Can hospitals compete on quality? Hospital competition.

PubMed

Sadat, Somayeh; Abouee-Mehrizi, Hossein; Carter, Michael W

2015-09-01

In this paper, we consider two hospitals with different perceived quality of care competing to capture a fraction of the total market demand. Patients select the hospital that provides the highest utility, which is a function of price and the patient's perceived quality of life during their life expectancy. We consider a market with a single class of patients and show that depending on the market demand and perceived quality of care of the hospitals, patients may enjoy a positive utility. Moreover, hospitals share the market demand based on their perceived quality of care and capacity. We also show that in a monopoly market (a market with a single hospital) the optimal demand captured by the hospital is independent of the perceived quality of care. We investigate the effects of different parameters including the market demand, hospitals' capacities, and perceived quality of care on the fraction of the demand that each hospital captures using some numerical examples.

Practice management/role of the medical director.

PubMed

Merrill, Douglas G

2014-06-01

Although the nature of ambulatory surgery has changed over the years, the ideal role of the medical director mirrors its earliest iterations, focusing on excellent customer service and high quality of care. These efforts are supported by 3 modern methods of quality management borrowed from industry: intentional process improvement, standard care pathways, and monitoring outcomes to determine the efficacy of each. These methods are critical to master in order to lead the facility and providers to the highest quality of care and service. Copyright © 2014 Elsevier Inc. All rights reserved.

Towards more patient centred healthcare: A new Consumer Quality Index instrument to assess patients' experiences with breast care.

PubMed

Damman, Olga C; Hendriks, Michelle; Sixma, Herman J

2009-06-01

To develop a Consumer Quality Index (CQ-index) Breast Care instrument that measures quality of care from the perspective of patients with (suspicion of) breast cancer. To develop a pilot questionnaire, three focus group discussions with breast cancer patients were performed. The questionnaire was sent to 1197 patients. We performed psychometric and descriptive analyses to optimise the new instrument. Focus group discussions revealed nine main themes related to breast care quality. Psychometric analyses resulted in 15 reliable scales. The final instrument consisted of 152 items, of which 118 items regarded patients' experiences. The aspect with the highest need for quality improvement was informing patients about a second opinion. The CQ-index Breast Care (CQI-BC) instrument provides a good starting point for further research on the quality of breast care seen from the perspective of patients. The newly developed instrument can be used by different stakeholders for future quality monitoring.

Update on value-based medicine.

PubMed

Brown, Melissa M; Brown, Gary C

2013-05-01

To update concepts in Value-Based Medicine, especially in view of the Patient Protection and Affordable Care Act. The Patient Protection and Affordable Care Act assures that some variant of Value-Based Medicine cost-utility analysis will play a key role in the healthcare system. It identifies the highest quality care, thereby maximizing the most efficacious use of healthcare resources and empowering patients and physicians.Standardization is critical for the creation and acceptance of a Value-Based Medicine, cost-utility analysis, information system, since 27 million different input variants can go into a cost-utility analysis. Key among such standards is the use of patient preferences (utilities), as patients best understand the quality of life associated with their health states. The inclusion of societal costs, versus direct medical costs alone, demonstrates that medical interventions are more cost effective and, in many instances, provide a net financial return-on-investment to society referent to the direct medical costs expended. Value-Based Medicine provides a standardized methodology, integrating critical, patient, quality-of-life preferences, and societal costs, to allow the highest quality, most cost-effective care. Central to Value-Based Medicine is the concept that all patients deserve the interventions that provide the greatest patient value (improvement in quality of life and/or length of life).

Longitudinal Analysis of Quality of Diabetes Care and Relational Climate in Primary Care.

PubMed

Soley-Bori, Marina; Benzer, Justin K; Burgess, James F

2018-04-01

To assess the influence of relational climate on quality of diabetes care. The study was conducted at the Department of Veterans Affairs (VA). The VA All Employee Survey (AES) was used to measure relational climate. Patient and facility characteristics were gathered from VA administrative datasets. Multilevel panel data (2008-2012) with patients nested into clinics. Diabetic patients were identified using ICD-9 codes and assigned to the clinic with the highest frequency of primary care visits. Multiple quality indicators were used, including an all-or-none process measure capturing guideline compliance, the actual number of tests and procedures, and three intermediate continuous outcomes (cholesterol, glycated hemoglobin, and blood pressure). The study sample included 327,805 patients, 212 primary care clinics, and 101 parent facilities in 2010. Across all study years, there were 1,568,180 observations. Clinics with the highest relational climate were 25 percent more likely to provide guideline-compliant care than those with the lowest relational climate (OR for a 1-unit increase: 1.02, p-value <.001). Among insulin-dependent diabetic veterans, this effect was twice as large. Contrary to that expected, relational climate did not influence intermediate outcomes. Relational climate is positively associated with tests and procedures provision, but not with intermediate outcomes of diabetes care. © Health Research and Educational Trust.

A Delphi Study Executive Skills 2010: A Toolbox of Competencies for Air Force Medical Service Corps Officers of the 21st Century

DTIC Science & Technology

2003-06-03

staff, health care delivery concepts, accessibility, ethics, quality / risk management , technology, and marketing (Table 5 - Hudak et al. 1993). The domain...cost/finance, healthcare delivery, access to care, quality / risk management , technology, professional staff relations, leadership, marketing, and ethics...finance was the second highest rated domain for physicians, this group included quality / risk management and technology among their top four (Hudak et al

Optimizing pain care delivery in outpatient facilities: experience in NCI, Cairo, Egypt.

PubMed

Hameed, Khaled Abdel

2011-04-01

As a result of increasing waiting lists of patients attending National Cancer Institute of Cairo, we are faced to provide high-quality pain care service through our outpatient pain clinic. The program description presented here shows the capacity of a 24 hours/7 days outpatient cancer pain management service to provide rapidly accessible, high-quality care to patients with complex pain and palliative care symptom burdens. In addition, this model avoids inpatient hospital admissions. Pain clinics of cancer are committed to helping patients and families identify and implement the treatments necessary to achieve optimum functional ability and the best possible quality of life. These clinics also help to communicate and work with the family physician, surgeon, and other physicians associated with patient treatment. Cancer pain is complex in its causes, and affects all parts of the body. It involves the tissues, body systems , and the mind. Being multidimensional, it is never adequately addressed with unidimensional treatment. Pain management must extend beyond physical approaches to include the psychological, social, and even spiritual aspects of the patient. Effective integrated treatment fosters self awareness and teaches appropriate and effective self care. With time, complex issues are managed, pain is reduced, and the patient moves toward peak physical and psychological functioning. These goals can be achieved by providing the highest quality pain management services. Patients attending the clinic get treated medically for their physical ailments. Their emotional and psychological problems also need to be attended with an atmosphere of love and care. The mission of the highest quality service is to obtain customer satisfaction with reduction of cost in a multidisciplinary (or better interdisciplinary) approach. This can be reached by proper identification of the customers either internal or external, assessing their needs, and implementing plans for their satisfaction. In addition, monitoring the improvement of such plans is an integral part of the quality process. Importantly, the facility provides comprehensive care with professionals available 24 hours/7 days. On-call teams assigned to manage pain and other treatment modalities comprises of staff supervised by the primary cancer clinicians; this arrangement facilitates reaching this goal. This study will illustrate our experience through 25 years, trying to provide the highest care of patients with cancer pain on an outpatient basis.

Service quality of delivered care from the perception of women with caesarean section and normal delivery.

PubMed

Tabrizi, Jafar S; Askari, Samira; Fardiazar, Zahra; Koshavar, Hossein; Gholipour, Kamal

2014-01-01

Our aim was to determine the service quality of delivered care for people with Caesarean Section and Normal Delivery. A cross-sectional study was conducted among 200 people who had caesarean section and normal delivery in Al-Zahra Teaching Hospital in Tabriz, north western Iran. Service quality was calculated using: Service Quality = 10 - (Importance × Performance) based on importance and performance of service quality aspects from the postpartum women's perspective.A hierarchical regression analysis was applied in two steps using the enter method to examine the associations between demographics and SQ scores. Data were analysed using the SPSS-17 software. "Confidentiality", "autonomy", "choice of care provider" and "communication" achieved scores at the highest level of quality; and "support group", "prompt attention", "prevention and early detection", "continuity of care", "dignity", "safety", "accessibility and "basic amenities" got service quality score less than eight. Statistically significant relationship was found between service quality score and continuity of care (P=0.008). A notable gap between the participants‟ expectations and what they have actually received in most aspects of provided care. So, there is an opportunityto improve the quality of delivered care.

Measuring risk-adjusted value using Medicare and ACS-NSQIP: is high-quality, low-cost surgical care achievable everywhere?

PubMed

Lawson, Elise H; Zingmond, David S; Stey, Anne M; Hall, Bruce L; Ko, Clifford Y

2014-10-01

To evaluate the relationship between risk-adjusted cost and quality for colectomy procedures and to identify characteristics of "high value" hospitals (high quality, low cost). Policymakers are currently focused on rewarding high-value health care. Hospitals will increasingly be held accountable for both quality and cost. Records (2005-2008) for all patients undergoing colectomy procedures in the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) were linked to Medicare inpatient claims. Cost was derived from hospital payments by Medicare. Quality was derived from the occurrence of 30-day postoperative major complications and/or death as recorded in ACS-NSQIP. Risk-adjusted cost and quality metrics were developed using hierarchical multivariable modeling, consistent with a National Quality Forum-endorsed colectomy measure. The study population included 14,745 colectomy patients in 169 hospitals. Average hospitalization cost was $21,350 (SD $20,773, median $16,092, interquartile range $14,341-$24,598). Thirty-four percent of patients had a postoperative complication and/or death. Higher hospital quality was significantly correlated with lower cost (correlation coefficient 0.38, P < 0.001). Among hospitals classified as high quality, 52% were found to be low cost (representing highest value hospitals) whereas 14% were high cost (P = 0.001). Forty-one percent of low-quality hospitals were high cost. Highest "value" hospitals represented a mix of teaching/nonteaching affiliation, small/large bed sizes, and regional locations. Using national ACS-NSQIP and Medicare data, this study reports an association between higher quality and lower cost surgical care. These results suggest that high-value surgical care is being delivered in a wide spectrum of hospitals and hospital types.

Moral distress in physicians and nurses: Impact on professional quality of life and turnover.

PubMed

Austin, Cindy L; Saylor, Robert; Finley, Phillip J

2017-07-01

The purpose of this study was to investigate moral distress (MD) and turnover intent as related to professional quality of life in physicians and nurses at a tertiary care hospital. Health care providers from a variety of hospital departments anonymously completed 2 validated questionnaires (Moral Distress Scale-Revised and Professional Quality of Life Scale). Compassion fatigue (as measured by secondary traumatic stress [STS] and burnout [BRN]) and compassion satisfaction are subscales which make up one's professional quality of life. Relationships between these constructs and clinicians' years in health care, critical care patient load, and professional discipline were explored. The findings (n = 329) demonstrated significant correlations between STS, BRN, and MD. Scores associated with intentions to leave or stay in a position were indicative of high verses low MD. We report highest scoring situations of MD as well as when physicians and nurses demonstrate to be most at risk for STS, BRN and MD. Both physicians and nurses identified the events contributing to the highest level of MD as being compelled to provide care that seems ineffective and working with a critical care patient load >50%. The results from this study of physicians and nurses suggest that the presence of MD significantly impacts turnover intent and professional quality of life. Therefore implementation of emotional wellness activities (e.g., empowerment, opportunity for open dialog regarding ethical dilemmas, policy making involvement) coupled with ongoing monitoring and routine assessment of these maladaptive characteristics is warranted. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Comparison of Primary Care Experiences in Village Clinics with Different Ownership Models in Guangdong Province, China

PubMed Central

Feng, Shanshan; Shi, Leiyu; Zeng, Jiazhi; Chen, Wen; Ling, Li

2017-01-01

Objectives In order to improve the quality of services at village clinics (VCs), which are important primary care service providers in rural China, the Chinese government has encouraged the township hospitals to own and manage VCs. There are currently three models of ownership and management of VCs: township hospital-owned and -managed (HVC), village committee-owned and -managed (VVC), and private-owned and -managed (PVC). This study aims to examine the association between these ownership models of VCs and patients' primary care experiences. Methods Villagers were selected by multistage stratified sampling and their experiences with primary care were measured using the Primary Care Assessment Tool—Adult Edition (PCAT-AS). Data were collected through face-to-face interviews and the questionnaires administered by investigators in the cross-sectional study from February to April 2015. The PCAT scores were compared among the three models by covariance analysis, and multiple linear regression was used to analyze factors associated with the PCAT total scores. Results A total of 1491 questionnaires were collected. After controlling for covariates, HVCs reported the highest PCAT scores and satisfaction rate. In terms of the domains, HVC reported the highest scores in the coordination and comprehensiveness domains, while PVC had the highest scores in the first contact-accessibility domain. Multivariate linear regression showed that HVC, married participants, aged 60 and older, satisfied with the services, receiving six or more visits, and those with medical expenditures over 20% of their total family expenditures, were also positively associated with better primary care quality. Conclusions This study demonstrates that villagers receiving medical care at HVCs perceived better primary care than those at PVCs and VVCs. In order to improve the quality of primary care at VCs, it is necessary to increase government subsidies for public service packages, tighten the township hospital's supervision of PVCs and VVCs, and develop performance-based incentive plans to motivate improvements in the accessibility of HVCs. PMID:28056038

Client satisfaction of maternity care in Lorestan province Iran

PubMed Central

Changee, Farahnaz; Irajpour, Alireza; Simbar, Masoumeh; Akbari, Soheila

2015-01-01

Background: Client satisfaction is an important indicator for assessment of the quality of care provided. Detecting patients dissatisfaction and trying to find the most effective and costly services is the basic way for improvement of service quality. The purpose of this study was to determine the satisfaction level of women in the maternity care centers (hospitals) of Lorestan University of Medical Sciences, Iran. Materials and Methods: In this descriptive cross-sectional study, the satisfaction level of 200 patients who received care during childbirth in province hospitals was assessed using a researcher-made questionnaire. Women in maternity care units completed the questionnaires. Results: The mean maternity care satisfaction score was 66.6 ± 3.5. The lowest satisfaction level was related to getting to know the delivery room (64%) and vaginal examination (66%). The highest satisfaction score was related to confidentiality of the information (86%) and trusting the midwife (84%). Regarding the environmental factors, the lowest satisfaction was related to respecting silence in the pain room (69.5%) and the highest was related to cleanliness and hygiene of the delivery room (84%). Conclusions: Our results suggest the relative satisfaction of women receiving care in the health centers of Lorestan province; but this level of satisfaction does not mean that the delivery of care in this province is perfect. By reviewing the policies and the existing care programs regarding promoting the quality of services, managers can increase clients’ satisfaction. PMID:26120342

Shop for quality or volume? Volume, quality, and outcomes of coronary artery bypass surgery.

PubMed

Auerbach, Andrew D; Hilton, Joan F; Maselli, Judith; Pekow, Penelope S; Rothberg, Michael B; Lindenauer, Peter K

2009-05-19

Care from high-volume centers or surgeons has been associated with lower mortality rates in coronary artery bypass surgery, but how volume and quality of care relate to each other is not well understood. To determine how volume and differences in quality of care influence outcomes after coronary artery bypass surgery. Observational cohort. 164 hospitals in the United States. 81,289 patients 18 years or older who had coronary artery bypass grafting from 1 October 2003 to 1 September 2005. Hospital and surgeon case volumes were estimated by using a data set. Quality measures were defined by whether patients received specific medications and by counting the number of measures missed. Hierarchical models were used to estimate effects of volume and quality on death and readmission up to 30 days. After adjustment for clinical factors, lowest surgeon volume and highest hospital volume were associated with higher mortality rates and lower readmission risk, respectively. Patients who did not receive aspirin (odds ratio, 1.89 [95% CI, 1.65 to 2.16) or beta-blockers (odds ratio, 1.29 [CI, 1.12 to 1.49]) had higher odds for death, after adjustment for clinical risk factors and case volume. Adjustment for individual quality measures did not alter associations between volume and readmission or death. However, if no quality measures were missed, mortality rates at the lowest-volume centers (adjusted mortality rate, 1.05% [CI, 0.81% to 1.29%]) and highest-volume centers (adjusted mortality rate, 0.98% [CI, 0.72% to 1.25%]) were similar. Because administrative data were used, the quality measures may not replicate measures collected through chart abstraction. Maximizing adherence to quality measures is associated with improved mortality rates, independent of hospital or surgeon volume. California HealthCare Foundation.

Patient engagement in the process of planning and designing outpatient care improvements at the Veterans Administration Health-care System: findings from an online expert panel.

PubMed

Khodyakov, Dmitry; Stockdale, Susan E; Smith, Nina; Booth, Marika; Altman, Lisa; Rubenstein, Lisa V

2017-02-01

There is a strong interest in the Veterans Administration (VA) Health-care System in promoting patient engagement to improve patient care. We solicited expert opinion using an online expert panel system with a modified Delphi structure called ExpertLens ™ . Experts reviewed, rated and discussed eight scenarios, representing four patient engagement roles in designing and improving VA outpatient care (consultant, implementation advisor, equal stakeholder and lead stakeholder) and two VA levels (local and regional). Rating criteria included desirability, feasibility, patient ability, physician/staff acceptance and impact on patient-centredness and care quality. Data were analysed using the RAND/UCLA Appropriateness Method for determining consensus. Experts rated consulting with patients at the local level as the most desirable and feasible patient engagement approach. Engagement at the local level was considered more desirable than engagement at the regional level. Being an equal stakeholder at the local level received the highest ratings on the patient-centredness and health-care quality criteria. Our findings illustrate expert opinion about different approaches to patient engagement and highlight the benefits and challenges posed by each. Although experts rated local consultations with patients on an as-needed basis as most desirable and feasible, they rated being an equal stakeholder at the local level as having the highest potential impact on patient-centredness and care quality. This result highlights a perceived discrepancy between what is most desirable and what is potentially most effective, but suggests that routine local engagement of patients as equal stakeholders may be a desirable first step for promoting high-quality, patient-centred care. © 2016 The Authors. Health Expectations Published by John Wiley & Sons Ltd.

42 CFR 483.25 - Quality of care.

Code of Federal Regulations, 2014 CFR

2014-10-01

... necessary care and services to attain or maintain the highest practicable physical, mental, and psychosocial... body weight and protein levels, unless the resident's clinical condition demonstrates that this is not possible; and (2) Receives a therapeutic diet when there is a nutritional problem. (j) Hydration. The...

42 CFR 483.25 - Quality of care.

Code of Federal Regulations, 2010 CFR

2010-10-01

... necessary care and services to attain or maintain the highest practicable physical, mental, and psychosocial... body weight and protein levels, unless the resident's clinical condition demonstrates that this is not possible; and (2) Receives a therapeutic diet when there is a nutritional problem. (j) Hydration. The...

42 CFR 483.25 - Quality of care.

Code of Federal Regulations, 2011 CFR

2011-10-01

... necessary care and services to attain or maintain the highest practicable physical, mental, and psychosocial... body weight and protein levels, unless the resident's clinical condition demonstrates that this is not possible; and (2) Receives a therapeutic diet when there is a nutritional problem. (j) Hydration. The...

42 CFR 483.25 - Quality of care.

Code of Federal Regulations, 2013 CFR

2013-10-01

... necessary care and services to attain or maintain the highest practicable physical, mental, and psychosocial... body weight and protein levels, unless the resident's clinical condition demonstrates that this is not possible; and (2) Receives a therapeutic diet when there is a nutritional problem. (j) Hydration. The...

42 CFR 483.25 - Quality of care.

Code of Federal Regulations, 2012 CFR

2012-10-01

... necessary care and services to attain or maintain the highest practicable physical, mental, and psychosocial... body weight and protein levels, unless the resident's clinical condition demonstrates that this is not possible; and (2) Receives a therapeutic diet when there is a nutritional problem. (j) Hydration. The...

The Health Quality and Safety Commission: making good health care better.

PubMed

Shuker, Carl; Bohm, Gillian; Bramley, Dale; Frost, Shelley; Galler, David; Hamblin, Richard; Henderson, Robert; Jansen, Peter; Martin, Geraint; Orsborn, Karen; Penny, Anthea; Wilson, Janice; Merry, Alan F

2015-01-30

New Zealand has one of the best value health care systems in the world, but as a proportion of GDP our spending on health care has increased every year since 1999. Further, there are issues of quality and safety in our system we must address, including rates of adverse events. The Health Quality and Safety Commission was formed in 2010 as a crown agent to influence, encourage, guide and support improvement in health care practice in New Zealand. The New Zealand Triple Aim has been defined as: improved quality, safety and experience of care; improved health and equity for all populations; and best value for public health system resources. The Commission is pursuing the Triple Aim via two fundamental objectives: doing the right thing by providing care supported by the best evidence available, focused on what matters to each individual patient, and doing the right thing right, first time, by making sure health care is safe and of the highest quality possible. Improvement efforts must be supported by robust but economical measurements. New Zealand has a strong culture of quality, so the Commission's role is to work with our colleagues to make good health care better.

Cost-Effective Adjustments to Nursing Home Staffing to Improve Quality.

PubMed

Bowblis, John R; Roberts, Amy Restorick

2018-06-01

Health care providers face fixed reimbursement rates from government sources and need to carefully adjust staffing to achieve the highest quality within a given cost structure. With data from the Certification and Survey Provider Enhanced Reports (1999-2015), this study holistically examined how staffing levels affect two publicly reported measures of quality in the nursing home industry, the number of deficiency citations and the deficiency score. While higher staffing consistently yielded better quality, the largest quality improvements resulted from increasing administrative registered nurses and social service staffing. After adjusting for wages, the most cost-effective investment for improving overall deficiency outcomes was increasing social services. Deficiencies related to quality of care were improved most by increasing administrative nursing and social service staff. Quality of life deficiencies were improved most by increasing social service and activities staff. Approaches to improve quality through staffing adjustments should target specific types of staff to maximize return on investment.

100 Years of inspiring quality at the ACS: how did we get here? Journal of Pediatric Surgery Lecture.

PubMed

Hoyt, David B; Schneidman, Diane S

2014-01-01

Throughout its 100-year history of working to ensure that surgical patients receive safe, high-quality, cost-effective care, the American College of Surgeons has adhered to four key principles: (1) Set the standards to identify and set the highest clinical standards based on the collection of outcomes data and other scientific evidence that can be customized to each patient's condition so that surgeons can offer the right care, at the right time, in the right setting. (2) Build the right infrastructure to provide the highest quality care with surgical facilities having in place appropriate and adequate staffing levels, a reasonable mix of specialists, and the right equipment. Checklists and health information technology, such as the electronic health record, are components of this infrastructure. (3) Collect robust data so that surgical decisions are based on clinical data drawn from medical charts that track patients after discharge from the hospital. Data should be risk-adjusted and collected in nationally benchmarked registries to allow institutions to compare their care with other providers. (4) Verify processes and infrastructure by having an external authority periodically affirm that the right systems are in place at health care institutions, that outcomes are being measured and benchmarked, and that hospitals and providers are proactively responding to these findings. © 2014.

Changes in Relatives' Perspectives on Quality of Death, Quality of Care, Pain Relief, and Caregiving Burden Before and After a Region-Based Palliative Care Intervention.

PubMed

Maeda, Isseki; Miyashita, Mitsunori; Yamagishi, Akemi; Kinoshita, Hiroya; Shirahige, Yutaka; Izumi, Noriko; Yamaguchi, Takuhiro; Igarashi, Miyuki; Kato, Masashi; Morita, Tatsuya

2016-11-01

A region-based palliative care intervention (Outreach Palliative Care Trial of Integrated Regional Model Study) increased home death, access to specialist palliative care, quality of care, and quality of death and dying. The objective of this study was to examine changes in palliative care outcomes in different care settings (hospitals, palliative care units, and home) and obtain insights into how to improve region-level palliative care. The intervention program was implemented from April 2008 to March 2011. Two bereavement surveys were conducted before and after intervention involving 4228 family caregivers of deceased cancer patients. Family-perceived quality of care (range 1-6), quality of death and dying (1-7), pain relief (1-7), and caregiver burden (1-7) were measured. Response rates were 69% (preintervention) and 66% (postintervention), respectively. Family-perceived quality of care (adjusted mean 4.89, 95% CI 4.54-5.23) and quality of death and dying (4.96, 4.72-5.20) at home were the highest and sustained throughout the study. Palliative care units were at the intermediate level between home and hospitals. In hospitals, both quality of care and quality of death and dying were low at baseline but significantly improved after intervention (quality of care: 4.24, 4.13-4.34 to 4.43, 4.31-4.54, P = 0.002; quality of death and dying: 4.22, 4.09-4.36 to 4.36, 4.22-4.50, P = 0.012). Caregiver burden did not significantly increase after intervention, regardless of place of death. The dual strategies of transition of place of death to home and improving quality of care in hospitals should be recognized as important targets for improving region-level palliative care. Copyright © 2016 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

The Relationship Between Financial Incentives and Quality of Diabetes Care in Ontario, Canada

PubMed Central

Kiran, Tara; Victor, J. Charles; Kopp, Alexander; Shah, Baiju R.; Glazier, Richard H.

2012-01-01

OBJECTIVE We assessed the impact of a diabetes incentive code introduced for primary care physicians in Ontario, Canada, in 2002 on quality of diabetes care at the population and patient level. RESEARCH DESIGN AND METHODS We analyzed administrative data for 757,928 Ontarians with diabetes to examine the use of the code and receipt of three evidence-based monitoring tests from 2006 to 2008. We assessed testing rates over time and before and after billing of the incentive code. RESULTS One-quarter of Ontarians with diabetes had an incentive code billed by their physician. The proportion receiving the optimal number of all three monitoring tests (HbA1c, cholesterol, and eye tests) rose gradually from 16% in 2000 to 27% in 2008. Individuals who were younger, lived in rural areas, were not enrolled in a primary care model, or had a mental illness were less likely to receive all three recommended tests. Patients with higher numbers of incentive code billings in 2006–2008 were more likely to receive recommended testing but also were more likely to have received the highest level of recommended testing prior to introduction of the incentive code. Following the same patients over time, improvement in recommended testing was no greater after billing of the first incentive code than before. CONCLUSIONS The diabetes incentive code led to minimal improvement in quality of diabetes care at the population and patient level. Our findings suggest that physicians who provide the highest quality care prior to incentives may be those most likely to claim incentive payments. PMID:22456866

Better big data.

PubMed

Al Kazzi, Elie S; Hutfless, Susan

2015-01-01

By 2018, Medicare payments will be tied to quality of care. The Centers for Medicare and Medicaid Services currently use quality-based metric for some reimbursements through their different programs. Existing and future quality metrics will rely on risk adjustment to avoid unfairly punishing those who see the sickest, highest-risk patients. Despite the limitations of the data used for risk adjustment, there are potential solutions to improve the accuracy of these codes by calibrating data by merging databases and compiling information collected for multiple reporting programs to improve accuracy. In addition, healthcare staff should be informed about the importance of risk adjustment for quality of care assessment and reimbursement. As the number of encounters tied to value-based reimbursements increases in inpatient and outpatient care, coupled with accurate data collection and utilization, the methods used for risk adjustment could be expanded to better account for differences in the care delivered in diverse settings.

Assessment of Service Quality in Teaching Hospitals of Yazd University of Medical Sciences: Using Multi-criteria Decision Making Techniques.

PubMed

Shafii, Milad; Rafiei, Sima; Abooee, Fatemeh; Bahrami, Mohammad Amin; Nouhi, Mojtaba; Lotfi, Farhad; Khanjankhani, Khatere

2016-08-01

Hospitals as integrated parts of the wide-ranging health care systems have dominant focus on health care provision to meet, maintain and promote people's health needs of a community. This study aimed to assess the service quality of teaching hospitals of Yazd University of Medical Sciences using Fuzzy Analytical Hierarchy Process (FAHP) and Technique for Order Preference by Similarity to Ideal Solution (TOPSIS). A literature review and a qualitative method were used to obtain experts' viewpoints about the quality dimensions of hospital services to design a questionnaire. Then, using a self-made questionnaire, perceptions of 300 patients about the quality of delivered services were gathered. Finally, FAHP was applied to weigh each quality dimension and TOPSIS method to rank hospital wards. Six dimensions including responsiveness, assurance, security, tangibles, health communication and Patient orientation were identified as affecting aspects of hospital services quality among which, security and tangibles got the highest and lowest importance respectively (0.25406, 0.06883). Findings also revealed that in hospital A, orthopedics and ophthalmology wards obtained the highest score in terms of quality while cardiology department got the lowest ranking (0.954, 0.323). In hospital B, the highest and the lowest ranking was belonged to cardiology and surgical wards (0.895, 0.00) while in hospital C, surgical units were rated higher than internal wards (0.959, 0.851). Findings emphasized that the security dimension got the lowest ranking among SERVQUAL facets in studied hospitals. This requires hospital executives to pay special attention to the issue of patients' security and plan effectively for its promotion.

Variations in patient safety climate and perceived quality of collaboration between professions in out-of-hours care

PubMed Central

Klemenc-Ketis, Zalika; Deilkås, Ellen Tveter; Hofoss, Dag; Bondevik, Gunnar Tschudi

2017-01-01

Purpose To get an overview of health care workers perceptions of patient safety climates and the quality of collaboration in Slovenian out-of-hours health care (OOHC) between professional groups. Materials and methods This was a cross-sectional study carried out in all (60) Slovenian OOHC clinics; 37 (61.7%) agreed to participate with 438 employees. The questionnaire consisted of the Slovenian version of the Safety Attitudes Questionnaire – Ambulatory Version (SAQ-AV). Results The study sample consisted of 175 (70.0%) physicians, nurse practitioners, and practice nurses. Practice nurses reported the highest patient safety climate scores in all dimensions. Total mean (standard deviation) SAQ-AV score was 60.9±15.2. Scores for quality of collaboration between different professional groups were high. The highest mean scores were reported by nurse practitioners on collaboration with practice nurses (4.4±0.6). The lowest mean scores were reported by practice nurses on collaboration with nurse practitioners (3.8±0.9). Conclusion Due to large variations in Slovenian OOHC clinics with regard to how health care workers from different professional backgrounds perceive safety culture, more attention should be devoted to improving the team collaboration in OOHC. A clearer description of professional team roles should be provided. PMID:29184416

Added value in health care with six sigma.

PubMed

Lenaz, Maria P

2004-06-01

Six sigma is the structured application of the tools and techniques of quality management applied on a project basis that can enable organizations to achieve superior performance and strategic business results. The Greek character sigma has been used as a statistical term that measures how much a process varies from perfection, based on the number of defects per million units. Health care organizations using this model proceed from the lower levels of quality performance to the highest level, in which the process is nearly error free.

42 CFR 488.303 - State plan requirement.

Code of Federal Regulations, 2010 CFR

2010-10-01

... requirements apply to the Medicaid program. (b) A State may establish a program to reward, through public recognition, incentive payments, or both, nursing facilities that provide the highest quality care to Medicaid...

Center Size and Center Performance.

ERIC Educational Resources Information Center

Helburn, Suzanne; Morris, John

1996-01-01

Examined the impact of child care center size on cost, quality, and profits per child. Examined centers ranging from 40 to 80 children and found total cost and revenue per child were similar for small, medium, and large centers. Found profits per child were highest in large centers and that there was no relationship between center quality and…

Popular on YouTube: a critical appraisal of the educational quality of information regarding asthma.

PubMed

Gonzalez-Estrada, Alexei; Cuervo-Pardo, Lyda; Ghosh, Bitan; Smith, Martin; Pazheri, Foussena; Zell, Katrina; Wang, Xiao-Feng; Lang, David M

2015-01-01

Asthma affects >300 million people globally, including 25 million in the United States. Patients with asthma frequently use the Internet as a source of information. YouTube is one of the three most popular Web sites. To determine the educational quality of YouTube videos for asthma. We performed a YouTube search by using the keyword "asthma." The 200 most frequently viewed relevant videos were included in the study. Asthma videos were analyzed for characteristics, source, and content. Source was further classified as asthma health care provider, other health care provider, patient, pharmaceutical company, and professional society and/or media. A scoring system was created to evaluate quality (-10 to 30 points). Negative points were assigned for misleading information. Two hundred videos were analyzed, with a median of 18,073.5 views, 31.5 likes, and 2 dislikes, which spanned a median of 172 seconds. More video presenters were male (60.5%). The most common type of video source was other health care providers (34.5%). The most common video content was alternative treatments (38.0%), including live-fish ingestion; reflexology; acupressure and/or acupuncture; Ayurveda; yoga; raw food, vegan, gluten-free diets; marijuana; Buteyko breathing; and salt therapy. Scores for videos supplied by asthma health care providers were statistically significantly different from other sources (p < 0.001) and had the highest average score (9.91). YouTube videos of asthma were frequently viewed but were a poor source of accurate health care information. Videos by asthma health care providers were rated highest in quality. The allergy/immunology community has a clear opportunity to enhance the value of educational material on YouTube.

Quality of Type II Diabetes Care in Primary Health Care Centers in Kuwait: Employment of a Diabetes Quality Indicator Set (DQIS).

PubMed

Badawi, Dalia; Saleh, Shadi; Natafgi, Nabil; Mourad, Yara; Behbehani, Kazem

2015-01-01

Diabetes Mellitus is one of the major public health challenges, affecting more than 347 million adults worldwide. The impact of diabetes necessitates assessing the quality of care received by people with diabetes, especially in countries with a significant diabetes burden such as Kuwait. This paper aimed at piloting an approach for measuring Type II diabetes care performance through the use of a diabetes quality indicator set (DQIS) in primary health care. The DQIS for Kuwait was adapted from that developed by the National Diabetes Quality Improvement Alliance and the International Diabetes Federation. Five key care domains/measures were employed: (1) Blood glucose level measurement, (2) Cholesterol level measurement, (3) Blood pressure measurement, (4) Kidney function testing and (5) Smoking status check. The sample included the four major primary health care centers with the highest case load in Kuwait City, 4,241 patients in 2012 and 3,211 in 2010. Findings revealed the applicability and utility of employing performance indicators for diabetes care in Kuwait. Furthermore, findings revealed that many of the primary health care centers have achieved noteworthy improvement in diabetes care between 2010 and 2012, with the exception of smoking status check. The DQIS can help policymakers identify performance gaps and investigate key system roadblocks related to diabetes care in Kuwait.

Providing Doctors With High-Quality Information: An Updated Evaluation of Web-Based Point-of-Care Information Summaries

PubMed Central

Kwag, Koren Hyogene; González-Lorenzo, Marien; Banzi, Rita; Bonovas, Stefanos

2016-01-01

Background The complexity of modern practice requires health professionals to be active information-seekers. Objective Our aim was to review the quality and progress of point-of-care information summaries—Web-based medical compendia that are specifically designed to deliver pre-digested, rapidly accessible, comprehensive, and periodically updated information to health care providers. We aimed to evaluate product claims of being evidence-based. Methods We updated our previous evaluations by searching Medline, Google, librarian association websites, and conference proceedings from August 2012 to December 2014. We included Web-based, regularly updated point-of-care information summaries with claims of being evidence-based. We extracted data on the general characteristics and content presentation of products, and we quantitatively assessed their breadth of disease coverage, editorial quality, and evidence-based methodology. We assessed potential relationships between these dimensions and compared them with our 2008 assessment. Results We screened 58 products; 26 met our inclusion criteria. Nearly a quarter (6/26, 23%) were newly identified in 2014. We accessed and analyzed 23 products for content presentation and quantitative dimensions. Most summaries were developed by major publishers in the United States and the United Kingdom; no products derived from low- and middle-income countries. The main target audience remained physicians, although nurses and physiotherapists were increasingly represented. Best Practice, Dynamed, and UptoDate scored the highest across all dimensions. The majority of products did not excel across all dimensions: we found only a moderate positive correlation between editorial quality and evidence-based methodology (r=.41, P=.0496). However, all dimensions improved from 2008: editorial quality (P=.01), evidence-based methodology (P=.015), and volume of diseases and medical conditions (P<.001). Conclusions Medical and scientific publishers are investing substantial resources towards the development and maintenance of point-of-care summaries. The number of these products has increased since 2008 along with their quality. Best Practice, Dynamed, and UptoDate scored the highest across all dimensions, while others that were marketed as evidence-based were less reliable. Individuals and institutions should regularly assess the value of point-of-care summaries as their quality changes rapidly over time. PMID:26786976

Providing Doctors With High-Quality Information: An Updated Evaluation of Web-Based Point-of-Care Information Summaries.

PubMed

Kwag, Koren Hyogene; González-Lorenzo, Marien; Banzi, Rita; Bonovas, Stefanos; Moja, Lorenzo

2016-01-19

The complexity of modern practice requires health professionals to be active information-seekers. Our aim was to review the quality and progress of point-of-care information summaries-Web-based medical compendia that are specifically designed to deliver pre-digested, rapidly accessible, comprehensive, and periodically updated information to health care providers. We aimed to evaluate product claims of being evidence-based. We updated our previous evaluations by searching Medline, Google, librarian association websites, and conference proceedings from August 2012 to December 2014. We included Web-based, regularly updated point-of-care information summaries with claims of being evidence-based. We extracted data on the general characteristics and content presentation of products, and we quantitatively assessed their breadth of disease coverage, editorial quality, and evidence-based methodology. We assessed potential relationships between these dimensions and compared them with our 2008 assessment. We screened 58 products; 26 met our inclusion criteria. Nearly a quarter (6/26, 23%) were newly identified in 2014. We accessed and analyzed 23 products for content presentation and quantitative dimensions. Most summaries were developed by major publishers in the United States and the United Kingdom; no products derived from low- and middle-income countries. The main target audience remained physicians, although nurses and physiotherapists were increasingly represented. Best Practice, Dynamed, and UptoDate scored the highest across all dimensions. The majority of products did not excel across all dimensions: we found only a moderate positive correlation between editorial quality and evidence-based methodology (r=.41, P=.0496). However, all dimensions improved from 2008: editorial quality (P=.01), evidence-based methodology (P=.015), and volume of diseases and medical conditions (P<.001). Medical and scientific publishers are investing substantial resources towards the development and maintenance of point-of-care summaries. The number of these products has increased since 2008 along with their quality. Best Practice, Dynamed, and UptoDate scored the highest across all dimensions, while others that were marketed as evidence-based were less reliable. Individuals and institutions should regularly assess the value of point-of-care summaries as their quality changes rapidly over time.

Scientific publications in critical care medicine journals from East Asia: A 10-year survey of the literature.

PubMed

Cao, Zhenyu; Ou, Chongyang; Teng, Hongfei; Liu, Xiguang; Tang, Hongxin

2016-01-01

The quantity and quality of publications in critical care medicine from East Asia haven't been reported. This study aimed to investigate the contribution of publications from East Asia. Articles from China, Japan and South Korea in 2005 to 2014 were retrieved from Web of Science and Pubmed. The number of publications, impact factor, citation, and article types were analyzed. There were 3076 publications from East Asia (1720 from China, 913 from Japan, and 443 from South Korea). There were a significant decrease in publications from Japan (p = 0.024) and significant increases from China (p = 0.000) and South Korea (p = 0.009). From 2006, the number of articles from China exceed Japan. China had the highest total impact factor (6618.48) and citation (18416), followed by Japan (4566.03; 15440) and South Korea (1998.19; 5599). Japan had the highest mean impact factor (5.00) and citations (16.91), followed by South Korea (4.51; 12.64) and China (3.85; 10.71). China and South Korea`s contributions to critical care medicine had significant increases during the past 10 years, while Japan had a significant decrease. China was the most productive region in East Asia since 2006. Japan had the highest quality research output.

STIGMA AROUND HIV IN DENTAL CARE: PATIENTS' EXPERIENCES.

PubMed

Brondani, Mario A; Phillips, J Craig; Kerston, R Paul; Moniri, Nardin R

2016-02-01

Tooth decay and other oral diseases can be highly prevalent among people living with HIV/AIDS (PLWHA). Even though dental professionals are trained to provide equal and non-judgemental services to all, intentional or unintentional biases may exist with regard to PLWHA. We conducted qualitative descriptive research using individual interviews to explore the experiences of PLWHA accessing dental care services in Vancouver, Canada. We interviewed 25 PLWHA, aged 23-67 years; 21 were men and 60% reported fair or poor oral health. Thematic analysis showed evidence of both self-stigma and public stigma with the following themes: fear, self-stigma and dental care; overcoming past offences during encounters with dental care professionals; resilience and reconciliation to achieve quality care for all; and current encounters with dental care providers. Stigma attached to PLWHA is detrimental to oral care. The social awareness of dental professionals must be enhanced, so that they can provide the highest quality care to this vulnerable population.

Team Members | Center for Cancer Research

Cancer.gov

Our Team Members The Foregut Team includes experts in the diagnosis and treatment of the diseases listed below. Our clinical experience and active research offers patients the highest quality care in the setting of groundbreaking clinical trials.

Relation Between the Level of American Indian and Alaska Native Diabetes Education Program Services and Quality-of-Care Indicators

PubMed Central

Noonan, Carolyn; Goldberg, Jack H.; Valdez, S. Lorraine; Brown, Tammy L.; Manson, Spero M.; Acton, Kelly

2008-01-01

Objectives. We examined the relation between the level of diabetes education program services in the Indian Health Service (IHS) and indicators of the quality of diabetes care to determine if more-comprehensive diabetes services were associated with better quality of diabetes care. Methods. In this cross-sectional study, we used the IHS Integrated Diabetes Education Recognition Program to rank program services into 1 of 3 levels of comprehensiveness, ranging from lowest (developmental) to highest (integrated). We compared quality-of-care indicators among programs of differing levels with the 2001 IHS Diabetes Care and Outcomes Audit. Quality indicators included patients having recommended yearly examinations, education, and laboratory tests and achieving recommended levels of intermediate outcomes of care. Results. Most of the 86 participating programs were classified at or below the developmental level; only 9 programs (11%) were ranked at higher levels. After adjusting for patient characteristics, program factors, and correlation of patients within programs, we associated programs that were more comprehensive with higher completion rates of yearly lipid and hemoglobin A1C tests (P < .05). Conclusions. System-wide improvements in diabetes education are associated with better diabetes care. The results can help inform the development of diabetes education programs. PMID:18511737

Achieving Goal-Concordant Care: A Conceptual Model and Approach to Measuring Serious Illness Communication and Its Impact

PubMed Central

Curtis, J. Randall; Tulsky, James A.

2018-01-01

Abstract Background: High-quality care for seriously ill patients aligns treatment with their goals and values. Failure to achieve “goal-concordant” care is a medical error that can harm patients and families. Because communication between clinicians and patients enables goal concordance and also affects the illness experience in its own right, healthcare systems should endeavor to measure communication and its outcomes as a quality assessment. Yet, little consensus exists on what should be measured and by which methods. Objectives: To propose measurement priorities for serious illness communication and its anticipated outcomes, including goal-concordant care. Methods: We completed a narrative review of the literature to identify links between serious illness communication, goal-concordant care, and other outcomes. We used this review to identify gaps and opportunities for quality measurement in serious illness communication. Results: Our conceptual model describes the relationship between communication, goal-concordant care, and other relevant outcomes. Implementation-ready measures to assess the quality of serious illness communication and care include (1) the timing and setting of serious illness communication, (2) patient experience of communication and care, and (3) caregiver bereavement surveys that include assessment of perceived goal concordance of care. Future measurement priorities include direct assessment of communication quality, prospective patient or family assessment of care concordance with goals, and assessment of the bereaved caregiver experience. Conclusion: Improving serious illness care necessitates ensuring that high-quality communication has occurred and measuring its impact. Measuring patient experience and receipt of goal-concordant care should be our highest priority. We have the tools to measure both. PMID:29091522

Achieving Goal-Concordant Care: A Conceptual Model and Approach to Measuring Serious Illness Communication and Its Impact.

PubMed

Sanders, Justin J; Curtis, J Randall; Tulsky, James A

2018-03-01

High-quality care for seriously ill patients aligns treatment with their goals and values. Failure to achieve "goal-concordant" care is a medical error that can harm patients and families. Because communication between clinicians and patients enables goal concordance and also affects the illness experience in its own right, healthcare systems should endeavor to measure communication and its outcomes as a quality assessment. Yet, little consensus exists on what should be measured and by which methods. To propose measurement priorities for serious illness communication and its anticipated outcomes, including goal-concordant care. We completed a narrative review of the literature to identify links between serious illness communication, goal-concordant care, and other outcomes. We used this review to identify gaps and opportunities for quality measurement in serious illness communication. Our conceptual model describes the relationship between communication, goal-concordant care, and other relevant outcomes. Implementation-ready measures to assess the quality of serious illness communication and care include (1) the timing and setting of serious illness communication, (2) patient experience of communication and care, and (3) caregiver bereavement surveys that include assessment of perceived goal concordance of care. Future measurement priorities include direct assessment of communication quality, prospective patient or family assessment of care concordance with goals, and assessment of the bereaved caregiver experience. Improving serious illness care necessitates ensuring that high-quality communication has occurred and measuring its impact. Measuring patient experience and receipt of goal-concordant care should be our highest priority. We have the tools to measure both.

Interventions that promote retention of experienced registered nurses in health care settings: a systematic review.

PubMed

Lartey, Sarah; Cummings, Greta; Profetto-McGrath, Joanne

2014-11-01

The aim of this review was to report the effectiveness of strategies for retaining experienced Registered Nurses. Nursing researchers have noted that the projected nursing shortage, if not rectified, is expected to affect healthcare cost, job satisfaction and quality patient care. Retaining experienced nurses would help to mitigate the shortage, facilitate the transfer of knowledge and provision of quality care to patients. A systematic review of studies on interventions that promote the retention of experienced Registered Nurses in health care settings. Twelve studies were included in the final analysis. Most studies reported improved retention as a result of the intervention. Team work and individually targeted strategies including mentoring, leadership interest and in-depth orientation increased job satisfaction and produced higher retention results. Few published studies have examined interventions that promote the retention of experienced Registered Nurses in healthcare. Retention was highest when multiple interventions were used. Further research is needed to inform nurse leaders of ways to retain nurses and to maintain quality care in health care settings. Programmes targeting the retention of experienced nurses need to be considered when implementing measures to decrease the nursing shortage and its effects on quality care. © 2013 John Wiley & Sons Ltd.

Enhancing the Evidence for Behavioral Counseling: A Perspective From the Society of Behavioral Medicine.

PubMed

Alcántara, Carmela; Klesges, Lisa M; Resnicow, Ken; Stone, Amy; Davidson, Karina W

2015-09-01

U.S. Preventive Services Task Force (USPSTF) clinical guidelines at present rarely assign the highest grade recommendation to behavioral counseling interventions for chronic disease prevention or risk reduction because of concerns about the certainty and quality of the evidence base. As a result, the broad integration of behavioral counseling interventions in primary care remains elusive. Thus, there is an urgent need for novel perspectives on how to generate the highest-quality and -certainty evidence for primary care-focused behavioral counseling interventions. As members of the Society of Behavioral Medicine (SBM)--a multidisciplinary scientific organization committed to improving population health through behavior change--we review the USPSTF mandate and current recommendations for behavioral counseling interventions and provide a perspective for the future that calls for concerted and coordinated efforts among SBM, USPSTF, and other organizations invested in the rapid and wider uptake of beneficial, feasible, and referable primary care-focused behavioral counseling interventions. This perspective highlights five areas for further development, including (1) behavioral counseling-focused practice-based research networks; (2) promotion of USPSTF evidence standards and the increased use of pragmatic RCT design; (3) quality control and improvement procedures for behavioral counseling training; (4) systematic research on effective primary care-based collaborative care models; and (5) methodologic innovations that capitalize on disruptive technologies and healthcare transformation. Collective efforts to improve the health of all Americans in the 21st century and beyond must ensure that effective, feasible, and referable behavioral counseling interventions are embedded in modern primary care practice. Copyright © 2015 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Quality of Diabetes Care: The Challenges of an Increasing Epidemic in Mexico. Results from Two National Health Surveys (2006 and 2012)

PubMed Central

Flores-Hernández, Sergio; Saturno-Hernández, Pedro J.; Reyes-Morales, Hortensia; Barrientos-Gutiérrez, Tonatiuh; Villalpando, Salvador; Hernández-Ávila, Mauricio

2015-01-01

Background The quality of diabetes care remains suboptimal according to numerous studies assessing the achievement of quality indicators for diabetes care in various healthcare settings. We report about global and specific quality indicators for diabetes care and their association to glycemic control at the population level in two national health surveys in Mexico. Methods We conducted a cross-sectional analysis of the 2006 and 2012 National Health Surveys in Mexico. We examined quality of care for 2,965 and 4,483 adults (≥ 20 years) with diagnosed type 2 diabetes using fourteen simple and two composite indicators derived from self-reported information. In a subsample for both surveys, glycated hemoglobin (HbA1c) was measured at the time of the interview. We obtained survey weight-adjusted estimators using multiple regression models (logistic and linear) with combined data files, including survey year as covariate to assess change. Results Global quality of care in 2012 was 40.8%, with a relative improvement of 11.7% between 2006 and 2012. Detections of cardiovascular disease risk factors (dyslipidemia and hypertension) were the indicators with the highest improvement, while non-pharmaceutical treatment and diabetic foot exams showed minor changes. We found a significant association between the quality of the process of diabetes care and glycemic control (OR 2.53, 95% CI 1.63-3.94). Age more than 65 years old, the type of health subsystem, gender (males), and high socio-economic status were also significantly associated to glycemic control. Conclusions Quality diabetes care and glycemic control improved and are significantly associated. However, according to international standards, the current situation remains suboptimal. A more holistic approach is needed, with an emphasis on improving quality in outpatient care. PMID:26230991

Quality of Diabetes Care: The Challenges of an Increasing Epidemic in Mexico. Results from Two National Health Surveys (2006 and 2012).

PubMed

Flores-Hernández, Sergio; Saturno-Hernández, Pedro J; Reyes-Morales, Hortensia; Barrientos-Gutiérrez, Tonatiuh; Villalpando, Salvador; Hernández-Ávila, Mauricio

2015-01-01

The quality of diabetes care remains suboptimal according to numerous studies assessing the achievement of quality indicators for diabetes care in various healthcare settings. We report about global and specific quality indicators for diabetes care and their association to glycemic control at the population level in two national health surveys in Mexico. We conducted a cross-sectional analysis of the 2006 and 2012 National Health Surveys in Mexico. We examined quality of care for 2,965 and 4,483 adults (≥ 20 years) with diagnosed type 2 diabetes using fourteen simple and two composite indicators derived from self-reported information. In a subsample for both surveys, glycated hemoglobin (HbA1c) was measured at the time of the interview. We obtained survey weight-adjusted estimators using multiple regression models (logistic and linear) with combined data files, including survey year as covariate to assess change. Global quality of care in 2012 was 40.8%, with a relative improvement of 11.7% between 2006 and 2012. Detections of cardiovascular disease risk factors (dyslipidemia and hypertension) were the indicators with the highest improvement, while non-pharmaceutical treatment and diabetic foot exams showed minor changes. We found a significant association between the quality of the process of diabetes care and glycemic control (OR 2.53, 95% CI 1.63-3.94). Age more than 65 years old, the type of health subsystem, gender (males), and high socio-economic status were also significantly associated to glycemic control. Quality diabetes care and glycemic control improved and are significantly associated. However, according to international standards, the current situation remains suboptimal. A more holistic approach is needed, with an emphasis on improving quality in outpatient care.

Development of Indicators to Assess Quality of Care for Prostate Cancer.

PubMed

Nag, Nupur; Millar, Jeremy; Davis, Ian D; Costello, Shaun; Duthie, James B; Mark, Stephen; Delprado, Warick; Smith, David; Pryor, David; Galvin, David; Sullivan, Frank; Murphy, Áine C; Roder, David; Elsaleh, Hany; Currow, David; White, Craig; Skala, Marketa; Moretti, Kim L; Walker, Tony; De Ieso, Paolo; Brooks, Andrew; Heathcote, Peter; Frydenberg, Mark; Thavaseelan, Jeffery; Evans, Sue M

2016-02-20

The development, monitoring, and reporting of indicator measures that describe standard of care provide the gold standard for assessing quality of care and patient outcomes. Although indicator measures have been reported, little evidence of their use in measuring and benchmarking performance is available. A standard set, defining numerator, denominator, and risk adjustments, will enable global benchmarking of quality of care. To develop a set of indicators to enable assessment and reporting of quality of care for men with localised prostate cancer (PCa). Candidate indicators were identified from the literature. An international panel was invited to participate in a modified Delphi process. Teleconferences were held before and after each voting round to provide instruction and to review results. Panellists were asked to rate each proposed indicator on a Likert scale of 1-9 in a two-round iterative process. Calculations required to report on the endorsed indicators were evaluated and modified to reflect the data capture of the Prostate Cancer Outcomes Registry-Australia and New Zealand (PCOR-ANZ). A total of 97 candidate indicators were identified, of which 12 were endorsed. The set includes indicators covering pre-, intra-, and post-treatment of PCa care, within the limits of the data captured by PCOR-ANZ. The 12 endorsed quality measures enable international benchmarking on the quality of care of men with localised PCa. Reporting on these indicators enhances safety and efficacy of treatment, reduces variation in care, and can improve patient outcomes. PCa has the highest incidence of all cancers in men. Early diagnosis and relatively high survival rates mean issues of quality of care and best possible health outcomes for patients are important. This paper identifies 12 important measurable quality indicators in PCa care. Copyright © 2016 European Association of Urology. Published by Elsevier B.V. All rights reserved.

Patient Experience Shows Little Relationship with Hospital Quality Management Strategies

PubMed Central

Groene, Oliver; Arah, Onyebuchi A.; Klazinga, Niek S.; Wagner, Cordula; Bartels, Paul D.; Kristensen, Solvejg; Saillour, Florence; Thompson, Andrew; Thompson, Caroline A.; Pfaff, Holger; DerSarkissian, Maral; Sunol, Rosa

2015-01-01

Objectives Patient-reported experience measures are increasingly being used to routinely monitor the quality of care. With the increasing attention on such measures, hospital managers seek ways to systematically improve patient experience across hospital departments, in particular where outcomes are used for public reporting or reimbursement. However, it is currently unclear whether hospitals with more mature quality management systems or stronger focus on patient involvement and patient-centered care strategies perform better on patient-reported experience. We assessed the effect of such strategies on a range of patient-reported experience measures. Materials and Methods We employed a cross-sectional, multi-level study design randomly recruiting hospitals from the Czech Republic, France, Germany, Poland, Portugal, Spain, and Turkey between May 2011 and January 2012. Each hospital contributed patient level data for four conditions/pathways: acute myocardial infarction, stroke, hip fracture and deliveries. The outcome variables in this study were a set of patient-reported experience measures including a generic 6-item measure of patient experience (NORPEQ), a 3-item measure of patient-perceived discharge preparation (Health Care Transition Measure) and two single item measures of perceived involvement in care and hospital recommendation. Predictor variables included three hospital management strategies: maturity of the hospital quality management system, patient involvement in quality management functions and patient-centered care strategies. We used directed acyclic graphs to detail and guide the modeling of the complex relationships between predictor variables and outcome variables, and fitted multivariable linear mixed models with random intercept by hospital, and adjusted for fixed effects at the country level, hospital level and patient level. Results Overall, 74 hospitals and 276 hospital departments contributed data on 6,536 patients to this study (acute myocardial infarction n = 1,379, hip fracture n = 1,503, deliveries n = 2,088, stroke n = 1,566). Patients admitted for hip fracture and stroke had the lowest scores across the four patient-reported experience measures throughout. Patients admitted after acute myocardial infarction reported highest scores on patient experience and hospital recommendation; women after delivery reported highest scores for patient involvement and health care transition. We found no substantial associations between hospital-wide quality management strategies, patient involvement in quality management, or patient-centered care strategies with any of the patient-reported experience measures. Conclusion This is the largest study so far to assess the complex relationship between quality management strategies and patient experience with care. Our findings suggest absence of and wide variations in the institutionalization of strategies to engage patients in quality management, or implement strategies to improve patient-centeredness of care. Seemingly counterintuitive inverse associations could be capturing a scenario where hospitals with poorer quality management were beginning to improve their patient experience. The former suggests that patient-centered care is not yet sufficiently integrated in quality management, while the latter warrants a nuanced assessment of the motivation and impact of involving patients in the design and assessment of services. PMID:26151864

Patient Experience Shows Little Relationship with Hospital Quality Management Strategies.

PubMed

Groene, Oliver; Arah, Onyebuchi A; Klazinga, Niek S; Wagner, Cordula; Bartels, Paul D; Kristensen, Solvejg; Saillour, Florence; Thompson, Andrew; Thompson, Caroline A; Pfaff, Holger; DerSarkissian, Maral; Sunol, Rosa

2015-01-01

Patient-reported experience measures are increasingly being used to routinely monitor the quality of care. With the increasing attention on such measures, hospital managers seek ways to systematically improve patient experience across hospital departments, in particular where outcomes are used for public reporting or reimbursement. However, it is currently unclear whether hospitals with more mature quality management systems or stronger focus on patient involvement and patient-centered care strategies perform better on patient-reported experience. We assessed the effect of such strategies on a range of patient-reported experience measures. We employed a cross-sectional, multi-level study design randomly recruiting hospitals from the Czech Republic, France, Germany, Poland, Portugal, Spain, and Turkey between May 2011 and January 2012. Each hospital contributed patient level data for four conditions/pathways: acute myocardial infarction, stroke, hip fracture and deliveries. The outcome variables in this study were a set of patient-reported experience measures including a generic 6-item measure of patient experience (NORPEQ), a 3-item measure of patient-perceived discharge preparation (Health Care Transition Measure) and two single item measures of perceived involvement in care and hospital recommendation. Predictor variables included three hospital management strategies: maturity of the hospital quality management system, patient involvement in quality management functions and patient-centered care strategies. We used directed acyclic graphs to detail and guide the modeling of the complex relationships between predictor variables and outcome variables, and fitted multivariable linear mixed models with random intercept by hospital, and adjusted for fixed effects at the country level, hospital level and patient level. Overall, 74 hospitals and 276 hospital departments contributed data on 6,536 patients to this study (acute myocardial infarction n = 1,379, hip fracture n = 1,503, deliveries n = 2,088, stroke n = 1,566). Patients admitted for hip fracture and stroke had the lowest scores across the four patient-reported experience measures throughout. Patients admitted after acute myocardial infarction reported highest scores on patient experience and hospital recommendation; women after delivery reported highest scores for patient involvement and health care transition. We found no substantial associations between hospital-wide quality management strategies, patient involvement in quality management, or patient-centered care strategies with any of the patient-reported experience measures. This is the largest study so far to assess the complex relationship between quality management strategies and patient experience with care. Our findings suggest absence of and wide variations in the institutionalization of strategies to engage patients in quality management, or implement strategies to improve patient-centeredness of care. Seemingly counterintuitive inverse associations could be capturing a scenario where hospitals with poorer quality management were beginning to improve their patient experience. The former suggests that patient-centered care is not yet sufficiently integrated in quality management, while the latter warrants a nuanced assessment of the motivation and impact of involving patients in the design and assessment of services.

Scaling up quality care for mothers and newborns around the time of birth: an overview of methods and analyses of intervention-specific bottlenecks and solutions.

PubMed

Dickson, Kim E; Kinney, Mary V; Moxon, Sarah G; Ashton, Joanne; Zaka, Nabila; Simen-Kapeu, Aline; Sharma, Gaurav; Kerber, Kate J; Daelmans, Bernadette; Gülmezoglu, A; Mathai, Matthews; Nyange, Christabel; Baye, Martina; Lawn, Joy E

2015-01-01

The Every Newborn Action Plan (ENAP) and Ending Preventable Maternal Mortality targets cannot be achieved without high quality, equitable coverage of interventions at and around the time of birth. This paper provides an overview of the methodology and findings of a nine paper series of in-depth analyses which focus on the specific challenges to scaling up high-impact interventions and improving quality of care for mothers and newborns around the time of birth, including babies born small and sick. The bottleneck analysis tool was applied in 12 countries in Africa and Asia as part of the ENAP process. Country workshops engaged technical experts to complete a tool designed to synthesise "bottlenecks" hindering the scale up of maternal-newborn intervention packages across seven health system building blocks. We used quantitative and qualitative methods and literature review to analyse the data and present priority actions relevant to different health system building blocks for skilled birth attendance, emergency obstetric care, antenatal corticosteroids (ACS), basic newborn care, kangaroo mother care (KMC), treatment of neonatal infections and inpatient care of small and sick newborns. The 12 countries included in our analysis account for the majority of global maternal (48%) and newborn (58%) deaths and stillbirths (57%). Our findings confirm previously published results that the interventions with the most perceived bottlenecks are facility-based where rapid emergency care is needed, notably inpatient care of small and sick newborns, ACS, treatment of neonatal infections and KMC. Health systems building blocks with the highest rated bottlenecks varied for different interventions. Attention needs to be paid to the context specific bottlenecks for each intervention to scale up quality care. Crosscutting findings on health information gaps inform two final papers on a roadmap for improvement of coverage data for newborns and indicate the need for leadership for effective audit systems. Achieving the Sustainable Development Goal targets for ending preventable mortality and provision of universal health coverage will require large-scale approaches to improving quality of care. These analyses inform the development of systematic, targeted approaches to strengthening of health systems, with a focus on overcoming specific bottlenecks for the highest impact interventions.

Scaling up quality care for mothers and newborns around the time of birth: an overview of methods and analyses of intervention-specific bottlenecks and solutions

PubMed Central

2015-01-01

Background The Every Newborn Action Plan (ENAP) and Ending Preventable Maternal Mortality targets cannot be achieved without high quality, equitable coverage of interventions at and around the time of birth. This paper provides an overview of the methodology and findings of a nine paper series of in-depth analyses which focus on the specific challenges to scaling up high-impact interventions and improving quality of care for mothers and newborns around the time of birth, including babies born small and sick. Methods The bottleneck analysis tool was applied in 12 countries in Africa and Asia as part of the ENAP process. Country workshops engaged technical experts to complete a tool designed to synthesise "bottlenecks" hindering the scale up of maternal-newborn intervention packages across seven health system building blocks. We used quantitative and qualitative methods and literature review to analyse the data and present priority actions relevant to different health system building blocks for skilled birth attendance, emergency obstetric care, antenatal corticosteroids (ACS), basic newborn care, kangaroo mother care (KMC), treatment of neonatal infections and inpatient care of small and sick newborns. Results The 12 countries included in our analysis account for the majority of global maternal (48%) and newborn (58%) deaths and stillbirths (57%). Our findings confirm previously published results that the interventions with the most perceived bottlenecks are facility-based where rapid emergency care is needed, notably inpatient care of small and sick newborns, ACS, treatment of neonatal infections and KMC. Health systems building blocks with the highest rated bottlenecks varied for different interventions. Attention needs to be paid to the context specific bottlenecks for each intervention to scale up quality care. Crosscutting findings on health information gaps inform two final papers on a roadmap for improvement of coverage data for newborns and indicate the need for leadership for effective audit systems. Conclusions Achieving the Sustainable Development Goal targets for ending preventable mortality and provision of universal health coverage will require large-scale approaches to improving quality of care. These analyses inform the development of systematic, targeted approaches to strengthening of health systems, with a focus on overcoming specific bottlenecks for the highest impact interventions. PMID:26390820

Research output on primary care in Australia, Canada, Germany, the Netherlands, the United Kingdom, and the United States: bibliometric analysis

PubMed Central

Glanville, Julie; Kendrick, Tony; McNally, Rosalind; Campbell, John

2011-01-01

Objective To compare the volume and quality of original research in primary care published by researchers from primary care in the United Kingdom against five countries with well established academic primary care. Design Bibliometric analysis. Setting United Kingdom, United States, Australia, Canada, Germany, and the Netherlands. Studies reviewed Research publications relevant to comprehensive primary care and authored by researchers from primary care, recorded in Medline and Embase, with publication dates 2001-7 inclusive. Main outcome measures Volume of published activity of generalist primary care researchers and the quality of the research output by those publishing the most using citation metrics: numbers of cited papers, proportion of cited papers, and mean citation scores. Results 82 169 papers published between 2001 and 2007 in the six countries were classified as research on primary care. In a 15% pragmatic random sample of these records, 40% of research on primary care from the United Kingdom and 46% from the Netherlands was authored by researchers employed in a primary care setting or employed in academic departments of primary care. The 141 researchers with the highest volume of publications reporting research findings published between 2001 and 2007 (inclusive) authored or part authored 8.3% of the total sample of papers. For authors with the highest proportion of publications cited at least five times, the best performers came from the United States (n=5), United Kingdom (n=4), and the Netherlands (n=2). In the top 10 of authors with the highest proportions of publications achieving 20 or more citations, six were from the United Kingdom and four from the United States. The mean Hirsch index (measure of a researcher’s productivity and impact of the published work) was 14 for the Netherlands, 13 for the United Kingdom, 12 for the United States, 7 for Canada, 4 for Australia, and 3 for Germany. Conclusion This international comparison of the volume and citation rates of papers by researchers from primary care consistently placed UK researchers among the best performers internationally. PMID:21385804

Reducing socioeconomic inequalities in COPD care in the hospital outpatient setting - A nationwide initiative.

PubMed

Tøttenborg, Sandra S; Lange, Peter; Thomsen, Reimar W; Nielsen, Henrik; Johnsen, Søren P

2017-04-01

Socioeconomic differences in quality of care have been suggested to contribute to inequality in clinical prognosis of COPD. We examined socioeconomic differences in the quality of COPD outpatient care and the potential of a systematic quality improvement initiative in reducing potential socioeconomic differences. A mandatory national quality improvement initiative has since 2008 monitored the quality of COPD care at all national pulmonary specialized outpatient clinics in Denmark using six evidence-based process performance measures. We followed patients aged ≥30 years with a first-ever outpatient contact for COPD during 2008-2012 (N = 23,741). Adjusted year-specific relative risks (RR) of fulfilling all relevant process performance measures was compared according to ethnicity, education, income, employment, and cohabitation using Poisson regression. Quality of care improved following the implementation of the clinical improvement initiative with 11% of COPD patients receiving optimal care in 2008 compared to 57% in 2012. Substantial socioeconomic differences were observed the first year: immigrants (RR 0.41, 95% CI 0.21-0.82), the unemployed (RR 0.37, 95% CI 0.18-0.74), disability pensioners (RR 0.63, 95% CI 0.46-0.87) and patients living alone (RR 0.80, 95% CI 0.60-0.97) were less likely to receive all relevant care processes, whereas those with highest education (RR 1.22, 95% CI 0.92-1.63) were more likely to receive these processes. These differences were eliminated during the study period. A systematic quality improvement initiative including regular audits, knowledge sharing, and detailed disease-specific recommendations for care improvement may increase the overall quality of care and considerably modify the substantial socioeconomic inequalities in COPD management. Copyright © 2017 Elsevier Ltd. All rights reserved.

Guiding Principles and Checklist for Population-Based Quality Metrics

PubMed Central

Brunelli, Steven M.; Maddux, Franklin W.; Parker, Thomas F.; Johnson, Douglas; Nissenson, Allen R.; Collins, Allan; Lacson, Eduardo

2014-01-01

The Centers for Medicare and Medicaid Services oversees the ESRD Quality Incentive Program to ensure that the highest quality of health care is provided by outpatient dialysis facilities that treat patients with ESRD. To that end, Centers for Medicare and Medicaid Services uses clinical performance measures to evaluate quality of care under a pay-for-performance or value-based purchasing model. Now more than ever, the ESRD therapeutic area serves as the vanguard of health care delivery. By translating medical evidence into clinical performance measures, the ESRD Prospective Payment System became the first disease-specific sector using the pay-for-performance model. A major challenge for the creation and implementation of clinical performance measures is the adjustments that are necessary to transition from taking care of individual patients to managing the care of patient populations. The National Quality Forum and others have developed effective and appropriate population-based clinical performance measures quality metrics that can be aggregated at the physician, hospital, dialysis facility, nursing home, or surgery center level. Clinical performance measures considered for endorsement by the National Quality Forum are evaluated using five key criteria: evidence, performance gap, and priority (impact); reliability; validity; feasibility; and usability and use. We have developed a checklist of special considerations for clinical performance measure development according to these National Quality Forum criteria. Although the checklist is focused on ESRD, it could also have broad application to chronic disease states, where health care delivery organizations seek to enhance quality, safety, and efficiency of their services. Clinical performance measures are likely to become the norm for tracking performance for health care insurers. Thus, it is critical that the methodologies used to develop such metrics serve the payer and the provider and most importantly, reflect what represents the best care to improve patient outcomes. PMID:24558050

Guideline for primary care management of headache in adults

PubMed Central

Becker, Werner J.; Findlay, Ted; Moga, Carmen; Scott, N. Ann; Harstall, Christa; Taenzer, Paul

2015-01-01

Abstract Objective To increase the use of evidence-informed approaches to diagnosis, investigation, and treatment of headache for patients in primary care. Quality of evidence A comprehensive search was conducted for relevant guidelines and systematic reviews published between January 2000 and May 2011. The guidelines were critically appraised using the AGREE (Appraisal of Guidelines for Research and Evaluation) tool, and the 6 highest-quality guidelines were used as seed guidelines for the guideline adaptation process. Main message A multidisciplinary guideline development group of primary care providers and other specialists crafted 91 specific recommendations using a consensus process. The recommendations cover diagnosis, investigation, and management of migraine, tension-type, medication-overuse, and cluster headache. Conclusion A clinical practice guideline for the Canadian health care context was created using a guideline adaptation process to assist multidisciplinary primary care practitioners in providing evidence-informed care for patients with headache. PMID:26273080

End-of-life care in nursing homes: the high cost of staff turnover.

PubMed

Tilden, Virginia P; Thompson, Sarah A; Gajewski, Byron J; Bott, Marjorie J

2012-01-01

Nursing home staff turnover results in high cost--both economic and personal--and has a negative impact on the quality of care provided to residents at the end of life. Reducing staff turnover in nursing homes would benefit both the cost to the U.S. health care system, and, most importantly, the care residents receive in the vulnerable period leading to death. There is rising pressure on nursing homes to improve their palliative and end-of-life care practices and reduce transfers to hospital for situations and conditions that can be safely managed on site. Nursing care staff deserve an investment in the specific training necessary for them to give the highest quality care to dying residents. This training should be multifaceted and include the physiological, psychological, spiritual, interpersonal, and cultural (including ethnic) aspects of dying. Empowerment with these necessary knowledge, skills, and attitudes will not only result in better care for residents but likely also will reduce the burnout and frustration staff experience in caring for residents near death.

Customer quality and type 2 diabetes from the patients' perspective: a cross-sectional study.

PubMed

Tabrizi, Jafar S; Wilson, Andrew J; O'Rourke, Peter K

2010-12-18

Quality in health care can be seen as having three principal dimensions: service, technical and customer quality. This study aimed to measure Customer Quality in relation to self-management of Type 2 diabetes. A cross-sectional survey of 577 Type 2 diabetes people was carried out in Australia. The 13-item Patient Activation Measure was used to evaluate Customer Quality based on self-reported knowledge, skills and confidence in four stages of self-management. All statistical analyses were conducted using SPSS 13.0. All participants achieved scores at the level of stage 1, but ten percent did not achieve score levels consistent with stage 2 and a further 16% did not reach the actual action stage. Seventy-four percent reported capacity for taking action for self-management and 38% reported the highest Customer Quality score and ability to change the action by changing health and environment. Participants with a higher education attainment, better diabetes control status and those who maintain continuity of care reported a higher Customer Quality score, reflecting higher capacity for self-management. Specific capacity building programs for health care providers and people with Type 2 diabetes are needed to increase their knowledge and skills; and improve their confidence to self-management, to achieve improved quality of delivered care and better health outcomes.

Quality of care in European home care programs using the second generation interRAI Home Care Quality Indicators (HCQIs).

PubMed

Foebel, Andrea D; van Hout, Hein P; van der Roest, Henriëtte G; Topinkova, Eva; Garms-Homolova, Vjenka; Frijters, Dinnus; Finne-Soveri, Harriet; Jónsson, Pálmi V; Hirdes, John P; Bernabei, Roberto; Onder, Graziano

2015-11-14

Evaluating the quality of care provided to older individuals is a key step to ensure that needs are being met and to target interventions to improve care. To this aim, interRAI's second-generation home care quality indicators (HCQIs) were developed in 2013. This study assesses the quality of home care services in six European countries using these HCQIs as well as the two derived summary scales. Data for this study were derived from the Aged in Home Care (AdHOC) study - a cohort study that examined different models of community care in European countries. The current study selected a sub-sample of the AdHOC cohort from six countries whose follow-up data were complete (Czech Republic, Denmark, Finland, Germany, Italy and the Netherlands). Data were collected from the interRAI Home Care instrument (RAI-HC) between 2000 and 2002. The 23 HCQIs of interest were determined according to previously established methodology, including risk adjustment. Two summary measures, the Clinical Balance Scale and Independence Quality Scale were also determined using established methodology. A total of 1,354 individuals from the AdHOC study were included in these analyses. Of the 23 HCQIs that were measured, the highest proportion of individuals experienced declines in Instrumental Activities of Daily Living (IADLs) (48.4 %). Of the clinical quality indicators, mood decline was the most prevalent (30.0 %), while no flu vaccination and being alone and distressed were the most prevalent procedural and social quality indicators, respectively (33.4 and 12.8 %). Scores on the two summary scales varied by country, but were concentrated around the median mark. The interRAI HCQIs can be used to determine the quality of home care services in Europe and identify areas for improvement. Our results suggest functional declines may prove the most beneficial targets for interventions.

Quality of care in the intensive care unit from the perspective of patient's relatives: development and psychometric evaluation of the consumer quality index 'R-ICU'.

PubMed

Rensen, Ans; van Mol, Margo M; Menheere, Ilse; Nijkamp, Marjan D; Verhoogt, Ellen; Maris, Bea; Manders, Willeke; Vloet, Lilian; Verharen, Lisbeth

2017-01-24

The quality standards of the Dutch Society of Intensive Care require monitoring of the satisfaction of patient's relatives with respect to care. Currently, no suitable instrument is available in the Netherlands to measure this. This study describes the development and psychometric evaluation of the questionnaire-based Consumer Quality Index 'Relatives in Intensive Care Unit' (CQI 'R-ICU'). The CQI 'R-ICU' measures the perceived quality of care from the perspective of patients' relatives, and identifies aspects of care that need improvement. The CQI 'R-ICU' was developed using a mixed method design. Items were based on quality of care aspects from earlier studies and from focus group interviews with patients' relatives. The time period for the data collection of the psychometric evaluation was from October 2011 until July 2012. Relatives of adult intensive care patients in one university hospital and five general hospitals in the Netherlands were approached to participate. Psychometric evaluation included item analysis, inter-item analysis, and factor analysis. Twelve aspects were noted as being indicators of quality of care, and were subsequently selected for the questionnaire's vocabulary. The response rate of patients' relatives was 81% (n = 455). Quality of care was represented by two clusters, each showing a high reliability: 'Communication' (α = .80) and 'Participation' (α = .84). Relatives ranked the following aspects for quality of care as most important: no conflicting information, information from doctors and nurses is comprehensive, and health professionals take patients' relatives seriously. The least important care aspects were: need for contact with peers, nuisance, and contact with a spiritual counsellor. Aspects that needed the most urgent improvement (highest quality improvement scores) were: information about how relatives can contribute to the care of the patient, information about the use of meal-facilities in the hospital, and involvement in decision-making on the medical treatment of the patient. The CQI 'R-ICU' evaluates quality of care from the perspective of relatives of intensive care patients and provides practical information for quality assurance and improvement programs. The development and psychometric evaluation of the CQI 'R-ICU' led to a draft questionnaire, sufficient to justify further research into the reliability, validity, and the discriminative power of the questionnaire.

Comparison of patient evaluations of health care quality in relation to WHO measures of achievement in 12 European countries.

PubMed

Kerssens, Jan J; Groenewegen, Peter P; Sixma, Herman J; Boerma, Wienke G W; van der Eijk, Ingrid

2004-02-01

To gain insight into similarities and differences in patient evaluations of quality of primary care across 12 European countries and to correlate patient evaluations with WHO health system performance measures (for example, responsiveness) of these countries. Patient evaluations were derived from a series of Quote (QUality of care Through patients' Eyes) instruments designed to measure the quality of primary care. Various research groups provided a total sample of 5133 patients from 12 countries: Belarus, Denmark, Finland, Greece, Ireland, Israel, Italy, the Netherlands, Norway, Portugal, United Kingdom, and Ukraine. Intraclass correlations of 10 Quote items were calculated to measure differences between countries. The world health report 2000 - Health systems: improving performance performance measures in the same countries were correlated with mean Quote scores. Intra-class correlation coefficients ranged from low to very high, which indicated little variation between countries in some respects (for example, primary care providers have a good understanding of patients' problems in all countries) and large variation in other respects (for example, with respect to prescription of medication and communication between primary care providers). Most correlations between mean Quote scores per country and WHO performance measures were positive. The highest correlation (0.86) was between the primary care provider's understanding of patients' problems and responsiveness according to WHO. Patient evaluations of the quality of primary care showed large differences across countries and related positively to WHO's performance measures of health care systems.

Measuring quality of adolescent preventive services of health plan enrollees and school-based health center users.

PubMed

Klein, Jonathan D; Handwerker, Lisa; Sesselberg, Tracy S; Sutter, Erika; Flanagan, Erinn; Gawronski, Beth

2007-08-01

To evaluate whether quality of care provided to adolescents enrolled in a community-based managed care plan was better for those who also received some care at school-based health centers (SBHCs). The Young Adult Health Care Survey (YAHCS) was administered to 374 adolescents (commercially insured, Medicaid-insured, and SBHC users) to assess risk behaviors, provision of preventive screening and counseling, and quality of care. SBHC users were most likely to report that their provider told them their discussions were confidential, and that they received screening/counseling on sexually transmitted diseases (STDs), HIV/AIDS, condom use, and birth control. Commercially insured adolescents were least likely to report discussion of sexual health issues. SBHC users had the highest mean YAHCS quality measure scores for screening/counseling on pregnancy/STDs, diet and exercise, and helpfulness of counseling provided; Medicaid-insured teens had the lowest scores on four of seven measures. Regression models controlled for demographics, use of screener, and site of care showed that use of a screener had a significant impact on six of seven quality measure models. Younger age predicted screening for risk behaviors; being female, African-American, and an SBHC user predicted screening on pregnancy/STDs. SBHCs may increase adolescents' access to confidential care, and SBHC providers may be more likely than those in other settings to screen and counsel patients about sexual health. Overall quality of preventive care reported by commercially insured adolescents may be better in some health content areas and worse in others compared with care reported by Medicaid-insured youth and SBHC users.

Pressure Injury Prevention: Knowledge and Attitudes of Iranian Intensive Care Nurses.

PubMed

Tirgari, Batool; Mirshekari, Leili; Forouzi, Mansooreh Azzizadeh

2018-04-01

Pressure injuries are the third most expensive condition after cancer and cardiovascular disease. Nurses are responsible for the direct and continuous care, treatment, and prevention of pressure injuries. To achieve optimal quality care, nursing knowledge and attitudes must be based on the best scientific evidence. This study aimed to examine the knowledge and attitudes of nurses working in intensive care units of hospitals affiliated with Zahedan Medical Sciences University regarding the prevention of pressure injuries. This was a descriptive analytic study involving 89 critical care nurses. Data analysis was conducted using a 3-part questionnaire: demographic data, knowledge, and attitudes of intensive care nurses toward the prevention of pressure injuries. Collected data were analyzed with SPSS version 19 (IBM, Armonk, New York), using descriptive and inferential statistics (such as Pearson correlation coefficient, independent t test, and analysis of variance). The results showed that the mean ± SD score of pressure injury knowledge was 0.44 ± 0.12, and the attitude of participants toward pressure injury prevention was 2.69 ± 0.47. Scores varied widely; "nutrition" showed the highest mean score (0.71 ± 0.45), but "etiology and development" (0.42 ± 0.21) and "classification and observation" (0.42 ± 0.24) showed the lowest mean scores. Of the different aspects of attitudes toward pressure injury prevention, "the impact of pressure injuries" showed the highest mean score (2.95 ± 0.56), and "confidence in the effectiveness of prevention" showed the lowest mean score (2.56 ± 0.46). A statistically significant relationship was observed between pressure injury knowledge and attitudes toward pressure injury prevention (P < .001). Pressure injury prevention is one of many nursing care priorities and is a key indicator of the quality of nursing care. In order to achieve optimal quality care in this area, nurse managers and other administrators should make efforts to improve nursing knowledge and attitudes based on the latest scientific evidence for pressure injury prevention.

Quality gap in primary health care services in Isfahan: women's perspective

PubMed Central

Sharifirad, Gholam R.; Shamsi, Mohsen; Pirzadeh, Asiyeh; Farzanegan, Parvin D.

2012-01-01

Background: Quality gap is the gap between client's understanding and expectations. The first step in removing this gap is to recognize client's understanding and expectations of the services. This study aimed to determine women's viewpoint of quality gap in primary health care centers of Isfahan. Materials and Methods: This cross-sectional study was conducted on women who came to primary health care centers in Isfahan city. Sample size was 1280 people. Service Quality was used to collect data including tangible dimensions, confidence, responsiveness, assurance and sympathy in providing services. Data were analyzed by t test and chi square test. Results: The results showed that women had controversy over all 5 dimensions. The least mean quality gap was seen in assurance (-11.08) and the highest mean quality gap was seen in tangible dimension (-14.41). The difference between women's viewpoint in all 5 dimensions was significant. (P < 0.05) Conclusion: Negative difference means clients’ expectations are much higher than their understanding of the current situation, so there is a large space to improve services and satisfy clients. PMID:23555148

Quality of care in investor-owned vs not-for-profit HMOs.

PubMed

Himmelstein, D U; Woolhandler, S; Hellander, I; Wolfe, S M

1999-07-14

The proportion of health maintenance organization (HMO) members enrolled in investor-owned plans has increased sharply, yet little is known about the quality of these plans compared with not-for-profit HMOs. To compare quality-of-care measures for investor-owned and not-for-profit HMOs. Analysis of the Health Plan Employer Data and Information Set (HEDIS) Version 3.0 from the National Committee for Quality Assurance's Quality Compass 1997, which included 1996 quality-of-care data for 329 HMO plans (248 investor-owned and 81 not-for-profit), representing 56% of the total HMO enrollment in the United States. Rates for 14 HEDIS quality-of-care indicators. Compared with not-for-profit HMOs, investor-owned plans had lower rates for all 14 quality-of-care indicators. Among patients discharged from the hospital after myocardial infarction, 59.2% of members in investor-owned HMOs vs 70.6% in not-for-profit plans received a beta-blocker (P<.001); 35.1% of patients with diabetes mellitus in investor-owned plans vs 47.9% in not-for-profit plans had annual eye examinations (P<.001). Investor-owned plans had lower rates than not-for-profit plans of immunization (63.9% vs 72.3%; P<.001), mammography (69.4% vs 75.1%; P<.001), Papanicolaou tests (69.2% vs 77.1%; P<.001), and psychiatric hospitalization (70.5% vs 77.1%; P<.001). Quality scores were highest for staff- and group-model HMOs. In multivariate analyses, investor ownership was consistently associated with lower quality after controlling for model type, geographic region, and the method each HMO used to collect data. Investor-owned HMOs deliver lower quality of care than not-for-profit plans.

38 CFR 52.120 - Quality of care.

Code of Federal Regulations, 2012 CFR

2012-07-01

... or maintain the highest practicable physical, mental, and psychosocial well-being, in accordance with... of nutritional status, such as body weight and protein levels, unless the participant's clinical condition demonstrates that this is not possible; and (2) Receives a therapeutic diet when a nutritional...

38 CFR 52.120 - Quality of care.

Code of Federal Regulations, 2013 CFR

2013-07-01

... or maintain the highest practicable physical, mental, and psychosocial well-being, in accordance with... of nutritional status, such as body weight and protein levels, unless the participant's clinical condition demonstrates that this is not possible; and (2) Receives a therapeutic diet when a nutritional...

38 CFR 52.120 - Quality of care.

Code of Federal Regulations, 2014 CFR

2014-07-01

... or maintain the highest practicable physical, mental, and psychosocial well-being, in accordance with... of nutritional status, such as body weight and protein levels, unless the participant's clinical condition demonstrates that this is not possible; and (2) Receives a therapeutic diet when a nutritional...

Differences in the quality of diabetes care caused by social inequalities disappear after treatment and education in a tertiary care centre.

PubMed

Bäz, L; Müller, N; Beluchin, E; Kloos, C; Lehmann, T; Wolf, G; Müller, U A

2012-05-01

To assess the relationship between social status and quality of diabetes care in a tertiary care centre in Germany. Social status was assessed in 940 consecutive patients in a university outpatient department by a questionnaire. The assessment comprised three components: education, highest professional position and household net income (total score 3-21). Quality of diabetes care was measured by HbA(1c) , blood pressure and BMI. The influence of social status on quality measures was analysed at entry and last visit by fitting linear mixed models. At the entry visit, patients with lower social status had a higher HbA(1c) compared with patients with higher status (0.06% per each point of social score difference). After a mean follow- up of 6.0 years (Type 2 diabetes) and 9.4 years (Type 1 diabetes) no significant differences in HbA(1c) could be found. However, difference in BMI (-0.41 kg/m² per each point of social score) persisted at last observation. Blood pressure was only negligibly affected by the care programme. Low social status is associated with worse quality of diabetes care at entry in a tertiary care centre. The differences in HbA(1c) disappeared after treatment and structured education, whereas the difference in BMI persisted. There was no significant influence of social status or treatment on blood pressure. © 2011 The Authors. Diabetic Medicine © 2011 Diabetes UK.

Bereaved family member perceptions of quality of end-of-life care in U.S. regions with high and low usage of intensive care unit care.

PubMed

Teno, Joan M; Mor, Vincent; Ward, Nicholas; Roy, Jason; Clarridge, Brian; Wennberg, John E; Fisher, Elliott S

2005-11-01

To compare the quality of end-of-life care of persons dying in regions of differing practice intensity. Mortality follow-back survey. Geographic regions in the highest and lowest deciles of intensive care unit (ICU) use. Bereaved family member or other knowledgeable informants. Unmet needs, concerns, and rating of quality of end-of-life care in five domains (physical comfort and emotional support of the decedent, shared decision-making, treatment of the dying person with respect, providing information and emotional support to family members). Decedents in high- (n=365) and low-intensity (n=413) hospital service areas (HSAs) did not differ in age, sex, education, marital status, leading causes of death, or the degree to which death was expected, but those in the high-intensity ICU HSAs were more likely to be black and to live in nonrural areas. Respondents in high-intensity HSAs were more likely to report that care was of lower quality in each domain, and these differences were statistically significant in three of five domains. Respondents from high-intensity HSAs were more likely to report inadequate emotional support for the decedent (relative risk (RR)=1.2, 95% confidence interval (CI)=1.0-1.4), concerns with shared decision-making (RR=1.8, 95% CI=1.0-2.9), inadequate information about what to expect (RR=1.5, 95% CI=1.3-1.8), and failure to treat the decedent with respect (RR=1.4, 95% CI=1.0-1.9). Overall ratings of the quality of end-of-life care were also significantly lower in high-intensity HSAs. Dying in regions with a higher use of ICU care is not associated with improved perceptions of quality of end-of-life care.

