acute care in 2013-2014. The cohort included beneficiaries >65 years of age hospitalized for stroke, joint replacement, or hip fracture and who survived for 90 days following discharge. 90-day unplanned readmissions. The cohort included 127,680 individuals with stroke, 442,195 undergoing joint replacement, and 117,002 with hip fracture. Thirty-day readmission rates ranged from 3.1% for knee replacement patients discharged to home health agencies (HHAs) to 14.4% for hemorrhagic stroke patients discharged to skilled nursing facilities (SNFs). Ninety-day readmission rates ranged from 5.0% for knee replacement patients discharged to HHAs to 26.1% for hemorrhagic stroke patients discharged to SNFs. Differences in readmission rates decreased between stroke subconditions (hemorrhagic and ischemic) and increased between joint replacement subconditions (knee, elective hip, and nonelective hip) from 30 to 90 days across all initial post-acute discharge settings. We observed clear patterns in readmissions over 90-day episodes of care across post-acute discharge settings and subconditions. Our findings suggest that patients with hemorrhagic stroke may be more vulnerable than those with ischemic over the first 30 days after hospital discharge. For patients receiving nonelective joint replacements, readmission prevention efforts should start immediately after discharge and continue, or even increase, over the 90-day episode of care. Copyright © 2018 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

The Role of Accreditation in Consumer Protection.

ERIC Educational Resources Information Center

Warner, W. Keith; Andersen, Kay J.

1982-01-01

Upper-level college administrators in the Western accreditation region were surveyed about how well the Western Association of Schools and Colleges (WASC) served its constituency. Questions concerned consumer protection as an objective of accreditation, emphasis on disseminating information about the accreditation process, and potential policy…

Developing hospital accreditation standards in Uganda.

PubMed

Galukande, Moses; Katamba, Achilles; Nakasujja, Noeline; Baingana, Rhona; Bateganya, Moses; Hagopian, Amy; Tavrow, Paula; Barnhart, Scott; Luboga, Sam

2016-07-01

Whereas accreditation is widely used as a tool to improve quality of healthcare in the developed world, it is a concept not well adapted in most developing countries for a host of reasons, including insufficient incentives, insufficient training and a shortage of human and material resources. The purpose of this paper is to describe refining use and outcomes of a self-assessment hospital accreditation tool developed for a resource-limited context. We invited 60 stakeholders to review a set of standards (from which a self-assessment tool was developed), and subsequently refined them to include 485 standards in 7 domains. We then invited 60 hospitals to test them. A study team traveled to each of the 40 hospitals that agreed to participate providing training and debrief the self-assessment. The study was completed in 8 weeks. Hospital self-assessments revealed hospitals were remarkably open to frank rating of their performance and willing to rank all 485 measures. Good performance was measured in outreach programs, availability of some types of equipment and running water, 24-h staff calls systems, clinical guidelines and waste segregation. Poor performance was measured in care for the vulnerable, staff living quarters, physician performance reviews, patient satisfaction surveys and sterilizing equipment. We have demonstrated the feasibility of a self-assessment approach to hospital standards in low-income country setting. This low-cost approach may be used as a good precursor to establishing a national accreditation body, as indicated by the Ministry's efforts to take the next steps. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

[Accreditation of Independent Ethics Committees].

PubMed

Ramiro Avilés, Miguel A

According to Law 14/2007 and Royal Decree 1090/2015, biomedical research must be assessed by an Research Ethics Committee (REC), which must be accredited as an Research ethics committee for clinical trials involving medicinal products (RECm) if the opinion is issued for a clinical trial involving medicinal products or clinical research with medical devices. The aim of this study is to ascertain how IEC and IECm accreditation is regulated. National and regional legislation governing biomedical research was analysed. No clearly-defined IEC or IECm accreditation procedures exist in the national or regional legislation. Independent Ethics Committees are vital for the development of basic or clinical biomedical research, and they must be accredited by an external body in order to safeguard their independence, multidisciplinary composition and review procedures. Copyright © 2016 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.

Acute respiratory distress syndrome: an audit of incidence and outcome in Scottish intensive care units.

PubMed

Hughes, M; MacKirdy, F N; Ross, J; Norrie, J; Grant, I S

2003-09-01

This prospective audit of incidence and outcome of the acute respiratory distress syndrome was conducted as part of the national audit of intensive care practice in Scotland. All patients with acute respiratory distress syndrome in 23 adult intensive care units were identified using the diagnostic criteria defined by the American-European Consensus Conference. Daily data collection was continued until death or intensive care unit discharge. Three hundred and sixty-nine patients were diagnosed with acute respiratory distress syndrome over the 8-month study period. The frequency of acute respiratory distress syndrome in the intensive care unit population was 8.1%; the incidence in the Scottish population was estimated at 16.0 cases.100,000(-1).year(-1). Intensive care unit mortality for acute respiratory distress syndrome was 53.1%, with a hospital mortality of 60.9%. In our national unselected population of critically ill patients, the overall outcome is comparable with published series (Acute Physiology and Chronic Health Evaluation II standardised mortality ratio = 0.99). However, mortality from acute respiratory distress syndrome in Scotland is substantially higher than in recent other series suggesting an improvement in outcome in this condition.

Perry Johnson Laboratory Accreditation, Inc. (PJLA)

DTIC Science & Technology

2011-03-28

Accreditation Body, established in 1999, located in Troy, Michigan • Current Accreditation Programs– ISO / IEC 17025 :2005 and DoD ELAP, EPA NLLAP...Upcoming Accreditation Programs–Field Site Sampling & Measurement Organizations (FSMO)–TNI Volume 1 and 2, Reference Material Producers– ISO Guide...Testing/Calibration – 17025 -Testing–120 – 17025 -Calibration–191 – 17025 & DoD ELAP–14 (5 Pending) – 17025 and EPA NLLAP–1 – Pending

9 CFR 439.51 - Probation of accreditation.

Code of Federal Regulations, 2010 CFR

2010-01-01

... ACCREDITATION OF NON-FEDERAL CHEMISTRY LABORATORIES § 439.51 Probation of accreditation. Upon a determination by the Administrator, a laboratory will be placed on probation for the following reasons: (a) If the laboratory fails to complete more than one interlaboratory accreditation maintenance check sample analysis as...

Transitioning from acute to primary health care nursing: an integrative review of the literature.

PubMed

Ashley, Christine; Halcomb, Elizabeth; Brown, Angela

2016-08-01

This paper seeks to explore the transition experiences of acute care nurses entering employment in primary health care settings. Internationally the provision of care in primary health care settings is increasing. Nurses are moving from acute care settings to meet the growing demand for a primary health care workforce. While there is significant research relating to new graduate transition experiences, little is known about the transition experience from acute care into primary health care employment. An integrative review, guided by Whittemore and Knafl's (2005) approach, was undertaken. Following a systematic literature search eight studies met the inclusion criteria. Papers which met the study criteria were identified and assessed against the inclusion and exclusion criteria. Papers were then subjected to methodological quality appraisal. Thematic analysis was undertaken to identify key themes within the data. Eight papers met the selection criteria. All described nurses transitioning to either community or home nursing settings. Three themes were identified: (1) a conceptual understanding of transition, (2) role losses and gains and (3) barriers and enablers. There is a lack of research specifically exploring the transitioning of acute care nurses to primary health care settings. To better understand this process, and to support the growth of the primary health care workforce there is an urgent need for further well-designed research. There is an increasing demand for the employment of nurses in primary health care settings. To recruit experienced nurses it is logical that many nurses will transition into primary health care from employment in the acute sector. To optimise retention and enhance the transition experience of these nurses it is important to understand the transition experience. © 2016 John Wiley & Sons Ltd.

Handbook of Accreditation 1994-96.

ERIC Educational Resources Information Center

North Central Association of Colleges and Schools, Chicago, IL. Commission on Institutions of Higher Education.

This comprehensive handbook contains accreditation materials of the North Central Association of Colleges and Schools Commission on Institutions of Higher Education. These include the general institutional requirements, the criteria for accreditation, and new policies on institutional change. The chapters are: (1) "Introduction to Voluntary…

22 CFR 96.63 - Renewal of accreditation or approval.

Code of Federal Regulations, 2010 CFR

2010-04-01

... for renewal in a timely fashion. Before deciding whether to renew the accreditation or approval of an... accrediting entity or the Secretary during its most current accreditation or approval cycle, the accrediting...

Accrediting osteopathic postdoctoral training institutions.

PubMed

Duffy, Thomas

2011-04-01

All postdoctoral training programs approved by the American Osteopathic Association are required to be part of an Osteopathic Postdoctoral Training Institution (OPTI) consortium. The author reviews recent activities related to OPTI operations, including the transfer the OPTI Annual Report to an electronic database, revisions to the OPTI Accreditation Handbook, training at the 2010 OPTI Workshop, and new requirements of the American Osteopathic Association Commission on Osteopathic College Accreditation. The author also reviews the OPTI accreditation process, cites common commendations and deficiencies for reviews completed from 2008 to 2010, and provides an overview of plans for future improvements.

General surgery 2.0: the emergence of acute care surgery in Canada

PubMed Central

Hameed, S. Morad; Brenneman, Frederick D.; Ball, Chad G.; Pagliarello, Joe; Razek, Tarek; Parry, Neil; Widder, Sandy; Minor, Sam; Buczkowski, Andrzej; MacPherson, Cailan; Johner, Amanda; Jenkin, Dan; Wood, Leanne; McLoughlin, Karen; Anderson, Ian; Davey, Doug; Zabolotny, Brent; Saadia, Roger; Bracken, John; Nathens, Avery; Ahmed, Najma; Panton, Ormond; Warnock, Garth L.

2010-01-01

Over the past 5 years, there has been a groundswell of support in Canada for the development of organized, focused and multidisciplinary approaches to caring for acutely ill general surgical patients. Newly forged acute care surgery (ACS) services are beginning to provide prompt, evidence-based and goal-directed care to acutely ill general surgical patients who often present with a diverse range of complex pathologies and little or no pre- or postoperative planning. Through a team-based structure with attention to processes of care and information sharing, ACS services are well positioned to improve outcomes, while finding and developing efficiencies and reducing costs of surgical and emergency health care delivery. The ACS model also offers enhanced opportunities for surgical education for students, residents and practicing surgeons, and it will provide avenues to strengthen clinical and academic bonds between the community and academic surgical centres. In the near future, cooperation of ACS services from community and academic hospitals across the country will lead to the formation of systems of acute surgical care whose development will be informed by rigorous data collection and research and evidence-based quality-improvement initiatives. In an era of increasing subspecialization, ACS is a strong unifying force in general surgery and a platform for collective advocacy for an important patient population. PMID:20334738

Perspectives on Accreditation of Postsecondary Occupational Education.

