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Sample records for quality perinatal care

  1. Quality-of-care audits and perinatal mortality in South Africa

    Directory of Open Access Journals (Sweden)

    Emma R Allanson

    2015-06-01

    Full Text Available Abstract Problem Suboptimal care contributes to perinatal mortality rates. Quality-of-care audits can be used to identify and change suboptimal care, but it is not known if such audits have reduced perinatal mortality in South Africa. Approach We investigated perinatal mortality trends in health facilities that had completed at least five years of quality-of-care audits. In a subset of facilities that began audits from 2006, we analysed modifiable factors that may have contributed to perinatal deaths. Local setting Since the 1990s, the perinatal problem identification programme has performed quality-of-care audits in South Africa to record perinatal deaths, identify modifiable factors and motivate change. Relevant changes Five years of continuous audits were available for 163 facilities. Perinatal mortality rates decreased in 48 facilities (29% and increased in 52 (32%. Among the subset of facilities that began audits in 2006, there was a decrease in perinatal mortality of 30% (16/54 but an increase in 35% (19/54. Facilities with increasing perinatal mortality were more likely to identify the following contributing factors: patient delay in seeking help when a baby was ill (odds ratio, OR: 4.67; 95% confidence interval, CI: 1.99-10.97; lack of use of antenatal steroids (OR: 9.57; 95% CI: 2.97-30.81; lack of nursing personnel (OR: 2.67; 95% CI: 1.34-5.33; fetal distress not detected antepartum when the fetus is monitored (OR: 2.92; 95% CI: 1.47-5.8 and poor progress in labour with incorrect interpretation of the partogram (OR: 2.77; 95% CI: 1.43-5.34. Lessons learnt Quality-of-care audits were not shown to improve perinatal mortality in this study.

  2. Quality-of-care audits and perinatal mortality in South Africa / ????? ???????? ??????????? ?????? ? ????????????? ?????????? ? ????? ?????? / Contrôle de la qualité des soins et mortalité périnatale en Afrique du Sud / ?????? ???? ??????? ???????? ??????? ???????? ?? ???? ??????? / ?????????????????? / Verificación de la calidad de la asistencia y mortalidad perinatal en Sudáfrica

    Scientific Electronic Library Online (English)

    Emma R, Allanson; Robert C, Pattinson.

    2015-06-01

    Full Text Available Resumen Situación El cuidado por debajo del nivel óptimo contribuye a las tasas de mortalidad perinatal. Las verificaciones de la calidad de la asistencia se puede utilizar para identificar y cambiar el cuidado por debajo del nivel óptimo, pero no se sabe si tales verificaciones han reducido la mort [...] alidad perinatal en Sudáfrica. Enfoque Se investigaron las tendencias de mortalidad perinatal en centros de salud que habían completado por lo menos cinco años de verificaciones de la calidad de la asistencia. En un subgrupo de centros que empezaron las verificaciones en 2006, se analizaron los factores modificables que podrían haber contribuido a las muertes perinatales. Marco regional Desde la década de 1990, el programa de identificación del problema perinatal ha realizado verificaciones de la calidad de la asistencia en Sudáfrica para registrar las muertes perinatales, identificar los factores modificables y estimular el cambio. Cambios importantes Cinco años de verificaciones continuas estuvieron disponibles para 163 centros. Las tasas de mortalidad perinatal disminuyeron en 48 centros (28%) y aumentaron en 52 (32%). En el subgrupo de centros que empezó la verificación en 2006, hubo una disminución en la mortalidad perinatal del 30% (16/54), pero un aumento del 35% (19/54). Los centros con una mortalidad perinatal en aumento tenían una mayor probabilidad de identificar los siguientes factores: retraso de los pacientes en la búsqueda de ayuda cuando un niño enfermaba (cociente de posibilidades, CP: 4,67; intervalo de confianza, IC, del 95%: 1,99-10,97); falta de uso de asteroides prenatales (CP: 9,57 (IC del 95%: 2,97-30,81); falta de personal de enfermería (CP: 2,67 (IC del 95%: 1,34-5,33); septicemia neonatal no identificada antes del parto durante el control del feto (CP: 2,92 (IC del 95%: 1,47-5,8) y escasos progresos en el parto con una interpretación incorrecta del partograma (CP: 2,77 (IC del 95%: 1,43-5,34). Lecciones aprendidas Las verificaciones de la calidad de la asistencia no ha mostrado mejoras en la mortalidad perinatal en este estudio. Abstract in english Abstract Problem Suboptimal care contributes to perinatal mortality rates. Quality-of-care audits can be used to identify and change suboptimal care, but it is not known if such audits have reduced perinatal mortality in South Africa. Approach We investigated perinatal mortality trends in health fac [...] ilities that had completed at least five years of quality-of-care audits. In a subset of facilities that began audits from 2006, we analysed modifiable factors that may have contributed to perinatal deaths. Local setting Since the 1990s, the perinatal problem identification programme has performed quality-of-care audits in South Africa to record perinatal deaths, identify modifiable factors and motivate change. Relevant changes Five years of continuous audits were available for 163 facilities. Perinatal mortality rates decreased in 48 facilities (29%) and increased in 52 (32%). Among the subset of facilities that began audits in 2006, there was a decrease in perinatal mortality of 30% (16/54) but an increase in 35% (19/54). Facilities with increasing perinatal mortality were more likely to identify the following contributing factors: patient delay in seeking help when a baby was ill (odds ratio, OR: 4.67; 95% confidence interval, CI: 1.99-10.97); lack of use of antenatal steroids (OR: 9.57; 95% CI: 2.97-30.81); lack of nursing personnel (OR: 2.67; 95% CI: 1.34-5.33); fetal distress not detected antepartum when the fetus is monitored (OR: 2.92; 95% CI: 1.47-5.8) and poor progress in labour with incorrect interpretation of the partogram (OR: 2.77; 95% CI: 1.43-5.34). Lessons learnt Quality-of-care audits were not shown to improve perinatal mortality in this study.

  3. High risk perinatal care in California.

    Science.gov (United States)

    Hawes, W E; Hodgman, J

    1976-01-01

    Rates of perinatal mortality are still too high in California. Mortality and morbidity, particularly for high risk pregnancies, can be reduced by the use of modern technology in the hands of highly trained personnel. New goals for perinatal care have been published by the California Medical Association reflecting these changes. This kind of care is too costly to be developed in all the small obstetric units presently providing services in California. Consolidation of obstetric and neonatal units into fewer hospitals can make it economically possible for these units to meet present-day standards. PMID:1251608

  4. Avaliação da qualidade da informação do Sistema de Informação Perinatal (SIP-CLAP /OPAS) para monitoramento da assistência perinatal hospitalar, Belo Horizonte, 2004 / Assessment of the quality of information from the Perinatal Information System (SIP-CLAP/OPAS) used to monitor hospital perinatal care, Belo Horizonte, 2004

    Scientific Electronic Library Online (English)

    Maria Albertina Santiago, Rego; Elisabeth Barboza, França; Deise Campos Cardoso, Afonso.

    2009-09-01

    Full Text Available OBJETIVO: avaliar a qualidade da informação do SIP-CLAP/OPAS em maternidades de Belo Horizonte. MÉTODOS: para avaliação da completude foi analisada amostra aleatória sistemática de 562 formulários SIP e prontuários médicos correspondentes, coletados durante a assistência em duas maternidades, em 200 [...] 4. Uma subamostra de 20% foi utilizada para avaliação da confiabilidade do banco de dados eletrônico do programa. Foram calculadas proporções de completude antes e após resgate da informação disponível em prontuário, e o índice Kappa e o coeficiente de correlação intraclasse (ICC), com nível de significância de 5%, para análise da concordância. RESULTADOS: a completude de variáveis do SIP durante a assistência foi em média 72% no Hospital 1 e 86% no Hospital 2. O ganho médio percentual após busca da informação em prontuários foi de 18% e 7%, respectivamente. Foram observados índices muito bons de concordância nos dois hospitais. CONCLUSÕES: o SIP-CLAP representa uma alternativa para monitoramento da assistência hospitalar perinatal, mas apresenta problemas para sua utilização adequada, pois a completude avaliada durante a assistência não foi satisfatória. São necessários investimentos para o aprimoramento do programa nos hospitais, fundamentais para obtenção de indicadores essenciais para a qualificação da assistência hospitalar ao parto e nascimento. Abstract in english OBJECTIVE: to assess the quality of information from the SIP-CLAP/OPAS in maternity hospitals in Belo Horizonte. METHODS: completeness was assessed by analyzing a systematic random sample of 562 SIP forms and the corresponding medical records, collected while care was being given at two maternity ho [...] spitals in 2004. A sub-sample of 20% was used to evaluate the reliability of the program's electronic database. Proportions were calculated for completeness before and after recovery of information available on medical records, along with the kappa index and the intra-class correlation coefficient (ICC), with a level of significance of 5%, for analysis of agreement. RESULTS: the completeness of SIP variables while care was being given was on average 72% in Hospital 1 and 86% in Hospital 2. The average increase after recovering the information in medical records was of 18% and 7%, respectively. A good level of agreement was found at both hospitals. CONCLUSIONS: although the SIP-CLAP represents an alternative way of monitoring perinatal hospital care, there are still some problems regarding it's adequate use, as completeness of the data evaluated during care was not completely satisfactory. Investments are necessary to improve the program's use in hospitals, in order to obtain essential indicators to qualify perinatal hospital care.

  5. Applying a science-based method to improve perinatal care: the institute for healthcare improvement perinatal improvement community.

    Science.gov (United States)

    Bisognano, Maureen; Cherouny, Peter H; Gullo, Sue

    2014-10-01

    The Institute for Healthcare Improvement applies a systems-focused, science-based approach to improving perinatal care. This approach is based on the pioneering work in quality improvement and statistical process control performed by Walter Shewhart and W. Edwards Deming, and it uses the Model for Improvement, a simple and effective tool for accelerating improvement. In 2008, the Institute for Healthcare Improvement articulated a Triple Aim for improvement-better care, better health for populations, and lower per capita costs. The Triple Aim has become a guiding framework throughout health care and also guides much of the work of the Institute for Healthcare Improvement. The Institute for Healthcare Improvement's collaborative effort to improve perinatal care-the Perinatal Improvement Community-is an ideal example of work that pursues all three dimensions of the Triple Aim. The improvement method used in the community creates the foundation for the kind of cultural transformation that Perinatal Improvement Community leaders and participants have learned is necessary to make significant and lasting change. Using a systems-focused and science-based approach to improvement equips obstetricians and gynecologists with the knowledge, skills, and tools they need to improve the systems of care they work in so they can deliver the best evidence-based care to all of their patients, all of the time. PMID:25198257

  6. Control prenatal vs resultado obstétrico perinatal / Prenatal care vs obstetric outcome perinatal

    Scientific Electronic Library Online (English)

    R.M., Rico Venegas; V.M., Ramos Frausto; P.C., Martínez.

    2012-07-01

    Full Text Available La cobertura del control prenatal, calidad, y atención del parto se refleja en la resolución obstétrica como en la morbi-mortalidad del binomio madre-hijo. Esta investigación aborda el problema del impacto de los controles prenatales sobre el resultado obstétrico y perinatal. Objetivo: conocer el im [...] pacto del control prenatal sobre los resultados obstétricos obtenidos. Material y método: mediante un estudio de cohortes reconstruidas en una población obtenida azarosamente por conglomerados diarios en el transcurso del mes de junio (2010), se obtuvieron 419 puérperas. El material de investigación fue el binomio madre-hijo. Algunas variables estudiadas fueron: edad, control prenatal, número de consultas, peso, talla, tensión arterial, medición fondo uterino, forma de término del embarazo, peso del producto, sexo, apgar, destino del producto, complicaciones maternas, etc. Se utilizo en el programa estadístico Riesgo® y Primer® obteniéndose el RR, RR con intervalo de confianza al 95%. Resultados. Se analizaron 395 productos mayores de 20 semanas y 35 menores, de los productos mayores de 20 semanas (f=355) tuvieron sus madres control prenatal (89.87%) y 40 no lo tuvieron (10.13%), las distocias fueron más frecuentes en las madres con control prenatal, X²=7.73 RR=1.45 IC95% 1.11-1.90, las complicaciones maternas tuvieron proporciones similares en madres con y sin control prenatal X² = 0.0091RR=0.96, diferencia de proporciones p=0.899, la enfermedad hipertensiva del embarazo fue la complicación mas frecuente (74.6% de ellas) sin haber diferencia entre las madres que tuvieron o no control prenatal X² =0.0010. Conclusión: Los resultados obtenidos señalan que en este grupo estudiado, en particular, la presencia del control prenatal no representó un factor que ayude a una resolución obstétrica y perinatal favorable, excepto en la prevención de la macrosomía. Abstract in english The coverage of prenatal care, quality and delivery care is reflected in the resolution as obstetric morbidity andmortality of mother and child. This research addresses the issue of the impact of prenatal care on the obstetric and perinatal outcome. Objective: To determine the impact of prenatal car [...] e on obstetric out comes achieved. Material and method: using a reconstructed cohort study in a population cluster randomly obtained daily duringthe month of June (2010), 419 were women in labour. The research material was the mother-child. Some ofthe studied variables were age, prenatal care, number of visits, weight, height, blood pressure, fundalmeasurement, method of pregnancy termination, product weight, sex, apgar, destination of the product, maternal complications, etc. It was used in the statistical program Primer® Risk® obtaining the RR, RR with aconfidence interval of 95%. Results: 395 products were analysed over 20 weeks and 35 children, of the goods over 20 weeks (f = 355) mothers had prenatal care (89.87%) and 40 did not have it (10.13%), dystocia were more common in mothers with prenatal care, X² = 7.73 RR = 1.45 95% CI 1.11-1.90, maternal complications were similar proportions in mothers with and without prenatal X² = 0.0091 RR = 0.96, difference in proportions p = 0.899, hypertensive disease of pregnancy was the most frequent complication (74.6% of them) without difference between themothers had no prenatal care or X² = 0.0010. Conclusion: Our results indicate that in this particular group studied, the presence of prenatal care is not afactor that helps an obstetric resolution and favourable perinatal, except for the macrosomia prevention.

  7. Eclampsia: maternal and perinatal outcomes in a tertiary care centre

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    Sunita Mor

    2015-06-01

    Conclusions: Eclampsia is one of the important causes of maternal and perinatal morbidity and mortality due to lack of proper antenatal care, low socio-economic status and lack of education. Early attention and intensive management are essential for improving the maternal and fetal outcomes. Unless the social and educational status of women is uplifted and obstetric care is brought to the doorstep, no miracle can be expected. [Int J Reprod Contracept Obstet Gynecol 2015; 4(3.000: 653-657

  8. Mortalidade perinatal por sífilis congênita: indicador da qualidade da atenção à mulher e à criança Perinatal mortality due to congenital syphilis: a quality-of-care indicator for women's and children's healthcare

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    Valéria Saraceni

    2005-08-01

    Full Text Available A sífilis permanece como causa importante de mortalidade perinatal no Município do Rio de Janeiro, Brasil, onde o presente estudo foi realizado utilizando os dados do Sistema de Informação de Mortalidade e das Fichas de Notificação e Investigação de Óbitos Fetais e Neonatais, obrigatórias para as maternidades municipais. Entre 1996 e 1998, a sífilis congênita foi responsável por 13,1% dos óbitos fetais e 6,5% dos neonatais nas maternidades municipais. Entre 1999 e 2002, os percentuais foram de 16,2% e 7,9%, respectivamente. Para o Município do Rio de Janeiro, de 1999 a 2002, os percentuais foram 5,4% e 2,2%, para óbitos fetais e neonatais. A taxa de mortalidade perinatal por sífilis congênita permanece estável no Município do Rio de Janeiro apesar dos esforços iniciados com as campanhas para eliminação do agravo em 1999 e 2000. Propomos a utilização da taxa de mortalidade perinatal por sífilis congênita como indicador de impacto das ações de controle e eliminação da sífilis congênita e sugerimos a utilização das fichas de notificação e investigação de óbitos fetais e neonatais para a vigilância de outros agravos evitáveis.Syphilis is a persistent cause of perinatal mortality in Rio de Janeiro, Brazil, where this study was performed using data from the mortality data system and investigational reports for fetal and neonatal deaths, mandatory in municipal maternity hospitals. From 1996 to 1998, 13.1% of fetal deaths and 6.5% of neonatal deaths in municipal maternity hospitals were due to congenital syphilis. From 1999 to 2002, the proportions were 16.2% and 7.9%, respectively. For the city of Rio de Janeiro as a whole from 1999 and 2002, the proportions were 5.4% of fetal deaths and 2.2% of neonatal deaths. The perinatal mortality rate due to congenital syphilis remains stable in Rio de Janeiro, despite efforts initiated with congenital syphilis elimination campaigns in 1999 and 2000. We propose that the perinatal mortality rate due to congenital syphilis be used as an impact indicator for activities to control and eliminate congenital syphilis, based on the investigational reports for fetal and neonatal deaths. Such reports could be extended to the surveillance of other avoidable perinatal disease outcomes.

  9. Allocation of health care resources in the neonatal and perinatal area –CPS Symposium 1996

    OpenAIRE

    McMillan, DD; Lee, SK; Serediak, M; Finn, JG; Saigal, S.; Walker, CR

    1999-01-01

    There have been publically expressed concerns about the costs and allocation of neonatal and perinatal health care resources in Canada and elsewhere for the past 15 years. This paper reports information from a symposium held during the 1996 Canadian Paediatric Society (CPS) annual meeting sponsored by the CPS Section on Perinatal Medicine. Experts in perinatal epidemiology, health care economics, public policy and finance, and consumer perspectives on the outcomes of neonatal and perinatal in...

  10. Mortalidade perinatal por sífilis congênita: indicador da qualidade da atenção à mulher e à criança Perinatal mortality due to congenital syphilis: a quality-of-care indicator for women's and children's healthcare

    OpenAIRE

    Valéria Saraceni; Maria Helena Freitas da Silva Guimarães; Mariza Miranda Theme Filha; Maria do Carmo Leal

    2005-01-01

    A sífilis permanece como causa importante de mortalidade perinatal no Município do Rio de Janeiro, Brasil, onde o presente estudo foi realizado utilizando os dados do Sistema de Informação de Mortalidade e das Fichas de Notificação e Investigação de Óbitos Fetais e Neonatais, obrigatórias para as maternidades municipais. Entre 1996 e 1998, a sífilis congênita foi responsável por 13,1% dos óbitos fetais e 6,5% dos neonatais nas maternidades municipais. Entre 1999 e 2002, os percentuais foram d...

  11. Pregnancy care in two adolescents perinatally infected with HIV.

    OpenAIRE

    Meloni, Alessandra; Tuveri, Milena; Floridia, Marco; Zucca, Francesca; Borghero, Grazia; Gariel, Donatella; Melis, Gian Benedetto

    2009-01-01

    Abstract We describe the main issues encountered in pregnancy care in two perinatally infected adolescents with HIV. Despite the young maternal age, both mothers complied well with visits and treatment during pregnancy and delivered at week 38 through elective caesarean section. Both, however, missed the regular gynaecological and the routine HIV visits scheduled after pregnancy. Both infants following HIV exposure were confirmed HIV negative at the end of tests performed in the fi...

  12. Cuidado perinatal según la opinión de las mujeres procedentes de la región de Podkarpacie (Polonia) / Perinatal care in the opinion of residents of the village of Podkarpacie (Poland)

    Scientific Electronic Library Online (English)

    Laura, Lorén Guerrero; Edyta, Barna& #347; ; Karolina, Kochma& #324; ska; Dominika, Pasierb; Renata, Ra& #347; ; Elzbieta, Porada.

    2014-06-01

    Full Text Available La última década ha traído modificaciones importantes en la atención perinatal en Polonia con los cambios propuestos por la OMS. Sin embargo, la introducción de cualquier cambio se enfrenta a obstáculos inherentes a las actitudes de las mujeres, así como la reticencia del personal. Objetivo principa [...] l: Conocer la opinión de las habitantes de las aldeas en cuanto a la atención perinatal se refiere y evaluar determinados aspectos de la calidad de la atención obstétrica. Metodología: La muestra fue de 250 residentes seleccionadas al azar de la región de Podkarpacie (Polonia), entre 18 y 60 años de edad que tenían al menos un hijo. Se realizó un cuestionario original llevándose a cabo el estudio en 2010. Resultados y conclusión principal: Aquellas mujeres cuyos nacimientos fueron menos intervenidos evaluaron mejor los servicios obstétricos. Un aspecto significativo fue la comodidad y seguridad, gracias a la continuidad de la atención prestada por el mismo equipo terapéutico. Abstract in english The last decade has brought significant changes in perinatal care in Poland with the changes proposed by the WHO. However, the introduction of any changes has been facing obstacles inherent in the attitudes of both women, as well as the routine approach of staff. Objective: To learn about the inhabi [...] tants of the village of perinatal care and the evaluation of selected aspects of quality of obstetric care. Methods: The sample consisted of 250 randomly selected residents of Podkarpacie region (Poland), aged 18-60 years of age, with at least one child. Original questionnaire was conducted by the study taking place in 2010. Results and Conclusions: Those women, whose births were less surgery, had the best evaluation of obstetric services. A significant aspect of obstetric care which is the comfort and security of labor in the hospital, thanks to the continuity of care provided by the same therapeutic team.

  13. Care and cure: Compete or collaborate? Improving inter-organizational designs in healthcare. A case study in Dutch perinatal care

    OpenAIRE

    Pieters, A.J.H.M.

    2013-01-01

    This research aims to contribute to the development of theory regarding inter-organizational designs for these care-cure conditions through a combination of case study research and simulation. The case setting chosen is that of perinatal care in the Netherlands. The research consists of three phases and combines both qualitative and quantitative methods (mixed methods approach). The first phase focuses on what goes wrong in Dutch perinatal care (what-question). The second phase focuses on und...

  14. Quality of Care

    Science.gov (United States)

    The Institute of Medicine (IOM) defines quality of care as "the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge." In 1999, the IOM issued Ensuring Quality Cancer Care, a report that documented significant gaps in the quality of cancer care in the United States.

  15. Association of antenatal care with facility delivery and perinatal survival – a population-based study in Bangladesh

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    Pervin Jesmin

    2012-10-01

    Full Text Available Abstract Background Antenatal Care (ANC during pregnancy can play an important role in the uptake of evidence-based services vital to the health of women and their infants. Studies report positive effects of ANC on use of facility-based delivery and perinatal mortality. However, most existing studies are limited to cross-sectional surveys with long recall periods, and generally do not include population-based samples. Methods This study was conducted within the Health and Demographic Surveillance System (HDSS of the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b in Matlab, Bangladesh. The HDSS area is divided into an icddr,b service area (SA where women and children receive care from icddr,b health facilities, and a government SA where people receive care from government facilities. In 2007, a new Maternal, Neonatal, and Child Health (MNCH program was initiated in the icddr,b SA that strengthened the ongoing maternal and child health services including ANC. We estimated the association of ANC with facility delivery and perinatal mortality using prospectively collected data from 2005 to 2009. Using a before-after study design, we also determined the role of ANC services on reduction of perinatal mortality between the periods before (2005 – 2006 and after (2008–2009 implementation of the MNCH program. Results Antenatal care visits were associated with increased facility-based delivery in the icddr,b and government SAs. In the icddr,b SA, the adjusted odds of perinatal mortality was about 2-times higher (odds ratio (OR 1.91; 95% confidence intervals (CI: 1.50, 2.42 among women who received ?1 ANC compared to women who received ?3 ANC visits. No such association was observed in the government SA. Controlling for ANC visits substantially reduced the observed effect of the intervention on perinatal mortality (OR 0.64; 95% CI: 0.52, 0.78 to non-significance (OR 0.81; 95% CI: 0.65, 1.01, when comparing cohorts before and after the MNCH program initiation (Sobel test of mediation P Conclusions ANC visits are associated with increased uptake of facility-based delivery and improved perinatal survival in the icddr,b SA. Further testing of the icddr,b approach to simultaneously improving quality of ANC and facility delivery care is needed in the existing health system in Bangladesh and in other low-income countries to maximize health benefits to mothers and newborns.

  16. An Emerging Best Practice Model for Perinatal Depression Care

    OpenAIRE

    Sit, Dorothy K. Y.; Flint, Cheryl; Svidergol, Donald; White, Joanne; Wimer, Michelle; Bish, Bettina; Wisner, Katherine L.

    2009-01-01

    Perinatal depression is a significant health problem, especially among inner-city women. The authors explored the feasibility of an innovative model that integrated depression screening and treatment within an agency for maternal-child health. The team conducted depression screening with the Edinburgh Postnatal Depression Scale; they confirmed the primary diagnosis with the PRIME-MD instrument for 29 women with positive screens. Most participants had moderate or severe major depressive disord...

  17. Preventing maternal and early childhood obesity: the fetal flaw in Australian perinatal care.

    Science.gov (United States)

    Miller, Margaret; Hearn, Lydia; van der Pligt, Paige; Wilcox, Jane; Campbell, Karen J

    2014-01-01

    Almost half of Australian women of child-bearing age are overweight or obese, with a rate of 30-50% reported in early pregnancy. Maternal adiposity is a costly challenge for Australian obstetric care, with associated serious maternal and neonatal complications. Excess gestational weight gain is an important predictor of offspring adiposity into adulthood and higher maternal weight later in life. Current public health and perinatal care approaches in Australia do not adequately address excess perinatal maternal weight or gestational weight gain. This paper argues that the failure of primary health-care providers to offer systematic advice and support regarding women's weight and related lifestyle behaviours in child-bearing years is an outstanding 'missed opportunity' for prevention of inter-generational overweight and obesity. Barriers to action could be addressed through greater attention to: clinical guidelines for maternal weight management for the perinatal period, training and support of maternal health-care providers to develop skills and confidence in raising weight issues with women, a variety of weight management programs provided by state maternal health services, and clear referral pathways to them. Attention is also required to service systems that clearly define roles in maternal weight management and ensure consistency and continuity of support across the perinatal period. PMID:24176286

  18. Poor perinatal care practices in urban slums: Possible role of social mobilization networks

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    Khan Zulfia

    2009-01-01

    Full Text Available Background: Making perinatal care accessible to women in marginalized periurban areas poses a public health problem. Many women do not utilize institutional care in spite of physical accessibility. Home-based care by traditional birth attendants (TBA is hazardous. Inappropriate early neonatal feeding practices are common. Many barriers to perinatal care can be overcome by social mobilization and capacity building at the community level. Objectives: To determine the existing perinatal practices in an urban slum and to identify barriers to utilization of health services by mothers. Study Design: This is a cross-sectional descriptive study. Setting and Participants: The high-risk periurban areas of Nabi Nagar, Aligarh has a population of 40,000 living in 5,480 households. Mothers delivering babies in September 2007 were identified from records of social mobilization workers (Community Mobilization Coordinators or CMCs already working in an NGO in the area. A total of 92 mothers were interviewed at home. Current perinatal practices and reasons for utilizing or not utilizing health services were the topics of inquiry. Statistical Analysis: Data was tabulated and analyzed using SPSS 12. Results: Analyses revealed that 80.4% of mothers had received antenatal care. However, this did not translate into safe delivery practices as more than 60% of the women had home deliveries conducted by traditional untrained or trained birth attendants. Reasons for preferring home deliveries were mostly tradition (41.9% or related to economics (30.7%. A total of 56% of the deliveries were conducted in the squatting position and in 25% of the cases, the umbilical cord was cut using the edge of a broken cup. Although breast-feeding was universal, inappropriate early neonatal feeding practices were common. Prelacteal feeds were given to nearly 50% of the babies and feeding was delayed beyond 24 hours in 8% of the cases. Several mothers had breastfeeding problems. Conclusion: Barriers to utilization of available services leads to hazardous perinatal practices in urban slums.

  19. [Quality of health care].

    Science.gov (United States)

    Medina, J L; De Melo, P C

    2000-01-01

    Quality assurance is a relatively recent concern but already plays a major role in health care management and provision. Quality involves the definition of a comprehensive programme tailored by realistic and effective objectives and norms that include the structured review of procedures (namely clinical audits) and the use of up-to-date protocols. The involvement and motivation of health professionals, together with an adequate internal and external communication strategy, play a key role in the planning and application of these programmes. The use of programmed assessment, based on a solid knowledge of current practice, should have practical implications, optimising procedures in order to improve the quality of care. This commitment towards quality in health care should go far beyond governmental policy and should have clear support from health professionals. PMID:11234496

  20. Care for perinatal illness in rural Nepal: a descriptive study with cross-sectional and qualitative components

    OpenAIRE

    Manandhar Madan; Manandhar Dharma S; Shrestha Bhim P; Tamang Suresh; Osrin David; Mesko Natasha; Standing Hilary; Costello Anthony

    2003-01-01

    Abstract Background Maternal, perinatal and neonatal mortality rates remain high in rural areas of developing countries. Most deliveries take place at home and care-seeking behaviour is often delayed. We report on a combined quantitative and qualitative study of care seeking obstacles and practices relating to perinatal illness in rural Makwanpur district, Nepal, with particular emphasis on consultation strategies. Methods The analysis included a survey of 8798 women who reported a birth in t...

  1. Identifying health care quality attributes.

    Science.gov (United States)

    Ramsaran-Fowdar, Roshnee R

    2005-01-01

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

  2. Quality of Cancer Care

    Science.gov (United States)

    Work is underway to make cancer a working model for quality of care research and the translation of this research into practice. This requires addressing how data collection about cancer care can be standardized and made most useful to a variety of audiences including providers, patients and their families, purchasers, payers, researchers, and policymakers. The Applied Research Program has spearheaded several key activities to carry out this initiative.

  3. Women's health groups to improve perinatal care in rural Nepal

    OpenAIRE

    Manandhar Dharma; Manandhar Madan; Shrestha Bhim; Osrin David; Mesko Natasha; Tamang Suresh; Morrison Joanna; Standing Hilary; Costello Anthony

    2005-01-01

    Abstract Background Neonatal mortality rates are high in rural Nepal where more than 90% of deliveries are in the home. Evidence suggests that death rates can be reduced by interventions at community level. We describe an intervention which aimed to harness the power of community planning and decision making to improve maternal and newborn care in rural Nepal. Methods The development of 111 women's groups in a population of 86 704 in Makwanpur district, Nepal is described. The groups, facilit...

  4. Effective Linkages of Continuum of Care for Improving Neonatal, Perinatal, and Maternal Mortality: A Systematic Review and Meta-Analysis

    Science.gov (United States)

    Kikuchi, Kimiyo; Enuameh, Yeetey; Yasuoka, Junko; Nanishi, Keiko; Shibanuma, Akira; Gyapong, Margaret; Owusu-Agyei, Seth; Oduro, Abraham Rexford; Asare, Gloria Quansah; Hodgson, Abraham; Jimba, Masamine

    2015-01-01

    Background Continuum of care has the potential to improve maternal, newborn, and child health (MNCH) by ensuring care for mothers and children. Continuum of care in MNCH is widely accepted as comprising sequential time (from pre-pregnancy to motherhood and childhood) and space dimensions (from community-family care to clinical care). However, it is unclear which linkages of care could have a greater effect on MNCH outcomes. The objective of the present study is to assess the effectiveness of different continuum of care linkages for reducing neonatal, perinatal, and maternal mortality in low- and middle-income countries. Methods We searched for randomized and quasi-randomized controlled trials that addressed two or more linkages of continuum of care and attempted to increase mothers’ uptake of antenatal care, skilled birth attendance, and postnatal care. The outcome variables were neonatal, perinatal, and maternal mortality. Results Out of the 7,142 retrieved articles, we selected 19 as eligible for the final analysis. Of these studies, 13 used packages of intervention that linked antenatal care, skilled birth attendance, and postnatal care. One study each used packages that linked antenatal care and skilled birth attendance or skilled birth attendance and postnatal care. Four studies used an intervention package that linked antenatal care and postnatal care. Among the packages that linked antenatal care, skilled birth attendance, and postnatal care, a significant reduction was observed in combined neonatal, perinatal, and maternal mortality risks (RR 0.83; 95% CI 0.77 to 0.89, I2 79%). Furthermore, this linkage reduced combined neonatal, perinatal, and maternal mortality when integrating the continuum of care space dimension (RR 0.85; 95% CI 0.77 to 0.93, I2 81%). Conclusions Our review suggests that continuous uptake of antenatal care, skilled birth attendance, and postnatal care is necessary to improve MNCH outcomes in low- and middle-income countries. The review was conclusive for the reduction of neonatal and perinatal deaths. Although maternal deaths were not significantly reduced, composite measures of all mortality were. Thus, the evidence is sufficient to scale up this intervention package for the improvement of MNCH outcomes. PMID:26422685

  5. MATERNAL AND PERINATAL OUTCOME IN ECLAMPSIA IN A TE RTIARY CARE CENTRE

    Directory of Open Access Journals (Sweden)

    Bharti

    2013-04-01

    Full Text Available ABSTRACT: BACKGROUND : Eclampsia is a life threatening emergency that con tinues to be a major cause of serious maternal morbidity and is st ill the leading cause of maternal mortality worldwide. OBJECTIVE: Analysis of all cases of Eclampsia patients to find out the incidence, to evaluate the clinical course, medical & obstetric m anagement, and complications and to study the maternal &perinatal outcome. METHODS : This study was a hospital based prospective observational study. We obtained the data for this study from the case records of all Eclampsia patients who admitted in the Department of Obstetrics & Gynaecology, Gandhi Medical College, Bhopal from 01.01.2011 to 31.12.2011 and data were r ecorded on a predesigned proforma. All the obstetrical women with convulsions after 20 wee ks pregnancy or in postpartum period were evaluated. Each case was documented with respec t to age, socioeconomic status, education, occupation, gestational age, time of onse t of Eclampsia, duration and frequency of seizures, mode of delivery, use of drugs (anticonvu lsant and antihypertensive, maternal and perinatal outcome RESULTS: Out of total 203 Eclampsia patients, 144 cases(70.93% were Antepartum Eclampsia, 22 patients (10.84% were intrapa rtum Eclampsia, 35 cases (17.24% were postpartum Eclampsia & 2 cases (0.9% were status Eclampticus.30% Patients did not have oedema,14% had BP<140/90 mm of Hg and 11.4% di d not have proteinuria at the time of admission. There were 21 maternal deaths and morbid ity consisted of pulmonary oedema in 31(33.6% cases, CVA in 17(18.4% cases, renal fail ure in 7(7.6% cases, HELLP syndrome in 6(6.5% cases and aspiration pneumonia in 2(2.2% cas es. Perinatal mortality was 44.3% with majority being related to extreme prematurity. CONCLUSIONS: There is a need of proper antenatal care to prevent Eclampsia and the need for intensive monitoring of women with Eclampsia throughout the hospitalization to improve bo th the maternal & perinatal outcome

  6. La atención de la salud perinatal como reto de incorporación del principio de vulnerabilidad / Perinatal health care as a challenge of incorporating the principle of vulnerability

    Scientific Electronic Library Online (English)

    Octaviano, Domínguez-Márquez.

    Full Text Available De acuerdo con el principio de vulnerabilidad, se hace una revisión para identificar aquellos factores fundamentales que afectan a los niños neonatos, desde la condición perinatal, en el embarazo, las condiciones maternas y las propias del neonato tanto desde el punto de vista biológico como el ambi [...] ental, social e institucional. Se identifican las implicancias bioéticas respecto a la dignidad, la autonomía descargada en los padres, la responsabilidad reconocida en los factores sociales y ambientales de las familias, el Estado y las instituciones. Se hacen planteamientos éticos en relación con su protección, el manejo clínico, así como la confrontación de los derechos de la madre y el neonato. Abstract in english With the perspective of the vulnerability principle, a review is made in order to identify fundamental factors affecting neonates during the perinatal condition, in pregnancy, the maternal and neonatal conditions in the biological, environmental, social and institutional aspects. Bioethical principl [...] es are analyzed in issues such as dignity, autonomy delegated into parents, the liability recognized in the social and environmental factors of the family, the State and the institutions. Some ethical statements are elaborated regarding their protection, clinical care and the confrontation between the mother's and the neonate's rights.

  7. Maternal perinatal mental illnesses and adverse pregnancy outcomes: population-based studies using data from United Kingdom primary care

    OpenAIRE

    Ban, Lu

    2012-01-01

    Background: Perinatal mental illness, especially depression, is a leading cause of maternal morbidity and mortality in high-income countries. In the United Kingdom (UK), mental illness commonly presents to and is treated at primary care level; however there are no up-to-date estimates of the burden of different mental illnesses in women in and around pregnancy. The potential impact of mental illness with or without psychotropic medication on the risk of non-live pregnancy outcomes is uncl...

  8. Care for perinatal illness in rural Nepal: a descriptive study with cross-sectional and qualitative components

    Directory of Open Access Journals (Sweden)

    Manandhar Madan

    2003-08-01

    Full Text Available Abstract Background Maternal, perinatal and neonatal mortality rates remain high in rural areas of developing countries. Most deliveries take place at home and care-seeking behaviour is often delayed. We report on a combined quantitative and qualitative study of care seeking obstacles and practices relating to perinatal illness in rural Makwanpur district, Nepal, with particular emphasis on consultation strategies. Methods The analysis included a survey of 8798 women who reported a birth in the previous two years [of whom 3557 reported illness in their pregnancy], on 30 case studies of perinatal morbidity and mortality, and on 43 focus group discussions with mothers, other family members and health workers. Results Early pregnancy was often concealed, preparation for birth was minimal and trained attendance at birth was uncommon. Family members were favoured attendants, particularly mothers-in-law. The most common recalled maternal complications were prolonged labour, postpartum haemorrhage and retained placenta. Neonatal death, though less definable, was often associated with cessation of suckling and shortness of breath. Many home-based care practices for maternal and neonatal illness were described. Self-medication was common. There were delays in recognising and acting on danger signs, and in seeking care beyond the household, in which the cultural requirement for maternal seclusion, and the perceived expense of care, played a part. Of the 760 women who sought care at a government facility, 70% took more than 12 hours from the decision to seek help to actual consultation. Consultation was primarily with traditional healers, who were key actors in the ascription of causation. Use of the government primary health care system was limited: the most common source of allopathic care was the district hospital. Conclusions Major obstacles to seeking care were: a limited capacity to recognise danger signs; the need to watch and wait; and an overwhelming preference to treat illness within the community. Safer motherhood and newborn care programmes in rural communities, must address both community and health facility care to have an impact on morbidity and mortality. The roles of community actors such as mothers-in-law, husbands, local healers and pharmacies, and increased access to properly trained birth attendants need to be addressed if delays in reaching health facilities are to be shortened.

  9. Case management: quality care today.

    Science.gov (United States)

    Firman, J

    1991-02-01

    The literature demonstrates that the concept of case management offers quality, patient-centered care. Case management promotes the wise utilization of resources and has economic advantages. The benefits of case management are widespread. Everyone concerned with patient care is affected positively, including the patient, family, caregivers, and the facility itself. The benefits far outweigh the potential problems outlined in the literature, and these problems can be eliminated with proper education. The movement toward the use of case management makes good business sense. It will continue. PMID:10108631

  10. Potentially avoidable perinatal deaths in Denmark and Sweden 1991

    DEFF Research Database (Denmark)

    Langhoff-Roos, J; Borch-Christensen, H; Larsen, S; Lindberg, B; Wennergren, M

    1996-01-01

    BACKGROUND: Since 1950 the perinatal mortality has been significantly higher in Denmark than in Sweden. In 1991 the rate in Denmark was 8.0/1000 deliveries compared to 6.5/1000 in Sweden. An international audit was designed to investigate whether the perinatal death rates in the two countries to some extent could reflect differences in the quality of care, indicated by the numbers of perinatal deaths in categories of potentially avoidable deaths. MATERIAL AND METHODS: Medical records of 97% of a...

  11. Nurse Reported Quality of Care: A Measure of Hospital Quality

    OpenAIRE

    McHugh, Matthew D.; Stimpfel, Amy Witkoski

    2012-01-01

    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...

  12. Introduction of a qualitative perinatal audit at Muhimbili National Hospital, Dar es Salaam, Tanzania

    Directory of Open Access Journals (Sweden)

    Thomas Angela N

    2009-09-01

    Full Text Available Abstract Background Perinatal death is a devastating experience for the mother and of concern in clinical practice. Regular perinatal audit may identify suboptimal care related to perinatal deaths and thus appropriate measures for its reduction. The aim of this study was to perform a qualitative perinatal audit of intrapartum and early neonatal deaths and propose means of reducing the perinatal mortality rate (PMR. Methods From 1st August, 2007 to 31st December, 2007 we conducted an audit of perinatal deaths (n = 133 with birth weight 1500 g or more at Muhimbili National Hospital (MNH. The audit was done by three obstetricians, two external and one internal auditors. Each auditor independently evaluated the cases narratives. Suboptimal factors were identified in the antepartum, intrapartum and early neonatal period and classified into three levels of delay (community, infrastructure and health care. The contribution of each suboptimal factor to adverse perinatal outcome was identified and the case graded according to possible avoidability. Degree of agreement between auditors was assessed by the kappa coefficient. Results The PMR was 92 per 1000 total births. Suboptimal factors were identified in 80% of audited cases and half of suboptimal factors were found to be the likely cause of adverse perinatal outcome and were preventable. Poor foetal heart monitoring during labour was indirectly associated with over 40% of perinatal death. There was a poor to fair agreement between external and internal auditors. Conclusion There are significant areas of care that need improvement. Poor monitoring during labour was a major cause of avoidable perinatal mortality. This type of audit was a good starting point for quality assurance at MNH. Regular perinatal audits to identify avoidable causes of perinatal deaths with feed back to the staff may be a useful strategy to reduce perinatal mortality.

  13. Defining Quality Child Care: Multiple Stakeholder Perspectives

    Science.gov (United States)

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

    2007-01-01

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

  14. Atenção hospitalar perinatal e mortalidade neonatal no município de Juiz de Fora, Minas Gerais Perinatal health care and neonatal mortality in the municipality of Juiz de Fora in the9* State of Minas Gerais

    Directory of Open Access Journals (Sweden)

    Maria da Consolação Magalhães

    2003-09-01

    Full Text Available OBJETIVOS: identificar os possíveis fatores que têm contribuído para o excesso da mortalidade neonatal no município de Juiz de Fora e avaliar a qualidade do preenchimento dos prontuários hospitalares. MÉTODOS: estudo caso-controle baseado em informações colhidas nos prontuários das três principais maternidades do município. Foram analisados 103 óbitos neonatais e amostra de 232 nascidos vivos. RESULTADOS: as variáveis peso ao nascer e índice de Apgar no quinto minuto foram importantes fatores preditivos para o óbito neonatal, independente do local de nascimento. Quando se comparou, o risco de morrer, entre os hospitais verificou-se que no Hospital 1 o risco foi 3,97 vezes maior que no Hospital 3. Baseado em consulta a especialistas, foi criado um escore para avaliação do prontuário, onde o Hospital 1 apresentou mediana mais baixa, tanto entre casos como em controles. CONCLUSÕES: a ausência de informações adequadamente registradas no prontuário é um indicador de precariedade na assistência, e, certamente, retarda a realização de conduta indicada. A pesquisa apontou deficiências, particularmente nos registros, da assistência perinatal oferecida nos três hospitais.OBJECTIVES: to identify possible causes for the excessive rates of neonatal mortality in the municipality of Juiz de Fora and to assess the quality of hospital records. METHODS: a case control study based on information from the medical records of the three main maternity hospitals in the municipality. One hundred and three neonatal deaths were analyzed together with the sample of 232 liveborn babies. RESULTS: birth weight and Apgar index in the fifth minute were important predictive factors for neonatal deaths regardless of the maternity ward. The odd ratio in Hospital 1 was 3,97 times higher than in Hospital 3. Based on specialists' opinion, a medical record score was implemented which indicated that Hospital 1 had the lowest mean not only in relation to the cases but to the controls as well. CONCLUSIONS: the absence of information adequately registered in medical records is an indicator of poor medical assistance and certainly, delays proper care. The investigation reported deficiencies, particularly in the records, of the perinatal care offered by the three maternity hospitals.

  15. Managing risk, clinical error, and quality of care.

    Science.gov (United States)

    Milne, J Kenneth

    2002-09-01

    Clinical risk presents enormous challenges for the health profession and governments. Despite excellent national and regional programs focused on the management of obstetrical conditions and prevention of newborn injury, an environment of clinical error persists; according to Canadian Medical Protective Association data, each year 6% of Canadian obstetricians face a legal challenge, with most cases also involving nurses and hospitals. Principles and lessons learned from risk management developed in high reliability organizations (HROs), such as air traffic controllers and nuclear power plants, can be applied to risk management in perinatal/obstetrical units. In 2002, the Society of Obstetricians and Gynaecologists of Canada will launch an obstetrical risk management program called "Managing Obstetrical Risk Efficiently" (MORE), integrating labour and delivery clinical core content with HRO principles and reflective learning and practice modification tools designed to help all obstetrical caregivers build and maintain confidence and competency, improve patient safety and quality of care, and reduce clinical error and adverse events. PMID:12360367

  16. Eliminating Perinatal HIV Transmission

    Centers for Disease Control (CDC) Podcasts

    2012-11-26

    In this podcast, CDCâ??s Dr. Steve Nesheim discusses perinatal HIV transmission, including the importance of preventing HIV among women, preconception care, and timely HIV testing of the mother. Dr. Nesheim also introduces the revised curriculum Eliminating Perinatal HIV Transmission intended for faculty of OB/GYN and pediatric residents and nurse midwifery students.  Created: 11/26/2012 by Division of HIV/AIDS Prevention.   Date Released: 11/26/2012.

  17. Effective perinatal intensive care in europe (epice): Descrição do Projeto e primeiros resultados em Portugal / Effective perinatal intensive care in europe (epice): project description and first results in Portugal

    Scientific Electronic Library Online (English)

    Henrique, Barros; Carina, Rodrigues; Raquel, Costa; Inês, Baía; Teresa, Rodrigues; Maria do Céu, Machado; Luís, Graça; Rui, Carrapato; Adelina Sá, Couto; Aldina, Lopes; Alexandra, Almeida; Alexandrina, Portela; Alice, Vilas Boas; Almerinda, Pereira; Ana, Aroso; Ana, Berdeja; Ana, Bettencourt; Ana, Campos; Ana Castilho, Santos; Ana Isabel, Machado; Ana Maria, Andrade; Ana Melo, Bento; Ana, Neto; Ana, Pita; Ana Rute, Ferreira; Angelina, Tavares; Anselmo, Costa; Antónia, Nazaré; António, Braga; António, Fonseca; António, Lanhoso; António, Vilarinho; Ariana, Gomes; Beatriz, Sousa; Carla, Marinho; Carla, Sá; Carlos, Moniz; Cármen, Carvalho; Catarina, Dâmaso; Célia, Araújo; Clara Paz, Dias; Cláudia, Araújo; Conceição, Casanova; Conceição, Cunha; Conceição Faria, Murinello; Conceição, Telhado; Cristina, Didelet; Cristina, Leite; Cristina, Martins; Cristina, Trindade; Daniela, Almeida; Domingos Jardim da, Pena; Dulce, Oliveira; Eduarda, Reis; Eduardo, Fernandes; Ester, Casal; Eurico, Gaspar; Fátima, Fonseca; Fátima, Romão; Fernanda, Matos; Fernando, Cirurgião; Filomena, Nunes; Gabriela, Pereira; Glória, Carvalhosa; Graça, Henriques; Gustavo, Rodrigues; Helena, Almeida; Helena, Oliveira; Helena, Sousa; Hercília, Guimarães; Ilídio, Quelhas; Isabel, Canelas; Isabel Carolino, Silva; Isabel, Knoch; Isabel, Martins; Jacinto, Torres; Joana, Saldanha; Joana, Sampaio; João, Mendes; Joaquim, Marinho; Joaquina, Baltazar; Jorge, Ribeiro; Jorge, Silva; José, Amorim; José, Furtado; José, Guimarães; José Luís, Fonseca; José Miguel, Nogueira; José, Oliveira; José, Pombeiro; José, Teixeira; Juan, Calviño; Judite, Marques; Lucília, Araújo; Luís, Caturra; Mª do Carmo, Serra; Mª Paula, Arteaga; Margarida, Cabral; Margarida, Pontes; Margarida, Seabra; Maria Lurdes, Pinho; Mª José, Carneiro; Mário, Furtado; Mário, Paiva; Marisa, Cabanas; Marta, Aguiar; Marta, Barbosa; Micaela, Serelha; Nuno, Montenegro; Olímpia do, Carmo; Óscar, Vaz; Osvaldo, Soares; Paula, Costa; Paula, Pinheiro; Paula, Soares; Pedro, Enes; Pedro, Rocha; Pedro, Silva; Pedro, Tiago; Raquel, Maciel; Ricardo, Mira; Rosa, Rodrigues; Rosalina, Barroso; Rosalinda, Rodrigues; Rubina, Mendonça; Rui, Costa; Rui, Pinto; Sara Noéme, Prado; Susana Gama de, Sousa; Teresa, Oliveira; Teresa, Teles; Teresa, Tomé; Teresa, Ventura; Valdemar, Martins; Vítor, Neves; Zélia, Nunes; Jennifer, Zeitlin.

    2014-12-01

    Full Text Available A melhoria da qualidade dos cuidados pré-natais e dos cuidados intensivos neonatais resultaram, nas últimas décadas, numa continuada diminuição da morbilidade e da mortalidade perinatais e infantis, particularmente de recém-nascidos muito pré-termo. No entanto, há uma grande variabilidade entre unid [...] ades de saúde na decisão sobre procedimentos e intervenções, quer a nível nacional quer internacional, que se pode refletir em desigualdades nos resultados em saúde e que importa identificar e compreender. Este artigo tem como objetivos descrever: (1) o projeto europeu “Effective Perinatal Intensive Care in Europe” (EPICE); (2) o estudo piloto desenvolvido na Região Norte de Portugal para testar o protocolo e o instrumento de recolha de dados do estudo de coorte; (3) o recrutamento e amostra final da coorte EPICE-Portugal. O projeto EPICE desenvolve-se em 19 regiões de 11 Estados Membros da União Europeia e tem como objetivo investigar como o conhecimento científico é efetivamente aplicado no acompanhamento de recém-nascidos muito pré-termo, usando metodologias quantitativas e qualitativas. Em Portugal, o estudo integra todas as unidades públicas de obstetrícia e neonatologia da região Norte e de Lisboa e Vale do Tejo (LVT), bem como três unidades privadas de LVT. Os procedimentos do estudo (recrutamento e questionários) foram testados em quatro unidades hospitalares da região Norte de Portugal, através da recolha de informação do processo clínico de 21 nados-vivos, entre maio e dezembro de 2010, sobre a gravidez e os cuidados pré-natais, o parto, os cuidados neonatais e a alta hospitalar, usando um formulário estruturado. O estudo piloto permitiu testar o instrumento de recolha de dados e verificar que, em geral, a informação registada nos processos era suficiente para assegurar a implementação do projeto EPICE em Portugal. O recrutamento da coorte EPICE-Portugal decorreu entre 1 de junho de 2011 e 31 de maio de 2012, tendo sido identificados 724 nados-vivos muito pré-termo, bem como 95 interrupções médicas da gravidez e 155 mortes fetais com idade gestacional entre as 22+0 e as 31+6 semanas de gestação. Dos 724 nados-vivos, 607 tiveram alta hospitalar, tendo sido obtidos 544 (89,6%) consentimentos para as avaliações de seguimento. Abstract in english In the last decades, the improvement of antenatal and neonatal care led to a continued decrease in perinatal and infant morbidity and mortality, particularly for very preterm infants. However, there is a great variability in medical procedures and interventions across health units, both at national [...] and international levels, which can result in avoidable inequalities in health outcomes. This study intends to describe (1) the European project “Effective Perinatal Intensive Care in Europe” (EPICE), designed to identify and understand such variation; (2) the pilot study conducted in the Northern Region of Portugal to test the protocol and the questionnaire for data collection and (3) the recruitment and final sample of the EPICE-Portugal cohort. The EPICE project includes 19 regions from 11 EU Member states and aims to explore how scientific knowledge is effectively applied to monitor very preterm infants, using both quantitative and qualitative methodologies. In Portugal, this study involves all the public maternity and neonatal intensive care units from Northern and Lisbon and Tagus Valley (LVT) regions, along with 3 private units from LVT. The study procedures (recruitment and questionnaires) were tested in 4 hospitals in the Northern region of Portugal, by collecting information from the clinical records of 21 live births, born between May and December 2010. Data on pregnancy and prenatal care, childbirth, neonatal care and discharge was collected using a structured questionnaire. The pilot study tested data collection instruments and showed that, in general, the information documented in clinical records was enough to answer the questionnaire items, guaranteeing the feasibility of the EPICE pr

  18. Leadership and the quality of care

    OpenAIRE

    Firth-Cozens, J; D. Mowbray

    2001-01-01

    The importance of good leadership is becoming increasingly apparent within health care. This paper reviews evidence which shows that it has effects, not only on financial management, but on the quality of care provided. Some theories of leadership are discussed, primarily in terms of how different types of leaders might affect quality in different ways, including the effects that they might have on the stress or wellbeing of their staff which, in turn, is related to the quality of care produc...

  19. Standards for perinatal education Part 1

    OpenAIRE

    Richter, M.S.

    2002-01-01

    Quality control in perinatal education is imperative, with the purpose to deliver a high quality and appropriate healthcare service to the family in the perinatal period. The purpose of this study was to develop valid standards for perinatal education in South Africa.

  20. [Quality of care in inflammatory bowel disease].

    Science.gov (United States)

    Seo, Geom Seog

    2015-03-01

    Since inflammatory bowel disease (IBD) is a chronic and relapsing disorder, maintaining high quality of care plays an important role in the management of patients with IBD. To develop process-based quality indicator set to improve quality of care, the indicator should be based directly on evidence and consensus. Initially, ImproveCareNow group demonstrated quality improvement by learning how to apply quality improvement methods to improve the care of pediatric patients with IBD. The American Gastroenterological Association has developed adult IBD physician performance measures set and Crohn's and Colitis Foundation of America (CCFA) has developed a set of ten most highly rated process and outcome measures. Recently, The Emerging Practice in IBD Collaborative (EPIC) group generated defining quality indicators for best-practice management of IBD in Canada. Quality of Care through the Patient's Eyes (QUOTE-IBD) was developed as a questionnaire to measure quality of care through the eyes of patients with IBD, and it is widely used in European countries. The current concept of quality of care as well as quality indicator will be discussed in this article. PMID:25797376

  1. Salud mental perinatal en la asistencia hospitalaria del parto y puerperio Perinatal mental health during the hospital care of labor and puerperal period

    Directory of Open Access Journals (Sweden)

    Guillermo Hernández G

    2000-11-01

    Full Text Available The biomedical model has successfully reduced mother and child mortality and diseases during the labor and puerperal period. In the perinatal period, the mother and her offspring can also have psychosocial problems, that have been insufficiently studied and that we propose considering. Based on neurobiological information, on bonding theory and on a focus change in the everyday work of human behavior experts in maternity hospitals, we propose that perinatal mental health should have an important place and can be harmoniously articulated with the biomedical model. This mental health work should aim at generating safe mother-child bonds. It should be maintained Thereafter through social networks to prevent child abuse, to promote healthy development and to prevent psychopathology. We review some of the programs carried out in the ten year period in which we have worked as a mental health team in the maternity ward of a public hospital in Santiago, Chile (Rev Méd Chile 2000; 128: 1283-89

  2. Protecting Quality under Medicaid Managed Care

    OpenAIRE

    Booth, Maureen

    1997-01-01

    The purpose of this article is to discuss the quality assessment mechanisms for monitoring the implementation of managed care. The clinical indicators and practice guidelines that direct the monitoring process are described on the national and state level. New directions for monitoring managed care as a delivery system for vulnerable populations in terms of quality of services is addressed.

  3. Protecting Quality under Medicaid Managed Care

    Directory of Open Access Journals (Sweden)

    Booth, Maureen

    1997-01-01

    Full Text Available The purpose of this article is to discuss the quality assessment mechanisms for monitoring the implementation of managed care. The clinical indicators and practice guidelines that direct the monitoring process are described on the national and state level. New directions for monitoring managed care as a delivery system for vulnerable populations in terms of quality of services is addressed.

  4. Quality of maternal health care at Shoklo Malaria Research Unit in Mae La refugee camp in 2008 : an evaluation using WHO Safe Motherhood Needs Assessment

    OpenAIRE

    Hoogenboom, G

    2010-01-01

    PROBLEM STATEMENT: As part of a quality improvement project a WHO Safe Motherhood Needs Assessment (SMNA) was performed at the SMRU clinic in Mae La refugee camp. OBJECTIVES: To describe availability, use and quality of perinatal care and to identify gaps in the provision of care. METHODS: Facility observations, record reviews, staff interviews and observations of deliveries were conducted using SMNA instruments with locally adapted structured survey forms. FINDINGS: Availability of appropria...

  5. Quality Assessment in the Primary care

    Directory of Open Access Journals (Sweden)

    Muharrem Ak

    2013-04-01

    Full Text Available -Quality Assessment in the Primary care Dear Editor; I have read the article titled as “Implementation of Rogi Kalyan Samiti (RKS at Primary Health Centre Durvesh” with great interest. Shrivastava et all concluded that assessment mechanism for the achievement of objectives for the suggested RKS model was not successful (1. Hereby I would like to emphasize the importance of quality assessment (QA especially in the era of newly established primary care implementations in our country. Promotion of quality has been fundamental part of primary care health services. Nevertheless variations in quality of care exist even in the developed countries. Accomplishment of quality in the primary care has some barriers like administration and directorial factors, absence of evidence-based medicine practice lack of continuous medical education. Quality of health care is no doubt multifaceted model that covers all components of health structures and processes of care. Quality in the primary care set up includes patient physician relationship, immunization, maternal, adolescent, adult and geriatric health care, referral, non-communicable disease management and prescribing (2. Most countries are recently beginning the implementation of quality assessments in all walks of healthcare. Organizations like European society for quality and safety in family practice (EQuiP endeavor to accomplish quality by collaboration. There are reported developments and experiments related to the methodology, processes and outcomes of quality assessments of health care. Quality assessments will not only contribute the accomplishment of the program / project but also detect the areas where obstacles also exist. In order to speed up the adoption of QA and to circumvent the occurrence of mistakes, health policy makers and family physicians from different parts of the world should share their experiences. Consensus on quality in preventive medicine implementations can help to yield helpful developments. Because “primary care helps prevent illness and death” (3, 4. References 1.Shrivastava SR, Bobhate PS. Implementation of Rogi Kalyan Samiti (RKS at Primary Health Centre Durvesh (2009 – 2010. TAF Prev Med Bull. (2012, 11(3: 307-314 2.Akturk Z, Set T. Quality in Family Practice: Opportunities and Tools Ready for Application. Turkish Journal of Family Medicine and Primary Care. 2010; 4(1:1-7. 3.Grol R, Baker R, Wensing M. Quality Assurance in General Practice: the State of the Art in Europe Family Practice 1994. Volume 11,Issue 4 p 460-467 4.Starfield B, Leiyu S, Macinko J. Contribution of Primary Care to Health Systems and Health. The Milbank Quarterly. 2005; 83(3:457-502. [TAF Prev Med Bull 2013; 12(2.000: 217-218

  6. Quality of institutional elderly care in Slovenia

    OpenAIRE

    Habjani?, Ana

    2012-01-01

    Abstract Elderly people, because of the frail health condition and consequent problems, have in most cases substantial difficulties living at home. Despite the need for widened nursing home custody, the field of quality institutional elderly care in Slovenia in the past did not undergo comprehensive research. The purpose of this two-part study was to investigate the quality of institutional elderly care and elderly care offered in Slovenian nursing homes. Additional purpose was to eval...

  7. Quality of Cancer Care - Applied Research

    Science.gov (United States)

    The purpose of these efforts, substantially supported by the Applied Research Program, is to enhance the state of the science on the quality of cancer care and inform federal and private-sector decision making on care delivery, coverage, regulation, and standard setting. Work is underway to make cancer a working model for quality of care research and the translation of this research into practice.

  8. Perinatal Death: Epidemiology and Etiology

    OpenAIRE

    Neto, MT

    2011-01-01

    Perinatal mortality rate is an important mark to evaluate women and perinatal health care. It is of utmost importance to know causes and the evolution of its two components aiming to improve health care in different fields – sanitary conditions, diagnosis and treatment of infectious disease, immunisations, diagnosing and caring for medical diseases induced by pregnancy or directly related to it, providing skilled birth attendance, preventing birth asphyxia, preventing preterm birth complic...

  9. Mindfulness meditation to improve care quality and quality of life in long-term care settings.

    Science.gov (United States)

    Zeller, Janice M; Lamb, Karen

    2011-01-01

    Quality of long-term care has been the focus of 2 recent Institute of Medicine reports: "Improving the Quality of Long-Term Care"(1) and "Improving the Quality of Care in Nursing Homes."(2) Although there has been some improvement in care quality since regulatory reforms were enacted in 1987,(3) poor care persists.(4) Certified nursing assistants (CNAs) are challenged in the provision of optimal care by chronic stress in the workplace, leading to absenteeism, reduced job satisfaction, and increased turnover.(5-7) Mindfulness training, which cultivates a practice of being present in the moment, recognizing stressful situations when they arise, and responding to stress in an adaptive manner,(8) holds promise as a simple, inexpensive approach to reduce CNA stress and improve quality of care and quality of life for residents in long-term care settings. Formal and informal mindfulness practices can readily be incorporated into CNA educational programs. PMID:21239085

  10. A Conceptual Framework for Quality of Care

    OpenAIRE

    Mosadeghrad, Ali Mohammad

    2012-01-01

    Despite extensive research on defining and measuring health care quality, little attention has been given to different stakeholders’ perspectives of high-quality health care services. The main purpose of this study was to explore the attributes of quality healthcare in the Iranian context. Exploratory in-depth individual and focus group interviews were conducted with key healthcare stakeholders including clients, providers, managers, policy makers, payers, suppliers and accreditation panel me...

  11. Nationwide quality improvement in lung cancer care

    DEFF Research Database (Denmark)

    Jakobsen, Erik Winther; Green, Anders; Oesterlind, Kell; Rasmussen, Torben Riis; Iachina, Maria; Palshof, Torben

    2013-01-01

    To improve prognosis and quality of lung cancer care the Danish Lung Cancer Group has developed a strategy consisting of national clinical guidelines and a clinical quality and research database. The first edition of our guidelines was published in 1998 and our national lung cancer registry was opened for registrations in 2000. This article describes methods and results obtained by multidisciplinary collaboration and illustrates how quality of lung cancer care can be improved by establishing and...

  12. Improving quality of tuberculosis care in India.

    Science.gov (United States)

    Pai, Madhukar; Satyanarayana, Srinath; Hopewell, Phil

    2014-01-01

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

  13. Perinatal Mortality Rate as a Quality Indicator of Healthcare in Al-Dakhiliyah Region, Oman

    OpenAIRE

    Asha Santosh; Geeta Zunjarwad; Ilham Hamdi; Al-Nabhani, Jamila A.; Bahaa E. Sherkawy; Al-Busaidi, Ibrahim H.