Defining High-Quality Palliative Care in Oncology Practice: An American Society of Clinical Oncology/American Academy of Hospice and Palliative Medicine Guidance Statement.

PubMed

Bickel, Kathleen E; McNiff, Kristen; Buss, Mary K; Kamal, Arif; Lupu, Dale; Abernethy, Amy P; Broder, Michael S; Shapiro, Charles L; Acheson, Anupama Kurup; Malin, Jennifer; Evans, Tracey; Krzyzanowska, Monika K

2016-09-01

Integrated into routine oncology care, palliative care can improve symptom burden, quality of life, and patient and caregiver satisfaction. However, not all oncology practices have access to specialist palliative medicine. This project endeavored to define what constitutes high-quality primary palliative care as delivered by medical oncology practices. An expert steering committee outlined 966 palliative care service items, in nine domains, each describing a candidate element of primary palliative care delivery for patients with advanced cancer or high symptom burden. Using modified Delphi methodology, 31 multidisciplinary panelists rated each service item on three constructs: importance, feasibility, and scope within medical oncology practice. Panelists endorsed the highest proportion of palliative care service items in the domains of End-of-Life Care (81%); Communication and Shared Decision Making (79%); and Advance Care Planning (78%). The lowest proportions were in Spiritual and Cultural Assessment and Management (35%) and Psychosocial Assessment and Management (39%). In the largest domain, Symptom Assessment and Management, there was consensus that all symptoms should be assessed and managed at a basic level, with more comprehensive management for common symptoms such as nausea, vomiting, diarrhea, dyspnea, and pain. Within the Appropriate Palliative Care and Hospice Referral domain, there was consensus that oncology practices should be able to describe the difference between palliative care and hospice to patients and refer patients appropriately. This statement describes the elements comprising high-quality primary palliative care for patients with advanced cancer or high symptom burden, as delivered by oncology practices. Oncology providers wishing to enhance palliative care delivery may find this information useful to inform operational changes and quality improvement efforts. Copyright © 2016 by American Society of Clinical Oncology.

Health-Related Quality of Life Among US Workers: Variability Across Occupation Groups.

PubMed

Shockey, Taylor M; Zack, Matthew; Sussell, Aaron

2017-08-01

To examine the health-related quality of life among workers in 22 standard occupation groups using data from the 2013-2014 US Behavioral Risk Factor Surveillance System. We examined the health-related quality of life measures of self-rated health, frequent physical distress, frequent mental distress, frequent activity limitation, and frequent overall unhealthy days by occupation group for 155 839 currently employed adults among 17 states. We performed multiple logistic regression analyses that accounted for the Behavioral Risk Factor Surveillance System's complex survey design to obtain prevalence estimates adjusted for potential confounders. Among all occupation groups, the arts, design, entertainment, sports, and media occupation group reported the highest adjusted prevalence of frequent physical distress, frequent mental distress, frequent activity limitation, and frequent overall unhealthy days. The personal care and service occupation group had the highest adjusted prevalence for fair or poor self-rated health. Workers' jobs affect their health-related quality of life.

Do Acute Myocardial Infarction and Heart Failure Readmissions Flagged as Potentially Preventable by the 3M Potentially Preventable Readmissions Software Have More Process-of-Care Problems?

PubMed

Borzecki, Ann M; Chen, Qi; Mull, Hillary J; Shwartz, Michael; Bhatt, Deepak L; Hanchate, Amresh; Rosen, Amy K

2016-09-01

The 3M Potentially Preventable Readmissions (3M-PPR) software matches clinically related index admission and readmission diagnoses that may signify in-hospital or postdischarge quality problems. To assess whether the PPR algorithm identifies preventable readmissions, we compared processes of care between PPR software-flagged and nonflagged cases. Using 2006 to 2010 national VA administrative data, we identified acute myocardial infarction and heart failure discharges associated with 30-day all-cause readmissions, then flagged cases (PPR-Yes/PPR-No) using the 3M-PPR software. To assess care quality, we abstracted medical records of 100 readmissions per condition using tools containing explicit processes organized into admission work-up, in-hospital evaluation/treatment, discharge readiness, postdischarge period. We derived quality scores, scaled to a maximum of 25 per section (maximum total score=100) and compared cases on total and section-specific mean scores. For acute myocardial infarction, 77 of 100 cases were flagged as PPR-Yes. Section quality scores were highest for in-hospital evaluation/treatment (20.5±2.8) and lowest for postdischarge care (6.8±9.1). Total and section-related mean scores did not differ by PPR status; respective PPR-Yes versus PPR-No total scores were 61.6±11.1 and 60.4±9.4; P=0.98. For heart failure, 86 of 100 cases were flagged as PPR-Yes. Section scores were highest for discharge readiness (18.8±2.4) and lowest for postdischarge care (7.3±8.1). Like acute myocardial infarction, total and section-related mean scores did not differ by PPR status; PPR-Yes versus PPR-No total scores were 61.2±10.8 and 63.4±7.0, respectively; P=0.47. Among VA acute myocardial infarction and heart failure readmissions, the 3M-PPR software does not distinguish differences in case-level quality of care. Whether 3M-PPR software better identifies preventable readmissions by using other methods to capture poorly documented processes or performing different comparisons requires further study. © 2016 American Heart Association, Inc.

Helping small babies survive: an evaluation of facility-based Kangaroo Mother Care implementation progress in Uganda

PubMed Central

Aliganyira, Patrick; Kerber, Kate; Davy, Karen; Gamache, Nathalie; Sengendo, Namaala Hanifah; Bergh, Anne-Marie

2014-01-01

Introduction Prematurity is the leading cause of newborn death in Uganda, accounting for 38% of the nation's 39,000 annual newborn deaths. Kangaroo mother care is a high-impact; cost-effective intervention that has been prioritized in policy in Uganda but implementation has been limited. Methods A standardised, cross-sectional, mixed-method evaluation design was used, employing semi-structured key-informant interviews and observations in 11 health care facilities implementing kangaroo mother care in Uganda. Results The facilities visited scored between 8.28 and 21.72 out of the possible 30 points with a median score of 14.71. Two of the 3 highest scoring hospitals were private, not-for-profit hospitals whereas the second highest scoring hospital was a central teaching hospital. Facilities with KMC services are not equally distributed throughout the country. Only 4 regions (Central 1, Central 2, East-Central and Southwest) plus the City of Kampala were identified as having facilities providing KMC services. Conclusion KMC services are not instituted with consistent levels of quality and are often dependent on private partner support. With increasing attention globally and in country, Uganda is in a unique position to accelerate access to and quality of health services for small babies across the country. PMID:25667699

Helping small babies survive: an evaluation of facility-based Kangaroo Mother Care implementation progress in Uganda.

PubMed

Aliganyira, Patrick; Kerber, Kate; Davy, Karen; Gamache, Nathalie; Sengendo, Namaala Hanifah; Bergh, Anne-Marie

2014-01-01

Prematurity is the leading cause of newborn death in Uganda, accounting for 38% of the nation's 39,000 annual newborn deaths. Kangaroo mother care is a high-impact; cost-effective intervention that has been prioritized in policy in Uganda but implementation has been limited. A standardised, cross-sectional, mixed-method evaluation design was used, employing semi-structured key-informant interviews and observations in 11 health care facilities implementing kangaroo mother care in Uganda. The facilities visited scored between 8.28 and 21.72 out of the possible 30 points with a median score of 14.71. Two of the 3 highest scoring hospitals were private, not-for-profit hospitals whereas the second highest scoring hospital was a central teaching hospital. Facilities with KMC services are not equally distributed throughout the country. Only 4 regions (Central 1, Central 2, East-Central and Southwest) plus the City of Kampala were identified as having facilities providing KMC services. KMC services are not instituted with consistent levels of quality and are often dependent on private partner support. With increasing attention globally and in country, Uganda is in a unique position to accelerate access to and quality of health services for small babies across the country.

Experiences of adult patients using primary care services in Poland - a cross-sectional study in QUALICOPC study framework.

PubMed

Oleszczyk, Marek; Krztoń-Królewiecka, Anna; Schäfer, Willemijn L A; Boerma, Wienke G W; Windak, Adam

2017-11-22

Patients as real healthcare system users are important observers of primary care and are able to provide reliable information about the quality of care. The aim of this study was to explore the patients' experiences and their level of satisfaction with the process and outcomes of care provided by primary care physicians in Poland and to identify the characteristics of the patients, their physicians, and facilities associated with patient satisfaction. The study is based on data from the Polish part of the Quality and Costs of Primary Care in Europe (QUALICOPC) cross-sectional, questionnaire-based study. In Poland, a nationally representative sample of 220 PC physicians and 1980 of their patients were recruited to take part in the study. As a study tool we used 3 out of 4 QUALICOPC questionnaires: "Patient Experience", "PC Physician" and "Fieldworker" questionnaires. The areas of the best quality perceived by Polish PC patients are: equity, accessibility of care and quality of service. Coordination and comprehensiveness of care are evaluated relatively worse. The patients' and their physicians' characteristics have a limited influence on patient satisfaction and experiences with Polish primary care. Primary health care in Poland is of good overall quality as perceived by the patients. Study participants were at most satisfied with accessibility and equity of care and less satisfied with coordination and comprehensiveness of care. Longer patient-doctor relationship and older age of patients were found as the most influential determinants of higher satisfaction. However, variables used in this study poorly explain the overall level of satisfaction. Further research is needed to identify the other determinants of patient satisfaction in the Polish population. Rural practices deserve additional attention due to highest proportions of both extremely satisfied and dissatisfied patients.

Using Computer-Extracted Data from Electronic Health Records to Measure the Quality of Adolescent Well-Care

PubMed Central

Gardner, William; Morton, Suzanne; Byron, Sepheen C; Tinoco, Aldo; Canan, Benjamin D; Leonhart, Karen; Kong, Vivian; Scholle, Sarah Hudson

2014-01-01

Objective To determine whether quality measures based on computer-extracted EHR data can reproduce findings based on data manually extracted by reviewers. Data Sources We studied 12 measures of care indicated for adolescent well-care visits for 597 patients in three pediatric health systems. Study Design Observational study. Data Collection/Extraction Methods Manual reviewers collected quality data from the EHR. Site personnel programmed their EHR systems to extract the same data from structured fields in the EHR according to national health IT standards. Principal Findings Overall performance measured via computer-extracted data was 21.9 percent, compared with 53.2 percent for manual data. Agreement measures were high for immunizations. Otherwise, agreement between computer extraction and manual review was modest (Kappa = 0.36) because computer-extracted data frequently missed care events (sensitivity = 39.5 percent). Measure validity varied by health care domain and setting. A limitation of our findings is that we studied only three domains and three sites. Conclusions The accuracy of computer-extracted EHR quality reporting depends on the use of structured data fields, with the highest agreement found for measures and in the setting that had the greatest concentration of structured fields. We need to improve documentation of care, data extraction, and adaptation of EHR systems to practice workflow. PMID:24471935

Physician Burnout: Improving Treatment Efficacy with Virtual Reality.

PubMed

Wiederhold, Brenda K; Riva, Giuseppe; Gaggioli, Andrea; Wiederhold, Mark D

2016-01-01

Creating a significant negative impact on both their quality of life and the quality of patient care with an evident economical burden for the healthcare system, there is a growing concern over physician burnout. The range of interventions and treatments that have been used to address this problem, however, appear quite fragmented and lack compelling efficacy. We describe the main factors known to contribute to the development of physician burnout as well as currently available treatments. Studies seem to indicate that both specialisation area as well as personality traits may contribute to the manifestation. The highest risk specialties appear to be critical care physicians, emergency physicians, oncologists and internal medicine physicians, while the highest risk personality attributes are high neuroticism, low agreeableness, introversion, and negative affectivity. In addition, being exceedingly enthusiastic about one's work and having high aspirations at work, with an idealistic approach, also serve as factors which contribute to increased risk of burnout, and in particular for those who are new to the occupation.

An evaluation of the guidelines of the Society of Obstetricians and Gynaecologists of Canada.

PubMed

Ghui, Roslyn; Bansal, Jassimran Kaur; McLaughlin, Catarina; Kotaska, Andrew; Lokugamage, Amali

2016-07-01

Clinical practice guidelines hope to offer unbiased, evidence-based guidance for clinicians. This paper examines levels of evidence contained within the guidelines of the Society of Obstetricians and Gynaecologists of Canada and compares classification of the recommendation (CoR) A/B/C/D/E/L (derived from evidence and consensus) versus quality of evidence assessment (QoEA) I-III. 1250 recommendations were analysed and 43% of recommendations were graded as "good" evidence, the highest grade of CoR, while just 24.6% of recommendations were based on the highest level of QoEA (level I). The paper discusses possible reasons for this discrepancy. The authors hope that this analysis promotes greater transparency in evidence-based medicine ultimately leading to using the best quality of evidence available yet taking into account any areas of scientific uncertainty. This will enhance respectful care of patients, while taking into account their autonomy and furthering the cause of patient centre care.

Quality and rural-urban comparison of tuberculosis care in Rivers State, Nigeria.

PubMed

Tobin-West, Charles Ibiene; Isodje, Anastasia

2016-01-01

Nigeria ranks among countries with the highest burden of tuberculosis. Yet evidence continues to indicate poor treatment outcomes which have been attributed to poor quality of care. This study aims to identify some of the systemic problems in order to inform policy decisions for improved quality of services and treatment outcomes in Nigeria. A comparative assessment of the quality of TB care in rural and urban health facilities was carried out between May and June 2013, employing the Donabedian model of quality assessment. Data was analysed using the SPSS software package version 20.0. The level of significance was set at p < 0.05. Health facility infrastructures were more constrained in the urban than rural settings. Both the urban and rural facilities lacked adequate facilities for infection control such as, running water, air filter respirators, hand gloves and extractor fans. Health education and HIV counselling and testing (HCT) were limited in rural facilities compared to urban facilities. Although anti-TB drugs were generally available in both settings, the DOTS strategy in patient care was completely ignored. Finally, laboratory support for diagnosis and patient monitoring was limited in the rural facilities. The study highlights suboptimal quality of TB care in Rivers State with limitations in health education and HCT of patients for HIV as well as laboratory support for TB care in rural health facilities. We, therefore, recommend that adequate infection control measures, strict observance of the DOTS strategy and sufficient laboratory support be provided to TB clinics in the State.

Measuring patients' experiences with rheumatic care: the consumer quality index rheumatoid arthritis.

PubMed

Zuidgeest, Marloes; Sixma, Herman; Rademakers, Jany

2009-12-01

Rheumatologists and other caregivers can learn from patients’ experiences with the quality of care that can be measured with the CQ-index Rheumatoid Arthritis (CQ-index RA) survey. Patients with RA (n = 590) received this survey were they rated their actual experiences and what they find important in rheumatic healthcare. Descriptive analyses and psychometric methods were used to test the reliability. The response rate was 69%. The items in the pilot instrument could be grouped into 10 scales (α ranged from 0.77 to 0.94). The most important quality aspects according to patients concerned the alertness when prescribing medication. Providing patients with information on a special website of the hospital about RA was the highest quality improvement aspect. The results of this study show that the CQ-index RA is a reliable instrument for quality assessment from the patients’ perspective. The instrument provides rheumatologists and other caregivers with feedback for service improvement initiatives.

Experienced job autonomy among maternity care professionals in The Netherlands.

PubMed

Perdok, Hilde; Cronie, Doug; van der Speld, Cecile; van Dillen, Jeroen; de Jonge, Ank; Rijnders, Marlies; de Graaf, Irene; Schellevis, François G; Verhoeven, Corine J

2017-11-01

High levels of experienced job autonomy are found to be beneficial for healthcare professionals and for the relationship with their patients. The aim of this study was to assess how maternity care professionals in the Netherlands perceive their job autonomy in the Dutch maternity care system and whether they expect a new system of integrated maternity care to affect their experienced job autonomy. A cross-sectional survey. The Leiden Quality of Work Life Questionnaire was used to assess experienced job autonomy among maternity care professionals. Data were collected in the Netherlands in 2015. 799 professionals participated of whom 362 were primary care midwives, 240 obstetricians, 93 clinical midwives and 104 obstetric nurses. The mean score for experienced job autonomy was highest for primary care midwives, followed by obstetricians, clinical midwives and obstetric nurses. Primary care midwives scored highest in expecting to lose their job autonomy in an integrated care system. There are significant differences in experienced job autonomy between maternity care professionals. When changing the maternity care system it will be a challenge to maintain a high level of experienced job autonomy for professionals. A decrease in job autonomy could lead to a reduction in job related wellbeing and in satisfaction with care among pregnant women. Copyright © 2017. Published by Elsevier Ltd.

Quality of basic maternal care functions in health facilities of five African countries: an analysis of national health system surveys.

PubMed

Kruk, Margaret E; Leslie, Hannah H; Verguet, Stéphane; Mbaruku, Godfrey M; Adanu, Richard M K; Langer, Ana

2016-11-01

Global efforts to increase births at health-care facilities might not reduce maternal or newborn mortality if quality of care is insufficient. However, little systematic evidence exists for the quality at health facilities caring for women and newborn babies in low-income countries. We analysed the quality of basic maternal care functions and its association with volume of deliveries and surgical capacity in health-care facilities in five sub-Saharan African countries. In this analysis, we combined nationally representative health system surveys (Service Provision Assessments by the Demographic and Health Survery Programme) with data for volume of deliveries and quality of delivery care from Kenya, Namibia, Rwanda, Tanzania, and Uganda. We measured the quality of basic maternal care functions in delivery facilities using an index of 12 indicators of structure and processes of care, including infrastructure and use of evidence-based routine and emergency care interventions. We regressed the quality index on volume of births and confounders (public or privately managed, availability of antiretroviral therapy services, availability of skilled staffing, and country) stratified by facility type: primary (no caesarean capacity) or secondary (has caesarean capacity) care facilities. The Harvard University Human Research Protection Program approved this analysis as exempt from human subjects review. The national surveys were completed between April, 2006, and May, 2010. Our sample consisted of 1715 (93%) of 1842 health-care facilities that provided normal delivery service, after exclusion of facilities with missing (n=126) or invalid (n=1) data. 1511 (88%) study facilities (site of 276 965 [44%] of 622 864 facility births) did not have caesarean section capacity (primary care facilities). Quality of basic maternal care functions was substantially lower in primary (index score 0·38) than secondary care facilities (0·77). Low delivery volume was consistently associated with poor quality, with differences in quality between the lowest versus highest volume facilities of -0·22 (95% CI -0·26 to -0·19) in primary care facilities and -0·17 (-0·21 to -0·11) in secondary care facilities. More than 40% of facility deliveries in these five African countries occurred in primary care facilities, which scored poorly on basic measures of maternal care quality. Facilities with caesarean section capacity, particularly those with birth volumes higher than 500 per year, had higher scores for maternal care quality. Low-income and middle-income countries should systematically assess and improve the quality of delivery care in health facilities to accelerate reduction of maternal and newborn deaths. None. Copyright © 2016 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND license. Published by Elsevier Ltd.. All rights reserved.

Quality of HIV care in the United Kingdom: key indicators for the first 12 months from HIV diagnosis.

PubMed

Delpech, V; Brown, A E; Croxford, S; Chau, C; Polavarapu, V; Cooper, N; Rooney, G; Yin, Z

2013-10-01

Prompt HIV diagnosis and treatment are associated with increased longevity and reduced transmission. The aim of the study was to examine late diagnoses and to assess the quality of care following diagnosis. National surveillance and cohort data were used to examine late HIV diagnoses and to assess the quality of care received in the 12 months following HIV diagnosis. In 2011, 79% (4910/6219) of persons (15 years and over) diagnosed with HIV infection had CD4 counts reported within 3 months; of these, 49% were diagnosed late (CD4 count < 350 cells/μL). Adults aged 50 years and over were more likely to be diagnosed late (67%) compared with those aged 15-24 years (31%). Sixty-four per cent of heterosexual men were diagnosed late compared with 46% of women and 36% of men who have sex with men (MSM) (P < 0.01). The percentage of late diagnoses was highest among black African adults (66%) compared with other ethnicities; 96% of black African adults diagnosed late were born abroad. Overall, 88% and 97% of patients were linked to care within 1 and 3 months of diagnosis, respectively, with little variation by demographics and exposure category. The crude 1-year mortality rate was 31.6 per 1000 persons diagnosed in 2010. It was highest among adults diagnosed late (40.3/1000 versus 5.2/1000 for prompt diagnoses) and particularly among those aged 50 years and over. Excluding deaths, 85% of the 5833 diagnosed in 2010 were retained in care in 2011; 92% of the 2264 adults diagnosed late in 2010 received antiretroviral therapy by the end of 2011. The National Health Service provides high-quality care to persons newly diagnosed with HIV infection in the UK, with no evidence of health inequalities. Despite excellent care, half of adults are diagnosed late according to the threshold at which national guidelines recommend treatment should begin. Such patients have an 8-fold increased risk of 1-year mortality compared with those diagnosed promptly. Reducing late diagnosis of HIV infection remains a public health priority in the UK. © 2013 British HIV Association.

Intensive Care and its Discontents: Psychiatric Illness in the Critically Ill.

PubMed

Hashmi, Ali M; Han, Jin Y; Demla, Vishal

2017-09-01

Critically ill patients can develop a host of cognitive and psychiatric complaints during their intensive care unit (ICU) stay, many of which persist for weeks or months following discharge from the ICU and can seriously affect their quality of life, including their ability to return to work. This article describes some common psychiatric problems encountered by clinicians in the ICU, including their assessment and management. A comprehensive approach is needed to decrease patient suffering, improve morbidity and mortality, and ensure that critically ill patients can return to the highest quality of life after an ICU stay. Copyright © 2017 Elsevier Inc. All rights reserved.

Diabetes quality management in Dutch care groups and outpatient clinics: a cross-sectional study.

PubMed

Campmans-Kuijpers, Marjo J E; Baan, Caroline A; Lemmens, Lidwien C; Rutten, Guy E H M

2014-08-07

In recent years, most Dutch general practitioners started working under the umbrella of diabetes care groups, responsible for the organisation and coordination of diabetes care. The quality management of these new organisations receives growing interest, although its association with quality of diabetes care is yet unclear. The best way to measure quality management is unknown and it has not yet been studied at the level of outpatient clinics or care groups. We aimed to assess quality management of type 2 diabetes care in care groups and outpatient clinics. Quality management was measured with online questionnaires, containing six domains (see below). They were divided into 28 subdomains, with 59 (care groups) and 57 (outpatient clinics) questions respectively. The mean score of the domains reflects the overall score (0-100%) of an organisation. Two quality managers of all Dutch care groups and outpatient clinics were invited to fill out the questionnaire.Sixty care groups (response rate 61.9%) showed a mean score of 59.6% (CI 57.1-62.1%). The average score in 52 outpatient clinics (response rate 50.0%) was 61.9% (CI 57.5-66.8%).Mean scores on the six domains for care groups and outpatient clinics respectively were: 'organisation of care' 71.9% (CI 68.8-74.9%), 76.8% (CI 72.8-80.7%); 'multidisciplinary teamwork' 67.1% (CI 62.4-71.9%), 71.5% (CI 65.3-77.8%); 'patient centeredness' 46.7% (CI 42.6-50.7%), 62.5% (CI 57.7-67.2%); 'performance management' 63.3% (CI 61.2-65.3%), 50.9% (CI 44.2-57.5%); 'quality improvement policy' 52.6% (CI 49.2-56.1%), 50.9% (CI 44.6-57.3%); and 'management strategies' 56.0% (CI 51.4-60.7%), 59.0% (CI 52.8-65.2%). On subdomains, care groups scored highest on 'care program' (83.3%) and 'measured outcomes' (98.3%) and lowest on 'patient safety' (15.1%) and 'patient involvement' (17.7%). Outpatient clinics scored high on the presence of a 'diabetic foot team' (81.6%) and the support in 'self-management' (81.0%) and low on 'patient involvement' (26.8%) and 'inspection of medical file' (28.0%). This nationwide assessment reveals that the level of quality management in diabetes care varies between several subdomains in both diabetes care groups and outpatient clinics.

Guiding principles and checklist for population-based quality metrics.

PubMed

Krishnan, Mahesh; Brunelli, Steven M; Maddux, Franklin W; Parker, Thomas F; Johnson, Douglas; Nissenson, Allen R; Collins, Allan; Lacson, Eduardo

2014-06-06

The Centers for Medicare and Medicaid Services oversees the ESRD Quality Incentive Program to ensure that the highest quality of health care is provided by outpatient dialysis facilities that treat patients with ESRD. To that end, Centers for Medicare and Medicaid Services uses clinical performance measures to evaluate quality of care under a pay-for-performance or value-based purchasing model. Now more than ever, the ESRD therapeutic area serves as the vanguard of health care delivery. By translating medical evidence into clinical performance measures, the ESRD Prospective Payment System became the first disease-specific sector using the pay-for-performance model. A major challenge for the creation and implementation of clinical performance measures is the adjustments that are necessary to transition from taking care of individual patients to managing the care of patient populations. The National Quality Forum and others have developed effective and appropriate population-based clinical performance measures quality metrics that can be aggregated at the physician, hospital, dialysis facility, nursing home, or surgery center level. Clinical performance measures considered for endorsement by the National Quality Forum are evaluated using five key criteria: evidence, performance gap, and priority (impact); reliability; validity; feasibility; and usability and use. We have developed a checklist of special considerations for clinical performance measure development according to these National Quality Forum criteria. Although the checklist is focused on ESRD, it could also have broad application to chronic disease states, where health care delivery organizations seek to enhance quality, safety, and efficiency of their services. Clinical performance measures are likely to become the norm for tracking performance for health care insurers. Thus, it is critical that the methodologies used to develop such metrics serve the payer and the provider and most importantly, reflect what represents the best care to improve patient outcomes. Copyright © 2014 by the American Society of Nephrology.

An operations-partnered evaluation of care redesign for high-risk patients in the Veterans Health Administration (VHA): Study protocol for the PACT Intensive Management (PIM) randomized quality improvement evaluation.

PubMed

Chang, Evelyn T; Zulman, Donna M; Asch, Steven M; Stockdale, Susan E; Yoon, Jean; Ong, Michael K; Lee, Martin; Simon, Alissa; Atkins, David; Schectman, Gordon; Kirsh, Susan R; Rubenstein, Lisa V

2018-06-01

Patient-centered medical homes have made great strides providing comprehensive care for patients with chronic conditions, but may not provide sufficient support for patients at highest risk for acute care use. To address this, the Veterans Health Administration (VHA) initiated a five-site demonstration project to evaluate the effectiveness of augmenting the VA's Patient Aligned Care Team (PACT) medical home with PACT Intensive Management (PIM) teams for Veterans at highest risk for hospitalization. Researchers partnered with VHA leadership to design a mixed-methods prospective multi-site evaluation that met leadership's desire for a rigorous evaluation conducted as quality improvement rather than research. We conducted a randomized QI evaluation and assigned high-risk patients to participate in PIM and compared them with high-risk Veterans receiving usual care through PACT. The summative evaluation examines whether PIM: 1) decreases VHA emergency department and hospital use; 2) increases satisfaction with VHA care; 3) decreases provider burnout; and 4) generates positive returns on investment. The formative evaluation aims to support improved care for high-risk patients at demonstration sites and to inform future initiatives for high-risk patients. The evaluation was reviewed by representatives from the VHA Office of Research and Development and the Office of Research Oversight and met criteria for quality improvement. VHA aims to function as a learning organization by rapidly implementing and rigorously testing QI innovations prior to final program or policy development. We observed challenges and opportunities in designing an evaluation consistent with QI standards and operations priorities, while also maintaining scientific rigor. This trial was retrospectively registered at ClinicalTrials.gov on April 3, 2017: NCT03100526. Protocol v1, FY14-17. Copyright © 2018 Elsevier Inc. All rights reserved.

The use of socially assistive robots for dementia care.

PubMed

Huschilt, Julie; Clune, Laurie

2012-10-01

Innovative solutions for dementia care are required to address the steady rise in adults living with dementia, lack of adequate staffing to provide high-quality dementia care, and the need for family caregivers to provide care for their loved ones in the home. This article provides an overview of the use of socially assistive robots (SARs) to offer support as therapists, companions, and educators for people living with dementia. Social, ethical, and legal challenges associated with the use of robotic technology in patient care and implications for the use of SARs by nurses are discussed. These items considered, the authors conclude that SARs should be considered as a viable way to assist people living with dementia to maintain their highest possible level of independence, enhance their quality of life, and provide support to overburdened family caregivers. Further research is needed to evaluate the merits of this technological approach in the care of adults with dementia. Copyright 2012, SLACK Incorporated.

Contribution of primary care to health: an individual level analysis from Tibet, China.

PubMed

Wang, Wenhua; Shi, Leiyu; Yin, Aitian; Mao, Zongfu; Maitland, Elizabeth; Nicholas, Stephen; Liu, Xiaoyun

2015-11-30

There have been significant improvements in health outcomes in Tibet, health disparities between Tibet and the rest of China has been greatly reduced. This paper tests whether there was a positive association between good primary care and better health outcomes in Tibet. A validated Tibetan version of the Primary Care Assessment Tool (PCAT-T) was used to collect data on 1386 patients aged over 18 years old accessing primary care. Self-rated health (SRH) was employed to measure health outcomes. A multiple binary logistic regression model was used to explore the association between primary care quality and self-rated health status after controlling for socio-demographic and lifestyle variables. This study found that primary care quality had a significant positive association with self-rated health status. Among the nine domains of PCAT-T, family centeredness domain had the highest Odds Ratio (OR = 1.013) with SRH. Patients located in rural area, with higher education levels, without depression, and less frequent drinking were more likely to self-rate as "good health" compared with the reference group. In Tibet, higher quality primary care was associated with better self-rated health status. Primary care should be much strengthened in future health system reform in Tibet.

A Study Protocol for Tracking Quality of Life Among U.S. Service Members Wounded in Iraq and Afghanistan: The Wounded Warrior Recovery Project

DTIC Science & Technology

2014-03-01

Freedorn and Iraqi Freedotn combat injury to improve care and treatment, and prevent poor physical, psychological , and social outcomes. We describe the...and Iraqi Freedom (OEF/OIF) is the highest in tnodem history primarily because of advanced protective gear and rapid effective medical care.’^ To date...useful to assess the need for care and rehabilitation.’" ’ ’ A theoretical model of trauma and its effect on QOL, devel- oped by Sprangers and Schwartz

[Federal admission criteria for levels of perinatal care: definition, interpretation and first conclusions].

PubMed

Eberhard, A; Wenzlaff, P; Lack, N; Misselwitz, B; Kaiser, A; Bartels, D B

2008-06-01

The outcome of high risk pregnancies is better in tertiary hospitals. The German government introduced levels of perinatal care only in 2006. The aim of this study was to investigate how many children are to be expected for each level, taking the possible width of interpretation of the admission criteria into account. Perinatal quality assurance data from four German states (2005) were available. Based on the admission criteria used for level definitions, children were categorised into four different levels of care. To illustrate the possible width of interpretation of these admission criteria three analytical strategies were used. In addition, the distribution of children on different types of hospitals prior to the introduction of levels of care was analysed. Most deliveries (86-93 %) correspond to the lowest level, and only 1-5 % to the highest. Up to 15 % of children who should have been cared for in the highest level were born in hospitals with less than 500 annual deliveries. Among the neonates with risk profiles corresponding to the admission criteria for the two highest levels, up to 30 % were born in delivery units without NICUs. The majority (83 %) of attached NICUs had low caseloads (< 50 neonates < 1500 g / year). Most children fulfil the admission criteria for the lowest level of care whereas the need for specialised centres is rather low. Optimising the place of birth appropriately remains a challenge. Definition of levels of care based on admission criteria are difficult to implement due to a broad variety of interpretations.

Development of quality standards in inflammatory bowel disease management and design of an evaluation tool of nursing care.

PubMed

Torrejón, Antonio; Oltra, Lorena; Hernández-Sampelayo, Paloma; Marín, Laura; García-Sánchez, Valle; Casellas, Francesc; Alfaro, Noelia; Lázaro, Pablo; Vera, María Isabel

2013-01-01

nursing management of inflammatory bowel disease (IBD) is highly relevant for patient care and outcomes. However, there is evidence of substantial variability in clinical practices. The objectives of this study were to develop standards of healthcare quality for nursing management of IBD and elaborate the evaluation tool "Nursing Care Quality in IBD Assessment" (NCQ-IBD) based on these standards. a 178-item healthcare quality questionnaire was developed based on a systematic review of IBD nursing management literature. The questionnaire was used to perform two 2-round Delphi studies: Delphi A included 27 IBD healthcare professionals and Delphi B involved 12 patients. The NCQ-IBD was developed from the list of items resulting from both Delphi studies combined with the Scientific Committee´s expert opinion. the final NCQ-IBD consists of 90 items, organized in13 sections measuring the following aspects of nursing management of IBD: infrastructure, services, human resources, type of organization, nursing responsibilities, nurse-provided information to the patient, nurses training, annual audits of nursing activities, and nursing research in IBD. Using the NCQ-IBD to evaluate these components allows the rating of healthcare quality for nursing management of IBD into 4 categories: A (highest quality) through D (lowest quality). the use of the NCQ-IBD tool to evaluate nursing management quality of IBD identifies areas in need of improvement and thus contribute to an enhancement of care quality and reduction in clinical practice variations.

"Talkin' about a revolution": How electronic health records can facilitate the scale-up of HIV care and treatment and catalyze primary care in resource-constrained settings.

PubMed

Braitstein, Paula; Einterz, Robert M; Sidle, John E; Kimaiyo, Sylvester; Tierney, William

2009-11-01

Health care for patients with HIV infection in developing countries has increased substantially in response to major international funding. Scaling up treatment programs requires timely data on the type, quantity, and quality of care being provided. Increasingly, such programs are turning to electronic health records (EHRs) to provide these data. We describe how a medical school in the United States and another in Kenya collaborated to develop and implement an EHR in a large HIV/AIDS care program in western Kenya. These data were used to manage patients, providers, and the program itself as it grew to encompass 18 sites serving more than 90,000 patients. Lessons learned have been applicable beyond HIV/AIDS to include primary care, chronic disease management, and community-based health screening and disease prevention programs. EHRs will be key to providing the highest possible quality of care for the funds developing countries can commit to health care. Public, private, and academic partnerships can facilitate the development and implementation of EHRs in resource-constrained settings.

Patient-centred quality of care in an IVF programme evaluated by men and women.

PubMed

Holter, Herborg; Sandin-Bojö, Ann-Kristin; Gejervall, Ann-Louise; Wikland, Matts; Wilde-Larsson, Bodil; Bergh, Christina

2014-12-01

Do men and women value the same aspects of quality of care during IVF treatment when measuring rates of importance by the validated instrument, quality from the patient's perspective of in vitro fertilization (QPP-IVF)? Women valued most aspects of care as significantly more important than their partner although men and women evaluated the importance of the different care factors in a similar pattern. A few validated tools measuring patient-centred quality of care during IVF have been developed. Few studies of gender differences concerning experiences of patient-centred quality of care have been reported in the literature to date. A two-centre study was conducted between September 2011 and May 2012. Heterosexual couples (n = 497) undergoing IVF were invited to complete a questionnaire before receiving the result of the pregnancy test. In all, 363 women and 292 men evaluated quality of care by answering the QPP-IVF questionnaire. The measurements consisted of two kinds of evaluations: the rating of the importance of various aspects of treatment (subjective importance) and the rating of perceived quality of care (perceived reality). Comparisons between men and women on importance ratings and perceived reality ratings were performed both on factor (subscale) and single item levels by intra-couple analyses and corrected for age. A stepwise multiple logistic regression analysis was performed in order to select baseline variables independently predicting evaluation at factor level. The response rate was 67.5%, with 363 women (74.2%) and 292 men (60.6%) completing the study. Both the woman and man responded in 251 couples. Women rated the different care aspects as significantly more important than their partner in all factors except the factor, 'Responsibility/continuity'. Both genders gave the factors, 'Medical care' and 'Information after treatment', the highest scores. At item level women rated the majority of items as significantly more important than men. Perceived reality for the majority of factors and items was similarly rated by men and women in the couples. For women, receiving embryo transfer, short duration of infertility, IVF as a method and number of previous cycles were independently correlated to the highest score of importance of certain factors. The lower response rate of men compared with women (60.6 versus 74.2%, respectively) might have influenced the results through selection bias. Only patients who had adequate fluency in the Swedish language participated. This study is an important contribution in comparing the needs of men and women undergoing IVF treatments. The QPP-IVF instrument is a suitable instrument for revealing important care aspects identified by both men and women and a useful tool for stimulating patient-centred quality improvements within and between clinics. The study was supported by the LUA/ALF agreement at Sahlgrenska University Hospital, Gothenburg, Sweden, and by Hjalmar Svensson's Research Foundation. None of the authors declared any conflict of interests. © The Author 2014. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Modelling the impact of new patient visits on risk adjusted access at 2 clinics.

PubMed

Kolber, Michael A; Rueda, Germán; Sory, John B

2018-06-01

To evaluate the effect new outpatient clinic visits has on the availability of follow-up visits for established patients when patient visit frequency is risk adjusted. Diagnosis codes for patients from 2 Internal Medicine Clinics were extracted through billing data. The HHS-HCC risk adjusted scores for each clinic were determined based upon the average of all clinic practitioners' profiles. These scores were then used to project encounter frequencies for established patients, and for new patients entering the clinic based on risk and time of entry into the clinics. A distinct mean risk frequency distribution for physicians in each clinic could be defined providing model parameters. Within the model, follow-up visit utilization at the highest risk adjusted visit frequencies would require more follow-up slots than currently available when new patient no-show rates and annual patient loss are included. Patients seen at an intermediate or lower visit risk adjusted frequency could be accommodated when new patient no-show rates and annual patient clinic loss are considered. Value-based care is driven by control of cost while maintaining quality of care. In order to control cost, there has been a drive to increase visit frequency in primary care for those patients at increased risk. Adding new patients to primary care clinics limits the availability of follow-up slots that accrue over time for those at highest risk, thereby limiting disease and, potentially, cost control. If frequency of established care visits can be reduced by improved disease control, closing the practice to new patients, hiring health care extenders, or providing non-face to face care models then quality and cost of care may be improved. © 2018 John Wiley & Sons, Ltd.

42 CFR 488.303 - State plan requirement.

Code of Federal Regulations, 2012 CFR

2012-10-01

... recognition, incentive payments, or both, nursing facilities that provide the highest quality care to Medicaid...) Transfer of residents. (5) Closure of the facility and transfer of residents. (6) State monitoring. (e... remedies that are in addition to those specified in paragraph (d) or (e) of this section, or alternative to...

Interdisciplinary Journal Club: Advancing Knowledge Translation in a Rural State

ERIC Educational Resources Information Center

Dennis, Ruth E.; Potvin, Marie-Christine; MacLeod, Marie

2010-01-01

Professionals who provide health and related supports and services to children with disabilities in educational programs and community settings must practice in an evidence-based manner to ensure children and families receive the highest quality care. Vermont's Interdisciplinary Journal Club provides a successful approach to supporting…

Self-reported financial burden and satisfaction with care among patients with cancer.

PubMed

Chino, Fumiko; Peppercorn, Jeffrey; Taylor, Donald H; Lu, Ying; Samsa, Gregory; Abernethy, Amy P; Zafar, S Yousuf

2014-04-01

Health care-related costs and satisfaction are compelling targets for quality improvement in cancer care delivery; however, little is known about how financial burden affects patient satisfaction. This was an observational, cross-sectional, survey-based study assessing patient-reported financial burden (FB). Eligible patients were ≥ 21 years with solid tumor malignancy and were receiving chemotherapy or hormonal therapy for ≥ 1 month. The Patient Satisfaction Questionnaire Short-Form assessed patient satisfaction with health care. Subjective FB related to cancer treatment was measured on a 5-point Likert scale. Of 174 participants (32% response rate), 47% reported significant/catastrophic FB. Participants reported highest satisfaction with interpersonal manner and lowest satisfaction with financial aspects of care. In adjusted analysis, high FB was negatively associated with general satisfaction (coefficient: -.29), satisfaction with technical quality (coefficient: -.26), and satisfaction with financial aspects of care (coefficient: -.62). Older age was associated with higher scores in all satisfaction subscales except patient-physician communication and financial aspects. Annual household income of <$20,000 was associated with lower satisfaction scores in all subscales except time spent with doctor. High FB was not associated with patient satisfaction scores for accessibility and convenience, communication, interpersonal manner, or time spent with doctor. FB is a potentially modifiable correlate of poor satisfaction with cancer care including general satisfaction and satisfaction with the technical quality of care. Addressing cancer-associated FB may lead to improved satisfaction, which in turn can influence adherence, outcomes, and quality of life.

Working Atmosphere and Job Satisfaction of Health Care Staff in Kenya: An Exploratory Study

PubMed Central

Marx, Michael; Marx, Irmgard; Brodowski, Marc; Nafula, Maureen; Prytherch, Helen; Omogi Awour, Irene K. E.; Szecsenyi, Joachim

2015-01-01

Background. Job satisfaction and working atmosphere are important for optimal health care delivery. The study aimed to document working atmosphere and job satisfaction of health care professionals in Kenya and to explore associations between job satisfaction, staff characteristics, and working atmosphere. Methods. Data from the integrated quality management system (IQMS) for the health sector in Kenya were used. Job satisfaction was measured with 10 items and with additional 5 items adapted to job situation in Kenya. Working atmosphere was measured with 13 item questionnaire. A stepwise linear regression analysis was performed with overall job satisfaction and working atmosphere, aspects of job satisfaction, and individual characteristics. Results. Out of 832 questionnaires handed out, 435 questionnaires were completed (response rate: 52.3%). Health care staff indicated high commitment to provide quality services and low levels regarding the adequacy and functionality of equipment at their work station. The aspect “support of the ministry of health” (β = 0.577) showed the highest score of explained variance (32.9%) regarding overall job satisfaction. Conclusions. IQMS which also evaluates job satisfaction and working atmosphere of health care staff provides a good opportunity for strengthening the recruitment and retention of health care staff as well as improving the provision of good quality of care. PMID:26504793

Working Atmosphere and Job Satisfaction of Health Care Staff in Kenya: An Exploratory Study.

PubMed

Goetz, Katja; Marx, Michael; Marx, Irmgard; Brodowski, Marc; Nafula, Maureen; Prytherch, Helen; Omogi Awour, Irene K E; Szecsenyi, Joachim

2015-01-01

Job satisfaction and working atmosphere are important for optimal health care delivery. The study aimed to document working atmosphere and job satisfaction of health care professionals in Kenya and to explore associations between job satisfaction, staff characteristics, and working atmosphere. Data from the integrated quality management system (IQMS) for the health sector in Kenya were used. Job satisfaction was measured with 10 items and with additional 5 items adapted to job situation in Kenya. Working atmosphere was measured with 13 item questionnaire. A stepwise linear regression analysis was performed with overall job satisfaction and working atmosphere, aspects of job satisfaction, and individual characteristics. Out of 832 questionnaires handed out, 435 questionnaires were completed (response rate: 52.3%). Health care staff indicated high commitment to provide quality services and low levels regarding the adequacy and functionality of equipment at their work station. The aspect "support of the ministry of health" (β = 0.577) showed the highest score of explained variance (32.9%) regarding overall job satisfaction. IQMS which also evaluates job satisfaction and working atmosphere of health care staff provides a good opportunity for strengthening the recruitment and retention of health care staff as well as improving the provision of good quality of care.

Quality and rural-urban comparison of tuberculosis care in Rivers State, Nigeria

PubMed Central

Tobin-West, Charles Ibiene; Isodje, Anastasia

2016-01-01

Introduction Nigeria ranks among countries with the highest burden of tuberculosis. Yet evidence continues to indicate poor treatment outcomes which have been attributed to poor quality of care. This study aims to identify some of the systemic problems in order to inform policy decisions for improved quality of services and treatment outcomes in Nigeria. Methods A comparative assessment of the quality of TB care in rural and urban health facilities was carried out between May and June 2013, employing the Donabedian model of quality assessment. Data was analysed using the SPSS software package version 20.0. The level of significance was set at p < 0.05. Results Health facility infrastructures were more constrained in the urban than rural settings. Both the urban and rural facilities lacked adequate facilities for infection control such as, running water, air filter respirators, hand gloves and extractor fans. Health education and HIV counselling and testing (HCT) were limited in rural facilities compared to urban facilities. Although anti-TB drugs were generally available in both settings, the DOTS strategy in patient care was completely ignored. Finally, laboratory support for diagnosis and patient monitoring was limited in the rural facilities. Conclusion The study highlights suboptimal quality of TB care in Rivers State with limitations in health education and HCT of patients for HIV as well as laboratory support for TB care in rural health facilities. We, therefore, recommend that adequate infection control measures, strict observance of the DOTS strategy and sufficient laboratory support be provided to TB clinics in the State. PMID:27642401

Child voice and noise: a pilot study of noise in day cares and the effects on 10 children's voice quality according to perceptual evaluation.

PubMed

McAllister, Anita M; Granqvist, Svante; Sjölander, Peta; Sundberg, Johan

2009-09-01

The purpose of this investigation was to study children's exposure to background noise at the ears during a normal day at the day care center and also to relate this to a perceptual evaluation of voice quality. Ten children, from three day care centers, with no history of hearing and speech problems or frequent infections were selected as subjects. A binaural recording technique was used with two microphones placed on both sides of the subject's head, at equal distance from the mouth. A portable digital audio tape (DAT) recorder (Sony TCD-D 100, Stockholm, Sweden) was attached to the subject's waist. Three recordings were made for each child during the day. Each recording was calibrated and started with three repetitions of three sentences containing only sonorants. The recording technique allowed separate analyses of the background noise level and of the sound pressure level (SPL) of each subjects' own voice. Results showed a mean background noise level for the three day care centers at 82.6dBA Leq, ranging from 81.5 to 83.6dBA Leq. Day care center no. 2 had the highest mean value and also the highest value at any separate recording session with a mean background noise level of 85.4dBA Leq during the noontime recordings. Perceptual evaluation showed that the children attending this day care center also received higher values on the following voice characteristics: hoarseness, breathiness, and hyperfunction. Girls increased their loudness level during the day, whereas for boys no such change could be observed.

Systematic synthesis of barriers and facilitators to service user-led care planning.

PubMed

Bee, Penny; Price, Owen; Baker, John; Lovell, Karina

2015-08-01

Service user (patient) involvement in care planning is a principle enshrined by mental health policy yet often attracts criticism from patients and carers in practice. To examine how user-involved care planning is operationalised within mental health services and to establish where, how and why challenges to service user involvement occur. Systematic evidence synthesis. Synthesis of data from 117 studies suggests that service user involvement fails because the patients' frame of reference diverges from that of providers. Service users and carers attributed highest value to the relational aspects of care planning. Health professionals inconsistently acknowledged the quality of the care planning process, tending instead to define service user involvement in terms of quantifiable service-led outcomes. Service user-involved care planning is typically operationalised as a series of practice-based activities compliant with auditor standards. Meaningful involvement demands new patient-centred definitions of care planning quality. New organisational initiatives should validate time spent with service users and display more tangible and flexible commitments to meeting their needs. © The Royal College of Psychiatrists 2015.

Systematic synthesis of barriers and facilitators to service user-led care planning

PubMed Central

Bee, Penny; Price, Owen; Baker, John; Lovell, Karina

2015-01-01

Background Service user (patient) involvement in care planning is a principle enshrined by mental health policy yet often attracts criticism from patients and carers in practice. Aims To examine how user-involved care planning is operationalised within mental health services and to establish where, how and why challenges to service user involvement occur. Method Systematic evidence synthesis. Results Synthesis of data from 117 studies suggests that service user involvement fails because the patients' frame of reference diverges from that of providers. Service users and carers attributed highest value to the relational aspects of care planning. Health professionals inconsistently acknowledged the quality of the care planning process, tending instead to define service user involvement in terms of quantifiable service-led outcomes. Conclusions Service user-involved care planning is typically operationalised as a series of practice-based activities compliant with auditor standards. Meaningful involvement demands new patient-centred definitions of care planning quality. New organisational initiatives should validate time spent with service users and display more tangible and flexible commitments to meeting their needs. PMID:26243762

An exploration of the caring attributes and perceptions of work place change among gerontological nursing staff in England, Scotland and China (Hong Kong).

PubMed

Schofield, Irene; Tolson, Debbie; Arthur, David; Davies, Sue; Nolan, Mike

2005-02-01

This study investigates caring attributes and perceptions of work place change among qualified and unqualified nursing staff working with older people in three countries. A Modified Caring Attributes Questionnaire and Perception of Workplace Change Schedule were administered to 737 staff. Caring attributes scores were highest for nurses working in long stay settings, and lowest in nurses aged 25-29 years. Nurses in Hong Kong appear better educated than UK counterparts. Staff development seemed more common in long stay settings. Results suggest workplace changes limiting care quality were more pronounced in Scotland. Reported job satisfaction and moral were lowest in the UK group.

Rehabilitation Practitioners' Prioritized Care Processes in Hip Fracture Post-Acute Care

PubMed Central

Kim, Lauren H.; Leland, Natalie E.

2017-01-01

Aims Occupational and physical therapy in post-acute care (PAC) has reached the point where quality indicators for hip fracture are needed. This study characterizes the practitioners' prioritized hip fracture rehabilitation practices, which can guide future quality improvement initiatives. Methods Ninety-two practitioners participating in a parent mixed methods study were asked to rank a series of evidence-based best practices across five clinical domains (assessment, intervention, discharge planning, caregiver training and patient education). Results Prioritized practices reflected patient-practitioner collaboration, facilitating an effective discharge, and preventing adverse events. The highest endorsed care processes include: developing meaningful goals with patient input (84%) in assessment, using assistive devices in intervention (75%) and patient education (65%), engaging the patient and caregiver (50%) in discharge planning, and fall prevention (60%) in caregiver education. Conclusions Practitioners identified key care priorities. This study lays the foundation for future work evaluating the extent to which these practices are delivered in PAC. PMID:28989216

Quality of osteoarthritis care in family medicine – A cross-sectional study.

PubMed

Račić, Maja; Tošić, Milena; Mašić, Srdjan

2016-01-01

Effective treatments for osteoarthritis are available, yet little is known about the quality of primary care in the Republic of Srpska for this disabling condition. The main objective of this study was to analyze the overall quality of osteoarthritis treatment in a family medicine setting, as well as to explore whether the achievement of quality indicators was associated with particular patient characteristics and severity of osteoarthritis. The cross-sectional study included 120 patients with confirmed hand, knee, and hip osteoarthritis, recruited at seven family practices in the town of Ugljevik, Republic of Srpska, Bosnia and Herzegovina. Data were extracted from a patient questionnaire on quality indicators, as well as from their electronic and paper records, to assess care against 14 indicators. The included quality indicators were based on the Arthritis Foundation’s Quality Indicator set for Osteoarthritis. Summary achievement rates for hip, knee, or hand osteoarthritis, as well as for the total sample, were calculated. The mean achievement rate for all 14 quality indicators obtained from medical records was 74%, and 77% obtained from patient interview. The quality indicators concerning referral for weight reduction (23%) and pharmacological treatment (24%) had the lowest achievement rates, whereas the highest achievement rates were related to physical examination (100%), pain and functional assessment (100%), and education (90.8%). Patients physical functioning was significantly associated with the quality indicator achievement rate (p = 0.001). Pharmacological therapy and the referral of osteoarthritis patients in need of weight reduction seem to have the greatest potential for improvement in primary health care.

Quality assessment of recent evidence-based clinical practice guidelines for management of type 2 diabetes mellitus in adults using the AGREE II instrument.

PubMed

Anwer, Muhammad A; Al-Fahed, Ousama B; Arif, Samir I; Amer, Yasser S; Titi, Maher A; Al-Rukban, Mohammed O

2018-02-01

Type 2 diabetes mellitus (T2DM) is a worldwide and national public health problem that has a great impact on the population in Saudi Arabia. High-quality clinical practice guidelines (CPGs) are cornerstones in improving the health care provided for patients with diabetes. This study evaluated the methodological rigour, transparency, and applicability of recently published CPGs. Our group conducted a systematic search for recently published CPGs for T2DM. The searching and screening for Source CPGs were guided by tools from the ADAPTE methods with specific inclusion/exclusion criteria. Five reviewers using the second version of the Appraisal of Guidelines for Research and Evaluation (AGREE II) Instrument independently assessed the quality of the retrieved Source CPGs. Domains of Scope and purpose and Clarity of presentation received the highest scores in all CPGs. Most of the assessed CPGs (86%) were considered with high overall quality and were recommended for use. Rigour of development and applicability domains were together highest in 3 CPGs (43%). The overall high quality of DM CPGs published in the last 3 years demonstrated the continuous development and improvement in CPG methodologies and standards. Health care professionals should consider the quality of any CPG for T2DM before deciding to use it in their daily clinical practice. Three CPGs have been identified, using the AGREE criteria, as high-quality and trustworthy. Ideally, the resources provided by the AGREE trust including the AGREE II Instrument should be used by a clinician to scan through the large number of published T2DM CPGs to identify the CPGs with high methodological quality and applicability. © 2017 John Wiley & Sons, Ltd.

Paediatric in-patient care in a conflict-torn region of Somalia: are hospital outcomes of acceptable quality?

PubMed Central

Zachariah, R.; Hinderaker, S. G.; Khogali, M.; Manzi, M.; van Griensven, J.; Ayada, L.; Jemmy, J. P.; Maalim, A.; Amin, H.

2013-01-01

Setting: A district hospital in conflict-torn Somalia. Objective: To report on in-patient paediatric morbidity, case fatality and exit outcomes as indicators of quality of care. Design: Cross-sectional study. Results: Of 6211 children, lower respiratory tract infections (48%) and severe acute malnutrition (16%) were the leading reasons for admission. The highest case-fatality rate was for meningitis (20%). Adverse outcomes occurred in 378 (6%) children, including 205 (3.3%) deaths; 173 (2.8%) absconded. Conclusion: Hospital exit outcomes are good even in conflict-torn Somalia, and should boost efforts to ensure that such populations are not left out in the quest to achieve universal health coverage. PMID:26393014

Shared vision, collective impact, and persistent challenges: the first decade of Georgia's oncology research network.

PubMed

Paris, Nancy M; Burke, James J; Schnell, Frederick M

2013-11-01

Ten years ago, Georgia was lauded for dedicating a portion of tobacco settlement funds to the Georgia Cancer Coalition (GCC). The plan championed by then-Governor Roy E. Barnes was designed to make Georgia a leader in prevention, treatment, and research. This plan called for the expansion of clinical trials to ensure Georgians had access to the highest quality care based on the most current treatments and discoveries. As a result, oncologists in the state were engaged in a planning process that resulted in a shared vision to improve the quality of cancer care through research and the formation of a new organization: the Georgia Center for Oncology Research and Education.

Enhancing the Evidence for Behavioral Counseling

PubMed Central

Alcántara, Carmela; Klesges, Lisa M.; Resnicow, Ken; Stone, Amy; Davidson, Karina W.

2015-01-01

U.S. Preventive Services Task Force (USPSTF) clinical guidelines at present rarely assign the highest grade recommendation to behavioral counseling interventions for chronic disease prevention or risk reduction because of concerns about the certainty and quality of the evidence base. As a result, the broad integration of behavioral counseling interventions in primary care remains elusive. Thus, there is an urgent need for novel perspectives on how to generate the highest-quality and -certainty evidence for primary care–focused behavioral counseling interventions. As members of the Society of Behavioral Medicine (SBM)—a multidisciplinary scientific organization committed to improving population health through behavior change—we review the USPSTF mandate and current recommendations for behavioral counseling interventions, and provide a perspective for the future that calls for concerted and coordinated efforts among SBM, USPSTF, and other organizations invested in the rapid and wider uptake of beneficial, feasible, and referable primary care–focused behavioral counseling interventions. This perspective highlights five areas for further development, including: (1) behavioral counseling–focused practice-based research networks; (2) promotion of USPSTF evidence standards and the increased use of pragmatic RCT design; (3) quality control and improvement procedures for behavioral counseling training; (4) systematic research on effective primary care–based collaborative care models; and (5) methodologic innovations that capitalize on disruptive technologies and healthcare transformation. Collective efforts to improve the health of all Americans in the 21st century and beyond must ensure that effective, feasible, and referable behavioral counseling interventions are embedded in modern primary care practice. PMID:26296553

Physicians' responses to financial and social incentives: A medically framed real effort experiment.

PubMed

Lagarde, Mylène; Blaauw, Duane

2017-04-01

Because compensation policies have critical implications for the provision of health care, and evidence of their effects is limited and difficult to study in the real world, laboratory experiments may be a valuable methodology to study the behavioural responses of health care providers. With this experiment undertaken in 2013, we add to this new literature by designing a new medically framed real effort task to test the effects of different remuneration schemes in a multi-tasking context. We assess the impact of different incentives on the quantity (productivity) and quality of outputs of 132 participants. We also test whether the existence of benefits to patients influences effort. The results show that salary yields the lowest quantity of output, and fee-for-service the highest. By contrast, we find that the highest quality is achieved when participants are paid by salary, followed by capitation. We also find a lot of heterogeneity in behaviour, with intrinsically motivated individuals hardly sensitive to financial incentives. Finally, we find that when work quality benefits patients directly, subjects improve the quality of their output, while maintaining the same levels of productivity. This paper adds to a nascent literature by providing a new approach to studying remuneration schemes and modelling the medical decision making environment in the lab. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

Mobile Health Applications for Pediatric Care: Review and Comparison.

PubMed

Morse, Samantha Sangie; Murugiah, Muthu Kumar; Soh, Yee Chang; Wong, Tin Wui; Ming, Long Chiau

2018-05-01

Despite the surge in mobile health (mHealth) applications (apps) about pediatric care in commercial app stores, to our knowledge, reviews of the quality of such apps are lacking. Consequently, it is a great challenge for health care professionals (HCPs) to identify appropriate and reliable mHealth apps for delivering health care services. Thus, we performed a structured review of the extant literature about mHealth apps in pediatric care and quality assessment of selected apps found in commercial app stores. A review and comparison of mHealth apps in pediatric care found in Google's Play Store (Android system) and Apple's App Store (iOS system) were performed. For the structured review of the available literature, Google Scholar, PubMed, IEEE Xplore Digital Library, and Science Direct online databases were used for the literature search. The assessment criteria used for comparison included requirement for Internet connection, size of application, information on disease, diagnostic tools, medical calculator, information on disease treatments, dosage recommendations, and drug interaction checker. Fifty mHealth apps for general pediatric care and 8 mHealth apps for specific pediatric diseases were discussed in the literature. Of the 90 mHealth apps we reviewed, 27 that fulfilled the study criteria were selected for quality assessment. Medscape, Skyscape, and iGuideline scored the highest (score=7), while PediaBP scored the lowest (score=3). Medscape, Skyscape, and iGuideline are the most comprehensive mHealth apps for HCPs as quick references for pediatric care. More studies about mHealth apps in pediatric care are warranted to ensure the quality and reliability of mHealth apps.

Answering the call to accessible quality health care for all using a new model of local community not-for-profit charity clinics: A return to Christ-centered care of the past

PubMed Central

Cuellar De la Cruz, Yuri

2017-01-01

This article uses studies and organizational trends to understand available solutions to the lack of quality health care access, especially for the poor and needy of local U.S. communities. The U.S. healthcare system seems to be moving toward the World Health Organization's recommendation for universal health coverage for healthcare sustainability. Healthcare trends and offered solutions are varied. Christian healthcare traditionally implements works of mercy guided by a Christian ethos embracing the teachings of human dignity, solidarity, the common good, and subsidiarity. Culture of Life Ministries is one of many new sustainable U.S. healthcare models which implements Christ-centered health care to meet the need of quality and accessible health care for the local community. Culture of Life Ministries employs a model of charity care through volunteerism. Volunteer workers not only improve but also transform the local healthcare system into a personal healing ministry of the highest quality for every person. Summary: The lack of access to quality health care is a common problem in the U.S. despite various solutions offered through legislative and socioeconomic works: universal healthcare models, insurance models, and other business models. U.S. health care would be best transformed by returning to the implementation of a traditional system founded on the Christian principles of human dignity, solidarity, subsidiarity, and the common good. Culture of Life Ministries is an example of such a local ministry in Texas, which has found success in practically applying these Christ-centered, healthcare principles into an emerging not-for-profit, economically sustainable, healthcare model. PMID:28392598

Development of pediatric emergency medicine at Addis Ababa University/Tikuranbessa Specialized Hospital, Ethiopia.

PubMed

Tefera, Muluwork; Bacha, Tigist; Butteris, Sabrina; Teshome, Getachew; Ross, Joshua; Hagen, Scott; Svenson, Jim; Busse, Heidi; Tefera, Girma

2014-07-01

In the world emergencies occur everywhere, and each day they consume ressources regardless of whether there are systems capable of achieving good outcomes. Low-income countries suffer the most highest rates of every category of injury--from traffic and the highest rates of acute complications of communicable diseases including tuberculosis, malaria and HIV. To describe the development of pediatrics emergency medicine at Tikur Anbesa Specialized Hospital A twinning partnership model was used in developing a pediatric emergency medicine training program helps in development of pediatrics emergency system. Strengthening the capacity of Addis Ababa University (AAU), Tikur Anbessa Hospital (TASH) to provide pediatric emergency medical services through improved organization of the pediatrics emergency department and strengthening of continuing education opportunities for faculty and staff capacity building by this improving quality of care in pediatrics patients in the country. The Addis Ababa University, University of Wiscosin and People to People partners intend to continue working together to strengthening and developing effetive systems to deliver quality pediatrics emergency medicine care troughout all regions of Ethiopia.

Effect of family nursing therapeutic conversations on health-related quality of life, self-care and depression among outpatients with heart failure: A randomized multi-centre trial.

PubMed

Østergaard, Birte; Mahrer-Imhof, Romy; Wagner, Lis; Barington, Torben; Videbæk, Lars; Lauridsen, Jørgen

2018-03-07

To evaluate the short-term (3 months) effects of family nursing therapeutic conversations (FNTC) on health-related quality of life, self-care and depression in outpatients with Heart failure (HF). A randomised multi-centre trial was conducted in three Danish HF clinics. The control group (n = 167) received usual care, and the intervention group (n = 180) received FNTCs as supplement to usual care. Primary outcome was clinically significant changes (6 points) in Kansas City Cardiomyopathy Questionnaire (KCCQ) summary score between groups. Secondary outcomes were changes in self-care behaviour and depression scores. Data were assessed before first consultation and repeated after three months. No statistically significant difference was found in the change of KCCQ, self-care and depression scores between the groups. KCCQ scores of patients in the FNTC group changed clinically significant in seven domains, compared to one domain in the control group, with the highest improvement in self-efficacy, social limitation and symptom burden. FNTC was not superior to standard care of patients with HF regarding health-related quality of life, self-care and depression. Addressing the impact of the disease on the family, might improve self-efficacy, social limitation and symptom burden in patients with heart failure. Copyright © 2018 Elsevier B.V. All rights reserved.

Diabetes quality management in Dutch care groups and outpatient clinics: a cross-sectional study

PubMed Central

2014-01-01

Background In recent years, most Dutch general practitioners started working under the umbrella of diabetes care groups, responsible for the organisation and coordination of diabetes care. The quality management of these new organisations receives growing interest, although its association with quality of diabetes care is yet unclear. The best way to measure quality management is unknown and it has not yet been studied at the level of outpatient clinics or care groups. We aimed to assess quality management of type 2 diabetes care in care groups and outpatient clinics. Results Quality management was measured with online questionnaires, containing six domains (see below). They were divided into 28 subdomains, with 59 (care groups) and 57 (outpatient clinics) questions respectively. The mean score of the domains reflects the overall score (0-100%) of an organisation. Two quality managers of all Dutch care groups and outpatient clinics were invited to fill out the questionnaire. Sixty care groups (response rate 61.9%) showed a mean score of 59.6% (CI 57.1-62.1%). The average score in 52 outpatient clinics (response rate 50.0%) was 61.9% (CI 57.5-66.8%). Mean scores on the six domains for care groups and outpatient clinics respectively were: ‘organisation of care’ 71.9% (CI 68.8-74.9%), 76.8% (CI 72.8-80.7%); ‘multidisciplinary teamwork’ 67.1% (CI 62.4-71.9%), 71.5% (CI 65.3-77.8%); ‘patient centeredness’ 46.7% (CI 42.6-50.7%), 62.5% (CI 57.7-67.2%); ‘performance management’ 63.3% (CI 61.2-65.3%), 50.9% (CI 44.2-57.5%); ‘quality improvement policy’ 52.6% (CI 49.2-56.1%), 50.9% (CI 44.6-57.3%); and ‘management strategies’ 56.0% (CI 51.4-60.7%), 59.0% (CI 52.8-65.2%). On subdomains, care groups scored highest on ‘care program’ (83.3%) and ‘measured outcomes’ (98.3%) and lowest on ‘patient safety’ (15.1%) and ‘patient involvement’ (17.7%). Outpatient clinics scored high on the presence of a ‘diabetic foot team’ (81.6%) and the support in ‘self-management’ (81.0%) and low on ‘patient involvement’ (26.8%) and ‘inspection of medical file’ (28.0%). Conclusions This nationwide assessment reveals that the level of quality management in diabetes care varies between several subdomains in both diabetes care groups and outpatient clinics. PMID:25099641

Identifying profiles of service users in housing services and exploring their quality of life and care needs.

PubMed

Bitter, Neis A; Roeg, Diana P K; van Nieuwenhuizen, Chijs; van Weeghel, Jaap

2016-11-23

Housing services aim to support people with mental illness in their daily life and recovery. As the level of recovery differs between service users, the quality of life and care needs also might vary. However, the type and amount of care and support that service users receive do not always match their recovery. In order to improve the quality of care, this study aims to explore whether subgroups of service users exist based on three dimensions of recovery and to examine and compare the quality of life and care needs of the persons in these subgroups. Latent class analysis was performed with data from 263 service users of housing services in the Netherlands. Classes were based on three variables: personal recovery (Mental Health Recovery Measure), social recovery (Social Functioning Scale), and clinical recovery (Brief Symptom Inventory). Subsequently, the quality of life (MANSA) and care needs (CANSAS) of the different classes were analysed by the use of descriptive and inferential statistics. Three classes could be distinguished. Class 1 (45%) comprised of people who score the highest of the three classes in terms of personal and social recovery and who experience the least number of symptoms. People in class 2 (44%) and class 3 (11%) score significantly lower on personal and social recovery, and they experience significantly more symptoms compared to class 1. The distinction between class 2 and 3 can be made on the significantly higher number of symptoms in class 3. All three classes differ significantly on quality of life and unmet needs. The quality of life of service users of housing services needs improvement, as even persons in the best-recovered subgroup have a lower quality of life than the average population. Workers of housing services need to be aware of the recovery of a client and what his or her individual needs and goals are. Furthermore, better care (allocation) concerning mental and physical health and rehabilitation is needed. Care should be provided on all dimensions of recovery at the same time, therefore mental health care organisations should work together and integrate their services. ISRCTN registry ISRCTN77355880 retrospectively registered 05/07/2013.

Outcome of Pediatric Critical Care Medicine Abstracts Presented at North American Academic National Meetings.

PubMed

Basu, Sonali; Pollack, Murray M

2017-05-05

Pediatric critical care medicine abstracts presented at North American national academic meetings have not been followed up to determine their publication outcomes. Our objective was to determine the following: 1) the proportion of these presentations that are published in peer-reviewed journals within 5 years; 2) the impact of trainee status on time to and success of publication; and 3) the quality of the research as reflected in the publishing journal's impact factor. Four years of abstracts (2007-2011) were reviewed from the American Academy of Pediatrics, Pediatric Academic Societies, and Society of Critical Care Medicine national meetings. Pediatric critical care medicine abstracts were delineated by the meeting or identified by keyword search. Data included mode of presentation, trainee status of first author, publication status within 5 years based on a PubMed search, trainee position in the journal of publication authorship list, and the impact factor of journal of publication. We evaluated 267 pediatric critical care medicine abstracts, 85-94 from each meeting. Overall, 41% were published, with the highest rate in Pediatric Academic Societies abstracts (54% Pediatric Academic Societies, 38% Society of Critical Care Medicine, and 33% American Academy of Pediatrics; p = 0.011). Mean time to publication was 22 (± 3) months and did not differ by conference or presentation mode. Journal first authorship was retained in 84%. Journal impact factor was highest in Society of Critical Care Medicine abstracts (3.38 Society of Critical Care Medicine, 2.64 Pediatric Academic Societies, and 1.92 American Academy of Pediatrics; p = 0.006). First author trainee status was not associated with publication rate, time to publication, and impact factor. A total of 100% of trainees but only 79% of nontrainees who published retained first authorship. Less than half of pediatric critical care medicine research abstracts presented at North American national academic meetings culminate in articles. Pediatric Academic Societies had the highest publication success rate, and Society of Critical Care Medicine abstracts were published in journals with the highest impact factors. All trainees who were first authors retained that status in the journal publications.

A critical care network pressure ulcer prevention quality improvement project.

PubMed

McBride, Joanna; Richardson, Annette

2015-03-30

Pressure ulcer prevention is an important safety issue, often underrated and an extremely painful event harming patients. Critically ill patients are one of the highest risk groups in hospital. The impact of pressure ulcers are wide ranging, and they can result in increased critical care and the hospital length of stay, significant interference with functional recovery and rehabilitation and increase cost. This quality improvement project had four aims: (1) to establish a critical care network pressure ulcer prevention group; (2) to establish baseline pressure ulcer prevention practices; (3) to measure, compare and monitor pressure ulcers prevalence; (4) to develop network pressure ulcer prevention standards. The approach used to improve quality included strong critical care nursing leadership to develop a cross-organisational pressure ulcer prevention group and a benchmarking exercise of current practices across a well-established critical care Network in the North of England. The National Safety Thermometer tool was used to measure pressure ulcer prevalence in 23 critical care units, and best available evidence, local consensus and another Critical Care Networks' bundle of interventions were used to develop a local pressure ulcer prevention standards document. The aims of the quality improvement project were achieved. This project was driven by successful leadership and had an agreed common goal. The National Safety Thermometer tool was an innovative approach to measure and compare pressure ulcer prevalence rates at a regional level. A limitation was the exclusion of moisture lesions. The project showed excellent engagement and collaborate working in the quest to prevent pressure ulcers from many critical care nurses with the North of England Critical Care Network. A concise set of Network standards was developed for use in conjunction with local guidelines to enhance pressure ulcer prevention. © 2015 British Association of Critical Care Nurses.

[How nationally concordated measures for quality assurance in clinical care of term and preterm infants are put into practice in Baden-Württemberg].

PubMed

Boehler, T; Schaeff, B; Hornberg, I; Waibel, B; Mohrmann, M

2009-01-01

By the end of the year 2007, pediatric hospitals in Baden-Württemberg had assigned themselves to one of three levels of perinatal care according to a checklist of the German Federal Joint Committee (F-JC) effective since January 1st, 2006. The Medical Service of Statutory Health Insurance had been assigned to prove the plausibility of that self-assessment according to quality criteria for clinical care of term and preterm newborn infants concordated by the F-JC. Between November 2007 and October 2008 31 providers were audited. Observations were documented in a checklist, reviewed and evaluated by expert auditors. For that purpose, quality criteria given by the F-JC were grouped into 7 quality categories which were weighted according to their practical relevance. In addition, a graded numeric system of evaluation was used for comparative analysis (absolute and relative benchmarking values). 3 of 23 providers fulfilled the quality criteria of the F-JC for PNC level 1 (highest level of care), 6 of 23 fulfilled them in part, and 14 of 23 did not fulfill them as judged by the auditors. Criteria for PNC level 2 were "fulfilled in part" by 2 of 6 providers and "not fulfilled" by 4. Both providers of perinatal special care ("level 3") fulfilled the quality criteria for "level 3" completely. There was no linear correlation between absolute or relative benchmarking values and assessment by expert auditors. If the criteria of the F-JC were interpreted very strictly, it would be difficult to guarantee comprehensive regional delivery of care in the state of Baden-Württemberg at the level formally requested by the F-JC for PNCs.

Review and Analysis of Existing Mobile Phone Apps to Support Heart Failure Symptom Monitoring and Self-Care Management Using the Mobile Application Rating Scale (MARS).

PubMed

Masterson Creber, Ruth M; Maurer, Mathew S; Reading, Meghan; Hiraldo, Grenny; Hickey, Kathleen T; Iribarren, Sarah

2016-06-14

Heart failure is the most common cause of hospital readmissions among Medicare beneficiaries and these hospitalizations are often driven by exacerbations in common heart failure symptoms. Patient collaboration with health care providers and decision making is a core component of increasing symptom monitoring and decreasing hospital use. Mobile phone apps offer a potentially cost-effective solution for symptom monitoring and self-care management at the point of need. The purpose of this review of commercially available apps was to identify and assess the functionalities of patient-facing mobile health apps targeted toward supporting heart failure symptom monitoring and self-care management. We searched 3 Web-based mobile app stores using multiple terms and combinations (eg, "heart failure," "cardiology," "heart failure and self-management"). Apps meeting inclusion criteria were evaluated using the Mobile Application Rating Scale (MARS), IMS Institute for Healthcare Informatics functionality scores, and Heart Failure Society of America (HFSA) guidelines for nonpharmacologic management. Apps were downloaded and assessed independently by 2-4 reviewers, interclass correlations between reviewers were calculated, and consensus was met by discussion. Of 3636 potentially relevant apps searched, 34 met inclusion criteria. Most apps were excluded because they were unrelated to heart failure, not in English or Spanish, or were games. Interrater reliability between reviewers was high. AskMD app had the highest average MARS total (4.9/5). More than half of the apps (23/34, 68%) had acceptable MARS scores (>3.0). Heart Failure Health Storylines (4.6) and AskMD (4.5) had the highest scores for behavior change. Factoring MARS, functionality, and HFSA guideline scores, the highest performing apps included Heart Failure Health Storylines, Symple, ContinuousCare Health App, WebMD, and AskMD. Peer-reviewed publications were identified for only 3 of the 34 apps. This review suggests that few apps meet prespecified criteria for quality, content, or functionality, highlighting the need for further refinement and mapping to evidence-based guidelines and room for overall quality improvement in heart failure symptom monitoring and self-care related apps.

Different paths to high-quality care: three archetypes of top-performing practice sites.

PubMed

Feifer, Chris; Nemeth, Lynne; Nietert, Paul J; Wessell, Andrea M; Jenkins, Ruth G; Roylance, Loraine; Ornstein, Steven M

2007-01-01

Primary care practices use different approaches in their quest for high-quality care. Previous work in the Practice Partner Research Network (PPRNet) found that improved outcomes are associated with strategies to prioritize performance, involve staff, redesign elements of the delivery system, make patients active partners in guideline adherence, and use tools embedded in the electronic medical record. The aim of this study was to examine variations in the adoption of improvements among sites achieving the best outcomes. This study used an observational case study design. A practice-level measure of adherence to clinical guidelines was used to identify the highest performing practices in a network of internal and family medicine practices participating in a national demonstration project. We analyzed qualitative and quantitative information derived from project documents, field notes, and evaluation questionnaires to develop and compare case studies. Nine cases are described. All use many of the same improvement strategies. Differences in the way improvements are organized define 3 distinct archetypes: the Technophiles, the Motivated Team, and the Care Enterprise. There is no single approach that explains the superior performance of high-performing practices, though each has adopted variations of PPRNet's improvement model. Practices will vary in their path to high-quality care. The archetypes could prove to be a useful guide to other practices selecting an overall quality improvement approach.

Visit, revamp, and revitalize your business plan: Part 2.

PubMed

Waldron, David

2011-01-01

The diagnostic imaging department strives for the highest quality outcomes in imaging quality, in diagnostic reporting, and in providing a caring patient experience while also satisfying the needs of referring physicians. Understand how tools such as process mapping and concepts such as Six Sigma and Lean Six Sigma can be used to facilitate quality improvements and team building, resulting in staff led process improvement initiatives. Discover how to integrate a continuous staff management cycle to implement process improvements,capture the promised performance improvements, and achieve a culture change away from the "way it has always been done".

[Diagnostic radiology in the technological era. Comparison between two models].

PubMed

Andrade-Barreto, O A; Villa-Caballero, Leonel

2005-01-01

Diagnostic Radiology is a medical specialty that has played a dynamic role in the medical arena during the last three decades of the XX century. As a part of the evolution of this specialty, medicine and society at large have received diverse benefits in areas of diagnosis and for the decision making process in the clinical practice. Modern radiology has provided numerous advances and refined tools that give more convenience speed and precise diagnosis in the current medical practice. At the present time, these technologies are part of the standard of care in the US and other industrialized countries, representing the ultimate desire or goal to reach for other healthcare systems in developing countries as well. Unfortunately, many of the clinical skills in the health care personal have not evolved at the same pace of those modern technologies, conditioning a reduction in the performance of sensitive areas to the patient's interest, such as the caring, compassion and quality of health care. It is unquestionable the value and benefits that technologies such as CAT and MRI scans have brought to the standard practice in the recent time. Nonetheless, it is desirable to maintain the highest possible level of clinical skills despite the extended use of modern technologies by the health personnel, without compromising the quality of care. Yet is pending the future role and rational use for those technologies in radiology, especially in times when delivering good, reliable health care have become a priority for many health institutions worldwide. This approach would be the ultimate goal to reach in times and circumstances where health for all is the highest precious value to obtain at global level.

Update in Hospice and Palliative Care.

PubMed

Gray, Nathan A; Horton, Jay R; Dionne-Odom, J Nicholas; Smith, Cardinale B; Johnson, Kimberly S

2016-05-01

The goal of this update in hospice and palliative care is to summarize and critique research published between January 1 and December 31, 2014 that has a high potential for impact on clinical practice. To identify articles we hand searched 22 leading journals, the Cochrane Database of Systematic Reviews, and Fast Article Critical Summaries for Clinicians in Palliative Care. We also performed a PubMed keyword search using the terms "hospice" and "palliative care." We ranked candidate articles based on study quality, appeal to a breadth of palliative care clinicians, and potential for impact on clinical practice. In this manuscript we have summarized the findings of eight articles with the highest ratings and make recommendations for clinical practice based on the strength of the resulting evidence.

Comparing the quality of preconception care provided in healthcare centers in Mashhad in 2012.

PubMed

Sardasht, Fatemeh Ghaffari; Shourab, Nahid Jahani; Jafarnejad, Farzaneh; Esmaily, Habibollah

2015-01-01

Improving the quality of healthcare services is considered as the main strategy to improve maternal and neonatal health outcomes. Providing appropriate healthcare for mothers and their newborn children is facilitated significantly by considering the mothers' health and welfare before pregnancy occurs. Therefore, the aim of this study was to compare the quality of preconception care provided to women of reproductive age provided by five health centers in Mashhad in 2012 and 2013. Multi-stage sampling was used to select the participants in this descriptive study. As a result, 360 women of reproductive age and 39 healthcare providers from 24 healthcare centers in Mashhad were selected to participate. The data gathering tool was a checklist based on the Donabedian model that includes the three dimensions of structure, process, and outcome. The data were analyzed by SPSS software (version 11.5), Kruskal-Wallis tests, ANOVA, and Spearman rank correlation. The results showed that preconception care at the 24 healthcare centers had essentially the same conditions. But in the process and outcome components, the quality of the preconception care at five of the health centers was significantly different (p=0.008). The highest quality of care processes was identified at health center number 3. The difference in the component of outcomes being followed up by the healthcare providers at five of the health centers was statistically significant (p=0.000); however, there were no significant differences found among the satisfaction and awareness of the women who participated at the five health centers. The results showed that the performance of health personnel in providing preconception care and providing follow-up care was not satisfactory.

Incentivising appropriate care: the case of immunizations.

PubMed

Forgione, D A; Galbraith, K S; Galbraith, K H

2000-01-01

Incentivising appropriate care is a two-way street. Patients need to take greater responsibility and provider payment systems need to reward the best quality care. Today we are seeing the reemergence of many vaccine-preventable diseases that we thought were eradicated long ago for all practical purposes. In the U.S., diphtheria, polio, measles, mumps, and rubella all are on an upsurge. In this era of stringent cost containment and "managed care," preventive childhood immunizations offer one of the highest financial returns on investment we can achieve. So why have our inner cities become worse than some third-world countries in terms of low immunization rates for preschool age children and high infant mortality? We argue that "it's the money."

Improving the quality of primary care by allocating performance-based targets, in a diverse insured population.

PubMed

Peled, Ronit; Porath, Avi; Wilf-Miron, Rachel

2016-11-21

Primary Care Health organizations, operating under universal coverage and a regulated package of benefits, compete mainly over quality of care. Monitoring, primary care clinical performance, has been repeatedly proven effective in improving the quality of care. In 2004, Maccabi Healthcare Services (MHS), the second largest Israeli HMO, launched its Performance Measurement System (PMS) based on clinical quality indicators. A unique module was built in the PMS to adjust for case mix while tailoring targets to the local units. This article presents the concept and formulas developed to adjust targets to the units' current performance, and analyze change in clinical indicators over a six year period, between sub-population groups. Six process and intermediate outcome indicators, representing screening for breast and colorectal cancer and care for patients with diabetes and cardiovascular disease, were selected and analyzed for change over time (2003-2009) in overall performance, as well as the difference between the lowest and the highest socio-economic ranks (SERs) and Arab and non-Arab members. MHS demonstrated a significant improvement in the selected indicators over the years. Performance of members from low SERs and Arabs improved to a greater extent, as compared to members from high ranks and non-Arabs, respectively. The performance measurement system, with its module for tailoring of units' targets, served as a managerial vehicle for bridging existing gaps by allocating more resources to lower performing units. This concept was proven effective in improving performance while reducing disparities between diverse population groups.

PS1-32: Doctor’s Role in Their Patient’s Healing: Practices of the Highest Performing Physicians by Patient Survey

PubMed Central

Sutherland, Elizabeth; Vuckovic, Nancy; Hsu, John; Tallman, Karen; Frankel, Richard; Stein, Terry; Sung, Sue Hee

2010-01-01

Background: The MD Patient Communication Study aims were to improve the best practice communication behaviors of physicians during outpatient clinic visits and to collect physician perspectives of communication behaviors. Researchers have consistently found the top predictors of overall patient satisfaction are quality of the physician-patient relationship and contributing communications. There is limited understanding however, of the range of specific behaviors in the interaction associated with positive and negative patient perceptions and reactions. Methods: In phase 1, we conducted a naturalistic, observational study of 55 Kaiser Permanente Primary Care physician-patient visits using videotape recordings, and incorporating patient and physician reactions to the tape. The physicians, who practiced in Los Angeles and Honolulu, spanned the three strata of high, medium, and low historical patient satisfaction scores. In phase 2, a standardized six-question set was posed in semi-structured, 60-minute interviews to 77 of the highest-performing physicians on this patient survey, including 20 of the highest performers (top 5%) from the LA and Honolulu groups and 42 and 15, respectively, of the highest performing physicians in Portland and Oakland. These interviews were audio taped with permission, transcribed and coded for patterns. Results: This abstract addresses the 4th question: What role do you feel you play in your patients’ healing? Do you think you, as a doctor, contribute to your patients’ healing through non-technical, non-physical, or non-scientific ways? All physicians agreed but varied in their role. Representative quotes: Giving people the confidence to go through something. People feel better coming in and seeing/talking to you. People realizing they have the power to heal themselves their involvement is essential. Our relationship: Interpersonal connection is so powerful. The art of medicine is the art of healing. These narratives provide deep, coherent learning about physicians’ role in healing: relationship, education, empowerment, emotion, personal connection, hope. Conclusions: With primary care in crisis nationally, and specialists increasingly procedure-focused, understanding physicians’ role in patients’ healing, especially as it creates high patient satisfaction, is of great importance to sustaining the highest quality medical care and service.

Holistic wound assessment in primary care.

PubMed

Cornforth, Amber

2013-12-01

Wound care is expensive and can cause immeasurable stress and inconvenience to patients and their significant others. It is therefore in the best interest of the patient, their significant others and the NHS as a whole that wounds are expertly assessed, managed and healed in the quickest timeframe possible. Nurses play a pivotal role in the process of accurate holistic wound assessment, evaluation and treatment. This article aims to help further develop and enhance both professional and clinical wound care assessment and evaluation skills. Pertinent wound care literature is critically reviewed and the crucial nature and important components of comprehensive wound assessment for facilitating the highest possible quality wound care to patients are presented alongside recommendations regarding how the enhanced knowledge and skills could be applied into everyday wound care practice.

Using Publicly Available Data to Construct a Transparent Measure of Health Care Value: A Method and Initial Results.

PubMed

Weeks, William B; Kotzbauer, Gregory R; Weinstein, James N

2016-06-01

Using publicly available Hospital Compare and Medicare data, we found a substantial range of hospital-level performance on quality, expenditure, and value measures for 4 common reasons for admission. Hospitals' ability to consistently deliver high-quality, low-cost care varied across the different reasons for admission. With the exception of coronary artery bypass grafting, hospitals that provided the highest-value care had more beds and a larger average daily census than those providing the lowest-value care. Transparent data like those we present can empower patients to compare hospital performance, make better-informed treatment decisions, and decide where to obtain care for particular health care problems. In the United States, the transition from volume to value dominates discussions of health care reform. While shared decision making might help patients determine whether to get care, transparency in procedure- and hospital-specific value measures would help them determine where to get care. Using Hospital Compare and Medicare expenditure data, we constructed a hospital-level measure of value from a numerator composed of quality-of-care measures (satisfaction, use of timely and effective care, and avoidance of harms) and a denominator composed of risk-adjusted 30-day episode-of-care expenditures for acute myocardial infarction (1,900 hospitals), coronary artery bypass grafting (884 hospitals), colectomy (1,252 hospitals), and hip replacement surgery (1,243 hospitals). We found substantial variation in aggregate measures of quality, cost, and value at the hospital level. Value calculation provided additional richness when compared to assessment based on quality or cost alone: about 50% of hospitals in an extreme quality- (and about 65% more in an extreme cost-) quintile were in the same extreme value quintile. With the exception of coronary artery bypass grafting, higher-value hospitals were larger and had a higher average daily census than lower-value hospitals, but were no more likely to be accredited by the Joint Commission or to have a residency program accredited by the American Council of Graduate Medical Education. While future efforts to compose value measures will certainly be modified and expanded to examine other reasons for admission, the construct that we present could allow patients to transparently compare procedure- and hospital-specific quality, spending, and value and empower them to decide where to obtain care. © 2016 Milbank Memorial Fund.

Cancer survivors' perceived need for supportive care and their attitude towards self-management and eHealth.

