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Sample records for quality perinatal care

  1. Improving quality of perinatal care through clinical audit : a study from a tertiary hospital in Dar es Salaam, Tanzania

    OpenAIRE

    Kidanto, Hussein L.

    2009-01-01

    Perinatal audit has been tested and proved an important tool for reduction of perinatal mortality and assessment of quality of perinatal care. At Muhimbili National Hospital (MNH), a tertiary hospital in Dar es salaam, Tanzania we performed a retrospective cross-sectional study using data from an obstetrics database to classify all perinatal deaths during 1999-2003. We also determined the prevalence of anaemia in pregnancy and its impact on perinatal outcome. Furthermore, we conducted a perin...

  2. Quality development in perinatal care -- the OBSQID project. OBStetrical Quality Indicators and Data.

    Science.gov (United States)

    Johansen, K S; Hod, M

    1999-02-01

    This special communication describes the objectives and strategies of the OBStetrical Quality Indicators and Data collection (OBSQID) project, a pan-European network of researchers, healthcare providers, and professional institutions and associations using agreed key quality indicators and served by a common database. OBSQID is based on the general concept of continuous assessment, management and development of quality of care and is geared to perinatal medicine. It allows contributors to measure, on an on-going basis, the outcomes of care they provide against those of other facilities within their own region or country as well as in Europe. It identifies 'best practices' and allows for the exchange and transfer of knowledge and expertise through 'twinning' or collaborative partnerships. It also assists in setting general quality standards as well as specific guidelines aimed at ensuring all patients high quality, cost-effective care. PMID:10189027

  3. Navigating the perinatal quality landscape.

    Science.gov (United States)

    Howard, Elisabeth; Jolles, Diana

    2015-01-01

    The National Quality Strategy, mandated by the Affordable Care Act, outlines the triple aim of better health, better care, and lower costs. Perinatal nurses are integral to the National Quality movement as care providers, leaders, and experts. The most notable accomplishments in perinatal care of the last decade relate to the endorsement of quality measures by the National Quality Forum that provide unified goals and the quality improvement frameworks provided by the Institute for Healthcare Improvement that help systems create action and change through education, team building, process improvement, and structure. Fourteen perinatal quality measures are currently endorsed by the National Quality Forum, 5 of which are mandated by The Joint Commission and required for accreditation. Understanding the current perinatal quality measures and the resources available for implementation is essential to nursing care delivery. Realizing the nurses' role within the quality improvement landscape and mobilizing nationally endorsed quality measures as levers for nurse-led improvement projects promise actualization of marked quality improvement in perinatal care. PMID:25919602

  4. 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.

  5. 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.

  6. Perinatal home care: one entrepreneur's experience.

    Science.gov (United States)

    Eaton, D G

    1994-10-01

    Nurses have responded to the entrepreneurial movement by entering into various nontraditional roles and starting their own businesses. This article describes the author's experience in establishing a perinatal home-care business. The characteristics of women and nurse entrepreneurs are discussed, as are the components of a business plan and how to manage a business. PMID:7836999

  7. New uses of legacy systems: examples in perinatal care.

    OpenAIRE

    Margolis, A.; Vázquez, R.; Mendoza, G; Zignago, A.; López, A.; Lucián, H.

    1999-01-01

    In this article, new uses of the Perinatal Information System at the Uruguayan Social Security health care facilities are described. The perinatal information system has been in place for over 13 years, with about 40 thousand clinical records on electronic files. A newly created Web interface allows a distributed access to existing perinatal information within the National Social Security Wide Area a Network. Perinatal data is also exported to a management information system, allowing to dyna...

  8. New uses of legacy systems: examples in perinatal care.

    Science.gov (United States)

    Margolis, A; Vázquez, R; Mendoza, G; Zignago, A; López, A; Lucián, H

    1999-01-01

    In this article, new uses of the Perinatal Information System at the Uruguayan Social Security health care facilities are described. The perinatal information system has been in place for over 13 years, with about 40 thousand clinical records on electronic files. A newly created Web interface allows a distributed access to existing perinatal information within the National Social Security Wide Area a Network. Perinatal data is also exported to a management information system, allowing to dynamically answer questions and make managerial decisions, and eventually link these data with other sources. Future steps regarding clinical information systems are outlined. PMID:10566481

  9. 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.

  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

    Directory of Open Access Journals (Sweden)

    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.

  11. Poor Perinatal Care Practices in Urban Slums: Possible Role of Social Mobilization Networks

    OpenAIRE

    Khan Zulfia; Mehnaz Saira; Khalique Najam; Ansari Mohd.; Siddiqui Abdul

    2009-01-01

    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 prac...

  12. 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...

  13. Patient safety and teamwork in perinatal care: resources for clinicians.

    Science.gov (United States)

    Miller, Lisa A

    2005-01-01

    Recent data reveal communication issues and organizational culture to be key factors in adverse perinatal outcomes. Hierarchical communication is common in healthcare and can be a significant impediment to safe care. Principles of teamwork employed by other industries, such as aviation and the military, can be appropriately applied to healthcare. This article provides a brief introduction to Crew Resource Management as well as a listing of print, multimedia, and Web resources for clinicians interested in promoting cultural change and effective teamwork. PMID:15796424

  14. 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.

  15. The impact of centralization of obstetric care resources in Japan on the perinatal mortality rate.

    Science.gov (United States)

    Sudo, Akira; Kuroda, Yoshiki

    2013-01-01

    Objective. We investigated the effects of the centralization of obstetricians and obstetric care facilities on the perinatal mortality rate in Japan. Methods. We used the Gini coefficient as an index to represent the centralization of obstetricians and obstetric care facilities. The Gini coefficients were calculated for the number of obstetricians and obstetric care facilities of 47 prefectures using secondary medical care zones as units. To measure the effects of the centralization of obstetricians and obstetric care facilities on the outcomes (perinatal mortality rates), we performed multiple regression analysis using the perinatal mortality rate as the dependent variable. Results. Obstetric care facilities were more evenly distributed than obstetricians. The perinatal mortality rate was found to be significantly negatively correlated with the number of obstetricians per capita and the Gini coefficient of obstetric care facilities. The latter had a slightly stronger effect on the perinatal mortality rate. Conclusion. The centralization of obstetric care facilities can improve the perinatal mortality rate, even when increasing the number of obstetricians is difficult. PMID:24167731

  16. Factors related to nurse comfort when caring for families experiencing perinatal loss: evidence for bereavement program enhancement.

    Science.gov (United States)

    Rondinelli, June; Long, Kathleen; Seelinger, Connie; Crawford, Cecelia L; Valdez, Regina

    2015-01-01

    As nurses provide holistic support, their own comfort in caring for parents and families experiencing perinatal loss must be considered. Study results showed that, although education is essential, experience independently predicted comfort in delivering perinatal bereavement care. Evidence from this study promotes the discussion of how nurse educators can structure professional development programs to best transfer the experience and confidence of perinatal nurses who are already comfortable with bereavement care to nurses who are not. PMID:25993455

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

    Directory of Open Access Journals (Sweden)

    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.

  18. Sub-optimal care in stillbirths - a retrospective audit:Evaluation of the prenatal care and possibilities for quality improvements with special focus on non-western immigrants

    OpenAIRE

    Saastad, Eli

    2006-01-01

    Background: Improved perinatal care has decreased stillbirth rates radically. Audits may identify main current quality of care issues in stillbirth to identify areas for further improvements. The aims of this study were to identify sub-optimal factors likely to have contributed to stillbirths and to test if sub-optimal factors were more frequent among non-western than western women. Material and method: Perinatal deaths in Oslo and Akershus have systematically been audited by perinatal commit...

  19. The Impact of Centralization of Obstetric Care Resources in Japan on the Perinatal Mortality Rate

    OpenAIRE

    Akira Sudo; Yoshiki Kuroda

    2013-01-01

    Objective. We investigated the effects of the centralization of obstetricians and obstetric care facilities on the perinatal mortality rate in Japan. Methods. We used the Gini coefficient as an index to represent the centralization of obstetricians and obstetric care facilities. The Gini coefficients were calculated for the number of obstetricians and obstetric care facilities of 47 prefectures using secondary medical care zones as units. To measure the effects of the centralization of obstet...

  20. How an extended perinatal audit may improve perinatal policy.

    Science.gov (United States)

    Dehaene, Isabelle; Roelens, Kristien; Page, Geert

    2014-09-29

    Abstract Objective: A perinatal audit has the intention of quality of care improvement based on analysis of perinatal death, with our without analysis of maternal morbidity and/or mortality. Additional analysis of cases of intrapartum asphyxia could provide more insight into ways to improve quality of perinatal care. Methods: Analysis of cases of perinatal death and asphyxia in Jan Yperman Hospital, Ieper, Belgium, in 2012. Results: Three perinatal deaths occurred, none were preventable. Nineteen cases of proven metabolic acidosis have been identified. Three cases are considered possibly preventable, four cases are considered preventable. In three (possibly) preventable cases, foetal monitoring was absent during the active second stage of labour. In two preventable cases, intervention following a significant ST event in the second stage of labour was delayed. In one case intervention was delayed in the first stage of labour, while in another, indicated operative delivery in the second stage was not conducted. Conclusions: Integrating intrapartum asphyxia in the perinatal audit gives an opportunity to identify and eliminate weak points in the perinatal care chain, thereby optimizing quality of care. Lessons learned from our internal audit are the value of foetal monitoring and adequate action on significant ST events during second stage of labour. PMID:25212976

  1. Screening of Substance Abuse Among Women in Perinatal Care

    OpenAIRE

    Tazanu Fossung, Joakem; Cudjoe, Kwame

    2013-01-01

    The purpose of this review was to describe contemporary screening methodologies and processes for determining the substance abuse status of perinatal women using recent literary works. It also outlines potential innovations to improve the screening process and subsequent treatment of the aforementioned. The study was undertaken as part of the Kuitinmäki project in Laurea University of Applied Sciences. This study sought to answer the research question; What is entailed in the screening of su...

  2. Influence of Culture and Community Perceptions on Birth and Perinatal Care of Immigrant Women: Doulas’ Perspective

    OpenAIRE

    Kang, Hye-kyung

    2014-01-01

    A qualitative study examined the perceptions of doulas practicing in Washington State regarding the influence of cultural and community beliefs on immigrant women’s birth and perinatal care, as well as their own cultural beliefs and values that may affect their ability to work interculturally. The findings suggest that doulas can greatly aid immigrant mothers in gaining access to effective care by acting as advocates, cultural brokers, and emotional and social support. Also, doulas share a ...

  3. Community Mobilization in Mumbai Slums to Improve Perinatal Care and Outcomes: A Cluster Randomized Controlled Trial

    OpenAIRE

    More, N. S.; Bapat, U.; Das, S.; Alcock, G.; Patil, S.; Porel, M.; Vaidya, L.; Fernandez, A.; Joshi, W.; Osrin, D.

    2012-01-01

    Improving maternal and newborn health in low-income settings requires both health service and community action. Previous community initiatives have been predominantly rural, but India is urbanizing. While working to improve health service quality, we tested an intervention in which urban slum-dweller women's groups worked to improve local perinatal health.

  4. [The art of being when there is nothing you can do: caring for perinatal bereavement].

    Science.gov (United States)

    Weber, Kerstin; Canuto, Alessandra; Toma, Simona; Bonnet, Jocelyne; Epiney, Manuella; Girard, Elodie

    2014-02-12

    The period of mourning after perinatal loss is not synonym for depression. The article illustrates a way of caring for bereaved parents, which takes into account the temporality and individual nature of the bereavement process. The use of rituals and symbolic gestures allows for calling into existence the loss of a human being, who is gone without leaving many reminders. Psychotherapeutic care by the liaison-psychiatric service is part of the multidisciplinary care program proposed by the maternity of the University Hospitals of Geneva. These encounters offer parents the possibility to continue to include the dead in the membership of our lives. PMID:24620464

  5. Mood and anxiety disorders in a sample of Canadian perinatal women referred for psychiatric care.

    Science.gov (United States)

    Grigoriadis, Sophie; de Camps Meschino, Diane; Barrons, Elaine; Bradley, Lana; Eady, Allison; Fishell, Alicja; Mamisachvili, Lana; Cook, Greer Slyfield; O'Keefe, Maura; Romans, Sarah; Ross, Lori E

    2011-08-01

    Perinatal depression currently receives considerable attention, but not all perinatal women presenting for psychiatric care are depressed. The Edinburgh Postnatal Depression Scale (EPDS) is now routinely administered, but high scores are interpreted as evidence for depressive illness only. This study examined psychiatric diagnoses and mean EPDS scores among perinatal women at a tertiary center. Women accessing care between March 2006 and June 2008 completed a clinical diagnostic interview and the EPDS. Mean EPDS scores were calculated for each psychiatric diagnosis; sensitivity and specificity were calculated for major depressive episode (MDE) and generalized anxiety disorder (GAD). The majority of the sample (N?=?91), 49.5%, had GAD comorbid with MDE or another anxiety disorder, followed by MDE (38.5%) comorbid with an anxiety disorder. One third (29.7%) met criteria for MDE and GAD. Only 3.3% had MDE alone and 5.5% had GAD alone. Half the sample (50.5%) had more than one psychiatric disorder. Mean EPDS scores exceeded 11 for the majority of diagnostic groups. Sensitivity of the EPDS for MDE was 0.78 and 0.70 for GAD. Most women had an anxiety disorder and met criteria for more than one psychiatric disorder. Mean EPDS scores were consistently high. Sensitivity of the EPDS for MDE and GAD was comparable. PMID:21695590

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

    OpenAIRE

    Karuga Robinson N; Wanyonyi Sikolia Z

    2010-01-01

    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. Me...

  8. 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...

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

    OpenAIRE

    Pervin Jesmin; Moran Allisyn; Rahman Monjur; Razzaque Abdur; Sibley Lynn; Streatfield Peter K; Reichenbach Laura J; Koblinsky Marge; Hruschka Daniel; Rahman Anisur

    2012-01-01

    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 Surveil...

  10. Maternal Opioid Drug Use during Pregnancy and Its Impact on Perinatal Morbidity, Mortality, and the Costs of Medical Care in the United States

    OpenAIRE

    Whiteman, Valerie E.; Jason L. Salemi; Mogos, Mulubrhan F.; Mary Ashley Cain; Aliyu, Muktar H; Salihu, Hamisu M.

    2014-01-01

    Objective. To identify factors associated with opioid use during pregnancy and to compare perinatal morbidity, mortality, and healthcare costs between opioid users and nonusers. Methods. We conducted a cross-sectional analysis of pregnancy-related discharges from 1998 to 2009 using the largest publicly available all-payer inpatient database in the United States. We scanned ICD-9-CM codes for opioid use and perinatal outcomes. Costs of care were estimated from hospital charges. Survey logistic...

  11. 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.

  12. Estudo da morbidade e da mortalidade perinatal em maternidades: II - mortalidade perinatal segundo peso ao nascer, idade materna, assistência pré-natal e hábito de fumar da mãe A study of perinatal morbidity and mortality in maternity hospitals: II - perinatal mortality according to birth weight, maternal age, prenatal care and maternal smoking

    Directory of Open Access Journals (Sweden)

    Ruy Laurenti

    1985-06-01

    Full Text Available Analisa-se a influência de variáveis como peso ao nascer, idade materna, assistência pré-natal e tabagismo materno. Do estudo dos 12.999 nascimentos (vivos e mortos ocorridos em nove maternidades no período de um ano, verificou-se que a mortalidade perinatal é muito maior para os recém-nascidos de baixo peso (665,3 ‰ para peso até 1.500 g, diminuindo à medida que aumenta o peso ao nascer. Também nos casos de mães jovens (menores de 15 anos ou mães com idade superior a 35 anos esse coeficiente foi mais elevado (45,5 ‰ para mães com menos de 15 anos e 47,0 ‰ para mães entre 35 a 39 anos. A faixa imediatamente superior - 40 a 44 anos - apresentou a mais alta mortalidade perinatal: 61,3 ‰ nascidos vivos e nascidos mortos. O número de consultas realizadas no pré-natal tem importância para a diminuição da gestação de alto risco. Mães que fizeram 7 ou mais consultas no pré-natal tiveram a menor mortalidade no período (17,7‰ nascidos vivos e nascidos mortos. Já o hábito materno de fumar influencia a mortalidade quando a quantidade é de mais de 10 cigarros por dia. A mortalidade perinatal dos produtos de mães que fumavam menos de 10 cigarros por dia não diferiu das taxas de mortalidade para as mães não-fumantes.The influence of birth weight, maternal age, prenatal care and smoking during pregnancy are analysed. Of 12,999 births (live and stillbirths ocurring in nine maternity hospitals during one year, the greatest perinatal mortality rate (PM was that of low birth weight babies (665.3 ‰ for those weighing less than 1,500 g. The PM decreases with increasing weight. Young mothers (less than 15 years of age and women aged 35 or more also had higher Perinatal Mortality rates - 45.5 ‰ for the former and 47.0 ‰ for the latter. Prenatal care is important for the decrease of high risk in pregnancy. Mothers who had made 7 or more consultations during pregnancy had the lowest PM (17.7 ‰ live and stillbirths. Smoking during pregnancy has an influence only when women smoke more than 10 cigarettes a day. Perinatal mortality for babies whose mothers smoked less than 10 cigarettes a day is not different from non-smoking women.

  13. 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.

  14. Managing the quality of health care.

    Science.gov (United States)

    Larson, James S; Muller, Andreas

    2002-01-01

    This article reviews quality of health care initiatives beginning with the quality assessment/quality assurance movement of the 1970s. Conceptually, modern quality of care management is rooted in the intellectual work of Avedis Donabedian who defined quality of care as a combination of structure, process, and outcome. Donabedian's model is presented and some limitations are pointed out. In the late 1980s and 1990s. the health care industry adopted total quality management (TQM). More recently, the pursuit of health care quality has led to substantial performance measurement initiatives such as ORYX by the Joint Commission on Accreditation of Healthcare Organizations and MEDIS by the National Commission of Quality Assurance. The importance of CONQUEST, a freely available performance measurement database developed at the Harvard School of Public Health, is noted and discussed. The article concludes with a list of challenges facing public and private parties interests in health care quality improvement. PMID:15188996

  15. Are there gaps in the provision of perinatal care in Greece?

    OpenAIRE

    Tzoumaka-Bakoula, C; Lekea-Karanika, V; Matsaniotis, N S; Shenton, T; Golding, J.

    1989-01-01

    STUDY OBJECTIVE: The objective was to test the hypothesis that easy access to sophisticated hospitals is associated with a reduction in perinatal mortality. DESIGN: The study was a nationwide questionnaire survey of a birth cohort. SUBJECTS: All deliveries greater than 500g weight of singleton live births and stillbirths occurring throughout Greece during April 1983 were included. Completed questionnaires were returned for 10,953 deliveries (8% of total annual registered births in Greece), an...

  16. Pregnancies in perinatally HIV-infected young women and implications for care and service programs.

    Science.gov (United States)

    Millery, Mari; Vazquez, Seydi; Walther, Virginia; Humphrey, Natalie; Schlecht, Jennifer; Van Devanter, Nancy

    2012-01-01

    A cohort of individuals with perinatally acquired HIV is maturing into reproductive age. This study describes pregnancy incidence and outcomes among females ages 15-25 with perinatally acquired HIV infection receiving comprehensive family-centered services in New York City. Chart reviews from 1998-2006 indicated 33 pregnancies among 96 young women. Twenty-six percent of the cohort experienced a pregnancy during the study period, with a rate of 125 per 1,000 person years in 2006. The age of first pregnancy ranged from 15-25; 24% were younger than 18. Fourteen pregnancies (42%) were terminated. Nineteen pregnancies resulted in live births, and all infants tested negative for HIV. The success of preventing vertical HIV transmission is attributed to interdisciplinary family-centered services, including reproductive health education, family planning, obstetric-gynecologic services and psychosocial support. Such approach is most likely to be effective at promoting healthy reproductive decisions and reducing morbidity in perinatally infected mothers and their children. PMID:21820325

  17. Factors for change in maternal and perinatal audit systems in Dar es Salaam hospitals, Tanzania

    OpenAIRE

    Kisanga Felix; Pembe Andrea B; Urassa David P; Nyamtema Angelo S; van Roosmalen Jos

    2010-01-01

    Abstract Background Effective maternal and perinatal audits are associated with improved quality of care and reduction of severe adverse outcome. Although audits at the level of care were formally introduced in Tanzania around 25 years ago, little information is available about their existence, performance, and practical barriers to their implementation. This study assessed the structure, process and impacts of maternal and perinatal death audit systems in clinical practice and presents a det...

  18. 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.

  19. Leadership and the quality of care

    OpenAIRE

    Firth-cozens, J.; Mowbray, D.

    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...

  20. African primary care research: quality improvement cycles

    OpenAIRE

    Claire van Deventer; Bob Mash

    2014-01-01

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

  1. 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

  2. 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.

  3. 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

  4. Basics of quality improvement in health care.

    Science.gov (United States)

    Varkey, Prathibha; Reller, M Katherine; Resar, Roger K

    2007-06-01

    With the rapid expansion of knowledge and technology and a health care system that performs far below acceptable levels for ensuring patient safety and needs, front-line health care professionals must understand the basics of quality improvement methodologies and terminology. The goals of this review are to provide clinicians with sufficient information to understand the fundamentals of quality improvement, provide a starting point for improvement projects, and stimulate further inquiry into the quality improvement methodologies currently being used in health care. Key quality improvement concepts and methodologies, including plan-do-study-act, six-sigma, and lean strategies, are discussed, and the differences between quality improvement and quality-of-care research are explored. PMID:17550754

  5. 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 compl...

  6. Which nurseries currently care for ventilated neonates in Illinois and Wisconsin? Implications for the next generation of perinatal regionalization.

    Science.gov (United States)

    Meadow, William; Kim, Mijung; Mendez, David; Bell, Anthony; Gray, Cathy; Corpuz, Maria; Lantos, John

    2002-05-01

    We were interested in the extent to which advances in the availability of neonatalogy expertise have provided a centrifugal impetus to perinatal care. Specifically, we wondered where infants who were sick enough to require mechanical ventilation were currently being managed. We surveyed 116 of 140 hospitals in Illinois and Wisconsin that offered obstetric/newborn services in 1998-1999. The 23 Level I nurseries were consistently small, and offered virtually no "advanced" neonatal intensive care unit (NICU) technology. The 16 Level III NICUs were consistently large, offered advanced technology and personnel, and received sick infants from many hospitals in their regional network. The 77 Level II nurseries (two thirds of all hospitals with newborn services) were less consistently characterized. In general, Level II nurseries were a "spoke" (not a hub), and did not offer extracorporeal-membrane oxygenation (ECMO), nitric oxide (NO), or cardiovascular (CV) surgery. However, 19 (25%) of 77 Level II centers self-designated as "Level II+". These were significantly more likely to offer ventilators, percutaneous central venous catheters (PCVCs), total parenteral nutrition (TPN), and surgery. Fifty-three percent (18/34) of all nurseries offering mechanical ventilation self-designated as a Level II or II+, as opposed to Level III. Facile inferences about the appropriate role of Level II centers derived from decades-old data are probably unsupportable. It is time to acknowledge the distinction between the Level II nursery of the past and the newly evolving Level II+ NICUs. PMID:12012281

  7. Do competition and managed care improve quality?

    Science.gov (United States)

    Sari, Nazmi

    2002-10-01

    In recent years, the US health care industry has experienced a rapid growth of managed care, formation of networks, and an integration of hospitals. This paper provides new insights about the quality consequences of this dynamic in US hospital markets. I empirically investigate the impact of managed care and hospital competition on quality using in-hospital complications as quality measures. I use random and fixed effects, and instrumental variable fixed effect models using hospital panel data from up to 16 states in the 1992-1997 period. The paper has two important findings: First, higher managed care penetration increases the quality, when inappropriate utilization, wound infections and adverse/iatrogenic complications are used as quality indicators. For other complication categories, coefficient estimates are statistically insignificant. These findings do not support the straightforward view that increases in managed care penetration are associated with decreases in quality. Second, both higher hospital market share and market concentration are associated with lower quality of care. Hospital mergers have undesirable quality consequences. Appropriate antitrust policies towards mergers should consider not only price and cost but also quality impacts. PMID:12369060

  8. The relationship between maternal education and mortality among women giving birth in health care institutions: Analysis of the cross sectional WHO Global Survey on Maternal and Perinatal Health

    Directory of Open Access Journals (Sweden)

    Gülmezoglu A Metin

    2011-07-01

    Full Text Available Abstract Background Approximately one-third of a million women die each year from pregnancy-related conditions. Three-quarters of these deaths are considered avoidable. Millennium Development Goal five calls for a reduction in maternal mortality and the establishment of universal access to high quality reproductive health care. There is evidence of a relationship between lower levels of maternal education and higher maternal mortality. This study examines the relationship between maternal education and maternal mortality among women giving birth in health care institutions and investigates the association of maternal age, marital status, parity, institutional capacity and state-level investment in health care with these relationships. Methods Cross-sectional information was collected on 287,035 inpatients giving birth in 373 health care institutions in 24 countries in Africa, Asia and Latin America, between 2004-2005 (in Africa and Latin America and 2007-2008 (in Asia as part of the WHO Global Survey on Maternal and Perinatal Health. Analyses investigated associations between indicators measured at the individual, institutional and country level and maternal mortality during the intrapartum period: from admission to, until discharge from, the institution where women gave birth. There were 363 maternal deaths. Results In the adjusted models, women with no education had 2.7 times and those with between one and six years of education had twice the risk of maternal mortality of women with more than 12 years of education. Institutional capacity was not associated with maternal mortality in the adjusted model. Those not married or cohabiting had almost twice the risk of death of those who were. There was a significantly higher risk of death among those aged over 35 (compared with those aged between 20 and 25 years, those with higher numbers of previous births and lower levels of state investment in health care. There were also additional effects relating to country of residence which were not explained in the model. Conclusions Lower levels of maternal education were associated with higher maternal mortality even amongst women able to access facilities providing intrapartum care. More attention should be given to the wider social determinants of health when devising strategies to reduce maternal mortality and to achieve the increasingly elusive MDG for maternal mortality.

  9. 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.

  10. 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.

    1283-12-01

    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)

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

    Science.gov (United States)

    Child Trends, 2010

    2010-01-01

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

  12. Leadership: improving the quality of patient care.

    Science.gov (United States)

    Clegg, A

    The satisfaction staff achieve from their work is in part determined by the style of management they work under. This article analyses the impact of a proactive leadership style on team performance and the quality of patient care. PMID:11973895

  13. Acceptance of HIV testing during prenatal care. Perinatal Guidelines Evaluation Project.

    OpenAIRE

    Ferna?ndez, M. I.; Wilson, T. E.; Ethier, K. A.; Walter, E. B.; Gay, C. L.; Moore, J.

    2000-01-01

    OBJECTIVE: The purpose of this study was to assess the factors associated with acceptance of HIV testing during pregnancy on the part of women receiving prenatal care at public clinics. METHODS: Trained interviewers recruited and interviewed 1,357 women receiving prenatal care at clinics in Florida, Connecticut, and New York City. RESULTS: Eighty-six percent of participants reported having been tested or having signed a consent form to be tested. Acceptance of testing was found to be related ...

  14. Kangaroo Mother Care in a Mozambican Perinatal ward : A Clinical Case study

    OpenAIRE

    Söderbäck, Maja; Erlandsson, Kerstin

    2012-01-01

    Kangaroo mother care (KMC) was first introduced in Mozambiquein 1984. The aim of this study was to describe Mozambicanmothers’ experiences of going through admission, passing froman intensive care ward to a nursery ward with their prematurebaby, undergoing KMC training before early discharge. A clinicalcase study was conducted, involving naturalistic observationsand a face-to-face interview with 41 mothers participating tocomplete a questionnaire. Descriptive statistics and manifestcontent ...