ERIC Educational Resources Information Center

Ward, Charles F., Ed.

The Center for Occupational Education sponsored a National Conference on Accreditation of Public Postsecondary Occupational Education, held in Atlanta, Georgia on June 10-12, 1970. The major papers presented at that conference were: (1) "The Continuing Need for Nongovernmental Accreditation" by Frank G. Dickey, (2) "Specialized Accrediting Agency…

[The accreditation of professional competence: the analysis of nursing
interventions to control anxiety in surgical patients].

PubMed

Brea-Rivero, Pilar; Herrera-Usagre, Manuel; Rojas-de-Mora-Figueroa, Ana; Esposito, Thomas

2016-01-01

. The accreditation of professional competence: the analysis of nursing interventions to control anxiety in surgical patients. The preoperative anxiety is a state of discomfort or unpleasant tension resulting from concerns about illness, hospitalization, anesthesia, surgery or the unknown. Nurses play a vital role reducing preoperative anxiety. An accreditation program was developed in Andalusia (Spain) to measure nurses' competences in this and others fields. To analyze the accredited nurses' interventions spectrum to reduce anxiety in surgical patients and to check if their range of interventions depends upon their professional skills accreditation level. Cross-sectional study. From 20016 to 2014, 1.282 interventions performed by 303 operating room nurses accredited through the Professional Skills Accreditation Program of the Andalusian Agency for Health Care Quality (ACSA) were analyzed with the latent class analysis (LCA) and multinomial logistic regression. Two-thirds of the sample was accredited in Advanced level, about 31% in Expert level and 2.6% in Excellent level. Mean age of patients was 58.5±19.8 years. Three professional profiles were obtained from the LCA. Those nurses classified in Class I (22.4% of the sample) were more likely to be women, to can for younger patients, and to be accredited in Expert or Excellent Level and to perform the larger range of interventions, becoming therefore the most complete professional profile. Those nurses who perform a wider range of interventions and specifically two evidence based interventions such Calming Technique and Coping Enhancement are those who have a higher level of accreditation level.

Patient protection and Affordable Care Act; data collection to support standards related to essential health benefits; recognition of entities for the accreditation of qualified health plans. Final rule.

PubMed

2012-07-20

This final rule establishes data collection standards necessary to implement aspects of section 1302 of the Patient Protection and Affordable Care Act (Affordable Care Act), which directs the Secretary of Health and Human Services to define essential health benefits. This final rule outlines the data on applicable plans to be collected from certain issuers to support the definition of essential health benefits. This final rule also establishes a process for the recognition of accrediting entities for purposes of certification of qualified health plans.

Elective course in acute care using online learning and patient simulation.

PubMed

Seybert, Amy L; Kane-Gill, Sandra L

2011-04-11

To enhance students' knowledge of and critical-thinking skills in the management of acutely ill patients using online independent learning partnered with high-fidelity patient simulation sessions. Students enrolled in the Acute Care Simulation watched 10 weekly Web-based video presentations on various critical care and advanced cardiovascular pharmacotherapy topics. After completing each online module, all students participated in groups in patient-care simulation exercises in which they prepared a pharmacotherapeutic plan for the patient, recommended this plan to the patient's physician, and completed a debriefing session with the facilitator. Students completed a pretest and posttest before and after each simulation exercise, as well as midterm and final evaluations and a satisfaction survey. Pharmacy students significantly improved their scores on 9 of the 10 tests (p ≤ 0.05). Students' performance on the final evaluation improved compared with performance on the midterm evaluation. Overall, students were satisfied with the unique dual approach to learning and enjoyed the realistic patient-care environment that the simulation laboratory provided. Participation in an elective course that combined self-directed Web-based learning and hands-on patient simulation exercises increased pharmacy students' knowledge and critical-thinking skills in acute care.

Healthcare Resource Availability, Quality of Care, and Acute Ischemic Stroke Outcomes.

PubMed

O'Brien, Emily C; Wu, Jingjing; Zhao, Xin; Schulte, Phillip J; Fonarow, Gregg C; Hernandez, Adrian F; Schwamm, Lee H; Peterson, Eric D; Bhatt, Deepak L; Smith, Eric E

2017-02-03

Healthcare resources vary geographically, but associations between hospital-based resources and acute stroke quality and outcomes remain unclear. Using Get With The Guidelines-Stroke and Dartmouth Atlas of Health Care data, we examined associations between healthcare resource availability, stroke care, and outcomes. We categorized hospital referral regions with high-, medium-, or low-resource levels based on the 2006 national per-capita availability median of 6 relevant acute stroke care resources. Using multivariable logistic regression, we examined healthcare resource level and in-hospital quality and outcomes. Of 1 480 308 admitted ischemic stroke patients (2006-2013), 28.8% were hospitalized in low-, 44.4% in medium-, and 26.9% in high-resource hospital referral regions. Quality-of-care/timeliness metrics, adjusted length of stay, and in-hospital mortality were similar across all resource levels. Significant variation exists in regional availability of healthcare resources for acute ischemic stroke treatment, yet among Get With the Guidelines-Stroke hospitals, quality of care and in-hospital outcomes did not differ by regional resource availability. © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

Aligning Assessments for COSMA Accreditation

ERIC Educational Resources Information Center

Laird, Curt; Johnson, Dennis A.; Alderman, Heather

2015-01-01

Many higher education sport management programs are currently in the process of seeking accreditation from the Commission on Sport Management Accreditation (COSMA). This article provides a best-practice method for aligning student learning outcomes with a sport management program's mission and goals. Formative and summative assessment procedures…

Incidence, care quality and outcomes of patients with acute kidney injury in admitted hospital care.

PubMed

Medcalf, J F; Davies, C; Hollinshead, J; Matthews, B; O'Donoghue, D

2016-12-01

Acute kidney injury (AKI) is common in acute hospital admission and associated with worse patient outcomes. To measure incidence, care quality and outcome of AKI in admitted hospital care. Forty-six of 168 acute NHS healthcare trusts in UK caring for 2 million acute hospital admissions per annum collected information on adults identified with AKI stage 3 (3-fold rise in serum creatinine or creatinine >354 µmol/l) through routine biochemical testing over a 5-month period in 2012. Information was collected on patient and care characteristics. Primary outcomes were survival and recovery of kidney function at 1 month. A total of 15 647 patients were identified with biochemical AKI stage 3. Case note reviews were available for 7726 patients. In 80%, biochemical AKI stage 3 was confirmed clinically. Among this group, median age was 75 years, median length of stay was 12 days and the overall mortality within 1 month was 38%. Significant factors in a multivariable model predicting survival included age and some causes of AKI. Dipstick urinalysis, medication review, discussion with a nephrologist and acceptance for transfer to a renal unit were also associated with higher survival, but not early review by a senior doctor, acceptance for transfer to critical care or requirement for renal replacement therapy. Eighteen percent of people did not have their kidney function checked 1 month after the episode had resolved. This large study of in-hospital AKI supports the efficacy of biochemical detection of AKI in common usage. AKI mortality remains substantial, length of stay comparable with single-centre studies, and much of the variation is poorly explained (model Cox and Snell R 2  =   0.131) from current predictors. © The Author 2016. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

The Council on Aviation Accreditation. Part 2; Contemporary Issues

NASA Technical Reports Server (NTRS)

Prather, C. Daniel

2007-01-01

The Council on Aviation Accreditation (CAA) was established in 1988 in response to the need for formal, specialized accreditation of aviation academic programs, as expressed by institutional members of the University Aviation Association (UAA). The first aviation programs were accredited by the CAA in 1992, and today, the CAA lists 60 accredited programs at 21 institutions nationwide. Although the number of accredited programs has steadily grown, there are currently only 20 percent of UAA member institutions with CAA accredited programs. In an effort to further understand this issue, a case study of the CAA was performed, which resulted in a two-part case study report. Part one addressed the historical foundation of the organization and the current environment in which the CAA functions. Part two focuses on the following questions: (a) what are some of the costs to a program seeking CAA accreditation (b) what are some fo the benefits of being CAA accredited; (c) why do programs seek CAA accreditation; (d) why do programs choose no to seek CAA accreditation; (e) what role is the CAA playing in the international aviation academic community; and (f) what are some possible strategies the CAA may adopt to enhance the benefits of CAA accreditation and increase the number of CAA accredited programs. This second part allows for a more thorough understanding of the contemporary issued faced by the organization, as well as alternative strategies for the CAA to consider in an effort to increase the number of CAA accredited programs and more fully fulfill the role of the CAA in the collegiate aviation community.

The utility of outpatient commitment: acute medical care access and protecting health.

PubMed

Segal, Steven P; Hayes, Stephania L; Rimes, Lachlan

2018-06-01

This study considers whether, in an easy access single-payer health care system, patients placed on outpatient commitment-community treatment orders (CTOs) in Victoria Australia-are more likely to access acute medical care addressing physical illness than voluntary patients with and without severe mental illness. For years 2000 to 2010, the study compared acute medical care access of 27,585  severely mentally ill psychiatrically hospitalized patients (11,424 with and 16,161 without CTO exposure) and 12,229 never psychiatrically hospitalized outpatients (individuals with less morbidity risk as they were not considered to have severe mental illness). Logistic regression was used to determine the influence of the CTO on the likelihood of receiving a diagnosis of physical illness requiring acute care. Validating their shared and elevated morbidity risk, 53% of each hospitalized cohort accessed acute care compared to 32% of outpatients during the decade. While not under mental health system supervision, however, the likelihood that a CTO patient would receive a physical illness diagnosis was 31% lower than for non-CTO patients, and no different from lower morbidity-risk outpatients without severe mental illness. While, under mental health system supervision, the likelihood that CTO patients would receive a physical illness diagnosis was 40% greater than non-CTO patients and 5.02 times more likely than outpatients were. Each CTO episode was associated with a 4.6% increase in the likelihood of a member of the CTO group receiving a diagnosis. Mental health system involvement and CTO supervision appeared to facilitate access to physical health care in acute care settings for patients with severe mental illness, a group that has, in the past, been subject to excess morbidity and mortality.