PubMed

Jansen, Femke; van Uden-Kraan, Cornelia F; van Zwieten, Valesca; Witte, Birgit I; Verdonck-de Leeuw, Irma M

2015-06-01

The aim of this study was to explore the perceived need for supportive care including healthy lifestyle programs among cancer survivors, their attitude towards self-management and eHealth, and its association with several sociodemographic and clinical variables and quality of life. A questionnaire on the perceived need for supportive care and attitude towards self-management and eHealth was completed by 212 cancer survivors from an online panel. Highest needs were reported regarding physical care (66 %), followed by healthy lifestyle programs (54 %), social care (43 %), psychological care (38 %), and life question-related programs (24 %). In general, cancer survivors had a positive attitude towards self-management and eHealth. Supportive care needs were associated with male gender, lower age, treatment with chemotherapy or (chemo)radiation (versus surgery alone), hematological cancer (versus skin cancer, breast cancer, and other types of cancer), and lower quality of life. A positive attitude towards self-management was associated with lower age. A more positive attitude towards eHealth was associated with lower age, higher education, higher income, currently being under treatment (versus treatment in the last year), treatment with chemotherapy or (chemo)radiation (versus surgery alone), prostate and testicular cancer (versus hematological, skin, gynecological, and breast cancer and other types of cancer), and lower quality of life. The perceived need for supportive care including healthy lifestyle programs was high, and in general, cancer survivors had a positive attitude towards self-management and eHealth. Need and attitude were associated with sociodemographic and clinical variables and quality of life. Therefore, a tailored approach seems to be warranted to improve and innovate supportive care targeting cancer survivors.

The Role of School Based Health Centers (SBHCs) in Improving Health Equity and Reducing Health Disparities. Position Statement

ERIC Educational Resources Information Center

Blacksin, Beth; Gall, Gail; Feldman, Elizabeth; Miller, Elizabeth

2010-01-01

Health inequities exist largely among socially disadvantaged people who are denied the highest attainable standard of health available to many Americans. Access to culturally competent, high quality, first-contact primary care through school-based health centers is an effective way to reduce health inequities and, therefore, improve health…

Regional variations in health care intensity and physician perceptions of quality of care.

PubMed

Sirovich, Brenda E; Gottlieb, Daniel J; Welch, H Gilbert; Fisher, Elliott S

2006-05-02

Research has documented dramatic differences in health care utilization and spending across U.S. regions with similar levels of patient illness. Although patient outcomes and quality of care have been found to be no better in regions of high health care intensity, it is unknown whether physicians in these regions feel more capable of providing good patient care than those in low-intensity regions. To determine whether physicians in high-intensity regions feel better able to care for patients than physicians in low-intensity regions. Physician telephone survey. 51 metropolitan and 9 nonmetropolitan areas of the United States and a supplemental national sample. 10,577 physicians who provided care to adults in 1998 or 1999 were surveyed for the Community Tracking Study (response rate, 61%). The End-of-Life Expenditure Index, a measure of spending that reflects differences in the overall quantity of medical services provided rather than differences in illness or price, was used to determine health care intensity in the physicians' community. Outcomes included physicians' perceived availability of clinical services, ability to provide high-quality care to patients, and career satisfaction. Although the highest-intensity regions have substantially more hospital beds and specialists per capita, physicians in these regions reported more difficulty obtaining needed services for their patients. The proportion of physicians who felt able to obtain elective hospital admissions ranged from 50% in high-intensity regions to 64% in the lowest-intensity region (P < 0.001 for the relationship between intensity and perceived ability to obtain hospital admissions); the proportion of physicians who felt able to obtain high-quality specialist referrals ranged from 64% in high-intensity regions to 79% in low-intensity regions (P < 0.001). Compared with low-intensity regions, fewer physicians in high-intensity regions felt able to maintain good ongoing patient relationships (range, 62% to 70%; P < 0.001) or able to provide high-quality care (range, 72% to 77%; P = 0.009). In most cases, differences persisted but were attenuated in magnitude after adjustment for physician attributes, practice characteristics, and local market factors (for example, managed care penetration); the difference in perceived ability to provide high-quality care was no longer statistically significant (P = 0.099). The cross-sectional design prevented demonstration of a causal relationship between intensity and physician perceptions of quality. Despite more resources, physicians in regions of high health care intensity did not report greater ease in obtaining needed services or greater ability to provide high-quality care.

Care provider order entry (CPOE): a perspective on factors leading to success or to failure.

PubMed

Ozdas, A; Miller, R A

2007-01-01

Authors provide a perspective on factors leading to successful care provider order entry (CPOE) implementations. Viewpoint of authors supported by background literature review. Authors review both benefits and challenges related to CPOE implementation using three guiding principles: (1) a clinical approach to clinical systems, which claims that CPOE implementation is analogous to a "good" clinician delivering care to a patient; (2) a commitment to quality, which advocates that no compromises should be made in implementing system functionality and clinical system content - the highest objective for CPOE implementation is to provide better quality of care and increased safety for patients; (3) a commitment to fairness, as evidenced by respect for individuals and support of local autonomy, which advocates for minimizing disruptions to clinician-users' workflows, and adequate local control over CPOE system design and evolution, including clinical content management. Past experiences with CPOE implementation can inform future installation attempts. Sociocultural factors dominate in determining the success of implementation, and should govern technical factors.

Demand management and case management: a conservation strategy.

PubMed

Bryant, C D R Anna K

2007-01-01

This article reviews the history and development of managed competition, and explores the possibilities of a new demand management strategy in the context of nurse case management to offer less costly, higher quality care for a greater number of patients. The article examines the history and principles of healthcare demand management, its implementation in the hospital and clinical practices of nurse case managers, and its impacts in reducing costs while maintaining care levels. The article develops and analyzes the conflicts and common ground between demand management and case management. First, demand-side strategies can be effective in reducing costs while maintaining quality of nursing care; second, nurse case managers should employ patient education, self-care, and staffing solutions to manage demand. Nurse case managers must apply demand management principles carefully. Their goal is not to restrict care, but to maintain the highest levels of care possible within the limits of their practice's resources and staffing. Two critical themes emerge: (1) demand management is a potential alternative to market-driven managed competition and (2) nursing case management can affect an effective form of demand management. However, the long-term implications of these nursing case management strategies on healthcare staffing need further exploration.

The balance of give and take in caregiver-partner relationships: An examination of self-perceived burden, relationship equity, and quality of life from the perspective of care recipients following stroke.

PubMed

McPherson, Christine J; Wilson, Keith G; Chyurlia, Livia; Leclerc, Charles

2010-05-01

We examined the sense of being a burden to others or self-perceived burden (SPB) in people with stroke. A mail survey was completed by 57 former inpatients and their partner caregivers. The care recipient survey included measures of functional status, quality of life, marital satisfaction, equity in the relationship, and psychological distress, as well as SPB using the Self-Perceived Burden Scale (SPBS; Cousineau, McDowell, Hotz, & Hébert, 2003). The caregiver survey included similar measures in addition to a caregiver burden measure. SPB was found to be a prevalent and distressing concern. SPBS scores correlated with measures of functional status and mood; however, the correlations were highest for measures of family roles and work/productivity. Using equity theory as a basis to examine the SPB construct, care recipients who perceived themselves as overbenefiting from the relationship had significantly higher SPB scores than those whose relationship was viewed as equitable or underbenefiting. For some receiving care from a partner after stroke is associated SPB. This sense of burden is related to changes in help-seeking behavior, quality of life, and distress.

Older Adults With a Combination of Vision and Hearing Impairment Experience Higher Rates of Cognitive Impairment, Functional Dependence, and Worse Outcomes Across a Set of Quality Indicators.

PubMed

Davidson, Jacob G S; Guthrie, Dawn M

2017-08-01

Hearing and vision impairment were examined across several health-related outcomes and across a set of quality indicators (QIs) in home care clients with both vision and hearing loss (or dual sensory impairment [DSI]). Data collected using the Resident Assessment Instrument for Home Care (RAI-HC) were analyzed in a sample of older home care clients. The QIs represent the proportion of clients experiencing negative outcomes (e.g., falls, social isolation). The average age of clients was 82.8 years ( SD = 7.9), 20.5% had DSI and 8.5% had a diagnosis of Alzheimer's disease (AD). Clients with DSI were more likely to have a diagnosis of dementia (not AD), have functional impairments, report loneliness, and have higher rates across 20 of the 22 QIs, including communication difficulty and cognitive decline. Clients with highly impaired hearing, and any visual impairment, had the highest QI rates. Individuals with DSI experience higher rates of adverse events across many health-related outcomes and QIs. Understanding the unique contribution of hearing and vision in this group can promote optimal quality of care.

Unraveling Motivational Profiles of Health Care Professionals for Continuing Education: The Example of Pharmacists in the Netherlands.

PubMed

Tjin A Tsoi, Sharon L N M; de Boer, Anthonius; Croiset, Gerda; Koster, Andries S; Kusurkar, Rashmi A

2016-01-01

Continuing education (CE) can support health care professionals in maintaining and developing their knowledge and competencies. Although lack of motivation is one of the most important barriers of pharmacists' participation in CE, we know little about the quality or the quantity of motivation. We used the self-determination theory, which describes autonomous motivation (AM) as originating from within an individual and controlled motivation (CM) as originating from external factors, as a framework for this study. Our aim was to obtain insight into the quality and quantity of pharmacists' motivation for CE. The scores of 425 pharmacists on Academic Motivation Scale were subjected to K-means cluster analysis to generate motivational profiles. We unraveled four motivational profiles: (1) good quality with high AM/low CM, (2) high quantity with high AM/high CM, (3) poor quality with low AM/high CM, and (4) low quantity with low AM/low CM. Female pharmacists, pharmacists working in a hospital pharmacy, pharmacists working for more than 10 years, and pharmacists not in training were highly represented in the good-quality profile. Pharmacists working in a community pharmacy, pharmacists working for less than 10 years, and pharmacists in training were highly represented in the high-quantity profile. Male pharmacists were more or less equally distributed over the four profiles. The highest percentage of pharmacy owners was shown in the low-quantity profile, and the highest percentage of the nonowners was shown in the good-quality profile. Pharmacists exhibit different motivational profiles, which are associated with their background characteristics, such as gender, ownership of business, practice setting, and current training. Motivational profiles could be used to tailor CE courses for pharmacists.

Quality of internal communication in health care and the professional-patient relationship.

PubMed

March Cerdá, Joan Carles; Prieto Rodríguez, María Angeles; Pérez Corral, Olivia; Lorenzo, Sergio Minué; Danet, Alina

2010-01-01

A study was undertaken for the purpose of describing internal communication and the professional-patient relationship and to establish a descriptive model of the interaction between these 2 variables. A nationwide survey was carried out in primary care and specialist care centers in Spain. A simple random sampling method was used with 1183 health care professionals. The data collection instrument was a Likert questionnaire that recorded information on the perceived quality of internal communication (0-100 scale), professional-patient relationships (0-100 scale), and sociodemographic variables. The results were analyzed using SPSS 15.0, performing mean comparisons and a suitable linear regression model.The total average of the quality of internal communication was 53.79 points, and that of the professional-patient relationships was 74.17 points. Sex made no statistically significant difference. Age shows that the older the participant, the better his/her opinion of internal communication and professional-patient relationships. Nursing staff had the highest opinion of internal communication and professional-patient relationships. The association between internal communication and professional-patient relationship was positive (R = 0.45).It was concluded that continuous exchange of information among health care professionals, together with learning and shared decision making or a positive emotional climate, is an element that will consolidate good professional-patient relationships and ensure patient satisfaction.

Improving service quality in primary care.

PubMed

Kennedy, Denise M; Nordrum, Jon T; Edwards, Frederick D; Caselli, Richard J; Berry, Leonard L

2015-01-01

A framework for improving health care service quality was implemented at a 12-provider family medicine practice in 2010. A national patient satisfaction research vendor conducted weekly telephone surveys of 840 patients served by that practice: 280 patients served in 2009, and 560 served during 2010 and 2011. After the framework was implemented, the proportion of "excellent" ratings of provider service (the highest rating on a 5-point scale) increased by 5% to 9%, most notably thoroughness (P = .04), listening (P = .04), and explaining (P = .04). Other improvements included prompt test result notification and telephone staff courtesy (each by 10%, P = .02), as well as teamwork (by 8%, P = .04). Overall quality increased by 10% (P = .01), moving the practice from the 68th to the 91st percentile of medical practices in the research vendor's database. Improvements in patient satisfaction suggest that this framework may be useful in value-based payment models. © 2014 by the American College of Medical Quality.

Optimising value and quality in general practice within the primary health care sector through relationship marketing: a conceptual framework.

PubMed

Bansal, Manjit K

2004-01-01

Discusses the rationale of applying relationship marketing and service quality concepts within the primary health care sector. The use of relational strategies in general practice, by modelling the relationships between practitioners and patients from a marketing perspective, could potentially lead to sustained high quality service being provided, and to more efficient use of resources. This essentially conceptually focused paper addresses an area that has not yet been researched in detail, and furthers understanding of the relationships that facilitate exchange within general practice and service delivery in non-profit, resource-constrained conditions. Deeper understanding of the needs and expectations of patients and the way these can be delivered by general practice can only lead to improvements for all parties involved. The relationship marketing paradigm presents itself as a potentially exciting way of addressing issues associated with ensuring that the highest level of quality is delivered in this area of the UK National Health Service.

A Model for Integrating Ambulatory Surgery Centers Into an Academic Health System Using a Novel Ambulatory Surgery Coordinating Council.

PubMed

Ishii, Lisa; Pronovost, Peter J; Demski, Renee; Wylie, Gill; Zenilman, Michael

2016-06-01

An increasing volume of ambulatory surgeries has led to an increase in the number of ambulatory surgery centers (ASCs). Some academic health systems have aligned with ASCs to create a more integrated care delivery system. Yet, these centers are diverse in many areas, including specialty types, ownership models, management, physician employment, and regulatory oversight. Academic health systems then face challenges in integrating these ASCs into their organizations. Johns Hopkins Medicine created the Ambulatory Surgery Coordinating Council in 2014 to manage, standardize, and promote peer learning among its eight ASCs. The Armstrong Institute for Patient Safety and Quality provided support and a model for this organization through its quality management infrastructure. The physician-led council defined a mission and created goals to identify best practices, uniformly provide the highest-quality patient-centered care, and continuously improve patient outcomes and experience across ASCs. Council members built trust and agreed on a standardized patient safety and quality dashboard to report measures that include regulatory, care process, patient experience, and outcomes data. The council addressed unintentional outcomes and process variation across the system and agreed to standard approaches to optimize quality. Council members also developed a process for identifying future goals, standardizing care practices and electronic medical record documentation, and creating quality and safety policies. The early success of the council supports the continuation of the Armstrong Institute model for physician-led quality management. Other academic health systems can learn from this model as they integrate ASCs into their complex organizations.

High-Cost Patients: Hot-Spotters Don't Explain the Half of It.

PubMed

Lee, Natalie S; Whitman, Noah; Vakharia, Nirav; Taksler, Glen B; Rothberg, Michael B

2017-01-01

Understanding resource utilization patterns among high-cost patients may inform cost reduction strategies. To identify patterns of high-cost healthcare utilization and associated clinical diagnoses and to quantify the significance of hot-spotters among high-cost users. Retrospective analysis of high-cost patients in 2012 using data from electronic medical records, internal cost accounting, and the Centers for Medicare and Medicaid Services. K-medoids cluster analysis was performed on utilization measures of the highest-cost decile of patients. Clusters were compared using clinical diagnoses. We defined "hot-spotters" as those in the highest-cost decile with ≥4 hospitalizations or ED visits during the study period. A total of 14,855 Medicare Fee-for-service beneficiaries identified by the Medicare Quality Resource and Use Report as having received 100 % of inpatient care and ≥90 % of primary care services at Cleveland Clinic Health System (CCHS) in Northeast Ohio. The highest-cost decile was selected from this population. Healthcare utilization and diagnoses. The highest-cost decile of patients (n = 1486) accounted for 60 % of total costs. We identified five patient clusters: "Ambulatory," with 0 admissions; "Surgical," with a median of 2 surgeries; "Critically Ill," with a median of 4 ICU days; "Frequent Care," with a median of 2 admissions, 3 ED visits, and 29 outpatient visits; and "Mixed Utilization," with 1 median admission and 1 ED visit. Cancer diagnoses were prevalent in the Ambulatory group, care complications in the Surgical group, cardiac diseases in the Critically Ill group, and psychiatric disorders in the Frequent Care group. Most hot-spotters (55 %) were in the "frequent care" cluster. Overall, hot-spotters represented 9 % of the high-cost population and accounted for 19 % of their overall costs. High-cost patients are heterogeneous; most are not so-called "hot-spotters" with frequent admissions. Effective interventions to reduce costs will require a more multi-faceted approach to the high-cost population.

Identification of priorities for improvement of medication safety in primary care: a PRIORITIZE study.

PubMed

Tudor Car, Lorainne; Papachristou, Nikolaos; Gallagher, Joseph; Samra, Rajvinder; Wazny, Kerri; El-Khatib, Mona; Bull, Adrian; Majeed, Azeem; Aylin, Paul; Atun, Rifat; Rudan, Igor; Car, Josip; Bell, Helen; Vincent, Charles; Franklin, Bryony Dean

2016-11-16

Medication error is a frequent, harmful and costly patient safety incident. Research to date has mostly focused on medication errors in hospitals. In this study, we aimed to identify the main causes of, and solutions to, medication error in primary care. We used a novel priority-setting method for identifying and ranking patient safety problems and solutions called PRIORITIZE. We invited 500 North West London primary care clinicians to complete an open-ended questionnaire to identify three main problems and solutions relating to medication error in primary care. 113 clinicians submitted responses, which we thematically synthesized into a composite list of 48 distinct problems and 45 solutions. A group of 57 clinicians randomly selected from the initial cohort scored these and an overall ranking was derived. The agreement between the clinicians' scores was presented using the average expert agreement (AEA). The study was conducted between September 2013 and November 2014. The top three problems were incomplete reconciliation of medication during patient 'hand-overs', inadequate patient education about their medication use and poor discharge summaries. The highest ranked solutions included development of a standardized discharge summary template, reduction of unnecessary prescribing, and minimisation of polypharmacy. Overall, better communication between the healthcare provider and patient, quality assurance approaches during medication prescribing and monitoring, and patient education on how to use their medication were considered the top priorities. The highest ranked suggestions received the strongest agreement among the clinicians, i.e. the highest AEA score. Clinicians identified a range of suggestions for better medication management, quality assurance procedures and patient education. According to clinicians, medication errors can be largely prevented with feasible and affordable interventions. PRIORITIZE is a new, convenient, systematic, and replicable method, and merits further exploration with a view to becoming a part of a routine preventative patient safety monitoring mechanism.

Effect of post-menstrual regulation family-planning service quality on subsequent contraceptive use in Bangladesh.

PubMed

Sultana, Farhana; Nahar, Quamrun; Marions, Lena; Oliveras, Elizabeth

2013-11-01

To determine whether the quality of post-menstrual regulation family-planning services (post-MRFP) affected contraceptive use at 3-month follow-up. 915 women who received post-MRFP in 2 public and 1 NGO clinics in a district in Bangladesh were interviewed to obtain information on service quality and other characteristics. Quality was scored based on 21 items and the score divided into 3 categories: low (0-6); medium (7-11); and high (12-21). Three months after menstrual regulation, 902 of the women were interviewed at their residence or a clinic and contraceptive status was recorded. Adjusted odd ratios (aORs) for using contraception were calculated via multivariate logistic regression. Contraceptive use was positively correlated with the level of service quality, with 78% use among women who received the lowest-quality care and 92% use among women who received the highest-quality care. The aOR for contraceptive use was 1.80 (95% confidence interval [CI], 1.11-2.93) among women who received moderate-quality services and 3.01 (95% CI, 1.43-6.37) among women receiving high-quality services compared with those who received poor-quality services. Good-quality post-MRFP increases contraceptive use, at least in the short term. © 2013.

Specializing in accountability: strategies to prepare a subspecialty workforce for care delivery redesign.

PubMed

Nambudiri, Vinod E; Sober, Arthur J; Kimball, Alexa B

2013-12-01

Accountable care organizations (ACOs) emphasize cost-effectiveness, rewarding health care systems that provide the highest-quality care delivered by the most cost-efficient providers. Transitioning to an ACO model introduces distinct challenges for specialist physicians within academic health centers. As skin diseases constitute a large number of visits to primary care providers and specialists and place a significant financial burden on the health care system, the authors sought to identify specialist-driven strategies for cost-effective, patient-centered care delivery in dermatology. As part of the Massachusetts General Hospital's transition to an ACO, the Department of Dermatology in 2012 employed a team-based strategy to identify measures aimed at curbing the rate of rise in per-patient medical expense. Their approach may represent a methodological framework that translates to other specialist workforces. The authors identified four action areas: (1) rational, cost-conscious prescribing within therapeutic classes; (2) enhanced management of urgent access and follow-up appointment scheduling; (3) procedure standardization; and (4) interpractitioner variability assessment. They describe the practices implemented in these action areas, which include a mix of changes in both clinical decision making and operational practice and are aimed at improving overall quality and value of care delivery. They also offer recommendations for other specialty departments Involving specialist physicians in care delivery redesign efforts provides unique insights to enhance quality, cost-effectiveness, and efficiency of care delivery. With increasing emphasis on ACO models, further specialist-driven strategies for ensuring patient-centered delivery warrant development alongside other delivery reform efforts.

Questionnaires on Family Satisfaction in the Adult ICU: A Systematic Review Including Psychometric Properties.

PubMed

van den Broek, Janneke M; Brunsveld-Reinders, Anja H; Zedlitz, Aglaia M E E; Girbes, Armand R J; de Jonge, Evert; Arbous, M Sesmu

2015-08-01

To perform a systematic review of the literature to determine which questionnaires are currently available to measure family satisfaction with care on the ICU and to provide an overview of their quality by evaluating their psychometric properties. We searched PubMed, Embase, The Cochrane Library, Web of Science, PsycINFO, and CINAHL from inception to October 30, 2013. Experimental and observational research articles reporting on questionnaires on family satisfaction and/or needs in the ICU were included. Two reviewers determined eligibility. Design, application mode, language, and the number of studies of the tools were registered. With this information, the tools were globally categorized according to validity and reliability: level I (well-established quality), II (approaching well-established quality), III (promising quality), or IV (unconfirmed quality). The quality of the highest level (I) tools was assessed by further examination of the psychometric properties and sample size of the studies. The search detected 3,655 references, from which 135 articles were included. We found 27 different tools that assessed overall or circumscribed aspects of family satisfaction with ICU care. Only four questionnaires were categorized as level I: the Critical Care Family Needs Inventory, the Society of Critical Care Medicine Family Needs Assessment, the Critical Care Family Satisfaction Survey, and the Family Satisfaction in the Intensive Care Unit. Studies on these questionnaires were of good sample size (n ≥ 100) and showed adequate data on face/content validity and internal consistency. Studies on the Critical Care Family Needs Inventory, the Family Satisfaction in the Intensive Care Unit also contained sufficient data on inter-rater/test-retest reliability, responsiveness, and feasibility. In general, data on measures of central tendency and sensitivity to change were scarce. Of all the questionnaires found, the Critical Care Family Needs Inventory and the Family Satisfaction in the Intensive Care Unit were the most reliable and valid in relation to their psychometric properties. However, a universal "best questionnaire" is indefinable because it depends on the specific goal, context, and population used in the inquiry.

An assessment of quality characteristics of randomised control trials published in dental journals.

PubMed

Pandis, Nikolaos; Polychronopoulou, Argy; Eliades, Theodore

2010-09-01

The purpose of this study was to investigate the quality of reporting of randomised clinical trials (RCTs) published in dental specialty journals. The journals possessing the highest impact factor (2008 data) in the six major dental specialties were included in the study. The contents of the 24 most recent issues of each journal were hand-searched and research articles identified as randomised controlled trials (RCTs) were selected. Quality evaluation was performed using the modified Consolidated Standards of Reporting Trials (CONSORT) statement checklist. The data were analysed using descriptive statistics followed by univariate and multivariate examination of statistical associations (alpha=0.05). Ninety-five RCTs were identified with generally suboptimal scores on quality reporting on key CONSORT areas. Significant differences were found among journals with the Journal of Clinical Periodontology achieving the highest score, followed by the American Journal of Orthodontics and Dentofacial Orthopedics. There was a positive association between quality score and number of authors, involvement of statistician/epidemiologist, and multicentre trials. The quality scores of RCTs in major dental journals are considered suboptimal in key CONSORT areas. This receives critical importance considering that improved quality of RCTs is a fundamental prerequisite for improved dental care. Copyright 2010 Elsevier Ltd. All rights reserved.

[The added value of information summaries supporting clinical decisions at the point-of-care.

PubMed

Banzi, Rita; González-Lorenzo, Marien; Kwag, Koren Hyogene; Bonovas, Stefanos; Moja, Lorenzo

2016-11-01

Evidence-based healthcare requires the integration of the best research evidence with clinical expertise and patients' values. International publishers are developing evidence-based information services and resources designed to overcome the difficulties in retrieving, assessing and updating medical information as well as to facilitate a rapid access to valid clinical knowledge. Point-of-care information summaries are defined as web-based medical compendia that are specifically designed to deliver pre-digested, rapidly accessible, comprehensive, and periodically updated information to health care providers. Their validity must be assessed against marketing claims that they are evidence-based. We periodically evaluate the content development processes of several international point-of-care information summaries. The number of these products has increased along with their quality. The last analysis done in 2014 identified 26 products and found that three of them (Best Practice, Dynamed e Uptodate) scored the highest across all evaluated dimensions (volume, quality of the editorial process and evidence-based methodology). Point-of-care information summaries as stand-alone products or integrated with other systems, are gaining ground to support clinical decisions. The choice of one product over another depends both on the properties of the service and the preference of users. However, even the most innovative information system must rely on transparent and valid contents. Individuals and institutions should regularly assess the value of point-of-care summaries as their quality changes rapidly over time.

Quality of care for anxiety and depression in different ethnic groups by family practitioners in urban areas in the Netherlands.

PubMed

Fassaert, Thijs; Nielen, Mark; Verheij, Robert; Verhoeff, Arnoud; Dekker, Jack; Beekman, Aartjan; de Wit, Matty

2010-01-01

There is widespread concern about access to good quality health care for ethnic minority groups. This study investigates differences between ethnic groups regarding prevalence of anxiety and depression, and adherence to treatment guidelines by family practitioners in urban areas in the Netherlands. Data from electronic medical records, collected for the Netherlands Information Network of General Practice. Diagnoses were based on the International Classification of Primary Care. Adherence to guidelines included at least five consultations, prescription of psychotropics for 6 weeks at most (indicative of cessation in case of nonresponse) or 5 months at least (suggesting continuation in case of response), and/or a referral to a mental health care specialist. Data were analyzed using multilevel logistic regression analyses. A total of 6413 patients (4.4% of practice population) were diagnosed with anxiety and/or depression. Prevalence was highest in Turkish patients (5.2%). Of diagnosed patients, 42.9% received guideline-concordant treatment. Only Surinamese/Antillean patients were less likely than ethnic Dutch to receive treatments according to guidelines. Prevalence of and quality of care for anxiety and depression were comparable between ethnic minority clients, but some differences suggest that efforts to educate primary care providers in management of anxiety/depression should be continued and tailored to specific ethnic groups. Copyright 2010 Elsevier Inc. All rights reserved.

Assessment of Cancer-Related Fatigue, Pain, and Quality of Life in Cancer Patients at Palliative Care Team Referral: A Multicenter Observational Study (JORTC PAL-09).

PubMed

Iwase, Satoru; Kawaguchi, Takashi; Tokoro, Akihiro; Yamada, Kimito; Kanai, Yoshiaki; Matsuda, Yoshinobu; Kashiwaya, Yuko; Okuma, Kae; Inada, Shuji; Ariyoshi, Keisuke; Miyaji, Tempei; Azuma, Kanako; Ishiki, Hiroto; Unezaki, Sakae; Yamaguchi, Takuhiro

2015-01-01

Cancer-related fatigue greatly influences quality of life in cancer patients; however, no specific treatments have been established for cancer-related fatigue, and at present, no medication has been approved in Japan. Systematic research using patient-reported outcome to examine symptoms, particularly fatigue, has not been conducted in palliative care settings in Japan. The objective was to evaluate fatigue, pain, and quality of life in cancer patients at the point of intervention by palliative care teams. Patients who were referred to palliative care teams at three institutions and met the inclusion criteria were invited to complete the Brief Fatigue Inventory, Brief Pain Inventory, and European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Core 15-Palliative. Of 183 patients recruited, the majority (85.8%) were diagnosed with recurrence or metastasis. The largest group (42.6%) comprised lung cancer patients, of whom 67.2% had an Eastern Cooperative Oncology Group Performance Status of 0-1. The mean value for global health status/quality of life was 41.4, and the highest mean European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Core 15-Palliative symptom item score was for pain (51.0). The mean global fatigue score was 4.1, and 9.8%, 30.6%, 38.7%, and 20.8% of patients' fatigue severity was classified as none (score 0), mild (1-3), moderate (4-6), and severe (7-10), respectively. Cancer-related fatigue, considered to occur more frequently in cancer patients, was successfully assessed using patient-reported outcomes with the Brief Fatigue Inventory for the first time in Japan. Results suggested that fatigue is potentially as problematic as pain, which is the main reason for palliative care.

Leadership models in health care - a case for servant leadership.

PubMed

Trastek, Victor F; Hamilton, Neil W; Niles, Emily E

2014-03-01

Our current health care system is broken and unsustainable. Patients desire the highest quality care, and it needs to cost less. To regain public trust, the health care system must change and adapt to the current needs of patients. The diverse group of stakeholders in the health care system creates challenges for improving the value of care. Health care providers are in the best position to determine effective ways of improving the value of care. To create change, health care providers must learn how to effectively lead patients, those within health care organizations, and other stakeholders. This article presents servant leadership as the best model for health care organizations because it focuses on the strength of the team, developing trust and serving the needs of patients. As servant leaders, health care providers may be best equipped to make changes in the organization and in the provider-patient relationship to improve the value of care for patients. Copyright © 2014 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

Social support network, mental health and quality of life: a cross-sectional study in primary care.

PubMed

Portugal, Flávia Batista; Campos, Mônica Rodrigues; Correia, Celina Ragoni; Gonçalves, Daniel Almeida; Ballester, Dinarte; Tófoli, Luis Fernando; Mari, Jair de Jesus; Gask, Linda; Dowrick, Christopher; Bower, Peter; Fortes, Sandra

2016-12-22

The objective of this study was to identify the association between emotional distress and social support networks with quality of life in primary care patients. This was a cross-sectional study involving 1,466 patients in the cities of São Paulo and Rio de Janeiro, Brazil, in 2009/2010. The General Health Questionnaire, the Hospital Anxiety and Depression Scale and the brief version of the World Health Organization Quality of Life Instrument were used. The Social Support Network Index classified patients with the highest and lowest index as socially integrated or isolated. A bivariate analysis and four multiple linear regressions were conducted for each quality of life outcome. The means scores for the physical, psychological, social relations, and environment domains were, respectively, 64.7; 64.2; 68.5 and 49.1. In the multivariate analysis, the psychological domain was negatively associated with isolation, whereas the social relations and environment domains were positively associated with integration. Integration and isolation proved to be important factors for those in emotional distress as they minimize or maximize negative effects on quality of life.

Facilitating Interdisciplinary Competence: Collaboration between Undergraduate Baccalaureate Nursing Students and Graduate Students Specializing in Communication Disorders

ERIC Educational Resources Information Center

McMillan, Libba Reed; Burrus, Embry; Willis, Laura; Grabowsky, Adelia

2016-01-01

The fast-paced nature of the healthcare setting, coupled with the number of allied professionals involved, demands accurate and concise written communication. It is imperative that written communication between nursing and allied professionals be clear to ensure that the highest quality of care is provided and that patient safety is maintained.…

Cost-Effectiveness and Cost-Utility of Internet-Based Computer Tailoring for Smoking Cessation

PubMed Central

Evers, Silvia MAA; de Vries, Hein; Hoving, Ciska

2013-01-01

Background Although effective smoking cessation interventions exist, information is limited about their cost-effectiveness and cost-utility. Objective To assess the cost-effectiveness and cost-utility of an Internet-based multiple computer-tailored smoking cessation program and tailored counseling by practice nurses working in Dutch general practices compared with an Internet-based multiple computer-tailored program only and care as usual. Methods The economic evaluation was embedded in a randomized controlled trial, for which 91 practice nurses recruited 414 eligible smokers. Smokers were randomized to receive multiple tailoring and counseling (n=163), multiple tailoring only (n=132), or usual care (n=119). Self-reported cost and quality of life were assessed during a 12-month follow-up period. Prolonged abstinence and 24-hour and 7-day point prevalence abstinence were assessed at 12-month follow-up. The trial-based economic evaluation was conducted from a societal perspective. Uncertainty was accounted for by bootstrapping (1000 times) and sensitivity analyses. Results No significant differences were found between the intervention arms with regard to baseline characteristics or effects on abstinence, quality of life, and addiction level. However, participants in the multiple tailoring and counseling group reported significantly more annual health care–related costs than participants in the usual care group. Cost-effectiveness analysis, using prolonged abstinence as the outcome measure, showed that the mere multiple computer-tailored program had the highest probability of being cost-effective. Compared with usual care, in this group €5100 had to be paid for each additional abstinent participant. With regard to cost-utility analyses, using quality of life as the outcome measure, usual care was probably most efficient. Conclusions To our knowledge, this was the first study to determine the cost-effectiveness and cost-utility of an Internet-based smoking cessation program with and without counseling by a practice nurse. Although the Internet-based multiple computer-tailored program seemed to be the most cost-effective treatment, the cost-utility was probably highest for care as usual. However, to ease the interpretation of cost-effectiveness results, future research should aim at identifying an acceptable cutoff point for the willingness to pay per abstinent participant. PMID:23491820

Health Care Spending and Quality in Year 1 of the Alternative Quality Contract

PubMed Central

Song, Zirui; Safran, Dana Gelb; Landon, Bruce E.; He, Yulei; Ellis, Randall P.; Mechanic, Robert E.; Day, Matthew P.; Chernew, Michael E.

2012-01-01

Background In 2009, Blue Cross Blue Shield of Massachusetts (BCBS) implemented a global payment system called the Alternative Quality Contract (AQC). Provider groups in the AQC system assume accountability for spending, similar to accountable care organizations that bear financial risk. Moreover, groups are eligible to receive bonuses for quality. Methods Seven provider organizations began 5-year contracts as part of the AQC system in 2009. We analyzed 2006–2009 claims for 380,142 enrollees whose primary care physicians (PCPs) were in the AQC system (intervention group) and for 1,351,446 enrollees whose PCPs were not in the system (control group). We used a propensity-weighted difference-in-differences approach, adjusting for age, sex, health status, and secular trends to isolate the treatment effect of the AQC in comparisons of spending and quality between the intervention group and the control group. Results Average spending increased for enrollees in both the intervention and control groups in 2009, but the increase was smaller for enrollees in the intervention group — $15.51 (1.9%) less per quarter (P = 0.007). Savings derived largely from shifts in outpatient care toward facilities with lower fees; from lower expenditures for procedures, imaging, and testing; and from a reduction in spending for enrollees with the highest expected spending. The AQC system was associated with an improvement in performance on measures of the quality of the management of chronic conditions in adults (P<0.001) and of pediatric care (P = 0.001), but not of adult preventive care. All AQC groups met 2009 budget targets and earned surpluses. Total BCBS payments to AQC groups, including bonuses for quality, are likely to have exceeded the estimated savings in year 1. Conclusions The AQC system was associated with a modest slowing of spending growth and improved quality of care in 2009. Savings were achieved through changes in referral patterns rather than through changes in utilization. The long-term effect of the AQC system on spending growth depends on future budget targets and providers’ ability to further improve efficiencies in practice. (Funded by the Commonwealth Fund and others.) PMID:21751900

Health care spending and quality in year 1 of the alternative quality contract.

PubMed

Song, Zirui; Safran, Dana Gelb; Landon, Bruce E; He, Yulei; Ellis, Randall P; Mechanic, Robert E; Day, Matthew P; Chernew, Michael E

2011-09-08

In 2009, Blue Cross Blue Shield of Massachusetts (BCBS) implemented a global payment system called the Alternative Quality Contract (AQC). Provider groups in the AQC system assume accountability for spending, similar to accountable care organizations that bear financial risk. Moreover, groups are eligible to receive bonuses for quality. Seven provider organizations began 5-year contracts as part of the AQC system in 2009. We analyzed 2006-2009 claims for 380,142 enrollees whose primary care physicians (PCPs) were in the AQC system (intervention group) and for 1,351,446 enrollees whose PCPs were not in the system (control group). We used a propensity-weighted difference-in-differences approach, adjusting for age, sex, health status, and secular trends to isolate the treatment effect of the AQC in comparisons of spending and quality between the intervention group and the control group. Average spending increased for enrollees in both the intervention and control groups in 2009, but the increase was smaller for enrollees in the intervention group--$15.51 (1.9%) less per quarter (P=0.007). Savings derived largely from shifts in outpatient care toward facilities with lower fees; from lower expenditures for procedures, imaging, and testing; and from a reduction in spending for enrollees with the highest expected spending. The AQC system was associated with an improvement in performance on measures of the quality of the management of chronic conditions in adults (P<0.001) and of pediatric care (P=0.001), but not of adult preventive care. All AQC groups met 2009 budget targets and earned surpluses. Total BCBS payments to AQC groups, including bonuses for quality, are likely to have exceeded the estimated savings in year 1. The AQC system was associated with a modest slowing of spending growth and improved quality of care in 2009. Savings were achieved through changes in referral patterns rather than through changes in utilization. The long-term effect of the AQC system on spending growth depends on future budget targets and providers' ability to further improve efficiencies in practice. (Funded by the Commonwealth Fund and others.).

Cervical cancer survivorship: Long-term quality of life and social support

PubMed Central

Pfaendler, Krista S.; Wenzel, Lari; Mechanic, Mindy B.; Penner, Kristine R.

2015-01-01

Purpose Surgery, radiotherapy and chemotherapy are the mainstays of cervical cancer treatment. Many patients receive multiple treatment modalities, each with its own long-term effects. Given the high 5 year survival rate for cervical cancer patients, evaluation and improvement of long-term quality of life are essential. Methods Pertinent articles were identified through searches of PubMed for literature published from 1993-2014. We summarize quality of life data from long-term follow up studies of cervical cancer patients. We additionally summarize small group interviews of Hispanic and non-Hispanic cervical cancer survivors regarding social support and coping. Findings Data is varied in terms of the long term impact of treatment on quality of life but consistent in suggesting that patients who receive radiotherapy as part of their treatment have the highest risk of increased long term dysfunction of bladder and bowel, as well as sexual dysfunction and psychosocial consequences. Rigorous investigations regarding long-term consequences of treatment modalities are lacking. Implications Continued work to improve treatment outcomes and survival should also include a focus on reducing adverse long-term side effects. Providing supportive care during treatment, and evaluating the effects of supportive care, may reduce the prevalence and magnitude of long-term sequelae of cervical cancer, which will in turn improve quality of life and quality of care. PMID:25592090

Impact of infection control activities on the rate of needle stick injuries at a tertiary care hospital of Pakistan over a period of six years: an observational study

PubMed Central

2009-01-01

Background Accidental exposure to blood and body fluids is frequent among health care workers. They are at high risk of nosocomial transmission of blood borne pathogens due to injuries caused by used sharps. We are reporting impact of surveillance and educational program on the rate of needle stick injuries among health care workers at a tertiary care hospital in Pakistan. Methods At Aga Khan University Hospital sharp injuries are reported to infection control office. To reduce these incidents a quality improvement project was inducted in the year 2005. Health care workers were educated; surveillance data from 2002 to 2007 was analyzed and compared with various risk factors. Results During study period 1382 incidents were reported. Junior doctors sustained highest number of injuries (n = 394; 28.5%) followed by registered nurses (n = 283; 20.4%). Highest number of incidents was reported during blood collection (19%). An increasing trend was observed in the pre intervention years (2002–04). However noticeable fall was noted in the post intervention period that is in year 2006 and 2007. Major decline was noted among nurses (from 13 to 5 NSI/100 FTE/year). By relating and comparing the rates with various activities directly linked with the use of syringes a significant reduction in incidents were found including; hospital admissions (p-value 0.01), surgeries and procedures performed (p = 0.01), specimens collected in the laboratory (p = 0.001) and patients visits in clinics (p = 0.01). Conclusion We report significant reduction in needle stick injuries especially during post intervention study period. This is being achieved by constant emphasis on improving awareness by regular educational sessions, implemented as a quality improvement project. PMID:19480683

Online Error Reporting for Managing Quality Control Within Radiology.

PubMed

Golnari, Pedram; Forsberg, Daniel; Rosipko, Beverly; Sunshine, Jeffrey L

2016-06-01

Information technology systems within health care, such as picture archiving and communication system (PACS) in radiology, can have a positive impact on production but can also risk compromising quality. The widespread use of PACS has removed the previous feedback loop between radiologists and technologists. Instead of direct communication of quality discrepancies found for an examination, the radiologist submitted a paper-based quality-control report. A web-based issue-reporting tool can help restore some of the feedback loop and also provide possibilities for more detailed analysis of submitted errors. The purpose of this study was to evaluate the hypothesis that data from use of an online error reporting software for quality control can focus our efforts within our department. For the 372,258 radiologic examinations conducted during the 6-month period study, 930 errors (390 exam protocol, 390 exam validation, and 150 exam technique) were submitted, corresponding to an error rate of 0.25 %. Within the category exam protocol, technologist documentation had the highest number of submitted errors in ultrasonography (77 errors [44 %]), while imaging protocol errors were the highest subtype error for computed tomography modality (35 errors [18 %]). Positioning and incorrect accession had the highest errors in the exam technique and exam validation error category, respectively, for nearly all of the modalities. An error rate less than 1 % could signify a system with a very high quality; however, a more likely explanation is that not all errors were detected or reported. Furthermore, staff reception of the error reporting system could also affect the reporting rate.

Application of WHOQOL-BREF in Measuring Quality of Life in Health-Care Staff.

PubMed

Gholami, Ali; Jahromi, Leila Moosavi; Zarei, Esmail; Dehghan, Azizallah

2013-07-01

The objective of this study was to evaluate the quality of life of Neyshabur health-care staff and some factors associated with it with use of WHOQOL-BREF scale. This cross-sectional study was conducted on 522 staff of Neyshabur health-care centers from May to July 2011. Cronbach's alpha coefficient was applied to examine the internal consistency of WHOQOL-BREF scale; Pearson's correlation coefficient was used to determine the level of agreement between different domains of WHOQOL-BREF. Paired t-test was used to compare difference between score means of different domains. T-independent test was performed for group analysis and Multiple Linear Regression was used to control confounding effects. In this study, a good internal consistency (α = 0.925) for WHOQOL-BREF and its four domains was observed. The highest and the lowest mean scores of WHOQOL-BREF domains was found for physical health domain (Mean = 15.26) and environmental health domain (Mean = 13.09) respectively. Backward multiple linear regression revealed that existence chronic disease in staff was significantly associated with four domains of WHOQOL-BREF, education years was associated with two domains (Psychological and Environmental) and sex was associated with psychological domain (P < 0.05). The findings from this study confirm that the WHOQOL-BREF questionnaire is a reliable instrument to measure quality of life in health-care staff. From the data, it appears that Neyshabur health-care staff has WHOQOL-BREF scores that might be considered to indicate a relatively moderate quality of life.

Quality of life and health care utilization in patients with chronic respiratory diseases.

PubMed

Kurpas, D; Mroczek, B; Sitko, Z; Helicka, D; Kuchar, E

2015-01-01

High quality of life (QoL) may reduce the costs of medical care of chronically ill patients due to lower health care utilization. The purpose of this study was to establish the influence of the QoL of primary care patients with chronic respiratory diseases on the level of health care utilization and the predictors of hospitalization. The study group consisted of 594 adult patients with chronic respiratory diseases of the mean age 59.8±14.9 years. The highest QoL was observed in the social relationship domain and the lowest in the physical domain. Low QoL was associated with a low level of health care utilization among patients with chronic respiratory diseases. Most patients were hospitalized during the past 3 years. In a group of patients with chronic respiratory diseases, chances for hospitalization were: higher among patients with low QoL and health satisfaction, low QoL levels in the physical and social relationship domains, high QoL levels in the psychological domain, those with higher education, residents of rural areas, patients using frequent consultations over the phone, and those with at least an average index of services.

Developing Federal Clinical Care Recommendations for Women.

PubMed

Godfrey, Emily M; Tepper, Naomi K; Curtis, Kathryn M; Moskosky, Susan B; Gavin, Loretta E

2015-08-01

The provision of family planning services has important health benefits for the U.S. Approximately 25 million women in the U.S. receive contraceptive services annually and 44 million make at least one family planning-related clinical visit each year. These services are provided by private clinicians, as well as publicly funded clinics, including specialty family planning clinics, health departments, Planned Parenthoods, community health centers, and primary care clinics. Recommendations for providing quality family planning services have been published by CDC and the Office of Population Affairs of the DHHS. This paper describes the process used to develop the women's clinical services portion of the new recommendations and the rationale underpinning them. The recommendations define family planning services as contraceptive care, pregnancy testing and counseling, achieving pregnancy, basic infertility care, sexually transmitted disease services, and preconception health. Because many women who seek family planning services have no other source of care, the recommendations also include additional screening services related to women's health, such as cervical cancer screening. These clinical guidelines are aimed at providing the highest-quality care and are designed to establish a national standard for family planning in the U.S. Published by Elsevier Inc.

Identification of opportunities for quality improvement and outcome measurement in pediatric otolaryngology.

PubMed

Shah, Rahul K; Stey, Anne M; Jatana, Kris R; Rangel, Shawn J; Boss, Emily F

2014-11-01

Despite increased emphasis on measuring safety outcomes and quality indicators for surgical care, little is known regarding which operative procedures should be prioritized for quality-improvement initiatives in pediatric otolaryngology. To describe the 30-day adverse event rates and relative contributions to morbidity for procedures in pediatric otolaryngology surgery using data from the American College of Surgeons' National Surgical Quality Improvement Program Pediatric database (ACS-NSQIP-P). Analysis of records contained in the ACS-NSQIP-P 2011-2012 clinical database. The ACS-NSQIP-P is a nationwide risk-adjusted, clinical outcomes-based program aimed at measuring and improving pediatric surgical care. Fifty hospitals participated in the 2011-2012 ACS-NSQIP-P program. Medical records of patients who underwent tracked otolaryngologic procedures were accrued in the ACS-NSQIP-P database. These were inclusive of specific otolaryngologic surgical procedures and do not represent the entire spectrum of pediatric otolaryngology surgical procedures. Individual 30-day adverse events, composite morbidity, composite serious adverse events, and composite hospital-acquired infections were compiled. Clinically related procedure groups were used to broadly evaluate outcomes. Procedures and groups were evaluated according to their relative contribution to otolaryngologic morbidity and their incidence of major complications. A total of 8361 patients underwent 1 of 40 selected otolaryngology procedures; 90% were elective; 76% were performed on an outpatient or ambulatory basis; and 46% were American Society of Anesthesiologists (ASA) class 2 cases. Individual 30-day adverse event rates were highest for return to the operating room (4%), surgical site infection (2%), pneumonia (1%), sepsis (1%), and reintubation (1%). The highest rates of composite morbidity were seen for tracheostomy in patients younger than 2 years (23%), airway reconstruction (19%), and tympanoplasty with mastoidectomy (2%). Airway reconstruction procedures had the highest rates of composite serious adverse events (16%), followed by tracheostomy (13%) and abscess drainage (5%). Tracheostomy (31%) and airway reconstruction (16%) made the largest relative contributions to composite morbidity rate of the procedures studied. Tracheostomy in patients younger than 2 years had the highest composite hospital-acquired infection rate (14%), followed by airway reconstruction procedures (11%) and tympanoplasty with mastoidectomy (2%). While the overall rate of major postoperative morbidity in pediatric otolaryngology is low, areas for targeted quality-improvement interventions include tracheostomy, airway reconstruction, mastoidectomy, and abscess drainage. Measurement of outcomes specific to otolaryngologic procedures will be necessary to further identify and measure the impact of quality-improvement initiatives in pediatric otolaryngology.

Global trends in testicular cancer incidence and mortality.

PubMed

Rosen, Alexandre; Jayram, Gautam; Drazer, Michael; Eggener, Scott E

2011-08-01

Epidemiologic studies on testicular cancer have focused primarily on European countries. Global incidence and mortality have been less thoroughly evaluated. Our goal was to gain a better understanding of the most recent global age-standardized incidence and mortality rates for testicular cancer and to use these values to estimate a region's health care quality. Age-standardized incidence rate (ASIR) and age-standardized mortality rate (ASMR) for testicular cancer were obtained for men of all ages in 172 countries by using the GLOBOCAN 2008 database, reflecting the annual rate of cancer incidence and mortality per 100,000 men. These data were evaluated on a regional level to compare incidence and mortality rates. Global plots of these values were constructed to better visualize geographic distributions. Finally, the ratio of ASIR to ASMR was calculated as a method to assess each region's proficiency in diagnosing and effectively treating testicular cancer. ASIR and ASMR were analyzed by region, and each region's ratio of ASIR to ASMR was calculated. Testicular cancer ASIR is highest in Western Europe (7.8%), Northern Europe (6.7%), and Australia (6.5%). Asia and Africa had the lowest incidence (<1.0%). ASMR was highest in Central America (0.7%), western Asia (0.6%), and Central and Eastern Europe (0.6%). Mortality was lowest in North America, Northern Europe, and Australia (0.1-0.2%). The ASIR-ASMR ratio was highest in Australia (65.0%) and lowest in western Africa (1.0%). National reporting systems varied by country, and data quality may have fluctuated between regions. Testicular cancer incidence remains highest in developed nations with primarily Caucasian populations. Variable ASIR-ASMR ratios suggest markedly different geographic-specific reporting mechanisms, access to care, and treatment capabilities. Copyright © 2011 European Association of Urology. Published by Elsevier B.V. All rights reserved.

Transitioning to a High-Value Health Care Model: Academic Accountability.

PubMed

Johnson, Pamela T; Alvin, Matthew D; Ziegelstein, Roy C

2018-06-01

Health care spending in the United States has increased to unprecedented levels, and these costs have broken medical providers' promise to do no harm. Medical debt is the leading contributor to U.S. personal bankruptcy, more than 50% of household foreclosures are secondary to medical debt and illness, and patients are choosing to avoid necessary care because of its cost. Evidence that the health care delivery model is contributing to patient hardship is a call to action for the profession to transition to a high-value model, one that delivers the highest health care quality and safety at the lowest personal and financial cost to patients. As such, value improvement work is being done at academic medical centers across the country. To promote measurable improvements in practice on a national scale, academic institutions need to align efforts and create a new model for collaboration, one that transcends cross-institutional competition, specialty divisions, and geographical constraints. Academic institutions are particularly accountable because of the importance of research and education in driving this transition. Investigations that elucidate effective implementation methodologies and evaluate safety outcomes data can facilitate transformation. Engaging trainees in quality improvement initiatives will instill high-value care into their practice. This article charges academic institutions to go beyond dissemination of best practice guidelines and demonstrate accountability for high-value quality improvement implementation. By effectively transitioning to a high-value health care system, medical providers will convincingly demonstrate that patients are their most important priority.

Risk for Depression, Burnout and Low Quality of Life Among Personnel of a University Hospital in Italy is a Consequence of the Impact One Economic Crisis in the Welfare System?

PubMed

Carta, M G; Preti, A; Portoghese, I; Pisanu, E; Moro, D; Pintus, M; Pintus, E; Perra, A; D'Oca, S; Atzeni, M; Campagna, M; Pascolo, E Fabrici; Sancassiani, F; Finco, G; D'Aloja, E; Grassi, L

2017-01-01

Research literature suggests that burnout, depression, and a low mental quality of life (QOL) are common among health care workers. Economic crisis might have increased the burden of burnout, depression and low QOL in health care workers. To identify depression risk, burnout levels, and quality of life in a sample of workers of an Italian university hospital. Cross sectional study with comparison with two community surveys database results (n = 2000 and 1500, respectively). Overall, 522 workers accepted to take part in the study, representing a 78% response rate (out of 669 individuals). The frequency of positivity at the screener for Major Depressive Disorder among health care workers was more than double than that in the standardized community sample (33.3% vs 14.1%, p<0.0001). All professionals, except the administrative staff and technicians ( i.e. those who do not have contact with patients), showed a statistically higher frequency of positivity for depressive episodes compared to the controls. Among the medical staff, the highest risk was found in the surgeon units, while the lowest one was in the laboratories. Surgeons also were those most exposed to high risk of burnout, as measured by the Maslach Burnout Inventory. Since burnout is linked to patient safety and quality of patient care, and contribute to medical errors, dedicated interventions aimed at reducing poor mental health and low quality of life in medical staff are indicated.

Where is information quality lost at clinical level? A mixed-method study on information systems and data quality in three urban Kenyan ANC clinics

PubMed Central

Hahn, Daniel; Wanjala, Pepela; Marx, Michael

2013-01-01

Background Well-working health information systems are considered vital with the quality of health data ranked of highest importance for decision making at patient care and policy levels. In particular, health facilities play an important role, since they are not only the entry point for the national health information system but also use health data (and primarily) for patient care. Design A multiple case study was carried out between March and August 2012 at the antenatal care (ANC) clinics of two private and one public Kenyan hospital to describe clinical information systems and assess the quality of information. The following methods were developed and employed in an iterative process: workplace walkthroughs, structured and in-depth interviews with staff members, and a quantitative assessment of data quality (completeness and accurate transmission of clinical information and reports in ANC). Views of staff and management on the quality of employed information systems, data quality, and influencing factors were captured qualitatively. Results Staff rated the quality of information higher in the private hospitals employing computers than in the public hospital which relies on paper forms. Several potential threats to data quality were reported. Limitations in data quality were common at all study sites including wrong test results, missing registers, and inconsistencies in reports. Feedback was seldom on content or quality of reports and usage of data beyond individual patient care was low. Conclusions We argue that the limited data quality has to be seen in the broader perspective of the information systems in which it is produced and used. The combination of different methods has proven to be useful for this. To improve the effectiveness and capabilities of these systems, combined measures are needed which include technical and organizational aspects (e.g. regular feedback to health workers) and individual skills and motivation. PMID:23993022

Where is information quality lost at clinical level? A mixed-method study on information systems and data quality in three urban Kenyan ANC clinics.

PubMed

Hahn, Daniel; Wanjala, Pepela; Marx, Michael

2013-08-29

Well-working health information systems are considered vital with the quality of health data ranked of highest importance for decision making at patient care and policy levels. In particular, health facilities play an important role, since they are not only the entry point for the national health information system but also use health data (and primarily) for patient care. A multiple case study was carried out between March and August 2012 at the antenatal care (ANC) clinics of two private and one public Kenyan hospital to describe clinical information systems and assess the quality of information. The following methods were developed and employed in an iterative process: workplace walkthroughs, structured and in-depth interviews with staff members, and a quantitative assessment of data quality (completeness and accurate transmission of clinical information and reports in ANC). Views of staff and management on the quality of employed information systems, data quality, and influencing factors were captured qualitatively. Staff rated the quality of information higher in the private hospitals employing computers than in the public hospital which relies on paper forms. Several potential threats to data quality were reported. Limitations in data quality were common at all study sites including wrong test results, missing registers, and inconsistencies in reports. Feedback was seldom on content or quality of reports and usage of data beyond individual patient care was low. We argue that the limited data quality has to be seen in the broader perspective of the information systems in which it is produced and used. The combination of different methods has proven to be useful for this. To improve the effectiveness and capabilities of these systems, combined measures are needed which include technical and organizational aspects (e.g. regular feedback to health workers) and individual skills and motivation.

Socioeconomic disparities in first stroke incidence, quality of care, and survival: a nationwide registry-based cohort study of 44 million adults in England.

PubMed

Bray, Benjamin D; Paley, Lizz; Hoffman, Alex; James, Martin; Gompertz, Patrick; Wolfe, Charles D A; Hemingway, Harry; Rudd, Anthony G

2018-04-01

We aimed to estimate socioeconomic disparities in the incidence of hospitalisation for first-ever stroke, quality of care, and post-stroke survival for the adult population of England. In this cohort study, we obtained data collected by a nationwide register on patients aged 18 years or older hospitalised for first-ever acute ischaemic stroke or primary intracerebral haemorrhage in England from July 1, 2013, to March 31, 2016. We classified socioeconomic status at the level of Lower Super Output Areas using the Index of Multiple Deprivation, a neighbourhood measure of deprivation. Multivariable models were fitted to estimate the incidence of hospitalisation for first stroke (negative binomial), quality of care using 12 quality metrics (multilevel logistic), and all-cause 1 year case fatality (Cox proportional hazards). Of the 43·8 million adults in England, 145 324 were admitted to hospital with their first-ever stroke: 126 640 (87%) with ischaemic stroke, 17 233 (12%) with intracerebral haemorrhage, and 1451 (1%) with undetermined stroke type. We observed a socioeconomic gradient in the incidence of hospitalisation for ischaemic stroke (adjusted incidence rate ratio 2·0, 95% CI 1·7-2·3 for the most vs least deprived deciles) and intracerebral haemorrhage (1·6, 1·3-1·9). Patients from the lowest socioeconomic groups had first stroke a median of 7 years earlier than those from the highest (p<0·0001), and had a higher prevalence of pre-stroke disability and diabetes. Patients from lower socioeconomic groups were less likely to receive five of 12 care processes but were more likely to receive early supported discharge (adjusted odds ratio 1·14, 95% CI 1·07-1·22). Low socioeconomic status was associated with a 26% higher adjusted risk of 1-year mortality (adjusted hazard ratio 1·26, 95% CI 1·20-1·33, for highest vs lowest deprivation decile), but this gradient was largely attenuated after adjustment for the presence of pre-stroke diabetes, hypertension, and atrial fibrillation (1·11, 1·05-1·17). Wide socioeconomic disparities exist in the burden of ischaemic stroke and intracerebral haemorrhage in England, most notably in stroke hospitalisation risk and case fatality and, to a lesser extent, in the quality of health care. Reducing these disparities requires interventions to improve the quality of acute stroke care and address disparities in cardiovascular risk factors present before stroke. NHS England and the Welsh Government. Copyright © 2018 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.

Large-Scale Evaluation of Quality of Care in 6 Countries of Eastern Europe and Central Asia Using Clinical Performance and Value Vignettes.

PubMed

Peabody, John W; DeMaria, Lisa; Smith, Owen; Hoth, Angela; Dragoti, Edmond; Luck, Jeff

2017-09-27

A significant determinant of population health outcomes is the quality of care provided for noncommunicable diseases, obstetric, and pediatric care. We present results on clinical practice quality in these areas as measured among nearly 4,000 providers working at more than 1,000 facilities in 6 Eastern European and Central Asian countries. This study was conducted between March 2011 and April 2013 in Albania, Armenia, Georgia, Kazakhstan, Kirov Province in Russia, and Tajikistan. Using a probability proportional-to-size sampling technique, based on number of hospital beds, we randomly selected within each country 42 hospitals and their associated primary health care clinics. Physicians and midwives within each clinical area of interest were randomly selected from each hospital and clinic and asked how they would care for simulated patients using Clinical Performance and Value (CPV) vignettes. Facility administrators were also asked to complete a facility survey to collect structural measures of quality. CPV vignettes were scored on a scale of 0% to 100% for each provider. We used descriptive statistics and t tests to identify significant differences in CPV scores between hospitals and clinics and rural vs. urban facilities, and ANOVA to identify significant differences in CPV scores across countries. We found that quality of care, as concurrently measured by performance on CPV vignettes, was generally poor and widely variable within and between countries. Providers in Kirov Province, Russia, had the highest overall performance, with an average score of 70.8%, while providers in Albania and Tajikistan had the lowest average score, each at 50.8%. The CPV vignettes with the lowest scores were for multiple noncommunicable disease risk factors and birth asphyxia. A considerable proportion (11%) of providers performed well on the CPV vignettes, regardless of country, facility, or structural resources available to them. Countries of Eastern Europe and Central Asia are challenged by poor performance as measured by clinical care vignettes, but there is potential for provision of high-quality care by a sizable proportion of providers. Large-scale assessments of quality of care have been hampered by the lack of effective measurement tools that provide generalizable and reliable results across diverse economic, cultural, and social settings. The feasibility of quality measurement using CPV vignettes in these 6 countries and the ability to combine results with individual feedback could significantly enhance strategies to improve quality of care, and ultimately population health. © Peabody et al.

Overall satisfaction of health care users with the quality of and access to health care services: a cross-sectional study in six Central and Eastern European countries.

PubMed

Stepurko, Tetiana; Pavlova, Milena; Groot, Wim

2016-08-02

The measurement of consumer satisfaction is an essential part of the assessment of health care services in terms of service quality and health care system responsiveness. Studies across Europe have described various strategies health care users employ to secure services with good quality and quick access. In Central and Eastern European countries, such strategies also include informal payments to health care providers. This paper analyzes the satisfaction of health care users with the quality of and access to health care services. The study focuses on six Central and Eastern European countries (Bulgaria, Hungary, Lithuania, Poland, Romania and Ukraine). We use data on past experience with health care use collected in 2010 through uniform national surveys in these countries. Based on these data, we carry out a multi-country analysis to investigate factors associated with the satisfaction of health care users in the six countries. The results indicate that about 10-14 % of the service users are not satisfied with the quality of, or access to health care services they used in the preceding year. However, significant differences across countries and services are observed, e.g. the highest level of dissatisfaction with access to outpatient services (16.4 %) is observed among patients in Lithuania, while in Poland, the level of dissatisfaction with quality of outpatient and inpatient services are much lower than dissatisfaction with access. The study also analyses the association of users' satisfaction with factors such as making informal payments, inability to pay and relative importance of service attributes stated by the service users. These multi-country findings provide evidence for health policy making in the Central and Eastern European countries. Although the average rates of satisfactions per country are relatively high, the results suggest that there is ample room for improvements. Specifically, many service-users still report dissatisfaction especially those who pay informally and those unable to pay. The high shares of informal payments and inability of users to deal with the health expenditures lead to doubts about the fairness of the health care provision in Central and Eastern Europe. There is an urgent need for policy makers in the region to not only acknowledge but also to effectively address this key problem.

Culture and Palliative Care: Preferences, Communication, Meaning, and Mutual Decision Making.

PubMed

Cain, Cindy L; Surbone, Antonella; Elk, Ronit; Kagawa-Singer, Marjorie

2018-05-01

Palliative care is gaining acceptance across the world. However, even when palliative care resources exist, both the delivery and distribution of services too often are neither equitably nor acceptably provided to diverse population groups. The goal of this study was to illustrate tensions in the delivery of palliative care for diverse patient populations to help clinicians to improve care for all. We begin by defining and differentiating culture, race, and ethnicity, so that these terms-often used interchangeably-are not conflated and are more effectively used in caring for diverse populations. We then present examples from an integrative literature review of recent research on culture and palliative care to illustrate both how and why varied responses to pain and suffering occur in different patterns, focusing on four areas of palliative care: the formation of care preferences, communication patterns, different meanings of suffering, and decision-making processes about care. For each area, we provide international and multiethnic examples of variations that emphasize the need for personalization of care and the avoidance of stereotyping beliefs and practices without considering individual circumstances and life histories. We conclude with recommendations for improving palliative care research and practice with cultural perspectives, emphasizing the need to work in partnerships with patients, their family members, and communities to identify and negotiate culturally meaningful care, promote quality of life, and ensure the highest quality palliative care for all, both domestically and internationally. Copyright © 2018 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

The European Society of Gastrointestinal Endoscopy Quality Improvement Initiative: developing performance measures.

PubMed

Rutter, Matthew D; Senore, Carlo; Bisschops, Raf; Domagk, Dirk; Valori, Roland; Kaminski, Michal F; Spada, Cristiano; Bretthauer, Michael; Bennett, Cathy; Bellisario, Cristina; Minozzi, Silvia; Hassan, Cesare; Rees, Colin; Dinis-Ribeiro, Mário; Hucl, Tomas; Ponchon, Thierry; Aabakken, Lars; Fockens, Paul

2016-02-01

The European Society of Gastrointestinal Endoscopy (ESGE) and United European Gastroenterology (UEG) have a vision to create a thriving community of endoscopy services across Europe, collaborating with each other to provide high quality, safe, accurate, patient-centered and accessible endoscopic care. Whilst the boundaries of what can be achieved by advanced endoscopy are continually expanding, we believe that one of the most fundamental steps to achieving our goal is to raise the quality of everyday endoscopy. The development of robust, consensus- and evidence-based key performance measures is the first step in this vision. ESGE and UEG have identified quality of endoscopy as a major priority. This paper explains the rationale behind the ESGE Quality Improvement Initiative and describes the processes that were followed. We recommend that all units develop mechanisms for audit and feedback of endoscopist and service performance using the ESGE performance measures that will be published in future issues of this journal over the next year. We urge all endoscopists and endoscopy services to prioritize quality and to ensure that these performance measures are implemented and monitored at a local level, so that we can provide the highest possible care for our patients.

A criteria-based clinical audit on the case-management of children presenting with malaria at Mangochi District Hospital, Malawi.

PubMed

Diep, Phuong Phuong; Lien, Lars; Hofman, Jan

2007-01-01

Malaria is a major threat to global health and is one of the leading causes of death worldwide. It is estimated that 2.3 billion people live in areas of malaria risk and each year 300-500 million cases of Plasmodium falciparum malaria occur worldwide. This parasitic infection is one of the major causes of morbidity and mortality in Africa and approximately 90% of cases which include life-threatening malaria are in children, the highest mortality rate being found in children under the age of five. Improvement in case-management of malaria in children is one of the strategies in the prevention of infant mortality. In particular, the health system needs to concentrate on good quality care at the first referral level of the district hospital, as health care provided at this level is crucial for reducing child mortality and for a credible and effective support for the primary health care system. The conduct of systematic assessments of clinical care of malaria including the diagnostic process, medical treatment and nursing care in order to reveal shortcomings in case-management and make improvements are vital. Clinical audit is now routinely used and accepted as part of quality assurance in the health care services of many developed countries, but it has yet to be widely applied to the developing world. The principal objective of the study conducted, was therefore to assess the clinical care of children with malaria at district hospital level in a low-income African country to highlight potential areas of improvement in the quality of care of malaria. At the same time, the specific objectives involved: Assessment of diagnostic process, medical treatment and nursing care; Identification of strengths and deficiencies in current practice; Identification of factors contributing to poor quality of care; Finding strategies to improve current practice.

Primary Care Physician Panel Size and Quality of Care: A Population-Based Study in Ontario, Canada.

PubMed

Dahrouge, Simone; Hogg, William; Younger, Jaime; Muggah, Elizabeth; Russell, Grant; Glazier, Richard H

2016-01-01

The purpose of this study was to determine the relationship between the number of patients under a primary care physician's care (panel size) and primary care quality indicators. We conducted a cross-sectional, population-based study of fee-for-service and capitated interprofessional and non-interprofessional primary health care practices in Ontario, Canada between April 2008 and March 2010, encompassing 4,195 physicians with panel sizes ≥1,200 serving 8.3 million patients. Data was extracted from multiple linked, health-related administrative databases and covered 16 quality indicators spanning 5 dimensions of care: access, continuity, comprehensiveness, and evidence-based indicators of cancer screening and chronic disease management. The likelihood of being up-to-date on cervical, colorectal, and breast cancer screening showed relative decreases of 7.9% (P <.001), 5.9% (P = .01), and 4.6% (P <.001), respectively, with increasing panel size (from 1,200 to 3,900). Eight chronic care indicators (4 medication-based and 4 screening-based) showed no significant association with panel size. The likelihood of individuals with a new diagnosis of congestive heart failure having an echocardiogram, however, increased by a relative 8.1% (P <.001) with higher panel size. Increasing panel size was also associated with a 10.8% relative increase in hospitalization rates for ambulatory-care-sensitive conditions (P = .04) and a 10.8% decrease in non-urgent emergency department visits (P = .004). Continuity was highest with medium panel sizes (P <.001), and comprehensiveness had a small decrease (P = .03) with increasing panel size. Increasing panel size was associated with small decreases in cancer screening, continuity, and comprehensiveness, but showed no consistent relationships with chronic disease management or access indicators. We found no panel size threshold above which quality of care suffered. © 2016 Annals of Family Medicine, Inc.

Examining asthma quality of care using a population-based approach

PubMed Central

Klomp, Helena; Lawson, Joshua A.; Cockcroft, Donald W.; Chan, Benjamin T.; Cascagnette, Paul; Gander, Laurie; Jorgenson, Derek

2008-01-01

Background Asthma accounts for considerable burden on health care, but in most cases, asthma can be controlled. Quality-of-care indicators would aid in monitoring asthma management. We describe the quality of asthma care using a set of proposed quality indicators. Methods We performed a retrospective cross-sectional study using health databases in Saskatchewan, a Canadian province with a population of about 1 million people. We assessed 6 quality-of-care indicators among people with asthma: admission to hospital because of asthma; poor asthma control (high use of short-acting β-agonists, admission to hospital because of asthma or death due to asthma); no inhaled corticosteroid use among patients with poor control; at least moderate inhaled corticosteroid use among patients with poor control; high inhaled corticosteroid use and use of another preventer medication among patients with poor control; and any main preventer use among patients with poor control. We calculated crude and adjusted rates with 95% confidence intervals. We tested for differences using the χ2 test for proportions and generalized linear modelling techniques. Results In 2002/03, there were 24 616 people aged 5–54 years with asthma in Saskatchewan, representing a prevalence of 3.8%. Poor symptom control was observed in 18% of patients with asthma. Among those with poor control, 37% were not dispensed any inhaled corticosteroids, and 40% received potentially inadequate doses. Among those with poor control who were dispensed high doses of inhaled corticosteroids, 26% also used another preventer medication. Hospital admissions because of asthma were highest among those aged 6–9 years and females aged 20–44 years. Males and those in adult age groups (predominantly 20–44 years) had worse quality of care for 4 indicators examined. Interpretation Suboptimal asthma management would be improved through increased use of inhaled corticosteroids and preventer medications, and reduced reliance on short-acting β-agonist medications as recommended by consensus guidelines. PMID:18390944

Output congestion leads to compromised care in Peruvian public hospital neonatal units.

PubMed

Arrieta, Alejandro; Guillén, Jorge

2017-06-01

Peru is moving toward a universal health insurance system, and it is facing important challenges in the provision of public health services. As more citizens gain access to health insurance, the flow of patients exceeds the capacity of public hospitals to provide care with quality. In this study we explore the relationship between technical efficiency and patient safety events in neonatal care units of Peru's public hospitals. We use Data Envelope Analysis (DEA) with output congestion to assess the association between technical efficiency and patient safety events. We study 35 neonatal care units of public hospitals in Peru's Social Security Health System, and identify two undesirable (risk-adjusted) safety outcomes: neonatal mortality and near-miss neonatal mortality. We found that for about half of hospital's neonatal care units, technical efficiency is affected by output congestion. For those hospitals, patient safety is being compromised by receiving too many patients. Our results are consistent with public reports indicating that hospitals in the Peru's Social Security Health System are overcrowded, affecting efficiency and jeopardizing quality of care. We found that most congested hospitals are located in the capital city and suburban areas, and are more likely to be hospitals with the lowest and the highest level of care. Our results call for improvements in the patient referral system and capacity expansion.

High Neonatal Mortality Rates in Rural India: What Options to Explore?

PubMed Central

Upadhyay, Ravi Prakash; Chinnakali, Palanivel; Odukoya, Oluwakemi; Yadav, Kapil; Sinha, Smita; Rizwan, S. A.; Daral, Shailaja; Chellaiyan, Vinoth G.; Silan, Vijay

2012-01-01

The neonatal mortality rate in India is amongst the highest in the world and skewed towards rural areas. Nonavailability of trained manpower along with poor healthcare infrastructure is one of the major hurdles in ensuring quality neonatal care. We reviewed case studies and relevant literature from low and middle income countries and documented alternative strategies that have proved to be favourable in improving neonatal health. The authors reiterate the fact that recruiting and retaining trained manpower in rural areas by all means is essential to improve the quality of neonatal care services. Besides this, other strategies such as training of local rural healthcare providers and traditional midwives, promoting home-based newborn care, and creating community awareness and mobilization also hold enough potential to influence the neonatal health positively and efforts should be made to implement them on a larger scale. More research is demanded for innovations such as “m-health” and public-private partnerships as they have been shown to offer potential in terms of improving the standards of care. The above proposed strategy is likely to reduce morbidity among neonatal survivors as well. PMID:23213561

Assessment of medication adherence app features, functionality, and health literacy level and the creation of a searchable Web-based adherence app resource for health care professionals and patients.

PubMed

Heldenbrand, Seth; Martin, Bradley C; Gubbins, Paul O; Hadden, Kristie; Renna, Catherine; Shilling, Rebecca; Dayer, Lindsey

2016-01-01

To assess the features and level of health literacy (HL) of available medication adherence apps and to create a searchable website to assist health care providers (HCP) and patients identify quality adherence apps. Medication nonadherence continues to be a significant problem and leads to poor health outcomes and avoidable health care expense. The average adherence rate for chronic medications, regardless of disease state, is approximately 50% leaving significant room for improvement. Smartphone adherence apps are a novel resource to address medication nonadherence. With widespread smartphone use and the growing number of adherence apps, both HCP and patients should be able to identify quality adherence apps to maximize potential benefits. Assess the features, functionality and level of HL of available adherence apps and create a searchable website to help both HCP and patients identify quality adherence apps. Online marketplaces (iTunes, Google Play, Blackberry) were searched in June of 2014 to identify available adherence apps. Online descriptions were recorded and scored based on 28 author-identified features across 4 domains. The 100 highest-scoring apps were user-tested with a standardized regimen to evaluate their functionality and level of HL. 461 adherence apps were identified. 367 unique apps were evaluated after removing "Lite/Trial" versions. The median initial score based on descriptions was 15 (max of 68; range: 3 to 47). Only 77 apps of the top 100 highest-scoring apps completed user-testing and HL evaluations. The median overall user-testing score was 30 (max of 73; range: 16 to 55). App design, functionality, and level of HL varies widely among adherence apps. While no app is perfect, several apps scored highly across all domains. The website www.medappfinder.com is a searchable tool that helps HCP and patients identify quality apps in a crowded marketplace. Copyright © 2016 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.

Providing Our Fellows in Training with Education on Inflammatory Bowel Disease Health Maintenance to Improve the Quality of Care in Our Health Care System.

PubMed

Lee, Ann Joo; Kraemer, Dale F; Smotherman, Carmen; Eid, Emely

2016-01-01

Inflammatory bowel disease (IBD) quality measures were established in an effort to standardize IBD health care. Despite effort to improve clinical performance, considerable variations in practice still exist. To further improve IBD health care, we propose incorporating an in-service educational session on IBD health maintenance to provide trainees with increasing awareness and knowledge on IBD management. Fifty electronic medical charts were randomly selected, and the level of quality documentation was assessed for 15 core IBD quality measures. Data were reported as the percentage of charts meeting audit criteria (compliance score). Fellows then attended an in-service educational session to review IBD quality measures and reinforce practice expectations. A second audit was then performed on an additional 50 patient charts to determine whether documentation practices improved after the educational session. We found a positive correlation between an in-service educational session and fellows' compliance with IBD health maintenance. Overall, the fellows' compliance score increased by 18% (before intervention, 65%; after intervention, 83%; P < 0.0001). The intervention was equally beneficial irrespective of training level. Although the magnitude of improvement was comparable, the mean compliance score was highest in year 2 at 81% (year 1: 72% [P = 0.019] and year 3: 70% [P = 0.002]). Fellows expressed a high degree of satisfaction with the educational intervention and emphasized the value in reviewing the conceptual bases for IBD health maintenance. Incorporating a standard curriculum on IBD health maintenance provides fellows in training with increased awareness and guidance on managing the unique preventive care needs of patients with IBD.

Preanalytical quality in clinical chemistry laboratory.

PubMed

Ahmad, M Imteyaz; Ramesh, K L; Kumar, Ravi

2014-01-01

Haemolysis is usually caused by inadequate specimen collection or preanalytical handling and is suggested to be a suitable indicator of preanalytical quality. We investigated the prevalence of detectable haemolysis in all routine venous blood samples in OPDs and IPDs to identify differences in preanalytical quality. Haemolysis index (HI) values were obtained from a Vitros 5,1 in the routine clinical chemistry laboratory for samples collected in the outpatient department (OPD) collection centres, a hospital, and inpatient departments (IPD). Haemolysis was defined as a HI > or = 15 (detection limit). Samples from the OPD with the highest prevalence of haemolysis were 6.1 times (95% confidence interval (CI) 4.0 - 9.2) more often haemolysed compared to the center with the lowest prevalence. Of the samples collected in primary health care, 10.4% were haemolysed compared to 31.1% in the IPDs (p = 0.001). A notable difference in haemolysed samples was found between the IPDs section staffed by emergency medicine physicians and the section staffed by primary health care physicians (34.8% vs. 11.3%, p = 0.001). The significant variation in haemolysis indices among the investigated units is likely to reflect varying preanalytical conditions. The HI is a valuable tool for estimation and follow-up of preanalytical quality in the health care laboratory.

The World Database for Pediatric and Congenital Heart Surgery: The Dawn of a New Era of Global Communication and Quality Improvement in Congenital Heart Disease.

PubMed

St Louis, James D; Kurosawa, Hiromi; Jonas, Richard A; Sandoval, Nestor; Cervantes, Jorge; Tchervenkov, Christo I; Jacobs, Jeffery P; Sakamoto, Kisaburo; Stellin, Giovanni; Kirklin, James K

2017-09-01

The World Society for Pediatric and Congenital Heart Surgery was founded with the mission to "promote the highest quality comprehensive cardiac care to all patients with congenital heart disease, from the fetus to the adult, regardless of the patient's economic means, with an emphasis on excellence in teaching, research, and community service." Early on, the Society's members realized that a crucial step in meeting this goal was to establish a global database that would collect vital information, allowing cardiac surgical centers worldwide to benchmark their outcomes and improve the quality of congenital heart disease care. With tireless efforts from all corners of the globe and utilizing the vast experience and invaluable input of multiple international experts, such a platform of global information exchange was created: The World Database for Pediatric and Congenital Heart Disease went live on January 1, 2017. This database has been thoughtfully designed to produce meaningful performance and quality analyses of surgical outcomes extending beyond immediate hospital survival, allowing capture of important morbidities and mortalities for up to 1 year postoperatively. In order to advance the societal mission, this quality improvement program is available free of charge to WSPCHS members. In establishing the World Database, the Society has taken an essential step to further the process of global improvement in care for children with congenital heart disease.

Ventanillas de Salud: A Collaborative and Binational Health Access and Preventive Care Program.

PubMed

Rangel Gomez, Maria Gudelia; Tonda, Josana; Zapata, G Rogelio; Flynn, Michael; Gany, Francesca; Lara, Juanita; Shapiro, Ilan; Rosales, Cecilia Ballesteros

2017-01-01

While individuals of Mexican origin are the largest immigrant group living in the U.S., this population is also the highest uninsured. Health disparities related to access to health care, among other social determinants, continue to be a challenge for this population. The government of Mexico, in an effort to address these disparities and improve the quality of life of citizens living abroad, has partnered with governmental and non-governmental health-care organizations in the U.S. by developing and implementing an initiative known as Ventanillas de Salud -Health Windows-(VDS). The VDS is located throughout the Mexican Consular network and aim to increase access to health care and health literacy, provide health screenings, and promote healthy lifestyle choices among low-income and immigrant Mexican populations in the U.S.

Quality indicators for musculoskeletal injury management in the emergency department: a systematic review.

PubMed

Strudwick, Kirsten; Nelson, Mark; Martin-Khan, Melinda; Bourke, Michael; Bell, Anthony; Russell, Trevor

2015-02-01

There is increasing importance placed on quality of health care for musculoskeletal injuries in emergency departments (EDs). This systematic review aimed to identify existing musculoskeletal quality indicators (QIs) developed for ED use and to critically evaluate their methodological quality. MEDLINE, EMBASE, CINAHL, and the gray literature, including relevant organizational websites, were searched in 2013. English-language articles were included that described the development of at least one QI related to the ED care of musculoskeletal injuries. Data extraction of each included article was conducted. A quality assessment was then performed by rating each relevant QI against the Appraisal of Indicators through Research and Evaluation (AIRE) Instrument. QIs with similar definitions were grouped together and categorized according to the health care quality frameworks of Donabedian and the Institute of Medicine. The search revealed 1,805 potentially relevant articles, of which 15 were finally included in the review. The number of relevant QIs per article ranged from one to 11, resulting in a total of 71 QIs overall. Pain (n = 17) and fracture management (n = 13) QIs were predominant. Ten QIs scored at least 50% across all AIRE Instrument domains, and these related to pain management and appropriate imaging of the spine. Methodological quality of the development of most QIs is poor. Recommendations for a core set of QIs that address the complete spectrum of musculoskeletal injury management in emergency medicine is not possible, and more work is needed. Currently, QIs with highest methodological quality are in the areas of pain management and medical imaging. © 2015 by the Society for Academic Emergency Medicine.

Medicaid program choice, inertia and adverse selection.

PubMed

Marton, James; Yelowitz, Aaron; Talbert, Jeffery C

2017-12-01

In 2012, Kentucky implemented Medicaid managed care statewide, auto-assigned enrollees to three plans, and allowed switching. Using administrative data, we find that the state's auto-assignment algorithm most heavily weighted cost-minimization and plan balancing, and placed little weight on the quality of the enrollee-plan match. Immobility - apparently driven by health plan inertia - contributed to the success of the cost-minimization strategy, as more than half of enrollees auto-assigned to even the lowest quality plans did not opt-out. High-cost enrollees were more likely to opt-out of their auto-assigned plan, creating adverse selection. The plan with arguably the highest quality incurred the largest initial profit margin reduction due to adverse selection prior to risk adjustment, as it attracted a disproportionate share of high-cost enrollees. The presence of such selection, caused by differential degrees of mobility, raises concerns about the long run viability of the Medicaid managed care market without such risk adjustment. Copyright © 2017 Elsevier B.V. All rights reserved.

Provincial development of a patient-reported outcome initiative to guide patient care, quality improvement, and research.

PubMed

Olson, Robert A; Howard, Fuchsia; Lapointe, Vincent; Schellenberg, Devin; Nichol, Alan; Bowering, Gale; Curtis, Susan; Walter, Allison; Brown, Steven; Thompson, Corinne; Bergin, Jackie; Lomas, Sheri; French, John; Halperin, Ross; Tyldesley, Scott; Beckham, Wayne

2018-01-01

The BC Cancer Agency Radiotherapy (RT) program started the Prospective Outcomes and Support Initiative (POSI) at all six centres to utilize patient-reported outcomes for immediate clinical care, quality improvement, and research. Patient-reported outcomes were collected at time of computed tomography simulation via tablet and 2 to 4 weeks post-RT via either tablet or over the phone by a registered nurse. From 2013 to 2016, patients were approached on 20,150 attempts by POSI for patients treated with RT for bone metastases (52%), brain metastases (11%), lung cancer (17%), gynecological cancer (16%), head and neck cancer (2%), and other pilots (2%). The accrual rate for all encounters was 85% (n = 17,101), with the accrual rate varying between the lowest and the highest accruing centre from 78% to 89% ( P < .001) and varying by tumour site ( P < .001). Using the POSI database, we have performed research and quality improvement initiatives that have changed practice.

The reliability of the German version of the Richards Campbell Sleep Questionnaire.

PubMed

Krotsetis, Susanne; Richards, Kathy C; Behncke, Anja; Köpke, Sascha

2017-07-01

The assessment of sleep quality in critically ill patients is a relevant factor of high-quality care. Despite the fact that sleep disturbances and insufficient sleep management contain an increased risk of severe morbidity for these patients, a translated and applicable instrument to evaluate sleep is not available for German-speaking intensive care settings. This study aimed to translate the Richards Campbell Sleep Questionnaire (RCSQ), a simple and validated instrument eligible for measuring sleep quality in critically ill patients, and subsequently to evaluate the internal consistency of the German version of the RCSQ. Furthermore, it also aimed to inquire into the perception of sleep in a sample of critically ill patients. The RCSQ was translated following established methodological standards. Data were collected cross-sectionally in a sample of 51 patients at 3 intensive care units at a university hospital in Germany. The German version of the RCSQ showed an overall internal consistency (Cronbach's alpha) of 0·88. The mean of the RSCQ in the sample was 47·00 (SD ± 27·57). Depth of sleep was rated the lowest and falling asleep again the highest of the RCSQ sleep items. The study demonstrated very good internal consistency of the German version of the RCSQ, allowing for its application in practice and research in German-speaking countries. Quality of sleep perception was generally low in this sample, emphasizing the need for enhanced care concepts regarding the sleep management of critically ill patients. Relevance to clinical practice Assessment of self-perception of sleep is crucial in order to plan an individually tailored care process. © 2017 British Association of Critical Care Nurses.

Influence of medical care in the quality of life (WHOQOL-100) of women living with systemic lupus erythematosus.

PubMed

da Silva, Juliana Passos; Amadei, Janete Lane

2016-01-01

Lupus requires careful treatment by medical specialists. This study aimed to evaluate the quality of life of patients living with Systemic Lupus Erythematosus (SLE). The method approached women with a confirmed diagnosis of SLE under medical supervision in a University hospital outpatient clinic or in a private clinic. We used an instrument containing relevant information of the patient and also the Portuguese version of the World Health Organization Quality of Life Group (WHOQOL-100) questionnaire. The study population consisted of 39 women, married in their majority (56.4%); prevalently aged 37-60 years old; prevalence of diagnosis time over five years (66.7%); and in use of less than 5 medications (69.2%). 92.3% had the disease inactive with higher means in mobility (p=0.0463) and quality of life (p=0.0199) facets; on the other hand, the physical safety and security facet (p=0.0093) showed higher mean for people with active disease. Health and social care analysis showed availability and quality (p=0.0434), even when with other associated diseases (33.3%); and the highest means were Dependence on medicinal substances and medical aids (p=0.0143). The negative results for associated diseases were higher in sexual activity (p=0.0431) and transportation (p=0.0319) facets. if women living with SLE receive continuous medical attention, they will enjoy good quality of life, while minimizing the complications inherent in this condition. Copyright © 2015 Elsevier Editora Ltda. All rights reserved.

Healthcare Access and Quality Index based on mortality from causes amenable to personal health care in 195 countries and territories, 1990-2015: a novel analysis from the Global Burden of Disease Study 2015.