  15. JAMA Patient Page: Quality of Care

    Science.gov (United States)

    ... professionals, as well as institutions (such as hospitals, nursing homes, mental health centers, and home health care agencies). Part of providing quality health care involves following standards, guidelines, and evidence-based practices. Evidence-based medicine involves using results from research ...

  16. Developing evidence-based maternity care in Iran: a quality improvement study

    Directory of Open Access Journals (Sweden)

    Mohammad Kazem

    2008-06-01

    Full Text Available Abstract Background Current Iranian perinatal statistics indicate that maternity care continues to need improvement. In response, we implemented a multi-faceted intervention to improve the quality of maternity care at an Iranian Social Security Hospital. Using a before-and-after design our aim was to improve the uptake of selected evidence based practices and more closely attend to identified women's needs and preferences. Methods The major steps of the study were to (1 identify women's needs, values and preferences via interviews, (2 select through a process of professional consensus the top evidence-based clinical recommendations requiring local implementation (3 redesign care based on the selected evidence-based recommendations and women's views, and (4 implement the new care model. We measured the impact of the new care model on maternal satisfaction and caesarean birth rates utilising maternal surveys and medical record audit before and after implementation of the new care model. Results Twenty women's needs and requirements as well as ten evidence-based clinical recommendations were selected as a basis for improving care. Following the introduction of the new model of care, women's satisfaction levels improved significantly on 16 of 20 items (p Conclusion The introduction of a quality improvement care model improved compliance with evidence-based guidelines and was associated with an improvement in women's satisfaction levels and a reduction in rates of caesarean birth.

  17. 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

  18. Dengue perinatal / Perinatal dengue

    Scientific Electronic Library Online (English)

    Doris Martha, Salgado; Jairo Antonio, Rodríguez; Liliana del Pilar, Lozano; Tatiana Esther, Zabaleta.

    2013-09-01

    Full Text Available El dengue es en la actualidad la enfermedad viral más relevante de transmisión vectorial hiperendémica en las Américas. El incremento en el número de casos se ha relacionado con la aparición de dengue durante la gestación y en el periodo neonatal. De acuerdo con la edad de gestación en la que ocurra [...] la infección, podrían presentarse manifestaciones en el feto, como aborto, y en los pacientes a término, dengue neonatal. En este artículo se presenta una reseña de los casos reportados a nivel mundial, y especialmente en las Américas, así como aspectos fisiopatogénicos de la enfermedad. Abstract in english Dengue is currently the most important viral disease transmitted by arthropods and which is hyperendemic in the Americas. An increase in the number of cases is related to dengue during pregnancy and the neonatal period. According to the gestational age in which infection occurs, there could be diffe [...] rent manifestations in the fetus including abortion, malformations or neonatal dengue in newborns. This article presents a review regarding some cases reported worldwide, especially in the Americas, and some pathophysiologic issues related to perinatal dengue.

  19. [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

  20. 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...

  1. The role of health care technology in support of perinatal nurse staffing.

    Science.gov (United States)

    Ivory, Catherine H

    2015-01-01

    Health care technology can generate massive amounts of data. However, when data are generated from disparate, uncoordinated systems, using them to make decisions related to staffing can be a challenge. In this article, I describe the importance of data standardization, system interoperability, standard terminologies that support nursing practice, and nursing informatics expertise as tools for improving the usefulness of electronic systems for informing staffing decisions. PMID:25652033

  2. 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...

  3. 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...

  4. A rare case of fetal spondylocostal dysostosis - prenatal diagnosis and perinatal care in a patient with multiple large leiomyomas.

    Science.gov (United States)

    Cirstoiu, M; Munteanu, O; Bodean, O; Cirstoiu, C

    2013-03-15

    The spondylocostal dysostosis (SCD) is one of the two major clinico-radiological subtypes of the Jarcho-Levin syndrome (JLS). The JLS is a rare heterogeneous entity characterized by facial dysmorphism, short-neck, short-trunk, normal sizes limbs, with multiple vertebral anomalies at all levels of the vertebral column and costal defects. The JLS has been classified into 2 major clinical phenotypes, based on the extent and distribution of skeletal anomalies, the pattern of inheritance and the prognosis. We report the case of a non-consanguineous 35-year-old female patient, with a history of multiple large leiomyomas gravida 1, para 1. A three-dimensional ultrasound at 18 weeks of gestation revealed: thoracic and lumbar hemivertebrae with abnormal alignment of the vertebral bodies and kypho-scoliosis, also the absence of two right ribs and abnormal shaped ribs. The biometric measurement was appropriate for gestational age and no other malformations were found. Although there was no previous history, based on the three-dimensional ultrasound findings a mild subtype of JLS was suspected. At term, the patient gave birth, by Cesarean section, to a male fetus, with a weight of 2700g, a length of 50cm and a calculated Apgar score of 9. The postpartum examination of the fetus confirmed the diagnose of SCD. The evolution of the newborn was good - he had no respiratory difficulty; he will benefit from an experimental surgery involving expandable titanium ribs. Our case illustrates the importance of an accurate ultrasound examination, which can be hindered by multiple large leyomiomas, in order to diagnose and to differentiate the two subtypes of JLS. The SCD can have a favorable evolution with the appropriate perinatal and postpartum care. PMID:23599829

  5. Changes in Perinatal Care and Predictors of In-Hospital Mortality for Very Low Birth Weight Preterm Infants

    Directory of Open Access Journals (Sweden)

    Ying Dong

    2012-09-01

    Full Text Available Objective: Mortality of very low birth weight premature infants is of great public health concern. To better guide local intervention program, it is essential that current and reliable statistics be collected to understand the factors associated with mortality of these infants.Methods: Data of very low birth weight premature infants admitted to a neonatal unit during 2002-2009 was retrospectively collected. Changes in perinatal care between two halves of the study period (2002-2005 and 2006-2009 were identified. Factors associated with in-hospital mortality were found by logistic regression and a predictive score model was established.Findings: A total of 475 cases were enrolled. In-hospital mortality decreased from 29.8% in 2002-2005 to 28.1% in 2006-2009 (P>0.05. More infants born<28 gestational weeks survived to discharge in the latter epoch (38.1% vs 8.3%, P<0.05. Persistent pulmonary hypertension of newborn, pulmonary hemorrhage,birth weight <000 grams, gestational age <33 weeks, feeding before 3 postnatal days and enteral feeding were found predictors of in-hospital mortality by logistic regression. The discriminating ability of the predictivemodel was 82.4% and the cutoff point was -0.56.Conclusion: Survival of very low birth weight premature neonates was not significantly improved in 2006-2009 than 2002-2005. Infants with a score higher than -0.56 were assessed to be at high risk of in-hospital mortality. Multi-center studies of planned follow-up are needed to develop a comprehensive and applicable score system.

  6. 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...

  7. Quality of Big Data in health care.

    Science.gov (United States)

    Sukumar, Sreenivas R; Natarajan, Ramachandran; Ferrell, Regina K

    2015-01-01

    Purpose - The current trend in Big Data analytics and in particular health information technology is toward building sophisticated models, methods and tools for business, operational and clinical intelligence. However, the critical issue of data quality required for these models is not getting the attention it deserves. The purpose of this paper is to highlight the issues of data quality in the context of Big Data health care analytics. Design/methodology/approach - The insights presented in this paper are the results of analytics work that was done in different organizations on a variety of health data sets. The data sets include Medicare and Medicaid claims, provider enrollment data sets from both public and private sources, electronic health records from regional health centers accessed through partnerships with health care claims processing entities under health privacy protected guidelines. Findings - Assessment of data quality in health care has to consider: first, the entire lifecycle of health data; second, problems arising from errors and inaccuracies in the data itself; third, the source(s) and the pedigree of the data; and fourth, how the underlying purpose of data collection impact the analytic processing and knowledge expected to be derived. Automation in the form of data handling, storage, entry and processing technologies is to be viewed as a double-edged sword. At one level, automation can be a good solution, while at another level it can create a different set of data quality issues. Implementation of health care analytics with Big Data is enabled by a road map that addresses the organizational and technological aspects of data quality assurance. Practical implications - The value derived from the use of analytics should be the primary determinant of data quality. Based on this premise, health care enterprises embracing Big Data should have a road map for a systematic approach to data quality. Health care data quality problems can be so very specific that organizations might have to build their own custom software or data quality rule engines. Originality/value - Today, data quality issues are diagnosed and addressed in a piece-meal fashion. The authors recommend a data lifecycle approach and provide a road map, that is more appropriate with the dimensions of Big Data and fits different stages in the analytical workflow. PMID:26156435

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

    Science.gov (United States)

    Pera, Pilar Isla

    2011-01-01

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

  9. Using clinical registries to improve the quality of neurosurgical care.

    Science.gov (United States)

    Asher, Anthony L; Parker, Scott L; Rolston, John D; Selden, Nathan R; McGirt, Matthew J

    2015-04-01

    Despite rising and unsustainable US health care costs, many stakeholders feel that the quality of medical services is limited and inconsistent. Value-based reforms are touted as the key to achieving health care system sustainability. Health care value is defined as quality delivered divided by cost incurred. Unfortunately, quality in health care is difficult to accurately define and methods to reliably assess and report health care quality are often lacking. Clinical registries have emerged as important mechanisms to define, measure, and promote health care quality. The purpose of this article is to describe the role of registries in neurosurgical quality improvement. PMID:25771281

  10. Blending Key Ingredients to Assure Quality in Home Health Care.

    Science.gov (United States)

    Griffith, Deloris G.

    1986-01-01

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

  11. Gauging food and nutritional care quality in hospitals

    OpenAIRE

    Diez-Garcia Rosa; de Sousa Anete; Proença Rossana Pacheco da Costa; Leandro-Merhi Vania; Martinez Edson

    2012-01-01

    Abstract Background Food and nutritional care quality must be assessed and scored, so as to improve health institution efficacy. This study aimed to detect and compare actions related to food and nutritional care quality in public and private hospitals. Methods Investigation of the Hospital Food and Nutrition Service (HFNS) of 37 hospitals by means of structured interviews assessing two quality control corpora, namely nutritional care quality (NCQ) and hospital food service quality (FSQ). HFN...

  12. 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...

  13. 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.

  14. 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.

  15. Improving the quality of perinatal mental health: a health visitor-led protocol.

    Science.gov (United States)

    Lewis, Anne; Ilot, Irene; Lekka, Chrysanthi; Oluboyede, Yemi

    2011-02-01

    The mental health of mothers is of significant concern to community practitioners. This paper reports on a case study exploring the success factors of a well established, health visitor-led protocol to identify and treat women with mild to moderate depression. Data were collected through interviews with a purposive sample of 12 community practitioners, a focus group of four health visitors and observation of a multidisciplinary steering group meeting. The protocol was described as an evidence-based tool and safety net that could be used flexibly to support clinical judgments and tailored to individual needs. Success factors included frontline clinician engagement and ownership, continuity of leadership to drive development and maintain momentum, comprehensive and on-going staff training, and strategic support for the protocol as a quality indicator at a time of organisational change. Quality and clinical leadership are continuing policy priorities. The protocol enabled frontline staff to lead a service innovation, providing a standardised multiprofessional approach to women's mental health needs through effective support, advice and treatment that can be measured and quality assured. PMID:21388041

  16. 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.

  17. Competition on quality in managed care.

    Science.gov (United States)

    Schoenbaum, S C; Coltin, K L

    1998-10-01

    There is intense competition between managed care organizations (MCOs) in the USA based on cost and benefit coverage, but scant attention to differences in quality. Consumer preference for 'choice' has stimulated the growth of overlapping networks of providers across competing MCOs. These networks have tended to perform less well on the quality indicators in report cards than staff model MCOs. Ideally one would measure individual provider performance; but the overlapping networks, and the fact that each MCO represents a small fraction of each provider's practice, make that difficult to do. MCOs could potentially collaborate to measure individual provider performance. Financial incentives and risk-adjusted premiums might stimulate competition on quality within MCOs. It seems more likely that true competition on quality will occur between groups of providers, organized or integrated delivery systems, than between MCOs. Nevertheless, MCOs are likely to offer some quality-improving programs directly to their members, and can stimulate the competition between providers by collaborating to obtain provider-specific measurements. PMID:9828031

  18. An Urban Perinatal Health Programme of Strategies to Improve Perinatal Health

    OpenAIRE

    Denktas?, S.; Bonsel, G. J.; Weg, E. J.; Voorham, A. J.; Torij, H. W.; Graaf, J. P.; Wildschut, H. I. J.; Peters, I. A.; Birnie, E.; Steegers-theunissen, R. P. M.

    2011-01-01

    Promotion of a healthy pregnancy is a top priority of the health care policy in many European countries. Perinatal mortality is an important indicator of the success of this policy. Recently, it was shown that the Netherlands has relatively high perinatal death rates when compared to other European countries. This is in particular true for large cities where perinatal mortality rates are 20-50% higher than elsewhere. Consequently in the Netherlands, there is heated debate on how to tackle the...

  19. 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.

  20. 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

    Scientific Electronic Library Online (English)

    Eduardo, Malvino; María, Muñoz; Claudia, Ceccotti; Gustavo, Janello; Diego, Mc Loughlin; Alberto, Pawlak; Pablo, Desmery; Osvaldo, López Gastón.

    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 intensivo [...] s 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. Abstract in english 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, Argent [...] ina. 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.

  1. Quality of intensive care chest imaging

    International Nuclear Information System (INIS)

    The authors have evaluated the image quality of a stimulable phosphorous plate system in intensive care chest radiography. Four radiologists examined 308 chest radiographs (200 conventional, 108 digital) according to the following criteria: visibility of catheters, tubes (artificial objects), bronchi, central and peripheral vessels, diaphragm, trachea, and retrocardial lung parenchyma. Detectability of these structures was classified as good, poor, or impossible to see. In addition, optical density was measured in the region of liver, heart, and lung. Results were evaluated by Student and ? test

  2. 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.

  3. 38 CFR 52.120 - Quality of care.

    Science.gov (United States)

    2010-07-01

    ...2010-07-01 false Quality of care. 52.120...Standards § 52.120 Quality of care. Each participant...receive, and the program management must provide, the...Extended Care Strategic Healthcare Group (114), within... (4) The program management must establish...

  4. [Measuring quality of life in palliative care].

    Science.gov (United States)

    Lopes Ferreira, Pedro; Pinto Barros, Ana; Barros Brito, Ana

    2008-01-01

    This paper describes the process followed to create and validate the Portuguese versión of a quality of life measurement instrument for patients in palliative care. After a literature review about the measurement of the quality of life in this particular and very specific kind of patients, we opt by the Irene Higginson's measurement instrument called Palliative Care Outcome Scale (POS). It has been selected as the one most appropriate to Portuguese patients' reality. For the creation of the Portuguese version we followed the recommended methodologies for the forward-backward translations. These methodologies allow us to determine semantic and linguistic equivalences of health outcomes measurement instruments. The validation was performed on a sample of 104 cancer patients aged between 40 and 85 years old. 70% were female, 29% had lung cancer, 46% breast cáncer and 22% had melanoma. Content validity was assured by two cognitive debriefing tests, respectively performed in oncologists and in patients. Construct validation allow us to find five ortogonal factors, including 'emotional well being' (19.7% of variance explained), 'consequences of the disease in life' (18.2%), 'received information and support' (11.7%), 'anxiety' (10.1%), and 'burden of illness' (9.8%). Criterion validity was tested by comparing the results obtained by POS to the ones obtained by the EORTC QLQ-C30, a genetic instrument especially designed for cancer patients. The found correlation values were moderated to strong and ranged from 0.51 to 0.63. The reliability of the Portuguese version was assured through the reproducibility test and the search for the internal consistency. The scores obtained by a one-week testrestest ranged from 0.66 to 1.00. Cronbach's alpha was 0.68, acceptable and allowing us to consider POS as a unique index Time responsiveness and diagnosis responsiveness were also analysed. Comparing values measured with a one-month interval showed sensibility to the lack of the quality of life felt by patients. This measurement instrument was also sensitive to the various pathologies. In conclusion, we may defend the quality of the performance of the Portuguese versión of the POS. This version may be used to prospectively assess the palliative care on advances cancer patients. PMID:18625090

  5. 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 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)

  6. The Impact of Financial Incentives on Quality of Health Care

    OpenAIRE

    Dudley, R. Adams; Miller, Robert H.; Korenbrot, Tamir Y.; Luft, Harold S.

    1998-01-01

    Purchasers of health care could offer financial incentives to plans or providers in order to increase quality. Unfortunately, the current health care market, in which quality is rarely measured and there is no risk adjustment, actively discourages both plans and providers from maximizing quality, resulting in a poor overall level of quality, both in fee-for-service arrangements and health maintenance organizations. Health plans and providers will not focus on quality until mechanisms to corre...

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

    OpenAIRE

    Sword Wendy; Heaman Maureen I; Brooks Sandy; Tough Suzanne; Janssen Patricia A; Young David; Kingston Dawn; Helewa Michael E; Akhtar-Danesh Noori; Hutton Eileen

    2012-01-01

    Abstract Background Much attention has been given to the adequacy of prenatal care use in promoting healthy outcomes for women and their infants. Adequacy of use takes into account the timing of initiation of prenatal care and the number of visits. However, there is emerging evidence that the quality of prenatal care may be more important than adequacy of use. The purpose of our study was to explore women's and care providers' perspectives of quality prenatal care to inform the development of...

  8. 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

  9. 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

    Scientific Electronic Library Online (English)

    Isabel, Río; Adela, Castelló; Mireia, Jané; Ramón, Prats; Carmen, Barona; Rosa, Más; Marisa, Rebagliato; Oscar, Zurriaga; Francisco, Bolúmar.

    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 d [...] e 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. Abstract in english 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.

  10. 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.

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

    OpenAIRE

    Chassin Mark R

    2012-01-01

    Abstract Israel has made impressive progress in improving performance on key measures of the quality of health care in the community in recent years. These achievements are all the more notable given Israel's modest overall spending on health care and because they have accrued to virtually the entire population of the country. Health care systems in most developed nations around the world find themselves in a similar position today with respect to health care quality. Despite significantly in...

  12. An urban perinatal health programme of strategies to improve perinatal health.

    Science.gov (United States)

    Denkta?, S; Bonsel, G J; Van der Weg, E J; Voorham, A J J; Torij, H W; De Graaf, J P; Wildschut, H I J; Peters, I A; Birnie, E; Steegers, E A P

    2012-11-01

    Promotion of a healthy pregnancy is a top priority of the health care policy in many European countries. Perinatal mortality is an important indicator of the success of this policy. Recently, it was shown that the Netherlands has relatively high perinatal death rates when compared to other European countries. This is in particular true for large cities where perinatal mortality rates are 20-50% higher than elsewhere. Consequently in the Netherlands, there is heated debate on how to tackle these problems. Without the introduction of measures throughout the entire perinatal health care chain, pregnancy outcomes are difficult to improve. With the support of health care professionals, the City of Rotterdam and the Erasmus University Medical Centre have taken the initiative to develop an urban perinatal health programme called 'Ready for a Baby'. The main objective of this municipal 10-year programme is to improve perinatal health and to reduce perinatal mortality in all districts to at least the current national average of l0 per 1000. Key elements are the understanding of the mechanisms of the large health differences between women living in deprived and non-deprived urban areas. Risk guided care, orientation towards shared-care and improvement of collaborations between health care professionals shapes the interventions that are being developed. Major attention is given to the development of methods to improve risk-selection before and during pregnancy and methods to reach low-educated and immigrant groups. PMID:21870042

  13. Evidence from community level inputs to improve quality of care for maternal and newborn health: interventions and findings.

    Science.gov (United States)

    Lassi, Zohra S; Das, Jai K; Salam, Rehana A; Bhutta, Zulfiqar A

    2014-09-01

    Annually around 40 million mothers give birth at home without any trained health worker. Consequently, most of the maternal and neonatal mortalities occur at the community level due to lack of good quality care during labour and birth. Interventions delivered at the community level have not only been advocated to improve access and coverage of essential interventions but also to reduce the existing disparities and reaching the hard to reach. In this paper, we have reviewed the effectiveness of care delivered through community level inputs for improving maternal and newborn health outcomes. We considered all available systematic reviews published before May 2013 on the pre-defined community level interventions and report findings from 43 systematic reviews. Findings suggest that home visitation significantly improved antenatal care, tetanus immunization coverage, referral and early initiation of breast feeding with reductions in antenatal hospital admission, cesarean-section rates birth, maternal morbidity, neonatal mortality and perinatal mortality. Task shifting to midwives and community health workers has shown to significantly improve immunization uptake and breast feeding initiation with reductions in antenatal hospitalization, episiotomy, instrumental delivery and hospital stay. Training of traditional birth attendants as a part of community based intervention package has significant impact on referrals, early breast feeding, maternal morbidity, neonatal mortality, and perinatal mortality. Formation of community based support groups decreased maternal morbidity, neonatal mortality, perinatal mortality with improved referrals and early breast feeding rates. At community level, home visitation, community mobilization and training of community health workers and traditional birth attendants have the maximum potential to improve a range of maternal and newborn health outcomes. There is lack of data to establish effectiveness of outreach services, mass media campaigns and community education as standalone interventions. Future efforts should be concerted on increasing the availability and training of the community based skilled health workers especially in resource limited settings where the highest burden exists with limited resources to mobilize. PMID:25209692

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

    OpenAIRE

    Higginson Irene J; Stewart Frances; Goddard Cassie; Hall Sue

    2011-01-01

    Abstract Background An increasing number of older people reach the end of life in care homes. The aim of this study is to explore the perceived benefits of, and barriers to, implementation of the Gold Standards Framework for Care Homes (GSFCH), a quality improvement programme in palliative care. Methods Nine care homes involved in the GSFCH took part. We conducted semi-structured interviews with nine care home managers, eight nurses, nine care assistants, eleven residents and seven of their f...

  15. 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.

  16. Quality indicators for primary care mental health services

    OpenAIRE

    Shield, T; Campbell, S.; Rogers, A.; 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.

  17. Dengue perinatal / Perinatal dengue infection

    Scientific Electronic Library Online (English)

    Griselda, Berberian; Diana, Fariña; María Teresa, Rosanova; Solange, Hidalgo; Delia, Enría; Alicia, Mitchenko; Julio, Moreno; Isabel, Sánchez Soto.

    2011-06-01

    Full Text Available El dengue es una enfermedad viral de amplia distribución en zonas tropicales y subtropicales. La Argentina fue declarada libre de Aedes aegypti en la década de 1960, pero en 1984 reapareció el vector. En la década de 1990 comenzaron a presentarse brotes de enfermedad autóctona limitados a las provin [...] cias del norte. Entre el 2008-2009, los casos autóctonos se extendieron a gran parte del país. La transmisión vertical madre-hijo es infrecuente y sus efectos en la mujer embarazada y en los recién nacidos son poco conocidos. Se hace una revisión del tema y se presenta un caso de transmisión perinatal de dengue en un recién nacido procedente de Salta, Argentina. Abstract in english Dengue is a mosquito-borne viral disease, with worldwide distribution in tropical and subtropical areas. Argentina was certifed free of Aedes aegypti in the sixties, however the vector reappered in 1984. In the nineties, small dengue outbreaks occurred with autocthonus diseases at frst limited to th [...] e northern provinces. In the summer of 2008-2009, autocthonus cases were reported in other parts of the country. Vertical dengue virus transmission has been infrequently described, and the effect on pregnant women and newborn has not been well documented. We review this condition and present a case of perinatal dengue infection in a newborn infant from Salta, Argentina.

  18. Managed care: the strategic future for education in quality.

    Science.gov (United States)

    Ziegenfuss, J T

    1992-01-01

    This paper discusses the needs for future education in quality assurance, assessment and improvement, particularly in relation to managed care. The pressures for increased education about quality are derived from different components of the health care system; e.g., regulatory and governmental agencies, purchasers of care, and competitors of health institutions. The content of future education in health care quality is defined in six areas: (1) organization and management; (2) health systems; (3) quality theory and methods; (4) management information systems and research; (5) governmental policy; and (6) economics and finance. Education in health care quality in these content areas is delivered at both the primary and continuing education levels by universities, professional associations and private training and development corporations. Future oriented, strategic thinking education in health care quality is needed. The pressures for education about quality, including traditional concepts of quality assurance, methodologies for quality assessment and the newer approaches to continuing quality improvement, are clearly growing stronger. This article discusses the need for education in health care quality, the content areas and levels of education and the delivery system. PMID:10148484

  19. 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 toass 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 ind

  20. Effects of multidisciplinary integrated care on quality of care in residential care facilities for elderly people: a cluster randomized trial

    Science.gov (United States)

    Boorsma, Marijke; Frijters, Dinnus H.M.; Knol, Dirk L.; Ribbe, Miel E.; Nijpels, Giel; van Hout, Hein P.J.

    2011-01-01

    Background: Sophisticated approaches are needed to improve the quality of care for elderly people living in residential care facilities. We determined the effects of multidisciplinary integrated care on the quality of care and quality of life for elderly people in residential care facilities. Methods: We performed a cluster randomized controlled trial involving 10 residential care facilities in the Netherlands that included 340 participating residents with physical or cognitive disabilities. Five of the facilities applied multidisciplinary integrated care, and five provided usual care. The intervention, inspired by the disease management model, consisted of a geriatric assessment of functional health every three months. The assessment included use of the Long-term Care Facility version of the Resident Assessment Instrument by trained nurse-assistants to guide the design of an individualized care plan; discussion of outcomes and care priorities with the family physician, the resident and his or her family; and monthly multidisciplinary meetings with the nurse-assistant, family physician, psychologist and geriatrician to discuss residents with complex needs. The primary outcome was the sum score of 32 risk-adjusted quality-of-care indicators. Results: Compared with the facilities that provided usual care, the intervention facilities had a significantly higher sum score of the 32 quality-of-care indicators (mean difference ? 6.7, p = 0.009; a medium effect size of 0.72). They also had significantly higher scores for 11 of the 32 indicators of good care in the areas of communication, delirium, behaviour, continence, pain and use of antipsychotic agents. Interpretation: Multidisciplinary integrated care resulted in improved quality of care for elderly people in residential care facilities compared with usual care. Trial registration: www.controlled-trials.com trial register no. ISRCTN11076857. PMID:21708967

  1. The Role of Acute Care Managers in Quality of Care and Patient Safety

    OpenAIRE

    Parand, Anam

    2013-01-01

    Healthcare managers have a responsibility for the standard of their services and patient care delivered. Their work is thought to be essential in achieving and improving high quality care and patient safety. However, little is empirically known about their role in this. This thesis investigates acute care managerial work and impact in the context of quality of care and patient safety. It draws upon power and work-activity group theories and literature from other industries to guide investigat...

  2. Patients’ perceptions of actual care conditions and patient satisfaction with care quality in hospital

    OpenAIRE

    Abrahamsen Grøndahl, Vigdis

    2012-01-01

    There are theoretical and methodological difficulties in measuring the concepts of quality of care and patient satisfaction, and the conditions associated with these concepts. A theoretical framework of patient satisfaction and a theoretical model of quality of care have been used as the theoretical basis in this thesis. Aim. The overall aim was to describe and explore relationships between person-related conditions, external objective care conditions, patients’ perceptions of quality of ca...

  3. Factors for change in maternal and perinatal audit systems in Dar es Salaam hospitals, Tanzania

    Directory of Open Access Journals (Sweden)

    Kisanga Felix

    2010-06-01

    Full Text Available Abstract Background Effective maternal and perinatal audits are associated with improved quality of care and reduction of severe adverse outcome. Although audits at the level of care were formally introduced in Tanzania around 25 years ago, little information is available about their existence, performance, and practical barriers to their implementation. This study assessed the structure, process and impacts of maternal and perinatal death audit systems in clinical practice and presents a detailed account on how they could be improved. Methods A cross sectional descriptive study was conducted in eight major hospitals in Dar es Salaam in January 2009. An in-depth interview guide was used for 29 health managers and members of the audit committees to investigate the existence, structure, process and outcome of such audits in clinical practice. A semi-structured questionnaire was used to interview 30 health care providers in the maternity wards to assess their awareness, attitude and practice towards audit systems. The 2007 institutional pregnancy outcome records were reviewed. Results Overall hospital based maternal mortality ratio was 218/100,000 live births (range: 0 - 385 and perinatal mortality rate was 44/1000 births (range: 17 - 147. Maternal and perinatal audit systems existed only in 4 and 3 hospitals respectively, and key decision makers did not take part in audit committees. Sixty percent of care providers were not aware of even a single action which had ever been implemented in their hospitals because of audit recommendations. There were neither records of the key decision points, action plan, nor regular analysis of the audit reports in any of the facilities where such audit systems existed. Conclusions Maternal and perinatal audit systems in these institutions are poorly established in structure and process; and are less effective to improve the quality of care. Fundamental changes are urgently needed for successful audit systems in these institutions.