The standard of healthcare accreditation standards: a review of empirical research underpinning their development and impact.

PubMed

Greenfield, David; Pawsey, Marjorie; Hinchcliff, Reece; Moldovan, Max; Braithwaite, Jeffrey

2012-09-20

Healthcare accreditation standards are advocated as an important means of improving clinical practice and organisational performance. Standard development agencies have documented methodologies to promote open, transparent, inclusive development processes where standards are developed by members. They assert that their methodologies are effective and efficient at producing standards appropriate for the health industry. However, the evidence to support these claims requires scrutiny. The study's purpose was to examine the empirical research that grounds the development methods and application of healthcare accreditation standards. A multi-method strategy was employed over the period March 2010 to August 2011. Five academic health research databases (Medline, Psych INFO, Embase, Social work abstracts, and CINAHL) were interrogated, the websites of 36 agencies associated with the study topic were investigated, and a snowball search was undertaken. Search criteria included accreditation research studies, in English, addressing standards and their impact. Searching in stage 1 initially selected 9386 abstracts. In stage 2, this selection was refined against the inclusion criteria; empirical studies (n = 2111) were identified and refined to a selection of 140 papers with the exclusion of clinical or biomedical and commentary pieces. These were independently reviewed by two researchers and reduced to 13 articles that met the study criteria. The 13 articles were analysed according to four categories: overall findings; standards development; implementation issues; and impact of standards. Studies have only occurred in the acute care setting, predominately in 2003 (n = 5) and 2009 (n = 4), and in the United States (n = 8). A multidisciplinary focus (n = 9) and mixed method approach (n = 11) are common characteristics. Three interventional studies were identified, with the remaining 10 studies having research designs to investigate clinical or organisational impacts. No study

International Accreditation as Global Position Taking: An Empirical Exploration of U.S. Accreditation in Mexico

ERIC Educational Resources Information Center

Blanco Ramírez, Gerardo

2015-01-01

Institutional accreditation in higher education holds universities accountable through external evaluation; at the same time, accreditation constitutes an opportunity for higher education leaders to demonstrate the quality of their institutions. In an increasingly global field of higher education, in which quality practices become diffused across…

Online medical care: the current state of "eVisits" in acute primary care delivery.

PubMed

Hickson, Ryan; Talbert, Jeffery; Thornbury, William C; Perin, Nathan R; Goodin, Amie J

2015-02-01

Online technologies offer the promise of an efficient, improved healthcare system. Patients benefit from increased access to care, physicians are afforded greater flexibility in care delivery, and the health system itself benefits from lower costs to provide such care. One method of incorporating online care into clinical practice, called electronic office visits or "eVisits," allows physicians to provide a consultation with patients online. We performed an analysis of the current published literature on eVisits as well as present emerging research describing the use of mobile platforms as the delivery model. We focused on the role of eVisits in acute primary care practice. A literature review was conducted using electronic databases with a variety of search terms related to the use of eVisits in primary care. Several advantages to eVisit utilization in the primary care setting were identified, namely, improvements in efficiency, continuity of care, quality of care, and access to care. Barriers to eVisit implementation were also identified, including challenges with incorporation into workflow, reimbursement, physician technological literacy, patient health literacy, overuse, security, confidentiality, and integration with existing medical technologies. Only one study of patient satisfaction with eVisit acute primary care services was identified, and this suggests that previous analyses of eVisit utilization are lacking this key component of healthcare service delivery evaluations. The delivery of primary care via eVisits on mobile platforms is still in adolescence, with few methodologically rigorous analyses of outcomes of efficiency, patient health, and satisfaction.

9 CFR 439.52 - Suspension of accreditation.

Code of Federal Regulations, 2010 CFR

2010-01-01

... ACCREDITATION OF NON-FEDERAL CHEMISTRY LABORATORIES § 439.52 Suspension of accreditation. The accreditation of a laboratory will be suspended if the laboratory or any individual or entity responsibly connected with the laboratory is indicted or has charges on information brought against them in a Federal or State court for any...

Patient Perspectives on Accessing Acute Illness Care

PubMed Central

Finta, Mary K.; Borkenhagen, Amy; Werner, Nicole E.; Duckles, Joyce; Sellers, Craig R.; Seshadri, Sandhya; Lampo, Denise; Shah, Manish N.

2017-01-01

Introduction Older adults use the emergency department (ED) at high rates, including for illnesses that could be managed by their primary care providers (PCP). Policymakers have implemented barriers and incentives, often financial, to try to modify use patterns but with limited success. This study aims to understand the factors that influence older adults’ decision to obtain acute illness care from the ED rather than from their PCPs. Methods We performed a qualitative study using a directed content analysis approach from February to October 2013. Fifteen community-dwelling older adults age≥65 years who presented to the ED of an academic medical center hospital for care and who were discharged home were enrolled. Semi-structured interviews were conducted initially in the ED and subsequently in patients’ homes over the following six weeks. All interviews were audio-recorded, transcribed, verified, and coded. The study team jointly analyzed the data and identified themes that emerged from the interviews. Results The average age of study participants was 74 years (standard deviation ±7.2 years); 53% were female; 80% were white. We found five themes that influenced participants’ decisions to obtain acute illness care from the ED: limited availability of PCP-based care, variable interactions with healthcare providers and systems, limited availability of transportation for illness care, desire to avoid burdening friends and family, and previous experiences with illnesses. Conclusion Community-dwelling older adults integrate multiple factors when deciding to obtain care from an ED rather than their PCPs. These factors relate to personal and social considerations, practical issues, and individual perceptions based on previous experiences. If these findings are validated in confirmatory studies, policymakers wishing to modify where older adults receive care should consider person-centered interventions at the system and individual level, such as decision support

Blending Key Ingredients to Assure Quality in Home Health Care.

ERIC Educational Resources Information Center

Griffith, Deloris G.

1986-01-01

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

Mobile integrated health to reduce post-discharge acute care visits: A pilot study.

PubMed

Siddle, Jennica; Pang, Peter S; Weaver, Christopher; Weinstein, Elizabeth; O'Donnell, Daniel; Arkins, Thomas P; Miramonti, Charles

2018-05-01

Mobile Integrated Health (MIH) leverages specially trained paramedics outside of emergency response to bridge gaps in local health care delivery. To evaluate the efficacy of a MIH led transitional care strategy to reduce acute care utilization. This was a retrospective cohort analysis of a quality improvement pilot of patients from an urban, single county EMS, MIH transitional care initiative. We utilized a paramedic/social worker (or social care coordinator) dyad to provide in home assessments, medication review, care coordination, and improve access to care. The primary outcome compared acute care utilization (ED visits, observation stays, inpatient visits) 90days before MIH intervention to 90days after. Of the 203 patients seen by MIH teams, inpatient utilization decreased significantly from 140 hospitalizations pre-MIH to 26 post-MIH (83% reduction, p=0.00). ED and observation stays, however, increased numerically, but neither was significant. (ED 18 to 19 stays, p=0.98; observation stays 95 to 106, p=0.30) Primary care visits increased 15% (p=0.11). In this pilot before/after study, MIH significantly reduces acute care hospitalizations. Copyright © 2017 Elsevier Inc. All rights reserved.

Variability in antibiotic use across Ontario acute care hospitals.

PubMed

Tan, Charlie; Vermeulen, Marian; Wang, Xuesong; Zvonar, Rosemary; Garber, Gary; Daneman, Nick

2017-02-01

Antibiotic stewardship is a required organizational practice for Canadian acute care hospitals, yet data are scarce regarding the quantity and composition of antibiotic use across facilities. We sought to examine the variability, and risk-adjusted variability, in antibiotic use across acute care hospitals in Ontario, Canada's most populous province. Antibiotic purchasing data from IMS Health, previously demonstrated to correlate strongly with internal antibiotic dispensing data, were acquired for 129 Ontario hospitals from January to December 2014 and linked to patient day (PD) denominator data from administrative datasets. Hospital variation in DDDs/1000 PDs was determined for overall antibiotic use, class-specific use and six practices of clinical or ecological significance. Multivariable risk adjustment for hospital and patient characteristics was used to compare observed versus expected utilization. There was 7.4-fold variability in the quantity of antibiotic use across the 129 acute care hospitals, from 253 to 1873 DDDs/1000 PDs. Variation was evident within hospital subtypes, exceeded that explained by hospital and patient characteristics, and included wide variability in proportion of broad-spectrum antibiotics (IQR 36%-48%), proportion of fluoroquinolones among respiratory antibiotics (IQR 40%-62%), proportion of ciprofloxacin among urinary anti-infectives (IQR 44%-60%), proportion of antibiotics with highest risk for Clostridium difficile (IQR 29%-40%), proportion of 'reserved-use' antibiotics (IQR 0.8%-3.5%) and proportion of anti-pseudomonal antibiotics among antibiotics with Gram-negative coverage (IQR 26%-40%). There is extensive variability in antibiotic use, and risk-adjusted use, across acute care hospitals. This could motivate, focus and benchmark antibiotic stewardship efforts. © The Author 2016. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please email

A national survey of the primary and acute care pediatric nurse practitioner educational preparation.

PubMed

Hawkins-Walsh, Elizabeth; Berg, Mary; Docherty, Sharron; Lindeke, Linda; Gaylord, Nan; Osborn, Kristen

2011-01-01

The past decade has been marked by a gradual expansion of the traditional primary care role of the pediatric nurse practitioner (PNP) into practice arenas that call for more acute and critical care of children. The purpose of the study was to explore the educational programming needs of dual (combined) track PNP programs that prepare graduates to provide care to children and adolescents across the continuum of health and illness. A two-phase, exploratory, mixed method design was utilized. An electronic survey was completed by 65% of PNP program directors in the country. Semi-structured telephone interviews were conducted with hospital-based PNPs who were practicing in roles that met a range of health care needs across the primary and acute care continuum. Primary care and acute care programs have more common than unique elements, and the vast majority of clinical competencies are common to both types of program. Only three competencies appear to be unique to acute care programs. The Association of Faculties of Pediatric Nurse Practitioner Programs should utilize existing evidence and develop guidelines for dual PNP programs that focus on the provision of care to children across a wide continuum of health and illness. Copyright © 2011 National Association of Pediatric Nurse Practitioners. Published by Mosby, Inc. All rights reserved.

Multidisciplinary acute care research organization (MACRO): if you build it, they will come.