PubMed

2017-07-15

National levels of personal health-care access and quality can be approximated by measuring mortality rates from causes that should not be fatal in the presence of effective medical care (ie, amenable mortality). Previous analyses of mortality amenable to health care only focused on high-income countries and faced several methodological challenges. In the present analysis, we use the highly standardised cause of death and risk factor estimates generated through the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) to improve and expand the quantification of personal health-care access and quality for 195 countries and territories from 1990 to 2015. We mapped the most widely used list of causes amenable to personal health care developed by Nolte and McKee to 32 GBD causes. We accounted for variations in cause of death certification and misclassifications through the extensive data standardisation processes and redistribution algorithms developed for GBD. To isolate the effects of personal health-care access and quality, we risk-standardised cause-specific mortality rates for each geography-year by removing the joint effects of local environmental and behavioural risks, and adding back the global levels of risk exposure as estimated for GBD 2015. We employed principal component analysis to create a single, interpretable summary measure-the Healthcare Quality and Access (HAQ) Index-on a scale of 0 to 100. The HAQ Index showed strong convergence validity as compared with other health-system indicators, including health expenditure per capita (r=0·88), an index of 11 universal health coverage interventions (r=0·83), and human resources for health per 1000 (r=0·77). We used free disposal hull analysis with bootstrapping to produce a frontier based on the relationship between the HAQ Index and the Socio-demographic Index (SDI), a measure of overall development consisting of income per capita, average years of education, and total fertility rates. This frontier allowed us to better quantify the maximum levels of personal health-care access and quality achieved across the development spectrum, and pinpoint geographies where gaps between observed and potential levels have narrowed or widened over time. Between 1990 and 2015, nearly all countries and territories saw their HAQ Index values improve; nonetheless, the difference between the highest and lowest observed HAQ Index was larger in 2015 than in 1990, ranging from 28·6 to 94·6. Of 195 geographies, 167 had statistically significant increases in HAQ Index levels since 1990, with South Korea, Turkey, Peru, China, and the Maldives recording among the largest gains by 2015. Performance on the HAQ Index and individual causes showed distinct patterns by region and level of development, yet substantial heterogeneities emerged for several causes, including cancers in highest-SDI countries; chronic kidney disease, diabetes, diarrhoeal diseases, and lower respiratory infections among middle-SDI countries; and measles and tetanus among lowest-SDI countries. While the global HAQ Index average rose from 40·7 (95% uncertainty interval, 39·0-42·8) in 1990 to 53·7 (52·2-55·4) in 2015, far less progress occurred in narrowing the gap between observed HAQ Index values and maximum levels achieved; at the global level, the difference between the observed and frontier HAQ Index only decreased from 21·2 in 1990 to 20·1 in 2015. If every country and territory had achieved the highest observed HAQ Index by their corresponding level of SDI, the global average would have been 73·8 in 2015. Several countries, particularly in eastern and western sub-Saharan Africa, reached HAQ Index values similar to or beyond their development levels, whereas others, namely in southern sub-Saharan Africa, the Middle East, and south Asia, lagged behind what geographies of similar development attained between 1990 and 2015. This novel extension of the GBD Study shows the untapped potential for personal health-care access and quality improvement across the development spectrum. Amid substantive advances in personal health care at the national level, heterogeneous patterns for individual causes in given countries or territories suggest that few places have consistently achieved optimal health-care access and quality across health-system functions and therapeutic areas. This is especially evident in middle-SDI countries, many of which have recently undergone or are currently experiencing epidemiological transitions. The HAQ Index, if paired with other measures of health-system characteristics such as intervention coverage, could provide a robust avenue for tracking progress on universal health coverage and identifying local priorities for strengthening personal health-care quality and access throughout the world. Bill & Melinda Gates Foundation. Copyright © 2017 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.

Medical Home Transformation in Pediatric Primary Care—What Drives Change?

PubMed Central

McAllister, Jeanne W.; Cooley, W. Carl; Van Cleave, Jeanne; Boudreau, Alexy Arauz; Kuhlthau, Karen

2013-01-01

PURPOSE The aim of this study was to characterize essential factors to the medical home transformation of high-performing pediatric primary care practices 6 to 7 years after their participation in a national medical home learning collaborative. METHODS We evaluated the 12 primary care practice teams having the highest Medical Home Index (MHI) scores after participation in a national medical home learning collaborative with current MHI scores, a clinician staff questionnaire (assessing adaptive reserve), and semistructured interviews. We reviewed factors that emerged from interviews and analyzed domains and subdomains for their agreement with MHI and adaptive reserve domains and subthemes using a process of triangulation. RESULTS At 6 to 7 years after learning collaborative participation, 4 essential medical home attributes emerged as drivers of transformation: (1) a culture of quality improvement, (2) family-centered care with parents as improvement partners, (3) team-based care, and (4) care coordination. These high-performing practices developed comprehensive, family-centered, planned care processes including flexible access options, population approaches, and shared care plans. Eleven practices evolved to employ care coordinators. Family satisfaction appeared to stem from better access, care, and safety, and having a strong relationship with their health care team. Physician and staff satisfaction was high even while leadership activities strained personal time. CONCLUSIONS Participation in a medical home learning collaborative stimulated, but did not complete, medical home changes in 12 pediatric practices. Medical home transformation required continuous development, ongoing quality improvement, family partnership skills, an attitude of teamwork, and strong care coordination functions. PMID:23690392

A Quality Improvement Collaborative to Improve the Discharge Process for Hospitalized Children.

PubMed

Wu, Susan; Tyler, Amy; Logsdon, Tina; Holmes, Nicholas M; Balkian, Ara; Brittan, Mark; Hoover, LaVonda; Martin, Sara; Paradis, Melisa; Sparr-Perkins, Rhonda; Stanley, Teresa; Weber, Rachel; Saysana, Michele

2016-08-01

To assess the impact of a quality improvement collaborative on quality and efficiency of pediatric discharges. This was a multicenter quality improvement collaborative including 11 tertiary-care freestanding children's hospitals in the United States, conducted between November 1, 2011 and October 31, 2012. Sites selected interventions from a change package developed by an expert panel. Multiple plan-do-study-act cycles were conducted on patient populations selected by each site. Data on discharge-related care failures, family readiness for discharge, and 72-hour and 30-day readmissions were reported monthly by each site. Surveys of each site were also conducted to evaluate the use of various change strategies. Most sites addressed discharge planning, quality of discharge instructions, and providing postdischarge support by phone. There was a significant decrease in discharge-related care failures, from 34% in the first project quarter to 21% at the end of the collaborative (P < .05). There was also a significant improvement in family perception of readiness for discharge, from 85% of families reporting the highest rating to 91% (P < .05). There was no improvement in unplanned 72-hour (0.7% vs 1.1%, P = .29) and slight worsening of the 30-day readmission rate (4.5% vs 6.3%, P = .05). Institutions that participated in the collaborative had lower rates of discharge-related care failures and improved family readiness for discharge. There was no significant improvement in unplanned readmissions. More studies are needed to evaluate which interventions are most effective and to assess feasibility in non-children's hospital settings. Copyright © 2016 by the American Academy of Pediatrics.

Breadth of Coverage, Ease of Use, and Quality of Mobile Point-of-Care Tool Information Summaries: An Evaluation

PubMed Central

Ren, Jinma

2016-01-01

Background With advances in mobile technology, accessibility of clinical resources at the point of care has increased. Objective The objective of this research was to identify if six selected mobile point-of-care tools meet the needs of clinicians in internal medicine. Point-of-care tools were evaluated for breadth of coverage, ease of use, and quality. Methods Six point-of-care tools were evaluated utilizing four different devices (two smartphones and two tablets). Breadth of coverage was measured using select International Classification of Diseases, Ninth Revision, codes if information on summary, etiology, pathophysiology, clinical manifestations, diagnosis, treatment, and prognosis was provided. Quality measures included treatment and diagnostic inline references and individual and application time stamping. Ease of use covered search within topic, table of contents, scrolling, affordance, connectivity, and personal accounts. Analysis of variance based on the rank of score was used. Results Breadth of coverage was similar among Medscape (mean 6.88), Uptodate (mean 6.51), DynaMedPlus (mean 6.46), and EvidencePlus (mean 6.41) (P>.05) with DynaMed (mean 5.53) and Epocrates (mean 6.12) scoring significantly lower (P<.05). Ease of use had DynaMedPlus with the highest score, and EvidencePlus was lowest (6.0 vs 4.0, respectively, P<.05). For quality, reviewers rated the same score (4.00) for all tools except for Medscape, which was rated lower (P<.05). Conclusions For breadth of coverage, most point-of-care tools were similar with the exception of DynaMed. For ease of use, only UpToDate and DynaMedPlus allow for search within a topic. All point-of-care tools have remote access with the exception of UpToDate and Essential Evidence Plus. All tools except Medscape covered criteria for quality evaluation. Overall, there was no significant difference between the point-of-care tools with regard to coverage on common topics used by internal medicine clinicians. Selection of point-of-care tools is highly dependent on individual preference based on ease of use and cost of the application. PMID:27733328

Perceived quality of physiotherapy services among informal caregivers of children with cerebral palsy in Ibadan, Nigeria.

PubMed

Olaleye, Olubukola A; Hamzat, Talhatu K; Oloso, Modinat O

2015-01-01

Effective physiotherapy intervention for children with cerebral palsy (CP) requires that expectations of their caregivers be incorporated into treatment plans and strategies. This study explored the perceived Quality of Physiotherapy (QoP) for children with CP in Ibadan, Nigeria This cross-sectional survey explored the perceived QoP using the SERVQUAL instrument among informal caregivers of children with CP from two different healthcare facilities. Data was analysed using Mann Whiney U and Wilcoxon Signed Rank tests at p ≤ 0.05. Fifty-three informal caregivers (50 females, 3 males) of children with CP (32 males, 21 females) were surveyed. Fourth-fifths (81.13%) of the caregivers perceived the QoP service for their children as poor. The highest negative and positive ranks were in the tangible and responsiveness dimensions of the SERVQUAL respectively. The study demonstrated that caregivers of children with CP perceived the quality of physiotherapy provided for their children as poor. This poor perception is related more to the tangible dimension of care. Strategies to improve care environment for children with CP and their informal caregivers should be implemented to engender satisfaction with care.

International hospital productivity comparison: experiences from the Nordic countries.

PubMed

Medin, Emma; Häkkinen, Unto; Linna, Miika; Anthun, Kjartan S; Kittelsen, Sverre A C; Rehnberg, Clas

2013-09-01

This article focuses on describing the methodological challenges intrinsic in international comparative studies of hospital productivity and how these challenges have been addressed within the context of hospital comparisons in the Nordic countries. The hospital sectors in the Nordic countries are suitable for international comparison as they exhibit similar structures in the organisation for hospital care, hold administrative data of good quality at the hospital level, apply a similar secondary patient classification system, and use similar definitions of operating costs. The results of a number of studies have suggested marked differences in hospital cost efficiency and hospital productivity across the Nordic countries and the Finnish hospitals have the highest estimates in all the analyses. Explanatory factors that were tested and seemed to be of limited importance included institutional, structural and technical. A factor that is yet to be included in the Nordic hospital productivity comparison is the quality of care. Patient-level data available from linkable national registers in each country enable the development of quality indicators and will be included in the forthcoming hospital productivity studies within the context of the EuroHOPE (European health care outcomes, performance and efficiency) project. Copyright © 2013 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

Determinants of Quality of Life and the Need for Support for the Elderly with Good Physical and Mental Functioning.

PubMed

Talarska, Dorota; Tobis, Sławomir; Kotkowiak, Marta; Strugała, Magdalena; Stanisławska, Joanna; Wieczorowska-Tobis, Katarzyna

2018-03-19

BACKGROUND The ageing of population is the reason that there are various strategies developed to help seniors acquire greater independence and a better quality of life. The aim of this study was to explore the relationship between the elderly peope's need for assistance and assessed quality of life. MATERIAL AND METHODS The study included 100 participants who were members of a Seniors Club in Poznań, Poland. The cross-sectional study utilized the following instruments: Abbreviated Mental Test Score (AMTS), Instrumental Activities of Daily Living (IADL), EASY-Care Standard 2010 questionnaire, (WHO Quality of Life-BREF (WHOQOL-BREF) questionnaire. RESULTS Members of the Seniors' Club showed good functional condition. In the AMTS test, they scored near maximum values (average 9.39±0.77 points), somewhat poorer results were found in the IADL scale (average 20.92±3.96 points). In the EASY-Care questionnaire, the study participants usually required partial support in the following areas: Mental health and well-being (59%), Staying healthy (29%), Getting around (22%), and Seeing, hearing and communicating (22%). The average score on Independence was 13.13±18.51, The risk of breakdown in care scale was 4.39±3.21. The risk of falls affected 21 participants (21%). Quality of life study using WHOQOL-BREF questionnaire found that the highest scores were achieved in Psychological and Environment domains, and the lowest score in the Physical health domain. CONCLUSIONS Quality of life as well as level of independence, risk of falls, and need for 24-hour care were significantly affected by the following factors: urinary incontinence, difficulties in mobility outside the home, despondency, and forgetfulness.

[Professional quality of life in the clinical governance model of Asturias (Spain)].

PubMed

Díaz Corte, Carmen; Suárez Álvarez, Óscar; Fueyo Gutiérrez, Alejandra; Mola Caballero de Rodas, Pablo; Rancaño García, Iván; Sánchez Fernández, Ana María; Suárez Gutiérrez, Rebeca; Díaz Vázquez, Carlos

2013-01-01

To evaluate professional quality of life in our clinical governance model by comparing differences according to the time since the model's implementation (1-3 years) and the setting (primary or hospital care). A cross-sectional descriptive study was performed. The 35-item, anonymous, self-administered Professional Quality of Life Questionnaire, with three additional questions, was applied. A minimum sample size for each clinical governance unit/area (CGU/CGA) was calculated. Descriptive, univariate and bivariate analyses were performed using the 35 items separately. The subscales of « management support », « workload » and « intrinsic motivation » were used as dependant variables, and the setting and time since implementation of the CGU/CGA as independent variables. Of the study population of 2572 professionals, 1395 (54%) responded (67% in primary care and 51% in hospital care). A total of 87% had been working for 5 years or more in their positions. Thirty-three percent had worked for less than a year in clinical governance. The item with the highest score was job training (8.39 ± 1.42) and that with the lowest was conflicts with peers (3.23 ± 2.2). Primary healthcare professionals showed better results in management support and quality of life at work and hospital professionals in workload. The clinical governance model obtained the best scores at 3 years and the worst at 1 year. These differences were especially favorable for clinical governance in hospitals: professionals working longer perceived a lower workload and more intrinsic motivation and quality of life. A longer time working in the clinical governance model was associated with better perception of professional quality of life, especially in hospital care. Copyright © 2012 SESPAS. Published by Elsevier Espana. All rights reserved.

Towards achievement of universal health care in India by 2020: a call to action

PubMed Central

Reddy, K Srinath; Patel, Vikram; Jha, Prabhat; Paul, Vinod K; Shiva Kumar, A K; Dandona, Lalit

2016-01-01

To sustain the positive economic trajectory that India has had during the past decade, and to honour the fundamental right of all citizens to adequate health care, the health of all Indian people has to be given the highest priority in public policy. We propose the creation of the Integrated National Health System in India through provision of universal health insurance, establishment of autonomous organisations to enable accountable and evidence-based good-quality health-care practices and development of appropriately trained human resources, the restructuring of health governance to make it coordinated and decentralised, and legislation of health entitlement for all Indian people. The key characteristics of our proposal are to strengthen the public health system as the primary provider of promotive, preventive, and curative health services in India, to improve quality and reduce the out-of-pocket expenditure on health care through a well regulated integration of the private sector within the national health-care system. Dialogue and consensus building among the stakeholders in the government, civil society, and private sector are the next steps to formalise the actions needed and to monitor their achievement. In our call to action, we propose that India must achieve health care for all by 2020. PMID:21227489

Towards achievement of universal health care in India by 2020: a call to action.

PubMed

Reddy, K Srinath; Patel, Vikram; Jha, Prabhat; Paul, Vinod K; Kumar, A K Shiva; Dandona, Lalit

2011-02-26

To sustain the positive economic trajectory that India has had during the past decade, and to honour the fundamental right of all citizens to adequate health care, the health of all Indian people has to be given the highest priority in public policy. We propose the creation of the Integrated National Health System in India through provision of universal health insurance, establishment of autonomous organisations to enable accountable and evidence-based good-quality health-care practices and development of appropriately trained human resources, the restructuring of health governance to make it coordinated and decentralised, and legislation of health entitlement for all Indian people. The key characteristics of our proposal are to strengthen the public health system as the primary provider of promotive, preventive, and curative health services in India, to improve quality and reduce the out-of-pocket expenditure on health care through a well regulated integration of the private sector within the national health-care system. Dialogue and consensus building among the stakeholders in the government, civil society, and private sector are the next steps to formalise the actions needed and to monitor their achievement. In our call to action, we propose that India must achieve health care for all by 2020. Copyright © 2011 Elsevier Ltd. All rights reserved.

A multicentre non-blinded randomised controlled trial to assess the impact of regular early specialist symptom control treatment on quality of life in malignant mesothelioma (RESPECT-MESO): study protocol for a randomised controlled trial.

PubMed

Gunatilake, Samal; Brims, Fraser J H; Fogg, Carole; Lawrie, Iain; Maskell, Nick; Forbes, Karen; Rahman, Najib; Morris, Steve; Ogollah, Reuben; Gerry, Stephen; Peake, Mick; Darlison, Liz; Chauhan, Anoop J

2014-09-19

Malignant pleural mesothelioma is an incurable cancer caused by exposure to asbestos. The United Kingdom has the highest death rate from mesothelioma in the world and this figure is increasing. Median survival is 8 to 12 months, and most patients have symptoms at diagnosis. The fittest patients may be offered chemotherapy with palliative intent. For patients not fit for systemic anticancer treatment, best supportive care remains the mainstay of management. A study from the United States examining advanced lung cancer showed that early specialist palliative care input improved patient health related quality of life and depression symptoms 12 weeks after diagnosis. While mesothelioma and advanced lung cancer share many symptoms and have a poor prognosis, oncology and palliative care services in the United Kingdom, and many other countries, vary considerably compared to the United States. The aim of this trial is to assess whether regular early symptom control treatment provided by palliative care specialists can improve health related quality of life in patients newly diagnosed with mesothelioma. This multicentre study is an non-blinded, randomised controlled, parallel group trial. A total of 174 patients with a new diagnosis of malignant pleural mesothelioma will be minimised with a random element in a 1:1 ratio to receive either 4 weekly regular early specialist symptom control care, or standard care. The primary outcome is health related quality of life for patients at 12 weeks. Secondary outcomes include health related quality of life for patients at 24 weeks, carer health related quality of life at 12 and 24 weeks, patient and carer mood at 12 and 24 weeks, overall survival and analysis of healthcare utilisation and cost. Current practice in the United Kingdom is to involve specialist palliative care towards the final weeks or months of a life-limiting illness. This study aims to investigate whether early, regular specialist care input can result in significant health related quality of life gains for patients with mesothelioma and if this change in treatment model is cost-effective. The results will be widely applicable to many institutions and patients both in the United Kingdom and internationally. Current controlled trials ISRCTN18955704. Date ISRCTN assigned: 31 January 2014.

Socioeconomic disparities in outcomes after acute myocardial infarction.

PubMed

Bernheim, Susannah M; Spertus, John A; Reid, Kimberly J; Bradley, Elizabeth H; Desai, Rani A; Peterson, Eric D; Rathore, Saif S; Normand, Sharon-Lise T; Jones, Philip G; Rahimi, Ali; Krumholz, Harlan M

2007-02-01

Patients of low socioeconomic status (SES) have higher mortality after acute myocardial infarction (AMI). Little is known about the underlying mechanisms or the relationship between SES and rehospitalization after AMI. We analyzed data from the PREMIER observational study, which included 2142 patients hospitalized with AMI from 18 US hospitals. Socioeconomic status was measured by self-reported household income and education level. Sequential multivariable modeling assessed the relationship of socioeconomic factors with 1-year all-cause mortality and all-cause rehospitalization after adjustment for demographics, clinical factors, and quality-of-care measures. Both household income and education level were associated with higher risk of mortality (hazard ratio 2.80, 95% CI 1.37-5.72, lowest to highest income group) and rehospitalization after AMI (hazard ratio 1.55, 95% CI 1.17-2.05). Patients with low SES had worse clinical status at admission and received poorer quality of care. In multivariable modeling, the relationship between household income and mortality was attenuated by adjustment for demographic and clinical factors (hazard ratio 1.19, 95% CI 0.54-2.62), with a further small decrement in the hazard ratio after adjustment for quality of care. The relationship between income and rehospitalization was only partly attenuated by demographic and clinical factors (hazard ratio 1.38, 95% CI 1.01-1.89) and was not influenced by adjustment for quality of care. Patients' baseline clinical status largely explained the relationship between SES and mortality, but not rehospitalization, among patients with AMI.

Quality of care in contraceptive services provided to young people in two Ugandan districts: a simulated client study.

PubMed

Nalwadda, Gorrette; Tumwesigye, Nazarius M; Faxelid, Elisabeth; Byamugisha, Josaphat; Mirembe, Florence

2011-01-01

Low and inconsistent use of contraceptives by young people contributes to unintended pregnancies. This study assessed quality of contraceptive services for young people aged 15-24 in two rural districts in Uganda. Five female and two male simulated clients (SCs) interacted with 128 providers at public, private not-for-profit (PNFP), and private for profit (PFP) health facilities. After consultations, SCs were interviewed using a structured questionnaire. Six aspects of quality of care (client's needs, choice of contraceptive methods, information given to users, client-provider interpersonal relations, constellation of services, and continuity mechanisms) were assessed. Descriptive statistics and factor analysis were performed. Means and categorized quality scores for all aspects of quality were low in both public and private facilities. The lowest quality scores were observed in PFP, and medium scores in PNFP facilities. The choice of contraceptive methods and interpersonal relations quality scores were slightly higher in public facilities. Needs assessment scores were highest in PNFP facilities. All facilities were classified as having low scores for appropriate constellation of services. Information given to users was suboptimal and providers promoted specific contraceptive methods. Minority of providers offered preferred method of choice and showed respect for privacy. The quality of contraceptive services provided to young people was low. Concurrent quality improvements and strengthening of health systems are needed.

Quality of Care in Contraceptive Services Provided to Young People in Two Ugandan Districts: A Simulated Client Study

PubMed Central

Nalwadda, Gorrette; Tumwesigye, Nazarius M.; Faxelid, Elisabeth; Byamugisha, Josaphat; Mirembe, Florence

2011-01-01

Background Low and inconsistent use of contraceptives by young people contributes to unintended pregnancies. This study assessed quality of contraceptive services for young people aged 15–24 in two rural districts in Uganda. Methods Five female and two male simulated clients (SCs) interacted with 128 providers at public, private not-for-profit (PNFP), and private for profit (PFP) health facilities. After consultations, SCs were interviewed using a structured questionnaire. Six aspects of quality of care (client's needs, choice of contraceptive methods, information given to users, client-provider interpersonal relations, constellation of services, and continuity mechanisms) were assessed. Descriptive statistics and factor analysis were performed. Results Means and categorized quality scores for all aspects of quality were low in both public and private facilities. The lowest quality scores were observed in PFP, and medium scores in PNFP facilities. The choice of contraceptive methods and interpersonal relations quality scores were slightly higher in public facilities. Needs assessment scores were highest in PNFP facilities. All facilities were classified as having low scores for appropriate constellation of services. Information given to users was suboptimal and providers promoted specific contraceptive methods. Minority of providers offered preferred method of choice and showed respect for privacy. Conclusions The quality of contraceptive services provided to young people was low. Concurrent quality improvements and strengthening of health systems are needed. PMID:22132168

Co-operative bidding of SMEs in health care sector.

PubMed

Mezgár, István; Kovács, György; Bonfatti, Fabio

2002-01-01

Tendering become an important process for customers in the health care sector to select products and services from the market for the lowest price, with the highest quality and with the shortest delivery time. The number of SMEs (Small and Medium-sized Enterprises) delivering products or services for the health care sector is increasing, but they have usually limited capital and expertise to participate in tenders. The paper introduces a possible solution for this problem, when SMEs form special groups, so called Smart Bidding Organisations (SBO), to prepare a bid for the tender jointly. The SBO appears for the customer (tender issuer) as a single enterprise and the bidding procedure will be faster and less expensive in this way.

Do Nursing Home Chain Size and Proprietary Status Affect Experiences With Care?

PubMed

You, Kai; Li, Yue; Intrator, Orna; Stevenson, David; Hirth, Richard; Grabowski, David; Banaszak-Holl, Jane

2016-03-01

In 2012, over half of nursing homes were operated by corporate chains. Facilities owned by the largest for-profit chains were reported to have lower quality of care. However, it is unknown how nursing home chain ownerships are related with experiences of care. To study the relationship between nursing home chain characteristics (chain size and profit status) with patients' family member reported ratings on experiences with care. Maryland nursing home care experience reports, the Online Survey, Certification, And Reporting (OSCAR) files, and Area Resource Files are used. Our sample consists of all nongovernmental nursing homes in Maryland from 2007 to 2010. Consumer ratings were reported for: overall care; recommendation of the facility; staff performance; care provided; food and meals; physical environment; and autonomy and personal rights. We identified chain characteristics from OSCAR, and estimated multivariate random effect linear models to test the effects of chain ownership on care experience ratings. Independent nonprofit nursing homes have the highest overall rating score of 8.9, followed by 8.6 for facilities in small nonprofit chains, and 8.5 for independent for-profit facilities. Facilities in small, medium, and large for-profit chains have even lower overall ratings of 8.2, 7.9, and 8.0, respectively. We find similar patterns of differences in terms of recommendation rate, and important areas such as staff communication and quality of care. Evidence suggests that Maryland nursing homes affiliated with large-for-profit and medium-for-profit chains had lower ratings of family reported experience with care.

Methodological Quality of National Guidelines for Pediatric Inpatient Conditions

PubMed Central

Hester, Gabrielle; Nelson, Katherine; Mahant, Sanjay; Eresuma, Emily; Keren, Ron; Srivastava, Rajendu

2014-01-01

Background Guidelines help inform standardization of care for quality improvement (QI). The Pediatric Research in Inpatient Settings (PRIS) network published a prioritization list of inpatient conditions with high prevalence, cost, and variation in resource utilization across children’s hospitals. The methodological quality of guidelines for priority conditions is unknown. Objective To rate the methodological quality of national guidelines for 20 priority pediatric inpatient conditions. Design We searched sources including PubMed for national guidelines published 2002–2012. Guidelines specific to one organism, test or treatment, or institution were excluded. Guidelines were rated by two raters using a validated tool (AGREE II) with an overall rating on a 7-point scale (7–highest). Inter-rater reliability was measured with a weighted kappa coefficient. Results 17 guidelines met inclusion criteria for 13 conditions, 7 conditions yielded no relevant national guidelines. The highest methodological quality guidelines were for asthma, tonsillectomy, and bronchiolitis (mean overall rating 7, 6.5 and 6.5 respectively); the lowest were for sickle cell disease (2 guidelines) and dental caries (mean overall rating 4, 3.5, and 3 respectively). The overall weighted kappa was 0.83 (95% confidence interval 0.78–0.87). Conclusions We identified a group of moderate to high methodological quality national guidelines for priority pediatric inpatient conditions. Hospitals should consider these guidelines to inform QI initiatives. PMID:24677729

Nursing home 5-star rating system exacerbates disparities in quality, by payer source.

PubMed

Konetzka, R Tamara; Grabowski, David C; Perraillon, Marcelo Coca; Werner, Rachel M

2015-05-01

Market-based reforms in health care, such as public reporting of quality, may inadvertently exacerbate disparities. We examined how the Centers for Medicare and Medicare Services' five-star rating system for nursing homes has affected residents who are dually enrolled in Medicare and Medicaid ("dual eligibles"), a particularly vulnerable and disadvantaged population. Specifically, we assessed the extent to which dual eligibles and non-dual eligibles avoided the lowest-rated nursing homes and chose the highest-rated homes once the five-star rating system began, in late 2008. We found that both populations resided in better-quality homes over time but that by 2010 the increased likelihood of choosing the highest-rated homes was substantially smaller for dual eligibles than for non-dual eligibles. Thus, the gap in quality, as measured by a nursing home's star rating, grew over time. Furthermore, we found that the benefit of the five-star system to dual eligibles was largely due to providers' improving their ratings, not to consumers' choosing different providers. We present evidence suggesting that supply constraints play a role in limiting dual eligibles' responses to quality ratings, since high-quality providers tend to be located close to relatively affluent areas. Increases in Medicaid payment rates for nursing home services may be the only long-term solution. Project HOPE—The People-to-People Health Foundation, Inc.

Health-related quality of life anticipated with different management strategies for paediatric febrile neutropaenia

PubMed Central

Cheng, S; Teuffel, O; Ethier, M C; Diorio, C; Martino, J; Mayo, C; Regier, D; Wing, R; Alibhai, S M H; Sung, L

2011-01-01

Background: To describe (1) anticipated health-related quality of life during different strategies for febrile neutropaenia (FN) management and (2) attributes of those preferring inpatient management. Methods: Respondents were parents of children 0–18 years and children 12–18 years receiving cancer treatment. Anticipated health-related quality of life was elicited for four different FN management strategies: entire inpatient, early discharge, outpatient oral and outpatient intravenous (i.v.) therapy. Tools used to measure health-related quality of life were visual analogue scale (VAS), willingness to pay and time trade off. Results: A total of 155 parents and 43 children participated. For parents, median VAS scores were highest for early discharge (5.9, interquartile range 4.4–7.2) and outpatient i.v. (5.9, interquartile range 4.4–7.3). For children, median scores were highest for early discharge (6.1, interquartile range 4.6–7.2). In contrast, the most commonly preferred strategy for parents and children was inpatient in 55.0% and 37.2%, respectively. Higher current child health-related quality of life was associated with a stronger preference for outpatient management. Conclusion: Early discharge and outpatient i.v. management are associated with higher anticipated health-related quality of life, although the most commonly preferred strategy was inpatient care. This data may help with determining more cost-effective strategies for paediatric FN. PMID:21694729

Health-related quality of life anticipated with different management strategies for paediatric febrile neutropaenia.

PubMed

Cheng, S; Teuffel, O; Ethier, M C; Diorio, C; Martino, J; Mayo, C; Regier, D; Wing, R; Alibhai, S M H; Sung, L

2011-08-23

To describe (1) anticipated health-related quality of life during different strategies for febrile neutropaenia (FN) management and (2) attributes of those preferring inpatient management. Respondents were parents of children 0-18 years and children 12-18 years receiving cancer treatment. Anticipated health-related quality of life was elicited for four different FN management strategies: entire inpatient, early discharge, outpatient oral and outpatient intravenous (i.v.) therapy. Tools used to measure health-related quality of life were visual analogue scale (VAS), willingness to pay and time trade off. A total of 155 parents and 43 children participated. For parents, median VAS scores were highest for early discharge (5.9, interquartile range 4.4-7.2) and outpatient i.v. (5.9, interquartile range 4.4-7.3). For children, median scores were highest for early discharge (6.1, interquartile range 4.6-7.2). In contrast, the most commonly preferred strategy for parents and children was inpatient in 55.0% and 37.2%, respectively. Higher current child health-related quality of life was associated with a stronger preference for outpatient management. Early discharge and outpatient i.v. management are associated with higher anticipated health-related quality of life, although the most commonly preferred strategy was inpatient care. This data may help with determining more cost-effective strategies for paediatric FN.

Validation of a Novel Electronic Health Record Patient Portal Advance Care Planning Delivery System.

PubMed

Bose-Brill, Seuli; Feeney, Michelle; Prater, Laura; Miles, Laura; Corbett, Angela; Koesters, Stephen

2018-06-26

Advance care planning allows patients to articulate their future care preferences should they no longer be able to make decisions on their own. Early advance care planning in outpatient settings provides benefits such as less aggressive care and fewer hospitalizations, yet it is underutilized due to barriers such as provider time constraints and communication complexity. Novel methods, such as patient portals, provide a unique opportunity to conduct advance care planning previsit planning for outpatient care. This follow-up to our pilot study aimed to conduct pragmatic testing of a novel electronic health record-tethered framework and its effects on advance care planning delivery in a real-world primary care setting. Our intervention tested a previsit advance care planning workflow centered around a framework sent via secure electronic health record-linked patient portal in a real-world clinical setting. The primary objective of this study was to determine its impact on frequency and quality of advance care planning documentation. We conducted a pragmatic trial including 2 sister clinical sites, one site implementing the intervention and the other continuing standard care. A total of 419 patients aged between 50 and 93 years with active portal accounts received intervention (n=200) or standard care (n=219). Chart review analyzed the presence of advance care planning and its quality and was graded with previously established scoring criteria based on advance care planning best practice guidelines from multiple nations. A total of 19.5% (39/200) of patients who received previsit planning responded to the framework. We found that the intervention site had statistically significant improvement in new advance care planning documentation rates (P<.01) and quality (P<.01) among all eligible patients. Advance care planning documentation rates increased by 105% (19/39 to 39/39) and quality improved among all patients who engaged in the previsit planning framework (n=39). Among eligible patients aged between 50 and 60 years at the intervention site, advance care planning documentation rates increased by 37% (27/96 to 37/96). Advance care planning documentation rates increased 34% among high users (27/67 to 36/67). Advance care planning previsit planning using a secure electronic health record-supported patient portal framework yielded improvement in the presence of advance care planning documentation, with highest improvement in active patient portal users and patients aged between 50 and 60 years. Targeted previsit patient portal advance care planning delivery in these populations can potentially improve the quality of care in these populations. ©Seuli Bose-Brill, Michelle Feeney, Laura Prater, Laura Miles, Angela Corbett, Stephen Koesters. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 26.06.2018.

The European Society of Gastrointestinal Endoscopy Quality Improvement Initiative: developing performance measures.

PubMed

Rutter, Matthew D; Senore, Carlo; Bisschops, Raf; Domagk, Dirk; Valori, Roland; Kaminski, Michal F; Spada, Cristiano; Bretthauer, Michael; Bennett, Cathy; Bellisario, Cristina; Minozzi, Silvia; Hassan, Cesare; Rees, Colin; Dinis-Ribeiro, Mário; Hucl, Tomas; Ponchon, Thierry; Aabakken, Lars; Fockens, Paul

2016-01-01

The European Society of Gastrointestinal Endoscopy (ESGE) and United European Gastroenterology (UEG) have a vision to create a thriving community of endoscopy services across Europe, collaborating with each other to provide high quality, safe, accurate, patient-centered and accessible endoscopic care. Whilst the boundaries of what can be achieved by advanced endoscopy are continually expanding, we believe that one of the most fundamental steps to achieving our goal is to raise the quality of everyday endoscopy. The development of robust, consensus- and evidence-based key performance measures is the first step in this vision.ESGE and UEG have identified quality of endoscopy as a major priority. This paper explains the rationale behind the ESGE Quality Improvement Initiative and describes the processes that were followed. We recommend that all units develop mechanisms for audit and feedback of endoscopist and service performance using the ESGE performance measures that will be published in future issues of this journal over the next year. We urge all endoscopists and endoscopy services to prioritize quality and to ensure that these performance measures are implemented and monitored at a local level, so that we can provide the highest possible care for our patients. © Georg Thieme Verlag KG Stuttgart · New York.

Ventanillas de Salud: A Collaborative and Binational Health Access and Preventive Care Program

PubMed Central

Rangel Gomez, Maria Gudelia; Tonda, Josana; Zapata, G. Rogelio; Flynn, Michael; Gany, Francesca; Lara, Juanita; Shapiro, Ilan; Rosales, Cecilia Ballesteros

2017-01-01

While individuals of Mexican origin are the largest immigrant group living in the U.S., this population is also the highest uninsured. Health disparities related to access to health care, among other social determinants, continue to be a challenge for this population. The government of Mexico, in an effort to address these disparities and improve the quality of life of citizens living abroad, has partnered with governmental and non-governmental health-care organizations in the U.S. by developing and implementing an initiative known as Ventanillas de Salud—Health Windows—(VDS). The VDS is located throughout the Mexican Consular network and aim to increase access to health care and health literacy, provide health screenings, and promote healthy lifestyle choices among low-income and immigrant Mexican populations in the U.S. PMID:28713806

CDC Grand Rounds: Public Health Strategies to Prevent Preterm Birth.

PubMed

Shapiro-Mendoza, Carrie K; Barfield, Wanda D; Henderson, Zsakeba; James, Arthur; Howse, Jennifer L; Iskander, John; Thorpe, Phoebe G

2016-08-19

Preterm birth (delivery before 37 weeks and 0/7 days of gestation) is a leading cause of infant morbidity and mortality in the United States. In 2013, 11.4% of the nearly 4 million U.S. live births were preterm; however, 36% of the 8,470 infant deaths were attributed to preterm birth (1). Infants born at earlier gestational ages, especially <32 0/7 weeks, have the highest mortality (Figure) and morbidity rates. Morbidity associated with preterm birth includes respiratory distress syndrome, necrotizing enterocolitis, and intraventricular hemorrhage; longer-term consequences include developmental delay and decreased school performance. Risk factors for preterm delivery include social, behavioral, clinical, and biologic characteristics (Box). Despite advances in medical care, racial and ethnic disparities associated with preterm birth persist. Reducing preterm birth, a national public health priority (2), can be accomplished by implementing and monitoring strategies that target modifiable risk factors and populations at highest risk, and by providing improved quality and access to preconception, prenatal, and interconception care through implementation of strategies with potentially high impact.

Continuous quality improvement in the ambulatory endoscopy center.

PubMed

Johanson, John F

2002-04-01

What does quality assessment have to do with the practicing gastroenterologist? Why should one spend the time and effort to incorporate CQI activities into an already busy practice? First and foremost, quality improvement should directly benefit the patient by ensuring that they receive the highest quality of care possible. For example, comparing endoscopic use or outcomes, such as procedure success or complications, with national standards or other endoscopists in the same community may identify physicians who could benefit from additional training. Similar analyses may likewise identify outstanding physicians who might serve as resources for other physicians. Surveys of patient satisfaction may reveal deficiencies, which might be unknown to a physician who is otherwise technically excellent; deficiencies that would never have been uncovered by traditional measures of quality. Second, applying the techniques of CQI to study one's own practice can provide a competitive edge when vying for managed care or corporate contracts. In this regard, CQI can be used to document physician or practice performance through tracking of endoscopic use, procedure success and complication rates, and patient satisfaction. Finally, the rising concern among various patient advocacy groups has led to an increased emphasis on quality improvement, and in most cases it is a required activity as part of the accreditation process. Steps to quality improvement There is more to quality improvement than simply selecting and implementing a performance improvement plan. A number of steps have been suggested to achieve fundamental improvement in the quality of medical care [3]. The first is to use outcomes management for improvement rather than for judgment. One of the major criticisms of QA is that it will be used to judge physicians providing care. It is feared that CQI will be used to identify poor performers who will then be punished. This strategy leads to fear and inhibits an honest pursuit of improvement. Second, learning must be viewed as a process. A quality improvement plan that is successful in one setting may not be as favorable in another situation. Clinicians must be able to focus on their individual situations and adapt what others have implemented to their own practice. Third, the most important aspect of the quality improvement is the implementation step. It matters little if elegant studies of endoscopic complications or patient satisfaction are completed if the information is not used to improve the delivery of health care to every single patient. The delivery of medical care continues to evolve. Resources are becoming increasingly scarce and the progressive rise of health care expenditures suggests a need for control. In this zeal for cost constraint, quality must not be sacrificed. This new-found attention to quality must be extended to the level of the individual practitioner to ensure that individual patients' interests are protected and the best possible care is delivered regardless of the economic implications. As providers of health care, endoscopists need to take an active role in these efforts both in understanding and implementing the techniques of quality assessment into their practices. If physicians are not actively involved in data collection and measurement to improve the quality and value of their own work, someone else will undoubtedly assume this role.

Non-Hodgkin's lymphomas: clinical governance issues.

PubMed

Fields, P A; Goldstone, A H

2002-09-01

Every patient in every part of the world has the right to expect the best possible quality of care from health care providers. Non-Hodgkin's lymphomas (NHL) are an extremely heterogeneous group of conditions which require important decisions to be taken at many points along the treatment pathway. To get this right every time requires that high-quality standards are instituted and adhered to, so that the best possible outcome is achieved. In the past this has not always been the case because of the failure of clinicians sometimes to adhere to an optimal management plan. In 1995, the UK government commissioned an inquiry into the running of cancer services in the United Kingdom, which culminated in a series of recommendations to improve them. Subsequently, these recommendations were implemented as objectives of the NHS Cancer Plan which is the framework by which the UK government wishes to improve cancer services. Concurrently another general concept has emerged which is designed to ensure that the highest quality standards may be achieved for all patients across the whole National Health Service (NHS). This concept, termed 'clinical governance', brings together a corporate responsibility of all health care workers to deliver high quality standards, in the hope that this will translate into better long-term survival of patients with malignant disease. This chapter focuses on the issues surrounding clinical governance and how the principles of this concept relate to non-Hodgkin's lymphomas.

QUOTEchemo: a patient-centred instrument to measure quality of communication preceding chemotherapy treatment through the patient's eyes.

PubMed

van Weert, Julia C M; Jansen, Jesse; de Bruijn, Gert-Jan; Noordman, Janneke; van Dulmen, Sandra; Bensing, Jozien M

2009-11-01

Knowing patients' needs is a prerequisite to ensure high quality cancer care. This study describes the development and psychometric properties of a patient-centred instrument to measure needs and actual experiences with communication preceding chemotherapy treatment: QUOTE(chemo). QUOTE-questionnaires (Quality Of care Through the patients' Eyes) are widely used to gain insight into unmet needs, but no validated, standardised questionnaire combining patients' needs and experiences surrounding chemotherapy treatment is available yet. To evaluate the psychometric properties of the QUOTE(chemo), content validity, internal structure and convergent validity were investigated amongst 345 cancer patients, new to chemotherapy, from 10 different hospitals. Literature study, focus group discussions and a categorisation procedure of 67 relevant topics revealed seven main themes: Treatment-related information, Prognosis information, Rehabilitation information, Coping information, Interpersonal communication, Tailored communication and Affective communication. Confirmatory factor analysis using structural equation modelling indicated that the measurement model provided good fit to the data with factor loadings ranging from .43 to .77. The seven QUOTE(chemo) dimensions captured relevant issues of concern with good internal consistency (alpha .72-.92), satisfactory item-total correlations (.35-.79) and satisfactory convergent validity. Affective communication, Treatment-related information and Rehabilitation information were perceived most important by patients. The instrument also appeared to be able to determine which aspects need improvement to ensure high quality care. The highest need for improvement was found for communicating Prognosis information and Rehabilitation information and for Interpersonal communication. These findings provide preliminary evidence of the reliability and validity of the QUOTE(chemo) for use in cancer care surrounding chemotherapy treatment. Researchers and health care providers can use the instrument to measure patients' needs and experiences with communication to identify aspects that need improvement.

Evidence Review Conducted for the Agency for Healthcare Research and Quality Safety Program for Improving Surgical Care and Recovery: Focus on Anesthesiology for Total Knee Arthroplasty.

PubMed

Soffin, Ellen M; Gibbons, Melinda M; Ko, Clifford Y; Kates, Stephen L; Wick, Elizabeth; Cannesson, Maxime; Scott, Michael J; Wu, Christopher L

2018-06-08

Enhanced recovery after surgery (ERAS) has rapidly gained popularity in a variety of surgical subspecialities. A large body of literature suggests that ERAS leads to superior outcomes, improved patient satisfaction, reduced length of hospital stay, and cost benefits, without affecting rates of readmission after surgery. These patterns have been described for patients undergoing elective total knee arthroplasty (TKA); however, adoption of ERAS to orthopedic surgery has lagged behind other surgical disciplines. The Agency for Healthcare Research and Quality, in partnership with the American College of Surgeons and the Johns Hopkins Medicine Armstrong Institute (AI) for Patient Safety and Quality, has developed the Safety Program for Improving Surgical Care and Recovery. The program comprises a national effort to incorporate best practice in perioperative care and improve patient safety, for over 750 hospitals and multiple procedures over the next 5 years, including orthopedic surgery. We have conducted a full evidence review of anesthetic interventions to derive anesthesiology-related components of an evidence-based ERAS pathway for TKA. A PubMed search was performed for each protocol component, focusing on the highest levels of evidence in the literature. Search findings are summarized in narrative format. Anesthesiology components of care were identified and evaluated across the pre-, intra-, and postoperative phases. A summary of the best available evidence, together with recommendations for inclusion in ERAS protocols for TKA, is provided. There is extensive evidence in the literature, and from society guidelines to support the Agency for Healthcare Research and Quality Safety Program for Improving Surgical Care and Recovery goals for TKA.

The effectiveness of the bone bridge transtibial amputation technique: A systematic review of high-quality evidence.

PubMed

Kahle, Jason T; Highsmith, M Jason; Kenney, John; Ruth, Tim; Lunseth, Paul A; Ertl, Janos

2017-06-01

This literature review was undertaken to determine if commonly held views about the benefits of a bone bridge technique are supported by the literature. Four databases were searched for articles pertaining to surgical strategies specific to a bone bridge technique of the transtibial amputee. A total of 35 articles were identified as potential articles. Authors included methodology that was applied to separate topics. Following identification, articles were excluded if they were determined to be low quality evidence or not pertinent. Nine articles were identified to be pertinent to one of the topics: Perioperative Care, Acute Care, Subjective Analysis and Function. Two articles sorted into multiple topics. Two articles were sorted into the Perioperative Care topic, 4 articles sorted into the Acute Care topic, 2 articles into the Subjective Analysis topic and 5 articles into the Function topic. There are no high quality (level one or two) clinical trials reporting comparisons of the bone bridge technique to traditional methods. There is limited evidence supporting the clinical outcomes of the bone bridge technique. There is no agreement supporting or discouraging the perioperative and acute care aspects of the bone bridge technique. There is no evidence defining an interventional comparison of the bone bridge technique. Current level III evidence supports a bone bridge technique as an equivalent option to the non-bone bridge transtibial amputation technique. Formal level I and II clinical trials will need to be considered in the future to guide clinical practice. Clinical relevance Clinical Practice Guidelines are evidence based. This systematic literature review identifies the highest quality evidence to date which reports a consensus of outcomes agreeing bone bridge is as safe and effective as alternatives. The clinical relevance is understanding bone bridge could additionally provide a mechanistic advantage for the transtibial amputee.

International and Interdisciplinary Identification of Health Care Transition Outcomes.

PubMed

Fair, Cynthia; Cuttance, Jessica; Sharma, Niraj; Maslow, Gary; Wiener, Lori; Betz, Cecily; Porter, Jerlym; McLaughlin, Suzanne; Gilleland-Marchak, Jordan; Renwick, Amy; Naranjo, Diana; Jan, Sophia; Javalkar, Karina; Ferris, Maria

2016-03-01

There is a lack of agreement on what constitutes successful outcomes for the process of health care transition (HCT) among adolescent and young adults with special health care needs. To present HCT outcomes identified by a Delphi process with an interdisciplinary group of participants. A Delphi method involving 3 stages was deployed to refine a list of HCT outcomes. This 18-month study (from January 5, 2013, of stage 1 to July 3, 2014, of stage 3) included an initial literature search, expert interviews, and then 2 waves of a web-based survey. On this survey, 93 participants from outpatient, community-based, and primary care clinics rated the importance of the top HCT outcomes identified by the Delphi process. Analyses were performed from July 5, 2014, to December 5, 2014. Health care transition outcomes of adolescents and young adults with special health care needs. Importance ratings of identified HCT outcomes rated on a Likert scale from 1 (not important) to 9 (very important). The 2 waves of surveys included 117 and 93 participants as the list of outcomes was refined. Transition outcomes were refined by the 3 waves of the Delphi process, with quality of life being the highest-rated outcome with broad agreement. The 10 final outcomes identified included individual outcomes (quality of life, understanding the characteristics of conditions and complications, knowledge of medication, self-management, adherence to medication, and understanding health insurance), health services outcomes (attending medical appointments, having a medical home, and avoidance of unnecessary hospitalization), and a social outcome (having a social network). Participants indicated that different outcomes were likely needed for individuals with cognitive disabilities. Quality of life is an important construct relevant to HCT. Future research should identify valid measures associated with each outcome and further explore the role that quality of life plays in the HCT process. Achieving consensus is a critical step toward the development of reliable and objective comparisons of HCT outcomes across clinical conditions and care delivery locations.

Prevalence of hepatitis C and B virus among patients infected with HIV: a cross-sectional analysis of a large HIV care programme in Myanmar.

PubMed

Zaw, Sai Ko Ko; Tun, Sai Thein Than; Thida, Aye; Aung, Thet Ko; Maung, Win; Shwe, Myint; Aye, Mar Mar; Clevenbergh, Phillipe

2013-07-01

Co-infection with the hepatitis C virus (HCV) and/or hepatitis B virus (HBV) influences the morbidity and mortality of patients with HIV. A cross sectional analysis was of 11,032 HIV-infected patients enrolled in the Integrated HIV Care Program from May 2005 to April 2012 and Epi-info 3.5 was used to determine the serological prevalence of chronic hepatitis B and hepatitis C. The mean ± standard deviation age of patients was 36 ± 8.4 years (adult cohort) and 7 ± 3 years (paediatric cohort). The sero prevalence of hepatitis B surface antigen, hepatitis C (anti HCV antibodies) and triple infection are 8.7%, 5.3% and 0.35%, respectively. Men who have sex with men are at the highest risk of being co-infected with hepatitis B while intravenous drug users are at the highest risk of being co-infected with hepatitis C. It is important to screen for hepatitis B and C in HIV infected people in order to provide quality care for HIV patients with co-infection.

Priorities for treatment, care and information if faced with serious illness: a comparative population-based survey in seven European countries.

PubMed

Higginson, Irene J; Gomes, Barbara; Calanzani, Natalia; Gao, Wei; Bausewein, Claudia; Daveson, Barbara A; Deliens, Luc; Ferreira, Pedro L; Toscani, Franco; Gysels, Marjolein; Ceulemans, Lucas; Simon, Steffen T; Cohen, Joachim; Harding, Richard

2014-02-01

Health-care costs are growing, with little population-based data about people's priorities for end-of-life care, to guide service development and aid discussions. We examined variations in people's priorities for treatment, care and information across seven European countries. Telephone survey of a random sample of households; we asked respondents their priorities if 'faced with a serious illness, like cancer, with limited time to live' and used multivariable logistic regressions to identify associated factors. Members of the general public aged ≥ 16 years residing in England, Flanders, Germany, Italy, the Netherlands, Portugal and Spain. In total, 9344 individuals were interviewed. Most people chose 'improve quality of life for the time they had left', ranging from 57% (95% confidence interval: 55%-60%, Italy) to 81% (95% confidence interval: 79%-83%, Spain). Only 2% (95% confidence interval: 1%-3%, England) to 6% (95% confidence interval: 4%-7%, Flanders) said extending life was most important, and 15% (95% confidence interval: 13%-17%, Spain) to 40% (95% confidence interval: 37%-43%, Italy) said quality and extension were equally important. Prioritising quality of life was associated with higher education in all countries (odds ratio = 1.3 (Flanders) to 7.9 (Italy)), experience of caregiving or bereavement (England, Germany, Portugal), prioritising pain/symptom control over having a positive attitude and preferring death in a hospice/palliative care unit. Those prioritising extending life had the highest home death preference of all groups. Health status did not affect priorities. Across all countries, extending life was prioritised by a minority, regardless of health status. Treatment and care needs to be reoriented with patient education and palliative care becoming mainstream for serious conditions such as cancer.

Economic Analysis of Children's Surgical Care in Low- and Middle-Income Countries: A Systematic Review and Analysis.

PubMed

Saxton, Anthony T; Poenaru, Dan; Ozgediz, Doruk; Ameh, Emmanuel A; Farmer, Diana; Smith, Emily R; Rice, Henry E

2016-01-01

Understanding the economic value of health interventions is essential for policy makers to make informed resource allocation decisions. The objective of this systematic review was to summarize available information on the economic impact of children's surgical care in low- and middle-income countries (LMICs). We searched MEDLINE (Pubmed), Embase, and Web of Science for relevant articles published between Jan. 1996 and Jan. 2015. We summarized reported cost information for individual interventions by country, including all costs, disability weights, health outcome measurements (most commonly disability-adjusted life years [DALYs] averted) and cost-effectiveness ratios (CERs). We calculated median CER as well as societal economic benefits (using a human capital approach) by procedure group across all studies. The methodological quality of each article was assessed using the Drummond checklist and the overall quality of evidence was summarized using a scale adapted from the Agency for Healthcare Research and Quality. We identified 86 articles that met inclusion criteria, spanning 36 groups of surgical interventions. The procedure group with the lowest median CER was inguinal hernia repair ($15/DALY). The procedure group with the highest median societal economic benefit was neurosurgical procedures ($58,977). We found a wide range of study quality, with only 35% of studies having a Drummond score ≥ 7. Our findings show that many areas of children's surgical care are extremely cost-effective in LMICs, provide substantial societal benefits, and are an appropriate target for enhanced investment. Several areas, including inguinal hernia repair, trichiasis surgery, cleft lip and palate repair, circumcision, congenital heart surgery and orthopedic procedures, should be considered "Essential Pediatric Surgical Procedures" as they offer considerable economic value. However, there are major gaps in existing research quality and methodology which limit our current understanding of the economic value of surgical care.

A profile of women at the highest risk of maternal death in Pakistan.

PubMed

Agha, Sohail

2015-09-01

Traditionally, health interventions implemented in Pakistan have been designed to increase the supply of maternal health services, but have not focused on reaching the poorest women or on providing high-quality services. Demand-side barriers to the utilization of health services are substantial in Pakistan, as are supply-side constraints to the provision of quality health care. This study uses data from the Pakistan Demographic and Health Survey 2006-07 to develop a profile of the poorest women in Pakistan in order to understand demand-side barriers to accessing maternal health care. The study shows stark differences in human capital, material and demographic resources between the poorest women and other women. It illustrates how these differences translate into low levels of service utilization among the poorest women. The purpose of the study is to stimulate a discussion of both the difficulty and the importance of reaching the poorest women with high-quality maternal health interventions. The findings from several pilot projects in Pakistan suggest that the poorest women can be reached at disproportionately higher rates than non-poor women through targeted, community-based, interventions. There is little demonstrable evidence, however, that high-quality care has been provided through these interventions. Evidence-based approaches, which have the potential to overcome financial and sociocultural barriers to service utilization, should be scaled up as soon as possible. However, measures should be taken to ensure that the quality of care provided through these interventions is adequate and able to lead to significant reductions in mortality. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2014; all rights reserved.

[Frailty, disability and multi-morbidity: the relationship with quality of life and healthcare costs in elderly people].

PubMed

Lutomski, Jennifer E; Baars, Maria A E; Boter, Han; Buurman, Bianca M; den Elzen, Wendy P J; Jansen, Aaltje P D; Kempen, Gertrudis I J M; Steunenberg, Bas; Steyerberg, Ewout W; Olde Rikkert, Marcel G M; Melis, René J F

2014-01-01

To assess the independent and combined impact of frailty, multi-morbidity, and activities of daily living (ADL) limitations on self-reported quality of life and healthcare costs in elderly people. Cross-sectional, descriptive study. Data came from The Older Persons and Informal Caregivers Minimum DataSet (TOPICS-MDS), a pooled dataset with information from 41 projects across the Netherlands from the Dutch national care for the Elderly programme. Frailty, multi-morbidity and ADL limitations, and the interactions between these domains, were used as predictors in regression analyses with quality of life and healthcare costs as outcome measures. Analyses were stratified by living situation (independent or care home). Directionality and magnitude of associations were assessed using linear mixed models. A total of 11,093 elderly people were interviewed. A substantial proportion of elderly people living independently reported frailty, multi-morbidity, and/or ADL limitations (56.4%, 88.3% and 41.4%, respectively), as did elderly people living in a care home (88.7%, 89.2% and 77,3%, respectively). One-third of elderly people living at home (31.9%) reported all three conditions compared with two-thirds of elderly people living in a care home (68.3%). In the multivariable analysis, frailty had a strong impact on outcomes independently of multi-morbidity and ADL limitations. Elderly people experiencing problems across all three domains reported the poorest quality-of-life scores and the highest healthcare costs, irrespective of their living situation. Frailty, multi-morbidity and ADL limitations are complementary measurements, which together provide a more holistic understanding of health status in elderly people. A multi-dimensional approach is important in mapping the complex relationships between these measurements on the one hand and the quality of life and healthcare costs on the other.

Finding the gap: revealing local disparities in coverage of maternal, newborn and child health services in South Sudan using lot quality assurance sampling.

PubMed

Valadez, Joseph J; Berendes, Sima; Lako, Richard; Gould, Simon; Vargas, William; Milner, Susan

2015-12-01

We adapted a rapid monitoring method to South Sudan, a new nation with one of the world's highest maternal and child mortality rates, aiming to assess coverage of maternal, neonatal and child health (MNCH) services at the time of independence, and introducing a monitoring and evaluation system (M&E) for equity-sensitive tracking of progress related to Millennium Development Goals (MDG) 4 and 5 at national, state and county levels to detect local variability. We conducted a national cross-sectional household survey among women from six client populations in all, but six of South Sudan's 79 counties. We used lot quality assurance sampling (LQAS) to measure coverage with diverse MNCH indicators to obtain information for national-, state- and county-level health system management decision-making. National coverage of MNCH services was low for all maternal and neonatal care, child immunisation, and child care indicators. However, results varied across states and counties. Central Equatoria State (CES), where the capital is located, showed the highest coverage for most indicators (e.g. ≥4 antenatal care visits range: 4.5% in Jonglei to 40.1% in CES). Urban counties often outperformed rural ones. This adaptation of LQAS to South Sudan demonstrates how it can be used in the future as an M&E system to track progress of MDGs at national, state and county levels to detect local disparities. Overall, our data reveal a desperate need for improving MNCH service coverage in all states. © 2015 The Authors.Tropical Medicine & International Health Published by John Wiley & Sons Ltd.

Make no mistake—errors can be controlled*

PubMed Central

Hinckley, C

2003-01-01



 Traditional quality control methods identify "variation" as the enemy. However, the control of variation by itself can never achieve the remarkably low non-conformance rates of world class quality leaders. Because the control of variation does not achieve the highest levels of quality, an inordinate focus on these techniques obscures key quality improvement opportunities and results in unnecessary pain and suffering for patients, and embarrassment, litigation, and loss of revenue for healthcare providers. Recent experience has shown that mistakes are the most common cause of problems in health care as well as in other industrial environments. Excessive product and process complexity contributes to both excessive variation and unnecessary mistakes. The best methods for controlling variation, mistakes, and complexity are each a form of mistake proofing. Using these mistake proofing techniques, virtually every mistake and non-conformance can be controlled at a fraction of the cost of traditional quality control methods. PMID:14532368

[Nutrition in older persons. Basis for functionality and quality of life].

PubMed

Bauer, J M

2011-08-01

With increasing age alterations of metabolism, appetite regulation, and body composition have been observed. As a consequence the risk of malnutrition is much higher in older than in younger persons. Though the highest prevalence rates have been described for the hospital and rehabilitation setting, most older persons with overt malnutrition are found in the community. Here persons with chronic comorbidity and low functionality show the highest risk. Routine screening for malnutrition is therefore indicated in older persons. For the successful treatment of malnutrition it is important to consider also medical and social etiologic factors before starting nutritional therapy. With regard to the preservation of muscle mass and muscle strength, adequate protein intake deserves careful consideration. Besides the implementation of regular snacks between meals, temporary application of oral supplements which are high in energy and protein is indicated. Especially during and after hospital stays, the beneficial interaction between nutrition and exercise has to be considered with regard to functionality and quality of life in older persons.

Key performance indicators to benchmark hospital information systems - a delphi study.

PubMed

Hübner-Bloder, G; Ammenwerth, E

2009-01-01

To identify the key performance indicators for hospital information systems (HIS) that can be used for HIS benchmarking. A Delphi survey with one qualitative and two quantitative rounds. Forty-four HIS experts from health care IT practice and academia participated in all three rounds. Seventy-seven performance indicators were identified and organized into eight categories: technical quality, software quality, architecture and interface quality, IT vendor quality, IT support and IT department quality, workflow support quality, IT outcome quality, and IT costs. The highest ranked indicators are related to clinical workflow support and user satisfaction. Isolated technical indicators or cost indicators were not seen as useful. The experts favored an interdisciplinary group of all the stakeholders, led by hospital management, to conduct the HIS benchmarking. They proposed benchmarking activities both in regular (annual) intervals as well as at defined events (for example after IT introduction). Most of the experts stated that in their institutions no HIS benchmarking activities are being performed at the moment. In the context of IT governance, IT benchmarking is gaining importance in the healthcare area. The found indicators reflect the view of health care IT professionals and researchers. Research is needed to further validate and operationalize key performance indicators, to provide an IT benchmarking framework, and to provide open repositories for a comparison of the HIS benchmarks of different hospitals.

Validating diagnostic information on the Minimum Data Set in Ontario Hospital-based long-term care.

PubMed

Wodchis, Walter P; Naglie, Gary; Teare, Gary F

2008-08-01

Over 20 countries currently use the Minimum Data Set Resident Assessment Instrument (MDS) in long-term care settings for care planning, policy, and research purposes. A full assessment of the quality of the diagnostic information recorded on the MDS is lacking. The primary goal of this study was to examine the quality of diagnostic coding on the MDS. Subjects for this study were admitted to Ontario Complex Continuing Care Hospitals (CCC) directly from acute hospitals between April 1, 1997 and March 31, 2005 (n = 80,664). Encrypted unique identifiers, common across acute and CCC administrative databases, were used to link administrative records for patients in the sample. After linkage, each resident had 2 sources of diagnostic information: the acute discharge abstract database and the MDS. Using the discharge abstract database as the reference standard, we calculated the sensitivity for each of 43 MDS diagnoses. Compared with primary diagnoses coded in acute care abstracts, 12 of 43 MDS diagnoses attained a sensitivity of at least 0.80, including 7 of the 10 diagnoses with the highest prevalence as an acute care primary diagnosis before CCC admission. Although the sensitivity was high for many of the most prevalent conditions, important diagnostic information is missed increasing the potential for suboptimal clinical care. Emphasis needs to be put on improving information flow across care settings during patient transitions. Researchers should exercise caution when using MDS diagnoses to identify patient populations, particularly those shown to have low sensitivity in this study.

Beyond the Examination Room

PubMed Central

O'Malley, Ann S; Forrest, Christopher B

2002-01-01

OBJECTIVE To assess whether primary care performance of low-income women's primary care delivery sites is associated with the strength of their relationships with their physicians. DESIGN Random-digit-dial and targeted household telephone survey of a population-based sample. SETTING Washington, D.C. census tracts with ≥30% of households below 200% of federal poverty threshold. PARTICIPANTS Women over age 40 (N = 1,205), 82% of whom were African American. MEASUREMENTS AND MAIN RESULTS The response rate was 85%. Primary care performance was assessed using women's ratings of their systems' accessibility (organizational, geographic, and financial), continuity, comprehensiveness, and coordination. Respondents' ratings of trust in their physicians, communication with their physicians, and compassion shown by their physicians were used to operationalize the patient-physician relationship. Controlling for population and insurance characteristics, 4 primary care features were positively associated with women's trust in and communication with their physicians: continuity with a single clinician, organizational accessibility of the practice, comprehensive care, and coordination of specialty care services. Better organizational access, but not geographic or financial access, was associated with greater levels of trust, compassion, and communication (odds ratios [ORs], 3.2, 7.4, and 6.9, respectively; P≤ .01). Women who rated highest their doctor's ability to take care of all of their health care needs (highest level of comprehensiveness) had 11 times the odds of trusting their physician (P≤ .01) and 6 times the odds of finding their physicians compassionate and communicative (P≤ .01), compared to those with the lowest level of comprehensiveness. CONCLUSIONS Primary care delivery sites organized to be more accessible, to link patients with the same clinician for their visits, to provide for all of a woman's health care needs, and to coordinate specialty care services are associated with stronger relationships between low-income women and their physicians. Primary care systems that fail to emphasize these features of primary care may jeopardize the clinician-patient relationship and indirectly the quality of care and health outcomes. PMID:11903777

Improved Quality in Aerospace Testing Through the Modern Design of Experiments

NASA Technical Reports Server (NTRS)

DeLoach, R.

2000-01-01

This paper illustrates how, in the presence of systematic error, the quality of an experimental result can be influenced by the order in which the independent variables are set. It is suggested that in typical experimental circumstances in which systematic errors are significant, the common practice of organizing the set point order of independent variables to maximize data acquisition rate results in a test matrix that fails to produce the highest quality research result. With some care to match the volume of data required to satisfy inference error risk tolerances, it is possible to accept a lower rate of data acquisition and still produce results of higher technical quality (lower experimental error) with less cost and in less time than conventional test procedures, simply by optimizing the sequence in which independent variable levels are set.

Prevalence and Losses in Quality-Adjusted Life Years of Child Health Conditions: A Burden of Disease Analysis.

PubMed

Craig, Benjamin M; Hartman, John D; Owens, Michelle A; Brown, Derek S

2016-04-01

To estimate the prevalence and losses in quality-adjusted life years (QALYs) associated with 20 child health conditions. Using data from the 2009-2010 National Survey of Children with Special Health Care Needs, preference weights were applied to 14 functional difficulties to summarize the quality of life burden of 20 health conditions. Among the 14 functional difficulties, "a little trouble with breathing" had the highest prevalence (37.1 %), but amounted to a loss of just 0.16 QALYs from the perspective of US adults. Though less prevalent, "a lot of behavioral problems" and "chronic pain" were associated with the greatest losses (1.86 and 3.43 QALYs). Among the 20 conditions, allergies and asthma were the most prevalent but were associated with the least burden. Muscular dystrophy and cerebral palsy were among the least prevalent and most burdensome. Furthermore, a scatterplot shows the association between condition prevalence and burden. In child health, condition prevalence is negatively associated with quality of life burden from the perspective of US adults. Both should be considered carefully when evaluating the appropriate role for public health prevention and interventions.

A unique funding opportunity for public health in Texas.

PubMed

Schlenker, Thomas; Huber, Carol A

2015-01-01

In addition to the Affordable Care Act, states are more frequently turning to Medicaid waivers to achieve the "Triple Aim" goals of improving the experience of care, improving population health, and reducing per capita costs. These demonstration waivers provide opportunities to test innovative ways to finance and deliver care. Texas is currently implementing a waiver known as the Transformation and Quality Improvement Program. Its inclusion of public health agencies is a unique approach to a system typically limited to traditional providers. San Antonio Metropolitan Health District is one public health agency taking advantage of this new funding opportunity to implement 6 new or expanded programs targeting health issues of highest priority in this south Texas region. This article discusses the use of Medicaid waivers and the advantages and challenges of public health agency participation.

Cell phone short messaging service (SMS) for HIV/AIDS in South Africa: a literature review.

PubMed

Mukund Bahadur, Khatry-Chhetry; Murray, Peter J

2010-01-01

The HIV/AIDS pandemic is one of the most serious threats to global health. HIV/AIDS is a chronic illness, requiring patient empowerment to enhance adherence to treatment regimes if it is to be managed effectively. While healthcare costs are rising, people still have expectations of high-quality care. This literature review-based study explored the use of cell phone (mobile phone) short messaging services (SMS) in health care, in particular for HIV/AIDS in South Africa. From an initial corpus of 212 papers, 28 were reviewed. The main findings include that SMS can improve service delivery through appointment reminders and improve communication between healthcare workers. It improves diagnosis, prevention, treatment and rehabilitation by supporting adherence to medication, and monitoring illness and medical interventions. SMS is useful in public health programmes, such as contact tracing and partner notification, therefore playing an important role in control of HIV/AIDS. As South Africa has one of the highest uptakes and demographic distributions of cellular technology in the world, SMS is feasible as a tool to deliver quality health care with low cost.

Prioritizing health services research: an economic perspective.

PubMed

Gandjour, Afschin

2016-05-01

Given limited resources policymakers need to decide about how much and in what areas of health services research (HSR) to invest. The purpose of this study is to provide guidance for priority setting of HSR projects based on economic theory. The conceptual analysis starts from the premise that competition in health care is valuable-a position that seems to predominate among Western policymakers. The principle of competition rests on economic theory and, in particular, its branch of welfare economics. Based on economic theory, the role of HSR is to detect and alleviate information asymmetry, negative externalities, and harm caused by competition and inappropriate incentives for competition. A hierarchy of HSR projects is provided; following the ethical principle of harm ('do not harm'), the detection and prevention of harm would receive highest priority among HSR projects. Agreeing that competition is valuable in achieving efficiency and quality of care (and therefore agreeing to the assumptions of economic theory) implies accepting the role of HSR in detecting market failure and the HSR hierarchy as suggested. Disagreement would require an alternative coherent concept of improving efficiency and quality of care.

Reducing quality-of-care disparities in childhood asthma: La Red de Asma Infantil intervention in San Juan, Puerto Rico.

PubMed

Lara, Marielena; Ramos-Valencia, Gilberto; González-Gavillán, Jesús A; López-Malpica, Fernando; Morales-Reyes, Beatriz; Marín, Heriberto; Rodríguez-Sánchez, Mario H; Mitchell, Herman

2013-03-01

Although children living in Puerto Rico have the highest asthma prevalence of all US children, little is known regarding the quality-of-care disparities they experience nor the adaptability of existing asthma evidence-based interventions to reduce these disparities. The objective of this study was to describe our experience in reducing quality-of-care disparities among Puerto Rican children with asthma by adapting 2 existing evidence-based asthma interventions. We describe our experience in adapting and implementing 2 previously tested asthma evidence-based interventions: the Yes We Can program and the Inner-City Asthma Study intervention. We assessed the feasibility of combining key components of the 2 interventions to reduce asthma symptoms and estimated the potential cost savings associated with reductions in asthma-related hospitalizations and emergency department visits. A total of 117 children with moderate and severe asthma participated in the 12-month intervention in 2 housing projects in San Juan, Puerto Rico. A community-academic team with the necessary technical and cultural competences adapted and implemented the intervention. Our case study revealed the feasibility of implementing the combined intervention, henceforth referred to as La Red intervention, in the selected Puerto Rican communities experiencing a disproportionately high level of asthma burden. After 1-year follow-up, La Red intervention significantly reduced asthma symptoms and exceeded reductions of the original interventions. Asthma-related hospitalizations and emergency department use, and their associated high costs, were also significantly reduced. Asthma evidence-based interventions can be adapted to improve quality of care for children with asthma in a different cultural community setting.

Systematic review of the application of quality improvement methodologies from the manufacturing industry to surgical healthcare.

PubMed

Nicolay, C R; Purkayastha, S; Greenhalgh, A; Benn, J; Chaturvedi, S; Phillips, N; Darzi, A

2012-03-01

The demand for the highest-quality patient care coupled with pressure on funding has led to the increasing use of quality improvement (QI) methodologies from the manufacturing industry. The aim of this systematic review was to identify and evaluate the application and effectiveness of these QI methodologies to the field of surgery. MEDLINE, the Cochrane Database, Allied and Complementary Medicine Database, British Nursing Index, Cumulative Index to Nursing and Allied Health Literature, Embase, Health Business(™) Elite, the Health Management Information Consortium and PsycINFO(®) were searched according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Empirical studies were included that implemented a described QI methodology to surgical care and analysed a named outcome statistically. Some 34 of 1595 articles identified met the inclusion criteria after consensus from two independent investigators. Nine studies described continuous quality improvement (CQI), five Six Sigma, five total quality management (TQM), five plan-do-study-act (PDSA) or plan-do-check-act (PDCA) cycles, five statistical process control (SPC) or statistical quality control (SQC), four Lean and one Lean Six Sigma; 20 of the studies were undertaken in the USA. The most common aims were to reduce complications or improve outcomes (11), to reduce infection (7), and to reduce theatre delays (7). There was one randomized controlled trial. QI methodologies from industry can have significant effects on improving surgical care, from reducing infection rates to increasing operating room efficiency. The evidence is generally of suboptimal quality, and rigorous randomized multicentre studies are needed to bring evidence-based management into the same league as evidence-based medicine. Copyright © 2011 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

Do nursing home chain size and proprietary status affect experiences with care?

PubMed Central

You, Kai; Li, Yue; Intrator, Orna; Stevenson, David; Hirth, Richard; Grabowski, David; Banaszak-Holl, Jane

2015-01-01

Background In 2012, over half of nursing homes were operated by corporate chains. Facilities owned by the largest for-profit chains were reported to have lower quality of care. However, it is unknown how nursing home chain ownerships are related with experiences of care. Objectives To study the relationship between nursing home chain characteristics (chain size and profit status) with patients' family member reported ratings on experiences with care. Data Sources and Study Design Maryland nursing home care experience reports, the Online Survey, Certification, And Reporting (OSCAR) files, and Area Resource Files are used. Our sample consists of all non-governmental nursing homes in Maryland from 2007 to 2010. Consumer ratings were reported for: overall care; recommendation of the facility; staff performance; care provided; food and meals; physical environment; and autonomy and personal rights. We identified chain characteristics from OSCAR, and estimated multivariate random effect linear models to test the effects of chain ownership on care experience ratings. Results Independent nonprofit nursing homes have the highest overall rating score of 8.9, followed by 8.6 for facilities in small nonprofit chains, and 8.5 for independent for-profit facilities. Facilities in small, medium and large for-profit chains have even lower overall ratings of 8.2, 7.9, and 8.0, respectively. We find similar patterns of differences in terms of recommendation rate, and important areas such as staff communication and quality of care. Conclusions Evidence suggests that Maryland nursing homes affiliated with large- and medium- for-profit chains had lower ratings of family reported experience with care. PMID:26765147

The Technical Quality of Delivered Care for People with Inflammatory Bowel Disease in Tabriz Gastroenterology Clinics.

PubMed

Tabrizi, Jafar Sadegh; Somi, Mohammad Hossein; Asghari, Sima; Asghari Jafarabadi, Mohammad; Gharibi, Farid; Alidoost, Saeideh

2015-01-01

The Inflammatory Bowel Disease (IBD) is considered as one of the chronic diseasesre-quiring complicated treatment. This study aimed to assess technical quality of providing care for pa-tients with IBD. This cross-sectional study was conducted on 94 people with IBD using interviews and simple random sampling methods in Gastroenterology, Endoscopy and clinic of Imam Reza Hospital and Golgasht Clinic in Tabriz in 2012. The data collection tool was a researcher-designed questionnaire whose validity and reliability had been confirmed. In order to investigate the statistical relationship between the background variables and compliance with the standards the Chi-square test was applied using SPSS 17 Software. "visit by the physician" and "diet advice by the dietitian" have had the highest and the lowest levels of compliance with the standard respectively, and "the care related to the disease exacerbation" and "the care provided by the other physicians" were not compatible with the standards in 80% of the cases. Data analyses also showed that there was a significant relationship between participant's age, job, education and the smoking status and compliance of some care with the relevant standards (P<0.05). The results indicate a substantial gap between provided care for the people with IBD and the relevant standards. This indicates the areas that need of improvement and requires the serious attention of the authorities.

Fear of Recurrence as a Predictor of Care Needs for Long-Term Breast Cancer Survivors.

PubMed

Fang, Su-Ying; Fetzer, Susan Jane; Lee, Kuo-Ting; Kuo, Yao-Lung

The improved survival rate for breast cancer has increased the number of women living with the diagnosis for more than 5 years. Limited studies have focused on the care needs for long-term healthy survivors of breast cancer. The aims of this study were to understand the care needs of long-term breast cancer survivors and identify related factors that influence these needs. A convenience sampling with a correlational study design was used. Women at least 20 years old, who were given a diagnosis of breast cancer at least 5 years, were recruited from 2 hospital clinics in southern Taiwan. A self-administered questionnaire measuring cancer survivors' unmet needs was administered after obtaining informed consent. Binary logistic regression was used to examine variables associated with unmet care needs. Of the 192 women participating, the highest unmet needs related to existential survivorship. The most frequently endorsed unmet need was for an ongoing case manager. Fear of recurrence was associated with 3 aspects including existential survivorship, comprehensive cancer, and quality-of-life unmet needs (odds ratio, 1.14-1.21). Even 5 years after the diagnosis and completion of therapy, women continue to report unmet needs. Evaluating women's fear of recurrence to identify high-risk women with unmet needs is critical to providing quality care. Developing appropriate survivorship care programs combined with managing concerns regarding recurrence by a nursing case manager is needed.

The science of quality improvement implementation: developing capacity to make a difference.

PubMed

Alexander, Jeffrey A; Hearld, Larry R

2011-12-01

Quality improvement (QI) holds promise to improve quality of care; however, organizations often struggle with its implementation. It has been recommended that practitioners, managers, and researchers attempt to increase systematic understanding of the structure, practices, and context of organizations that facilitate or impede the implementation of QI innovations. To critically review the empirical research on QI implementation in health care organizations. A literature review of 107 studies that examined the implementation of QI innovations in health care organizations. Studies were classified into 4 groups based on the types of predictors that were assumed to affect implementation (content of QI innovation, organizational processes, internal context, and external context). Internal context and organizational processes were the most frequently studied categories. External context and organizational process categories exhibited the highest rate of positive effects on QI implementation. The review revealed several important gaps in the QI implementation literature. Studies often lacked clear conceptual frameworks to guide the research, which may hinder efforts to compare relationships across studies. Studies also tended to adopt designs that were narrowly focused on independent effects of predictors and did not include holistic frameworks to capture interactions among the many factors involved in implementation. Other design limitations included the use of cross-sectional designs, single-source data collection, and potential selection bias among study participants.

Satisfaction with Quality of Care Received by Patients without National Health Insurance Attending a Primary Care Clinic in a Resource-Poor Environment of a Tertiary Hospital in Eastern Nigeria in the Era of Scaling up the Nigerian Formal Sector Health Insurance Scheme

PubMed Central

Iloh, GUP; Ofoedu, JN; Njoku, PU; Okafor, GOC; Amadi, AN; Godswill-Uko, EU

2013-01-01

Background: The increasing importance of the concept of patients’ satisfaction as a valuable tool for assessing quality of care is a current global healthcare concerns as regards consumer-oriented health services. Aim: This study assessed satisfaction with quality of care received by patients without national health insurance (NHI) attending a primary care clinic in a resource-poor environment of a tertiary hospital in South-Eastern Nigeria. Subject and Methods: This was a cross-sectional study carried out on 400 non-NHI patients from April 2011 to October 2011 at the primary care clinic of Federal Medical Centre, Umuahia, Nigeria. Adult patients seen within the study period were selected by systematic sampling using every second non-NHI patient that registered to see the physicians and who met the selection criteria. Data were collected using pretested, structured interviewer administered questionnaire designed on a five points Likert scale items with 1 and 5 indicating the lowest and highest levels of satisfaction respectively. Satisfaction was measured from the following domains: patient waiting time, patient–staff communication, patient-staff relationship, and cost of care, hospital bureaucracy and hospital environment. Operationally, patients who scored 3 points and above in the assessed domain were considered satisfied while those who scored less than 3 points were dissatisfied. Results: The overall satisfaction score of the respondents was 3.1. Specifically, the respondents expressed satisfaction with patient–staff relationship (3.9), patient–staff communication (3.8), and hospital environment (3.6) and dissatisfaction with patient waiting time (2.4), hospital bureaucracy (2.5), and cost of care (2.6). Conclusion: The overall non-NHI patient's satisfaction with the services provided was good. The hospital should set targets for quality improvement in the current domains of satisfaction while the cost of care has implications for government intervention as it mirrors the need to make NHI universal for all Nigerians irrespective of the employment status. PMID:23634326

Satisfaction with Quality of Care Received by Patients without National Health Insurance Attending a Primary Care Clinic in a Resource-Poor Environment of a Tertiary Hospital in Eastern Nigeria in the Era of Scaling up the Nigerian Formal Sector Health Insurance Scheme.

PubMed

Iloh, Gup; Ofoedu, Jn; Njoku, Pu; Okafor, Goc; Amadi, An; Godswill-Uko, Eu

2013-01-01

The increasing importance of the concept of patients' satisfaction as a valuable tool for assessing quality of care is a current global healthcare concerns as regards consumer-oriented health services. This study assessed satisfaction with quality of care received by patients without national health insurance (NHI) attending a primary care clinic in a resource-poor environment of a tertiary hospital in South-Eastern Nigeria. This was a cross-sectional study carried out on 400 non-NHI patients from April 2011 to October 2011 at the primary care clinic of Federal Medical Centre, Umuahia, Nigeria. Adult patients seen within the study period were selected by systematic sampling using every second non-NHI patient that registered to see the physicians and who met the selection criteria. Data were collected using pretested, structured interviewer administered questionnaire designed on a five points Likert scale items with 1 and 5 indicating the lowest and highest levels of satisfaction respectively. Satisfaction was measured from the following domains: patient waiting time, patient-staff communication, patient-staff relationship, and cost of care, hospital bureaucracy and hospital environment. Operationally, patients who scored 3 points and above in the assessed domain were considered satisfied while those who scored less than 3 points were dissatisfied. The overall satisfaction score of the respondents was 3.1. Specifically, the respondents expressed satisfaction with patient-staff relationship (3.9), patient-staff communication (3.8), and hospital environment (3.6) and dissatisfaction with patient waiting time (2.4), hospital bureaucracy (2.5), and cost of care (2.6). The overall non-NHI patient's satisfaction with the services provided was good. The hospital should set targets for quality improvement in the current domains of satisfaction while the cost of care has implications for government intervention as it mirrors the need to make NHI universal for all Nigerians irrespective of the employment status.

The satisfaction of families in the care of their loved ones in CCUs in Lebanon.

PubMed

Hajj, Madeleine; Gulgulian, Taline; Haydar, Lili; Saab, Amali; Dirany, Fatima; Badr, Lina Kurdahi

2017-07-01

The needs of family members vary among cultures and hospitals. Often, these needs remain unmet increasing their stress and anxiety and decreasing their satisfaction with care, which may negatively impact the quality of patient care. To assess the satisfaction of families with the care of their loved ones in critical care units (CCUs) in a large university medical centre in Lebanon and to assess the predictors of satisfaction. A cross-sectional descriptive design was conducted using the Critical Care Family Satisfaction Survey (CCFSS). The participants were 123 adult relatives or significant others of patients cared for in both adult and paediatric intensive care units for at least 3 days. The CCFSS showed acceptable internal reliability and construct validity in a Lebanese population. In general, families were satisfied with the care their loved ones received in the CCUs, and the least satisfaction was in the area of 'comfort' and the highest was in 'assurance'. Younger family members with more education were less satisfied with care and Christian families expressed less satisfaction with informational needs compared with Muslim families. Families of children in the paediatric CCU expressed least satisfaction with care. Gender, residency, relationship to patient, unit, prior experience in a CCU and diagnosis had no effect on satisfaction scores. Assessment of family satisfaction in different cultures is important as each culture has specific needs that are essential to decipher. Patient satisfaction leads to improved quality of care; thus, it behoves nurses to meet the needs of families from different cultures to help them cope and increase their satisfaction, which leads to improve patient outcomes. © 2015 British Association of Critical Care Nurses.

Experience matters: neurologists' perspectives on ALS patients' well-being.

PubMed

Aho-Özhan, Helena E A; Böhm, Sarah; Keller, Jürgen; Dorst, Johannes; Uttner, Ingo; Ludolph, Albert C; Lulé, Dorothée

2017-04-01

Despite the fatal outcome and progressive loss of physical functioning in amyotrophic lateral sclerosis (ALS), many patients maintain contentment in life. It has been shown that non-professionals tend to underestimate the well-being of patients with ALS, but professionals' perspective is yet to be studied. In total, 105 neurologists with varying degrees of experience with ALS were included in an anonymous survey. They were asked to estimate the quality of life and depressiveness of ALS patients with artificial ventilation and nutrition. Physicians' estimations were compared with previously reported subjective ratings of ALS patients with life-prolonging measures. Neurologists with significant experience on ALS and palliative care were able to accurately estimate depressiveness and quality of life of ALS patients with life-prolonging measures. Less experienced neurologists' estimation differed more from patients' reports. Of all life-prolonging measures neurologists regarded invasive ventilation as the measure associated with lowest quality of life and highest depressiveness of the patients. Experienced neurologists as well as neurologists with experience in palliative care are able to better empathize with patients with a fatal illness such as ALS and support important decision processes.

Mixed methods research in music therapy research.

PubMed

Bradt, Joke; Burns, Debra S; Creswell, John W

2013-01-01

Music therapists have an ethical and professional responsibility to provide the highest quality care possible to their patients. Much of the time, high quality care is guided by evidence-based practice standards that integrate the most current, available research in making decisions. Accordingly, music therapists need research that integrates multiple ways of knowing and forms of evidence. Mixed methods research holds great promise for facilitating such integration. At this time, there have not been any methodological articles published on mixed methods research in music therapy. The purpose of this article is to introduce mixed methods research as an approach to address research questions relevant to music therapy practice. This article describes the core characteristics of mixed methods research, considers paradigmatic issues related to this research approach, articulates major challenges in conducting mixed methods research, illustrates four basic designs, and provides criteria for evaluating the quality of mixed methods articles using examples of mixed methods research from the music therapy literature. Mixed methods research offers unique opportunities for strengthening the evidence base in music therapy. Recommendations are provided to ensure rigorous implementation of this research approach.

Perceived Benefits, Barriers, and Drivers of Telemedicine From the Perspective of Skilled Nursing Facility Administrative Staff Stakeholders.

PubMed

Driessen, Julia; Castle, Nicholas G; Handler, Steven M

2018-01-01

Potentially avoidable hospitalizations (PAHs) of skilled nursing facility (SNF) patients are common and costly. Telemedicine represents a unique approach to manage and potentially reduce PAHs in SNFs, having been used in a variety of settings to improve coordination of care and enhance access to providers. Nonetheless, broad implementation and use of telemedicine lags in SNFs relative to other health care settings. To understand why, we surveyed SNF administrative staff attending a 1-day telemedicine summit. Participants saw the highest value of telemedicine in improving the quality of care and reducing readmissions. They identified hospital and managed care telemedicine requirements as primary drivers of adoption. The most significant barrier to adoption was the initial investment required. A joint research-policy effort to improve the evidence base around telemedicine in SNFs and introduce incentives may improve adoption and continued use of telemedicine in this setting.

Dietary Quality of Preschoolers’ Sack Lunches as Measured by the Healthy Eating Index

PubMed Central

Romo-Palafox, Maria Jose; Ranjit, Nalini; Sweitzer, Sara J.; Roberts-Gray, Cindy; Hoelscher, Deanna M.; Byrd-Williams, Courtney E.; Briley, Margaret E.

2015-01-01

Background Eating habits are developed during the preschool years and track into adulthood, but few studies have quantified dietary quality of meals packed by parents for preschool children enrolled in early care and education centers. Objective Our aim was to evaluate the dietary quality of preschoolers’ sack lunches using the Healthy Eating Index (HEI) 2010 to provide parents of preschool children with guidance to increase the healthfulness of their child’s lunch. Design This study is a cross-sectional analysis of baseline dietary data from the Lunch Is in the Bag trial. Participants A total of 607 parent–child dyads from 30 early care and education centers in Central and South Texas were included. Main outcome measures Total and component scores of the HEI were computed using data obtained from direct observations of packed lunches and of children’s consumption. Statistical analysis Three-level regression models with random intercepts at the early care and education center and child level were used; all models were adjusted for child sex, age, and body mass index (calculated as kg/m2). Results Mean HEI-2010 total scores were 58 for lunches packed and 52 for lunches consumed, out of 100 possible points. Mean HEI component scores for packed and consumed lunches were lowest for greens and beans (6% and 8% of possible points), total vegetables (33% and 28%), seafood and plant proteins (33% and 29%), and whole grains (38% and 34%); and highest for empty calories (85% and 68% of possible points), total fruit (80% and 70%), whole fruit (79% and 64%), and total protein foods (76% and 69%). Conclusions Parents of preschool children pack lunches with low dietary quality that lack vegetables, plant proteins, and whole grains, as measured by the HEI. Education of parents and care providers in early care and education centers is vital to ensure that preschoolers receive high dietary-quality meals that promote their preference for and knowledge of a healthy diet. PMID:26190228

Dietary Quality of Preschoolers' Sack Lunches as Measured by the Healthy Eating Index.