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

    Science.gov (United States)

    Singer, Peter A; Bowman, Kerry W

    2002-07-25

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

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

    Directory of Open Access Journals (Sweden)

    Singer Peter A

    2002-07-01

    Full Text Available 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 large-scale, population based nature of some possible interventions. It is a health systems problem because one of its main features is the need for better information on quality end-of-life care. We examine the context of end-of-life care, including the epidemiology of death and cross-cultural considerations. Although there are examples of success, we could not identify systematic data on capacity for delivering quality end-of-life care in developing countries. We also address a possible objection to improving end-of-life care in developing countries; many deaths are preventable and reduction of avoidable deaths should be the focus of attention. Conclusions We make three recommendations: (1 reinforce the recasting of quality end-of-life care as a global public health and health systems problem; (2 strengthen capacity to deliver quality end-of-life care; and (3 develop improved strategies to acquire information about the quality of end-of-life care.

  6. 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

  7. Child Outcome Measures in the Study of Child Care Quality

    Science.gov (United States)

    Zaslow, Martha; Halle, Tamara; Martin, Laurie; Cabrera, Natasha; Calkins, Julia; Pitzer, Lindsay; Margie, Nancy Geyelin

    2006-01-01

    This article assesses whether there are methodological problems with child outcome measures that may contribute to the small associations between child care quality and child outcomes found in the literature. Outcome measures used in 65 studies of child care quality published between 1979 and December 2005 were examined, taking the previous review…

  8. Using Quality Experts from Manufacturing to Transform Primary Care

    Science.gov (United States)

    Steiner, Rose M.; Walsworth, David T.

    2010-01-01

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

  9. Measuring the Quality of Care in Different Settings

    OpenAIRE

    Docteur, Elizabeth

    2001-01-01

    As HCFA initiates the next generation of health plan performance measures, the agency must address challenges associated with measuring the quality of care in all of the settings in which Medicare and Medicaid beneficiaries obtain care. One such challenge will be to integrate health plan performance measurement and health care quality measurement initiatives, which have been proceeding separately. Of equal importance is the challenge to improve coordination across the diverse, setting-specifi...

  10. The quality of general dental care: public and users' perceptions

    OpenAIRE

    Calnan, M.; Dickinson, M.; Manley, G.

    1999-01-01

    Background - Systematic evidence about how the public and users perceive and experience the quality of general dental care is in short supply, particularly in light of the recent changes in the general dental service. The study reported here attempted to fill this gap. Objectives - To identify the criteria the public and users adopt in evaluating the quality of general dental care, and to identify the extent and nature of perceived concerns with general dental care. De...

  11. Improving quality of cancer care through surgical audit

    OpenAIRE

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

    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...

  12. 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

  13. 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...

  14. Health-care quality promotion through infection prevention: beyond 2000.

    OpenAIRE

    Gerberding, J. L.

    2001-01-01

    Health-care value purchasing, complex health-care systems, and information technology are the three most important change drivers influencing the interrelated themes of the 4th decennial conference: accountability, quality promotion through infection prevention across the health-care delivery system, and medical informatics. Among the change drivers influencing themes of future conferences may be a societal mandate for health promotion and health-care access for all.

  15. A question of quality and quantity of chiropractic care

    OpenAIRE

    Grier, Alexander; Cassidy, J. David

    1986-01-01

    Faced with great increases in the costs of health care, the government agencies responsible for funding are taking a much more active role in the decision making process regarding the expenditure of health care dollars. This paper reviews how a government analysis of the type of care rendered by chiropractors can result in assumptions about the quality of care which may be erroneous. Although data from Saskatchewan is presented, the issues and arguments are relevant in all areas where chiropr...

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

    Directory of Open Access Journals (Sweden)

    Sword Wendy

    2012-04-01

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

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

    Science.gov (United States)

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

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

  18. 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…

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

    Science.gov (United States)

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

    2005-01-01

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

  20. 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…

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

    Science.gov (United States)

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

    2011-01-01

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

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

    Science.gov (United States)

    2011-01-01

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

  3. 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.

  4. Parental Involvement in Pediatric Hospital Care-Implications for Clinical Practice and Quality of Care

    OpenAIRE

    Ygge, Britt Marie

    2004-01-01

    The overall aim of this thesis was to gain a deeper understanding about parents’ perceptions of quality of care and their own involvement in pediatric hospital care. Parental involvement in the care of hospitalized children has gained increased attention in recent years. The aim of this thesis was to study parental involvement in pediatric hospital care and investigate its association to the work conditions of pediatric hospital staff. The first study validated a parent questionnaire that me...

  5. Many quality measurements, but few quality measures assessing the quality of breast cancer care in women: A systematic review

    Directory of Open Access Journals (Sweden)

    Zhang Li

    2006-12-01

    Full Text Available Abstract Background Breast cancer in women is increasingly frequent, and care is complex, onerous and expensive, all of which lend urgency to improvements in care. Quality measurement is essential to monitor effectiveness and to guide improvements in healthcare. Methods Ten databases, including Medline, were searched electronically to identify measures assessing the quality of breast cancer care in women (diagnosis, treatment, followup, documentation of care. Eligible studies measured adherence to standards of breast cancer care in women diagnosed with, or in treatment for, any histological type of adenocarcinoma of the breast. Reference lists of studies, review articles, web sites, and files of experts were searched manually. Evidence appraisal entailed dual independent assessments of data (e.g., indicators used in quality measurement. The extent of each quality indicator's scientific validation as a measure was assessed. The American Society of Clinical Oncology (ASCO was asked to contribute quality measures under development. Results Sixty relevant reports identified 58 studies with 143 indicators assessing adherence to quality breast cancer care. A paucity of validated indicators (n = 12, most of which assessed quality of life, only permitted a qualitative data synthesis. Most quality indicators evaluated processes of care. Conclusion While some studies revealed patterns of under-use of care, all adherence data require confirmation using validated quality measures. ASCO's current development of a set of quality measures relating to breast cancer care may hold the key to conducting definitive studies.

  6. 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...

  7. 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 ...

  8. Gauging food and nutritional care quality in hospitals

    Directory of Open Access Journals (Sweden)

    Diez-Garcia Rosa

    2012-09-01

    Full Text Available Abstract Background Food and nutritional care quality must be assessed and scored, so as to improve health institution efficacy. This study aimed to detect and compare actions related to food and nutritional care quality in public and private hospitals. Methods Investigation of the Hospital Food and Nutrition Service (HFNS of 37 hospitals by means of structured interviews assessing two quality control corpora, namely nutritional care quality (NCQ and hospital food service quality (FSQ. HFNS was also evaluated with respect to human resources per hospital bed and per produced meal. Results Comparison between public and private institutions revealed that there was a statistically significant difference between the number of hospital beds per HFNS staff member (p?=?0.02 and per dietitian (p? Conclusions Food and nutritional care in hospital is still incipient, and actions concerning both nutritional care and food service take place on an irregular basis. It is clear that the design of food and nutritional care in hospital indicators is mandatory, and that guidelines for the development of actions as well as qualification and assessment of nutritional care are urgent.

  9. 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.

  10. Quality of hospice care: comparison between rural and urban residents.

    Science.gov (United States)

    Baernholdt, Marianne; Campbell, Cathy L; Hinton, Ivora D; Yan, Guofen; Lewis, Erica

    2015-01-01

    Discrepancies between needed and received hospice care exist, especially in rural areas. Hospice care quality ratings for 743 rural and urban patients and their families were compared. Rural participants reported higher overall satisfaction and with pain/symptom management. Regardless of geographic location, satisfaction was higher when patients were informed and emotionally supported. Patients and family ratings did not differ. Findings support prior reports using retrospective rather than our study's point-of-care surveys. PMID:25546093

  11. Improving regional variation using quality of care measures

    OpenAIRE

    Berkowitz, Scott A; 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...

  12. 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.

  13. Criteria-Based Audit of Quality of Care to Women with Severe Pre-Eclampsia and Eclampsia in a Referral Hospital in Accra, Ghana

    Science.gov (United States)

    Srofenyoh, Emmanuel K.; Grobbee, Diederick E.; Klipstein-Grobusch, Kerstin

    2015-01-01

    Objectives Severe pre-eclampsia and eclampsia are one of the major causes of maternal mortality globally. Reducing maternal morbidity and mortality demands optimizing quality of care. Criteria-based audits are a tool to define, assess and improve quality of care. The aim of this study was to determine applicability of a criteria-based audit to assess quality of care delivered to women with severe hypertensive disorders in pregnancy, and to assess adherence to protocols and quality of care provided at a regional hospital in Accra, Ghana. Methods Checklists for management of severe preeclampsia, hypertensive emergency and eclampsia were developed in an audit cycle based on nine existing key clinical care protocols. Fifty cases were audited to assess quality of care, defined as adherence to protocols. Analysis was stratified for complicated cases, defined as (imminent) eclampsia, perinatal mortality and/or one or more WHO maternal near miss C-criteria. Results Mean adherence to the nine protocols ranged from 15–85%. Protocols for ‘plan for delivery’ and ‘magnesium sulphate administration’ were best adhered to (85%), followed by adherence to protocols for ‘eclampsia’ (64%), ‘severe pre-eclampsia at admission’ (60%), ‘severe pre-eclampsia ward follow-up’ (53%) and ‘hypertensive emergency’ (53%). Protocols for monitoring were least adhered to (15%). No difference was observed for severe disease. Increased awareness, protocol-based training of staff, and clear task assignment were identified as contributors to better adherence. Conclusion A criteria-based audit is an effective tool to determine quality of care, identify gaps in standard of care, and allow for monitoring and evaluation in a health facility, ultimately resulting in improved quality of care provided and reduced maternal morbidity and mortality. In our audit, good adherence was observed for plan for delivery and treatment with magnesium sulphate. Substandard adherence to a number of protocols was identified, and points towards opportunities for targeted improvement strategies. PMID:25923663

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

    Science.gov (United States)

    Yin, Aitian; Mao, Zongfu; Liu, Xiaoyun

    2015-01-01

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

  15. Small and big quality in health care.

    Science.gov (United States)

    Lillrank, Paul

    2015-01-01

    Purpose - The purpose of this paper is to clarify healthcare quality's ontological and epistemological foundations; and examine how these lead to different measurements and technologies. Design/methodology/approach - Conceptual analysis. Findings - Small quality denotes conformance to ex ante requirements. Big quality includes product and service design, based on customer requirements and expectations. Healthcare quality can be divided into three areas: clinical decision making; patient safety; and patient experience, each with distinct measurement and improvement technologies. Practical implications - The conceptual model is expected to bring clarity to constructing specific definitions, measures, objectives and technologies for improving healthcare. Originality/value - This paper claims that before healthcare quality can be defined, measured and integrated into systems, it needs to be clearly separated into ontologically and epistemologically different parts. PMID:25982636

  16. 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.

  17. 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.

  18. Óbitos perinatais investigados e falhas na assistência hospitalar ao parto / Perinatal deaths investigated and failures in hospital care delivery / Muertes perinatales investigadas y los fracasos en la atención hospitalaria al parto

    Scientific Electronic Library Online (English)

    Eunice Francisca, Martins; Edna Maria, Rezende; Francisco Carlos Félix, Lana; Kleyde Ventura de, Souza.

    2013-03-01

    Full Text Available Objetivou-se analisar as falhas na assistência hospitalar ao parto, o perfil materno e as características do feto e do recém-nascido que evoluíram para óbito perinatal, em Belo Horizonte. MÉTODOS: Estudo transversal, dos óbitos perinatais investigados pelo Comitê de Prevenção de Óbitos de Belo Horiz [...] onte, ocorridos entre 2003 e 2007. A fonte dos dados foram as fichas de investigação do Comitê. Os dados foram analisados pela distribuição de frequência das variáveis e análise bivariada utilizando-se o teste de Qui-quadrado de Pearson, considerando o nível de significância de 5% (p Abstract in spanish Analizar las deficiencias en la prestación de la atención hospitalaria al parto, el perfil materno y las características del feto y del recién nacido que murió durante el período perinatal, en Belo Horizonte (MG). MÉTODOS: eEstudio transversal de las muertes perinatales investigadas por el Comité pa [...] ra la Prevención de Muertes de Belo Horizonte, que se produjo entre 2003 y 2007. La fuente de datos fueron informes de investigación del Comité. Los datos fueron analizados mediante distribución de frecuencias de las variables y el análisis bivariado se utilizó la prueba de Qui-Quadrado, teniendo en cuenta el nivel de significación del 5% (p Abstract in english To analyze the shortcomings in hospital care delivery, the maternal profile and characteristics of the fetus and newborn that died perinatally, in Belo Horizonte. METHODS: Cross sectional study of perinatal deaths investigated by the Committee for the Prevention of Deaths of Belo Horizonte, which oc [...] curred between 2003 and 2007. The data source was the Committee's investigation forms. Data were analyzed by frequency distribution of variables and the bivariate analysis used the chi-square test, considering the significance level of 5% (p

  19. Quality of care emerges as a determinant of creditworthiness.

    Science.gov (United States)

    Oszustowicz, R J

    1992-03-01

    Sophisticated profiles of the quality of care provided in hospitals are prompting investors and bond rating agencies to ask questions about debt capitalization: What elements of the quality of care--measured by illness outcome, length of stay, morbidity, and mortality--will improve as a result of a proposed capital financing? Can the hospital demonstrate that cost benefits will result from a proposed financing by correlating costs with measurable improvements in patient outcomes? Can the hospital show, through financial feasibility analyses that reflect quality assessments, that its market share will remain stable? Hospitals' ability to gain access to credit markets will be influenced materially by their answers to these questions. PMID:10145599

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

    OpenAIRE

    Peters, M; Jenkinson, C; Perera, S (Sarath); Loder, E.; Jensen, R.; Katsarava, Z; Gouveia, RG; Broner, S; STEINER, T

    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...

  1. 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 St...

  2. Perinatal health and mother-child health care in the municipality of São Luís, Maranhão State, Brazil

    Directory of Open Access Journals (Sweden)

    Silva Antônio Augusto M. da

    2001-01-01

    Full Text Available The purpose of this article was to evaluate socioeconomic and demographic indicators, reproductive health, use of prenatal, childbirth, and neonatal services, and anthropometric data for mothers and infants. The authors performed a cross-sectional analysis of a systematic sample of 2,831 hospital births in São Luís, Maranhão State, from March 1997 to February 1998 at ten public and private maternity hospitals. The sample was stratified proportionally according to the number of births in each maternity hospital. Mothers answered a standard questionnaire. Of the total, 97.9% were live births and 98% were singletons. Prenatal coverage was 89.5%, and prevalence of cesarean sections was 33.8%. A physician provided prenatal care in 75.7% of cases and performed 73.8% of the deliveries. The Unified Health System covered the costs of 76.4% of the prenatal visits and 89.7% of the deliveries. A pediatrician was present in the delivery room in 50.2% of cases. The low birth weight rate was 9.6% and the preterm birth rate 13.9%. Reasons for concern included a high percentage of adolescent mothers, single mothers (or without partners, the high cesarean rate, and the high percentage of births attended by unqualified personnel.

  3. 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

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

    Science.gov (United States)

    Fatati, Giuseppe

    2014-10-01

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

  5. Care and Quality of Life in the Dying Phase: The contribution of the Liverpool Care Pathway for the Dying Patient

    OpenAIRE

    Veerbeek, L.

    2008-01-01

    This thesis concerns the professional care and the quality of life for dying patients and their relatives in the hospital, the nursing home and the primary care setting. The effect of introducing the Liverpool Care Pathway for the Dying Patient (LCP) on the content of care and the quality of life of the dying patient was studied. The Liverpool Care Pathway for the Dying Patient (LCP) provides care goals to ensure that dying patients and their family receive the best possible co...

  6. 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 pr...

  7. 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.

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

    Science.gov (United States)

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

    2015-01-01

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

  9. Prevention Health Care Quality in America: Findings From the First National Healthcare Quality and Disparities Reports

    Directory of Open Access Journals (Sweden)

    Ed Kelley

    2004-07-01

    Full Text Available The Agency for Healthcare Research and Quality (AHRQ released in December 2003 the first National Healthcare Quality Report (NHQR and National Healthcare Disparities Report (NHDR on behalf of the U.S. Department of Health and Human Services (1,2. In this commentary, we summarize the main findings of the reports on preventive care for both primary prevention of disease and secondary prevention of increasing acuity of existing disease and discuss the implications for quality measurement and improvement efforts. Federal partners within the U.S. health care system have recently focused on increasing the use of preventive care services. Tommy G. Thompson, Secretary of Health and Human Services, issued a challenge in April 2003 at the launch of the Steps to a HealthierUS national initiative: "Approximately 95% of the $1.4 trillion that we spend as a nation on health goes to direct medical services, while approximately 5% is allocated to preventing disease and promoting health. This approach is equivalent to waiting for your car to break down before you take it in for maintenance. By changing the way we view our health, the Steps initiative helps move us from a disease care system to a true health care system." (3 Good quality preventive care holds the promise of greatly reducing the nation?s health care costs and overall burden of disease. Numerous studies and reports have examined the general quality of preventive care services in the United States (4-7. Others have explored the performance of the U.S. health care system in delivering specific preventive care services such as immunizations (8,9, cancer screening (10-12, and cholesterol and blood pressure screening (13-15. The NHQR and NHDR provide the first national baseline views of the quality of health care services and of differences in how at-risk groups in America use the services. The reports provide one of the broadest examinations to date of prevention health care quality for the nation and among key priority populations, measuring quality of care across a range of dimensions, including the degree to which care is safe, patient centered, timely, and effectively delivered. They track more than 50 primary and secondary prevention quality-of-care measures in five clinical areas, including cancer, diabetes, heart disease, maternal and child health, and respiratory disease.

  10. 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

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

    Science.gov (United States)

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

    2013-01-01

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

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

    Science.gov (United States)

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

    2013-10-01

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

  13. Organized practice and the quality of medical care.

    Science.gov (United States)

    Eisenberg, J M; Kabcenell, A

    1988-01-01

    Larger, more complex medical care organizations have the inherent capability to improve the quality of the care they deliver because of the improved competency that follows higher volumes of service, the interdependence of staff, and the emergence of responsible leadership in large organizations. The potential for slackened physician-patient relationships, however, could jeopardize that quality. We suggest that professional associations can counterbalance the negative influences of large organizations. We envision that the changing political and economic environment of medical practice, along with the greater professional and public scrutiny of care in highly visible large organizations, will act together to exert pressure on organized practices to examine and demonstrate quality clinical practice. PMID:2966129

  14. Initial Steps for Quality Improvement of Obesity Care Across Divisions at a Tertiary Care Pediatric Hospital

    Directory of Open Access Journals (Sweden)

    Sheila Z. Chang

    2014-09-01

    Full Text Available Background: Pediatric subspecialists can participate in the care of obese children. Objective: To describe steps to help subspecialty providers initiate quality improvement efforts in obesity care. Methods: An anonymous patient data download, provider surveys and interviews assessed subspecialty providers’ identification and perspectives of childhood obesity and gathered information on perceived roles and care strategies. Participating divisions received summary analyses of quantitative and qualitative data and met with study leaders to develop visions for division/service-specific care improvement. Results: Among 13 divisions/services, subspecialists’ perceived role varied by specialty; many expressed the need for cross-collaboration. All survey informants agreed that identification was the first step, and expressed interest in obtaining additional resources to improve care. Conclusions: Subspecialists were interested in improving the quality and coordination of obesity care for patients across our tertiary care setting. Developing quality improvement projects to achieve greater pediatric obesity care goals starts with engagement of providers toward better identifying and managing childhood obesity.

  15. 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...

  16. Estimation of perinatal mortality rate for institutional births in Rajasthan state, India, using capture–recapture technique

    Science.gov (United States)

    Mony, Prem K; Varghese, Beena; Thomas, Tinku

    2015-01-01

    Objective The objective of our investigation was to estimate the perinatal mortality rate among institutional births and to compare the sensitivities of different data collection methods. Setting A hospital-based prospective cohort study was undertaken during late-2012 in 21 public sector health facilities of 10 districts of the northern state of Rajasthan, India. Participants A total of 6872 births were included in this epidemiological study. Primary and secondary outcome measures Perinatal mortality rate of institutional births was the primary outcome. Sensitivities of ‘active’ and passive’ data collection methods were the secondary outcome measures. Methods All stillbirth data were from routine government records (‘passive system’); early neonatal outcome data from government records (‘passive’) were compared against the method of ‘phone-tracking’ of outcomes through the community health worker (‘active system’). The Lincoln-Petersen formula for capture-recapture method was used to calculate the probable missing number of early neonatal deaths and thereby estimate the institutional perinatal mortality rate. Results Ratio of births in district:subdistrict facilities was 55:45. The estimated perinatal mortality rate (95% CI) by capture–recapture method was 35.8 (34 to 37) per 1000 births. The sensitivity of the passive system was 87–89% while the sensitivity of the active system was 91%. Three-fourths of perinatal deaths were documented as stillbirths. However, for these reported intrauterine deaths or stillbirths, clinical classification by typologies (term vs preterm; intrapartum vs antepartum; macerated vs fresh; with or without congenital anomalies) was absent in the recording system. Conclusions Capture–recapture technique can be used to estimate the institutional perinatal mortality rate and also to assess the level of under-reporting by the ‘passive’ government reporting system. This can subsequently be used for monitoring of trends and studying the impact of health interventions. Accurate clinical categorisation of perinatal deaths is also recommended for improving quality of care. PMID:25783418

  17. 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

  18. Automating Quality Measurement: A System for Scalable, Comprehensive, and Routine Care Quality Assessment

    OpenAIRE

    Hazlehurst, Brian; Mcburnie, Maryann; Mularski, Richard; Puro, Jon; Chauvie, Susan

    2009-01-01

    Electronic medical records (EMRs) hold the promise of making routine comprehensive measurement of care quality a reality. However, there are many informatics challenges that stand in the way of this goal. Guidelines are rarely stated in precise enough language for automated measurement of clinical practices and the data necessary for that measurement often reside in the text notes of EMRs. We designed a technology platform for scalable and routine measurement of care quality using comprehensi...

  19. PERINATAL OUTCOME OF PRETERM INFANTS IN FEDERATION OF BOSNIA AND HERZEGOVINA

    Directory of Open Access Journals (Sweden)

    Skokic Fahrija

    2015-05-01

    Full Text Available Introduction: Despite growing progress of perinatal medicine and perinatal care, between 9–19% of preterm infants are born each year. Improvement in survival of infants and the reduction in infant mortality rates is a key role of perinatal quality healthcare. The Aim: To evaluate the perinatal outcome of preterm infants in maternity wards of the Federation of Bosnia and Herzegovina for a period of one year. Material and methods: Of 22 897 live newborns, the research criteria matched 669 (2.9% preterm infants with complete medical records in ten cantons of the Federation Bosnia and Herzegovina. We analyzed data from maternity wards documentation and discharge letters from tertiary health care centers. Results: Most deliveries were in the Tuzla and Sarajevo Canton with 42.5% of preterm infants. The mean gestational age of preterm infants was 31.4 weeks, with SD ± 5.34, and the mean birth weight 1295 grams, SD ± 234.2. The mean Apgar score was 4.6 ± 2.1, and in the fifthminute 6.6 ± 1.9.Of 669 examinees, there were 345 (51.56% males and 324 (48.44% females (51.56 vs 48.44; 2 = 1.19; P = 0.27. By analyzing the frequency of preterm infant birth rate according toweight categories, we found a significant difference in some levels of perinatal health institution, between the 1st and 2nd institutions levels (1.76% vs 3.01%; P< 0.0001, also between 2nd and 3rd institutions levels (3.01% vs 3.03%; P < 0.0002, and between 1st and 3rd institutions levels (1.76% vs 3.03%; P < 0.0001. A significant statistical difference in survival of tested newborns was found in institutions of 3rd level 2 = 49.25; P < 0.0001 with a low risk for unfavorable outcome ŠOR = 0.436; 95%CI (0.346–0.550. Conclusion: Perinatal outcome of preterm infants in the Federation Bosnia and Herzegovina significantly depends on the level of perinatal health care. Survival rate of infants born in the institutions of the 3rd level was statistically much higher than the survival rate of infants who were born in the 1st and the 2nd level institutions.

  20. 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 perfor...

  1. Preventing physician quality of life from impinging on patient quality of care: Weakening the weekend effect

    OpenAIRE

    Basson, Marc D.

    2007-01-01

    Imprecise or delayed care can reflect many factors, including straightforward difficulties in physician judgment and false negative tests. However, the movement toward decreasing physician work hours also leads to delays in care caused by inadequate staffing or inadequate communication between staffing, which must be addressed if quality of care is to remain high. The demonstration of delays in the management of anastomotic leaks over weekends or in association with false positive radiologic ...

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

    Science.gov (United States)

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

    2013-01-01

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

  3. Palliative Care Integration Project (PCIP) quality improvement strategy evaluation.

    Science.gov (United States)

    Dudgeon, Deborah J; Knott, Christine; Eichholz, Mary; Gerlach, Jacqueline Lochhaas; Chapman, Cheryl; Viola, Raymond; Van Dijk, Janice; Preston, Sharon; Batchelor, Diane; Bartfay, Emma

    2008-06-01

    This study evaluated the effectiveness of implementation of common assessment tools, collaborative care plans, and symptom management guidelines for cancer patients as a strategy to improve the quality, coordination, and integration of palliative care service across organizations and health care sectors. A pre-post design to measure the impact on symptom management, caregiver burden and satisfaction with care delivery, and service utilization was used. Two cohorts of eligible patients and caregivers completed Edmonton Symptom Assessment Scales, Caregiver Reaction Assessment and FAMCARE Scales and chart audits were conducted. Administrative data from each participating site were examined for utilization trends. Audits of 53 charts preimplementation and 63 postimplementation showed an increase in documentation of pain from 24.5% to 74.6% (P<0.001) of charts. Administrative data showed a decrease in the percentage of patients with at least one emergency room visit from 94.3% to 84.8% (P<0.001), in the percentage of patients with at least one admission to the acute care hospital (P<0.001), and deaths in acute care 43.1%-35.7% (P=0.133). There was minimal change in the intensity of symptoms (P=0.591), and no change in the burden on the caregiver (P=0.086) or caregiver satisfaction with care (P=0.942). This study showed that implementation of common assessment tools, collaborative care plans, and symptom management guidelines across health sectors can result in some increased documentation of symptoms and efficiencies in care. Future projects should consider imbedding a continuous quality improvement methodology and longer timelines into their projects to improve outcomes. PMID:18358693

  4. Reaching perinatal women online: the Healthy You, Healthy Baby website and app.

    Science.gov (United States)

    Hearn, Lydia; Miller, Margaret; Lester, Leanne

    2014-01-01

    Overwhelming evidence reveals the close link between unwarranted weight gain among childbearing women and childhood adiposity. Yet current barriers limit the capacity of perinatal health care providers (PHCPs) to offer healthy lifestyle counselling. In response, today's Internet savvy women are turning to online resources to access health information, with the potential of revolutionising health services by enabling PHCPs to guide women to appropriate online resources. This paper presents the findings of a project designed to develop an online resource to promote healthy lifestyles during the perinatal period. The methodology involved focus groups and interviews with perinatal women and PHCPs to determine what online information was needed, in what form, and how best it should be presented. The outcome was the development of the Healthy You, Healthy Baby website and smartphone app. This clinically-endorsed, interactive online resource provides perinatal women with a personalised tool to track their weight, diet, physical activity, emotional wellbeing, and sleep patterns based on the developmental stage of their child with links to quality-assured information. One year since the launch of the online resource, data indicates it provides a low-cost intervention delivered across most geographic and socioeconomic strata without additional demands on health service staff. PMID:24872891

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

    Science.gov (United States)

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

    2012-08-01

    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. PMID:22733141

  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. 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)

  9. Quality-of-care indicators for oesophageal cancer surgery: A review

    OpenAIRE

    Courrech Staal, E.F.W.; Wouters, M.W.J.M.; Boot, H.; Tollenaar, R A E M; van Sandick, J W

    2010-01-01

    Abstract Background Quality-of-care indicators are measurable elements of practice performance that can assess the (change in) quality of the care provided. To date, the literature on quality-of-care indicators for oesophageal cancer surgery has not been reviewed. Methods We performed a review of the literature on quality-of-care indicators for oesophageal cancer surgery. The indicators were classified by their nature of care provision (structural, ...