    2013-01-01

    Objectives: This study aimed to provide insight into the causes of stillbirths and early neonatal deaths and identify better intervention strategies. Methods: This was a retrospective study during a 7-year period (January 2003 to December 2009) of all stillbirths and early neonatal deaths at the Nizwa regional referral hospital in Al- Dakhiliyah region, Oman. Results: Of a total 27,668 births, there were 244 stillbirths and 157 early neonatal deaths. The perinatal mortality rate (PMR) was ...

  14. Families' experiences of intensive care unit quality of care

    DEFF Research Database (Denmark)

    Jensen, Hanne Irene; Gerritsen, Rik T; Koopmans, Matty; Zijlstra, Jan G; Curtis, Jared Randall; Ørding, Helle

    2015-01-01

    PURPOSE: The purpose of the study is to adapt and provide preliminary validation for questionnaires evaluating families' experiences of quality of care for critically ill patients in the intensive care unit (ICU). MATERIALS AND METHODS: This study took place in 2 European ICUs. Based on literature and qualitative interviews, we adapted 2 previously validated North American questionnaires: "Family Satisfaction with the ICU" and "Quality of Dying and Death." Family members were asked to assess rel...

  15. Total quality management in health care.

    Science.gov (United States)

    McDonald, S C

    1994-01-01

    Total quality management (TQM), continuous quality improvement (CQI) and quality control are terms that are becoming very familiar to workers in the health care environment. The purpose of this article is to discuss these terms and the concepts they describe. The origins of TQM and the keen interest in its application to the health care environment today are addressed. In other environments, TQM has shown significant increases in productivity while increasing effectiveness. Its application to the health care environment is the provision of the best possible care through continuously improving service to meet or exceed the needs and expectations of the customer. The customer in the health care environment could be the patient, staff, physician and community serviced by the hospital. Characteristics of the new organizational structure are reviewed. Established techniques and processes are commonly used to identify process-improvement opportunities to assist the manager in continuously evaluating quality trends. PMID:10133741

  16. [Perinatal mortality in the Netherlands: everyone's problem and yet no one's problem].

    Science.gov (United States)

    Mackenbach, J P

    2006-02-25

    In 1986, this journal published a paper showing that the rate of decline of perinatal mortality in the Netherlands was lower than in several other European countries. As a result, the Netherlands had lost its position as a country with one of the lowest perinatal mortality rates in the world. Since then, relatively little has happened to redress the situation, despite the fact that several studies have shown that the higher perinatal mortality rates are not due to registration artefacts, and that the quality of perinatal care in the Netherlands is lower than that in countries with lower perinatal mortality rates. In a recent analysis by the Rijksinstituut voor Volksgezondheid en Milieu (State Institute for Public Health and the Environment) it was estimated that between 20 and 25% of the difference between the perinatal mortality rates of the Netherlands and those of Sweden and Finland is due to the higher frequency in the Netherlands of five factors: multiple pregnancies (probably as a result of in-vitro fertilisation), smoking during pregnancy, pregnancies among non-western immigrants, no screening for congenital disorders, and (other) 'substandard' factors in perinatal care. Unfortunately, there are still no signs of a determined policy response. It seems that twenty years of working on the basis of the voluntary participation of many different organisations, and without clear leadership, have not produced the gain in perinatal mortality that would theoretically have been possible. PMID:16538837

  17. The utility of clinical care pathways in determining perinatal outcomes for women with one previous caesarean section; a retrospective service evaluation

    Directory of Open Access Journals (Sweden)

    Karuga Robinson N

    2010-10-01

    Full Text Available Abstract Background The rising rates of primary caesarean section have resulted in a larger obstetric population with scarred uteri. Subsequent pregnancies in these women are risk-prone and may complicate. Besides ensuring standardised management, care pathways could be used to evaluate for perinatal outcomes in these high risk pregnancies. We aim to demonstrate the use of a care pathway for vaginal birth after caesarean section as a service evaluation tool to determine perinatal outcomes. Methods A retrospective service evaluation by review of delivery case notes and records was undertaken at the Aga Khan University Hospital, Nairobi, Kenya between January 2008 and December 2009 Women with ?2 previous caesarean sections, previous classical caesarean section, multiple gestation, breech presentation, severe pre-eclampsia, transverse lie, placenta praevia, conditions requiring induction of labour and incomplete records were excluded. Outcome measures included the proportion of eligible women who opted for test of scar (ToS, success rate of vaginal birth after caesarean section (VBAC; proportion on women opting for elective repeat caesarean section (ERCS and their perinatal outcomes. Results A total of 215 women with one previous caesarean section were followed up using a standard care pathway. The median parity (minimum-maximum was 1.01234. The other demographic characteristics were comparable. Only 44.6% of eligible mothers opted to have a ToS. The success rate for VBAC was 49.4% with the commonest (31.8% reason for failure being protracted active phase of labour. Maternal morbidity was comparable for the failed and successful VBAC group. The incidence of hemorrhage was 2.3% and 4.4% for the successful and failed VBAC groups respectively. The proportion of babies with acidotic arterial PH ( Conclusions Besides ensuring standardised management, care pathways could be objective audit and service evaluation tools for determining perinatal outcomes.

  18. Interest of pregnant women in the use of SMS (short message service) text messages for the improvement of perinatal and postnatal care

    OpenAIRE

    Cormick Gabriela; Kim Natalie A; Rodgers Ashlei; Gibbons Luz; Buekens Pierre M; Belizán José M; Althabe Fernando

    2012-01-01

    Abstract Background Mobile health (mHealth) is emerging as a useful tool to improve healthcare access especially in the developing world, where limited access to health services is linked to poor antenatal care, and maternal and perinatal mortality. The objective of this study is to 1) understand pregnant women’s access and usage of cell phones and 2) survey the health information needs and interests in a population attending public hospitals and health centers of two cities in Argentina. Thi...

  19. Impact of perinatal oral health care education programme on the knowledge, attitude and practice behavior amongst gynaecologists of Vadodara city

    Directory of Open Access Journals (Sweden)

    Anshula Neeraj Deshpande

    2015-01-01

    Full Text Available Context: Gynecologists the Primary Health Care providers, for pregnant mothers bear the unique responsibility to detect and diagnose oral health problems for timely and effective interventions. Aim: The aim of the study was to assess the impact of Perinatal Oral Health Care (POHC education program on the knowledge, attitude and practice behavior amongst Gynaecologists of Vadodara City. Settings and Design: An analytical cross sectional study was conducted amongst Gynecologists practicing in Vadodara city, registered under Indian Medical Association (IMA, Baroda, Gujarat. Materials and Methods: A validated questionnaire survey was conducted to establish a baseline level of knowledge, attitude and practice behavior of 46 Gynecologists. After that education and awareness regarding POHC to Gynecologists was provided with the help of flip charts and resource brochures. To determine the impact of recent provision of education and awareness a post-test was conducted. Statistical analysis used: Data was analyzed by paired t-test using the SPSS Version 20. Results: The results after evaluating the data from pretest and posttest showed a mean increase of correct answers in knowledge (from 7.304-9.891; P = 0.00, Attitude (from 3.978-4.108; P = 0.49 and practice behavior (from 4.130-5.521; P = 0.00 in POHC amongst Gynecologists following the education program. Conclusions: It can be concluded that there is a need for provision of education and awareness to the primary health care providers which would help in improving pregnant women and infant?s oral health status along with establishment of dental home.

  20. Salud mental perinatal en la asistencia hospitalaria del parto y puerperio / Perinatal mental health during the hospital care of labor and puerperal period

    Scientific Electronic Library Online (English)

    Guillermo, Hernández G; Mónica, Kimelman J; Olga, Montino R.

    2000-11-01

    Full Text Available [...] Abstract in english The biomedical model has successfully reduced mother and child mortality and diseases during the labor and puerperal period. In the perinatal period, the mother and her offspring can also have psychosocial problems, that have been insufficiently studied and that we propose considering. Based on neur [...] obiological information, on bonding theory and on a focus change in the everyday work of human behavior experts in maternity hospitals, we propose that perinatal mental health should have an important place and can be harmoniously articulated with the biomedical model. This mental health work should aim at generating safe mother-child bonds. It should be maintained Thereafter through social networks to prevent child abuse, to promote healthy development and to prevent psychopathology. We review some of the programs carried out in the ten year period in which we have worked as a mental health team in the maternity ward of a public hospital in Santiago, Chile (Rev Méd Chile 2000; 128: 1283-89)

  1. Neonatal respiratory and intensive care in emerging regions of China: learning curve, cost-effectiveness, quality and standard of care

    Directory of Open Access Journals (Sweden)

    Bo Sun

    2015-10-01

    Full Text Available The article presents informations on birth population and policy change in China, along with data on neonatal and perinatal morbidity and mortality, covering four decades. Care standard and cost-effectiveness are also analyzed, highlighting the measures that significantly improved general and specified maternal and infant care, and established modern perinatal care system. Moreover, results from multicenter studies – through nation-wide or province-wide collaborative NICU network for respiratory diseases – are reported. Development of neonatal-perinatal care in China is representative in its transition over more than 3 decades from a poor condition into a modernized one. Public health care policy and professionally integrated service mode played pivotal roles, whereas social economic and cultural factors play either synergistic or detrimental roles for such a transition. The progress in Chinese neonatal-perinatal care is also influenced by international collaboration and exchange, and in a sense followed right the foot-print of international pioneers and their colleagues. In foreseeable future, many Chinese perinatal and neonatal centers would actively participate in international collaborations aiming at improving not only domestic but developing country neonatal-perinatal care as a whole. Proceedings of the 11th International Workshop on Neonatology and Satellite Meetings · Cagliari (Italy · October 26th-31st, 2015 · From the womb to the adultGuest Editors: Vassilios Fanos (Cagliari, Italy, Michele Mussap (Genoa, Italy, Antonio Del Vecchio (Bari, Italy, Bo Sun (Shanghai, China, Dorret I. Boomsma (Amsterdam, the Netherlands, Gavino Faa (Cagliari, Italy, Antonio Giordano (Philadelphia, USA

  2. Antenatal care packages with reduced visits and perinatal mortality: a secondary analysis of the WHO antenatal care trial - Comentary: routine antenatal visits for healthy pregnant women do make a difference

    OpenAIRE

    Hofmeyr, G Justus; Hodnett, Ellen D.

    2013-01-01

    The practice and timing of routine antenatal visits for healthy pregnant women, introduced arbitrarily and without evidence of effectiveness, have become entrenched in obstetric practice over the last century. In 2001 the large, cluster randomized WHO Antenatal Care Trial concluded that a goal-orientated package of antenatal care with reduced visits seemed not to affect maternal and perinatal outcomes. The reduced visit package has been implemented in several countries. The current re-analysi...

  3. Quality Nursing Care Celebrates Diversity

    OpenAIRE

    Leonard, B.

    2001-01-01

    At the beginning of the 21st century, the familiar biomedical health care "culture" must accommodate not only persons from diverse cultures, but also diverse systems of care. For perhaps the first time in over a century, biomedicine must accommodate others rather than require them to assimilate into its "culture." This fundamental shift requires nurses to move quickly to develop cultural competency as individuals and to provide leadership for this system-wide change. Such competence is import...

  4. Quality Nursing Care Celebrates Diversity

    Directory of Open Access Journals (Sweden)

    Leonard, B

    2001-05-01

    Full Text Available At the beginning of the 21st century, the familiar biomedical health care "culture" must accommodate not only persons from diverse cultures, but also diverse systems of care. For perhaps the first time in over a century, biomedicine must accommodate others rather than require them to assimilate into its "culture." This fundamental shift requires nurses to move quickly to develop cultural competency as individuals and to provide leadership for this system-wide change. Such competence is important when using complementary and alternative modalities. This article addresses America’s experience with diversity and its legacy in today’s health indicators; it explores cultural competency and its achievement at the individual and system levels; and it discusses the use of complementary and alternative treatments that are a part of this health care "revolution." Nurses are challenged to shape this reform as did the founder of modern nursing 150 years ago.

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

    Directory of Open Access Journals (Sweden)

    Pilar Isla Pera

    2011-01-01

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

  6. [Quality of care: from theory to practice].

    Science.gov (United States)

    Guillain, H; Raetzo, M A

    1997-03-29

    Quality of care is growing concern among health care professionals and managers. As a multidimensional concept, it cannot be reduced to simple customer satisfaction. Taking into account the views of the three major players in the health care system-patients, providers and payers-quality can be defined as the capacity to satisfy patients' needs according to professional knowledge and within available resources. Efficacy, efficiency, appropriateness, acceptability, legitimacy and equity are dimensions of health care quality. Contrary to popular belief, quality is neither maximum performance, nor satisfaction at all costs, nor punishment or elimination of "bad apples". In ambulatory medicine, quality implies first of all the ability to master the processes occurring during an office visit. However, although history taking and physical examination are the cornerstones of medical practice, they have not been well studied. Improving quality of care in the ambulatory sector will require better knowledge about medical decision-making processes, in particular identification of the most relevant information required for a decision and the optimal way of obtaining it in any specific clinical situation. PMID:9190666

  7. Perinatal depression: implications for child mental health

    OpenAIRE

    Muzik, Maria; Borovska, Stefana

    2010-01-01

    Perinatal depression is common and primary care holds a crucial role for detecting, treating or, if necessary, providing referrals to mental health care for affected women. Family doctors should be aware of risk factors for peripartum depression, including previous history of depression, life events and interpersonal conflict. Perinatal depression has been associated with many poor outcomes, including maternal, child and family unit challenges. Infants and young children of perinatally depres...

  8. Quality improvement in cardiac critical care

    OpenAIRE

    Lobdell, K; Camp, S., de; Stamou, S.; Swanson, R.; Reames, M; Madjarov, J; Stiegel, R; Skipper, E; Geller, R; Velardo, B; Mishra, A.(Indian Institute of Technology, Indore, India (IITI)); F. Robicsek

    2009-01-01

    Our quality improvement program began in 2004 to improve cardiac surgery outcomes. Early tracheal extubation in the cardiovascular intensive unit was utilized as a multidisciplinary driver for the quality improvement program. Continuous improvement in the rate of early extubation to drive multidisciplinary quality improvement in cardiac critical care correlated with decreased mortality, morbidity, and improved operational efficiency. Supportive educational efforts included, but were not limit...

  9. Perinatal Palliative Care: Barriers and Attitudes of Neonatologists and Nurses in Poland

    OpenAIRE

    Aleksandra Korzeniewska-Eksterowicz; Maria Respondek-Liberska; ?ukasz Przys?o; Wojciech Fendler; Wojciech M?ynarski; Ewa Gulczy?ska

    2013-01-01

    Objective. To identify barriers and personnel attitudes towards realization of palliative care principles in neonatological units. Study Design. An anonymous questionnaire was posted to all heads of departments and head nurses of all the 27 neonatological units in the Lodz area. Results. We received 46 (85%) questionnaires. Final analysis comprised 42 properly filled-in questionnaires (by 22 doctors and 20 nurses). In case of prenatal diagnosis of a lethal defect, 77.27% of doctors and 65% of...

  10. Empathy and quality of care.

    OpenAIRE

    Mercer, Stewart W; Reynolds, William J

    2002-01-01

    Empathy is a complex multi-dimensional concept that has moral cognitive emotive and behavioural components Clinical empathy involves an ability to: (a) understand the patient's situation, perspective, and feelings (and their attached meanings); (b) to communicate that understanding and check its accuracy; and (c) to act on that understanding with the patient in a helpful (therapeutic) way. Research on the effect of empathy on health outcomes in primary care is lacking, but studies in mental h...

  11. Perinatal needs of immigrant Hmong women: surveys of women and health care providers.

    OpenAIRE

    Faller, H S

    1985-01-01

    The Hill People of Laos in Southeast Asia, who are called the Hmong, are from a primitive culture which has had a written language for only 31 years. By 1980, about 3,000 of them were living in Colorado, one of 9 States to which they had migrated. In an effort to determine whether or not local health care service was accessible and acceptable to child-bearing families, a pilot survey was conducted in the Denver area. The survey consisted of interviews of the Hmong women themselves and questio...

  12. Practical advice for caring for women with eating disorders during the perinatal period.

    Science.gov (United States)

    Harris, Amy A

    2010-01-01

    Pregnancy is a critical time for women struggling with disordered eating and weight concerns. For the majority of women with eating disorders, symptoms improve during pregnancy. Other women, particularly those with either subclinical or binge eating disorders, are at risk for an escalation of pathologic behaviors, putting both mother and fetus at risk for negative birth outcomes. Routinely screening for eating disorders will help identify those women who will most benefit from specialized care. Attention must be paid to possible harmful comorbid behaviors found in women with eating disorders, such as smoking, alcohol use, abusing laxatives or herbal supplements, and self-injurious behavior. This article reviews the mixed research findings of the impact of eating disorders upon pregnancy and identifies key times in prenatal care where nutritional counseling and specific interventions will increase the likelihood of positive pregnancy outcomes. The postpartum period is another critical time for provider intervention that may lower women's risks for eating disorder relapse, postpartum depression, and breastfeeding difficulties. PMID:20974420

  13. Patient Mobility, Health Care Quality and Welfare

    OpenAIRE

    Brekke, Kurt Richard; Levaggi, Rosella; Siciliani, Luigi; Straume, Odd Rune

    2011-01-01

    Patient mobility is a key issue in the EU who recently passed a new law on patients right to EU-wide provider choice. In this paper we use a Hotelling model with two regions that differ in technology to study the impact of patient mobility on health care quality, health care nancing and welfare. A decentralised solution without patient mobility leads to too low (high) quality and too few (many) patients being treated in the high-skill (low-skill) region. A centralised solution with patient m...

  14. Prospective study on quality of newborn care

    Directory of Open Access Journals (Sweden)

    N Khanam

    2013-12-01

    Full Text Available Background: Quality of services provided by health care provider, the closest health functionary to the community has impact on neonatal mortality. Aims: Study on quality of newborn care in rural areas.  Settings and Design: This is a prospective study in the field practice areas of J.N. Medical College and areas under primary health centre of public health care system in Wardha district.  Methods and Material: Modified quality check list on the basis of PHC MAP module guidelines for assessing the quality of service-module 6-user’s guide was prepared. Face to face interview with 205 (group-A/104 nos + group-B/101 nos mother of newborn was method to collected information in three postnatal visits.  Statistical analysis: Quality (verbal response of each service was quantified as acceptable, average and worst.  Quality of both the groups was compared by calculating P-value after utilizing Z-test.  Results: Over all acceptable quality of medical history was 30.03%, physical examination was 21.73%, preventive service was 91.17% and counseling was 24.83%. Significant difference between two groups were found on history taking for (cry, breathing and body movement of baby, recording weight and counseling regarding exclusive breast feeding for first 6 month of life. Worst quality in this study were observed in history for anything applying to eyes, umbilical cord stump and complication of baby for which appropriate management was taken. Except for weight recording and examination of head and fontanels all other variables under physical examination were not acceptable. Counseling regarding high risk condition of baby was only 13.66%. Conclusion: Existing newborn services except immunization is inadequate and needs to be strengthened especially physical examination and counseling services. 

  15. RECURRENT PERINATAL LOSS: A CASE STUDY*

    OpenAIRE

    KAVANAUGH, KAREN; ROBERTSON, PAMELA A.

    1999-01-01

    To date, investigators have not demonstrated a clear relationship between a parent’s history of prior perinatal losses and intensity of grief response following a subsequent perinatal loss. Examining this relationship for low-income, African-American parents is important because they are a vulnerable population due to the high incidence of perinatal mortality in Blacks and their other life stressors that can impact on grief response and caring needs. The purpose of this case study was to exam...

  16. Measuring the quality of nutritional care.

    Science.gov (United States)

    Relph, Wendy-Ling

    2015-09-01

    Despite various campaigns and initiatives, and publication of numerous standards, malnutrition in healthcare settings often goes unrecognised and untreated. This negatively affects patients' experiences and outcomes, and has financial implications for the NHS. The British Association for Parenteral and Enteral Nutrition has launched a new online tool that helps trusts measure the quality of the nutritional care they provide. This article describes the tool and explains its structure, how organisations and nurses can access and use it, and the benefits of implementing this resource as a routine part of clinical care. PMID:26309011

  17. Quality of Care in Humanitarian Surgery

    OpenAIRE

    Chu, Kathryn M.; Trelles, Miguel; Ford, Nathan P

    2011-01-01

    Humanitarian surgical programs are set up de novo, within days or hours in emergency or disaster settings. In such circumstances, insuring quality of care is extremely challenging. Basic structural inputs such as a safe structure, electricity, clean water, a blood bank, sterilization equipment, a post-anesthesia recovery unit, appropriate medications should be established. Currently, no specific credentials are needed for surgeons to operate in a humanitarian setting; the training of more hum...

  18. Peripheral venous catheters : Quality of care assessment

    OpenAIRE

    Ahlqvist, Margary

    2009-01-01

    About half of the patients admitted to hospitals receive intravenous therapy through peripheral venous catheters (PVCs). Unfortunately, the use of PVCs is associated with the risk of complications that may lead to increased morbidity and prolonged hospitalisation. Because of the frequent use of PVCs and the risk of PVC-related complications, there are good reasons to assess quality of care. The overall aim of this study was to attain increased knowledge about PVC documen...

  19. Quality Reforms in Danish Home Care

    DEFF Research Database (Denmark)

    Rostgaard, Tine

    2012-01-01

    Despite relatively generous coverage of the over-65 population, Danish home help services receive regular criticism in the media and public opinion polls. Perhaps as a consequence, reforms of Danish home care policy for senior citizens have placed strong emphasis on quality since the 1990s. This reform strategy represents a shift from the welfare state modernisation program of the 1980s, which built mainly on economic strategies of cost-efficiency and New Public Management (NPM) princi-ples, inc...

  20. Utilization of free dental health care services provided to the perinatally infected human immunodeficiency virus children in Bangalore: Longitudinal study

    Directory of Open Access Journals (Sweden)

    Beena Javaregowda Parvathy

    2014-01-01

    Full Text Available Background: Use of Highly active anti-retroviral therapy have increased the life expectancy of human immunodeficiency virus (HIV infected patients and hence it is imperative that all efforts have to be made by Pediatric dentists to provide a better oral health for these children. Aim: The aim of this study was to evaluate the rate of utilization of free dental treatment provided to these perinatally infected HIV positive children who were previously screened as a part of oral health survey. Design: Purposive sampling was used. Inclusion criteria: Perinatally infected HIV children screened for oral health status. Exclusion criteria: Patients not screened during the oral health survey. Materials and Methods: Attendance records of 319 perinatally HIV infected children consisting of 178 males and 141 females attending a specialized pediatric outpatient clinic at Indira Gandhi Institute of Child Health were examined to compare treatment compliance rates. Results: The number of patients in the severe category who completed treatment was significantly less compared with mild and advanced categories (P 0.05. Conclusion: The results show that children with HIV have significantly lower compliance. Even though all dental treatment provided to them was free of the cost it still had no impetus to encourage them to go through with the treatment.

  1. Increasing access to quality health care for the poor: Community perceptions on quality care in Uganda

    OpenAIRE

    Kiguli, Julie; Ekirapa-Kiracho, Elizabeth; Okui, Olico; Mutebi, Aloysius; MacGregor, Hayley; Pariyo, George William

    2009-01-01

    This paper examines the community’s perspectives and perceptions on quality of health care delivery in two Uganda districts. The paper addresses community concerns on service quality. It focuses on the poor because they are a vulnerable group and often bear a huge burden of disease. Community views were solicited and obtained using eight focus group discussions, six in-depth and 12 key informant interviews. User perceptions and definitions of the quality of health services depended on a numbe...

  2. Managing Quality in Health Care: Involving Patient Care Information Systems and Healthcare Professionals in Quality Monitoring and Improvement

    OpenAIRE

    Mul, M.

    2009-01-01

    It is no longer possible to ignore the issue of quality in health care. Care institutions strive to provide all patients with effective, efficient, safe, timely, patient-centered care. Increased attention for quality is also found in discussions regarding use of information and communication technologies (ICTs) in health care processes. In these discussions, ICT is almost always brought into a direct relationship with improving the quality of care, especially ICTs that professi...

  3. Internet Use and Access Among Pregnant Women via Computer and Mobile Phone: Implications for Delivery of Perinatal Care

    Science.gov (United States)

    Peragallo Urrutia, Rachel; Berger, Alexander A; Ivins, Amber A; Beckham, A Jenna; Thorp Jr, John M

    2015-01-01

    Background The use of Internet-based behavioral programs may be an efficient, flexible method to enhance prenatal care and improve pregnancy outcomes. There are few data about access to, and use of, the Internet via computers and mobile phones among pregnant women. Objective We describe pregnant women’s access to, and use of, computers, mobile phones, and computer technologies (eg, Internet, blogs, chat rooms) in a southern United States population. We describe the willingness of pregnant women to participate in Internet-supported weight-loss interventions delivered via computers or mobile phones. Methods We conducted a cross-sectional survey among 100 pregnant women at a tertiary referral center ultrasound clinic in the southeast United States. Data were analyzed using Stata version 10 (StataCorp) and R (R Core Team 2013). Means and frequency procedures were used to describe demographic characteristics, access to computers and mobile phones, and use of specific Internet modalities. Chi-square testing was used to determine whether there were differences in technology access and Internet modality use according to age, race/ethnicity, income, or children in the home. The Fisher’s exact test was used to describe preferences to participate in Internet-based postpartum weight-loss interventions via computer versus mobile phone. Logistic regression was used to determine demographic characteristics associated with these preferences. Results The study sample was 61.0% white, 26.0% black, 6.0% Hispanic, and 7.0% Asian with a mean age of 31.0 (SD 5.1). Most participants had access to a computer (89/100, 89.0%) or mobile phone (88/100, 88.0%) for at least 8 hours per week. Access remained high (>74%) across age groups, racial/ethnic groups, income levels, and number of children in the home. Internet/Web (94/100, 94.0%), email (90/100, 90.0%), and Facebook (50/100, 50.0%) were the most commonly used Internet technologies. Women aged less than 30 years were more likely to report use of Twitter and chat rooms compared to women 30 years of age or older. Of the participants, 82.0% (82/100) were fairly willing or very willing to participate in postpartum lifestyle intervention. Of the participants, 83.0% (83/100) were fairly willing or very willing to participate in an Internet intervention delivered via computer, while only 49.0% (49/100) were fairly willing or very willing to do so via mobile phone technology. Older women and women with children tended to be less likely to desire a mobile phone-based program. Conclusions There is broad access and use of computer and mobile phone technology among southern US pregnant women with varied demographic characteristics. Pregnant women are willing to participate in Internet-supported perinatal interventions. Our findings can inform the development of computer- and mobile phone-based approaches for the delivery of clinical and educational interventions. PMID:25835744

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

    OpenAIRE

    Pilar Isla Pera

    2011-01-01

    Pilar Isla PeraDepartment of Public Health Nursing, Mental and Mother and Child Health, University of Barcelona, SpainBackground: The aim of this research was to characterize the experience of living with diabetes mellitus (DM) and identify patients’ opinions of the quality of care received and the results of interventions.Methods: A descriptive, exploratory evaluation study using qualitative methodology was performed. Participants consisted of 40 adult patients diagnosed with DM an...

  5. Bridging worlds, breaking rules: Clinician perspectives on transitioning young people with perinatally acquired HIV into adult care in a low prevalence setting.

    Science.gov (United States)

    Newman, Christy; Persson, Asha; Miller, Angela; Cama, Elena

    2014-07-01

    The first generation of young people with perinatally acquired HIV is moving into adulthood, precipitating a transition from pediatric to adult care. As the first research appraisal of Australian clinician perspectives on this process, this article makes a unique contribution by examining the particular challenges associated with transitioning this population into adult care in regions of low HIV prevalence among young people. Qualitative interviews were conducted with twelve pediatric and adult care clinicians and analyzed for dominant and diverging themes. Clinicians anticipated significant client vulnerabilities during transition and worked beyond the boundaries of their roles and service parameters to keep clients engaged as they moved between pediatric and adult care. Strategies to strengthen the transition process focused on communication and teamwork, informed by and responsive to the needs of individual young people and their families. Clinicians working in settings with very small numbers of young people with HIV must advocate for a hidden minority with little potential for gaining large scale recognition or system changes. New conversations are needed to design a stronger and more sustainable transition process for both young people living with HIV, and their clinicians who care for them, in low prevalence settings. PMID:24749770

  6. Care seeking at time of childbirth, and maternal and perinatal mortality in Matlab, Bangladesh / Recours aux soins au moment de l'accouchement et mortalité maternelle et périnatale à Matlab, au Bangladesh / Búsqueda de atención para el parto y mortalidad materna y perinatal en Matlab, Bangladesh

    Scientific Electronic Library Online (English)

    Carine, Ronsmans; Mahbub Elahi, Chowdhury; Marge, Koblinsky; Anisuddin, Ahmed.

    2010-04-01

    Full Text Available OBJETIVO: Estudiar la naturaleza de la relación entre el recurso a asistencia calificada en torno al momento del parto y la mortalidad materna y perinatal. MÉTODOS: Analizamos datos del sistema de vigilancia sanitaria y demográfica reunidos entre 1987 y 2005 por el Centro Internacional de Investigac [...] ión de Enfermedades Diarreicas de Bangladesh en Matlab, Bangladesh. RESULTADOS: El estudio registró 59 165 embarazos, 173 muertes maternas, 1661 defunciones prenatales y 1418 muertes neonatales tempranas en su zona de influencia a lo largo del periodo de estudio. Durante ese tiempo, el recurso a asistencia calificada durante el parto aumentó del 5,2% al 52,6%. Más de la mitad (57,8%) de las mujeres que murieron y una tercera parte (33,7%) de las que tuvieron un problema de mortalidad perinatal (esto es, de los casos de mortinatalidad o mortalidad neonatal precoz) habían buscado asistencia especializada. La mortalidad materna fue baja entre las mujeres que no buscaron atención especializada (160 por 100 000 embarazos) y unas 32 veces superior (razón de posibilidades ajustada, OR: 31,66; intervalo de confianza del 95%: 22,03-45,48) entre las que entraron en contacto con servicios de atención obstétrica integral de emergencia. A lo largo del tiempo, la solidez de la relación entre atención obstétrica calificada y mortalidad materna disminuyó paralelamente al aumento del número de mujeres que buscaban atención. La mortalidad perinatal fue también más alta entre las mujeres que buscaron atención especializada que entre las que no lo hicieron, aunque en este caso la asociación fue mucho más débil. CONCLUSIÓN: Considerando los elevados valores de las razones de mortalidad materna y las tasas de mortalidad perinatal entre las mujeres que buscaron atención obstétrica, es necesario hacer un mayor esfuerzo para lograr que las mujeres y sus recién nacidos reciban una atención obstétrica eficaz a su debido tiempo. Para reducir la mortalidad perinatal se requerirán estrategias como la detección y el tratamiento tempranos de los problemas de salud durante el embarazo. Abstract in english OBJECTIVE: To examine the nature of the relationship between the use of skilled attendance around the time of delivery and maternal and perinatal mortality. METHODS: We analysed health and demographic surveillance system data collected between 1987 and 2005 by the International Centre for Diarrhoeal [...] Disease Research, Bangladesh (ICDDR,B) in Matlab, Bangladesh. FINDINGS: The study recorded 59 165 pregnancies, 173 maternal deaths, 1661 stillbirths and 1418 early neonatal deaths in its service area over the study period. During that time, the use of skilled attendance during childbirth increased from 5.2% to 52.6%. More than half (57.8%) of the women who died and one-third (33.7%) of those who experienced a perinatal death (i.e. a stillbirth or early neonatal death) had sought skilled attendance. Maternal mortality was low among women who did not seek skilled care (160 per 100 000 pregnancies) and was nearly 32 times higher (adjusted odds ratio, OR: 31.66; 95% confidence interval, CI: 22.03-45.48) among women who came into contact with comprehensive emergency obstetric care. Over time, the strength of the association between skilled obstetric care and maternal mortality declined as more women sought such care. Perinatal death rates were also higher for those who sought skilled care than for those who did not, although the strength of association was much weaker. CONCLUSION: Given the high maternal mortality ratio and perinatal mortality rate among women who sought obstetric care, more work is needed to ensure that women and their neonates receive timely and effective obstetric care. Reductions in perinatal mortality will require strategies such as early detection and management of health problems during pregnancy.

  7. Delivery of maternal health care in Indigenous primary care services: baseline data for an ongoing quality improvement initiative

    Directory of Open Access Journals (Sweden)

    Kwedza Ru K

    2011-03-01

    Full Text Available Abstract Background Australia's Aboriginal and Torres Strait Islander (Indigenous populations have disproportionately high rates of adverse perinatal outcomes relative to other Australians. Poorer access to good quality maternal health care is a key driver of this disparity. The aim of this study was to describe patterns of delivery of maternity care and service gaps in primary care services in Australian Indigenous communities. Methods We undertook a cross-sectional baseline audit for a quality improvement intervention. Medical records of 535 women from 34 Indigenous community health centres in five regions (Top End of Northern Territory 13, Central Australia 2, Far West New South Wales 6, Western Australia 9, and North Queensland 4 were audited. The main outcome measures included: adherence to recommended protocols and procedures in the antenatal and postnatal periods including: clinical, laboratory and ultrasound investigations; screening for gestational diabetes and Group B Streptococcus; brief intervention/advice on health-related behaviours and risks; and follow up of identified health problems. Results The proportion of women presenting for their first antenatal visit in the first trimester ranged from 34% to 49% between regions; consequently, documentation of care early in pregnancy was poor. Overall, documentation of routine antenatal investigations and brief interventions/advice regarding health behaviours varied, and generally indicated that these services were underutilised. For example, 46% of known smokers received smoking cessation advice/counselling; 52% of all women received antenatal education and 51% had investigation for gestational diabetes. Overall, there was relatively good documentation of follow up of identified problems related to hypertension or diabetes, with over 70% of identified women being referred to a GP/Obstetrician. Conclusion Participating services had both strengths and weaknesses in the delivery of maternal health care. Increasing access to evidence-based screening and health information (most notably around smoking cessation were consistently identified as opportunities for improvement across services.

  8. Perinatal Asphyxia

    OpenAIRE

    H Shajari

    2000-01-01

    Asphyxia before, during or after delivery is an important cause of perinatal mortality and neurologic morbidity. The fetus and newborn are equipped with a wide range of adaptive mechanisms to survive an Asphyxia episode, and when these fail, injury can occur. The American academy or pediatrics (AAP) and the American college of obstetrics and gynecology (AcoG) committees on maternal-fetal medicine and fetus and newborn have recently defined certain criteria that must be present: Profound umbil...

  9. Nursing care quality: a concept analysis

    Directory of Open Access Journals (Sweden)

    Virya Koy

    2015-08-01

    Full Text Available The purpose of this paper is to provide a clear definition of nursing care quality that contributes to the formulation, application, and measurement of quality nursing outcomes for patients, organisations, and nursing staff. It also indicates the manner in which, by using the definition, empirically based operational definitions can be developed for different operational environments and settings. The study employed a concept analysis methodology to extract terms, attributes, antecedents, and consequences (outcomes from relevant literature databases. The analysis identified nine attributes: nurse competency performance, met nursing care needs, good experiences for patients, good leadership, staff characteristics, preconditions of care, physical environment, progress of nursing process, and cooperation with relatives. Antecedences include nurse-staffing levels, positive practice environment, and nursing turnover. Consequences include patient safety, patient satisfaction, nursing outcomes, nurse satisfaction, and budget management. Because of the breadth and depth of modern nursing practice, further research and development of the concept is required. [Int J Res Med Sci 2015; 3(8.000: 1832-1838

  10. Complicaciones maternas y mortalidad perinatal en el Síndrome de Hellp: Registro multicéntrtico en unidades de cuidados intensivos del área Buenos Aires Maternal morbidity and perinatal mortality in HELLP syndrome. Multicentric studies in intensive care units in Buenos Aires area

    Directory of Open Access Journals (Sweden)

    Eduardo Malvino

    2005-03-01

    Full Text Available Se analizaron en forma retrospectiva las características clínicas, complicaciones, gravedad, y sobrevivencia materna y fetal, en un grupo de gestantes con síndrome HELLP ( Hemolysis , Elevated Liver enzyme levels, Low Platelet count que requirieron admisión en cuatro unidades de cuidados intensivos del área metropolitana Buenos Aires, Argentina. Durante el período comprendido entre marzo de 1997 y marzo de 2003 se evaluaron 62 pacientes en la segunda mitad del embarazo o el puerperio inmediato que cumplían criterios diagnósticos de hipertensión inducida por el embarazo, asociado a plaquetopenia 70 UI/l, láctico deshidrogenasa >600 UI/l, bilirrubina total >1.2 mg / dl , y/o frotis de sangre periférica con signos de hemólisis. La edad promedio fue 28 ± 8 años; número de gestas promedio 2.7 ± 2.3; edad gestacional media 33 ± 4 semanas. Según el grado de plaquetopenia, 23 casos pertenecieron a la clase 1, 29 a la clase 2 y el resto a la clase 3 de la clasificación de Martin . Hubo 16 formas eclámpticas. El recuento plaquetario promedio fue 67 604 ± 31 535/ mm3 ; TGO 271 ± 297 UI/l; TGP 209 ± 178 UI/l; LDH 1 444 ± 1 295 UI/l; creatininemia 1.1 ± 0.8 mg / dl. Cuarenta y una pacientes cursaron con diverso grado de deterioro del filtrado glomerular, con requerimiento de tratamiento hemodialítico y plasmaféresis en un caso. Se presentó insuficiencia respiratoria vinculada a síndrome de distrés respiratorio del adulto en cuatro enfermas. Todas las puérperas sobrevivieron y se comprobaron cuatro muertes perinatales. En la población estudiada, se observó baja prevalencia de complicaciones graves, óptima sobrevivencia materna y baja mortalidad perinatal.We analized the clinical characteristics, complications, severity, and maternal and fetal survival of patients suffering from HELLP syndrome ( Hemolysis , Elevated Liver enzymes level, Low Platelet count requiring admission to the intensive care unit in four hospitals from Buenos Aires area, Argentina. Data was revised in the charts from March 1997 to March 2003 and 62 patients were included in the study. During the second half of pregnancy or immediate puerperal period, diagnostic criteria were defined on the basis of preeclampsia and the following laboratory abnormalities: platelet count nadir 70 UI/l, and serum lactic dehydrogenase >600 UI/l, total bilirubin >1.2 mg/dl and/or periferical blood smear with hemolysis. The mean maternal age was 28 ± 8 years; parity 2.7 ± 2.3; gestational age 33 ± 4 weeks. According to platelet count, 23 cases were identified to class 1, 29 to class 2 and the rest to Martin's class 3. There were 16 eclamptic patients. The platelet count was 67 604 ± 31 535/mm3; alanine aminotransferase 271 ± 297 UI/l; aspartate aminotransferase 209 ± 178 UI/l; serum lactic dehydrogenase 1 444 ± 1 295 UI/l; serum creatininine levels 1.1 ± 0.8 mg/dl. Forty-one patients had diverse degree of renal function damage, renal dialysis and plasmapheresis was required in one female. Respiratory failure due to pulmonary edema was observed in four patients. All obstetric patients survived. There were four perinatal deaths. In our population sample, low rate of life-threatening maternal complications and low perinatal mortality were observed.

  11. Identifying Tools and Strategies to Provide Quality Oncology Care

    OpenAIRE

    Ganz, Patricia A.

    2013-01-01

    This session of the ASCO Quality Symposium provided an opportunity to examine a variety of research and quality improvement strategies aimed at improving the quality of cancer care along the continuum.

  12. Deming's quality principles: a health care application.

    Science.gov (United States)

    Lynn, M L; Osborn, D P

    1991-01-01

    W. Edwards Deming is considered a guru of quality by many international manufacturers. His ideas revolutionized Japan's auto industry in the 1950s, but did not make a substantial impact in the United States until 1980. Increasingly, service organizations, from hotels to public utility companies, are experimenting with his principles. This article explains how a 165-bed community hospital--Brazosport Memorial Hospital in Lake Jackson, Texas--is putting Deming's ideas to work in health care. Deming's philosophy and principles are described as is the hospital's application and implementation of his ideas; preliminary results are encouraging. PMID:10108969

  13. Increasing access to quality health care for the poor: Community perceptions on quality care in Uganda

    OpenAIRE

    Julie Kiguli; Elizabeth Ekirapa-Kiracho; Olico Okui; Aloysius Mutebi; et. al.

    2009-01-01

    Julie Kiguli1, Elizabeth Ekirapa-Kiracho1, Olico Okui1, Aloysius Mutebi1, Hayley MacGregor2, George William Pariyo11Makerere University School of Public Health, Kampala, Uganda; 2Institute of Development Studies, Sussex, UKAbstract: This paper examines the community’s perspectives and perceptions on quality of health care delivery in two Uganda districts. The paper addresses community concerns on service quality. It focuses on the poor because they are a vulnerable group and often b...

  14. Carepaths: a framework for quality patient care

    International Nuclear Information System (INIS)

    Purpose/Objective: The goals of a carepath are to provide a framework for quality patient care, enhance collaborative practice, improve resource utilization, and increase patient satisfaction. Carepaths are designed to move the patient toward specific clinical outcomes, which have been defined by a multidisciplinary team. Carepaths enhance the quality improvement process by tracking clinical outcomes and patient satisfaction. The purpose of this report is to share the 1996 results of our breast cancer carepath. Methods: In 1994 the multidisciplinary Quality Improvement Committee of the Division of Radiation Oncology constructed a carepath for women with breast cancer receiving breast or chest wall radiation. Eleven clinical outcomes were defined which reflected the educational and selfcare focus of the carepath. Recording on the carepath of patient attainment of the outcomes was done by the RN, RTT and MD. Patient satisfaction tools were designed by the quality improvement committee in conjunction with the Department of Marketing Support. Each patient was given a written survey at two points along the carepath: post simulation and post treatment. Results: Ninety-five women were placed on the breast carepath in 1996. Outcomes were reviewed for 40 of these carepaths. The return rate of patient satisfaction surveys post simulation and post treatment approached 99%. Overall satisfaction was high with 76% of patients feeling 'very satisfied' with the simulation process and 93% 'very satisfied' with the treatment experience. Common themes noted in anecdotes related to comfort and privacy issues. Conclusions: Based on our experience, carepaths facilitated the structuring of a comprehensive and collaborative approach to patient care. Strategies for process improvement were guided by the ongoing surveillance of clinical outcomes and patient satisfaction

  15. Maternal, Perinatal and Neonatal Mortality in South-East Asia Region

    Directory of Open Access Journals (Sweden)

    Gaurav Sharma

    2012-01-01

    Full Text Available South East Asia Region (SEAR is one of the most populous world regions and also bears a disproportionate burden of mortality compared to other world regions. The purpose of this article was to analyze the situation of maternal, neonatal and perinatal health in SEAR to inform public health practitioners, program managers and policy makers about the situation in this world region. A secondary review of policy and programmatic documents published by ministries of health in SEAR countries, WHO, other UN agencies and peer reviewed journal articles in the area of maternal, child, neonatal and perinatal health published in the last five years was conducted. This article discusses the current situation of maternal, perinatal and neonatal health in SEAR countries, highlights some of the key challenges and provides recommendations to countries on the way forward for improving perinatal and maternal health. Key issues are discussed under the broad themes of improving maternal and perinatal health information systems, improving quality of care and human resource management. The article concludes that Health Systems Strengthening, Scaling up of Skilled Human Resource, Investing in information systems and improving the quality of maternal and neonatal care services are essential for future progress in countries but these are long term processes which need sustained commitment and ownership at all levels.

  16. 38 CFR 52.120 - Quality of care.

    Science.gov (United States)

    2010-07-01

    ...2010-07-01 2010-07-01 false Quality of care. 52.120 Section 52.120 Pensions...CONTINUED) PER DIEM FOR ADULT DAY HEALTH CARE OF VETERANS IN STATE HOMES Standards § 52.120 Quality of care. Each participant must receive,...

  17. Predictors of Perinatal Hemorrhagic Stroke

    Directory of Open Access Journals (Sweden)

    J Gordon Millichap

    2009-04-01

    Full Text Available The prevalence and predictors of perinatal hemorrhagic stroke were determined in a case-control study of infants born from 1993 to 2003 in the Northern California Kaiser Permanente Medical Care Program, Oakland, CA, and reported from the University of California, San Francisco, CA.

  18. Perinatal Safety: From Concept to Nursing Practice

    OpenAIRE

    LYNDON, Audrey; Kennedy, Holly Powell

    2010-01-01

    Communication and teamwork problems are leading causes of documented preventable adverse outcomes in perinatal care. An essential component of perinatal safety is the organizational culture in which clinicians work. Clinicians’ individual and collective authority to question the plan of care and take action to change the direction of a clinical situation in the patient’s best interest can be viewed as their “agency for safety.” However, collective agency for safety and commitment to support n...

  19. Molecular imaging in quality health care

    International Nuclear Information System (INIS)

    Full text: Quality Health Care results from applying fundamental basic science and preclinical concepts as well as novel technologies to patient care within specific socio-economic frameworks. Cancer mortality has improved recently but outcomes of cancer patients are still unacceptably poor. Molecular Imaging has the potential to improve the outcome of cancer patients in several ways. In the preclinical setting, high resolution molecular imaging devices designed for small animal research have developed into valuable tools for drug evaluation and imaging probe design. These have enabled us to study drug effects in vivo by monitoring longitudinally their effects on tumor cell metabolism or proliferation. The success of Imatinib in treating chronic myeloid leukemia (CML) and gastrointestinal stromal tumors (GIST) has demonstrated that targeted drugs can induce remarkable tumor responses and may even cure cancer patients. Targeted drugs have been used for treating various common solid human tumors, including breast cancer, colorectal cancer, and non-small cell lung cancer. However, diverse signaling pathways are involved in the development and progression of these genetically heterogeneous diseases. Consequently, inhibition of one specific pathway is likely to be efficacious in only in small subsets of patients with specific histological tumor types. It is unlikely that a single 'blockbuster' drug can be effective for all patients with a 'common' tumor. Rather, it will be necessary to develop multiple targeted drugs even for patients that share a single histologically defined tumor type. The inevitable consequence is a decreased revenue/cost ratio for the industry and increasing costs for patients and health care systems. It is therefore of paramount importance to identify drug failure as early as possible in preclinical and clinical trials. Human studies with positron emission tomography (PET) with molecular imaging probes targeting physiological processes such as glycolysis, lipid synthesis, amino acid transport, cell surface receptors, gene expression and others are available for evaluating in animal experimental studies and humans the extent of disease as well as treatment effects in vivo. With the advent of PET/CT anatomic and molecular images can be fused affording assignment of normal or abnormal molecular imaging findings to specific anatomical structures. The major vendors have invested millions of dollars into bringing together the highest quality CT with 'state of the art' PET instrumentation. Similar technology mergers are currently happening for PET and MRI. These technological advances come at a time of increasing health care expenditures worldwide. One must therefore carefully evaluate whether the increasing costs are met by increasing effectiveness of the technology. This needs to be carefully determined within the varying health care systems and frameworks. This presentation will provide cancer statistics, introduce molecular imaging tools and will describe the concept of targeted imaging. Animal experimental studies will be used to demonstrate promising treatment approaches in vivo and how imaging can be used to monitor therapeutic effects. Further, the clinical molecular PET/CT imaging technology will be introduced and its impact on patient management and cost-effectiveness will be reviewed and discussed within the confines of different health care systems. Finally, Initial clinical trials will be presented that use molecular PET rather than anatomical CT imaging for prospectively arriving at patient management decisions. (author)

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

    OpenAIRE

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

    2011-01-01

    In 2008, the federal government allotted $7 billion in child care subsidies to low-income families through the state-administered Child Care and Development Fund (CCDF), now the government’s largest child care program (US DHHS, 2008). Although subsidies reduce costs for families and facilitate parental employment, it is unclear how they impact the quality of care families purchase. This study investigates the impact of government subsidization on parents’ selection of child care quality using...

  1. Evaluating the Quality of the Child Care in Finland

    Science.gov (United States)

    Hujala, Eeva; Fonsen, Elina; Elo, Janniina

    2012-01-01

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

  2. Calidad de los datos utilizados para el cálculo de indicadores de salud reproductiva y perinatal en población autóctona e inmigrante Quality of data used to calculate reproductive and perinatal health indicators in native and migrant populations

    Directory of Open Access Journals (Sweden)

    Isabel Río

    2010-04-01

    Full Text Available Objetivos: Evaluar la calidad de los datos sobre nacimientos recogidos en el Movimiento Natural de la Población (MNP y en los registros de metabolopatías para el cálculo de indicadores de salud reproductiva y perinatal. Métodos: Comparación entre registros acerca de 1 número total de nacimientos de madre residente en Cataluña y Comunitat Valenciana registrados durante 2005-2006, 2 grado de cumplimentación de los datos sobre origen geográfico de la madre, y 3 grado de cumplimentación de la edad materna, peso al nacer y edad gestacional según el origen de la madre. Resultados: Los registros de metabolopatías recogen de forma exhaustiva los nacimientos registrados en el MNP. El grado de cumplimentación de los datos sobre el origen y la edad materna fue algo menor en los registros de metabolopatías, aunque la proporción de nacimientos según el origen de la madre fue muy similar a la del MNP, así como la media de edad materna según el origen. El grado de cumplimentación de los datos sobre peso al nacer y edad gestacional según el origen materno fue muy inferior en el MNP, especialmente entre los nacimientos de madre inmigrante registrados en Cataluña. Conclusiones: Nuestros resultados sugieren una limitación en la calidad de los datos sobre edad gestacional y peso al nacer del MNP, sobre todo de cara al cálculo y la comparación de indicadores de prematuridad y bajo peso al nacer en población autóctona e inmigrante. A la vez, apoyan la utilidad de los registros de metabolopatías como fuente para el cálculo diferencial de tales indicadores.Objective: To assess the quality of data on births in the Natural Population Movement (NPM and congenital metabolic disorders registers with regard to calculation of reproductive and perinatal health indicators. Methods: The following comparisons between registers were made: (1 the total number of births to mothers living in Catalonia and Valencia from 2005 to 2006, (2 the percentage of missing data on the mother's geographical origin, (3 the percentage of missing data on the mother's age and the infant's birthweight and gestational age according to maternal origin. Results: The congenital metabolic disorders registers exhaustively collected the total number of births gathered in the NPM. The percentages of missing data on material origin and age were higher in the congenital metabolic disorders registers, although the proportion of births by maternal origin and the mean maternal age in each ethnic group was fairly similar to that in the NPM. The percentages of missing data on birthweight and gestational age were much higher in the NPM data than in the congenital metabolic disorders registers, especially among births registered in Catalonia and births to foreign mothers. Conclusions: Our results suggest some limitations in the quality of the data on gestational age and birthweight provided by NPM data, especially for comparisons of preterm and low birthweight indicators in the Spanish-born and immigrant populations. Moreover, the results point to the quality of the congenital metabolic disorders registers as a source to compare reproductive and perinatal health indicators.

  3. Quality indicators for international benchmarking of mental health care

    DEFF Research Database (Denmark)

    Hermann, Richard C; Mattke, Soeren; Somekh, David; Silfverhielm, Helena; Goldner, Elliot; Glover, Gyles; Pirkis, Jane; Mainz, Jan; Chan, Jeffrey A

    2006-01-01

    To identify quality measures for international benchmarking of mental health care that assess important processes and outcomes of care, are scientifically sound, and are feasible to construct from preexisting data.

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

    Science.gov (United States)

    Jesus, Tiago Silva; Hoenig, Helen

    2015-05-01

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

  5. Improving quality of cancer care through surgical audit

    DEFF Research Database (Denmark)

    van Gijn, W; van de Velde, C J H; Laurberg, Søren

    2010-01-01

    Quality of healthcare is a hot topic and this is especially true for cancer care. New surgical techniques and effective neoadjuvant treatment regimens have significantly improved colorectal cancer outcome. Nevertheless, there seem to be substantial differences in quality of care between European countries, hospitals and doctors. To reduce hospital variation, most initiatives aim on selective referral, encouraging patients to seek care in high-volume hospitals, where cancer care is concentrated t...

  6. Correlates of Perinatal Depression in HIV-Infected Women

    OpenAIRE

    KAPETANOVIC, Suad; Christensen, Shawna; Karim, Roksana; Lin, Florence; Mack, Wendy J.; Operskalski, Eva; Frederick, Toni; Spencer, LaShonda; Stek, Alice; Kramer, Francoise; KOVACS, ANDREA

    2009-01-01

    Maternal perinatal depression (PND) may interfere with effective perinatal HIV care. In order to begin examining the prevalence and characteristics of PND in HIV-infected women, we analyzed data from the medical records of all HIV-infected women who had received perinatal care in the Maternal-Child and Adolescent Center for Infectious Diseases and Virology at LAC/USC Medical Center from 1997 through 2006. Data from 273 individual women (328 live births) were analyzed. Demographic, medical his...

  7. Mortalidade perinatal e evitabilidade: revisão da literatura Perinatal mortality and evitability: a review

    Directory of Open Access Journals (Sweden)

    Sônia Lansky

    2002-12-01

    Full Text Available Neste artigo, realizou-se uma revisão da literatura sobre mortalidade perinatal com maior enfoque na evitabilidade desses óbitos. Foram pesquisadas, sobretudo, publicações da década de 90 nas bases Medline e Lilacs (América Latina e Caribe. Discutiram-se as dificuldades para a realização de estudos nesta área, ainda em número restrito no Brasil, em decorrência do grande subregistro de óbitos fetais e da má qualidade da informação nas declarações de óbitos. Foram apresentadas as principais propostas de classificação dos óbitos perinatais baseadas em enfoque de evitabilidade, com destaque para a classificação de Wigglesworth. Nesta abordagem, os óbitos perinatais foram relacionados a momentos específicos da assistência, sendo evidenciadas as possibilidades de sua prevenção. Recomenda-se o enfoque de evitabilidade para a abordagem da mortalidade perinatal no Brasil, dado que as taxas são ainda elevadas, a maioria dos óbitos é considerada evitável e poderia ser prevenida com a melhoria da assistência pré-natal, ao parto e ao recém-nascido, não apenas quanto à sua resolubilidade clínica, mas também à organização da assistência em sistemas hierarquizados e regionalizados, assegurando o acesso da gestante e do recém-nascido em tempo oportuno a serviços de qualidade.This is a literature review onperinatal mortality focusing its evitability. A Medline and Lilacs (Latin-America and Caribbean search was conducted for the 90s. There are few research studies on this subject in Brazil due to the great number of underreported fetal deaths and the low quality information provided in death certificates. Different proposals for perinatal death classification are presented. Most are based on grouping the underlying causes of deaths in a functional system in order to facilitate the analysis. In the Wigglesworth classification system, one of the most recommended methods, deaths are related to the different stages of care for pregnant women and children, evidencing the possibilities of their prevention. The evitability approach of perinatal deaths in Brazil is highly recommended, as mortality rates are still very high and most of the deaths are considered avoidable. Premature deaths could be avoided improving the quality of health care. Besides improving the medical assistance, the organization of health care regarding pre-natal, birth and neonatal care must also be better developed to ensure access to qualified assistance.

  8. Systematic review of quality of care in Saudi Arabia. A forecast of a high quality health care

    OpenAIRE

    Khalid M. Almutairi; Mahaman Moussa

    2014-01-01

    Objectives: To explore the current structure of the Saudi health care system, and assess the quality of health care in the Kingdom of Saudi Arabia (KSA) based on the indicators provided by the Institute of Medicine (IOM), and to provide recommendations for improvements. Methods: This study explores the current structure of the Saudi health care system using a systematic review of studies published between 2009 and 2013. The IOM indicators of quality health care (safe, effective, patient-cente...

  9. Quality indicators for primary care mental health services

    OpenAIRE

    Shield, T; CAMPBELL, S; A. Rogers; Worrall, A; Chew-Graham, C.; Gask, L.

    2003-01-01

    Objectives: To identify a generic set of face valid quality indicators for primary care mental health services which reflect a multi-stakeholder perspective and can be used for facilitating quality improvement.

  10. Molecular imaging in quality health care

    International Nuclear Information System (INIS)

    Full text: Quality health care results from translating fundamental bench discoveries and making them available to patients. During the past decade, 'molecular imaging' has emerged both as a new tool/technology and as a research and clinical discipline. Molecular imaging is an interdisciplinary approach involving biologists, physicists, physicians, mathematicians, conventional chemists, radiochemists and other specialists who have joined forces for better understanding and visualizing of both normal physiological processes and the molecular processes preceding the morphological manifestations of disease in vivo. Molecular imaging has been defined as 'non-invasive, quantitative, and repetitive imaging of targeted macromolecules and biological processes in living organisms' or as 'the visual representation, characterization, and quantification of biological processes at the cellular and sub-cellular levels within intact living organisms'. Weissleder defined molecular imaging in the most simple terms as 'studying diseases non-invasively at the molecular level'. Regardless of these semantic differences molecular imaging can contribute significantly to the preclinical and clinical drug and disease evaluation process. It is interesting to note, that despite major advances in imaging technology, cancer mortality has remained largely unchanged over the last three decades. Imaging has thus far enabled us to look through a magnifying glass at disease processes but has failed to dramatically influence disease outcomes. Emerging data suggest that molecular PET imaging is about to change this situation. High resolution molecular imaging devices designed for small animal research have developed into valuable tools for drug evaluation and imaging probe design. These include microPET, microCT, microMRI and optical imaging devices. These have enabled us to study drug effects in vivo by monitoring longitudinally their effects on tumour cell metabolism or proliferation. The only currently available molecular imaging tool for human studies is positron emission tomography (PET). Many different molecular imaging probes targeting physiological processes such as glycolysis, lipid synthesis, amino acid transport, cell surface receptors, gene expression and others are available for evaluating in animal experimental studies and humans the extent of disease as well as treatment effects in vivo. With the advent of PET/CT anatomic and molecular images can be fused affording assignment of normal or abnormal molecular imaging findings to specific anatomical structures. The major vendors have invested millions of dollars into bringing together the highest quality CT with state-of-the-art PET instrumentation. As a result more than 1000 PET/CT scanners have been installed worldwide over the last four years. These technological advances come at a time of increasing health care expenditures worldwide. One must therefore carefully evaluate whether the increasing costs are met by increasing effectiveness of the technology. As an additional problem, health care systems vary substantially between countries and cultures and cost-effectiveness analyses need to be tailored towards specific health care environments. A paradigm shift from morphological to molecular imaging is occurring on every level of preclinical and clinical research and in clinical practice. Animal tumour models are being used for serial non-invasive monitoring of preclinical drug effects in vivo using molecular imaging technology. This molecular imaging application reduces the numbers of animals required for preclinical studies and might allow for some predictions of drug effectiveness in humans. Molecular imaging should be used in phase I, II and III trials to identify drug success and failure early. Applications of molecular imaging to patient stratification will define appropriate patient populations for smaller, more rapid clinical trials. Recent studies in lung cancer, lymphoma, esophageal cancer and gastrointestinal stromal tumour have clearly indicated that FDG PET/CT imaging can be used

  11. Incorporating health care quality into health antitrust law

    OpenAIRE

    Schneider Helen

    2008-01-01

    Abstract Background Antitrust authorities treat price as a proxy for hospital quality since health care quality is difficult to observe. As the ability to measure quality improved, more research became necessary to investigate the relationship between hospital market power and patient outcomes. This paper examines the impact of hospital competition on the quality of care as measured by the risk-adjusted mortality rates with the hospital as the unit of analysis. The study separately examines t...

  12. Quality measurement and system change of cancer care delivery.

    Science.gov (United States)

    Haggstrom, David A; Doebbeling, Bradley N

    2011-12-01

    Cancer care quality measurement and system change may serve as a case example for larger possibilities in the health care system related to other diseases. Cancer care quality gaps and variation exist across both technical and patient-centered cancer quality measures, especially among vulnerable populations. There is a need to develop measures that address the following dimensions of quality and its context: disparities, overuse, patient-centeredness, and uncertainty. Developments that may promote system change in cancer care delivery include changes in the information market, organizational accountability, and consumer empowerment. Information market changes include public cancer care quality reporting, enabled by health information exchange, and incentivized by pay-for-performance. Moving organizational accountability, reimbursement, and quality measurement from individual episodes of care to multiple providers providing coordinated cancer care may address quality gaps associated with the fragmentation of care delivery. Consumer empowerment through new technologies, such as personal health records, may lead to the collection of patient-centered quality measures and promote patient self-management. Across all of these developments, leadership and ongoing research to guide informed system changes will be necessary to transform the cancer care delivery system. PMID:20940654

  13. Providers caring for adolescents with perinatally-acquired HIV: Current practices and barriers to communication about sexual and reproductive health.

    Science.gov (United States)

    Albright, Jamie N; Fair, Cynthia D

    2014-11-01

    The population of adolescents and young adults (AYA) with perinatally-acquired HIV (PHIV) present challenges to HIV healthcare providers (HHCPs). Originally not expected to survive childhood, they are now living well into young adulthood. Little is known about the type of sexual and reproductive (SRH) information/services offered to AYA with PHIV by HHCPs. HHCPs (n=67) were recruited using snowball sampling, and completed an online survey. Providers' most frequently endorsed SRH topics discussed with both male and female patients included condom use (77.3%), STD prevention (73.1%), and screening (62.1%). Providers' reports indicated that females received significantly more education about SRH topics overall. The most frequently noted barriers to SRH communication included more pressing health concerns (53.0%), parent/guardian not receptive (43.9%), and lack of time during appointment (43.9%). Provider-reported SRH conversations with HHCPs were highly focused on horizontal transmission and pregnancy prevention. Salient social aspects of SRH promotion for AYAs with PHIV (e.g., managing disclosure and romantic relationships) were less commonly discussed, though such conversations may serve to reduce secondary transmission and enhance the overall well-being of AYA with PHIV. Findings indicated that further work must be done to identify strategies to address unmet SRH needs of the aging population of AYA with PHIV. PMID:25290765

  14. The perinatal loss and parental reflection

    Directory of Open Access Journals (Sweden)

    Kamile Kukulu

    2010-12-01

    Full Text Available In this review, the causes of prenatal losses, pregnancy termination and reflection of this situation for the parents were investigated. Despite great attention in improving perinatal care, perinatal loss (fetal loss and newborn death continues to occur. According to the World Health Organization (WHO, the perinatal period extends from the 20th gestational week through 1 month after birth. However, researchers who study perinatal loss use a broader definition that includes early (during the first 12 weeks following conception as well as late fetal loss (>20 weeks’ gestation. Of all known pregnancies, an estimated ratio of 12% to 20% ends in an early fetal loss. The most recent available data have revealed that the rates translate to about 1.03 million annual fetal losses and, for 2004, 18.602 newborn deaths. According to the results of 2008, infant mortality rate decreased very rapidly in Turkey. Of the many parents who suffer a perinatal loss, at least 80% become pregnant again, an event that occurs within 18 months. Therefore, it is important for nurses and health care professionals to understand the impact of a perinatal loss on a subsequent pregnancy. The purpose of this article is to perform an investigation on parental, primarily maternal, responses to pregnancy subsequent to perinatal loss, and to describe nursing implications for parents during the subsequent pregnancy.

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

    Science.gov (United States)

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

    2007-01-01

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

  16. Improving quality of cancer care through surgical audit

    OpenAIRE

    Van Gijn, W.; van de Velde, C.J.H.