PubMed

Romo-Palafox, Maria Jose; Ranjit, Nalini; Sweitzer, Sara J; Roberts-Gray, Cindy; Hoelscher, Deanna M; Byrd-Williams, Courtney E; Briley, Margaret E

2015-11-01

Eating habits are developed during the preschool years and track into adulthood, but few studies have quantified dietary quality of meals packed by parents for preschool children enrolled in early care and education centers. Our aim was to evaluate the dietary quality of preschoolers' sack lunches using the Healthy Eating Index (HEI) 2010 to provide parents of preschool children with guidance to increase the healthfulness of their child's lunch. This study is a cross-sectional analysis of baseline dietary data from the Lunch Is in the Bag trial. A total of 607 parent-child dyads from 30 early care and education centers in Central and South Texas were included. Total and component scores of the HEI were computed using data obtained from direct observations of packed lunches and of children's consumption. Three-level regression models with random intercepts at the early care and education center and child level were used; all models were adjusted for child sex, age, and body mass index (calculated as kg/m(2)). Mean HEI-2010 total scores were 58 for lunches packed and 52 for lunches consumed, out of 100 possible points. Mean HEI component scores for packed and consumed lunches were lowest for greens and beans (6% and 8% of possible points), total vegetables (33% and 28%), seafood and plant proteins (33% and 29%), and whole grains (38% and 34%); and highest for empty calories (85% and 68% of possible points), total fruit (80% and 70%), whole fruit (79% and 64%), and total protein foods (76% and 69%). Parents of preschool children pack lunches with low dietary quality that lack vegetables, plant proteins, and whole grains, as measured by the HEI. Education of parents and care providers in early care and education centers is vital to ensure that preschoolers receive high dietary-quality meals that promote their preference for and knowledge of a healthy diet. Copyright © 2015 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.

Measuring the perceived quality of ophthalmology services in private organizations. A marketing perspective.

PubMed

Gheorghe, Iuliana Raluca; Gheorghe, Consuela-Mădălina; Purcărea, Victor Lorin

2018-01-01

Nowadays, the competition registered on the Romanian markets regarding the activity of private ophthalmology organizations has raised their interest in developing consumer-oriented strategies. The key factor that assures a differentiation as well as a competitive advantage is the service quality from a marketing perspective. From a marketing perspective, service quality is measured as a perceived discrepancy between the consumers' expectations and was actually performed in health care services. The most widely and validated measurement is the SERVQUAL scale. However, a variety of SERVQUAL scales have been applied in different health care environments without taking into consideration the specialty of the health care service. Thus, the objective of this paper was to measure the service quality in the Romanian ophthalmology private organizations using the SERVQUAL measurement, by identifying the SERVQUAL dimensions, which register the highest and the lowest gap scores. The instrument for data collection was the SERVQUAL self-administered questionnaire that consisted of 22 items measured on a 5-point Likert scale. The sample size encompassed 100 participants and the sampling technique was the snowball. The internal consistency, validity and the reliability of the SERVQUAL scale was determined by the Cronbach's alpha coefficients and factor analysis. The SERVQUAL questionnaire focused on 5 dimensions (tangibles, reliability, assurance, empathy and responsiveness) and each dimension, in its turn, was characterized by different items. The mean age of the participants was 49.52 years, with a mean income of 3031 Romanian Currency and the mean period of wearing eyeglasses was 5 years (±2). Further, there were 47% females and 53% males. The overall internal consistency of the SERVQUAL scale, as well as the dimensions' internal consistency were all above 0.7 and the factor analysis revealed that the items loaded properly on each dimension. Moreover, the gap scores of the SERVQUAL scale's dimensions pinpointed that the highest gap score was registered by the Tangibles dimension and the lowest gap score was registered by the Reliability dimension. Performing the ophthalmology service right the first time, contributes significantly to the improvement of the marketing effectiveness and the operating efficiency.

Measuring the perceived quality of ophthalmology services in private organizations. A marketing perspective

PubMed Central

Gheorghe, Iuliana Raluca; Gheorghe, Consuela-Mădălina; Purcărea, Victor Lorin

2018-01-01

Nowadays, the competition registered on the Romanian markets regarding the activity of private ophthalmology organizations has raised their interest in developing consumer-oriented strategies. The key factor that assures a differentiation as well as a competitive advantage is the service quality from a marketing perspective. Objectives: From a marketing perspective, service quality is measured as a perceived discrepancy between the consumers’ expectations and was actually performed in health care services. The most widely and validated measurement is the SERVQUAL scale. However, a variety of SERVQUAL scales have been applied in different health care environments without taking into consideration the specialty of the health care service. Thus, the objective of this paper was to measure the service quality in the Romanian ophthalmology private organizations using the SERVQUAL measurement, by identifying the SERVQUAL dimensions, which register the highest and the lowest gap scores. Materials and methods: The instrument for data collection was the SERVQUAL self-administered questionnaire that consisted of 22 items measured on a 5-point Likert scale. The sample size encompassed 100 participants and the sampling technique was the snowball. The internal consistency, validity and the reliability of the SERVQUAL scale was determined by the Cronbach’s alpha coefficients and factor analysis. The SERVQUAL questionnaire focused on 5 dimensions (tangibles, reliability, assurance, empathy and responsiveness) and each dimension, in its turn, was characterized by different items. Results: The mean age of the participants was 49.52 years, with a mean income of 3031 Romanian Currency and the mean period of wearing eyeglasses was 5 years (±2). Further, there were 47% females and 53% males. The overall internal consistency of the SERVQUAL scale, as well as the dimensions’ internal consistency were all above 0.7 and the factor analysis revealed that the items loaded properly on each dimension. Moreover, the gap scores of the SERVQUAL scale’s dimensions pinpointed that the highest gap score was registered by the Tangibles dimension and the lowest gap score was registered by the Reliability dimension. Conclusions: Performing the ophthalmology service right the first time, contributes significantly to the improvement of the marketing effectiveness and the operating efficiency. PMID:29796435

Care Coordination Challenges Among High-Needs, High-Costs Older Adults in a Medigap Plan

PubMed Central

Wells, Timothy S.; Bhattarai, Gandhi R.; Hawkins, Kevin; Cheng, Yan; Ruiz, Joann; Barnowski, Cynthia A.; Spivack, Barney; Yeh, Charlotte S.

2016-01-01

Purpose of the Study: Many adults 65 years or older have high health care needs and costs. Here, we describe their care coordination challenges. Primary Practice Setting: Individuals with an AARP Medicare Supplement Insurance plan insured by UnitedHealthcare Insurance Company (for New York residents, UnitedHealthcare Insurance Company of New York). Methodology and Sample: The three groups included the highest needs, highest costs (the “highest group”), the high needs, high costs (the “high group”), and the “all other group.” Eligibility was determined by applying an internally developed algorithm based upon a number of criteria, including hierarchical condition category score, the Optum ImpactPro prospective risk score, as well as diagnoses of coronary artery disease, congestive heart failure, or diabetes. Results: The highest group comprised 2%, although consumed 12% of health care expenditures. The high group comprised 20% and consumed 46% of expenditures, whereas the all other group comprised 78% and consumed 42% of expenditures. On average, the highest group had $102,798 in yearly health care expenditures, compared with $34,610 and $7,634 for the high and all other groups, respectively. Fifty-seven percent of the highest group saw 16 or more different providers annually, compared with 21% and 2% of the high and all other groups, respectively. Finally, 28% of the highest group had prescriptions from at least seven different providers, compared with 20% and 5% of the high and all other groups, respectively. Implications for Case Management Practice: Individuals with high health care needs and costs have visits to numerous health care providers and receive multiple prescriptions for pharmacotherapy. As a result, these individuals can become overwhelmed trying to manage and coordinate their health care needs. Care coordination programs may help these individuals coordinate their care. PMID:27301064

Care Coordination Challenges Among High-Needs, High-Costs Older Adults in a Medigap Plan.

PubMed

Wells, Timothy S; Bhattarai, Gandhi R; Hawkins, Kevin; Cheng, Yan; Ruiz, Joann; Barnowski, Cynthia A; Spivack, Barney; Yeh, Charlotte S

Many adults 65 years or older have high health care needs and costs. Here, we describe their care coordination challenges. Individuals with an AARP Medicare Supplement Insurance plan insured by UnitedHealthcare Insurance Company (for New York residents, UnitedHealthcare Insurance Company of New York). The three groups included the highest needs, highest costs (the "highest group"), the high needs, high costs (the "high group"), and the "all other group." Eligibility was determined by applying an internally developed algorithm based upon a number of criteria, including hierarchical condition category score, the Optum ImpactPro prospective risk score, as well as diagnoses of coronary artery disease, congestive heart failure, or diabetes. The highest group comprised 2%, although consumed 12% of health care expenditures. The high group comprised 20% and consumed 46% of expenditures, whereas the all other group comprised 78% and consumed 42% of expenditures. On average, the highest group had $102,798 in yearly health care expenditures, compared with $34,610 and $7,634 for the high and all other groups, respectively. Fifty-seven percent of the highest group saw 16 or more different providers annually, compared with 21% and 2% of the high and all other groups, respectively. Finally, 28% of the highest group had prescriptions from at least seven different providers, compared with 20% and 5% of the high and all other groups, respectively. Individuals with high health care needs and costs have visits to numerous health care providers and receive multiple prescriptions for pharmacotherapy. As a result, these individuals can become overwhelmed trying to manage and coordinate their health care needs. Care coordination programs may help these individuals coordinate their care.

Mental health in primary care: an evaluation using the Item Response Theory.

PubMed

Rocha, Hugo André da; Santos, Alaneir de Fátima Dos; Reis, Ilka Afonso; Santos, Marcos Antônio da Cunha; Cherchiglia, Mariângela Leal

2018-01-01

OBJECTIVE To determine the items of the Brazilian National Program for Improving Access and Quality of Primary Care that better evaluate the capacity to provide mental health care. METHODS This is a cross-sectional study carried out using the Graded Response Model of the Item Response Theory using secondary data from the second cycle of the National Program for Improving Access and Quality of Primary Care, which evaluates 30,523 primary care teams in the period from 2013 to 2014 in Brazil. The internal consistency, correlation between items, and correlation between items and the total score were tested using the Cronbach's alpha, Spearman's correlation, and point biserial coefficients, respectively. The assumptions of unidimensionality and local independence of the items were tested. Word clouds were used as one way to present the results. RESULTS The items with the greatest ability to discriminate were scheduling of the agenda according to risk stratification, keeping of records of the most serious cases of users in psychological distress, and provision of group care. The items that required a higher level of mental health care in the parameter of location were the provision of any type of group care and the provision of educational and mental health promotion activities. Total Cronbach's alpha coefficient was 0.87. The items that obtained the highest correlation with total score were the recording of the most serious cases of users in psychological distress and scheduling of the agenda according to risk stratification. The final scores obtained oscillated between -2.07 (minimum) and 1.95 (maximum). CONCLUSIONS There are important aspects in the discrimination of the capacity to provide mental health care by primary health care teams: risk stratification for care management, follow-up of the most serious cases, group care, and preventive and health promotion actions.

Information and communication technology-enabled person-centered care for the "big five" chronic conditions: scoping review.

PubMed

Wildevuur, Sabine E; Simonse, Lianne W L

2015-03-27

Person-centered information and communication technology (ICT) could encourage patients to take an active part in their health care and decision-making process, and make it possible for patients to interact directly with health care providers and services about their personal health concerns. Yet, little is known about which ICT interventions dedicated to person-centered care (PCC) and connected-care interactions have been studied, especially for shared care management of chronic diseases. The aim of this research is to investigate the extent, range, and nature of these research activities and identify research gaps in the evidence base of health studies regarding the "big 5" chronic diseases: diabetes mellitus, cardiovascular disease, chronic respiratory disease, cancer, and stroke. The objective of this paper was to review the literature and to scope the field with respect to 2 questions: (1) which ICT interventions have been used to support patients and health care professionals in PCC management of the big 5 chronic diseases? and (2) what is the impact of these interventions, such as on health-related quality of life and cost efficiency? This research adopted a scoping review method. Three electronic medical databases were accessed: PubMed, EMBASE, and Cochrane Library. The research reviewed studies published between January 1989 and December 2013. In 5 stages of systematic scanning and reviewing, relevant studies were identified, selected, and charted. Then we collated, summarized, and reported the results. From the initial 9380 search results, we identified 350 studies that qualified for inclusion: diabetes mellitus (n=103), cardiovascular disease (n=89), chronic respiratory disease (n=73), cancer (n=67), and stroke (n=18). Persons with one of these chronic conditions used ICT primarily for self-measurement of the body, when interacting with health care providers, with the highest rates of use seen in chronic respiratory (63%, 46/73) and cardiovascular (53%, 47/89) diseases. We found 60 relevant studies (17.1%, 60/350) on person-centered shared management ICT, primarily using telemedicine systems as personalized ICT. The highest impact measured related to the increase in empowerment (15.4%, 54/350). Health-related quality of life accounted for 8%. The highest impact connected to health professionals was an increase in clinical outcome (11.7%, 41/350). The impacts on organization outcomes were decrease in hospitalization (12.3%, 43/350) and increase of cost efficiency (10.9%, 38/350). This scoping review outlined ICT-enabled PCC in chronic disease management. Persons with a chronic disease could benefit from an ICT-enabled PCC approach, but ICT-PCC also yields organizational paybacks. It could lead to an increase in health care usage, as reported in some studies. Few interventions could be regarded as "fully" addressing PCC. This review will be especially helpful to those deciding on areas where further development of research or implementation of ICT-enabled PCC may be warranted.

Information and Communication Technology–Enabled Person-Centered Care for the “Big Five” Chronic Conditions: Scoping Review

PubMed Central

Simonse, Lianne WL

2015-01-01

Background Person-centered information and communication technology (ICT) could encourage patients to take an active part in their health care and decision-making process, and make it possible for patients to interact directly with health care providers and services about their personal health concerns. Yet, little is known about which ICT interventions dedicated to person-centered care (PCC) and connected-care interactions have been studied, especially for shared care management of chronic diseases. The aim of this research is to investigate the extent, range, and nature of these research activities and identify research gaps in the evidence base of health studies regarding the “big 5” chronic diseases: diabetes mellitus, cardiovascular disease, chronic respiratory disease, cancer, and stroke. Objective The objective of this paper was to review the literature and to scope the field with respect to 2 questions: (1) which ICT interventions have been used to support patients and health care professionals in PCC management of the big 5 chronic diseases? and (2) what is the impact of these interventions, such as on health-related quality of life and cost efficiency? Methods This research adopted a scoping review method. Three electronic medical databases were accessed: PubMed, EMBASE, and Cochrane Library. The research reviewed studies published between January 1989 and December 2013. In 5 stages of systematic scanning and reviewing, relevant studies were identified, selected, and charted. Then we collated, summarized, and reported the results. Results From the initial 9380 search results, we identified 350 studies that qualified for inclusion: diabetes mellitus (n=103), cardiovascular disease (n=89), chronic respiratory disease (n=73), cancer (n=67), and stroke (n=18). Persons with one of these chronic conditions used ICT primarily for self-measurement of the body, when interacting with health care providers, with the highest rates of use seen in chronic respiratory (63%, 46/73) and cardiovascular (53%, 47/89) diseases. We found 60 relevant studies (17.1%, 60/350) on person-centered shared management ICT, primarily using telemedicine systems as personalized ICT. The highest impact measured related to the increase in empowerment (15.4%, 54/350). Health-related quality of life accounted for 8%. The highest impact connected to health professionals was an increase in clinical outcome (11.7%, 41/350). The impacts on organization outcomes were decrease in hospitalization (12.3%, 43/350) and increase of cost efficiency (10.9%, 38/350). Conclusions This scoping review outlined ICT-enabled PCC in chronic disease management. Persons with a chronic disease could benefit from an ICT-enabled PCC approach, but ICT-PCC also yields organizational paybacks. It could lead to an increase in health care usage, as reported in some studies. Few interventions could be regarded as “fully” addressing PCC. This review will be especially helpful to those deciding on areas where further development of research or implementation of ICT-enabled PCC may be warranted. PMID:25831199

The nexus of nursing leadership and a culture of safer patient care.

PubMed

Murray, Melanie; Sundin, Deborah; Cope, Vicki

2018-03-01

To explore the connection between +6 nursing leadership and enhanced patient safety. Critical reports from the Institute of Medicine in 1999 and Francis QC report of 2013 indicate that healthcare organisations, inclusive of nursing leadership, were remiss or inconsistent in fostering a culture of safety. The factors required to foster organisational safety culture include supportive leadership, effective communication, an orientation programme and ongoing training, appropriate staffing, open communication regarding errors, compliance to policy and procedure, and environmental safety and security. As nurses have the highest patient interaction, and leadership is discernible at all levels of nursing, nurse leaders are the nexus to influencing organisational culture towards safer practices. The position of this article was to explore the need to form a nexus between safety culture and leadership for the provision of safe care. Safety is crucial in health care for patient safety and patient outcomes. A culture of safety has been exposed as a major influence on patient safety practices, heavily influenced by leadership behaviours. The relationship between leadership and safety plays a pivotal role in creating positive safety outcomes for patient care. A safe culture is one nurtured by effective leadership. Patient safety is the responsibility of all healthcare workers, from the highest executive to the bedside nurse, thus effective leadership throughout all levels is essential in engaging staff to provide high quality care for the best possible patient outcomes. © 2017 John Wiley & Sons Ltd.

Psychological abuse behavior exhibited by caregivers in the care of the elderly and correlated factors in long-term care facilities in Taiwan.

PubMed

Wang, Jing-Jy

2005-12-01

This study explored the state and the correlated factors of psychological abuse behavior among caregivers in long-term care facilities in Taiwan. A cross-sectional design utilizing a descriptive-correlational approach was conducted. A sociodemographic sheet, Caregiver Psychological Elder Abuse Behavior Scale (CPEAB), and Caregiver's Burden Scale (CBS) were employed to collect data. A total of 114 caregivers completed the study, of whom 16.1% returned an CPEAB score greater than 40. The potential range of CPEAB scores ranged from 20 to 80, with the highest score indicating the greatest tendency toward psychological abuse behavior. Among the total of 20 CPEAB indicators, "Accuse him/her verbally", "Ignore his/her request", and "Insult him/her" received the highest item mean scores (M = 2.18, 2.12, 2.02; SD = 0.83, 0.84, 0.91). Significant relationships between the CPEAB and subject age, professional status, educational level, geriatric care training, and CBS score were found (p < .05 - .001). These results indicate that caregivers who are younger in age, less educated and lacking in geriatric training had a greater burden and displayed a tendency toward more abusive behavior. Another important finding was that nurses displayed more abusive behavior than their care attendant counterparts. Results of this study provide important information that may be used in medical and social interventions and policies aimed at improving quality of life for the institutionalized elderly.

Quality of hip and knee osteoarthritis management in primary health care in a Norwegian county: a cross-sectional survey.

PubMed

Grønhaug, Gudmund; Østerås, Nina; Hagen, Kåre Birger

2014-11-25

Osteoarthritis (OA) is one of the most common causes of pain and disability in the adult population. Several studies have documented discordance between general practioners (GP) practice and management recommendations, but there is limited published information about patient reported experience of quality of care. The primary aim of this study was to assess the patient perceived quality of OA management in primary health care. Secondly, we wanted to explore the factors associated with the perceived quality of OA care. A cross-sectional survey in six general practices in the county of Nord-Trøndelag in Norway, patients with radiologically diagnosed OA, according to ICPC codes L89, L90 or L91 or clinical signs and symptoms corresponding to OA in the hip or knee and patient-reported quality of OA care on the 17-item OsteoArthritis Quality Indicator questionnaire (OA-QI). OA-QI summary pass rates were calculated, in which the numerator represents the number with indicators passed and the denominator represents the total number of eligible persons. Associations with summary pass rates were explored with demographic, disease related and health care related factors as independent variables. A total of 119 patients were included (response rate 42%). The median summary QI pass rate for all 17 QIs was 47% (Inter Quartile Range 33-65%), but there were large variation between the different items. The referral for weight reduction had the lowest pass rate (8%), whereas the highest pass rate was having received information about the importance of physical activity and exercise (84%). The median summary QI pass rates for both non-pharmacological- (QIs 1-11) and pharmacological (QIs 13-16) treatments were 50% (IQR 25-75). In bivariate regression analyses, only overall treatment satisfaction was significantly associated with QI pass rate (p = 0.001), with unstandardized beta = 6.1 (95% CI 2.7 to 9.5), i.e. a one-point increase on the five-point satisfaction scale was associated with a 6% increase in pass rate. Considering that the median summary QI pass rate was 47%, there might be room for improvement in OA care. Advice and the referral of OA patients in need of weight reduction seem to have the greatest potential for improvement.

[Admission, discharge and triage guidelines for paediatric intensive care units in Spain].

PubMed

de la Oliva, Pedro; Cambra-Lasaosa, Francisco José; Quintana-Díaz, Manuel; Rey-Galán, Corsino; Sánchez-Díaz, Juan Ignacio; Martín-Delgado, María Cruz; de Carlos-Vicente, Juan Carlos; Hernández-Rastrollo, Ramón; Holanda-Peña, María Soledad; Pilar-Orive, Francisco Javier; Ocete-Hita, Esther; Rodríguez-Núñez, Antonio; Serrano-González, Ana; Blanch, Luis

2018-05-01

A paediatric intensive care unit (PICU) is a separate physical facility or unit specifically designed for the treatment of paediatric patients who, because of the severity of illness or other life-threatening conditions, require comprehensive and continuous inten-sive care by a medical team with special skills in paediatric intensive care medicine. Timely and personal intervention in intensive care reduces mortality, reduces length of stay, and decreases cost of care. With the aim of defending the right of the child to receive the highest attainable standard of health and the facilities for the treatment of illness and rehabilitation, as well as ensuring the quality of care and the safety of critically ill paediatric patients, the Spanish Association of Paediatrics (AEP), Spanish Society of Paediatric Intensive Care (SECIP) and Spanish Society of Critical Care (SEMICYUC) have approved the guidelines for the admission, discharge and triage for Spanish PICUs. By using these guidelines, the performance of Spanish paediatric intensive care units can be optimised and paediatric patients can receive the appropriate level of care for their clinical condition. Copyright © 2017 Asociación Española de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.

Admission, discharge and triage guidelines for paediatric intensive care units in Spain.

PubMed

de la Oliva, Pedro; Cambra-Lasaosa, Francisco José; Quintana-Díaz, Manuel; Rey-Galán, Corsino; Sánchez-Díaz, Juan Ignacio; Martín-Delgado, María Cruz; de Carlos-Vicente, Juan Carlos; Hernández-Rastrollo, Ramón; Holanda-Peña, María Soledad; Pilar-Orive, Francisco Javier; Ocete-Hita, Esther; Rodríguez-Núñez, Antonio; Serrano-González, Ana; Blanch, Luis

2018-05-01

A paediatric intensive care unit (PICU) is a separate physical facility or unit specifically designed for the treatment of paediatric patients who, because of the severity of illness or other life-threatening conditions, require comprehensive and continuous inten-sive care by a medical team with special skills in paediatric intensive care medicine. Timely and personal intervention in intensive care reduces mortality, reduces length of stay, and decreases cost of care. With the aim of defending the right of the child to receive the highest attainable standard of health and the facilities for the treatment of illness and rehabilitation, as well as ensuring the quality of care and the safety of critically ill paediatric patients, the Spanish Association of Paediatrics (AEP), Spanish Society of Paediatric Intensive Care (SECIP) and Spanish Society of Critical Care (SEMICYUC) have approved the guidelines for the admission, discharge and triage for Spanish PICUs. By using these guidelines, the performance of Spanish paediatric intensive care units can be optimised and paediatric patients can receive the appropriate level of care for their clinical condition. Copyright © 2017. Publicado por Elsevier España, S.L.U.

The development of the nursing care system for patients with cleft lip-palate and craniofacial deformities at Tawanchai Cleft Center, Srinagarind Hospital, Khon Kaen, Thailand.

PubMed

Pradubwong, Suteera; Pongpagatip, Sumalee; Volrathongchai, Kanittha; Chowchuen, Bowornsilp

2012-11-01

The highest incidence of cleft lip-palate and craniofacial deformities in Thailand occur in the Northeastern Region. There is the necessity for an interdisciplinary care team as well as the specialized care center with systematic coordinated care, thus "Tawanchai Cleft Center" is becoming a superior medical center for patients with cleft lip-palate and craniofacial deformities. Therefore, the development of the nursing care system for patients with cleft lip-palate and craniofacial deformities at Tawanchai Cleft Center, Srinagarind Hospital is extremely important and necessary. To develop the nursing care system appropriate for a super tertiary hospital (Tawanchai Cleft Center). It is a participation study which has 3 steps as follows, 1) Analyzing the situations and collecting the opinions of the 22 Out-patient Surgery Department staff and Tawanchai Cleft Center staff by using 6 questions, 2) Summarizing of the situation analysis from the meetings and the questionnaires, then using such summary as the guidelines for developing the nursing care system from January 2011 onwards, 3) evaluating the satisfaction after the 4 month development period (May-August 2011) with 106 caregivers by using 8 questions and being analyzed by the average value, percentage and standard deviation. 1) The nursing care system consisted of psychosocial care, breast feeding, counseling and other assistance as required. This various assistance responded to the patient/family problems by following the treatment guideline of the multidisciplinary team which uses the continuous evaluation processes for the holistic patient/family care. 2) The patients with complete cleft lip-palate were the most common type, found in 44 cases or 41.53 percent. The highest number of caregivers were mothers which were 68 percent; the average age of those mothers was 36 years old. The highest number of them finished elementary school at 43 percent and 40 percent were farmers. The satisfaction for the services of Tawanchai Cleft Center showed the average for each satisfaction subject all at very good level (x = 3.56, SD = 0.13). The care for patients with CLP and craniofacial deformities at Tawanchai Cleft Center Srinagarind Hospital has been developed in order to have the appropriate nursing care system to provide superior quality care, which provides patient-holistic care, as well as improving effective accessibility to the services. Thus, the patients/caregivers who are satisfied with given services, get continuing monitoring and treatment and are able to live their lives in the society happily.

Dental Care in an Equal Access System Valuing Equity: Are There Racial Disparities?

PubMed

Boehmer, Ulrike; Glickman, Mark; Jones, Judith A; Orner, Michelle B; Wheler, Carolyn; Berlowitz, Dan R; Kressin, Nancy R

2016-11-01

Racial disparities in dental care have previously been shown in the Veterans Health Administration (VA)-a controlled access setting valuing equitable, high-quality care. The aim of this study is to examine current disparities in dental care by focusing on the receipt of root canal therapy (RCT) versus tooth extraction. This is a retrospective analysis of data contained in the VA's electronic health records. We performed logistic regressions on the independent measures along with a facility-specific random effect, using dependent binary variables that distinguished RCT from tooth extraction procedures. VA outpatients who had at least 1 tooth extraction or RCT visit in the VA in fiscal year 2011. A dependent binary measure of tooth extraction or RCT. Other measures are medical record data on medical comorbidities, dental morbidity, prior dental utilization, and demographic characteristics. The overall rate of preferred tooth-preserving RCT was 18.1% during the study period. Black and Asian patients were most dissimilar with respect to dental morbidity, medical and psychological disorders, and black patients had the least amount of eligibility for comprehensive dental care. After adjustment for known confounding factors of RCT, black patients had the lowest RCT rates, whereas Asians had the highest. Current quality improvement efforts and a value to improve the equity of care are not sufficient to address racial/ethnic disparities in VA dental care; rather more targeted efforts will be needed to achieve equity for all.

Primary care provider cultural competence and racial disparities in HIV care and outcomes.

PubMed

Saha, Somnath; Korthuis, P Todd; Cohn, Jonathan A; Sharp, Victoria L; Moore, Richard D; Beach, Mary Catherine

2013-05-01

Health professional organizations have advocated for increasing the "cultural competence" (CC) of healthcare providers, to reduce racial and ethnic disparities in patient care. It is unclear whether provider CC is associated with more equitable care. To evaluate whether provider CC is associated with quality of care and outcomes for patients with HIV/AIDS. Survey of 45 providers and 437 patients at four urban HIV clinics in the U.S. Providers' self-rated CC was measured using a novel, 20-item instrument. Outcome measures included patients' receipt of antiretroviral (ARV) therapy, self-efficacy in managing medication regimens, complete 3-day ARV adherence, and viral suppression. Providers' mean age was 44 years; 56 % were women, and 64 % were white. Patients' mean age was 45; 67 % were men, and 77 % were nonwhite. Minority patients whose providers scored in the middle or highest third on self-rated CC were more likely than those with providers in the lowest third to be on ARVs, have high self-efficacy, and report complete ARV adherence. Racial disparities were observed in receipt of ARVs (adjusted OR, 95 % CI for white vs. nonwhite: 6.21, 1.50-25.7), self-efficacy (3.77, 1.24-11.4), and viral suppression (13.0, 3.43-49.0) among patients of low CC providers, but not among patients of moderate and high CC providers (receipt of ARVs: 0.71, 0.32-1.61; self-efficacy: 1.14, 0.59-2.22; viral suppression: 1.20, 0.60-2.42). Provider CC was associated with the quality and equity of HIV care. These findings suggest that enhancing provider CC may reduce racial disparities in healthcare quality and outcomes.

Measuring quality in community based housing support - the QPC-H instrument.

PubMed

Lundqvist, Lars-Olov; Rask, Mikael; Brunt, David; Ivarsson, Ann-Britt; Schröder, Agneta

2016-04-18

Purpose - The purpose of this paper is to test the psychometric properties and dimensionality of the instrument Quality in Psychiatric Care-Housing (QPC-H) and briefly describe the residents' perception of quality of housing support. Design/methodology/approach - A sample of 174 residents from 22 housing support services in nine Swedish municipalities participated in the study. Confirmatory factor analysis (CFA) revealed that the QPC-H consisted of six dimensions and had a factor structure largely corresponding to that found among other instruments in the Quality in Psychiatric Care (QPC) family of instruments. Findings - CFA revealed that the QPC-H consisted of six dimensions and had a factor structure largely corresponding to that found among other instruments in the QPC family of instruments. The internal consistency of the factors was acceptable except in the case of secure and secluded environment, probably due to few numbers of items. With this exception, the QPC-H shows adequate psychometric properties. Social implications - The residents' ratings of quality of housing service were generally high; the highest rating was for secluded environment and the lowest for participation. This dimension would thus seem to indicate an important area for improvement. Originality/value - The QPC-H includes important aspects of residents' assessment of quality of housing service and offers a simple and inexpensive way to evaluate housing support services from the residents' perspective.

Comparison of health care professionals' self-assessments of standards of care and patients' opinions on the care they received in hospital: observational study

PubMed Central

Durieux, P; Bissery, A; Dubois, S; Gasquet, I; Coste, J

2004-01-01

Objectives: To compare the views of healthcare professionals and patients regarding compliance with standards of care concerning patient information. Design: Self-rated questionnaire survey. Setting: Nine wards in short stay French hospitals. Participants: 939 patients and 359 healthcare professionals (physicians, nurses, assistants and other professionals). Main outcome measure: Patients' and healthcare professionals' views of compliance with 20 standards of patient care described in the French accreditation manual. Comparison of the rank order of the standards within the two samples. Results: The response rate was 61.5% in the patient group and 85.8% in the healthcare professionals. The rank orders for the 20 items were similar in both groups (Spearman rank order correlation 0.6, p = 0.004). The two items ranked highest by healthcare professionals ("consent request for a surgical procedure" and "the doctors ask the visitors to leave the room before examining a patient") were also the two ranked highest by the patients. Three items were ranked low by both groups: "consent request for students to be present", "health education given to patients", and "possibility to express satisfaction during discharge". Patients were more satisfied with their pain management than were healthcare providers. Professionals were more satisfied with the social services than the patients. Conclusion: There are both similarities and differences between patients' and healthcare professionals' views of care. Accurate assessments of quality performed during the accreditation procedure require that both patients' and professionals' views be taken into account. PMID:15175490

Service quality from the perspective of myocardial infarction patients.

PubMed

Gholipour, Kamal; Tabrizi, Jafar Sadegh; Azimzadeh, Solmaz; Ghafari, Samad; Iezadi, Shabnam

2018-04-01

Service quality (SQ) generally refers to the nonclinical aspects of health services and primarily focuses on the relationship between the care provider and the customers, and the environment in which care services are delivered. The aim of this study was to assess the SQ provided for myocardial infarction (MI) from the patients' perspective. A cross-sectional study was conducted with 164 patients with MI at the Tabriz Shahid Madani cardiology clinic. Study participants were selected using convenience sampling. SQ was measured using a validated Comprehensive Quality Measurement in Healthcare SQ questionnaire. The reliability was confirmed based on Cronbach's alpha coefficient (α=0.81). SQ was calculated using the formula SQ=10- (importance × performance), based on the importance and performance of non-health-related aspects from the customers' perspective. Importance scores ranged from 1 to 10 and performance was scored between 0 and 1. Of 164 participants, about 75% were men and almost 44% were between 51 and 65 years of age. From the customers' perspective, the total SQ score was 6.80 (0-10 scale), and the individual scores for all SQ aspects were below an acceptable level. Confidentiality, dignity and continuity were given the highest scores, while availability of support groups had the lowest score. The study findings revealed an opportunity to improve SQ. Patient and provider participation in quality improvement activities could be an effective strategy to improve the aspects of health care quality that were most important to the customers and those with low scores, such as availability of support groups.

Quality of extra virgin olive oils produced in an emerging olive growing area in north-western Spain.

PubMed

Reboredo-Rodríguez, P; González-Barreiro, C; Cancho-Grande, B; Simal-Gándara, J

2014-12-01

Systematic studies of physico-chemical and stability-related properties, and chemical composition, of extra virgin olive oils (EVOOs) obtained from drupes cropped in specific regions are of special agricultural interest. This is particularly so with new production areas, where careful selection of the most suitable olive varieties for EVOO production is required. This paper reports the first comprehensive chemical characterisation of EVOOs obtained from three different olive varieties (viz., Picual, Morisca and Manzanilla de Sevilla) grown in a new cultivation area in Galicia (NW Spain). The Morisca variety was that providing the highest industrial oil yield (21%). However, the three types of EVOO exhibited no statistically significant differences in standard quality-related indices other than acidity. Morisca EVOO was that with the lowest content in oleic acid (mean=68%) and highest content in linoleic acid (mean=13%). Also, Morisca EVOO exhibited the highest sterol levels (mean=1,616 mg/kg) and Picual EVOO the lowest (mean=1,160 mg/kg). Picual EVOO contained greater amounts of the phenolic compounds luteolin and pinoresinol than both Morisca and Manzanilla de Sevilla EVOOs. Finally, Manzanilla de Sevilla EVOO exhibited differential attributes, with banana and olive fruit aromatic series prevailing predominantly over bitter-like, pungent-like and leaf series. Copyright © 2014 Elsevier Ltd. All rights reserved.

Impact of aggressive management and palliative care on cancer costs in the final month of life.

PubMed

Cheung, Matthew C; Earle, Craig C; Rangrej, Jagadish; Ho, Thi H; Liu, Ning; Barbera, Lisa; Saskin, Refik; Porter, Joan; Seung, Soo Jin; Mittmann, Nicole

2015-09-15

A significant share of the cost of cancer care is concentrated in the end-of-life period. Although quality measures of aggressive treatment may guide optimal care during this timeframe, little is known about whether these metrics affect costs of care. This study used population data to identify a cohort of patients who died of cancer in Ontario, Canada (2005-2009). Individuals were categorized as having received or having not received aggressive end-of-life care according to quality measures related to acute institutional care or chemotherapy administration in the end-of-life period. Costs (2009 Canadian dollars) were collected over the last month of life through the linkage of health system administrative databases. Multivariate quantile regression was used to identify predictors of increased costs. Among 107,253 patients, the mean per-patient cost over the final month was $18,131 for patients receiving aggressive care and $12,678 for patients receiving nonaggressive care (P < .0001). Patients who received chemotherapy in the last 2 weeks of life also sustained higher costs than those who did not (P < .0001). For individuals receiving end-of-life care in the highest cost quintile, early and repeated palliative care consultation was associated with reduced mean per-patient costs. In a multivariate analysis, chemotherapy in the 2 weeks of life remained predictive of increased costs (median increase, $536; P < .0001), whereas access to palliation remained predictive for lower costs (median decrease, $418; P < .0001). Cancer patients who receive aggressive end-of-life care incur 43% higher costs than those managed nonaggressively. Palliative consultation may partially offset these costs and offer resultant savings. © 2015 The Authors. Cancer published by Wiley Periodicals, Inc. on behalf of American Cancer Society.

Relationship between Unwanted Pregnancy and Health-Related Quality of Life in Pregnant Women.

PubMed

Ali, Azizi

2016-06-01

To determine the relationship between unwanted pregnancy and health-related quality of life in pregnant women. Case-control study. Department of Community Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran, from October 2013 to July 2014. Of the pregnant women who presented to primary healthcare centers of Kermanshah, Iran to receive prenatal care at 6 - 10 weeks of their pregnancy, those with unwanted pregnancy were selected as cases and those with wanted pregnancy were selected as control group. The selection process was done using multi-stage stratified random sampling. Frequency matching was applied to match the two groups. Quality of life was measured by the SF-36 questionnaire and was compared by the t-test. Relationship power between pregnancy type (wanted or unwanted pregnancy) and impairment of quality of life subscales as the outcome was assessed using odds ratio (OR). Frequency distribution of matched variables was not statistically different between the two studied groups. Mean scores of mental component summary and physical component summary as well as eight subscales (physical functioning, role, bodily pain, general health, vitality, social functioning, role emotional, and mental health) were lower in the unwanted pregnancy group compared to women with wanted pregnancy (p < 0.001). The highest high impairment odds ratio was highest for the mental component summary (MCS) (OR = 9.19; 95% CI = 5.17- 16.32) and vitality subscale (OR = 5.2; 95% CI = 2.89- 9.33). Mental health of the pregnant women with unwanted pregnancy is affected more than their physical health. Mental health in women with unwanted pregnancy is 9.19 times more likely to be reduced. Among mental health subscales, vitality (energy/fatigue) showed the highest decrease.

The quality of free antenatal and delivery services in Northern Sierra Leone.

PubMed

Koroma, Manso M; Kamara, Samuel S; Bangura, Evelyn A; Kamara, Mohamed A; Lokossou, Virgil; Keita, Namoudou

2017-07-12

The number of maternal deaths in sub-Saharan Africa continues to be overwhelmingly high. In West Africa, Sierra Leone leads the list, with the highest maternal mortality ratio. In 2010, financial barriers were removed as an incentive for more women to use available antenatal, delivery and postnatal services. Few published studies have examined the quality of free antenatal services and access to emergency obstetric care in Sierra Leone. A cross-sectional survey was conducted in 2014 in all 97 peripheral health facilities and three hospitals in Bombali District, Northern Region. One hundred antenatal care providers were interviewed, 276 observations were made and 486 pregnant women were interviewed. We assessed the adequacy of antenatal and delivery services provided using national standards. The distance was calculated between each facility providing delivery services and the nearest comprehensive emergency obstetric care (CEOC) facility, and the proportion of facilities in a chiefdom within 15 km of each CEOC facility was also calculated. A thematic map was developed to show inequities. The quality of services was poor. Based on national standards, only 27% of women were examined, 2% were screened on their first antenatal visit and 47% received interventions as recommended. Although 94% of facilities provided delivery services, a minority had delivery rooms (40%), delivery kits (42%) or portable water (46%). Skilled attendants supervised 35% of deliveries, and in only 35% of these were processes adequately documented. None of the five basic emergency obstetric care facilities were fully compliant with national standards, and the central and northernmost parts of the district had the least access to comprehensive emergency obstetric care. The health sector needs to monitor the quality of antenatal interventions in addition to measuring coverage. The quality of delivery services is compromised by poor infrastructure, inadequate skilled staff, stock-outs of consumables, non-functional basic emergency obstetric care facilities, and geographic inequities in access to CEOC facilities. These findings suggest that the health sector needs to urgently investigate continuing inequities adversely influencing the uptake of these services, and explore more sustainable funding mechanisms. Without this, the country is unlikely to achieve its goal of reducing maternal deaths.

A Unique Funding Opportunity for Public Health in Texas

PubMed Central

Schlenker, Thomas; Huber, Carol A.

2015-01-01

In addition to the Affordable Care Act, states are more frequently turning to Medicaid waivers to achieve the “Triple Aim” goals of improving the experience of care, improving population health, and reducing per capita costs. These demonstration waivers provide opportunities to test innovative ways to finance and deliver care. Texas is currently implementing a waiver known as the Transformation and Quality Improvement Program. Its inclusion of public health agencies is a unique approach to a system typically limited to traditional providers. San Antonio Metropolitan Health District is one public health agency taking advantage of this new funding opportunity to implement 6 new or expanded programs targeting health issues of highest priority in this south Texas region. This article discusses the use of Medicaid waivers and the advantages and challenges of public health agency participation. PMID:25423061

Update in Hospice and Palliative Care.

PubMed

Taylor, Richard A; Smith, Cardinale B; Coats, Heather; Gelfman, Laura P; Dionne-Odom, J Nicholas

2017-11-01

The objective of this update, presented at the 2017 Annual Assembly of the American Association of Palliative and Hospice Medicine (AAHPM) and the Hospice and Palliative Nurses Association (HPNA), is to identify, summarize, and critique a sampling of research from the prior year that has the potential for marked impact on hospice and palliative clinical practice. Eight reports of original research published between January 1, 2016 and December 31, 2016 were identified through a systematic PubMed search using the terms "hospice" and "palliative care," a hand search of 22 leading healthcare journals, and discussion with experts in the field. Candidate articles were ranked based on the study's methodological quality, appeal to a breadth of palliative care clinicians across different settings, and potential clinical practice impact. We summarize the eight articles with the highest ratings and give recommendations for clinical practice.

Medical savings accounts make waves.

PubMed

Gardner, J

1995-02-27

MSAs: the theory. Medical savings account legislation would allow consumers to set aside pre-tax dollars to pay for day-to-day healthcare costs. The accounts are to be backed up by a catastropic policy with a deductible roughly equal to the maximum amount allowed in the MSA. The aim is to reduce healthcare cost inflation by making consumers more aware of the costs of healthcare than they are under comprehensive policies and enabling them to shop for the lowest-cost, highest-quality care.

Systematic overview and critical appraisal of meta-analyses of interventions in intensive care medicine.

PubMed

Koster, T M; Wetterslev, J; Gluud, C; Keus, F; van der Horst, I C C

2018-05-24

Meta-analysed intervention effect estimates are perceived to represent the highest level of evidence. However, such effects and the randomized clinical trials which are included in them need critical appraisal before the effects can be trusted. Critical appraisal of a predefined set of all meta-analyses on interventions in intensive care medicine to assess their quality and assessed the risks of bias in those meta-analyses having the best quality. We conducted a systematic search to select all meta-analyses of randomized clinical trials on interventions used in intensive care medicine. Selected meta-analyses were critically appraised for basic scientific criteria, (1) presence of an available protocol, (2) report of a full search strategy, and (3) use of any bias risk assessment of included trials. All meta-analyses which qualified these criteria were scrutinized by full "Risk of Bias in Systematic Reviews" ROBIS evaluation of 4 domains of risks of bias, and a "Preferred Reporting Items for Systematic Reviews and Meta-Analyses" PRISMA evaluation. We identified 467 meta-analyses. A total of 56 meta-analyses complied with these basic scientific criteria. We scrutinized the risks of bias in the 56 meta-analyses by full ROBIS evaluation and a PRISMA evaluation. Only 4 meta-analyses scored low risk of bias in all the 4 ROBIS domains and 41 meta-analyses reported all 27 items of the PRISMA checklist. In contrast with what might be perceived as the highest level of evidence only 0.9% of all meta-analyses were judged to have overall low risk of bias. © 2018 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

[Strategies for improving care of oncologic patients: SHARE Project results].

PubMed

Reñones Crego, María de la Concepción; Fernández Pérez, Dolores; Vena Fernández, Carmen; Zamudio Sánchez, Antonio

2016-01-01

Cancer treatment is a major burden for the patient and its family that requires an individualized management by healthcare professionals. Nurses are in charge of coordinating care and are the closest healthcare professionals to patient and family; however, in Spain, there are not standard protocols yet for the management of oncology patients. The Spanish Oncology Nursing Society developed between 2012 and 2014 the SHARE project, with the aim of establishing strategies to improve quality of life and nursing care in oncology patients. It was developed in 3 phases. First, a literature search and review was performed to identify nursing strategies, interventions and tools to improve cancer patients' care. At the second stage, these interventions were agreed within a group of oncology nursing experts; and at the third phase, a different group of experts in oncology care categorized the interventions to identify the ones with highest priority and most feasible to be implemented. As a result, 3 strategic actions were identified to improve nursing care during cancer treatment: To provide a named nurse to carry out the follow up process by attending to the clinic or telephonic consultation, develop therapeutic education with adapted protocols for each tumor type and treatment and ensure specific training for nurses on the management of the cancer patients. Strategic actions proposed in this paper aim to improve cancer patients' healthcare and quality of life through the development of advanced nursing roles based on a higher level of autonomy, situating nurses as care coordinators to assure an holistic care in oncology patients. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

Psychosocial needs of children undergoing an invasive procedure for a CHD and their parents.

PubMed

Levert, Eveline M; Helbing, Willem A; Dulfer, Karolijn; van Domburg, Ron T; Utens, Elisabeth M W J

2017-03-01

The aim of this study was to investigate the psychosocial needs of both parents of children with CHD (aged 0-18 years) and patients themselves (aged 8-18 years) in the week before cardiac surgery or a catheter intervention. Patients Eligible participants included all consecutive patients (0-18 years) scheduled to undergo cardiac surgery or a catheter intervention in our hospital between March, 2012 and July, 2013. Psychosocial needs were assessed using a disease-specific questionnaire designed for this study, consisting of a 83-item parent version and a 59-item child version (for children ⩾8 years), each covering five domains: physical/medical, emotional, social, educational/occupational, and health behaviour; two items assessed from whom and in what format psychosocial care was preferred. Quality of life was also assessed. Interventions If parents/patients reported a need for psychosocial care, referral to adequate mental health-care professionals was arranged. More than 40% of participating parents and >50% of participating children reported a need for psychosocial care on each of the five domains. Needs for psychosocial care for parents themselves were highest for those with children aged 0-12 years. Parents and patients report clear preferences when asked from whom and in what format they would like to receive psychosocial care. Quality of life was relatively high for both parents and patients. Psychosocial care interventions in our hospital increased significantly after the implementation of this study. Results show that psychosocial care is rated as (very) important by both parents and children during an extremely stressful period of their life.

The Financial Burden of Non-Communicable Chronic Diseases in Rural Nigeria: Wealth and Gender Heterogeneity in Health Care Utilization and Health Expenditures.

PubMed

Janssens, Wendy; Goedecke, Jann; de Bree, Godelieve J; Aderibigbe, Sunday A; Akande, Tanimola M; Mesnard, Alice

2016-01-01

Better insights into health care utilization and out-of-pocket expenditures for non-communicable chronic diseases (NCCD) are needed to develop accessible health care and limit the increasing financial burden of NCCDs in Sub-Saharan Africa. A household survey was conducted in rural Kwara State, Nigeria, among 5,761 individuals. Data were obtained using biomedical and socio-economic questionnaires. Health care utilization, NCCD-related health expenditures and distances to health care providers were compared by sex and by wealth quintile, and a Heckman regression model was used to estimate health expenditures taking selection bias in health care utilization into account. The prevalence of NCCDs in our sample was 6.2%. NCCD-affected individuals from the wealthiest quintile utilized formal health care nearly twice as often as those from the lowest quintile (87.8% vs 46.2%, p = 0.002). Women reported foregone formal care more often than men (43.5% vs. 27.0%, p = 0.058). Health expenditures relative to annual consumption of the poorest quintile exceeded those of the highest quintile 2.2-fold, and the poorest quintile exhibited a higher rate of catastrophic health spending (10.8% among NCCD-affected households) than the three upper quintiles (4.2% to 6.7%). Long travel distances to the nearest provider, highest for the poorest quintile, were a significant deterrent to seeking care. Using distance to the nearest facility as instrument to account for selection into health care utilization, we estimated out-of-pocket health care expenditures for NCCDs to be significantly higher in the lowest wealth quintile compared to the three upper quintiles. Facing potentially high health care costs and poor accessibility of health care facilities, many individuals suffering from NCCDs-particularly women and the poor-forego formal care, thereby increasing the risk of more severe illness in the future. When seeking care, the poor spend less on treatment than the rich, suggestive of lower quality care, while their expenditures represent a higher share of their annual household consumption. This calls for targeted interventions that enhance health care accessibility and provide financial protection from the consequences of NCCDs, especially for vulnerable populations.

Can we do better? Economic analysis of human resource investment to improve home care service for the elderly in Serbia.

PubMed

Mihic, Marko M; Todorovic, Marija Lj; Obradovic, Vladimir Lj; Mitrovic, Zorica M

2016-01-01

Social services aimed at the elderly are facing great challenges caused by progressive aging of the global population but also by the constant pressure to spend funds in a rational manner. This paper focuses on analyzing the investments into human resources aimed at enhancing home care for the elderly since many countries have recorded progress in the area over the past years. The goal of this paper is to stress the significance of performing an economic analysis of the investment. This paper combines statistical analysis methods such as correlation and regression analysis, methods of economic analysis, and scenario method. The economic analysis of investing in human resources for home care service in Serbia showed that the both scenarios of investing in either additional home care hours or more beneficiaries are cost-efficient. However, the optimal solution with the positive (and the highest) value of economic net present value criterion is to invest in human resources to boost the number of home care hours from 6 to 8 hours per week and increase the number of the beneficiaries to 33%. This paper shows how the statistical and economic analysis results can be used to evaluate different scenarios and enable quality decision-making based on exact data in order to improve health and quality of life of the elderly and spend funds in a rational manner.

Special requirements for electronic health record systems in ophthalmology.

PubMed

Chiang, Michael F; Boland, Michael V; Brewer, Allen; Epley, K David; Horton, Mark B; Lim, Michele C; McCannel, Colin A; Patel, Sayjal J; Silverstone, David E; Wedemeyer, Linda; Lum, Flora

2011-08-01

The field of ophthalmology has a number of unique features compared with other medical and surgical specialties regarding clinical workflow and data management. This has important implications for the design of electronic health record (EHR) systems that can be used intuitively and efficiently by ophthalmologists and that can promote improved quality of care. Ophthalmologists often lament the absence of these specialty-specific features in EHRs, particularly in systems that were developed originally for primary care physicians or other medical specialists. The purpose of this article is to summarize the special requirements of EHRs that are important for ophthalmology. The hope is that this will help ophthalmologists to identify important features when searching for EHR systems, to stimulate vendors to recognize and incorporate these functions into systems, and to assist federal agencies to develop future guidelines regarding meaningful use of EHRs. More broadly, the American Academy of Ophthalmology believes that these functions are elements of good system design that will improve access to relevant information at the point of care between the ophthalmologist and the patient, will enhance timely communications between primary care providers and ophthalmologists, will mitigate risk, and ultimately will improve the ability of physicians to deliver the highest-quality medical care. Proprietary or commercial interest disclosure may be found after the references. Copyright © 2011 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

Multipayer patient-centered medical home implementation guided by the chronic care model.

PubMed

Gabbay, Robert A; Bailit, Michael H; Mauger, David T; Wagner, Edward H; Siminerio, Linda

2011-06-01

A unique statewide multipayer ini Pennsylvania was undertaken to implement the Patient-Centered Medical Home (PCMH) guided by the Chronic Care Model (CCM) with diabetes as an initial target disease. This project represents the first broad-scale CCM implementation with payment reform across a diverse range of practice organizations and one of the largest PCMH multipayer initiatives. Practices implemented the CCM and PCMH through regional Breakthrough Series learning collaboratives, supported by Improving Performance in Practice (IPIP) practice coaches, with required monthly quality reporting enhanced by multipayer infrastructure payments. Some 105 practices, representing 382 primary care providers, were engaged in the four regional collaboratives. The practices from the Southeast region of Pennsylvania focused on diabetes patients (n = 10,016). During the first intervention year (May 2008-May 2009), all practices achieved at least Level 1 National Committee for Quality Assurance (NCQA) Physician Practice Connections Patient-Centered Medical Home (PPC-PCMH) recognition. There was significant improvement in the percentage of patients who had evidence-based complications screening and who were on therapies to reduce morbidity and mortality (statins, angiotensin-converting enzyme inhibitors). In addition, there were small but statistically significant improvements in key clinical parameters for blood pressure and cholesterol levels, with the greatest absolute improvement in the highest-risk patients. Transforming primary care delivery through implementation of the PCMH and CCM supported by multipayer infrastructure payments holds significant promise to improve diabetes care.

Factors contributing to nursing team work in an acute care tertiary hospital.

PubMed

Polis, Suzanne; Higgs, Megan; Manning, Vicki; Netto, Gayle; Fernandez, Ritin

Effective nursing teamwork is an essential component of quality health care and patient safety. Understanding which factors foster team work ensures teamwork qualities are cultivated and sustained. This study aims to investigate which factors are associated with team work in an Australian acute care tertiary hospital across all inpatient and outpatient settings. All nurses and midwives rostered to inpatient and outpatient wards in an acute care 600 bed hospital in Sydney Australia were invited to participate in a cross sectional survey between September to October 2013. Data were collected, collated, checked and analysed using Statistical Package for the Social Sciences (SPSS) Version 21. Factors reporting a significant correlation with where p < 0.05 were analysed in a multiple regression model. A total of 501 surveys were returned. Nursing teamwork scores ranged between 3.32 and 4.08. Teamwork subscale Shared Mental Model consistently rated the highest. Mean scores for overall communication between nurses and team leadership were 3.6 (S.D. 0.57) and 3.8 (SD 0.6) respectively. Leadership and communication between nurses were significant predictors of team work p < 0.001. Our findings describe factors predictive of teamwork in an acute care tertiary based hospital setting across inpatient and outpatient specialty units. Our findings are of particular relevance in identifying areas of nurse education and workforce planning to improve nursing team work.

[Determining biomedical equipment calibration in health care Institutions in the Risaralda Department of Colombia].

PubMed

López-Isaza, Giovanni A; Llamosa-Rincón, Luis E

2008-01-01

Determining quality features related to tracking biomedical equipment calibration patterns and their electrical safety as implemented by Health Care Institutions in the Risaralda department. This was a descriptive study using non-probabilistic sampling and the criterion of a greater equipment inventory and service demand for Clinics, Aesthetic, Radiology and Dentistry Centres and Hospitals. Census; the instrument was applied to 32 health-care institutions distributed throughout the Risaralda departments 14 municipalities between September 2005 and January 2006. Hospitals was the category having a highest number of electro-medical equipment (56%). Pereira (the capital of Risaralda) had 81% of all electro-medical equipment. All the institutions lacked NTC-ISO-IEC-17025 accreditation regarding standards certified by the Superintendence of Industry and Commerce. None of the institutions externally contracted by the institutions being surveyed was accredited. There is a public health risk in the Risaralda department; all health-care institutions lacked NTC-ISO-IEC-17025 accreditation and external institutions (in turn being hired by them for calibrating their equipment) also lacked accreditation. Based on the information obtained from non-calibrated equipment having international patterns, there is a great danger that determining the quality of biomedical equipment calibration patterns may be erroneous. It also places health-care institutions at a competitive disadvantage when compared to other accredited institutions in Colombia or in other countries.

Cancer management: the difficulties of a target-driven healthcare system.

PubMed

Anderson, Beverley

This article gives a reflective overview on cancer management from a urological perspective. It is based on anecdotal evidence and observations of local practice, and highlights some of the inherent difficulties of delivering a robust service in a target-driven healthcare system. Cancer is a complex disease. It is crucial that stringent measures are used to ensure those affected by it receive care that is of the highest quality, delivered in a timely manner, and tailored to meet the individual's needs. In 2000, the Government's attempt to increase competition among healthcare providers in the delivery of care, and thereby healthcare quality and efficiency, resulted in a number of healthcare reforms being introduced in the UK. Central to these were the NHS Cancer Waiting Time standards, which were designed to fast-track care delivery in the management of cancer patients. The multidisciplinary teams play a pivotal role in this process and their contribution is imperative to achieving the desired outcomes. It is acknowledged that targets can be beneficial, but there are clear unintended consequences as well. Increases in urgent referrals result in significant screening demands and, consequently, newly diagnosed cancers. This, combined with factors such as patient choice and costs, put added pressure on NHS establishments and health professionals to deliver care within the target specifications.

Variations in achievement of evidence-based, high-impact quality indicators in general practice: An observational study

PubMed Central

West, Robert; Rushforth, Bruno; Stokes, Tim; Glidewell, Liz; Carder, Paul; Faulkner, Simon; Foy, Robbie

2017-01-01

Background There are widely recognised variations in the delivery and outcomes of healthcare but an incomplete understanding of their causes. There is a growing interest in using routinely collected ‘big data’ in the evaluation of healthcare. We developed a set of evidence-based ‘high impact’ quality indicators (QIs) for primary care and examined variations in achievement of these indicators using routinely collected data in the United Kingdom (UK). Methods Cross-sectional analysis of routinely collected, electronic primary care data from a sample of general practices in West Yorkshire, UK (n = 89). The QIs covered aspects of care (including processes and intermediate clinical outcomes) in relation to diabetes, hypertension, atrial fibrillation, myocardial infarction, chronic kidney disease (CKD) and ‘risky’ prescribing combinations. Regression models explored the impact of practice and patient characteristics. Clustering within practice was accounted for by including a random intercept for practice. Results Median practice achievement of the QIs ranged from 43.2% (diabetes control) to 72.2% (blood pressure control in CKD). Considerable between-practice variation existed for all indicators: the difference between the highest and lowest performing practices was 26.3 percentage points for risky prescribing and 100 percentage points for anticoagulation in atrial fibrillation. Odds ratios associated with the random effects for practices emphasised this; there was a greater than ten-fold difference in the likelihood of achieving the hypertension indicator between the lowest and highest performing practices. Patient characteristics, in particular age, gender and comorbidity, were consistently but modestly associated with indicator achievement. Statistically significant practice characteristics were identified less frequently in adjusted models. Conclusions Despite various policy and improvement initiatives, there are enduring inappropriate variations in the delivery of evidence-based care. Much of this variation is not explained by routinely collected patient or practice variables, and is likely to be attributable to differences in clinical and organisational behaviour. PMID:28704407

Salud Mesoamérica 2015 Initiative: design, implementation, and baseline findings.

PubMed

Mokdad, Ali H; Colson, Katherine Ellicott; Zúñiga-Brenes, Paola; Ríos-Zertuche, Diego; Palmisano, Erin B; Alfaro-Porras, Eyleen; Anderson, Brent W; Borgo, Marco; Desai, Sima; Gagnier, Marielle C; Gillespie, Catherine W; Giron, Sandra L; Haakenstad, Annie; Romero, Sonia López; Mateus, Julio; McKay, Abigail; Mokdad, Ali A; Murphy, Tasha; Naghavi, Paria; Nelson, Jennifer; Orozco, Miguel; Ranganathan, Dharani; Salvatierra, Benito; Schaefer, Alexandra; Usmanova, Gulnoza; Varela, Alejandro; Wilson, Shelley; Wulf, Sarah; Hernandez, Bernardo; Lozano, Rafael; Iriarte, Emma; Regalia, Ferdinando

2015-01-01

Health has improved markedly in Mesoamerica, the region consisting of southern Mexico and Central America, over the past decade. Despite this progress, there remain substantial inequalities in health outcomes, access, and quality of medical care between and within countries. Poor, indigenous, and rural populations have considerably worse health indicators than national or regional averages. In an effort to address these health inequalities, the Salud Mesoamérica 2015 Initiative (SM2015), a results-based financing initiative, was established. For each of the eight participating countries, health targets were set to measure the progress of improvements in maternal and child health produced by the Initiative. To establish a baseline, we conducted censuses of 90,000 households, completed 20,225 household interviews, and surveyed 479 health facilities in the poorest areas of Mesoamerica. Pairing health facility and household surveys allows us to link barriers to care and health outcomes with health system infrastructure components and quality of health services. Indicators varied significantly within and between countries. Anemia was most prevalent in Panama and least prevalent in Honduras. Anemia varied by age, with the highest levels observed among children aged 0 to 11 months in all settings. Belize had the highest proportion of institutional deliveries (99%), while Guatemala had the lowest (24%). The proportion of women with four antenatal care visits with a skilled attendant was highest in El Salvador (90%) and the lowest in Guatemala (20%). Availability of contraceptives also varied. The availability of condoms ranged from 83% in Nicaragua to 97% in Honduras. Oral contraceptive pills and injectable contraceptives were available in just 75% of facilities in Panama. IUDs were observed in only 21.5% of facilities surveyed in El Salvador. These data provide a baseline of much-needed information for evidence-based action on health throughout Mesoamerica. Our baseline estimates reflect large disparities in health indicators within and between countries and will facilitate the evaluation of interventions and investments deployed in the region over the next three to five years. SM2015's innovative monitoring and evaluation framework will allow health officials with limited resources to identify and target areas of greatest need.

Respiratory Protection Toolkit: Providing Guidance Without Changing Requirements-Can We Make an Impact?

PubMed

Bien, Elizabeth Ann; Gillespie, Gordon Lee; Betcher, Cynthia Ann; Thrasher, Terri L; Mingerink, Donna R

2016-12-01

International travel and infectious respiratory illnesses worldwide place health care workers (HCWs) at increasing risk of respiratory exposures. To ensure the highest quality safety initiatives, one health care system used a quality improvement model of Plan-Do-Study-Act and guidance from Occupational Safety and Health Administration's (OSHA) May 2015 Hospital Respiratory Protection Program (RPP) Toolkit to assess a current program. The toolkit aided in identification of opportunities for improvement within their well-designed RPP. One opportunity was requiring respirator use during aerosol-generating procedures for specific infectious illnesses. Observation data demonstrated opportunities to mitigate controllable risks including strap placement, user seal check, and reuse of disposable N95 filtering facepiece respirators. Subsequent interdisciplinary collaboration resulted in other ideas to decrease risks and increase protection from potentially infectious respiratory illnesses. The toolkit's comprehensive document to evaluate the program showed that while the OSHA standards have not changed, the addition of the toolkit can better protect HCWs. © 2016 The Author(s).

Systematic and progressive implementation of the centers of excellence for rheumatoid arthritis: a methodological proposal.

PubMed

Santos-Moreno, Pedro; Caballero-Uribe, Carlo V; Massardo, Maria Loreto; Maldonado, Claudio Galarza; Soriano, Enrique R; Pineda, Carlos; Cardiel, Mario; Benavides, Juan Alberto; Beltrán, Paula Andrea

2017-12-01

The implementation of excellence centers in specific diseases has been gaining recognition in the field of health; specifically in rheumatoid arthritis, where the prognosis of the disease is related to an early diagnosis and a timely intervention, it is necessary that the provision of health services is developed in an environment of quality, opportunity, and safety with the highest standards of care. A methodology that allows this implementation in such a way that is achievable by the most of the care centers is a priority to achieve a better attention to populations with this disease. In this paper, we propose a systematic and progressive methodology that will help all the institutions to develop successful models without faltering in the process. The expected impact on public health is defined by a better effective coverage of high-quality treatments, obtaining better health outcomes with safety and accessibility that reduces the budgetary impact for the health systems of our countries.

Complications and Failure to Rescue After Inpatient Noncardiac Surgery in the Veterans Affairs Health System.

PubMed

Massarweh, Nader N; Kougias, Panagiotis; Wilson, Mark A

2016-12-01

The quality of surgical care in the Veterans Health Administration improved markedly in the 1990s after implementation of the Veterans Affairs (VA) National Surgical Quality Improvement Program (now called the VA Surgical Quality Improvement Program). Although there have been many recent evaluations of surgical care in the private sector, to date, a contemporary global evaluation has not been performed within the VA health system. To provide a contemporaneous report of noncardiac postoperative outcomes in the VA health system during the past 15 years. A retrospective cohort study was conducted using data from the VA Surgical Quality Improvement Program among veterans who underwent inpatient general, vascular, thoracic, genitourinary, neurosurgical, orthopedic, or spine surgery from October 1, 1999, through September 30, 2014. Rates of 30-day morbidity, mortality, and failure to rescue (FTR) over time. Among 704 901 patients (mean [SD] age, 63.7 [11.8] years; 676 750 [96%] male) undergoing noncardiac surgical procedures at 143 hospitals, complications occurred in 97 836 patients (13.9%), major complications occurred in 66 816 (9.5%), FTR occurred in 12 648 of the 97 836 patients with complications (12.9%), FTR after major complications occurred in 12 223 of the 66 816 patients with major complications (18.3%), and 18 924 patients (2.7%) died within 30 days of surgery. There were significant decreases from 2000 to 2014 in morbidity (8202 of 59 421 [13.8%] vs 3368 of 32 785 [10.3%]), major complications (5832 of 59 421 [9.8%] vs 2284 of 32 785 [7%]), FTR (1445 of 8202 [17.6%] vs 351 of 3368 [10.4%]), and FTR after major complications (1388 of 5832 [23.8%] vs 343 of 2284 [15%]) (trend test, P < .001 for all). Although there were no clinically meaningful differences in rates of complications and major complications across hospital risk-adjusted mortality quintiles (any complications: lowest quintile, 20 945 of 147 721 [14.2%] vs highest quintile, 18 938 of 135 557 [14%]; major complications: lowest quintile, 14 044 of 147 721 [9.5%] vs highest quintile, 12 881 of 135 557 [9.5%]), FTR rates (any complications: lowest quintile, 2249 of 20 945 [10.7%] vs highest quintile, 2769 of 18 938 [14.6%]; major complications: lowest quintile, 2161 of 14 044 [15.4%] vs highest quintile, 2663 of 12 881 [20.7%]) were significantly higher with increasing quintile (P < .001). However, across hospital quintiles, there were significant decreases in morbidity (20.6%-29.9% decrease; trend test, P < .001 for all) and FTR (29.2%-50.6% decrease; trend test, P < .001 for all) during the study period. After hierarchical modeling, the odds of postoperative mortality, FTR, and FTR after a major complication were approximately 40% to 50% lower in the most recent study year compared with 15 years ago (P < .001 for all). For the past 15 years, morbidity, mortality, and FTR have improved within the VA health system. Other integrated health systems providing a high volume of surgical care for their enrollees may benefit by critically evaluating the system-level approaches of the VA health system to surgical quality improvement.

Nurses' knowledge of advance directives and perceived confidence in end-of-life care: a cross-sectional study in five countries.

PubMed

Coffey, Alice; McCarthy, Geraldine; Weathers, Elizabeth; Friedman, M Isabel; Gallo, Katherine; Ehrenfeld, Mally; Chan, Sophia; Li, William H C; Poletti, Piera; Zanotti, Renzo; Molloy, D William; McGlade, Ciara; Fitzpatrick, Joyce J; Itzhaki, Michal

2016-06-01

Nurses' knowledge regarding advance directives may affect their administration and completion in end-of-life care. Confidence among nurses is a barrier to the provision of quality end-of-life care. This study investigated nurses' knowledge of advance directives and perceived confidence in end-of-life care, in Hong Kong, Ireland, Israel, Italy and the USA using a cross-sectional descriptive design (n = 1089). In all countries, older nurses and those who had more professional experience felt more confident managing patients' symptoms at end-of-life and more comfortable stopping preventive medications at end-of-life. Nurses in the USA reported that they have more knowledge and experience of advance directives compared with other countries. In addition, they reported the highest levels of confidence and comfort in dealing with end-of-life care. Although legislation for advance directives does not yet exist in Ireland, nurses reported high levels of confidence in end-of-life care. © 2016 The Authors International Journal of Nursing Practice Published by Wiley Publishing Asia Pty Ltd.

Rural-to-Urban Migrants' Experiences with Primary Care under Different Types of Medical Institutions in Guangzhou, China

PubMed Central

Zeng, Jiazhi; Shi, Leiyu; Zou, Xia; Chen, Wen; Ling, Li

2015-01-01

Objectives China is facing the unprecedented challenge of rapidly increasing rural-to-urban migration. Migrants are in a vulnerable state when they attempt to access to primary care services. This study was designed to explore rural-to-urban migrants’ experiences in primary care, comparing their quality of primary care experiences under different types of medical institutions in Guangzhou, China. Methods The study employed a cross-sectional survey of 736 rural-to-urban migrants in Guangzhou, China in 2014. A validated Chinese version of Primary Care Assessment Tool—Adult Short Version (PCAT-AS), representing 10 primary care domains was used to collect information on migrants’ quality of primary care experiences. These domains include first contact (utilization), first contact (accessibility), ongoing care, coordination (referrals), coordination (information systems), comprehensiveness (services available), comprehensiveness (services provided), family-centeredness, community orientation and culturally competent. These measures were used to assess the quality of primary care performance as reported from patients’ perspective. Analysis of covariance was conducted for comparison on PCAT scores among migrants accessing primary care in tertiary hospitals, municipal hospitals, community health centers/community health stations, and township health centers/rural health stations. Multiple linear regression models were used to explore factors associated with PCAT total scores. Results After adjustments were made, migrants accessing primary care in tertiary hospitals (25.49) reported the highest PCAT total scores, followed by municipal hospitals (25.02), community health centers/community health stations (24.24), and township health centers/rural health stations (24.18). Tertiary hospital users reported significantly better performance in first contact (utilization), first contact (accessibility), coordination (information system), comprehensiveness (service available), and cultural competence. Community health center/community health station users reported significantly better experience in the community orientation domain. Township health center/rural health station users expressed significantly better experience in the ongoing care domain. There were no statistically significant differences across settings in the ongoing care, comprehensiveness (services provided), and family-centeredness domains. Multiple linear regression models showed that factors positively associated with higher PCAT total scores also included insurance covering parts of healthcare payment (P<0.001). Conclusions This study highlights the need for improvement in primary care provided by primary care institutions for rural-to-urban migrants. Relevant policies related to medical insurance should be implemented for providing affordable healthcare services for migrants accessing primary care. PMID:26474161

The prevalence of child sexual abuse in out-of-home care: a comparison between abuse in residential and in foster care.

PubMed

Euser, Saskia; Alink, Lenneke R A; Tharner, Anne; van Ijzendoorn, Marinus H; Bakermans-Kranenburg, Marian J

2013-11-01

We investigated the 2010 year prevalence of child sexual abuse (CSA) in residential and foster care and compared it with prevalence rates in the general population. We used two approaches to estimate the prevalence of CSA. First, 264 professionals working in residential or foster care (sentinels) reported CSA for the children they worked with (N = 6,281). Second, 329 adolescents staying in residential or foster care reported on their own experiences with CSA. Sentinels and adolescents were randomly selected from 82 Dutch out-of-home care facilities. We found that 3.5 per 1,000 children had been victims of CSA based on sentinel reports. In addition, 58 per 1,000 adolescents reported having experienced CSA. Results based on both sentinel report and self-report revealed higher prevalence rates in out-of-home care than in the general population, with the highest prevalence in residential care. Prevalence rates in foster care did not differ from the general population. According to our findings, children and adolescents in residential care are at increased risk of CSA compared to children in foster care. Unfortunately, foster care does not fully protect children against sexual abuse either, and thus its quality needs to be further improved.

Fundholders' referral patterns and perceptions of service quality in hospital provision of elective general surgery.

PubMed Central

Whynes, D K; Reed, G

1994-01-01

BACKGROUND. The introduction of fundholding established an internal market in public sector health care, involving purchasers and providers contracting for the supply of health care. AIM. This study set out to examine fundholders' hospital referral patterns, and to evaluate the quality of the service provided to patients undergoing elective general surgery, as perceived by fundholding general practitioners. METHOD. A questionnaire was posted to the senior partners of all fundholding practices in the Trent Regional Health Authority area. This questionnaire requested assessments of the importance of 13 specified aspects of service quality and the quality of provision by general practitioners' most frequently-used hospitals. Five-point scales were employed in each case. Respondents were asked to provide additional details about their practice. RESULTS. A 67% response rate was achieved. Confidence in the consultant's ability, short waiting times and informative feedback from the providers emerged as the most important elements in referral decisions, while the cost of treatment and patient convenience received lower importance ratings. In terms of how well their providers were seen to perform, fundholders ranked confidence in the consultant and patient convenience highest, and style of hospital management lowest. The majority of referrals seemed to be local. CONCLUSION. Judged in terms of fundholders' perceptions, sizeable variations in service quality between hospital providers of general surgery are evident. PMID:7748666

A survey of family members' satisfaction with the services provided by hospice palliative care volunteers.

PubMed

Claxton-Oldfield, Stephen; Gosselin, Natasha; Schmidt-Chamberlain, Kirsten; Claxton-Oldfield, Jane

2010-05-01

A total of 22 family members, whose deceased loved ones had used the services of a hospice palliative care volunteer, responded to a brief survey designed to assess the importance of the different kinds of support offered to them (family members) by the volunteer, their impressions of the volunteers' personal qualities/characteristics, their general experiences with the volunteer, and their overall satisfaction with the volunteer services. The kind of support that received the highest importance rating from family members was the opportunity to take a much-needed break from the demands of caring for their loved one, closely followed by emotional support, the volunteer spending time with them, and the volunteer providing them with information. Family members rated volunteers highly on a list of qualities/characteristics that exemplify individuals who are effective in this role. In all, 85% of the family members felt that their volunteer was well trained and 95% did not feel that their or their loved one's privacy had been invaded by having a volunteer. Overall, family members were very satisfied with the volunteer support they received. Some limitations of the study are discussed.

Improving the home health acute-care hospitalization quality measure.

PubMed

Schade, Charles P; Brehm, John G

2010-06-01

(1) To demonstrate average length of service (ALOS) bias in the currently used acute-care hospitalization (ACH) home health quality measure, limiting comparability across agencies, and (2) to propose alternative ACH measures. Secondary analysis of Medicare home health service data 2004-2007; convenience sample of Medicare fee-for-service hospital discharges. Cross-sectional analysis and patient-level simulation. We aggregated outcome and ALOS data from 2,347 larger Medicare-certified home health agencies (HHAs) in the United States between 2004 and 2007, and calculated risk-adjusted monthly ACH rates. We used multiple regression to identify agency characteristics associated with ACH. We simulated ACH during and immediately after home health care using patient and agency characteristics similar to those in the actual data, comparing the existing measure with alternative fixed-interval measures. Of agency characteristics studied, ALOS had by far the highest partial correlation with the current ACH measure (r(2)=0.218, p<.0001). We replicated the correlation between ACH and ALOS in the patient-level simulation. We found no correlation between ALOS and the alternative measures. Alternative measures do not exhibit ALOS bias and would be appropriate for comparing HHA ACH rates with one another or over time.

Application of a framework to assess the usefulness of alternative sepsis criteria

PubMed Central

Seymour, Christopher W.; Coopersmith, Craig M.; Deutschman, Clifford S; Gesten, Foster; Klompas, Michael; Levy, Mitchell; Martin, Gregory S.; Osborn, Tiffany M.; Rhee, Chanu; Warren, David; Watson, R. Scott; Angus, Derek C.

2016-01-01

The current definition for sepsis is life-threatening, acute organ dysfunction secondary to a dysregulated host response to infection. Criteria to operationalize this definition can be judged by 6 domains of usefulness (reliability; content, construct and criterion validity, measurement burden, and timeliness). The relative importance of these 6 domains depends on the intended purpose for the criteria (clinical care, basic and clinical research, surveillance, or quality improvement (QI) and audit). For example, criteria for clinical care should have high content and construct validity, timeliness, and low measurement burden to facilitate prompt care. Criteria for surveillance or QI/audit place greater emphasis on reliability across individuals and sites and lower emphasis on timeliness. Criteria for clinical trials require timeliness to ensure prompt enrollment and reasonable reliability but can tolerate high measurement burden. Basic research also tolerates high measurement burden and may not need stability over time. In an illustrative case study, we compared examples of criteria designed for clinical care, surveillance and QI/audit among 396,241 patients admitted to 12 academic and community hospitals in an integrated health system. Case rates differed 4-fold and mortality 3-fold. Predictably, clinical care criteria, which emphasized timeliness and low burden and therefore used vital signs and routine laboratory tests, had the highest case identification with lowest mortality. QI /audit criteria, which emphasized reliability and criterion validity, used discharge information and had the lowest case identification with highest mortality. Using this framework to identify the purpose and apply domains of usefulness can help with the evaluation of existing sepsis diagnostic criteria and provide a roadmap for future work. PMID:26901560

Bibliometric Analysis of Palliative Care-Related Publication Trends During 2001 to 2016.

PubMed

Liu, Chia-Jen; Yeh, Te-Chun; Hsu, Su-Hsuan; Chu, Chao-Mei; Liu, Chih-Kuang; Chen, Mingchih; Huang, Sheng-Jean

2018-01-01

The scientific contributions (publications) and international influence (citations) from authors providing the palliative care (PC)-related literature has a limited number of bibliometric reports. We aimed to analyze PC-related literature using the Institute for Scientific Information Web of Science (WoS) database. WoS database was used to retrieve publications with the following key words with title: "palliative care" OR "End of Life care" OR "terminal care.". The statistical analysis of the documents published during 2001 to 2016 was performed. The quantity and quality of research were assessed by the number of total publications and citation analysis. In addition, we also analyzed whether there were possible correlations between publication and socioeconomic factors. The total research output was 6273 articles for PC. There was a 3-fold increase in the number of publications during the period and strong correlation between the year and number of PC-related publications ( R 2 = .96). The United States took a leading position in PC research (2448, 39.0%). The highest average citations was reported for the Norway (21.8). Australia had gained the highest productive ability in PC research (24.9 of articles per million populations). The annual impact factor rose progressively with time and increased 1.13 to 2.24 from 2003 to 2016. The number of publications correlated with gross domestic product ( r = .74; P < .001). The United States and United Kingdom contributed most of the publications, but some East Asian countries also had a great performance. According to the socioeconomic factors, the publication capacity of top 20 countries is correlated with their economic scale.

Modifying the Toyota Production System for continuous performance improvement in an academic children's hospital.

PubMed

Stapleton, F Bruder; Hendricks, James; Hagan, Patrick; DelBeccaro, Mark

2009-08-01

The Toyota Production System (TPS) has become a successful model for improving efficiency and eliminating errors in manufacturing processes. In an effort to provide patients and families with the highest quality clinical care, our academic children's hospital has modified the techniques of the TPS for a program in continuous performance improvement (CPI) and has expanded its application to educational and research programs. Over a period of years, physicians, nurses, residents, administrators, and hospital staff have become actively engaged in a culture of continuous performance improvement. This article provides background into the methods of CPI and describes examples of how we have applied these methods for improvement in clinical care, resident teaching, and research administration.

Nursing and philanthropy: a partnership to advance professional excellence and exceptional care.

PubMed

Janney, Michelle A

2014-01-01

Michelle A. Janney, PhD, RN, NEA-BC, 2013 AONE President, Senior Vice President, and Wood-Prince Family Chief Nurse Executive at Northwestern Memorial Hospital, discusses the impact of engaging institutional leadership in nursing philanthropic and strategic priorities and the importance of developing a culture of philanthropy that permeates the organization and encourages participation from all levels. The article highlights key outcomes of Northwestern Memorial Hospital's collective efforts to build a culture of philanthropy that prioritizes nursing as consequential to the mission of the organization. The outcomes demonstrate how such a culture provides a critical platform for creating opportunities that enable nurses to be indispensable partners in a shared commitment to the highest-quality, scientifically driven, personalized care.

Patterns of Self-care in Adults With Heart Failure and Their Associations With Sociodemographic and Clinical Characteristics, Quality of Life, and Hospitalizations: A Cluster Analysis.

PubMed

Vellone, Ercole; Fida, Roberta; Ghezzi, Valerio; D'Agostino, Fabio; Biagioli, Valentina; Paturzo, Marco; Strömberg, Anna; Alvaro, Rosaria; Jaarsma, Tiny

Self-care is important in heart failure (HF) treatment, but patients may have difficulties and be inconsistent in its performance. Inconsistencies in self-care behaviors may mirror patterns of self-care in HF patients that are worth identifying to provide interventions tailored to patients. The aims of this study are to identify clusters of HF patients in relation to self-care behaviors and to examine and compare the profile of each HF patient cluster considering the patient's sociodemographics, clinical variables, quality of life, and hospitalizations. This was a secondary analysis of data from a cross-sectional study in which we enrolled 1192 HF patients across Italy. A cluster analysis was used to identify clusters of patients based on the European Heart Failure Self-care Behaviour Scale factor scores. Analysis of variance and χ test were used to examine the characteristics of each cluster. Patients were 72.4 years old on average, and 58% were men. Four clusters of patients were identified: (1) high consistent adherence with high consulting behaviors, characterized by younger patients, with higher formal education and higher income, less clinically compromised, with the best physical and mental quality of life (QOL) and lowest hospitalization rates; (2) low consistent adherence with low consulting behaviors, characterized mainly by male patients, with lower formal education and lowest income, more clinically compromised, and worse mental QOL; (3) inconsistent adherence with low consulting behaviors, characterized by patients who were less likely to have a caregiver, with the longest illness duration, the highest number of prescribed medications, and the best mental QOL; (4) and inconsistent adherence with high consulting behaviors, characterized by patients who were mostly female, with lower formal education, worst cognitive impairment, worst physical and mental QOL, and higher hospitalization rates. The 4 clusters identified in this study and their associated characteristics could be used to tailor interventions aimed at improving self-care behaviors in HF patients.

Cross-sectional examination of the association between shift length and hospital nurses job satisfaction and nurse reported quality measures.

PubMed

Ball, Jane; Day, Tina; Murrells, Trevor; Dall'Ora, Chiara; Rafferty, Anne Marie; Griffiths, Peter; Maben, Jill

2017-01-01

Twenty-four hour nursing care involves shift work including 12-h shifts. England is unusual in deploying a mix of shift patterns. International evidence on the effects of such shifts is growing. A secondary analysis of data collected in England exploring outcomes with 12-h shifts examined the association between shift length, job satisfaction, scheduling flexibility, care quality, patient safety, and care left undone. Data were collected from a questionnaire survey of nurses in a sample of English hospitals, conducted as part of the RN4CAST study, an EU 7 th Framework funded study. The sample comprised 31 NHS acute hospital Trusts from 401 wards, in 46 acute hospital sites. Descriptive analysis included frequencies, percentages and mean scores by shift length, working beyond contracted hours and day or night shift. Multi-level regression models established statistical associations between shift length and nurse self-reported measures. Seventy-four percent (1898) of nurses worked a day shift and 26% (670) a night shift. Most Trusts had a mixture of shifts lengths. Self-reported quality of care was higher amongst nurses working ≤8 h (15.9%) compared to those working longer hours (20.0 to 21.1%). The odds of poor quality care were 1.64 times higher for nurses working ≥12 h (OR = 1.64, 95% CI 1.18-2.28, p  = 0.003). Mean 'care left undone' scores varied by shift length: 3.85 (≤8 h), 3.72 (8.01-10.00 h), 3.80 (10.01-11.99 h) and were highest amongst those working ≥12 h (4.23) ( p  < 0.001). The rate of care left undone was 1.13 times higher for nurses working ≥12 h (RR = 1.13, 95% CI 1.06-1.20, p  < 0.001). Job dissatisfaction was higher the longer the shift length: 42.9% (≥12 h (OR = 1.51, 95% CI 1.17-1.95, p  = .001); 35.1% (≤8 h) 45.0% (8.01-10.00 h), 39.5% (10.01-11.99 h). Our findings add to the growing international body of evidence reporting that ≥12 shifts are associated with poor ratings of quality of care and higher rates of care left undone. Future research should focus on how 12-h shifts can be optimised to minimise potential risks.

Relationship between Primary and Secondary Dental Care in Public Health Services in Brazil.

PubMed

Martins, Renata Castro; Reis, Clarice Magalhães Rodrigues Dos; Matta Machado, Antonio Thomaz Gonzaga da; Amaral, João Henrique Lara do; Werneck, Marcos Azeredo Furquim; Abreu, Mauro Henrique Nogueira Guimarães de

2016-01-01

This cross-sectional study evaluated the relationship between primary and secondary oral health care in Brazil. For this purpose, data from the National Program for Improving Access and Quality of Primary Care were used. Dentists from 12,403 oral health teams (OHTs) answered a structured questionnaire in 2012. The data were analyzed descriptively and by cluster analysis. Of the 12,387 (99.9%) OHTs that answered all the questions, 62.2% reported the existence of Dental Specialties Centers (DSCs) to which they could refer patients. The specialties with the highest frequencies were endodontics (68.4%), minor oral surgery (65.8%), periodontics (63.0%), radiology (46.8%), oral medicine (40.2%), orthodontics (20.5%) and implantology (6.2%). In all percentiles, the shortest wait time for secondary care was for radiology, followed by oral medicine and the other specialties. In the 50th percentile, the wait for endodontics, periodontics, minor oral surgery and orthodontics was 30 days, while for implantology, the wait was 60 days. Finally, in the 75th percentile, the wait for endodontics, orthodontics and implantology was 90 days or more. Two clusters, with different frequencies of OHT access to specialties, were identified. Cluster 1 (n = 7,913) included the OHTs with lower frequencies in all specialties except orthodontics and implantology compared with Cluster 2 (n = 4,474). Of the Brazilian regions, the South and Southeast regions had the highest frequencies for Cluster 2, with better rates for the relationship between primary and secondary care. This study suggests certain difficulties in the relationship between primary and secondary care in specific specialties in oral health, with a great number of OHTs with limited access to DSCs, in addition to different performance in terms of OHT access to DSCs across Brazilian regions.

Economic Analysis of Children’s Surgical Care in Low- and Middle-Income Countries: A Systematic Review and Analysis

PubMed Central

Poenaru, Dan; Ozgediz, Doruk; Ameh, Emmanuel A.; Farmer, Diana; Smith, Emily R.; Rice, Henry E.

2016-01-01

Background Understanding the economic value of health interventions is essential for policy makers to make informed resource allocation decisions. The objective of this systematic review was to summarize available information on the economic impact of children’s surgical care in low- and middle-income countries (LMICs). Methods We searched MEDLINE (Pubmed), Embase, and Web of Science for relevant articles published between Jan. 1996 and Jan. 2015. We summarized reported cost information for individual interventions by country, including all costs, disability weights, health outcome measurements (most commonly disability-adjusted life years [DALYs] averted) and cost-effectiveness ratios (CERs). We calculated median CER as well as societal economic benefits (using a human capital approach) by procedure group across all studies. The methodological quality of each article was assessed using the Drummond checklist and the overall quality of evidence was summarized using a scale adapted from the Agency for Healthcare Research and Quality. Findings We identified 86 articles that met inclusion criteria, spanning 36 groups of surgical interventions. The procedure group with the lowest median CER was inguinal hernia repair ($15/DALY). The procedure group with the highest median societal economic benefit was neurosurgical procedures ($58,977). We found a wide range of study quality, with only 35% of studies having a Drummond score ≥ 7. Interpretation Our findings show that many areas of children’s surgical care are extremely cost-effective in LMICs, provide substantial societal benefits, and are an appropriate target for enhanced investment. Several areas, including inguinal hernia repair, trichiasis surgery, cleft lip and palate repair, circumcision, congenital heart surgery and orthopedic procedures, should be considered “Essential Pediatric Surgical Procedures” as they offer considerable economic value. However, there are major gaps in existing research quality and methodology which limit our current understanding of the economic value of surgical care. PMID:27792792

Resident-Specific Morbidity Reduced Following ACS NSQIP Data-Driven Quality Program.