  10. The economics of health care quality and medical errors.

    Science.gov (United States)

    Andel, Charles; Davidow, Stephen L; Hollander, Mark; Moreno, David A

    2012-01-01

    Hospitals have been looking for ways to improve quality and operational efficiency and cut costs for nearly three decades, using a variety of quality improvement strategies. However, based on recent reports, approximately 200,000 Americans die from preventable medical errors including facility-acquired conditions and millions may experience errors. In 2008, medical errors cost the United States $19.5 billion. About 87 percent or $17 billion were directly associated with additional medical cost, including: ancillary services, prescription drug services, and inpatient and outpatient care, according to a study sponsored by the Society for Actuaries and conducted by Milliman in 2010. Additional costs of $1.4 billion were attributed to increased mortality rates with $1.1 billion or 10 million days of lost productivity from missed work based on short-term disability claims. The authors estimate that the economic impact is much higher, perhaps nearly $1 trillion annually when quality-adjusted life years (QALYs) are applied to those that die. Using the Institute of Medicine's (IOM) estimate of 98,000 deaths due to preventable medical errors annually in its 1998 report, To Err Is Human, and an average of ten lost years of life at $75,000 to $100,000 per year, there is a loss of $73.5 billion to $98 billion in QALYs for those deaths--conservatively. These numbers are much greater than those we cite from studies that explore the direct costs of medical errors. And if the estimate of a recent Health Affairs article is correct-preventable death being ten times the IOM estimate-the cost is $735 billion to $980 billion. Quality care is less expensive care. It is better, more efficient, and by definition, less wasteful. It is the right care, at the right time, every time. It should mean that far fewer patients are harmed or injured. Obviously, quality care is not being delivered consistently throughout U.S. hospitals. Whatever the measure, poor quality is costing payers and society a great deal. However, health care leaders and professionals are focusing on quality and patient safety in ways they never have before because the economics of quality have changed substantially. PMID:23155743

  11. Impact of the Perinatal Environment on the Child's Development: Implications for Prevention Policies.

    Science.gov (United States)

    Molenat, Françoise

    2015-01-01

    Basic emotional security is central to the construction of the child and has an impact on the brain's organisation, the personal autonomy and the capacity to explore the world. The key concept of the attachment theory is supported by recent neuroimaging findings of brain development and the structuring of the hypothalamic-pituitary-adrenal axonal regulatory systems.In addition to the child's potential, the essential variable lies in the quality of the environment's responses, and consequently in the quality of the maternal security, from the very early intrauterine life. The understanding of the effects of parental stress during the early developmental stages is advancing. In France, the emotional security of pregnant women and future parents has become a major stake of perinatal policies for the prevention of developmental disorders.Specific strategies are being developed to improve both the maternal and the infant well-being. These are not restricted only to mental health specialists but rather involve every health-care professional of the perinatal period. The mechanisms of change for vulnerable parents emerge from the prospective analysis of support methods. Continuity and coherence of such care serve as a holding function, which enables the restructuring of previous emotional traumas.A new interdisciplinary perinatal medicine is emerging, structured rigorously around a well-coordinated obstetrical and paediatric follow-up. Considering the future of children, teenagers and adults, the stakes are enormous. PMID:25287551

  12. Examining older patient preferences for quality of care in postacute transition care and day rehabilitation programs

    Directory of Open Access Journals (Sweden)

    Julie Ratcliffe

    2013-06-01

    Full Text Available Background: Quality in health care has traditionally been determined based on clinical or health outcomes. However, these factors may not be the only aspects of health care that are important to patients. Within rehabilitation factors related to the process of care, the way in which rehabilitation services are delivered, may also be important to patients when defining quality of care. Objective: The purpose of this study was to examine and compare the preferences of older people receiving post-acute outpatient rehabilitation or residential intermediate (transition care for alternative configurations of rehabilitation programs. Methods: A discrete choice experiment (DCE was designed to elicit the preferences of older people for the design and delivery of post-acute rehabilitation programs. The participants were older adults (?65 years receiving post-acute outpatient rehabilitation or residential intermediate (transition care in South Australia. Each participant was presented with a series of choice questions involving two hypothetical programs, the characteristics of which varied in every choice. Participants were then asked to select their preferred program. Results: Despite marked differences in case-mix and dependency levels, the preferences of the two groups were very similar, focusing on relationships and communication with health care professionals. Both groups demonstrated very strong preferences for the use of an electronic medical record and for receiving information about their treatment and progress via a meeting with a specialist physician and nurse. The outpatient rehabilitation group also exhibited a strong preference for a shared decision making model in relation to their future care needs. Conclusions: The findings highlight the commonality of preferences of older patients receiving post-acute services for the optimal configuration of rehabilitation services. Issues prioritised were service integration and access to senior medical and nursing staff. The study demonstrates the practicality and validity of DCEs to determine older people’s preferences in defining quality of care.

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

    Science.gov (United States)

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

    2010-01-01

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

  14. Clinical protocols are key to quality health care delivery.

    Science.gov (United States)

    Heymann, T

    1994-01-01

    The use of clinical protocols allows health care providers to offer appropriate diagnostic treatment and care services to patients, variance reports to purchasers and quality training to clinical staff. Such protocols provide a locally agreed standard to which clinicians and the organization can work and against which they can be audited. By embedding protocols into patients' records and reporting by exception, the use of protocols may help to tackle a raft of other issues successfully such as the reduction in junior doctors' hours, and the facilitation of shared care. It may also bolster the medico-legal robustness of the health care delivered. If the protocols are sufficiently detailed, costing, coding and other resource usage information can flow directly from the clinical records. Such benefits may be maximized by using protocols within the framework of an electronic patient record system. PMID:10140847

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

    OpenAIRE

    Higashi Takahiro

    2010-01-01

    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...

  16. [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

  17. 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

  18. Health Care Quality vs Health Care Quantity: A General Equilibrium Analysis

    OpenAIRE

    Chatterjee, Tonmoy; Gupta, Kausik

    2014-01-01

    This paper attempts to relate the issues of health care quality with international trade. For this purpose we have mixed both flavours of Heckscher-Ohlin-Samuelson and Neo- Heckscher-Ohlin frameworks and developed a hybrid type of trade theoretic general equilibrium model. In such a set up we have shown that a movement from a regime of international health capital immobility to a regime of international health capital mobility may lead to an expansion of the health quality exporting sector. A...

  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. Quality-of-care standards for early arthritis clinics.

    Science.gov (United States)

    Ivorra, José Andrés Román; Martínez, Juan Antonio; Lázaro, Pablo; Navarro, Federico; Fernandez-Nebro, Antonio; de Miguel, Eugenio; Loza, Estibaliz; Carmona, Loreto

    2013-10-01

    The diagnosis and treatment of early arthritis is associated with improved patient outcomes. One way to achieve this is by organising early arthritis clinics (EACs). The objective of this project was to develop standards of quality for EACs. The standards were developed using the two-round Delphi method. The questionnaire, developed using the best-available scientific evidence, includes potentially relevant items describing the dimensions of quality of care in the EAC. The questionnaire was completed by 26 experts (physicians responsible for the EACs in Spain and chiefs of the rheumatology service in Spanish hospitals). Two hundred and forty-four items (standards) describing the quality of the EAC were developed, grouped by the following dimensions: (1) patient referral to the EAC; (2) standards of structure for an EAC; (3) standards of process; (4) relation between primary care physicians and the EAC; (5) diagnosis and assessment of early arthritis; (6) patient treatment and follow-up in the EAC; (7) research and training in an EAC; and (8) quality of care perceived by the patient. An operational definition of early arthritis was also developed based on eight criteria. The standards developed can be used to measure/establish the requirements, resources, and processes that EACs have or should have to carry out their treatment, research, and educational activities. These standards may be useful to health professionals, patient associations, and health authorities. PMID:23568381

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

    Directory of Open Access Journals (Sweden)

    Higginson Irene J

    2011-06-01

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

  2. Licensure Portability: Assuring Access to Quality Care in Physical Therapy

    Directory of Open Access Journals (Sweden)

    Mark Lane

    2014-09-01

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

  3. Óbitos perinatais evitáveis e ambiente externo ao sistema de assistência: estudo de caso em município da Região Metropolitana do Rio de Janeiro Avoidable perinatal deaths and the environment outside the health care system: a case study in a city in Greater Metropolitan Rio de Janeiro

    Directory of Open Access Journals (Sweden)

    Maria L. G. Rosa

    2002-06-01

    Full Text Available Este artigo visa compreender a contribuição de fatores do ambiente externo ao sistema de assistência na ocorrência de óbitos perinatais em maternidades, que em 1994, compunham a rede de atendimento obstétrico em um município da região metropolitana do Rio de Janeiro. Dividiram-se os elementos em quatro grupos de variáveis, para entender a relação entre falhas no atendimento e deficiências no ambiente externo e institucionalizado: repasse de recursos para custeio, fatores geográficos e temporais, características organizacionais e administrativas e ação/participação de grupos de interesse. Entrevistas semi-estruturadas foram realizadas. Os resultados indicaram as seguintes falhas: repasses de recursos para custeio insuficientes para manter cuidados de qualidade, sobretudo nos casos das maternidades privadas; nenhuma regionalização ou hierarquização formal ou informal dos cuidados obstétricos no município; desconhecimento das normas do Ministério da Saúde nas maternidades estudadas e as adotadas em três das quatro maternidades não faziam referência nem aos procedimentos para a admissão, nem ao seguimento do trabalho de parto, nem ao seguimento fetal e o nível de participação não era o efetivamente implementado.This paper focuses on the role of environmental factors external to the health care system in the occurrence of perinatal deaths in maternity hospitals belonging to the local health system in a city in Greater Metropolitan Rio de Janeiro in 1994. Elements from the political and administrative context that contribute to an understanding of the relationship between failures in health care and structural deficiencies in these maternity hospitals were divided into four groups of variables: distribution of resources, spatial and temporal factors, organizational and managerial features, and action by interest groups. Semi-structured interviews were conducted. The study concluded that poor performance in four groups of variables may have contributed to perinatal mortality: distribution of resources was insufficient to provide quality in health care, especially in private maternity hospitals; there was no formal or informal regional or hierarchical organization of obstetric care in the city; Ministry of Health guidelines were ignored in all four maternity hospitals, while in three of the hospitals there were no admissions procedures and delivery and fetal follow-up listed in their own rules; and the level of actual participation was low.

  4. 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.

  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. Staffing subsidies and the quality of care in nursing homes.

    Science.gov (United States)

    Foster, Andrew D; Lee, Yong Suk

    2015-05-01

    Concerns about the quality of state-financed nursing home care has led to the wide-scale adoption by states of pass-through subsidies, in which Medicaid reimbursement rates are directly tied to staffing expenditure. We examine the effects of Medicaid pass-through on nursing home staffing and quality of care by adapting a two-step FGLS method that addresses clustering and state-level temporal autocorrelation. We find that pass-through subsidies increases staffing by about 1% on average and 2.7% in nursing homes with a low share of Medicaid patients. Furthermore, pass-through subsidies reduce the incidences of pressure ulcer worsening by about 0.9%. PMID:25814437

  7. Improvement in inpatient glycemic care: pathways to quality.

    Science.gov (United States)

    Aloi, Joseph A; Mulla, Christopher; Ullal, Jagdeesh; Lieb, David C

    2015-04-01

    The management of inpatient hyperglycemia is a focus of quality improvement projects across many hospital systems while remaining a point of controversy among clinicians. The association of inpatient hyperglycemia with suboptimal hospital outcomes is accepted by clinical care teams; however, the clear benefits of targeting hyperglycemia as a mechanism to improve hospital outcomes remain contentious. Glycemic management is also frequently confused with efforts aimed at intensive glucose control, further adding to the confusion. Nonetheless, several regulatory agencies assign quality rankings based on attaining specified glycemic targets for selected groups of patients (Surgical Care Improvement Project (SCIP) measures). The current paper reviews the data supporting the benefits associated with inpatient glycemic control projects, the components of a successful glycemic control intervention, and utilization of the electronic medical record in implementing an inpatient glycemic control project. PMID:25715828

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

    Directory of Open Access Journals (Sweden)

    Chassin Mark R

    2012-01-01

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

  9. 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 management inclination. No differences were found between lean (intermediate-) and high-performing hospitals, or between high- and low-performing hospitals. Originality/value - These findings support a need for hospital managers to acquire appropriate traits to achieve lean transformation, support a benefit of 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

  10. Quality and utilisation of antenatal care services in Lao PDR

    OpenAIRE

    Manithip, Chanthanom

    2012-01-01

    Background Antenatal care (ANC) plays an important role in reducing maternal mortality and morbidity by detecting early risk factors in order to have an effective intervention in time and by linking the pregnant women to a planned delivery with a skilled birth attendant. However, the utilisation of ANC services of pregnant women is problematic in many low-income countries, and in Laos only 39% used the services in 2005. Aims To assess the quality and utilisation of A...

  11. Exploring physicians’ decision making and perception of quality in health care delivery

    OpenAIRE

    Mikkelsen, Yngve

    2013-01-01

    The importance of health and quality health care in people’s daily lives is widely recognised. Physicians play a key role in delivering quality health care and improved patient outcomes. However, the evidence regarding physicians’ decision making and their perception of quality of health care delivery and its influencers is inconclusive. The overall aim of this thesis is to increase the understanding of quality in health care delivery and the factors that influence it from a physician’s...

  12. 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)

  13. Improving quality of cancer care through surgical audit

    DEFF Research Database (Denmark)

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

    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 to site-specialist multidisciplinary teams. As an alternative to volume-based referral, hospitals and surgeons can also improve their results by learning from their own outcome statistics and those from colleagues treating a similar patient group. European national audit registries in surgical oncology have led to improvements with a greater impact on survival than any of the adjuvant therapies currently under study. Moreover, they offer the possibility to perform research on patient groups that are usually excluded from clinical trials. Nevertheless, between European countries remain differences in outcome and treatment schedules that cannot be easily explained. The European CanCer Organisation (ECCO) has recognised these importances and created the 'European Registration of Cancer Care' (EURECCA) framework to develop a European colorectal audit structure. EURECCA will advance future treatment improvements and spread these to all European cancer patients. It provides opportunities to treat elderly and comorbid patients evidence based while it offers an unique insight in social-economical healthcare matters such as the consequences of commercialisation, treatment availability and screening initiatives. As such, ECCO has established the basis for a strong, multidisciplinary audit structure with the commitment to improve cancer care for every European cancer patient.

  14. 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.

  15. Improving quality of care through improved audit and feedback

    Directory of Open Access Journals (Sweden)

    Hysong Sylvia J

    2012-05-01

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

  16. The implementation of unit-based perinatal mortality audit in perinatal cooperation units in the northern region of the Netherlands

    Directory of Open Access Journals (Sweden)

    van Diem Mariet Th

    2012-07-01

    Full Text Available Abstract Background Perinatal (mortality audit can be considered to be a way to improve the careprocess for all pregnant women and their newborns by creating an opportunity to learn from unwanted events in the care process. In unit-based perinatal audit, the caregivers involved in cases that result in mortality are usually part of the audit group. This makes such an audit a delicate matter. Methods The purpose of this study was to implement unit-based perinatal mortality audit in all 15 perinatal cooperation units in the northern region of the Netherlands between September 2007 and March 2010. These units consist of hospital-based and independent community-based perinatal caregivers. The implementation strategy encompassed an information plan, an organization plan, and a training plan. The main outcomes are the number of participating perinatal cooperation units at the end of the project, the identified substandard factors (SSF, the actions to improve care, and the opinions of the participants. Results The perinatal mortality audit was implemented in all 15 perinatal cooperation units. 677 different caregivers analyzed 112 cases of perinatal mortality and identified 163 substandard factors. In 31% of cases the guidelines were not followed and in 23% care was not according to normal practice. In 28% of cases, the documentation was not in order, while in 13% of cases the communication between caregivers was insufficient. 442 actions to improve care were reported for ‘external cooperation’ (15%, ‘internal cooperation’ (17%, ‘practice organization’ (26%, ‘training and education’ (10%, and ‘medical performance’ (27%. Valued aspects of the audit meetings were: the multidisciplinary character (13%, the collective and non-judgmental search for substandard factors (21%, the perception of safety (13%, the motivation to reflect on one’s own professional performance (5%, and the inherent postgraduate education (10%. Conclusion Following our implementation strategy, the perinatal mortality audit has been successfully implemented in all 15 perinatal cooperation units. An important feature was our emphasis on the delicate character of the caregivers evaluating the care they provided. However, the actual implementation of the proposed actions for improving care is still a point of concern.

  17. The implementation of unit-based perinatal mortality audit in perinatal cooperation units in the northern region of the Netherlands

    OpenAIRE

    van Diem Mariet Th; Timmer Albertus; Bergman Klasien A; Bouman Katelijne; van Egmond Nico; Stant Dennis A; Ulkeman Lida H M; Veen Wenda B; Erwich JanJaapHM

    2012-01-01

    Abstract Background Perinatal (mortality) audit can be considered to be a way to improve the careprocess for all pregnant women and their newborns by creating an opportunity to learn from unwanted events in the care process. In unit-based perinatal audit, the caregivers involved in cases that result in mortality are usually part of the audit group. This makes such an audit a delicate matter. Methods The purpose of this study was to implement unit-based perinatal mortality audit in all 15 peri...

  18. 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 wasdocumented 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.

  19. 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.

  20. 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.

  1. Quality of Prenatal Care Services in Karabuk Community Health Center

    Directory of Open Access Journals (Sweden)

    Binali Catak

    2012-04-01

    Full Text Available The aim of the study was to evaluate the quality and quantity of prenatal care services according to gestastional week in Karabuk Community Health Center (CHC. Methods: In this descriptive study 365 pregnant women was selected as sample among 753 pregnant women registered at Karabuk CHC in 18/01/2011. 93.0% of women in the selected sample has been visited in their homes and the face to face interviews were done. The questionnaire was prepared according to Prenatal Care Management Guidelines (PCMG of Ministry of Health. Findings The number of follow-ups was not complete in 23.7% of 15-24 month, 34.4% of 25-32 month, 52,1% of 33-42 month pregnant women. At least four follow-up visits were completed only in 66,7% of postpartum women. Timing of first visit was after 15th week in 15,6% of women. In follow up visits 62.5% of of women’s height were never measured, in 13,0% the women hearth sound of infants didn’t monitored at least once. Laboratory test numbers were under the level required by PCMG. The delivery conditions weren’t planned in 41,8% of last trimester and postpartum women and training about breastfeeding wasn’t given to 15,5 of the same group. Result In family medicine model in Karabuk CHC developments in number of prenatal follow-up visits were observed, but no substantial improvements were found in quality of prenatal visits. Regular in service trainings shoud be given to family doctors and midwives. The use of prenatal care guideline published by MoH should be increased. Keywords: Prenatal care, pregnancy, timing of first visit, qality of prenatal care [TAF Prev Med Bull 2012; 11(2.000: 153-162

  2. Candidate quality of care indicators for localized bladder cancer.

    Science.gov (United States)

    Cooperberg, Matthew R; Porter, Michael P; Konety, Badrinath R

    2009-01-01

    The surgical management of clinically localized bladder cancer is challenging, and the quality of care delivered to patients with bladder cancer is a subject of increasing interest. Multiple large studies have examined the association between surgical volume and outcomes after radical cystectomy. These studies generally find lower mortality and complication rates at high-volume centers, though interpretation of the data must be tempered by limitations of the datasets driving the studies. Benefits of regionalization of care also must be weighed against other measures proven to predict outcomes; a delay in time to cystectomy beyond 3 months, for example, is strongly associated with increased mortality. Other candidate process measures supported by existing literature include adequacy of lymphadenectomy as measured by nodal yield and availability or offering of orthotopic diversion when appropriate. Assessment and reporting of bladder cancer outcomes should be risk adjusted based on oncologic risk factors and patient comorbid illness. Perioperative morbidity and mortality, cause-specific survival, and overall survival are all key measures. Assessment of health-related quality of life after bladder cancer treatment should also be standardized for reporting. Multiple survey instruments have been developed in recent years, but none has yet been well validated or widely adopted. In particular, capturing variation in quality of life outcomes between patients undergoing bladder-sparing protocols vs. continent diversion vs. incontinent diversion is an important but difficult goal that has not yet been met. The urologic oncology community should take a strong lead in achieving consensus regarding the definition, assessment, and reporting of quality of care data for bladder cancer. PMID:19573775

  3. Management of perinatal lung malformations.

    Science.gov (United States)

    Macardle, C A; Kunisaki, S M

    2015-02-01

    This review uses the most up-to-date literature to help guide obstetrical providers through the diagnosis and management of perinatal lung malformations. These lesions, which include congenital pulmonary airway malformation [CPAM, formerly congenital cystic adenomatoid malformation (CCAM)] and bronchopulmonary sequestration (BPS), are relatively rare but are becoming increasingly common because of the improved resolution and enhanced sensitivity of fetal ultrasound. Serial assessment throughout pregnancy remains the norm rather than the exception. Perinatal management strategies can differ based on the sonographic characteristics and dynamic growth patterns of lung masses. Fetal magnetic resonance imaging and other diagnostic testing can sometimes be helpful in providing additional prognostic information. Over the last decade, the importance of echocardiography and utility of maternal steroids have been recognized in cases of non-immune hydrops. Fetal surgery is now rarely performed. Decisions regarding whether delivery of these fetuses should occur in a tertiary care center with pediatric surgery coverage versus delivery at a local community hospital are now highly relevant in most prenatal counseling discussions with families. Large lung malformations may require urgent surgical removal in the early postnatal period because of respiratory distress. Other complications, such as recurrent pneumonia, pneumothorax, and cancer, are indications for lung resection on an elective basis. In the vast majority of cases, the overall prognosis remains excellent. PMID:25310108

  4. Effect of an Innovative Medicare Managed Care Program on the Quality of Care for Nursing Home Residents

    Science.gov (United States)

    Kane, Robert L.; Flood, Shannon; Bershadsky, Boris; Keckhafer, Gail

    2004-01-01

    Purpose: We sought to assess the quality of care provided by an innovative Medicare+Choice HMO targeted specifically at nursing home residents and employing nurse practitioners to provide additional primary care over and above that provided by physicians. The underlying premise of the Evercare approach is that the additional primary care will…

  5. 42 CFR 476.72 - Review of the quality of care of risk-basis health maintenance organizations and competitive...

    Science.gov (United States)

    2010-10-01

    ...false Review of the quality of care of risk-basis health maintenance organizations and...and Quality Control Quality Improvement Organizations...72 Review of the quality of care of risk-basis health maintenance organizations...

  6. Quality improvement in pre-hospital critical care: increased value through research and publication

    OpenAIRE

    Rehn, Marius; Kru?ger, Andreas J.

    2014-01-01

    Pre-hospital critical care is considered to be a complex intervention with a weak evidence base. In quality improvement literature, the value equation has been used to depict the inevitable relationship between resources expenditure and quality. Increased value of pre-hospital critical care involves moving a system from quality assurance to quality improvement. Agreed quality indicators can be integrated in existing quality improvement and complex intervention methodology. A QI system for pre...

  7. Comparative analysis of quality assurance in health care delivery and higher medical education

    OpenAIRE

    Busari, Jamiu O.

    2012-01-01

    Quality assurance (QA) in higher medical education involves the development, sustenance, improvement, and evaluation of the standard of training of medical professionals. In health care delivery, QA focuses on guaranteeing and maintaining a high standard of the service provided in different health care systems. When the service delivered by the care provider is in accordance with what the recipients of health care expect, then quality in health care is considered to be present. There are seve...

  8. Quality of antenatal care in Zambia: a national assessment

    Directory of Open Access Journals (Sweden)

    Kyei Nicholas N A

    2012-12-01

    Full Text Available Abstract Background Antenatal care (ANC is one of the recommended interventions to reduce maternal and neonatal mortality. Yet in most Sub-Saharan African countries, high rates of ANC coverage coexist with high maternal and neonatal mortality. This disconnect has fueled calls to focus on the quality of ANC services. However, little conceptual or empirical work exists on the measurement of ANC quality at health facilities in low-income countries. We developed a classification tool and assessed the level of ANC service provision at health facilities in Zambia on a national scale and compared this to the quality of ANC received by expectant mothers. Methods We analysed two national datasets with detailed antenatal provider and user information, the 2005 Zambia Health Facility Census and the 2007 Zambia Demographic and Health Survey (DHS, to describe the level of ANC service provision at 1,299 antenatal facilities in 2005 and the quality of ANC received by 4,148 mothers between 2002 and 2007. Results We found that only 45 antenatal facilities (3% fulfilled our developed criteria for optimum ANC service, while 47% of facilities provided adequate service, and the remaining 50% offered inadequate service. Although 94% of mothers reported at least one ANC visit with a skilled health worker and 60% attended at least four visits, only 29% of mothers received good quality ANC, and only 8% of mothers received good quality ANC and attended in the first trimester. Conclusions DHS data can be used to monitor “effective ANC coverage” which can be far below ANC coverage as estimated by current indicators. This “quality gap” indicates missed opportunities at ANC for delivering effective interventions. Evaluating the level of ANC provision at health facilities is an efficient way to detect where deficiencies are located in the system and could serve as a monitoring tool to evaluate country progress.

  9. Splanchnic haemodynamic disturbances in perinatal sepsis

    OpenAIRE

    Kempley, S.; Murdoch, E.

    2000-01-01

    AIM—To determine the effect of perinatal bacterial infection on the neonatal splanchnic circulation.?SUBJECTS/SETTING—76 premature infants with appropriate birth weight for gestation admitted for neonatal intensive care.?METHODS—Doppler ultrasound was used to measure blood flow velocity and pulsatility index in the superior mesenteric artery and coeliac axis during the first 24 hours of life. Babies were classified according to the results of blood and surface c...

  10. Quality Control Issues in Point of Care Testing

    OpenAIRE

    Martin, Cameron L.

    2008-01-01

    Quality Control (QC) in Point of Care Testing (PoCT) is often thought of as a complex issue; however intelligent system analysis can simplify matters and greatly increase the chances of a well controlled system. What we want to achieve is a QC program which adequately controls the PoCT system, but does not excessively contribute to the operating costs or complexity of maintaining a PoCT instrument, or network of instruments.Don’t neglect effective pre-analytical work: good documentation, op...

  11. 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...

  12. 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

  13. 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.

  14. 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.

  15. PERINATAL LEUKODYSTROPHY CLINICAL CASE

    OpenAIRE

    Dana Mihut; Aniko Manea; Daniela Iacob; V Botiu; ES Boia; Marioara Boia

    2004-01-01

    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.

  16. 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.

  17. Purchaser strategies to influence quality of care: from rhetoric to global applications

    OpenAIRE

    Mcnamara, P.