    2010-01-01

    Abstract Quality of healthcare is a hot topic and this is especially true for cancer care. New surgical techniques and effective neoadjuvant treatment regimens have significantly improved colorectal cancer outcome. Nevertheless, there seem to be substantial differences in quality of care between European countries, hospitals and doctors. To reduce hospital variation, most initiatives aim on selective referral, encouraging patients to seek care in high-volume hospitals, where cancer...

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

    DEFF Research Database (Denmark)

    Mainz, Jan; Kristensen, Solvejg

    2015-01-01

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

  18. Systems and processes that ensure high quality care.

    Science.gov (United States)

    Bassett, Sally; Westmore, Kathryn

    2012-10-01

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

  19. Quality improvement in end-of-life critical care.

    Science.gov (United States)

    Kahn, Jeremy M

    2012-08-01

    Patients, clinicians and policy makers are increasingly interested in measuring and improving the quality of health care at the end of life. The intensive care unit (ICU) is characterized by high mortality and frequent use of life-sustaining treatments, making critical care a natural target for these efforts. Indeed, multiple local and regional quality improvement efforts now specifically target the dying experience for ICU patients, patients at risk for ICU admission, and their families. These activities either target ICU caregivers through educational programs and quality incentives, or target patients and their families directly through palliative care and efforts to improve decisions around the end of life. Although these initiatives hold great promise, they also face inherent challenges-it is difficult to measure the quality of end-of-life care, we lack practical targets for affecting quality, and uncertain political climates can often preclude serious discussions about end-of-life care. Moreover, these programs may lead to unintended consequences, potentially negatively impacting the very care they seek to improve. Future innovations surrounding how we measure the quality of end-of-life care and paradigm shifts in the way we think about ICU quality may help us to fully realize the goal of improving the dying process for ICU patients. PMID:22875384

  20. Quality, costs and the role of primary health care

    OpenAIRE

    Engström, Sven

    2004-01-01

    The general aim of this thesis is to describe and analyse the role of primary care in health care systems in terms of health, health care utilisation and costs, and to study the feasibility of retrieval of data from computerised medical records to monitor medical quality. The thesis includes five studies, a systematic literature review, a register study of utilisation of hospital and primary care, a study based on data from computerised medical records of individual patients cost for primary ...

  1. Measuring quality in social care services: theory and practice

    OpenAIRE

    Malley, Juliette; Fernández, José-Luis

    2010-01-01

    Measuring and assessing service quality in the social care sector presents distinct challenges. The 'experience' good properties of social care, for instance, and the large influence played by subjective judgements about the quality of personal relationships between carer and user and of process-related service characteristics make it difficult to develop indicators of service quality, including those of service impact on final outcomes. Using some of the key features of the 'Production of We...

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

    OpenAIRE

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

    2013-01-01

    ?Quality Indicators (QIs) are measures of health care quality that make use of readily available hospital inpatient administrative data. Assessment quality of care can be performed on different levels: national, regional, on a hospital basis or on an individual basis. It can be a mandatory or voluntary system. In all cases development of an adequate database for data extraction, and feedback of the findings is of paramount importance. In the present paper we performed a Medline search on “QIs...

  3. Specialized operating room for cesarean section in the perinatal care unit: a review of the opening process and operating room management.

    Science.gov (United States)

    Kasagi, Yoshihiro; Okutani, Ryu; Oda, Yutaka

    2015-02-01

    We have opened an operating room in the perinatal care unit (PNCU), separate from our existing central operating rooms, to be used exclusively for cesarean sections. The purpose is to meet the increasing need for both emergency cesarean sections and non-obstetric surgeries. It is equipped with the same surgical instruments, anesthesia machine, monitoring system, rapid infusion system and airway devices as the central operating rooms. An anesthesiologist and a nurse from the central operating rooms trained the nurses working in the new operating room, and discussed solutions to numerous problems that arose before and after its opening. Currently most of the elective and emergency cesarean sections carried out during the daytime on weekdays are performed in the PNCU operating room. A total of 328 and 347 cesarean sections were performed in our hospital during 2011 and 2012, respectively, of which 192 (55.5 %) and 254 (73.2 %) were performed in the PNCU operating room. The mean occupancy rate of the central operating rooms also increased from 81 % in 2011 to 90 % in 2012. The PNCU operating room was built with the support of motivated personnel and multidisciplinary teamwork, and has been found to be beneficial for both surgeons and anesthesiologists, while it also contributes to hospital revenue. PMID:24917221

  4. Efforts to Improve Perinatal Outcomes for Women Enrolled in Medicaid.

    Science.gov (United States)

    Daniel-Robinson, Lekisha; Cha, Stephen; Lillie-Blanton, Marsha

    2015-08-01

    Improving women's health and perinatal health outcomes is a high priority for Medicaid, the jointly financed federal-state health coverage program. The authorities provided by the Affordable Care Act give Medicaid new resources and opportunities to improve coverage and perinatal care. Given that the Medicaid program currently covers almost half of all births in the United States, the Centers for Medicare and Medicaid Services, working in partnership with states and other stakeholders, is using new and existing authorities to improve birth outcomes. Quality measurement, quality-improvement projects, and expanded models of care underscore the major quality approach of the center. As an outgrowth of an expert panel that included membership of several state Medicaid medical directors, Medicaid providers, and consumer representatives, the Centers for Medicare and Medicaid Services' Center for Medicaid and CHIP Services launched the Maternal and Infant Health Initiative, which aims to increase postpartum visit rates and the use of effective contraception among women covered by Medicaid. This Initiative provides focus on key opportunities and strategies to improve the rate, measurement, timing, and content of postpartum visits. Additionally, a focus on contraception will serve to improve pregnancy planning and spacing and prevent unintended pregnancy. As the Initiative evolves, the Center for Medicaid and CHIP Services plans to identify policy, service delivery, and reimbursement policies to advance the Initiative's goals and improve outcomes for women covered by Medicaid. PMID:26241435

  5. Introduction of abortion technologies: a quality of care management approach.

    Science.gov (United States)

    Greenslade, F C; Winkler, J; Leonard, A H

    1992-01-01

    Development of antiprogestins for use to induce early abortion clearly advances reproductive health to a higher level. A heated debate has arisen over the appropriateness of its being introduced in health care settings, however. Since the introduction of new contraceptive technologies into health care and family planning programs has produced serious shortcomings, some abortion care specialists propose a management approach to introducing RU-486/prostaglandin which stresses women's needs and preferences. This quality of care framework is based on 20 years of experience of introducing manual vacuum aspiration into developing countries. It takes into consideration that decisions about introducing RU-486/prostaglandin are country-specific and often program- or clinic-specific. Decision makers need to look at preparedness of local policy and service delivery infrastructure to take on the specific responsibilities of integrating it into ongoing programs and how this new technology will affect quality of care. The quality of care framework consists of those elements appropriate to women' access to care which include appropriate abortion care technology; technical competence of all members of the health care team at all levels of the health system; interactions between women and providers/staff (respect and support for women and nonjudgemental attitudes); comprehensive information and counseling; quality and accessible postabortion family planning and reproductive health care; and equipment, supplies, and medication. Decision makers need to consider whether RU-486/prostaglandin is acceptable to women and providers, manufactured to high standards, consistent with relevant regulatory requirements and appropriate to specific service delivery settings. PMID:1434757

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

    Science.gov (United States)

    Goodson, Justin; Jang, Wooseung; Rantz, Marilyn

    2008-01-01

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

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

    Science.gov (United States)

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

    2012-01-01

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

  8. Health care provider quality improvement organization Medicare data-sharing: a diabetes quality improvement initiative.

    OpenAIRE

    Ballard, David J; Nicewander, David; Skinner, Cheryl

    2002-01-01

    BACKGROUND: This paper describes a collaborative Medicare claims data linkage and sharing effort between the Baylor Health Care System (BHCS) and Texas Medical Foundation (TMF, the Texas Quality Improvement Organization) designed to assess the effect of three quality improvement interventions on care delivered to elderly patients with diabetes. The randomized controlled trial is being conducted among a network of primary care physician practices owned by BHCS and focuses on measures of care p...

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

    Directory of Open Access Journals (Sweden)

    Havig Anders

    2011-11-01

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

  10. Interest of pregnant women in the use of SMS (short message service text messages for the improvement of perinatal and postnatal care

    Directory of Open Access Journals (Sweden)

    Cormick Gabriela

    2012-08-01

    Full Text Available Abstract Background Mobile health (mHealth is emerging as a useful tool to improve healthcare access especially in the developing world, where limited access to health services is linked to poor antenatal care, and maternal and perinatal mortality. The objective of this study is to 1 understand pregnant women’s access and usage of cell phones and 2 survey the health information needs and interests in a population attending public hospitals and health centers of two cities in Argentina. This information is not available and it is the basis to develop a strategy for improving maternal care via cell phones. Methods Questionnaires were verbally administered to pregnant women who were attending an antenatal care visit in community health centers and public hospitals in Rosario, Santa Fe and Mercedes, Corrientes. Participants were 18?years of age or older and had previously given birth. The data obtained was qualitative and analyzed using SPSS version 18. Results A total of 147 pregnant women meeting inclusion criteria (Rosario: 63; Mercedes: 84 were approached and verbally consented to participate. The average age was 29.5?years, most lived in urban areas (89% with a mean travel time of 43.4 minutes required to get to the health center and 57.3 minutes to get the hospital. Ninety-six percent of women (n?=?140 responded that they would like to receive text messages and cell phone calls with information regarding prenatal care, although the topics and period of time to receive information varied greatly. Conclusions Considering the vast majority of the interviewed women had access to and were interested in receiving text messages and calls with educational information regarding pregnancy and infant health, pregnant women in Argentina could benefit from such an mHealth program. The low access to Internet suggests it is not an option for this population; however, this cannot be assumed as representative of the country’s situation. To retain active participation, other forms of health communication, such as a 2-way text message systems or toll-free numbers, could be considered in the future. Cost of use and implementing these options should be studied.

  11. 42 CFR 480.141 - Disclosure of QIO interpretations on the quality of health care.

    Science.gov (United States)

    2010-10-01

    ...interpretations on the quality of health care. 480.141 Section 480.141...interpretations on the quality of health care. Subject to the procedures...generalizations on the quality of health care that identify a particular...

  12. Validade, confiabilidade e evitabilidade da causa básica dos óbitos neonatais ocorridos em unidade de cuidados intensivos da Rede Norte-Nordeste de Saúde Perinatal / Validity and reliability of data and avoidability of the underlying cause of neonatal deaths in the intensive care unit of the North-Northeast Perinatal Care Network / Validez, confiabilidad y evitabilidad de la causa básica de óbitos neonatales ocurridos en una unidad de cuidados intensivos de la Red Norte-Nordeste de Salud Perinatal

    Scientific Electronic Library Online (English)

    Carla Maria de Castro Dias e, Silva; Keila R. O., Gomes; Oneide Angélica Monteiro Santos, Rocha; Isabel Marlúcia Lopes Moreira de, Almeida; José Machado, Moita Neto.

    2013-03-01

    Full Text Available Analisar a validade e confiabilidade da causa básica e a evitabilidade dos óbitos neonatais ocorridos em unidade de cuidados intensivos da Rede Norte-Nordeste de Saúde Perinatal (RENOSPE). A amostra foi de 53 óbitos neonatais contidos no banco de dados da RENOSPE e ocorridos em maternidade de Teresi [...] na, Piauí, Brasil. A validade foi feita comparando-se as causas da Rede com as obtidas dos prontuários, sendo calculado kappa, sensibilidade e valor preditivo positivo (VPP). Na análise da evitabilidade, foi utilizada a Lista Brasileira de Causas de Mortes Evitáveis. Quando comparadas as causas de óbitos entre RENOSPE e prontuários, o kappa foi de 47,6% para causas maternas e 73,9% para malformações congênitas, sensibilidade de 95% e 83,3%, e VPP de 88,9% e 85,7%, respectivamente. O percentual de óbitos evitáveis na RENOSPE foi elevado, sendo por adequada atenção à mulher na gestação em 72% dos casos. As causas classificadas como malformações congênitas foram válidas, e os óbitos evitáveis apontam para necessidade do controle da gravidez. Abstract in spanish Analizar la validez y confiabilidad de la causa básica de los óbitos neonatales y su evitabilidad, ocurridos en una unidad de cuidados intensivos de la Red Norte-Nordeste de Salud Perinatal (RENOSPE). La muestra fue de 53 óbitos neonatales, incluidos en el banco de datos de la RENOSPE y ocurridos en [...] la maternidad de Teresina, Piauí, Brasil. La validez fue realizada comparándose las causas de la red, con las obtenidas de los historiales médicos, calculándose kappa, sensibilidad y valor predictivo positivo (VPP). En el análisis de la evitabilidad, se utilizó la lista brasileña de causas de muertes evitables. Resultados: cuando se comparan las causas de óbitos entre RENOSPE y los historiales, el kappa fue de un 47,6% con respecto a causas maternas y un 73,9% para malformaciones congénitas, sensibilidad de un 95% y un 83,3%, y VPP de un 88,9% y un 85,7%, respectivamente. El porcentaje de óbitos evitables en la RENOSPE fue elevado, considerándose adecuada la atención a la mujer en la gestación en un 72% de los casos. Conclusión: las causas clasificadas como malformaciones congénitas fueron válidas, y los óbitos evitables indican una necesidad de control del embarazo. Abstract in english The aim of this study was to analyze the validity and reliability of data and the avoidability of neonatal deaths in the intensive care unit in the North-Northeast Perinatal Care Network (RENOSPE). The sample included 53 neonatal deaths recorded in the RENOSPE database that occurred in a maternity h [...] ospital in Teresina, Piauí State, Brazil. Validity was assessed by comparing causes recorded in the database with those from patient charts and calculating kappa index, sensitivity, and positive predictive value (PPV). Analysis of avoidability used the Brazilian List of Avoidable Deaths. When causes of death recorded in the RENOSPE database were compared with patient charts, kappa was 47.6% for maternal causes and 73.9% for congenital malformations, sensitivity was 95% and 83.3%, and PPV was 88.9% and 85.7%, respectively. The percentage of avoidable deaths in the RENOSPE database was high, attributable to lack of adequate prenatal care in 72% of cases. In conclusion, causes classified as congenital malformations were valid, and the high rate of avoidable deaths points to the need for improved prenatal care.

  13. Barriers to appropriate care for mothers and infants during the perinatal period in rural Afghanistan: A qualitative assessment

    OpenAIRE

    Newbrander, William; Natiq, Kayhan; Shahim, Shafiqullah; Hamid, Najibullah; Skena, Naomi Brill

    2013-01-01

    This study, conducted in five rural districts in Afghanistan, used qualitative methods to explore traditional practices of women, families and communities related to maternal and newborn care, and sociocultural and health system issues that create access barriers. The traditional practices discussed include delayed bathing of mothers and delayed breastfeeding of infants, seclusion of women after childbirth, restricted maternal diet, and use of traditional home remedies and self-medication ins...

  14. MRI of perinatal brain injury

    International Nuclear Information System (INIS)

    MRI is invaluable in assessing the neonatal brain following suspected perinatal injury. Good quality imaging requires adaptations to both the hardware and the sequences used for adults or older children. The perinatal and postnatal details often predict the pattern of lesions sustained and should be available to aid interpretation of the imaging findings. Perinatal lesions, the pattern of which can predict neurodevelopmental outcome, are at their most obvious on conventional imaging between 1 and 2 weeks from birth. Very early imaging during the first week may be useful to make management decisions in ventilated neonates but brain abnormalities may still be subtle using conventional sequences. Diffusion-weighted imaging (DWI) is very useful for the early identification of ischaemic tissue in the neonatal brain but may underestimate the final extent of injury, particularly basal ganglia and thalamic lesions. MR imaging is an excellent predictor of outcome following perinatal brain injury and can therefore be used as a biomarker in interventional trials designed to reduce injury and improve neurodevelopmental outcome. (orig.)

  15. Patients' perceptions of care are associated with quality of hospital care: a survey of 4605 hospitals.

    Science.gov (United States)

    Stein, Spencer M; Day, Michael; Karia, Raj; Hutzler, Lorraine; Bosco, Joseph A

    2015-01-01

    Favorable patient experience and low complication rates have been proposed as essential components of patient-centered medical care. Patients' perception of care is a key performance metric and is used to determine payments to hospitals. It is unclear if there is a correlation between technical quality of care and patient satisfaction. The study authors correlated patient perceptions of care measured by the Hospital Consumer Assessment of Healthcare Providers and Systems scores with accepted quality of care indicators. The Hospital Compare database (4605 hospitals) was used to examine complication rates and patient-reported experience for hospitals across the nation in 2011. The majority of the correlations demonstrated an inverse relationship between patient experience and complication rates. This negative correlation suggests that reducing these complications can lead to a better hospital experience. Overall, these results suggest that patient experience is generally correlated with the quality of care provided. PMID:24740016

  16. Labour complications remain the most important risk factors for perinatal mortality in rural Kenya / Les complications du travail restent les facteurs de risque les plus importants de mortalité périnatale dans les zones rurales du Kenya / Las complicaciones del parto siguen siendo el factor de riesgo de mortalidad perinatal más importante en la Kenya rural

    Scientific Electronic Library Online (English)

    Renay, Weiner; Carine, Ronsmans; Ed, Dorman; Hilton, Jilo; Anne, Muhoro; Caroline, Shulman.

    Full Text Available OBJETIVO: Identificar y cuantificar los factores de riesgo de mortalidad perinatal en un hospital de distrito de Kenya y evaluar la proporción de defunciones perinatales atribuibles a complicaciones del parto, desnutrición materna, malaria, anemia y virus de la inmunodeficiencia humana (VIH). MÉTODO [...] S: Entre enero de 1996 y julio de 1997 se realizó un estudio transversal de 910 nacimientos para analizar los factores de riesgo de defunción perinatal. RESULTADOS: La tasa de mortalidad perinatal fue de 118 por 1000 nacimientos. Las complicaciones del parto consistentes en hemorragias, ruptura prematura de membranas/parto prematuro, y parto obstruido/presentación defectuosa multiplicaban el riesgo de defunción por un factor de entre 8 y 62, y el 53% de todas las defunciones perinatales se atribuyeron a complicaciones del parto. La malaria placentaria y el VIH materno, en cambio, no se asociaron a mortalidad perinatal. CONCLUSIÓN: Es necesario prestar más atención a la calidad de la atención obstétrica dispensada en el entorno de los hospitales de distrito rurales. Abstract in english OBJECTIVES: To identify and quantify risk factors for perinatal mortality in a Kenyan district hospital and to assess the proportion of perinatal deaths attributable to labour complications, maternal undernutrition, malaria, anaemia and human immunodeficiency virus (HIV). METHODS: A cross-sectional [...] study of 910 births was conducted between January 1996 and July 1997 and risk factors for perinatal mortality were analysed. FINDINGS: The perinatal mortality rate was 118 per 1000 births. Complications of labour such as haemorrhage, premature rupture of membranes/premature labour, and obstructed labour/ malpresentation increased the risk of death between 8- and 62-fold, and 53% of all perinatal deaths were attributable to labour complications. Placental malaria and maternal HIV, on the other hand, were not associated with perinatal mortality. CONCLUSIONS: Greater attention needs to be given to the quality of obstetric care provided in the rural district-hospital setting.

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

    OpenAIRE

    Havig Anders; Skogstad Anders; Kjekshus Lars; Romøren Tor

    2011-01-01

    Abstract Background Leadership and staffing are recognised as important factors for quality of care. This study examines the effects of ward leaders' task- and relationship-oriented leadership styles, staffing levels, ratio of registered nurses and ratio of unlicensed staff on three independent measures of quality of care. Methods A cross-sectional survey of forty nursing home wards throughout Norway was used to collect the data. Five sources of data were utilised: self-report questionnaires ...

  18. Quality of Care in Women With Stage I Cervical Cancer

    OpenAIRE

    Chu, Joseph; Polissar, Lincoln; Tamimi, Hisham K.

    1982-01-01

    A study was done to assess the quality of care received by women with stage I cervical cancer. Through a population-based registry serving 13 counties of western Washington, including Seattle, we identified all women residents in whom local-stage cervical cancer developed between January 1974 and December 1978 (N=369). The cases were subdivided into stage IA (microinvasive) and stage IB (frankly invasive). Quality of care was defined as optimal or suboptimal at the outset of the study; this d...

  19. Improving regional variation using quality of care measures

    OpenAIRE

    Scott A Berkowitz; Gary Gerstenblith; Robert Herbert; et. al.

    2009-01-01

    Scott A Berkowitz1, Gary Gerstenblith1, Robert Herbert2, Gerard Anderson1,21Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; 2Center for Hospital Finance and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USAAbstract: There is significant regional variability in the quality of care provided in the United States. This article compares regional performance for three measures that focus on transitions in care, and the care of p...

  20. Availability and Quality of Prehospital Care on Pakistani Interurban Roads

    OpenAIRE

    Bhatti, Junaid A; Waseem, Hunniya; Junaid A Razzak; Shiekh, Naeem-ul-lah; Khoso, Ajmal Khan; Salmi, L.-Rachid

    2013-01-01

    Interurban road crashes often result in severe Road Traffic Injuries (RTIs). Prehospital emergency care on interurban roads was rarely evaluated in the low- and middle-income countries. The study highlighted the availability and quality of prehospital care facilities on interurban roads in Pakistan, a low-income country. The study setting was a 592-km-long National highway in the province of Sindh, Pakistan. Using the questionnaires adapted from the World Health Organization prehospital care ...

  1. The European initiative for quality management in lung cancer care

    DEFF Research Database (Denmark)

    Blum, Torsten G; Rich, Anna; Baldwin, David; Beckett, Paul; De Ruysscher, Dirk; Faivre-Finn, Corinne; Gaga, Mina; Gamarra, Fernando; Grigoriu, Bogdan; Hansen, Niels C G; Hubbard, Richard; Huber, Rudolf Maria; Jakobsen, Erik; Jovanovic, Dragana; Konsoulova, Assia; Kollmeier, Jens; Massard, Gilbert; McPhelim, John; Meert, Anne-Pascale; Milroy, Robert; Paesmans, Marianne; Peake, Mick; Putora, Paul-Martin; Scherpereel, Arnaud; Schönfeld, Nicolas; Sitter, Helmut; Skaug, Knut; Spiro, Stephen; Strand, Trond-Eirik; Taright, Samya; Thomas, Michael; van Schil, Paul E; Vansteenkiste, Johan F; Wiewrodt, Rainer; Sculier, Jean-Paul

    2014-01-01

    Lung cancer is the commonest cause of cancer-related death worldwide and poses a significant respiratory disease burden. Little is known about the provision of lung cancer care across Europe. The overall aim of the Task Force was to investigate current practice in lung cancer care across Europe. The Task Force undertook four projects: 1) a narrative literature search on quality management of lung cancer; 2) a survey of national and local infrastructure for lung cancer care in Europe; 3) a benchm...

  2. The European initiative for quality management in lung cancer care

    DEFF Research Database (Denmark)

    Blum, Torsten G; Rich, Anna

    2014-01-01

    Lung cancer is the commonest cause of cancer-related death worldwide and poses a significant respiratory disease burden. Little is known about the provision of lung cancer care across Europe. The overall aim of the Task Force was to investigate current practice in lung cancer care across Europe. The Task Force undertook four projects: 1) a narrative literature search on quality management of lung cancer; 2) a survey of national and local infrastructure for lung cancer care in Europe; 3) a benchmarking project on the quality of (inter)national lung cancer guidelines in Europe; and 4) a feasibility study of prospective data collection in a pan-European setting. There is little peer-reviewed literature on quality management in lung cancer care. The survey revealed important differences in the infrastructure of lung cancer care in Europe. The European guidelines that were assessed displayed wide variation in content and scope, as well as methodological quality but at the same time there was relevant duplication. The feasibility study demonstrated that it is, in principle, feasible to collect prospective demographic and clinical data on patients with lung cancer. Legal obligations vary among countries. The European Initiative for Quality Management in Lung Cancer Care has provided the first comprehensive snapshot of lung cancer care in Europe.

  3. Quality of care in Crohn's disease

    OpenAIRE

    Makharia, Govind K.

    2014-01-01

    Crohn’s disease (CD) is a chronic and progressive inflammatory disease of the intestine. Overall, healthcare delivery for patients with CD is not optimal at the present time and therefore needs improvement. There are evidences which suggest that there is a variation in the care provided to patients with CD by the inflammatory bowel disease (IBD) experts and community care providers. The delivery of healthcare for patients with CD is often complex and requires coordination between gastroentero...

  4. Effective multidisciplinary working: the key to high-quality care.

    Science.gov (United States)

    Ndoro, Samuel

    This article explores multidisciplinary team working, inter-disciplinary, trans-disciplinary and effective collaborative practice in order to provide high-quality patient care. It discusses different views on collaboration, some of the issues around cross-discipline and multi-agency working and concerns around promoting 'high-quality' care. It also discusses the importance of evidence-based practice in multidisciplinary teams. Issues around good-quality care, clinical governance and the audit cycle in MDTs are addressed. The article highlights the importance of the 6Cs (care, compassion, competence, communication, courage and commitment) in MDTs if quality care is to be achieved. The article also explores advantages and limitations of multidisciplinary team working, trans-disciplinary working and inter-professional working in developing and delivering high-quality patient-centred care. Further research is needed on how clinical audits can help to improve how MDTs function in order improve the quality of service provided to clients. PMID:25072333

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

    Science.gov (United States)

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

    2015-01-01

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

  6. Evaluación de la mortalidad perinatal en mujeres autóctonas e inmigrantes: influencia de la exhaustividad y la calidad de los registros Perinatal mortality assessment in native and immigrant women: influence of exhaustiveness and quality of the registries

    Directory of Open Access Journals (Sweden)

    Isabel Río Sánchez

    2009-10-01

    Full Text Available Objetivo: Realizar un análisis comparativo de la exhaustividad de los datos sobre mortalidad perinatal en la Comunitat Valenciana recogidos en el Instituto Nacional de Estadística (INE y en el Registro de Mortalidad Perinatal (RMPCV. Posteriormente, calcular y comparar la tasa de mortalidad perinatal (TMP y sus componentes en gestantes autóctonas e inmigrantes, tomando como referencia los casos notificados a ambos registros durante 2005 y 2006. Métodos: Se definieron los distintos tipos de mortalidad de acuerdo con los criterios establecidos por la OMS. La magnitud de la infradeclaración se analizó calculando las frecuencias y porcentajes de muertes infradeclaradas para el período 2005-2006. Se calcularon y compararon las diversas tasas entre mujeres autóctonas e inmigrantes de los cuatro grupos mayoritarios a partir de ambos registros, así como los intervalos de confianza del 95% para dichas tasas. Resultados: En el INE existe un importante subregistro de muertes fetales y neonatales. Además, constan neonatos fallecidos de madre extranjera con nacionalidad española asignada. Ambos factores distorsionan la proporción de muertes fetales y neonatales en inmigrantes, y provocan una infraestimación de la TMP y sus componentes en estos colectivos, pues las obtenidas a partir del RMPCV son muy superiores en las mujeres inmigrantes, en particular en las de Europa del Este y las subsaharianas, en comparación con las autóctonas. Conclusiones: En definitiva, nuestros resultados indican que ambos registros son complementarios, pero el RMPCV presenta una mayor exhaustividad y fiabilidad para el cálculo de tasas. Además, sugieren la necesidad de monitorizar la evolución de la TMP en la población inmigrante en España.Objective: To analyze the exhaustiveness and reliability of the data on perinatal mortality in two Spanish registries, namely, the National Statistics Institute and the Perinatal Mortality Registry of the Valencian Community and to calculate and compare the perinatal mortality rate (PMR and its components in native and immigrant women, based on the cases reported to both registries in 2005 and 2006. Methods: Perinatal mortality and its components were defined according to the World Health Organization's criteria. The magnitude of underreporting was calculated by taking into account the frequencies and percentages of deaths not declared for 2005-2006. Rates and their 95% confidence intervals were calculated and compared between native and immigrant women using data from both registries. Results: Fetal and neonatal deaths were substantially underreported in the National Statistics Institute compared with the Perinatal Mortality Registry of the Valencian Community. Moreover, in the National Statistics Institute, some neonatal deaths among the offspring of immigrant women were misclassified as being of Spanish nationality. These two factors distorted the proportion of fetal and neonatal deaths in immigrant women, giving rise to an underestimation of the PMR and its components, since the rates obtained from the Perinatal Mortality Registry of the Valencian Community were higher in immigrant than in Spanish women, particularly among east-European and sub-Saharan women. Conclusions: Our results indicate that both registries are complementary. However, the Perinatal Mortality Registry of the Valencian Community was found to be more exhaustive and to have greater reliability. Our results also suggest the importance of monitoring trends in PMR in the immigrant population in Spain.

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

    Science.gov (United States)

    Gilbert, Jaesook Lee; Harte, Helene Arbouet

    2013-01-01

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

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

    Science.gov (United States)

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

    2007-08-01

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

  9. cura, care, C A R E, Care: Dimensions and Qualities of Care (re)forming an Ecology of Care

    DEFF Research Database (Denmark)

    Coxon, Ian Robert

    This working paper, as we will call it, presents two (pro)positions that should be seen as works in progress. Their job is to enable the beginnings of a conversation directed at advancing another work in progress, the Ecology of Care project. The essential goal of this paper and the symposium that it serves to inform is to begin a process of concretizing the otherwise lost but vitally important concept we call Care. In writing this paper we will attempt to adopt a 'position' through an extensive but not complete review of existing and past thinking in order to "find a line and then to hang a convincing and interesting story on it" (Glanville, 2014). In doing this we also recognise and appreciate that some readers may find the text less than accessible at times because of what might be viewed as philosophical or esoteric language. Using this language and writing style is not intentionally done to make the reading and understanding process heavy going. It is quite the opposite, in fact. At times it has been necessary to delve sufficiently deeply into some of the topics discussed using the language of the thinkers who have paved the way. This may be off-putting to some who are not familiar with these fields and these types of terminology and this has been avoided where possible as we would like to speak clearly to an intentionally diverse audience from academia, government and industry. So if you, the reader, feel a little confused by some of the arguments, then that is also helpful. Please remember that your reactions are important as they tell us what we need to make clearer. Through the concepts presented in this paper, we have tried to tell the most understandable story, knowing that for some readers the presentation will be too dense and for others too simplistic. If you find that you struggle with some of the ways the concepts are presented, please follow Glanville's suggestion and not simply dismiss the ideas by giving up on the reading but do persevere. By monitoring the way in which you grapple with someor all of the propositions put forward in this paper you will be contributing to the collective understanding that we are striving for. The 'position' or in this case propositions, delivered in this paper take two forms. Firstly we will present a framework for understanding Care in terms of Dimensions of Care. This framework is very conceptual and in some ways a severe abstraction of the acknowledged complexity of such a holistic notion such as Care. Its role is to simplify Care, as we formulate it, to a point where its complexity can begin to be understood in ways that might be practically useful. After all, Care derives much of its meaning through the actions taken in its name, but more on this later. The second proposition offers a set of essential qualities that Care possesses which might help us to better understand the concept so that we might apply them in more practical ways. These qualities take on increased importance when we consider that Care is essentially what it means to be human so essentially these qualities of Care form a kind of conceptual DNA , a set of building blocks for how we might recognise Care in and for ourselves as a species differentiated from others. Again, more on this later. In presenting these two propositions as Dimensions of Care and Qualities of Care we fully acknowledge that they and the sub-elements that constitute them are never discrete or fixed at any point. Like the relationship between light particles and light waves, these 'parts' constitute an evolving system of living interaction and Being that defines Care, where any or all of Cares parts at any given point in time are continually co-constituting each other within a dynamic and interactive whole we call everyday life. In a highly abbreviated form our two key propositions are presented as follows; PROPOSITION 1: DIMENSIONS OF CARE Care is informed and shaped by everyday experience; it is constituted over time in consciously aware responses that impact on our self, others and the world. PROPOSITION 2: QUALITIES OF CARE.

  10. Quality of care delivered to hospitalized inflammatory bowel disease patients

    Directory of Open Access Journals (Sweden)

    Geoffrey C Nguyen

    2013-01-01

    Full Text Available Hospitalized patients with inflammatory bowel disease (IBD are at high risk for morbidity, mortality, and health care utilization costs. While the literature on trends in hospitalization rates for this disease is conflicting, there does appear to be significant variation in the delivery of care to this complex group, which may be a marker of suboptimal quality of care. There is a need for improvement in identifying patients at risk for hospitalization in an effort to reduce admissions. Moreover, appropriate screening for a number of hospital acquired complications such as venous thromboembolism and Clostridium difficile infection is suboptimal. This review discusses areas of inpatient care for IBD patients that are in need of improvement and outlines a number of potential quality improvement initiatives such as pay-for-performance models, quality improvement frameworks, and healthcare information technology.

  11. Quality of Health Care Activity in Educational Institutions: Conceptual Aspect

    Directory of Open Access Journals (Sweden)

    N. V. Tretyakova

    2015-03-01

    Full Text Available The paper deals with one of the priority tasks of Russian educational system – developing the health responsibility. The recent health deterioration trend among children and adolescents calls for the complex health care measures, equally affecting the learning outcomes. The authors argue that there is a need for proper definition and specification of the key term of health care quality. However, the analysis of the available scientific and documentary recourses demonstrates the absence of such unified definition. The authors describe the existing approaches to defining the health care quality, and examine structural components of the health care activity, their interrelations and interdependence. In authors’ opinion, the synthesis of the available research materials provides the basis for further studies in the theory and practice of quality management activities regarding the health protection of children, adolescents and young adults in educational institutions. 

  12. Quality in the provision of headache care. 2 : defining quality and its indicators

    DEFF Research Database (Denmark)

    Peters, Michele; Jenkinson, Crispin

    2012-01-01

    The objective of this study was to define "quality" of headache care, and develop indicators that are applicable in different settings and cultures and to all types of headache. No definition of quality of headache care has been formulated. Two sets of quality indicators, proposed in the US and UK, are limited to their localities and/or specific to migraine and their development received no input from people with headache. We first undertook a literature review. Then we conducted a series of focus-group consultations with key stakeholders (doctors, nurses and patients) in headache care. From the findings we proposed a large number of putative quality indicators, and refined these and reduced their number in consultations with larger international groups of stakeholder representatives. We formulated a definition of quality from the quality indicators. Five main themes were identified: (1) headache services; (2) health professionals; (3) patients; (4) financial resources; (5) political agenda and legislation. An initial list of 160 putative quality indicators in 14 domains was reduced to 30 indicators in 9 domains. These gave rise to the following multidimensional definition of quality of headache care: "Good-quality headache care achieves accurate diagnosis and individualized management, has appropriate referral pathways, educates patients about their headaches and their management, is convenient and comfortable, satisfies patients, is efficient and equitable, assesses outcomes and is safe." Quality in headache care is multidimensional and resides in nine essential domains that are of equal importance. The indicators are currently being tested for feasibility of use in clinical settings.

  13. Evaluation of perinatal and neonatal risk factors of children with cerebral palsy referred from health-care centers in north and east of Tehran

    Directory of Open Access Journals (Sweden)

    Soleimani F

    2009-09-01

    Full Text Available "n Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 st1":*{behavior:url(#ieooui } /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:Arial; mso-bidi-theme-font:minor-bidi;} Background: Cerebral palsy (CP is a group of nonprogressive motor impairment syndromes with potentially different risk factors and causal pathways which is caused by damage in the very young brain. The etiology of CP is mostly unknown and the prevalence has not decreased in comparison to past decades, although many advances have occurred in obstetric and neonatal care. In fact, it seems that the prevalence might have even increased in term infants. The aim of this study was the evaluation of cerebral palsy risk factors in Iran to compare them with other countries."n"nMethods: In this case-control study, all one to six years old children who were referred to a rehabilitation center from Shahid Beheshti child-health-care centers during the years 2007-2008, with documented cerebral palsy for evaluation of perinatal and neonatal risk factors were enrolled in the study, with matched controls. "n"nResults: 112 in the case and 113 in the control group were studied. The main factors associated with CP, were: preterm delivery, neonatal and postnatal seizures, Apgar score of zero to three at twentieth minute after birth, low birth weight, and multiple gestations. The majority of infants with CP were born at term and only 37.8% before 37 weeks."n"nConclusions: Preterm birth, hypoxic-ischemic encephalopathy and low birth weight were the independent predictors of CP in this population.

  14. The transition to continuous quality improvement: a home care model.

    Science.gov (United States)

    Ruden, J C

    1994-01-01

    Managers of home care organizations in the 1990s are faced with serious challenges. The magnitude of change occurring makes it difficult to distinguish a reasonable course of action. Quality improvement techniques offer an exciting opportunity for organizations to regain control of their strengths by identifying and improving their weaknesses. This article presents a transitional model for quality improvement involving structure, process, and outcome variables adapted to home care organizations. It encompasses unique committee structures mandated by licensure and certification requirements, which can be adapted to quality improvement focus. Finally, it identifies customer service trends that provide managers with information to fine-tune good business practice. PMID:8312599

  15. Quality in the provision of headache care. 2

    DEFF Research Database (Denmark)

    Peters, Michele; Jenkinson, Crispin; Perera, Suraj; Loder, Elizabeth; Jensen, Rigmor; Katsarava, Zaza; Gil Gouveia, Raquel; Broner, Susan; Steiner, Timothy

    2012-01-01

    The objective of this study was to define "quality" of headache care, and develop indicators that are applicable in different settings and cultures and to all types of headache. No definition of quality of headache care has been formulated. Two sets of quality indicators, proposed in the US and UK, are limited to their localities and/or specific to migraine and their development received no input from people with headache. We first undertook a literature review. Then we conducted a series of foc...

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

    Science.gov (United States)

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

    2007-12-01

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

  17. Quality care means valuing care assistants, porters, and cleaners too

    OpenAIRE

    Toynbee, P

    2003-01-01

    All too often, the focus of the very clever strategy papers produced in the upper reaches of the health department is on the next grand plan. Some of these reforms have been catastrophic for the quality of service that patients experience at ward level. Of these, the contracting out culture introduced in the 1980s and the 1990s has been the worst. Researching my book, Hard work—life in low pay Britain, I took six jobs at around the minimum wage, including work as a hospital porter, as a hospi...

  18. Nurse care manager contribution to quality of care in a dual-eligible special needs plan.

    Science.gov (United States)

    Roth, Carol P; Ganz, David A; Nickles, Lorraine; Martin, David; Beckman, Robin; Wenger, Neil S

    2012-07-01

    We evaluated the quality of care provided to older patients with complex needs in a dual-eligible, community-based Medicare Special Needs Plan that used a nurse care manager model. Care provided by physicians was substantially supplemented by nurse care managers, as measured by Assessing Care of Vulnerable Elders quality indicators. We describe selected nurse care manager activities for six geriatric conditions (falls, dementia, depression, nutrition, urinary incontinence, and end-of-life care) during provision of patient care coordination and management for patients in the highest decile of clinical complexity. We identify areas of high nurse performance (i.e., falls screening, functional assessment, behavioral interventions for dementia problems, advance care planning) and areas of potential missed opportunities (i.e., follow up for new memory problems, targeted dementia counseling, nutrition, and behavioral approaches to urinary incontinence). Increasing the collaborative interaction between nurses providing care in this model and physicians has the potential to enhance nurses' contributions to primary care for vulnerable older adults. PMID:22833891

  19. Changing personnel behavior to promote quality care practices in an intensive care unit

    OpenAIRE

    Cooper, Dominic; Farmery, Keith; Johnson, Martin; Harper, Christine; Clarke, Fiona L; Holton, Phillip; Wilson, Susan; Rayson, Paul; Bence, Hugh

    2005-01-01

    The delivery of safe high quality patient care is a major issue in clinical settings. However, the implementation of evidence-based practice and educational interventions are not always effective at improving performance. A staff-led behavioral management process was implemented in a large single-site acute (secondary and tertiary) hospital in the North of England for 26 weeks. A quasi-experimental, repeated-measures, within-groups design was used. Measurement focused on quality care behavior...

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

    OpenAIRE

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

    2013-01-01

    Studies document that, on average, children cared for in centers, as compared to homes, have higher cognitive test scores but worse socioemotional and health outcomes. The authors assessed whether the quality of care received explains these associations. They considered multiple domains of child development—cognitive, socioemotional, and health—and examined whether mediation is greater when quality measures are better aligned with outcome domains. Using the Early Childhood Longitudinal Study ...

  1. LSCS audit in a tertiary care center in Mumbai: to study indications and risk factors in LSCS and it's effect on early peri-natal morbidity and mortality rate

    Directory of Open Access Journals (Sweden)

    Rajshree Dayanand Katke

    2014-08-01

    Methods: The Cama and Albless hospital is a tertiary care center located in South Mumbai, which cares for over 3000 deliveries per year. In the present retrospective analytical study, all cases of caesarean delivery from August 2013 to January 2014 were analyzed regarding the indication, associated risks factors, and all NICU admissions were studied. The decision to perform a caesarean section in each of these patients was made by a consultant on duty in consultation with the unit head telephonically. The primary objective of the study was to do LSCS audit with the secondary objective to analyse relationship of early peri-natal morbidity with indication of LSCS and risk factors associated. Results: In the present study we found that the overall incidence of LSCS is 25.7%, incidence of primary LSCS is 23.1 %, incidence of LSCS in Referred cases is 61.7 %. So overall high incidence of LSCS is justified as our's is a tertiary care referral unit. 3.5% of total LSCS cases were elderly gravidas and teenage pregnancies each. In our study, 11.8% and 3.5% patients were less than 37 weeks and 34 weeks respectively. However 30.6 % of NICU admissions were due to low birth weight. So IUGR in near term patients is an important morbid factor. Previous LSCS was the leading indication in 35.2% of cases followed by foetal distress in 14.9% of cases and Previous 2 LSCS 10.5%. Two important relative indications we found were Previous 1 LSCS and PIH contributing for nearly half of the total cases. Average duration of surgery was 86 minutes in our study and average stay in hospital was 9 days. In our study early perinatal mortality was 1.6% and morbidity in the form of NICU admissions was 20.8%. Most common cause for NICU admission was LBW followed by Respiratory distress. After comparing high risks factors and indications with NICU admissions we found highest morbidity in neonates who underwent LSCS for fetal distress, multiple pregnancy and premature rupture of membranes. Conclusions: Individualization of the indication and careful evaluation can help us limiting early peri-natal morbidity and mortality. Obstetric audits in the institution, following standardized guidelines and practice of evidenced-based medicine will help us a lot in reducing the peri-natal morbidity and mortality. [Int J Reprod Contracept Obstet Gynecol 2014; 3(4.000: 963-968

  2. The emerging EU quality of care policy

    DEFF Research Database (Denmark)

    Vollaard, Hans; van de Bovenkamp, Hester M.; Vrangbæk, Karsten

    2013-01-01

    Despite the fact that Member States and many citizens of the EU like to keep healthcare a foremost national competence and the EU treaties state that Member States remain primarily responsible for the organization and delivery of health care services, the European Union (EU) has expanded its involvement in healthcare policy over the last twenty years. Based on interviews and document and literature analysis we show that the scope of EU involvement has widened from public health and access to car...

  3. Payment Reform in Massachusetts: Health Care Spending and Quality in Accountable Care Organizations Four Years into Global Payment

    OpenAIRE

    Song, Zirui

    2014-01-01

    Background: The United States health care system faces two fundamental challenges: a high growth rate of health care spending and deficiencies in quality of care. The growth rate of health care spending is the dominant driver of our nation’s long-term federal debt, while the inconsistent quality of care hinders the ability of the health care system to maximize value for patients. To address both of these challenges, public and private payers are increasingly changing the way they pay prov...

  4. Incorporating health care quality into health antitrust law

    Directory of Open Access Journals (Sweden)

    Schneider Helen

    2008-04-01

    Full Text Available Abstract Background Antitrust authorities treat price as a proxy for hospital quality since health care quality is difficult to observe. As the ability to measure quality improved, more research became necessary to investigate the relationship between hospital market power and patient outcomes. This paper examines the impact of hospital competition on the quality of care as measured by the risk-adjusted mortality rates with the hospital as the unit of analysis. The study separately examines the effect of competition on non-profit hospitals. Methods We use California Office of Statewide Health Planning and Development (OSHPD data from 1997 through 2002. Empirical model is a cross-sectional study of 373 hospitals. Regression analysis is used to estimate the relationship between Coronary Artery Bypass Graft (CABG risk-adjusted mortality rates and hospital competition. Results Regression results show lower risk-adjusted mortality rates in the presence of a more competitive environment. This result holds for all alternative hospital market definitions. Non-profit hospitals do not have better patient outcomes than investor-owned hospitals. However, they tend to provide better quality in less competitive environments. CABG volume did not have a significant effect on patient outcomes. Conclusion Quality should be incorporated into the antitrust analysis. When mergers lead to higher prices and lower quality, thus lower social welfare, the antitrust challenge of hospital mergers is warranted. The impact of lower hospital competition on quality of care delivered by non-profit hospitals is ambiguous.

  5. Helping You Choose Quality Behavioral Health Care

    Science.gov (United States)

    ... would like a printed copy, please call the Customer Service Center at (630) 792-5800. To report information or concerns about accredited organizations: ? Call or e-mail our Office of Quality Monitoring (800) 994-6610 or complaint@jointcommission.org .

  6. Sociodemographic risk factors of perinatal depression: a cohort study in the public health care system / Fatores sociodemográficos de risco de depressão perinatal: um estudo populacional no sistema público de cuidados de saúde

    Scientific Electronic Library Online (English)

    Ricardo, Silva; Karen, Jansen; Luciano, Souza; Luciana, Quevedo; Luana, Barbosa; Inácia, Moraes; Bernardo, Horta; Ricardo, Pinheiro.

    2012-06-01

    Full Text Available OBJETIVO: Avaliar os fatores sociodemográficos de risco quanto à prevalência e à incidência de sintomas depressivos pós-parto relevantes. MÉTODO: Estudou-se um grupo de mulheres em seu período perinatal sendo assistidas pelo sistema público de saúde na cidade de Pelotas, RS, Brasil. Foram avaliados [...] os sintomas depressivos com o uso da Edinburgh Postnatal Depression Scale (EDPS) nos períodos pré-natal e pós-natal. RESULTADOS: Foram entrevistadas 1.019 mulheres. A prevalência de sintomas depressivos significativos durante a gravidez foi de 20,5% e no período pós-parto de 16,5%. As mulheres com depressão pré-natal apresentaram um risco maior de depressão pós-parto. CONCLUSÃO: O nível de pobreza, a história psiquiátrica, a ausência do parceiro e eventos vitais estressantes devem ser considerados fatores de risco importantes para sintomas depressivos pós-parto relevantes. Abstract in english OBJECTIVE: To assess the sociodemographic risk factors for the prevalence and incidence of relevant postpartum depressive symptoms. METHOD: We studied a cohort of women in their perinatal period with the assistance of the public health system in the city of Pelotas-RS, Brazil. We assessed depressive [...] symptoms with the Edinburgh Postnatal Depression Scale (EPDS) in the prenatal and postnatal periods. RESULTS We interviewed 1,109 women. The prevalence of meaningful depressive symptoms during pregnancy was 20.5% and postpartum was 16.5%. Women with prenatal depression were at higher risk for postpartum depression. CONCLUSION: The mother's poverty level, psychiatric history, partner absence and stressful life events should be considered important risk factors for relevant postpartum depressive symptoms.

  7. Measuring the quality of therapeutic apheresis care in the pediatric intensive care unit.

    Science.gov (United States)

    Sussmane, Jeffrey B; Torbati, Dan; Gitlow, Howard S

    2012-01-01

    Our goal was to measure the quality of care provided in the Pediatric Intensive Care Unit (PICU) during Therapeutic Apheresis (TA). We described the care as a step by step process. We designed a flow chart to carefully document each step of the process. We then defined each step with a unique clinical indictor (CI) that represented the exact task we felt provided quality care. These CIs were studied and modified for 1 year. We measured our performance in this process by the number of times we accomplished the CI vs. the total number of CIs that were to be performed. The degree of compliance, with these clinical indicators, was analyzed and used as a metric for quality by calculating how close the process is running exactly as planned or "in control." The Apheresis Process was in control (compliance) for 47% of the indicators, as measured in the aggregate for the first observational year. We then applied the theory of Total Quality Management (TQM) through our Design, Measure, Analyze, Improve, and Control (DMAIC) model. We were able to improve the process and bring it into control by increasing the compliance to > 99.74%, in the aggregate, for the third and fourth quarter of the second year. We have implemented TQM to increase compliance, thus control, of a highly complex and multidisciplinary Pediatric Intensive Care therapy. We have shown a reproducible and scalable measure of quality for a complex clinical process in the PICU, without additional capital expenditure. PMID:22095668

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

    Science.gov (United States)

    Donaldson, L J

    2001-12-01

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

  9. Neurosurgical practice and health care reform: moving toward quality-based health care delivery.

    Science.gov (United States)

    Groman, Rachel F; Rubin, Koryn Y

    2013-01-01

    In an effort to rein in spending and improve patient outcomes, the US government and the private sector have adopted a number of policies over the last decade that hold health care professionals increasingly accountable for the cost and quality of the care they provide. A major driver of these efforts is the Patient Protection and Affordable Care Act of 2010 (ACA or Pub.L. 111-148), which aims to change the US health care system from one that rewards quantity to one that rewards better value through the use of performance measurement. However, for this strategy to succeed in raising the bar on quality and efficiency, it will require the development of more standardized and accurate methods of data collection and further streamlined federal regulations that encourage enhanced patient-centered care instead of creating additional burdens that interfere with the physician-patient relationship. PMID:23278262

  10. Health Literacy and Communication Quality in Health Care Organizations

    OpenAIRE

    Wynia, Matthew K.; Osborn, Chandra Y

    2010-01-01

    The relationship between limited health literacy and poor health may be due to poor communication quality within health care delivery organizations. We explored the relationship between health literacy status and receiving patient-centered communication in clinics and hospitals serving communication-vulnerable patient populations. Thirteen health care organizations nationwide distributed a survey to 5,929 patients. All patients completed seven items assessing patient-centered communication. O...

  11. Why Good Quality Care Needs Philosophy More Than Compassion

    Science.gov (United States)

    Leget, Carlo

    2015-01-01

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

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

    OpenAIRE

    Aldana Jorge Mendoza; Piechulek Helga; Al-Sabir Ahmed

    2001-01-01

    OBJECTIVE: To assess user expectations and degree of client satisfaction and quality of health care provided in rural Bangladesh. METHODS: A total of 1913 persons chosen by systematic random sampling were successfully interviewed immediately after having received care in government health facilities. FINDINGS: The most powerful predictor for client satisfaction with the government services was provider behaviour, especially respect and politeness. For patients this aspect was much more import...

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

    Science.gov (United States)

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

    2013-03-01

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

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

    OpenAIRE

    Singer Peter A.; Bowman Kerry W

    2002-01-01

    Abstract Background Quality end-of-life care has emerged as an important concept in industrialized countries. Discussion We argue quality end-of-life care should be seen as a global public health and health systems problem. It is a global problem because 85 % of the 56 million deaths worldwide that occur annually are in developing countries. It is a public health problem because of the number of people it affects, directly and indirectly, in terms of the well being of loved ones, and the larg...

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

    OpenAIRE

    Donaldson, L.

    2001-01-01

    The agenda for health care in developed countries in the 21st century will be dominated by a vision of quality which seeks to address the deep seated problems of the past. The ability to deliver safe, effective, high quality care within organisations with the right cultures, the best systems, and the most highly skilled and motivated work forces will be the key to meeting this challenge. This is an issue which should be a priority for education and training bodies. The need for health service...

  16. Current status of quality evaluation of nursing care through director review and reflection from the Nursing Quality Control Centers

    OpenAIRE

    Duan, Xia; Shi, Yan

    2014-01-01

    Background: The quality evaluation of nursing care is a key link in medical quality management. It is important and worth studying for the nursing supervisors to know the disadvantages during the process of quality evaluation of nursing care and then to improve the whole nursing quality. This study was to provide director insight on the current status of quality evaluation of nursing care from Nursing Quality Control Centers (NQCCs). Material and Methods: This qualitative study used a sample ...

  17. The quality of nursing home care in Taiwan.

    Science.gov (United States)

    Yeh, Shu-hui; Sehy, Yvonne A; Lin, Li-Wei

    2002-08-01

    This study describes the quality of care in nursing homes in Taiwan using demographic data, functional status measures, resident clinical care outcomes, and resident's ratings of satisfaction with nursing home care. Three hundred and eight randomly selected elderly residents in 13 nursing homes were interviewed through a structured interview process and demographic and medical information was collected from their nursing home records. Nursing home residents were younger and less functional than their counterparts in the United States. Stroke and dementia were the most common primary diagnoses and more than 27% of the residents had a history of urinary tract infections while more than 25% had been physically restrained within the past 3 months. There was no correlation between the number of nursing home staff per resident and the prevalence of selected clinical care outcomes. A moderate level of satisfaction with nursing home care was reported with acceptance of family visits and nursing home cleanliness rating highest, and loss of personal belongings and life as boring rating lowest. Level of satisfaction with nursing home care was positively correlated with the number of RNs and nursing assistants (NAs) on staff. Recommendations for improving the quality of nursing home care in Taiwan include increased recruitment of multidisciplinary professional and technical nursing home staff; restrictions in the use of restraints with development of alternatives; and use of standardized resident assessment, care planning, and evaluation tools. The authors recommend continuing education in geriatric nursing and continued nursing research focusing on identifying structure and process variables that affect clinical care outcomes and satisfaction with nursing home care. PMID:12219549

  18. Comparing public and private hospital care service quality.

    Science.gov (United States)

    Camilleri, D; O'Callaghan, M

    1998-01-01

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

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

    OpenAIRE

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

    2015-01-01

    Objectives: To examine the effectiveness of the quality management programme—European Practice Assessment—in primary care in Switzerland. Design: Longitudinal study with three points of measurement. Setting: Primary care practices in Switzerland. Participants: In total, 45 of 91 primary care practices completed European Practice Assessment three times. Outcomes: The interval between each assessment was around 36?months. A variance analyses for repeated measurements were performed ...

  20. Quality in occupational health care: management's view.

    Science.gov (United States)

    Callahan, E W

    1994-04-01

    Total Quality Management (TQM) is a continual improvement process that requires common sense, education and training, and the ability to communicate and work as part of a team. TQM can improve all aspects of a business, including health, safety, and environmental functions. Physicians and nonphysician managers can use TQM to identify and respond to customer needs and improve the efficiency and effectiveness of programs. Examples of TQM to improve medical programs have included (1) an Audit Program that assesses medical programs and provides specific measurements ("metrics") of medical programs, and (2) a team that developed an Alternative Return-to-Work Program, which now assists in early rehabilitation of injured employees. In addition to expecting its physicians to be knowledgeable, fair, and objective, management expects them to use and understand TQM principles. PMID:8014711

  1. Mortes perinatais evitáveis em Belo Horizonte, Minas Gerais, Brasil, 1999 Avoidable perinatal deaths in Belo Horizonte, Minas Gerais, Brazil, 1999

    Directory of Open Access Journals (Sweden)

    Sônia Lansky

    2002-10-01

    Full Text Available Tendo em vista a elevada taxa de mortalidade perinatal em Belo Horizonte, foi realizado estudo dos 826 óbitos perinatais da coorte de nascimentos ocorridos no município em 1999, com análise da possibilidade de sua prevenção, utilizando-se o enfoque de evitabilidade de Wigglesworth. A taxa de mortalidade perinatal observada foi 20,2 por mil e o risco de morte perinatal foi vinte vezes maior para as crianças com baixo peso ao nascer. Cerca de um quarto das crianças tinham peso maior que 2.500g e a asfixia intraparto foi a principal causa de óbito neste grupo. A causa anteparto contribuiu com 30% dos óbitos e 25% destas crianças tinham peso maior que 2.500g. Observou-se ainda a ocorrência de óbitos perinatais fora do hospital e óbitos de crianças cujas mães chegaram à maternidade já em período expulsivo. Cerca de 40% dos óbitos perinatais e 60% dos óbitos neonatais poderiam ter sido evitados. Estas mortes precoces sugerem falhas na assistência à gestante e ao recém-nascido no município, tanto no atendimento clínico como na organização da rede assistencial, sendo necessário avançar na qualificação e responsabilização dos serviços e do sistema de saúde como um todo sobre esta população.The perinatal mortality rate is still high in Belo Horizonte. This study investigated all 826 perinatal deaths taking place in 1999, focusing on the possibility of their prevention, using the Wigglesworth classification. The perinatal mortality rate was 20.2 per one thousand births, and the risk of perinatal death was 20 times higher in children with low birthweight. Some 24.6% of the children weighed more than 2,500g, and the main cause of death in this group was asphyxia during labor. The antepartum cause of death contributed to 30% of all deaths, and 25% of these children weighed more than 2,500g. Some deaths occurred out of hospital, and in some cases the mother arrived at hospital in end-stage labor. About 40% of all perinatal deaths or 60% of all early neonatal deaths could have been prevented, suggesting flaws in prenatal, intrapartum, and neonatal care at both the clinical and health-care organizational levels. To intervene in this situation, progress is needed in improving quality of care and ensuring accountability in the specific health services and the health care system as a whole.

  2. Patient involvement in education for enhanced quality of care.

    Science.gov (United States)

    Le Var, R M H

    2002-12-01

    Government policies in the UK are promoting health care practitioners working in partnership with patients and clients as an important constituent of quality in health care delivery. However, for practitioners to work in this way requires experience of such partnerships in the educational preparation. The involvement of patients and clients (i.e. service users) and their carers in the curriculum has been encouraged and supported in England since the early 1990s. From 1998, the comprehensive involvement in all phases of programme provision has been a requirement, ensuring that service users have a real 'voice' in influencing the direction of programmes. Examples of good practice are provided, demonstrating a range of approaches in the different stages of the educational process. Issues to be considered for successful implementation are included. Benefits to education and patient/client care are identified on the basis of literature and recent experience. They are strongly associated with enhanced quality of care. The article argues for a need to continue to broaden implementation for the major benefits of influencing the attitudes and approaches of students, and empowering users, with the end result of enhancing the quality of care. A strategic approach is needed to make user involvement an effective and workable reality. The need for systematic evaluation of the outcomes and for publications is highlighted. The principle of service user involvement in educational preparation is deemed to be equally relevant in other countries. PMID:12492943

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

    Science.gov (United States)

    Hewes, Dorothy

    1994-01-01

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

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

    Science.gov (United States)

    Chassin, Mark R

    2013-10-01

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

  5. Quality of Institutional Care and Early Childhood Development

    Science.gov (United States)

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

    2015-01-01

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

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

    Science.gov (United States)

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

    2011-01-01

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

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

    OpenAIRE

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

    2011-01-01

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

  8. Manager traits and quality-of-care performance in hospitals.

    Science.gov (United States)

    Aij, Kjeld Harald; Aernoudts, René L M C; Joosten, Gepke

    2015-07-01

    Purpose - This paper aims to assess the impact of the leadership traits of chief executive officers (CEOs) on hospital performance in the USA. The effectiveness and efficiency of the CEO is of critical importance to the performance of any organization, including hospitals. Management systems and manager behaviours (traits) are of crucial importance to any organization because of their connection with organizational performance. To identify key factors associated with the quality of care delivered by hospitals, the authors gathered perceptions of manager traits from chief executive officers (CEOs) and followers in three groups of US hospitals delivering different levels of quality of care performance. Design/methodology/approach - Three high- and three low-performing hospitals were selected from the top and bottom 20th percentiles, respectively, using a national hospital ranking system based on standard quality of care performance measures. Three lean hospitals delivering intermediate performance were also selected. A survey was used to gather perceptions of manager traits (providing a modern or lean management system inclination) from CEOs and their followers in the three groups, which were compared. Findings - Four traits were found to be significantly different (alpha measuring manager traits to assess progress towards lean transformation and lend weight to improved quality of care that can be delivered by hospitals adopting a lean system of management. PMID:26083635

  9. Improving regional variation using quality of care measures

    Directory of Open Access Journals (Sweden)

    Scott A Berkowitz

    2009-11-01

    Full Text Available Scott A Berkowitz1, Gary Gerstenblith1, Robert Herbert2, Gerard Anderson1,21Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; 2Center for Hospital Finance and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USAAbstract: There is significant regional variability in the quality of care provided in the United States. This article compares regional performance for three measures that focus on transitions in care, and the care of patients with multiple conditions. Admissions for people with ambulatory care-sensitive conditions, hospital readmissions within 30 days of discharge, and compliance with practice guidelines for people with three chronic conditions (congestive heart failure, chronic obstructive pulmonary disease, and diabetes were analyzed using data drawn from the Centers for Medicare & Medicaid Services’ Standard Analytic Files for 5% of a 2004 national sample of Medicare beneficiaries which was divided by hospital referral regions and regional performance. There were significant regional differences in performance which we hypothesize could be improved through better care coordination and system management.Keywords: performance, quality, chronic condition, ambulatory care, sensitive conditions, readmissions

  10. Good Care in Ongoing Dialogue. Improving the Quality of Care Through Moral Deliberation and Responsive Evaluation

    OpenAIRE

    Abma, T.A.; Molewijk, A.C.; Widdershoven, G.A.M.

    2009-01-01

    Recently, moral deliberation within care institutions is gaining more attention in medical ethics. Ongoing dialogues about ethical issues are considered as a vehicle for quality improvement of health care practices. The rise of ethical conversation methods can be understood against the broader development within medical ethics in which interaction and dialogue are seen as alternatives for both theoretical or individual reflection on ethical questions. In other disciplines, intersubjectivity i...

  11. Quality of Care and Mortality among Long-term Care Residents with Dementia

    OpenAIRE

    Reid, Colin R.

    2008-01-01

    EnglishSeniors with dementia who enter long-term care facilities are at greater risk of death than are similar individuals that remain in the community. Previous research has focused primarily on social selection factors such as health status to explain mortality in this population. This study seeks to determine whether resident mortality within 12 months of admission to a facility can be explained by post-admission social causative factors, that is, by institutional quality of care. Logistic...

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

    Science.gov (United States)

    Junoy, J P

    1997-01-01

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

  13. Using empowerment to make quality work in health care.

    Science.gov (United States)

    Byham, W C; Nelson, G D

    1994-01-01

    Is TQM dead in health care? If it is alive and well, what role does quality improvement play in managing the changes that come with health care reform? William Byham and Greg Nelson begin this article by presenting results from a recent international study on TQM, outlining factors common to successful and unsuccessful quality initiatives. The key to success? Organizations must improve how people work as much as what they do in their work, and that means empowering people to improve processes. Easier said than done, say Byham and Nelson. Empowerment requires culture change and training. People first need the right environment to work differently, then the skills, knowledge, and techniques to participate in and influence the quality process. PMID:10135584

  14. QUALITY ASSESSEMENT OF ANTE-NATAL CARE USING THE METHOD OF LOT QUALITY ASSURANCE SAMPLING

    Directory of Open Access Journals (Sweden)

    Sh. Salarilak

    1999-08-01

    Full Text Available To determine the coverage rate, timeliness and quality of ante-natal care in rural areas under the coverage of Health Houses in West Azerbaijan province, 30 Health Houses (HH were randomly selected out of 731 HH in the province. In each HH, using the method of Lot Quality Assurance Sampling (LQAS 28 women having recently born babies was selected. Data were collected using check-list for facilities, and questionnaires and forms to be completed from the files by interview. The study showed that the method of LQAS is quite effective for evaluation of this service at HH level. The weighted total coverage of ante-natal care was 46.2%. Quality of care was acceptable for 53.9% of mothers. The weighted average of time lines of care was 49.8%. Availability of facilities in delivery of this service was 100%, showing there was no short coming in this respect.