PubMed

Early, Barbara J; Huang, David T; Callaway, Clifton W; Zenati, Mazen; Angus, Derek C; Gunn, Scott R; Yealy, Donald M; Unikel, Daniel; Billiar, Timothy R; Peitzman, Andrew B; Sperry, Jason L

2013-07-01

Clinical research will increasingly play a core role in the evolution and growth of acute care surgery program development across the country. What constitutes an efficient and effective clinical research infrastructure in the current fiscal and academic environment remains obscure. We sought to characterize the effects of implementation of a multidisciplinary acute care research organization (MACRO) at a busy tertiary referral university setting. In 2008, to minimize redundancy and cost as well as to maximize existing resources promoting acute care research, MACRO was created, unifying clinical research infrastructure among the Departments of Critical Care Medicine, Emergency Medicine, and Surgery. During the periods 2008 to 2012, we performed a retrospective analysis and determined volume of clinical studies, patient enrollment for both observational and interventional trials, and staff growth since MACRO's origination and characterized changes over time. From 2008 to 2011, the volume of patients enrolled in clinical studies, which MACRO facilitates has significantly increased more than 300%. The percentage of interventional/observational trials has remained stable during the same period (50-60%). Staff has increased from 6 coordinators to 10, with an additional 15 research associates allowing 24/7 service. With this significant growth, MACRO has become financially self-sufficient, and additional outside departments now seek MACRO's services. Appropriate organization of acute care clinical research infrastructure minimizes redundancy and can promote sustainable, efficient growth in the current academic environment. Further studies are required to determine if similar models can be successful at other acute care surgery programs.

The state of cancer survivorship programming in Commission on Cancer-accredited hospitals in Georgia.

PubMed

Kirsch, Logan J; Patterson, Angela; Lipscomb, Joseph

2015-03-01

In Georgia, there are more than 356,000 cancer survivors. Although many encounter challenges as a result of treatment, there is limited data on the availability of survivorship programming. This paper highlights findings from two surveys assessing survivorship care in Commission on Cancer (CoC)-accredited hospitals in Georgia. In 2010, 38 CoC-accredited hospitals were approached to complete a 36-item survey exploring knowledge of national standards and use of survivorship care plans (SCPs), treatment summaries (TSs), and psychosocial assessment tools. In 2012, 37 CoC-accredited hospitals were asked to complete a similar 21-item survey. Seventy-nine percent (n = 30) of cancer centers completed the 2010 survey. Sixty percent (n = 18) reported having a cancer survivorship program in place or in development. Forty-three percent (n = 13) provided survivors with a SCP and 40% (n = 12) a TS. Sixty percent (n = 18) reported either never or rarely using a psychosocial assessment tool. Sixty-two percent (n = 23) completed the 2012 survey. Ninety-six percent (n = 22) were aware of the new CoC guideline 3.3. Thirty-nine percent (n = 9) provided a SCP and/or TS. Eighty-seven percent (n = 20) stated they were very confident or somewhat confident their organization could implement a SCP and/or TS by 2015. The data indicated the importance of collaboration and shared responsibility for survivorship care. Broad implementation of SCPs and TSs can help address the late and long-term effects of treatment. Increasing knowledge on survivorship care is imperative as the Georgia oncology community engages oncologists and primary care providers to achieve higher quality of life for all survivors.

[Quality of health care for diabetic and hypertensive patients in primary care settings servicing Mexican Seguro Popular].

PubMed

Ortiz-Domínguez, Maki E; Garrido-Latorre, Francisco; Orozco, Ricardo; Pineda-Pérez, Dayana; Rodríguez-Salgado, Marlenne

2011-01-01

To assess health care quality provided to type-2 diabetic and hypertensive patients in primary care settings from the Mexican Ministry of Health and to evaluate whether accredited clinics providing services to the Mexican Seguro Popular performed better in terms of metabolic control of those patients compared to the non-accredited. Cross-sectional study performed on 2008. Previous year clinical measures were obtained from 5 444 diabetic and 5 827 hypertensive patient's clinical records. Adequate metabolic control (glucose <110 mg/dl for diabetes and blood pressure <140/90 mmHg for hypertension) associated factors were assessed by multiple-multilevel logistic regression methods. Patients attending accredited clinics were more likely to be controlled, however, metabolic control was not constant over time of accreditation. Additional efforts are required to monitor accredited clinics' performance in order to maintain both metabolic control and clinical assessment of patients.

Teacher Education Accreditation Council Brochure

ERIC Educational Resources Information Center

Teacher Education Accreditation Council, 2009

2009-01-01

The Teacher Education Accreditation Council (TEAC), founded in 1997, is dedicated to improving academic degree programs for professional educators--those who teach and lead in schools, pre-K through grade 12. TEAC accredits undergraduate and graduate programs, including alternate route programs, based on (1) the evidence they have that they…

Urinary NGAL in patients with and without acute kidney injury in a cardiology intensive care unit

PubMed Central

Watanabe, Mirian; Silva, Gabriela Fulan e; da Fonseca, Cassiane Dezoti; Vattimo, Maria de Fatima Fernandes

2014-01-01

Objective To assess the diagnostic and prognostic efficacy of urine neutrophil gelatinase-associated lipocalin in patients admitted to an intensive care unit. Methods Longitudinal, prospective cohort study conducted in a cardiology intensive care unit. The participants were divided into groups with and without acute kidney injury and were followed from admission to the intensive care unit until hospital discharge or death. Serum creatinine, urine output and urine neutrophil gelatinase-associated lipocalin were measured 24 and 48 hours after admission. Results A total of 83 patients admitted to the intensive care unit for clinical reasons were assessed, most being male (57.8%). The participants were divided into groups without acute kidney injury (N=18), with acute kidney injury (N=28) and with severe acute kidney injury (N=37). Chronic diseases, mechanical ventilation and renal replacement therapy were more common in the groups with acute kidney injury and severe acute kidney injury, and those groups exhibited longer intensive care unit stay and hospital stay and higher mortality. Serum creatinine did not change significantly in the group with acute kidney injury within the first 24 hours of admission to the intensive care unit, although, urine neutrophil gelatinase-associated lipocalin was high in the groups with acute kidney injury and severe acute kidney injury (p<0.001). Increased urine neutrophil gelatinase-associated lipocalin was associated with death. Conclusion An increase in urine neutrophil gelatinase-associated lipocalin precedes variations in serum creatinine in patients with acute kidney injury and may be associated with death. PMID:25607262

Accreditation status and geographic location of outpatient vascular testing facilities among Medicare beneficiaries: the VALUE (Vascular Accreditation, Location & Utilization Evaluation) study.

PubMed

Rundek, Tatjana; Brown, Scott C; Wang, Kefeng; Dong, Chuanhui; Farrell, Mary Beth; Heller, Gary V; Gornik, Heather L; Hutchisson, Marge; Needleman, Laurence; Benenati, James F; Jaff, Michael R; Meier, George H; Perese, Susana; Bendick, Phillip; Hamburg, Naomi M; Lohr, Joann M; LaPerna, Lucy; Leers, Steven A; Lilly, Michael P; Tegeler, Charles; Alexandrov, Andrei V; Katanick, Sandra L

2014-10-01

There is limited information on the accreditation status and geographic distribution of vascular testing facilities in the US. The Centers for Medicare & Medicaid Services (CMS) provide reimbursement to facilities regardless of accreditation status. The aims were to: (1) identify the proportion of Intersocietal Accreditation Commission (IAC) accredited vascular testing facilities in a 5% random national sample of Medicare beneficiaries receiving outpatient vascular testing services; (2) describe the geographic distribution of these facilities. The VALUE (Vascular Accreditation, Location & Utilization Evaluation) Study examines the proportion of IAC accredited facilities providing vascular testing procedures nationally, and the geographic distribution and utilization of these facilities. The data set containing all facilities that billed Medicare for outpatient vascular testing services in 2011 (5% CMS Outpatient Limited Data Set (LDS) file) was examined, and locations of outpatient vascular testing facilities were obtained from the 2011 CMS/Medicare Provider of Services (POS) file. Of 13,462 total vascular testing facilities billing Medicare for vascular testing procedures in a 5% random Outpatient LDS for the US in 2011, 13% (n=1730) of facilities were IAC accredited. The percentage of IAC accredited vascular testing facilities in the LDS file varied significantly by US region, p<0.0001: 26%, 12%, 11%, and 7% for the Northeast, South, Midwest, and Western regions, respectively. Findings suggest that the proportion of outpatient vascular testing facilities that are IAC accredited is low and varies by region. Increasing the number of accredited vascular testing facilities to improve test quality is a hypothesis that should be tested in future research. © The Author(s) 2014.

Reconciling conceptualizations of relationships and person-centred care for older people with cognitive impairment in acute care settings.

PubMed

Rushton, Carole; Edvardsson, David

2018-04-01

Relationships are central to enacting person-centred care of the older person with cognitive impairment. A fuller understanding of relationships and the role they play facilitating wellness and preserving personhood is critical if we are to unleash the productive potential of nursing research and person-centred care. In this article, we target the acute care setting because much of the work about relationships and older people with cognitive impairment has tended to focus on relationships in long-term care. The acute care setting is characterized by archetypal constraints which differentiate it from long-term care, in terms of acuity and haste, task-orientated work patterns and influence from "the rule of medicine," all of which can privilege particular types of relating. In this article, we drew on existing conceptualizations of relationships from theory and practice by tapping in to the intellectual resources provided by nurse researchers, the philosophy of Martin Buber and ANT scholars. This involved recounting two examples of dyadic and networked relationships which were re-interpreted using two complementary theoretical approaches to provide deeper and more comprehensive conceptualizations of these relationships. By re-presenting key tenets from the work of key scholars on the topic relationships, we hope to hasten socialization of these ideas into nursing into the acute care setting. First, by enabling nurses to reflect on how they might work toward cultivating relationships that are more salutogenic and consistent with the preservation of personhood. Second, by stimulating two distinct but related lines of research enquiry which focus on dyadic and networked relationships with the older person with cognitive impairment in the acute care setting. We also hope to reconcile the schism that has emerged in the literature between preferred approaches to care of the older person with cognitive impairment, that is person-centred care versus relationship-centred care

Acute stroke care at rural hospitals in Idaho: challenges in expediting stroke care.