    2006-01-01

    The potential of purchasers to influence the quality and safety of care has captured the attention of health sector leaders worldwide. Quality based purchasing explicitly seeks to hold providers accountable for the quality and safety of care. Three strategies are available to purchasers: (1) selective contracting based on quality; (2) payment differentials based on quality; and (3) sponsorship of comparative provider report cards. Examples are given to illustrate each of the three strategies....

  18. Quality of Care for Myocardial Infarction in Rural and Urban Hospitals

    Science.gov (United States)

    Baldwin, Laura-Mae; Chan, Leighton; Andrilla, C. Holly A.; Huff, Edwin D.; Hart, L. Gary

    2010-01-01

    Background: In the mid-1990s, significant gaps existed in the quality of acute myocardial infarction (AMI) care between rural and urban hospitals. Since then, overall AMI care quality has improved. This study uses more recent data to determine whether rural-urban AMI quality gaps have persisted. Methods: Using inpatient records data for 34,776…

  19. 45 CFR 98.51 - Activities to improve the quality of child care.

    Science.gov (United States)

    2010-10-01

    ...2010-10-01 false Activities to improve the quality of child care. 98.51...Development Funds § 98.51 Activities to improve the quality of child care. (a...and (iii) Activities designed to improve the quality and availability of...

  20. Intensive Care Unit Utilization and Interhospital Transfers As Potential Indicators of Rural Hospital Quality

    Science.gov (United States)

    Wakefield, Douglas S.; Ward, Marcia; Miller, Thomas; Ohsfeldt, Robert; Jaana, Mirou; Lei, Yang; Tracy, Roger; Schneider, John

    2004-01-01

    Obtaining meaningful information from statistically valid and reliable measures of the quality of care for disease-specific care provided in small rural hospitals is limited by small numbers of cases and different definitive care capacities. An alternative approach may be to aggregate and analyze patient services that reflect more generalized care

  1. 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

    2014-12-01

    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

  2. Perinatal health and mother-child health care in the municipality of São Luís, Maranhão State, Brazil Saúde perinatal e atenção à saúde da mãe e da criança no Município de São Luís, Maranhão, Brasil

    Directory of Open Access Journals (Sweden)

    Antônio Augusto M. da Silva

    2001-12-01

    Full Text Available The purpose of this article was to evaluate socioeconomic and demographic indicators, reproductive health, use of prenatal, childbirth, and neonatal services, and anthropometric data for mothers and infants. The authors performed a cross-sectional analysis of a systematic sample of 2,831 hospital births in São Luís, Maranhão State, from March 1997 to February 1998 at ten public and private maternity hospitals. The sample was stratified proportionally according to the number of births in each maternity hospital. Mothers answered a standard questionnaire. Of the total, 97.9% were live births and 98% were singletons. Prenatal coverage was 89.5%, and prevalence of cesarean sections was 33.8%. A physician provided prenatal care in 75.7% of cases and performed 73.8% of the deliveries. The Unified Health System covered the costs of 76.4% of the prenatal visits and 89.7% of the deliveries. A pediatrician was present in the delivery room in 50.2% of cases. The low birth weight rate was 9.6% and the preterm birth rate 13.9%. Reasons for concern included a high percentage of adolescent mothers, single mothers (or without partners, the high cesarean rate, and the high percentage of births attended by unqualified personnel.Este artigo teve o objetivo de estimar indicadores sócio-econômicos, demográficos, saúde reprodutiva, utilização de serviços pré-natais e de atenção ao parto e ao recém-nascido, dados antropométricos da mãe e da criança. Foi realizado estudo transversal em amostra sistemática de 2.831 nascimentos hospitalares ocorridos em São Luís, estratificada por maternidades, com partilha proporcional ao número de nascimentos em cada unidade, no período de março de 1997 a fevereiro de 1998. Utilizou-se questionário padronizado respondido pela puérpera. Analisaram-se nascimentos em dez unidades de saúde, públicas e privadas, dos quais, 97,9%, eram nascidos vivos e 98% de parto único. A cobertura do pré-natal foi de 89,5%. A prevalência de cesarianas 33,8%. O médico realizou 75,7% do atendimento pré-natal e 73,5% dos partos. O Sistema Único de Saúde custeou 76,4% do atendimento pré-natal e 89,7% da assistência ao parto. O atendimento por pediatra em sala de parto foi de 50,2%. A taxa de baixo peso ao nascer foi de 9,6% e de prematuridade 13,9%. Alta porcentagem de mães adolescentes e sem companheiro, alta taxa de cesáreas e de partos assistidos por pessoal não qualificado, são razões para preocupação.

  3. 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.

  4. 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.

  5. 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.

  6. Identifying and Improving Quality of Care at an Emergency Department : Patient and healthcare professional perspectives

    OpenAIRE

    Muntlin, Åsa

    2009-01-01

    Background: Patients in the emergency department are not always satisfied with the care received and the nursing care in the emergency department is sometimes described as instrumental and non-holistic. Structured quality improvement work and evidence-based practice are needed. Aim: The overall aim was to emphasize general patients in the emergency department to enhance the knowledge on how they perceive the quality of care and how the care could be improved through collaboration with the hea...

  7. Quality in transitional care of the elderly: Key challenges and relevant improvement measures

    OpenAIRE

    Marianne Storm; Inger Margrete Dyrholm Siemsen; Kristin Alstveit Laugaland; Dagrunn Nåden Dyrstad; Karina Aase

    2014-01-01

    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 e...

  8. Developing a patient and family-centred approach for measuring the quality of injury care: a study protocol

    OpenAIRE

    Stelfox Henry T; Boyd Jamie M; Straus Sharon E; Gagliardi Anna R

    2013-01-01

    Abstract Background Quality indicators (QI) are used in health care to measure quality of service and performance improvement. Health care professionals and organizations caring for patients with injuries need information regarding the quality of care provided and the outcomes experienced in order to target improvement efforts. However, very little is known about the quality of injury care provided to individual patients and populations and even less about patients’ perspectives on quality ...

  9. 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

  10. Psychiatric Nurse Reports on the Quality of Psychiatric Care in General Hospitals

    OpenAIRE

    Hanrahan, Nancy P.; Aiken, Linda H.

    2008-01-01

    Although acute inpatient psychiatric care has changed dramatically over the past 2 decades, little is known about how these changes have affected the quality of care, psychiatric nurse staffing, or patient outcomes. The purpose of this report is to explore the quality of care, quality of the practice environment, and adverse events as assessed by psychiatric nurses in the general hospital setting. The study sample consisted of 456 registered nurses permanently assigned to psychiatric units, c...

  11. In search of excellence—the Neonatal Intensive Care Quality Improvement Collaborative

    OpenAIRE

    Whitfield, Jonathan; Charsha, Dianne; Sprague, Pam

    2001-01-01

    As part of its effort to improve the quality of care in the neonatal intensive care unit at Baylor University Medical Center (BUMC), the unit has participated in the Vermont Oxford Network. This network tracks outcomes and pools data, allowing comparisons and benchmarking. A group of 34 nurseries from the Vermont Oxford Network has collaborated in an innovative quality improvement initiative. This article describes this initiative, called the Neonatal Intensive Care Quality Collaborative 2000...

  12. Assessing the perceived quality of care in MDR TB treatment services in Jakarta, Indonesia

    OpenAIRE

    Sugiharto, J.

    2012-01-01

    INTRODUCTION: Assuring quality of MDR TB care is essential to ensure high treatment outcome. The MDR TB program in Indonesia is struggling with poor treatment results. So far, not much research has been done on the quality of care of MDR TB services particularly from the patient’s perspective. OBJECTIVES: To assess the quality of MDR TB care services in hospitAl and health centres in Jakarta from the patient’s perspective. METHODOLOGY: Literature review, interviews with patients and provi...

  13. 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...

  14. Postinsertion central line site care: quality improvement in a medical cardiac ICU.

    Science.gov (United States)

    Hickox, Benjamin C

    2015-01-01

    Using the Six Sigma quality improvement framework of Define, Measure, Analyze, Improve, and Control, nurses in the medical cardiac intensive care unit at a large academic medical center in the Midwest identified a gap in the quality of central line site care, evaluated the current state of site care, implemented an intervention to create an improvement in nursing performance of site care, quantified this improvement, and created a model for sustained quality control. Reasons for nonocclusive dressings were revealed and addressed. An unexpected benefit was found in a unifying sense of pride in improving patient care. PMID:25545973

  15. Relationship between Quality of Senior Nursing Students' Caring Behaviors and Patients' Satisfaction

    Directory of Open Access Journals (Sweden)

    Tajmohammad Arazi Ghojegh

    2012-08-01

    Full Text Available Background & Aim: Quality of nursing care is a major issue in nursing management. In the last year of nursing studies (internships in Iran, nursing students are going to independently carry out responsibilities of graduated nurses. Patients' satisfaction is a main indicator for nursing care quality. This study was to determine the correlation between the quality of caring behaviors among internship students with the patients' satisfaction with nursing care quality. Methods & Materials: In this cross-sectional study, 200 patients were selected using convenience sampling method from the hospitals affiliated to the Tehran University of Medical Sciences. Data were gathered using two questionnaires including: 1 quality of the caring behaviors; and 2 patient satisfaction with nursing care quality questionnaire (PSNCQQ. Data were analyzed using statistical tests in the SPSS-13. Results: Regarding quality of caring behaviors, the subscale scores of the knowledge and skills were good; and patient education was low. The relationship between the nurses and patients, and nursing morality were in average level. Regarding the patient satisfaction, the highest level of satisfaction was related to nursing knowledge and skills; and the lowest level was related to the patient education. Significant correlation was found between the total quality of the caring behaviors with the patients' satisfaction and their subscales (P<0.001. Conclusion: Based on the findings, patients are more satisfied with the caring behaviors of the students who focus on the communication with patients, nursing ethics, and especially patient education during the care.

  16. 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 =

  17. 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...

  18. The patient as the pivot point for quality in health care delivery.

    Science.gov (United States)

    Lengnick-Hall, C A

    1995-01-01

    Health care enterprises make comprehensive and durable changes in people. This human-centered purpose defines the fundamental nature of quality in health care settings. Traditional perspectives of quality and familiar views of customer satisfaction are inadequate to manage the complex relationships between the health care delivery firm and its patients. Patients play four roles in health care systems that must be reflected when defining and measuring quality in these settings: patient as supplier, patient as product, patient as participant, and patient as recipient. This article presents a conceptual model of quality that incorporates these diverse patient roles. The strategic and managerial implications of the model are also discussed. PMID:10140872

  19. The role of culture in quality improvement in the intensive care unit: A literature review

    Directory of Open Access Journals (Sweden)

    Kim Lam Soh

    2012-12-01

    Full Text Available Improving the quality of patient care and patient outcomes is a major concern internationally.  In a developing health care system, implementing quality improvement is challenging due not only to resource and workforce issues but also cultural factors.  Using the method of a focussed literature review, this paper discusses the importance of assessing a societal view of culture, social mores and customs, and power relationships in quality improvement activities using the intensive care unit as an exemplar.   We conclude that implementing quality improvement strategies in a developing health care system needs to address the broader perspectives of social and cultural systems particularly hierarchical relationships and issues of non-disclosure. 

  20. Perinatal loss: a family perspective.

    Science.gov (United States)

    Callister, Lynn Clark

    2006-01-01

    Perinatal loss is a profound experience for childbearing families. Examples of perinatal loss include miscarriage, ectopic pregnancy, stillbirth, neonatal death, and other losses. Perinatal loss engenders a unique kind of mourning since the child is so much a part of the parental identity. Societal expectations for mourning associated with perinatal loss are noticeably absent. Gender differences in response to such loss, as well as sibling and grandparent grief have been identified in the literature. Descriptive studies provide information on cultural responses to perinatal loss. Nursing interventions have been refined over the past two decades as research studies have been performed, in order to more fully promote health and healing in the face of perinatal loss. These include helping to create meaning through the sharing of the story of parental loss, the facilitation of sociocultural rituals associated with loss, the provision of tangible mementos, sensitive presence, and the validation of the loss. Outcome evaluations of such interventions are recommended. PMID:16915054

  1. 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

  2. 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.

  3. Does quality of care for hypertension in primary care vary with postcode area deprivation? An observational study

    OpenAIRE

    Hammouche Salah; Holland Richard; Steel Nicholas

    2011-01-01

    Abstract Background Hypertension is a common major risk factor for stroke and coronary heart disease. Little is known about how achievement of financially incentivised and non-incentivised indicators of quality of care varies with deprivation, or about the effect of financial incentives on health inequalities in hypertension. General practices in the UK have received financial incentives for high quality care since 2004. This study set out to assess the variations in achievement of incentivis...

  4. Perinatal tuberculosis: a diagnostic challenge

    Directory of Open Access Journals (Sweden)

    Edna Lúcia S. de Souza

    2006-06-01

    Full Text Available Despite the high prevalence of tuberculosis in adults and children, the congenital and perinatal forms of tuberculosis are rare. In Brazil, there has been only one published case of congenital tuberculosis and two cases of the perinatal form of this disease. We report a case of perinatal tuberculosis presenting with pneumonia. Alcohol-acid-resistant bacilli were found in the gastric lavage. Diagnosis of this disease presentation requires a high index of suspicion.

  5. How can quality of health care be safeguarded across the European Union?

    OpenAIRE

    Legido-quigley, Helena; McKee, Martin; Walshe, Kieran; Suñol, Rosa; Nolte, Ellen; Klazinga, Niek

    2008-01-01

    Can Europeans be confident about the quality of care received in another EU country? Helena Legido-Quigley and colleagues discuss the various mechanisms at work across Europe to ensure quality and safety

  6. Nursing home staffing and training recommendations for promoting older adults' quality of care and life: Part 1. Deficits in the quality of care due to understaffing and undertraining.

    Science.gov (United States)

    Maas, Meridean L; Specht, Janet P; Buckwalter, Kathleen C; Gittler, Josephine; Bechen, Kate

    2008-04-01

    Caught between the inability or unwillingness of nursing home corporations and owners to redistribute revenue and the reluctance of federal and state agencies to increase payments to nursing homes, the nation's most vulnerable older adults are not receiving the care they deserve. Widespread recognition of substandard care and quality of life of older adults in nursing homes has existed for decades. In addition, there is substantial evidence that poor quality of care is related to inadequate numbers and training of nursing staff. Still, policy makers and nursing home owners have failed to take needed action. In the first article of this two-part series, major deficits in the care of older adult nursing home residents are reviewed, and research documenting the relationship between nursing home staffing and the quality of care and life of residents is summarized. PMID:20078025

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

    Directory of Open Access Journals (Sweden)

    I.A. Mouzas A.G. Pallis,

    2007-03-01

    Full Text Available 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 ill patient. Regarding money spent on chronic illnesses in terms of societal costs, IBD is less costly than, for example, coronary diseases, since loss of work hours, disability, or early death are less common. In terms of pure economic costs, IBD patients can be more costly than other chronic patients depending on age of disease onset and severity of illness. Crohn?s disease patients consider cost aspects as an important element of quality more than ulcerative colitis patients do. Standard framework for the assessment of quality of care remains Donabedian?s approach according to the Structure-Process-Outcome characterization. Lack of information is associated with more disease related worries and concerns of patients and, accordingly, with decreased quality of life. Finally, the patient ?s perception about high quality health care and his/ her satisfaction as a ?consumer? of health care services are extremely important issues for assessing quality of health care. Key words: Inflammatory bowel disease, Ulcerative colitis, Crohn?s disease, care, quality of care, health services, health system, patient?s satisfaction

  8. Quality in the provision of headache care. 1 : systematic review of the literature and commentary

    DEFF Research Database (Denmark)

    Peters, Michele; Perera, Suraj

    2012-01-01

    Widely accepted quality indicators for headache care would provide a basis not only for assessment of care but also, and more importantly, for its improvement. The objective of the study was to identify and summarize existing information on such indicators: specifically, did indicators exist, how had they been developed, what aspects of headache care did they relate to and how and with what utility were they being used? A systematic review of the medical literature was performed. A total of 32 articles met criteria for inclusion. We identified 55 existing headache quality indicators of which 37 evaluated processes of headache care. Most were relevant only to specific populations of patients and to care delivered in high-resource settings. Indicators had been used to describe overall quality of headache care at a national level, but not systematically applied to the evaluation and improvement of headache services in other settings. Some studies had evaluated the use of existing disability and quality of life instruments, but their findings had not been incorporated into quality indicators. Existing headache care quality indicators are incomplete and inadequate for purpose. They emphasize processes of care rather than structure or outcomes, and are not widely applicable to different levels and locations of headache care. Furthermore, they do not fully incorporate accepted evidence regarding optimal methods of care. There is a clear need for consensus-based indicators that fully reflect patients' and public-health priorities. Ideally, these will be valid across cultures and health-care settings.

  9. Investing in Our Children's Future: The Path to Quality Child Care through the Pennsylvania Child Care/Early Childhood Development Training System.

    Science.gov (United States)

    Iutcovich, Joyce; Fiene, Richard; Johnson, James; Koppel, Ross; Langan, Francine

    This study identified training needs for Pennsylvania child care providers and assessed the impact of training, classroom/caregiver dynamics, and staff characteristics on child care quality. Participating were 29 family child care providers, 30 group homes, and 60 child care centers, stratified by type of site and geographic region. Quality of…

  10. 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.

  11. The evolving nature of perinatal nursing.

    Science.gov (United States)

    Arnold, L; Kirby, A

    1996-06-01

    Current and future health-care trends create many challenges for perinatal nurses. A new mind set is required for the profession not only to accommodate the paradigm shift but provide leadership in designing a new future for health care. Interestingly, it has been predicted that the movement toward achieving healthier communities will result in a decentralized, community-based, nonhierarchical system that will not be male dominated. Nurses will be called on to participate in the development and implementation of health-care programs rather than assume a passive, recipient role. On the brink of the 21st century, nursing is in a position to emerge as a leader in providing cost-effective, needs-based, health-care services aimed at improving the health status of a community. PMID:8637803

  12. The identification and measurement of quality dimensions in health care: focus group interview results.

    Science.gov (United States)

    Jun, M; Peterson, R T; Zsidisin, G A

    1998-01-01

    The identification and measurement of service quality are critical factors that are responsible for customer satisfaction. This article identifies 11 attributes that define quality of care and patient satisfaction and reveals various gaps among the patient, physician, and administrator groups in the perceived importance of those dimensions. Managerial implications for patient-focused health care are discussed. PMID:9803321

  13. 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…

  14. Improving communication and coordination of complex perinatal patients.

    Science.gov (United States)

    Gordon, Sara; Aydam, Joan; Hamm, Kenna; Rocha, Morgan; Northcut, Andrea; Roberson, Becky; Shook, Marilyn

    2015-01-01

    Pregnant women with complex medical problems require comprehensive communication among members of their healthcare team. Using the Magnet Hospital model, our Patient and Perinatal Interprofessional Team at Seton Medical Center Austin focused on improving communication and patient satisfaction by initiating Perinatal Patient Care Conferences. Pregnant women with medical or obstetric complications and their families became a part of care plan development prior to admission to promote consistent communication and excellent care. We report our 7-year history of proactive meetings with pregnant women and their families in a nonclinical environment to discuss diagnosis, treatment, and prognosis. A collaborative written plan of care is developed that accommodates the woman's needs and wishes and is then disseminated among the healthcare team. This process has decreased women's and caregivers' anxiety and supported a culture of safety across the continuum of care. PMID:25919209

  15. 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.

  16. Multimorbidity and quality of life in primary care: a systematic review

    OpenAIRE

    Ntetu Antoine L; Vanasse Alain; Hudon Catherine; Lapointe Lise; Fortin Martin; Maltais Danielle

    2004-01-01

    Abstract Background Many patients with several concurrent medical conditions (multimorbidity) are seen in the primary care setting. A thorough understanding of outcomes associated with multimorbidity would benefit primary care workers of all disciplines. The purpose of this systematic review was to clarify the relationship between the presence of multimorbidity and the quality of life (QOL) or health-related quality of life (HRQOL) of patients seen, or likely to be seen, in the primary care s...

  17. 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

  18. 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.

  19. Quality indicators in intensive care medicine: why? Use or burden for the intensivist

    Science.gov (United States)

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

    2010-01-01

    In order to improve quality (of therapy), one has to know, evaluate and make transparent, one’s own daily processes. This process of reflection can be supported by the presentation of key data or indicators, in which the real as-is state can be represented. Quality indicators are required in order to depict the as-is state. Quality indicators reflect adherence to specific quality measures. Continuing registration of an indicator is useless once it becomes irrelevant or adherence is 100%. In the field of intensive care medicine, studies of quality indicators have been performed in some countries. Quality indicators relevant for medical quality and outcome in critically ill patients have been identified by following standardized approaches. Different German societies of intensive care medicine have finally agreed on 10 core quality indicators that will be valid for two years and are currently recommended in German intensive care units (ICUs). PMID:21063472

  20. Efectos de un programa de mejoramiento de la calidad en servicios materno perinatales en el Peru: la experiencia del proyecto 2000 Effects of a continuous quality improvement program in maternal and perinatal health services in Peru: the experience of Project 2000

    Directory of Open Access Journals (Sweden)

    Juan A. Seclen-Palacín

    2003-12-01

    Full Text Available OBJETIVOS: comparar la calidad de los servicios de salud materno perinatales (SMP de los establecimientos participantes en un programa de mejora de calidad (PMC y compararlos con un grupo control; evaluar comparativamente los conocimientos y actitudes de usuarias de servicios de salud materna; y determinar la contribución del PMC en los niveles de calidad. MÉTODOS: fue implementado un PMC en 74 establecimientos de salud seleccionados para mejorar la calidad. Se desarrolló un cuasiexperimento controlado en 74 hospitales, centros de salud y establecimientos periféricos. El análisis de la calidad de los SMP se realizó mediante comparación de promedios de escalas centesimales; los conocimientos y actitudes de las usuarias mediante análisis bivariado; y la predicción del nivel de calidad a través de análisis multivariado. RESULTADOS: al final de la intervención, la puntuación de los establecimientos con PMC tuvo un promedio de 61,8 puntos y de 37,5 en el grupo de comparación, (p OBJECTIVES: to compare the quality of the maternal-perinatal health services (MPHS between health facilities with a continuos quality improvement (CQI and those without such program; to evaluate the knowledge and attitudes of the users of maternal health services; to determine the contribution of the CQI on the level of quality. METHODS: it was conducted a CQI program in 74 selected health facilities from Perú (1996-2000 for improved the quality of MPHS. A controlled, quasiexperimental study in facilities health (hospital, health centers and peripheral facilities was conducted. The quality of care was measured by scores of the MPHS by comparing averages; the knowledge and attitudes of users by bivariate analysis, and the prediction of the quality level was studied through multivariate analysis. RESULTS: at the end of the intervention, CQI facilities score was 61,8 points and of 37,5 in the comparison group, (p <0,001. The average of obstetrical warms signs knowledge was greater in CQI facilities (3,6 signs/interviewed versus 2,5 in comparison facilities users, (p <0,05. The intention of institutional childbirth was two times greater among users of CQI facilities, (p = 0,038. The main predictions factors of quality were the CQI intervention and the availability of health professionals. CONCLUSIONS: the level quality is greater in the participant health facilities (with CQI. The users of these facilities had more knowledge of warning signs and better attitude towards the institutional delivery. The CQI has contributed to those achievements.

  1. 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.

  2. 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

  3. Comparative analysis of quality assurance in health care delivery and higher medical education

    Directory of Open Access Journals (Sweden)

    Busari JO

    2012-12-01

    Full Text Available 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 service delivered by the care provider is in accordance with what the recipients of health care expect, then quality in health care is considered to be present. There are several factors in higher medical education and health care that are responsible for the emergence of QA. These include externally imposed obligations requiring demonstration of public accountability and responsibility from educational institutions, as well as the need for activity-specific information by policy makers as an aid for important decision-making within educational institutions. In health care delivery on the other hand, the emergence of QA is linked to the need for containing rising health care costs in the face of limited resources and to guaranteeing high quality patient care in a changing health care environment where the power relationship between doctors and patients is shifting towards patients. Although medical education can be regarded as a distinct entity in the health care industry, it still remains an inherent part of the health care delivery system. As a result, different strategies aimed at guaranteeing and assuring high standards of health care and education in many countries tend to overlap. This paper reflects on whether quality assurance in health care delivery and medical education should be seen as separate entities.Keywords: quality assurance, health care, higher medical education

  4. A study of causes of perinatal mortality in tertiary center in Bundelkhand region

    Directory of Open Access Journals (Sweden)

    Shilpi Srivastava

    2015-02-01

    Full Text Available Background: The distribution of causes of death in population suggests a great potential for prevention. So the aim of study is to evaluate the cause of perinatal death in tertiary center of Bundelkhand region in M.L.B. medical college Jhansi, Uttar Pradesh (India. Methods: A retrospective study was done over a period of last one year from June 2013 to May 2014, which included total 2691 deliveries out of which 184 perinatal deaths occurred, hence perinatal mortality rate was 68.37 per 1000 birth and causes of perinatal deaths was identified and analysed. Results: Out of 68.37% perinatal mortality, majority of perinatal deaths (54.3% occurred due to preterm low birth weight with or without associated other factors, 8.6% due to congenital anomalies, more than 38% perinatal death due to maternal factor antepartum haemorrhage, eclampsia, obstructed labour, malpresentation, medical problem in pregnancy. Conclusions: Early identification of mothers at risk of pregnancy complications through antenatal care screening, teaching pregnant women to recognize signs of pregnancy complications, timely access to obstetric care, monitoring of labour for fetal distress, and proper newborn resuscitation may reduce some of the categories of deaths. There should also be increased awareness among paediatrics and obstetrics about coordinated approach to bring down perinatal mortality. [Int J Reprod Contracept Obstet Gynecol 2015; 4(1.000: 43-46

  5. 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...

  6. 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

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

    Directory of Open Access Journals (Sweden)

    Reid, Colin R.

    2008-01-01

    Full Text Available 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 regression results are based on the study of 402 residents in 73 long-term care facilities throughout British Columbia, Canada. Mortality data were obtained from Vital Statistics. Although social selection factors (e.g.,physical dependency emerge as the strongest predictors, one social causative factor – facility level restraint use – also predicts mortality. This study provides some evidence that social causative factors play a role in determining mortality among long-term care residents with dementia. Further research on the social causative factors is needed to understand the degree to which they affect mortality, and the way in which they do so.FrenchLes personnes âgées atteintes de démence qui entrent en établissements de soinsde longue durée encourent un risque plus élevé de décès que d’autres personnessouffrant de manière similaire mais qui demeurent au sein de leur communauté.Jusqu’à présent la recherche s’est surtout intéressée aux facteurs de sélectionsociale tels que l’âge, le genre, et l’état de santé, pour expliquer le taux demortalité au sein de cette population. L’étude présente cherche à déterminer si lamort d’un résident dans les 12 mois qui suivent l’admission dans unétablissement peut être expliqué par des facteurs causals sociaux survenant aprèsleur admission, et qui seraient donc liés à la qualité des soins dans lesinstitutions. Les résultats de régression logique sont basés sur une étude de 402résidents dans 73 établissements de soins de longue durée en Colombie-Britannique au Canada. Les données sur la mortalité ont été obtenues par VitalStatistics BC. Bien que les facteurs de sélection sociale (âge, genre, etdépendance physique émergent comme étant de bons prédicteurs, il a été trouvéqu’un facteur causal social – l’usage de contentions dans les établissements –détermine aussi le taux de mortalité. Cet article offre pour preuve que lesfacteurs causals sociaux jouent un rôle dans la détermination des causes demortalité au sein des résidents d’établissements de soins de longue duréesouffrant de démence. Il est nécessaire de continuer cette recherche pourcomprendre à quel point ces facteurs influencent le taux de mortalité et en quellefaçon.