  15. A vision for world-class quality in health care.

    Science.gov (United States)

    Gaucher, E

    1993-01-01

    When we talk about world-class health care, we are finding that we are in a position where the purchasers of our services find there is little or no value for the health-care dollars they are spending. Even the father of American Quality, W. Edwards Deming, has listed the high cost of health care as one of the seven deadly diseases, so we know that we are in trouble. According to a 1989 study, the public tells us that 32% of the time the value of health care they receive is good to excellent, and 65% of the time it is fair to poor. When we look at what our physicians say, 76% of them believe that we get good value for health-care dollars as opposed to 23% who think it is fair to poor. As I have been thinking about what world-class quality would mean, one of the things that comes to mind is the fact that health care is now consuming 15% of the gross national product. We are approaching an expenditure level of one trillion dollars. If our results were good, we could feel comfortable resting on our laurels, because for those we serve in the American health-care system, we serve them very well. But our results are not good. We are 23rd in the world in infant mortality, and we are 16th in the world for life expectancy. The real tragedy in the American health-care system is that 37 million Americans are uninsured. Obviously this cannot continue.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:10127169

  16. Implementing community-based perinatal care: results from a pilot study in rural Pakistan / Mise en œuvre des soins périnatals en communauté: résultats d'une étude pilote dans le Pakistan rural / Implantación de la atención perinatal comunitaria: resultados de un estudio piloto realizado en el Pakistán rural

    Scientific Electronic Library Online (English)

    Zulfiqar A, Bhutta; Zahid A, Memon; Sajid, Soofi; Muhammad Suhail, Salat; Simon, Cousens; Jose, Martines.

    2008-06-01

    Full Text Available OBJETIVO: Se decidió investigar mediante un estudio piloto la viabilidad de la implantación efectiva de un paquete de intervenciones comunitarias de mejora de la atención perinatal basadas en el uso de trabajadoras sanitarias (lady health workers, LHW) y parteras tradicionales (Dais) en el Pakistán [...] rural. MÉTODOS: La intervención se llevó a cabo en cuatro de ocho grupos de aldeas (en total: 315 aldeas y 138 600 habitantes), utilizando los otros cuatro para comparar los resultados. Las trabajadoras sanitarias de los grupos de intervención recibieron capacitación adicional centrada en servicios esenciales de atención de la madre y el recién nacido, dirigieron sesiones de grupo de educación comunitaria, y fueron alentadas a estar en contacto con las Dais locales. La intervención se llevó a cabo en el marco del programa habitual de LHW del gobierno, y para apoyarla se crearon comités voluntarios de salud comunitaria. RESULTADOS: En las aldeas de intervención se registraron reducciones considerables de las tasas de mortinatalidad (de 65,9 a 43,1 por 1000 nacimientos, P Abstract in english OBJECTIVE: This pilot study investigated the feasibility of delivering a package of community-based interventions for improving perinatal care using lady health workers (LHWs) and traditional birth attendants (Dais) in rural Pakistan. METHODS: The intervention was implemented in four of eight villag [...] e clusters (315 villages, total population 138 600), while four served as a comparison group. The LHWs in intervention clusters received additional training focused on essential maternal and newborn care, conducted community education group sessions, and were encouraged to link up with local Dais. The intervention was delivered within the regular government LHW programme and was supported by the creation of voluntary community health committees. FINDINGS: In intervention villages, there were significant reductions from baseline in stillbirth (from 65.9 to 43.1 per 1000 births, P

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

    Science.gov (United States)

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

    2013-09-01

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

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

    Science.gov (United States)

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

    2014-10-01

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

  19. MORTALIDAD PERINATAL DE LA POBLACIÓN AFILIADA A UNA EPS DE PASTO. DEPARTAMENTO DE NARIÑO. 2007. MORTALIDADE PERINATAL DA POVOACÃO AFILIADA A UMA EPS DE PASTO. ESTADO DE NARINHO. 2007. PERINATAL MORTALITY OF A POPULATION OF HEALTH CARE AFFILIATES IN THE CITY OF PASTO, DEPARTMENT OF NARIÑO, 2007.

    Directory of Open Access Journals (Sweden)

    Adriana Isabel Delgado Bravo

    2010-07-01

    Full Text Available Objetivo: identificar los factores que se relacionan con mortalidad perinatal de la población afiliada a una EPS del departamento de Nariño durante 2007. Materiales y Métodos: la investigación fue de tipo cuantitativo, descriptivo, retrospectivo-evaluativo, dado que los datos corresponden a la revisión documental realizada a las historias clínicas de las gestantes con eventos de mortalidad en el año 2007. Se tomó el 100% de los casos de mortalidad perinatal, lo cual representó el total de la población. Se estudiaron las variables socio-demográficas; se realizó análisis de casos (manejo de protocolo de atención, diligenciamiento de ficha de notificación, cumplimiento de las normas técnicas y guías de atención. Se estudiaron 34 eventos, de los cuales 61,8% murieron en el ante-parto, 20,6% en el intra-parto y 17,6% en la pre-alta. Se diseñó una ficha de verificación, se aplicó a los eventos, los datos se consolidaron en el sistema estadístico de información EPIINFO versión 2000, y se realizó el cruce de variables existentes. Una vez identificados los hallazgos en cuanto a las causas de riesgo, se aplicó el chi2 y determinando el valor de P, se levantó la línea de base con el fin de priorizar planes o proyectos enfocados a la reducción del indicador de mortalidad perinatal para la EPS. Resultados: de la población total las madres con edades comprendidas entre 23 y 26 años de edad, registran el mayor número de casos, procedentes el 56% de cabecera municipal quienes tenían un grado de escolaridad de primaria completa, el 23% con cónyuge, el 26% presentaban antecedentes de multiparidad; durante el embarazo asistieron a cuatro controles realizados por médico general en el primer nivel de atención, de ellas el 67% no utilizaban método de planificación familiar. Con relación a los riesgos que tenían las madres se encontraron 3 casos con hipertensión crónica; infecciones urinarias 3 casos; tabaquismo, alcoholismo y alteraciones sicológicas, así como retardo en el crecimiento intrauterino fue reportado un caso; los cuales fueron clasificados como embarazo de alto riesgo; 6 embarazos no se clasificaron, los cuales sí tenían aspectos relevantes a tener en cuenta. El estudio demostró la omisión al momento de escribir o consignar aspectos en la historia clínica. En el proceso de parto y puerperio se identificaron las semanas de gestación entre las 28 y 40 semanas, de las cuales el 71% tuvo parto vaginal; 26,57% cesárea, de las cuales la mitad fueron atendidas por médico obstetra y el restante por médico general; el 11% no registra datos y el 5% corresponde a otros. El nivel de atención fue el nivel 1 en un 70%. Entre las causas más frecuentes de complicaciones en el momento del parto están la retención de restos placentarios, partos pretermino, sufrimiento fetal, shock hipovolémico, hemorragias de tercer trimestre. Con respecto a la notificación obligatoria de casos de mortalidad perinatal reportados al Sistema de Vigilancia Epidemiológica (Sivigila, en ninguno de los eventos se realizó investigación de campo; igualmente no hubo comités de análisis de las muertes perinatales. La ficha perinatal se lleva en un 100%, pero al hacer el análisis de la confrontación de los datos con la historia clínica no concuerdan, posiblemente debido a que lo diligencian diferentes profesionales de la salud.Objetivo: identificar os fatores que se relacionam com mortalidade perinatal de a povoação afiliada a uma EPS do Estado de Narinho durante 2007. Materiais e Métodos: A pesquisa foi de tipo quantitativo, descritivo, retrospetivo- avaliativo, os dados que correspondem à revisão documental realizada às historias clinicas das gestantes com eventos de mortalidade no ano 2007. Tomou-se o 100% dos casos de mortalidade perinatal, o qual representou o total da povoação. Estudaram se a variável sócia- demográficas; se realizou analise de casos (manejo de protocolo de atenção diligencia mento de fichas de notificação, comprimento das normas técnicas e guias de a

  20. The Quality of Clinical Care Caesarean Section in Hospitals that have been Implementing Quality Management Systems

    OpenAIRE

    Fridawaty, Rivai; Tjahjono, Koentjoro; Adi, Utarini

    2013-01-01

    Background/Objective: In recent years the problem of poor quality in health care is a major issue, especially regarding the impact for the patient and hospital. Various attempts have been made to achieve the quality of service and quality of clinical care but it???s still not able to attempt improvement especially on clinical performance. One of services provided by hospital is Caesarean Section and the trend has been increasing from year to year. The purpose of this study was to measure the ...

  1. Quality of assistive technologies in the home care for elderly.

    Science.gov (United States)

    Hauer, Katharina

    2015-01-01

    Due to demographic changes, the number of elderly people who are in need of care is increasing. Assistive technologies make it possible for many elderly people to remain home despite their health conditions, which many prefer. Quality is an essential element of nursing care, and the elderly are becoming increasingly aware of this and are beginning to make high demands. The aims of this paper, which is based on a master's thesis, were to identify quality criteria in the field of assistive technologies and to present indicators for measuring quality. An extensive literature research was conducted for the theoretical part, and the empirical part employed a qualitative survey. The results show that the elderly's contentment and quality of life are the decisive factors for quality. A catalogue of quality indicators was developed by merging the results from literature with those from the expert consultation. To conclude, further research in this context, based on the results of this paper, is needed, in order to support the increasing use of assistive technologies. PMID:26063268

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

    Science.gov (United States)

    Conrad, Douglas A; Perry, Lisa

    2009-01-01

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

  3. Diversity in diabetes care programmes and views on high quality diabetes care: are we in need of a standardized framework?

    Directory of Open Access Journals (Sweden)

    Liesbeth A.D. Borgermans

    2008-04-01

    Full Text Available Methods: A review of systematic reviews was performed. Four databases (MEDLINE database of the National Library of Medicine, COCHRANE database of Systematic Reviews, the Cumulative Index to Nursing and Allied Health Database-CINAHL and Pre-Cinahl were searched for English review articles published between November 1989 and December 2006. Methodological quality of the articles was assessed. A standardized extraction form was used to assess features of diabetes care programmes and diabetes quality indicators with special reference to those aspects that hinder the conceptualization of high quality diabetes care. Based on these findings the relationship between diversity in diabetes care programmes and the conceptualization of high quality diabetes care was further explored. Results: Twenty-one systematic reviews met the inclusion criteria representing a total of 185 diabetes care programmes. Six elements were identified to produce a picture of diversity in diabetes care programmes and hinder their standardization: 1 the variety and relative absence of conceptual backgrounds in diabetes care programmes, 2 confusion over what is considered a constituent of a diabetes care program and components of the implementation strategy, 3 large variety in type of diabetes care programmes, settings and related goals, 4 a large number and variety in interventions and quality indicators used, 5 no conclusive evidence on effectiveness, 6 no systematic results on costs. Conclusions: There is large diversity in diabetes care programmes and related quality indicators. From this review and our analysis on the mutual relationship between diversity in diabetes care programmes and the conceptualization of high quality diabetes care, we conclude that no single conceptual framework used to date provides a comprehensive overview of attributes of high quality diabetes care linked to quality indicators at the structure, process and outcome level. There is a need for a concerted action to develop a standardized framework on high quality diabetes care that is complemented by a practical tool to provide guidance to the design, implementation and evaluation of diabetes care programmes.

  4. Management of nursing care quality with ethical principles

    Directory of Open Access Journals (Sweden)

    Cabarcas-Ortega Nirva del Socorro

    2011-06-01

    Full Text Available Quality is a guiding principle of nursing care, law 266 defines it as an efficient helpin terms of opportunity and proper use of resources. Nursing care is based oncomprehensive care on the basis of individual dignity, rights and needs, not just thedisease. Changes and trends in care have imposed new roles in professional practiceof nursing, often presenting ethical dilemmas and conflicts that require you to haveknowledge of principles and values to better analyze situations and exercise properorientation; the nurse must use their knowledge in ethics and bioethics to meet theneeds of patients for their welfare.The management of nursing care quality involves planning, organization, directionand control of financial, human and material resources with the intent to effectivelyimplement the quality policy of the institution, bearing in mind the ethical principlesestablished by law 266 of 1996. In conclusion, the quality is the result of the entire healthcare process; to reach it, it is necessary to implement a system of quality managementthat tends to achieve a balance between user needs, available infrastructure for care,objectives of the institution and satisfaction of customer and care providers.RESUMEN:La calidad es un principio rector del cuidado de enfermería, la ley 266 define la calidadcomo una ayuda eficiente, en términos de oportunidad y uso adecuado de los recursos.La atención de enfermería se basa en el cuidado integral del individuo teniendo comobase la dignidad, necesidades derechos y no simplemente la enfermedad. Los cambiosy tendencias del cuidado han impuesto nuevos roles en la práctica profesional de laenfermera, presentándose con frecuencia dilemas y conflictos éticos que le exigentener conocimientos de principios y valores para un mejor análisis de las situaciones yorientación adecuada del ejercicio, debiendo la enfermera hacer uso de sus conocimientosen ética y bioética para la satisfacción de las necesidades del paciente en búsqueda desu bienestar. La gestión de la calidad del cuidado de enfermería implica la planificación,organización, dirección y control de los recursos financieros, humanos y materiales conla intención de cumplir eficazmente con la política de calidad de la institución, teniendopresente los principios éticos establecidos en la ley 266 de 1996. En conclusión la calidades el resultado de todo el proceso de atención en salud, para llegar a la consecución deesta es necesario implementar un sistema de gestión de la calidad que propenda porlograr el equilibrio entre las necesidades del usuario, infraestructura disponible parala atención, objetivos de la institución, satisfacción de quien provee el cuidado y delusuario.

  5. MORTALIDAD PERINATAL DE LA POBLACIÓN AFILIADA A UNA EPS DE PASTO. DEPARTAMENTO DE NARIÑO. 2007. / PERINATAL MORTALITY OF A POPULATION OF HEALTH CARE AFFILIATES IN THE CITY OF PASTO, DEPARTMENT OF NARIÑO, 2007. / MORTALIDADE PERINATAL DA POVOACÃO AFILIADA A UMA EPS DE PASTO. ESTADO DE NARINHO. 2007.

    Scientific Electronic Library Online (English)

    Adriana Isabel, Delgado Bravo; Janeth Verónica, López Maya; Fanny Carmenza, Meneses Paredes.

    2010-07-01

    Full Text Available Objetivo: identificar os fatores que se relacionam com mortalidade perinatal de a povoação afiliada a uma EPS do Estado de Narinho durante 2007. Materiais e Métodos: A pesquisa foi de tipo quantitativo, descritivo, retrospetivo- avaliativo, os dados que correspondem à revisão documental realizada às [...] historias clinicas das gestantes com eventos de mortalidade no ano 2007. Tomou-se o 100% dos casos de mortalidade perinatal, o qual representou o total da povoação. Estudaram se a variável sócia- demográficas; se realizou analise de casos (manejo de protocolo de atenção diligencia mento de fichas de notificação, comprimento das normas técnicas e guias de atenção). Estudaram se 34 eventos, dos quais 61,8% morreram no ante- parto, 20,6% no intra-parto e 17,6% na pré- alta. Desenhou-se uma ficha de verificação, se aplicaram aos eventos, os dados se consolidaram no sistema estadístico de informação EPIINFO versão 2000, e realizou se o Cruzamento de variáveis existentes. Uma vez identificados os descobrimentos em quanto ás causas de risco, aplicou se o chi2 e determinando o valor de P, se levantou a línea de base com o fim de priorizar planos ou projetos enfocados à redução do indicador de mortalidade perinatal para a EPS. Resultados: da povoação total as mães com idades compreendidas entre 23 e 26 anos de idade, registram o maior números de casos, procedentes o 56% de cabeceira municipal quens tinham um grau de escolaridade de primaria completa, o 23% com conjugue, o 26% apresentavam antecedentes de multi- paridade; durante o embaraço assistiram a quatro controles realizados por médico general no primeiro nível de atenção, delas o 67% não utilizavam método de planificação familiar. Com relação aos riscos que tinham as mães encontraram se 3 casos com hipertensão crônica; infecções urinarias 3 casos; tabaquismo, alcoolismo e alterações psicológicas, assim como retardo no crescimento intra-uterino foi reportado um caso; os quais foram classificados como embaraço de alto risco; 6 embaraços não se classificaram, os quais se tinham aspectos relevantes a ter em conta. A pesquisa demonstrou a omissão ao momento de escrever ou consignar aspectos na historia clinica. Em o proceso de parto e puerpério se identificaram as semanas de gestação entre as 28 e 40 semanas, das quais o 71% teve parto vaginal; 26,57% cesárea, das quais a metade foi atendida por medico obstetra e o restante por medico general; o 11% não registra dados e o 5% corresponde a outros. O nível de atenção foi o nível 1 num 70%. Entre as causas mais freqüentes de complicações no momento do parto estão a retenção de restos placentários, partos predetermino, sofrimento fetal, shock hipovolêmico, hemorragias de terceiro trimestre. Com respeito à notificação obrigatória de casos de mortalidade perinatal, foram reportados ao Sistema de Vigilância Epidemiologia (Sivigila), em nenhum dos eventos se realizou pesquisa de campo; igualmente não teve comitês de analise das mortes perinatales. A ficha se leva em um 100%, mas ao fazer o analise de a confrontação dos dados com historia clinica não concordam possivelmente devido a que o diligenciam diferentes profissionais da saúde. Abstract in spanish Objetivo: identificar los factores que se relacionan con mortalidad perinatal de la población afiliada a una EPS del departamento de Nariño durante 2007. Materiales y Métodos: la investigación fue de tipo cuantitativo, descriptivo, retrospectivo-evaluativo, dado que los datos corresponden a la revis [...] ión documental realizada a las historias clínicas de las gestantes con eventos de mortalidad en el año 2007. Se tomó el 100% de los casos de mortalidad perinatal, lo cual representó el total de la población. Se estudiaron las variables socio-demográficas; se realizó análisis de casos (manejo de protocolo de atención, diligenciamiento de ficha de notificación, cumplimiento de las normas técnicas y guías de atención). Se estudiaron 34 eventos, de los cuales 61,8% mu

  6. Do patients "like" good care? measuring hospital quality via Facebook.

    Science.gov (United States)

    Timian, Alex; Rupcic, Sonia; Kachnowski, Stan; Luisi, Paloma

    2013-01-01

    With the growth of Facebook, public health researchers are exploring the platform's uses in health care. However, little research has examined the relationship between Facebook and traditional hospital quality measures. The authors conducted an exploratory quantitative analysis of hospitals' Facebook pages to assess whether Facebook "Likes" were associated with hospital quality and patient satisfaction. The 30-day mortality rates and patient recommendation rates were used to quantify hospital quality and patient satisfaction; these variables were correlated with Facebook data for 40 hospitals near New York, NY. The results showed that Facebook "Likes" have a strong negative association with 30-day mortality rates and are positively associated with patient recommendation. These exploratory findings suggest that the number of Facebook "Likes" for a hospital may serve as an indicator of hospital quality and patient satisfaction. These findings have implications for researchers and hospitals looking for a quick and widely available measure of these traditional indicators. PMID:23378059

  7. Quality assessment of child care services in primary health care settings of Central Karnataka (Davangere District

    Directory of Open Access Journals (Sweden)

    Rashmi

    2010-01-01

    Full Text Available Background: Infectious disease and malnutrition are common in children. Primary health care came into being to decrease the morbidity. Quality assessment is neither clinical research nor technology assessment. It is primarily an administrative device used to monitor performance to determine whether it continues to remain within acceptable bounds. Aims and Objectives: To assess the quality of service in the delivery of child health care in a primary health care setting. To evaluate client satisfaction. To assess utilization of facilities by the community. Materials and Methods: Study Type: Cross-sectional community-based study. Quality assessment was done by taking 30-50%, of the service provider. Client satisfaction was determined with 1 Immunization and child examination-90 clients each. Utilization of services was assessed among 478 households. Statistical Analysis: Proportions, Likert?s scale to grade the services and Chi-square. Results: Immunization service: Identification of needed vaccine, preparation and care was average. Vaccination technique, documentation, EPI education, maintenance of cold chain and supplies were excellent. Client satisfaction was good. Growth monitoring: It was excellent except for mother?s education andoutreach educational session . Acute respiratory tract infection care: History, physical examination, ARI education were poor. Classification, treatment and referral were excellent. Client satisfaction was good. Diarrheal disease care: History taking was excellent. But examination, classification, treatment, ORT education were poor. Conclusion: Mothers education was not stressed by service providers. Service providers? knowledge do not go with the quality of service rendered. Physical examination of the child was not good. Except for immunization other services were average.

  8. 78 FR 69418 - Patient Protection and Affordable Care Act; Exchanges and Qualified Health Plans, Quality Rating...

    Science.gov (United States)

    2013-11-19

    ...Protection and Affordable Care Act; Exchanges and Qualified Health Plans, Quality Rating System...and illness, access to care, member experience, plan services and efficiency...appropriateness of care and plan management. The...

  9. Relationship between maternal hemoglobin and perinatal outcome

    International Nuclear Information System (INIS)

    To Study the Relationship between Maternal Hemoglobin and Perinatal outcome in a cohort of 860 pregnant women and to highlight the importance of antenatal care regarding maternal health and fetal outcome. All Singleton pregnancies delivering at Pakistan Railway Hospital Rawalpindi from January 2004 to December 2005 that fulfilled the required criteria were included. Out of the 860 patients, 402 were anemic (<11gm/dl) and 458 were non anemic. Perinatal outcome included preterm delivery, low birth weight, intrauterine growth retardation, perinatal death, low apgr scores and intrauterine fetal deaths. Risk of preterm and Low birth weight among anemic women was 3.4 and 1.8 times more than non anaemic women. The neonates of anemic woman also had 1.7 times increased risk of having low apgr scores at 1 min. Among anemic women there was 2.2 times greater risk of intrauterine fetal death than the non-anemic women. Regular antenatal care from first trimester has a vital role in assessing and managing maternal anemia timely and it directly affects the perinatal outcome. The patients with anemia have also higher risk of having low birth weight, preterm births and intra uterine fetal death. (author)

  10. Leading quality improvement in primary care: recommendations for success.

    Science.gov (United States)

    Van Hoof, Thomas J; Bisognano, Maureen; Reinertsen, James L; Meehan, Thomas P

    2012-09-01

    Leadership is increasingly recognized as a potential factor in the success of primary care quality improvement efforts, yet little is definitively known about which specific leadership behaviors are most important. Until more research is available, the authors suggest that primary care clinicians who are committed to developing their leadership skills should commit to a series of actions. These actions include embracing a theory of leadership, modeling the approach for others, focusing on the goal of improving patient outcomes, encouraging teamwork, utilizing available sources of power, and reflecting on one's approach in order to improve it. Primary care clinicians who commit themselves to such actions will be more effective leaders and will be more prepared as new research becomes available on this important factor. PMID:22800874

  11. Quality and equity in early childhood care in Peru

    Science.gov (United States)

    Izu, Regina Moromizato

    2007-01-01

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

  12. Barriers to quality patient care in rural district hospitals

    OpenAIRE

    Ethelwynn L. Stellenberg; Johanna E. Eygelaar

    2012-01-01

    Currently barriers exist in delivering quality health care. This study aimed to investigate such barriers in the eight rural district hospitals of the West Coast Winelands Region, three type A and five type B hospitals. A quantitative descriptive design was applied which included the total population of nursing staff (n = 340) working at the time of data collection. A self-administered questionnaire was distributed with a response rate of 82%.Reliability of the instrument was verified using t...

  13. Improving Quality of Care in Peptic Ulcer Bleeding

    DEFF Research Database (Denmark)

    Rosenstock, Steffen Jais; Møller, Morten H; Larsson, Heidi; Johnsen, Søren P; Madsen, Anders H; Bendix, Jørgen; Adamsen, Sven; Jensen, Anders G; Zimmermann-Nielsen, Erik; Nielsen, Ann-Sophie; Kallehave, Finn; Oxholm, Dorthe; Skarbye, Mona; Jølving, Line R; Schaffalitzky de Muckadell, Ove B.; Thomsen, RW; Jørgensen, Henrik Stig

    2013-01-01

    OBJECTIVES:The treatment of peptic ulcer bleeding (PUB) is complex, and mortality remains high. We present results from a nationwide initiative to monitor and improve the quality of care (QOC) in PUB.METHODS:All Danish hospitals treating PUB patients between 2004 and 2011 prospectively registered demographic, clinical, and prognostic data. QOC was evaluated using eight process and outcome indicators, including time to initial endoscopy, hemostasis obtainment, proportion undergoing surgery, reble...

  14. Quality of Life in Cancer Patients Receiving Palliative Care

    OpenAIRE

    Singh Divya

    2010-01-01

    Background: The main focus of palliative care services is to improve the patient?s quality of life (QOL), which is defined as the subjective evaluation of life as a whole or the patient?s appraisal and satisfaction with their current level of functioning compared with what they perceive to be possible or ideal. Aims: In this prospective study we attempt to validate the Hindi version of a questionnaire designed by the functional assessment of chronic illness therapy (FACIT) me...

  15. Barriers to quality patient care in rural district hospitals

    Directory of Open Access Journals (Sweden)

    Ethelwynn L. Stellenberg

    2012-05-01

    Full Text Available Currently barriers exist in delivering quality health care. This study aimed to investigate such barriers in the eight rural district hospitals of the West Coast Winelands Region, three type A and five type B hospitals. A quantitative descriptive design was applied which included the total population of nursing staff (n = 340 working at the time of data collection. A self-administered questionnaire was distributed with a response rate of 82%.Reliability of the instrument was verified using the Cronbach alpha coefficient and a pilot study. The validity, specifically construct and content validity, were assured by means of an extensive literature review, pilot study and use of experts. Ethics approval was obtained from the relevant stakeholders.Results showed that 272 participants (97% disagreed that provision of staff was adequate, with staff above 40 years of age more likely to disagree (p = p = n =212; 76% indicated that they were not receiving continuing education, with the registered nurses more likely to disagree (?² test, p = 0.02. Participants in both hospital types A (n = 131; 82% and B (n = 108; 91% also disagreed that provision of equipment and consumables was adequate.The research showed that inadequacies relating to human resources, professional development, consumables and equipment influenced the quality of patient care. Urgent attention should be given to the problems identified to ensure quality of patient care in rural hospitals.

  16. How to reduce perinatal mortality? The contribution of Portuguese reform of perinatal healthcare

    Directory of Open Access Journals (Sweden)

    Hercília Guimarães

    2015-03-01

    Full Text Available In 2008, the World Health Organization indicated Portugal as an example to follow in reducing perinatal, neonatal and infant mortalities. The success achieved over the last five decades is a source of pride for the perinatology professionals today. Of paramount importance was the program “Child and Maternal Hospital Healthcare Referral Network”, to start in 1990 and to be fulfilled in a decade. The key point made in the document was the classification of hospitals in health care levels with definition of the roles of each one. The goal of the closure of hospitals with few births (less than 1,500 deliveries per year was successfully achieved, with the closing of about 150 delivery rooms at that time. A neonatal transport in the country started to work in Lisbon, Porto and Coimbra. The aims of regionalization were achieved. The organization in primary, secondary and tertiary healthcare resulted in the improvement of perinatal care centered on both mother and child needs. The perinatal care reform of perinatal care in Portugal is an example of how a good diagnosis and adequate proposals combined with a strong political will are crucial for changing.

  17. Monitoring quality in Israeli primary care: The primary care physicians' perspective

    Directory of Open Access Journals (Sweden)

    Nissanholtz-Gannot Rachel

    2012-06-01

    Full Text Available Abstract Background Since 2000, Israel has had a national program for ongoing monitoring of the quality of the primary care services provided by the country's four competing non-profit health plans. Previous research has demonstrated that quality of care has improved substantially since the program's inception and that the program enjoys wide support among health plan managers. However, prior to this study there were anecdotal and journalistic reports of opposition to the program among primary care physicians engaged in direct service delivery; these raised serious questions about the extent of support among physicians nationally. Goals To assess how Israeli primary care physicians experience and rate health plan efforts to track and improve the quality of care. Method The study population consisted of primary care physicians employed by the health plans who have responsibility for the quality of care of a panel of adult patients. The study team randomly sampled 250 primary-care physicians from each of the four health plans. Of the 1,000 physicians sampled, 884 met the study criteria. Every physician could choose whether to participate in the survey by mail, e-mail, or telephone. The anonymous questionnaire was completed by 605 physicians – 69% of those eligible. The data were weighted to reflect differences in sampling and response rates across health plans. Main findings The vast majority of respondents (87% felt that the monitoring of quality was important and two-thirds (66% felt that the feedback and subsequent remedial interventions improved medical care to a great extent. Almost three-quarters (71% supported continuation of the program in an unqualified manner. The physicians with the most positive attitudes to the program were over age 44, independent contract physicians, and either board-certified in internal medicine or without any board-certification (i.e., residents or general practitioners. At the same time, support for the program was widespread even among physicians who are young, board-certified in family medicine, and salaried. Many physicians also reported that various problems had emerged to a great or very great extent: a heavier workload (65%, over-competitiveness (60%, excessive managerial pressure (48%, and distraction from other clinical issues (35%. In addition, there was some criticism of the quality of the measures themselves. Respondents also identified approaches to addressing these problems. Conclusions The findings provide perspective on the anecdotal reports of physician opposition to the monitoring program; they may well accurately reflect the views of the small number of physicians directly involved, but they do not reflect the views of primary care physicians as a whole, who are generally quite supportive of the program. At the same time, the study confirms the existence of several perceived problems. Some of these problems, such as excess managerial pressure, can probably best be addressed by the health plans themselves; while others, such as the need to refine the quality indicators, are probably best addressed at the national level. Cooperation between primary care physicians and health plan managers, which has been an essential component of the program's success thus far, can also play an important role in addressing the problems identified.

  18. Mortalidade perinatal em São Paulo, Brasil Perinatal mortality in S. Paulo, Brazil

    Directory of Open Access Journals (Sweden)

    Ruy Laurenti

    1975-06-01

    Full Text Available Foi analisada a mortalidade perinatal em São Paulo num período de dois anos. Partiu o estudo da totalidade dos atestados de nascidos mortos e de uma amostra de óbitos de menores de sete dias, para a qual a metodologia foi a de entrevistas domiciliares e junto aos médicos e hospitais que tenham prestado assistência às crianças falecidas. O coeficiente de mortalidade perinatal encontrado foi igual a 42,04 por mil nascidos vivos. Esse valor apresenta-se bastante elevado quando comparado ao de áreas desenvolvidas. Foi verificado que ele poderia ser diminuído com a simples redução dos coeficientes específicos por algumas causas evitáveis a nível de pré-natal (sífilis congênita, doenças próprias ou associadas à gravidez, do parto (distócias, traumatismos obstétricos e anóxia, ou da atenção ao recém-nascido (causas infecciosas, do aparelho respiratório, hemorragias e certas anóxias. O coeficiente de mortalidade perinatal segundo a idade da mãe mostrou que o risco varia com a idade, apresentando-se maior nas mulheres de 40 a 49 anos.Perinatal mortality in S. Paulo, over a period of two years, was analysed. The study took in all death certificates of the stillborn and a sample of children under a week of age. For the latter the methodology used was by interviewing phisicians and hospitals that cared for the deceased. The perinatal mortality rate was 42,05 per thousand live births. This value is really high when compared with those of developed areas. Nevertheless it can be reduced once the specific rates for some of the avoidable diseases be reduced by proper pre-natal care (congenital syphilis, illness pertaining to or associated with pregnancy. This can also be done by improving care at delivery (Distocias, obstetrical traumatism and anoxia and towards the newlyborn (infeccious diseases, respiratory diseases, haemorrages and anoxia. The perinatal mortality rate varies with the age of the mother, the risk being largest in women between 40 and 49 years of age.

  19. Mortalidade perinatal em São Paulo, Brasil / Perinatal mortality in S. Paulo, Brazil

    Scientific Electronic Library Online (English)

    Ruy, Laurenti; Maria Helena, Silveira; Arnaldo A. F., Siqueira.

    1975-06-01

    Full Text Available Foi analisada a mortalidade perinatal em São Paulo num período de dois anos. Partiu o estudo da totalidade dos atestados de nascidos mortos e de uma amostra de óbitos de menores de sete dias, para a qual a metodologia foi a de entrevistas domiciliares e junto aos médicos e hospitais que tenham prest [...] ado assistência às crianças falecidas. O coeficiente de mortalidade perinatal encontrado foi igual a 42,04 por mil nascidos vivos. Esse valor apresenta-se bastante elevado quando comparado ao de áreas desenvolvidas. Foi verificado que ele poderia ser diminuído com a simples redução dos coeficientes específicos por algumas causas evitáveis a nível de pré-natal (sífilis congênita, doenças próprias ou associadas à gravidez), do parto (distócias, traumatismos obstétricos e anóxia), ou da atenção ao recém-nascido (causas infecciosas, do aparelho respiratório, hemorragias e certas anóxias). O coeficiente de mortalidade perinatal segundo a idade da mãe mostrou que o risco varia com a idade, apresentando-se maior nas mulheres de 40 a 49 anos. Abstract in english Perinatal mortality in S. Paulo, over a period of two years, was analysed. The study took in all death certificates of the stillborn and a sample of children under a week of age. For the latter the methodology used was by interviewing phisicians and hospitals that cared for the deceased. The perinat [...] al mortality rate was 42,05 per thousand live births. This value is really high when compared with those of developed areas. Nevertheless it can be reduced once the specific rates for some of the avoidable diseases be reduced by proper pre-natal care (congenital syphilis, illness pertaining to or associated with pregnancy). This can also be done by improving care at delivery (Distocias, obstetrical traumatism and anoxia) and towards the newlyborn (infeccious diseases, respiratory diseases, haemorrages and anoxia). The perinatal mortality rate varies with the age of the mother, the risk being largest in women between 40 and 49 years of age.

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

    Directory of Open Access Journals (Sweden)

    Aldana Jorge Mendoza

    2001-01-01

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

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

    Science.gov (United States)

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

    2013-01-01

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

  2. Diagnostic image quality of mammograms in German outpatient medical care

    International Nuclear Information System (INIS)

    Purpose: A total of 79 115 mammograms from statutory health insurance (SHI) physicians within German outpatient care were evaluated with respect to the diagnostic image quality. Materials and Methods: Mammograms were randomly selected between 2006 and 2008 by the regional Associations of Statutory Health Insurance Physicians and submitted to regional boards of experts for external evaluation. The mammogram quality was evaluated using a 3-point scale (adequate, borderline, failure) and documented using a nationally standardized protocol. Results: 87.6 % of the mammograms were classified as adequate, 11.0 % as borderline and 1.4 % as failure. Mediolateral oblique mammograms (mlo) had worse ratings than craniocaudal mammograms (cc). Main reasons for classifying the mammograms as borderline or failure were 'inframammary fold not adequately visualized' (mlo), 'pectoral muscle not in the correct angle or not to the level with the nipple' (mlo), 'the nipple not in profile' (mlo, cc) and 'breast not completely or not adequately visualized' (cc). Conclusion: The results show a good overall quality of mammograms in German outpatient medical care. Failures can be associated predominantly with incorrect positioning of the breast. More precisely defined quality criteria using objective measures are recommended, especially for craniocaudal mammograms (cc). (orig.)

  3. Caring about Business in the Care Business : How private elderly care providers can generate profit while maintaining care quality

    OpenAIRE

    Oscanoa, Mery; Bergdahl, Roger

    2008-01-01

    The social service care system for the elderly has undergone a number of changes during the last decades. These reforms, especially the purchaser-provider split, have changed the role of the state in this sector somewhat, from being a monolithic provider of tax-financed elderly care to primarily being a purchaser who might choose to purchase elderly care services from private providers. However, the state has still retained a public elderly care service. Needless to say, the reform paved the ...

  4. Antenatal care strengthening for improved quality of care in Jimma, Ethiopia : an effectiveness study

    DEFF Research Database (Denmark)

    Villadsen, Sarah Fredsted; Negussie, Dereje

    2015-01-01

    BACKGROUND: Interventions for curing most diseases and save lives of pregnant and delivering women exist, yet the power of health systems to deliver them to those in most need is not sufficient. The aims of this study were to design a participatory antenatal care (ANC) strengthening intervention and assess the implementation process and effectiveness on quality of ANC in Jimma, Ethiopia. METHODS: The intervention comprised trainings, supervisions, equipment, development of health education material, and adaption of guidelines. It was implemented at public facilities and control sites were included in the evaluation. Improved content of care (physical examinations, laboratory testing, tetanus toxoid (TT)-immunization, health education, conduct of health professionals, and waiting time) were defined as proximal project outcomes and increased quality of care (better identification of health problems and increased overall user satisfaction with ANC) were distal project outcomes. The process of implementation was documented in monthly supervision reports. Household surveys, before (2008) and after (2010) intervention, were conducted amongst all women who had given birth within the previous 12 months. The effect of the intervention was assessed by comparing the change in quality of care from before to after the intervention period at intervention sites, relative to control sites, using logistic mixed effect regression. RESULTS: The continued attention to the ANC provision during implementation stimulated increased priority of ANC among health care providers. The organizational structure of the facilities and lack of continuity in care provision turned out to be a major challenge for implementation. There was a positive effect of the intervention on health education on danger signs during pregnancy (OR: 3.9, 95% CI: 2.6;5.7), laboratory testing (OR for blood tests other than HIV 2.9, 95% CI: 1.9;4.5), health problem identification (OR 1.8, 95% CI: 1.1;3.1), and satisfaction with the service (OR: 0.4, 95% CI: 0.2;0.9). There was no effect of intervention on conduct of health professionals. The effect of intervention on various outcomes was significantly modified by maternal education. CONCLUSION: The quality of care can be improved in some important aspects with limited resources. Moreover, the study provides strategic perspectives on how to facilitate improved quality of ANC.

  5. Quality of prenatal and maternal care: bridging the know-do gap” (QUALMAT study): an electronic clinical decision support system for rural Sub-Saharan Africa

    Science.gov (United States)

    2013-01-01

    Background Despite strong efforts to improve maternal care, its quality remains deficient in many countries of Sub-Saharan Africa as persistently high maternal mortality rates testify. The QUALMAT study seeks to improve the performance and motivation of rural health workers and ultimately quality of primary maternal health care services in three African countries Burkina Faso, Ghana, and Tanzania. One major intervention is the introduction of a computerized Clinical Decision Support System (CDSS) for rural primary health care centers to be used by health care workers of different educational levels. Methods A stand-alone, java-based software, able to run on any standard hardware, was developed based on assessment of the health care situation in the involved countries. The software scope was defined and the final software was programmed under consideration of test experiences. Knowledge for the decision support derived from the World Health Organization (WHO) guideline “Pregnancy, Childbirth, Postpartum and Newborn Care; A Guide for Essential Practice”. Results The QUALMAT CDSS provides computerized guidance and clinical decision support for antenatal care, and care during delivery and up to 24 hours post delivery. The decision support is based on WHO guidelines and designed using three principles: (1) Guidance through routine actions in maternal and perinatal care, (2) integration of clinical data to detect situations of concern by algorithms, and (3) electronic tracking of peri- and postnatal activities. In addition, the tool facilitates patient management and is a source of training material. The implementation of the software, which is embedded in a set of interventions comprising the QUALMAT study, is subject to various research projects assessing and quantifying the impact of the CDSS on quality of care, the motivation of health care staff (users) and its health economic aspects. The software will also be assessed for its usability and acceptance, as well as for its influence on workflows in the rural setting of primary health care in the three countries involved. Conclusion The development and implementation of a CDSS in rural primary health care centres presents challenges, which may be overcome with careful planning and involvement of future users at an early stage. A tailored software with stable functionality should offer perspectives to improve maternal care in resource-poor settings. Trial registration http://www.clinicaltrials.gov/NCT01409824. PMID:23574764

  6. Resident workload, pager communications, and quality of care.

    Science.gov (United States)

    Patel, Shaun P; Lee, Jay S; Ranney, David N; Al-Holou, Shaza N; Frost, Christopher M; Harris, Meredith E; Lewin, Sarah A; Liu, Erqi; Madenci, Arin; Majkrzak, Allen A; Nelson, Jessica; Peterson, Sarah F; Serecky, Kerri A; Wilkinson, David A; Wojcik, Brandon M; Englesbe, Michael J; Lynch, Raymond J

    2010-11-01

    With the recent regulations limiting resident work hours, it has become more important to understand how residents spend their time. The volume and content of the pages they receive provide a valuable source of information that give insight into their workload and help identify inefficiencies in hospital communication. We hypothesized that above a certain workload threshold, paging data would suggest breakdowns in communication and implications for quality of care. All pages sent to six general surgery interns at the University of Michigan over the course of one academic year (7/1/2008-6/30/2009) were retrospectively categorized by sender type, message type, message modifier, and message quality. Census, discharge, and admission information for each intern service were also collected, and intern duties were further analyzed with respect to schedule. "On-call" days were defined as days on which the intern bore responsibility for care of all admitted floor patients. The interns received a total of 9,843 pages during the study period. During on-call shifts, each intern was paged an average of 57 ± 3 times, and those on non-call shifts received an average of 12 ± 3 pages. Floor/intensive care unit (ICU) nurses represented 32% of the page volume received by interns. Interestingly, as patient volume increased, there was a decrease in the number of pages received per patient. By contrast, at higher patient volumes, there was a trend toward an increasing percentage of urgent pages per patient. At high intern workloads, our data suggest no major communication breakdowns but reveal the potential for inferior quality of care. PMID:20703470

  7. Quality of diabetes care in Dutch care groups: no differences between diabetes patients with and without co-morbidity

    Directory of Open Access Journals (Sweden)

    Simone R de Bruin

    2013-12-01

    Full Text Available Objective: To evaluate the relationship between presence and nature of co-morbidity and quality of care for diabetes patients enrolled in diabetes disease management programmes provided by care groups.Methods: We performed an observational study within eight Dutch diabetes care groups. Data from patient record systems of care groups and patient questionnaires were used to determine quality of care. Quality of care was measured as provision of the recommended diabetes care, patients’ achievement of recommended clinical outcomes and patients’ perception of coordination and integration of care.Results: 527 diabetes patients without and 1187 diabetes patients with co-morbidity were included. Of the co-morbid patients, 7.8% had concordant co-morbid conditions only, 63.8% had discordant co-morbid diseases only and 28.4% had both types of conditions. Hardly any differences were observed between patients with and without co-morbidity in terms of provided care, achievement of clinical outcomes and perceived coordination and integration of care.Conclusions: Our study implies that care groups are able to provide similar quality of diabetes care for diabetes patients with and without co-morbidity. Considering the expected developments regarding additional disease management programmes in care groups, it is of importance to monitor quality of care, including patient experiences, for all chronic diseases. It will then become clear whether accountable provider-led organisations such as care groups are able to ensure quality of care for the increasing number of patients with multiple chronic conditions.

  8. Quality of asthma care: Western Cape Province, South Africa

    Scientific Electronic Library Online (English)

    Bob, Mash; Hilary, Rhode; Michael, Pather; Gillian, Ainslie; Elvis, Irusen; Angeni, Bheekie; Pat, Mayers.

    2009-12-01

    Full Text Available BACKGROUND: Asthma is the eighth leading contributor to the burden of disease in South Africa, but has received less attention than other chronic diseases. The Asthma Guidelines Implementation Project (AGIP) was established to improve the impact of the South African guidelines for chronic asthma in [...] adults and adolescents in the Western Cape. One strategy was an audit tool to assist with assessing and improving the quality of care. METHODS: The audit of asthma care targeted all primary care facilities that managed adult patients with chronic asthma within all six districts of the Western Cape province. The usual steps in the quality improvement cycle were followed. RESULTS: Data were obtained from 957 patients from 46 primary care facilities. Only 80% of patients had a consistent diagnosis of asthma, 11.5% of visits assessed control and 23.2% recorded a peak expiratory flow (PEF), 14% of patients had their inhaler technique assessed and 11.2% were given a self-management plan; 81% of medication was in stock, and the controller/reliever dispensing ratio was 0.6. Only 31.5% of patients were well controlled, 16.3% of all visits were for exacerbations, and 17.6% of all patients had been hospitalised in the previous year. CONCLUSION: The availability of medication and prescription of inhaled steroids is reasonable, yet control is poor. Health workers do not adequately distinguish asthma from chronic obstructive pulmonary disease, do not assess control by questions or PEF, do not adequately demonstrate or assess the inhaler technique, and have no systematic approach to or resources for patient education. Ten recommendations are made to improve asthma care.

  9. Mortes perinatais e avaliação da assistência ao parto em maternidades do Sistema Único de Saúde em Belo Horizonte, Minas Gerais, Brasil, 1999 Perinatal deaths and childbirth healthcare evaluation in maternity hospitals of the Brazilian Unified Health System in Belo Horizonte, Minas Gerais, Brazil, 1999

    Directory of Open Access Journals (Sweden)

    Sônia Lansky

    2006-01-01

    Full Text Available Este trabalho analisa a associação entre a morte perinatal e o processo de assistência hospitalar ao parto, considerando-se que grande parte das mortes perinatais pode ser prevenível pela atenção qualificada de saúde e que a avaliação da qualidade da assistência perinatal ao parto é necessária para a redução da morbi-mortalidade perinatal. Realizou-se estudo caso-controle de base populacional dos óbitos perinatais (n = 118 e nascimentos (n = 492, ocorridos em maternidades do Sistema Único de Saúde (SUS de Belo Horizonte, Minas Gerais, Brasil. Sexo masculino, prematuridade, doenças na gravidez, baixo peso ao nascer, doenças do recém-nascido, não realização de pré-natal, não utilização de partograma e menos de uma avaliação fetal por hora durante o trabalho de parto apresentaram associação estatisticamente significativa com o óbito perinatal. No modelo de regressão logística múltipla, não utilização do partograma durante o trabalho de parto e tipo de maternidade apresentaram-se como fatores de risco independentes para a morte perinatal. O estudo indica que é deficiente a qualidade da assistência hospitalar ao parto e que aspectos da estrutura dos serviços e do processo de assistência relacionam-se com a mortalidade perinatal por causas evitáveis.This paper analyzes the association between perinatal mortality and factors related to hospital care during labor, considering that healthcare assessment is needed in order to reduce perinatal mortality. A population-based case-control study was conducted with 118 perinatal deaths (cases and 492 births (controls that took place in maternity hospitals of the Brazilian Unified Health System (SUS in Belo Horizonte, Minas Gerais, Brazil. Male sex, prematurity, diseases during pregnancy, low birth weight, newborn diseases, lack of prenatal care, lack of partograph use during labor, and less than one fetus assessment per hour during labor were significantly associated with perinatal deaths. In the multiple regression analysis, lack of partograph use during labor and type of hospital were associated with perinatal deaths. These results indicate inadequate quality of care in maternity hospitals and show that health services structure and health care process are related to perinatal mortality due to preventable causes.

  10. Mortes perinatais e avaliação da assistência ao parto em maternidades do Sistema Único de Saúde em Belo Horizonte, Minas Gerais, Brasil, 1999 / Perinatal deaths and childbirth healthcare evaluation in maternity hospitals of the Brazilian Unified Health System in Belo Horizonte, Minas Gerais, Brazil, 1999

    Scientific Electronic Library Online (English)

    Sônia, Lansky; Elisabeth, França; Cibele Comini, César; Luiz Costa, Monteiro Neto; Maria do Carmo, Leal.

    2006-01-01

    Full Text Available Este trabalho analisa a associação entre a morte perinatal e o processo de assistência hospitalar ao parto, considerando-se que grande parte das mortes perinatais pode ser prevenível pela atenção qualificada de saúde e que a avaliação da qualidade da assistência perinatal ao parto é necessária para [...] a redução da morbi-mortalidade perinatal. Realizou-se estudo caso-controle de base populacional dos óbitos perinatais (n = 118) e nascimentos (n = 492), ocorridos em maternidades do Sistema Único de Saúde (SUS) de Belo Horizonte, Minas Gerais, Brasil. Sexo masculino, prematuridade, doenças na gravidez, baixo peso ao nascer, doenças do recém-nascido, não realização de pré-natal, não utilização de partograma e menos de uma avaliação fetal por hora durante o trabalho de parto apresentaram associação estatisticamente significativa com o óbito perinatal. No modelo de regressão logística múltipla, não utilização do partograma durante o trabalho de parto e tipo de maternidade apresentaram-se como fatores de risco independentes para a morte perinatal. O estudo indica que é deficiente a qualidade da assistência hospitalar ao parto e que aspectos da estrutura dos serviços e do processo de assistência relacionam-se com a mortalidade perinatal por causas evitáveis. Abstract in english This paper analyzes the association between perinatal mortality and factors related to hospital care during labor, considering that healthcare assessment is needed in order to reduce perinatal mortality. A population-based case-control study was conducted with 118 perinatal deaths (cases) and 492 bi [...] rths (controls) that took place in maternity hospitals of the Brazilian Unified Health System (SUS) in Belo Horizonte, Minas Gerais, Brazil. Male sex, prematurity, diseases during pregnancy, low birth weight, newborn diseases, lack of prenatal care, lack of partograph use during labor, and less than one fetus assessment per hour during labor were significantly associated with perinatal deaths. In the multiple regression analysis, lack of partograph use during labor and type of hospital were associated with perinatal deaths. These results indicate inadequate quality of care in maternity hospitals and show that health services structure and health care process are related to perinatal mortality due to preventable causes.

  11. Is the quality of care in general medical practice improving? Results of a longitudinal observational study.

    OpenAIRE

    Campbell, Stephen; Steiner, Andrea; Robison, Judy; Webb, Dale; Raven, Ann; Roland, Martin

    2003-01-01

    BACKGROUND: The demand for increased accountability within health care has led to a myriad of government initiatives in the United Kingdom, with the aim of improving care, setting minimum standards, and addressing poor performance. AIM: To assess the quality of care in English general practice in the year 2001 compared with 1998, in terms of access, interpersonal care, and clinical care (chronic disease management, elderly care, and mental health care). DESIGN OF STUDY: Observational study in...

  12. Understanding quality patient care and the role of the practicing nurse.

    Science.gov (United States)

    Owens, Laura D; Koch, Robert W

    2015-03-01

    Nurses play a vital role in improving the safety and quality of patient care. The authors provide the front-line nurse providers with an overview of critical concepts related to quality management of patient care. A historical approach provides the reader with an overview of the trajectory or the quality in health care movement. Furthermore, the article provides the nurse with a basic understanding of national and international organizations that focus on quality patient care. A brief introduction of measures of quality care is presented as well as implications for nursing practice. PMID:25680485

  13. Availability and quality of prehospital care on pakistani interurban roads.

    Science.gov (United States)

    Bhatti, Junaid A; Waseem, Hunniya; Razzak, Junaid A; Shiekh, Naeem-Ul-Lah; Khoso, Ajmal Khan; Salmi, L-Rachid

    2013-01-01

    Interurban road crashes often result in severe Road Traffic Injuries (RTIs). Prehospital emergency care on interurban roads was rarely evaluated in the low- and middle-income countries. The study highlighted the availability and quality of prehospital care facilities on interurban roads in Pakistan, a low-income country. The study setting was a 592-km-long National highway in the province of Sindh, Pakistan. Using the questionnaires adapted from the World Health Organization prehospital care guidelines [Sasser et al., 2005], managers and ambulance staff at the stations along highways were interviewed regarding the process of care, supplies in ambulances, and their experience of trauma care. Ambulance stations were either managed by the police or the Edhi Foundation (EF), a philanthropic organization. All highway stations were managed by the EF; the median distance between highway stations was 38 km (Interquartile Range [IQR]=27-46). We visited 14 stations, ten on the highway section, and four in cities, including two managed by the police. Most highway stations (n=13) received one RTI call per day. Half of stations (n=5) were inside highway towns, usually near primary or secondary-level healthcare facilities. Travel time to the nearest tertiary healthcare facility ranged from 31 to 70 minutes (median=48 minutes; IQR=30-60). Other shortcomings noted for stations were not triaging RTI cases (86%), informing hospitals (64%), or recording response times (57%). All ambulances (n=12) had stretchers, but only 58% had oxygen cylinders. The median schooling of ambulance staff (n=13) was 8 years (IQR=3-10), and the median paramedic training was 3 days (IQR=2-3). Observed shortcomings in prehospital care could be improved by public-private partnerships focusing on paramedic training, making available essential medical supplies, and linking ambulance stations with designated healthcare facilities for appropriate RTI triage. PMID:24406963

  14. Risk factors for inadequate prenatal care use in the metropolitan area of Aracaju, Northeast Brazil

    OpenAIRE

    Souza Luiz de; Almeida Maria; Lima Danilo DF; Bettiol Heloísa; Guimarães Alzira Maria DN; Ribeiro Eleonora RO; Silva Antônio; Gurgel Ricardo Q

    2009-01-01

    Abstract Background The aim of prenatal care is to promote good maternal and foetal health and to identify risk factors for adverse pregnancy outcomes in an attempt to promptly manage and solve them. Although high prenatal care attendance is reported in most areas in Brazil, perinatal and neonatal mortalities are disproportionally high, raising doubts about the quality and performance of the care provided. The objective of the present study was to evaluate the adequacy of prenatal care use an...

  15. Family physicians are complex care physicians and quality of care advancement experts.

    Science.gov (United States)

    Bowman, Marjorie A; Neale, Anne Victoria

    2014-01-01

    This issue's policy brief provides a good summary point for this issue: family physicians are complex care physicians (in addition to their other many roles). Another article demonstrates that family physicians provide more care during a preventive gynecologic visit than obstetrician-gynecologists. Completing the American Board of Family Medicine Maintenance of Certification modules are associated with higher quality of care. A learning collaborative shows the fruits of their effort to implement patient-centered medical homes. A new risk calculator for colorectal cancer is presented. Pregnant patients are more likely to accept the flu vaccine when presented by a physician rather than a nurse or medical assistant. We can "maladapt" to new information, such as not using aspirin for primary cardiac disease prevention or the low risk of lactic acidosis with metformin. PMID:24390876

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

    Science.gov (United States)

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

    2014-01-01

    Background Child health care is an important part of the UK general practice workload; in 2009 children aged NICE) and Scottish Intercollegiate Guidelines Network (SIGN) clinical guidelines, translation of guideline recommendations into quality indicators, and assessment of their validity and implementation feasibility (applying consensus methodology used in selecting QOF indicators). Results Of the 296 national guidelines published, 48 were potentially relevant to children in primary care, but only 123 of 1863 recommendations (6.6%) met selection criteria for translation into 56 potential quality indicators. A further 13 potential indicators were articulated after review of existing quality indicators and standards. Assessment of the validity and feasibility of implementation of these 69 candidate indicators by a clinical expert group identified 35 with median scores 8 on a 9-point Likert scale. However, only seven of the 35 achieved a GRADE rating >1 (were based on more than expert opinion). Conclusion Producing valid primary care quality indicators for children is feasible but difficult. These indicators require piloting before wide adoption but have the potential to raise the standard of primary care for all children. PMID:25452539

  17. Antenatal care strengthening for improved quality of care in Jimma, Ethiopia

    DEFF Research Database (Denmark)

    Villadsen, Sarah Fredsted; Negussie, Dereje; GebreMariam, Abebe; Tilahun, Abebech; Friis, Henrik; Rasch, Vibeke

    2015-01-01

    BACKGROUND: Interventions for curing most diseases and save lives of pregnant and delivering women exist, yet the power of health systems to deliver them to those in most need is not sufficient. The aims of this study were to design a participatory antenatal care (ANC) strengthening intervention and assess the implementation process and effectiveness on quality of ANC in Jimma, Ethiopia. METHODS: The intervention comprised trainings, supervisions, equipment, development of health education mater...

  18. Indicators for Evaluating the Performance and Quality of Care of Ambulatory Care Nurses.

    Science.gov (United States)

    Rapin, Joachim; D'Amour, Danielle; Dubois, Carl-Ardy

    2015-01-01

    The quality and safety of nursing care vary from one service to another. We have only very limited information on the quality and safety of nursing care in outpatient settings, an expanding area of practice. Our aim in this study was to make available, from the scientific literature, indicators potentially sensitive to nursing that can be used to evaluate the performance of nursing care in outpatient settings and to integrate those indicators into the theoretical framework of Dubois et al. (2013). We conducted a scoping review in three databases (CINAHL, MEDLINE, and EMBASE) and the bibliographies of selected articles. From a total of 116 articles, we selected 22. The results of our study not only enable that framework to be extended to ambulatory nursing care but also enhance it with the addition of five new indicators. Our work offers nurses and managers in ambulatory nursing units indicators potentially sensitive to nursing that can be used to evaluate performance. For researchers, it presents the current state of knowledge on this construct and a framework with theoretical foundations for future research in ambulatory settings. This work opens an unexplored field for further research. PMID:26380108

  19. Indicators for Evaluating the Performance and Quality of Care of Ambulatory Care Nurses

    Science.gov (United States)

    Rapin, Joachim; D'Amour, Danielle; Dubois, Carl-Ardy

    2015-01-01

    The quality and safety of nursing care vary from one service to another. We have only very limited information on the quality and safety of nursing care in outpatient settings, an expanding area of practice. Our aim in this study was to make available, from the scientific literature, indicators potentially sensitive to nursing that can be used to evaluate the performance of nursing care in outpatient settings and to integrate those indicators into the theoretical framework of Dubois et al. (2013). We conducted a scoping review in three databases (CINAHL, MEDLINE, and EMBASE) and the bibliographies of selected articles. From a total of 116 articles, we selected 22. The results of our study not only enable that framework to be extended to ambulatory nursing care but also enhance it with the addition of five new indicators. Our work offers nurses and managers in ambulatory nursing units indicators potentially sensitive to nursing that can be used to evaluate performance. For researchers, it presents the current state of knowledge on this construct and a framework with theoretical foundations for future research in ambulatory settings. This work opens an unexplored field for further research. PMID:26380108

  20. A Profile Approach to Child Care Quality, Quantity, and Type of Setting: Parent Selection of Infant Child Care Arrangements

    Science.gov (United States)

    Sosinsky, Laura Stout; Kim, Se-Kang

    2013-01-01

    Building on prior variable-oriented research which demonstrates the independence of the associations of child care quality, quantity, and type of setting with family factors and child outcomes, the current study identifies four profiles of child care dimensions from the NICHD Study of Early Child Care and Youth Development. Profiles accounted for…

  1. Analysis of early accountable care organizations defines patient, structural, cost, and quality-of-care characteristics.

    Science.gov (United States)

    Epstein, Arnold M; Jha, Ashish K; Orav, E John; Liebman, Daniel L; Audet, Anne-Marie J; Zezza, Mark A; Guterman, Stuart

    2014-01-01

    Accountable care organizations (ACOs) have attracted interest from many policy makers and clinical leaders because of their potential to improve the quality of care and reduce costs. Federal ACO programs for Medicare beneficiaries are now up and running, but little information is available about the baseline characteristics of early entrants. In this descriptive study we present data on the structural and market characteristics of these early ACOs and compare ACOs' patient populations, costs, and quality with those of their non-ACO counterparts at baseline. We found that ACO patients were more likely than non-ACO patients to be older than age eighty and had higher incomes. ACO patients were less likely than non-ACO patients to be black, covered by Medicaid, or disabled. The cost of care for ACO patients was slightly lower than that for non-ACO patients. Slightly fewer than half of the ACOs had a participating hospital. Hospitals that were in ACOs were more likely than non-ACO hospitals to be large, teaching, and not-for-profit, although there was little difference in their performance on quality metrics. Our findings can be useful in interpreting the early results from the federal ACO programs and in establishing a baseline to assess the programs' development. PMID:24395940

  2. Patent Ductus Arteriosus: Perinatal Risk Factors

    OpenAIRE

    Nizarali, Z; Marques, T; Costa, C.; Barroso, R.; Cunha, M.

    2012-01-01

    Background: Patent Ductus Arteriosus (PDA) is the most common heart disease among the newborn population. Besides prematurity, other factors are believed to play a significant role in this condition. Aims: Identification of perinatal risk factors associated with PDA in premature or Very Low Birth Weight Infants (VLBW). Material and methods: Transversal study including all infants admitted to a Level III Neonatal Intensive Care Unit, from January 2005 to December 2009 and includ...

  3. Neonatal Thrombocytopenia after Perinatal Asphyxia Treated with Hypothermia: A Retrospective Case Control Study

    OpenAIRE

    Boutaybi, N.; Razenberg, F.; V. E. H. J. Smits-Wintjens; E. W. van Zwet; Rijken, M.; Steggerda, S J; Lopriore, E.

    2014-01-01

    Our objective was to estimate the effect of therapeutic hypothermia on platelet count in neonates after perinatal asphyxia. We performed a retrospective case control study of all (near-) term neonates with perinatal asphyxia admitted between 2004 and 2012 to our neonatal intensive care unit. All neonates treated with therapeutic hypothermia were included in this study (hypothermia group) and compared with a historic control group of neonates with perinatal asphyxia treated before introduction...

  4. Pathophysiology of perinatal asphyxia: can we predict and improve individual outcomes?

    OpenAIRE

    Morales, Paola; Bustamante, Diego; Espina-Marchant, Pablo; Neira-Peña, Tanya; Gutiérrez-Hernández, Manuel A.; Allende-Castro, Camilo; Rojas-Mancilla, Edgardo

    2011-01-01

    Perinatal asphyxia occurs still with great incidence whenever delivery is prolonged, despite improvements in perinatal care. After asphyxia, infants can suffer from short- to long-term neurological sequelae, their severity depend upon the extent of the insult, the metabolic imbalance during the re-oxygenation period and the developmental state of the affected regions. Significant progresses in understanding of perinatal asphyxia pathophysiology have achieved. However, predictive diagnostics a...

  5. Sonographic assessment of placental location: a mere notional description or an important key to improve both pregnancy and perinatal obstetrical care? A large cohort study

    Science.gov (United States)

    Gizzo, Salvatore; Noventa, Marco; Vitagliano, Amerigo; Quaranta, Michela; Giovanni, Valentina Di; Borgato, Shara; Saccardi, Carlo; D’Antona, Donato

    2015-01-01

    During a standard obstetrical sonogram, the assessment of placental location (PL) is often limited to a mere notional description without formulating any association to possible implications on pregnancy and childbirth. The aim of the study was to speculate if different sites of PL may have a role in influencing fetal presentation-(FP) at birth and if certain pregnancy-complications may be more closely associated with one rather than with another PL. We conducted an observational-prospective-cohort study on pregnant women referred to the Ob/Gyn Unit of Padua University for routine third-trimester ultrasound scan. For all eligible patients we evaluated the correlation between sites of PL and perinatal maternal/fetal outcomes. Non-cephalic presentation was found in 1.4% of anterior, 8.9% of posterior, 6.2% of fundal and 7.2% of lateral insertions. FP at the beginning of the third trimester as opposed to presentation at birth was concordant in 90.3% of anterior, 63.3% of posterior and 76.5% of lateral insertions. Considering only non-cephalic fetuses we observed a decreasing probability for spontaneous rotation in the following lies: 88% anterior-PL, 80% posterior-PL, 77% lateral-PL, and 70% fundal-PL. Patients with posterior-PL (significantly associated with previous-CS) had a significantly higher CS-rate (due to previous-CS and breech-presentation). Significant differences were found in terms of gestational-hypertension and fresh-placental-weight between different sites of PL. In conclusion our data showed that an understanding of the role that PL plays in influencing the incidence of certain maternal-fetal conditions may assist Clinicians in improving perinatal maternal/fetal outcomes. PMID:26550228

  6. Health and quality of care from older peoples' and formal caregivers' perspective

    OpenAIRE

    From, Ingrid

    2011-01-01

    Aim: The overall aim of this thesis was to gain a deeper understanding of older people's view of health and care while dependent on community care. Furthermore to describe and compare formal caregivers' perceptions of quality of care, working conditions, competence, general health, and factors associated with quality of care from the caregivers' perspective. Method: Qualitative interviews were conducted with 19 older people in community care who were asked to describe what health and ill heal...