PubMed

Turrentine, Florence E; Hanks, John B; Tracci, Megan C; Jones, R Scott; Schirmer, Bruce D; Smith, Philip W

2018-04-16

The Accreditation Council for Graduate Medical Education Milestone Project for general surgery provided a more robust method for developing and tracking residents' competence. This framework enhanced systematic and progressive development of residents' competencies in surgical quality improvement. A 22-month interactive, educational program based on resident-specific surgical outcomes data culminated in a quality improvement project for postgraduate year 4 surgery residents. Self- assessment, quality knowledge test, and resident-specific American College of Surgeons National Surgical Quality Improvement Program Quality In-Training Initiative morbidity were compared before and after the intervention. Quality in-training initiative morbidity decreased from 25% (82/325) to 18% (93/517), p = 0.015 despite residents performing more complex cases. All participants achieved level 4 competency (4/4) within the general surgery milestones improvement of care, practice-based learning and improvement competency. Institutional American College of Surgeons National Surgical Quality Improvement Program general surgery morbidity improved from the ninth to the sixth decile. Quality assessment and improvement self-assessment postintervention scores (M = 23.80, SD = 4.97) were not significantly higher than preintervention scores (M = 19.20, SD = 5.26), p = 0.061. Quality Improvement Knowledge Application Tool postintervention test scores (M = 17.4, SD = 4.88), were not significantly higher than pretest scores (M = 13.2, SD = 1.92), p = 0.12. Sharing validated resident-specific clinical data with participants was associated with improved surgical outcomes. Participating fourth year surgical residents achieved the highest score, a level 4, in the practice based learning and improvement competency of the improvement of care practice domain and observed significantly reduced surgical morbidity for cases in which they participated. Copyright © 2018. Published by Elsevier Inc.

Geographic Variation in the Quality and Cost of Care for Patients with Rheumatoid Arthritis.

PubMed

Shafrin, Jason; Ganguli, Arijit; Gonzalez, Yuri Sanchez; Shim, Jin Joo; Seabury, Seth A

2016-12-01

There is considerable push to improve value in health care by simultaneously increasing quality while lowering or containing costs. However, for diseases that are best treated with comparatively expensive treatments, such as rheumatoid arthritis (RA), there could be tension between these aims. In this study, we measured geographic variation in quality, access, and cost for patients with RA, a disease with effective but costly specialty treatments. To assess the geographic differences in the quality, access, and cost of care for patients with RA. Using large claims databases covering the period between 2008 and 2014, we measured quality of care metrics by metropolitan statistical areas (MSAs) for patients with RA. Quality measures included use of disease-modifying antirheumatic drugs (DMARDs) and tuberculosis (TB) screening before initiating biologic DMARD therapy. Access to care measures included measured detection and the share of patients with RA who visited a rheumatologist. Regression models were used to control for differences in patient demographics and health status across MSAs. For the 501,376 patients diagnosed with RA, in the average MSA 64.1% of RA patients received a DMARD, and 29.6% of RA patients initiating a biologic DMARD appropriately received a TB screening. Only 17% (73/430) of MSAs comprised the top 2 Medicare Advantage star ratings for DMARD use. Measured detection was 0.59% (IQR = 0.47%-0.71%; CV = 0.355) on average, and 57.6% (IQR = 48%-69%; CV = 0.341) of RA patients visited a rheumatologist. MSAs with the highest DMARD use spent $26,724 (in 2015 U.S. dollars) annually treating patients with RA, $5,428 more (P < 0.001) than low DMARD-use MSAs, largely because of higher pharmacy cost ($5,090 vs. $7,610, P < 0.001). However, MSAs with higher DMARD use had lower RA-related inpatient cost ($1,890 vs. $2,342, P = 0.024). There were significant geographic variations in the quality of care received by patients with RA, although quality was poor in most areas. Fewer than 1 in 5 MSAs could be considered high quality based on patient DMARD use. Access to specialist care may be an issue, since just over half of patients with RA visited a rheumatologist annually. Efforts to incentivize better quality of care holds promise in terms of unlocking value for patients, but for some diseases, this approach may result in higher costs. The research reported in this manuscript was supported by AbbVie through consulting fees paid to Precision Health Economics (PHE). AbbVie and PHE collaborated to develop the study design and protocol. AbbVie and PHE participated in the interpretation of data, review, and approval of the manuscript. Shafrin and Shim are employed by PHE. Ganguli and Sanchez Gonzalez are employed by AbbVie. Seabury reports consulting fees from PHE. The results from this study were presented in poster form at the Academy of Managed Care Pharmacy's 2015 Annual Meeting and Expo; April 7-10, 2015; San Diego, California, and at the Academy of Managed Care Pharmacy's 2016 Annual Meeting and Expo; April 19-22, 2016; San Francisco, California. Study concept and design were contributed primarily by Shafrin, along with Ganguli and Seabury. Shafrin and Shim took the lead in data collection, and data interpretation was performed by Ganguli, Sanchez Gonzalez, Seabury, and Shafrin. The manuscript was written primarily by Shafrin, along with Shim and Seabury, and revised primarily by Ganguli, along with Sanchez Gonzalez and Seabury.

Effects of poor asthma control, insomnia, anxiety and depression on quality of life in young asthmatics.

PubMed

Sundbom, Fredrik; Malinovschi, Andrei; Lindberg, Eva; Alving, Kjell; Janson, Christer

2016-01-01

Asthma-related quality of life has previously been shown to be associated with asthma control. The aims of the present study were to further analyze this correlation, identify other variables with impact on asthma-related quality of life and investigate the covariance among these variables. Information was retrieved from a cohort of 369 patients, aged 12-35, with physician-diagnosed asthma requiring anti-inflammatory treatment for at least 3 months per year. Questionnaire data [including the mini-Asthma Quality of Life Questionnaire (mAQLQ), asthma control test (ACT) and Hospital Anxiety and Depression Scale (HADS)], quality of sleep, lung function data and blood samples were analyzed. Linear regression models with the mAQLQ score as the dependent scalar variable were calculated. ACT was the single variable that had the highest explanatory value for the mAQLQ score (51.5%). High explanatory power was also observed for anxiety and depression (17.0%) and insomnia (14.1%). The population was divided into groups depending on the presence of anxiety and depression, uncontrolled asthma and insomnia. The group that reported none of these conditions had the highest mean mAQLQ score (6.3 units), whereas the group reporting all of these conditions had the lowest mAQLQ score (3.8 units). The ACT score was the single most important variable in predicting asthma-related quality of life. Combining the ACT score with the data on insomnia, anxiety and depression showed considerable additive effects of the conditions. Hence, we recommend the routine use of the ACT and careful attention to symptoms of insomnia, anxiety or depression in the clinical evaluation of asthma-related quality of life.

What is needed to implement a web-based audit and feedback intervention with outreach visits to improve care quality: A concept mapping study among cardiac rehabilitation teams.

PubMed

van Engen-Verheul, Mariëtte M; Peek, Niels; Haafkens, Joke A; Joukes, Erik; Vromen, Tom; Jaspers, Monique W M; de Keizer, Nicolette F

2017-01-01

Evidence on successful quality improvement (QI) in health care requires quantitative information from randomized clinical trials (RCTs) on the effectiveness of QI interventions, but also qualitative information from professionals to understand factors influencing QI implementation. Using a structured qualitative approach, concept mapping, this study determines factors identified by cardiac rehabilitation (CR) teams on what is needed to successfully implement a web-based audit and feedback (A&F) intervention with outreach visits to improve the quality of CR care. Participants included 49 CR professionals from 18 Dutch CR centres who had worked with the A&F system during a RCT. In three focus group sessions participants formulated statements on factors needed to implement QI successfully. Subsequently, participants rated all statements for importance and feasibility and grouped them thematically. Multi dimensional scaling was used to produce a final concept map. Forty-two unique statements were formulated and grouped into five thematic clusters in the concept map. The cluster with the highest importance was QI team commitment, followed by organisational readiness, presence of an adequate A&F system, access to an external quality assessor, and future use and functionalities of the A&F system. Concept mapping appeared efficient and useful to understand contextual factors influencing QI implementation as perceived by healthcare teams. While presence of a web-based A&F system and external quality assessor were seen as instrumental for gaining insight into performance and formulating QI actions, QI team commitment and organisational readiness were perceived as essential to actually implement and carry out these actions. These two sociotechnical factors should be taken into account when implementing and evaluating the success of QI implementations in future research. Copyright © 2016. Published by Elsevier Ireland Ltd.

An assessment of primary care attributes from the perspective of female healthcare users1

PubMed Central

Lima, Eliane de Fátima Almeida; Sousa, Ana Inês; Primo, Cândida Caniçali; Leite, Francielie Marabotti Costa; Lima, Rita de Cassia Duarte; Maciel, Ethel Leonor Nóia

2015-01-01

OBJECTIVE: this study sought to assess the quality of the Family Health Strategy (FHS) and investigated the association between primary care attributes (PCAs) and the sociodemographic characteristics of users. METHOD: a total of 215 female FHS users were interviewed for this descriptive and cross-sectional study. The Primary Care Assessment Tool (PCATool), Adult Edition was used, and the results were analyzed using Fisher's exact tests, Pearson's chi-square tests and logistic regressions. RESULTS: the lowest average score corresponded to the dimension "accessibility" (1.80), and the highest score corresponded to "access" (8.76). The results corresponding to the attributes "longitudinality", "coordination", "comprehensiveness", and "orientation" were not significant. No association was found between the participants' sociodemographic characteristics and the essential, derivative, and general attributes (p>0.05). CONCLUSION: several attributes must be improved across all the investigated services from the perspective of female FHS users. PMID:26155006

Implementing microbicides in low income countries

PubMed Central

Gengiah, Tanuja; Karim, Quarraisha Abdool

2012-01-01

The magnitude of the global HIV epidemic is determined by women from lower income countries, specifically sub-Saharan Africa. Microbicides offer women who are unable to negotiate safe sex practices a self-initiated HIV prevention method. Of note, is its potential to yield significant public health benefits even with relatively conservative efficacy, coverage and user adherence estimates, making microbicides an effective intervention to invest scarce health care resources. Existing health care delivery systems provide an excellent opportunity to identify women at highest risk for infection and to also provide an access point to initiate microbicide use. Innovative quality improvement approaches, which strengthen existing sexual reproductive health services and include HIV testing, and linkages to care and treatment services provide an opportunity to lay the foundations for wide-scale provision of microbicides. The potential to enhance health outcomes in women and infants and potentially impact rates of new HIV infection may soon be realised. PMID:22498040

Transformation to a recovery-oriented model of care on a veterans administration inpatient unit.

PubMed

Zuehlke, Jessica B; Kotecki, Robert M; Kern, Shira; Sholty, Gretchen; Hauser, Peter

2016-12-01

Recovery-oriented care is among the highest treatment priorities for the Veteran Health Administration, which has endorsed organizational change of mental health care to reflect recovery values. The purpose of this quality improvement project was to determine whether recovery interventions would yield positive outcomes when delivered on in inpatient psychiatry. Recovery interventions on the unit included recovery-focused interdisciplinary team meetings, opportunities for stakeholder feedback, recovery staff education, increased group programming, peer support, and changes to treatment planning to include increased Veteran engagement and responsibility. Participants included 352 patients and 27 staff. Outcomes were number of restraints/seclusions used, 30-day readmission rates, and staff satisfaction. Our results showed an overall decrease in restraint/seclusion use by over 50% and an increase in staff satisfaction. Our results suggest that implementing a recovery-oriented model of care in an acute psychiatric inpatient unit may have significant benefits for both staff and patients. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

Germany's long-term-care insurance: putting a social insurance model into practice.

PubMed

Geraedts, M; Heller, G V; Harrington, C A

2000-01-01

A growing population of elderly has intensified the demand for long-term care (LTC) services. In response to the mounting need, Germany put into effect a LTC Insurance Act in 1995 that introduced mandatory public or private LTC insurance for the entire population of 82 million. The program was based on the organizational principles that define the German social insurance system. Those individuals in the public system and their employers each pay contributions equal to 0.85 percent of each employee's gross wages or salary. Ten percent of the population with the highest incomes have chosen the option of purchasing private long term care insurance. Provisions were made for uniform eligibility criteria, benefits based on level of care needs, cost containment, and quality assurance. Over the first four years of its operation, the system has proved financially sound and has expanded access to organized LTC services. The German system thus may serve as an example for other countries that are planning to initiate social LTC insurance systems in other nations.

Application of Sigma Metrics Analysis for the Assessment and Modification of Quality Control Program in the Clinical Chemistry Laboratory of a Tertiary Care Hospital.

PubMed

Iqbal, Sahar; Mustansar, Tazeen

2017-03-01

Sigma is a metric that quantifies the performance of a process as a rate of Defects-Per-Million opportunities. In clinical laboratories, sigma metric analysis is used to assess the performance of laboratory process system. Sigma metric is also used as a quality management strategy for a laboratory process to improve the quality by addressing the errors after identification. The aim of this study is to evaluate the errors in quality control of analytical phase of laboratory system by sigma metric. For this purpose sigma metric analysis was done for analytes using the internal and external quality control as quality indicators. Results of sigma metric analysis were used to identify the gaps and need for modification in the strategy of laboratory quality control procedure. Sigma metric was calculated for quality control program of ten clinical chemistry analytes including glucose, chloride, cholesterol, triglyceride, HDL, albumin, direct bilirubin, total bilirubin, protein and creatinine, at two control levels. To calculate the sigma metric imprecision and bias was calculated with internal and external quality control data, respectively. The minimum acceptable performance was considered as 3 sigma. Westgard sigma rules were applied to customize the quality control procedure. Sigma level was found acceptable (≥3) for glucose (L2), cholesterol, triglyceride, HDL, direct bilirubin and creatinine at both levels of control. For rest of the analytes sigma metric was found <3. The lowest value for sigma was found for chloride (1.1) at L2. The highest value of sigma was found for creatinine (10.1) at L3. HDL was found with the highest sigma values at both control levels (8.8 and 8.0 at L2 and L3, respectively). We conclude that analytes with the sigma value <3 are required strict monitoring and modification in quality control procedure. In this study application of sigma rules provided us the practical solution for improved and focused design of QC procedure.

Perceptions of antenatal care services by pregnant women attending government health centres in the Buea Health District, Cameroon: a cross sectional study

PubMed Central

Edie, Gregory Edie Halle Ekane; Obinchemti, Thomas Egbe; Tamufor, Emmanuel Njuma; Njie, Martin Mafany; Njamen, Theophile Nana; Achidi, Eric Akum

2015-01-01

Introduction User'sperception of quality of ANC services crucially impacts continuity of use of these services and hence pregnancy outcome. However in our community, ANC user's perceptions of quality are not known. Methods An observational analytic cross-sectional study was carried out amongst pregnant women attending selected government health centres in the Buea Health District. We recruited 385 consenting pregnant women for the study. Demographic and clinical data were collected using structured questionnaires. The data was entered into Microsoft Excel and exported toEpi-Info (Version 3.5.1) for analysis. Results Geographical accessibility and perceived quality of care were the predominant reasons for choosing or changing a site for ANC. One third of respondents (30.1%) attended a health centre out of their catchment health area with Buea Town health centre receiving the highest proportion of women out of the health area (56.8% of attendees). Knowledge about antenatal care varied and majority of respondents (96.4%) were satisfied with the antenatal services received. However, there were elements of dissatisfaction with health centre services, poor sitting facilities, amenities, few health education talks and poor nursing skills. High educational level (high school and university) (X2 = 8.714; p = 0.01) and first time pregnancy(X2= 4.217; p= 0.04) were significantly associated with poor satisfaction. Conclusion Policy makers should implement changes in the health care delivery system taking into account the users’ preferences, more so in the light of increasing female education in Cameroon. PMID:26405481

Perceptions of antenatal care services by pregnant women attending government health centres in the Buea Health District, Cameroon: a cross sectional study.

PubMed

Edie, Gregory Edie Halle Ekane; Obinchemti, Thomas Egbe; Tamufor, Emmanuel Njuma; Njie, Martin Mafany; Njamen, Theophile Nana; Achidi, Eric Akum

2015-01-01

User'sperception of quality of ANC services crucially impacts continuity of use of these services and hence pregnancy outcome. However in our community, ANC user's perceptions of quality are not known. An observational analytic cross-sectional study was carried out amongst pregnant women attending selected government health centres in the Buea Health District. We recruited 385 consenting pregnant women for the study. Demographic and clinical data were collected using structured questionnaires. The data was entered into Microsoft Excel and exported toEpi-Info (Version 3.5.1) for analysis. Geographical accessibility and perceived quality of care were the predominant reasons for choosing or changing a site for ANC. One third of respondents (30.1%) attended a health centre out of their catchment health area with Buea Town health centre receiving the highest proportion of women out of the health area (56.8% of attendees). Knowledge about antenatal care varied and majority of respondents (96.4%) were satisfied with the antenatal services received. However, there were elements of dissatisfaction with health centre services, poor sitting facilities, amenities, few health education talks and poor nursing skills. High educational level (high school and university) (X(2) = 8.714; p = 0.01) and first time pregnancy(X(2)= 4.217; p= 0.04) were significantly associated with poor satisfaction. Policy makers should implement changes in the health care delivery system taking into account the users' preferences, more so in the light of increasing female education in Cameroon.

Accounting for the effect of GERD symptoms on patients' health-related quality of life: supporting optimal disease management by primary care physicians.

PubMed

Flook, N W; Wiklund, I

2007-12-01

To review, from a primary care physician (PCP) perspective, the use of patient-reported outcome (PRO) instruments for assessment of gastro-oesophageal reflux disease (GERD) symptoms, their impact on health-related quality of life (HRQL) and the effectiveness of therapy. While generic and disease-specific PRO instruments have been used in the assessment of GERD, the latter can be considered to be more appropriate as they focus only on problems relevant to the disease in question (and therefore tend to be more responsive to change). Such instruments include the Quality of Life in Reflux and Dyspepsia (QOLRAD) questionnaire and the Gastrointestinal Symptom Rating Scale and the Reflux Disease Questionnaire (RDQ). Their use indicates that GERD symptoms are troublesome and significantly reduce patients' HRQL, and that effective treatment of GERD improves HRQL. The GERD Impact Scale (GIS) questionnaire, primarily developed for use within primary care, can also help to determine the impact of symptoms on patients' everyday lives and, in turn, the benefit of appropriately targeted therapy. Notably, these PRO instruments were developed from focus groups of GERD patients, and only aspects rated of highest importance are used in the final instruments. Consequently, PCPs can feel confident that these questionnaires encompass the most relevant points that they are likely to ask in terms of how symptoms affect patients' everyday lives. Primary care physicians are encouraged to make wider use of PRO instruments within routine practice to improve communication with their GERD patients that, in turn, could lead to improved clinical outcomes and greater patient satisfaction.

The RHESA-CARE study: an extended baseline survey of the regional myocardial infarction registry of Saxony-Anhalt (RHESA) design and objectives.

PubMed

Hirsch, Katharina; Bohley, Stefanie; Mau, Wilfried; Schmidt-Pokrzywniak, Andrea

2016-08-17

Cardiovascular disease (CVD) is a leading cause of death in Europe. In Germany, a declining mortality rate from acute myocardial infarction (AMI) has been observed in the last decades. Nevertheless, there are large differences between the federal states when looking at the mortality and morbidity of AMI. Saxony-Anhalt is one of the federal states with the highest mortality rates for AMI in Germany. In 2012, the regional myocardial infarction registry of Saxony-Anhalt (RHESA) was established to investigate the individual, infrastructural, and health care factors with respect to an urban (city of Halle) and rural (region of Altmark) population. For detailed observation the RHESA-CARE study was conducted in 2014. RHESA-CARE focuses on the symptoms during infarction, the behaviour of patients while alerting for infarction, the use of rehabilitation possibilities, and long-term care. RHESA-CARE is an extended baseline survey of AMI patients registered in RHESA who are aged 25 or more, and inhabitants of the city of Halle (Saale) or the district of Altmark in the federal state of Saxony-Anhalt, Germany. Detailed information was collected on classical and psychosocial cardiovascular risk factors as well as factors of alerting behaviour, first aid, and utilization of medical and rehabilitation services. High data quality is ensured by a detailed system of quality control. RHESA-CARE has the main objective to investigate factors that influence morbidity and mortality rates due to AMI. Another purpose is the comparison of a rural and urban patient population. It provides an opportunity to serve as a base for improvement of patients' behaviour and health care as well as further research.

Interspecialty communication supported by health information technology associated with lower hospitalization rates for ambulatory care-sensitive conditions.

PubMed

O'Malley, Ann S; Reschovsky, James D; Saiontz-Martinez, Cynthia

2015-01-01

Practice tools such as health information technology (HIT) have the potential to support care processes, such as communication between health care providers, and influence care for "ambulatory care-sensitive conditions" (ACSCs). ACSCs are conditions for which good outpatient care can potentially prevent the need for hospitalization. To date, associations between such primary care practice capabilities and hospitalizations for ambulatory care-sensitive conditions have been primarily limited to smaller, local studies or unique delivery systems rather than nationally representative studies of primary care physicians in the United States. We analyzed a nationally representative sample of 1,819 primary care physicians who responded to the Center for Studying Health System Change's Physician Survey. We linked 3 years of Medicare claims (2007 to 2009) with these primary care physician survey respondents. This linkage resulted in the identification of 123,760 beneficiaries with one or more of 4 ambulatory care-sensitive chronic conditions (diabetes, chronic obstructive pulmonary disease, asthma, and congestive heart failure) for whom these physicians served as the usual provider. Key independent variables of interest were physicians' practice capabilities, including communication with specialists, use of care managers, participation in quality and performance measurement, use of patient registries, and HIT use. The dependent variable was a summary measure of ambulatory care-sensitive hospitalizations for one or more of these 4 conditions. Higher provider-reported levels of communication between primary care and specialist physicians were associated with lower rates of potentially avoidable hospitalizations. While there was no significant main effect between HIT use and ACSC hospitalizations, the associations between interspecialty communication and ACSC hospitalizations were magnified in the presence of higher HIT use. For example, patients in practices with both the highest level of interspecialty communication and the highest level of HIT use had lower odds of ambulatory care-sensitive hospitalizations than did those in practices with lower interspecialty communication and high HIT use (adjusted odds ratio, 0.70; 95% confidence limits, 0.59, 0.82). Greater primary care and specialist communication is associated with reduced hospitalizations for ambulatory care-sensitive conditions. This effect was magnified in the presence of higher provider-reported HIT use, suggesting that coordination of care with support from HIT is important in the treatment of ambulatory care-sensitive conditions. © Copyright 2015 by the American Board of Family Medicine.

KernPaeP - a web-based pediatric palliative documentation system for home care.

PubMed

Hartz, Tobias; Verst, Hendrik; Ueckert, Frank

2009-01-01

KernPaeP is a new web-based on- and offline documentation system, which has been developed for pediatric palliative care-teams supporting patient documentation and communication among health care professionals. It provides a reliable system making fast and secure home care documentation possible. KernPaeP is accessible online by registered users using any web-browser. Home care teams use an offline version of KernPaeP running on a netbook for patient documentation on site. Identifying and medical patient data are strictly separated and stored on two database servers. The system offers a stable, enhanced two-way algorithm for synchronization between the offline component and the central database servers. KernPaeP is implemented meeting highest security standards while still maintaining high usability. The web-based documentation system allows ubiquitous and immediate access to patient data. Sumptuous paper work is replaced by secure and comprehensive electronic documentation. KernPaeP helps saving time and improving the quality of documentation. Due to development in close cooperation with pediatric palliative professionals, KernPaeP fulfils the broad needs of home-care documentation. The technique of web-based online and offline documentation is in general applicable for arbitrary home care scenarios.

5HTTLPR genotype moderates the longitudinal impact of early caregiving on externalizing behavior

PubMed Central

Smyke, Anna T.; Gleason, Mary Margaret; Nelson, Charles A.; Zeanah, Charles H.; Fox, Nathan A; Drury, Stacy S.

2014-01-01

We examined caregiver report of externalizing behavior from 12 to 54 months of age in 102 children randomized to care as usual in institutions or to newly-created high quality foster care. At baseline no differences by group or genotype in externalizing were found. However, changes in externalizing from baseline to 42 months of age were moderated by 5HTTLPR genotype and intervention group, where the slope for s/s individuals differed as a function of intervention group. The slope for individuals carrying the l allele did not significantly differ between groups. At 54 months of age, s/s children in the foster care group had the lowest levels of externalizing behavior, while children with the s/s genotype in the care as usual group demonstrated the highest rates of externalizing behavior. No intervention group differences were found in externalizing behavior among children who carried the l allele. These findings, within a randomized control trial of foster care compared to continued care as usual, indicate that 5HTTLPR genotype moderates the relation between early caregiving environments to predict externalizing behavior in children exposed to early institutional care in a manner most consistent with differential susceptibility. PMID:25640827

Quality of Voluntary Medical Male Circumcision Services during Scale-Up: A Comparative Process Evaluation in Kenya, South Africa, Tanzania and Zimbabwe

PubMed Central

Jennings, Larissa; Bertrand, Jane; Rech, Dino; Harvey, Steven A.; Hatzold, Karin; Samkange, Christopher A.; Omondi Aduda, Dickens S.; Fimbo, Bennett; Cherutich, Peter; Perry, Linnea; Castor, Delivette; Njeuhmeli, Emmanuel

2014-01-01

Background The rapid expansion of voluntary medical male circumcision (VMMC) has raised concerns whether health systems can deliver and sustain VMMC according to minimum quality criteria. Methods and Findings A comparative process evaluation was used to examine data from SYMMACS, the Systematic Monitoring of the Voluntary Medical Male Circumcision Scale-Up, among health facilities providing VMMC across two years of program scale-up. Site-level assessments examined the availability of guidelines, supplies and equipment, infection control, and continuity of care services. Direct observation of VMMC surgeries were used to assess care quality. Two sample tests of proportions and t-tests were used to examine differences in the percent of facilities meeting requisite preparedness standards and the mean number of directly-observed surgical tasks performed correctly. Results showed that safe, high quality VMMC can be implemented and sustained at-scale, although substantial variability was observed over time. In some settings, facility preparedness and VMMC service quality improved as the number of VMMC facilities increased. Yet, lapses in high performance and expansion of considerably deficient services were also observed. Surgical tasks had the highest quality scores, with lower performance levels in infection control, pre-operative examinations, and post-operative patient monitoring and counseling. The range of scale-up models used across countries additionally underscored the complexity of delivering high quality VMMC. Conclusions Greater efforts are needed to integrate VMMC scale-up and quality improvement processes in sub-Saharan African settings. Monitoring of service quality, not just adverse events reporting, will be essential in realizing the full health impact of VMMC for HIV prevention. PMID:24801073

Inpatient care of small and sick newborns: a multi-country analysis of health system bottlenecks and potential solutions

PubMed Central

2015-01-01

Background Preterm birth is the leading cause of child death worldwide. Small and sick newborns require timely, high-quality inpatient care to survive. This includes provision of warmth, feeding support, safe oxygen therapy and effective phototherapy with prevention and treatment of infections. Inpatient care for newborns requires dedicated ward space, staffed by health workers with specialist training and skills. Many of the estimated 2.8 million newborns that die every year do not have access to such specialised care. Methods The bottleneck analysis tool was applied in 12 countries in Africa and Asia as part of the Every Newborn Action Plan process. Country workshops involved technical experts to complete the survey tool, which is designed to synthesise and grade health system "bottlenecks" (or factors that hinder the scale up) of maternal-newborn intervention packages. For this paper, we used quantitative and qualitative methods to analyse the bottleneck data, and combined these with literature review, to present priority bottlenecks and actions relevant to different health system building blocks for inpatient care of small and sick newborns. Results Inpatient care of small and sick newborns is an intervention package highlighted by all country workshop participants as having critical health system challenges. Health system building blocks with the highest graded (significant or major) bottlenecks were health workforce (10 out of 12 countries) and health financing (10 out of 12 countries), followed by community ownership and partnership (9 out of 12 countries). Priority actions based on solution themes for these bottlenecks are discussed. Conclusions Whilst major bottlenecks to the scale-up of quality inpatient newborn care are present, effective solutions exist. For all countries included, there is a critical need for a neonatal nursing cadre. Small and sick newborns require increased, sustained funding with specific insurance schemes to cover inpatient care and avoid catastrophic out-of-pocket payments. Core competencies, by level of care, should be defined for monitoring of newborn inpatient care, as with emergency obstetric care. Rather than fatalism that small and sick newborns will die, community interventions need to create demand for accessible, high-quality, family-centred inpatient care, including kangaroo mother care, so that every newborn can survive and thrive. PMID:26391335

Online continuing medical education as a key link for successful noncommunicable disease self-management: the CASALUD™ Model.

PubMed

Gallardo-Rincón, Héctor; Saucedo-Martínez, Rodrigo; Mujica-Rosales, Ricardo; Lee, Evan M; Israel, Amy; Torres-Beltran, Braulio; Quijano-González, Úrsula; Atkinson, Elena Rose; Kuri-Morales, Pablo; Tapia-Conyer, Roberto

2017-01-01

The purpose of this study is to evaluate how the benefits of online continuing medical education (CME) provided to health care professionals traveled along a patient "educational chain". In this study, the educational chain begins with the influence that CME can have on the quality of health care, with subsequent influence on patient knowledge, disease self-management, and disease biomarkers. A total of 422 patients with at least one noncommunicable disease (NCD) treated in eight different Mexican public health clinics were followed over 3 years. All clinics were participants in the CASALUD Model, an NCD care model for primary care, where all clinic staff were offered CME. Data were collected through a questionnaire on health care, patient disease knowledge, and self-management behaviors; blood samples and anthropometric measurements were collected to measure patient disease biomarkers. Between 2013 and 2015, the indexes measuring quality of health care, patient health knowledge, and diabetes self-management activities rose moderately but significantly (from 0.54 to 0.64, 0.80 to 0.84, and 0.62 to 0.67, respectively). Performing self-care activities - including owning and using a glucometer and belonging to a disease support group - saw the highest increase (from 0.65 to 0.75). A1C levels increased between 2013 and 2015 from 7.95 to 8.41% (63-68 mmol/mol) ( P <0.001), and blood pressure decreased between 2014 and 2015 from 143.7/76.8 to 137.5/74.4 (systolic/diastolic reported in mmHg) ( P <0.001). The mean levels of other disease biomarkers remained statistically unchanged, despite the improvements seen in the previous "links" of the educational chain. Online CME can effect certain changes in the educational chain linking quality of health care, patient knowledge, and self-management behaviors. However, in order to assure adequate NCD control, the entire health care system must be improved in tandem. Online CME programs, such as CASALUD's, are feasible strategies for impacting changes in disease self-management at a clinic level throughout a country.

Patient Satisfaction with Hospital Inpatient Care: Effects of Trust, Medical Insurance and Perceived Quality of Care

PubMed Central

Wu, Qunhong; Liu, Chaojie; Jiao, Mingli; Hao, Yanhua; Han, Yuzhen; Gao, Lijun; Hao, Jiejing; Wang, Lan; Xu, Weilan; Ren, Jiaojiao

2016-01-01

Objective Deteriorations in the patient-provider relationship in China have attracted increasing attention in the international community. This study aims to explore the role of trust in patient satisfaction with hospital inpatient care, and how patient-provider trust is shaped from the perspectives of both patients and providers. Methods We adopted a mixed methods approach comprising a multivariate logistic regression model using secondary data (1200 people with inpatient experiences over the past year) from the fifth National Health Service Survey (NHSS, 2013) in Heilongjiang Province to determine the associations between patient satisfaction and trust, financial burden and perceived quality of care, followed by in-depth interviews with 62 conveniently selected key informants (27 from health and 35 from non-health sectors). A thematic analysis established a conceptual framework to explain deteriorating patient-provider relationships. Findings About 24% of respondents reported being dissatisfied with hospital inpatient care. The logistic regression model indicated that patient satisfaction was positively associated with higher level of trust (OR = 14.995), lower levels of hospital medical expenditure (OR = 5.736–1.829 as compared with the highest quintile of hospital expenditure), good staff attitude (OR = 3.155) as well as good ward environment (OR = 2.361). But patient satisfaction was negatively associated with medical insurance for urban residents and other insurance status (OR = 0.215–0.357 as compared with medical insurance for urban employees). The qualitative analysis showed that patient trust—the most significant predictor of patient satisfaction—is shaped by perceived high quality of service delivery, empathic and caring interpersonal interactions, and a better designed medical insurance that provides stronger financial protection and enables more equitable access to health care. Conclusion At the core of high levels of patient dissatisfaction with hospital care is the lack of trust. The current health care system reform in China has yet to address the fundamental problems embedded in the system that caused distrust. A singular focus on doctor-patient inter-personal interactions will not offer a successful solution to the deteriorated patient-provider relationships unless a systems approach to accountability is put into place involving all stakeholders. PMID:27755558

Online continuing medical education as a key link for successful noncommunicable disease self-management: the CASALUD™ Model

PubMed Central

Gallardo-Rincón, Héctor; Saucedo-Martínez, Rodrigo; Mujica-Rosales, Ricardo; Lee, Evan M; Israel, Amy; Torres-Beltran, Braulio; Quijano-González, Úrsula; Atkinson, Elena Rose; Kuri-Morales, Pablo; Tapia-Conyer, Roberto

2017-01-01

Purpose The purpose of this study is to evaluate how the benefits of online continuing medical education (CME) provided to health care professionals traveled along a patient “educational chain”. In this study, the educational chain begins with the influence that CME can have on the quality of health care, with subsequent influence on patient knowledge, disease self-management, and disease biomarkers. Methods A total of 422 patients with at least one noncommunicable disease (NCD) treated in eight different Mexican public health clinics were followed over 3 years. All clinics were participants in the CASALUD Model, an NCD care model for primary care, where all clinic staff were offered CME. Data were collected through a questionnaire on health care, patient disease knowledge, and self-management behaviors; blood samples and anthropometric measurements were collected to measure patient disease biomarkers. Results Between 2013 and 2015, the indexes measuring quality of health care, patient health knowledge, and diabetes self-management activities rose moderately but significantly (from 0.54 to 0.64, 0.80 to 0.84, and 0.62 to 0.67, respectively). Performing self-care activities – including owning and using a glucometer and belonging to a disease support group – saw the highest increase (from 0.65 to 0.75). A1C levels increased between 2013 and 2015 from 7.95 to 8.41% (63–68 mmol/mol) (P<0.001), and blood pressure decreased between 2014 and 2015 from 143.7/76.8 to 137.5/74.4 (systolic/diastolic reported in mmHg) (P<0.001). The mean levels of other disease biomarkers remained statistically unchanged, despite the improvements seen in the previous “links” of the educational chain. Conclusion Online CME can effect certain changes in the educational chain linking quality of health care, patient knowledge, and self-management behaviors. However, in order to assure adequate NCD control, the entire health care system must be improved in tandem. Online CME programs, such as CASALUD’s, are feasible strategies for impacting changes in disease self-management at a clinic level throughout a country. PMID:29089779

Patient Satisfaction with Hospital Inpatient Care: Effects of Trust, Medical Insurance and Perceived Quality of Care.

PubMed

Shan, Linghan; Li, Ye; Ding, Ding; Wu, Qunhong; Liu, Chaojie; Jiao, Mingli; Hao, Yanhua; Han, Yuzhen; Gao, Lijun; Hao, Jiejing; Wang, Lan; Xu, Weilan; Ren, Jiaojiao

2016-01-01

Deteriorations in the patient-provider relationship in China have attracted increasing attention in the international community. This study aims to explore the role of trust in patient satisfaction with hospital inpatient care, and how patient-provider trust is shaped from the perspectives of both patients and providers. We adopted a mixed methods approach comprising a multivariate logistic regression model using secondary data (1200 people with inpatient experiences over the past year) from the fifth National Health Service Survey (NHSS, 2013) in Heilongjiang Province to determine the associations between patient satisfaction and trust, financial burden and perceived quality of care, followed by in-depth interviews with 62 conveniently selected key informants (27 from health and 35 from non-health sectors). A thematic analysis established a conceptual framework to explain deteriorating patient-provider relationships. About 24% of respondents reported being dissatisfied with hospital inpatient care. The logistic regression model indicated that patient satisfaction was positively associated with higher level of trust (OR = 14.995), lower levels of hospital medical expenditure (OR = 5.736-1.829 as compared with the highest quintile of hospital expenditure), good staff attitude (OR = 3.155) as well as good ward environment (OR = 2.361). But patient satisfaction was negatively associated with medical insurance for urban residents and other insurance status (OR = 0.215-0.357 as compared with medical insurance for urban employees). The qualitative analysis showed that patient trust-the most significant predictor of patient satisfaction-is shaped by perceived high quality of service delivery, empathic and caring interpersonal interactions, and a better designed medical insurance that provides stronger financial protection and enables more equitable access to health care. At the core of high levels of patient dissatisfaction with hospital care is the lack of trust. The current health care system reform in China has yet to address the fundamental problems embedded in the system that caused distrust. A singular focus on doctor-patient inter-personal interactions will not offer a successful solution to the deteriorated patient-provider relationships unless a systems approach to accountability is put into place involving all stakeholders.

Nuchal translucency and first trimester risk assessment: a systematic review.

PubMed

Sheppard, Celeste; Platt, Lawrence D

2007-06-01

First-trimester risk assessment for fetal aneuploidy using nuchal translucency (NT) measurement is rapidly gaining popularity in the United States. In combination with maternal serum markers in the first trimester, the screening performance is exceptionally good, with detection rates of more than 80% at a screen positive rate of 5%. Recently, the method has been validated for screening for Down syndrome and other aneuploidies in multicenter trials in the United States and elsewhere. Compliance with established criteria for measurement of the NT is essential to achieve uniform reliability and high screening test sensitivity. There is an international consensus about the importance of specific training in the NT examination, conformity to standards of NT measurement, and regular audit for quality assurance. In the United States, the Nuchal Translucency Quality Review program has been developed to administer credentialing and quality review for registered practitioners. The Nuchal Translucency Quality Review credentials signify the proficiency of the sonographer or sonologist in NT measurement and participation in a regular quality assurance audit. We encourage accreditation of clinical sites offering first-trimester risk assessment to ensure the highest quality care.

Consumer preferences and values as an integral key to evidence-based practice.

PubMed

Melnyk, Bernadette Mazurek; Fineout-Overholt, Ellen

2006-01-01

Although evidence-based practice (EBP) integrates the best evidence from well-designed studies with a clinician's expertise and patient preferences and values, most of what is emphasized in books and reports on EBP is the 5-step EBP process. However, the consideration of patient values and preferences in making clinical decisions is essential to deliver the highest quality of care. This article briefly reviews the status of EBP in the United States, described the ARCC mentorship model, and highlights how to engage consumers in the EBP process.

Comprehensive Strategies to Reduce Readmissions in Older Patients With Cardiovascular Disease.

PubMed

Dharmarajan, Kumar

2016-11-01

Older adults are frequently readmitted to the hospital soon after hospitalization for common cardiovascular conditions. Yet there are few high-quality data on the best strategies to reduce short-term readmissions because most studies have involved small numbers of participants, single-centre design, and strong susceptibility to bias. Despite these limitations in the literature, a clear signal exists that most studies involving a singular type of intervention, a singular type of health provider, or a low intensity of intervention have failed to reduce readmissions. In contrast, interventions that are most likely to lower readmissions have used comprehensive approaches, including combined hospital and postacute care, multimodal interventions, multidisciplinary teams, or frequent longitudinal contact. Components of a comprehensive approach with the highest level of evidence include high-quality, disease-specific care; multiple transitional care interventions; involvement of multidisciplinary teams; early and frequent outpatient follow-up; and, when possible, home visits. These findings are consistent with data demonstrating that older adults have multiple sources of vulnerability and experience elevated readmission risk from a broad spectrum of medical conditions for an extended time after hospital discharge. Because readmission reduction is difficult and requires new ways of conceptualizing links between inpatient and postacute care, financial incentives may ultimately be required to motivate hospitals and health systems to redesign care processes, deploy new resources, and collaborate with out-of-hospital providers and organizations. Copyright © 2016 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

[Diabetes related visual disability incidence as an indicator of the quality of ophthalmic and diabetic care].

PubMed

Bandurska-Stankiewicz, Elzbieta; Wiatr, Dorota

2007-01-01

This study was to investigate the incidence of blindness due to diabetes in the years 1989-2003, and to compare the studied coefficients in view of the changes in diabetic and ophthalmic care proceeding in the region. Studies on the incidence of diabetes related blindness were conducted in the Warmia & Mazury Region in the years 1989-2003 among patients with type 1 (DM1) and type 2 (DM2) diabetes. Blindness recognized according to the WHO criteria. The incidence rate (IR) was expressed as the number of new blindness cases per 100,000 population per year. The register covered 274 patients visually disabled due to diabetes, in this 69 with DM1, in average of age 47.1, and 205 with DM2, in average of age 65.6. At the beginning of the observation IR varied with the highest in 1995--4.8/100000 (CI: 3.2-6.3). This period was characterized by limited access of patients to diabetologists and laserotherapy. From 1996 it decreased from 4.3/100000 (CI: 2.8-5.7) to 0.9/100000 (CI: 0.2-1.6) in 2003--a new programme of diabetic care with early detection and treatment of retinopathy was introduced. A growth of funds for basic and outpatient clinic specialist care was observed. Analysis of diabetes related blindness is a good indicator of the quality of diabetic and ophthalmic care.

Can we do better? Economic analysis of human resource investment to improve home care service for the elderly in Serbia

PubMed Central

Mihic, Marko M; Todorovic, Marija Lj; Obradovic, Vladimir Lj; Mitrovic, Zorica M

2016-01-01

Background Social services aimed at the elderly are facing great challenges caused by progressive aging of the global population but also by the constant pressure to spend funds in a rational manner. Purpose This paper focuses on analyzing the investments into human resources aimed at enhancing home care for the elderly since many countries have recorded progress in the area over the past years. The goal of this paper is to stress the significance of performing an economic analysis of the investment. Methods This paper combines statistical analysis methods such as correlation and regression analysis, methods of economic analysis, and scenario method. Results The economic analysis of investing in human resources for home care service in Serbia showed that the both scenarios of investing in either additional home care hours or more beneficiaries are cost-efficient. However, the optimal solution with the positive (and the highest) value of economic net present value criterion is to invest in human resources to boost the number of home care hours from 6 to 8 hours per week and increase the number of the beneficiaries to 33%. Conclusion This paper shows how the statistical and economic analysis results can be used to evaluate different scenarios and enable quality decision-making based on exact data in order to improve health and quality of life of the elderly and spend funds in a rational manner. PMID:26869778

An "All Teach, All Learn" Approach to Research Capacity Strengthening in Indigenous Primary Health Care Continuous Quality Improvement.

PubMed

McPhail-Bell, Karen; Matthews, Veronica; Bainbridge, Roxanne; Redman-MacLaren, Michelle Louise; Askew, Deborah; Ramanathan, Shanthi; Bailie, Jodie; Bailie, Ross

2018-01-01

In Australia, Indigenous people experience poor access to health care and the highest rates of morbidity and mortality of any population group. Despite modest improvements in recent years, concerns remains that Indigenous people have been over-researched without corresponding health improvements. Embedding Indigenous leadership, participation, and priorities in health research is an essential strategy for meaningful change for Indigenous people. To centralize Indigenous perspectives in research processes, a transformative shift away from traditional approaches that have benefited researchers and non-Indigenous agendas is required. This shift must involve concomitant strengthening of the research capacity of Indigenous and non-Indigenous researchers and research translators-all must teach and all must learn. However, there is limited evidence about how to strengthen systems and stakeholder capacity to participate in and lead continuous quality improvement (CQI) research in Indigenous primary health care, to the benefit of Indigenous people. This paper describes the collaborative development of, and principles underpinning, a research capacity strengthening (RCS) model in a national Indigenous primary health care CQI research network. The development process identified the need to address power imbalances, cultural contexts, relationships, systems requirements and existing knowledge, skills, and experience of all parties. Taking a strengths-based perspective, we harnessed existing knowledge, skills and experiences; hence our emphasis on capacity "strengthening". New insights are provided into the complex processes of RCS within the context of CQI in Indigenous primary health care.

An “All Teach, All Learn” Approach to Research Capacity Strengthening in Indigenous Primary Health Care Continuous Quality Improvement

PubMed Central

McPhail-Bell, Karen; Matthews, Veronica; Bainbridge, Roxanne; Redman-MacLaren, Michelle Louise; Askew, Deborah; Ramanathan, Shanthi; Bailie, Jodie; Bailie, Ross; Matthews, Veronica

2018-01-01

In Australia, Indigenous people experience poor access to health care and the highest rates of morbidity and mortality of any population group. Despite modest improvements in recent years, concerns remains that Indigenous people have been over-researched without corresponding health improvements. Embedding Indigenous leadership, participation, and priorities in health research is an essential strategy for meaningful change for Indigenous people. To centralize Indigenous perspectives in research processes, a transformative shift away from traditional approaches that have benefited researchers and non-Indigenous agendas is required. This shift must involve concomitant strengthening of the research capacity of Indigenous and non-Indigenous researchers and research translators—all must teach and all must learn. However, there is limited evidence about how to strengthen systems and stakeholder capacity to participate in and lead continuous quality improvement (CQI) research in Indigenous primary health care, to the benefit of Indigenous people. This paper describes the collaborative development of, and principles underpinning, a research capacity strengthening (RCS) model in a national Indigenous primary health care CQI research network. The development process identified the need to address power imbalances, cultural contexts, relationships, systems requirements and existing knowledge, skills, and experience of all parties. Taking a strengths-based perspective, we harnessed existing knowledge, skills and experiences; hence our emphasis on capacity “strengthening”. New insights are provided into the complex processes of RCS within the context of CQI in Indigenous primary health care. PMID:29761095

Mental health in primary care: an evaluation using the Item Response Theory

PubMed Central

da Rocha, Hugo André; dos Santos, Alaneir de Fátima; Reis, Ilka Afonso; Santos, Marcos Antônio da Cunha; Cherchiglia, Mariângela Leal

2018-01-01

ABSTRACT OBJECTIVE To determine the items of the Brazilian National Program for Improving Access and Quality of Primary Care that better evaluate the capacity to provide mental health care. METHODS This is a cross-sectional study carried out using the Graded Response Model of the Item Response Theory using secondary data from the second cycle of the National Program for Improving Access and Quality of Primary Care, which evaluates 30,523 primary care teams in the period from 2013 to 2014 in Brazil. The internal consistency, correlation between items, and correlation between items and the total score were tested using the Cronbach’s alpha, Spearman’s correlation, and point biserial coefficients, respectively. The assumptions of unidimensionality and local independence of the items were tested. Word clouds were used as one way to present the results. RESULTS The items with the greatest ability to discriminate were scheduling of the agenda according to risk stratification, keeping of records of the most serious cases of users in psychological distress, and provision of group care. The items that required a higher level of mental health care in the parameter of location were the provision of any type of group care and the provision of educational and mental health promotion activities. Total Cronbach’s alpha coefficient was 0.87. The items that obtained the highest correlation with total score were the recording of the most serious cases of users in psychological distress and scheduling of the agenda according to risk stratification. The final scores obtained oscillated between -2.07 (minimum) and 1.95 (maximum). CONCLUSIONS There are important aspects in the discrimination of the capacity to provide mental health care by primary health care teams: risk stratification for care management, follow-up of the most serious cases, group care, and preventive and health promotion actions. PMID:29489992

Quality of healthcare services and its relationship with patient safety culture and nurse-physician professional communication

PubMed Central

Ghahramanian, Akram; Rezaei, Tayyebeh; Abdullahzadeh, Farahnaz; Sheikhalipour, Zahra; Dianat, Iman

2017-01-01

Background: This study investigated quality of healthcare services from patients’ perspectives and its relationship with patient safety culture and nurse-physician professional communication. Methods: A cross-sectional study was conducted among 300 surgery patients and 101 nurses caring them in a public hospital in Tabriz–Iran. Data were collected using the service quality measurement scale (SERVQUAL), hospital survey on patient safety culture (HSOPSC) and nurse physician professional communication questionnaire. Results: The highest and lowest mean (±SD) scores of the patients’ perception on the healthcare services quality belonged to the assurance 13.92 (±3.55) and empathy 6.78 (±1.88) domains,respectively. With regard to the patient safety culture, the mean percentage of positive answers ranged from 45.87% for "non-punitive response to errors" to 68.21% for "organizational continuous learning" domains. The highest and lowest mean (±SD) scores for the nurse physician professional communication were obtained for "cooperation" 3.44 (±0.35) and "non-participative decision-making" 2.84 (±0.34) domains, respectively. The "frequency of reported errors by healthcare professionals" (B=-4.20, 95% CI = -7.14 to -1.27, P<0.01) and "respect and sharing of information" (B=7.69, 95% CI=4.01 to 11.36, P<0.001) predicted the patients’perceptions of the quality of healthcare services. Conclusion: Organizational culture in dealing with medical error should be changed to non-punitive response. Change in safety culture towards reporting of errors, effective communication and teamwork between healthcare professionals are recommended. PMID:28695106

Tools to Assess Behavioral and Social Science Competencies in Medical Education: A Systematic Review.

PubMed

Carney, Patricia A; Palmer, Ryan T; Fuqua Miller, Marissa; Thayer, Erin K; Estroff, Sue E; Litzelman, Debra K; Biagioli, Frances E; Teal, Cayla R; Lambros, Ann; Hatt, William J; Satterfield, Jason M

2016-05-01

Behavioral and social science (BSS) competencies are needed to provide quality health care, but psychometrically validated measures to assess these competencies are difficult to find. Moreover, they have not been mapped to existing frameworks, like those from the Liaison Committee on Medical Education (LCME) and Accreditation Council for Graduate Medical Education (ACGME). This systematic review aimed to identify and evaluate the quality of assessment tools used to measure BSS competencies. The authors searched the literature published between January 2002 and March 2014 for articles reporting psychometric or other validity/reliability testing, using OVID, CINAHL, PubMed, ERIC, Research and Development Resource Base, SOCIOFILE, and PsycINFO. They reviewed 5,104 potentially relevant titles and abstracts. To guide their review, they mapped BSS competencies to existing LCME and ACGME frameworks. The final included articles fell into three categories: instrument development, which were of the highest quality; educational research, which were of the second highest quality; and curriculum evaluation, which were of lower quality. Of the 114 included articles, 33 (29%) yielded strong evidence supporting tools to assess communication skills, cultural competence, empathy/compassion, behavioral health counseling, professionalism, and teamwork. Sixty-two (54%) articles yielded moderate evidence and 19 (17%) weak evidence. Articles mapped to all LCME standards and ACGME core competencies; the most common was communication skills. These findings serve as a valuable resource for medical educators and researchers. More rigorous measurement validation and testing and more robust study designs are needed to understand how educational strategies contribute to BSS competency development.

Tools to Assess Behavioral and Social Science Competencies in Medical Education: A Systematic Review

PubMed Central

Carney, Patricia A.; Palmer, Ryan T.; Miller, Marissa Fuqua; Thayer, Erin K.; Estroff, Sue E.; Litzelman, Debra K.; Biagioli, Frances E.; Teal, Cayla R.; Lambros, Ann; Hatt, William J.; Satterfield, Jason M.

2015-01-01

Purpose Behavioral and social science (BSS) competencies are needed to provide quality health care, but psychometrically validated measures to assess these competencies are difficult to find. Moreover, they have not been mapped to existing frameworks, like those from the Liaison Committee on Medical Education (LCME) and Accreditation Council for Graduate Medical Education (ACGME). This systematic review aimed to identify and evaluate the quality of assessment tools used to measure BSS competencies. Method The authors searched the literature published between January 2002 and March 2014 for articles reporting psychometric or other validity/reliability testing, using OVID, CINAHL, PubMed, ERIC, Research and Development Resource Base, SOCIOFILE, and PsycINFO. They reviewed 5,104 potentially relevant titles and abstracts. To guide their review, they mapped BSS competencies to existing LCME and ACGME frameworks. The final, included articles fell into three categories: instrument development, which were of the highest quality; educational research, which were of the second highest quality; and curriculum evaluation, which were of lower quality. Results Of the 114 included articles, 33 (29%) yielded strong evidence supporting tools to assess communication skills, cultural competence, empathy/compassion, behavioral health counseling, professionalism, and teamwork. Sixty-two (54%) articles yielded moderate evidence and 19 (17%) weak evidence. Articles mapped to all LCME standards and ACGME core competencies; the most common was communication skills. Conclusions These findings serve as a valuable resource for medical educators and researchers. More rigorous measurement validation and testing and more robust study designs are needed to understand how educational strategies contribute to BSS competency development. PMID:26796091

Total integrated performance excellence system (TIPES): A true north direction for a clinical trial support center.

PubMed

Sather, Mike R; Parsons, Sherry; Boardman, Kathy D; Warren, Stuart R; Davis-Karim, Anne; Griffin, Kevin; Betterton, Jane A; Jones, Mark S; Johnson, Stanley H; Vertrees, Julia E; Hickey, Jan H; Salazar, Thelma P; Huang, Grant D

2018-03-01

This paper presents the quality journey taken by a Federal organization over more than 20 years. These efforts have resulted in the implementation of a Total Integrated Performance Excellence System (TIPES) that combines key principles and practices of established quality systems. The Center has progressively integrated quality system frameworks including the Malcom Baldrige National Quality Award (MBNQA) Framework and Criteria for Performance Excellence, ISO 9001, and the Organizational Project Management Maturity Model (OPM3), as well as supplemental quality systems of ISO 15378 (packaging for medicinal products) and ISO 21500 (guide to project management) to systematically improve all areas of operations. These frameworks were selected for applicability to Center processes and systems, consistency and reinforcement of complimentary approaches, and international acceptance. External validations include the MBNQA, the highest quality award in the US, continued registration and conformance to ISO standards and guidelines, and multiple VA and state awards. With a focus on a holistic approach to quality involving processes, systems and personnel, this paper presents activities and lessons that were critical to building TIPES and establishing the quality environment for conducting clinical research in support of Veterans and national health care.

[Structure Parameters and Quality Outcomes of Ambulant Home-care].

PubMed

Suhr, Ralf; Raeder, Kathrin; Kuntz, Simone; Strube-Lahmann, Sandra; Latendorf, Antje; Klingelhöfer-Noe, Jürgen; Lahmann, Nils

2018-05-14

So far, there are few data available on the changes of ambulant home-care in Germany over the last decades. Therefore, the aim of this research was to provide structure data on nursing personnel, funding, size, regional differences, and training needs of ambulant home-care services in Germany. In addition, a possible association between structure parameters and quality outcomes for pressure ulcer and malnutrition was investigated. In 2015, a multicenter cross-sectional study was conducted in home-care services in Germany. Structure data from 99 randomly selected home-care services as well as data on pressure ulcers and malnutrition of 903 care-dependent clients were analyzed. The median (<98 clients) was used as a cut-off to differentiate between small and large home-care services. From a cut-off of 20,000 inhabitants, a region was considered urban. The average prevalence for decubitus and malnutrition (BMI<20 Kg/m2) were determined for each home-care service, and possible associations with structure parameters were analyzed using a multiple linear regression model. The proportion of registered nurses in non-private (private) home-care services was 60.6% (52.3%). The proportion of employees with a 200- h basic qualification in nursing was higher in private (12.5 vs. 4.7%), small home-care services (14.0 vs. 5.8%) and in urban regions (11.5 vs 5.7%). In average, registered nurses working in small home-care services spent significantly more time per client than the ones working in large services (3.8 vs. 2.9 h/week). The highest need for further training was shown on the subjects of pain, medication and cognitive impairment. No statistically significant correlation could be found between the average decubitus prevalence and structure parameters. Only the association between malnutrition prevalence and the proportion of registered nurses was statistically significant. The present representative study provides structure data on nursing personnel, funding, size, regional differences, and training needs of ambulant home-care services in Germany that could be used as a baseline for further investigations. No statistically significant association could be found between structure and outcome quality parameters. There is a need for further training of nursing personnel on the subjects of medication, pain and cognitive impairment. © Georg Thieme Verlag KG Stuttgart · New York.

Do systematic reviews address community healthcare professionals' wound care uncertainties? Results from evidence mapping in wound care.

PubMed

Christie, Janice; Gray, Trish A; Dumville, Jo C; Cullum, Nicky A

2018-01-01

Complex wounds such as leg and foot ulcers are common, resource intensive and have negative impacts on patients' wellbeing. Evidence-based decision-making, substantiated by high quality evidence such as from systematic reviews, is widely advocated for improving patient care and healthcare efficiency. Consequently, we set out to classify and map the extent to which up-to-date systematic reviews containing robust evidence exist for wound care uncertainties prioritised by community-based healthcare professionals. We asked healthcare professionals to prioritise uncertainties based on complex wound care decisions, and then classified 28 uncertainties according to the type and level of decision. For each uncertainty, we searched for relevant systematic reviews. Two independent reviewers screened abstracts and full texts of reviews against the following criteria: meeting an a priori definition of a systematic review, sufficiently addressing the uncertainty, published during or after 2012, and identifying high quality research evidence. The most common uncertainty type was 'interventions' 24/28 (85%); the majority concerned wound level decisions 15/28 (53%) however, service delivery level decisions (10/28) were given highest priority. Overall, we found 162 potentially relevant reviews of which 57 (35%) were not systematic reviews. Of 106 systematic reviews, only 28 were relevant to an uncertainty and 18 of these were published within the preceding five years; none identified high quality research evidence. Despite the growing volume of published primary research, healthcare professionals delivering wound care have important clinical uncertainties which are not addressed by up-to-date systematic reviews containing high certainty evidence. These are high priority topics requiring new research and systematic reviews which are regularly updated. To reduce clinical and research waste, we recommend systematic reviewers and researchers make greater efforts to ensure that research addresses important clinical uncertainties and is of sufficient rigour to inform practice.

The Financial Burden of Non-Communicable Chronic Diseases in Rural Nigeria: Wealth and Gender Heterogeneity in Health Care Utilization and Health Expenditures

PubMed Central

Janssens, Wendy; de Bree, Godelieve J.; Aderibigbe, Sunday A.; Akande, Tanimola M.; Mesnard, Alice

2016-01-01

Objectives Better insights into health care utilization and out-of-pocket expenditures for non-communicable chronic diseases (NCCD) are needed to develop accessible health care and limit the increasing financial burden of NCCDs in Sub-Saharan Africa. Methods A household survey was conducted in rural Kwara State, Nigeria, among 5,761 individuals. Data were obtained using biomedical and socio-economic questionnaires. Health care utilization, NCCD-related health expenditures and distances to health care providers were compared by sex and by wealth quintile, and a Heckman regression model was used to estimate health expenditures taking selection bias in health care utilization into account. Results The prevalence of NCCDs in our sample was 6.2%. NCCD-affected individuals from the wealthiest quintile utilized formal health care nearly twice as often as those from the lowest quintile (87.8% vs 46.2%, p = 0.002). Women reported foregone formal care more often than men (43.5% vs. 27.0%, p = 0.058). Health expenditures relative to annual consumption of the poorest quintile exceeded those of the highest quintile 2.2-fold, and the poorest quintile exhibited a higher rate of catastrophic health spending (10.8% among NCCD-affected households) than the three upper quintiles (4.2% to 6.7%). Long travel distances to the nearest provider, highest for the poorest quintile, were a significant deterrent to seeking care. Using distance to the nearest facility as instrument to account for selection into health care utilization, we estimated out-of-pocket health care expenditures for NCCDs to be significantly higher in the lowest wealth quintile compared to the three upper quintiles. Conclusions Facing potentially high health care costs and poor accessibility of health care facilities, many individuals suffering from NCCDs—particularly women and the poor—forego formal care, thereby increasing the risk of more severe illness in the future. When seeking care, the poor spend less on treatment than the rich, suggestive of lower quality care, while their expenditures represent a higher share of their annual household consumption. This calls for targeted interventions that enhance health care accessibility and provide financial protection from the consequences of NCCDs, especially for vulnerable populations. PMID:27832107

[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 standards, and providing other services in the field of healthcare quality assurance, improvement, promotion and monitoring, according to the Act. Formal activities of the Agency in the field of HTA actually began in summer 2009. In the field of quality and accreditation, the plan and program of healthcare quality assurance, improvement, promotion and monitoring was finished and published in October 2010; preparation of the healthcare quality standards as well as the accreditation standards is still in process, with the aim to start accreditation process at 10 hospitals in 2011. Education in the field of healthcare quality assurance, improvement and promotion has been established as a continuous process from the beginning. The Agency is member of the International Society for Quality in Health Care (ISQua) and participates in the work of the European Accreditation Network (EAN). In the field of HTA, the Agency has established international collaboration and support, which resulted in its appointment and participation in the European network for Health Technology Assessment (EUnetHTA) Joint Action Project as a EUnetHTA Partner, as well as its membership in the international society, HTAi. TAIEX project has been approved as a two-day workshop in December 2010. The Croatian HTA Guidelines have been issued with the aim to start the HTA process and reports that should serve as recommendations, as a support to policy-makers at the national level, in particular the Croatian Ministry of Health and Social Welfare, and Croatian Institute of Health Insurance, in making evidence-informed decisions on the strategic planning, investment, management and implementation of technologies in health care, on funding (reimbursement) and coverage of health technologies, and at hospital level on the request from hospital directors and policy teams. In conclusion, establishment of all these measures in Croatia is by no means an easy and quick process, however, we do believe that it is feasible through continuous and close collaboration of all those involved.

Assessment of cost of innovation versus the value of health gains associated with treatment of chronic hepatitis C in the United States: The quality-adjusted cost of care.

PubMed

Younossi, Zobair M; Park, Haesuk; Dieterich, Douglas; Saab, Sammy; Ahmed, Aijaz; Gordon, Stuart C

2016-10-01

New direct-acting antiviral (DAA) therapy has dramatically increased cure rates for patients infected with hepatitis C virus (HCV), but has also substantially raised treatment costs. The aim of this analysis was to evaluate the therapeutic benefit and net costs (i.e. efficiency frontier) and the quality-adjusted cost of care associated with the evolution of treatment regimens for patients with HCV genotype 1 in the United States. A decision-analytic Markov model. Published literature and clinical trial data. Life Time. Third-party payer. This study compared four approved regimens in treatment-naïve genotype 1 chronic hepatitis C patients, including pegylated interferon and ribavirin (PR), first generation triple therapy (boceprevir + PR and telaprevir + PR), second generation triple therapy (sofosbuvir + PR and simeprevir + PR) and all-oral DAA regimens (ledipasvir/sofosbuvir and ombitasvir + paritaprevir/ritonavir + dasabuvir ± ribavirin). Quality-adjusted cost of care (QACC). QACC was defined as the increase in treatment cost minus the increase in the patient's quality-adjusted life years (QALYs) when valued at $50,000 per QALY. All-oral therapy improved the average sustained virologic response (SVR) rate to 96%, thereby offsetting the high drug acquisition cost of $85,714, which resulted in the highest benefit based on the efficiency frontier. Furthermore, while oral therapies increased HCV drug costs by $48,350, associated QALY gains decreased quality-adjusted cost of care by $14,120 compared to dual therapy. When the value of a QALY was varied from $100,000 to $300,000, the quality adjusted cost of care compared to dual therapy ranged from - $21,234 to - $107,861, - $89,007 to - $293,130, - $176,280 to - $500,599 for first generation triple, second generation triple, and all-oral therapies, respectively. Primary efficacy and safety measurements for drug regimens were sourced from clinical trials data rather than a real-world setting. Factors such as individual demographic characteristics, comorbidities and alcohol consumption of the individual patients treated may alter disease progression but were not captured in this analysis. New DAA treatments provide short-term and long-term clinical and economic value to society. Gilead Sciences, Inc.

The impact of health information exchange on healthcare quality and cost-effectiveness: A systematic literature review.

PubMed

Sadoughi, Farahnaz; Nasiri, Somayeh; Ahmadi, Hossein

2018-07-01

Health Information Exchange (HIE) is known as a technology that electronically shares all clinical and administrative data throughout healthcare settings. Despite this technology has a great potential in the healthcare industry, there is a limited and sparse evidence of articles which illustrated the impact of HIE on quality of care and cost-effectiveness. This work presents a systematic review that evaluates the impact of HIE on quality and cost-effectiveness, and the rates of HIE adoption and participation in healthcare organizations. We systematically searched all English papers that were indexed in four major databases (Science Direct, PubMed, IEEE and Web of Science) between 2005 and 2016. Consequently, 32 identified papers appeared in 21 international journals and conferences. Eligible studies independently were critically appraised, collected within data extraction form and then thematically analyzed by two reviewers and if necessary, the third author. The selected papers have been classified based on 11 main categories including publication year, journal and conference names, country and study design, types of data exchanged, healthcare levels, disease or disorder, participants in organizations and individuals, settings characteristics and HIE types, the impact of HIE on quality and cost-effectiveness, and the rates of HIE adoption and participation. Of the 32 articles, 25 studies investigated the financial and clinical impact of HIE. Overwhelmingly, HIE studies have reported positive findings for quality and cost-effectiveness of care. 15 of HIE studies (60%) demonstrated positive financial effects and 16 studies (64%) reported positive effects on quality improvement of patient care. However, the overall quality of the evidences was low. In this regard, cohort study (59.38%) was the most common used study design. Nine studies presented the rates of HIE adoption and participation. The lowest and highest participation rates were 15.7% and 79%, respectively. HIE can be considered as a superior potential for healthcare information system, resulting to promote patient care quality and reduce costs related to resource utilization. However, further researches are needed in order to provide a better understanding of this domain and accordingly attain new opportunities to increase users' participation and motivation for successfully adopting this technology. Copyright © 2018 Elsevier B.V. All rights reserved.

Integrating an EMR-based Transition Planning Tool for CYSHCN at a Children's Hospital: A Quality Improvement Project to Increase Provider Use and Satisfaction

PubMed Central

Wiemann, Constance M.; Hergenroeder, Albert C.; Bartley, Krystle A.; Sanchez-Fournier, Blanca; Hilliard, Marisa E.; Warren, Laura J.; Graham, Sarah C.

2016-01-01

An electronic medical record (EMR)-based transition planning tool (TPT) designed to facilitate transition from pediatric to adult-based health care for youth (16–25 years) with special health care needs was introduced at a large children's hospital. Activities to increase provider use were implemented in five plan–do–study–act cycles. Overall, 22 of 25 (88%) consenting providers in four pediatric subspecialty services used the TPT during 303 patient encounters, with nurses and case-managers the top users and physicians the least likely users. Use was highest with intensive technical assistance and following the introduction of an upgraded tool. Provider satisfaction with the TPT and self-reported transition planning activities notably increased across the PDSA cycles. PMID:26209173

International nursing: a student outlook.

PubMed

Roberts, C J

1993-01-01

World health depends upon our field of vision. If we selectively view the world from a narrow perspective, we will be unable to function effectively as nurses. The sobering reality of health conditions throughout the world should awaken our consciousness and sharpen our focus on priorities for the future. We can agree with Lindquist, that "nursing must be viewed from a global perspective if it is to influence the quality of health care provided in the future." Although not every student has the means and availability to travel overseas in a volunteer capacity, students may begin to examine the possibilities and start their own correspondence with an international agency. Regardless of our realm of service, the opportunity to provide care for individuals of all cultures, whether abroad or at home, remains the highest privilege of our profession.

Corporate social responsibility of future radiology professionals.

PubMed

Collins, Sandra K; Collins, Kevin S

2011-01-01

Plagued by difficult economic times, many radiology managers may find themselves faced with ethical dilemmas surrounding ongoing organizational pressures to maintain high levels of productivity with restricted resources. This often times tests the level of moral resilience and corporate social consciousness of even the most experienced radiology professionals. A study was conducted to determine what Corporate Social Responsibility (CSR) orientation and viewpoint future radiology professionals may have. The results of the study indicate that these study participants may initially consider patient care more important than profit maximization. Study results indicate that these specific future radiology professionals will not need laws, legal sanctions, and intensified rules to force them to act ethically. However,they may need ongoing training as to the necessity of profit maximization if they seek the highest quality of care possible for their patients.

The health status of Russian-speaking immigrants in Germany.

PubMed

Tselmin, S; Korenblum, W; Reimann, M; Bornstein, S R; Schwarz, P E H

2007-12-01

Germany developed today into a country of immigration, which creates an additional burden for the social security system and results in a new challenge for the healthcare. In the last 17 years more than two million "Russia Germans" have been repatriated and about two hundred thousand Jewish refugees have resettled in Germany from the former Soviet Union. Nevertheless relevant data concerning migration-related public health care are very scare. Search of PubMed and Journals extracts combined with the own researches, analysing the health status indices of the Russian-speaking immigrants in Germany. Both repatriates of German origin and Jewish refugees demonstrated higher prevalence of impaired lipid metabolism in comparison with native population. 42 % of the 503,040 HBsAg (hepatitis B s-Antigen) carriers in Germany were migrants. The Jewish refugees demonstrated the highest rates of depression and anxiety and the highest levels of awakening cortisol. On the other side German resettlers showed lower cardiovascular as well as all-cause death rates compared to the native Germans. The development of adequate health care programmes to address migratory aspects as well as the establishment of quality standards will realistically enhance the capability of responding rapidly to migrant health aspects and help to tackle inequalities in health.

Effect on maternal and child health services in Rwanda of payment to primary health-care providers for performance: an impact evaluation.

PubMed

Basinga, Paulin; Gertler, Paul J; Binagwaho, Agnes; Soucat, Agnes L B; Sturdy, Jennifer; Vermeersch, Christel M J

2011-04-23

Evidence about the best methods with which to accelerate progress towards achieving the Millennium Development Goals is urgently needed. We assessed the effect of performance-based payment of health-care providers (payment for performance; P4P) on use and quality of child and maternal care services in health-care facilities in Rwanda. 166 facilities were randomly assigned at the district level either to begin P4P funding between June, 2006, and October, 2006 (intervention group; n=80), or to continue with the traditional input-based funding until 23 months after study baseline (control group; n=86). Randomisation was done by coin toss. We surveyed facilities and 2158 households at baseline and after 23 months. The main outcome measures were prenatal care visits and institutional deliveries, quality of prenatal care, and child preventive care visits and immunisation. We isolated the incentive effect from the resource effect by increasing comparison facilities' input-based budgets by the average P4P payments made to the treatment facilities. We estimated a multivariate regression specification of the difference-in-difference model in which an individual's outcome is regressed against a dummy variable, indicating whether the facility received P4P that year, a facility-fixed effect, a year indicator, and a series of individual and household characteristics. Our model estimated that facilities in the intervention group had a 23% increase in the number of institutional deliveries and increases in the number of preventive care visits by children aged 23 months or younger (56%) and aged between 24 months and 59 months (132%). No improvements were seen in the number of women completing four prenatal care visits or of children receiving full immunisation schedules. We also estimate an increase of 0·157 standard deviations (95% CI 0·026-0·289) in prenatal quality as measured by compliance with Rwandan prenatal care clinical practice guidelines. The P4P scheme in Rwanda had the greatest effect on those services that had the highest payment rates and needed the least effort from the service provider. P4P financial performance incentives can improve both the use and quality of maternal and child health services, and could be a useful intervention to accelerate progress towards Millennium Development Goals for maternal and child health. World Bank's Bank-Netherlands Partnership Program and Spanish Impact Evaluation Fund, the British Economic and Social Research Council, Government of Rwanda, and Global Development Network. Copyright © 2011 Elsevier Ltd. All rights reserved.

Role of prospective registries in defining the value and effectiveness of spine care.

PubMed

McGirt, Matthew J; Parker, Scott L; Asher, Anthony L; Norvell, Dan; Sherry, Ned; Devin, Clinton J

2014-10-15

Literature review and case example. Describe methodological considerations of spine surgery registries. Review existing spine surgery registries. Describe the Vanderbilt Prospective Spine Registry (VPSR) as a case example and demonstrate its impact on comparative effectiveness research, value analysis, quality improvement, and practice-based learning. To bend the cost curve and ultimately achieve sustainability in health care, medical providers and surgical treatments of the highest quality and effectiveness must be preferentially used and purchased. As the current US health care environment continues to evolve, it will be essential for all spine clinicians to understand and be facile with the principles of evidence-based health care reform. We describe the methodological considerations of spine surgery registries, review the literature to describe existing spine surgery registries, and discuss the VPSR as a case example. We were able to obtain detailed information on 13 existing spine surgery registries through various internet-based resources. Of the 13, 2 registries had start dates before 2000, 3 between 2001 and 2005, 5 starting in 2006, and 3 were indeterminate. Follow-up rates were in the range from 22% to 79%, with longer follow-up times consistently producing lower follow-up rates. Prospective, longitudinal, patient-reported outcomes registries are powerful tools that allow measurement of cost, safety, effectiveness, and health care value across clinically meaningful episodes of care. Registries entirely based on claims or billing data, safety measures alone, process measures, or other proxies of outcome offer valuable insights, but do not provide comprehensive data to drive patient-centered value-based reform. As more spine-focused registries emerge and their integration into the US health care delivery evolve, the evidence to power value-based reform will be enabled.

Peer-to-peer nursing rounds and hospital-acquired pressure ulcer prevalence in a surgical intensive care unit: a quality improvement project.

PubMed

Kelleher, Alyson Dare; Moorer, Amanda; Makic, MaryBeth Flynn

2012-01-01

We conducted a quality improvement project in order to evaluate the effect of nurse-to-nurse bedside "rounding" as a strategy to decrease hospital-acquired pressure ulcers (HAPU) in a surgical intensive care unit. We instituted weekly peer-to-peer bedside skin rounds in a 17-bed surgical intensive care unit. Two nurses were identified as skin champions and trained by the hospital's certified WOC nurse to conduct skin rounds. The skin champion nurses conducted weekly peer-to-peer rounds that included discussions about key elements of our patients' skin status including current Braden Scale for Pressure Sore Risk score, and implementation of specific interventions related to subscale risk assessment. If a pressure ulcer was present, the current action plan was reevaluated for effectiveness. Quarterly HAPU prevalence studies were conducted from January 2008 to December 2010. Nineteen patients experienced a HAPU: 17 were located on the coccyx and 2 on the heel. Ten ulcers were classified as stage II, 3 PU were stage IV, 5 were deemed unstageable, and 1 was classified as a deep tissue injury. The frequency of preventive interventions rose during our quality improvement project. Specifically, the use of prevention surfaces increased 92%, repositioning increased 30%, nutrition interventions increased 77%, and moisture management increased 100%. Prior to focused nursing rounds, the highest HAPU prevalence rate was 27%. After implementing focused nursing rounds, HAPU rates trended down and were 0% for 3 consecutive quarters.

Unplanned admissions in day-case surgery as a clinical indicator for quality assurance.

PubMed

Margovsky, A

2000-03-01

Day surgery is a modern, effective and economical way to treat patients while maintaining the same level of quality of patient care. Quality improvement in day surgery units, however, continues to be an issue due to high rates of unplanned admissions. The aim of the present retrospective study was to investigate reasons for and methods of preventing unplanned postoperative admissions in a day surgical unit over a 12-month period in respect to different surgical specialties. The study was based on an audit from the Endoscopy and Day Surgery Unit (EDSU) at Launceston General Hospital, which provides health care to a population of more than 120000. For the accounted period 920 outpatients had elective day surgical procedures. Overall the unplanned admission rate was 4.7%, and surgical, anaesthetic and social reasons accounted for 58.2, 37.2 and 4.6% of the unplanned admissions, respectively. The highest rate of unplanned admissions was for plastic and reconstructive surgery (12.8%) and orthopaedic surgery (7.5%) despite the relatively small number of patients who underwent such procedures in the day surgery unit. The results also showed a correlation between age group, pre-operative medical status of the patients found suitable for the day surgical procedure and unplanned admissions. Strategies to reduce the unplanned admission rate which include patient selection and pre-operative assessment, patient waiting time and education, pre-operative anaesthesia, follow-up with nursing care and postoperative analgesia are discussed.

Increased Severe Trauma Patient Volume is Associated With Survival Benefit and Reduced Total Health Care Costs: A Retrospective Observational Study Using a Japanese Nationwide Administrative Database.

PubMed

Endo, Akira; Shiraishi, Atsushi; Fushimi, Kiyohide; Murata, Kiyoshi; Otomo, Yasuhiro

2017-06-07

The aim of this study was to evaluate the associations of severe trauma patient volume with survival benefit and health care costs. The effect of trauma patient volume on survival benefit is inconclusive, and reports on its effects on health care costs are scarce. We conducted a retrospective observational study, including trauma patients who were transferred to government-approved tertiary emergency hospitals, or hospitals with an intensive care unit that provided an equivalent quality of care, using a Japanese nationwide administrative database. We categorized hospitals according to their annual severe trauma patient volumes [1 to 50 (reference), 51 to 100, 101 to 150, 151 to 200, and ≥201]. We evaluated the associations of volume categories with in-hospital survival and total cost per admission using a mixed-effects model adjusting for patient severity and hospital characteristics. A total of 116,329 patients from 559 hospitals were analyzed. Significantly increased in-hospital survival rates were observed in the second, third, fourth, and highest volume categories compared with the reference category [94.2% in the highest volume category vs 88.8% in the reference category, adjusted odds ratio (95% confidence interval, 95% CI) = 1.75 (1.49-2.07)]. Furthermore, significantly lower costs (in US dollars) were observed in the second and fourth categories [mean (standard deviation) for fourth vs reference = $17,800 ($17,378) vs $20,540 ($32,412), adjusted difference (95% CI) = -$2559 (-$3896 to -$1221)]. Hospitals with high volumes of severe trauma patients were significantly associated with a survival benefit and lower total cost per admission.

An aging population and growing disease burden will require a large and specialized health care workforce by 2025.

PubMed

Dall, Timothy M; Gallo, Paul D; Chakrabarti, Ritasree; West, Terry; Semilla, April P; Storm, Michael V

2013-11-01

As the US population ages, the increasing prevalence of chronic disease and complex medical conditions will have profound implications for the future health care system. We projected future prevalence of selected diseases and health risk factors to model future demand for health care services for each person in a representative sample of the current and projected future population. Based on changing demographic characteristics and expanded medical coverage under the Affordable Care Act, we project that the demand for adult primary care services will grow by approximately 14 percent between 2013 and 2025. Vascular surgery has the highest projected demand growth (31 percent), followed by cardiology (20 percent) and neurological surgery, radiology, and general surgery (each 18 percent). Market indicators such as long wait times to obtain appointments suggest that the current supply of many specialists throughout the United States is inadequate to meet the current demand. Failure to train sufficient numbers and the correct mix of specialists could exacerbate already long wait times for appointments, reduce access to care for some of the nation's most vulnerable patients, and reduce patients' quality of life.

Quality of Acute Care for Patients With Urinary Stones in the United States.

PubMed

Scales, Charles D; Bergman, Jonathan; Carter, Stacey; Jack, Gregory; Saigal, Christopher S; Litwin, Mark S

2015-11-01

To describe guideline adherence for patients with suspected upper tract stones. We performed a cross-sectional analysis of visits recorded by the National Hospital Ambulatory Medical Care Survey (emergency department [ED] component) in 2007-2010 (most recent data). We assessed adherence to clinical guidelines for diagnostic laboratory testing, imaging, and pharmacologic therapy. Multivariable regression models controlled for important covariates. An estimated 4,956,444 ED visits for patients with suspected kidney stones occurred during the study period. Guideline adherence was highest for diagnostic imaging, with 3,122,229 (63%) visits providing optimal imaging. Complete guideline-based laboratory testing occurred in only 2 of every 5 visits. Pharmacologic therapy to facilitate stone passage was prescribed during only 17% of eligible visits. In multivariable analysis of guideline adherence, we found little variation by patient, provider, or facility characteristics. Guideline-recommended care was absent from a substantial proportion of acute care visits for patients with suspected kidney stones. These failures of care delivery likely increase costs and temporary disability. Targeted interventions to improve guideline adherence should be designed and evaluated to improve care for patients with symptomatic kidney stones. Published by Elsevier Inc.

Quality of Acute Care for Patients with Urinary Stones in the United States

PubMed Central

Scales, Charles D.; Bergman, Jonathan; Carter, Stacey; Jack, Gregory; Saigal, Christopher S.; Litwin, Mark S.

2015-01-01

Objective To describe guideline adherence for patients with suspected upper tract stones. Methods We performed a cross-sectional analysis of visits recorded by the National Hospital Ambulatory Medical Care Survey (ED component) in 2007–2010 (most recent data). We assessed adherence to clinical guidelines for diagnostic laboratory testing, imaging, and pharmacologic therapy. Multivariable regression models controlled for important covariates. Results An estimated 4,956,444 ED visits for patients with suspected kidney stones occurred during the study period. Guideline adherence was highest for diagnostic imaging, with 3,122,229 (63%) visits providing optimal imaging. Complete guideline-based laboratory testing occurred in only 2 of every 5 visits. Pharmacologic therapy to facilitate stone passage was prescribed during only 17% of eligible visits. In multivariable analysis of guideline adherence, we found little variation by patient, provider or facility characteristics. Conclusions Guideline-recommended care was absent from a substantial proportion of acute care visits for patients with suspected kidney stones. These failures of care delivery likely increase costs and temporary disability. Targeted interventions to improve guideline adherence should be designed and evaluated to improve care for patients with symptomatic kidney stones. PMID:26335495

Addressing standards of care in resource-limited settings.

PubMed

Dawson, Liza; Klingman, Karin L; Marrazzo, Jeanne

2014-01-01

: The choice between "best-known" standards of care (SOC) or "best available" standards as the control arm in a clinical trial is a fundamental dilemma in clinical research in resource-limited settings (RLS). When the health system is delivering less than an optimal level of care, using highest standard of care in a clinical trial may produce results that cannot be implemented or sustained locally. On the other hand, using interventions that are more feasible in the local setting may involve suboptimal care, and clinical outcomes may be affected. The need for improved standards in health systems in RLS, and the difficulty in securing them, has led many researchers advocate for policy changes at the national or international level to improve clinical care more systemically. SOC decisions in a clinical trial affect the level of benefit provided to study participants and the policy implications of the trial findings. SOC choices should provide high-quality care to help advance the health care system in host countries participating in the trial, but balancing the scientific and ethical objectives of SOC choices is difficult, and there is no single formula for selecting the appropriate SOC. Despite the challenges, well-designed and conducted clinical trials can and should make significant contributions to health systems in RLS.

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

Swallowing Dysfunctions in Parkinson's Disease.

PubMed

Simons, Janine A

2017-01-01

Dysphagia is a very frequent and highly relevant symptom in Parkinson's disease (PD) for quality of life, morbidity, and remaining lifetime, which is unfortunately widely underdiagnosed and underestimated regarding patients' centered care. Especially in early stages, the causal association between disease and swallowing disabilities remains unnoticed, which may be accounted for by the inability of caregivers and physicians to detect subtle swallowing problems and by the low self-awareness among PD patients. In order to prevent patients from serious negative consequences for health issues (e.g., aspiration pneumonia or malnutrition) as well as for negative impact on their quality of life, it is on the highest importance of managing dysphagia timely and working closely together in a multidisciplinary team, who all are involved in the patients' care system. This chapter includes background information on epidemiology, pathophysiology, and symptomatology of swallowing disorders in PD. This is followed by a summary of the clinical course and health treats, adequate diagnostic procedures for early identification of dysphagia as well as effective treatment strategies. The conclusion provides recommendations for clinical practice routine. © 2017 Elsevier Inc. All rights reserved.

PubMed Central

Guay, Stéphane; Mainguy, Nicole; Marchand, André

2002-01-01

OBJECTIVE: To educate family physicians about screening, diagnosis, and treatment of psychological disorders related to traumatic events. QUALITY OF EVIDENCE: PsycLIT, PsychINFO, PILOTS, and MEDLINE databases were searched from January 1985 to December 2000 using the terms "acute stress disorder," "posttraumatic stress disorder," "traumatic stress," "psychotherapy," "psychosocial treatment," "treatment," and "pharmacotherapy." Recommendations concerning treatment of acute stress disorder (ASD) and posttraumatic stress disorder (PTSD) are based on evidence from trials of the highest quality. Conclusions about assessment and diagnosis are based on the most recent epidemiologic studies, consensus, and expert opinion. MAIN MESSAGE: Very often, ASD and PTSD are underdiagnosed and undertreated. Family physicians are likely to see patients suffering from these disorders. Early screening in primary care is a function of active listening; warm, safe patient-physician relationships; and careful examination of difficulties related to traumatic events. Ideally, patients with either ASD or PTSD should be referred to a specialist. If a specialist is unavailable, family physicians can offer support and prescribe medication to address patients' symptoms. CONCLUSION: Family physicians can help identify and treat patients presenting with disorders related to traumatic events. PMID:11935715

The quality of intensive care unit nurse handover related to end of life: a descriptive comparative international study.

PubMed

Ganz, Freda DeKeyser; Endacott, Ruth; Chaboyer, Wendy; Benbinishty, Julie; Ben Nun, Maureen; Ryan, Helen; Schoter, Amanda; Boulanger, Carole; Chamberlain, Wendy; Spooner, Amy

2015-01-01

Quality ICU end-of-life-care has been found to be related to good communication. Handover is one form of communication that can be problematic due to lost or omitted information. A first step in improving care is to measure and describe it. The objective of this study was to describe the quality of ICU nurse handover related to end-of-life care and to compare the practices of different ICUs in three different countries. This was a descriptive comparative study. The study was conducted in seven ICUs in three countries: Australia (1 unit), Israel (3 units) and the UK (3 units). A convenience sample of 157 handovers was studied. Handover quality was rated based on the ICU End-of-Life Handover tool, developed by the authors. The highest levels of handover quality were in the areas of goals of care and pain management while lowest levels were for legal issues (proxy and advanced directives) related to end of life. Significant differences were found between countries and units in the total handover score (country: F(2,154)=25.97, p=<.001; unit: F(6,150)=58.24, p=<.001), for the end of life subscale (country: F(2, 154)=28.23, p<.001; unit: F(6,150)=25.25, p=<.001), the family communication subscale (country: F(2,154)=15.04, p=<.001; unit: F(6,150)=27.38, p=<.001), the family needs subscale (F(2,154)=22.33, p=<.001; unit: F(6,150)=42.45, p=<.001) but only for units on the process subscale (F(6,150)=8.98, p=<.001. The total handover score was higher if the oncoming RN did not know the patient (F(1,155)=6.51, p=<.05), if the patient was expected to die during the shift (F(1,155)=89.67, p=<.01) and if the family were present (F(1,155)=25.81, p=<.01). Practices of end-of-life-handover communication vary greatly between units. However, room for improvement exists in all areas in all of the units studied. The total score was higher when quality of care might be deemed at greater risk (if the nurses did not know the patient or the patient was expected to die), indicating that nurses were exercising some form of discretionary decision making around handover communication; thus validating the measurement tool. Copyright © 2014. Published by Elsevier Ltd.