  8. Quality of life and persisting symptoms in intensive care unit survivors: implications for care after discharge

    Directory of Open Access Journals (Sweden)

    Dorsett Joanna

    2009-08-01

    Full Text Available Abstract Background We assessed the quality of life of ICU survivors using SF-36 at 4 months after ICU discharge and investigated any correlation of PCS and MCS with age, illness severity and hospital or ICU length of stay. We examined the relationship between these variables, persisting physical and psychological symptoms and the perceived benefit of individual patients of follow-up. Findings For one year, adult patients admitted for multiple organ or advanced respiratory support for greater than 48 hours to a 16-bedded teaching hospital general intensive care unit were identified. Those surviving to discharge were sent a questionnaire at 4 months following ICU discharge assessing quality of life and persisting symptoms. Demographic, length of stay and illness severity data were recorded. Higher or lower scores were divided at the median value. A two-tailed Students t-test assuming equal variances was used for normally-distributed data and Mann-Whitney tests for non-parametric data. 87 of 175 questionnaires were returned (50%, but only 65 had sufficient data giving a final response rate of 37%. Elderly patients had increased MCS as compared with younger patients. The PCS was inversely related to hospital LOS. There was a significant correlation between the presence of psychological and physical symptoms and desire for follow-up. Conclusion Younger age and prolonged hospital stay are associated with lower mental or physical quality of life and may be targets for rehabilitation. Patients with persisting symptoms at 4 months view follow-up as beneficial and a simple screening questionnaire may identify those likely to attend outpatient services.

  9. [Service quality in health care: the application of the results of marketing research].

    Science.gov (United States)

    Verheggen, F W; Harteloh, P P

    1993-01-01

    This paper deals with quality assurance in health care and its relation to quality assurance in trade and industry. We present the service quality model--a model of quality from marketing research--and discuss how it can be applied to health care. Traditional quality assurance appears to have serious flaws. It lacks a general theory of the sources of hazards in the complex process of patient care and tends to stagnate, for no real improvement takes place. Departing from this criticism, modern quality assurance in health care is marked by: defining quality in a preferential sense as "fitness for use"; the use of theories and models of trade and industry (process-control); an emphasis on analyzing the process, instead of merely inspecting it; use of the Deming problem solving technique (plan, do, check, act); improvement of the process of care by altering perceptions of parties involved. We present an experience of application and utilization of this method in the University Hospital Maastricht, The Netherlands. The successful application of this model requires a favorable corporate culture and motivation of the health care workers. This model provides a useful framework to uplift the traditional approach to quality assurance in health care. PMID:8322109

  10. [Quality improvement of health care services in Croatian emergency medicine].

    Science.gov (United States)

    Predavec, Sanja; Sogori?, Selma; Jurkovi?, Drazen

    2010-12-01

    Emergency medical services (EMS) in the Republic of Croatia are currently organized as part of the existing health care system and delivered in the form of pre-hospital and hospital EMS. The pre-hospital EMS are delivered by standalone EMS Centers, EMS units set up in community health centers, and by general practitioners working in shifts and on call in remote and scarcely populated areas. In hospitals, each ward usually has its own emergency reception area, and only in a couple of cases there is an integrated emergency admission unit for the entire hospital. The current EMS structure does not meet the basic requirements that would make an EMS system optimal, i.e. equal quality, equal access, effectiveness and appropriate equipment. The EMS Restructuring Project is part of the Croatian health care system reform and is addressed by the National Health Development Strategy 2006-2011. As part of restructuring efforts, the Croatian National Institute of Emergency Medicine, 21 County Institutes of Emergency Medicine and county-level call centers are going to be set up. In addition, the project will introduce the following: integrated emergency admission areas at hospitals; telemedicine as part of emergency medicine; emergency medicine specialty for physicians and additional specialized training for nurses/technicians; separation of emergency and non-emergency transport; standards for vehicles and equipment and guidelines/protocols/algorithms for care. The Croatian National Institute of Emergency Medicine is an umbrella EMS organization. It shapes the EMS in Croatia and proposes, plans, monitors and analyzes EMS actions in Croatia. In addition, it submits a proposal of the Emergency Medicine Network to the minister, sets standards for EMS transport, and coordinates, guides and supervises the work of County Institutes of Emergency Medicine. County Institutes organize and deliver pre-hospital EMS in their counties. Integrated hospital emergency admission units represent a single point of entry for all emergencies at a particular hospital. Upon triage, depending on the level of emergency, patients are provided with appropriate care and treatment. The introduction of EMS specialty for physicians and additional specialized training for nurses/ technicians is going to increase competencies of all EMS team members. The main objectives of the EMS Restructuring Project to be achieved in the 5-year period are the following: to reduce the response time of pre-hospital EMS teams to 10 minutes in urban areas and 20 minutes in rural areas in 20% of team interventions; to bring patients to hospital within the "golden hour" in 80% of cases; to have 200 physicians specialized in emergency medicine; and to have 220 nurses/technicians that have successfully completed their specialized training in emergency medicine. The objectives are going to be monitored through indicators as part of the World Bank Project for which data have already been collected throughout Croatia: number of interventions; number of emergency interventions; time between call receipt and arrival to scene; time between call receipt and arrival to hospital emergency reception area; percentage of arrivals to hospital by EMS vehicles within 12 hours of symptom onset; polytrauma and cardiac arrest survival rate before admission to hospital; time spent in hospital emergency reception areas and integrated hospital emergency admission units; polytrauma and cardiac arrest survival rate within 24 hours of hospital admission; number of integrated hospital emergency admission units per county; and number of pre-hospital EMS teams per capita. PMID:21692265

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

    OpenAIRE

    Diego Fornaciari

    2009-01-01

    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 institut...

  12. 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.

  13. An assessment of the quality of primary health care in India

    OpenAIRE

    Powell-Jackson, T; A Acharya; Mills, A

    2013-01-01

    There is limited evidence on the quality of primary health care provision in India. Using data on the availability of inputs from a nationally representative survey of primary health centres, a composite measure of structural quality of care for primary health centres was developed with a view to examine its geographical variation, associations with mortality and healthcare utilisation, and the determinants of better quality, giving particular attention to the role of management. The mean qua...

  14. Quality of Antenatal Care and Obstetrical Coverage in Rural Burkina Faso

    OpenAIRE

    Nikiema, L.; Kameli, Y.; Capon, G.; Sondo, B.; Martin-Prével, Y.

    2010-01-01

    Improving maternal health is one of the Millennium Development Goals of the United Nations. Despite the efforts to promote maternal and neonatal care to achieve this goal, the use of delivery care remains below expectations in Burkina Faso. This situation raises the question of the quality of care offered in maternity wards. The aim of this study was to identify primary healthcare facility and antenatal care characteristics predictive of an assisted delivery in rural Burkina Faso. A cross-sec...

  15. 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 enr 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)

  16. The experience of the implementation of perinatal audit in Moldova.

    Science.gov (United States)

    Stratulat, P; Curteanu, A; Caraus, T; Petrov, V; Gardosi, J

    2014-09-01

    The Beyond the Numbers project in Moldova implemented perinatal mortality audit as a means to improve maternity and newborn care. Key activities for this project included training in audit, the setting up of audit committees, implementation of the review of cases and dissemination of information. During the project, a significant reduction was noted of perinatal deaths at term (from 37 weeks gestation and birthweight of ?2500 g) by 1.5 per 1000; from 5.1 per 1000 in 2006 to 3.6 per 1000 in 2013. PMID:25236652

  17. The impact of competition on quality and prices in the English care homes market

    Science.gov (United States)

    Forder, Julien; Allan, Stephen

    2014-01-01

    This study assesses the impact of competition on quality and price in the English care/nursing homes market. Considering the key institutional features, we use a theoretical model to assess the conditions under which further competition could increase or reduce quality. A dataset comprising the population of 10,000 care homes was used. We constructed distance/travel-time weighted competition measures. Instrumental variable estimations, used to account for the endogeneity of competition, showed quality and price were reduced by greater competition. Further analyses suggested that the negative quality effect worked through the effect on price – higher competition reduces revenue which pushes down quality. PMID:24487075

  18. Users' perceptions of outpatient quality of care in Kilosa District Hospital in central Tanzania.

    Science.gov (United States)

    Juma, D; Manongi, R

    2009-10-01

    Use of users' perception in measuring quality of care has been shown to be useful in screening problems and in planning for improvement of quality of health care delivery. Traditionally, quality of care has been measured using professional standards, neglecting users' opinions which may leave psychosocial needs unattended. The objective of this descriptive cross-sectional study was to assess users' perceptions of quality of care given at outpatient department (OPD) at Kilosa District Hospital in Central Tanzania. Hospital based exit interviews were conducted to adult patients or caregivers of children attending the hospital. Focus Group Discussions were conducted among community members in selected villages within the hospital catchment area. Information on perceptions on care provider-patient interaction, cost of service, availability of medicines, equipment and health personnel was sought from the participants. Overall OPD was perceived to have several shortcomings including verbal abuse of patients by care providers, lack of responsiveness to patients' needs, delays, inadequate examination, unreliable supply of medicines, lack of confidentiality and favouritism in health care provision. Cost of service was perceived to be reasonable provided medicines were available. In conclusion, provider-patient interactions, timely services, supply of medicines and favouritism were the major factors affecting quality of service at the hospital. Efforts should be made to address the shortcomings so as to improve quality of care and users perceptions. PMID:20734699

  19. Consumer assessment of perceived quality of antenatal care services in a tertiary health care institution in Osun State, Nigeria

    OpenAIRE

    Esther Olufunmilayo Asekun-olarinmoye; James Olusegun Bamidele; Bolaji Emmanuel Egbewale; Ifeoluwapo Oyebola Asekun-Olarinmoye; Ebenezer Olabamiji Ojofeitimi

    2009-01-01

    Objective: To describe consumer assessment of the perceived-quality of antenatal care services in a tertiary health care institution in Osun State.Material and Methods: In a descriptive cross-sectional study, information was obtained (utilizing a semi-structured questionnaire) from 289 pregnant women randomly selected from the Antenatal Clinic (ANC) of Obafemi Awolowo University Teaching Hospital. Chi-square statistic test was used to explore associations. Level of significance was p

  20. Quality Control Issues in Point of Care Testing

    Science.gov (United States)

    Martin, Cameron L

    2008-01-01

    Summary Quality Control (QC) in Point of Care Testing (PoCT) is often thought of as a complex issue; however intelligent system analysis can simplify matters and greatly increase the chances of a well controlled system. What we want to achieve is a QC program which adequately controls the PoCT system, but does not excessively contribute to the operating costs or complexity of maintaining a PoCT instrument, or network of instruments.Don’t neglect effective pre-analytical work: good documentation, operator training, monitoring, and analyser maintenance programs are essential, as for any analyser.Look closely at your analyser:Is it a “laboratory type” instrument or cartridge or strip based?Can it perform multiple test types or a single test only?How is it calibrated?Does it have built in self-check capabilities or an electronic check cartridge?Is the sample in contact with the instrument?What are the cartridge/strip/reagent storage requirements?Establish where the analysis is taking place and which system component is involved.Tailor your QC program to target this component, but still check the system as a whole.A common approach is to check cartridges/strips on delivery and run a QA sample at least monthly to check storage conditions and operator performance. If there is no independent electronic instrument check, daily QC checks are also recommended.Don’t be afraid to stray beyond conventional QC models if necessary. Some PoCT systems are not adequately controlled by the application of conventional QC alone. PMID:18852863

  1. Quality of care and 30 day mortality among patients with hip fractures: a nationwide cohort study

    Directory of Open Access Journals (Sweden)

    Ingeman Annette

    2009-10-01

    Full Text Available Abstract Background We examined the association between quality of care and 30 day mortality in a nationwide cohort of patients hospitalized with hip fracture. Methods We used data from The Danish National Indicator Project, a quality improvement initiative with participation of more than 90% of Danish hospital departments caring for patients with hip fracture between August 16, 2005 and August 15, 2006. Quality of care was measured in terms of meeting five specific criteria: early assessment of the patient's nutritional risk, systematic pain assessment during mobilization, assessment of Activities of Daily Living (ADL before the fracture, assessment of ADL before discharge, and initiation of treatment to prevent future osteoporotic fractures. The association between meeting each of the quality of care criteria for the patient and 30 day mortality was examined using logistic regression to adjust for potential confounders. Results 6,266 patients hospitalized with an incident episode of hip fracture were included in the study. For four of the five quality of care criteria, patients who met the criterion had substantially lower 30 day mortality after hip fracture. The adjusted mortality odds ratios (ORs ranged from 0.42 (95% CI, 0.30 to 0.58 for assessment of ADL before discharge (excluding deaths during hospitalization to 0.72 (95% CI, 0.52 to 1.00 for systematic pain assessment. We found an inverse dose-response relationship between the number of quality of care criteria met and 30 day mortality; the lowest mortality was found among patients for whom all five quality of care criteria were met, as compared with patients for whom no quality of care criteria were met: adjusted mortality OR 0.18 (95% CI, 0.09 to 0.36. Conclusion Higher quality of care during hospitalization with hip fracture was associated with lowered 30 day mortality.

  2. Service Quality of Delivered Care from the Perception of Women with Caesarean Section and Normal Delivery

    Directory of Open Access Journals (Sweden)

    Jafar S. Tabrizi

    2014-12-01

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

  3. Chronic disease management: a review of current performance across quality of care domains and opportunities for improving osteoarthritis care.

    Science.gov (United States)

    Brand, Caroline A; Ackerman, Ilana N; Bohensky, Megan A; Bennell, Kim L

    2013-02-01

    Osteoarthritis is the most prevalent chronic joint disease worldwide. The incidence and prevalence are increasing as the population ages and lifestyle risk factors such as obesity increase. There are several evidence-based clinical practice guidelines available to guide clinician decision making, but there is evidence that care provided is suboptimal across all domains of quality: effectiveness, safety, timeliness and appropriateness, patient-centered care, and efficiency. System, clinician, and patient barriers to optimizing care need to be addressed. Innovative models designed to meet patient needs and those that harness social networks must be developed, especially to support those with mild to moderate disease. PMID:23312413

  4. 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 ...

  5. 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.

  6. 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.

  7. Does quality of care for hypertension in primary care vary with postcode area deprivation? An observational study

    Directory of Open Access Journals (Sweden)

    Hammouche Salah

    2011-11-01

    Full Text Available Abstract Background Hypertension is a common major risk factor for stroke and coronary heart disease. Little is known about how achievement of financially incentivised and non-incentivised indicators of quality of care varies with deprivation, or about the effect of financial incentives on health inequalities in hypertension. General practices in the UK have received financial incentives for high quality care since 2004. This study set out to assess the variations in achievement of incentivised and non-incentivised quality indicators for hypertension by patient area deprivation, before and after the introduction of financial incentives. Methods Achievement of 14 quality indicators for hypertension in 304 patient participants in 18 general practices in Norfolk, England was assessed one year before (2003 and one year after (2005 the introduction of financial incentives. Four indicators were incentivised and 10 were non-incentivised. Each participant's postcode was linked to an index of multiple deprivation score. Results The range of achievement of incentivised quality indicators was 65-94% in the least deprived third of participants, and 77-94% in the most deprived third in 2003 and 2005 combined. For non-incentivised indicators, the range was 7-85% in the least deprived and 24-93% in the most deprived third. Achievement of incentivised quality indicators in 2003 and 2005 combined did not vary significantly by area deprivation. Achievement of three of 10 non-incentivised indicators was higher in participants from more deprived postcode areas: providing lifestyle advice (odds ratio 1.34, 95% confidence interval 1.00-1.79, assessment of peripheral vascular disease (1.54, 1.02-2.35 and electrocardiography (1.38, 1.04-1.82. Conclusions Participants from more deprived areas received at least the same, and sometimes better, quality of care than those from less deprived areas. Quality of care for hypertension in general practice may not follow the inequitable distribution seen with some other conditions.

  8. 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

  9. Social support, self-care, and quality of life in cancer patients receiving radiotherapy in Thailand

    International Nuclear Information System (INIS)

    The purpose of the study was two-fold: (1) to examine the relationships among self-care, social support, and quality of life in adult cancer patients receiving radiotherapy while the selected basic conditioning factors of age, marital and socio-economic status, living arrangement, stage and site of cancer were statistically controlled; and (2) to test a theoretical model which postulated that (a) quality of life was predicted jointly by the selected basic conditioning factors, social support and self-care, and (b) self-care was predicted jointly by the selected basic conditioning factors and social support. A convenience sample of 112 adult cervical and head/neck cancer patients receiving radiotherapy was obtained from radiotherapy outpatient clinic in three hospitals located in Bangkok, Thailand. Results of the study indicated positive relationships among self-care, social support, and quality of life. Socio-economic status, site of cancer, and self-care were significant predictors for reported quality of life. Social support appeared to be a significant predictor of quality of life indirectly through self-care. Socio-economic status and social support were also significant predictors of self-care, whereas, stage and site of cancer seemed to predict self-care indirectly through social support

  10. 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

  11. 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.

  12. Quality infant day-care and grade school behavior and performance.

    Science.gov (United States)

    Field, T

    1991-08-01

    Relations between attendance in stable high-quality day-care programs and grade school behavior and performance were determined using 2 longitudinal data sets. The first sample included grade school children who had received stable, full-time infant day-care and preschool day-care until they reached school age in the same high-quality day-care center. In this sample the amount of time (months) spent in full-time center care was positively related to the number of friends and extracurricular activities of the children. In addition, more time in the center was positively related to parents' ratings of the children's emotional well-being, leadership, popularity, attractiveness, and assertiveness and negatively related to aggressivity. Study 2 sampled sixth graders who had also received varying amounts (months) of stable full-time day-care, but this group attended a variety of quality day-care centers. In this sample the amount of time in day-care was related to the teachers' ratings of their emotional well-being, attractiveness, and assertiveness. In addition, children with more time in high-quality day-care showed more physical affection during peer interactions, were more often assigned to the gifted program, and received higher math grades. PMID:1935347

  13. Can Evidence-Based Dental Health Care Assure Quality?

    Science.gov (United States)

    McCulloch, Christopher A. G.

    1994-01-01

    It is suggested that evidence-based health care is appropriate in dental care delivery, and dental educators can play an important role in overcoming barriers to teaching and practice of this approach. Obstacles include misinterpretations, insufficient evidence, undeveloped critical appraisal skills, skepticism, inadequate time, and poor access to…

  14. Validity and reliability of criterion based clinical audit to assess obstetrical quality of care in West Africa

    Directory of Open Access Journals (Sweden)

    Pirkle Catherine M

    2012-10-01

    Full Text Available Abstract Background In Mali and Senegal, over 1% of women die giving birth in hospital. At some hospitals, over a third of infants are stillborn. Many deaths are due to substandard medical practices. Criterion-based clinical audits (CBCA are increasingly used to measure and improve obstetrical care in resource-limited settings, but their measurement properties have not been formally evaluated. In 2011, we published a systematic review of obstetrical CBCA highlighting insufficient considerations of validity and reliability. The objective of this study is to develop an obstetrical CBCA adapted to the West African context and assess its reliability and validity. This work was conducted as a sub-study within a cluster randomized trial known as QUARITE. Methods Criteria were selected based on extensive literature review and expert opinion. Early 2010, two auditors applied the CBCA to identical samples at 8 sites in Mali and Senegal (n = 185 to evaluate inter-rater reliability. In 2010–11, we conducted CBCA at 32 hospitals to assess construct validity (n = 633 patients. We correlated hospital characteristics (resource availability, facility perinatal and maternal mortality with mean hospital CBCA scores. We used generalized estimating equations to assess whether patient CBCA scores were associated with perinatal mortality. Results Results demonstrate substantial (ICC = 0.67, 95% CI 0.54; 0.76 to elevated inter-rater reliability (ICC = 0.84, 95% CI 0.77; 0.89 in Senegal and Mali, respectively. Resource availability positively correlated with mean hospital CBCA scores and maternal and perinatal mortality were inversely correlated with hospital CBCA scores. Poor CBCA scores, adjusted for hospital and patient characteristics, were significantly associated with perinatal mortality (OR 1.84, 95% CI 1.01-3.34. Conclusion Our CBCA has substantial inter-rater reliability and there is compelling evidence of its validity as the tool performs according to theory. Trial registration Current Controlled Trials ISRCTN46950658

  15. 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...

  16. Effect of Self-Care Program on the Quality of Life in Sickle Cell Anemia

    Directory of Open Access Journals (Sweden)

    Sadigeh Fayazi

    2012-04-01

    Full Text Available Background & Objective: sickle cell anemia, a chronic disease, which has many complication affects patient’s. This quality of life’s. Therefor, they need caring to maintain their life. The goal of this study was investigating the effect of self care plan on the quality of life’s sickle cell anemia. Subjects and Methods: This study was a clinical trial research Carried out on 70 sickle cell anemics and allocated in two groups randomly. The instruments of data collection were demographic, assessment educational needs and SF-36 quality of life questionnaire. One educational session of self care (60 minute was implemented for the experimental group. The patients’ quality of life was measured in two times (before and three months past intervention. Results: T-test showed that the total scores of quality of life’s two groups have not significant difference before intervention (p=0/58, but the difference was significant between two groups in after intervention (p<0/001. PAIR T-TEST showed that the total scores of patients’ quality of life in before and after intervention have significant difference in the control group and the quality of life has decreased in this group (p=0/019(,but this difference was not significant in experimental group and quality of life has remained in this group (p=0/91. Conclusion Reduced quality of life of control group and stable quality of life of experimental group indicate that the self care program improve the quality of life of these patients. Designing program based on patient educational needs, capabilities and cooperation can have a positive influence on the patients’ quality of life of patient make to achieve results positive. ?Please cite this paper as: Mahmodi GR, Fayazi S, Jahani S, Kaykhaei B, latifi SM. Effect of Self-Care Program on the Quality of Life in Sickle Cell Anemia. Jundishapur Sci Med J 2012;11(2:201-211

  17. [Assessment of medical care quality in craniocerebral trauma on the base of data analysis].

    Science.gov (United States)

    Moguchaia, O V; Gumanenko, E K; Simonova, I A; Shchedrenok, V V; Romashova, O V; Kaurova, T A

    2014-01-01

    An analysis of 658 medical records of inpatient treatment from 15 hospitals of St.Petersburg was made using a computer-aided technology of the assessment of medical care quality. It was revealed that a proper quality of medical care in craniocerebral trauma was only in 52.9% cases. Different defects of medical care were noted in the rest of observations. It influenced on the condition of the patients (1.0%), the delivery and assessment of health care (40% and 38%, respectively), health resources (18%), social resources (1.0%). Defects of medical records were indicated in 38% patients. It caused a reduction of medical care. Risks of occurrence of medical care defects are low in children hospitals in the case of combined craniocerebral trauma. PMID:25552116

  18. Optimizing safe, comfortable ICU care through multi-professional quality improvement: just DO it

    OpenAIRE

    Montpetit, Alison J.; Sessler, Curtis N.

    2013-01-01

    Translating research to the bedside can present significant challenges in the complex ICU environment. In this issue of Critical Care, de Jong and colleagues report on a quality improvement project (NURSE-DO) that led to a decrease in severe pain and serious adverse events during nursing care procedures in their ICU. In this commentary we describe three aspects of this quality improvement study that we think contributed to the overall success of the NURSE-DO project: the hospital environment ...

  19. Fatigue and concerns about quality of care among Ontario interns and residents.

    OpenAIRE

    Lewittes, L R; Marshall, V W

    1989-01-01

    In postgraduate medical training the heavy and irregular workloads are thought to result in fatigue and a potential decrease in the quality of care provided by interns and residents. We investigated these concerns among Ontario interns and residents. Information from 1805 house staff in all specialties and different years of postgraduate education suggested a relation between hours of work, fatigue and concerns about the quality of care.

  20. 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...

  1. The "Palliative Care Quality of Life Instrument (PQLI)" in terminal cancer patients

    OpenAIRE

    Kouvaris John; Katsouda Emmanuela; Parpa Efi; Kouloulias Vassilios; Tsilika Eleni; Mystakidou Kyriaki; Vlahos Lambros

    2004-01-01

    Abstract Background This paper describes the development of a new quality of life instrument in advanced cancer patients receiving palliative care. Methods The Palliative Care Quality of Life Instrument incorporates six multi-item and one single-item scale. The questionnaire was completed at baseline and one-week after. The final sample consisted of 120 patients. Results The average time required to complete the questionnaire, in both time points, was approximately 8 minutes. All multi-item s...

  2. The impact of competition on quality and prices in the English care homes market

    OpenAIRE

    Forder, Julien; Allan, Stephen

    2014-01-01

    This study assesses the impact of competition on quality and price in the English care/nursing homes market. Considering the key institutional features, we use a theoretical model to assess the conditions under which further competition could increase or reduce quality. A dataset comprising the population of 10,000 care homes was used. We constructed distance/travel-time weighted competition measures. Instrumental variable estimations, used to account for the endogeneity of competition, showe...

  3. 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.

  4. 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

  5. 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...

  6. 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...

  7. Hospice in Assisted Living: Promoting Good Quality Care at End of Life

    OpenAIRE

    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 urban and rural settings. A semistructured interview guide facilitated interviews where 38 participants described specific examples of care that ?...

  8. The Quality of Clinical Maternal and Neonatal Healthcare – A Strategy for Identifying ‘Routine Care Signal Functions’

    Science.gov (United States)

    Brenner, Stephan; De Allegri, Manuela; Gabrysch, Sabine; Chinkhumba, Jobiba; Sarker, Malabika; Muula, Adamson S.

    2015-01-01

    Background A variety of clinical process indicators exists to measure the quality of care provided by maternal and neonatal health (MNH) programs. To allow comparison across MNH programs in low- and middle-income countries (LMICs), a core set of essential process indicators is needed. Although such a core set is available for emergency obstetric care (EmOC), the ‘EmOC signal functions’, a similar approach is currently missing for MNH routine care evaluation. We describe a strategy for identifying core process indicators for routine care and illustrate their usefulness in a field example. Methods We first developed an indicator selection strategy by combining epidemiological and programmatic aspects relevant to MNH in LMICs. We then identified routine care process indicators meeting our selection criteria by reviewing existing quality of care assessment protocols. We grouped these indicators into three categories based on their main function in addressing risk factors of maternal or neonatal complications. We then tested this indicator set in a study assessing MNH quality of clinical care in 33 health facilities in Malawi. Results Our strategy identified 51 routine care processes: 23 related to initial patient risk assessment, 17 to risk monitoring, 11 to risk prevention. During the clinical performance assessment a total of 82 cases were observed. Birth attendants’ adherence to clinical standards was lowest in relation to risk monitoring processes. In relation to major complications, routine care processes addressing fetal and newborn distress were performed relatively consistently, but there were major gaps in the performance of routine care processes addressing bleeding, infection, and pre-eclampsia risks. Conclusion The identified set of process indicators could identify major gaps in the quality of obstetric and neonatal care provided during the intra- and immediate postpartum period. We hope our suggested indicators for essential routine care processes will contribute to streamlining MNH program evaluations in LMICs. PMID:25875252

  9. Quality of primary care practice in a large HMO according to physician specialty.

    OpenAIRE

    Grumbach, K; Selby, J V; Schmittdiel, J A; Quesenberry, C P

    1999-01-01

    OBJECTIVE: To determine whether physician specialty was associated with differences in the quality of primary care practice and patient satisfaction in a large, group model HMO. DATA SOURCES/STUDY SETTING: 10,608 patients ages 35-85 years, selected using stratified probability sampling from the primary care panels of 60 family physicians (FPs), 245 general internists (GIMs), and 55 subspecialty internists (SIMs) at 13 facilities in the Kaiser Permanente Medical Care Program of Northern Califo...

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

    Science.gov (United States)

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

    2015-01-01

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

  11. Information-Seeking in Family Day Care: Access, Quality and Personal Cost

    Science.gov (United States)

    Corr, L.; Davis, E.; Cook, K.; Mackinnon, A.; Sims, M.; Herrman, H.