PubMed

Gebhardt, James G; Norris, Thomas E

2006-01-01

Thrombolytics are currently the most effective treatment for stroke. However, the National Institute for Neurological Disorders and Stroke criteria for initiation of thrombolytic therapy, most notably the 3-hour time limit from symptom onset, have proven challenging for many rural hospitals to achieve. To provide a snapshot of stroke care at rural hospitals in Idaho and to investigate the experiences of these hospitals in expediting stroke care. Using a standard questionnaire, a telephone survey of hospital staff at 21 rural hospitals in Idaho was performed. The survey focused on acute stroke care practices and strategies to expedite stroke care. The median number of stroke patients treated per year was 23.3. Patient delays were reported by 77.8% of hospitals, transport delays by 66.7%, in-hospital delays by 61.1%, equipment delays by 22.2%, and ancillary services delays by 61.1%. Approximately 67% of hospitals had implemented a clinical pathway for stroke and 80.0% had provided staff with stroke-specific training. No hospitals surveyed had a designated stroke team, and only 33.3% reported engaging in quality improvement efforts to expedite stroke care. Thrombolytics (tPA) were available and indicated for stroke at 55.6% of the hospitals surveyed. Rural hospitals in Idaho face many difficult challenges as they endeavor to meet the 3-hour deadline for thrombolytic therapy, including limited resources and experience in acute stroke care, and many different types of prehospital and in-hospital delays.

Library Standards: Evidence of Library Effectiveness and Accreditation.

ERIC Educational Resources Information Center

Ebbinghouse, Carol

1999-01-01

Discusses accreditation standards for libraries based on experiences in an academic law library. Highlights include the accreditation process; the impact of distance education and remote technologies on accreditation; and a list of Internet sources of standards and information. (LRW)

Accreditations as Local Management Tools

ERIC Educational Resources Information Center

Cret, Benoit

2011-01-01

The development of accreditation agencies within the Higher Education sector in order to assess and guarantee the quality of services or product is still a growing phenomenon in Europe. Accreditations are conceived by institutional authors and by authors who directly deal with quality assurance processes as a means of legitimization or a means of…

American Accreditation: Why Do It?

ERIC Educational Resources Information Center

Prince, Deborah

2012-01-01

A review of the history and purpose of accreditation followed by a brief case study of how a small specialist institution outside of the USA went through the process of becoming accredited. The changes needed inside the curriculum and inside the organization in order to make this significant organizational development are reviewed and discussed.…

An Overview of U.S. Accreditation. Revised November 2015

ERIC Educational Resources Information Center

Eaton, Judith S.

2015-01-01

This publication provides a general description of the key features of U.S. accreditation of higher education and recognition of accrediting organizations. Accreditation in the United States is about quality assurance and quality improvement. It is a process to scrutinize higher education institutions and programs. Accreditation is private…

Health Care Seeking Behavior of Persons with Acute Chagas Disease in Rural Argentina: A Qualitative View.

PubMed

Llovet, Ignacio; Dinardi, Graciela; Canevari, Cecilia; Torabi, Nahal

2016-01-01

Chagas disease (CD) is a tropical parasitic disease largely underdiagnosed and mostly asymptomatic affecting marginalized rural populations. Argentina regularly reports acute cases of CD, mostly young individuals under 14 years old. There is a void of knowledge of health care seeking behavior in subjects experiencing a CD acute condition. Early treatment of the acute case is crucial to limit subsequent development of disease. The article explores how the health outcome of persons with acute CD may be conditioned by their health care seeking behavior. The study, with a qualitative approach, was carried out in rural areas of Santiago del Estero Province, a high risk endemic region for vector transmission of CD. Narratives of 25 in-depth interviews carried out in 2005 and 2006 are analyzed identifying patterns of health care seeking behavior followed by acute cases. Through the retrospective recall of paths for diagnoses, weaknesses of disease information, knowledge at the household level, and underperformance at the provincial health care system level are detected. The misdiagnoses were a major factor in delaying a health care response. The study results expose lost opportunities for the health care system to effectively record CD acute cases.

Health Care Seeking Behavior of Persons with Acute Chagas Disease in Rural Argentina: A Qualitative View

PubMed Central

Dinardi, Graciela; Canevari, Cecilia; Torabi, Nahal

2016-01-01

Chagas disease (CD) is a tropical parasitic disease largely underdiagnosed and mostly asymptomatic affecting marginalized rural populations. Argentina regularly reports acute cases of CD, mostly young individuals under 14 years old. There is a void of knowledge of health care seeking behavior in subjects experiencing a CD acute condition. Early treatment of the acute case is crucial to limit subsequent development of disease. The article explores how the health outcome of persons with acute CD may be conditioned by their health care seeking behavior. The study, with a qualitative approach, was carried out in rural areas of Santiago del Estero Province, a high risk endemic region for vector transmission of CD. Narratives of 25 in-depth interviews carried out in 2005 and 2006 are analyzed identifying patterns of health care seeking behavior followed by acute cases. Through the retrospective recall of paths for diagnoses, weaknesses of disease information, knowledge at the household level, and underperformance at the provincial health care system level are detected. The misdiagnoses were a major factor in delaying a health care response. The study results expose lost opportunities for the health care system to effectively record CD acute cases. PMID:27829843

A patient-centered research agenda for the care of the acutely ill older patient.

PubMed

Wald, Heidi L; Leykum, Luci K; Mattison, Melissa L P; Vasilevskis, Eduard E; Meltzer, David O

2015-05-01

Hospitalists and others acute-care providers are limited by gaps in evidence addressing the needs of the acutely ill older adult population. The Society of Hospital Medicine sponsored the Acute Care of Older Patients Priority Setting Partnership to develop a research agenda focused on bridging this gap. Informed by the Patient-Centered Outcomes Research Institute framework for identification and prioritization of research areas, we adapted a methodology developed by the James Lind Alliance to engage diverse stakeholders in the research agenda setting process. The work of the Partnership proceeded through 4 steps: convening, consulting, collating, and prioritizing. First, the steering committee convened a partnership of 18 stakeholder organizations in May 2013. Next, stakeholder organizations surveyed members to identify important unanswered questions in the acute care of older persons, receiving 1299 responses from 580 individuals. Finally, an extensive and structured process of collation and prioritization resulted in a final list of 10 research questions in the following areas: advanced-care planning, care transitions, delirium, dementia, depression, medications, models of care, physical function, surgery, and training. With the changing demographics of the hospitalized population, a workforce with limited geriatrics training, and gaps in evidence to inform clinical decision making for acutely ill older patients, the identified research questions deserve the highest priority in directing future research efforts to improve care for the older hospitalized patient and enrich training. © 2015 Society of Hospital Medicine.

Development and Evaluation of a Computer-Based Program for Assessing Quality of Family Medicine Teams Based on Accreditation Standards

PubMed Central

Valjevac, Salih; Ridjanovic, Zoran; Masic, Izet

2009-01-01

CONFLICT OF INTEREST: NONE DECLARED SUMMARY Introduction Agency for healthcare quality and accreditation in Federation of Bosnia and Herzegovina (AKAZ) is authorized body in the field of healthcare quality and safety improvement and accreditation of healthcare institutions. Beside accreditation standards for hospitals and primary health care centers, AKAZ has also developed accreditation standards for family medicine teams. Methods Software development was primarily based on Accreditation Standards for Family Medicine Teams. Seven chapters / topics: (1. Physical factors; 2. Equipment; 3. Organization and Management; 4. Health promotion and illness prevention; 5. Clinical services; 6. Patient survey; and 7. Patient’s rights and obligations) contain 35 standards describing expected level of family medicine team’s quality. Based on accreditation standards structure and needs of different potential users, it was concluded that software backbone should be a database containing all accreditation standards, self assessment and external assessment details. In this article we will present the development of standardized software for self and external evaluation of quality of service in family medicine, as well as plans for the future development of this software package. Conclusion Electronic data gathering and storing enhances the management, access and overall use of information. During this project we came to conclusion that software for self assessment and external assessment is ideal for accreditation standards distribution, their overview by the family medicine team members, their self assessment and external assessment. PMID:24109157

[Self-owned versus accredited network: comparative cost analysis in a Brazilian health insurance provider].

PubMed

Souza, Marcos Antônio de; Salvalaio, Dalva

2010-10-01

to analyze the cost of a self-owned network maintained by a Brazilian health insurance provider as compared to the price charged by accredited service providers, so as to identify whether or not the self-owned network is economically advantageous. for this exploratory study, the company's management reports were reviewed. The cost associated with the self-owned network was calculated based on medical and dental office visits and diagnostic/laboratory tests performed at one of the company's most representative facilities. The costs associated with third parties were derived from price tables used by the accredited network for the same services analyzed in the self-owned network. The full-cost method was used for cost quantification. Costs are presented as absolute values (in R$) and percent comparisons between self-owned network costs versus accredited network costs. overall, the self-owned network was advantageous for medical and dental consultations as well as diagnostic and laboratory tests. Pediatric and labor medicine consultations and x-rays were less costly in the accredited network. the choice of verticalization has economic advantages for the health care insurance operator in comparison with services provided by third parties.

Effect of Accreditation on Accuracy of Diagnostic Tests in Medical Laboratories

PubMed Central

Jang, Mi-Ae; Yoon, Young Ahn; Song, Junghan; Kim, Jeong-Ho; Min, Won-Ki; Lee, Ji Sung

2017-01-01

Background Medical laboratories play a central role in health care. Many laboratories are taking a more focused and stringent approach to quality system management. In Korea, laboratory standardization efforts undertaken by the Korean Laboratory Accreditation Program (KLAP) and the Korean External Quality Assessment Scheme (KEQAS) may have facilitated an improvement in laboratory performance, but there are no fundamental studies demonstrating that laboratory standardization is effective. We analyzed the results of the KEQAS to identify significant differences between laboratories with or without KLAP and to determine the impact of laboratory standardization on the accuracy of diagnostic tests. Methods We analyzed KEQAS participant data on clinical chemistry tests such as albumin, ALT, AST, and glucose from 2010 to 2013. As a statistical parameter to assess performance bias between laboratories, we compared 4-yr variance index score (VIS) between the two groups with or without KLAP. Results Compared with the group without KLAP, the group with KLAP exhibited significantly lower geometric means of 4-yr VIS for all clinical chemistry tests (P<0.0001); this difference justified a high level of confidence in standardized services provided by accredited laboratories. Confidence intervals for the mean of each test in the two groups (accredited and non-accredited) did not overlap, suggesting that the means of the groups are significantly different. Conclusions These results confirmed that practice standardization is strongly associated with the accuracy of test results. Our study emphasizes the necessity of establishing a system for standardization of diagnostic testing. PMID:28224767

Feasibility and Efficacy of Nurse-Driven Acute Stroke Care.