Assessment of the responsiveness of a public health service from the perspective of older adults

PubMed Central

Melo, Denise da Silva; Martins, René Duarte; de Jesus, Renata Patrícia Freitas Soares; Samico, Isabella Chagas; Santo, Antônio Carlos Gomes do Espírito

2017-01-01

ABSTRACT OBJECTIVE To assess the quality of health care of older adults using as a parameter the assessment of the responsiveness of the service. METHODS This is a descriptive cross-sectional study conducted in a reference unit of the Brazilian Unified Health System at the outpatient level. The sample was probabilistic and had 385 older adults; data collection occurred in 2014. The domains assessed were: choice, autonomy, confidentiality, dignity, communication, physical facilities, and fast service. To this end, we used Pearson correlation test and Fisher’s exact test. RESULTS The domains of dignity, confidentiality, and communication reached the highest level of adequate responsiveness. On the other hand, freedom of choice and fast service received the worst assessments. Participation in decision-making regarding treatment was significantly lower among the older adults who had no education. In addition, the older adults that self-reported as black receive a lower quality of care regarding clear explanation and respected privacy in the appointment, when compared to users of any other race. CONCLUSIONS Although most domains studied have receive a positive assessment, we have found a need for an equal care by the health professionals, regardless of race, education level, or any other adjective characteristic of older adults, users of public health services. PMID:28678911

Optimizing primary care research participation: a comparison of three recruitment methods in data-sharing studies.

PubMed

Lord, Paul A; Willis, Thomas A; Carder, Paul; West, Robert M; Foy, Robbie

2016-04-01

Recruitment of representative samples in primary care research is essential to ensure high-quality, generalizable results. This is particularly important for research using routinely recorded patient data to examine the delivery of care. Yet little is known about how different recruitment strategies influence the characteristics of the practices included in research. We describe three approaches for recruiting practices to data-sharing studies, examining differences in recruitment levels and practice representativeness. We examined three studies that included varying populations of practices from West Yorkshire, UK. All used anonymized patient data to explore aspects of clinical practice. Recruitment strategies were 'opt-in', 'mixed opt-in and opt-out' and 'opt-out'. We compared aggregated practice data between recruited and not-recruited practices for practice list size, deprivation, chronic disease management, patient experience and rates of unplanned hospital admission. The opt-out strategy had the highest recruitment (80%), followed by mixed (70%) and opt-in (58%). Practices opting-in were larger (median 7153 versus 4722 patients, P = 0.03) than practices that declined to opt-in. Practices recruited by mixed approach were larger (median 7091 versus 5857 patients, P = 0.04) and had differences in the clinical quality measure (58.4% versus 53.9% of diabetic patients with HbA1c ≤ 59 mmol/mol, P < 0.01). We found no differences between practices recruited and not recruited using the opt-out strategy for any demographic or quality of care measures. Opt-out recruitment appears to be a relatively efficient approach to ensuring participation of typical general practices. Researchers should, with appropriate ethical safeguards, consider opt-out recruitment of practices for studies involving anonymized patient data sharing. © The Author 2016. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Implementation of a Nurse Driven Pathway to Reduce Incidence of Hospital Acquired Pressure Injuries in the Pediatric Intensive Care Setting.

PubMed

Rowe, Angela D; McCarty, Karen; Huett, Amy

2018-03-13

A large, freestanding pediatric hospital in the southern United States saw a 117% increase in reported hospital acquired pressure injuries (HAPI) between 2013 and 2015, with the intensive care units being the units of highest occurrence. Design and Methods A quality improvement project was designed and implemented to assist with pressure injury prevention. Literature review confirmed that pediatric HAPIs are a challenge and that usage of bundles and user-friendly guidelines/pathways can help eliminate barriers to prevention. The aim of this quality improvement project had two aims. First, to reduce HAPI incidence in the PICU by 10%. Second, to increase consistent usage of pressure injury prevention strategies as evidenced by a 10% increase in pressure injury bundle compliance. The third aim was to identify if there are differences in percentage of interventions implemented between two different groups of patients. Donabedian's model of Structure, Process, and Outcomes guided the development and implementation of this quality improvement project. Interventions focused on risk assessment subscale scores have the opportunity to mitigate specific risk factors and improve pressure injury prevention. Through implementation of the nurse driven pathway there was as 57% decrease in reported HAPIs in the PICU as well as a 66% increase in pressure ulcer prevention bundle compliance. Implementation of the nurse driven pressure injury prevention pathway was successful. There was a significant increase in bundle compliance for pressure ulcer prevention and a decrease in reported HAPIs. The pathway developed and implemented for this quality improvement project could be adapted to other populations and care settings to provide guidance across the continuum. Copyright © 2018 Elsevier Inc. All rights reserved.

Iranian women's perceptions of family-planning services quality: a client-satisfaction survey.

PubMed

Nakhaee, N; Mirahmadizadeh, A-R

2005-09-01

As Iran (IR) is included among the most successful developing countries in family planning, clarification and expression of the ideas and needs of women receiving the services not only have a great positive impact on national policies but also may be of interest to other nations. This research was conducted to clarify the client perceptions of the quality of family planning services in the capital cities of the two largest provinces of Iran. A representative sample of 909 women aged 15-50 referred to health centers were interviewed by skillful interviewers in a private area after obtaining informed consent. A questionnaire consisting of baseline data and 17 five-point Likert-scaled items measuring the satisfaction of clients and perceived importance of each item was developed by investigators. Half were aged 26-35 years, and most (84%) were housewives. The highest percentage of dissatisfaction was reported in relation to 'privacy protection' item. However, when the importance score was included, too, 'provision of sufficient information regarding other contraceptive methods' and 'unavailability of all methods' implicated the areas where priorities should be focused. The satisfaction levels obtained by the survey should be carefully heeded, and the supply chain and provision of information to the clients may be the first priorities in the process of improving the quality of care.

Quality of life among Malaysian mothers with a child with Down syndrome.

PubMed

Geok, Chan Kim; Abdullah, Khatijah Lim; Kee, Ling How

2013-08-01

The purpose of this paper is to examine the quality of life (QOL) among mothers with a child with Down syndrome using The World Health Organization Quality of Life scale instrument. A convenience sample of 161 mothers was accessed through the various institutions which provide interventional or educational programmes to children with disabilities within two of the regions of the Borneo State of Malaysia (Sarawak). Nearly half of the group of mothers perceived their QOL as neither poor nor good (n = 73). An overall QOL score of 14.0 ± 1.84 was obtained. The highest and lowest domain scores were found for social relationship domain (Mean = 14.9 ± 2.1) and environmental support domain (Mean = 13.3 ± 2.1) respectively. Correlation analysis of selected background variables (i.e. locality, education, income and marital status) and overall QOL indicated rho (161) = 0.22-0.28 (P < 0.01). Inverse correlation between maternal age and overall QOL score was indicated, with rho (161) = -0.17 (P < 0.05). Linear regression analysis indicated that the combination of these few variables together accounted for 14.5% of the QOL variability in the sample. Findings point to implications for priorities of care provisions by policy-makers and care professionals in their practice. © 2013 Wiley Publishing Asia Pty Ltd.

Assessment of the quality of fall detection and management in primary care in the Netherlands based on the ACOVE quality indicators.

PubMed

Askari, M; Eslami, S; van Rijn, M; Medlock, S; Moll van Charante, E P; van der Velde, N; de Rooij, S E; Abu-Hanna, A

2016-02-01

We determined adherence to nine fall-related ACOVE quality indicators to investigate the quality of management of falls in the elderly population by general practitioners in the Netherlands. Our findings demonstrate overall low adherence to these indicators, possibly indicating insufficiency in the quality of fall management. Most indicators showed a positive association between increased risk for functional decline and adherence, four of which with statistical significance. This study aims to investigate the quality of detection and management of falls in the elderly population by general practitioners in the Netherlands, using the Assessing Care of Vulnerable Elders (ACOVE) quality indicators. Community-dwelling persons aged 70 years or above, registered in participating general practices, were asked to fill in a questionnaire designed to determine general practitioner (GP) adherence to fall-related indicators. We used logistic regression to estimate the association between increased risk for functional decline-quantified by the Identification of Seniors At Risk for Primary Care score-and adherence. We then cross-validated the self-reported falls with medical records. Of the 950 elders responding to our questionnaire, only 10.6 % reported that their GP proactively asked them about falls. Of the 160 patients who reported two or more falls, or one fall for which they visited the GP, only 23.1 % had fall documentation in their records. Adherence ranged between 13.6 and 48.6 %. There was a significant positive association between the ISAR-PC scores and adherence in four QIs. Documentation of falls was highest (36.7 %) in patients whom the GP had proactively asked about falls. Based on patient self-reports, adherence to the ACOVE fall-related indicators was poor, suggesting that the quality of evaluation and management of falls in community-dwelling older persons in the Netherlands is poor. The documentation of falls and fall-related risk factors was also poor. However, for most QIs, adherence to them increased with the increase in the risk of functional decline.

Short hospitalization after caesarean delivery: effects on maternal pain and stress at discharge.

PubMed

Zanardo, Vincenzo; Giliberti, Lara; Volpe, Francesca; Simbi, Alphonse; Guerrini, Pietro; Parotto, Matteo; Straface, Gianluca

2018-09-01

To characterize predischarge maternal pain and stress after caesarean delivery and short hospitalization. This is a descriptive study with 60 women in the postoperative period of caesarean section and 60 control women after vaginal delivery. Pain and stress were measured by McGill Pain Questionnaire (MGPQ) and by the Stress Measure (Psychological Stress Measure (PSM)), respectively, at mother-infant dyad discharge, scheduled at 36 hours after delivery. Caesarean section was the delivery modality with the highest MGPQ pain and sensorial, evaluative and mixed pain descriptive categories scores. The pain location involved lower abdomen, with associated localizations at back, breast and shoulders. Conversely, vaginal delivery was the delivery modality with the highest stress scores. This study provides important information on the quality of care implications of early discharge practices in puerperae after caesarean delivery, a critical time characterized by qualitatively and quantitatively high pain and stress.

A history of the American Board of Surgery: vignettes from the certifying examination: The Edgar J. Poth Memorial Lecture.

PubMed

Walker, John Patrick

2015-12-01

The American Board of Surgery was established in 1937 to certify surgeons who through training, experience, and examination meet the highest standards of surgical care. This lecture was given as the Edgar Poth lecture at the April 2015 meeting of the Southwestern Surgical Congress. Dr Poth was a surgical educator from the University of Texas Medical Branch, Galveston who was President of the Southwestern in 1963. The paper presents the history of the founding of the American Board of Surgery, with particular emphasis on the certifying examination-Part 2. Vignettes of occurrences associated with the "Oral" examination are given. The examination has changed substantially from a 2-day event involving an actual surgical procedure to the 90-minute quiz given today. The oral examinations remain an important part in the process of certification of surgeons of the highest quality. Copyright © 2015 Elsevier Inc. All rights reserved.

Explicating Filipino student nurses' preferences of clinical instructors' attributes: A conjoint analysis.

PubMed

Factor, Elisa Monette R; de Guzman, Allan B

2017-08-01

The role of clinical instructor in student nurses' preparation for the professional nursing practice cannot be underestimated. The extent to which such role is achieved depends highly on the instructors' ability to realize the desired qualities expected of them. While a number of empirical studies have qualitatively explored the attributes of an effective clinical instructor, no attempt has ventured yet on the power of experimental vignettes for conjoint analysis in explicating the preferences of a select group of Filipino student nurses relative to their clinical instructors' attributes. Junior and senior nursing students (n=227), recruited from one of the comprehensive universities in the Philippines, were asked to sort out orthogonal cards generated by Sawtooth Software. As shown, the full-profile conjoint analysis was considerably fit for this study: Pearson's R=0.988, (p<0.05) and Kendall's t=0.944, (p<0.05). Results indicated that the student nurses are one in terms of their most preferred clinical instructor attribute, which was clinical teaching capacity (38.14%) followed by interpersonal relationship and caring behavior (33.17%). In regard to the clinical teaching capability, a clinical instructor who parallels clinical teaching skills with the students' understanding and experience (0.089) was the highest part-worth. As for the interpersonal relationship and caring behavior, the highest part-worth was a clinical instructor who respects a student nurse as an individual and cares about him/her as a person (0.114). Findings of this study can be a basis for clinical instructors as to which qualities to cultivate best to facilitate a first-rate clinical nursing instruction. Likewise, the results of this study can inform current practices of clinical instructors by making them aware of how they can nurture a pedagogical approach consistent with the student nurses' preferences. Copyright © 2017 Elsevier Ltd. All rights reserved.

A Clinical Nurse Specialist-Led Interprofessional Quality Improvement Project to Reduce Hospital-Acquired Pressure Ulcers.

PubMed

Fabbruzzo-Cota, Christina; Frecea, Monica; Kozell, Kathryn; Pere, Katalin; Thompson, Tamara; Tjan Thomas, Julie; Wong, Angela

2016-01-01

The purpose of this clinical nurse specialist-led interprofessional quality improvement project was to reduce hospital-acquired pressure ulcers (HAPUs) using evidence-based practice. Hospital-acquired pressure ulcers (PUs) have been linked to morbidity, poor quality of life, and increasing costs. Pressure ulcer prevention and management remain a challenge for interprofessional teams in acute care settings. Hospital-acquired PU rate is a critical nursing quality indicator for healthcare organizations and ties directly with Mount Sinai Hospital's (MSH's) mission and vision, which mandates providing the highest quality care to patients and families. This quality improvement project, guided by the Donabedian model, was based on the Registered Nurses' Association of Ontario Best Practice Guideline Risk Assessment & Prevention of Pressure Ulcers. A working group was established to promote evidence-based practice for PU prevention. Initiatives such as documentation standardization, development of staff education and patient and family educational resources, initiation of a hospital-wide inventory for support surfaces, and procurement of equipment were implemented to improve PU prevention and management across the organization. An 80% decrease in HAPUs has been achieved since the implementation of best practices by the Best Practice Guideline Pressure Ulcer working group. The implementation of PU prevention strategies led to a reduction in HAPU rates. The working group will continue to work on building interprofessional awareness and collaboration in order to prevent HAPUs and promote an organizational culture that supports staff development, teamwork and communication. This quality improvement project is a successful example of an interprofessional clinical nurse specialist-led initiative that impacts patient/family and organization outcomes through the identification and implementation of evidence-based nursing practice.

Predictors and Effective Factors on Quality of Life Among Iranian Patients with Rheumatoid Arthritis

PubMed Central

Karimi, Saied; Yarmohammadian, Mohammad Hossein; Shokri, Azad; Mottaghi, Payman; Qolipour, Kamal; Kordi, Ayan; Bahman Ziari, Najmeh

2013-01-01

Introduction: Rheumatoid arthritis is a chronic autoimmune disorder that leads to joint swelling, stiffness, pain and progressive joint destruction. It is a common disease with prevalence of 1% worldwide that affecting all aspects of patients’ lives. Therefore, this study was conducted to summarize and provide a clear view of quality of life among the patients in Iran through a literature review. Methods: This study was conducted as a literature review over article published between 2000 to 2013, by using data bases comprise of Google scholar, Science Direct, Pubmed, IRANDOC, SID, Medlib, Magiran and by key words: “quality of life”, “rheumatoid arthritis”, “Iran” and their Persian equivalents. Finally 2065 articles assessed and according to the aim of the study are 11 studies synthesized. Extracted results first were summarized in Extraction Table, and then analyzed manually. Results: In reviewed articles rheumatoid arthritis patients’ quality of life was measured by using five different tools, the most important one of them was SF36 questionnaire. Among eight dimensions of SF36 questionnaire, the highest mean according included articles result was social functioning with average score of 63.4 and the lowest for physical limitation (physical role functioning) with score of 43. Overall, mean of eight dimensions was 52.47. The most important factors affecting quality of life were disease severity and pain, depression, income, educational, occupational status, married status, sign of disease, fatigue, anxiety and disease activity scores. Conclusion: The results of the study showed relatively low quality of life of rheumatoid arthritis patients in Iran. Empowering patients by participating them in service delivery process and decision making can improves quality of life and in this regard health care provider must be focused on patient self-care abilities and reinforcing this factor by training them. PMID:24167426

The association between quality of care and quality of life in long-stay nursing home residents with preserved cognition.

PubMed

Kim, Sun Jung; Park, Eun-Cheol; Kim, Sulgi; Nakagawa, Shunichi; Lung, John; Choi, Jong Bum; Ryu, Woo Sang; Min, Too Jae; Shin, Hyun Phil; Kim, Kyudam; Yoo, Ji Won

2014-03-01

To assess the overall quality of life of long-stay nursing home residents with preserved cognition, to examine whether the Centers for Medicare and Medicaid Service's Nursing Home Compare 5-star quality rating system reflects the overall quality of life of such residents, and to examine whether residents' demographics and clinical characteristics affect their quality of life. Quality of life was measured using the Participant Outcomes and Status Measures-Nursing Facility survey, which has 10 sections and 63 items. Total scores range from 20 (lowest possible quality of life) to 100 (highest). Long-stay nursing home residents with preserved cognition (n = 316) were interviewed. The average quality- of-life score was 71.4 (SD: 7.6; range: 45.1-93.0). Multilevel regression models revealed that quality of life was associated with physical impairment (parameter estimate = -0.728; P = .04) and depression (parameter estimate = -3.015; P = .01) but not Nursing Home Compare's overall star rating (parameter estimate = 0.683; P = .12) and not pain (parameter estimate = -0.705; P = .47). The 5-star quality rating system did not reflect the quality of life of long-stay nursing home residents with preserved cognition. Notably, pain was not associated with quality of life, but physical impairment and depression were. Copyright © 2014 American Medical Directors Association, Inc. Published by Elsevier Inc. All rights reserved.

Findings from a Clinical Learning Needs Survey at Ireland's first children's hospice.

PubMed

Quinn, Claire; Hillis, Rowan

2015-12-01

Caring for children with life-limiting conditions places exceptional demands on health professionals. Staff require the optimal skills and expertise necessary to provide the highest quality of care and to achieve this it is essential to understand their learning requirements. The aim is to share the main findings from a Clinical Learning Needs Survey conducted at LauraLynn, currently Ireland's only children's hospice. To date no other Irish service has conducted a formal identification of professional learning and development needs specific to the Irish context. The findings from the study assist workforce planning by providing a glimpse into the immediate study needs of staff working in a children's palliative care setting. The study had two main aims: a) Assist clinical staff within one organisation to identify their own professional learning priorities in children's palliative care and b) Inform the design and delivery of a responsive suite of workshops, programmes and study sessions for children's palliative care. The study identified the key learning needs as end-of-life care, palliative emergencies, communication skill development and bereavement support. These findings are similar to those found internationally and demonstrate the commitment of a new organisation to ensure that specific employee learning requirements are met if the organisation and wider specialty of Irish children's palliative care is to continue its evolution.

Serotonin transporter linked polymorphic region (5-HTTLPR) genotype moderates the longitudinal impact of early caregiving on externalizing behavior.

PubMed

Brett, Zoë H; Humphreys, Kathryn L; Smyke, Anna T; Gleason, Mary Margaret; Nelson, Charles A; Zeanah, Charles H; Fox, Nathan A; Drury, Stacy S

2015-02-01

We examined caregiver report of externalizing behavior from 12 to 54 months of age in 102 children randomized to care as usual in institutions or to newly created high-quality foster care. At baseline no differences by group or genotype in externalizing were found. However, changes in externalizing from baseline to 42 months of age were moderated by the serotonin transporter linked polymorphic region genotype and intervention group, where the slope for short-short (S/S) individuals differed as a function of intervention group. The slope for individuals carrying the long allele did not significantly differ between groups. At 54 months of age, S/S children in the foster care group had the lowest levels of externalizing behavior, while children with the S/S genotype in the care as usual group demonstrated the highest rates of externalizing behavior. No intervention group differences were found in externalizing behavior among children who carried the long allele. These findings, within a randomized controlled trial of foster care compared to continued care as usual, indicate that the serotonin transporter linked polymorphic region genotype moderates the relation between early caregiving environments to predict externalizing behavior in children exposed to early institutional care in a manner most consistent with differential susceptibility.

The current and future role of the medical oncologist in the professional care for cancer patients: a position paper by the European Society for Medical Oncology (ESMO).

PubMed

Popescu, R A; Schäfer, R; Califano, R; Eckert, R; Coleman, R; Douillard, J-Y; Cervantes, A; Casali, P G; Sessa, C; Van Cutsem, E; de Vries, E; Pavlidis, N; Fumasoli, K; Wörmann, B; Samonigg, H; Cascinu, S; Cruz Hernández, J J; Howard, A J; Ciardiello, F; Stahel, R A; Piccart, M

2014-01-01

The number of cancer patients in Europe is rising and significant advances in basic and applied cancer research are making the provision of optimal care more challenging. The concept of cancer as a systemic, highly heterogeneous and complex disease has increased the awareness that quality cancer care should be provided by a multidisciplinary team (MDT) of highly qualified healthcare professionals. Cancer patients also have the right to benefit from medical progress by receiving optimal treatment from adequately trained and highly skilled medical professionals. Built on the highest standards of professional training and continuing medical education, medical oncology is recognised as an independent medical specialty in many European countries. Medical oncology is a core member of the MDT and offers cancer patients a comprehensive and systemic approach to treatment and care, while ensuring evidence-based, safe and cost-effective use of cancer drugs and preserving the quality of life of cancer patients through the entire 'cancer journey'. Medical oncologists are also engaged in clinical and translational research to promote innovation and new therapies and they contribute to cancer diagnosis, prevention and research, making a difference for patients in a dynamic, stimulating professional environment. Medical oncologists play an important role in shaping the future of healthcare through innovation and are also actively involved at the political level to ensure a maximum contribution of the profession to Society and to tackle future challenges. This position paper summarises the multifarious and vital contributions of medical oncology and medical oncologists to today's and tomorrow's professional cancer care.

Supporting formal education to improve quality of health care provided by mothers of children with malaria in rural western Kenya.

PubMed

Kakai, Rose; Menya, Diana; Odero, Wilson

2009-08-30

Home management of malaria (HMM) has been shown to be an effective strategy for reducing childhood mortality from malaria. The direct and especially indirect costs of seeking health care from formal facilities may be substantial, providing a major barrier for many households. Further evaluations of HMM and community-based utilization of available options will help to optimize treatment strategies and maximize health benefits. The purpose of this study was to determine the effect of education, occupation, and family income on the choice of health care options for malaria. This was a cross-sectional, community-based study conducted between November 2007 and December 2007, using quantitative data collection methods. Mothers of children aged younger than five years were interviewed using a questionnaire to elicit responses on the mothers' level of education, occupation, income and malaria health care options. A total of 240 mothers of children aged younger than 5 years were interviewed between November and December, 2007. There was a direct relationship between formal education and occupation. The mean monthly family income was highest among those employed (KSh. 14,421) followed by businesswomen (KSh. 3,106) and farmers (KSh. 1,827) respectively (p<0.01). Those employed were more likely to take their ill children to a health facility (p = 0.05) or choose an antimalarial drug for home treatment. Supporting formal education may scale up the income of family health care providers and improve the quality of HMM among children living in rural communities.

Promising Practices for Achieving Patient-centered Hospital Care: A National Study of High-performing US Hospitals.

PubMed

Aboumatar, Hanan J; Chang, Bickey H; Al Danaf, Jad; Shaear, Mohammad; Namuyinga, Ruth; Elumalai, Sathyanarayanan; Marsteller, Jill A; Pronovost, Peter J

2015-09-01

Patient-centered care is integral to health care quality, yet little is known regarding how to achieve patient-centeredness in the hospital setting. The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey measures patients' reports on clinician behaviors deemed by patients as key to a high-quality hospitalization experience. We conducted a national study of hospitals that achieved the highest performance on HCAHPS to identify promising practices for improving patient-centeredness, common challenges met, and how those were addressed. We identified hospitals that achieved the top ranks or remarkable recent improvements on HCAHPS and surveyed key informants at these hospitals. Using quantitative and qualitative methods, we described the interventions used at these hospitals and developed an explanatory model for achieving patient-centeredness in hospital care. Fifty-two hospitals participated in this study. Hospitals used similar interventions that focused on improving responsiveness to patient needs, the discharge experience, and patient-clinician interactions. To improve responsiveness, hospitals used proactive nursing rounds (reported at 83% of hospitals) and executive/leader rounds (62%); for the discharge experience, multidisciplinary rounds (56%), postdischarge calls (54%), and discharge folders (52%) were utilized; for clinician-patient interactions, hospitals promoted specific desired behaviors (65%) and set behavioral standards (60%) for which employees were held accountable. Similar strategies were also used to achieve successful intervention implementation including HCAHPS data feedback, and employee and leader engagement and accountability. High-performing hospitals used a set of patient-centered care processes that involved both leaders and clinicians in ensuring that patient needs and preferences are addressed.

The ethical dimension in published animal research in critical care: the dark side of our moon.

PubMed

Huet, Olivier; de Haan, Judy B

2014-03-13

The replacement, refinement, and reduction (3Rs) guidelines are the cornerstone of animal welfare practice for medical research. Nowadays, no animal research can be performed without being approved by an animal ethics committee. Therefore, we should expect that any published article would respect and promote the highest standard of animal welfare. However, in the previous issue of Critical Care, Bara and Joffe reported an unexpected finding: animal welfare is extremely poorly reported in critical care research publications involving animal models.This may have a significant negative impact on the reliability of the results and on future funding for our research.The ability of septic shock animal models to translate into clinical studies has been a challenge. Therefore, every means to improve the quality of these models should be pursued. Animal welfare issues should be seen as an additional benefit to achieve this goal. It is therefore critical to draw conclusions from this study to improve the standard of animal welfare in critical care research. This has already been achieved in other fields of research, and we should follow their example.

Evidence-based practice, step by step: critical appraisal of the evidence: part II: digging deeper--examining the "keeper" studies.

PubMed

Fineout-Overholt, Ellen; Melnyk, Bernadette Mazurek; Stillwell, Susan B; Williamson, Kathleen M

2010-09-01

This is the sixth article in a series from the Arizona State University College of Nursing and Health Innovation's Center for the Advancement of Evidence-Based Practice. Evidence-based practice (EBP) is a problem-solving approach to the delivery of health care that integrates the best evidence from studies and patient care data with clinician expertise and patient preferences and values. When delivered in a context of caring and in a supportive organizational culture, the highest quality of care and best patient outcomes can be achieved. The purpose of this series is to give nurses the knowledge and skills they need to implement EBP consistently, one step at a time. Articles will appear every two months to allow you time to incorporate information as you work toward implementing EBP at your institution. Also, we've scheduled "Chat with the Authors" calls every few months to provide a direct line to the experts to help you resolve questions. Details about how to participate in the next call will be published with November's Evidence-Based Practice, Step by Step.

The Identification and Care of Those at Highest Risk of Cancer

Cancer.gov

Frederick P. Li, MD, Chief, Cancer Control Program, Division of Cancer Epidemiology and Control, Adult Oncology Department at Dana-Farber/Harvard Cancer Center, Boston, MA, presented "The Identification and Care of Those at Highest Risk of Cancer".

Factors contributing to high-cost hospital care for patients with COPD.

PubMed

Mulpuru, Sunita; McKay, Jennifer; Ronksley, Paul E; Thavorn, Kednapa; Kobewka, Daniel M; Forster, Alan J

2017-01-01

Chronic obstructive pulmonary disease (COPD) is a leading cause of hospital admission, the fifth leading cause of death in North America, and is estimated to cost $49 billion annually in North America by 2020. The majority of COPD care costs are attributed to hospitalizations; yet, there are limited data to understand the drivers of high costs among hospitalized patients with COPD. In this study, we aimed to determine the patient and hospital-level factors associated with high-cost hospital care, in order to identify potential targets for the reorganization and planning of health services. We conducted a retrospective cohort study at a Canadian academic hospital between September 2010 and 2014, including adult patients with a first-time admission for COPD exacerbation. We calculated total costs, ranked patients by cost quintiles, and collected data on patient characteristics and health service utilization. We used multivariable regression to determine factors associated with highest hospital costs. Among 1,894 patients included in the study, the mean age was 73±12.6 years, median length of stay was 5 (interquartile range 3-9) days, mortality rate was 7.8% (n=147), and 9% (n=170) required intensive care. Hospital spending totaled $19.8 million, with 63% ($12.5 million) spent on 20% of patients. Factors associated with highest costs for COPD care included intensive care unit admission (odds ratio [OR] 32.4; 95% confidence interval [CI] 20.3, 51.7), death in hospital (OR 2.6; 95% CI 1.3, 5.2), discharge to long-term care facility (OR 5.7; 95% CI 3.5, 9.2), and use of the alternate level of care designation during hospitalization (OR 23.5; 95% CI 14.1, 39.2). High hospital costs are driven by two distinct groups: patients who require acute medical treatment for severe illness and patients with functional limitation who require assisted living facilities upon discharge. Improving quality of care and reducing cost in this high-needs population require a strong focus on early recognition and management of functional impairment for patients living with chronic disease.

Racial, Ethnic, and Gender Equity in Veteran Satisfaction with Health Care in the Veterans Affairs Health Care System.

PubMed

Zickmund, Susan L; Burkitt, Kelly H; Gao, Shasha; Stone, Roslyn A; Jones, Audrey L; Hausmann, Leslie R M; Switzer, Galen E; Borrero, Sonya; Rodriguez, Keri L; Fine, Michael J

2018-03-01

Patient satisfaction is an important dimension of health care quality. The Veterans Health Administration (VA) is committed to providing high-quality care to an increasingly diverse patient population. To assess Veteran satisfaction with VA health care by race/ethnicity and gender. We conducted semi-structured telephone interviews with gender-specific stratified samples of black, white, and Hispanic Veterans from 25 predominantly minority-serving VA Medical Centers from June 2013 to January 2015. Satisfaction with health care was assessed in 16 domains using five-point Likert scales. We compared the proportions of Veterans who were very satisfied, somewhat satisfied, and less than satisfied (i.e., neither satisfied nor dissatisfied, somewhat dissatisfied, or very dissatisfied) in each domain, and used random-effects multinomial regression to estimate racial/ethnic differences by gender and gender differences by race/ethnicity. Interviews were completed for 1222 of the 1929 Veterans known to be eligible for the interview (63.3%), including 421 white, 389 black, and 396 Hispanic Veterans, 616 of whom were female. Veterans were less likely to be somewhat satisfied or less than satisfied versus very satisfied with care in each of the 16 domains. The highest satisfaction ratings were reported for costs, outpatient facilities, and pharmacy (74-76% very satisfied); the lowest ratings were reported for access, pain management, and mental health care (21-24% less than satisfied). None of the joint tests of racial/ethnic or gender differences in satisfaction (simultaneously comparing all three satisfaction levels) was statistically significant (p > 0.05). Pairwise comparisons of specific levels of satisfaction revealed racial/ethnic differences by gender in three domains and gender differences by race/ethnicity in five domains, with no consistent directionality across demographic subgroups. Our multisite interviews of a diverse sample of Veterans at primarily minority-serving sites showed generally high levels of health care satisfaction across 16 domains, with few quantitative differences by race/ethnicity or gender.

The long and winding road--the journey of a cleft lip and palate patient part 1.

PubMed

Madahar, Arun; Murray, Alison; Orr, Robert; Sandler, Paul Jonathan

2013-12-01

Patients with a cleft lip and palate (CLP) deformity require the highest standard of care that can be provided and this requires multidisciplinary care from teams located in regional cleft centres. Care of these cases is from birth to adulthood and requires several phases of intervention, corresponding to the stages of facial and dental development. Management ideally starts pre-natally, following the initial diagnosis, and occasionally pre-surgical appliances are prescribed. The lip is ideally repaired within three months, followed by palate closure between 12 and 18 months. Careful monitoring is required in the first few years and ENT referral, where necessary, will diagnose middle ear infection, which commonly affects CLP patients. Speech therapy is an integral part of the ongoing care. Excellent oral hygiene is essential and preventive dietary advice must be given and regularly reinforced. Orthodontic expansion is often needed at 9 years of age in preparation for a bone graft and, once the permanent dentition erupts, definitive orthodontic treatment will be required. Maxillary forward growth may have been constrained by scarring from previous surgery, so orthognathic correction may be required on growth completion. Final orthodontic alignment and high quality restorative care will allow the patients to have a pleasing aesthetic result. CLP patients and their families will need continuing support from medical and dental consultants, specialist nurses, health visitors, speech and language specialists and, perhaps, psychologists. These two articles outline the principles of care for the CLP patient and, secondly, illustrate this with a case report, documenting one patient's journey from birth to 21 years of age. A successful outcome for CLP patients requires a sound dentition.The general dental practitioner role is vital to establish and maintain excellent oral hygiene, a healthy diet and good routine preventive and restorative care. Understanding the total needs of CLP patients can help the dentist to provide high quality care as part of the multidisciplinary management.

Assessing key cost drivers associated with caring for chronic kidney disease patients.

PubMed

Damien, Paul; Lanham, Holly J; Parthasarathy, Murali; Shah, Nikhil L

2016-12-28

To examine key factors influencing chronic kidney disease (CKD) patients' total expenditure and offer recommendations on how to reduce total cost of CKD care without compromising quality. Using the 2002-2011 Medical Expenditure Panel Survey (MEPS) data, our cross-sectional study analyzed 197 patient records-79 patients with one record and 59 with two entries per patient (138 unique patients). We used three patient groups, based on international statistical classification of diseases version 9 code for condition (ICD9CODX) classification, to focus inference from the analysis: (a) non-dialysis dependent CKD, (b) dialysis and (c) transplant. Covariate information included region, demographic, co-morbid conditions and types of services. We used descriptive methods and multivariate generalized linear models to understand the impact of cost drivers. We compared actual and predicted CKD cost of care data using a hold-out sample of nine, randomly selected patients to validate the models. Total costs were significantly affected by treatment type, with dialysis being significantly higher than non-dialysis and transplant groups. Costs were highest in the West region of the U.S. Average costs for patients with public insurance were significantly higher than patients with private insurance (p < .0743), and likewise, for patients with co-morbid conditions over those without co-morbid conditions (p < .001). Managing CKD patients both before and after the onset of dialysis treatment and managing co-morbid conditions in individuals with CKD are potential sources of substantial cost savings in the care of CKD patients. Comparing total costs pre and post the United States Affordable Care Act could provide invaluable insights into managing the cost-quality tradeoff in CKD care.

Research Priorities to Advance the Health and Health Care of Older Adults with Multiple Chronic Conditions.

PubMed

Tisminetzky, Mayra; Bayliss, Elizabeth A; Magaziner, Jay S; Allore, Heather G; Anzuoni, Kathryn; Boyd, Cynthia M; Gill, Thomas M; Go, Alan S; Greenspan, Susan L; Hanson, Leah R; Hornbrook, Mark C; Kitzman, Dalane W; Larson, Eric B; Naylor, Mary D; Shirley, Benjamin E; Tai-Seale, Ming; Teri, Linda; Tinetti, Mary E; Whitson, Heather E; Gurwitz, Jerry H

2017-07-01

To prioritize research topics relevant to the care of the growing population of older adults with multiple chronic conditions (MCCs). Survey of experts in MCC practice, research, and policy. Topics were derived from white papers, funding announcements, or funded research projects relating to older adults with MCCs. Survey conducted through the Health Care Systems Research Network (HCSRN) and Claude D. Pepper Older Americans Independence Centers (OAICs) Advancing Geriatrics Infrastructure and Network Growth Initiative, a joint endeavor of the HCSRN and OAICs. Individuals affiliated with the HCSRN or OAICs and national MCC experts, including individuals affiliated with funding agencies having MCC-related grant portfolios. A "top box" methodology was used, counting the number of respondents selecting the top response on a 5-point Likert scale and dividing by the total number of responses to calculate a top box percentage for each of 37 topics. The highest-ranked research topics relevant to the health and healthcare of older adults with MCCs were health-related quality of life in older adults with MCCs; development of assessment tools (to assess, e.g., symptom burden, quality of life, function); interactions between medications, disease processes, and health outcomes; disability; implementation of novel (and scalable) models of care; association between clusters of chronic conditions and clinical, financial, and social outcomes; role of caregivers; symptom burden; shared decision-making to enhance care planning; and tools to improve clinical decision-making. Study findings serve to inform the development of a comprehensive research agenda to address the challenges relating to the care of this "high-need, high-cost" population and the healthcare delivery systems responsible for serving it. © 2017, Copyright the Authors Journal compilation © 2017, The American Geriatrics Society.

The Health Tourists’ Satisfaction Level of Services Provided: A Cross-Sectional Study in Iran

PubMed Central

Varzi, Ali Mohammad; Saki, Koroush; Momeni, Khalil; Vasokolaei, Ghasem Rajabi; Khodakaramifard, Zahra; Zouzani, Morteza Arab; Jalilian, Habib

2016-01-01

Introduction: Patient satisfaction with provided services is used as an indicator of health care quality. Patient satisfaction is defined as patient perception of provided care compared to expected care. This study was administered to evaluate the health tourists’ satisfaction of provided services in Lorestan University of Medical Sciences affiliated hospitals in 2015. Method: In this descriptive case study, 1800 (696 (54.4%) men and 812 (45.6%) women, 74.5 province native) patients were selected by random sampling from among the patients of Lorestan University of Medical Sciences affiliated hospitals in 2015 spring. The data collection instrument is a semi-structured questionnaire in this study. The questionnaire has 62 general and specific items. Each of the specific items is scaled on four points; satisfied, fairly satisfied, dissatisfied and O.K. In order to analyze the data both descriptive and inferential statistics were used. Results: Poldokhtar Imam Khomeini Hospital had the highest Level of satisfaction of 68 percent in all aspects (hoteling, discharge, paramedical, nurses, medical and admission) among the studied hospitals. Kuhdasht Imam Khomeini hospital had the lowest level of satisfaction of 53 percent. The overall satisfaction level in all hospitals was 61%. Discussion and Conclusion: Despite the shortcomings observed in different areas, the results of the present study are in an intermediate status compared to other studies. While treating patients, patient-centered issue and patients ‘need and preferences should be focused on to enhance health care quality. Considering Patients preferences not only are morally good but also lead to improved care and access to sustainable care practices. Therefore it is needed to drive organizational management approach toward the customer preferences management and needs. PMID:27157181

A perverse quality incentive in surgery: implications of reimbursing surgeons less for doing laparoscopic surgery.

PubMed

Fader, Amanda N; Xu, Tim; Dunkin, Brian J; Makary, Martin A

2016-11-01

Surgery is one of the highest priced services in health care, and complications from surgery can be serious and costly. Recently, advances in surgical techniques have allowed surgeons to perform many common operations using minimally invasive methods that result in fewer complications. Despite this, the rates of open surgery remain high across multiple surgical disciplines. This is an expert commentary and review of the contemporary literature regarding minimally invasive surgery practices nationwide, the benefits of less invasive approaches, and how minimally invasive compared with open procedures are differentially reimbursed in the United States. We explore the incentive of the current surgeon reimbursement fee schedule and its potential implications. A surgeon's preference to perform minimally invasive compared with open surgery remains highly variable in the U.S., even after adjustment for patient comorbidities and surgical complexity. Nationwide administrative claims data across several surgical disciplines demonstrates that minimally invasive surgery utilization in place of open surgery is associated with reduced adverse events and cost savings. Reducing surgical complications by increasing adoption of minimally invasive operations has significant cost implications for health care. However, current U.S. payment structures may perversely incentivize open surgery and financially reward physicians who do not necessarily embrace newer or best minimally invasive surgery practices. Utilization of minimally invasive surgery varies considerably in the U.S., representing one of the greatest disparities in health care. Existing physician payment models must translate the growing body of research in surgical care into physician-level rewards for quality, including choice of operation. Promoting safe surgery should be an important component of a strong, value-based healthcare system. Resolving the potentially perverse incentives in paying for surgical approaches may help address disparities in surgical care, reduce the prevalent problem of variation, and help contain health care costs.

MO-G-BRE-05: Clinical Process Improvement and Billing in Radiation Oncology: A Case Study of Applying FMEA for CPT Code 77336 (continuing Medical Physics Consultation)

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

Spirydovich, S; Huq, M

2014-06-15

Purpose: The improvement of quality in healthcare can be assessed by Failure Mode and Effects Analysis (FMEA). In radiation oncology, FMEA, as applied to the billing CPT code 77336, can improve both charge capture and, most importantly, quality of the performed services. Methods: We created an FMEA table for the process performed under CPT code 77336. For a given process step, each member of the assembled team (physicist, dosimetrist, and therapist) independently assigned numerical values for: probability of occurrence (O, 1–10), severity (S, 1–10), and probability of detection (D, 1–10) for every failure mode cause and effect combination. The riskmore » priority number, RPN, was then calculated as a product of O, S and D from which an average RPN was calculated for each combination mentioned above. A fault tree diagram, with each process sorted into 6 categories, was created with linked RPN. For processes with high RPN recommended actions were assigned. 2 separate R and V systems (Lantis and EMR-based ARIA) were considered. Results: We identified 9 potential failure modes and corresponding 19 potential causes of these failure modes all resulting in unjustified 77336 charge and compromised quality of care. In Lantis, the range of RPN was 24.5–110.8, and of S values – 2–10. The highest ranking RPN of 110.8 came from the failure mode described as “end-of-treatment check not done before the completion of treatment”, and the highest S value of 10 (RPN=105) from “overrides not checked”. For the same failure modes, within ARIA electronic environment with its additional controls, RPN values were significantly lower (44.3 for end-of-treatment missing check and 20.0 for overrides not checked). Conclusion: Our work has shown that when charge capture was missed that also resulted in some services not being performed. Absence of such necessary services may result in sub-optimal quality of care rendered to patients.« less

The reliability of physical examination tests for the diagnosis of anterior cruciate ligament rupture--A systematic review.

PubMed

Lange, Toni; Freiberg, Alice; Dröge, Patrik; Lützner, Jörg; Schmitt, Jochen; Kopkow, Christian

2015-06-01

Systematic literature review. Despite their frequent application in routine care, a systematic review on the reliability of clinical examination tests to evaluate the integrity of the ACL is missing. To summarize and evaluate intra- and interrater reliability research on physical examination tests used for the diagnosis of ACL tears. A comprehensive systematic literature search was conducted in MEDLINE, EMBASE and AMED until May 30th 2013. Studies were included if they assessed the intra- and/or interrater reliability of physical examination tests for the integrity of the ACL. Methodological quality was evaluated with the Quality Appraisal of Reliability Studies (QAREL) tool by two independent reviewers. 110 hits were achieved of which seven articles finally met the inclusion criteria. These studies examined the reliability of four physical examination tests. Intrarater reliability was assessed in three studies and ranged from fair to almost perfect (Cohen's k = 0.22-1.00). Interrater reliability was assessed in all included studies and ranged from slight to almost perfect (Cohen's k = 0.02-0.81). The Lachman test is the physical tests with the highest intrarater reliability (Cohen's k = 1.00), the Lachman test performed in prone position the test with the highest interrater reliability (Cohen's k = 0.81). Included studies were partly of low methodological quality. A meta-analysis could not be performed due to the heterogeneity in study populations, reliability measures and methodological quality of included studies. Systematic investigations on the reliability of physical examination tests to assess the integrity of the ACL are scarce and of varying methodological quality. Copyright © 2014 Elsevier Ltd. All rights reserved.

The quality, safety and governance of telephone triage and advice services - an overview of evidence from systematic reviews.

PubMed

Lake, Rebecca; Georgiou, Andrew; Li, Julie; Li, Ling; Byrne, Mary; Robinson, Maureen; Westbrook, Johanna I

2017-08-30

Telephone triage and advice services (TTAS) are increasingly being implemented around the world. These services allow people to speak to a nurse or general practitioner over the telephone and receive assessment and healthcare advice. There is an existing body of research on the topic of TTAS, however the diffuseness of the evidence base makes it difficult to identify key lessons that are consistent across the literature. Systematic reviews represent the highest level of evidence synthesis. We aimed to undertake an overview of such reviews to determine the scope, consistency and generalisability of findings in relation to the governance, safety and quality of TTAS. We searched PubMed, MEDLINE, EMBASE, CINAHL, Web of Science and the Cochrane Library for English language systematic reviews focused on key governance, quality and safety findings related to telephone based triage and advice services, published since 1990. The search was undertaken by three researchers who reached consensus on all included systematic reviews. An appraisal of the methodological quality of the systematic reviews was independently undertaken by two researchers using A Measurement Tool to Assess Systematic Reviews. Ten systematic reviews from a potential 291 results were selected for inclusion. TTAS was examined either alone, or as part of a primary care service model or intervention designed to improve primary care. Evidence of TTAS performance was reported across nine key indicators - access, appropriateness, compliance, patient satisfaction, cost, safety, health service utilisation, physician workload and clinical outcomes. Patient satisfaction with TTAS was generally high and there is some consistency of evidence of the ability of TTAS to reduce clinical workload. Measures of the safety of TTAS tended to show that there is no major difference between TTAS and traditional care. Taken as a whole, current evidence does not provide definitive answers to questions about the quality of care provided, access and equity of the service, its costs and outcomes. The available evidence also suggests that there are many interactional factors (e.g., relationship with other health service providers) which can impact on measures of performance, and also affect the external validity of the research findings.

Curriculum Recommendations of the AACP-PSSC Task Force on Caring for the Underserved

PubMed Central

Roche, Victoria F.; Assemi, Mitra; Conry, John M.; Shane-McWhorter, Laura; Sorensen, Todd D.

2008-01-01

A task force was convened by the American Association of Colleges of Pharmacy (AACP) and the Pharmaceutical Services Support Center (PSSC) and charged with the development of a curriculum framework to guide pharmacy programs in educating students on caring for the underserved. Utilizing a literature-based model, the task force constructed a framework that delineated evidence-based practice, clinical prevention and health promotion, health systems and policy, and community aspects of practice. Specific learning outcomes tailored to underserved populations were crafted and linked to resources readily available to the academy. The AACP-PSSC curriculum framework was shared with the academy in 2007. Schools and Colleges are urged to share experiences with implementation so that the impact of the tool can be evaluated. The task force recommends that the AACP Institutional Research Advisory Committee be involved in gathering assessment data. Implementation of the curriculum framework can help the academy fulfill the professional mandate to proactively provide the highest quality care to all, including underserved populations. PMID:18698398

Three lessons from a randomized trial of massage and meditation at end of life: patient benefit, outcome measure selection, and design of trials with terminally ill patients.

PubMed

Downey, Lois; Engelberg, Ruth A; Standish, Leanna J; Kozak, Leila; Lafferty, William E

2009-01-01

Improving end-of-life care is a priority in the United States, but assigning priorities for standard care services requires evaluations using appropriate study design and appropriate outcome indicators. A recent randomized controlled trial with terminally ill patients produced no evidence of benefit from massage or guided meditation, when evaluated with measures of global quality of life or pain distress over the course of patient participation. However, reanalysis using a more targeted outcome, surrogates' assessment of patients' benefit from the study intervention, suggested significant gains from massage-the treatment patients gave their highest preassignment preference ratings. The authors conclude that adding a menu of complementary therapies as part of standard end-of-life care may yield significant benefit, that patient preference is an important predictor of outcome, and that modifications in trial design may be appropriate for end-of-life studies.

Challenges and economics of private breast cancer surgery practice.

PubMed

Bailey, Lisa

2010-08-01

The role of the breast cancer surgeon has changed from one with performance of one operation, to a position in which the surgeon is the patient's initial contact, leader of a multidisciplinary team, the clinical leader who ensures that the patient receives the most appropriate breast cancer treatment and then also receives follow up and surveillance services. Breast conservation rates, patient satisfaction rates, clear margins, use of oncoplastic surgical techniques, appropriate referral to other consultants, clinical trial referral, and survival rates are all higher when patients are cared for by breast-focused surgeons. This new role requires greater time both before and after surgery to provide the proper planning and care for these patients. Women with breast cancer should have access to these dedicated breast-focused surgeons. Recognition of this expanding responsibility and reimbursement for this time and expertise is needed so that women with breast cancer can be offered the highest quality of care. 2010 Elsevier Ltd. All rights reserved.

Patient satisfaction in Malaysia's busiest outpatient medical care.

PubMed

Ganasegeran, Kurubaran; Perianayagam, Wilson; Manaf, Rizal Abdul; Jadoo, Saad Ahmed Ali; Al-Dubai, Sami Abdo Radman

2015-01-01

This study aimed to explore factors associated with patient satisfaction of outpatient medical care in Malaysia. A cross-sectional exit survey was conducted among 340 outpatients aged between 13 and 80 years after successful clinical consultations and treatment acquirements using convenience sampling at the outpatient medical care of Tengku Ampuan Rahimah Hospital (HTAR), Malaysia, being the country's busiest medical outpatient facility. A survey that consisted of sociodemography, socioeconomic, and health characteristics and the validated Short-Form Patient Satisfaction Questionnaire (PSQ-18) scale were used. Patient satisfaction was the highest in terms of service factors or tangible priorities, particularly "technical quality" and "accessibility and convenience," but satisfaction was low in terms of service orientation of doctors, particularly the "time spent with doctor," "interpersonal manners," and "communication" during consultations. Gender, income level, and purpose of visit to the clinic were important correlates of patient satisfaction. Effort to improve service orientation among doctors through periodical professional development programs at hospital and national level is essential to boost the country's health service satisfaction.

Quality Assessment of Medical Apps that Target Medication-Related Problems.

PubMed

Loy, John Shiguang; Ali, Eskinder Eshetu; Yap, Kevin Yi-Lwern

2016-10-01

The advent of smartphones has enabled a plethora of medical apps for disease management. As of 2012, there are 40,000 health care-related mobile apps available in the market. Since most of these medical apps do not go through any stringent quality assessment, there is a risk of consumers being misinformed or misled by unreliable information. In this regard, apps that target medication-related problems (MRPs) are not an exception. There is little information on what constitutes quality in apps that target MRPs and how good the existing apps are. To develop a quality assessment tool for evaluating apps that target MRPs and assess the quality of such apps available in the major mobile app stores (iTunes and Google Play). The top 100 free and paid apps in the medical categories of iTunes and Google Play stores (total of 400 apps) were screened for inclusion in the final analysis. English language apps that targeted MRPs were downloaded on test devices to evaluate their quality. Apps intended for clinicians, patients, or both were eligible for evaluation. The quality assessment tool consisted of 4 sections (appropriateness, reliability, usability, privacy), which determined the overall quality of the apps. Apps that fulfilled the inclusion criteria were classified based on the presence of any 1 or more of the 5 features considered important for apps targeting MRPs (monitoring, interaction checker, dose calculator, medication information, medication record). Descriptive statistics and Mann-Whitney tests were used for analysis. Final analysis was based on 59 apps that fulfilled the study inclusion criteria. Apps with interaction checker (66.9%) and monitoring features (54.8%) had the highest and lowest overall qualities. Paid apps generally scored higher for usability than free apps (P = 0.006) but lower for privacy (P = 0.003). Half of the interaction checker apps were unable to detect interactions with herbal medications. Blood pressure and heart rate monitoring apps had the highest overall quality scores (67.7%), while apps that monitored visual, hearing, and temperature changes scored the lowest (35.5%). A quality assessment tool for evaluating medical apps targeting MRPs has been developed. Clinicians can use this tool to guide their assessments of medical apps that are appropriate for use in the health care setting. Although potentially useful apps were identified, many apps were found to have deficiencies in quality, among which was poor reliability scores for most of the apps. Continued assessments of the quality of apps targeting MRPs are recommended to ensure their usefulness for clinicians and patients. No outside funding supported this study. The authors have no conflicts of interests directly related to this study. Study concept and design were contributed by Loy and Yap. Loy collected the data and took the lead in data interpretation, along with Ali and Yap. The manuscript was primarily written by Loy, along with Yap, and revised primarily by Ali, along with Yap.

Job satisfaction survey among health centers staff.

PubMed

Shahnazi, Hossein; Daniali, Seyede Shahrbanoo; Sharifirad, Gholamreza

2014-01-01

Due to the importance of health care organizations with significant responsibility for prevention and care, assessment of job satisfaction among health care staff is essential. Quality of health services will be decreased provided they are not satisfied. This study was a cross-sectional analysis of health care staff in Khomeinishahr (centers, buildings, and networks) If they had at least 6 months work experience, they could enter the study. Data included a two-part questionnaire with a standardized questionnaire, demographic variables, and Smith job descriptive index, which is a questionnaire with six domains. Reliability was obtained for each domain and its validity was reported 0.93. The results showed an overall satisfaction score averages 43.55 ± 12.8 (from 100). Job satisfaction score was not significantly different between the sexes. However, within the current attitude toward job satisfaction, men scores was better than women (P = 0.001). Highest score in job satisfaction was related to relationships with colleagues and lowest score was related to the income, benefits, and job promotion. The more the years of work, the less the job satisfaction was. The attitude toward the current job had a direct relationship with income (P = 0.01). There was a significant inverse relationship between educational level and job satisfaction in domains promotion, income, and benefits (P = 0.01). The staff with higher education levels was less satisfied with income and job promotion qualification. Managers should focus on job qualification to increase job satisfaction and improve the quality of work.

Orthopaedic nursing in developing nations: A collaboration between the Republic of the Union of Myanmar (Burma) and Australia.

PubMed

Han, Yin Mar; Awng, Nang; Nu, Lahkri Hkawn; Thway, Ni Mya; McLiesh, Paul

2017-11-01

This paper describes a collaboration between orthopaedic nurses in Myanmar (Burma) and Australia. It aims to explores how that collaboration began and how it can grow and has grown. The unique needs and challenges of healthcare delivery in developing nations are discussed. Understanding these unique needs and challenges is vital in tailoring strategies to provide orthopaedic nurses in those countries with resources that are suitable to assist them in providing the highest level of quality care to their patients. The authors hope that this example may inspire other orthopaedic nurses and organisations around the globe to participate in this type of activity with the understanding that it benefits all those involved, nurses from both developed and developing countries, as well as improving patient care. Copyright © 2016 Elsevier Ltd. All rights reserved.

Predictors of the highest long-term care expenditures in Japan.

PubMed

Olivares-Tirado, Pedro; Tamiya, Nanako; Kashiwagi, Masayo; Kashiwagi, Kimikazu

2011-05-17

In Japan, as the number of elderly covered by the Long-term Care Insurance (LTCI) system has increased, demand for long-term care services has increased substantially and consequently growing expenditures are threatening the sustainability of the system. Understanding the predictive factors associated with long-term care expenditures among the elderly would be useful in developing future strategies to ensure the sustainability of the system. We report a set of predictors of the highest long-term care expenditures in a cohort of elderly persons who received consecutive long-term care services during a year in a Japanese city. Data were obtained from databases of the LTC insurer of City A in Japan. Binary logistic regression was used to examine the predictors of the highest long-term care expenditures. We used a simplified model that focused on the effects of disability status and type of services used, while controlling for several relevant factors. Goodness of fit, a multicollinearity test, and logistic regression diagnostics were carried out for the final model. The study cohort consisted of 862 current users of LTCI system in city A. After controlling for gender and income, age, increased utilization rate of benefits, decline in functional status, higher care needs level and institutional care were found to be associated with the highest LTCI expenditures. An increased utilization rate of benefits (OR = 24.2) was a strong main effect predictors of the high LTC expenditures. However, a significant interaction between institutional care and high care need level was found, providing evidence of the combined effect of the two covariates. Beyond to confirm that disability status of elderly persons is the main factor driving the demand of LTC services and consequently the expenditures, we showed that changes in utilization rate of benefits -a specific insurance factor- and the use of institutional care conditional on the high care level, were strongest predictors of the highest LTC expenditures. These findings could become crucial for tracking policies aimed at ensuring financial sustainability of LTCI from a public insurer perspective in Japan.

Predictors of the highest long-term care expenditures in Japan

PubMed Central

2011-01-01

Background In Japan, as the number of elderly covered by the Long-term Care Insurance (LTCI) system has increased, demand for long-term care services has increased substantially and consequently growing expenditures are threatening the sustainability of the system. Understanding the predictive factors associated with long-term care expenditures among the elderly would be useful in developing future strategies to ensure the sustainability of the system. We report a set of predictors of the highest long-term care expenditures in a cohort of elderly persons who received consecutive long-term care services during a year in a Japanese city. Methods Data were obtained from databases of the LTC insurer of City A in Japan. Binary logistic regression was used to examine the predictors of the highest long-term care expenditures. We used a simplified model that focused on the effects of disability status and type of services used, while controlling for several relevant factors. Goodness of fit, a multicollinearity test, and logistic regression diagnostics were carried out for the final model. Results The study cohort consisted of 862 current users of LTCI system in city A. After controlling for gender and income, age, increased utilization rate of benefits, decline in functional status, higher care needs level and institutional care were found to be associated with the highest LTCI expenditures. An increased utilization rate of benefits (OR = 24.2) was a strong main effect predictors of the high LTC expenditures. However, a significant interaction between institutional care and high care need level was found, providing evidence of the combined effect of the two covariates. Conclusions Beyond to confirm that disability status of elderly persons is the main factor driving the demand of LTC services and consequently the expenditures, we showed that changes in utilization rate of benefits -a specific insurance factor- and the use of institutional care conditional on the high care level, were strongest predictors of the highest LTC expenditures. These findings could become crucial for tracking policies aimed at ensuring financial sustainability of LTCI from a public insurer perspective in Japan. PMID:21575260

Measuring performance on the Healthcare Access and Quality Index for 195 countries and territories and selected subnational locations: a systematic analysis from the Global Burden of Disease Study 2016.

PubMed

2018-06-02

A key component of achieving universal health coverage is ensuring that all populations have access to quality health care. Examining where gains have occurred or progress has faltered across and within countries is crucial to guiding decisions and strategies for future improvement. We used the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) to assess personal health-care access and quality with the Healthcare Access and Quality (HAQ) Index for 195 countries and territories, as well as subnational locations in seven countries, from 1990 to 2016. Drawing from established methods and updated estimates from GBD 2016, we used 32 causes from which death should not occur in the presence of effective care to approximate personal health-care access and quality by location and over time. To better isolate potential effects of personal health-care access and quality from underlying risk factor patterns, we risk-standardised cause-specific deaths due to non-cancers by location-year, replacing the local joint exposure of environmental and behavioural risks with the global level of exposure. Supported by the expansion of cancer registry data in GBD 2016, we used mortality-to-incidence ratios for cancers instead of risk-standardised death rates to provide a stronger signal of the effects of personal health care and access on cancer survival. We transformed each cause to a scale of 0-100, with 0 as the first percentile (worst) observed between 1990 and 2016, and 100 as the 99th percentile (best); we set these thresholds at the country level, and then applied them to subnational locations. We applied a principal components analysis to construct the HAQ Index using all scaled cause values, providing an overall score of 0-100 of personal health-care access and quality by location over time. We then compared HAQ Index levels and trends by quintiles on the Socio-demographic Index (SDI), a summary measure of overall development. As derived from the broader GBD study and other data sources, we examined relationships between national HAQ Index scores and potential correlates of performance, such as total health spending per capita. In 2016, HAQ Index performance spanned from a high of 97·1 (95% UI 95·8-98·1) in Iceland, followed by 96·6 (94·9-97·9) in Norway and 96·1 (94·5-97·3) in the Netherlands, to values as low as 18·6 (13·1-24·4) in the Central African Republic, 19·0 (14·3-23·7) in Somalia, and 23·4 (20·2-26·8) in Guinea-Bissau. The pace of progress achieved between 1990 and 2016 varied, with markedly faster improvements occurring between 2000 and 2016 for many countries in sub-Saharan Africa and southeast Asia, whereas several countries in Latin America and elsewhere saw progress stagnate after experiencing considerable advances in the HAQ Index between 1990 and 2000. Striking subnational disparities emerged in personal health-care access and quality, with China and India having particularly large gaps between locations with the highest and lowest scores in 2016. In China, performance ranged from 91·5 (89·1-93·6) in Beijing to 48·0 (43·4-53·2) in Tibet (a 43·5-point difference), while India saw a 30·8-point disparity, from 64·8 (59·6-68·8) in Goa to 34·0 (30·3-38·1) in Assam. Japan recorded the smallest range in subnational HAQ performance in 2016 (a 4·8-point difference), whereas differences between subnational locations with the highest and lowest HAQ Index values were more than two times as high for the USA and three times as high for England. State-level gaps in the HAQ Index in Mexico somewhat narrowed from 1990 to 2016 (from a 20·9-point to 17·0-point difference), whereas in Brazil, disparities slightly increased across states during this time (a 17·2-point to 20·4-point difference). Performance on the HAQ Index showed strong linkages to overall development, with high and high-middle SDI countries generally having higher scores and faster gains for non-communicable diseases. Nonetheless, countries across the development spectrum saw substantial gains in some key health service areas from 2000 to 2016, most notably vaccine-preventable diseases. Overall, national performance on the HAQ Index was positively associated with higher levels of total health spending per capita, as well as health systems inputs, but these relationships were quite heterogeneous, particularly among low-to-middle SDI countries. GBD 2016 provides a more detailed understanding of past success and current challenges in improving personal health-care access and quality worldwide. Despite substantial gains since 2000, many low-SDI and middle-SDI countries face considerable challenges unless heightened policy action and investments focus on advancing access to and quality of health care across key health services, especially non-communicable diseases. Stagnating or minimal improvements experienced by several low-middle to high-middle SDI countries could reflect the complexities of re-orienting both primary and secondary health-care services beyond the more limited foci of the Millennium Development Goals. Alongside initiatives to strengthen public health programmes, the pursuit of universal health coverage hinges upon improving both access and quality worldwide, and thus requires adopting a more comprehensive view-and subsequent provision-of quality health care for all populations. Bill & Melinda Gates Foundation. Copyright © 2018 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.

Positive aspects of caregiving and its correlates in caregivers of schizophrenia: a study from north India.

PubMed

Kate, N; Grover, S; Kulhara, P; Nehra, R

2013-06-01

OBJECTIVE. To study the positive aspects of caregiving and its correlates in primary caregivers of patients with schizophrenia. METHODS. A total of 100 patients with schizophrenia and their primary caregivers were evaluated. Regarding the caregivers, their positive aspects of caregiving were assessed on the Scale for Positive Aspects of Caregiving Experience (SPACE). To examine the correlates of positive aspects of caregiving, they were also assessed on the Family Burden Interview (FBI) Schedule, the Involvement Evaluation Questionnaire (IEQ), coping checklist, the Social Support Questionnaire, the World Health Organization Quality of Life-BREF (Hindi version), the WHO Quality of Life-Spirituality, Religiousness and Personal Beliefs Scale, as well as the General Health Questionnaire-12. The patients were assessed on the Positive and Negative Syndrome Scale (PANSS) and the Global Assessment of Functioning Scale. RESULTS. On the SPACE, the highest mean score was seen in the domain of motivation for the caregiving role (2.7), followed by that of caregiver satisfaction (2.4) and caregiver gains (2.3). The mean score was least for the domain of self-esteem and social aspect of caring (1.9). The SPACE domain of caregiver satisfaction correlated negatively with many aspects of burden as assessed by FBI Schedule and coping as assessed by the coping checklist; whereas the self-esteem and social aspect of caring domain correlated positively with worrying-urging II domain and the total IEQ score. No significant correlations between the SPACE and socio-demographics as well as most of the clinical variables were noted. Motivation for the caregiving had a positive correlation with the PANSS negative symptom scale. Multiple correlations were found between the SPACE and quality of life, suggesting that higher positive caregiving experience was associated with better quality of life in caregivers. CONCLUSION. Caregivers of patients with schizophrenia do enjoy positive aspects of caregiving while taking care of their ill relatives. In these caregivers, the positive aspects of caregiving were associated with better quality of life.

Assessment of Clinical Risk Management System in Hospitals: An Approach for Quality Improvement

PubMed Central

Farokhzadian, Jamileh; Nayeri, Nahid Dehghan; Borhani, Fariba

2015-01-01

Background: Clinical risks have created major problems in healthcare system such as serious adverse effects on patient safety and enhancing the financial burden for the healthcare. Thus, clinical risk management (CRM) system has been introduced for improving the quality and safety of services to health care. The aim of this study was to assess the status of CRM in the hospitals. Methods: A cross-sectional study was conducted on 200 nursing staff from three teaching hospitals affiliated with the Kerman University of Medical Sciences in southeast of Iran. Data were collected from the participants using questionnaire and observational checklist in quality improvement offices and selected wards. The data were analyzed using SPSS version 20. Results: Almost, 57% of persons participated in at least one of training sessions on CRM. The status of CRM system was rated from weak to moderate (2.93±0.72- 3.18±0.66). Among the six domains of CRM system, the highest mean belonged to domain the monitoring of analysis, evaluation and risk control (3.18±0.72); the lowest mean belonged to domain the staff’s knowledge, recognition and understanding of CRM (2.93±0.66). There were no integrated electronic systems for recording and analyzing clinical risks and incidents in the hospitals. Conclusion: Attempts have been made to establish CRM through improvement quality approach such as clinical governance and accreditation, but not enough, however, health care should move toward quality improvement and safe practice through the effective integration of CRM in organizational process. PMID:26156927

Experience of plastic surgery registrars in a European Working Time Directive compliant rota.

PubMed

de Blacam, Catherine; Tierney, Sean; Shelley, Odhran

2017-08-01

Surgical training requires exposure to clinical decision-making and operative experience in a supervised environment. It is recognised that learning ability is compromised when fatigued. The European Working Time Directive requires a decrease in working hours, but compliance reduces trainees' clinical exposure, which has profound implications for plastic surgery training. The aim of this study was to evaluate plastic surgery registrars' experience of an EWTD-compliant rota, and to examine its impact on patient care, education, and logbook activity. An electronic survey was distributed to plastic surgery registrars in a university teaching hospital. Registrars were asked to rate 31 items on a five-point Likert scale, including statements on patient care, clinical and operative duties, training, and quality-of-life. Interquartile deviations explored consensus among responses. Operative caseload was objectively evaluated using eLogbook data to compare activity at equal time points before and after implementation of the EWTD rota. Highest levels of consensus among respondents were found in positive statements addressing alertness and preparation for theatre, as well as time to read and study for exams. Registrars agreed that EWTD compliance improved their quality-of-life. However, it was felt that continuity of patient care was compromised by work hours restriction. Registrars were concerned about their operative experience. eLogbook data confirmed a fall-off in mean caseload of 31.8% compared to activity prior to EWTD rota implementation. While EWTD compliant rotas promote trainee quality-of-life and satisfaction with training, attention needs to be paid to optimising operative opportunities.

Gaps in Addressing Cardiovascular Risk in Rheumatoid Arthritis: Assessing Performance Using Cardiovascular Quality Indicators.

PubMed

Barber, Claire E H; Esdaile, John M; Martin, Liam O; Faris, Peter; Barnabe, Cheryl; Guo, Selynne; Lopatina, Elena; Marshall, Deborah A

2016-11-01

Cardiovascular disease (CVD) is a major comorbidity for patients with rheumatoid arthritis (RA). This study sought to determine the performance of 11 recently developed CVD quality indicators (QI) for RA in clinical practice. Medical charts for patients with RA (early disease or biologic-treated) followed at 1 center were retrospectively reviewed. A systematic assessment of adherence to 11 QI over a 2-year period was completed. Performance on the QI was reported as a percentage pass rate. There were 170 charts reviewed (107 early disease and 63 biologic-treated). The most frequent CVD risk factors present at diagnosis (early disease) and biologic start (biologic-treated) included hypertension (26%), obesity (25%), smoking (21%), and dyslipidemia (15%). Performance on the CVD QI was highly variable. Areas of low performance (< 10% pass rates) included documentation of a formal CVD risk assessment, communication to the primary care physician (PCP) that patients with RA were at increased risk of CVD, body mass index documentation and counseling if overweight, communication to a PCP about an elevated blood pressure, and discussion of risks and benefits of antiinflammatories in patients at CVD risk. Rates of diabetes screening and lipid screening were 67% and 69%, respectively. The area of highest performance was observed for documentation of intent to taper corticosteroids (98%-100% for yrs 1 and 2, respectively). Gaps in CVD risk management were found and highlight the need for quality improvements. Key targets for improvement include coordination of CVD care between rheumatology and primary care, and communication of increased CVD risk in RA.

The Quality of Toddler Child Care and Cognitive Skills at 24 Months: Propensity Score Analysis Results from the ECLS-B.

PubMed

Ruzek, Erik; Burchinal, Margaret; Farkas, George; Duncan, Greg J

2014-01-01

Over half of the toddlers in the U.S. experience routine nonparental care, but much less is known about early care than about preschool care. This study analyzed 2-year-old child care and child outcome data from the nationally representative ECLS-B sample of children born in 2001. At two-years of age, 51% of children experienced exclusive parental care, 18% relative care, 15% family child care, and 16% center care. More children in nonparental care were in medium quality care (61%) than in high quality (26%) or low quality (13%) care. Low-income children were more likely than non-low income children to be cared for by their parents and, when in care, were more often in lower quality care. The impact of toddler care quality on cognitive skills was estimated using propensity score adjustments to account for potential selection confounds due to family and child characteristics. Children's cognitive scores were higher in high or medium quality care than in low quality care, but no evidence emerged suggesting that poverty moderated the quality effects. Nevertheless, this suggests that increasing the proportion of low-income children in high quality care could reduce the achievement gap because low-income children are very unlikely to experience high quality care.

The Quality of Toddler Child Care and Cognitive Skills at 24 Months: Propensity Score Analysis Results from the ECLS-B

PubMed Central

Ruzek, Erik; Burchinal, Margaret; Farkas, George; Duncan, Greg J.

2013-01-01

Over half of the toddlers in the U.S. experience routine nonparental care, but much less is known about early care than about preschool care. This study analyzed 2-year-old child care and child outcome data from the nationally representative ECLS-B sample of children born in 2001. At two-years of age, 51% of children experienced exclusive parental care, 18% relative care, 15% family child care, and 16% center care. More children in nonparental care were in medium quality care (61%) than in high quality (26%) or low quality (13%) care. Low-income children were more likely than non-low income children to be cared for by their parents and, when in care, were more often in lower quality care. The impact of toddler care quality on cognitive skills was estimated using propensity score adjustments to account for potential selection confounds due to family and child characteristics. Children’s cognitive scores were higher in high or medium quality care than in low quality care, but no evidence emerged suggesting that poverty moderated the quality effects. Nevertheless, this suggests that increasing the proportion of low-income children in high quality care could reduce the achievement gap because low-income children are very unlikely to experience high quality care. PMID:24347815

Gender-related needs and preferences in cancer care indicate the need for an individualized approach to cancer patients.

PubMed

Wessels, Hester; de Graeff, Alexander; Wynia, Klaske; de Heus, Miriam; Kruitwagen, Cas L J J; Woltjer, Gerda T G J; Teunissen, Saskia C C M; Voest, Emile E

2010-01-01

Improving quality of care for cancer patients requires insight into their specific wishes, needs, and preferences concerning cancer care. The aim of this study was to explore the impact of gender on cancer patients' needs and preferences. Data were obtained from 386 questionnaires assessing cancer patients' preferences for health care. Multivariate regression analyses were performed with data obtained from medical oncology patients treated in seven Dutch hospitals, using the scales of the questionnaire as dependent variables. Patients rated safety, expertise, performance, and attitude of physicians and nurses highest on their list of preferences. There were significant differences between male and female patients concerning preferences in health care in 15 of the 21 scales and in two of the eight single items. Without exception, women found the care aspects mentioned in these scales and items more important than men. Multivariate regression analysis showed that, of all the patient- and disease-related factors, gender was the most important independent predictor of patient preferences. Gender impacts cancer patients' needs and preferences and should be taken into account for optimal cancer care. Cancer care might be tailored toward gender, for example, with regard to the means and extent of communication, manner and extent of support, counseling and rehabilitation, consultation length, and physician assignment. The results of this study may guide health care professionals and organizations to develop a gender-specific health care approach to further improve cancer patient-centered care.

Gender-Related Needs and Preferences in Cancer Care Indicate the Need for an Individualized Approach to Cancer Patients

PubMed Central

Wessels, Hester; de Graeff, Alexander; Wynia, Klaske; de Heus, Miriam; Kruitwagen, Cas L.J.J.; Woltjer, Gerda T.G.J.; Teunissen, Saskia C.C.M.

2010-01-01

Aim. Improving quality of care for cancer patients requires insight into their specific wishes, needs, and preferences concerning cancer care. The aim of this study was to explore the impact of gender on cancer patients' needs and preferences. Patients and Methods. Data were obtained from 386 questionnaires assessing cancer patients' preferences for health care. Multivariate regression analyses were performed with data obtained from medical oncology patients treated in seven Dutch hospitals, using the scales of the questionnaire as dependent variables. Results. Patients rated safety, expertise, performance, and attitude of physicians and nurses highest on their list of preferences. There were significant differences between male and female patients concerning preferences in health care in 15 of the 21 scales and in two of the eight single items. Without exception, women found the care aspects mentioned in these scales and items more important than men. Multivariate regression analysis showed that, of all the patient- and disease-related factors, gender was the most important independent predictor of patient preferences. Conclusion. Gender impacts cancer patients' needs and preferences and should be taken into account for optimal cancer care. Cancer care might be tailored toward gender, for example, with regard to the means and extent of communication, manner and extent of support, counseling and rehabilitation, consultation length, and physician assignment. The results of this study may guide health care professionals and organizations to develop a gender-specific health care approach to further improve cancer patient–centered care. PMID:20507890

Use of information technology for medication management in residential care facilities: correlates of facility characteristics.

PubMed

Bhuyan, Soumitra S; Chandak, Aastha; Powell, M Paige; Kim, Jungyoon; Shiyanbola, Olayinka; Zhu, He; Shiyanbola, Oyewale

2015-06-01

The effectiveness of information technology in resolving medication problems has been well documented. Long-term care settings such as residential care facilities (RCFs) may see the benefits of using such technologies in addressing the problem of medication errors among their resident population, who are usually older and have numerous chronic conditions. The aim of this study was two-fold: to examine the extent of use of Electronic Medication Management (EMM) in RCFs and to analyze the organizational factors associated with the use of EMM functionalities in RCFs. Data on RCFs were obtained from the 2010 National Survey of Residential Care Facilities. The association between facility, director and staff, and resident characteristics of RCFs and adoption of four EMM functionalities was assessed through multivariate logistic regression. The four EMM functionalities included were maintaining lists of medications, ordering for prescriptions, maintaining active medication allergy lists, and warning of drug interactions or contraindications. About 12% of the RCFs adopted all four EMM functionalities. Additionally, maintaining lists of medications had the highest adoption rate (34.5%), followed by maintaining active medication allergy lists (31.6%), ordering for prescriptions (19.7%), and warning of drug interactions or contraindications (17.9%). Facility size and ownership status were significantly associated with adoption of all four EMM functionalities. Medicaid certification status, facility director's age, education and license status, and the use of personal care aides in the RCF were significantly associated with the adoption of some of the EMM functionalities. EMM is expected to improve the quality of care and patient safety in long-term care facilities including RCFs. The extent of adoption of the four EMM functionalities is relatively low in RCFs. Some RCFs may strategize to use these functionalities to cater to the increasing demands from the market and also to provide better quality of care.

WE-D-16A-01: ACR Radiology Leadership Institute

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

Rubin, G

The Radiology Leadership Institute (RLI) was established in 2011 by the American College of Radiology with a mission to prepare leaders who will shape the future of radiology to ensure quality, elevate service and deliver extraordinary patient care. Leadership skills are critical to medical physicists in order for them to assure that imaging and therapy are safe and of the highest quality possible. This session will provide an introduction to the RLI and its programs with an emphasis on how medical physicists can get involved and what they might expect to gain through their engagement with the RLI. The sessionmore » will also provide a framework for leadership in healthcare with an emphasis on roles and opportunities for medical physicists to enhance their effectiveness as members of the healthcare, medical education, and research communities.« less

Charge Master: Friend or Foe?

PubMed

Wan, Wenshuai; Itri, Jason

2016-01-01

Prices charged for imaging services can be found in the charge master, a catalog of retail list prices for medical goods and services. This article reviews the evolution of reimbursement in the United States and provides a balanced discussion of the factors that influence charge master prices. Reduced payments to hospitals have pressured hospitals to generate additional revenue by increasing charge master prices. An unfortunate consequence is that those least able to pay for health care, the uninsured, are subjected to the highest charges. Yet, differences in pricing also represent an opportunity for radiology practices, which provide imaging services that are larger in scope or superior in quality to promote product differentiation. Physicians, hospital executives, and policy makers need to work together to improve the existing reimbursement system to promote high-quality, low-cost imaging. Copyright © 2016 Mosby, Inc. All rights reserved.

Validation of quality indicators for the organization of palliative care: a modified RAND Delphi study in seven European countries (the Europall project).

PubMed

Woitha, Kathrin; Van Beek, Karen; Ahmed, Nisar; Jaspers, Birgit; Mollard, Jean M; Ahmedzai, Sam H; Hasselaar, Jeroen; Menten, Johan; Vissers, Kris; Engels, Yvonne

2014-02-01

Validated quality indicators can help health-care professionals to evaluate their medical practices in a comparative manner to deliver optimal clinical care. No international set of quality indicators to measure the organizational aspects of palliative care settings exists. To develop and validate a set of structure and process indicators for palliative care settings in Europe. A two-round modified RAND Delphi process was conducted to rate clarity and usefulness of a previously developed set of 110 quality indicators. In total, 20 multi-professional palliative care teams of centers of excellence from seven European countries. In total, 56 quality indicators were rated as useful. These valid quality indicators concerned the following domains: the definition of a palliative care service (2 quality indicators), accessibility to palliative care (16 quality indicators), specific infrastructure to deliver palliative care (8 quality indicators), symptom assessment tools (1 quality indicator), specific personnel in palliative care services (9 quality indicators), documentation methodology of clinical data (14 quality indicators), evaluation of quality and safety procedures (1 quality indicator), reporting of clinical activities (1 quality indicator), and education in palliative care (4 quality indicator). The modified RAND Delphi process resulted in 56 international face-validated quality indicators to measure and compare organizational aspects of palliative care. These quality indicators, aimed to assess and improve the organization of palliative care, will be pilot tested in palliative care settings all over Europe and be used in the EU FP7 funded IMPACT project.

Workplace Violence in Health Care-It's Not "Part of the Job".

PubMed

Wax, Joseph R; Pinette, Michael G; Cartin, Angelina

2016-08-01

While health care workers comprise just 13% of the US workforce, they experience 60% of all workplace assaults. This violence is the second leading cause of fatal occupational injury. Women comprise 45% of the US labor force but 80% of health care workers, the highest proportion of females in any industry. The purpose was to describe the prevalence, forms, and consequences of health care workplace violence (WPV). The role and components of prevention programs for avoiding or mitigating violence are discussed, including opportunities for participation by obstetrician-gynecologists. A search of PubMed from 1990 to February 1, 2016, identified relevant manuscripts. Additional studies were found by reviewing the manuscripts' references. Government Web sites were visited for relevant data, publications, and resources. Health care WPV continues to rise despite an overall decrease in US WPV. While workers are most likely to be assaulted by clients or patients, they are most frequently bullied and threatened by coworkers. All incidents are markedly underreported in the absence of physical injury or lost work time. Sequelae include physical and psychological trauma, adverse patient outcomes, and perceived lower quality of care. The human, societal, and economic costs of health care WPV are enormous and unacceptable. Comprehensive prevention, planning, and intervention offer the best means of mitigating risks. As women's health physicians and health care workers, obstetrician-gynecologists should be encouraged to participate in such efforts.

Quality of nursing documentation: Paper-based health records versus electronic-based health records.

PubMed

Akhu-Zaheya, Laila; Al-Maaitah, Rowaida; Bany Hani, Salam

2018-02-01

To assess and compare the quality of paper-based and electronic-based health records. The comparison examined three criteria: content, documentation process and structure. Nursing documentation is a significant indicator of the quality of patient care delivery. It can be either paper-based or organised within the system known as the electronic health records. Nursing documentation must be completed at the highest standards, to ensure the safety and quality of healthcare services. However, the evidence is not clear on which one of the two forms of documentation (paper-based versus electronic health records is more qualified. A retrospective, descriptive, comparative design was used to address the study's purposes. A convenient number of patients' records, from two public hospitals, were audited using the Cat-ch-Ing audit instrument. The sample size consisted of 434 records for both paper-based health records and electronic health records from medical and surgical wards. Electronic health records were better than paper-based health records in terms of process and structure. In terms of quantity and quality content, paper-based records were better than electronic health records. The study affirmed the poor quality of nursing documentation and lack of nurses' knowledge and skills in the nursing process and its application in both paper-based and electronic-based systems. Both forms of documentation revealed drawbacks in terms of content, process and structure. This study provided important information, which can guide policymakers and administrators in identifying effective strategies aimed at enhancing the quality of nursing documentation. Policies and actions to ensure quality nursing documentation at the national level should focus on improving nursing knowledge, competencies, practice in nursing process, enhancing the work environment and nursing workload, as well as strengthening the capacity building of nursing practice to improve the quality of nursing care and patients' outcomes. © 2017 John Wiley & Sons Ltd.

Patients’ perceptions of access to primary care

PubMed Central

Premji, Kamila; Ryan, Bridget L.; Hogg, William E.; Wodchis, Walter P.

2018-01-01

Abstract Objective To gain a more comprehensive understanding of patients’ perceptions of access to their primary care practice and how these relate to patient characteristics. Design Cross-sectional study. Setting Ontario. Participants Adult primary care patients in Ontario (N = 1698) completing the Quality and Costs of Primary Care (QUALICOPC) Patient Experiences Survey. Main outcome measures Responses to 11 access-related survey items, analyzed both individually and as a Composite Access Score (CAS). Results The mean (SD) CAS was 1.78 (0.16) (the highest possible CAS was 2 and the lowest was 1). Most patients (68%) waited more than 1 day for their appointment. By far most (96%) stated that it was easy to obtain their appointment and that they obtained that appointment as soon as they wanted to (87%). There were no statistically significant relationships between CAS and sex, language fluency, income, education, frequency of emergency department use, or chronic disease status. A higher CAS was associated with being older and being born in Canada, better self-reported health, and increased frequency of visits to a doctor. Conclusion Despite criticisms of access to primary care, this study found that Ontario patients belonging to primary care practices have favourable impressions of their access. There were few statistically significant relationships between patient characteristics and access, and these relationships appeared to be weak. PMID:29540392

Predictors of micro-costing components in liver transplantation

PubMed Central

de Paiva Haddad, Luciana Bertocco; Ducatti, Liliana; Mendes, Luana Regina Baratelli Carelli; Andraus, Wellington; D’Albuquerque, Luiz Augusto Carneiro

2017-01-01

OBJECTIVES: Although liver transplantation procedures are common and highly expensive, their cost structure is still poorly understood. This study aimed to develop models of micro-costs among patients undergoing liver transplantation procedures while comparing the role of individual clinical predictors using tree regression models. METHODS: We prospectively collected micro-cost data from patients undergoing liver transplantation in a tertiary academic center. Data collection was conducted using an Intranet registry integrated into the institution’s database for the storing of financial and clinical data for transplantation cases. RESULTS: A total of 278 patients were included and accounted for 300 procedures. When evaluating specific costs for the operating room, intensive care unit and ward, we found that in all of the sectors but the ward, human resources were responsible for the highest costs. High cost supplies were important drivers for the operating room, whereas drugs were among the top four drivers for all sectors. When evaluating the predictors of total cost, a MELD score greater than 30 was the most important predictor of high cost, followed by a Donor Risk Index greater than 1.8. CONCLUSION: By focusing on the highest cost drivers and predictors, hospitals can initiate programs to reduce cost while maintaining high quality care standards. PMID:28658432

Does legal physician-assisted dying impede development of palliative care? The Belgian and Benelux experience.

PubMed

Chambaere, Kenneth; Bernheim, Jan L

2015-08-01

In 2002, physician-assisted dying was legally regulated in the Netherlands and Belgium, followed in 2009 by Luxembourg. An internationally frequently expressed concern is that such legislation could stunt the development of palliative care (PC) and erode its culture. To study this, we describe changes in PC development 2005-2012 in the permissive Benelux countries and compare them with non-permissive countries. Focusing on the seven European countries with the highest development of PC, which include the three euthanasia-permissive and four non-permissive countries, we compared the structural service indicators for 2005 and 2012 from successive editions of the European Atlas of Palliative Care. As an indicator for output delivery of services to patients, we collected the amounts of governmental funding of PC 2002-2011 in Belgium, the only country where we could find these data. The rate of increase in the number of structural PC provisions among the compared countries was the highest in the Netherlands and Luxembourg, while Belgium stayed on a par with the UK, the benchmark country. Belgian government expenditure for PC doubled between 2002 and 2011. Basic PC expanded much more than endowment-restricted specialised PC. The hypothesis that legal regulation of physician-assisted dying slows development of PC is not supported by the Benelux experience. On the contrary, regulation appears to have promoted the expansion of PC. Continued monitoring of both permissive and non-permissive countries, preferably also including indicators of quantity and quality of delivered care, is needed to evaluate longer-term effects. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Economic burden of cancer in India: Evidence from cross-sectional nationally representative household survey, 2014.

PubMed

Rajpal, Sunil; Kumar, Abhishek; Joe, William

2018-01-01

With the ongoing demographic and epidemiological transition, cancer is emerging as a major public health concern in India. This paper uses nationally representative household survey to examine the overall prevalence and economic burden of cancer in India. The age-standardized prevalence of cancer is estimated to be 97 per 100,000 persons with greater prevalence in urban areas. The evidence suggests that cancer prevalence is highest among the elderly and also among females in the reproductive age groups. Cancer displays a significant socioeconomic gradient even after adjusting for age-sex specifics and clustering in a multilevel regression framework. We find that out of pocket expenditure on cancer treatment is among the highest for any ailment. The average out of pocket spending on inpatient care in private facilities is about three-times that of public facilities. Furthermore, treatment for about 40 percent of cancer hospitalization cases is financed mainly through borrowings, sale of assets and contributions from friends and relatives. Also, over 60 percent of the households who seek care from the private sector incur out of pocket expenditure in excess of 20 percent of their annual per capita household expenditure. Given the catastrophic implications, this study calls for a disease-based approach towards financing such high-cost ailment. It is suggested that universal cancer care insurance should be envisaged and combined with existing accident and life insurance policies for the poorer sections in India. In concluding, we call for policies to improve cancer survivorship through effective prevention and early detection. In particular, greater public health investments in infrastructure, human resources and quality of care deserve priority attention.