    2014-01-01

    Family day-care (FDC) educators work autonomously to provide care and education for children of mixed ages, backgrounds and abilities. To meet the demands and opportunities of their work and regulatory requirements, educators need access to context-relevant and high quality information. No previous research has examined how and where these workers…

  12. The Quality of Life of Palliative Care Staff: A Personal Construct Approach.

    Science.gov (United States)

    Viney, Linda L.; And Others

    1994-01-01

    Compared palliative care staff with staff from burn and neonatal units and with mature age general nursing trainees at end of training. Found that palliative care staff expressed better quality of life, in terms of significantly less anxiety and depression, as well as more good feelings than other staff groups. (Author/NB)

  13. 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...

  14. 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.

  15. A comparison of perinatal and infant mortality rates in British Columbia and Finland: Similarities and differences

    Directory of Open Access Journals (Sweden)

    Jaakko Matomäki

    2013-03-01

    Full Text Available Introduction: Despite similarities, perinatal and infant mortality rates between British Columbia, (BC Canada and Finland differ. Key variables that may influence stillbirth, early neonatal, perinatal and infant mortality rates in BC and Finland were studied. Methods: After standardizing definitions, data for all births between 2001 and 2009 from provincial and national registries were used to compare perinatal outcomes between BC and Finland. Annual change was evaluated with regression analyses. Results: Births before 22 weeks gestation were excluded. All mortality rates per 1000 were lower in Finland vs BC (perinatal: 5.1 vs 6.2, stillbirth: 3.4 vs 3.9, early neonatal 1.7 vs 2.4, infant 2.9 vs 4.0; all p Higher multiple birth and preterm birth rates in BC are affecting mortality rates. Finland’s policy of single embryo transfer is a potential explanation. It is possible to have good perinatal outcomes and low caesarean section rates. Conclusions: The Finnish health care system may suggest possible solutions for improved perinatal outcomes. Lower per capita health care expenditures in Finland do not appear to have adversely affected perinatal outcomes.

  16. Disparities in Health Care Quality among Minority Women

    Science.gov (United States)

    ... were less likely to have health insurance than non-Hispanic White women. In 2008, the percentage of people without a usual source of care who indicated a financial or insurance reason for not having a usual ...

  17. Taking care of business: HMOs that spend more on administration deliver lower-quality care.

    Science.gov (United States)

    Himmelstein, David U; Woolhandler, Steffie

    2002-01-01

    The authors analyzed health maintenance organizations' administrative costs and quality measures from the National Committee for Quality Assurance's Quality Compass database for the years 1997-2000. HMOs with higher administrative overhead had consistently worse quality scores in univariate analysis. Multivariate analyses controlling for geographic region (all years) and HMO model type (1997 and 1998 analyses only) confirmed that higher administrative costs were associated with lower quality. Excess HMO bureaucracy is not only wasteful but harmful. PMID:12456120

  18. 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...

  19. 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.

  20. Quality of Care and Service Expansion for HIV Care and Treatment.

    Science.gov (United States)

    Moore, Carolyn Bolton; Ciaraldi, Erica

    2015-06-01

    The last two decades have seen exceptional development of antiretroviral treatment programs throughout the world. Over 14 million persons are accessing antiretroviral treatment (ART) treatment as of early 2015, and life expectancy has risen markedly in the most-affected populations. However, large patient numbers threaten to overwhelm already over-burdened health care systems and retention in care remains suboptimal. Developing innovative strategies to alleviate these burdens and retain patients in care remains a challenge. Furthermore, despite this expansion, large populations of HIV-infected persons remain undiagnosed and are unwilling or unable to access care and treatment programs. Marginalized and high-risk populations are particularly in danger of remaining outside of care and are also disproportionately affected by HIV. To reverse the trend and "fast track" our way out of the epidemic, ambitious treatment targets are required, and a concerted effort has to be made to engage these populations into care, initiate ART, and attain viral suppression. PMID:25855339

  1. Trends in quality of non-Hodgkin's lymphoma care: is it getting better?

    Science.gov (United States)

    Stienen, J J C; Ottevanger, P B; Wennekes, L; van de Schans, S A M; Dekker, H M; van der Maazen, R W M; van Krieken, J H J M; Blijlevens, N M A; Hermens, R P M G

    2015-07-01

    This study outlines trends in quality of delivered non-Hodgkin's lymphoma (NHL) care in the Netherlands between 2007 and 2011 and to what extend this was influenced by the national Visible Care program, which aimed at increasing transparency by providing insight into the quality of healthcare. We analyzed data collected from medical records in two observational studies, combined into 20 validated quality indicators (QIs) of which 6 were included in the national program. A random sample of 771 patients, diagnosed with NHL in 26 Dutch hospitals, was examined. Multilevel regression analyses were used to assess differences in quality of NHL care and to provide insight into the effect of the national program. We reported improved adherence to only 3 out of 6 QIs involved in the national program and none of the other 14 validated QIs. Improvement was shown for performance of all recommended staging techniques (from 26? to ?43 %), assessment of International Prognostic Index (from 21? to ?43 %), and multidisciplinary discussion of patients (from 23? to ?41 %). We found limited improvement in quality of NHL care between 2007 and 2011; improvement potential (indicators which represent the most important, measurable parts in quality of NHL care. These results illustrate the need for tailored implementation and quality improvement initiatives. PMID:25772630

  2. 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

  3. 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

  4. Managing the relationship between quality and cost-effective burn care.

    Science.gov (United States)

    Stavrou, Demetris; Weissman, Oren; Winkler, Eyal; Millet, Eran; Nardini, Gil; Tessone, Ariel; Zmora, Niv; Mushin, Oren Paul; Haik, Joseph

    2011-05-01

    In the modern era of fiscal prudence, managing the relationship between quality health care and cost reduction is a complex and challenging task for policy makers and health care providers. Health economics is an applied field that aids in assessing the feasibility of incorporating new interventions in a certain field. Applying these tools when allocating funds for burn care is even more complicated due to the lack of clinical data regarding the cost effectiveness of different aspects in burn care. Herein we review the existing literature and summarize different approaches for achieving cost effective health care in general and in burn care specifically. Special considerations to funds allocation in burn care are also discussed. PMID:21130580

  5. Variation in Quality of Diabetes Care at the Levels of Patient, Physician, and Clinic

    OpenAIRE

    Patrick J. O’Connor, MD, MPH; William A. Rush, PhD; Gestur Davidson, PhD; Thomas A. Louis, PhD; Leif I. Solberg, MD; A. Lauren Crain, PhD; Paul E. Johnson, PhD; Robin R. Whitebird, PhD

    2007-01-01

    IntroductionWe studied variance in glycated hemoglobin (HbA1c) values among adults with diabetes to identify variation in quality of diabetes care at the levels of patient, physician, and clinic, and to identify which levels contribute the most to variation and which variables at each level are related to quality of diabetes care. MethodsStudy subjects were 120 primary care physicians and their 2589 eligible adult patients with diabetes seen at 18 clinics. The dependent variable was HbA1c val...

  6. 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.

  7. Readiness to Implement a National Quality Framework: Evidence from Irish Early Childhood Care and Education Centres

    Science.gov (United States)

    Doyle, Orla; Logue, Caitriona; McNamara, Kelly A.

    2011-01-01

    This study examined the factors associated with childcare staff members' readiness to implement quality standards in early childhood settings in Ireland. To coincide with a new government policy that provides every three-year-old child with access to a free preschool year, a framework designed to improve the quality of early childhood care and…

  8. Purchaser strategies to influence quality of care: from rhetoric to global applications.

    Science.gov (United States)

    McNamara, P

    2006-06-01

    The potential of purchasers to influence the quality and safety of care has captured the attention of health sector leaders worldwide. Quality based purchasing explicitly seeks to hold providers accountable for the quality and safety of care. Three strategies are available to purchasers: (1) selective contracting based on quality; (2) payment differentials based on quality; and (3) sponsorship of comparative provider report cards. Examples are given to illustrate each of the three strategies. Governments, employers, social insurance funds, community based insurance organizations, health plans, donors, and other buyers of health services are encouraged to explore and debate these purchaser strategies within the context of an overarching national or local quality framework. Public and private funders of operations research are encouraged to support and disseminate evaluations of purchaser efforts to improve quality. This paper is designed to highlight and frame purchasers' strategies explicitly crafted to enhance the quality and safety of care. The ultimate aim is to encourage thoughtful discussion about whether or not one or more purchaser strategy might support a particular country's goals to improve care. Experiences from both developed and developing countries are included to facilitate the exchange of ideas and provide the broadest of perspectives. PMID:16751465

  9. Starting Strong III: A Quality Toolbox for Early Childhood Education and Care

    Science.gov (United States)

    OECD Publishing (NJ3), 2011

    2011-01-01

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

  10. Evaluation and implementation of quality standards to ensure relevant medical care in the system of military medical services of Armenia.

    Science.gov (United States)

    Khachatryan, R

    2014-10-01

    It was the goal of this review to determine if the MHS of Armenia meets benchmarks for health care quality; to provide military medical officials with relevant information to create an adequate environment for all the quality improvement initiatives being undertaken at the medical care level; to design and implement effective interventions to make informed strategic choices and promote quality and a culture of safety in. Documents addressing the quality of care in the MHS of Armenia were reviewed. PMID:25416224

  11. Impact of weight bias and stigma on quality of care and outcomes for patients with obesity.

    Science.gov (United States)

    Phelan, S M; Burgess, D J; Yeazel, M W; Hellerstedt, W L; Griffin, J M; van Ryn, M

    2015-04-01

    The objective of this study was to critically review the empirical evidence from all relevant disciplines regarding obesity stigma in order to (i) determine the implications of obesity stigma for healthcare providers and their patients with obesity and (ii) identify strategies to improve care for patients with obesity. We conducted a search of Medline and PsychInfo for all peer-reviewed papers presenting original empirical data relevant to stigma, bias, discrimination, prejudice and medical care. We then performed a narrative review of the existing empirical evidence regarding the impact of obesity stigma and weight bias for healthcare quality and outcomes. Many healthcare providers hold strong negative attitudes and stereotypes about people with obesity. There is considerable evidence that such attitudes influence person-perceptions, judgment, interpersonal behaviour and decision-making. These attitudes may impact the care they provide. Experiences of or expectations for poor treatment may cause stress and avoidance of care, mistrust of doctors and poor adherence among patients with obesity. Stigma can reduce the quality of care for patients with obesity despite the best intentions of healthcare providers to provide high-quality care. There are several potential intervention strategies that may reduce the impact of obesity stigma on quality of care. PMID:25752756

  12. 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.

  13. 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.

  14. Developing a process to support perinatal nurses after a critical event.

    Science.gov (United States)

    Foreman, Suzan

    2014-01-01

    The work of perinatal nurses sometimes includes emergencies involving death, or near death, which can leave health care providers with feelings of stress and grief. After experiencing a particularly stressful period, nurses at our organization identified processes to help themselves recover and to support each other. The result of this work is a written plan to facilitate the support of perinatal nurses after critical events. This article describes the development and implementation of this plan. PMID:24548497

  15. Perinatal Outcome in Unbooked Teenage Pregnancies in the University of Calabar Teaching Hospital, Calabar, Nigeria

    OpenAIRE

    Iklaki, C. U.; Inaku, J. U.; Ekabua, J. E.; E. I. Ekanem; 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...

  16. Socio-cultural factors surrounding mental distress during the perinatal period in Zambia: a qualitative investigation

    OpenAIRE

    Mwape Lonia; McGuinness Teena M; Dixey Rachael; Johnson Sally E

    2012-01-01

    Abstract Background The presence of mental distress during pregnancy and after childbirth imposes detrimental developmental and health consequences for families in all nations. In Zambia, the Ministry of Health (MoH) has proposed a more comprehensive approach towards mental health care, recognizing the importance of the mental health of women during the perinatal period. Aim The study explores factors contributing to mental distress during the perinatal period of motherhood in Zambia. Methods...

  17. 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.

  18. Responding to poor-quality care during research in nursing homes.

    Science.gov (United States)

    Krause, Melanie R; Palmer, Janice L; Bowers, Barbara J; Buckwalter, Kathleen C

    2011-01-01

    For nurse researchers, responding appropriately to resident abuse is straightforward: The abuse must be reported. However, responding to care that is of poor quality-where care practices are problematic but do not meet the definition of reportable abuse-is not so straightforward. Decision making may be influenced by ethical and professional principles, as well as self-interest to complete a research project. The purpose of this article is to provoke a dialogue about a dilemma faced by many researchers conducting research in long-term care: responding to poor-quality care that does not meet the state's definition of resident abuse. We will accomplish this by providing a real-life situation faced by a novice researcher conducting her first funded research project, identifying some of the important considerations and possible responses by nurse researchers. Optimally, nurse researchers will develop a plan for responding to poor care before beginning the study. PMID:20509593

  19. Perspectives on provider behaviors: a qualitative study of sexual and gender minorities regarding quality of care.

    Science.gov (United States)

    Rounds, Kelsey E; McGrath, Barbara Burns; Walsh, Elaine

    2013-04-01

    Lesbian, gay, bisexual, transgender, and queer (LGBTQ) identified patients report receiving substandard care from healthcare providers. They face the fear and disturbing reality of discrimination when accessing health care. Without culturally sensitive treatment, nursing and other health professions do not properly care for this population. Following the recent trend towards awareness and need for inclusion of LGBTQ populations in healthcare, this paper provides a summary of the current literature on the treatment and needs of LGBTQ people and describes focus groups conducted to explore perceptions regarding provider behaviors. It concludes with a list of behaviors that enhance or impede quality care that can serve as a guide for healthcare professionals. PMID:23721392

  20. Patients' recollections of experiences in the intensive care unit may affect their quality of life.

    OpenAIRE

    GRANJA, C.; Lopes, A; Moreira, S.; Dias, C.; COSTA?PEREIRA, A.; carneiro, a; JMIP STUDY GROUP

    2005-01-01

    Crit Care. 2005 Apr;9(2):R96-109. Epub 2005 Jan 31. Patients' recollections of experiences in the intensive care unit may affect their quality of life. Granja C, Lopes A, Moreira S, Dias C, Costa-Pereira A, Carneiro A; JMIP Study Group. Medical Intensive Care Unit, Hospital Pedro Hispano, Matosinhos, Portugal. cristinagranja@oninet.pt Comment in: Crit Care. 2005 Apr;9(2):145-6. Abstract INTRODUCTION: We wished to obtain the experiences felt by patients during their ...

  1. 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

  2. Factors Influencing RNs' Perceptions of Quality Geriatric Care in Rural Hospitals.

    Science.gov (United States)

    Cline, Daniel D; Dickson, Victoria Vaughan; Kovner, Christine; Boltz, Marie; Kolanowski, Ann; Capezuti, Elizabeth

    2013-12-01

    The rapidly aging population and their frequent use of hospital services will create substantial quality challenges in the near future. Redesigning rural hospital work environments is the key to improving the quality of care for older adults. This study explored how the work environment influences registered nurses' (RNs') perceived quality of geriatric care in rural hospitals. We used an exploratory mixed-methods research design emphasizing the qualitative data (in-depth, semi-structured interviews). Quantitative data (questionnaire) measuring the RN work environment were also collected to augment qualitative data. Four themes emerged: (a) collegial RN relationships, (b) poor staffing/utilization, (c) technology benefits/challenges, and (d) RN-physician interactions, which were identified as key factors influencing the quality of geriatric care. We concluded that rural hospital work environments may not be optimized to facilitate the delivery of quality geriatric care. Targeted interventions are needed to improve overall quality of care for hospitalized older adults in rural settings. PMID:24319004

  3. A comparative study of total quality management of health care system in India and Iran

    Directory of Open Access Journals (Sweden)

    Heidari Gorji Ali

    2011-12-01

    Full Text Available Abstract Background Total quality management (TQM has a great potential to address quality problems in a wide range of industries and improve the organizational performance. The growing need to take initiatives by hospitals in countries like India and Iran to improve the service quality and reduce wastage of resources has inspired the authors to develop a survey instrument to measure health care quality and performance in the two countries. Methods Based on the Baldrige health care criteria for performance excellence 2009-2010 and the guidelines proposed by the American Hospitals Association for hospitals in pursuit of excellence, compared health care services in three countries. The data are collected from the capital cities and their nearby places in India and Iran. Using ANOVAs, three groups in quality planning and performance have been compared. Result Results showed there is significantly difference between groups and in no case the hospitals from India and Iran are found scoring close to the benchmarks. The average scores of Indian and Iranian hospitals on different constructs of the IHCQPM model are compared with the major results achieved by the recipients of the MBNQ award. Conclusion In no case the hospitals from India and Iran are found scoring close to the benchmarks (Baldrige health care criteria for performance excellence 2009-2010 and the guidelines proposed by the American Hospitals Association for hospitals. These results suggested to health care services more attempt to achieve high quality in management and performance.

  4. Parental stress is associated with poor sleep quality in parents caring for children with developmental disabilities

    OpenAIRE

    Gallagher, Stephen; Phillips, Anna C; Carroll, Douglas

    2009-01-01

    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,...

  5. Effect of Self-Care Program on the Quality of Life in Sickle Cell Anemia

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    Gholam Reza Mahmodi

    2012-05-01

    Full Text Available Background & Objective: sickle cell anemia, a chronic disease, which has many complication affects patient’s. This quality of life’s. Therefor, they need caring to maintain their life. The goal of this study was investigating the effect of self care plan on the quality of life’s sickle cell anemia.Subjects and Methods: This study was a clinical trial research carried out on 70 sickle cell anemics and allocated in two groups randomly. The instruments of data collection were demographic, assessment educational needs and SF-36 quality of life questionnaire. One educational session of self care (60 minute was implemented for the experimental group. The patients’ quality of life was measured in two times (before and three months past intervention. Results: T-test showed that the total scores of quality of life’s two groups have not significant difference before intervention p=0.58, but the difference was significant between two groups in after intervention (p<0.001. PAIR T-TEST showed that the total scores of patients’ quality of life in before and after intervention have significant difference in the control group and the quality of life has decreased in this group (p=0.019(,but this difference was not significant in experimental group and quality of life has remained in this group p=0.91(.Conclusion: Reduced quality of life of control group and stable quality of life of experimental group indicate that the self care program improve the quality of life of these patients. Designing program based on patient educational needs, capabilities and cooperation can have a positive influence on the patients’ quality of life of patient make to achieve results positive.

  6. Improving the Quality of Health Care when Health Workers are in Short Supply

    OpenAIRE

    Mæstad, Ottar; Torsvik, Gaute

    2008-01-01

    A number of low- and middle-income countries have a severe shortage of health workers. This paper studies how health workers’ choices of labour supply and work effort impact on the quality of health services when health workers are in short supply. We analyse how policy measures such as monetary incentives, monitoring, provisions of quality-enhancing inputs, and the building of professionalism and organisational identity can improve the quality of health care in the presence of a health wor...

  7. Developing Quality Indicators for Family Support Services in Community Team-Based Mental Health Care

    OpenAIRE

    Olin, S Serene; Kutash, Krista; Pollock, Michele; Burns, Barbara J; Kuppinger, Anne; Craig, Nancy; Purdy, Frances; Armusewicz, Kelsey; Wisdom, Jennifer; Hoagwood, Kimberly E.

    2014-01-01

    Quality indicators for programs integrating parent-delivered family support services for children’s mental health have not been systematically developed. Increasing emphasis on accountability under the Affordable Care Act highlights the importance of quality-benchmarking efforts. Using a modified Delphi approach, quality indicators were developed for both program level and family support specialist level practices. These indicators were pilot tested with 21 community-based mental health pro...

  8. Research in action: using positive deviance to improve quality of health care

    Directory of Open Access Journals (Sweden)

    Nembhard Ingrid M

    2009-05-01

    Full Text Available Abstract Background Despite decades of efforts to improve quality of health care, poor performance persists in many aspects of care. Less than 1% of the enormous national investment in medical research is focused on improving health care delivery. Furthermore, when effective innovations in clinical care are discovered, uptake of these innovations is often delayed and incomplete. In this paper, we build on the established principle of 'positive deviance' to propose an approach to identifying practices that improve health care quality. Methods We synthesize existing literature on positive deviance, describe major alternative approaches, propose benefits and limitations of a positive deviance approach for research directed toward improving quality of health care, and describe an application of this approach in improving hospital care for patients with acute myocardial infarction. Results The positive deviance approach, as adapted for use in health care, presumes that the knowledge about 'what works' is available in existing organizations that demonstrate consistently exceptional performance. Steps in this approach: identify 'positive deviants,' i.e., organizations that consistently demonstrate exceptionally high performance in the area of interest (e.g., proper medication use, timeliness of care; study the organizations in-depth using qualitative methods to generate hypotheses about practices that allow organizations to achieve top performance; test hypotheses statistically in larger, representative samples of organizations; and work in partnership with key stakeholders, including potential adopters, to disseminate the evidence about newly characterized best practices. The approach is particularly appropriate in situations where organizations can be ranked reliably based on valid performance measures, where there is substantial natural variation in performance within an industry, when openness about practices to achieve exceptional performance exists, and where there is an engaged constituency to promote uptake of discovered practices. Conclusion The identification and examination of health care organizations that demonstrate positive deviance provides an opportunity to characterize and disseminate strategies for improving quality.

  9. [The internal quality control of medical care in military medical organizations].

    Science.gov (United States)

    Kuvshinov, K É; Ryzhman, N N; Reutski?, I A; Butsenko, S A

    2015-02-01

    Quality control of medical care and safety of medical practice in the military medical organizations of the Ministry of Defence of Russia is one of the priorities. Guidelines set by The plan for improvement of effectiveness of health protection in servicemen and certain categories of citizens, which is approved by the relevant order of the Minister of Defence of the Russian Federation, can be regarded as a criteria for quality assessment of medical care. The internal quality control and safety of medical practice is a multilevel system of making and implementing. management decisions aimed at ensuring the rights of patients to receive quality medical care, as.well as provides a continuous internal audit of medical diagnostic work-military medical organization. The overriding objective is the use of technical means during all forms of internal control. . .. PMID:25920169

  10. 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.

  11. 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.

  12. Anxiety, Depression, and Quality of Life in Primary Care Patients

    OpenAIRE

    Brenes, Gretchen A

    2007-01-01

    Background: Anxiety and depressive disorders have a significant and negative impact on quality of life. However, less is known about the effects of anxiety and depressive symptoms on quality of life. The purpose of this study was to examine the impact of anxiety and depressive symptoms on emotional and physical functioning, the effects of anxiety symptoms on functioning independent of depressive symptoms, and the effects of depressive symptoms on functioning independent of anxiety symptoms.

  13. Perinatal mortality in Indonesia: an unfinished agenda

    Directory of Open Access Journals (Sweden)

    Riawati Jahja

    2011-10-01

    Full Text Available Perinatal mortality is a profound issue in maternal and child health due to its close relation with the maternal condition. There exist Millennium Development Goals (MDGs which are to be achieved by 2015. These are coupled with a continuing need for comprehensively monitoring and identifying factors associated with perinatal mortality, which is a primary concern for developing countries inclusive of Indonesia. Previous and on-going health programs could have brought about strategic interventions but as different attributes can emerge due to epidemiological transition, and given the fact that associated factors may remain persistent, forward thinking strategies in public health are forever in need of renewal.     Results from our research show that educational variables, poor awareness towards proper antenatal care visits and weak services at the front-line of healthcare delivery (community outreach worsen the condition of childbearing women, raising the question of biological risk factors in line with socio-economic variables.

  14. Psychosocial impact of perinatal loss among Muslim women

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    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.

  15. Improving the quality of mental health care in primary care settings: a view from the United Kingdom

    Directory of Open Access Journals (Sweden)

    Linda Gask

    2007-03-01

    Full Text Available Background and objectives: In the forty years since 'general practice' became a focus for research in psychiatry the UK there have been considerable developments in policy, practice and research. The aim of this paper is to review recent research and policy developments concerned with improving quality of mental health in primary care settings. Methods: Narrative review of the literature. Results: Disappointing results from large scales trials in the last decade have led to a move towards more exploratory studies and attempts to understand more about contextual factors. Policy initiatives such as the NICE (National Institute of Health and Clinical Excellence guidelines have set clear standards for the delivery of care, but considerable variation in quality of care persists in primary care settings. The Medical Research Council of the UK has suggested a sequential model for future randomised trials of complex interventions. Conclusion: Major outstanding challenges are the difficulties in recruiting GPs (General Practitioners into research studies who are not particularly interested in mental health and linking research and policy such that the findings of such studies are effectively implemented in everyday practice.

  16. Time to have a paradigm shift in health care quality measurement.

    Science.gov (United States)

    Hung, Kuan-Yu; Jerng, Jih-Shuin

    2014-10-01

    Quality measurement is important to stakeholders in providing valid information for improvement, and has been associated with hospital accreditation in most countries. The commonly used categories of indicators are structure, process, and outcome. Outcome indicators are of foremost importance as they reflect the effect of health care; structure indicators are commonly used for assessing capacities or facilities available for providing services, whereas process indicators assess how well the service is delivered, and provide essential and important information for quality improvement. For a process indicator to be valid, it should be linked to an outcome, whereas a structure indicator must be linked to a better outcome. Although there are no strict rules for usage or selection of indicators, it is important to ensure adequate coverage of relevant domains of the health care services intended to be evaluated. Because the trends in health care services and management are changing, it is time to have a paradigm shift in health care quality measurement. Although evaluating the quality had also been extended to include quality of life and patient satisfaction, the ultimate aim of health care services should be "staying healthy, getting healthy, and living healthy". It is important for physicians to learn how to use these clinical indicators for improving service performance and organizational growth. PMID:25106904

  17. 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

  18. Óbitos perinatais evitáveis e estrutura de atendimento obstétrico na rede pública: estudo de caso de um município da região metropolitana do Rio de Janeiro Avoidable perinatal deaths and obstetric health care structure in the public health care system: a case study in a city in Greater Metropolitan Rio de Janeiro

    Directory of Open Access Journals (Sweden)

    Maria Luiza Garcia Rosa

    2000-09-01

    Full Text Available Este artigo tem por objetivo compreender a ocorrência de óbitos perinatais potencialmente evitáveis, ao relacionar as falhas do atendimento obstétrico às deficiências na estrutura de quatro maternidades que, em 1994, compunham a rede do SUS em um município da região metropolitana do Rio de Janeiro. Utilizou-se diversas fontes de informação: questionários, entrevistas, observação e documentos oficiais. Um modelo teórico organizacional orientou a análise dos dados. Os resultados mostram que as maternidades apresentavam problemas nos três grupos de fatores estudados: estrutura física, serviços e equipamentos; características organizacionais e administrativas e organização de pessoal. A demora para a realização de uma cesariana pôde ser explicada por deficiências do grupo de fatores da estrutura física, serviços e equipamentos em duas maternidades. As falhas no processo de atendimento obstétrico de responsabilidade direta do médico foram explicadas pelos altos percentuais dos fatores determinantes predisponentes negativos (sobretudo nas duas conveniadas e de capacidade (mais evidentes nas duas públicas e pela ausência de intervenções visando reorientar a prática.This paper investigates the occurrence of potentially avoidable perinatal deaths by associating failures in obstetric care with structural deficiencies in four maternity hospital comprising the local health care system in a city in Greater Metropolitan Rio de Janeiro in 1994. Information sources were a questionnaire, interview, observation, and hospital records. A theoretical organizational model was applied in data analysis. The four maternity hospitals showed problems in the three groups of factors used in this study: physical infrastructure, services, and equipment; organizational and administrative characteristics; and professional organization. In two maternity hospitals, the delay in cesarean deliveries was explained by deficiencies in the group of factors that includes facilities, services, and equipment. Health care failures directly associated with the physician were explained by high percentages of negative predisposing factors (mainly in the two private hospital, skill-related problems (more clearly in the two public hospitals, and by absence of measures for redirecting practice.

  19. Experiences with perinatal death reviews in South Africa--the Perinatal Problem Identification Programme: scaling up from programme to province to country.