  7. Validade, confiabilidade e evitabilidade da causa básica dos óbitos neonatais ocorridos em unidade de cuidados intensivos da Rede Norte-Nordeste de Saúde Perinatal Validez, confiabilidad y evitabilidad de la causa básica de óbitos neonatales ocurridos en una unidad de cuidados intensivos de la Red Norte-Nordeste de Salud Perinatal Validity and reliability of data and avoidability of the underlying cause of neonatal deaths in the intensive care unit of the North-Northeast Perinatal Care Network

    OpenAIRE

    Isabel Marlúcia Lopes Moreira de Almeida; Oneide Angélica Monteiro Santos Rocha; Keila R O Gomes; Carla Maria de Castro Dias e Silva; José Machado Moita Neto

    2013-01-01

    Analisar a validade e confiabilidade da causa básica e a evitabilidade dos óbitos neonatais ocorridos em unidade de cuidados intensivos da Rede Norte-Nordeste de Saúde Perinatal (RENOSPE). A amostra foi de 53 óbitos neonatais contidos no banco de dados da RENOSPE e ocorridos em maternidade de Teresina, Piauí, Brasil. A validade foi feita comparando-se as causas da Rede com as obtidas dos prontuários, sendo calculado kappa, sensibilidade e valor preditivo positivo (VPP). Na análise da evitabil...

  8. [Nurses deliver quality care in the community nurses deliver quality care in the community].

    Science.gov (United States)

    Huang, Yu-Chu; Lin, Chouh-Jiaun

    2009-08-01

    In Taiwan, responsibility for administering healthcare services is being gradually moved out of hospitals and into the community. As such, nurses are increasingly required to address new problems and meet the specific healthcare needs of important subgroups such as Taiwan's growing elderly population and young adult immigrants. Because policies have lagged behind such developments, nurses are expected to provide leadership in addressing these new challenges. Their status within the medical system, however, continues to reflect earlier, more 'traditional' stereotypes and gives inadequate credit for current responsibilities, which include providing long term healthcare and public health nursing, in addition to homecare responsibilities. In the face of these challenges, Taiwan community nurses have continued to develop new ways to provide care and demonstrated innovation, commitment and flexibility in their roles. If nurses are to continue to take a leading role in developing community healthcare services, they require professional recognition as well as appropriate policy support from regulatory and local government authorities. PMID:19634095

  9. The quality of diabetic care in a London health district.

    OpenAIRE

    Yudkin, J.S.; Boucher, B.J.; Schopflin, K. E.; Harris, B. T.; Claff, H R; Whyte, N J; Taylor, B.; Mellins, D H; Wootliff, A B; Safir, J G; Jones, E J

    1980-01-01

    In order to assess the quality of care in a community-wide sample of diabetic patients, a study was performed on 217 such patients identified in three group practices in an east London health district. Only 46% of the patients were currently attending a hospital. In the two years before review, 64% of patients had had their blood pressure recorded and 59% had had retinal examinations. Levels of glycosylated haemoglobin were significantly higher in patients on insulin than in those on oral reg...

  10. Quality improvement in depression care in the Netherlands: the Depression Breakthrough Collaborative. A quality improvement report

    Directory of Open Access Journals (Sweden)

    Gerdien Franx

    2009-06-01

    Full Text Available Background: Improving the healthcare for patients with depression is a priority health policy across the world. Roughly, two major problems can be identified in daily practice: (1 the content of care is often not completely consistent with recommendations in guidelines and (2 the organization of care is not always integrated and delivered by multidisciplinary teams. Aim: To describe the content and preliminary results of a quality improvement project in primary care, aiming at improving the uptake of clinical depression guidelines in daily practice as well as the collaboration between different mental health professionals. Method: A Depression Breakthrough Collaborative was initiated from December 2006 until March 2008. The activities included the development and implementation of a stepped care depression model, a care pathway with two levels of treatment intensity: a first step treatment level for patients with non-severe depression (brief or mild depressive symptoms and a second step level for patients with severe depression. Twelve months data were measured by the teams in terms of one outcome and several process indicators. Qualitative data were gathered by the national project team with a semi-structured questionnaire amongst the local team coordinators. Results: Thirteen multidisciplinary teams participated in the project. In total 101 health professionals were involved, and 536 patients were diagnosed. Overall 356 patients (66% were considered non-severely depressed and 180 (34% patients showed severe symptoms. The mean percentage of non-severe patients treated according to the stepped care model was 78%, and 57% for the severely depressed patient group. The proportion of non-severely depressed patients receiving a first step treatment according to the stepped care model, improved during the project, this was not the case for the severely depressed patients. The teams were able to monitor depression symptoms to a reasonable extent during a period of 6 months. Within 3 months, 28% of monitored patients had recovered, meaning a Beck Depression Inventory (BDI score of 10 and lower, and another 27% recovered between 3 and 6 months. Conclusions and discussion: A stepped care approach seems acceptable and feasible in primary care, introducing different levels of care for different patient groups. Future implementation projects should pay special attention to the quality of care for severely depressed patients. Although the Depression Breakthrough Collaborative introduced new treatment concepts in primary and specialty care, the change capacity of the method remains unclear. Thorough data gathering is needed to judge the real value of these intensive improvement projects.

  11. Quality of Mental Health Care for Nursing Home Residents: A Literature Review

    OpenAIRE

    Grabowski, David C.; Aschbrenner, Kelly A.; Rome, Vincent F.; Bartels, Stephen J

    2010-01-01

    Because of the high proportion of nursing home residents with a mental illness other than dementia, the quality of mental health care in nursing homes is a major clinical and policy issue. The authors apply Donabedian's framework for assessing quality of care based on the triad of structure, process, and outcome-based measures in reviewing the literature on the quality of mental health care in nursing homes. Quality measures used within the literature include mental health consultations and h...

  12. Human Care Theory and Influences on the Life Quality Index of Cancer Patients in Household Life

    OpenAIRE

    Yali Sun; Ling Gao; Ying Dong; Ling Gong

    2013-01-01

    To investigatetheinfluences of the application of human care theory on the life quality and happiness of cancer patients after they receiveda community nursing care which was implemented by the human care theory. The quality life and the happiness index of 93 patients with cancer living in the six communities in Jillin were assessed, the assessment of the life quality was based on a life quality scale (SF-36) and that of the happiness index was based on Memorial Univers...

  13. Intensive-care unit lungs - possibilities to improve the quality

    International Nuclear Information System (INIS)

    X-ray lung diagnosis in an intensive-care unit makes special demands on technique, imaging and on the physician's experience. The quality of image interpretation and evaluation is considerably improved by superimposing the technical data on the X-ray image and by using an antiscatter grid cassette. Proper evaluation of the parameters important for diagnosis is improved by registration of the data on the X-ray film; taking a maximum possible score of 100 as reference value, quality of evaluation is improved from 66.5 points to 71.8 points by data registration on the film itself, whereas the simultaneous use of an antiscatter grid cassette improves the score still further, namely, to 84.3 points. The importance of the clinical condition of the patient, and of the type of breathing chosen, for assessing the chest X-ray, is emphasized. (orig.)

  14. Lessons learned in the development of process quality indicators for cancer care in Japan

    Directory of Open Access Journals (Sweden)

    Higashi Takahiro

    2010-11-01

    Full Text Available Abstract In Japan, attention has increasingly focused on ensuring the quality of care, particularly in the area of cancer care. The 2006 Basic Cancer Control Act reinforced efforts to ensure the quality of cancer care in a number of sectors, including the role of government in ensuring quality. We initiated a government-funded research project to develop quality indicators to measure the quality of care for five major cancers (breast, lung, stomach, colorectal, and liver cancer in Japan, and palliative care for cancers in general. While we successfully developed a total of 206 quality indicators, a number of issues have been raised regarding the concepts and methodologies used to measure quality. Examples include the choice between measuring the process of care versus the outcome of care; the degree to which the process-outcome link should be confirmed in real-world measurement; handling of exceptional cases; interpretation of measurement results between quality of care versus quality of documentation; creation of summary scores; and the optimal number of quality indicators for measurement considering the trade-off between the measurement validity versus resource limitations. These and other issues must be carefully considered when attempting to measure quality of care, and although many appear to have no correct answer, continuation of the project requires that a decision nevertheless be made. Future activities in this project, which is still ongoing, should focus on the further exploration of these problems.

  15. Impact of point-of-care ultrasound on quality of care in clinical practice

    Directory of Open Access Journals (Sweden)

    Adhikari S

    2014-09-01

    Full Text Available Srikar Adhikari,1 Richard Amini,1 Lori A Stolz,1 Michael Blaivas2 1Department of Emergency Medicine, University of Arizona Medical Center, Tucson, AZ, 2Department of Internal Medicine, University of South Carolina School of Medicine, Columbia, SC, USA Abstract: The use of point-of-care (POC ultrasonography has rapidly expanded in recent years, in both academic and community settings. It is one of the few diagnostic modalities that can be performed rapidly at the bedside by a physician and has significant impact on patient outcomes. It is portable, readily accessible, and cost-effective, and has no risk of ionizing radiation. There is an abundance of evidence that supports the use of POC ultrasound by physicians in different subspecialties. Multiple studies have documented the diagnostic accuracy of POC ultrasound and its ability to decrease the time to definitive treatment. As ultrasound technology has advanced, POC ultrasound applications have also evolved from being used solely in patients with blunt abdominal trauma to applications for nearly every clinical scenario imaginable. From performing procedures more safely to diagnosing pathology more quickly, POC ultrasound is radically changing clinical practice, patient outcomes, and the overall quality of patient care a clinician can provide. Recently, there has been a paradigm shift involving a symptom-based approach to POC ultrasound. This unique symptom-based ultrasound approach has led to improved quality of care in a variety of clinical settings. Keywords: point-of-care ultrasound, ultrasonography, bedside ultrasound, emergency physician, emergency department, quality, symptom-based

  16. Assessing methods for measurement of clinical outcomes and quality of care in primary care practices

    Directory of Open Access Journals (Sweden)

    Green Michael E

    2012-07-01

    Full Text Available Abstract Purpose To evaluate the appropriateness of potential data sources for the population of performance indicators for primary care (PC practices. Methods This project was a cross sectional study of 7 multidisciplinary primary care teams in Ontario, Canada. Practices were recruited and 5-7 physicians per practice agreed to participate in the study. Patients of participating physicians (20-30 were recruited sequentially as they presented to attend a visit. Data collection included patient, provider and practice surveys, chart abstraction and linkage to administrative data sets. Matched pairs analysis was used to examine the differences in the observed results for each indicator obtained using multiple data sources. Results Seven teams, 41 physicians, 94 associated staff and 998 patients were recruited. The survey response rate was 81% for patients, 93% for physicians and 83% for associated staff. Chart audits were successfully completed on all but 1 patient and linkage to administrative data was successful for all subjects. There were significant differences noted between the data collection methods for many measures. No single method of data collection was best for all outcomes. For most measures of technical quality of care chart audit was the most accurate method of data collection. Patient surveys were more accurate for immunizations, chronic disease advice/information dispensed, some general health promotion items and possibly for medication use. Administrative data appears useful for indicators including chronic disease diagnosis and osteoporosis/ breast screening. Conclusions Multiple data collection methods are required for a comprehensive assessment of performance in primary care practices. The choice of which methods are best for any one particular study or quality improvement initiative requires careful consideration of the biases that each method might introduce into the results. In this study, both patients and providers were willing to participate in and consent to, the collection and linkage of information from multiple sources that would be required for such assessments.

  17. A comparative study of pregnancy complications and outcomes for the years 1999 and 2004 at a rural hospital in South Africa: Implications for antenatal care

    OpenAIRE

    Shahnaz Hoque; Monjurul Hoque

    2010-01-01

    Background: Detection and management of high-risk pregnancies, all the way through antenatal care, have been advocated as a high-quality mean of reducing maternal and perinatal morbidity and mortality.

    Objectives: This study reviewed the demographic variables, pregnancy and obstetric complications and perinatal outcomes for the years 1999 and 2004 in a rural hospital in KwaZulu-Natal Province, South Africa, with the aim of eval...

  18. PERINATAL LEUKODYSTROPHY CLINICAL CASE

    Directory of Open Access Journals (Sweden)

    Dana Mihut

    2004-01-01

    Full Text Available In this study the authors want to present a case of a premature newborn who presented an extremely rare disease for medical practice. Low prevalence of the perinatal leukodystrophy, the difficulty of the clinical diagnosis and the echography resemblance with other diseases of the periventricular white matter is the subjects of this presentation.

  19. Quality in Family Child Care Settings: The Relationship between Provider Educational Experiences and Global Quality Scores in a Statewide Quality Rating and Improvement System

    Science.gov (United States)

    Hallam, Rena A.; Bargreen, Kaitlin N.; Ridgley, Robyn

    2013-01-01

    This study is a secondary analysis of a statewide sample of licensed family child care providers in the Tennessee Child Care Evaluation and Report Card Program ("N"?=?1,145) that describes the general quality of family child care programs in the state and examines the relationships between provider education and global quality. Study…

  20. Optimizing the treatment of mood disorders in the perinatal period.

    Science.gov (United States)

    Meltzer-Brody, Samantha; Jones, Ian

    2015-06-01

    The perinatal period is a time of high risk for women with unipolar and bipolar mood disorders. We discuss treatment considerations for perinatal mood disorders, including unipolar and bipolar depression as well as postpartum psychosis. We further explore the unique issues faced by women and their families across the full trajectory of the perinatal period from preconception planning through pregnancy and following childbirth. Treatment of perinatal mood disorders requires a collaborative care approach between obstetrics practitioners and mental health providers, to ensure that a thoughtful risk : benefit analysis is conducted. It is vital to consider the risks of the underlying illness versus risks of medication exposure during pregnancy or lactation. When considering medication treatment, attention must be paid to prior medication trials that were most efficacious and best tolerated. Lastly, it is important to assess the impact of individual psychosocial stressors and lifestyle factors on treatment response. PMID:26246794

  1. Trends in quality of care among patients with incident heart failure in Denmark 2003-2010

    DEFF Research Database (Denmark)

    Nakano, Anne; Johnsen, Søren Paaske; Frederiksen, Birgitte Lidegaard; Svendsen, Marie Louise Overgaard; Agger, Carsten; Schjødt, Inge; Egstrup, Kenneth

    2013-01-01

    The treatment of heart failure (HF) is complex and the prognosis remains serious. A range of strategies is used across health care systems to improve the quality of care for HF patients. We present results from a nationwide multidisciplinary initiative to monitor and improve the quality of care and clinical outcome of HF patients using indicator monitoring combined with systematic auditing.

  2. An Integrative Review on Development of "QUality Of care Through the patients' Eyes" (QUOTE) Instruments.

    Science.gov (United States)

    Oh, Jina; Cho, Haeryun; Kim, Yae Young; Park, Hyun Jung; Kim, Hyun Kyoung

    2015-01-01

    "QUality Of care Through the patients' Eyes" (QUOTE) instruments for measuring care quality were classified in terms of procedures, structures, and content. The content and structures of each instrument were found to include (a) participation of the client in the tool development process, (b) evaluation of the importance and performance of care based on the client's needs, and PMID:26018567

  3. Assessment of quality of care in maternal and newborn health services available in public health care facilities in Bangladesh.

    Science.gov (United States)

    Chowdhury, Sameena; Hossain, Syed Akram; Halim, Abdul

    2009-08-01

    The study was conducted using the exit interview with patients (n=120), in depth interview with health care providers (n=87) and focus group discussion (n=16) with stakeholders to assess the perceived level of quality of care in maternal and newborn health at public facilities in Bangladesh. Both clients and providers expressed dissatisfaction for inadequate quality of care represented by poor cleanliness, long waiting time with less consultation time, poor compassion by providers, inadequate supply of drugs and unnoticed cost for services varied by level of facilities. Inadequacy in human resource and absenteeism and poor laboratory service were reported to worsen the condition especially at lower level of service delivery. Thus this study explored some important factors like poor quality of care, inadequate technical competencies, information exchange and follow-up services. A deficit in supplies and logistics are strong barrier in regards to quality of care at various levels which needs to be addressed immediately. PMID:20120780

  4. Practice size, caseload, deprivation and quality of care of patients with coronary heart disease, hypertension and stroke in primary care: national cross-sectional study

    OpenAIRE

    Soljak Michael; Eldred Darren; Car Josip; Saxena Sonia; Majeed Azeem

    2007-01-01

    Abstract Background Reports of higher quality care by higher-volume secondary care providers have fuelled a shift of services from smaller provider units to larger hospitals and units. In the United Kingdom, most patients are managed in primary care. Hence if larger practices provide better quality of care; this would have important implications for the future organization of primary care services. We examined the association between quality of primary care for cardiovascular disease achieved...

  5. Complexity of drug therapy and its implications for quality of diabetes care

    Directory of Open Access Journals (Sweden)

    James X Zhang

    2011-01-01

    Full Text Available Diabetes is a leading cause of mortality, morbidity and disability around the globe. In the past two decades, diabetes care has grown more complex as patients have received multi-component care. Recent studies have illumined the complexity of drug therapy in patients with diabetes. A high level of drug utilization in diabetes patients has serious implications for quality of care, in terms of coordination of care, drug safety and access to care. Practitioners, researchers, payers and policy makers should be aware of these implications and incorporate the complexity of diabetes care into practice guidelines, benefit design and policy formulation to improve the quality of care.

  6. Quality improvement in radiography in a neonatal intensive care unit

    International Nuclear Information System (INIS)

    The primary objective of this study was to ensure that X-rays performed consistently adhere to established technological quality standards and are achieved without compromising patient care while minimizing exposure risks. The secondary objective was to evaluate whether educational sessions targeting areas deemed suboptimal would facilitate improvement. A retrospective, 1-week review of all neonatal X-rays and documentation of clinical information on X-ray requisitions (n = 132) was completed in a tertiary care neonatal intensive care unit (NICU), by a single observer. Standards for X-ray evaluation were defined a priori based on radiographic principles and essential documented medical information for correct interpretation. Targeted areas for improvement were identified and addressed through brief educational sessions and printed pamphlets. The review was repeated after recommendations were implemented. 1 month (n = 93) and 1 year (n = 76) later. Improvements were evident in both the completion of X-ray requisitions and image quality. In particular, there was a statistically significant improvement in requisition legibility (P = 0.019), completeness of the medical history (P < 0.001), reduction in X-ray rotation (P < 0.001), collimation to the specific area of interest (P <0.001), gonadal shielding (P < 0.001), and decrease in monitor leads or artifacts obscuring views (P < 0.001). These improvements were sustained both 1 month and 1 year following the educational sessions. A neonatal X-ray audit is a simple, effective way to evaluate radiographic technique and encourage provision of basic clinical information for diagnostic interpretation by radiologists and neonatologists. As well, structured, collaborative educational sessions between radiology and neonatology staff appear to be a successful and sustainable method to effect overall improvement. (author)

  7. Eclampsia: Repercusión materna y perinatal

    Scientific Electronic Library Online (English)

    Marianela, Rivas; Pedro, Faneite; Guillermina, Salazar.

    2012-03-01

    Full Text Available Objetivo: Determinar la incidencia de eclampsia y su repercusión materna y perinatal en el Departamento de Obstetricia y Ginecología. Departamento Clínico Integral de la Costa. Universidad de Carabobo. Hospital “Dr. Adolfo Prince Lara” Puerto Cabello. Métodos: Estudio descriptivo, retrospectivo, lon [...] gitudinal y analítico de 40 casos con diagnóstico de eclampsia en 31 532 nacimientos en un período de 10 años: 1998 - 2007. Resultados: La incidencia fue de 0,13 %, 1 caso por cada 788 nacimientos. Predominó el grupo etario de 10 - 19 años (52,5 %), concubinas 60 %, grado de instrucción primaria (60 %). Prevaleció el antecedente familiar de hipertensión en la madre (25 %), el antecedente personal de preeclampsia en embarazo anterior (12,5 %). Los principales signos y síntomas fueron: hiperreflexia (65 %), cefalea (50 %), escotomas y amaurosis (20 %). La primera convulsión se presentó ante-parto (75 %). Sin control de embarazo (55.%). Destacaron las I gestas (72,5 %), edad de embarazo 37-41 semanas (50 %), tipo de parto: cesárea (85.%). En los resultados perinatales prevaleció: neonatos deprimidos (52,5 %), peso neonatal entre 2.500-3.499 g (50 %), con morbilidad de 30,55 %, la mayoría debido a síndrome de dificultad respiratoria. La mortalidad fetal fue de 9,09 % y la mortalidad neonatal 9,09 %. Morbilidad materna fue de 53,84 %, asociada: síndrome Hellp (23,07 %), insuficiencia renal aguda (7,69 %), desprendimiento prematuro de placenta (7,69 %); hubo una muerte materna (2,5 %). Conclusión: Es importante que todas las mujeres embarazadas reciban atención médica continua y oportuna, lo cual permite el diagnóstico y tratamiento temprano de afecciones como la pre-eclampsia y eclampsia, esta última es una de las mayores emergencias obstétricas; esta revisión revela una vez más que contribuye decididamente a la morbi-mortalidad materna y perinatal. Implica una asistencia precoz e intensiva para disminuir sus repercusiones. Abstract in english Objective: To determine the incidence of eclampsia and maternal and perinatal impact en el Departamento de Obstetricia y Ginecologia, Hospital “Dr. Adolfo Prince Lara”, Departamento Clínico Integral de la Costa, Universidad de Carabobo. Puerto Cabello. Methods: A descriptive, retrospective, longitud [...] inal and analytical diagnosis of 40 cases in 31 532 births eclampsia over a period of 10 years from 1998 to 2007. Results: The incidence was 0.13 %, 1 case per 788 births. The predominant age group of 10 - 19 years (52.5 %), concubines 60 %, primary education level (60 %). The prevailing family history of hypertension in the mother (25 %), personal history of preeclampsia in previous pregnancy (12.5 %). The main signs and symptoms were hyperreflexia (65 %), headache (50 %), scotoma and amaurosis (20 %). The first seizure came before delivery (75 %). Without birth control (55 %). First gravity (72.5 %), gestational age 37-41 weeks (50 %), type of delivery: cesarean section (85 %). Prevailed in perinatal outcomes: depressed neonates (52.5 %), birth weight between 2 500-3 499 g (50 %), with morbidity of 30.55 %, mostly due to respiratory distress syndrome. Fetal mortality was 9.09 % and 9.09 % neonatal mortality. Maternal morbidity was 53.84 %, associated: HELLP syndrome (23.07 %), acute renal failure (7.69 %), abruption (7.69 %) there was one maternal death (2.5 % ). Conclusion: It is important that all pregnant women receive ongoing and timely medical care, allowing early diagnosis and treatment of conditions such as pre-eclampsia and eclampsia, the latter is a major obstetric emergencies, this review reveals once again that contributes decisively to the morbidity and maternal and perinatal mortality. It involves an early and intensive support to reduce their impact.

  8. Measuring quality of diabetes care by linking health care system administrative databases with laboratory data

    Directory of Open Access Journals (Sweden)

    Klomp Helena

    2010-08-01

    Full Text Available Abstract Background Chronic complications of diabetes can be reduced through optimal glycemic and lipid control as evaluated through measurement of glycosylated hemoglobin (A1C and low-density lipoprotein cholesterol (LDL-C. We aimed to produce measures of quality of diabetes care in Saskatchewan and to identify sub-groups at particular risk of developing complications. Findings Prevalent adult cases of diabetes in 2005/06 were identified from administrative databases and linked with A1C and LDL-C tests measured in centralized laboratories. A1C results were performed in 33,927 of 50,713 (66.9% diabetes cases identified in Saskatchewan, and LDL-C results were performed in 12,031 of 24,207 (49.7% cases identified within the province's two largest health regions. The target A1C of Conclusions Linkage of laboratory with administrative data is an effective method of assessing quality of diabetes care on a population basis and to identify sub-groups requiring particular attention. We found that less than 50% of Saskatchewan people with diabetes achieved optimal glycemic and lipid control. Disparities were most evident among First Nations people and young women. The indicators described can be used to provide standardized information that would support quality improvement initiatives.

  9. Quality and Safety in Health Care, Part I: Five Pioneers in Quality.

    Science.gov (United States)

    Harolds, Jay

    2015-08-01

    Five pioneers had a huge impact on the quality movement in health care in the United States. Ernest Codman contributed in many ways, including his focus on outcome analysis. Avidis Donabedian is known for his focus on the 3 domains of structure, process, and outcome in health care. Walter Shewhart is known especially for the control chart and early work on what W. Edwards Deming made into the PDSA cycle. Deming is also known for other contributions, including his 14 points of management, correcting system problems rather than blaming the workers, and his System of Profound Knowledge. Juran is known for the Pareto principle and his emphasis on customer satisfaction and addressing the human, not just statistical side, of quality improvement. PMID:26147460

  10. Task shifting in the provision of home and social care in Ontario, Canada: implications for quality of care.

    Science.gov (United States)

    Denton, Margaret; Brookman, Catherine; Zeytinoglu, Isik; Plenderleith, Jennifer; Barken, Rachel

    2015-09-01

    Growing healthcare costs have caused home-care providers to look for more efficient use of healthcare resources. Task shifting is suggested as a strategy to reduce the costs of delivering home-care services. Task shifting refers to the delegation or transfer of tasks from regulated healthcare professionals to home-care workers (HCWs). The purpose of this paper is to explore the impacts of task shifting on the quality of care provided to older adults from the perspectives of home healthcare workers. This qualitative study was completed in collaboration with a large home and community care organisation in Ontario, Canada, in 2010-2011. Using a purposive sampling strategy, semi-structured telephone interviews were conducted with 46 home healthcare workers including HCWs, home-care worker supervisors, nurses and therapists. Study participants reported that the most common skills transferred or delegated to HCWs were transfers, simple wound care, exercises, catheterisation, colostomies, compression stockings, G-tube feeding and continence care. A thematic analysis of the data revealed mixed opinions on the impacts of task shifting on the quality of care. HCWs and their supervisors, more often than nurses and therapists, felt that task shifting improved the quality of care through the provision of more consistent care; the development of trust-based relationships with clients; and because task shifting reduced the number of care providers entering the client's home. Nurses followed by therapists, as well as some supervisors and HCWs, expressed concerns that task shifting might compromise the quality of care because HCWs lacked the knowledge, training and education necessary for more complex tasks, and that scheduling problems might leave clients with inconsistent care once tasks are delegated or transferred. Policy implications for regulating bodies, employers, unions and educators are discussed. PMID:25471361

  11. Developing a Total Quality Management Model for Health Care Systems

    Directory of Open Access Journals (Sweden)

    AM Mosadegh Rad

    2005-10-01

    Full Text Available Background: Total quality management (TQM is a managerial practice to improve the effectiveness, efficiency, flexibility, and competitiveness of a business as a whole. However, in practice, these TQM benefits are not easy to achieve. Despite its theoretical promise and the enthusiastic response to TQM, recent evidence suggests that attempts to implement it are often unsuccessful. Many of these TQM programmes have been cancelled, or are in the process of being cancelled, as a result of the negative impact on profits. Therefore, there is a pressing need for a clinical approach to establishing TQM. Method: The aim of this article is therefore: “To identify the strengths and weakness of TQM, the logical steps towards TQM, and to develop a model so that health care organizations aiming at using TQM to achieve excellence can follow through easily”. Based on the research questions proposed in this study, the research strategies of a literature review, a questionnaire survey, semi-structured interviews, and a participatory action research were adopted in this study. For determining the success and barriers of TQM in health care organizations, a questionnaire survey has done in 90 health acre organizations in Isfahan Province, which implement TQM. The results of this survey were used for introducing a new model of TQM. This model will be developed via a semi-structured interview with at minimum 10 health care and quality managers. Then, through a participatory action research, this model will be implemented in 3 sites. At this time, the questionnaire survey has done and the model is introduced. Therefore, developing the model and its implementation will be done later. Results: In this survey, the mean score of TQM success was 3.48±0.68 (medium from 5 credits. Implementation of TQM was very low, low, medium, high and very high successful respectively in 3.6, 10.9, 21.8, 56.4 and 7.3 percent of health care organizations. TQM had the most effect on process management and focus on employees and the less effect on focus on material resources, customers, and suppliers. The mean score of TQM implementation problems was 3.01±0.83 (medium on a 5 scale. TQM Barriers in health care organizations were strategic problems, performance appraisal problems, human resource problems, structural problems, process problems respectively. Based on these results a Model with 10 enablers and 3 results’ indicators is introduced. Enablers are factors that enable organization to reach excellent and results are the out comes of organization, which can be achieved through implementation of enablers. This model will be developed through semi structure interviews and implemented in 3 health care organizations for determining the efficacy and efficiency ( this two phases has not done. Discussion: Total quality management is a good strategy for improving the productivity of organizations. However, if some important principles are not considered in TQM models before its implementation, the overall strategy of a TQM initiative may fail.

  12. Hospital competition, resource allocation and quality of care

    Directory of Open Access Journals (Sweden)

    Zwanziger Jack

    2002-05-01

    Full Text Available Abstract Background A variety of approaches have been used to contain escalating hospital costs. One approach is intensifying price competition. The increase in price based competition, which changes the incentives hospitals face, coupled with the fact that consumers can more easily evaluate the quality of hotel services compared with the quality of clinical care, may lead hospitals to allocate more resources into hotel rather than clinical services. Methods To test this hypothesis we studied hospitals in California in 1982 and 1989, comparing resource allocations prior to and following selective contracting, a period during which the focus of competition changed from quality to price. We estimated the relationship between clinical outcomes, measured as risk-adjusted-mortality rates, and resources. Results In 1989, higher competition was associated with lower clinical expenditures levels compared with 1982. The trend was stronger for non-profit hospitals. Lower clinical resource use was associated with worse risk adjusted mortality outcomes. Conclusions This study raises concerns that cost reductions may be associated with increased mortality.

  13. Assessment of quality of care in acute postoperative pain management

    Directory of Open Access Journals (Sweden)

    Milutinovi? Dragana

    2009-01-01

    Full Text Available Background/Aim. Managing of acute postoperative pain should be of great interest for all hospital institutions, as one of the key components of patients satisfaction, which indicates quality, as well as the outcome of treatment. The aim of this study was to assess the quality of nursing care in managing acute postoperative pain and to establish factors which influence patients assessment of the same. Method. The investigation was conducted on the sample of 135 patients hospitalized in surgical clinics of the Clinical Centre of Vojvodina in Novi Sad in the form of cross-sectional study, by interviewing patients during the second postoperative day and collecting sociodemographic variables, type of surgical procedure and applied analgesic therapy which were taken from their medical documentation. The modified questionnaire of the Strategic and Clinical Quality Indicators in Postoperative Pain Management (SCQIPP was used as the instrument of the investigation. The data were processed with suitable mathematical statistics methods such as multivariate analyses of variance (MANOVA, discriminative and other parametric procedures and methods. Roy's test, Pearson's coefficient contingency (?, multiple correlation coefficient (R were conducted amongst other invariant procedures. Results. The mean score for the individual items of SCQIPP questionnaire was between 2.0 and 4.7 (scale range 1-5 and the percentage of patients answers 'strongly agree' ranged from 4.4 to 77%. The smallest number of positive answers were given by the patients for the item 'In order to assess pain intensity, some of the staff asked me at least once in the morning, in the afternoon and in the evening to show the number from 0-10'. Most of the patients (57% evaluated severe pain during the previous 24 hours, as moderate pain, which represents significantly greater number of patients which complain of severe pain and mild pain (p < 0.001. The analysis of patients evaluation (MANOVA p < 0.05 and discriminative p < 0.05 indicates the existence of significant difference between the assessment of nursing care quality in managing acute postoperative pain as regards to clinics as the place for pain management, patient's sex and his expectations. Evaluation from 'communication' subscale gives the greatest contribution (24.9% to the difference between the observed clinics, and the greatest contribution (25.7% to the difference in evaluation of nursing care quality as regards to patients' sex has the evaluations from 'procedure' subscale. Conclusion. The results of this study show a useful evidence and identify aspects of nursing care in postoperative management of acute pain which are still to be improved. According to the patients' answers the priority should be given to a regular assessment of the intensity of postoperative pain and evaluation of the effects of analgesic therapy.

  14. cura, care, C A R E, Care: Dimensions and Qualities of Care (re)forming an Ecology of Care

    DEFF Research Database (Denmark)

    Coxon, Ian Robert

    2015-01-01

    This working paper, as we will call it, presents two (pro)positions that should be seen as works in progress. Their job is to enable the beginnings of a conversation directed at advancing another work in progress, the Ecology of Care project. The essential goal of this paper and the symposium that it serves to inform is to begin a process of concretizing the otherwise lost but vitally important concept we call Care. In writing this paper we will attempt to adopt a 'position' through an extensive...

  15. End-user perspectives on e-commerce and health care web site quality.

    Science.gov (United States)

    Le Rouge, Cynthia; De Leo, Gianluca

    2008-01-01

    We explore and compare the importance of various quality dimensions for health care and e-commerce web sites. The results show that the importance of various quality attributes for all except four of ten quality dimensions studied differ between health care and e-commerce web sites. These results can help health care managers to improve and/or to guide the design of their web sites. PMID:18998907

  16. Hospital implementation of health information technology and quality of care: are they related?

    OpenAIRE

    Restuccia Joseph D; Cohen Alan B; Horwitt Jedediah N; Shwartz Michael

    2012-01-01

    Abstract Background Recently, there has been considerable effort to promote the use of health information technology (HIT) in order to improve health care quality. However, relatively little is known about the extent to which HIT implementation is associated with hospital patient care quality. We undertook this study to determine the association of various HITs with: hospital quality improvement (QI) practices and strategies; adherence to process of care measures; risk-adjusted inpatient mort...

  17. Nurse Burnout and Quality of Care: Cross-National Investigation in Six Countries

    OpenAIRE

    Poghosyan, Lusine; Clarke, Sean P.; Finlayson, Mary; Aiken, Linda H

    2010-01-01

    We explored the relationship between nurse burnout and ratings of quality of care in 53,846 nurses from six countries. In this secondary analysis, we used data from the International Hospital Outcomes Study; data were collected from1998 to 2005. The Maslach Burnout Inventory and a single-item reflecting nurse-rated quality of care were used inmultiple logistic regression modeling to investigate the association between nurse burnout and nurse-rated quality of care. Across countries, higher lev...

  18. Perinatal and pediatric issues in palliative and end-of-life care from the 2011 Summit on the Science of Compassion.

    Science.gov (United States)

    Youngblut, Jonne M; Brooten, Dorothy

    2012-01-01

    More than 25,000 infants and children die in US hospitals annually; 86% occur in the NICU or PICU. Parents see the child's pain and suffering and, near the point of death, must decide whether to resuscitate, limit medical treatment, and/or withdraw life support. Immediately after the death, parents must decide whether to see and/or hold the infant/child, donate organs, agree to an autopsy, make funeral arrangements, and somehow maintain functioning. Few children and their families receive pediatric palliative care services, especially those from minority groups. Barriers to these programs include lack of services, difficulty identifying the dying point, discomfort in withholding or withdrawing treatments, communication problems, conflicts in care among providers and between parents and providers, and differences in cultural beliefs about end-of-life care. The 2011 NIH Summit on the Science of Compassion provided recommendations in family involvement, end-of-life care, communication, health care delivery, and transdisciplinary participation. PMID:23036690

  19. Concepts of quality and the provision of periodontal care: a survey.

    Science.gov (United States)

    Marcus, M; Spolsky, V

    1998-02-01

    This is a survey of various concepts of quality of care in the health care field and their application to periodontics. Definitions of quality care, measuring and improving quality, third party payment and quality of care, and the role of periodontists in managing quality are presented. The definitions of quality care include the following dimensions: access, appropriateness, technical quality, and the art of care. Examples of each of these dimensions are presented, and their implications for quality assessment are discussed. Emphasis is placed on appropriateness of care and the strengths and weaknesses of mechanisms for deriving evidence-based decision making. The use of randomized clinical trials (RCT), employing expert opinion such as consensus panels, and meta-analysis are discussed as they apply to appropriateness of periodontal treatment. Work in the area of technical quality of care (i.e., the third dimension of quality care) has resulted in the development of quality assurance guidelines. Examples of guidelines and practice parameters such as those developed by the U.S. Food and Drug Administration and by various dental specialties are presented. The fourth dimension of quality deals with the art of care. It focuses on the patient's participation in the process of care and the input of the provider in this interaction. The description of outcomes of care includes the concept of measuring clinical outcomes of treatment as well as efforts to measure the health and well-being of a patient. It deals with quality of life measures. Patient satisfaction is another outcome that is presented. Examples of these aspects of quality measurement are discussed. These concepts and measures are presented within the context of a quality assurance program. The steps used to assess and assure quality are outlined. Examples of provider and patient profiles are presented, along with a discussion on how they are used in a quality assurance system. Lastly, the role of the periodontist in quality of care is presented, emphasizing the efforts that have already been made as well as the leadership role that the periodontist has in influencing the profession of dentistry. The advent of managed care and its implications for the quality of periodontal treatment and patient management are discussed using situations obtained from dental plans. PMID:9526923

  20. Barriers to quality patient care in rural district hospitals

    Scientific Electronic Library Online (English)

    Johanna E., Eygelaar; Ethelwynn L., Stellenberg.

    2012-01-01

    Full Text Available Currently barriers exist in delivering quality health care. This study aimed to investigate such barriers in the eight rural district hospitals of the West Coast Winelands Region, three type A and five type B hospitals. A quantitative descriptive design was applied which included the total populatio [...] n of nursing staff (n = 340) working at the time of data collection. A self-administered questionnaire was distributed with a response rate of 82%. Reliability of the instrument was verified using the Cronbach alpha coefficient and a pilot study. The validity, specifically construct and content validity, were assured by means of an extensive literature review, pilot study and use of experts. Ethics approval was obtained from the relevant stakeholders. Results showed that 272 participants (97%) disagreed that provision of staff was adequate, with staff above 40 years of age more likely to disagree (p =

  1. Quality of long-term care in nursing homes and swing-bed hospitals.

    OpenAIRE

    Shaughnessy, P W; Schlenker, R E; Kramer, A M

    1990-01-01

    By 1989, more than 1,100 hospitals in rural communities throughout the United States were using hospital beds as swing beds to provide both long-term and acute care. In this study, the quality of long-term care in swing-bed hospitals was compared with the quality of nursing home care, using patient outcomes along with both process and structural measures of quality. Several methodological and conceptual points on measuring and analyzing the quality of long-term care are discussed in this arti...

  2. Quality and quantity of infertility care in Bangladesh.

    Science.gov (United States)

    Fatima, P; Ishrat, S; Rahman, D; Banu, J; Deeba, F; Begum, N; Anwary, S A; Hossain, H B

    2015-01-01

    Infertility is an important health issue which has been neglected in the developing countries. First test-tube babies (triplet) in Bangladesh were born on 30th May, 2001. Although there is no tertiary level infertility center in the public sector, several private centers have come up with the facilities. The objective of the study was to find i) the quality and quantity of infertility care in Bangladesh and ii) the cause of infertility in the attending patients iii) the treatment seeking behaviors iv) and the reasons for not taking treatment among the attending patients. There are now 10 tertiary level Infertility centers in Bangladesh. The information was collected in a preformed datasheet about the facilities and the profile of the patients and the treatment seeking behavior of the attending patients. Out of the ten centers two centers refused to respond and did not disclose their data. Around 16700 new patients are enrolled in a year in the responsive clinics. Five percent (5%) of the patients underwent ART, 7% of the patients gave only one visit, 84% of the patients completed their evaluation, 76% of the patients took treatment. Causes of infertility in the patients taking treatment were male factor in 36.4%, bilateral tubal block in 20.2%, PCOS and anovulation in 31.7%, endometriosis in 19.6%, unexplained in 10.95, combined in 3.5%, ovarian failure in 1.4%, testicular failure in 0.33%, congenital anomaly in 0.3%. The main reason for not taking treatment was financial constrainment. The quality and quantity of infertility care is dependent on the available resources and on the use of the resources by the patients. In developing countries the resources are merging and confined to specified areas which cannot meet the demand of their population. The study gives us the idea of the need and the demand of the services in the country. PMID:25725670

  3. Quality of care in the management of major obstetric haemorrhage.

    LENUS (Irish Health Repository)

    Johnson, S N

    2012-02-01

    Substandard care is reported to occur in a large number of cases of major obstetric haemorrhage (MOH). A prospective audit was carried out by a multidisciplinary team at our hospital over a one year period to assess the quality of care (QOC) delivered to women experiencing MOH. MOH was defined according to criteria outlined in the Scottish Audit of Maternal Morbidity (SAMM). 31 cases were identified yielding an incidence of 3.5\\/1000 deliveries. The predominant causes were uterine atony 11 (35.4%), retained products of conception 6 (19.3%) and placenta praevia\\/accreta 6 (19.3%). Excellent initial resuscitation and monitoring was noted with a high level of senior staff input. Indicators of QOC compared favourably with the SAMM. Areas for improvement were identified. This pilot study demonstrates the feasibility of detailed prospective data collection in MOH in a busy Dublin obstetric unit with a view to developing a national audit. Standardization of definitions allows for international comparisons.

  4. Using a Computer to Conduct Utilization and Quality of Care Review in a Prepaid Medical Care Network

    OpenAIRE

    Jones, Linda F.; Coleman, John R.

    1982-01-01

    This paper describes how a computerized MIS is used to assist HMO management to conduct utilization and quality of care review activities in a prepaid medical care network. The HMO is a ‘network’ HMO consisting of 5 medical groups, 4 hospitals and a number of other community health organizations. The network currently provides prepaid medical care for approximately 5,000 members. The MIS generates a number of special reports that are used by HMO administration, the HMO medical director and th...

  5. Quebec's Child Care Services: What Are the Mechanisms Influencing Children's Behaviors across Quantity, Type, and Quality of Care Experienced?

    Science.gov (United States)

    Lemay, Lise; Bigras, Nathalie; Bouchard, Caroline

    2015-01-01

    The objective of this study was to examine how quantity, type, and quality of care interact in predicting externalizing and internalizing behaviors of 36-month-old children attending Quebec's educational child care from their first years of life. To do so, the authors examined two hypothesized models: (1) a mediation model where quantity, type,…

  6. 77 FR 70786 - Request for Information Regarding Health Care Quality for Exchanges

    Science.gov (United States)

    2012-11-27

    ...meaningful for Exchange consumers and...transparency efforts that states and private entities use to display health care quality information? 12. What types...quality data in an Exchange? What suggested...strategies that states are...

  7. Complexity of drug therapy and its implications for quality of diabetes care

    OpenAIRE

    Zhang, James X

    2011-01-01

    Diabetes is a leading cause of mortality, morbidity and disability around the globe. In the past two decades, diabetes care has grown more complex as patients have received multi-component care. Recent studies have illumined the complexity of drug therapy in patients with diabetes. A high level of drug utilization in diabetes patients has serious implications for quality of care, in terms of coordination of care, drug safety and access to care. Practitioners, researchers, payers and policy ma...

  8. Cost, Utilization, and Quality of Care: An Evaluation of Illinois’ Medicaid Primary Care Case Management Program

    Science.gov (United States)

    Phillips, Robert L.; Han, Meiying; Petterson, Stephen M.; Makaroff, Laura A.; Liaw, Winston R.

    2014-01-01

    PURPOSE In 2006, Illinois established Illinois Health Connect (IHC), a primary care case management program for Medicaid that offered enhanced fee-for-service, capitation payments, performance incentives, and practice support. Illinois also implemented a complementary disease management program, Your Healthcare Plus (YHP). This external evaluation explored outcomes associated with these programs. METHODS We analyzed Medicaid claims and enrollment data from 2004 to 2010, covering both pre- and post-implementation. The base year was 2006, and 2006–2010 eligibility criteria were applied to 2004–2005 data to allow comparison. We studied costs and utilization trends, overall and by service and setting. We studied quality by incorporating Healthcare Effectiveness Data and Information Set (HEDIS) measures and IHC performance payment criteria. RESULTS Illinois Medicaid expanded considerably between 2006 (2,095,699 full-year equivalents) and 2010 (2,692,123). Annual savings were 6.5% for IHC and 8.6% for YHP by the fourth year, with cumulative Medicaid savings of $1.46 billion. Per-beneficiary annual costs fell in Illinois over this period compared to those in states with similar Medicaid programs. Quality improved for nearly all metrics under IHC, and most prevention measures more than doubled in frequency. Medicaid inpatient costs fell by 30.3%, and outpatient costs rose by 24.9% to 45.7% across programs. Avoidable hospitalizations fell by 16.8% for YHP, and bed-days fell by 15.6% for IHC. Emergency department visits declined by 5% by 2010. CONCLUSIONS The Illinois Medicaid IHC and YHP programs were associated with substantial savings, reductions in inpatient and emergency care, and improvements in quality measures. This experience is not typical of other states implementing some, but not all, of these same policies. Although specific features of the Illinois reforms may have accounted for its better outcomes, the limited evaluation design calls for caution in making causal inferences. PMID:25354404

  9. Thalassaemia in children: from quality of care to quality of life.

    Science.gov (United States)

    Amid, Ali; Saliba, Antoine N; Taher, Ali T; Klaassen, Robert J

    2015-11-01

    Over the past few decades, there has been a remarkable improvement in the survival of patients with thalassaemia in developed countries. Availability of safe blood transfusions, effective and accessible iron chelating medications, the introduction of new and non-invasive methods of tissue iron assessment and other advances in multidisciplinary care of thalassaemia patients have all contributed to better outcomes. This, however, may not be true for patients who are born in countries where the resources are limited. Unfortunately, transfusion-transmitted infections are still major concerns in these countries where paradoxically thalassaemia is most common. Moreover, oral iron chelators and MRI for monitoring of iron status may not be widely accessible or affordable, which may result in poor compliance and suboptimal iron chelation. All of these limitations will lead to reduced survival and increased thalassaemia-related complications and subsequently will affect the patient's quality of life. In countries with limited resources, together with improvement of clinical care, strategies to control the disease burden, such as public education, screening programmes and appropriate counselling, should be put in place. Much can be done to improve the situation by developing partnerships between developed countries and those with limited resources. Future research should also particularly focus on patient's quality of life as an important outcome of care. PMID:26289062

  10. PLACENTAL SIZE AND PERINATAL OUTCOMES

    Directory of Open Access Journals (Sweden)

    Nagamani

    2015-03-01

    Full Text Available BACKGROUND : The human placenta, a transient organ or pregnancy provides information about fetal well - being and pregnancy outcome . AIMS: To study the placental ultrasound characters in relation to perinatal outcomes . SETTINGS: Tertiary care hospital in southern India . METHODS AND MATERIAL S: The study sample comprised 500 consecutive women who presented to the Depart ment of Obstetrics and Gynecology at the King George Hospital who met the inclusion criteria. Ultrasonographic study was performed using a transabdominal 3.5 MHz volume transducer. Post natally the weight of the baby and of the placenta was recorded. Perina tal outcome was assessed by birth weight, APGAR score and the need for admission in neonatal intensive care unit. STATISTICAL ANALYSIS : Pearson’s correlation analysis and Chi square test was used. Statistical significance was considered at a p value <0.05 . RESULTS: The mean placental thickness was 3.10 cm; 76% (n:380 had normal thickness. Mean placental diameter was 21.306 cm, and its weight varied from 310 women 62% (n:310. Correlation of placental thickness (normal and abnormal, with birth weight, the difference was significant ( <0.001. CONCLUSION: Ultrasound forms a readily available, fairly safe, effective non - invasive method to identify and prevent fetal malnutrition in a cost - effective way.

  11. Developing a Patient Care Co-ordination Centre in Trafford, England: lessons from the International Foundation for Integrated Care (IFIC/Advancing Quality Alliance integrated care fellowship experience

    Directory of Open Access Journals (Sweden)

    Michael Gregory

    2015-05-01

    Full Text Available The NHS and Social Care in England are facing one of the biggest financial challenges for a generation. Commissioners and providers need to work on collaborative schemes to manage the increasing demand on health and social care within a period of financial constraint. Different forms of care co-ordination have been developed at different levels across the world.In the north-west of England, the Trafford health and social care economy have been working through a competitive dialogue process with industry to develop an innovative and dynamic solution to deliver seamless co-ordination for all patients and service users. The strategy is to develop a new Patient Care Co-ordination Centre, which will be responsible for the delivery of co-ordinated, quality care. The Patient Care Co-ordination Centre will work at clinical, service, functional and community levels across multiple providers covering risk stratification, preventative, elective and unscheduled care.I am the clinical lead for the Patient Care Co-ordination Centre and during my year as an Advancing Quality Alliance Integrated Care Fellow, I have had the opportunity to study examples of care coordination from UK and international sites. The learning from these visits has been assimilated into the design process of the Patient Care Co-ordination Centre.

  12. Developing a Patient Care Co-ordination Centre in Trafford, England: lessons from the International Foundation for Integrated Care (IFIC)/Advancing Quality Alliance integrated care fellowship experience.

    Science.gov (United States)

    Gregory, Michael

    2015-01-01

    The NHS and Social Care in England are facing one of the biggest financial challenges for a generation. Commissioners and providers need to work on collaborative schemes to manage the increasing demand on health and social care within a period of financial constraint. Different forms of care co-ordination have been developed at different levels across the world. In the north-west of England, the Trafford health and social care economy have been working through a competitive dialogue process with industry to develop an innovative and dynamic solution to deliver seamless co-ordination for all patients and service users. The strategy is to develop a new Patient Care Co-ordination Centre, which will be responsible for the delivery of co-ordinated, quality care. The Patient Care Co-ordination Centre will work at clinical, service, functional and community levels across multiple providers covering risk stratification, preventative, elective and unscheduled care. I am the clinical lead for the Patient Care Co-ordination Centre and during my year as an Advancing Quality Alliance Integrated Care Fellow, I have had the opportunity to study examples of care coordination from UK and international sites. The learning from these visits has been assimilated into the design process of the Patient Care Co-ordination Centre. PMID:26034468

  13. Quality assurance of radiotherapy in cancer treatment. Toward improvement of patient safety and quality of care

    International Nuclear Information System (INIS)

    The process of radiotherapy (RT) is complex and involves understanding of the principles of medical physics, radiobiology, radiation safety, dosimetry, radiation treatment planning, simulation and interaction of radiation with other treatment modalities. Each step in the integrated process of RT needs quality control and quality assurance (QA) to prevent errors and to give high confidence that patients will receive the prescribed treatment correctly. Recent advances in RT, including intensity-modulated and image-guided RT, focus on the need for a systematic RTQA program that balances patient safety and quality with available resources. It is necessary to develop more formal error mitigation and process analysis methods, such as failure mode and effect analysis, to focus available QA resources optimally on process components. External audit programs are also effective. The International Atomic Energy Agency has operated both an on-site and off-site postal dosimetry audit to improve practice and to assure the dose from RT equipment. Several countries have adopted a similar approach for national clinical auditing. In addition, clinical trial QA has a significant role in enhancing the quality of care. The Advanced Technology Consortium has pioneered the development of an infrastructure and QA method for advanced technology clinical trials, including credentialing and individual case review. These activities have an impact not only on the treatment received by patients enrolled in clinical trials, but also on the quality of treatment administered to all patients treated in each institution, and have been adopted globally; by the USA, Europe and Japan also. (author)

  14. Human resources and the quality of emergency obstetric care in developing countries: a systematic review of the literature

    OpenAIRE

    Fournier Pierre; Dogba Maman

    2009-01-01

    Abstract Background This paper reports on a systematic literature review exploring the importance of human resources in the quality of emergency obstetric care and thus in the reduction of maternal deaths. Methods A systematic search of two electronic databases (ISI Web of Science and MEDLINE) was conducted, based on the following key words "quality obstetric* care" OR "pregnancy complications OR emergency obstetric* care OR maternal mortality" AND "quality health care OR quality care" AND "d...

  15. Ethics in perinatal medicine: A global perspective.

    Science.gov (United States)

    Chervenak, Frank A; McCullough, Laurence B

    2015-10-01

    This article describes the professional responsibility model of perinatal ethics, which requires the perinatologist in all cases to identify and balance beneficence-based and autonomy-based obligations to the pregnant patient, beneficence-based obligations to the fetal patient, and beneficence-based obligations to the neonatal patient. We explain how this model avoids the clinical failure of both fetal and maternal rights-based reductionism, i.e., insistence either on unlimited fetal rights or on unlimited maternal rights, respectively. The professional responsibility model of perinatal ethics provides the basis for the transnational clinical ethical concept of healthcare justice, which requires that beneficence-based obligations to all patients be routinely fulfilled by providing them with an evidence-based standard of care. We then show how healthcare justice can be used to identify and address ethically unacceptable allocation of healthcare resources. The professional responsibility model of perinatal ethics creates an important role for the perinatologist as responsible advocate for pregnant, fetal, and neonatal patients. PMID:26049210

  16. Age and gender as predictors of allied health quality stroke care

    Directory of Open Access Journals (Sweden)

    Luker JA

    2011-07-01

    Full Text Available Julie A Luker1, Julie Bernhardt2, Karen A Grimmer-Somers11International Centre for Allied Health Evidence, University of South Australia Adelaide, South Australia, Australia; 2School of Physiotherapy, La Trobe University Melbourne, Victoria, Australia and Stroke Division, Florey Neurosciences Institutes Heidelberg Heights, Melbourne, Victoria, AustraliaBackground: Improvement in acute stroke care requires the identification of variables which may influence care quality. The nature and impact of demographic and stroke-related variables on care quality provided by allied health (AH professionals is unknown.Aims: Our research explores the association of age and gender on an index of acute stroke care quality provided by AH professionals.Methods: A retrospective clinical audit of 300 acute stroke patients extracted data on AH care, patients' age and gender. AH care quality was determined by the summed compliance with 20 predetermined process indicators. Our analysis explored relationships between this index of quality, age, and gender. Age was considered in different ways (as a continuous variable, and in different categories. It was correlated with care quality, using gender-specific linear and logistic regression models. Gender was then considered as a confounder in an overall model.Results: No significant association was found for any treatment of age and the index of AH care quality. There were no differences in gender-specific models, and gender did not significantly adjust the age association with care quality.Conclusion: Age and gender were not predictors of the quality of care provided to acute stroke patients by AH professionals.Keywords: acute stroke, allied health, quality of care, age, gender

  17. La calidad del cuidado infantil: Un resumen para padres (Child Care Quality: An Overview for Parents). ERIC Digest.

    Science.gov (United States)

    Patten, Peggy; Ricks, Omar Benton

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

  18. Parental Child Care Selection Criteria and Program Quality in Metropolitan and Nonmetropolitan Communities.

    Science.gov (United States)

    Ispa, Jean M.; Thornburg, Kathy R.; Venter-Barkley, Janet

    1998-01-01

    A study of 127 families and 50 child care facilities in 17 Missouri communities found that criteria for selecting child care were similar for metropolitan and nonmetropolitan parents; parents were more concerned with quality child care and caregiver "warmth" than with practical considerations; but ratings on caregiver warmth did not predict…

  19. Caring for Animals. Animal Well-Being, Quality Assurance, Show Ring Ethics. Discussion Guide.

    Science.gov (United States)

    Kleilein, Ann McGovern; Nickles, Sherry; Smith, David R.

    This discussion guide was developed for use in conjunction with the "Caring for Animals" videotape. It includes information for teachers to use in facilitating class discussions about animal care and well-being. The guide covers the following: (1) goals and objectives; (2) animal well-being; (3) animal health; (4) care for animals; (5) quality

  20. Resident Behaviors and Characteristics as Determinants of Quality of Residential Care: An Observational Study.

    Science.gov (United States)

    Seys, Daniel; Duker, Pieter; Salemink, Wineke; Franken-Wijnhoven, Jolanda

    1998-01-01

    The effects of resident behavior and resident characteristics on the quantity and quality of care 452 residents with severe mental retardation received from 416 direct-care staff was examined. Results found certain resident characteristics, and behavior did influence specific aspects of the care they received, especially ambulance, communication,…

  1. Child Care Quality and Children's Cortisol in Basque Country and the Netherlands

    Science.gov (United States)

    Vermeer, Harriet J.; Groeneveld, Marleen G.; Larrea, Inaki; van IJzendoorn, Marinus H.; Barandiaran, Alexander; Linting, Marielle

    2010-01-01

    A cross-country comparison of children's cortisol levels at child care was performed in relation to their cortisol levels at home and the quality and quantity of child care they received. Participants were toddlers visiting child care centers in Spanish Basque Country (N = 60) and the Netherlands (N = 25) with substantial variation in structural…

  2. Determinants of Quality of Life in Primary Care Patients with Diabetes: Implications for Social Workers

    Science.gov (United States)

    Ayalon, Liat; Gross, Revital; Tabenkin, Hava; Porath, Avi; Heymann, Anthony; Porter, Boaz

    2008-01-01

    Using a cross-sectional design of 400 primary care patients with diabetes, the authors evaluated demographics, health status, subjective health and mental health, health behaviors, health beliefs, knowledge of diabetes treatment, satisfaction with medical care, and quality of medical care as potential predictors of QoL and QoL in the hypothetical…

  3. Stigma, AIDS and quality of nursing care: state of the science.

    Science.gov (United States)

    Siminoff, L A; Erlen, J A; Lidz, C W

    1991-03-01

    Reports of fear and psychological distress on the part of nurses when caring for AIDS patients have drawn attention to the real possibility that care for this very sick group of patients may be less than adequate. This paper reviews what is currently known about the attitudes of nurses and the care provided to HIV-infected individuals. The authors reveal the paucity of empirical data concerning quality of care and how the concept of stigma might serve to aid our understanding. The need for more research documenting the quality of care provided to HIV-infected patients is discussed. PMID:2037730

  4. Quality of stroke care at an Irish Regional General Hospital and Stroke Rehabilitation Unit.

    LENUS (Irish Health Repository)

    Walsh, T

    2012-01-31

    BACKGROUND: Robust international data support the effectiveness of stroke unit (SU) care. Despite this, most stroke care in Ireland are provided outside of this setting. Limited data currently exist on the quality of care provided. AIM: The aim of this study is to examine the quality of care for patients with stroke in two care settings-Regional General Hospital (RGH) and Stroke Rehabilitation Unit (SRU). METHODS: A retrospective analysis of the stroke records of consecutive patients admitted to the SRU between May-November 2002 and April-November 2004 was performed applying the UK National Sentinel Audit of Stroke (NSAS) tool. RESULTS: The results of the study reveal that while SRU processes of care was 74% compliant with standards; compliance with stroke service organisational standards was only 15 and 43% in the RGH and SRU, respectively. CONCLUSION: The quality of stroke care in our area is deficient. Comprehensive reorganisation of stroke services is imperative.

  5. Corioamnionitis: Repercusión perinatal

    Directory of Open Access Journals (Sweden)

    Pedro Faneite

    2010-12-01

    Full Text Available Objetivo: Determinar en las gestantes complicadas con corioamnionitis las características, factores maternos y las repercusiones maternas y perinatales. Métodos: Estudio descriptivo, retrospectivo, epidemiológico y analítico. Ambiente: Departamento de Obstetricia y Ginecología, Hospital "Dr. Adolfo Prince Lara", Universidad de Carabobo, Puerto Cabello, Estado Carabobo. Resultados: En las 44 pacientes las características maternas que predominaron fueron: residentes en barrios (45,45 %, solteras y concubinas (77,27 %, edad materna 20-24 años (40,91 % y antecedente personal hipertensión (20,45 %. El diagnóstico de ingreso destacó la rotura prematura de membranas 50 % e infección uro-vaginal 13,6 %; eran multigestas 50,0 %, y en 52,28 % la edad del embarazo fue de 36 semanas y menos, en 84,08 % hubo conducción-inducción del trabajo de parto, terminaron en cesárea 45,45 %. Factores de riesgo: múltiples tactos (4 y más 40,9 % y tiempo entre rotura de membranas e inicio de trabajo de parto mayor de 12 horas 18,44 %. El diagnóstico se hizo por la clínica y laboratorio; tratadas con antibióticos en su totalidad, acompañadas por oxitócicos 68,18 %. Recién nacidos de sexo femeninos 48,84 %, peso entre 3 000- 3 499 g 31,31 % y tallas 45-49 cm 28,89 %; índice Apgar 6 o menos 28,94 %. La morbilidad perinatal neonatal fue 39,47 %, especialmente por sepsis y patología respiratoria; la morbilidad materna 56,81 %, por sepsis y anemia; la perinatal global 28,88 %, la fetal 15,55 % y la neonatal 13,13 %. Conclusión: La corioamninitis se relacionó con múltiples tactos intraparto, el tiempo de rotura prematura de membranas al inicio del parto y las infecciones uro-vaginales; sus repercusiones revelaron elevadas cifras de morbimortalidad perinatal por sepsis y deficiencias respiratorias, también alta morbilidad materna. Todo señala a implementar programas preventivos y mejorar la atención materno-neonatal.

  6. Enfermedad hemolítica perinatal / Perinatal hemolytic disease

    Scientific Electronic Library Online (English)

    María del Rosario, López de Roux; Lázaro, Cortina Rosales.