Economic burden of cancer in India: Evidence from cross-sectional nationally representative household survey, 2014

PubMed Central

Kumar, Abhishek; Joe, William

2018-01-01

With the ongoing demographic and epidemiological transition, cancer is emerging as a major public health concern in India. This paper uses nationally representative household survey to examine the overall prevalence and economic burden of cancer in India. The age-standardized prevalence of cancer is estimated to be 97 per 100,000 persons with greater prevalence in urban areas. The evidence suggests that cancer prevalence is highest among the elderly and also among females in the reproductive age groups. Cancer displays a significant socioeconomic gradient even after adjusting for age-sex specifics and clustering in a multilevel regression framework. We find that out of pocket expenditure on cancer treatment is among the highest for any ailment. The average out of pocket spending on inpatient care in private facilities is about three-times that of public facilities. Furthermore, treatment for about 40 percent of cancer hospitalization cases is financed mainly through borrowings, sale of assets and contributions from friends and relatives. Also, over 60 percent of the households who seek care from the private sector incur out of pocket expenditure in excess of 20 percent of their annual per capita household expenditure. Given the catastrophic implications, this study calls for a disease-based approach towards financing such high-cost ailment. It is suggested that universal cancer care insurance should be envisaged and combined with existing accident and life insurance policies for the poorer sections in India. In concluding, we call for policies to improve cancer survivorship through effective prevention and early detection. In particular, greater public health investments in infrastructure, human resources and quality of care deserve priority attention. PMID:29481563

The role of emergency medicine clerkship e-Portfolio to monitor the learning experience of students in different settings: a prospective cohort study.

PubMed

Cevik, Arif Alper; Shaban, Sami; El Zubeir, Margret; Abu-Zidan, Fikri M

2018-04-12

Although emergency departments provide acute care learning opportunities for medical students, student exposure to recommended curriculum presentations and procedures are limited. In this perspective, clinical environments providing learning opportunities for students should be monitored as part of an ongoing quality improvement process. This study aims to analyze student exposures and their involvement levels in two different hospitals (Tawam and Al Ain) so as to improve the teaching and learning activities. This is a prospective study on all 76 final year medical students' electronic logbooks (e-Portfolio) of the academic year 2016/2017. Students recorded 5087 chief complaints and 3721 procedures. The average patient and procedure exposure in a shift per student in Al Ain Hospital compared with Tawam Hospital were 7.2 vs 6.4 and 5.8 vs 4.3, respectively. The highest full involvement with presentations was seen in the pediatric unit (67.1%, P < 0.0001). Urgent care shifts demonstrated the highest area of "full involvement" with procedures for our students (73.2%, P < 0.0001). Students' highest involvement with presentations and procedures were found during the night shifts (P < 0.0001, 66.5 and 75.1%, respectively). The electronic portfolio has proven to be a very useful tool in defining the learning activities of final year medical students during their emergency medicine clerkship and in comparing activities in two different clinical settings. Data collected and analyzed using this e-Portfolio has the potential to help medical educators and curriculum designers improve emergency medicine teaching and learning activities.

Quality comparison of websites related to developmental disabilities.

PubMed

Reichow, Brian; Shefcyk, Allison; Bruder, Mary Beth

2013-10-01

The Internet is commonly used to seek health-related information, but little is known about the quality of websites on developmental disabilities. Therefore, we sought to evaluate the characteristics and quality of websites located by searching ten common terms related to developmental disabilities and explore relations between website characteristics and website quality in order to make recommendations on ways to ensure locating good online information. We located 208 unique websites in our November 2012 US searches of Google and Bing. Two independent coders evaluated 10 characteristics of the websites and two different coders assessed the quality of the websites. From the 208 websites, 104 (50%) provided relevant information about the disability being searched. Of these 104 websites, those found to be of highest quality were least likely to be a sponsored result, contain advertisements, be from a for-profit company, and did contain references to peer-reviewed publications or had a top-level domain of .gov or .org. Individuals with developmental disabilities and their family members who choose to obtain disability-related information online should remain vigilant to ensure that they locate high-quality and accurate information and should not replace information obtained from health-care professionals and educational specialists with information found online. Copyright © 2013 Elsevier Ltd. All rights reserved.

Building Systemwide Improvement Capability: Does an Organization's Strategy for Quality Improvement Matter?

PubMed

Babich, Lauren P; Charns, Martin P; McIntosh, Nathalie; Lerner, Barbara; Burgess, James F; Stolzmann, Kelly L; VanDeusen Lukas, Carol

2016-01-01

Health care organizations have used different strategies to implement quality improvement (QI) programs but with only mixed success in implementing and spreading QI organization-wide. This suggests that certain organizational strategies may be more successful than others in developing an organization's improvement capability. To investigate this, our study examined how the primary focus of grant-funded QI efforts relates to (1) key measures of grant success and (2) organization-level measures of success in QI and organizational learning. Using a mixed-methods design, we conducted one-way analyses of variance to relate Veterans Affairs administrative survey data to data collected as part of a 3.5-year evaluation of 29 health care organization grant recipients. We then analyzed qualitative evidence from the evaluation to explain our results. We found that hospitals that focused on developing organizational infrastructure to support QI implementation compared with those that focused on training or conducting projects rated highest (at α = .05) on all 4 evaluation measures of grant success and all 3 systemwide survey measures of QI and organizational learning success. This study adds to the literature on developing organizational improvement capability and has practical implications for health care leaders. Focusing on either projects or staff training in isolation has limited value. Organizations are more likely to achieve systemwide transformation of improvement capability if their strategy emphasizes developing or strengthening organizational systems, structures, or processes to support direct improvement efforts.

Contamination sources and distribution patterns of pharmaceuticals and personal care products in Alpine rivers strongly affected by tourism.

PubMed

Mandaric, Ladislav; Diamantini, Elena; Stella, Elisa; Cano-Paoli, Karina; Valle-Sistac, Jennifer; Molins-Delgado, Daniel; Bellin, Alberto; Chiogna, Gabriele; Majone, Bruno; Diaz-Cruz, M Silvia; Sabater, Sergi; Barcelo, Damia; Petrovic, Mira

2017-07-15

Knowledge regarding the impact of tourism on the emergence of pharmaceuticals and personal care products (PPCPs) in Alpine river waters is limited and scarce. Therefore, a study on the occurrence patterns and spatiotemporal variability of 105 PPCPs in an Alpine river basin located in the Trentino-Alto Adige region (North-Eastern Italy) has been conducted. We observed that the total concentration of analyzed PPCPs was generally higher in all sampling sites during winter than in the summer. The analysis of tourist data revealed that during both sampling campaigns the number of tourists was lower in the downstream sites in comparison with the upstream area of the basin (Val di Sole). Particularly, sampling sites located near important tourist resorts have shown the highest abundance of the PPCPs during winter, being analgesics/anti-inflammatories, antihypertensives and antibiotics the most abundant pharmaceutically active compounds (PhACs). Diclofenac showed the highest concentration amongst PhACs, reaching concentrations up to 675ngL -1 in the sampling site situated downstream of the Tonale wastewater treatment plant (WWTP). Antihypertensives were found at concentrations >300ngL -1 , while antibiotics were quantified up to 196ngL -1 , respectively. Amongst personal care products (PCPs), the most abundant compound was octyl-dimethyl-p-aminobenzoic acid (ODPABA) with concentrations reaching up to 748ngL -1 in the sampling site situated within the Rotaliana district. In general, concentrations and detection frequencies were higher in water than in the sediment samples. The most frequently detected PhACs in sediments from both sampling campaigns were antibiotics, while amongst PCPs in sediments, octocrylene (OC) showed the highest concentration in both sampling campaigns. As a result, this study highlights the potential impact of tourism on the water quality of the Alpine aquatic ecosystems. Copyright © 2017 Elsevier B.V. All rights reserved.

An oral health survey of vulnerable older people in Belgium.

PubMed

De Visschere, Luc; Janssens, Barbara; De Reu, Griet; Duyck, Joke; Vanobbergen, Jacques

2016-11-01

The aim of this study was to gain insight in the oral health of persons aged 65 years or more. Data were obtained from 652 vulnerable older persons (≥65) by means of a clinical oral examination. Additional demographic data were gathered including age, gender, residence, and care dependency. The mean age of the total study sample was 83 (7.7) years and 71 % was female. Nearly 33 % of the sample was living at home with support, and 67 % was residing in nursing homes. The number of occluding pairs was low and the proportion of edentulous people was highest among persons with the highest care dependency. The mean Decay-missing-filled teeth index (DMFT) was 20.3 (9.0). A prosthetic treatment need and inadequate oral hygiene levels were observed in 40 % and more than 60 % of the subjects, respectively. The highest treatment need was observed in the oldest age group and the highest mean dental plaque in older persons with the highest care dependency. The oral health in frail older people in Belgium is poor. The restorative and prosthetic treatment need is high and oral hygiene levels are problematic. Age, residence, and care dependency seemed to have some influence on oral health parameters. In the long term, the most important future challenge of oral health care policies is to identify older adults before they begin to manifest such oral health deterioration. Regular dental visits should be strongly promoted by all (oral) health care workers during the lifespan of all persons including older adults.

Poor Quality for Poor Women? Inequities in the Quality of Antenatal and Delivery Care in Kenya.

PubMed

Sharma, Jigyasa; Leslie, Hannah H; Kundu, Francis; Kruk, Margaret E

2017-01-01

Quality of healthcare is an important determinant of future progress in global health. However, the distributional aspects of quality of care have received inadequate attention. We assessed whether high quality maternal care is equitably distributed by (1) mapping the quality of maternal care in facilities located in poorer versus wealthier areas of Kenya; and (2) comparing the quality of maternal care available to Kenyans in and not in poverty. We assessed three measures of maternal care quality: facility infrastructure and clinical quality of antenatal care and delivery care, using indicators from the 2010 Kenya Service Provision Assessment (SPA), a standardized facility survey with direct observation of maternal care provision. We calculated poverty of the area served by antenatal or delivery care facilities using the Multidimensional Poverty Index. We used regression analyses and non-parametric tests to assess differences in maternal care quality in facilities located in more and less impoverished areas. We estimated effective coverage with a minimum standard of care for the full population and those in poverty. A total of 564 facilities offering at least one maternal care service were included in this analysis. Quality of maternal care was low, particularly clinical quality of antenatal and delivery care, which averaged 0.52 and 0.58 out of 1 respectively, compared to 0.68 for structural inputs to care. Maternal healthcare quality varied by poverty level: at the facility level, all quality metrics were lowest for the most impoverished areas and increased significantly with greater wealth. Population access to a minimum standard (≥0.75 of 1.00) of quality maternal care was both low and inequitable: only 17% of all women and 8% of impoverished women had access to minimally adequate delivery care. The quality of maternal care is low in Kenya, and care available to the impoverished is significantly worse than that for the better off. To achieve the national targets of maternal and neonatal mortality reduction, policy initiatives need to tackle low quality of care, starting with high-poverty areas.

Poor Quality for Poor Women? Inequities in the Quality of Antenatal and Delivery Care in Kenya

PubMed Central

Sharma, Jigyasa; Leslie, Hannah H.; Kundu, Francis; Kruk, Margaret E.

2017-01-01

Background Quality of healthcare is an important determinant of future progress in global health. However, the distributional aspects of quality of care have received inadequate attention. We assessed whether high quality maternal care is equitably distributed by (1) mapping the quality of maternal care in facilities located in poorer versus wealthier areas of Kenya; and (2) comparing the quality of maternal care available to Kenyans in and not in poverty. Methods We assessed three measures of maternal care quality: facility infrastructure and clinical quality of antenatal care and delivery care, using indicators from the 2010 Kenya Service Provision Assessment (SPA), a standardized facility survey with direct observation of maternal care provision. We calculated poverty of the area served by antenatal or delivery care facilities using the Multidimensional Poverty Index. We used regression analyses and non-parametric tests to assess differences in maternal care quality in facilities located in more and less impoverished areas. We estimated effective coverage with a minimum standard of care for the full population and those in poverty. Results A total of 564 facilities offering at least one maternal care service were included in this analysis. Quality of maternal care was low, particularly clinical quality of antenatal and delivery care, which averaged 0.52 and 0.58 out of 1 respectively, compared to 0.68 for structural inputs to care. Maternal healthcare quality varied by poverty level: at the facility level, all quality metrics were lowest for the most impoverished areas and increased significantly with greater wealth. Population access to a minimum standard (≥0.75 of 1.00) of quality maternal care was both low and inequitable: only 17% of all women and 8% of impoverished women had access to minimally adequate delivery care. Conclusion The quality of maternal care is low in Kenya, and care available to the impoverished is significantly worse than that for the better off. To achieve the national targets of maternal and neonatal mortality reduction, policy initiatives need to tackle low quality of care, starting with high-poverty areas. PMID:28141840

A Framework of Care in Multiple Sclerosis, Part 2

PubMed Central

Aliotta, Philip J.; Bainbridge, Jacquelyn; Bennett, Susan E.; Cutter, Gary; Fenton, Kaylan; Lublin, Fred; Northrop, Dorothy; Rintell, David; Walker, Bryan D.; Weigel, Megan; Zackowski, Kathleen; Jones, David E.

2017-01-01

Abstract The Consortium of Multiple Sclerosis Centers (CMSC) convened a Framework Taskforce composed of a multidisciplinary group of clinicians and researchers to examine and evaluate the current models of care in multiple sclerosis (MS). The methodology of this project included analysis of a needs assessment survey and an extensive literature review. The outcome of this work is a two-part continuing education series of articles. Part 1, published previously, covered the updated disease phenotypes of MS along with recommendations for the use of disease-modifying therapies. Part 2, presented herein, reviews the variety of symptoms and potential complications of MS. Mobility impairment, spasticity, pain, fatigue, bladder/bowel/sexual dysfunction, cognitive dysfunction, and neuropsychiatric issues are examined, and both pharmacologic and nonpharmacologic interventions are described. Because bladder and bowel symptoms substantially affect health-related quality of life, detailed information about elimination dysfunction is provided. In addition, a detailed discussion about mental health and cognitive dysfunction in people with MS is presented. Part 2 concludes with a focus on the role of rehabilitation in MS. The goal of this work is to facilitate the highest levels of independence or interdependence, function, and quality of life for people with MS. PMID:28243186

Development of an evidence-based review with recommendations using an online iterative process.

PubMed

Rudmik, Luke; Smith, Timothy L

2011-01-01

The practice of modern medicine is governed by evidence-based principles. Due to the plethora of medical literature, clinicians often rely on systematic reviews and clinical guidelines to summarize the evidence and provide best practices. Implementation of an evidence-based clinical approach can minimize variation in health care delivery and optimize the quality of patient care. This article reports a method for developing an "Evidence-based Review with Recommendations" using an online iterative process. The manuscript describes the following steps involved in this process: Clinical topic selection, Evidence-hased review assignment, Literature review and initial manuscript preparation, Iterative review process with author selection, and Manuscript finalization. The goal of this article is to improve efficiency and increase the production of evidence-based reviews while maintaining the high quality and transparency associated with the rigorous methodology utilized for clinical guideline development. With the rise of evidence-based medicine, most medical and surgical specialties have an abundance of clinical topics which would benefit from a formal evidence-based review. Although clinical guideline development is an important methodology, the associated challenges limit development to only the absolute highest priority clinical topics. As outlined in this article, the online iterative approach to the development of an Evidence-based Review with Recommendations may improve productivity without compromising the quality associated with formal guideline development methodology. Copyright © 2011 American Rhinologic Society-American Academy of Otolaryngic Allergy, LLC.

Significance of Psychological Stress Response and Health-related Quality of Life in Spouses of Cancer Patients When Given Bad News

PubMed Central

Kugimoto, Toyoko; Katsuki, Ryo; Kosugi, Toshifumi; Ohta, Akihide; Sato, Hidetoshi

2017-01-01

Objective: This study illuminates the degree of psychological stress response experienced by spouses of cancer patients when given bad news at three different times (notification of the name of the disease, notification of recurrence, and notification of terminality) as well as the factors that influence the response and the health status of the spouse as measured by health-related quality of life (QOL). Methods: A total of 203 individuals (57 men and 146 women) who had received the three types of news were surveyed using a self-report questionnaire on psychological stress response, marital satisfaction, and health-related QOL scales. Results: The degree of the psychological stress response was the highest for notification of terminality, followed by notification of the name of the disease, and notification of recurrence. The influencing factors varied depending on the notification period. Although no significant difference was observed for health-related QOL among the three notification types, significant differences were observed for certain items when compared with national standard values. Conclusions: When a notification of terminality, which produced the highest psychological stress response, is given, providing care that considers health-related QOL is necessary not only for patients but also for their spouses. PMID:28503648

Patient- and Caregiver-Reported Assessment Tools for Palliative Care: Summary of the 2017 Agency for Healthcare Research and Quality Technical Brief.

PubMed

Aslakson, Rebecca A; Dy, Sydney M; Wilson, Renee F; Waldfogel, Julie; Zhang, Allen; Isenberg, Sarina R; Blair, Alex; Sixon, Joshua; Lorenz, Karl A; Robinson, Karen A

2017-12-01

Assessment tools are data collection instruments that are completed by or with patients or caregivers and which collect data at the individual patient or caregiver level. The objectives of this study are to 1) summarize palliative care assessment tools completed by or with patients or caregivers and 2) identify needs for future tool development and evaluation. We completed 1) a systematic review of systematic reviews; 2) a supplemental search of previous reviews and Web sites, and/or 3) a targeted search for primary articles when no tools existed in a domain. Paired investigators screened search results, assessed risk of bias, and abstracted data. We organized tools by domains from the National Consensus Project Clinical Practice Guidelines for Palliative Care and selected the most relevant, recent, and highest quality systematic review for each domain. We included 10 systematic reviews and identified 152 tools (97 from systematic reviews and 55 from supplemental sources). Key gaps included no systematic review for pain and few tools assessing structural, cultural, spiritual, or ethical/legal domains, or patient-reported experience with end-of-life care. Psychometric information was available for many tools, but few studies evaluated responsiveness (sensitivity to change) and no studies compared tools. Few to no tools address the spiritual, ethical, or cultural domains or patient-reported experience with end-of-life care. While some data exist on psychometric properties of tools, the responsiveness of different tools to change and/or comparisons between tools have not been evaluated. Future research should focus on developing or testing tools that address domains for which few tools exist, evaluating responsiveness, and comparing tools. Copyright © 2017 American Academy of Hospice and Palliative Medicine. All rights reserved.

Consumer satisfaction with tertiary healthcare in China: findings from the 2015 China National Patient Survey.

PubMed

Sun, Jing; Hu, Guangyu; Ma, Jing; Chen, Yin; Wu, Laiyang; Liu, Qiannan; Hu, Jia; Livoti, Christine; Jiang, Yu; Liu, Yuanli

2017-04-01

This study aims to develop understanding of Chinese patient satisfaction with tertiary hospitals. The study draws on data collected from the 2015 China National Patient Survey. A Likert five-point scale was used to formulate the questionnaires. Descriptive analysis and logistic regression analysis were conducted. A structured questionnaire was used by 1432 interviewers to interview 27 475 outpatients and 19 938 inpatients in 136 tertiary hospitals from 31 provinces. Outpatients in the dispensing area and inpatients in the discharging area were randomly interviewed. Key domains of the questionnaire include the layout of service functions, environment maintenance, process management, quality of care, humane care and the patient-doctor relationship. Within each domain, several indicators were set, and each indicator was given a statement. The overall satisfaction scores are 4.42 ± 0.68 and 4.67 ± 0.62 for outpatient and inpatient, respectively. The domains with highest satisfaction are 'diagnosis and treatment' for outpatient and 'nursing care' for inpatient. Outpatients were least satisfied with long waiting time, while inpatients were least satisfied with the food. The strongest predictor of overall satisfaction appears to be 'patient-doctor relationship' for both outpatients (OR = 3.53, 95% CI: 3.17-3.92) and inpatients (OR = 7.34, 95% CI: 5.55-9.70). Chinese hospitals need to pay more attention to offering more humane care to patients, hospital environment and process management improvement, reducing waiting times for seeing doctors and outpatient testing, and improving amenity services such as better food in the wards. © 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

Intelligent Monitoring? Assessing the ability of the Care Quality Commission's statistical surveillance tool to predict quality and prioritise NHS hospital inspections.

PubMed

Griffiths, Alex; Beaussier, Anne-Laure; Demeritt, David; Rothstein, Henry

2017-02-01

The Care Quality Commission (CQC) is responsible for ensuring the quality of the health and social care delivered by more than 30 000 registered providers in England. With only limited resources for conducting on-site inspections, the CQC has used statistical surveillance tools to help it identify which providers it should prioritise for inspection. In the face of planned funding cuts, the CQC plans to put more reliance on statistical surveillance tools to assess risks to quality and prioritise inspections accordingly. To evaluate the ability of the CQC's latest surveillance tool, Intelligent Monitoring (IM), to predict the quality of care provided by National Health Service (NHS) hospital trusts so that those at greatest risk of providing poor-quality care can be identified and targeted for inspection. The predictive ability of the IM tool is evaluated through regression analyses and χ 2 testing of the relationship between the quantitative risk score generated by the IM tool and the subsequent quality rating awarded following detailed on-site inspection by large expert teams of inspectors. First, the continuous risk scores generated by the CQC's IM statistical surveillance tool cannot predict inspection-based quality ratings of NHS hospital trusts (OR 0.38 (0.14 to 1.05) for Outstanding/Good, OR 0.94 (0.80 to -1.10) for Good/Requires improvement, and OR 0.90 (0.76 to 1.07) for Requires improvement/Inadequate). Second, the risk scores cannot be used more simply to distinguish the trusts performing poorly-those subsequently rated either 'Requires improvement' or 'Inadequate'-from the trusts performing well-those subsequently rated either 'Good' or 'Outstanding' (OR 1.07 (0.91 to 1.26)). Classifying CQC's risk bandings 1-3 as high risk and 4-6 as low risk, 11 of the high risk trusts were performing well and 43 of the low risk trusts were performing poorly, resulting in an overall accuracy rate of 47.6%. Third, the risk scores cannot be used even more simply to distinguish the worst performing trusts-those subsequently rated 'Inadequate'-from the remaining, better performing trusts (OR 1.11 (0.94 to 1.32)). Classifying CQC's risk banding 1 as high risk and 2-6 as low risk, the highest overall accuracy rate of 72.8% was achieved, but still only 6 of the 13 Inadequate trusts were correctly classified as being high risk. Since the IM statistical surveillance tool cannot predict the outcome of NHS hospital trust inspections, it cannot be used for prioritisation. A new approach to inspection planning is therefore required. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Implementation of Instrument Based on Eight Health Related Quality of Life Domains for Measuring of Willingness to Pay for Psoriasis Treatment.

PubMed

Dobrev, Hristo P; Atanasov, Nikolay G; Dimitrova, Donka D

2017-09-01

Psoriasis vulgaris (PsV) is a chronic skin condition that has a major impact on health-related quality of life (HRQOL). To determine the individual burden of PsV on HRQOL using willingness to pay (WTP) instrument. Fifty-one consecutive PsV patients were asked to evaluate their overall health and psoriasis affected health by visual analogue scale (VAS), and interviewed on 8 domains (physical, emotional, sleep, work, social, self-care, intimacy, and concentration) of HRQOL and WTP for a hypothetical cure in each domain. Two additional questions proposing 6 alternatives for therapy were also asked. The analysis is performed with descriptive and frequency statistics, Mann-Whitney and Kruskal-Wallis tests. The domains ranked highly were: physical comfort (90%), social comfort (77%), emotional health (75%) and work (53%). The following tendencies concerning WTP for top four impacted domains were found: the median WTP were the highest in the top impacted domains; the younger patients were willing to pay more than the older ones; the highest median WTP amounts appear in the lowest income group; the highest median WTP is associated with smaller psoriasis affected health VAS scores. The largest proportion and number of patients (37.3%, n=19) stated preferences for the systemic therapy. The second preferred choice was the thalassotherapy (29.4%, n=15). The utility and reliability of the instrument based on the assessment of WTP stated preferences for 8 domains of HRQOL for evaluation the individual burden of psoriasis were strongly supported.

[Views of final-year medical students at Damascus University about clinical skills acquired before graduation].

PubMed

Alourfi, Z; Hassan, R El Sayed; Koudsi, A

2012-06-01

Medical education in Syrian universities is facing many challenges that may affect the quality of the education and the standard of graduates. We therefore conducted a cross-sectional study using a self-administrated questionnaire with 76 items to investigate the perceptions of 290 final-year medical students regarding the confidence of performing some core clinical skills. A total of 271 responded (response rate 93.4%). Student responses differed. While confidence was highest for skills that do not require practice in the clinical skills laboratory, it was low for skills that need training in emergency and intensive care units, or when students were participating in patient care with partial responsibility. Our findings confirm the need for effective clinical laboratory training, student participation in emergency room shifts, and that students to be allowed to take some egree of responsibility.

Geographic variability of adherence to occupational injury treatment guidelines.

PubMed

Trujillo, Antonio J; Heins, Sara E; Anderson, Gerard F; Castillo, Renan C

2014-12-01

To determine the geographic variability and relationship between six occupational injury practice guidelines. Guidelines were developed by an expert panel and evaluated using workers' compensation claims data from a large, national insurance company (1999 to 2010). Percentage compliance for each guideline was adjusted for age and sex using linear regression and mapped by hospital referral region. Regions with the lowest compliance were identified, and correlations between guidelines were calculated. Compliance to the unnecessary home care guideline showed the lowest geographic variation (interquartile range: 97.3 to 99.0), and inappropriate shoulder bracing showed the highest variation (interquartile range: 77.7 to 90.8). Correlation between the guidelines was weak and not always positive. Different guidelines showed different degrees of geographic variation. Lack of correlation between guidelines suggests that these indicators were not associated with a single underlying health care quality or patient severity construct.

Reaching common ground: a patient-family-based conceptual framework of quality EOL care.

PubMed

Howell, Doris; Brazil, Kevin

2005-01-01

Improvement in the quality of end-of-life (EOL) care is a priority health care issue since serious deficiencies in quality of care have been reported across care settings. Increasing pressure is now focused on Canadian health care organizations to be accountable for the quality of palliative and EOL care delivered. Numerous domains of quality EOL care upon which to create accountability frameworks are now published, with some derived from the patient/family perspective. There is a need to reach common ground on the domains of quality EOL care valued by patients and families in order to develop consistent performance measures and set priorities for health care improvement. This paper describes a meta-synthesis study to develop a common conceptual framework of quality EOL care integrating attributes of quality valued by patients and their families.

The spectrum of ethical issues in a Learning Health Care System: a systematic qualitative review.

PubMed

McLennan, Stuart; Kahrass, Hannes; Wieschowski, Susanne; Strech, Daniel; Langhof, Holger

2018-04-01

To determine systematically the spectrum of ethical issues that is raised for stakeholders in a 'Learning Health Care System' (LHCS). The systematic review was conducted in PubMed and Google Books between the years 2007 and 2015. The literature search retrieved 1258 publications. Each publication was independently screened by two reviewers for eligibility for inclusion. Ethical issues were defined as arising when a relevant normative principle is not adequately considered or two principles come into conflict. A total of 65 publications were included in the final analysis and were analysed using an adapted version of qualitative content analysis. A coding frame was developed inductively from the data, only the highest-level categories were generated deductively for a life-cycle perspective. A total of 67 distinct ethical issues could be categorized under different phases of the LHCS life-cycle. An overarching theme that was repeatedly raised was the conflict between the current regulatory system and learning health care. The implementation of a LHCS can help realize the ethical imperative to continuously improve the quality of health care. However, the implementation of a LHCS can also raise a number of important ethical issues itself. This review highlights the importance for health care leaders and policy makers to balance the need to protect and respect individual participants involved in learning health care activities with the social value of improving health care.

Is It a Trust Issue? Factors That Influence Trust for Persons Living With HIV/AIDS.

PubMed

Krause, Denise D; May, Warren L

2016-09-01

Trust in one's health care provider, trust in the health care system in general, and even trust in one's community affects engagement in HIV-related health care. This article examines the issue of trust among a random sample of HIV-infected individuals residing in Mississippi, an area hard-hit by the HIV/AIDS epidemic. Five constructs based on survey responses from these individuals were developed: (1) trust in one's provider to offer the best possible medical care, (2) trust in one's provider to protect patient privacy, (3) willingness to disclose HIV status to one's provider, (4) trust in the health care system, and (5) trust in one's community. Findings suggest that interventions to improve trust in providers to deliver the highest quality of care should be targeted to young people, African Americans, and the more highly educated. Interventions to increase trust in providers to protect privacy should focus on creating and strengthening social support groups or networks that build relationships and foster trust. Interventions aimed to increase community trust also should be targeted to young people. This information is useful to researchers, policy makers, health care providers, and organizations interested in prioritizing interventions and strategies that have the greatest potential to reduce health disparities in HIV diagnosis and treatment in the Deep South. © 2016 Society for Public Health Education.

Quality nursing care in the words of nurses.

PubMed

Burhans, Linda Maas; Alligood, Martha Raile

2010-08-01

This paper is a report of a study of the meaning of quality nursing care for practising nurses. Healthcare quality continues to be a subject of intense criticism and debate. Although quality nursing care is vital to patient outcomes and safety, meaningful improvements have been disturbingly slow. Analysis of quality care literature reveals that practising nurses are rarely involved in developing or defining improvement programs for quality nursing care. Therefore, two major study premises were that quality nursing care must be meaningful and relevant to nurses and that uncovering their meaning of quality nursing care could facilitate more effective improvement approaches. Using van Manen's hermeneutic phenomenology, meaning was revealed through analysis of interviews to answer the research question 'What is the lived meaning of quality nursing care for practising nurses?' Twelve nurses practising on medical or surgical adult units at general or intermediate levels of care within acute care hospitals in the United States of America were interviewed. Emerging themes were discovered through empirical and reflective analysis of audiotapes and transcripts. The data were collected in 2008. The revealed lived meaning of quality nursing care for practising nurses was meeting human needs through caring, empathetic, respectful interactions within which responsibility, intentionality and advocacy form an essential, integral foundation. Nurse managers could develop strategies that support nurses better in identifying and delivering quality nursing care reflective of responsibility, caring, intentionality, empathy, respect and advocacy. Nurse educators could modify education curricula to model and teach students the intrinsic qualities identified within these meanings of quality nursing care.

Cardiovascular disease outcomes: priorities today, priorities tomorrow for research and community health.

PubMed

Yancy, Clyde W

2012-01-01

The disparities and differences in heart disease and stroke among Black, White and Hispanic populations tell a compelling and continuing story that should drive research agendas to improve health outcomes. With Black men and women having the highest prevalence of hypertension, Black females having higher rates of coronary heart disease, stroke and breast cancer than White females, and Blacks, at all ages, having a greater risk for stroke mortality than Whites, researchers and health care providers must understand the clinical appropriateness of treatment for different states of disease among distinct populations. Further, to eliminate health disparities, the health care systems and legal regulatory climate must facilitate access to care while biases, prejudices and stereotyping by health care providers and all those in the health care system must be eliminated. Importantly, research continues to illustrate that many are dying prematurely or have advanced stages of disease because of disparate care. This article explores four strategies to address inequitable care and to work toward eliminating poorer health outcomes among minorities. First, those who deliver health care must adopt a quality-focused approach that improves the care of all patients while facilitating the reduction and elimination of health disparities. Second, cultural awareness and cultural competency must be improved. Third, we must remove barriers to access and promote public policies that lead to greater health awareness and healthier environments. Lastly, but most importantly, we need a prevention focus as the reduction in the onset of disease is the first step towards improving health outcomes.

Working in silos? - Head & Neck cancer patients during and after treatment with or without early palliative care referral.

PubMed

Ullgren, Helena; Kirkpatrick, Lily; Kilpeläinen, Sini; Sharp, Lena

2017-02-01

The primary aim was to describe patients with Head and Neck (H&N) cancer referred to palliative care and how the care transition from acute oncological to palliative care impacted on both Health related quality of life (HRQoL) and information. The secondary aim was to explore H&N cancer patients' HRQoL and perceived information. H&N cancer patients were identified via the Swedish Cancer Register. Data were collected using the following questionnaires; European Organization for Research and Treatment of Cancer (EORTC) QLQ C-30, INFO25, and a study-specific questionnaire. Out of 289 patients, 203 (70%) responded and among these, 43 (21%) reported being referred to palliative care. Global health was the lowest reported functional scale (median score = 67) and fatigue (median scores 33) the highest reported symptom (QLQ C-30). Patients with a written care plan were significantly more satisfied with information regarding self-care compared to patients without a care plan. Patients referred to palliative care were less satisfied with information regarding disease (p < 0.000), the spread of the disease (p < 0.001) and were more likely to visit hospital emergency departments (43% vs. 19% p < 0.000). To avoid H&N cancer care in silos, a closer integration between the oncology and the palliative care team is needed. Further research on the complex situation of having oncological treatment concurrent with palliative care, is needed. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

The public role in promoting child health information technology.

PubMed

Conway, Patrick H; White, P Jonathan; Clancy, Carolyn

2009-01-01

The public sector plays an important role in promoting child health information technology. Public sector support is essential in 5 main aspects of child health information technology, namely, data standards, pediatric functions in health information systems, privacy policies, research and implementation funding, and incentives for technology adoption. Some innovations in health information technology for adult populations can be transferred to or adapted for children, but there also are unique needs in the pediatric population. Development of health information technology that addresses children's needs and effective adoption of that technology are critical for US children to receive care of the highest possible quality in the future.

Treating dementia: the complementing team approach of occupational therapy and psychology.

PubMed

Keough, J; Huebner, R A

2000-07-01

Dementia is a chronic progressive disorder that necessitates an interdisciplinary team approach to provide the highest quality of health care. The purpose of this article is to describe and promote the collaboration of psychologists and occupational therapists as key interdisciplinary team members. Multiple sources were referenced to develop and describe an interdisciplinary team model. Occupational therapists possess skills in understanding function, maximizing residual strengths, defining small changes, modifying the environment, and developing caregiver strengths and compensations. These skills can complement the skills of psychologists in understanding behavior and emotion, developing behavioral interventions, supporting team development, and providing psychosocial support to caregivers.

Novel approaches to increasing the brightness of broad area lasers

NASA Astrophysics Data System (ADS)

Crump, P.; Winterfeldt, M.; Decker, J.; Ekterai, M.; Fricke, J.; Knigge, S.; Maaßdorf, A.; Erbert, G.

2016-03-01

Progress in studies to increase the lateral brightness Blat of broad area lasers is reviewed. Blat=Pout/BPPlat is maximized by developing designs and technology for lowest lateral beam parameter product, BPPlat, at highest optical output power Pout. This can be achieved by limiting the number of guided lateral modes and by improving the beam quality of low-order lateral modes. Important effects to address include process and packaging induced wave-guiding, lateral carrier accumulation and the thermal lens profile. A careful selection of vertical design is also shown to be important, as are advanced techniques to filter out higher order modes.

Most Important Factors for the Implementation of Shared Decision Making in Sciatica Care: Ranking among Professionals and Patients

PubMed Central

Hofstede, Stefanie N.; van Bodegom-Vos, Leti; Wentink, Manon M.; Vleggeert-Lankamp, Carmen L. A.; Vliet Vlieland, Thea P. M.; de Mheen, Perla J. Marang-van

2014-01-01

Introduction Due to the increasing specialization of medical professionals, patients are treated by multiple disciplines. To ensure that delivered care is patient-centered, it is crucial that professionals and the patient together decide on treatment (shared decision making (SDM)). However, it is not known how SDM should be integrated in multidisciplinary practice. This study determines the most important factors for SDM implementation in sciatica care, as it is known that a prior inventory of factors is crucial to develop a successful implementation strategy. Methods 246 professionals (general practitioners, physical therapists, neurologists, neurosurgeons, orthopedic surgeons) (30% response) and 155 patients (96% response) responded to an internet-based survey. Respondents ranked barriers and facilitators identified in previous interviews, on their importance using Maximum Difference Scaling. Feeding back the personal top 5 most important factors, each respondent indicated whether these factors were barriers or facilitators. Hierarchical Bayes estimation was used to estimate the relative importance (RI) of each factor. Results Professionals assigned the highest importance to: quality of professional-patient relationship (RI 4.87; CI 4.75–4.99); importance of quick recovery of patient (RI 4.83; CI 4.69–4.97); and knowledge about treatment options (RI 6.64; CI 4.53–4.74), which were reported as barrier and facilitator. Professionals working in primary care had a different ranking than those working in hospital care. Patients assigned the highest importance to: correct diagnosis by professionals (barrier, RI 8.19; CI 7.99–8.38); information provision about treatment options and potential harm and benefits (RI 7.87; CI 7.65–8.08); and explanation of the professional about the care trajectory (RI 7.16; CI 6.94–7.38), which were reported as barrier and facilitator. Conclusions Knowledge, information provision and a good relationship are the most important conditions for SDM perceived by both patients and professionals. These conditions are not restricted to one specific disease or health care system, because they are mostly professional or patient dependent and require healthcare professional training. PMID:24710328

Does quality influence utilization of primary health care? Evidence from Haiti.

PubMed

Gage, Anna D; Leslie, Hannah H; Bitton, Asaf; Jerome, J Gregory; Joseph, Jean Paul; Thermidor, Roody; Kruk, Margaret E

2018-06-20

Expanding coverage of primary healthcare services such as antenatal care and vaccinations is a global health priority; however, many Haitians do not utilize these services. One reason may be that the population avoids low quality health facilities. We examined how facility infrastructure and the quality of primary health care service delivery were associated with community utilization of primary health care services in Haiti. We constructed two composite measures of quality for all Haitian facilities using the 2013 Service Provision Assessment survey. We geographically linked population clusters from the Demographic and Health Surveys to nearby facilities offering primary health care services. We assessed the cross-sectional association between quality and utilization of four primary care services: antenatal care, postnatal care, vaccinations and sick child care, as well as one more complex service: facility delivery. Facilities performed poorly on both measures of quality, scoring 0.55 and 0.58 out of 1 on infrastructure and service delivery quality respectively. In rural areas, utilization of several primary cares services (antenatal care, postnatal care, and vaccination) was associated with both infrastructure and quality of service delivery, with stronger associations for service delivery. Facility delivery was associated with infrastructure quality, and there was no association for sick child care. In urban areas, care utilization was not associated with either quality measure. Poor quality of care may deter utilization of beneficial primary health care services in rural areas of Haiti. Improving health service quality may offer an opportunity not only to improve health outcomes for patients, but also to expand coverage of key primary health care services.

Specialty Payment Model Opportunities and Assessment

PubMed Central

Huckfeldt, Peter J.; Chan, Chris; Hirshman, Samuel; Kofner, Aaron; Liu, Jodi L.; Mulcahy, Andrew W.; Popescu, Ioana; Stevens, Clare; Timbie, Justin W.; Hussey, Peter S.

2015-01-01

Abstract This article describes research related to the design of a payment model for specialty oncology services for possible testing by the Center for Medicare and Medicaid Innovation at the Centers for Medicare & Medicaid Services (CMS). Cancer is a common and costly condition. Episode-based payment, which aims to create incentives for high-quality, low-cost care, has been identified as a promising alternative payment model for oncology care. Episode-based payment systems can provide flexibility to health care providers to select among the most effective and efficient treatment alternatives, including activities that are not currently reimbursed under Medicare payment policies. However, the model design also needs to ensure that high-quality care is delivered and that beneficial treatments are not withheld from patients. CMS asked MITRE and RAND to conduct analyses to inform design decisions related to an episode-based oncology model for Medicare beneficiaries undergoing chemotherapy treatment for cancer. In particular, this study focuses on analyses of Medicare claims data related to the definition of the initiation of an episode of chemotherapy, patterns of spending during and surrounding episodes of chemotherapy, and attribution of episodes of chemotherapy to physician practices. We found that the time between the primary cancer diagnosis and chemotherapy initiation varied widely across patients, ranging from one day to over seven years, with a median of 2.4 months. The average level of total monthly payments varied considerably across cancers, with the highest spending peak of $9,972 for lymphoma, and peaks of $3,109 for breast cancer and $2,135 for prostate cancer. PMID:28083364

Specialty Payment Model Opportunities and Assessment: Oncology Model Design Report.

PubMed

Huckfeldt, Peter J; Chan, Chris; Hirshman, Samuel; Kofner, Aaron; Liu, Jodi L; Mulcahy, Andrew W; Popescu, Ioana; Stevens, Clare; Timbie, Justin W; Hussey, Peter S

2015-07-15

This article describes research related to the design of a payment model for specialty oncology services for possible testing by the Center for Medicare and Medicaid Innovation at the Centers for Medicare & Medicaid Services (CMS). Cancer is a common and costly condition. Episode-based payment, which aims to create incentives for high-quality, low-cost care, has been identified as a promising alternative payment model for oncology care. Episode-based payment systems can provide flexibility to health care providers to select among the most effective and efficient treatment alternatives, including activities that are not currently reimbursed under Medicare payment policies. However, the model design also needs to ensure that high-quality care is delivered and that beneficial treatments are not withheld from patients. CMS asked MITRE and RAND to conduct analyses to inform design decisions related to an episode-based oncology model for Medicare beneficiaries undergoing chemotherapy treatment for cancer. In particular, this study focuses on analyses of Medicare claims data related to the definition of the initiation of an episode of chemotherapy, patterns of spending during and surrounding episodes of chemotherapy, and attribution of episodes of chemotherapy to physician practices. We found that the time between the primary cancer diagnosis and chemotherapy initiation varied widely across patients, ranging from one day to over seven years, with a median of 2.4 months. The average level of total monthly payments varied considerably across cancers, with the highest spending peak of $9,972 for lymphoma, and peaks of $3,109 for breast cancer and $2,135 for prostate cancer.

Team science as interprofessional collaborative research practice: a systematic review of the science of team science literature

PubMed Central

Little, Meg M; St Hill, Catherine A; Ware, Kenric B; Swanoski, Michael T; Chapman, Scott A; Lutfiyya, M Nawal; Cerra, Frank B

2017-01-01

The National Institute of Health's concept of team science is a means of addressing complex clinical problems by applying conceptual and methodological approaches from multiple disciplines and health professions. The ultimate goal is the improved quality of care of patients with an emphasis on better population health outcomes. Collaborative research practice occurs when researchers from >1 health-related profession engage in scientific inquiry to jointly create and disseminate new knowledge to clinical and research health professionals in order to provide the highest quality of patient care to improve population health outcomes. Training of clinicians and researchers is necessary to produce clinically relevant evidence upon which to base patient care for disease management and empirically guided team-based patient care. In this study, we hypothesized that team science is an example of effective and impactful interprofessional collaborative research practice. To assess this hypothesis, we examined the contemporary literature on the science of team science (SciTS) produced in the past 10 years (2005–2015) and related the SciTS to the overall field of interprofessional collaborative practice, of which collaborative research practice is a subset. A modified preferred reporting items for systematic reviews and meta-analyses (PRISMA) approach was employed to analyze the SciTS literature in light of the general question: Is team science an example of interprofessional collaborative research practice? After completing a systematic review of the SciTS literature, the posed hypothesis was accepted, concluding that team science is a dimension of interprofessional collaborative practice. PMID:27619555

Team science as interprofessional collaborative research practice: a systematic review of the science of team science literature.

PubMed

Little, Meg M; St Hill, Catherine A; Ware, Kenric B; Swanoski, Michael T; Chapman, Scott A; Lutfiyya, M Nawal; Cerra, Frank B

2017-01-01

The National Institute of Health's concept of team science is a means of addressing complex clinical problems by applying conceptual and methodological approaches from multiple disciplines and health professions. The ultimate goal is the improved quality of care of patients with an emphasis on better population health outcomes. Collaborative research practice occurs when researchers from >1 health-related profession engage in scientific inquiry to jointly create and disseminate new knowledge to clinical and research health professionals in order to provide the highest quality of patient care to improve population health outcomes. Training of clinicians and researchers is necessary to produce clinically relevant evidence upon which to base patient care for disease management and empirically guided team-based patient care. In this study, we hypothesized that team science is an example of effective and impactful interprofessional collaborative research practice. To assess this hypothesis, we examined the contemporary literature on the science of team science (SciTS) produced in the past 10 years (2005-2015) and related the SciTS to the overall field of interprofessional collaborative practice, of which collaborative research practice is a subset. A modified preferred reporting items for systematic reviews and meta-analyses (PRISMA) approach was employed to analyze the SciTS literature in light of the general question: Is team science an example of interprofessional collaborative research practice? After completing a systematic review of the SciTS literature, the posed hypothesis was accepted, concluding that team science is a dimension of interprofessional collaborative practice. Copyright © 2016 American Federation for Medical Research.

Seizure-related hospital admissions, readmissions and costs: Comparisons with asthma and diabetes in South Australia.

PubMed

Bellon, Michelle L; Barton, Christopher; McCaffrey, Nikki; Parker, Denise; Hutchinson, Claire

2017-08-01

Seizures are listed as an Ambulatory Care Sensitive Condition (ACSC), where, in some cases, hospitalisation may be avoided with appropriate preventative and early management in primary care. We examined the frequencies, trends and financial costs of first and subsequent seizure-related hospital admissions in the adult and paediatric populations, with comparisons to bronchitis/asthma and diabetes admissions in South Australia between 2012 and 2014. De-identified hospital separation data from five major public hospitals in metropolitan South Australia were analysed to determine the number of children and adults admitted for the following Australian Refined Diagnosis Related Groups: seizure related conditions; bronchitis/asthma; and diabetes. Additional data included length of hospital stay and type of admission. Demographic data were analysed to identify whether social determinants influence admission, and a macro costing approach was then applied to calculate the financial costs to the Health Care System. The rate of total seizure hospitalizations was 649 per 100,000; lower than bronchitis/asthma (751/100,000), yet higher than diabetes (500/100,000). The highest proportions of subsequent separations were recorded by children with seizures regardless of complexity (47% +CSCC; 17% -CSCC) compared with asthma (11% +CSCC; 14% -CSCC) or diabetes (14% +CSCC; 13% -CSCC), and by adults with seizures with catastrophic or severe complications/comorbidity (25%), compared with diabetes (22%) or asthma (14%). The mean cost per separation in both children and adults was highest for diabetes (AU$4438/$7656), followed by seizures (AU$2408/$5691) and asthma (AU$2084/$3295). Following the lead of well-developed and resourced health promotion initiatives in asthma and diabetes, appropriate primary care, community education and seizure management services (including seizure clinics) should be targeted in an effort to reduce seizure related hospitalisations which may be avoidable, minimise costs to the health budget, and maximise health care quality. Copyright © 2017 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.

Exploring end of life priorities in Saudi males: usefulness of Q-methodology.

PubMed

Hammami, Muhammad M; Al Gaai, Eman; Hammami, Safa; Attala, Sahar

2015-11-26

Quality end-of-life care depends on understanding patients' end-of-life choices. Individuals and cultures may hold end-of-life priorities at different hierarchy. Forced ranking rather than independent rating, and by-person factor analysis rather than averaging may reveal otherwise masked typologies. We explored Saudi males' forced-ranked, end-of-life priorities and dis-priorities. Respondents (n = 120) rank-ordered 47 opinion statements on end-of-life care following a 9-category symmetrical distribution. Statements' scores were analyzed by averaging analysis and factor analysis (Q-methodology). Respondents' mean age was 32.1 years (range, 18-65); 52% reported average religiosity, 88 and 83% ≥ very good health and life-quality, respectively, and 100% ≥ high school education. Averaging analysis revealed that the extreme five end-of-life priorities were to, be at peace with God, be able to say the statement of faith, maintain dignity, resolve conflicts, and have religious death rituals respected, respectively. The extreme five dis-priorities were to, die in the hospital, not receive intensive care if in coma, die at peak of life, be informed about impending death by family/friends rather than doctor, and keep medical status confidential from family/friends, respectively. Q-methodology classified 67% of respondents into five highly transcendent opinion types. Type-I (rituals-averse, family-caring, monitoring-coping, life-quality-concerned) and Type-V (rituals-apt, family-centered, neutral-coping, life-quantity-concerned) reported the lowest and highest religiosity, respectively. Type-II (rituals-apt, family-dependent, monitoring-coping, life-quantity-concerned) and Type-III (rituals-silent, self/family-neutral, avoidance-coping, life-quality & quantity-concerned) reported the best and worst life-quality, respectively. Type-I respondents were the oldest with the lowest general health, in contrast to Type-IV (rituals-apt, self-centered, monitoring-coping, life-quality/quantity-neutral). Of the extreme 14 priorities/dis-priorities for the five types, 29, 14, 14, 50, and 36%, respectively, were not among the extreme 20 priorities/dis-priorities identified by averaging analysis for the entire cohort. 1) Transcendence was the extreme end-of-life priority, and dying in the hospital was the extreme dis-priority. 2) Quality of life was conceptualized differently with less emphasize on its physiological aspects. 3) Disclosure of terminal illness to family/close friends was preferred as long it is through the patient. 4) Q-methodology identified five types of constellations of end-of-life priorities and dis-priorities that may be related to respondents' demographics and are partially masked by averaging analysis.

Defining quality of care.

PubMed

Campbell, S M; Roland, M O; Buetow, S A

2000-12-01

This paper defines quality of health care. We suggest that there are two principal dimensions of quality of care for individual patients; access and effectiveness. In essence, do users get the care they need, and is the care effective when they get it? Within effectiveness, we define two key components--effectiveness of clinical care and effectiveness of inter-personal care. These elements are discussed in terms of the structure of the health care system, processes of care, and outcomes resulting from care. The framework relates quality of care to individual patients and we suggest that quality of care is a concept that is at its most meaningful when applied to the individual user of health care. However, care for individuals must placed in the context of providing health care for populations which introduces additional notions of equity and efficiency. We show how this framework can be of practical value by applying the concepts to a set of quality indicators contained within the UK National Performance Assessment Framework and to a set of widely used indicators in the US (HEDIS). In so doing we emphasise the differences between US and UK measures of quality. Using a conceptual framework to describe the totality of quality of care shows which aspects of care any set of quality indicators actually includes and measures and, and which are not included.

Differences in the volume of services and in prices drive big variations in Medicaid spending among US states and regions.

PubMed

Gilmer, Todd P; Kronick, Richard G

2011-07-01

It is well known that Medicaid spending per beneficiary varies widely across states. However, less is known about the cause of this variation, or about whether increased spending is associated with better outcomes. In this article we describe and analyze sources of interstate variation in Medicaid spending over several years. We find substantial variations both in the volume of services and in prices. Overall, per capita spending in the ten highest-spending states was $1,650 above the average national per capita spending, of which $1,186, or 72 percent, was due to the volume of services delivered. Spending in the ten lowest-spending states was $1,161 below the national average, of which $672, or 58 percent, was due to volume. In the mid-Atlantic region, increased price and volume resulted in the most expensive care among regions, whereas reduced price and volume in the South Central region resulted in the least expensive care among regions. Understanding these variations in greater detail should help improve the quality and efficiency of care-a task that will become more important as Medicaid is greatly expanded under the Affordable Care Act of 2010.

Incentivizing primary care providers to innovate: building medical homes in the post-Katrina New Orleans safety net.

PubMed

Rittenhouse, Diane R; Schmidt, Laura A; Wu, Kevin J; Wiley, James

2014-02-01

To evaluate safety-net clinics' responses to a novel community-wide Patient-Centered Medical Home (PCMH) financial incentive program in post-Katrina New Orleans. Between June 2008 and June 2010, we studied 50 primary care clinics in New Orleans receiving federal funds to expand services and improve care delivery. Multiwave, longitudinal, observational study of a local safety-net primary care system. Clinic-level data from a semiannual survey of clinic leaders (89.3 percent response rate), augmented by administrative records. Overall, 62 percent of the clinics responded to financial incentives by achieving PCMH recognition from the National Committee on Quality Assurance (NCQA). Higher patient volume, higher baseline PCMH scores, and type of ownership were significant predictors of achieving NCQA recognition. The steepest increase in adoption of PCMH processes occurred among clinics achieving the highest, Level 3, NCQA recognition. Following NCQA recognition, 88.9 percent stabilized or increased their use of PCMH processes, although several specific PCMH processes had very low rates of adoption overall. Findings demonstrate that widespread PCMH implementation is possible in a safety-net environment when external financial incentives are aligned with the goal of practice innovation. © Health Research and Educational Trust.

Designing quality of care--contributions from parents: Parents' experiences of care processes in paediatric care and their contribution to improvements of the care process in collaboration with healthcare professionals.

PubMed

Gustavsson, Susanne; Gremyr, Ida; Kenne Sarenmalm, Elisabeth

2016-03-01

The aim of this article was to explore whether current quality dimensions for health care services are sufficient to capture how parents perceive and contribute to quality of health care. New quality improvement initiatives that actively involve patients must be examined with a critical view on established quality dimensions to ensure that these measures support patient involvement. This paper used a qualitative and descriptive design. This paper is based on interviews with parents participating in two experience-based co-design projects in a Swedish hospital that included qualitative content analysis of data from 12 parent interviews in paediatric care. Health care professionals often overemphasize their own significance for value creation in care processes and underappreciate parents' ability to influence and contribute to better quality. However, quality is not based solely on how professionals accomplish their task, but is co-created by health care professionals and parents. Consequently, assessment of quality outcomes also must include parents' ability and context. This paper questions current models of quality dimensions in health care, and suggests additional sub-dimensions, such as family quality and involvement quality. This paper underscores the importance of involving parents in health care improvements with health care professionals to capture as many dimensions of quality as possible. © 2015 John Wiley & Sons Ltd.

Implementation issues relevant to outpatient neurology palliative care.

PubMed

Kluger, Benzi M; Persenaire, Michael J; Holden, Samantha K; Palmer, Laura T; Redwine, Hannah; Berk, Julie; Anderson, C Alan; Filley, Christopher M; Kutner, Jean; Miyasaki, Janis; Carter, Julie

2017-11-29

There is growing interest in the application of palliative care principles to improve care for patients and families affected by neurologic diseases. We developed an interdisciplinary outpatient clinic for patients and families affected by neurologic disorders to better address the problems faced by our highest need patients. We have developed and improved this program over the past three years and share several of our most important lessons as well as ongoing challenges and areas where we see our clinic evolving in the future. We provide a description of our clinic logistics, including key steps in the initiation of the clinic, and provide descriptions from similar clinics at other institutions to demonstrate some of the variability in this growing field. We also provide results from a formal one-year quality improvement project and a one-year retrospective study of patients attending this clinic. Our clinic has grown steadily since its inception and maintains high satisfaction ratings from patients, caregivers, and referring providers. To maintain standardized and efficient care we have developed materials for patients and referring physicians as well as checklists and other processes used by our interdisciplinary team. Feedback from our quality improvement project helped define optimal visit duration and refine communication among team members and with patients and families. Results from our chart review suggest our clinic influences advance care planning and place of death. Common referral reasons include psychosocial support, complex symptom management, and advance care planning. Current challenges for our clinic include developing a strategy for continued growth, creating a sustainable financial model for interdisciplinary care, integrating our services with disease-specific sections, improving primary palliative care knowledge and skills within our referral base, and building effective alliances with community neurologists, geriatrics, primary care, nursing homes, and hospices. Specialized outpatient palliative care for neurologic disorders fills several important gaps in care for this patient population, provides important educational opportunities for trainees, and creates opportunities for patient and caregiver-centered research. Educational initiatives are needed to train general neurologists in primary palliative care, to train neurologists in specialist palliative care, and to train palliative medicine specialists in neurology. Research is needed to build an evidence base to identify patient and caregiver needs, support specific interventions, and to build more efficient models of care in both academic and community settings.

Specialist practitioner' in surgical dentistry: preliminary report on a pilot scheme at East Surrey Hospital, Redhill, UK.

PubMed

Parker, J K

1999-12-01

This continuing pilot scheme was designed to assess whether minor oral operations could be done by a 'specialist practitioner' in surgical dentistry in hospital. The preliminary results indicate that patients benefit from the improved facilities and expertise that are available in the hospital, that the provision of treatment within the hospital is at a sufficiently 'local' level to meet their requirements, and that this increased quality of service can be provided at no greater cost to the NHS than treating them in a dental surgery. A large amount of the dentoalveolar surgery done (such as removal of third molars) is regarded as routine, but 'routine' is often mistakenly thought to mean 'simple' or 'easy'. Dentoalveolar surgery not only demands the highest quality of care and expertise but it also requires the necessary immediate support if medical or surgical complications arise.

Quality of maternity care and its determinants along the continuum in Kenya: A structural equation modeling analysis

PubMed Central

Mendez, Bomar Rojas

2017-01-01

Background Improving access to delivery services does not guarantee access to quality obstetric care and better survival, and therefore, concerns for quality of maternal and newborn care in low- and middle-income countries have been raised. Our study explored characteristics associated with the quality of initial assessment, intrapartum, and immediate postpartum and newborn care, and further assessed the relationships along the continuum of care. Methods The 2010 Service Provision Assessment data of Kenya for 627 routine deliveries of women aged 15–49 were used. Quality of care measures were assessed using recently validated quality of care measures during initial assessment, intrapartum, and postpartum periods. Data were analyzed with negative binomial regression and structural equation modeling technique. Results The negative binomial regression results identified a number of determinants of quality, such as the level of health facilities, managing authority, presence of delivery fee, central electricity supply and clinical guideline for maternal and neonatal care. Our structural equation modeling (SEM) further demonstrated that facility characteristics were important determinants of quality for initial assessment and postpartum care, while characteristics at the provider level became more important in shaping the quality of intrapartum care. Furthermore we also noted that quality of initial assessment had a positive association with quality of intrapartum care (β = 0.71, p < 0.001), which in turn was positively associated with the quality of newborn and immediate postpartum care (β = 1.29, p = 0.004). Conclusions A continued focus on quality of care along the continuum of maternity care is important not only to mothers but also their newborns. Policymakers should therefore ensure that required resources, as well as adequate supervision and emphasis on the quality of obstetric care, are available. PMID:28520771

Association between the application of ISO 9001:2008 alone or in combination with health-specific standards and quality-related activities in Hungarian hospitals.

PubMed

Dombrádi, Viktor; Csenteri, Orsolya Karola; Sándor, János; Godény, Sándor

2017-04-01

To investigate how International Organization for Standardization (ISO) 9001 and the Hungarian Health Care Standards (HHCS) certifications are associated with quality management, patient safety, patient rights and human resource management activities. A cross-sectional study was implemented using the 2009 Hungarian hospital survey's database. Hungary. Fifty-three general hospitals were included in the statistical analysis. No intervention was carried out in the study. The outcomes included the percentage of compliance in the dimensions of quality management, patient safety, patient rights, human resource management and the overall score for each hospital, and they were grouped according to the hospitals' certifications. Sixteen hospitals did not have either ISO 9001 or HHCS certifications, 19 had ISO 9001 certification only and 18 had both. Hospitals with ISO 9001 alone or in combination with the HHCS significantly outperformed hospitals with no certifications in terms of quality management and human resource management activities but not in terms of patient safety or patient rights activities. Combined, the two models provided the highest median levels in all cases. Nevertheless, no significant differences were observed when the hospitals with both certifications were compared with hospitals with ISO 9001 only. Although the combination of ISO 9001 and the HHCS showed the best results, the benefits were not decisive. Furthermore, although the HHCS include standards addressing patient safety, no direct association was found with regard to compliance. Thus, further investigation is required to understand this enigma. © 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

Cost-effectiveness of health care service delivery interventions in low and middle income countries: a systematic review.

PubMed

Watson, Samuel I; Sahota, Harvir; Taylor, Celia A; Chen, Yen-Fu; Lilford, Richard J

2018-01-01

Low and middle income countries (LMICs) face severe resource limitations but the highest burden of disease. There is a growing evidence base on effective and cost-effective interventions for these diseases. However, questions remain about the most cost-effective method of delivery for these interventions. We aimed to review the scope, quality, and findings of economic evaluations of service delivery interventions in LMICs. We searched PUBMED, MEDLINE, EconLit, and NHS EED for studies published between 1st January 2000 and 30th October 2016 with no language restrictions. We included all economic evaluations that reported incremental costs and benefits or summary measures of the two such as an incremental cost effectiveness ratio. Studies were grouped by both disease area and outcome measure and permutation plots were completed for similar interventions. Quality was judged by the Drummond checklist. Overall, 3818 potentially relevant abstracts were identified of which 101 studies were selected for full text review. Thirty-seven studies were included in the final review. Twenty-three studies reported on interventions we classed as "changing by whom and where care was provided", specifically interventions that entailed task-shifting from doctors to nurses or community health workers or from facilities into the community. Evidence suggests this type of intervention is likely to be cost-effective or cost-saving. Nine studies reported on quality improvement initiatives, which were generally found to be cost-effective. Quality and methods differed widely limiting comparability of the studies and findings. There is significant heterogeneity in the literature, both methodologically and in quality. This renders further comparisons difficult and limits the utility of the available evidence to decision makers.

Older Patients' Perspectives on Quality of Serious Illness Care in Primary Care.

PubMed

Abu Al Hamayel, Nebras; Isenberg, Sarina R; Hannum, Susan M; Sixon, Joshua; Smith, Katherine Clegg; Dy, Sydney M

2018-01-01

Despite increased focus on measuring and improving quality of serious illness care, there has been little emphasis on the primary care context or incorporation of the patient perspective. To explore older patients' perspectives on the quality of serious illness care in primary care. Qualitative interview study. Twenty patients aged 60 or older who were at risk for or living with serious illness and who had participated in the clinic's quality improvement initiative. We used a semistructured, open-ended guide focusing on how older patients perceived quality of serious illness care, particularly in primary care. We transcribed interviews verbatim and inductively identified codes. We identified emergent themes using a thematic and constant comparative method. We identified 5 key themes: (1) the importance of patient-centered communication, (2) coordination of care, (3) the shared decision-making process, (4) clinician competence, and (5) access to care. Communication was an overarching theme that facilitated coordination of care between patients and their clinicians, empowered patients for shared decision-making, related to clinicians' perceived competence, and enabled access to primary and specialty care. Although access to care is not traditionally considered an aspect of quality, patients considered this integral to the quality of care they received. Patients perceived serious illness care as a key aspect of quality in primary care. Efforts to improve quality measurement and implementation of quality improvement initiatives in serious illness care should consider these aspects of care that patients deem important, particularly communication as an overarching priority.

Understanding public preferences for prioritizing health care interventions in England: does the type of health gain matter?

PubMed

Mason, Helen; Baker, Rachel; Donaldson, Cam

2011-04-01

Health care budgets are finite and decisions must be made about which interventions to provide and, by implication, which will not be provided. The aim of this study was to investigate what features of health care interventions, including the type of health gain, are important to members of the public in England in making priority-setting decisions and to understand why. Q methodology was used with 52 members of the public in north east England. Respondents rank ordered 36 health care interventions from those they would give highest priority to through to those they would give lowest priority to. A form of factor analysis was used to reveal a small number of shared viewpoints. Five factors emerged: 'life saving to maximize the size of the health gain', 'everyone deserves a chance at life', '(potential for) own benefit', 'maximum benefit for (perceived) lowest cost' and 'quality of life and social responsibility'. There were different views about which interventions should be given priority. Respondents considered not only the type of health gain received from an intervention as important, but also the size of the health gain, who received the health gain and an individual's personal responsibility. Aspects other than health gain need to be considered when soliciting the public's views of priorities for health care interventions.

Layered stigma among health-care and social service providers toward key affected populations in Jamaica and The Bahamas.

PubMed

Rogers, S J; Tureski, K; Cushnie, A; Brown, A; Bailey, A; Palmer, Q

2014-01-01

While considerable research has documented stigma toward key populations affected by HIV and AIDS - men who have sex with men (MSM), sex workers (SWs) - it provided limited empirical evidence on the presence of layered stigma among health-care professionals providing services for these populations. C-Change conducted a survey among 332 staff of health-care and social service agencies in Jamaica and The Bahamas to understand the levels of stigma toward people living with HIV (PLHIV), including MSM and SWs and factors associated with stigma. While most health-care professionals responding to the survey said that PLHIV, MSM, and SWs deserved quality care, they expressed high levels of blame and negative judgments, especially toward MSM and SWs. Across a stigma assessment involving eight vignette characters, the highest levels of stigma were expressed toward PLHIV who were also MSM or SWs, followed by PLHIV, MSM, and SWs. Differences were assessed by gender, country, type of staff, type of agency, and exposure to relevant training. Findings indicate higher reported stigma among nonclinical vs. clinical staff, staff who worked in general vs. MSM/SW-friendly health facilities, and among untrained vs. training staff. This implies the need for targeted staff capacity strengthening as well as improved facility environments that are MSM/SW-friendly.

Motivating factors among Iranian nurses

PubMed Central

Negarandeh, Reza; Dehghan-Nayeri, Nahid; Ghasemi, Elham

2015-01-01

Background: One of the most important challenges of Iranian health care system is “quality of care,” and it is assumed that motivated nurses are more ready to provide better care. There are limited studies investigating Iranian nurses’ motivations; however, factors which motivate them have not been studied yet. Identifying the motivating factors enables nurse managers to inspire nurses for continuous quality improvement. The aim of this study was to identify motivating factors for Iranian hospital nurses. Materials and Methods: This is a cross-sectional descriptive study in which 310 nurses working at 14 hospitals of Tehran University of Medical Sciences were selected by proportionate stratified random sampling. Data were collected in 2010 by a researcher-developed questionnaire. Descriptive statistics and independent t-test, analysis of variance, Tukey post-hoc test, Chi-Square and Fisher's exact test were used for statistical analysis by Statistical Package for Social Sciences (SPSS) version 16. Results: The mean score of motivation was 90.53 ± 10.76 (range: 59–121). Four motivating factors including “career development” (22.63 ± 5.66), “job characteristics” (34.29 ± 4), “job authority” (18.48 ± 2.79), and “recognition” (15.12 ± 2.5) were recognized. The least mean of the motivation score, considering the number of items, was 3.23 for career development, while the highest mean was 3.81 for job characteristics. Conclusions: The findings showed that motivation of nurses was at a medium level, which calls for improvement. The factors that have the greatest potential to motivate nurses were identified in this study and they can help managers to achieve the goal of continuous quality improvement. PMID:26257797

Does informal care reduce public care expenditure on elderly care? Estimates based on Finland’s Age Study

PubMed Central

2013-01-01

Background To formulate sustainable long-term care policies, it is critical first to understand the relationship between informal care and formal care expenditure. The aim of this paper is to examine to what extent informal care reduces public expenditure on elderly care. Methods Data from a geriatric rehabilitation program conducted in Finland (Age Study, n = 732) were used to estimate the annual public care expenditure on elderly care. We first constructed hierarchical multilevel regression models to determine the factors associated with elderly care expenditure. Second, we calculated the adjusted mean costs of care in four care patterns: 1) informal care only for elderly living alone; 2) informal care only from a co-resident family member; 3) a combination of formal and informal care; and 4) formal care only. We included functional independence and health-related quality of life (15D score) measures into our models. This method standardizes the care needs of a heterogeneous subject group and enabled us to compare expenditure among various care categories even when differences were observed in the subjects’ physical health. Results Elder care that consisted of formal care only had the highest expenditure at 25,300 Euros annually. The combination of formal and informal care had an annual expenditure of 22,300 Euros. If a person received mainly informal care from a co-resident family member, then the annual expenditure was only 4,900 Euros and just 6,000 Euros for a person living alone and receiving informal care. Conclusions Our analysis of a frail elderly Finnish population shows that the availability of informal care considerably reduces public care expenditure. Therefore, informal care should be taken into account when formulating policies for long-term care. The process whereby families choose to provide care for their elderly relatives has a significant impact on long-term care expenditure. PMID:23947622

[To be a woman in Africa. On the danger of being a mother. Mortality].

PubMed

Sow, F

1994-10-01

Losing their life while giving birth is a risk that too many women face. More than 33% of all maternal deaths each year occur in Africa, which has less than 12% of the world's population. 30-60% of deaths among African women aged 15-44 are pregnancy-related. Africa has the highest global maternal mortality rate. Its rural areas have an even greater maternal mortality rate. Common causes of maternal death are hemorrhaging, infections, anemia, vascular-renal problems, and abortion complications. In Asia and Africa, girls receive a lower quality and quantity of food than boys. They are also taken for medical care later and when in a more serious state. The lack of attention directed to medical care in early childhood is extended to adolescence, when girls are exposed to the risks of pregnancy and premature births. The culture protects young single mothers less than young wives. Single mothers hide their pregnancy and avoid medical visits. Others try to terminate the pregnancy. In developing countries, 25% of pregnancies are terminated. Menopausal women in Africa also face health risks (e.g., uterine cancer). Few underequipped health centers, lack of personnel, and the relative high cost of medical fees contribute to high maternal mortality rates. In Burkina Faso in 1985, there was only one gynecologist, one midwife, and one maternity hospital for every 225,000, 6250, and 69,230 women of reproductive age, respectively. Access to quality care is still a luxury. The recent devaluation of the CFA franc and the total destabilization of the zaire only exacerbates the awful status of women's lives in Africa. Priorities should be: ensuring prevention and treatment of obstetrical problems, increasing information on pregnancy risks, making family planning services accessible, and improving the quality of care. The most important priority is to let women have control over their own bodies, sexuality, and fertility. An inalienable right of women is to not have to die during childbirth.

Effects of Carcass Weight and Back-fat Thickness on Carcass Properties of Korean Native Pigs.

PubMed

Kim, Gye-Woong; Kim, Hack-Youn

2017-01-01

Our study analyzed the carcass properties of 170 Korean native pigs in relation to carcass weight and back-fat thickness to provide general data for the production and distribution of high quality pig meat. The 70-74 kg group showed highest yield (73.41%). The ≥80 kg group showed the highest thickest back-fat (24.13 mm) ( p <0.05). The ≥80 kg group showed the best quality grade (1.00). Back-fat thickness showed significant differences in the weight among groups ( p <0.05). The ≥25 mm group showed the highest carcass weight (75.93 kg). The thickest back-fat group (≥25 mm) showed the highest yield (73.03%). There were significant differences in back-fat thickness among groups ( p <0.05), and the ≥25 mm group showed the highest thickness back-fat (27.60 mm). We found a strong positive correlation between carcass weight and back-fat thickness (r=0.346) as well as meat quality grade (r=0.739). Back-fat thickness had a relatively strong positive correlation with meat quality grade (r=0.444). Therefore, there are required to manage the breeding through selection of excellent native species for increasing their carcass weight and enhance meat quality.

Effects of Carcass Weight and Back-fat Thickness on Carcass Properties of Korean Native Pigs

PubMed Central

2017-01-01

Our study analyzed the carcass properties of 170 Korean native pigs in relation to carcass weight and back-fat thickness to provide general data for the production and distribution of high quality pig meat. The 70-74 kg group showed highest yield (73.41%). The ≥80 kg group showed the highest thickest back-fat (24.13 mm) (p<0.05). The ≥80 kg group showed the best quality grade (1.00). Back-fat thickness showed significant differences in the weight among groups (p<0.05). The ≥25 mm group showed the highest carcass weight (75.93 kg). The thickest back-fat group (≥25 mm) showed the highest yield (73.03%). There were significant differences in back-fat thickness among groups (p<0.05), and the ≥25 mm group showed the highest thickness back-fat (27.60 mm). We found a strong positive correlation between carcass weight and back-fat thickness (r=0.346) as well as meat quality grade (r=0.739). Back-fat thickness had a relatively strong positive correlation with meat quality grade (r=0.444). Therefore, there are required to manage the breeding through selection of excellent native species for increasing their carcass weight and enhance meat quality. PMID:28747824

How to build and evaluate an integrated health care system for chronic patients: study design of a clustered randomised controlled trial in rural China.

PubMed

Tang, Wenxi; Sun, Xiaowei; Zhang, Yan; Ye, Ting; Zhang, Liang

2015-01-01

While integrated health care system has been proved an effective way to help improving patient health and system efficiency, the exact behaviour model and motivation approach are not so clear in poor rural areas where health human resources and continuous service provision are urgently needed. To gather solid evidence, we initiated a comprehensive intervention project in Qianjiang District, southwest part of rural China in 2012. And after one-year's pilot, we developed an intervention package of team service, comprehensive pathway and prospective- and performance-based payment system. To testify the potential influence of payment interventions, we use clustered randomised controlled trial, 60 clusters are grouped into two treatment groups and one control group to compare the time and group differences. Difference-in-differences model and structural equation modelling will be used to analyse the intervention effects and pathway. The outcomes are: quality of care, disease burden, supplier cooperative behaviour and patient utilisation behaviour and system efficiency. Repeated multivariate variance analysis will be used to statistically examine the outcome differences. This is the first trial of its kind to prove the effects and efficiency of integrated care. Though we adopted randomised controlled trial to gather the highest rank of evidence, still the fully randomisation was hard to realise in health policy reform experiment. To compensate, the designer should take efforts on control for the potential confounders as much as possible. With this trial, we assume the effects will come from: (1) improvement on the quality of life through risk factors control and lifestyles change on patient's behaviours; (2) improvement on quality of care through continuous care and coordinated supplier behaviours; (3) improvement on the system efficiency through active interaction between suppliers and patients. The integrated care system needs collaborative work from different levels of caregivers. So it is extremely important to consider the supplier cooperative behaviour. In this trial, we introduced payment system to help the delivery system integration through providing financial incentives to motivate people to play their roles. Also, the multidisciplinary team, the multi-institutional pathway and system global budget and pay-for-performance payment system could afford as a solution.

How to build and evaluate an integrated health care system for chronic patients: study design of a clustered randomised controlled trial in rural China

PubMed Central

Tang, Wenxi; Sun, Xiaowei; Zhang, Yan; Ye, Ting; Zhang, Liang

2015-01-01

Background While integrated health care system has been proved an effective way to help improving patient health and system efficiency, the exact behaviour model and motivation approach are not so clear in poor rural areas where health human resources and continuous service provision are urgently needed. To gather solid evidence, we initiated a comprehensive intervention project in Qianjiang District, southwest part of rural China in 2012. And after one-year's pilot, we developed an intervention package of team service, comprehensive pathway and prospective- and performance-based payment system. Methods To testify the potential influence of payment interventions, we use clustered randomised controlled trial, 60 clusters are grouped into two treatment groups and one control group to compare the time and group differences. Difference-in-differences model and structural equation modelling will be used to analyse the intervention effects and pathway. The outcomes are: quality of care, disease burden, supplier cooperative behaviour and patient utilisation behaviour and system efficiency. Repeated multivariate variance analysis will be used to statistically examine the outcome differences. Discussion This is the first trial of its kind to prove the effects and efficiency of integrated care. Though we adopted randomised controlled trial to gather the highest rank of evidence, still the fully randomisation was hard to realise in health policy reform experiment. To compensate, the designer should take efforts on control for the potential confounders as much as possible. With this trial, we assume the effects will come from: (1) improvement on the quality of life through risk factors control and lifestyles change on patient's behaviours; (2) improvement on quality of care through continuous care and coordinated supplier behaviours; (3) improvement on the system efficiency through active interaction between suppliers and patients. Conclusion The integrated care system needs collaborative work from different levels of caregivers. So it is extremely important to consider the supplier cooperative behaviour. In this trial, we introduced payment system to help the delivery system integration through providing financial incentives to motivate people to play their roles. Also, the multidisciplinary team, the multi-institutional pathway and system global budget and pay-for-performance payment system could afford as a solution. PMID:26034466

Nurse Reported Quality of Care: A Measure of Hospital Quality

PubMed Central

McHugh, Matthew D.; Stimpfel, Amy Witkoski

2013-01-01

As the primary providers of round-the-clock bedside care, nurses are well positioned to report on hospital quality of care. Researchers have not examined how nurses’ reports of quality correspond with standard process or outcomes measures of quality. We assess the validity of evaluating hospital quality by aggregating hospital nurses’ responses to a single item that asks them to report on quality of care. We found that a 10% increment in the proportion of nurses reporting excellent quality of care was associated with lower odds of mortality and failure to rescue; greater patient satisfaction; and higher composite process of care scores for acute myocardial infarction, pneumonia, and surgical patients. Nurse reported quality of care is a useful indicator of hospital performance. PMID:22911102

Self-rated competency and education/programming needs for Care of the Older Adult with Cardiovascular Disease: a survey of the members of the Council of Cardiovascular Nursing.

PubMed

Holm, Karyn; Chyun, Deborah; Lanuza, Dorothy M

2006-01-01

An online survey, Care of the Older Adult with Cardiovascular Disease (COA-CVD), was used to describe self-rated competency in the care of the aging adult with cardiovascular disease and subsequently determine the future education and programming needs of the Council of Cardiovascular Nursing. Respondents indicated that developing relationships, patient teaching, and assessment were areas where they felt most competent. The areas of highest priority for future programming included assessment of the older adult, diagnosis of health status, deriving a plan of care, implementing a treatment plan, patient teaching, and ensuring quality care. Most stated that content relative to the care of the older adult should be available at the annual meeting, Scientific Sessions of the American Heart Association, followed by self-study modules (65%), local and regional conferences (64%), and stand-alone national conferences (53%). The conclusions are that the Council of Cardiovascular Nursing and its membership need to address the importance of care of aging adults with cardiovascular disease and stroke in future programming. Although the Scientific Sessions of the American Heart Association is an appropriate venue, efforts can be directed toward developing self-study modules and local and regional conferences. As always, there is a need to work collaboratively with the other councils of the American Heart Association and other nursing organizations who view the care of the older adult as a high priority.

Who's your best customer?

PubMed

MacStravic, S

1998-01-01

Conventional wisdom holds that the best customers and prospects for managed care are the healthiest consumers. This is true only because of the meager extent to which premiums can be adjusted for varying risk among individuals. If a decent health/risk adjustment system were used, the best consumers for managed care to go after would be the highest-risk, highest users of health care, provided only that risk and use can be improved. The healthiest consumers have both the least potential for improvement and the least reasons for loyalty.

Variation in Quality of Urgent Health Care Provided During Commercial Virtual Visits.

PubMed

Schoenfeld, Adam J; Davies, Jason M; Marafino, Ben J; Dean, Mitzi; DeJong, Colette; Bardach, Naomi S; Kazi, Dhruv S; Boscardin, W John; Lin, Grace A; Duseja, Reena; Mei, Y John; Mehrotra, Ateev; Dudley, R Adams

2016-05-01

Commercial virtual visits are an increasingly popular model of health care for the management of common acute illnesses. In commercial virtual visits, patients access a website to be connected synchronously-via videoconference, telephone, or webchat-to a physician with whom they have no prior relationship. To date, whether the care delivered through those websites is similar or quality varies among the sites has not been assessed. To assess the variation in the quality of urgent health care among virtual visit companies. This audit study used 67 trained standardized patients who presented to commercial virtual visit companies with the following 6 common acute illnesses: ankle pain, streptococcal pharyngitis, viral pharyngitis, acute rhinosinusitis, low back pain, and recurrent female urinary tract infection. The 8 commercial virtual visit websites with the highest web traffic were selected for audit, for a total of 599 visits. Data were collected from May 1, 2013, to July 30, 2014, and analyzed from July 1, 2014, to September 1, 2015. Completeness of histories and physical examinations, the correct diagnosis (vs an incorrect or no diagnosis), and adherence to guidelines of key management decisions. Sixty-seven standardized patients completed 599 commercial virtual visits during the study period. Histories and physical examinations were complete in 417 visits (69.6%; 95% CI, 67.7%-71.6%); diagnoses were correctly named in 458 visits (76.5%; 95% CI, 72.9%-79.9%), and key management decisions were adherent to guidelines in 325 visits (54.3%; 95% CI, 50.2%-58.3%). Rates of guideline-adherent care ranged from 206 visits (34.4%) to 396 visits (66.1%) across the 8 websites. Variation across websites was significantly greater for viral pharyngitis and acute rhinosinusitis (adjusted rates, 12.8% to 82.1%) than for streptococcal pharyngitis and low back pain (adjusted rates, 74.6% to 96.5%) or ankle pain and recurrent urinary tract infection (adjusted rates, 3.4% to 40.4%). No statistically significant variation in guideline adherence by mode of communication (videoconference vs telephone vs webchat) was found. Significant variation in quality was found among companies providing virtual visits for management of common acute illnesses. More variation was found in performance for some conditions than for others, but no variation by mode of communication.

Quality Indicators for Evaluating Prehospital Emergency Care: A Scoping Review.

PubMed

Howard, Ian; Cameron, Peter; Wallis, Lee; Castren, Maaret; Lindstrom, Veronica

2018-02-01

Introduction Historically, the quality and performance of prehospital emergency care (PEC) has been assessed largely based on surrogate, non-clinical endpoints such as response time intervals or other crude measures of care (eg, stakeholder satisfaction). However, advances in Emergency Medical Services (EMS) systems and services world-wide have seen their scope and reach continue to expand. This has dictated that novel measures of performance be implemented to compliment this growth. Significant progress has been made in this area, largely in the form of the development of evidence-informed quality indicators (QIs) of PEC. Problem Quality indicators represent an increasingly popular component of health care quality and performance measurement. However, little is known about the development of QIs in the PEC environment. The purpose of this study was to assess the development and characteristics of PEC-specific QIs in the literature. A scoping review was conducted through a search of PubMed (National Center for Biotechnology Information, National Institutes of Health; Bethesda, Maryland USA); EMBase (Elsevier; Amsterdam, Netherlands); CINAHL (EBSCO Information Services; Ipswich, Massachusetts USA); Web of Science (Thomson Reuters; New York, New York USA); and the Cochrane Library (The Cochrane Collaboration; Oxford, United Kingdom). To increase the sensitivity of the literature, a search of the grey literature and review of select websites was additionally conducted. Articles were selected that proposed at least one PEC QI and whose aim was to discuss, analyze, or promote quality measurement in the PEC environment. The majority of research (n=25 articles) was published within the last decade (68.0%) and largely originated within the USA (68.0%). Delphi and observational methodologies were the most commonly employed for QI development (28.0%). A total of 331 QIs were identified via the article review, with an additional 15 QIs identified via the website review. Of all, 42.8% were categorized as primarily Clinical, with Out-of-Hospital Cardiac Arrest contributing the highest number within this domain (30.4%). Of the QIs categorized as Non-Clinical (57.2%), Time-Based Intervals contributed the greatest number (28.8%). Population on Whom the Data Collection was Constructed made up the most commonly reported QI component (79.8%), followed by a Descriptive Statement (63.6%). Least reported were Timing of Data Collection (12.1%) and Timing of Reporting (12.1%). Pilot testing of the QIs was reported on 34.7% of QIs identified in the review. Overall, there is considerable interest in the understanding and development of PEC quality measurement. However, closer attention to the details and reporting of QIs is required for research of this type to be more easily extrapolated and generalized. Howard I , Cameron P , Wallis L , Castren M , Lindstrom V . Quality indicators for evaluating prehospital emergency care: a scoping review. Prehosp Disaster Med. 2018;33(1):43-52.

Redefining Health: The Evolution of Health Ideas from Antiquity to the Era of Value-Based Care.

PubMed

Badash, Ido; Kleinman, Nicole P; Barr, Stephanie; Jang, Julie; Rahman, Suraiya; Wu, Brian W

2017-02-09

The current healthcare system in the United States (US) is characterized by high costs and poor patient outcomes. A value-based healthcare system, centered on providing the highest quality of care for the lowest cost, is the country's chosen solution for its healthcare crisis. As the US transitions to a value-based model, a new definition of health is necessary to clearly define what constitutes a healthy state. However, such a definition is impossible to develop without a proper understanding of what "health" actually means. To truly understand its meaning, one must have a thorough historical understanding of the changes in the concept of health and how it has evolved to reflect the beliefs and scientific understanding of each time period. Thus, this review summarizes the changes in the definition of health over time in order to provide a context for the definition needed today. We then propose a new definition of health that is specifically tailored to providers working in the era of value-based care.

Redefining Health: The Evolution of Health Ideas from Antiquity to the Era of Value-Based Care

PubMed Central

Kleinman, Nicole P; Barr, Stephanie; Jang, Julie; Rahman, Suraiya; Wu, Brian W

2017-01-01

The current healthcare system in the United States (US) is characterized by high costs and poor patient outcomes. A value-based healthcare system, centered on providing the highest quality of care for the lowest cost, is the country’s chosen solution for its healthcare crisis. As the US transitions to a value-based model, a new definition of health is necessary to clearly define what constitutes a healthy state. However, such a definition is impossible to develop without a proper understanding of what “health” actually means. To truly understand its meaning, one must have a thorough historical understanding of the changes in the concept of health and how it has evolved to reflect the beliefs and scientific understanding of each time period. Thus, this review summarizes the changes in the definition of health over time in order to provide a context for the definition needed today. We then propose a new definition of health that is specifically tailored to providers working in the era of value-based care.  PMID:28348937

[Mobile emergency care medical records audit: the need for Tunisian guidelines].

PubMed

Mallouli, Manel; Hchaichi, Imen; Ammar, Asma; Sehli, Jihène; Zedini, Chekib; Mtiraoui, Ali; Ajmi, Thouraya

2017-03-06

Objective: This study was designed to assess the quality of the Gabès (Tunisia) mobile emergency care medical records and propose corrective actions.Materials and methods: A clinical audit was performed at the Gabès mobile emergency care unit (SMUR). Records of day, night and weekend primary and secondary interventions during the first half of 2014 were analysed according to a data collection grid comprising 56 criteria based on the SMUR guidelines and the 2013 French Society of Emergency Medicine evaluation guide. A non-conformance score was calculated for each section.Results: 415 medical records were analysed. The highest non-conformance rates (48.5%) concerned the “specificities of the emergency medical record” section. The lowest non-conformance rates concerned the surveillance data section (23.4%). The non-conformance score for the medical data audit was 24%.Conclusion: This audit identified minor dysfunctions that could be due to the absence of local guidelines concerning medical records in general and more specifically SMUR. Corrective measures were set up in the context of a short-term and intermediate-term action plan.

Patterns and predictors of patient and caregiver engagement in heart failure care: a multi-level dyadic study.

PubMed

Lee, Christopher S; Vellone, Ercole; Lyons, Karen S; Cocchieri, Antonello; Bidwell, Julie T; D'Agostino, Fabio; Hiatt, Shirin O; Alvaro, Rosaria; Buck, Harleah G; Riegel, Barbara

2015-02-01

Heart failure is a burdensome clinical syndrome, and patients and their caregivers are responsible for the vast majority of heart failure care. This study aimed to characterize naturally occurring archetypes of patient-caregiver dyads with respect to patient and caregiver contributions to heart failure self-care, and to identify patient-, caregiver- and dyadic-level determinants thereof. Dyadic analysis of cross-sectional data on patients and their caregivers. Outpatient heart failure clinics in 28 Italian provinces. 509 Italian heart failure patients and their primary caregivers. Multilevel and mixture modeling were used to generate dyadic averages and incongruence in patient and caregiver contributions to heart failure self-care and identify common dyadic archetypes, respectively. Three distinct archetypes were observed. 22.4% of dyads were labeled as novice and complementary because patients and caregivers contributed to different aspects of heart failure self-care that was generally poor; these dyads were predominantly older adults with less severe heart failure and their adult child caregivers. 56.4% of dyads were labeled as inconsistent and compensatory because caregivers reported greater contributions to the areas of self-care most insufficient on the part of the patients; patients in these dyads had the highest prevalence of hospitalizations for heart failure in the past year and the fewest limitations to performing activities of daily living independently. Finally, 21.2% of dyads were labeled as expert and collaborative because of high contributions to all aspects of heart failure self-care, the best relationship quality and lowest caregiver strain compared with the other archetypes; patients in this archetype were likely the sickest because they also had the worst heart failure-related quality of life. Three distinct archetypes of dyadic contributions to heart failure care were observed that represent a gradient in the level of contributions to self-care, in addition to different approaches to working together to manage heart failure. Interventions and clinical programs that involve heart failure dyads should tailor strategies to take into consideration these distinct archetypes and their attributes. Copyright © 2014 Elsevier Ltd. All rights reserved.