PubMed

Mainali, Shraddha; Stutzman, Sonja; Sengupta, Samarpita; Dirickson, Amanda; Riise, Laura; Jones, Donald; Yang, Julian; Olson, DaiWai M

2017-05-01

Acute stroke care requires rapid assessment and intervention. Replacing traditional sequential algorithms in stroke care with parallel processing using telestroke consultation could be useful in the management of acute stroke patients. The purpose of this study was to assess the feasibility of a nurse-driven acute stroke protocol using a parallel processing model. This is a prospective, nonrandomized, feasibility study of a quality improvement initiative. Stroke team members had a 1-month training phase, and then the protocol was implemented for 6 months and data were collected on a "run-sheet." The primary outcome of this study was to determine if a nurse-driven acute stroke protocol is feasible and assists in decreasing door to needle (intravenous tissue plasminogen activator [IV-tPA]) times. Of the 153 stroke patients seen during the protocol implementation phase, 57 were designated as "level 1" (symptom onset <4.5 hours) strokes requiring acute stroke management. Among these strokes, 78% were nurse-driven, and 75% of the telestroke encounters were also nurse-driven. The average door to computerized tomography time was significantly reduced in nurse-driven codes (38.9 minutes versus 24.4 minutes; P < .04). The use of a nurse-driven protocol is feasible and effective. When used in conjunction with a telestroke specialist, it may be of value in improving patient outcomes by decreasing the time for door to decision for IV-tPA. Copyright © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.

Assessment and Accreditation for Languages: The Emerging Consensus?

ERIC Educational Resources Information Center

Hubner, Anke, Ed.; Ibarz, Toni, Ed.; Laviosa, Sara, Ed.

Chapter titles include the following: "Language Teaching, Accreditation and the Social Purpose of Adult Education" (Liam Kane); "Student Attitudes to Learning, Assessment and Accreditation" (Fran Beaton); "Assessment on a Fully Accredited Open Language Programme: Achieving Beneficial Backwash in a Standardised Scheme" (Dounia Bissar); "Introducing…

Persistent Super-Utilization of Acute Care Services Among Subgroups of Veterans Experiencing Homelessness.

PubMed

Szymkowiak, Dorota; Montgomery, Ann Elizabeth; Johnson, Erin E; Manning, Todd; O'Toole, Thomas P

2017-10-01

Acute health care utilization often occurs among persons experiencing homelessness. However, knowing which individuals will be persistent super-utilizers of acute care is less well understood. The objective of the study was to identify those more likely to be persistent super-utilizers of acute care services. We conducted a latent class analysis of secondary data from the Veterans Health Administration Corporate Data Warehouse, and Homeless Operations Management and Evaluation System. The study sample included 16,912 veterans who experienced homelessness and met super-utilizer criteria in any quarter between July 1, 2014 and December 31, 2015. The latent class analysis included veterans' diagnoses and acute care utilization. Medical, mental health, and substance use morbidity rates were high. More than half of the sample utilized Veterans Health Administration Homeless Programs concurrently with their super-utilization of acute care. There were 7 subgroups of super-utilizers, which varied considerably on the degree to which their super-utilization persisted over time. Approximately a third of the sample met super-utilizer criteria for ≥3 quarters; this group was older and disproportionately male, non-Hispanic white, and unmarried, with lower rates of post-9/11 service and higher rates of rural residence and service-connected disability. They were much more likely to be currently homeless with more medical, mental health, and substance use morbidity. Only a subset of homeless veterans were persistent super-utilizers, suggesting the need for more targeted interventions.

Acute myocardial infarction quality of care: the Strong Heart Study.

PubMed

Best, Lyle G; Butt, Amir; Conroy, Britt; Devereux, Richard B; Galloway, James M; Jolly, Stacey; Lee, Elisa T; Silverman, Angela; Yeh, Jeun-Liang; Welty, Thomas K; Kedan, Ilan

2011-01-01

Evaluate the quality of care provided patients with acute myocardial infarction and compare with similar national and regional data. Case series. The Strong Heart Study has extensive population-based data related to cardiovascular events among American Indians living in three rural regions of the United States. Acute myocardial infarction cases (72) occurring between 1/1/2001 and 12/31/2006 were identified from a cohort of 4549 participants. The proportion of cases that were provided standard quality of care therapy, as defined by the Healthcare Financing Administration and other national organizations. The provision of quality services, such as administration of aspirin on admission and at discharge, reperfusion therapy within 24 hours, prescription of beta blocker medication at discharge, and smoking cessation counseling were found to be 94%, 91%, 92%, 86% and 71%, respectively. The unadjusted, 30 day mortality rate was 17%. Despite considerable challenges posed by geographic isolation and small facilities, process measures of the quality of acute myocardial infarction care for participants in this American Indian cohort were comparable to that reported for Medicare beneficiaries nationally and within the resident states of this cohort.

Oral hygiene and mouth care for older people in acute hospitals: part 1.

PubMed

Steel, Ben J

2017-10-31

The oral health of older people in acute hospitals has rarely been studied. Hospital admission provides a prime opportunity for identification and rectification of problems, and oral health promotion. This two-part article explores oral hygiene and mouth care provision for older adults in acute hospitals. The first article presents the findings of a literature review exploring oral and dental disease in older adults, the importance of good oral health and mouth care, and the current situation. Searches of electronic databases and the websites of relevant professional health service bodies in the UK were undertaken to identify articles and guidelines. The literature shows a high prevalence of oro-dental disease in this population, with many known detrimental effects, combined with suboptimal oral hygiene and mouth care provision in acute hospitals. Several guidelines exist, although the emphasis on oral health is weaker than other aspects of hospital care. Older adults admitted to acute hospitals have a high burden of oro-dental disease and oral and mouth care needs, but care provision tends to be suboptimal. The literature is growing, but this area is still relatively neglected. Great potential exists to develop oral and mouth care in this context. The second part of this article explores clinical recommendations. ©2012 RCN Publishing Company Ltd. All rights reserved. Not to be copied, transmitted or recorded in any way, in whole or part, without prior permission of the publishers.

Chiropractic care and risk for acute lumbar disc herniation: a population-based self-controlled case series study.

PubMed

Hincapié, Cesar A; Tomlinson, George A; Côté, Pierre; Rampersaud, Y Raja; Jadad, Alejandro R; Cassidy, J David

2017-10-16

Chiropractic care is popular for low back pain, but may increase the risk for acute lumbar disc herniation (LDH). Low back pain is a common early (prodromal) symptom of LDH and commonly precedes LDH diagnosis. Our objective was to investigate the association between chiropractic care and acute LDH with early surgical intervention, and contrast this with the association between primary care physician (PCP) care and acute LDH with early surgery. Using a self-controlled case series design and population-based healthcare databases in Ontario, Canada, we investigated all adults with acute LDH requiring emergency department (ED) visit and early surgical intervention from April 1994 to December 2004. The relative incidence of acute LDH with early surgery in exposed periods after chiropractic visits relative to unexposed periods was estimated within individuals, and compared with the relative incidence of acute LDH with early surgery following PCP visits. 195 cases of acute LDH with early surgery (within 8 weeks) were identified in a population of more than 100 million person-years. Strong positive associations were found between acute LDH and both chiropractic and PCP visits. The risk for acute LDH with early surgery associated with chiropractic visits was no higher than the risk associated with PCP visits. Both chiropractic and primary medical care were associated with an increased risk for acute LDH requiring ED visit and early surgery. Our analysis suggests that patients with prodromal back pain from a developing disc herniation likely seek healthcare from both chiropractors and PCPs before full clinical expression of acute LDH. We found no evidence of excess risk for acute LDH with early surgery associated with chiropractic compared with primary medical care.

Mild traumatic brain injury in children: management practices in the acute care setting.

PubMed

Kool, Bridget; King, Vivienne; Chelimo, Carol; Dalziel, Stuart; Shepherd, Michael; Neutze, Jocelyn; Chambers, Nikki; Wells, Susan

2014-08-01

Accurate diagnosis, treatment and follow up of children suffering mild traumatic brain injury (MTBI) is important as post-concussive symptoms and long-term disability might occur. This research explored the decisions clinicians make in their assessment and management of children with MTBI in acute care settings, and identified barriers and enablers to the delivery of best-practice care. A purposeful sample of 29 clinicians employed in two metropolitan paediatric EDs and one Urgent Care clinic was surveyed using a vignette-based questionnaire that also included domains of guideline awareness, attitudes to MTBI care, use of clinical decision support systems, and knowledge and skills for practising evidence-based healthcare. Overall, the evaluation and management of children presenting acutely with MTBI generally followed best-practice guidelines, particularly in relation to identifying intracranial injuries that might require surgical intervention, observation for potential deterioration, adequate pain management and the provision of written head injury advice on discharge. Larger variation emerged in regard to follow-up care and referral pathways. Potential barriers to best- practice were lack of guideline awareness, attitudes to MTBI, and lack of time or other priorities. Opportunities exist to improve care for children who present in acute care settings following mild traumatic brain injury. These include having up-to-date guidelines that are consistent across acute care settings; providing clearer pathways for referral and follow up; targeting continuing medical education towards potential complications; and providing computerised decision support so that assessment and management are conducted systematically. © 2014 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

What Should Gerontology Learn from Health Education Accreditation?

ERIC Educational Resources Information Center

Bradley, Dana Burr; Fitzgerald, Kelly

2012-01-01

Quality assurance and accreditation are closely tied together. This article documents the work toward a unified and comprehensive national accreditation program in health education. By exploring the accreditation journey of another discipline, the field of gerontology should learn valuable lessons. These include an attention to inclusivity, a…

7 CFR 205.502 - Applying for accreditation.

Code of Federal Regulations, 2010 CFR

2010-01-01

..., Inspections, Marketing Practices), DEPARTMENT OF AGRICULTURE (CONTINUED) ORGANIC FOODS PRODUCTION ACT PROVISIONS NATIONAL ORGANIC PROGRAM Accreditation of Certifying Agents § 205.502 Applying for accreditation...

Building on a national health information technology strategic plan for long-term and post-acute care: comments by the Long Term Post Acute Care Health Information Technology Collaborative.