    2000-12-01

    Full Text Available La enfermedad hemolítica perinatal (EHPN) es una afección inmunológica aloinmune contra antígenos de origen paterno presentes en los hematíes fetales y del recién nacido. Se han reportado numerosos aloanticuerpos dirigidos contra antígenos eritrocitarios como causa de la EHPN, más frecuentemente los [...] del sistema ABO y Rh. La EHPN por el sistema Rh (EHPN-Rh) suele ser severa, en particular por el antígeno D. Es muy común encontrar el anti-D asociado con otros anticuerpos Rh (C, E, de título menor). El anticuerpo anti-c por sí solo puede producir EHPN severa. Los avances en la prevención de la inmunización por el antígeno D han disminuido la incidencia de esta enfermedad. La EHPN por ABO (EHPN-ABO) ha sido siempre más frecuente, pero su relación con muerte fetal o neonatal es menor que la de la EHPN-Rh. En este tipo de EHPN los anticuerpos están preformados. Las subclases de IgG, predominantes en esta enfermedad son las IgG1 y las IgG3. A la luz de los conocimientos actuales, el diagnóstico de esta enfermedad puede efectuarse precozmente, es posible incluso hacerlo antes del nacimiento e indicar la transfusión fetal intrauterina como método de salvamento de los fetos con hematócritos (Hto) menores o iguales al 30 %. En los recién nacidos se emplean la fototerapia y la exanguinotransfusión para disminuir los niveles séricos de bilirrubina producida por la hemólisis y evitar el kerníctero. Siempre que se sospeche la enfermedad deberá actuarse con rapidez y precisar los anticuerpos involucrados, para de esta forma disminuir su incidencia y morbimortalidad Abstract in english The perinatal hemolytic disease (PHD) is an alloimmune immunological affection against those antigens of paternal origin that are present in the erythrocytes of the fetus and the newborn infant. Several alloantibodies directed against erythrocytic antigens have been reported as the cause of PHD. The [...] most frequently reported are those of the ABO and Rh systems. The PHD caused by the Rh system is usually severe, particularly that produced by the antigen D. It is very common to find the anti-D associated with other Rh antibodies (C,E, of lower titer).The anti-c antibody may produce severe PHD by itself. The advances in the prevention of immunization by D antigen have reduced the incidende of this disease. The PHD caused by ABO has always been more frequent, but its relationship with fetal or neonatal death is lower than that of PHD-Rh. In this type of PHD the antibodies are preformed. The IgG subclasses predominating in this disease are IgG1 and IgG3. In the light of the present knowledge, the diagnosis of this disease may be made early. It is possible to make it even before birth and to indicate the intrauterine fetal transfusion as a method for saving the fetuses with hematocrites lower or equal to 30%. The phototherapy and the exchange transfusion are used among the newborn infants to reduce the serum levels of bilirubin produced by hemolysis and to prevent kernicterus. As long as the disease is suspected it is necessary to act quickly and to determine the involved antibodies in order to reduce its incidence and morbimortality

  7. Enfermedad hemolítica perinatal Perinatal hemolytic disease

    Directory of Open Access Journals (Sweden)

    María del Rosario López de Roux

    2000-12-01

    Full Text Available La enfermedad hemolítica perinatal (EHPN es una afección inmunológica aloinmune contra antígenos de origen paterno presentes en los hematíes fetales y del recién nacido. Se han reportado numerosos aloanticuerpos dirigidos contra antígenos eritrocitarios como causa de la EHPN, más frecuentemente los del sistema ABO y Rh. La EHPN por el sistema Rh (EHPN-Rh suele ser severa, en particular por el antígeno D. Es muy común encontrar el anti-D asociado con otros anticuerpos Rh (C, E, de título menor. El anticuerpo anti-c por sí solo puede producir EHPN severa. Los avances en la prevención de la inmunización por el antígeno D han disminuido la incidencia de esta enfermedad. La EHPN por ABO (EHPN-ABO ha sido siempre más frecuente, pero su relación con muerte fetal o neonatal es menor que la de la EHPN-Rh. En este tipo de EHPN los anticuerpos están preformados. Las subclases de IgG, predominantes en esta enfermedad son las IgG1 y las IgG3. A la luz de los conocimientos actuales, el diagnóstico de esta enfermedad puede efectuarse precozmente, es posible incluso hacerlo antes del nacimiento e indicar la transfusión fetal intrauterina como método de salvamento de los fetos con hematócritos (Hto menores o iguales al 30 %. En los recién nacidos se emplean la fototerapia y la exanguinotransfusión para disminuir los niveles séricos de bilirrubina producida por la hemólisis y evitar el kerníctero. Siempre que se sospeche la enfermedad deberá actuarse con rapidez y precisar los anticuerpos involucrados, para de esta forma disminuir su incidencia y morbimortalidadThe perinatal hemolytic disease (PHD is an alloimmune immunological affection against those antigens of paternal origin that are present in the erythrocytes of the fetus and the newborn infant. Several alloantibodies directed against erythrocytic antigens have been reported as the cause of PHD. The most frequently reported are those of the ABO and Rh systems. The PHD caused by the Rh system is usually severe, particularly that produced by the antigen D. It is very common to find the anti-D associated with other Rh antibodies (C,E, of lower titer.The anti-c antibody may produce severe PHD by itself. The advances in the prevention of immunization by D antigen have reduced the incidende of this disease. The PHD caused by ABO has always been more frequent, but its relationship with fetal or neonatal death is lower than that of PHD-Rh. In this type of PHD the antibodies are preformed. The IgG subclasses predominating in this disease are IgG1 and IgG3. In the light of the present knowledge, the diagnosis of this disease may be made early. It is possible to make it even before birth and to indicate the intrauterine fetal transfusion as a method for saving the fetuses with hematocrites lower or equal to 30%. The phototherapy and the exchange transfusion are used among the newborn infants to reduce the serum levels of bilirubin produced by hemolysis and to prevent kernicterus. As long as the disease is suspected it is necessary to act quickly and to determine the involved antibodies in order to reduce its incidence and morbimortality

  8. Midwifery and quality care: findings from a new evidence-informed framework for maternal and newborn care.

    Science.gov (United States)

    Renfrew, Mary J; McFadden, Alison; Bastos, Maria Helena; Campbell, James; Channon, Andrew Amos; Cheung, Ngai Fen; Silva, Deborah Rachel Audebert Delage; Downe, Soo; Kennedy, Holly Powell; Malata, Address; McCormick, Felicia; Wick, Laura; Declercq, Eugene

    2014-09-20

    In this first paper in a series of four papers on midwifery, we aimed to examine, comprehensively and systematically, the contribution midwifery can make to the quality of care of women and infants globally, and the role of midwives and others in providing midwifery care. Drawing on international definitions and current practice, we mapped the scope of midwifery. We then developed a framework for quality maternal and newborn care using a mixed-methods approach including synthesis of findings from systematic reviews of women's views and experiences, effective practices, and maternal and newborn care providers. The framework differentiates between what care is provided and how and by whom it is provided, and describes the care and services that childbearing women and newborn infants need in all settings. We identified more than 50 short-term, medium-term, and long-term outcomes that could be improved by care within the scope of midwifery; reduced maternal and neonatal mortality and morbidity, reduced stillbirth and preterm birth, decreased number of unnecessary interventions, and improved psychosocial and public health outcomes. Midwifery was associated with more efficient use of resources and improved outcomes when provided by midwives who were educated, trained, licensed, and regulated. Our findings support a system-level shift from maternal and newborn care focused on identification and treatment of pathology for the minority to skilled care for all. This change includes preventive and supportive care that works to strengthen women's capabilities in the context of respectful relationships, is tailored to their needs, focuses on promotion of normal reproductive processes, and in which first-line management of complications and accessible emergency treatment are provided when needed. Midwifery is pivotal to this approach, which requires effective interdisciplinary teamwork and integration across facility and community settings. Future planning for maternal and newborn care systems can benefit from using the quality framework in planning workforce development and resource allocation. PMID:24965816

  9. Instrucción familiar perinatal

    Directory of Open Access Journals (Sweden)

    González Hoyos Dolly Magnolia

    1990-12-01

    Full Text Available

    Durante los últimos años ha habido una serie de descubrimientos científicos en el campo de la medicina y la educación que nos han permitido contar con recursos tendientes a garantizar que la mujer llegue a la edad fértil en óptimas condiciones. Con el objeto de evitar riesgos se procura excelente atención prenatal y en el parto. La atención prenatal que se proporciona al niño lo lleva a crecer, sano, alegre, creativo, autónomo, flexible, seguro de sí mismo, y la atención médica obstétrica adecuada hace que la morbimortalidad perinatal disminuya.


  10. Did a quality improvement collaborative make stroke care better? A cluster randomized trial

    OpenAIRE

    Power, Maxine; Tyrrell, Pippa J; Rudd, Anthony G.; Tully, Mary P; Dalton, David; Marshall, Martin; Chappell, Ian; Corgié, Delphine; Goldmann, Don; Webb, Dale; Dixon-Woods, Mary; Parry, Gareth

    2014-01-01

    Background: Stroke can result in death and long-term disability. Fast and high-quality care can reduce the impact of stroke, but UK national audit data has demonstrated variability in compliance with recommended processes of care. Though quality improvement collaboratives (QICs) are widely used, whether a QIC could improve reliability of stroke care was unknown. Methods: Twenty-four NHS hospitals in the Northwest of England were randomly allocated to participate either in Stroke 90:10, a QIC ...

  11. Does Palliative Care Improve Quality? A Survey of Bereaved Family Members

    OpenAIRE

    Gelfman, Laura P.; Meier, Diane E; Morrison, R Sean

    2008-01-01

    Palliative care (PC) is the interdisciplinary specialty that aims to relieve suffering and improve the quality of care for patients with serious illness and their families. Although PC programs are becoming increasingly prevalent in United States hospitals, the impact of hospital PC consultation programs on the quality of care received by family members is not well understood. We conducted prospective quantitative telephonic interviews of family members of patients who died at Mount Sinai Med...

  12. Baseline assessment of adult and adolescent primary care delivery in Rwanda: an opportunity for quality improvement

    OpenAIRE

    Vasan, Ashwin; Anatole, Manzi; Mezzacappa, Catherine; Hedt-Gauthier, Bethany L; Lisa R. Hirschhorn; Nkikabahizi, Fulgence; Hagenimana, Marc; Ndayisaba, Aphrodis; Cyamatare, Felix R; Nzeyimana, Bonaventure; Drobac, Peter; Gupta, Neil

    2013-01-01

    Background: As resource-limited health systems evolve to address complex diseases, attention must be returned to basic primary care delivery. Limited data exists detailing the quality of general adult and adolescent primary care delivered at front-line facilities in these regions. Here we describe the baseline quality of care for adults and adolescents in rural Rwanda. Methods: Patients aged 13 and older presenting to eight rural health center outpatient departments in one district in southea...

  13. Patients' perceptions of service quality dimensions: an empirical examination of health care in New Zealand.

    Science.gov (United States)

    Clemes, M D; Ozanne, L K; Laurensen, W L

    2001-01-01

    The 1984 liberalization of the New Zealand economy has resulted in a health care sector that has become very competitive (Zwier and Clarke, 1999). The private sector is now able to supply health care services and, as a result, a greater value is being placed on patient satisfaction (Zwier and Clarke, 1999). However, despite the increasing focus on customer satisfaction, research into health care patients' perceptions of the dimensions of service quality is scarce. This can be problematic, as quality of care is an essential issue in the strategic marketing of health care services (Turner and Pol, 1995). This study takes a step towards addressing this deficiency by identifying patients' perceptions of the dimensions of service quality in health care. The findings of this study are based on the empirical analysis of a sample of 389 respondents interviewed by telephone. The findings indicate that the service quality dimensions identified in this health care specific study differ in number and dimensional structure from the widely adopted service quality dimensions first identified by Parasuraman, Berry and Zeithaml (1988): reliability, responsiveness, assurance, empathy and tangibles. The service quality dimensions identified in this study were: reliability, tangibles, assurance, empathy, food, access, outcome, admission, discharge and responsiveness. In addition, health care patients perceive the service quality dimensions relating to the core product in health care delivery (for example, outcome and reliability) as more important than the service quality dimensions relating to the peripheral product in health care delivery (for example, food, access and tangibles). Finally, the results of this study suggest that patients with different geographic, demographic, and behavioristic characteristics have different needs and wants during health care delivery and therefore perceive different service quality dimensions as important. PMID:11727291

  14. Assessing the knowledge of perinatal mental illness among student midwives.

    Science.gov (United States)

    Phillips, Louise

    2015-11-01

    The experience of perinatal mental illness (mental illness occurring around the time of pregnancy) currently affect 1 in 10 women and can have adverse effects on the mother and her child (Massie and Szajnberg, 2002; O'Connor et al., 2002). The care and effective management of women experiencing perinatal mental illness is therefore an important issue for health care staff, managers, psychiatrists, commissioners and campaigners. Midwives play a significant part in caring for women throughout their pregnancies, during labour and up to the first month after birth. Midwives are in a unique position to assess a woman's well-being and to offer appropriate support. However, previous research has revealed that midwives often have poor understanding and knowledge of perinatal mental health issues and require improved training (Ross-Davie et al, 2006; McCann and Clark, 2010). This research project aims to systematically assess student midwives awareness of perinatal mental illness. The findings of this study will inform curriculum development for graduate and post-graduate midwifery students therefore improving the care and support women with mental illness receive from antenatal services. The findings from this study will also be used for the formation of an educational web-based programme for student and qualified midwives. PMID:25300675

  15. Quality Health Care in the European Union Thanks to Competition Law

    Directory of Open Access Journals (Sweden)

    Diego Fornaciari

    2009-12-01

    Full Text Available There are many biases concerning the application of competition law in health care. Quality concerns can however be integrated into competition law analysis. The aim of this paper is to identify the links between the application of competition law in the European Union and the right to quality health care and to point out the problems that arise when integrating quality concerns in competition law analysis. Guidelines must be issued and competition authorities must work together with institutions that have expertise in the field of health care quality measurement in order to integrate these dimensions in competition practice.

  16. Quality Health Care in the European Union Thanks to Competition Law

    Science.gov (United States)

    Fornaciari, Diego

    2010-01-01

    There are many biases concerning the application of competition law in health care. Quality concerns can however be integrated into competition law analysis. The aim of this paper is to identify the links between the application of competition law in the European Union and the right to quality health care and to point out the problems that arise when integrating quality concerns in competition law analysis. Guidelines must be issued and competition authorities must work together with institutions that have expertise in the field of health care quality measurement in order to integrate these dimensions in competition practice. PMID:20195428

  17. Cesariana e resultados neonatais em hospitais privados no Brasil: estudo comparativo de dois diferentes modelos de atenção perinatal / Caesarean section and neonatal outcomes in private hospitals in Brazil: comparative study of two different perinatal models of care / Cesárea y resultados neonatales de hospitales privados en Brasil: un estudio comparativo de dos diferentes modelos de prestación de servicios perinatales

    Scientific Electronic Library Online (English)

    Jacqueline Alves, Torres; Rosa Maria Soares Madeira, Domingues; Jane, Sandall; Zulmira, Hartz; Silvana Granado Nogueira da, Gama; Mariza Miranda Theme, Filha; Arthur Orlando Correa, Schilithz; Maria do Carmo, Leal.

    2014-08-01

    Full Text Available Objetiva-se comparar a prevalência de cesariana e desfechos neonatais de dois modelos de atenção ao parto em hospitais privados brasileiros, utilizando-se dados do estudo Nascer no Brasil, coorte de base hospitalar realizada nos anos 2011/2012. Foram analisadas 1.664 puérperas e seus conceptos, aten [...] didos em 13 hospitais localizados na Região Sudeste, divididos em “típico” – modelo de atenção padrão, e “atípico” – Hospital Amigo da Criança com equipes de plantão e trabalho colaborativo entre enfermeiras obstétricas e médicos na atenção ao parto. A classificação de Robson foi adotada para a comparação das prevalências de cesariana, que foram menores no hospital atípico (47,8% vs. 90,8%, p Abstract in spanish El objetivo de este estudio es comparar la tasa de cesárea y los resultados neonatales de dos modelos de atención al parto en hospitales privados en Brasil. Se utilizaron datos de la encuesta Nacer en Brasil, una cohorte de base hospitalaria durante los años 2011/2012. Se analizaron a 1.664 madres y [...] a sus recién nacidos en 13 hospitales de la región sureste, divididos en "típico" -modelo de atención estándar- y "atípico" -Hospital Amigo del Niño-, con atención al parto por equipos de turno integrados por médicos y parteras. Se adoptó la clasificación de Robson con el fin comparar las tasas de cesárea, que fueron inferiores en el hospital atípico (47,8% vs. 90,8%, p Abstract in english This study aims at comparing caesarean section rates and neonatal outcomes of two perinatal models of care provided in private hospitals in Brazil. Birth in Brazil data, a national hospital-based cohort conducted in the years 2011/2012 was used. We analysed 1,664 postpartum women and their offspring [...] attended at 13 hospitals located in the South-east region of Brazil, divided into a "typical” – standard care model and "atypical" – Baby-Friendly hospital with collaborative practices between nurse-midwives and obstetricians on duty to attend deliveries in an alternative labour ward. The Robson’s classification system was used to compare caesarean sections, which was lower in the atypical hospital (47.8% vs. 90.8%, p

  18. eHealth, care and quality of life

    CERN Document Server

    Capello, Fabio; Manca, Marco

    2014-01-01

    The debate over eHealth is alive as never before. Supporters suggest that it will result in dramatic innovations in healthcare, including a giant leap towards patient-centered care, new opportunities to improve effectiveness, and enhanced wellness and quality of life. In addition, the growing market value of investments in health IT suggests that eHealth can offer at least a partial cure for the current economic stagnation. Detractors counter these arguments by claiming that eHealth has already failed: the UK Department of Health has shut down the NHS National Program for IT, Google has discontinued its Health flagship, and doubts have arisen over privacy safeguards for both patients and medical professionals. This book briefly explains why caregivers, professionals, technicians, patients, politicians, and others should all consider themselves stakeholders in eHealth. It offers myth-busting responses to some ill-considered arguments from both sides of the trench, in the process allowing a fresh look at eHeal...

  19. Venous leg ulcer patient priorities and quality of care: results of a survey

    DEFF Research Database (Denmark)

    Kjaer, Monica Linda; Mainz, Jan

    2004-01-01

    A comprehensive patient evaluation of quality of care encompasses assessment and patient-rated prioritization of the various provisions of care. One hundred consecutive venous leg ulcer patients treated in a multidisciplinary wound healing center were invited to participate in a cross-sectional study to assess the quality of and assign priority to 28 aspects of medical technical, interpersonal, and organizational care. The response rate to the mailed questionnaire and follow-up telephone survey was 80%. Almost half (46%) of patients (median age 76 years, range 30 to 92) had an ulcer history of >5 years. Seventy-three patients (91%) were satisfied with the overall quality of care. A linear relationship was observed between average assessment score and the relative importance of the quality aspects studied. The quality of medical technical care and empathy aspects of interpersonal care received the most positive assessments and were given highest priority. Next in importance were the quality and coherence of information provided and cooperation between different healthcare sectors. Organizational aspects of care were less positively assessed and received lower priority ratings. Venous leg ulcer care, as provided in a multidisciplinary wound healing center, was assessed as satisfactory by patients, but areas for improvement - notably, cooperation between healthcare sectors and continuity of care - were observed.

  20. Perspectives of Retired Nurses on Factors that Affect Quality of Nursing Care

    Directory of Open Access Journals (Sweden)

    F Ahmadi

    2011-02-01

    Full Text Available Background & Aim: Quality of health care services shows the degree of achievement of health outcomes. From ethical and legal perspectives, nurses should be responsible for quality of presented care. Retired nurses can help to elaborate real and valuable concepts related to effective factors on quality of nursing care due to their experiences. The aim of this study was to explore the perspectives of retired nurses on factors that affect quality of nursing care in Semnan. Methods & Materials: In this qualitative content analysis method, 20 retired nurses were invited to the study using purposeful sampling. Data were collected mainly using semi-structured interviews. The analysis was carried out using content analysis. Results: Findings of the study yielded to three significant themes including: 1 necessity of humanistic relationships; 2 suitable selection and education (3 planning and organizing nursing cares related to quality of nursing cares. Conclusion: Findings of this study explored perspectives of retired nurses on the effective factors on quality of nursing care. The three themes emerged in the study should be mentioned in planning programs.   Key words: Nursing, Retired nurses, Quality of nursing cares, Content analysis

  1. The impact of a minimal smoking cessation intervention for pregnant women and their partners on perinatal smoking behaviour in primary health care: A real-life controlled study

    OpenAIRE

    Jenssen Jon A; Storrø Ola; Øien Torbjørn; Johnsen Roar

    2008-01-01

    Abstract Background There is a demand for strategies to promote smoking cessation in high-risk populations like smoking pregnant women and their partners. The objectives of this study were to investigate parental smoking behaviour during pregnancy after introduction of a prenatal, structured, multi-disciplinary smoking cessation programme in primary care, and to compare smoking behaviour among pregnant women in the city of Trondheim with Bergen and Norway. Methods Sequential birth cohorts wer...

  2. Quality of health care in inflammatory bowel disease and its assessment

    OpenAIRE

    I.A. Mouzas A.G. Pallis,

    2007-01-01

    SUMMARY Patients with inflammatory bowel disease (IBD) are consistently high users of health care services. They need continuous medication, frequent follow up visits, while their life expectancy is normal. One major parameter, which creeps into the assessment of quality of care, is organization of health care system. However, relatively little research exists on the characteristics and the organization of an ideal health care system which will effectively satisfy the needs of the chronically...

  3. Assuring Quality Cancer Survivorship Care: We've Only Just Begun.

    Science.gov (United States)

    Mayer, Deborah K; Shapiro, Charles L; Jacobson, Paul; McCabe, Mary S

    2015-01-01

    Clinical practice guidelines, quality metrics, and performance improvement projects are the key tools of the national movement to improve and assure quality cancer care. Each of these evaluation instruments is intended to assess quality from a unique perspective, including that of the individual provider, the practice/hospital, and the health care system. A number of organizations have developed or endorsed quality measures specific to cancer, however, these have not formally included survivorship measures. Fortunately, the American Society of Clinical Oncology (ASCO), the National Comprehensive Cancer Network, the American Cancer Society, and the American College of Surgeons (ACoS) have taken a leadership role in developing survivorship guidelines and quality metrics. Both ASCO and ACoS have focused their efforts on the treatment summary and care plan, a document that was proposed in the 2006 Institute of Medicine report on cancer survivorship. ASCO has proposed a care plan template for implementation and incorporation into the electronic health records (EHR), which will lend itself to structure, process, and outcome measurement. ACoS, conversely, has included the care plan in its cancer program standards with annual evaluation metrics. In addition, ASCO has developed a number of key survivorship-relevant metrics as part of its Quality Oncology Practice Initiative (QOPI), a tool developed to measure quality cancer care and assess adherence to guidelines across academic and community practices. Together, these efforts will direct us to more effective ways to disseminate guideline recommendations and to better methods of assessing quality survivorship care nationally. PMID:25993226

  4. Hospital implementation of health information technology and quality of care: are they related?

    Directory of Open Access Journals (Sweden)

    Restuccia Joseph D

    2012-09-01

    Full Text Available Abstract Background Recently, there has been considerable effort to promote the use of health information technology (HIT in order to improve health care quality. However, relatively little is known about the extent to which HIT implementation is associated with hospital patient care quality. We undertook this study to determine the association of various HITs with: hospital quality improvement (QI practices and strategies; adherence to process of care measures; risk-adjusted inpatient mortality; patient satisfaction; and assessment of patient care quality by hospital quality managers and front-line clinicians. Methods We conducted surveys of quality managers and front-line clinicians (physicians and nurses in 470 short-term, general hospitals to obtain data on hospitals’ extent of HIT implementation, QI practices and strategies, assessments of quality performance, commitment to quality, and sufficiency of resources for QI. Of the 470 hospitals, 401 submitted complete data necessary for analysis. We also developed measures of hospital performance from several publicly data available sources: Hospital Compare adherence to process of care measures; Medicare Provider Analysis and Review (MEDPAR file; and Hospital Consumer Assessment of Healthcare Providers and Systems HCAHPS® survey. We used Poisson regression analysis to examine the association between HIT implementation and QI practices and strategies, and general linear models to examine the relationship between HIT implementation and hospital performance measures. Results Controlling for potential confounders, we found that hospitals with high levels of HIT implementation engaged in a statistically significant greater number of QI practices and strategies, and had significantly better performance on mortality rates, patient satisfaction measures, and assessments of patient care quality by hospital quality managers; there was weaker evidence of higher assessments of patient care quality by front-line clinicians. Conclusions Hospital implementation of HIT was positively associated with activities intended to improve patient care quality and with higher performance on four of six performance measures.

  5. Quality standards for child and adolescent mental health in primary care

    Directory of Open Access Journals (Sweden)

    Sayal Kapil

    2012-06-01

    Full Text Available Abstract Background Child and adolescent mental health problems are common in primary healthcare settings. However, few parents of children with mental health problems express concerns about these problems during consultations. Based on parental views, we aimed to create quality of care measures for child and adolescent mental health in primary care and develop consensus about the importance of these quality standards within primary care. Methods Quality Standards were developed using an iterative approach involving four phases: 1 34 parents with concerns about their child’s emotional health or behaviour were recruited from a range of community settings including primary care practices to participate in focus group discussions, followed by validation groups or interviews. 2 Preliminary Quality Standards were generated that fully represented the parents’ experiences and were refined following feedback from an expert parent nominal group. 3 55 experts, including parents and representatives from voluntary organisations, across five panels participated in a modified two-stage Delphi study to develop consensus on the importance of the Quality Standards. The panels comprised general practitioners, other community-based professionals, child and adolescent psychiatrists, other child and adolescent mental health professionals and public health and policy specialists. 4 The final set of Quality Standards was piloted with 52 parents in primary care. Results In the Delphi process, all five panels agreed that 10 of 31 Quality Standards were important. Although four panels rated 25–27 statements as important, the general practitioner panel rated 12 as important. The final 10 Quality Standards reflected healthcare domains involving access, confidentiality for young people, practitioner knowledge, communication, continuity of care, and referral to other services. Parents in primary care agreed that all 10 statements were important. Conclusions It is feasible to develop a set of Quality Standards to assess mental healthcare provision for children and adolescents seen within primary healthcare services. Primary care practitioners should be aware of parental perspectives about quality of care as these may influence help-seeking behaviours.

  6. Healthy Mothers Healthy Babies: awareness and perceptions of existing breastfeeding and postpartum depression support among parents and perinatal health care providers in Hawai'i.

    Science.gov (United States)

    Kimura, Lisa J; McGee, Amelia; Baird, Shelagh; Viloria, Joanne; Nagatsuka, Melissa

    2015-03-01

    Healthy Mothers, Healthy Babies Coalition of Hawai'i (HMHB) is a local nonprofit organization dedicated to eliminating health disparities and improving Hawai'i's maternal, child, and family health though collaborative efforts in public education, advocacy, and partner development. A review of HMHB services revealed overwhelming requests for both breastfeeding and postpartum depression (PPD) support. The purpose of this article is to present the findings of two surveys that highlight the awareness of existing breastfeeding and PPD resources based on both parents and health care providers; perceptions of where and how care is accessed; and whether mothers throughout Hawai'i have equitable access to support. Results helped assess gaps in resources and determine barriers to care, as well as provide suggestions for new services or resources. Web-based surveys were sent to 450 providers and 2,955 parents with response rates of 8.9% and 4.0%, respectively. Less than half of parent participants reported that their health provider discussed PPD with them. Participants identified a number of barriers to increasing access and utilization of PPD support resources, including: not feeling like symptoms were server enough, feeling embarrassed to seek help, not knowing where to find support/information, and not able to afford or insurance wouldn't cover PPD support. Only 40% of providers reported screening for PPD and 33% felt they had not received adequate training. Barriers identified by providers were a lack of trained providers, lack of PPD specific support groups, cultural stigma, and lack of PPD awareness among providers. Of the women who did not exclusively breastfeed for the full six-month recommendation, the most common breastfeeding concerns included: perceptions of low milk supply; lack of lactation support; medical reasons; and pain. Providers described an environment of uneven distribution of resources, general lack of awareness of available resources, along with a widespread lack of support for breastfeeding efforts. Recommendations for future efforts include comprehensive breastfeeding and PPD training for health care providers enhanced support groups, and improving awareness and access to information and support resources. PMID:25821653

  7. What is important in evaluating health care quality? An international comparison of user views

    Directory of Open Access Journals (Sweden)

    van der Eijk Ingrid

    2005-02-01

    Full Text Available Abstract Background Quality of care from the perspective of users is increasingly used in evaluating health care performance. Going beyond satisfaction studies, quality of care from the users' perspective is conceptualised in two dimensions: the importance users attach to aspects of care and their actual experience with these aspects. It is well established that health care systems differ in performance. The question in this article is whether there are also differences in what people in different health care systems view as important aspects of health care quality. The aim is to describe and explain international differences in the importance that health care users attach to different aspects of health care. Methods Data were used from different studies that all used a version of the QUOTE-questionnaire that measures user views of health care quality in two dimensions: the importance that users attach to aspects of care and their actual experience. Data from 12 European countries and 5133 individuals were used. They were analysed using multi-level analysis. Results Although most of the variations in importance people attach to aspects of health care is located at the individual level, there are also differences between countries. The ranking of aspects shows similarities. 'My GP should always take me seriously' was in nearly all countries ranked first, while an item about waiting time in the GP's office was always ranked lowest. Conclusion Differences between countries in how health care users value different aspects of care are difficult to explain. Further theorising should take into account that importance and performance ratings are positively related, that people compare their experiences with those of others, and that general and instrumental values might be related through the institutions of the health care system.

  8. Aggressiveness of Cancer Care Near the End of Life: Is It a Quality-of-Care Issue?

    OpenAIRE

    Earle, Craig C; Landrum, Mary Beth; Souza, Jeffrey M.; Neville, Bridget A; Weeks, Jane C.; Ayanian, John Z

    2008-01-01

    The purpose of this article is to review the literature and update analyses pertaining to the aggressiveness of cancer care near the end of life. Specifically, we will discuss trends and factors responsible for chemotherapy overuse very near death and underutilization of hospice services. Whether the concept of overly aggressive treatment represents a quality-of-care issue that is acceptable to all involved stakeholders is an open question.

  9. Quality-of-care framework in urological cancers: where do we stand?

    Science.gov (United States)

    Wang, Tim T; Ahmed, Kamran; Khan, Mohammed Shamim; Dasgupta, Prokar

    2012-05-01

    What's known on the subject? and What does the study add? Provision of high-quality care necessitates the identification and measurement of relevant quality indicators. Urological surgery currently does not have a validated quality-of-care framework to guide surgical quality improvement. This article aims to delineate quality of care processes, current status of quality indicators for major urological cancers as well as recommend a provisional framework for evaluation of quality for urological procedures. Growing demands for patient safety, lower cost and quality of care have resulted in several initiatives of quality measurement across urological surgery. Although candidate indicators have been proposed in various procedures, the field still lacks a valid quality framework. Better understanding of the interplay between patient selection, surgical expertise, preoperative-, intraoperative, postoperative processes and outcomes is needed. Consensus needs to be achieved in which validated structural, process and outcomes measures to employ, how this data should be collected, which agencies to share this data with and how to use this data to effect change in health policy. Compliance with quality framework needs to be continuously audited with its outcomes frequently benchmarked against international standards. Pursuit of quality improvement schemes require significant investment and need to be weighed against current budgetary constraints. PMID:22077852

  10. Corioamnionitis: Repercusión perinatal

    Scientific Electronic Library Online (English)

    Pedro, Faneite; Clara, Rivera; Rosanna, Amato; Josmery, Faneite.

    2010-12-01

    Full Text Available Objetivo: Determinar en las gestantes complicadas con corioamnionitis las características, factores maternos y las repercusiones maternas y perinatales. Métodos: Estudio descriptivo, retrospectivo, epidemiológico y analítico. Ambiente: Departamento de Obstetricia y Ginecología, Hospital "Dr. Adolfo [...] Prince Lara", Universidad de Carabobo, Puerto Cabello, Estado Carabobo. Resultados: En las 44 pacientes las características maternas que predominaron fueron: residentes en barrios (45,45 %), solteras y concubinas (77,27 %), edad materna 20-24 años (40,91 %) y antecedente personal hipertensión (20,45 %). El diagnóstico de ingreso destacó la rotura prematura de membranas 50 % e infección uro-vaginal 13,6 %; eran multigestas 50,0 %, y en 52,28 % la edad del embarazo fue de 36 semanas y menos, en 84,08 % hubo conducción-inducción del trabajo de parto, terminaron en cesárea 45,45 %. Factores de riesgo: múltiples tactos (4 y más) 40,9 % y tiempo entre rotura de membranas e inicio de trabajo de parto mayor de 12 horas 18,44 %. El diagnóstico se hizo por la clínica y laboratorio; tratadas con antibióticos en su totalidad, acompañadas por oxitócicos 68,18 %. Recién nacidos de sexo femeninos 48,84 %, peso entre 3 000- 3 499 g 31,31 % y tallas 45-49 cm 28,89 %; índice Apgar 6 o menos 28,94 %. La morbilidad perinatal neonatal fue 39,47 %, especialmente por sepsis y patología respiratoria; la morbilidad materna 56,81 %, por sepsis y anemia; la perinatal global 28,88 %, la fetal 15,55 % y la neonatal 13,13 %. Conclusión: La corioamninitis se relacionó con múltiples tactos intraparto, el tiempo de rotura prematura de membranas al inicio del parto y las infecciones uro-vaginales; sus repercusiones revelaron elevadas cifras de morbimortalidad perinatal por sepsis y deficiencias respiratorias, también alta morbilidad materna. Todo señala a implementar programas preventivos y mejorar la atención materno-neonatal. Abstract in english Objective: To study the pregnant women complicated with chorioamnionitis, knowing its impact, identify characteristics and factors related maternal and establish maternal and perinatal impact. Methods: Observational, descriptive, retrospective, epidemiological and analytical study of 44 pregnant wom [...] en complicated with chorioamnionitis, which occurred during the period 2005-2009. Setting: Department of Obstetrics and Gynecology, Hospital "Dr. Adolfo Prince Lara ", Universidad de Carabobo, Puerto Cabello, Estado Carabobo. Results: Maternal characteristics were predominant in patients living in urban region (45.45 %), single and concubines (77.27 %), maternal age between 20-24 years (40.91 %) and personal history hypertension (20.45 %). In obstetrical situation, first admission diagnosis of premature rupture of membranes 50 % and infection urology and vaginal 13.6 %, were multiparous 50 %, with 52.28 % of gestational age 36 weeks and less, in 84.08 % were induction-conduction of labor, ending 45.45 % cesarean. Outstanding risk factors, vaginal digital exam (4 and more) 40.9 %, exam gynecology and time between rupture of membranes at the onset of labor more than 12 hours 18.44 %, diagnosis was mainly clinical and laboratory, were treated with antibiotics in its entirety accompanied by oxytocic 68.18 %. The neonates were 48.84 % female, weighing between 3 000 and 3 499 g, 31.31 % and 28.89 % height 45-49 cm, Apgar Index 6 or less 28.94 %. Neonatal perinatal morbidity was 39.47 %, represented especially by sepsis and respiratory disease, maternal morbidity 56.81 %, given by sepsis and anemia in various forms, the overall perinatal mortality 28.88 %, fetal mortality 15.55 %, neonatal mortality 13.13 %, was decisive sepsis and prematurity in all these deaths. Conclusion: The chorioamnionitis related to exam gynecology, premature rupture of membranes at the start time delivery and urology and vaginal infections; its impact revealed high numbers of perinatal morbidity and mortality from sepsis and respiratory impairment, also high maternal morbidity.

  11. The prevention of psychological morbidity following perinatal death.

    OpenAIRE

    Hammersley, L; Drinkwater, C

    1997-01-01

    In recent years, a significant volume of hospital-based literature has been produced about the management of women and their families after a perinatal death. There has also been a considerable amount of work in the voluntary sector which has recognized this as an area of unmet need. The introduction of regional neonatal intensive care units and the shift from secondary to primary care make the development of a structured community-based approach for this group of vulnerable patients increasi...

  12. Mobile phone intervention reduces perinatal mortality in zanzibar

    DEFF Research Database (Denmark)

    Lund, Stine; Rasch, Vibeke; Hemed, Maryam; Boas, Ida Marie; Said, Azzah; Said, Khadija; Makundu, Mkoko Hassan; Nielsen, Birgitte Bruun

    2014-01-01

    BACKGROUND: Mobile phones are increasingly used in health systems in developing countries and innovative technical solutions have great potential to overcome barriers of access to reproductive and child health care. However, despite widespread support for the use of mobile health technologies, evidence for its role in health care is sparse. OBJECTIVE: We aimed to evaluate the association between a mobile phone intervention and perinatal mortality in a resource-limited setting. METHODS: This stud...

  13. Mobile phone intervention reduces perinatal mortality in Zanzibar

    DEFF Research Database (Denmark)

    Lund, Stine; Rasch, Vibeke; Hemed, Maryam; Boas, Ida Marie; Said, Azzah; Said, Khadija; Makundu, Mkoko Hassan; Nielsen, Birgitte Bruun

    2014-01-01

    BACKGROUND: Mobile phones are increasingly used in health systems in developing countries and innovative technical solutions have great potential to overcome barriers of access to reproductive and child health care. However, despite widespread support for the use of mobile health technologies, evidence for its role in health care is sparse. OBJECTIVE: We aimed to evaluate the association between a mobile phone intervention and perinatal mortality in a resource-limited setting. METHODS: This stud...

  14. Total quality management in a 300-bed community hospital: the quality improvement process translated to health care.

    Science.gov (United States)

    Hughes, J M

    1992-09-01

    Winter Park Memorial Hospital (Winter Park, Florida) began implementation of a well-strategized plan for total quality management (TQM) in 1987. Having no guidelines for applying TQM to health care but using the industrial quality management techniques of Philip Crosby Associates, Inc, the hospital made the transition and saved thousands of dollars in the process. This article describes the transition, especially the integral part played by the Medical Staff Quality Council in changing the hospital's culture. PMID:1437093

  15. The Quality of Tuberculosis Services in Health Care Centres in a Rural District in Uganda: The Providers’ and Clients’ Perspective

    OpenAIRE

    Lilian Bulage; Juliet Sekandi; Omar Kigenyi; Ezekiel Mupere

    2014-01-01

    Quality of care plays an important role in the status of tuberculosis (TB) control, by influencing timely diagnosis, treatment adherence, and treatment completion. In this study, we aimed at establishing the quality of TB service care in Kamuli district health care centres using Donabedian structure, process, and outcomes model of health care. A cross-sectional study was conducted in 8 health care facilities, among 20 health care workers and 392 patients. Data was obtained using face-to-face ...

  16. Challenges in validating quality of care data in a schizophrenia registry : experience from the Danish National Indicator Project

    DEFF Research Database (Denmark)

    Pedersen, Charlotte GjØrup; Gradus, Jaimie L

    2012-01-01

    Improvement of quality of care for psychiatric patients is a key objective of health care systems worldwide. Consequently, there is an increasing interest in documenting quality of care; however, little is known about the validity of the available data on psychiatric care.

  17. Setting standards at the forefront of delivery system reform: aligning care coordination quality measures for multiple chronic conditions.

    Science.gov (United States)

    DuGoff, Eva H; Dy, Sydney; Giovannetti, Erin R; Leff, Bruce; Boyd, Cynthia M

    2013-01-01

    The primary study objective is to assess how three major health reform care coordination initiatives (Accountable Care Organizations, Independence at Home, and Community-Based Care Transitions) measure concepts critical to care coordination for people with multiple chronic conditions. We find that there are major differences in quality measurement across these three large and politically important programs. Quality measures currently used or proposed for these new health reform-related programs addressing care coordination primarily capture continuity of care. Other key areas of care coordination, such as care transitions, patient-centeredness, and cross-cutting care across multiple conditions are infrequently addressed. The lack of a comprehensive and consistent measure set for care coordination will pose challenges for healthcare providers and policy makers who seek, respectively, to provide and reward well-coordinated care. In addition, this heterogeneity in measuring care coordination quality will generate new information, but will inhibit comparisons between these care coordination programs. PMID:24004040

  18. The short-term effects of an integrated care model for the frail elderly on health, quality of life, health care use and satisfaction with care

    Directory of Open Access Journals (Sweden)

    Wilhelmina Mijntje Looman

    2014-12-01

    Full Text Available Purpose: This study explores the short-term value of integrated care for the frail elderly by evaluating the effects of the Walcheren Integrated Care Model on health, quality of life, health care use and satisfaction with care after three months.Intervention: Frailty was preventively detected in elderly living at home with the Groningen Frailty Indicator. Geriatric nurse practitioners and secondary care geriatric nursing specialists were assigned as case managers and co-ordinated the care agreed upon in a multidisciplinary meeting. The general practitioner practice functions as a single entry point and supervises the co-ordination of care. The intervention encompasses task reassignment between nurses and doctors and consultations between primary, secondary and tertiary care providers. The entire process was supported by multidisciplinary protocols and web-based patient files.Methods: The design of this study was quasi-experimental. In this study, 205 frail elderly patients of three general practitioner practices that implemented the integrated care model were compared with 212 frail elderly patients of five general practitioner practices that provided usual care. The outcomes were assessed using questionnaires. Baseline measures were compared with a three-month follow-up by chi-square tests, t-tests and regression analysis.Results and conclusion: In the short term, the integrated care model had a significant effect on the attachment aspect of quality of life. The frail elderly patients were better able to obtain the love and friendship they desire. The use of care did not differ despite the preventive element and the need for assessments followed up with case management in the integrated care model. In the short term, there were no significant changes in health. As frailty is a progressive state, it is assumed that three months are too short to influence changes in health with integrated care models. A more longitudinal approach is required to study the value of integrated care on changes in health and the preservation of the positive effects on quality of life and health care use.

  19. Measuring quality in maternal-newborn care: developing a clinical dashboard.

    Science.gov (United States)

    Sprague, Ann E; Dunn, Sandra I; Fell, Deshayne B; Harrold, Joann; Walker, Mark C; Kelly, Sherrie; Smith, Graeme N

    2013-01-01

    Pregnancy, birth, and the early newborn period are times of high use of health care services. As well as opportunities for providing quality care, there are potential missed opportunities for health promotion, safety issues, and increased costs for the individual and the system when quality is not well defined or measured. There has been a need to identify key performance indicators (KPIs) to measure quality care within the provincial maternal-newborn system. We also wanted to provide automated audit and feedback about these KPIs to support quality improvement initiatives in a large Canadian province with approximately 140 000 births per year. We therefore worked to develop a maternal-newborn dashboard to increase awareness about selected KPIs and to inform and support hospitals and care providers about areas for quality improvement. We mapped maternal-newborn data elements to a quality domain framework, sought feedback via survey for the relevance and feasibility of change, and examined current data and the literature to assist in setting provincial benchmarks. Six clinical performance indicators of maternal-newborn quality care were identified and evidence-informed benchmarks were set. A maternal-newborn dashboard with "drill down" capacity for detailed analysis to enhance audit and feedback is now available for implementation. While audit and feedback does not guarantee individuals or institutions will make practice changes and move towards quality improvement, it is an important first step. Practice change and quality improvement will not occur without an awareness of the issues. PMID:23343794

  20. Impacts of pay for performance on the quality of primary care

    Directory of Open Access Journals (Sweden)

    Allen T

    2014-07-01

    Full Text Available T Allen, T Mason, W WhittakerManchester Centre for Health Economics, University of Manchester, Manchester, United KingdomAbstract: Increasingly, financial incentives are being used in health care as a result of increasing demand for health care coupled with fiscal pressures. Financial incentive schemes are one approach by which the system may incentivize providers of health care to improve productivity and/or adapt to better quality provision. Pay for performance (P4P is an example of a financial incentive which seeks to link providers' payments to some measure of performance. This paper provides a discussion of the theoretical underpinnings of P4P, gives an overview of the health P4P evidence base, and provide a detailed case study of a particularly large scheme from the English National Health Service. Lessons are then drawn from the evidence base. Overall, we find that the evidence for the effectiveness of P4P for improving quality of care in primary care is mixed. This is to some extent due to the fact that the P4P schemes used in primary care are also mixed. There are many different schemes that incentivize different aspects of care in different ways and in different settings, making evaluation problematic. The Quality and Outcomes Framework in the United Kingdom is the largest example of P4P in primary care. Evidence suggests incentivized quality initially improved following the introduction of the Quality and Outcomes Framework, but this was short-lived. If P4P in primary care is to have a long-term future, the question about scheme effectiveness (perhaps incorporating the identification and assessment of potential risk factors needs to be answered robustly. This would require that new schemes be designed from the onset to support their evaluation: control and treatment groups, coupled with before and after data.Keywords: pay for performance, primary care, financial incentives, quality of health care

  1. The American College of Surgeons: an enduring commitment to quality and patient care.

    Science.gov (United States)

    Hoyt, David B; Schneidman, Diane S

    2015-03-01

    This paper describes the American College of Surgeons' 100-plus-year commitment to improving quality and patient care. It summarizes programs that the College established a century ago to improve patient care, including the Hospital Standardization Program, and new initiatives, such as the ACS National Surgical Quality Improvement Program. The College's longstanding experience with quality improvement programs is enabling the organization to play a critical and influential role in helping to ensure that health care reforms, including those in the Affordable Care Act, are implemented in a way that best serves that interests of the surgical patient. Through a combination of these data analysis systems and the application of a finely tuned set of values, the College has become a respected voice in quality and patient safety. The ultimate goal is to create an environment where high value and high reliability take precedence over high volume and where all health care professionals play an active leadership role in delivering optimal, coordinated care. This article further describes how the surgical culture can be reshaped to meet these evolving needs and demands. The American College of Surgeons (ACS) has a longstanding commitment to improving the quality of surgical care through outcome measurement, standards setting, accreditation, and educational activities. This legacy has enabled the ACS to play an influential role in recent developments related to implementation of the Affordable Care Act (ACA) and Medicare physician payment reform. PMID:25637309

  2. Communication skills training for health care professionals improves the adult orthopaedic patient's experience of quality of care

    DEFF Research Database (Denmark)

    NØrgaard, Birgitte; Kofoed, Poul-Erik

    2012-01-01

    Scand J Caring Sci; 2012; Communication skills training for health care professionals improves the adult orthopaedic patient's experience of quality of care Rationale:? Despite the fact that communication has become a core topic in health care, patients still experience the information provided as insufficient or incorrect and a lack of involvement. Objective:? To investigate whether adult orthopaedic patients' evaluation of the quality of care had improved after a communication skills training course for healthcare professionals. Design and methods:? The study was designed as an intervention study offering professionals training in communicating with patients and colleagues. The outcome was measured by assessing patients' experience of quality of care. Data were collected by means of a questionnaire and analysed using a linear regression model. Approval was obtained from the Danish Data Protection Agency. Results:? A total of 3133 patients answered the questionnaire, 1279 before staff had attended courses and 1854 in the postcourse period, with response rates of 67.8 and 77.8%, respectively. After the course period, significant increases in responses indicating 'considerable' improvement were recorded for 15/19 questions, nonsignificant increases were registered for 3/19 questions and a statistically significant decrease for one question. Study limitations:? This being an effectiveness study, it is deemed that the organizational changes taking place during the study period constitute no serious limitation. Response rates were comparable to those of other studies. Conclusion:? Patients show increased satisfaction with the quality of health care after professionals have attended a communication skills training course, even when implemented in an entire department. Practice implications:? We recommend that healthcare professionals are trained in patient-centred communication and that training is extended to the entire organization.

  3. Classification of Perinatal Ischemic Stroke

    Directory of Open Access Journals (Sweden)

    J Gordon Millichap

    2009-03-01

    Full Text Available Advances in classification, causes, treatment and outcome of perinatal ischemic stroke are reviewed by researchers at Alberta Children's Hospital, Calgary; and the Hospital for Sick Children, Toronto, Canada.

  4. Continuous quality improvement in acute health care: creating a holistic and integrated approach.

    Science.gov (United States)

    Sewell, N

    1997-01-01

    Reviews the range of quality activity in a National Health Service hospital trust, using a staff questionnaire survey, self-assessment against the Baldrige Quality Award criteria, and the application of the SERVQUAL approach to service quality assessment. Reviews the acute health care quality programme literature. Finds that there are needs for greater integration of quality effort, to engage with patients in a more meaningful manner, and to achieve greater commitment and involvement from clinicians and managers. Identifies lack of time and resources as a major barrier to greater application of quality programmes. Explores ways of developing a more holistic and integrated programme of quality improvement. Describes the creation and implementation of a model for continuous improvement in health care quality. PMID:10166023

  5. Prevalence and Factors Influencing Perinatal Mortality in Rural Mysore, India

    OpenAIRE

    Siddalingappa, Hugara; Murthy M.R, Nrayana; Kulkarni, Praveen; N.C, Ashok

    2013-01-01

    Background: With decreasing Infant Mortality Rate, Perinatal Mortality is gaining importance as it takes into consideration most of the factors influencing child birth and its survival, mortality during this period is a better indicator of quality of Maternal and Child Health services.

  6. Our Day-Care Centers Respect Children: Quality Criteria for Day-Care = Criterios para um Atendimento em Creches que Respeite os Direitos Fundamentais das Criancas.

    Science.gov (United States)

    Campos, Maria Malta; Rosemberg, Fulvia

    Prepared as part of an effort to attain minimum quality standards for Brazilian day care centers, this document focuses on day-to-day provision of day care services for children from birth to 6 years old as well as broader day care administrative concerns. The first version of this document was prepared as part of a training project for day care

  7. [Gender differences in the demand for quality-related information on health care providers].

    Science.gov (United States)

    Geraedts, M; Amhof, R

    2008-01-01

    Information on health care providers' quality enables patients to make an informed quality-oriented choice. For this purpose, the information should meet the demand of patients. Since it remains unexplained whether differences exist between men and women in this connection, the aim of our study was to analyze the demand for quality-related information in relation to gender. In the framework of the so called Health Monitor Survey of the Bertelsmann Foundation we surveyed a representative sample of 1,523 German adults about their demand for quality-related information on health care providers. We performed a multivariate analysis of the responses by considering age, socioeconomic status, recent experiences with or occupation in the health care system, and gender as independent variables. The results showed that among all sociodemographic variables considered, gender exerted the strongest influence on the responses. Women in comparison to men expressed a higher demand for quality-related information on health care providers, chose health care providers differently to some extent, and rated a multiplicity of criteria used to make a quality-oriented choice of hospitals more important than men. Thus, the publication of quality-related information on health care providers should be performed gender sensitive. PMID:18185969

  8. Perinatal Grief in Latino Parents

    OpenAIRE

    Whitaker, Claudia; KAVANAUGH, KAREN; Klima, Carrie

    2010-01-01

    Extensive research exists that describes the meaning of perinatal loss to some parents, but the experience of loss from the perspective of Latino parents is not clearly understood. Additionally, current perinatal bereavement practices used often to facilitate memory-making for parents (such as viewing or holding the baby, taking photographs, or collecting mementos) are based upon research done primarily with non-Latino families. Are these common practices appropriate for this population? Beca...

  9. Perinatal transmission of Hepatitis B

    OpenAIRE

    Chowdhury Sudipta; Eapen C

    2009-01-01

    There is a high global prevalence of hepatitis B. Perinatal transmission of hepatitis B is the predominant mode of transmission in high prevalence areas. The risk of progression to chronic liver disease and development of hepatocellular carcinoma in individuals who acquire the infection at birth is high. Perinatal transmission of hepatitis B can be reduced by early identification of hepatitis B virus (HBV) carrier mothers. High maternal viral loads and maternal serum HBeAg positivity increase...

  10. Patient Safety in Critical Care Unit: Development of a Nursing Quality Indicator System.

    Science.gov (United States)

    Lima, Camila S P; Barbosa, Sayonara F F

    2015-01-01

    This is a methodological study and technological production that aims to describe the development of a computerized system of nursing care quality indicators for the Intensive Care Unit. The study population consisted of a systems analyst and fifteen critical care nurses. For the development of the system we adopted some of the best practices of the Unified Process methodology using the Unified Modeling Language and the programming language Java Enterprise Edition 7. The system consists of an access menu with the following functions: Home (presents general information), New Record (records the indicator), Record (record search), Census (add information and indicators of the patient), Report (generates report of the indicators) and Annex (accesses the Braden Scale). This information system allows for measurement of the quality of nursing care and to evaluate patient safety in intensive care unit by monitoring quality indicators in nursing. PMID:26262049

  11. Health information technology capacity at federally qualified health centers: a mechanism for improving quality of care

    Directory of Open Access Journals (Sweden)

    Frimpong Jemima A

    2013-01-01

    Full Text Available Abstract Background The adoption of health information technology has been recommended as a viable mechanism for improving quality of care and patient health outcomes. However, the capacity of health information technology (i.e., availability and use of multiple and advanced functionalities, particularly in federally qualified health centers (FQHCs on improving quality of care is not well understood. We examined associations between health information technology (HIT capacity at FQHCs and quality of care, measured by the receipt of discharge summary, frequency of patients receiving reminders/notifications for preventive care/follow-up care, and timely appointment for specialty care. Methods The analyses used 2009 data from the National Survey of Federally Qualified Health Centers. The study included 776 of the FQHCs that participated in the survey. We examined the extent of HIT use and tested the hypothesis that level of HIT capacity is associated with quality of care. Multivariable logistic regressions, reporting unadjusted and adjusted odds ratios, were used to examine whether ‘FQHCs’ HIT capacity’ is associated with the outcome measures. Results The results showed a positive association between health information technology capacity and quality of care. FQHCs with higher HIT capacity were significantly more likely to have improved quality of care, measured by the receipt of discharge summaries (OR=1.43; CI=1.01, 2.40, the use of a patient notification system for preventive and follow-up care (OR=1.74; CI=1.23, 2.45, and timely appointment for specialty care (OR=1.77; CI=1.24, 2.53. Conclusions Our findings highlight the promise of HIT in improving quality of care, particularly for vulnerable populations who seek care at FQHCs. The results also show that FQHCs may not be maximizing the benefits of HIT. Efforts to implement HIT must include strategies that facilitate the implementation of comprehensive and advanced functionalities, as well as promote meaningful use of these systems. Further examination of the role of health information systems in clinical decision-making and improvements in patient outcomes are needed to better understand the benefits of HIT in improving overall quality of care.

  12. Quality Measures for Palliative Care in Patients With Cancer: A Systematic Review

    OpenAIRE

    Kamal, Arif H.; Gradison, Margaret; Maguire, Jennifer M.; Taylor, Donald; Abernethy, Amy P.

    2014-01-01

    Within quality measures for palliative care, there is often a focus on symptoms and adverse effects of therapy; little attention is given to other aspects of suffering observed in patients with advanced cancer, such as psychological and social distress.

  13. Quality improvement programme for cardiovascular disease risk factor recording in primary care

    OpenAIRE

    Ketola, E.; Sipila, R.; Makela, M.; Klockars, M

    2000-01-01

    Objectives—Evaluation of the effect of a quality improvement programme on cardiovascular disease (CVD) risk factor recording and risk factor levels in a controlled study at two primary health care centres serving 26 000 inhabitants in Northern Helsinki.

  14. QUOTE-HIV: an instrument for assessing quality of HIV care from the patients' perspective

    OpenAIRE

    Hekkink, C.F.; Sixma, H; Wigersma, L.; Yzermans, C.J.; Meer, J.T.M. van der; Bindels, P.J.E.; Brinkman, K.; Danner, S. A.

    2003-01-01

    Background: An HIV-specific version of the QUOTE questionnaire was developed to measure the quality of care of patients infected with HIV from the patients' perspective. The consistency and validity of the questionnaire was assessed.

  15. Programa "Casa das Gestantes": perfil das usuárias e resultados da assistência à saúde materna e perinatal / "The House of the Pregnant women" program: users' profile and maternal and perinatal health care results / Programa "Casa de Embarazadas": perfil de las usuarias y resultados de la asistencia a la salud materna y perinatal

    Scientific Electronic Library Online (English)

    Adriano Marçal, Pimenta; Juliana Vieira, Nazareth; Kleyde Ventura de, Souza; Gisele Marçal, Pimenta.

    2012-12-01

    Full Text Available Estudo transversal, descritivo-exploratório, cujo objetivo foi caracterizar o perfil e os resultados da assistência prestada a 820 usuárias da "Casa das Gestantes" de uma maternidade filantrópica de Belo Horizonte, Minas Gerais, Brasil, entre março/2008 e dezembro/2009. A análise estatística baseou- [...] se na apresentação de frequências absolutas e relativas das variáveis. Os diagnósticos obstétricos mais frequentes à internação foram relacionados ao trabalho de parto prematuro e à pressão arterial. A maioria das gestantes recebeu alta (44,1%) ou teve parto na maternidade após a estabilização do quadro clínico (45,5%); 10,2% tiveram seu quadro clínico agravado e retornaram ao hospital. Dos recém-nascidos, 2,8% tiveram Apgar no 5º minuto Abstract in spanish Estudio transversal, descriptivo-exploratorio que objetivó caracterizar el perfil y los resultados de atención de salud dada a 820 usuarias de la "Casa de Embarazadas" de una maternidad filantrópica en Belo Horizonte, Minas Gerais, Brasil, entre marzo/2008 y diciembre/2009. Análisis estadística fue [...] basada en presentación de frecuencias absolutas y relativas de variables. Los diagnósticos obstétricos más frecuentes de ingreso fueron relacionados al trabajo de parto prematuro y presión arterial. La mayoría de embarazadas tuvieran alta (44,1%) o parto en maternidad tras estabilización de la condición clínica (45,5%); 10,2% agravaran la condición clínica y regresaron al hospital. De los niños, 2,8% tuvieron Apgar a los 5 minutos Abstract in english This is a cross-sectional, descriptive and exploratory study, which was aimed at characterizing the profile and results of health care delivery to 820 users of the "House of the Pregnant Women" at a philanthropic maternity in Belo Horizonte, Minas Gerais, Brazil, admitted from March 2008 till Decemb [...] er 2009. Statistical analysis was based on absolute and relative frequencies. The most common obstetric diagnoses on admission were related to preterm labor and blood pressure. Most pregnant women were discharged (44.1%) or gave birth at the maternity after the stabilization of their clinical condition (45.5%); in 10.2% of cases, the clinical condition worsened and the women returned to the hospital. Among newborns, 2.8% had Apgar

  16. Assessing quality of care for migraineurs: a model health plan measurement set.

    Science.gov (United States)

    Leas, Brian F; Gagne, Joshua J; Goldfarb, Neil I; Rupnow, Marcia F T; Silberstein, Stephen

    2008-08-01

    Quality of care measures are increasingly important to health plans, purchasers, physicians, and patients. Appropriate measures can be used to assess quality and evaluate improvement and are necessary components of pay-for-performance programs. Despite the broad scope of activity in the development of quality measures, migraine headache has received little attention. Given the enormous costs associated with migraine, especially in terms of lost productivity and preventable health care utilization, health plans could gain from a structured approach to measuring the quality of migraine care their beneficiaries receive. A potential migraine quality measurement set was developed through a review of migraine care literature and guidelines, interviews with leaders in migraine care, health care purchasing, and managed care, and the assembly of an advisory board. The board discussed candidate measures and established consensus on a testable measurement set. Twenty measures were developed, focused primarily on diagnosis and utilization. Areas of utilization include physician visits, emergency department visits, hospitalizations, and imaging. Use of both acute and preventive medications is included. More complex aspects of migraine care are also addressed, including triptan overuse, the relationship between acute and preventive medications, and follow-up after emergency department visits. The measures are currently being tested in health plans to assess their feasibility and value. A compelling case can be made for the development of migraine-specific quality measures for health plans. This effort to develop and test a starter set of measures should lead to new and innovative efforts to assess and improve quality of care for migraineurs. PMID:18942925

  17. Management by Objective Approach in Nursing Performance Appraisal and its Impact on Quality of Nursing Care

    Directory of Open Access Journals (Sweden)

    Emamzadeh Ghasemi

    2007-10-01

    Full Text Available ackground & Aim: Performance appraisal is one of the most important duties for nursing managers. This will improve the quality of nursing care, and it needs suitable approaches and effective strategies in nursing services. The aim of this study is to determine the impact of performance appraisal using management by objective approach on nursing care quality. Methods & Materials: This was a quasi-experimental and single-blind study that was carried out in two surgical units of an affiliated hospital of Tehran University of Medical Sciences. 80 patients were selected using a randomized sampling. The quality of nursing care were controlled in both experiment and control units before and after the performance appraisal procedure. The procedure was programmed on the basis of management by objective approach for six months in the experiment unit. In the intervention unit, nursing performance appraisal was done three times and in every time head nurse and supervisors participated in giving feedbacks and recommendations for the nurses. At the end of the intervention, quality of nursing care was assessed in both groups blindly. The results were compared and statistically analyzed. Results: Significant difference was found between quality of nursing care in the experiment and control units (P<0.001. Quality of nursing care was significantly different before and after intervention in the experiment unit (P=0.009. Conclusion: Performance appraisal using management by objective approach could increase the quality of nursing care. As a result, using nursing performance appraisal plans according to the basis of MBO could be an effective evaluation way to access the quality of nursing care.

  18. The quality of antenatal care services in Shivrajpur block of district Kanpur: a community based survey

    OpenAIRE

    Harish Chandra Tiwari; Richa Mishra

    2014-01-01

    Background: India is amongst the top five countries in terms of absolute numbers of maternal deaths. In Uttar Pradesh MMR is even higher than national average. In spite of better utilisation of ante-natal services, pregnancy outcome is not significantly improving. Reason behind it is that worrying gaps in quality of antenatal care exist which lead to poor effectiveness of ANC in practice. Methods: In the present study quality of antenatal care services utilised by 286 recently delivered ...

  19. Top Nurse-Management Staffing Collapse and Care Quality in Nursing Homes

    OpenAIRE

    Hunt, Selina R.; Corazzini, Kirsten; Ruth A. Anderson

    2012-01-01

    Director of nursing turnover is linked to staff turnover and poor quality of care in nursing homes; however the mechanisms of these relationships are unknown. Using a complexity science framework, we examined how nurse management turnover impacts system capacity to produce high quality care. This study is a longitudinal case analysis of a nursing home (n = 97 staff) with 400% director of nursing turnover during the study time period. Data included 100 interviews, observations and documents co...

  20. Improving Quality of Care among COPD outpatients in Denmark 2008-2011

    DEFF Research Database (Denmark)

    Tøttenborg, Sandra Søgaard; Thomsen, Reimar Wernich; Statistician, Henrik Nielsen; Johnsen, Søren Paaske; Hansen, Ejvind Frausing; Lange, Peter

    2013-01-01

    OBJECTIVE: To examine whether the quality of care among Danish patients with chronic obstructive pulmonary disease (COPD) has improved since the initiation of a national multidisciplinary quality improvement program. METHODS: We conducted a nationwide, population-based prospective cohort study using data from the Danish Clinical Register of COPD (DrCOPD). Since 2008 the register has systematically monitored and audited the use of recommended processes of COPD care. RESULTS: Substantial improveme...

  1. Higher Quality of Care and Patient Safety Associated With Better NICU Work Environments.

    Science.gov (United States)

    Lake, Eileen T; Hallowell, Sunny G; Kutney-Lee, Ann; Hatfield, Linda A; Del Guidice, Mary; Boxer, Bruce Alan; Ellis, Lauren N; Verica, Lindsey; Aiken, Linda H

    2016-01-01

    The objective of this study was to investigate the associations between the neonatal intensive care unit (NICU) work environment, quality of care, safety, and patient outcomes. A secondary analysis was conducted of responses of 1247 NICU staff nurses in 171 hospitals to a large nurse survey. Better work environments were associated with lower odds of nurses reporting poor quality, safety, and outcomes. Improving the work environment may be a promising strategy to achieve safer settings for at-risk newborns. PMID:26262450

  2. Assessing decision quality in patient-centred care requires a preference-sensitive measure

    OpenAIRE

    Kaltoft, Mette; Cunich, Michelle; Salkeld, Glenn; Dowie, Jack

    2014-01-01

    A theory-based instrument for measuring the quality of decisions made using any form of decision technology, including both decision-aided and unaided clinical consultations is required to enable person- and patient-centred care and to respond positively to individual heterogeneity in the value aspects of decision making. Current instruments using the term ‘decision quality’ have adopted a decision- and thus condition-specific approach. We argue that patient-centred care requir...