PubMed

Alexander, Gregory L; Alwan, Majd; Batshon, Lynne; Bloom, Shawn M; Brennan, Richard D; Derr, John F; Dougherty, Michelle; Gruhn, Peter; Kirby, Annessa; Manard, Barbara; Raiford, Robin; Serio, Ingrid Johnson

2011-07-01

The LTPAC (Long Term Post Acute Care) Health Information Technology (HIT) Collaborative consists of an alliance of long-term services and post-acute care stakeholders. Members of the collaborative are actively promoting HIT innovations in long-term care settings because IT adoption for health care institutions in the United States has become a high priority. One method used to actively promote HIT is providing expert comments on important documents addressing HIT adoption. Recently, the Office of the National Coordinator for HIT released a draft of the Federal Health Information Technology Strategic Plan 2011-2015 for public comment. The following brief is intended to inform about recommendations and comments made by the Collaborative on the strategic plan. Copyright 2011, SLACK Incorporated.

State Health Agencies' Perceptions of the Benefits of Accreditation.

PubMed

Kittle, Alannah; Liss-Levinson, Rivka

The national voluntary accreditation program serves to encourage health agencies to seek departmental accreditation as a mechanism for continuous quality improvement. This study utilizes data from the 2016 Association of State and Territorial Health Officials Profile Survey to examine the perceived benefits of accreditation among state health agencies. Respondents answered questions on topics such as agency structure, workforce, and quality improvement activities. Frequencies and cross tabulations were conducted using IBM SPSS (version 21) statistical software. Results indicate that among accredited agencies, the most commonly endorsed benefits of accreditation include stimulating quality and performance improvement opportunities (95%), strengthening the culture of quality improvement (90%), and stimulating greater collaboration across departments/units within the agency (90%). Policy and practice implications, such as how these data can be used to promote accreditation within health agencies, as well as how accreditation strengthens governmental public health systems, are also discussed.

A Comparison of Compliance and Aspirational Accreditation Models: Recounting a University's Experience with Both a Taiwanese and an American Accreditation Body

ERIC Educational Resources Information Center

Cheng, Nellie S.

2015-01-01

Despite the widespread adoption of accreditation processes and the belief in their effectiveness for improving educational quality, the search for good accreditation practices remains a critical issue. This article recounts one university's experiences when simultaneously undergoing the accreditation processes of both the Middle States Commission…

Does hospital accreditation impact bariatric surgery safety?

PubMed

Morton, John M; Garg, Trit; Nguyen, Ninh

2014-09-01

To evaluate the impact of hospital accreditation upon bariatric surgery outcomes. Since 2004, the American College of Surgeons and the American Society of Metabolic and Bariatric Surgery have accredited bariatric hospitals. Few studies have evaluated the impact of hospital accreditation on all bariatric surgery outcomes. Bariatric surgery hospitalizations were identified using International Classification of Diseases, Ninth Revision (ICD9) codes in the 2010 Nationwide Inpatient Sample (NIS). Hospital names and American Hospital Association (AHA) codes were used to identify accredited bariatric centers. Relevant ICD9 codes were used for identifying demographics, length of stay (LOS), total charges, mortality, complications, and failure to rescue (FTR) events. There were 117,478 weighted bariatric patient discharges corresponding to 235 unique hospitals in the 2010 NIS data set. A total of 72,615 (61.8%) weighted discharges, corresponding to 145 (61.7%) named or AHA-identifiable hospitals were included. Among the 145 hospitals, 66 (45.5%) were unaccredited and 79 (54.5%) accredited. Compared with accredited centers, unaccredited centers had a higher mean LOS (2.25 vs 1.99 days, P < 0.0001), as well as total charges ($51,189 vs $42,212, P < 0.0001). Incidence of any complication was higher at unaccredited centers than at accredited centers (12.3% vs 11.3%, P = 0.001), as was mortality (0.13% vs 0.07%, P = 0.019) and FTR (0.97% vs 0.55%, P = 0.046). Multivariable logistic regression analysis identified unaccredited status as a positive predictor of incidence of complication [odds ratio (OR) = 1.08, P < 0.0001], as well as mortality (OR = 2.13, P = 0.013). Hospital accreditation status is associated with safer outcomes, shorter LOS, and lower total charges after bariatric surgery.

Accreditation standards for undergraduate forensic science programs

NASA Astrophysics Data System (ADS)

Miller, Marilyn Tebbs

Undergraduate forensic science programs are experiencing unprecedented growth in numbers of programs offered and, as a result, student enrollments are increasing. Currently, however, these programs are not subject to professional specialized accreditation. This study sought to identify desirable student outcome measures for undergraduate forensic science programs that should be incorporated into such an accreditation process. To determine desirable student outcomes, three types of data were collected and analyzed. All the existing undergraduate forensic science programs in the United States were examined with regard to the input measures of degree requirements and curriculum content, and for the output measures of mission statements and student competencies. Accreditation procedures and guidelines for three other science-based disciplines, computer science, dietetics, and nursing, were examined to provide guidance on accreditation processes for forensic science education programs. Expert opinion on outcomes for program graduates was solicited from the major stakeholders of undergraduate forensic science programs-forensic science educators, crime laboratory directors, and recent graduates. Opinions were gathered by using a structured Internet-based survey; the total response rate was 48%. Examination of the existing undergraduate forensic science programs revealed that these programs do not use outcome measures. Of the accreditation processes for other science-based programs, nursing education provided the best model for forensic science education, due primarily to the balance between the generality and the specificity of the outcome measures. From the analysis of the questionnaire data, preliminary student outcomes, both general and discipline-specific, suitable for use in the accreditation of undergraduate forensic science programs were determined. The preliminary results were reviewed by a panel of experts and, based on their recommendations, the outcomes

7 CFR 205.507 - Denial of accreditation.

Code of Federal Regulations, 2010 CFR

2010-01-01

..., Inspections, Marketing Practices), DEPARTMENT OF AGRICULTURE (CONTINUED) ORGANIC FOODS PRODUCTION ACT PROVISIONS NATIONAL ORGANIC PROGRAM Accreditation of Certifying Agents § 205.507 Denial of accreditation. (a...

77 FR 60315 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-10-03

... Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Fiscal Year 2013 Rates; Hospitals' Resident Caps for Graduate Medical Education Payment Purposes; Quality... entitled ``Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and...

Accreditation Standards: Policies, Procedures, and Criteria. Revised Edition.

ERIC Educational Resources Information Center

Association of Independent Colleges and Schools, Washington, DC.

Statements of policies and procedures and evaluation criteria used by the Accrediting Commission of the Association of Independent Colleges and Schools are presented. The organization and function of the Accrediting Commission, the bases of eligibility for evaluation and accreditation of all types of institutions, and the general classification of…

Optimizing the care model for an uncomplicated acute pain episode in sickle cell disease.

PubMed

Telfer, Paul; Kaya, Banu

2017-12-08

The pathophysiology, clinical presentation, and natural history of acute pain in sickle cell disease are unique and require a disease-centered approach that also applies general principles of acute and chronic pain management. The majority of acute pain episodes are managed at home without the need to access health care. The long-term consequences of poorly treated acute pain include chronic pain, adverse effects of chronic opioid usage, psychological maladjustment, poor quality of life, and excessive health care utilization. There is no standard protocol for management of an acute pain crisis in either the hospital or the community. The assumptions that severe acute pain must be managed in the hospital with parenteral opioids and that strong opioids are needed for home management of pain need to be questioned. Pain management in the emergency department often does not meet acceptable standards, while chronic use of strong opioids is likely to result in opioid-induced hyperalgesia, exacerbation of chronic pain symptoms, and opioid dependency. We suggest that an integrated approach is needed to control the underlying condition, modify psychological responses, optimize social support, and ensure that health care services provide safe, effective, and prompt treatment of acute pain and appropriate management of chronic pain. This integrated approach should begin at an early age and continue through the adolescent, transition, and adult phases of the care model. © 2016 by The American Society of Hematology. All rights reserved.

Vertical integration and diversification of acute care hospitals: conceptual definitions.

PubMed

Clement, J P

1988-01-01

The terms vertical integration and diversification, although used quite frequently, are ill-defined for use in the health care field. In this article, the concepts are defined--specifically for nonuniversity acute care hospitals. The resulting definitions are more useful than previous ones for predicting the effects of vertical integration and diversification.

Post-Acute Care Facility as a Discharge Destination for Patients in Need of Palliative Care in Brazil.

PubMed

Soares, Luiz Guilherme L; Japiassu, André M; Gomes, Lucia C; Pereira, Rogéria

2018-02-01

Patients with complex palliative care needs can experience delayed discharge, which causes an inappropriate occupancy of hospital beds. Post-acute care facilities (PACFs) have emerged as an alternative discharge destination for some of these patients. The aim of this study was to investigate the frequency of admissions and characteristics of palliative care patients discharged from hospitals to a PACF. We conducted a retrospective analysis of PACF admissions between 2014 and 2016 that were linked to hospital discharge reports and electronic health records, to gather information about hospital-to-PACF transitions. In total, 205 consecutive patients were discharged from 6 different hospitals to our PACF. Palliative care patients were involved in 32% (n = 67) of these discharges. The most common conditions were terminal cancer (n = 42, 63%), advanced dementia (n = 17, 25%), and stroke (n = 5, 8%). During acute hospital stays, patients with cancer had significant shorter lengths of stay (13 vs 99 days, P = .004), a lower use of intensive care services (2% vs 64%, P < .001) and mechanical ventilation (2% vs 40%, P < .001), when compared to noncancer patients. Approximately one-third of discharges from hospitals to a PACF involved a heterogeneous group of patients in need of palliative care. Further studies are necessary to understand the trajectory of posthospitalized patients with life-limiting illnesses and what factors influence their decision to choose a PACF as a discharge destination and place of death. We advocate that palliative care should be integrated into the portfolio of post-acute services.

Mixed-method research protocol: defining and operationalizing patient-related complexity of nursing care in acute care hospitals.