  3. Quality of COPD care in hospital outpatient clinics in Denmark: The KOLIBRI study

    DEFF Research Database (Denmark)

    Lange, Peter; Andersen, Klaus Kaae; Munch, Erik; Sørensen, Tina Brandt; Dollerup, Jens; Kassø, Kirsten; Larsen, Hanne Bormann; Dahl, Ronald

    2009-01-01

    BACKGROUND: We studied the quality of care for COPD patients in 22 hospital-based outpatient clinics in Denmark and evaluated if participation by the staff in an educational programme could improve the quality of care and adherence to the COPD guidelines. METHODS: We performed two audits of the hospital records one year apart before and after the educational programme for the participating doctors and nurses. A total of 941 patient records were included in the first audit and 927 in the second. ...

  4. Quality of COPD care in hospital outpatient clinics in Denmark: The KOLIBRI study

    DEFF Research Database (Denmark)

    Lange, P.; Andersen, Klaus Kaae; Munch, E.; Sorensen, T.B.; Dollerup, J.; Kasso, K.; Larsen, H.B.; Dahl, R.

    2009-01-01

    Background: We studied the quality of care for COPD patients in 22 hospital-based outpatient clinics in Denmark and evaluated if participation by the staff in an educational programme could improve the quality of care and adherence to the COPD guidelines. Methods: We performed two audits of the hospital records one year apart before and after the educational programme for the participating doctors and nurses. A total of 941 patient records were included in the first audit and 927 in the second. ...

  5. Assessing decision quality in patient-centred care requires a preference-sensitive measure

    DEFF Research Database (Denmark)

    Kjer Kaltoft, Mette; Cunich, Michelle; Salkeld, Glenn; Dowie, Jack

    2014-01-01

    A theory-based instrument for measuring the quality of decisions made using any form of decision technology, including both decision-aided and unaided clinical consultations is required to enable person- and patient-centred care and to respond positively to individual heterogeneity in the value aspects of decision making. Current instruments using the term 'decision quality' have adopted a decision- and thus condition-specific approach. We argue that patient-centred care requires decision qualit...

  6. Quality Gap of Primary Health Care Services at Kashan District Health Centers, Iran

    OpenAIRE

    A. Kebriaei; F Akbari

    2006-01-01

    This study aims to identify quality gap by assessing users` perceptions and expectations of primary health care quality at Kashan district health centers in Iran. This cross sectional study was carried out during the first three months of 2002. A total of 324 regular female users of primary health care services at Kashan district health centers have been approached. Random sampling of the households covered by each health center was undertaken. The survey instrument was designed around the va...

  7. Nursing Home Prices and Quality of Care - Evidence from Administrative Data

    OpenAIRE

    Reichert, Arndt R.; Stroka, Magdalena A.

    2014-01-01

    There is widespread concern about the quality of care in nursing homes. Based on administrative data of a large health insurance fund, we investigate whether nursing home prices affect relevant quality of care indicators at the resident level. Our results indicate a significantly negative price effect on inappropriate and psychotropic medication. In contrast, we find no evidence for fewer painful physical sufferings for residents of nursing homes with higher prices.

  8. Health information technology capacity at federally qualified health centers: a mechanism for improving quality of care

    OpenAIRE

    Frimpong Jemima A; Jackson Bradford E; Stewart LaShonda M; Singh Karan P; Rivers Patrick A; Bae Sejong

    2013-01-01

    Abstract Background The adoption of health information technology has been recommended as a viable mechanism for improving quality of care and patient health outcomes. However, the capacity of health information technology (i.e., availability and use of multiple and advanced functionalities), particularly in federally qualified health centers (FQHCs) on improving quality of care is not well understood. We examined associations between health information technology (HIT) capacity at FQHCs and ...

  9. Clinically relevant quality measures for risk factor control in primary care: a retrospective cohort study

    OpenAIRE

    Weiler, Stefan; Gemperli, Armin; Collet, Tinh-Hai; Bauer, Douglas. C.; Zimmerli, Lukas; Cornuz, Jacques; Battegay, Edouard; Gaspoz, Jean-Michel; Kerr, Eve A; Aujesky, Drahomir; RODONDI, Nicolas

    2014-01-01

    BACKGROUND Assessment of the proportion of patients with well controlled cardiovascular risk factors underestimates the proportion of patients receiving high quality of care. Evaluating whether physicians respond appropriately to poor risk factor control gives a different picture of quality of care. We assessed physician response to control cardiovascular risk factors, as well as markers of potential overtreatment in Switzerland, a country with universal healthcare coverage but without sys...

  10. Availability and quality of emergency obstetric care in Gambia's main referral hospital: women-users' testimonies

    OpenAIRE

    Sundby Johanne; Cham Mamady; Vangen Siri

    2009-01-01

    Abstract Background Reduction of maternal mortality ratio by two-thirds by 2015 is an international development goal with unrestricted access to high quality emergency obstetric care services promoted towards the attainment of that goal. The objective of this qualitative study was to assess the availability and quality of emergency obstetric care services in Gambia's main referral hospital. Methods From weekend admissions a group of 30 women treated for different acute obstetric conditions in...

  11. An Exploratory Study: Reducing Nursing Students Stress Levels Facilitate Perceived Quality of Patient Care

    OpenAIRE

    Kristiann T. Williams

    2014-01-01

    The aim of this project was to examine if stress levels in Associate Degree (AD) nursing students can affect their perceived quality of care provided to patients. Nursing students experience tremendous amounts of stress especially during their clinical experience. High levels of stress may affect the quality of patient care provided. This project implemented a stress reducing workshop and an instructional deep breathing compact disk (CD) to determine the effects of this...

  12. Depression and Quality of Informal Care: A Longitudinal Investigation of Caregiving Stressors

    OpenAIRE

    Smith, G. Rush; Williamson, Gail M.; Miller, L. Stephen; Schulz, Richard

    2011-01-01

    This research examined longitudinal associations between caregiving stressors, caregiver depression, and quality of care. Informal caregivers of elderly care recipients were interviewed at baseline (N = 310) and again one year later (N = 213). Hierarchical regression analyses indicated that increases in caregiving stressors (i.e., caregiver physical health symptoms, caregiver activity restriction, and care recipient controlling and manipulative behavior) were related to increased caregiver de...

  13. Quality of antenatal care in rural Tanzania : counselling on pregnancy danger signs

    OpenAIRE

    Lindmark Gunilla; Urassa David P; Carlstedt Anders; Pembe Andrea B; Nyström Lennarth; Darj Elisabeth

    2010-01-01

    Abstract Background The high rate of antenatal care attendance in sub-Saharan Africa, should facilitate provision of information on signs of potential pregnancy complications. The aim of this study was to assess quality of antenatal care with respect to providers' counselling of pregnancy danger signs in Rufiji district, Tanzania. Methods A cross-sectional study was conducted in 18 primary health facilities. Thirty two providers were observed providing antenatal care to 438 pregnant women. In...

  14. Adult Obesity and Office-based Quality of Care in the U.S

    OpenAIRE

    Ma, Jun; Xiao, Lan; Stafford, Randall S.

    2009-01-01

    Nationally representative data are limited on the quality of care for obese patients in U.S. ambulatory care settings. We conducted a cross-sectional analysis of the 2005 and 2006 National Ambulatory Medical Care Survey, which for the first time, collected patient weights and heights during a representative sample of visits to U.S. private physician practices. We examined obesity screening, diagnosis and counseling during adult visits and associations with patient and provider characteristics...

  15. Quality-of-care initiative in patients treated surgically for perforated peptic ulcer

    DEFF Research Database (Denmark)

    MØller, M H; Larsson, Heidi Jeanet

    2013-01-01

    Mortality and morbidity are considerable after treatment for perforated peptic ulcer (PPU). Since 2003, a Danish nationwide quality-of-care (QOC) improvement initiative has focused on reducing preoperative delay, and improving perioperative monitoring and care for patients with PPU. The present study reports the results of this initiative.

  16. Assessment of drug treatment quality in two Danish health-care centres

    DEFF Research Database (Denmark)

    Andersen, Stig Ejdrup; Edfors, Kajsa

    2011-01-01

    Bridging the primary and secondary sector, health-care centres aim to reduce morbidity and prevent further hospitalization in patients with chronic heart diseases. The aim of this study was to describe the quality of drug treatment in patients with chronic heart diseases in two Copenhagen health-care centres.

  17. Hospice in Assisted Living: Promoting Good Quality Care at End of Life

    Science.gov (United States)

    Cartwright, Juliana C.; Miller, Lois; Volpin, Miriam

    2009-01-01

    Purpose: The purpose of this study was to describe good quality care at the end of life (EOL) for hospice-enrolled residents in assisted living facilities (ALFs). Design and Methods: A qualitative descriptive design was used to obtain detailed descriptions of EOL care provided by ALF medication aides, caregivers, nurses, and hospice nurses in…

  18. The impact of horizontal mergers and acquisitions on cost and quality in health care.

    Science.gov (United States)

    Taylor, M J; Porper, R W; Manji, S

    1995-12-01

    Mergers and acquisitions among HMOs, hospitals and other health care providers can be disconcerting to benefits staff and employees, but they can be successfully managed. They may offer an employer the opportunity to improve the quality of care provided and to do so at reduced costs. PMID:10153603

  19. Parents' and Providers' Views of Important Aspects of Child Care Quality. Publication #2015-13

    Science.gov (United States)

    Sosinsky, Laura; Halle, Tamara; Susman-Stillman, Amy; Cleveland, Jennifer; Li, Weilin

    2015-01-01

    The Maryland-Minnesota Child Care Research Partnership brought together two states committed to examining critical issues in early care and education and using research findings to inform policy with an interdisciplinary team of researchers experienced in conducting studies on (1) subsidy policy; (2) quality improvement strategies; and (3)…

  20. The quality of work life in the health care revolution.

    Science.gov (United States)

    Campbell, J W

    1988-01-01

    Today's health care professionals are fast becoming the victims of burnout, says Mr. Campbell. He proposes methods individuals and organizations can use to detect and deal with the symptoms of job-related stress. PMID:10286319

  1. Caregiver Evaluation of the Quality of End-Of-Life Care (CEQUEL) Scale: The Caregiver's Perception of Patient Care Near Death

    OpenAIRE

    Higgins, Philip C.; Prigerson, Holly G.

    2013-01-01

    Purpose End-of-life (EOL) measures are limited in capturing caregiver assessment of the quality of EOL care. Because none include caregiver perception of patient suffering or prolongation of death, we sought to develop and validate the Caregiver Evaluation of Quality of End-of-Life Care (CEQUEL) scale to include these dimensions of caregiver-perceived quality of EOL care. Patients and Methods Data were derived from Coping with Cancer (CwC), a multisite, prospective, longitudinal study of adva...

  2. Psychosocial stress at work and perceived quality of care among clinicians in surgery

    Directory of Open Access Journals (Sweden)

    von dem Knesebeck Olaf

    2011-05-01

    Full Text Available Abstract Background Little is known about the association between job stress and job performance among surgeons, although physicians' well-being could be regarded as an important quality indicator. This paper examines associations between psychosocial job stress and perceived health care quality among German clinicians in surgery. Methods Survey data of 1,311 surgeons from 489 hospitals were analysed. Psychosocial stress at work was measured by the effort-reward imbalance model (ERI and the demand-control model (job strain. The quality of health care was evaluated by physicians' self-assessed performance, service quality and error frequency. Data were collected in a nationwide standardised mail survey. 53% of the contacted hospitals sent back the questionnaire; the response rate of the clinicians in the participating hospitals was about 65%. To estimate the association between job stress and quality of care multiple logistic regression analyses were conducted. Results Clinicians exposed to job stress have an increased risk of reporting suboptimal quality of care. Magnitude of the association varies depending on the respective job stress model and the indicator of health care quality used. Odds ratios, adjusted for gender, occupational position and job experience vary between 1.04 (CI 0.70-1.57 and 3.21 (CI 2.23-4.61. Conclusion Findings indicate that theoretical models of psychosocial stress at work can enrich the analysis of effects of working conditions on health care quality. Moreover, results suggest interventions for job related health promotion measures to improve the clinicians' working conditions, their quality of care and their patients' health.

  3. Measuring quality of care in nursing home - what matters?

    OpenAIRE

    Nakrem, Sigrid

    2011-01-01

    Residential care in nursing homes continues to be necessary for those individuals who are no longer able to live safely and comfortably at home. The demographic change with increasing number of persons over 65 years in the next 20 years also means that the percentage of those who will require care in a nursing home some time before the end of their lives will increase. Therefore, anticipating this pressure to expand nursing home availability, it is critical that these services are developed f...

  4. Quality care at the end of life in Africa

    OpenAIRE

    Sepulveda, Cecilia; Habiyambere, Vincent; Amandua, Jacinto; Borok, Margaret; Kikule, Ekie; Mudanga, Barbara; Ngoma, Twalib; Solomon, Bogale

    2003-01-01

    Each year about 0.5% of the total population in Botswana, Ethiopia, Tanzania, Uganda, and Zimbabwe die from HIV/AIDS or cancer. The members of a WHO project to improve palliative care in these countries discuss their work. The greatest needs of terminally ill patients were for adequate pain relief, accessible and affordable drugs, and financial support to counter the loss of income of both patient and family caregiver. Special emphasis should be given to home based palliative care provi...

  5. Quality of life of the nursing caregiver and its relationship with care

    Directory of Open Access Journals (Sweden)

    Everton Fernando Alves

    2013-03-01

    Full Text Available Objective: To identify aspects that affect the quality of life of nursing caregivers and their relationship with care in an Intensive Care Unit for Adults (A-ICU. Methods: This was a descriptive study with qualitative approach, taking as subjects 21 professionals who constitute the nursing staff of the A-ICU of a school hospital in Maringá-PR. Unstructured interview was used as a strategy to collect data, conducted between May and June 2009. Data analysis was based on the method of content analysis. The categories identified were: overlooking improvement in quality of life related to the resources in an A-ICU; the quality of life influencing the form of care; interpersonal relationships into the health team reflecting on the quality of life and care. Results: The analysis of caregivers’ speech and the results of the observation showed that there is correlation between the aspects they consider influential in their quality of life and the way of caring for patients in an A-ICU. Conclusion: The findings indicate that, among the influential aspects, the stressful factors overlap the enhancing ones. From this perspective, dealing with caregiver’s suffering might be the starting point for the improvement in quality of care in an A-ICU

  6. Quality of life of the nursing caregiver and its relationship with care

    Directory of Open Access Journals (Sweden)

    Everton Fernando Alves

    2013-08-01

    Full Text Available Objective: To identify aspects that affect the quality of life of nursing caregivers and their relationship with care in an Intensive Care Unit for Adults (A-ICU. Methods: This was a descriptive study with qualitative approach, taking as subjects 21 professionals who constitute the nursing staff of the A-ICU of a school hospital in Maringá-PR. Unstructured interview was used as a strategy to collect data, conducted between May and June 2009. Data analysis was based on the method of content analysis. The categories identified were: overlooking improvement in quality of life related to the resources in an A-ICU; the quality of life influencing the form of care; interpersonal relationships into the health team reflecting on the quality of life and care. Results: The analysis of caregivers’ speech and the results of the observation showed that there is correlation between the aspects they consider influential in their quality of life and the way of caring for patients in an A-ICU. Conclusion: The findings indicate that, among the influential aspects, the stressful factors overlap the enhancing ones. From this perspective, dealing with caregiver’s suffering might be the starting point for the improvement in quality of care in an A-ICU.

  7. Traveling abroad for medical care: U.S. medical tourists' expectations and perceptions of service quality.

    Science.gov (United States)

    Guiry, Michael; Vequist, David G

    2011-01-01

    The SERVQUAL scale has been widely used to measure service quality in the health care industry. This research is the first study that used SERVQUAL to assess U.S. medical tourists' expectations and perceptions of the service quality of health care facilities located outside the United States. Based on a sample of U.S. consumers, who had traveled abroad for medical care, the results indicated that there were significant differences between U.S. medical tourists' perceived level of service provided and their expectations of the service that should be provided for four of the five dimensions of service quality. Reliability had the largest service quality gap followed by assurance, tangibles, and empathy. Responsiveness was the only dimension without a significantly different gap score. The study establishes a foundation for future research on service quality in the rapidly growing medical tourism industry. PMID:21815742

  8. Structured chronic primary care and health-related quality of life in chronic heart failure

    Directory of Open Access Journals (Sweden)

    Schers Henk

    2009-06-01

    Full Text Available Abstract Background Structured care is proposed as a lever for improving care for patients with chronic conditions. The purpose of this study was to explore the associations of structured care characteristics, derived from the Chronic Care Model, with health-related quality of life (HRQOL and optimal clinical management in chronic heart failure (CHF patients in primary care, as well as the association between optimal management and HRQOL. Methods Cross-sectional observational study using multi-level random-coefficient analyses of a representative sample of 357 patients diagnosed with CHF from 42 primary care practices in the Netherlands. We combined individual medical record data with patient and physician questionnaires. Results There was large variation in the levels and presence of structured care elements. A 91% of physicians indicated that next appointments for CHF patients were made immediately after visits, while 11% indicated that reminders on CHF management were periodically received in their practice. Few associations were found between the organizational characteristics and optimal treatment or HRQOL. Optimal pharmacological treatment related to better quality of life (? = -11.5, P P = .04. Conclusion HRQOL and treatment quality in CHF patients were not consistently associated with characteristics of structured care in primary care practices.

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

    DEFF Research Database (Denmark)

    Mainz, Jan; Kristensen, Solvejg; Bartels, Paul

    2015-01-01

    Denmark has unique opportunities for quality measurement and benchmarking since Denmark has well-developed health registries and unique patient identifier that allow all registries to include patient-level data and combine data into sophisticated quality performance monitoring. Over decades, Denmark has developed and implemented national quality and patient safety initiatives in the healthcare system in terms of national clinical guidelines, performance and outcome measurement integrated in clin...

  10. The quality of care delivered to patients within the same hospital varies by insurance type.

    Science.gov (United States)

    Spencer, Christine S; Gaskin, Darrell J; Roberts, Eric T

    2013-10-01

    In attempting to explain why hospitals vary in the quality of care delivered to patients, a considerable body of health policy research points to differences in hospital characteristics such as ownership, safety-net status, and geographic location as the most important contributing factors. This article examines the extent to which a patient's type or lack of insurance may also play a role in determining the quality of care received at any given hospital. We compared within-hospital quality, as measured by risk-adjusted mortality rates, for patients according to their insurance status. We examined the Agency for Healthcare Research and Quality's innovative Inpatient Quality Indicators and pooled 2006-08 State Inpatient Database records from eleven states. We found that privately insured patients had lower risk-adjusted mortality rates than did Medicare enrollees for twelve out of fifteen quality measures examined. To a lesser extent, privately insured patients also had lower risk-adjusted mortality rates than those in other payer groups. Medicare patients appeared particularly vulnerable to receiving inferior care. These findings suggest that to help reduce care disparities, public payers and hospitals should measure care quality for different insurance groups and monitor differences in treatment practices within hospitals. PMID:24101062

  11. Patient Centeredness and Engagement in Quality-of-Care Oncology Research.

    Science.gov (United States)

    Clauser, Steven B; Gayer, Christopher; Murphy, Elizabeth; Majhail, Navneet S; Baker, K Scott

    2015-05-01

    More than a decade after the Institute of Medicine (IOM) first studied the quality of cancer care, obstacles to achieving high-quality care remain, and studies suggest that cancer care is often not as patient centered, accessible, coordinated, or evidence based as it could be. Patients, their families, and clinicians face a wide range of complex and often confusing choices regarding their health and health care concerns and require trustworthy information to decide which options are best for them. The Patient-Centered Outcomes Research Institute (PCORI) strives to fund clinical comparative effectiveness research, guided by patients, caregivers, and the broader health care community, that will provide high-integrity, evidence-based information to help people make informed health care decisions. This mission is well aligned with the IOM's recent conceptual framework and corresponding recommendations that recognize that addressing the needs of patients with cancer and their families is the most important component of a high-quality cancer care delivery system. PCORI seeks the opportunity to partner with diverse interdisciplinary research teams who demonstrate a strong commitment to the inclusion and engagement of patients and stakeholders as they work to develop high-quality cancer care delivery systems. We see rich opportunities for such partnership in the cancer care community, given the wealth of well-established patient advocacy groups and organizations and cutting-edge research institutions, all of which are working toward the common goal of improving the quality of cancer care for patients and their families. This article and the project it describes provide an example of an avenue for advancing this goal. PMID:25852140

  12. Reforming Cardiovascular Care in the United States towards High-Quality Care at Lower Cost with Examples from Model Programs in the State of Michigan

    Directory of Open Access Journals (Sweden)

    Daniel Alyeshmerni

    2014-07-01

    Full Text Available Despite its status as a world leader in treatment innovation and medical education, a quality chasm exists in American health care. Care fragmentation and poor coordination contribute to expensive care with highly variable quality in the United States. The rising costs of health care since 1990 have had a huge impact on individuals, families, businesses, the federal and state governments, and the national budget deficit. The passage of the Affordable Care Act represents a large shift in how health care is financed and delivered in the United States. The objective of this review is to describe some of the economic and social forces driving health care reform, provide an overview of the Patient Protection and Affordable Care Act (ACA, and review model cardiovascular quality improvement programs underway in the state of Michigan. As health care reorganization occurs at the federal level, local and regional efforts can serve as models to accelerate improvement toward achieving better population health and better care at lower cost. Model programs in Michigan have achieved this goal in cardiovascular care through the systematic application of evidence-based care, the utilization of regional quality improvement collaboratives, community-based childhood wellness promotion, and medical device-based competitive bidding strategies. These efforts are examples of the direction cardiovascular care delivery will need to move in this era of the Affordable Care Act.

  13. Cancer rehabilitation and palliative care: critical components in the delivery of high-quality oncology services.

    Science.gov (United States)

    Silver, Julie K; Raj, Vishwa S; Fu, Jack B; Wisotzky, Eric M; Smith, Sean Robinson; Kirch, Rebecca A

    2015-12-01

    Palliative care and rehabilitation practitioners are important collaborative referral sources for each other who can work together to improve the lives of cancer patients, survivors, and caregivers by improving both quality of care and quality of life. Cancer rehabilitation and palliative care involve the delivery of important but underutilized medical services to oncology patients by interdisciplinary teams. These subspecialties are similar in many respects, including their focus on improving cancer-related symptoms or cancer treatment-related side effects, improving health-related quality of life, lessening caregiver burden, and valuing patient-centered care and shared decision-making. They also aim to improve healthcare efficiencies and minimize costs by means such as reducing hospital lengths of stay and unanticipated readmissions. Although their goals are often aligned, different specialized skills and approaches are used in the delivery of care. For example, while each specialty prioritizes goal-concordant care through identification of patient and family preferences and values, palliative care teams typically focus extensively on using patient and family communication to determine their goals of care, while also tending to comfort issues such as symptom management and spiritual concerns. Rehabilitation clinicians may tend to focus more specifically on functional issues such as identifying and treating deficits in physical, psychological, or cognitive impairments and any resulting disability and negative impact on quality of life. Additionally, although palliative care and rehabilitation practitioners are trained to diagnose and treat medically complex patients, rehabilitation clinicians also treat many patients with a single impairment and a low symptom burden. In these cases, the goal is often cure of the underlying neurologic or musculoskeletal condition. This report defines and describes cancer rehabilitation and palliative care, delineates their respective roles in comprehensive oncology care, and highlights how these services can contribute complementary components of essential quality care. An understanding of how cancer rehabilitation and palliative care are aligned in goal setting, but distinct in approach may help facilitate earlier integration of both into the oncology care continuum-supporting efforts to improve physical, psychological, cognitive, functional, and quality of life outcomes in patients and survivors. PMID:26314705

  14. Identifying resident care areas for a quality improvement intervention in long-term care: a collaborative approach

    Directory of Open Access Journals (Sweden)

    Cranley Lisa A

    2012-09-01

    Full Text Available Abstract Background In Canada, healthcare aides (also referred to as nurse aides, personal support workers, nursing assistants are unregulated personnel who provide 70-80% of direct care to residents living in nursing homes. Although they are an integral part of the care team their contributions to the resident care planning process are not always acknowledged in the organization. The purpose of the Safer Care for Older Persons [in residential] Environments (SCOPE project was to evaluate the feasibility of engaging front line staff (primarily healthcare aides to use quality improvement methods to integrate best practices into resident care. This paper describes the process used by teams participating in the SCOPE project to select clinical improvement areas. Methods The study employed a collaborative approach to identify clinical areas and through consensus, teams selected one of three areas. To select the clinical areas we recruited two nursing homes not involved in the SCOPE project and sampled healthcare providers and decision-makers within them. A vote counting method was used to determine the top five ranked clinical areas for improvement. Results Responses received from stakeholder groups included gerontology experts, decision-makers, registered nurses, managers, and healthcare aides. The top ranked areas from highest to lowest were pain/discomfort management, behaviour management, depression, skin integrity, and assistance with eating. Conclusions Involving staff in selecting areas that they perceive as needing improvement may facilitate staff engagement in the quality improvement process.

  15. Hearing Parents' and Carers' Voices: Experiences of Accessing Quality Long Day Care in Northern Regional Australia

    Science.gov (United States)

    Harris, Nonie; Tinning, Beth

    2012-01-01

    This article explores parents' and carers' experiences of accessing quality long day care in northern regional Australia. The data was gathered in 2009, after the collapse of ABC Developmental Learning Centres (herein referred to as ABC Learning) and before the implementation of the "National Quality Framework," and provides a snapshot of…

  16. Respite Care, Marital Quality, and Stress in Parents of Children with Autism Spectrum Disorders

    Science.gov (United States)

    Harper, Amber; Dyches, Tina Taylor; Harper, James; Roper, Susanne Olsen; South, Mikle

    2013-01-01

    Parents of children with autism spectrum disorders (ASD) are at risk for having higher stress and lower marital quality than other parents. Survey data regarding respite care, marital quality, and daily hassles and uplifts were obtained from 101 mother-father dyads who were together raising at least one child with ASD (total # of children = 118).…

  17. The Quality of Early Childhood Educators: Children's Interaction in Greek Child Care Centers

    Science.gov (United States)

    Rentzou, Konstantina; Sakellariou, Maria

    2011-01-01

    Though quality in early childhood education and care has attracted last decades enormous research interest there is still not a unanimous agreement about its definition. Yet, almost all definitions attempted include interaction, group size, adult:child ratio and early childhood educators' level of education, as important indices of quality.…

  18. Child Care Quality and Cognitive Development: Trajectories Leading to Better Preacademic Skills

    Science.gov (United States)

    Cote, Sylvana M.; Mongeau, Chantal; Japel, Christa; Xu, Qian; Seguin, Jean R.; Tremblay, Richard E.

    2013-01-01

    The associations between trajectories of child care quality from ages 2 to 4 years and children's cognitive performance at 4 years ("n" = 250) were tested. Distinct quality trajectories were identified: low and high ascending Teaching and Interactions trajectory; low and high Provision for Learning trajectory. Membership in the high ascending…

  19. The Minimum Data Set Prevalence of Restraint Quality Indicator: Does It Reflect Differences in Care?

    Science.gov (United States)

    Schnelle, John F.; Bates-Jensen, Barbara M.; Levy-Storms, Lene; Grbic, Valena; Yoshii, June; Cadogan, Mary; Simmons, Sandra F.

    2004-01-01

    Purpose: This study investigated whether the use of restraining devices and related measures of care quality are different in nursing homes that score in the upper and lower quartiles on the Minimum Data Set (MDS) "prevalence of restraint" quality indicator, which assesses daily use of restraining devices when residents are out of bed. Design and…

  20. Effect of Physician Delegation to Other Healthcare Providers on the Quality of Care for Geriatric Conditions.

    Science.gov (United States)

    Lichtenstein, Brian J; Reuben, David B; Karlamangla, Arun S; Han, Weijuan; Roth, Carol P; Wenger, Neil S

    2015-10-01

    The quality of care of older adults in the United States has been consistently shown to be inadequate. This gap between recommended and actual care provides an opportunity to improve the value of health care for older adults. Prior work from the Assessing Care of Vulnerable Elders (ACOVE) investigators first defined, and then sought to improve, clinical practice for common geriatric conditions. A critical component of the ACOVE intervention for practice improvement was an emphasis on the delegation of specific care processes, but the independent effect of delegation on the quality of care has not been evaluated. This study analyzed the pooled results of prior ACOVE projects from 1998 to 2010. Totaled, these studies included 4,776 individuals aged 65 and older of mixed demographic backgrounds and 16,204 ACOVE quality indicators (QIs) for three geriatric conditions: falls, urinary incontinence, and dementia. In unadjusted analyses, QI pass probabilities were 0.36 for physician-performed tasks, 0.55 for nurse practitioner (NP)-, physician assistant (PA)-, and registered nurse (RN)-performed tasks; and 0.61 for medical assistant- and licensed vocational nurse-performed tasks. In multiply adjusted models, the independent pass-probability effect of delegation to NPs, PAs, and RNs was 1.37 (P = .05). These findings suggest that delegation of selected tasks to nonphysician healthcare providers is associated with higher quality of care for these geriatric conditions in community practices and supports the value of interdisciplinary team management for common outpatient conditions in older adults. PMID:26480977

  1. Will Choosing Wisely® improve quality and lower costs of care for patients with critical illness?

    Science.gov (United States)

    Admon, Andrew J; Cooke, Colin R

    2014-06-01

    In 2009, a group of experts convened by the Institute of Medicine estimated that 30% of health care costs amounted to waste, including a substantial share from nonbeneficial and often harmful services. Professional organizations and medical ethicists subsequently called on specialty groups to generate "top five" lists of expensive tests or treatments without known benefits. Responding to this call, the American Board of Internal Medicine launched its Choosing Wisely campaign, with the top-five Choosing Wisely lists for pulmonary medicine and critical care released in 2014. In order for the critical care list to have an impact on costs and quality, two things must occur: providers whose practice is discordant with the list must adhere to the list when making decisions, and those decisions must lead to improvements in the quality of care at lower costs. Although the campaign addresses some limitations of past efforts to improve quality and reduce waste, we believe it will do little to change provider behavior. Even if the top-five list for critical care were to change the behavior of providers, its ultimate impact on costs and quality will be lower than anticipated. Here we suggest several strategies for stakeholders to increase the impact of the critical care top-five list, and further discuss that despite limitations of the campaign it is still imperative for advancing best practice in critical care. PMID:24762102

  2. Perinatal Outcome in Unbooked Teenage Pregnancies in the University of Calabar Teaching Hospital, Calabar, Nigeria

    OpenAIRE

    C. U. Iklaki; J. U. Inaku; J. E. Ekabua; Ekanem, E. I.; Udo, A. E.

    2012-01-01

    Background. Teenage pregnancy being a high risk condition requires skilled attention for good outcome. Objectives. To determine the influence of antenatal care on perinatal outcome in teenage pregnancies in Calabar. Materials and Methods. A review of patient records in Calabar was conducted between 1st January, 2006 and 31st December, 2010, to determine perinatal outcome in teenage pregnancy. Results. Teenage pregnancy accounted for 644 (6.5%) of the total deliveries with 245 (38.0%) booked w...

  3. Attitudes to viability of preterm infants and their effect on figures for perinatal mortality.

    OpenAIRE

    Fenton, A C; Field, D. J.; Mason, E.; CLARKE, M

    1990-01-01

    OBJECTIVE--To examine how local attitudes to management of extreme preterm labour can influence data on perinatal mortality. DESIGN--One year prospective study in a geographically defined population. SETTING--The 17 perinatal units of Trent region. PATIENTS--All preterm infants of less than or equal to 32 weeks' gestation in the Trent region. INTERVENTIONS--Infants who had been considered viable at birth were referred for intensive care; those who had been considered non-viable received termi...

  4. Factors associated with and causes of perinatal mortality in northeastern Tanzania

    DEFF Research Database (Denmark)

    Schmiegelow, Christentze; Minja, Daniel

    2012-01-01

    Objective. To identify factors associated with perinatal mortality in northeastern Tanzania. Design. Prospective cohort study. Setting. Northeastern Tanzania. Population. 872 mothers and their newborns. Methods. Pregnant women were screened for factors possibly associated with perinatal mortality, including preeclampsia, small-for-gestational age, preterm delivery, anemia, and health-seeking behavior. Fetal growth was monitored using ultrasound. Finally, the specific causes of the perinatal deaths were evaluated. Main outcome measure. Perinatal mortality. Results. Forty-six deaths occurred. Key factors associated with perinatal mortality were preterm delivery (adjusted odds ratio (OR) 14.47, 95% confidence interval (CI) 3.23-64.86, p < 0.001), small-for-gestational age (adjusted OR 3.54, 95%CI 1.18-10.61, p = 0.02), and maternal anemia (adjusted OR 10.34, 95%CI 1.89-56.52, p = 0.007). Adherence to the antenatal care program (adjusted OR 0.027, 95%CI 0.003-0.26, p = 0.002) protected against perinatal mortality. The cause of death in 43% of cases was attributed to complications related to labor and specifically to intrapartum asphyxia (30%) and neonatal infection (13%). Among the remaining deaths, 27% (7/26) were attributed to preeclampsia and 23% (6/26) to small-for-gestational age. Of these, 54% (14/26) were preterm. Conclusions. Preeclampsia, small-for-gestational age and preterm delivery were key risk factors and causes of perinatal mortality in this area of Tanzania. Maternal anemia was also strongly associated with perinatal mortality. Furthermore, asphyxia accounted for a large proportion of the perinatal deaths. Interventions should target the prevention and handling of these conditions in order to reduce perinatal mortality. © 2012 Nordic Federation of Societies of Obstetrics and Gynecology.

  5. Physician leadership: a health-care system's investment in the future of quality care.

    Science.gov (United States)

    Orlando, Rocco; Haytaian, Marcia

    2012-08-01

    The current state of health care and its reform will require physician leaders to take on greater management responsibilities, which will require a set of organizational and leadership competencies that traditional medical education does not provide. Physician leaders can form a bridge between the clinical and administrative sides of a health-care organization, serving to further the organization's strategy for growth and success. Recognizing that the health-care industry is rapidly changing and physician leaders will play a key role in that transformation, Hartford HealthCare has established a Physician Leadership Development Institute that provides advanced leadership skills and management education to select physicians practicing within the health-care system. PMID:23248866

  6. Can structured data fields accurately measure quality of care? The example of falls

    Directory of Open Access Journals (Sweden)

    David A. Ganz, MD, PhD

    2012-12-01

    Full Text Available By automating collection of data elements, electronic health records may simplify the process of measuring the quality of medical care. Using data from a quality improvement initiative in primary care medical groups, we sought to determine whether the quality of care for falls and fear of falling in outpatients aged 75 and older could be accurately measured solely from codable (non-free-text data in a structured visit note. A traditional medical record review by trained abstractors served as the criterion standard. Among 215 patient records reviewed, we found a structured visit note in 54% of charts within 3 mo of the date patients had been identified as having falls or fear of falling. The reliability of an algorithm based on codable data was at least good (kappa of at least 0.61 compared with full medical record review for three care processes recommended for patients with two falls or one fall with injury in the past year: orthostatic vital signs, vision test/eye examination, and home safety evaluation. However, the automated algorithm routinely underestimated quality of care. Performance standards based on automated measurement of quality of care from electronic health records need to account for documentation occurring in nonstructured form.

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

    OpenAIRE

    Singer, P A; N. Macdonald

    1998-01-01

    A physician who receives a call from the emergency department to see a patient with heart failure will have a clear framework within which to approach this problem. The thesis of this article is that physicians do not have an analogous conceptual framework for approaching end-of-life care. The authors present and describe a framework for end-of-life care with 3 main elements: control of pain and other symptoms, the use of life-sustaining treatments and support of those who are dying and their...

  8. The Versatility of the Perinatal Educator

    OpenAIRE

    Humenick, Sharron S.

    1999-01-01

    Perinatal educators can expand their role beyond that of childbirth preparation. One such role is the perinatal bereavement counselor. Having the courage to balance one's skills with one's intuitive impulses may greatly enrich carrying out this or any role.

  9. Quality in transitional care of the elderly: Key challenges and relevant improvement measures

    Directory of Open Access Journals (Sweden)

    Marianne Storm

    2014-05-01

    Full Text Available Introduction: Elderly people aged over 75 years with multifaceted care needs are often in need of hospital treatment. Transfer across care levels for this patient group increases the risk of adverse events. The aim of this paper is to establish knowledge of quality in transitional care of the elderly in two Norwegian hospital regions by identifying issues affecting the quality of transitional care and based on these issues suggest improvement measures.Methodology: Included in the study were elderly patients (75+ receiving health care in the municipality admitted to hospital emergency department or discharged to community health care with hip fracture or with a general medical diagnosis. Participant observations of admission and discharge transitions (n = 41 were carried out by two researchers.Results: Six main challenges with belonging descriptions have been identified: (1 next of kin (bridging providers, advocacy, support, information brokering, (2 patient characteristics (level of satisfaction, level of insecurity, complex clinical conditions, (3 health care personnel's competence (professional, system, awareness of others’ roles, (4 information exchange (oral, written, electronic, (5 context (stability, variability, change incentives, number of patient handovers and (6 patient assessment (complex clinical picture, patient description, clinical assessment.Conclusion: Related to the six main challenges, several measures have been suggested to improve quality in transitional care, e.g. information to and involvement of patients and next of kin, staff training, standardisation of routines and inter-organisational staff meetings.

  10. An approach to quality management in anaesthesia: a focus on perioperative care and outcome.

    Science.gov (United States)

    Dahmen, K G; Albrecht, D M

    2001-01-01

    Health care systems throughout the world are faced with continuously rising health care expenditure. In Germany, a fee per capita system will be introduced by 2003 to keep the budgets for hospital care within limits. As a result, numbers of hospital beds and hospitals will be cut in the coming years. On the other hand, more and more patients and health care providers are asking if they are really receiving an adequate value for their money in the treatment they receive. All this will have a strong impact on the anaesthesiologist's work and her/his perception of the different facets of quality. Quality has various aspects for the anaesthesiologist. The patient as a customer should not incur any detrimental effects after a surgical procedure, and is accompanied by the anaesthesiologist throughout the perioperative setting. The surgeon needs optimal conditions to perform a procedure. The hospital must balance equally costs and income; this requires optimal operating room utilization. Finally, health insurance companies and the government are responsible for covering the cost of treatment according to the quality of the care delivered. Quality assessment concerning structure, process and outcome has to take these demands into account. Continuous quality improvement in the spirit of Deming's 'plan-do-check-act cycle' has to be part of anaesthesiologist's everyday routine. In future, the traditional barriers between the specialities treating a patient will be disrupted when reimbursement for treatment is made according to quality and efficacy of treatment. PMID:11766245

  11. Impacts of pay for performance on the quality of primary care.

    Science.gov (United States)

    Allen, T; Mason, T; Whittaker, W

    2014-01-01

    Increasingly, financial incentives are being used in health care as a result of increasing demand for health care coupled with fiscal pressures. Financial incentive schemes are one approach by which the system may incentivize providers of health care to improve productivity and/or adapt to better quality provision. Pay for performance (P4P) is an example of a financial incentive which seeks to link providers' payments to some measure of performance. This paper provides a discussion of the theoretical underpinnings of P4P, gives an overview of the health P4P evidence base, and provide a detailed case study of a particularly large scheme from the English National Health Service. Lessons are then drawn from the evidence base. Overall, we find that the evidence for the effectiveness of P4P for improving quality of care in primary care is mixed. This is to some extent due to the fact that the P4P schemes used in primary care are also mixed. There are many different schemes that incentivize different aspects of care in different ways and in different settings, making evaluation problematic. The Quality and Outcomes Framework in the United Kingdom is the largest example of P4P in primary care. Evidence suggests incentivized quality initially improved following the introduction of the Quality and Outcomes Framework, but this was short-lived. If P4P in primary care is to have a long-term future, the question about scheme effectiveness (perhaps incorporating the identification and assessment of potential risk factors) needs to be answered robustly. This would require that new schemes be designed from the onset to support their evaluation: control and treatment groups, coupled with before and after data. PMID:25061341

  12. Neighborhood Characteristics, and Child Care Type and Quality

    Science.gov (United States)

    Burchinal, Margaret; Nelson, Lauren; Carlson, Mary; Brooks-Gunn, Jeanne

    2008-01-01

    Research Findings: Using data from the Project on Human Development in Chicago Neighborhoods, this article relates neighborhood characteristics to the type of child care used in families with toddlers and preschoolers (N = 1,121; representative of children in Chicago in 1996-1998). Neighborhood structural disadvantage was assessed via U.S. Census…

  13. Parental stress is associated with poor sleep quality in parents caring for children with developmental disabilities

    OpenAIRE

    Gallagher, Stephen; Phillips, Anna C; Carroll, Douglas

    2010-01-01

    Objective This study examined the psychosocial predictors of poor sleep quality in parents caring for children with developmental disabilities. Methods Sixty-seven parents of children with developmental disabilities and 42 parents of typically developing children completed the Pittsburgh Sleep Quality Index, and measures of parental stress, child problem behaviors, and social support. Results Parents of children with developmental disabilities reported poorer sleep quality. Further, the major...

  14. Private Health Care and Drug Quality in Germany – A Game-Theoretical Approach

    OpenAIRE

    Tristan Nguyen; Karsten Rohlf

    2012-01-01

    Quality of medical treatment is a major goal of Germany's statutory health insurance system. According to our game theoretical approach, existing price-discrimination between statutory and private health insurance leads to a higher quality of innovative drugs. Hence, a move into the direction of a single payer health care (so-called citizens’ insurance) should result in a reduction of innovative drugs' quality. Moreover, and in the case of citizens insurance's implementation, innovative drugs...

  15. Assessing Quality across Health Care Subsystems in Mexico

    OpenAIRE

    Puig, Andrea; José A. Pagán; Wong, Rebeca

    2009-01-01

    Recent healthcare reform efforts in Mexico have focused on the need to improve the efficiency and equity of a fragmented healthcare system. In light of these reform initiatives, there is a need to assess whether healthcare subsystems are effective at providing high-quality healthcare to all Mexicans. Nationally representative household survey data from the 2006 Encuesta Nacional de Salud y Nutrición (National Health and Nutrition Survey) were used to assess perceived healthcare quality across...

  16. Trends in quality of care among patients with incident heart failure in Denmark 2003--2010 : a nationwide cohort study

    DEFF Research Database (Denmark)

    Nakano, Anne; Johnsen, SØren Paaske

    2013-01-01

    The treatment of heart failure (HF) is complex and the prognosis remains serious. A range of strategies is used across health care systems to improve the quality of care for HF patients. We present results from a nationwide multidisciplinary initiative to monitor and improve the quality of care and clinical outcome of HF patients using indicator monitoring combined with systematic auditing.

  17. Improving quality and safety in the hospital: the link between organizational culture, burnout, and quality of care.

    Science.gov (United States)

    Montgomery, Anthony; Todorova, Irina; Baban, Adriana; Panagopoulou, Efharis

    2013-09-01

    The need to improve quality of care represents a major goal of all health care systems. The objective of this series is to illuminate how the contextual factors of hospitals from eight European countries, and the well-being of their healthcare professionals, contribute to either construct or degrade quality of care. The studies reported here provide an important bottom-up perspective on quality of care, and the way that burnout and organizational culture are intertwined within it. Overall, the collected studies represent an in-depth examination through focus groups of the experiences of 153 physicians, 133 nurses, and 46 patients from Greece, Portugal, Bulgaria, Romania, Ireland, Turkey, Croatia, and the Republic of Macedonia. Each paper makes a unique contribution to the understanding of how institutional contexts, organizational management, and job characteristics impose constrains, both on the capacity of health workers for better treatment decisions and choices, but also on their day-to-day professional satisfaction and quality of life. Taken as a whole, the papers make an even greater contribution, by pointing out the underlying similarities and differences across these eight European countries. PMID:23607495

  18. Relationship between nursing care quality, nurse staffing, nurse job satisfaction, nurse practice environment, and burnout: literature review

    Directory of Open Access Journals (Sweden)

    Virya Koy

    2015-08-01

    Full Text Available The purpose of this literature review is to explore the relationship between nurse staffing, nurse job satisfaction, nurse practice environment, burnout, and nursing care quality through a consideration of what is meant by perceptions of nursing care quality. Different people define nursing care quality in many ways. It is complex, multi-faceted and multi-dimensional, and attempts to assess, monitor, evaluate and improve nursing care quality have evolved over a number of years. Of particular interest is the way in which changes in nurse staffing, nurse job satisfaction, nurse practice environment, and burnout may affect the quality of nursing care delivery. A search was conducted using the CINAHL, Medline and Embase databases, HINARI, Science Direct, Google, and PubMed. The terms searched included quality of health care; nursing care quality; nurse job satisfaction; nurse practice environment; burnout; and nurse staffing. Papers were included for their relevance to the field of enquiry. The original search was conducted in 2003 and updated in 2004. Quality of care is a complex, multi-dimensional concept, which presents researchers with a challenge when attempting to evaluate it. Many different tools have assessed nursing care quality. In addition, the review found that there were relationships between nurse staffing, nurse job satisfaction, nurse practice environment, burnout, and nursing care quality. [Int J Res Med Sci 2015; 3(8.000: 1825-1831

  19. Implementing collaborative care for depression treatment in primary care: A cluster randomized evaluation of a quality improvement practice redesign

    Directory of Open Access Journals (Sweden)

    Lee Martin

    2011-10-01

    Full Text Available Abstract Background Meta-analyses show collaborative care models (CCMs with nurse care management are effective for improving primary care for depression. This study aimed to develop CCM approaches that could be sustained and spread within Veterans Affairs (VA. Evidence-based quality improvement (EBQI uses QI approaches within a research/clinical partnership to redesign care. The study used EBQI methods for CCM redesign, tested the effectiveness of the locally adapted model as implemented, and assessed the contextual factors shaping intervention effectiveness. Methods The study intervention is EBQI as applied to CCM implementation. The study uses a cluster randomized design as a formative evaluation tool to test and improve the effectiveness of the redesign process, with seven intervention and three non-intervention VA primary care practices in five different states. The primary study outcome is patient antidepressant use. The context evaluation is descriptive and uses subgroup analysis. The primary context evaluation measure is naturalistic primary care clinician (PCC predilection to adopt CCM. For the randomized evaluation, trained telephone research interviewers enrolled consecutive primary care patients with major depression in the evaluation, referred enrolled patients in intervention practices to the implemented CCM, and re-surveyed at seven months. Results Interviewers enrolled 288 CCM site and 258 non-CCM site patients. Enrolled intervention site patients were more likely to receive appropriate antidepressant care (66% versus 43%, p = 0.01, but showed no significant difference in symptom improvement compared to usual care. In terms of context, only 40% of enrolled patients received complete care management per protocol. PCC predilection to adopt CCM had substantial effects on patient participation, with patients belonging to early adopter clinicians completing adequate care manager follow-up significantly more often than patients of clinicians with low predilection to adopt CCM (74% versus 48%%, p = 0.003. Conclusions Depression CCM designed and implemented by primary care practices using EBQI improved antidepressant initiation. Combining QI methods with a randomized evaluation proved challenging, but enabled new insights into the process of translating research-based CCM into practice. Future research on the effects of PCC attitudes and skills on CCM results, as well as on enhancing the link between improved antidepressant use and symptom outcomes, is needed. Trial Registration ClinicalTrials.gov: NCT00105820

  20. Psychosocial impact of perinatal loss among Muslim women

    Directory of Open Access Journals (Sweden)

    Sutan Rosnah

    2012-06-01

    Full Text Available Abstract Background Women of reproductive age are vulnerable to psychosocial problems, but these have remained largely unexplored in Muslim women in developing countries. The aim of this study was to explore and describe psychosocial impact and social support following perinatal loss among Muslim women. Methods A qualitative study was conducted in a specialist centre among Muslim mothers who had experienced perinatal loss. Purposive sampling to achieve maximum variation among Muslims in relation to age, parity and previous perinatal death was used. Data was collected by focus group discussion and in-depth unstructured interview until the saturation point met. Sixteen mothers who had recent perinatal loss of wanted pregnancy, had received antenatal follow up from public or private health clinics, and had delivery in our centre participated for the study. All of them had experienced psychological difficulties including feelings of confusion, emptiness and anxiety over facing another pregnancy. Results Two out of sixteen showed anger and one felt guilt. They reported experiencing a lack of communication and privacy in the hospital during the period of grief. Family members and friends play an important role in providing support. The majority agreed that the decision makers were husbands and families instead of themselves. The respondents felt that repetitive reminder of whatever happened was a test from God improved their sense of self-worth. They appreciated this reminder especially when it came from husband, family or friends closed to them. Conclusion Muslim mothers who had experienced perinatal loss showed some level of adverse psychosocial impact which affected their feelings. Husbands and family members were the main decision makers for Muslim women. Health care providers should provide psychosocial support during antenatal, delivery and postnatal care. On-going support involving husband should be available where needed.

  1. The transport on newborns in the perinatal and neonatal period

    Directory of Open Access Journals (Sweden)

    M. Adnan Öztürk

    2007-06-01

    Full Text Available The rapid advances in neonatal care of the past two decades have been accompanied by a decrease in neonatal mortality. Neonatal mortality and morbidity rates depend not only on technological advances, but also on the way in which perinatal care is organized. The transport of mother and her baby from a referring hospital to a tertiary care center may become necessary. Ideally the mother would be transferred to the tertiary center before delivery of a high-risk infant, but this is not always possible.

  2. [Perinatal sources of stem cells].

    Science.gov (United States)

    Piskorska-Jasiulewicz, Magdalena Maria; Witkowska-Zimny, Ma?gorzata

    2015-01-01

    Recently, stem cell biology has become an interesting topic. Several varieties of human stem cells have been isolated and identified in vivo and in vitro. Successful application of hematopoietic stem cells in hematology has led to the search for other sources of stem cells and expanding the scale of their application. Perinatal stem cells are a versatile cell population, and they are interesting for both scientific and practical objectives. Stem cells from perinatal tissue may be particularly useful in the clinic for autologous transplantation for fetuses and newborns, and after banking in later stages of life, as well as for in utero transplantation in the case of genetic disorders. In this review paper we focus on the extraction and therapeutic potential of stem cells derived from perinatal tissues such as the placenta, the amnion, amniotic fluid, umbilical cord blood and Wharton's jelly. PMID:25748624

  3. Governing Ideals of Good Care: Quality improvement in mental health care

    OpenAIRE

    Broer, T.

    2012-01-01

    In the spring of 2008 I attended a conference on the use of coercion in mental health care. A healthcare worker who was also a “practicing patient”, as the program told us, held an impressive lecture that captured the audience from the moment the woman walked to the front. She referred to herself as “difficult patient” and questioned certain care practices in her lecture, mainly those on the use of coercion within psychiatry. “How free are you actually?” she asked the audience....

  4. Measuring the Quality of Care in Illinois Nursing Homes. Illinois Long Term Care Research and Demonstration Projects Series. Final Report. (1987).

    Science.gov (United States)

    Cella, Margot; Gabay, Mary

    This report evaluates the types of data gathered about nursing homes during a survey process by the State of Illinois through its Inspection of Care Review and Quality Incentive Program (QUIP) assessments. The data are compared to other State systems/demonstrations in an effort to choose those indicators which best measure the quality of care in…

  5. Diversity in diabetes care programmes and views on high quality diabetes care: are we in need of a standardized framework?

    OpenAIRE

    Borgermans, Liesbeth A.D.; Geert Goderis; Marielle Ouwens; Johan Wens; Jan Heyrman; Grol, Richard P. T. M.

    2008-01-01

    Methods: A review of systematic reviews was performed. Four databases (MEDLINE database of the National Library of Medicine, COCHRANE database of Systematic Reviews, the Cumulative Index to Nursing and Allied Health Database-CINAHL and Pre-Cinahl) were searched for English review articles published between November 1989 and December 2006. Methodological quality of the articles was assessed. A standardized extraction form was used to assess features of diabetes care programmes and diabetes qua...

  6. Servant leadership: enhancing quality of care and staff satisfaction.

    Science.gov (United States)

    Neill, Mark W; Saunders, Nena S

    2008-09-01

    Servant leadership encompasses a powerful skill set that is particularly effective in implementing a team approach to the delivery of nursing practice. This model encourages the professional growth of nurses and simultaneously promotes the improved delivery of healthcare services through a combination of interdisciplinary teamwork, shared decision making, and ethical behavior. The authors describe the case application of servant leadership principles in a Department of Veterans Affairs Medical Intensive Care Unit located in a large urban center. PMID:18791423

  7. Preconception care for diabetic women for improving maternal and fetal outcomes: a systematic review and meta-analysis

    OpenAIRE

    Alansari Lubna A; Bawazeer Ghada A; Alzeidan Rasmeia A; Wahabi Hayfaa A; Esmaeil Samia A

    2010-01-01

    Abstract Background Preexisting diabetes mellitus is associated with increased risk for maternal and fetal adverse outcomes. Despite improvement in the access and quality of antenatal care recent population based studies demonstrating increased congenital abnormalities and perinatal mortality in diabetic mothers as compared to the background population. This systematic review was carried out to evaluate the effectiveness and safety of preconception care in improving maternal and fetal outcome...

  8. Effect of Home Postpartum Care on Quality of Life of Low Risk Mothers

    Directory of Open Access Journals (Sweden)

    ST Mirmolaei

    2011-09-01

    Full Text Available Background & Aim: Home care visits have unique advantages in many social problems and health complications such as psychologic complications and adverse birth outcomes. The aim of this study was to identify the effect of postpartum care at home on quality of life among low risk mothers.Methods & Materials: This interventional study was conducted in Akbarabad health center of Tehran University of Medical Sciences in 2010. A total of 200 mothers were randomly allocated in two intervention and control groups. Mothers in the control group received two post partum visits in health care center and the intervention group received care at home. Data were collected through a questionnaire including demographic characteristics and the mothers' quality of life items; along with a growth and development monitoring chart for newborns. For analyzing data, Mann-Withney U, Wilcoxon and Chi-square tests were used.Results: Most of the mothers aged 20-29 years old. The number of visits were statistically different between the two groups (P=0.00, P=0.01. Dimensions of quality of life in the two groups were not statistically different: (Physical dimension: P=0.052, (Emotional dimension: P=0.775, (Public health dimension: P=0.068, (Social performance dimension: P=0.780 and (Total score: P=0.213.Conclusion: the results of our study did not show no positive improvements in home postpartum care in comparison with the health care centers care. More studies are recommended.

  9. [Quality of abortion care in the Unified Health System of Northeastern Brazil: what do women say?].

    Science.gov (United States)

    Aquino, Estela M L; Menezes, Greice; Barreto-de-Araújo, Thália Velho; Alves, Maria Teresa; Alves, Sandra Valongueiro; de Almeida, Maria da Conceição Chagas; Schiavo, Eleonora; Lima, Luci Praciano; de Menezes, Carlos Augusto Santos; Marinho, Lilian Fátima Barbosa; Coimbra, Liberata Campos; Campbell, Oona

    2012-07-01

    Abortion is a serious health problem in Brazil and complications can be avoided by adequate and timely care. The article evaluates the quality of care given to women admitted for abortion in hospitals operated by the Unified Health System, in Salvador, Recife and São Luis, the benchmarks being Ministry of Health norms and user satisfaction. The article analyzes 2804 women admitted to hospital for abortion complications in 19 hospitals, between August and December 2010. Four dimensions were defined: reception and guidance; inputs and physical environment; technical quality and continuity of care. There was a closer fit to norms on reception and guidance. Social support and the right to information were not well rated in all three cities. The technical quality of care was rated poor. With respect to inputs and physical environment, cleanliness was the least adequate criterion. Continuity of care was the most critical situation in all three cities, due to the lack of scheduled follow-up appointments, information about care available after hospital discharge, the risk of further pregnancy and family planning. Abortion care falls short of that advocated under Brazilian norms and by international agencies. PMID:22872338

  10. Predictors of Adult Quality of Life for Foster Care Alumni with Physical and/or Psychiatric Disabilities

    Science.gov (United States)

    Anctil, Tina M.; McCubbin, Laurie D.; O'Brien, Kirk; Pecora, Peter; Anderson-Harumi, Cheryl A.

    2007-01-01

    Introduction: This study used quality of life and resilience as theoretical frameworks for evaluating predictors of outcomes for adults who received foster care services alumni of foster care and were diagnosed with a physical or psychiatric disability while in foster care. Method: First, outcomes for foster care alumni with and without physical…

  11. Quality audit--a review of the literature concerning delivery of continence care.

    Science.gov (United States)

    Swaffield, J

    1995-09-01

    This paper outlines the role of quality audit within the framework of quality assurance, presenting the concurrent and retrospective approaches available. The literature survey provides a review of the limited audit tools available and their application to continence services and care delivery, as well as attempts to produce tools from national and local standard setting. Audit is part of a process; it can involve staff, patients and their relatives and the team of professionals providing care, as well as focusing on organizational and management levels. In an era of market delivery of services there is a need to justify why audit is important to continence advisors and managers. Effectiveness, efficiency and economics may drive the National Health Service, but quality assurance, which includes standards and audit tools, offers the means to ensure the quality of continence services and care to patients and auditing is also required in the purchaser/provider contracts for patient services. An overview and progress to date of published and other a projects in auditing continence care and service is presented. By outlining and highlighting the audit of continence service delivery and care as a basis on which to build quality assurance programmes, it is hoped that this knowledge will be shared through the setting up of a central auditing clearing project. PMID:7551434

  12. Preschool center care quality effects on academic achievement: an instrumental variables analysis.

    Science.gov (United States)

    Auger, Anamarie; Farkas, George; Burchinal, Margaret R; Duncan, Greg J; Vandell, Deborah Lowe

    2014-12-01

    Much of child care research has focused on the effects of the quality of care in early childhood settings on children's school readiness skills. Although researchers increased the statistical rigor of their approaches over the past 15 years, researchers' ability to draw causal inferences has been limited because the studies are based on nonexperimental designs. The purpose of the present study was to demonstrate how an instrumental variables approach can be used to estimate causal impacts of preschool center care quality on children's academic achievement when applied to a study in which preschool curricula were randomly assigned across multiple sites. We used data from the Preschool Curriculum Evaluation Research Initiative (PCER; n = 2,700), in which classrooms or preschools were randomly assigned to that grantee's treatment curriculum or "business as usual" conditions in 18 research sites. Using this method, we demonstrate how developmental researchers can exploit the random-assignment designs of multisite studies to investigate characteristics of programs, such as preschool center care quality, that cannot be randomly assigned and their impacts on children's development. We found that the quality of preschool care received by children has significant, albeit modest, effects on children's academic school readiness, with effect sizes of .03 to .14 standard deviation increases in academic achievement associated with a 1 standard deviation increase in quality. Applications and potential policy implications of this method are discussed. PMID:25437755

  13. Psychological and social consequences among mothers suffering from perinatal loss: perspective from a low income country

    Directory of Open Access Journals (Sweden)

    Ali Mohammed

    2011-06-01

    Full Text Available Abstract Background In developed countries, perinatal death is known to cause major emotional and social effects on mothers. However, little is known about these effects in low income countries which bear the brunt of perinatal mortality burden. This paper reports the impact of perinatal death on psychological status and social consequences among mothers in a rural area of Bangladesh. Methods A total of 476 women including 122 women with perinatal deaths were assessed with the Edinburgh Postnatal Depression Scale (EPDS-B at 6 weeks and 6 months postpartum, and followed up for negative social consequences at 6 months postpartum. Trained female interviewers carried out structured interviews at women's home. Results Overall 43% (95% CI: 33.7-51.8% of women with a perinatal loss at 6 weeks postpartum were depressed compared to 17% (95% CI: 13.7-21.9% with healthy babies (p = Conclusions This study highlights the greatly increased vulnerability of women with perinatal death to experience negative psychological and social consequences. There is an urgent need to develop appropriate mental health care services for mothers with perinatal deaths in Bangladesh, including interventions to develop positive family support.

  14. Organizational factors associated with quality of care in US teaching hospitals.

    Science.gov (United States)

    Harrison, Jeffrey P; Lambiase, Louis R; Zhao, Mei

    2010-01-01

    This study is unique because it uses multiple regression and data envelopment analysis (DEA) to evaluate teaching hospital quality. The results support the premise that teaching hospital leadership through the effective allocation of resources can improve the quality of care. This study has managerial implications by demonstrating the positive correlation between HMO market penetration and improved clinical quality outcomes. This would suggest that improved efficiency caused by limited HMO reimbursement and tight utilization controls encourage hospitals to cut waste as well as improve their clinical care processes. Additionally, our research found that teaching hospitals with higher levels of long-term debt also had improved quality. This shows that increased investments in facilities and advanced technology at teaching hospitals can lead to enhanced quality. PMID:22329326

  15. Interventions and targets aimed at improving quality in inflammatory bowel disease ambulatory care

    Directory of Open Access Journals (Sweden)

    Geoffrey C Nguyen

    2013-01-01

    Full Text Available Over the past decade, there has been increasing focus on improving the quality of healthcare delivered to patients with chronic diseases, including inflammatory bowel disease. Inflammatory bowel disease is a complex, chronic condition with associated morbidity, health care costs, and reductions in quality of life. The condition is managed primarily in the outpatient setting. The delivery of high quality of care is suboptimal in several ambulatory inflammatory bowel disease domains including objective assessments of disease activity, the use of steroid-sparing agents, screening prior to anti-tumor necrosis factor therapy, and monitoring thiopurine therapy. This review outlines these gaps in performance and provides potential initiatives aimed at improvement including reimbursement programs, quality improvement frameworks, collaborative efforts in quality improvement, and the use of healthcare information technology.

  16. Measuring perinatal complications: methodologic issues related to gestational age

    Directory of Open Access Journals (Sweden)

    Caughey Aaron B

    2007-08-01

    Full Text Available Abstract Background Perinatal outcomes differ by week of gestational age. However, it appears that how measures to examine these outcomes vary among various studies. The current paper explores how perinatal complications are reported and how they might differ when different denominators, numerators, and comparison groups are utilized. Conclusion One issue that can clearly affect absolute rates and trends is how groups of women are categorized by their gestational age. Since most perinatal outcomes can only occur in women and neonates who have delivered, using the number of pregnancies delivered (PD as the denominator of outcomes is appropriate. However, for an outcome such as antepartum stillbirth, all women who are pregnant at a particular gestational age are at risk. Thus, the denominator should include all ongoing pregnancies (OP. When gestational age is used by week this means using both deliveries during a particular week plus those women who deliver beyond the particular week of gestation in the denominator. Researchers should be careful to make sure they are utilizing the appropriate measure of perinatal complications so they do not report findings that would be misleading to clinicians, patients, and policy makers.

  17. Perinatal antidepressant use: understanding women's preferences and concerns.

    Science.gov (United States)

    Battle, Cynthia L; Salisbury, Amy L; Schofield, Casey A; Ortiz-Hernandez, Samia

    2013-11-01

    Perinatal depression is prevalent and linked with a host of adverse consequences for women and newborns. Rates of engagement in depression treatment are, however, strikingly low among pregnant and postpartum women, with the majority of affected women receiving no mental health treatment. Research indicates that perinatal women are extremely reluctant to take antidepressant medications, yet the nature of women's concerns and treatment decision- making patterns have not been well documented. Developing a clearer understanding of women's treatment preferences and behaviors may help identify solutions to the under-treatment of perinatal depression. In this mixed methods study, we conducted in-depth interviews with 61 pregnant women, approximately half of whom were experiencing clinical levels of depression. In addition to assessing psychiatric diagnoses, symptoms, and functional impairment, we conducted qualitative interviews addressing women's preferences for depression treatment, concerns, and decision-making patterns. Consistent with prior reports, women were significantly more likely to voice a preference for non-pharmacologic depression treatments, as opposed to antidepressant medications. Many depressed women reported a great degree of uncertainty regarding how to treat their depression, and those with more severe depression symptoms were more likely to endorse decisional conflict. Analysis of qualitative comments yielded detailed information about the nature of women's concerns and preferences related to use of antidepressant medications and other aspects of treatment engagement. We discuss findings in the context of improving patient-centered care for perinatal depression. PMID:24241498

  18. Implementation and quality monitoring of e-communication across health care sectors

    DEFF Research Database (Denmark)

    Nicolaisen, Anne; Qvist, Peter

    Background: There has been an increased focus on how to improve the quality of care for patients that receives services from more than one sector in the health care system. Continuity in and coordination of patient pathways in the health care system are included in accreditation standards both for general practice and hospitals. An important factor for patient-perceived quality of care is the cooperation between the health care sectors that provides services for the patient. In 2009 the Region of Southern Denmark launched a collaboration agreement called Sam:Bo between general practice, hospitals and municipalities. The Sam:Bo agreement comprises guidelines for clinical pathways that involves more than one of the participating stakeholders and specified quality standards for the content and timeliness of information exchange across sectors. Part of the Sam:Bo agreement is the implementation of quality monitoring of specified quality standards. Objective: To monitor the implementation and quality of the Sam:Bo e-communication Method: An explicit audit performed in all local municipalities and at selected hospital departments from all hospital units in the Region of Southern Denmark. The audit was conducted in January-March 2015. Data will be analysed at the regional Centre for Quality. Results from each hospital and local municipalities will be presented at local audit meetings, in which challenges to address and subsequent initiatives are discussed. Results: The audit is ongoing and results will be presented at the conference. Preliminary results show that the assessed general quality of hospital admissions reports was good (37%), reasonable (35%) or inferior (29%): For correspondence messages the assessed general quality was good (65%), reasonable (25%) or inferior (9%). Conclusion: Results from this audit will identify challenges in e-communication across health care sectors and provide knowledge of the implementation and quality of the Sam:Bo e-communication. Points for discussion: How to improve quality of care using e-communication in general practice in the handover of patients and how to measure it? What are the general practitioners responsibilities?

  19. The Human Side of Quality: Employee Care and Empowerment.

    Science.gov (United States)

    Thor, Linda M.

    Frequently, educational institutions seeking to implement Total Quality Management (TQM) as a means to improve institutional effectiveness, overemphasize training in the application of TQM tools and fail to fully address human needs and concerns, such as the critical issue of employee empowerment. Four principal barriers exist to adequately…

  20. Improving critical care discharge summaries: a collaborative quality improvement project using PDSA

    Science.gov (United States)

    Goulding, Lucy; Parke, Hannah; Maharaj, Ritesh; Loveridge, Robert; McLoone, Anne; Hadfield, Sophie; Helme, Eloise; Hopkins, Philip; Sandall, Jane

    2015-01-01

    Around 110,000 people spend time in critical care units in England and Wales each year. The transition of care from the intensive care unit to the general ward exposes patients to potential harms from changes in healthcare providers and environment. Nurses working on general wards report anxiety and uncertainty when receiving patients from critical care. An innovative form of enhanced capability critical care outreach called ‘iMobile’ is being provided at King's College Hospital (KCH). Part of the remit of iMobile is to review patients who have been transferred from critical care to general wards. The iMobile team wished to improve the quality of critical care discharge summaries. A collaborative evidence-based quality improvement project was therefore undertaken by the iMobile team at KCH in conjunction with researchers from King's Improvement Science (KIS). Plan, Do, Study, Act (PDSA) methodology was used. Three PDSA cycles were undertaken. Methods adopted comprised: a scoping literature review to identify relevant guidelines and research evidence to inform all aspects of the quality improvement project; a process mapping exercise; informal focus groups / interviews with staff; patient story-telling work with people who had experienced critical care and subsequent discharge to a general ward; and regular audits of the quality of both medical and nursing critical care discharge summaries. The following behaviour change interventions were adopted, taking into account evidence of effectiveness from published systematic reviews and considering the local context: regular audit and feedback of the quality of discharge summaries, feedback of patient experience, and championing and education delivered by local opinion leaders. The audit results were mixed across the trajectory of the project, demonstrating the difficulty of sustaining positive change. This was particularly important as critical care bed occupancy and through-put fluctuates which then impacts on work-load, with new cohorts of staff regularly passing through critical care. In addition to presenting the results of this quality improvement project, we also reflect on the lessons learned and make suggestions for future projects.

  1. Behavioral effects of perinatal opioid exposure.

    Science.gov (United States)

    Fodor, Anna; Tímár, Júlia; Zelena, Dóra

    2014-05-28

    Opioids are among the world's oldest known drugs used mostly for pain relief, but recreational use is also widespread. A particularly important problem is opioid exposure in females, as their offspring can also be affected. Adverse intrauterine and postnatal environments can affect offspring development and may lead to various disabilities later in life. It is clear that repetitive painful experiences, such as randomly occurring invasive procedures during neonatal intensive care, can permanently alter neuronal and synaptic organization and therefore later behavior. At the same time, analgesic drugs can also be harmful, inducing neuronal apoptosis or withdrawal symptoms in the neonate and behavioral alterations in adulthood. Hence, risk-benefit ratios should be taken into consideration when pain relief is required during pregnancy or in neonates. Recreational use of opioids can also alter many aspects of life. Intrauterine opioid exposure has many toxic effects, inducing poor pregnancy outcomes due to underdevelopment, but it is believed that later negative consequences are more related to environmental factors such as a chaotic lifestyle and inadequate prenatal care. One of the crucial components is maternal care, which changes profoundly in addicted mothers. In substance-dependent mothers, pre- and postnatal care has special importance, and controlled treatment with a synthetic opioid (e.g., methadone) could be beneficial. We aimed to summarize and compare human and rodent data, as it is important to close the gap between scientific knowledge and societal policies. Special emphasis is given to gender differences in the sensitivity of offspring to perinatal opioid exposure. PMID:24746901

  2. Quality Reforms in Danish Home Care : Balancing between Standardisation and Individualisation

    DEFF Research Database (Denmark)

    Rostgaard, Tine

    2012-01-01

    Despite relatively generous coverage of the over-65 population, Danish home help services receive regular criticism in the media and public opinion polls. Perhaps as a consequence, reforms of Danish home care policy for senior citizens have placed strong emphasis on quality since the 1990s. This reform strategy represents a shift from the welfare state modernisation program of the 1980s, which built mainly on economic strategies of cost-efficiency and New Public Management (NPM) princi-ples, including contract management and performance management. Recent reforms have instead attempted to increase the overall quality of care by increasing the transparency at the political, administrative and user levels. However, reforms have revolved around conflicting principles of standardisation and the individualisation of care provision and primarily succeeded in increasing the political and ad-ministrative control over home help at the expense of the control by users, care workers and case managers.

  3. Is readmission a valid indicator of the quality of inpatient psychiatric care?

    Science.gov (United States)

    Durbin, Janet; Lin, Elizabeth; Layne, Crystal; Teed, Moira

    2007-04-01

    Early return to hospital is a frequently measured outcome in mental health system performance monitoring yet its validity for evaluating quality of inpatient care is unclear. This study reviewed research conducted in the last decade on predictors of early readmission (within 30 to 90 days of discharge) to assess the association between this indicator and quality of inpatient psychiatric care. Only 13 studies met inclusion criteria. Results indicated that risk is greatest in the 30-day period immediately after discharge. There was modest support that attending to stability of clinical condition and preparing patients for discharge can protect against early readmission. A history of repeated admission increases risk, suggesting that special efforts are required to break the revolving door cycle. The authors identified a need for more standardization in measurement of client status at discharge and related care processes, more intervention studies on discharge practices, and studies of the effect of community care on early readmission. PMID:17437186

  4. Instrument for assessing the quality of mobile emergency pre-hospital care: content validation

    Directory of Open Access Journals (Sweden)

    Rodrigo Assis Neves Dantas

    2015-06-01

    Full Text Available OBJECTIVES To validate an instrument to assess quality of mobile emergency pre-hospital care. METHOD A methodological study where 20 professionals gave their opinions on the items of the proposed instrument. The analysis was performed using Kappa test (K and Content Validity Index (CVI, considering K> 0.80 and CVI ? 0.80. RESULTS Three items were excluded from the instrument: Professional Compensation; Job Satisfaction and Services Performed. Items that obtained adequate K and CVI indexes and remained in the instrument were: ambulance conservation status; physical structure; comfort in the ambulance; availability of material resources; user/staff safety; continuous learning; safety demonstrated by the team; access; welcoming; humanization; response time; costumer privacy; guidelines on care; relationship between professionals and costumers; opportunity for costumers to make complaints and multiprofessional conjunction/actuation. CONCLUSION The instrument to assess quality of care has been validated and may contribute to the evaluation of pre-hospital care in mobile emergency services.

  5. Instrument for assessing the quality of mobile emergency pre-hospital care: content validation.

    Science.gov (United States)

    Dantas, Rodrigo Assis Neves; Torres, Gilson de Vasconcelos; Salvetti, Marina de Góes; Dantas, Daniele Vieira; Mendonça, Ana Elza Oliveira de

    2015-01-01

    OBJECTIVES To validate an instrument to assess quality of mobile emergency pre-hospital care. METHOD A methodological study where 20 professionals gave their opinions on the items of the proposed instrument. The analysis was performed using Kappa test (K) and Content Validity Index (CVI), considering K> 0.80 and CVI ? 0.80. RESULTS Three items were excluded from the instrument: Professional Compensation; Job Satisfaction and Services Performed. Items that obtained adequate K and CVI indexes and remained in the instrument were: ambulance conservation status; physical structure; comfort in the ambulance; availability of material resources; user/staff safety; continuous learning; safety demonstrated by the team; access; welcoming; humanization; response time; costumer privacy; guidelines on care; relationship between professionals and costumers; opportunity for costumers to make complaints and multiprofessional conjunction/actuation. CONCLUSION The instrument to assess quality of care has been validated and may contribute to the evaluation of pre-hospital care in mobile emergency services. PMID:26107697

  6. Perinatally infected adolescents living with human immunodeficiency virus (perinatally human immunodeficiency virus)

    Science.gov (United States)

    Cruz, Maria Leticia S; Cardoso, Claudete A

    2015-01-01

    The availability of highly potent antiretroviral treatment during the last decades has transformed human immunodeficiency virus (HIV) infection into a chronic disease. Children that were diagnosed during the first months or years of life and received treatment, are living longer and better and are presently reaching adolescence and adulthood. Perinatally HIV-infected adolescents (PHIV) and young adults may present specific clinical, behavior and social characteristics and demands. We have performed a literature review about different aspects that have to be considered in the care and follow-up of PHIV. The search included papers in the MEDLINE database via PubMed, located using the keywords “perinatally HIV-infected” AND “adolescents”. Only articles published in English or Portuguese from 2003 to 2014 were selected. The types of articles included original research, systematic reviews, and quantitative or qualitative studies; case reports and case series were excluded. Results are presented in the following topics: “Puberal development and sexual maturation”, “Growth in weight and height”, “Bone metabolism during adolescence”, “Metabolic complications”, “Brain development, cognition and mental health”, “Reproductive health”, “Viral drug resistance” and “Transition to adult outpatient care”. We hope that this review will support the work of pediatricians, clinicians and infectious diseases specialists that are receiving these subjects to continue treatment. PMID:26279988

  7. Identifying organisational principles and management practices important to the quality of health care services for chronic conditions

    DEFF Research Database (Denmark)

    Frølich, Anne

    2012-01-01

    The quality of health care services offered to people suffering from chronic diseases often fails to meet standards in Denmark or internationally. The population consisting of people with chronic diseases is large and accounts for about 70% of total health care expenses. Given that resources are limited, it is necessary to identify efficient methods to improve the quality of care. Comparing health care systems is a well-known method for identifying new knowledge regarding, for instance, organisa...

  8. Setting Standards at the Forefront of Delivery System Reform: Aligning Care Coordination Quality Measures for Multiple Chronic Conditions

    OpenAIRE

    Dugoff, Eva H.; Dy, Sydney; Giovannetti, Erin R.; Leff, Bruce; Boyd, Cynthia M

    2013-01-01

    The primary study objective is to assess how three major health reform care coordination initiatives (Accountable Care Organizations, Independence at Home, and Community-based Care Transitions) measure concepts critical to care coordination for people with multiple chronic conditions. We find that there are major differences in quality measurement across these three large and politically important programs. Quality measures currently used or proposed for these new health reform-related progra...

  9. Panel discussion: the role of quality management in health care today and tomorrow.

    Science.gov (United States)

    1993-05-01

    In March 1993, the Quality Research Institute (Princeton, NJ) held a two-day seminar in Winter Park, Florida, sponsored by Philip Crosby Associates and The Gallup Organization, to discuss quality management in health care. The highlight of the seminar was a panel discussion among some key "down-in-the-trenches" leaders of quality about how to lead an organization through a cultural change; involve physicians in the quality process; reduce costs and variation; introduce guidelines; involve patients; and do more with less. PMID:8332333

  10. Development of paediatric quality of inpatient care indicators for low-income countries - A Delphi study

    OpenAIRE

    Weber Martin; Carpenter James; Sanderson Colin; Hutchings Andrew; Ntoburi Stephen; English Mike

    2010-01-01

    Abstract Background Indicators of quality of care for children in hospitals in low-income countries have been proposed, but information on their perceived validity and acceptability is lacking. Methods Potential indicators representing structural and process aspects of care for six common conditions were selected from existing, largely qualitative WHO assessment tools and guidelines. We employed the Delphi technique, which combines expert opinion and existing scientific information, to assess...

  11. An assessment of routine primary care health information system data quality in Sofala Province, Mozambique

    OpenAIRE

    Cuembelo Fatima; Karagianis Marina; Lara Joseph; Lambdin Barrot; Micek Mark; Gimbel Sarah; Gloyd Stephen S; Pfeiffer James; Sherr Kenneth

    2011-01-01

    Abstract Background Primary health care is recognized as a main driver of equitable health service delivery. For it to function optimally, routine health information systems (HIS) are necessary to ensure adequate provision of health care and the development of appropriate health policies. Concerns about the quality of routine administrative data have undermined their use in resource-limited settings. This evaluation was designed to describe the availability, reliability, and validity of a sam...

  12. An evaluation of the quality of care midwives provide during the postpartum period in northern Botswana

    OpenAIRE

    Kebalepile, Tapiwa Mavis

    2001-01-01

    Objective: To assess the quality of care midwives provide to clients during the postpartum period. Design: A cross sectional descriptive qualitative and quantitative survey among 65 practising registered nurse midwives. They were interviewed and observed in health institutions while examining the mother and baby prior to discharge. A convenient non-probability sampling was used to identify and select respondents from 14 primary health care facilities in northern Botswana, who were actively in...

  13. Linkages between workplace stressors and quality of care from health professionals' perspective - Macedonian experience

    OpenAIRE

    2013-01-01

    Objectives. During last two decades, within the process of transition, the socioeconomic reforms in Republic of Macedonia reflected on the national health care system. The objective of this article was to identify workplace stressors and factors that influence quality of care, from the perspective of health professionals (HPs), and to understand how they were linked in the context of such social circumstances. Methods. A qualitative research based on focus group (FG) m...

  14. Comparative analysis of quality assurance in health care delivery and higher medical education

    OpenAIRE

    Busari JO

    2012-01-01

    Jamiu O BusariDepartment of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, University of Maastricht, Maastricht, The NetherlandsAbstract: Quality assurance (QA) in higher medical education involves the development, sustenance, improvement, and evaluation of the standard of training of medical professionals. In health care delivery, QA focuses on guaranteeing and maintaining a high standard of the service provided in different health care systems. When the...

  15. Use of a customer satisfaction survey by health care regulators: a tool for total quality management.

    OpenAIRE

    Andrzejewski, N; Lagua, R T

    1997-01-01

    OBJECTIVES: To conduct a survey of health care providers to determine the quality of service provided by the staff of a regulatory agency; to collect information on provider needs and expectations; to identify perceived and potential problems that need improvement; and to make changes to improve regulatory services. METHODS: The authors surveyed health care providers using a customer satisfaction questionnaire developed in collaboration with a group of providers and a research consultant. The...

  16. Quality standards for health care delivery and management in publicly oriented health services

    OpenAIRE

    Unger, J. P.; B Marchal; Green, A

    2005-01-01

    In 1999, the multidisciplinary Tavistock group prepared a generic statement of ethical principles to govern health care systems. This paper elaborates on these principles in two directions. First, it develops a set of quality standards, based on ethical principles, intended to regulate health care delivery and service management. Second, it focuses them on 'publicly oriented' (not necessarily governmental) as opposed to 'for profit' (not necessarily private) services. We propose ten principle...

  17. Quality of Nursing Care in Psychiatric Wards of University Hospitals in Northwest of Iran from the Perceptions of Nurses

    OpenAIRE

    Hossein EBRAHIMI; Namdar, Hossein; Vahidi, Maryam

    2012-01-01

    Introduction: Nursing care is considered as an essential component of health services. Patients’ health improvement depends upon the quality of nursing care. As an important principle, perceptions of nurses as well as their active participation in decision-makings has an important role in the quality of services. This study aimed to determine the percep-tion of nurses toward the quality of nursing care in psychiatric wards. Methods: In this descriptive study, we used census ...

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

    OpenAIRE

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

    2004-01-01

    OBJECTIVES: 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. METHODS: 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 pa...

  19. Putting the spotlight on health literacy to improve quality care.

    Science.gov (United States)

    2003-07-01

    A recent survey from the American Medical Association Foundation found that the issue of health literacy is just a blip on many physicians' radar screens. However, this problem is beginning to receive greater attention because of its magnitude: An estimated 90 million adult Americans face challenges in understanding basic, common instructions given to them by their physicians. Related to low health literacy is the potential impact on patient outcomes, which could mean additional healthcare costs of up to $73 billion annually. This issue of The Quality Letter for Healthcare Leaders looks at how health literacy is defined and what can be done to improve communication among providers and patients from all walks of life to promote quality healthcare. PMID:12918286

  20. Developing a Total Quality Management Model for Health Care Systems

    OpenAIRE

    AM Mosadegh Rad; M Ansarian

    2005-01-01

    Background: Total quality management (TQM) is a managerial practice to improve the effectiveness, efficiency, flexibility, and competitiveness of a business as a whole. However, in practice, these TQM benefits are not easy to achieve. Despite its theoretical promise and the enthusiastic response to TQM, recent evidence suggests that attempts to implement it are often unsuccessful. Many of these TQM programmes have been cancelled, or are in the process of being cancelled, as a result of the ne...

  1. PELAYANAN KESEHATAN PERINATAL DI DAERAH PEDESAAN UJUNG BERUNG

    Directory of Open Access Journals (Sweden)

    Anna Alisjahbana

    2012-09-01

    Full Text Available A survey on perinatal care in a rural area at Ujung Berung district, located 15—20 km outside Bandung, West Java was conducted. Three villages with a population of 40,787 were selected. Health services were provided by one health post and several family planning posts. In this study 1303 pregnant women were followed throughout the 28 weeks of pregnancy until the infant is 28 days of age. Among the 1303 pregnant women 5.7% had received tetanus toxoid immunization. Perinatal mortality rate (PMR was 43.6 per thousand and incidence of low birth weight was 14.3 percent. Only 12.8% pregnant women were using some kind of contraception before the last pregnancy. The PMR decreased in spite of the low percentage users. The main causes of death during perinatal period vece asphyxia neonatorum and infections. The incidence of tetanus neonatorum during neonatal period was 17 per thousand live births. An evaluation of health service activities showed 47.5% of these pregnant women had antenatal care. Care during delivery and early postnatal period was carried out by TBAs. No significant difference was found between the PMR of trained and untrained TBAs. Another aspect of health service activities is referral to the health centre or hospital. A total of 3.8 percent infants were referred because of neo­natal problems; among these, refusal was 12.5% due to the totalistic attitude of the parents in the village. The results showed that coverage of pregnant women and their infants by safe health care services is very low. This may be due to lack of facilities and health personnel, and probably also due to the confidence of village people for traditional health care providers. Thus, education and training as well as supervision of traditional health care providers and their integration into the formal health care structure is of extreme importance.  

  2. Relationships, The Heart of Quality Care: Creating Community among Adults in Early Care Settings

    Science.gov (United States)

    Baker, Amy; Manfredi-Petitt, Lynn

    2004-01-01

    Children's interactions with their special grown-ups affect everything in their lives, especially in their earliest years. And the relationships between those special people matter, too. When adult connections are caring and strong, parents, caregivers, and directors are motivated and empowered to work together to help children thrive. The book…

  3. General practitioners’ views on quality markers for children in UK primary care: a qualitative study

    Directory of Open Access Journals (Sweden)

    Gill Peter J

    2012-09-01

    Full Text Available Abstract Background Children make up about 20% of the UK population and caring for them is an important part of a general practitioner’s (GP’s workload. However, the UK Quality Outcomes Framework (pay-for-performance system largely ignores children – less than 3% of the quality markers relate to them. As no previous research has investigated whether GPs would support or oppose the introduction of child-specific quality markers, we sought their views on this important question. Methods Qualitative interview study with 20 GPs from four primary care trusts in Thames Valley, England. Semi-structured interviews explored GPs’ viewpoints on quality markers and childhood conditions that could be developed into markers in general practice. Interviews were audiotaped and transcribed verbatim. Analysis was thematic and used constant comparative method to look for anticipated and emergent themes as the analysis progressed. Results All the GPs interviewed supported the development of ‘benchmarks’ or ‘standards’ to measure and improve quality of care for children. However no consensus was expressed about the clinical conditions for which quality markers should be developed. Many participants reflected on their concerns about unmet health care needs and felt there may be opportunities to improve proactive care in ‘at risk’ groups. Some expressed feelings of powerlessness that important child-relevant outcomes such as emergency department visits and emergency admissions were out of their control and more directly related to public health, school and parents/carers. The importance of access was a recurrent theme; access to urgent general practice appointments for children and GP access to specialists when needed. Conclusion The GPs expressed support for the development of quality markers for the care of children in UK general practice. However, they flagged up a number of important challenges which need to be addressed if markers are to be developed that are measureable, targeted and within the direct control of primary care. Easy access to primary and secondary care appointments may be an important benchmark for commissioners of care.

  4. Nursing theory based changes of work organisation in an ICU: effects on quality of care.

    Science.gov (United States)

    Boström, I; Hall-Lord, M L; Larsson, G; Wilde, B

    1992-03-01

    The study evaluated the effects of an organisational change programme on quality of care in a Swedish intensive care unit (ICU). The programme included: structural components e.g. converting assistant nurse positions to nurse positions; behavioural components e.g. improvements of report routines; and attitudinal components e.g. explication of what quality of care could mean in the ICU. Planning and implementation of the programme took about 1 year. Quality of care was studied on 40 patients 3 months before the intervention and on 40 patients 18 months after. An observation and question scheme was used for data collection. using Henderson's (1960) nursing model of patient's needs as point of departure. Statistically significant improvements of quality of care were noted on several observations at the postintervention assessment. Most of the improvements were noted on activities aimed at assisting the patient with basic physical needs such as breathing, nutrition, elimination, movement, sleep and rest, and avoiding dangers. No effects were noted on activities aimed at assisting the patient with psychological and spiritual needs. Discussing the results, the multimodal character of the intervention programme was believed to be a significant factor. PMID:1559018

  5. Incorporating Interprofessional Evidenced-Based Sepsis Simulation Education for Certified Nursing Assistants (CNAs) and Licensed Care Providers Within Long-term Care Settings for Process and Quality Improvement.

    Science.gov (United States)

    Mihaljevic, Susan E; Howard, Valerie M

    2016-01-01

    Improving resident safety and quality of care by maximizing interdisciplinary communication among long-term care providers is essential in meeting the goals of the United States' Federal Health care reform. The new Triple Aim goals focus on improved patient outcomes, increasing patient satisfaction, and decreased health care costs, thus providing consumers with quality, efficient patient-focused care. Within the United States, sepsis is the 10th leading cause of death with a 28.6% mortality rate in the elderly, increasing to 40% to 60% in septic shock. As a result of the Affordable Care Act, the Centers for Medicare & Medicaid services supported the Interventions to Reduce Acute Care Transfers 3.0 program to improve health care quality and prevent avoidable rehospitalization by improving assessment, documentation, and communication among health care providers. The Interventions to Reduce Acute Care Transfers 3.0 tools were incorporated in interprofessional sepsis simulations throughout 19 long-term care facilities to encourage the early recognition of sepsis symptoms and prompt communication of sepsis symptoms among interdisciplinary teams. As a result of this simulation training, many long-term care organizations have adopted the STOP and WATCH and SBAR tools as a venue to communicate resident condition changes. PMID:26633155

  6. The trade-off between hospital cost and quality of care. An exploratory empirical analysis.

    Science.gov (United States)

    Morey, R C; Fine, D J; Loree, S W; Retzlaff-Roberts, D L; Tsubakitani, S

    1992-08-01

    The debate concerning quality of care in hospitals, its "value" and affordability, is increasingly of concern to providers, consumers, and purchasers in the United States and elsewhere. We undertook an exploratory study to estimate the impact on hospital-wide costs if quality-of-care levels were varied. To do so, we obtained costs and service output data regarding 300 U.S. hospitals, representing approximately a 5% cross section of all hospitals operating in 1983; both inpatient and outpatient services were included. The quality-of-care measure used for the exploratory analysis was the ratio of actual deaths in the hospital for the year in question to the forecasted number of deaths for the hospital; the hospital mortality forecaster had earlier (and elsewhere) been built from analyses of 6 million discharge abstracts, and took into account each hospital's actual individual admissions, including key patient descriptors for each admission. Such adjusted death rates have increasingly been used as potential indicators of quality, with recent research lending support for the viability of that linkage. The authors then utilized the economic construct of allocative efficiency relying on "best practices" concepts and peer groupings, built using the "envelopment" philosophy of Data Envelopment Analysis and Pareto efficiency. These analytical techniques estimated the efficiently delivered costs required to meet prespecified levels of quality of care. The marginal additional cost per each death deferred in 1983 was estimated to be approximately $29,000 (in 1990 dollars) for the average efficient hospital. Also, over a feasible range, a 1% increase in the level of quality of care delivered was estimated to increase hospital cost by an average of 1.34%. This estimated elasticity of quality on cost also increased with the number of beds in the hospital. PMID:1640765

  7. Spanish-speaking patients perceive high quality care in resident continuity practices: a CORNET study.

    Science.gov (United States)

    Krugman, Scott D; Parra-Roide, Lilia; Hobson, Wendy L; Garfunkel, Lynn C; Serwint, Janet R

    2009-04-01

    Prior research has demonstrated that limited English proficiency in Hispanic patients is associated with adverse health outcomes. The authors sought to compare the perception of primary care in resident practices between Spanish-speaking and English-speaking parents using a previously validated tool, the Parents' Perception of Primary Care. Using survey results from 19 CORNET sites nationwide, they compared mean scores for each primary care domain and the full scale between the groups using Student's t test. Multiple linear regression models compared outcomes controlling for demographic variables. Of the 2122 analyzable surveys, 490 (23%) were completed in Spanish and 1632 (77%) in English. The mean scores for each domain and the total scale were not statistically different between the 2 groups. After adjustment, Spanish-speaking parents rated communication significantly higher. Resident clinics may use systems to provide high quality care to Spanish-speaking patients, which may help other sites improve care. PMID:19023106

  8. Multistate Collaboration to Confidentially Review Unanticipated Perinatal Outcomes: Lessons Learned.

    Science.gov (United States)

    Donnelly, Kyla; Lauria, Michele R; Flanagan, Victoria

    2015-10-01

    This commentary describes the development of The Northern New England Perinatal Quality Improvement Network's Confidential Review and Improvement Board and its lessons learned from reviewing cases of unanticipated perinatal outcomes between 2010 and 2013. The Confidential Review and Improvement Board is a multistate mechanism for rigorous and confidential case review of unanticipated perinatal outcomes among unaffiliated academic medical centers, community hospitals, and home birth midwives. We performed semistructured interviews with key individuals participating in the Confidential Review and Improvement Board since its inception and used inductive content analysis to analyze 22 consecutive case reviews. The Confidential Review and Improvement Board's case reviews involved five key clinical situations: second stage of labor management with neonatal depression, obstetric hemorrhage, uterine rupture, fetal demise, and maternal sepsis. A recurrent theme was failure to differentiate maternal from fetal heart rate associated with the birth of severely compromised newborns. Analysis of the Confidential Review and Improvement Board cases revealed opportunities for improvement in the following categories: 1) timely application of best practice, 2) documentation, and 3) communication. The Confidential Review and Improvement Board's evidence-based recommendations centered on strengthening multidisciplinary training through simulation, improving documentation and communication systems, and developing and implementing guidelines with appropriate tools. The Confidential Review and Improvement Board demonstrates that collaboration among unaffiliated rural perinatal providers-who are often direct market competitors-is possible and catalyzes regional improvement efforts. PMID:26348191

  9. The impact of managed care penetration and hospital quality on efficiency in hospital staffing.

    Science.gov (United States)

    Mobley, Lee R; Magnussen, Jon

    2002-01-01

    The state of California has recently mandated minimum nurse-staffing ratios, raising concerns about possible affects on hospital efficiency. In this study, we examine how market factors and quality were related to staffing levels in California hospitals in 1995 (prior to implementation of the new law). We are particularly interested in the affect of managed care penetration on this aspect of hospital efficiency because the call to legislative action was predicated on fears that hospitals were reducing staffing below optimal levels in response to managed care pressures. We derive a unique measure of excess staffing in hospitals based on a data envelopment analysis (DEA) production function model, which explicitly includes ancillary care among the inputs and outputs. This careful specification of production is important because ancillary care use has risen relative to daily hospital services, with the spread of managed care and advances in medical technology. We find that market share (adjusted for size) and market concentration are the major determinants of excess staffing while managed care penetration is insignificant. We also find that poor quality (outcomes worse than expected) is associated with less efficient staffing. These findings suggest that the larger, more efficient urban hospitals will be penalized more heavily under binding staffing ratios than smaller, less-urban hospitals. PMID:12148662

  10. Racial and ethnic disparities in access to and quality of health care.

    Science.gov (United States)

    Escarce, Jose J; Goodell, Sarah

    2007-09-01

    Racial and ethnic disparities in access to care and quality of care are pervasive but not universal. This Synthesis reviews the evidence on racial and ethnic disparities. Key findings include: disparities exist in many indicators of access, such as having a usual source of care, number of ambulatory visits, and receiving recommended preventive care, but some disparities are reduced or nearly eliminated after adjusting for factors such as income and insurance coverage. Hispanics have a large gap relative to Whites in many access factors. Spanish-speaking Hispanics have the greatest disparities relative to non-Hispanic whites, suggesting language is a barrier. Both Blacks and Hispanics are less likely than Whites to identify a doctor's office as their usual source of care, which can point to problems with continuity of care and less favorable outcomes. The most significant disparities in quality of care involve newer therapies and invasive procedures. Adjusting the data for insurance coverage demonstrates that expanding coverage will reduce but not eliminate disparities. PMID:22051771

  11. Performance management excellence among the Malcolm Baldrige National Quality Award Winners in Health Care.

    Science.gov (United States)

    Duarte, Neville T; Goodson, Jane R; Arnold, Edwin W

    2013-01-01

    When carefully constructed, performance management systems can help health care organizations direct their efforts toward strategic goals, high performance, and continuous improvement needed to ensure high-quality patient care and cost control. The effective management of performance is an integral component in hospital and health care systems that are recognized for excellence by the Malcolm Baldrige National Quality Award in Health Care. Using the framework in the 2011-2012 Health Care Criteria for Performance Excellence, this article identifies the best practices in performance management demonstrated by 15 Baldrige recipients. The results show that all of the recipients base their performance management systems on strategic goals, outcomes, or competencies that cascade from the organizational to the individual level. At the individual level, each hospital or health system reinforces the strategic direction with performance evaluations of leaders and employees, including the governing board, based on key outcomes and competencies. Leader evaluations consistently include feedback from internal and external stakeholders, creating a culture of information sharing and performance improvement. The hospitals or health care systems also align their reward systems to promote high performance by emphasizing merit and recognition for contributions. Best practices can provide a guide for leaders in other health systems in developing high-performance work systems. PMID:24168871

  12. The new health-care quality: value, outcomes, and continuous improvement.

    Science.gov (United States)

    O'Connor, S J; Lanning, J A

    1991-01-01

    No longer convinced that their viewpoint on quality is the only one, different stakeholders in the health-care arena are sharing perspectives to piece together the quality picture. Although still preoccupied with the cost of health care, purchasers are concerned about value--efficiency, appropriateness, and effectiveness--as well as price. Faced with evidence of medically unnecessary procedures and unexamined medical theory, practitioners are searching for appropriateness guidelines, useful outcome measures, and methods to elicit informed patient preferences about elective surgeries. Underlying this search for reliable indicators of quality--now expanded to include patient satisfaction--is a new interest in the Japanese notion of "Kaizen" or continuous quality improvement. The end product of this ferment may determine whether good medicine drives out the bad--or vice versa. PMID:10118887

  13. Quality and effectiveness of different approaches to primary care delivery in Brazil

    Directory of Open Access Journals (Sweden)

    Trindade Thiago G

    2006-12-01

    Full Text Available Abstract Background Since 1994, Brazil has developed a primary care system based on multidisciplinary teams which include not only a physician and a nurse, but also 4–6 lay community health workers. This system now consists of 26,650 teams, covering 46% of the Brazilian population. Yet relatively few investigations have examined its effectiveness, especially in contrast with that of the traditional multi-specialty physician team approach it is replacing, or that of other existing family medicine approaches placing less emphasis on lay community health workers. Primary health care can be defined through its domains of access to first contact, continuity, coordination, comprehensiveness, community orientation and family orientation. These attributes can be ascertained via instruments such as the Primary Care Assessment Tool (PCATool, and correlated with the effectiveness of care. The objectives of our study are to validate the adult version of this instrument in Portuguese, identify the extent (quality of primary care present in different models of primary care services, and correlate this extent with measures of process and outcomes in patients with diabetes, hypertension and coronary heart disease (CHD. Methods/Design We are conducting a population-based cross-sectional study of primary care in the municipality of Porto Alegre. We will interview a random sample totaling 3000 adults residing in geographic areas covered by four distinct models of primary care of the Brazilian national health system or, alternatively, by one nationally prominent complementary health care service, as well as the physicians and nurses of the health teams of these services. Interviews query perceived quality of care (PCATool-Adult Version, patient satisfaction, and process indicators of management of diabetes, hypertension and known CHD. We are measuring blood pressure, anthropometrics and, in adults with known diabetes, glycated hemoglobin. Discussion We hope to contribute not only by validating the PCATool-Adult Version for use in Brazil, but also by furnishing ample data concerning the appropriate mix of health care professionals in the primary care team, a question of international import. Once validated, future use of this instrument should help direct advances aiming at improving the quality of primary care in Brazil.

  14. Health care quality, access, cost, workforce, and surgical education: the ultimate perfect storm.

    Science.gov (United States)

    Schwartz, Marshall Z

    2012-01-01

    The discussions on health care reform over the past two years have focused on cost containment while trying to maintain quality of care. Focusing on just cost and quality unfortunately does not address other very important factors that impact on our health care delivery system. Availability of a well-trained workforce, maintaining the sophisticated medical/surgical education system, and ultimately access to quality care by the public are critical to maintaining and enhancing our health care delivery system. Unfortunately, all five of these components are under at risk. Thus, we have evolving the ultimate perfect storm affecting our health care delivery system. Although not ideal and given the uniqueness of our population and their expectations, our current delivery system is excellent compared to other countries. However, the cost of our current system is rising at an alarming rate. Currently, health care consumes 17% of our gross domestic product. If our system is not revised this will continue to rise and by 2025 it will consume 48%. The dilemma, given the current state of our overall economy and rising debt, is how to address this major problem. Unfortunately, the Affordable Care Act, which is now law, does not address most of the issues and the cost was initially grossly under estimated. Furthermore, the law does not address the issues of workforce, maintaining our medical education system or ultimately, access. A major revision of our system will be necessary to truly create a system that protects and enhances all five of the components of our health care delivery system. To effectively accomplish this will require addressing those issues that lead to wasteful spending and diversion of our health care dollars to profit instead of care. Improved and efficient delivery systems that reduce complications, reduction of duplication of tertiary and quaternary programs or services within the same markets (i.e. regionalization of care), health insurance reform, and tort reform collectively could save hundreds of billion dollars per year! These changes may not be easy to accomplish politically but will be essential to save what is likely the best health care system in the world. PMID:22244385

  15. Using hospital surveys to enhance the quality of care.

    Science.gov (United States)

    Carey, R G

    1989-11-01

    Hospitals need the data that valid surveys can provide. However, no data are better than inaccurate or poorly interpreted data. Survey research appears to be deceptively simple. Many hospital managers are not sensitive to the pitfalls in writing a quality questionnaire and some who have their own personal computers believe that they can enter and tabulate the data. However, just as medical technology has advanced and become more complicated in recent years, survey research has also become more sophisticated during the past decade. The use of computers has assisted in the display of vast amounts of survey data, but interpretation is still the key to effective survey research. Many people can read the same table of data but come to different conclusions, depending on their point of view and their level of involvement with the issues being discussed. It is only human nature to interpret data to support what we believe to be the truth. Hospital managers should understand that interpretation of survey data is best done by neutral and skilled professionals who have worked closely with those who have authority to make costly decisions based on the results. A radiologist will tell you that reading a CT scan is an art as well as a science. So is quality survey research. PMID:10295772

  16. Enhancing Patient Safety and Quality of Surgical Cancer Care: The French National Cancer Plans

    OpenAIRE

    Evrard, Serge

    2010-01-01

    Abstract Two National Cancer Plans (2003 – 2007 and 2009 – 2013) have been launched in France to organise the healthcare offer in order to enhance quality and safety. The current Cancer Plan[1] defines regulatory frameworks across the three major areas of cancer therapy: surgery, chemotherapy and radiotherapy. These regulatory frameworks are based on three pillars: transversal requirements for the quality of care; establishment of minimal thresholds for institutions and technical c...

  17. Assessing the Acceptability of Quality Indicators and Linkages to Payment in Primary Care in Nova Scotia

    OpenAIRE

    Burge, Fred; Lawson, Beverley; Putnam, Wayne

    2011-01-01

    In 2006, the Canadian Institute for Health Information (CIHI) released a comprehensive set of quality indicators (QIs) for primary healthcare (PHC). We explored the acceptability of a subset of these as measures of the technical quality of care and the potential link to payment incentive tools. A modified Delphi approach, based on the RAND consensus panel method, was used with an expert panel composed of PHC providers (family physicians, nurses and nurse practitioners) and decision-makers wit...

  18. Developing Indicators of Service Quality Provided for CardiovascularPatients Hospitalized in Cardiac Care Unit

    OpenAIRE

    AZAMI-AGHDASH, Saber; Ghaffari, Samad; Sadeghi-bazargani, Homayoun; Tabrizi, Jafar-Sadegh; Yagoubi, Alireza; NAGHAVI-BEHZAD, Mohammad

    2013-01-01

    Introduction:Cardiovascular diseases are among the most prevalent chronic diseases leading to high degrees of mortality and morbidity worldwide and in Iran. The aim of the current study was to determine and develop appropriate indicators for evaluating provided service quality for cardiovascular patients admitted to Cardiac Care Units (CCU) in Iran. Methods:In order to determine the indicators for evaluating provided service quality, a four-stage process including reviewing systematic revi...

  19. Quality of Delivered Care for People with Type 2 Diabetes: A New Patient-Centred Model

    OpenAIRE

    JS Tabrizi

    2011-01-01

    Background: The quality of care from the perspective of people with Type 2 diabetes using a new model (CQMH) including three dimensions of quality ...

  20. Psychosocial stress at work and perceived quality of care among clinicians in surgery

    OpenAIRE

    von dem Knesebeck Olaf; Blum Karl; Frie Kirstin; Klein Jens

    2011-01-01

    Abstract Background Little is known about the association between job stress and job performance among surgeons, although physicians' well-being could be regarded as an important quality indicator. This paper examines associations between psychosocial job stress and perceived health care quality among German clinicians in surgery. Methods Survey data of 1,311 surgeons from 489 hospitals were analysed. Psychosocial stress at work was measured by the effort-reward imbalance model (ERI) and the ...

  1. Health Care Quality-Improvement Approaches to Reducing Child Health Disparities

    OpenAIRE

    Marshall H. Chin; Alexander-Young, Morgen; Burnet, Deborah L

    2009-01-01

    Relatively few quality-improvement efforts have been aimed at reducing differences in children’s care and outcomes across race and ethnicity, socioeconomic status, and insurance status. To inform quality-improvement efforts to reduce child health disparities, we summarize lessons learned from the adult disparities-intervention literature, identify interventions that have reduced disparities in pediatric asthma outcomes and immunization rates, and outline special considerations for child dispa...

  2. Evaluating the Quality of Health Care Services in the Hashemite Kingdom of Jordan

    OpenAIRE

    Suliman Kharmeh

    2012-01-01

    The purpose of this study is to evaluate the quality of health care services provided in the Hashemite Kingdom ofJordan. An instrument of the quality of health service was developed in order to achieve the purpose of this study.The instrument consisted of (31) items, distributed on five dimensions: tangibles, reliability, responsiveness,assurance and empathy. The indications of validity and reliability were confirmed.The sample of this study consisted of (556) patients admitted in hospitals l...

  3. Real teams and their effect on the quality of care in nursing homes

    OpenAIRE

    Havig, Anders Kvale; SKOGSTAD, Anders; Veenstra, Marijke; Romøren, Tor Inge

    2014-01-01

    Background: Use of teams has shown to be an important factor for organizational performance. However, research has shown that a team has to meet certain criteria and operate in a certain way to realize the potential benefits of team organizing. There are few studies that have examined how teams operate in the nursing home sector and their effect on quality of care. This study investigates the relationship between teams that meet an academic definition of the team concept and quality of ...

  4. Analysis of nursing records as to care quality: a retrospective descriptive exploratory study of quantitative approach.

    OpenAIRE

    Dagmar Willamowius Vituri; Laura Misue Matsuda

    2008-01-01

    Uneasiness in professional practice arises due to failures detected in the nursing records and, consequently, in the given assistance. This study is intended to support discussions and meditation on this issue, aiming at the promotion of quality care. The purpose is to analyze the 2003-2006 Yearly Nursing Records Quality Evaluation Reports accomplished by the nursing team of a medical surgeon unit of a school hospital. It is a retrospective descriptive exploratory study of quantitative approa...

  5. Quality of Care in Children and Adolescents with Type 1 Diabetes : Patients’ and Healthcare Professionals’ Perspectives

    OpenAIRE

    Hanberger, Lena

    2010-01-01

    Background: Type 1 diabetes is a chronic disease for which there is currently no cure, and high quality care is essential if acute and long-term complications are to be avoided. Many children and adolescents have inadequate metabolic control with increased risk for complications later in life, and adolescent girls have reported low quality of life. Differences in metabolic control between treatment centres have been found but the reasons for this are unclear. Diabetes is a largely self-manage...

  6. Adolescent pregnancy and parenthood in Swaziland : Quality of care, community support and health care service needs

    OpenAIRE

    Mngadi, Patricia Thuli

    2006-01-01

    The aim of this thesis was to study - from different perspectives - adolescent pregnancy and parenthood in Swaziland. The specific objectives were to: i) explore maternity care practices and support for adolescent mothers during their stay in the maternity unit; ii) study the postpartum support to adolescent mothers and their newborns at home by families, communities and health professionals; iii) explore adolescents' views regarding risky sexual behaviour; iv) explore adole...

  7. Ventilation, indoor air quality, and human health and comfort in dwellings and day-care centers

    Energy Technology Data Exchange (ETDEWEB)

    Ruotsalainen, R.

    1995-12-31

    The objective of the study was to assess the actual ventilation and indoor air quality in the Finnish building stock (dwellings and day-care centers) with special reference to the existing guideline values. Furthermore, the objective was to evaluate the occurrence of symptoms and perceptions among occupants (adult residents, children, workers) in relation to ventilation system, ventilation rate and dampness. The measurements of ventilation and indoor air quality in the dwellings and day-care centers included ventilation rate, CO{sub 2} concentration, and temperature and humidity. Self- and parent-administered questionnaires were distributed to the occupants inquiring their personal characteristics, occurrence of symptoms of interest, perceived indoor air quality and details of their home and work environments. Airflows and air change rates varied remarkably both in the dwellings and day-care centers. In the majority of the dwellings and day-care centers, the Finnish guideline values of ventilation rates were not achieved. No consistent associations were observed between the magnitude of mechanical ventilation rates and the occurrence of eye, respiratory, skin and general symptoms, that is, symptoms of sick building syndrome (SBS) among the day-care workers. The results indicate that there is much room for improvement in the ventilation and indoor air quality of Finnish dwellings and day-care centers. The control of ventilation, temperature and humidity and the prevention of water damage are important issues on which to concentrate in the future. There is need to improve the quality in all phases of construction: design, installation, adjustment, operation, and maintenance

  8. Educational background of nurses and their perceptions of the quality and safety of patient care

    Scientific Electronic Library Online (English)

    Reece P., Swart; Ronel, Pretorius; Hester, Klopper.

    Full Text Available BACKGROUND: International health systems research confirms the critical role that nurses play in ensuring the delivery of high quality patient care and subsequent patient safety. It is therefore important that the education of nurses should prepare them for the provision of safe care of a high quali [...] ty. The South African healthcare system is made up of public and private hospitals that employ various categories of nurses. The perceptions of the various categories of nurses with reference to quality of care and patient safety are unknown in South Africa (SA OBJECTIVE: To determine the relationship between the educational background of nurses and their perceptions of quality of care and patient safety in private surgical units in SA METHODS: A descriptive correlational design was used. A questionnaire was used for data collection, after which hierarchical linear modelling was utilised to determine the relationships amongst the variables RESULTS: Both the registered- and enrolled nurses seemed satisfied with the quality of care and patient safety in the units were they work. Enrolled nurses (ENs) indicated that current efforts to prevent errors are adequate, whilst the registered nurses (RNs) obtained high scores in reporting incidents in surgical wards CONCLUSION: From the results it was evident that perceptions of RNs and ENs related to the quality of care and patient safety differed. There seemed to be a statistically-significant difference between RNs and ENs perceptions of the prevention of errors in the unit, losing patient information between shifts and patient incidents related to medication errors, pressure ulcers and falls with injury

  9. [How to bring quality into the focus of health care--results of a delphi and stakeholder survey].

    Science.gov (United States)

    Geraedts, Max; Busse, Reinhard; Jäckel, Wilfried H; Klemperer, David; Mauersberg, Susanne; Sauerland, Dirk; Volbracht, Eckhard; Schwenk, Uwe

    2010-01-01

    Although plenty of statutory requirements, concepts and tools to promote the quality of health care exist, Germany's health care system seems far from being pervaded by a vivid quality culture. In order to show ways how to succeed in developing and implementing such a quality culture in the German health care system, the Bertelsmann foundation conducted a delphi survey of seven quality of care experts and an online survey of 239 stakeholders, encompassing health care providers and representatives of the self administration of the health care system, politicians, the health care industry, and patient representatives. Based on the delphi results 31 theses within 12 subject areas have been formulated and assessed, which describe building blocks to put quality in the center of Germany's health care system. After dichotomizing the answers (school grades 1-6 into 1-2 = best, and 3-6 = worse) > 66% of the stakeholders rated 28 of 31 theses with grades 1-2. The ten most accepted theses received grades 1 or 2 from more than 85% of the stakeholders. Following the main results of the surveys, establishing a vivid quality culture requires outcome oriented quality goals and quality indicators to be defined, quality management to be embedded better into the education of all health care providers, and quality promotion to be introduced which is build on quality incentives and objective quality transparency. Since experts and stakeholders agree to such a high degree in the steps necessary to establish a quality culture in the German health care system, the realization of these steps seems to be possible. PMID:20441019

  10. Stakeholder Engagement to Identify Priorities for Improving the Quality and Value of Critical Care

    Science.gov (United States)

    Stelfox, Henry T.; Niven, Daniel J.; Clement, Fiona M.; Bagshaw, Sean M.; Cook, Deborah J.; McKenzie, Emily; Potestio, Melissa L.; Doig, Christopher J.; O’Neill, Barbara; Zygun, David

    2015-01-01

    Background Large amounts of scientific evidence are generated, but not implemented into patient care (the ‘knowledge-to-care’ gap). We identified and prioritized knowledge-to-care gaps in critical care as opportunities to improve the quality and value of healthcare. Methods We used a multi-method community-based participatory research approach to engage a Network of all adult (n = 14) and pediatric (n = 2) medical-surgical intensive care units (ICUs) in a fully integrated geographically defined healthcare system serving 4 million residents. Participants included Network oversight committee members (n = 38) and frontline providers (n = 1,790). Network committee members used a modified RAND/University of California Appropriateness Methodology, to serially propose, rate (validated 9 point scale) and revise potential knowledge-to-care gaps as priorities for improvement. The priorities were sent to frontline providers for evaluation. Results were relayed back to all frontline providers for feedback. Results Initially, 68 knowledge-to-care gaps were proposed, rated and revised by the committee (n = 32 participants) over 3 rounds of review and resulted in 13 proposed priorities for improvement. Then, 1,103 providers (62% response rate) evaluated the priorities, and rated 9 as ‘necessary’ (median score 7–9). Several factors were associated with rating priorities as necessary in multivariable logistic regression, related to the provider (experience, teaching status of ICU) and topic (strength of supporting evidence, potential to benefit the patient, potential to improve patient/family experience, potential to decrease costs). Conclusions A community-based participatory research approach engaged a diverse group of stakeholders to identify 9 priorities for improving the quality and value of critical care. The approach was time and cost efficient and could serve as a model to prioritize areas for research quality improvement across other settings. PMID:26492196

  11. Quality of Care and Services of a Public Hospital: Awareness and Assessment

    Directory of Open Access Journals (Sweden)

    Abdel-ilah Aziane

    2015-04-01

    Full Text Available In order to give everyone access to quality care, this study attempts to make quality awareness, highlighting the importance of the implementation of the quality management system in health care facilities. The objective of our work is to make a quality awareness, to analyze the current situation and to provide recommendations. The analysis of the existing situation consists of identifying, describing, and analyzing the key processes implemented, listing the dysfunctions, classifying them, deciding on the corresponding actions and putting in place indicators and dashboards, which will help track improvements. The overall situation of the hospital regarding the requirements of ISO 9001 indicated a respect of about 28% of the requirements of the standard. The state of the premises of the establishment does not indicate a clear organization at the hospital. The hospital environment is a prerequisite to the establishment of a system of quality management that enables you to deploy a clear and shared policy to improve the quality of care and services.

  12. Measuring nursing essential contributions to quality patient care outcomes.

    Science.gov (United States)

    Wolgast, Kelly A; Taylor, Katherine; Garcia, Dawn; Watkins, Miko

    2011-01-01

    Workload Management System for Nursing (WMSN) is a core Army Medical Department business system that has provided near real-time, comprehensive nursing workload and manpower data for decision making at all levels for over 25 years. The Army Manpower Requirements and Documentation Agency populates data from WMSN into the Manpower Staffing Standards System (Inpatient module within Automated Staffing Assessment Model). The current system, Workload Management System for Nursing Internet (WMSNi), is an interim solution that requires additional functionalities for modernization and integration at the enterprise level. The expanding missions and approved requirements for WMSNi support strategic initiatives on the Army Medical Command balanced scorecard and require continued sustainment for multiple personnel and manpower business processes for both inpatient and outpatient nursing care. This system is currently being leveraged by the TRICARE Management Activity as an interim multiservice solution, and is being used at 24 Army medical treatment facilities. The evidenced-based information provided to Army decision makers through the methods used in the WMSNi will be essential across the Army Medical Command throughout the system's life cycle. PMID:22124876

  13. Maternity Care in Russia: Issues, Achievements, and Potential.

    Science.gov (United States)

    Shuvalova, Marina P; Yarotskaya, Ekaterina L; Pismenskaya, Tatiana V; Dolgushina, Nataliya V; Baibarina, Elena N; Sukhikh, Gennady T

    2015-10-01

    In this review, we provide basic facts about maternity care services within the health care system in Russia. We give a short overview of such key aspects as the demographic situation, reproductive behaviour, regulatory framework for providing health care for women and children, maternal and perinatal mortality, and the availability of medical personnel. In 2012, Russia began registration of births in accordance with the WHO recommendations (births with weight ? 500 g at ? 22 weeks' gestation). Introduction of this new registration system increased the completeness and quality of the collected information and expanded possibilities for future international comparative assessments. A three-level system of specialized medical care has been introduced in Russia for women and newborns during pregnancy, childbirth, and the postpartum period. In 2014, the system included 1942 state (public) maternity hospitals providing 20 obstetric beds per 10?000 women aged 15 to 49 years. More than 100 perinatal centres (level III) are currently functioning in the country, with 32 new perinatal centres planned to open by 2016. The total number of obstetrician-gynaecologists in Russia is approximately 44?000, providing a ratio of 5.7 specialists per 10?000 women. The total number of midwives is 62?000, providing a ratio of 8.1 midwives per 10?000 women. In recent years we have succeeded in optimizing the maternity care system by increasing its accessibility and quality. This was achieved through qualitative and quantitative progress in the training of neonatologists, the development of intensive care technologies and neonatal critical care, capacity building of medical-genetic services and counselling, prenatal diagnosis, and the standardization of health care with data collection. PMID:26606698

  14. Factores de riesgo de mortalidad perinatal en hospitales de la seguridad social peruana: análisis de los datos del Sistema de Vigilancia Perinatal de EsSalud / Risk factors for perinatal mortality in Peruvian social security hospitals: EsSalud’s Perinatal Surveillance System data analysis

    Scientific Electronic Library Online (English)

    Alejandro, Arrieta-Herrera; Gloria, Riesco de la Vega.

    2009-12-01

    Full Text Available Introducción: El estudio utiliza la información del Sistema de Vigilancia Perinatal (SVP) de la red hospitalaria del Seguro Social de Salud del Perú (EsSalud) para identificar factores de riesgo que inciden en la mortalidad perinatal. El SVP incluye policlínicos y hospitales en todo el Perú, con dif [...] erentes niveles de capacidad resolutiva. El estudio agrupa hospitales según mayor y menor capacidad de resolución, para investigar la magnitud de la incidencia de los factores de riesgo en cada grupo. Finalmente, el estudio resalta la importancia de mantener un sistema de información perinatal eficiente y ágil que pueda ser integrado entre diferentes redes de salud en el país, con el objetivo de reducir la mortalidad perinatal nacional. Objetivos: El primer objetivo fue encontrar los principales factores de riesgo de mortalidad perinatal en la red hospitalaria de EsSalud. El segundo objetivo fue identificar diferencias en la magnitud de la incidencia de dichos factores en hospitales de menor y mayor capacidad resolutiva. Diseño: Estudio descriptivo, comparativo y transversal. Lugar: Red nacional de hospitales de EsSalud, Perú. Participantes: Madres y sus recién nacidos. Intervenciones: Se utilizó información clínica del SVP de EsSalud para estimar probabilidad de muerte perinatal, basado en un modelo logístico multivariado, que incluyó 108 813 nacimientos correspondientes a madres y sus recién nacidos en EsSalud, en los años 2005 y 2006. Principales medidas de resultados: Muertes perinatales. Resultados: La anomalía congénita fue el principal factor de riesgo de la mortalidad perinatal en los hospitales de menor y mayor capacidad resolutiva (OR=30,99 y 15,26, respectivamente), seguido por prematuridad menor a 32 semanas (OR=15,68 y 4,20) y peso mayor a 4 000 gramos (OR=4,17 y 3,87). Factores de riesgo de la madre también resultaron asociados a mortalidad perinatal, pero en menor magnitud, resaltando el sangrado genital después de la semana 24 del embarazo (OR=4,23 y 3,81) y otras entidades obstétricas diferentes a anemia, preeclampsia y rotura prematura de membranas (OR=4,53 y 1,76). Conclusiones: Los factores de riesgo identificados son consistentes con la literatura sobre mortalidad perinatal. En los hospitales con mayor capacidad resolutiva, la incidencia de los factores de riesgo sobre mortalidad es menor, a pesar de que estos concentran pacientes con riesgo obstétrico alto y por tanto mayor mortalidad. Los hospitales de menor capacidad resolutiva requieren focalizar recursos más adecuadamente y mejorar sus sistemas de referencias. El SVP de EsSalud resulta una herramienta válida, consistente y útil para un mejor monitoreo y control de la mortalidad perinatal. Abstract in english Introduction: This study uses information from the Perinatal Surveillance System (Sistema de Vigilancia Perinatal, SVP) of the Peruvian social security hospitals (EsSalud) to identify risk factors for perinatal mortality. The SVP includes health centers in all the country with different levels of ho [...] spital care. The study groups hospitals based on higher or lower levels of care in order to quantify the incidence of risk factors in each group. Finally, the study highlights the importance to keep an efficient clinical database that could be integrated with other health organizations in the country, in order to joint efforts to reduce perinatal mortality in Peru. Objectives: The first goal was to find the main risk factors for perinatal mortality in EsSalud’s hospitals. The second goal was to identify differences in the incidence of these factors on hospitals with higher and lower levels of care. Design: Descriptive, comparative and transversal study. Setting: EsSalud national hospitals net, Peru. Participants: Mothers and their newborns. Interventions: Clinical data from the SVP was used to estimate probability of death during the perinatal period; 108 813 newborns and their mothers whose deliveries were in years 2005 and 2006 were studied. Estimations were based on multivariate logisti

  15. The Door's Perinatal Program for Pregnant and Parenting Teens

    OpenAIRE

    Dewart, Tracey; Zaengle, Donna

    2000-01-01

    The perinatal program for urban youth at The Door, located in New York City, provides accessible, comprehensive, high-quality prenatal services to pregnant teens. Through a holistic, family-centered, youth-development approach, the program seeks to counteract the adverse medical risks and psychosocial consequences of early childbirth and child rearing in order to improve the immediate and long-term futures of the mother and her new family. The Door's services are presented, along with a descr...

  16. Perinatal outcomes after fresh versus vitrified-warmed blastocyst transfer

    DEFF Research Database (Denmark)

    Ozgur, Kemal; Berkkanoglu, Murat; Bulut, Hasan; Humaidan, Peter; Coetzee, Kevin

    2015-01-01

    OBJECTIVE: To investigate the possible effect of controlled ovarian stimulation on the perinatal outcomes of assisted reproductive technology pregnancies, by comparing the outcomes from fresh ET with frozen ET (FET) with blastocysts of similar quality. DESIGN: Retrospective observational study. SETTING: Private fertility center. PATIENT(S): Seven hundred eighty-four fresh transfers and 382 vitrified-warmed double blastocyst transfers. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Miscarriage, ...

  17. Medicare Accountable Care Organizations: program eligibility, beneficiary assignment, and quality measures.

    Science.gov (United States)

    MacKinney, A Clinton; Mueller, Keith J; Zhu, Xi; Vaughn, Thomas

    2014-04-01

    Accountable Care Organizations (ACOs) are groups of providers (generally physicians and/or hospitals) that may receive financial rewards by maintaining or improving care quality for a group of patients while reducing the cost of care for those patients. The Patient Protection and Affordable Care Act of 2010 (ACA) established a Medicare Shared Savings Program (MSSP) and accompanying Medicare ACOs to “facilitate coordination and cooperation among providers to improve the quality of care for Medicare fee-for-service (FFS) beneficiaries and reduce unnecessary costs.” The MSSP now includes 343 ACOs; an additional 23 ACOs participate in the Medicare Pioneer ACO demonstration program, and there are approximately 240 private ACOs. Based on our analysis, among the Medicare ACOs 119 operate in both rural and urban counties and seven operate exclusively in rural counties. A little over 24 percent of non-metropolitan counties are included in Medicare ACOs. To assist rural providers considering ACO formation, this policy brief describes MSSP eligibility and participation requirements, beneficiary assignment processes, and quality measures. PMID:25399468

  18. Communication and access to information in assessing the quality of multiprofessional care of patients

    Directory of Open Access Journals (Sweden)

    Leny Vieira Cavalheiro

    2010-09-01

    Full Text Available Objective: To assess the quality of a multiprofessional healthcare model for in-hospital patients by means of two performance indicators (communication and knowledge about the case. Methods: A cross-sectional study assessed the knowledge that professionals had about the clinical information of patients and the use of communication strategies by the team. Healthcare professionals were interviewed during their work period. Seven occupational categories were interviewed. A total of 199 medical charts were randomly selected for interviews, and 312 professionals of different categories were interviewed. The sample comprised mostly nurses and physical therapists in the charts that were interviewed. Results: There were no statistically significant differences between the expected performing model group and the under-performing model group for sex, location and job. In the under-performing model group, a larger number of professionals correlated with less knowledge. Communication was improved when nurses had the relevant information about interdisciplinary care (97.4%, appropriate use of the Plan of Care form (97.0%, and formalized discussions with physicians (88.2%. In the expected performing model group, it was observed that the higher the number of healthcare professionals involved, the higher the communication levels. Conclusions: This model of care based on case knowledge and multiprofessional team communication performance indices allowed to assess quality of care. This assessment is measurable and there is the possibility of establishing the quality of care delivered.

  19. QUALICOPC, a multi-country study evaluating quality, costs and equity in primary care

    Directory of Open Access Journals (Sweden)

    Van den Berg Michael J

    2011-10-01

    Full Text Available Abstract Background The QUALICOPC (Quality and Costs of Primary Care in Europe study aims to evaluate the performance of primary care systems in Europe in terms of quality, equity and costs. The study will provide an answer to the question what strong primary care systems entail and which effects primary care systems have on the performance of health care systems. QUALICOPC is funded by the European Commission under the "Seventh Framework Programme". In this article the background and design of the QUALICOPC study is described. Methods/design QUALICOPC started in 2010 and will run until 2013. Data will be collected in 31 European countries (27 EU countries, Iceland, Norway, Switzerland and Turkey and in Australia, Israel and New Zealand. This study uses a three level approach of data collection: the system, practice and patient. Surveys will be held among general practitioners (GPs and their patients, providing evidence at the process and outcome level of primary care. These surveys aim to gain insight in the professional behaviour of GPs and the expectations and actions of their patients. An important aspect of this study is that each patient's questionnaire can be linked to their own GP's questionnaire. To gather data at the structure or national level, the study will use existing data sources such as the System of Health Accounts and the Primary Health Care Activity Monitor Europe (PHAMEU database. Analyses of the data will be performed using multilevel models. Discussion By its design, in which different data sources are combined for comprehensive analyses, QUALICOPC will advance the state of the art in primary care research and contribute to the discussion on the merit of strengthening primary care systems and to evidence based health policy development.

  20. Head Start/Child Care Partnerships: Program Characteristics and Classroom Quality

    Science.gov (United States)

    Schilder, Diane; Smith Leavell, Ashley

    2015-01-01

    As part of President Obama's Early Education Plan, Congress authorized $500 million in the 2014 Omnibus Act to support states and communities in expanding high-quality early learning through the creation of a new Early Head Start-Child Care Partnership initiative. This initiative has placed renewed interest on research regarding the nature…