PubMed

Huber, Evelyn; Kleinknecht-Dolf, Michael; Müller, Marianne; Kugler, Christiane; Spirig, Rebecca

2017-06-01

To define the concept of patient-related complexity of nursing care in acute care hospitals and to operationalize it in a questionnaire. The concept of patient-related complexity of nursing care in acute care hospitals has not been conclusively defined in the literature. The operationalization in a corresponding questionnaire is necessary, given the increased significance of the topic, due to shortened lengths of stay and increased patient morbidity. Hybrid model of concept development and embedded mixed-methods design. The theoretical phase of the hybrid model involved a literature review and the development of a working definition. In the fieldwork phase of 2015 and 2016, an embedded mixed-methods design was applied with complexity assessments of all patients at five Swiss hospitals using our newly operationalized questionnaire 'Complexity of Nursing Care' over 1 month. These data will be analysed with structural equation modelling. Twelve qualitative case studies will be embedded. They will be analysed using a structured process of constructing case studies and content analysis. In the final analytic phase, the quantitative and qualitative data will be merged and added to the results of the theoretical phase for a common interpretation. Cantonal Ethics Committee Zurich judged the research programme as unproblematic in December 2014 and May 2015. Following the phases of the hybrid model and using an embedded mixed-methods design can reach an in-depth understanding of patient-related complexity of nursing care in acute care hospitals, a final version of the questionnaire and an acknowledged definition of the concept. © 2016 John Wiley & Sons Ltd.

34 CFR 602.12 - Accrediting experience.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 34 Education 3 2010-07-01 2010-07-01 false Accrediting experience. 602.12 Section 602.12 Education Regulations of the Offices of the Department of Education (Continued) OFFICE OF POSTSECONDARY EDUCATION, DEPARTMENT OF EDUCATION THE SECRETARY'S RECOGNITION OF ACCREDITING AGENCIES The Criteria for Recognition...

42 CFR 414.68 - Imaging accreditation.

Code of Federal Regulations, 2013 CFR

2013-10-01

...) Computed tomography. (iii) Nuclear medicine. (iv) Positron emission tomography. CMS-approved accreditation... if CMS takes an adverse action based on accreditation findings. (vi) Notify CMS, in writing... organization must permit its surveyors to serve as witnesses if CMS takes an adverse action based on...

42 CFR 414.68 - Imaging accreditation.

Code of Federal Regulations, 2014 CFR

2014-10-01

...) Computed tomography. (iii) Nuclear medicine. (iv) Positron emission tomography. CMS-approved accreditation... if CMS takes an adverse action based on accreditation findings. (vi) Notify CMS, in writing... organization must permit its surveyors to serve as witnesses if CMS takes an adverse action based on...

42 CFR 414.68 - Imaging accreditation.

Code of Federal Regulations, 2012 CFR

2012-10-01

...) Computed tomography. (iii) Nuclear medicine. (iv) Positron emission tomography. CMS-approved accreditation... if CMS takes an adverse action based on accreditation findings. (vi) Notify CMS, in writing... organization must permit its surveyors to serve as witnesses if CMS takes an adverse action based on...

15 CFR 285.9 - Granting accreditation.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 15 Commerce and Foreign Trade 1 2010-01-01 2010-01-01 false Granting accreditation. 285.9 Section 285.9 Commerce and Foreign Trade Regulations Relating to Commerce and Foreign Trade NATIONAL INSTITUTE OF STANDARDS AND TECHNOLOGY, DEPARTMENT OF COMMERCE ACCREDITATION AND ASSESSMENT PROGRAMS NATIONAL...

42 CFR 422.157 - Accreditation organizations.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 3 2011-10-01 2011-10-01 false Accreditation organizations. 422.157 Section 422.157 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES...-walk reflecting the new requirements; and (iii) An explanation of how the accreditation organization...

42 CFR 423.168 - Accreditation organizations.

Code of Federal Regulations, 2014 CFR

2014-10-01

... any proposed changes in its accreditation standards or requirements or survey process. If the... application and enforcement of those standards to the comparable CMS requirements and processes when— (i) CMS imposes new requirements or changes its survey process; (ii) An accreditation organization proposes to...

42 CFR 423.168 - Accreditation organizations.

Code of Federal Regulations, 2013 CFR

2013-10-01

... any proposed changes in its accreditation standards or requirements or survey process. If the... application and enforcement of those standards to the comparable CMS requirements and processes when— (i) CMS imposes new requirements or changes its survey process; (ii) An accreditation organization proposes to...

42 CFR 423.168 - Accreditation organizations.

Code of Federal Regulations, 2011 CFR

2011-10-01

... any proposed changes in its accreditation standards or requirements or survey process. If the... application and enforcement of those standards to the comparable CMS requirements and processes when— (i) CMS imposes new requirements or changes its survey process; (ii) An accreditation organization proposes to...

42 CFR 423.168 - Accreditation organizations.

Code of Federal Regulations, 2012 CFR

2012-10-01

... any proposed changes in its accreditation standards or requirements or survey process. If the... application and enforcement of those standards to the comparable CMS requirements and processes when— (i) CMS imposes new requirements or changes its survey process; (ii) An accreditation organization proposes to...

The prevailing winds of oppression: understanding the new graduate experience in acute care.

PubMed

Duchscher, Judy Boychuk; Myrick, Florence

2008-01-01

The experience of new graduates in acute care. The majority of newly graduated nurses make their initial professional role transition in acute care. Being socialized into the dynamic culture of today's hospitals creates significant challenges not only for the nurses themselves but also for institutions of higher education, healthcare administrators, and policy makers across this country. Demanding workloads for hospital nurses, an aging nursing workforce, and the high level of stress inherent in workplaces across North America are factors contributing to an exodus of both new and seasoned nurses out of acute care. This article outlines the implicit and explicit factors that may be contributing to the dissatisfaction and distress in nursing graduates entering professional practice through hospital nursing. CINAHL, MEDLINE, Sociolit, and PubMed. Discussion is focused on the oppressive context in which hospital nursing continues to be situated and explores the ideological, structural, and relational aspects of domination that continue to surface in the work experiences of novice as well as seasoned nurses. Suggestions for addressing the issues that plague the acute care environment are integrated throughout the article, and a detailed framework of empowerment for this nursing context is offered.

Understanding stakeholders' perspectives and experiences of general practice accreditation.

PubMed

Debono, Deborah; Greenfield, David; Testa, Luke; Mumford, Virginia; Hogden, Anne; Pawsey, Marjorie; Westbrook, Johanna; Braithwaite, Jeffrey

2017-07-01

To examine general practice accreditation stakeholders' perspectives and experiences to identify program strengths and areas for improvements. Individual (n=2) and group (n=9) interviews were conducted between September 2011-March 2012 with 52 stakeholders involved in accreditation in Australian general practices. Interviews were recorded, transcribed and thematically analysed. Member checking activities in April 2016 assessed the credibility and currency of the findings in light of current reforms. Overall, participants endorsed the accreditation program but identified several areas of concern. Noted strengths of the program included: program ownership, peer review and collaborative learning; access to Practice Incentives Program payments; and, improvements in safety and quality. Noted limitations in these and other aspects of the program offer potential for improvement: evidence for the impact of accreditation; resource demands; clearer outcome measures; and, specific experiences of accreditation. The effectiveness of accreditation as a strategy to improve safety and quality was shaped by the attitudes and experience of stakeholders. Strengths and weaknesses in the accreditation program influence, and are influenced by, stakeholder engagement and disengagement. After several accreditation cycles, the sector has the opportunity to reflect on, review and improve the process. This will be important if the continued or extended engagement of practices is to be realised to assure the continuation and effectiveness of the accreditation program. Copyright © 2017 Elsevier B.V. All rights reserved.

Utilization of Chiropractic Care at the World Games 2013.

PubMed

Nook, Debra D; Nook, Erik C; Nook, Brian C

The purpose of this study was to describe chiropractic care use at the World Games 2013. In this retrospective study, we reviewed treatment charts of athletes and non-athletes who sought chiropractic care at The World Games in Cali, Colombia, from July 25 to August 4, 2013. Doctors of chiropractic of the International Federation of Sports Chiropractic provided care. Chart notes included body region treated, treatment modality, and pretreatment and posttreatment pain ratings. Of the participants, 537 of 2964 accredited athletes and 403 of 4131 accredited non-athletes sought chiropractic treatment; these represent utilization rates of 18.1% for athletes and 9.8% for non-athletes. A total of 1463 treatments were recorded for athletes (n = 897) and non-athletes (n = 566). The athletes who were treated represented 28 of 33 sports and 68 of 93 countries that were present at the games. Among athletes, the thoracic spine was the most frequent area of treatment (57.2%), followed by the lumbar spine (48.7%) and the cervical spine (38.9%). Myotherapy was the most frequently used treatment method (80.9%), followed by chiropractic manipulation (78.5%), taping (38.0%), and mobilization (24.6%). Reports of acute injury were higher among athletes (45.4%) compared with non-athletes (23.8%). Reported pain was reduced after treatment (P < .001), and 86.9% patients reported immediate improvement after receiving chiropractic treatment. The majority of people seeking chiropractic care at an international sporting competition were athletes. For those seeking care, the injury rate was higher among athletes than among non-athletes. The majority of patients receiving chiropractic care reported improvement after receiving care. Copyright © 2016. Published by Elsevier Inc.

Frequency and Reasons for Return to Acute Care in Leukemia Patients Undergoing Inpatient Rehabilitation

PubMed Central

Fu, Jack Brian; Lee, Jay; Smith, Dennis W.; Bruera, Eduardo

2012-01-01

Objective To assess the frequency and reasons for return to the primary acute care service among leukemia patients undergoing inpatient rehabilitation. Design Retrospective study of all patients with leukemia, myelodysplastic syndrome, aplastic anemia, or myelofibrosis admitted to inpatient rehabilitation at a tertiary referral-based cancer center between January 1, 2005, and April 10, 2012. Items analyzed from patient records included return to the primary acute care service with demographic information, leukemia characteristics, medications, hospital admission characteristics, and laboratory values. Results 225 patients were admitted a total of 255 times. 93/255 (37%) of leukemia inpatient rehabilitation admissions returned to the primary acute care service. 18/93 (19%) and 42/93 (45%) of these patients died in the hospital and were discharged home respectively. Statistically significant factors (p<.05) associated with return to the primary acute care service include peripheral blast percentage and the presence of an antifungal agent on the day of inpatient rehabilitation transfer. Using an additional two factors (platelet count and the presence of an antiviral agent both with a p<.11), a Return To Primary (RTP) - Leukemia index was formulated. Conclusions Leukemia patients with the presence of circulating peripheral blasts and/or antifungal agent may be at increased risk of return to the primary acute care service. The RTP-Leukemia index should be tested in prospective studies to determine its usefulness. PMID:23117267