    Science.gov (United States)

    Rhoda, N R; Greenfield, D; Muller, M; Prinsloo, R; Pattinson, R C; Kauchali, S; Kerber, K

    2014-09-01

    The Perinatal Problem Identification Programme (PPIP) was designed and developed in South Africa as a facility audit tool for perinatal deaths. It has been used by only a few hospitals since the late 1990s, but since the country's commitment to achieve Millennium Development Goal 4-the use of PPIP is now mandatory for all facilities delivering pregnant mothers and caring for newborns. To date 588 sites, representing 73% of the deliveries captured by the District Health Information System for South Africa, provide data to the national database at the Medical Research Council Unit for Maternal and Infant Health Care Strategies in Pretoria. PMID:25236651

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

    DEFF Research Database (Denmark)

    Lange, Peter; Andersen, Klaus Kaae

    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. The indicators of quality of care comprised amongst others referral to pulmonary rehabilitation, smoking cessation advice, nutritional advice, instruction in inhalation technique and assessment of BMI, smoking status, pack years, lung function parameters, dyspnoea oxygen saturation and co-morbidities. RESULTS: In general, the quality of care for COPD patients in Denmark was suboptimal and not in accordance with the recently published guidelines both in the 1st and the 2nd audit. Yet, we observed a substantial improvement from the 1st to the 2nd audit. For example, referral to rehabilitation improved from 56.3 to 62.7% (p=0.006) Assessment of BMI improved from 7.8 to 56.1% and assessment of dyspnoea using MRC dyspnoea scale increased from 7.2 to 47.2% (both p<0.001). When analysing the results with focus on the performance of the individual outpatient clinics we also observed an improvement in the quality. CONCLUSION: We conclude that it is possible to improve the quality of care for COPD by focusing on a more systematic approach to the patient assessment by education of the staff of the outpatient clinics. A repeated and continuous education and discussion with the clinical staff is probably essential to reach an acceptable level of the quality of care for outpatients with COPD.

  1. Quality of Delivered Care for People with Type 2 Diabetes: A New Patient-Centred Model

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    JS Tabrizi

    2011-06-01

    Full Text Available

    Background: The quality of care from the perspective of people with Type 2 diabetes using a new model (CQMH including three dimensions of quality in health care (Technical, Service and Customer Quality was assessed.

    Methods: A cross-sectional survey with a sample of 577 people with Type 2 diabetes was conducted. Measures were self-reported adherence to national guidelines for technical quality, the Netherlands Institute for Health Services Research questionnaire for service quality and the short form of the Patient Activation Measure for Customer Quality.

    Results: There was a significant gap in technical quality between what diabetes care the patients reported receiving and what was recommended in the guideline, particularly for management and lifestyle aspects. For service quality, the lowest scores were for choice of care provider and accessibility of care. The mean Customer Quality score was 64.5 (meaning higher score indicating better quality. A positive relationship was demonstrated between higher technical, service and customer quality scores, and better diabetes control status as well as maintaining continuity of care. The average Quality Index was 70.0 of a 0-100 scale.

    Conclusion: Customer Quality appears to be a useful third dimension in conceptualising quality in health care, particularly in the context of chronic disease, where good self-management can improve the outcomes of care. A high proportion of Queensland adults with Type 2 diabetes reported receiving suboptimal care in the majority aspects of provided care services as reflected in the overall Quality Index score indicating substantial room for quality improvement.

  2. Predicting adverse maternal and perinatal outcome after threatened miscarriage

    OpenAIRE

    Swati Agrawal; Susheela Khoiwal; Kumar Jayant; Rajendra Agarwal

    2013-01-01

    Objectives: Threatened miscarriage is the most common complication of pregnancy, occurring in 20% - 25% of ongoing pregnancies. The purpose is to study maternal and perinatal outcome in women with threatened miscarriage. Methods: A prospective study was conducted over a period of 20 months in the Department of Obstetrics and Gynaecology, Pannadhay Mahila Chikitsalaya, a tertiary care center in Udaipur, India. It included a cohort of pregnant patients with a history of thre...

  3. Maternal and perinatal outcomes in critically ill obstetric patients

    Directory of Open Access Journals (Sweden)

    Arati Appinabhavi

    2014-02-01

    Conclusions: Pregnancy-induced hypertensive disorders and hemorrhage were the major risk factors apart from pneumonia and hepatitis that continue to take toll in obstetric patients. Adequate antenatal care, increased vigilance of women during pregnancy for subtle signs and symptoms, early transfer to tertiary centre and aggressive management to prevent complications can bring about the desired reduction in maternal-perinatal morbidity and mortality. [Int J Reprod Contracept Obstet Gynecol 2014; 3(1.000: 189-194

  4. Review article: Emergency department models of care in the context of care quality and cost: a systematic review.

    Science.gov (United States)

    Wylie, Kate; Crilly, Julia; Toloo, Ghasem Sam; FitzGerald, Gerry; Burke, John; Williams, Ged; Bell, Anthony

    2015-04-01

    To identify current ED models of care and their impact on care quality, care effectiveness, and cost. A systematic search of key health databases (Medline, CINAHL, Cochrane, EMbase) was conducted to identify literature on ED models of care. Additionally, a focused review of the contents of 11 international and national emergency medicine, nursing and health economic journals (published between 2010 and 2013) was undertaken with snowball identification of references of the most recent and relevant papers. Articles published between 1998 and 2013 in the English language were included for initial review by three of the authors. Studies in underdeveloped countries and not addressing the objectives of the present study were excluded. Relevant details were extracted from the retrieved literature, and analysed for relevance and impact. The literature was synthesised around the study's main themes. Models described within the literature mainly focused on addressing issues at the input, throughput or output stages of ED care delivery. Models often varied to account for site specific characteristics (e.g. onsite inpatient units) or to suit staffing profiles (e.g. extended scope physiotherapist), ED geographical location (e.g. metropolitan or rural site), and patient demographic profile (e.g. paediatrics, older persons, ethnicity). Only a few studies conducted cost-effectiveness analysis of service models. Although various models of delivering emergency healthcare exist, further research is required in order to make accurate and reliable assessments of their safety, clinical effectiveness and cost-effectiveness. PMID:25752589

  5. Team climate and quality of care in primary health care: a review of studies using the Team Climate Inventory in the United Kingdom

    Directory of Open Access Journals (Sweden)

    Goh Teik T

    2009-10-01

    Full Text Available Abstract Background Attributes of teams could affect the quality of care delivered in primary care. The aim of this study was to systematically review studies conducted within the UK NHS primary care that have measured team climate using the Team Climate Inventory (TCI, and to describe, if reported, the relationship between the TCI and measures of quality of care. Findings The databases MEDLINE, EMBASE, and CINAHL were searched. The reference lists of included article were checked and one relevant journal was hand-searched. Eight papers were included. Three studies used a random sample; the remaining five used convenience or purposive samples. Six studies were cross sectional surveys, whilst two were before and after studies. Four studies examined the relationship between team climate and quality of care. Only one study found a positive association between team climate and higher quality care in patients with diabetes, positive patient satisfaction and self-reported effectiveness. Conclusion While the TCI has been used to measure team attributes in primary care settings in the UK it is difficult to generalise from these data. A small number of studies reported higher TCI scores being associated with only certain aspects of quality of care; reasons for the pattern of association are unclear. There are a number of methodological challenges to conducting such studies in routine service settings. Further research is needed in order to understand how to measure team functioning in relation to quality of care.

  6. 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.

  7. Measuring efficiency: the association of hospital costs and quality of care.

    Science.gov (United States)

    Jha, Ashish K; Orav, E John; Dobson, Allen; Book, Robert A; Epstein, Arnold M

    2009-01-01

    Providers with lower costs may be more efficient and, therefore, provide better care than those with higher costs. However, the relationship between risk-adjusted costs (often described as efficiency) and quality is not well understood. We examined the relationship between hospitals' risk-adjusted costs and their structural characteristics, nursing levels, quality of care, and outcomes. U.S. hospitals with low risk-adjusted costs were more likely to be for-profit, treat more Medicare patients, and employ fewer nurses. They provided modestly worse care for acute myocardial infarction and congestive heart failure but had comparable rates of risk-adjusted mortality. We found no evidence that low-cost providers provide better care. PMID:19414903

  8. “The Golden Rule”: Only a starting point for quality care

    OpenAIRE

    Corazzini, Kirsten N.; Lekan-rutledge, Deborah; Utley-smith, Queen; Piven, Mary L.; Colo?n-emeric, Cathleen S.; Bailey, Donald; Ammarell, Natalie; Anderson, Ruth A.

    2005-01-01

    The Golden Rule guides people to choose for others what they would choose for themselves. The Golden Rule is often described as ‘putting yourself in someone else's shoes’, or ‘Do unto others as you would have them do unto you’(Baumrin 2004). The viewpoint held in the Golden Rule is noted in all the major world religions and cultures, suggesting that this may be an important moral truth (Cunningham 1998). The Golden Rule underlies acts of kindness, caring, and altruism that go above an...

  9. Realizing and allocating savings from improving health care quality and efficiency.

    Science.gov (United States)

    Fox, Daniel M

    2010-09-01

    International efforts to increase the quality and efficiency of health care services may be creating financial savings that can be used to improve population health. This article examines evidence that such savings (ie, a quality/efficiency or value dividend) are accruing and how they have been allocated and assesses the prospects for reallocating future savings to improve population health. Savings have resulted mainly from reducing the number of inappropriate or harmful interventions, managing care of people with chronic disease more effectively, and implementing health information technology. Savings to date have accrued to the revenues of public and private collective purchasers of care and large provider organizations, but none seem to have been reallocated to address other determinants of health. Furthermore, improved quality sometimes increases spending. PMID:20712947

  10. Quality of Nursing Care in Psychiatric Wards of University Hospitals in Northwest of Iran from the Perceptions of Nurses

    OpenAIRE

    Ebrahimi, Hossein; 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 ...

  11. Comparative analysis of quality assurance in health care delivery and higher medical education

    OpenAIRE

    Jo, Busari

    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...

  12. Postdischarge quality of care: Do age disparities exist among Department of Veterans Affairs ischemic stroke patients?

    OpenAIRE

    Neale R Chumbler, Phd; Huanguang Jia; Michael S Phipps, Md; Xinli Li, Phd; Diana Ordin, Md; Linda S Williams, Md; Laura J Myers, Phd; Dawn M Bravata, Md

    2013-01-01

    This study examined whether age disparities existed across postdischarge quality indicators (QIs) for veterans with ischemic stroke who received care at Department of Veterans Affairs medical centers (VAMCs). This retrospective cohort included a national sample of 3,196 veterans who were diagnosed with ischemic stroke and received acute and postdischarge stroke care at 127 VAMCs in fiscal year 2007 (10/1/06 through 9/30/07). Data included an assessment of postdischarge stroke QIs in the outpa...

  13. 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...

  14. Research methods used in developing and applying quality indicators in primary care

    OpenAIRE

    Campbell, S.; Braspenning, J; Hutchinson, A; Marshall, M

    2003-01-01

    ?? Quality indicators have been developed throughout Europe primarily for use in hospitals, but also increasingly for primary care. Both development and application are important but there has been less research on the application of indicators. Three issues are important when developing or applying indicators: (1) which stakeholder perspective(s) are the indicators intended to reflect; (2) what aspects of health care are being measured; and (3) what evidence is available? The information...

  15. Impact of a continuous education program on the quality of assistance offered by intensive care physiotherapy

    Science.gov (United States)

    Pinto, Walkyria Araújo Macedo; Rossetti, Heloisa Baccaro; Araújo, Abigail; Spósito Júnior, José Jonas; Salomão, Hellen; Mattos, Simone Siqueira; Rabelo, Melina Vieira; Machado, Flávia Ribeiro

    2014-01-01

    Objective To evaluate the role of quality indicators and adverse events registering in the quality assessment of intensive care physiotherapy and to evaluate the impact of implementing protocolized care and professional training in the quality improvement process. Methods A prospective before-after study was designed to assess 15 indicators of the quality of care. Baseline compliance and adverse events were collected before and after the implementation of treatment protocols and staff training. Results Eighty-nine patients admitted, being 48 in the pre-intervention period and 41 in the post-intervention period with a total of 1246 and 1191 observations respectively. Among the indicators related to the global population, there was a significant improvement in chest x-ray control, multidisciplinary rounds and shift changes as well as in compliance with these decisions. Indicators related to the population under mechanical ventilation, obtained by direct observation at bedside, showed a significant improvement in the compliance with the tidal volume of 6-8mL/Kg, plateau pressure <30cmH2O, adequate mechanical ventilation alarm setting, mechanical ventilation humidification control, adequate humidification line exchange and orotracheal tube position. Among the mechanical ventilation indicators collected through the physiotherapy records, there was significantly improved compliance with the predicted tidal volume registry and cuff pressure registry. There was a significant reduction in the number of adverse events. There was no impact on intensive care unit mortality, length of stay, duration of mechanical ventilation and ventilator-free days. Conclusion It is possible to measure the quality of physiotherapy care using indicators of quality control. The implementation of care protocols and training of the professionals can improve team performance. PMID:24770683

  16. Levels of maternal care.

    Science.gov (United States)

    Menard, M Kathryn; Kilpatrick, Sarah; Saade, George; Hollier, Lisa M; Joseph, Gerald F; Barfield, Wanda; Callaghan, William; Jennings, John; Conry, Jeanne

    2015-03-01

    In the 1970s, studies demonstrated that timely access to risk-appropriate neonatal and obstetric care could reduce perinatal mortality. Since the publication of the Toward Improving the Outcome of Pregnancy report, more than 3 decades ago, the conceptual framework of regionalization of care of the woman and the newborn has been gradually separated with recent focus almost entirely on the newborn. In this current document, maternal care refers to all aspects of antepartum, intrapartum, and postpartum care of the pregnant woman. The proposed classification system for levels of maternal care pertains to birth centers, basic care (level I), specialty care (level II), subspecialty care (level III), and regional perinatal health care centers (level IV). The goal of regionalized maternal care is for pregnant women at high risk to receive care in facilities that are prepared to provide the required level of specialized care, thereby reducing maternal morbidity and mortality in the United States. PMID:25620372

  17. Productivity and quality improvements in health care through airboss mobile messaging services.

    Science.gov (United States)

    Shah, P J; Martinez, R; Cooney, E

    1997-01-01

    The US health care industry is in the midst of revolutionary changes. Under tremendous pressures from third-party payers and managed care programs to control costs while providing high quality medical services, health care entities are now looking at information technologies to help them achieve their goals. These goals typically include improved productivity, efficiency and decision-making capabilities among staff members. Moreover, hospitals and other health care facilities that provide a broad and integrated range of inpatient and outpatient care, wellness and home care services are in the best position to offer comprehensive packages to managed care and private insurers. Many health care providers and administrators are considered mobile employees. This mobility can range from intra-building and intra-campus to multi-site and metropolitan areas. This group often relies on a variety of information technologies such as personal computers, communicating laptops, pagers, cellular phones, wireline phones, cordless phones and fax machines to stay in touch and handle information needs. These health care professionals require mobile information access and messaging tools to improve communications, control accessibility and enhance decision-making capabilities. AirBoss mobile messaging services could address the health care industry's need for improved messaging capabilities for its mobile employees. The AirBoss family of services supports integrated voice services, data messaging, mobile facsimile and customized information delivery. This paper describes overview of the current mobile data networking capability, the AirBoss architecture, the health care-related applications it addresses and long-term benefits. In addition, a prototype application for mobile home health care workers is illustrated. This prototype application provides integrated e-mail, information services, web access, real-time access and update of patient records from wireline or wireless networks, and cross media delivery and notification. It provides seamless wide area access to patient data in a secure environment, thus providing a continuity of care from the hospital to home. PMID:10168952

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

    OpenAIRE

    Am, Mosadegh Rad; Ansarian, M.

    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...

  19. Socioeconomic associations of improved maternal, neonatal, and perinatal survival in Qatar.

    Science.gov (United States)

    Rahman, Sajjad; Salameh, Khalil; Bener, Abdulbari; El Ansari, Walid

    2010-01-01

    This retrospective study analyzed the temporal association between socioeconomic development indices and improved maternal, neonatal, and perinatal survival in the State of Qatar over a period of 35 years (1974-2008). We explored the association between reduction in poverty, improvement in maternal education, and perinatal health care on the one hand, and increased maternal, neonatal, and perinatal survival on the other hand. Yearly mortality data was ascertained from the perinatal and neonatal mortality registers of the Women's Hospital and the national database in the Department of Preventive Medicine at Hamad Medical Corporation in Doha. A total of 323,014 births were recorded during the study period. During these 35 years, there was a remarkable decline (P Qatar's neonatal mortality rate from 26.27/1000 in 1974 to 4.4/1000 in 2008 and in the perinatal mortality rate from 44.4/1000 in 1974 to 10.58/1000 in 2008. Qatar's maternal mortality rate remained zero during 1993, 1995, and then in 1998-2000. The maternal mortality rate was 11.6/100,000 in 2008. For the rest of the years it has been approximately 10/100,000. Across the study period, the reduction in poverty, increase in maternal education, and improved perinatal health care were temporally associated with a significant improvement in maternal, neonatal, and perinatal survival. The total annual births increased five-fold during the study period, with no negative impact on survival rates. Neonatal mortality rates in Qatar have reached a plateau since 2005. We also conducted a substudy to assess the association between improvements in survival rates in relation to health care investment. For this purpose, we divided the study period into two eras, ie, era A (1974-1993) during which major health care investment was in community-based, low-cost interventions, and era B (1994-2008) during which the major health care investment was in high-technology institutional interventions. Although from 1974-1993 (era A) the per capita health expenditure increased by only 19% as compared with a 137% increase in 1994-2008 (era B). The decline in neonatal and perinatal mortality rates was three times steeper during era A than in era B. The decline in neonatal and perinatal mortality rates was also significant (P Qatar. From the subanalysis of era A and era B, we concluded that low-cost, community-based interventions, on the background of socioeconomic development, have a stronger impact on maternal, neonatal, and perinatal survival as compared with high-cost institutional interventions. PMID:21151678

  20. Emergency care and the national quality strategy: highlights from the centers for medicare & medicaid services.

    Science.gov (United States)

    Venkatesh, Arjun K; Goodrich, Kate

    2015-04-01

    The Centers for Medicare & Medicaid Services (CMS) of the US Department of Health and Human Services seeks to optimize health outcomes by leading clinical quality improvement and health system transformation through a variety of activities, including quality measure alignment, prioritization, and implementation. CMS manages more than 20 federal quality measurement and public reporting programs that cover the gamut of health care providers and facilities, including both hospital-based emergency departments (EDs) and individual emergency physicians. With more than 130 million annual visits, and as the primary portal of hospital admission, US hospital-based EDs deliver a substantial portion of acute care to Medicare beneficiaries. Given the position of emergency care across clinical conditions and between multiple settings of care, the ED plays a critical role in fulfilling all 6 priorities of the National Quality Strategy. We outline current CMS initiatives and future opportunities for emergency physicians and EDs to effect each of these priorities and help CMS achieve the triple aim of better health, better health care, and lower costs. PMID:25128008

  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. Quest for quality care and patient safety: the case of Singapore.

    Science.gov (United States)

    Lim, M K

    2004-02-01

    Quality of care in Singapore has seen a paradigm shift from a traditional focus on structural approaches to a broader multidimensional concept which includes the monitoring of clinical indicators and medical errors. Strong political commitment and institutional capacities have been important factors for making the transition. What is still lacking, however, is a culture of rigorous programme evaluation, public involvement, and patient empowerment. Despite these imperfections, Singapore has made considerable strides and its experience may hold lessons for other small developing countries in the common quest for quality care and patient safety. PMID:14757804

  3. A Survey of the quality of nursing care in several health districts in South Africa.

    OpenAIRE

    Naidoo Joanne R; Uys Leana R

    2004-01-01

    Abstract Background South Africa is currently focusing strongly on human resource development. The purpose of this study was to describe and compare the quality of nursing service and care in three health districts in the KwaZulu Natal Province. To identify deficiencies which could be addressed by education and training, it might be useful to measure the quality of care given by nurses. Methods From March to August 2002 a survey was done in six hospitals and six clinics in three health distri...

  4. Quality of life of three health care workers categories in a hospital in minas gerais, brazil

    Directory of Open Access Journals (Sweden)

    Josiane Costa Sales, Carolina Marques Borges, Odete Vicente Moreira Alves, Lívia Wagner Paes

    2010-07-01

    Full Text Available Objective: investigate the quality of life of three health care workers in a philanthropic Hospital in Minas Gerais. Method: this is about a descriptive study, from transversal design (n=27 with nurses, doctors and physiotherapists whom work in a philanthropic Hospital in Minas Gerais. The valid and reliable Portuguese WHOQOL-bref version was used as a tool to measure quality of life. The study was approved by the Research Ethics Committee of the Pontifícia Universidade Católica de Minas Gerais, Brazil with protocol number 1662.0.000.213-0. Results: dichotomization of all WHOQoL scores based on respective medians showed that most of professionals had partial scores under it: Physic (55.6%, Psychology (63.0%, Social (74.1% and Environmental (70.4%. Conclusions: measurement of health care workers’ quality of life suggests low quality of life among them, however due descriptive study design it was not possible to consider none comparison among the three health care worker’s categories. Descriptors: quality if life; professional practice; intensive care units.

  5. 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

  6. [Endorsement of risk management and patient safety by certification of conformity in health care quality assessment].

    Science.gov (United States)

    Waßmuth, Ralf

    2015-01-01

    Certification of conformity in health care should provide assurance of compliance with quality standards. This also includes risk management and patient safety. Based on a comprehensive definition of quality, beneficial effects on the management of risks and the enhancement of patient safety can be expected from certification of conformity. While these effects have strong face validity, they are currently not sufficiently supported by evidence from health care research. Whether this relates to a lack of evidence or a lack of investigation remains open. Advancing safety culture and "climate", as well as learning from adverse events rely in part on quality management and are at least in part reflected in the certification of healthcare quality. However, again, evidence of the effectiveness of such measures is limited. Moreover, additional factors related to personality, attitude and proactive action of healthcare professionals are crucial factors in advancing risk management and patient safety which are currently not adequately reflected in certification of conformity programs. PMID:25412583

  7. The "Palliative Care Quality of Life Instrument (PQLI)" in terminal cancer patients

    Science.gov (United States)

    Mystakidou, Kyriaki; Tsilika, Eleni; Kouloulias, Vassilios; Parpa, Efi; Katsouda, Emmanuela; Kouvaris, John; Vlahos, Lambros

    2004-01-01

    Background This paper describes the development of a new quality of life instrument in advanced cancer patients receiving palliative care. Methods The Palliative Care Quality of Life Instrument incorporates six multi-item and one single-item scale. The questionnaire was completed at baseline and one-week after. The final sample consisted of 120 patients. Results The average time required to complete the questionnaire, in both time points, was approximately 8 minutes. All multi-item scales met the minimal standards for reliability (Cronbach's alpha coefficient ?.70) either before or during palliative treatment. Test-retest reliability in terms of Spearman-rho coefficient was also satisfactory (p AQEL), and the European Organisation for Research and Treatment of Cancer (EORTC) Core Quality of Life Questionnaire (QLQ-C30, version 3.0). Conclusion The PQLI is a reliable and valid measure for the assessment of quality of life in patients with advanced stage cancer. PMID:14962348

  8. 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

  9. Association of age, sex and deprivation with quality indicators for diabetes: population-based cross sectional survey in primary care

    OpenAIRE

    Gray, Jeremy; Millett, Christopher; O'Sullivan, Caoimhe; Omar, Rumana Z.; Majeed, Azeem

    2006-01-01

    Objectives To determine the quality of diabetes management in primary care after the publication of the National Service Framework and examine the impact of age, gender and deprivation on the achievement of established quality indicators.

  10. 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.

  11. Measuring and Improving the Safety and Quality of Care in Older Medical Inpatients

    OpenAIRE

    Long, Susannah

    2011-01-01

    Older people, often frail with multiple co-morbidities, constitute the largest proportion of hospital inpatient populations. Yet existing ways of measuring the quality and safety of care that they receive are not usually designed with the unique problems encountered by this vulnerable population in mind. The aims of the work presented in this thesis were to investigate what is known about the types, incidence and causes of safety and quality issues in older medical inpatients, to develop and ...

  12. 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 ...

  13. 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...

  14. Patients providing the answers: narrowing the gap in data quality for emergency care

    OpenAIRE

    Porter, Stephen Calder; Forbes, Peter; Manzi, Shannon; Kalish, Leslie A.

    2010-01-01

    Objective The authors examined the validity of documentation produced during paediatric emergency care to determine if a patient-driven health information technology called ParentLink produced higher-quality data than documentation completed by nurses and physicians. Design The authors analysed the quality of information across elements of allergies to medications and the history of present illness (HPI) collected during a quasi-experimental intervention study where control periods with u...

  15. 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...

  16. Implementing quality indicators in intensive care units: exploring barriers to and facilitators of behaviour change

    OpenAIRE

    de Keizer Nicolette F; Graafmans Wilco C; van der Veer Sabine N; de Vos Maartje LG; Jager Kitty J; Westert Gert P; van der Voort Peter HJ

    2010-01-01

    Background Quality indicators are increasingly used in healthcare but there are various barriers hindering their routine use. To promote the use of quality indicators, an exploration of the barriers to and facilitating factors for their implementation among healthcare professionals and managers of intensive care units (ICUs) is advocated. Methods All intensivists, ICU nurses, and managers (n = 142) working at 54 Dutch ICUs who participated in training sessions to support future implementatio...

  17. Realizing and Allocating Savings From Improving Health Care Quality and Efficiency

    OpenAIRE

    Fox, Daniel M

    2010-01-01

    International efforts to increase the quality and efficiency of health care services may be creating financial savings that can be used to improve population health. This article examines evidence that such savings (ie, a quality/efficiency or value dividend) are accruing and how they have been allocated and assesses the prospects for reallocating future savings to improve population health. Savings have resulted mainly from reducing the number of inappropriate or harmful interventions, manag...

  18. Quality of Antenatal Care and Obstetrical Coverage in Rural Burkina Faso

    Science.gov (United States)

    Kameli, Y.; Capon, G.; Sondo, B.; Martin-Prével, Y.

    2010-01-01

    Improving maternal health is one of the Millennium Development Goals of the United Nations. Despite the efforts to promote maternal and neonatal care to achieve this goal, the use of delivery care remains below expectations in Burkina Faso. This situation raises the question of the quality of care offered in maternity wards. The aim of this study was to identify primary healthcare facility and antenatal care characteristics predictive of an assisted delivery in rural Burkina Faso. A cross-sectional study was carried out in Gnagna province (North-East Burkina Faso) in November 2003. The operational capacities of health facilities were assessed, and a non-participating observation of the antenatal care (ANC) procedure was undertaken to evaluate their quality. Scores were established to summarize the information gathered. The rate of professional childbirth (obstetrical coverage) was derived from the number of childbirths registered in the health facility compared to the size of the population. The established scores were related to the obstetrical coverage using non-parametric tests (Kendall). In total, 17 health facilities were visited, and 81 antenatal consultations were observed. Insufficiencies were observed at all steps of ANC (mean total score for the quality of ANC=10.3±3.0, ranging from 6 to 16, out of a maximum of 20). Health facilities are poorly equipped, and the availability of qualified staff remained low (mean total score for the provision of care was 22.9±4.2, ranging from 14 to 33). However, these scores were not significantly related to the rate of professional childbirth (tau Kendall=0.27: p=0.14 and 0.01, p=0.93 respectively). The ability of the primary health centres to provide good antenatal care remains low in rural Burkina Faso. The key factors involved in the limited use of professional childbirth relating to maternal health services may be the quality of ANC. PMID:20214088

  19. 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

  20. 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

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

    DEFF Research Database (Denmark)

    TØttenborg, Sandra SØgaard; Thomsen, Reimar W.

    2012-01-01

    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 improvements were observed for all processes of care and registration fulfillment increased to well above 85% for all indicators. Compared to 2008, a higher proportion of COPD outpatients in 2011 received annual measurements of the forced expiratory volume in one second in percent of predicted (FEV1% predicted) (RR 2.14, 95% CI, 2.09; 2.19), assessment of BMI (RR 2.24, 95% CI, 2.19; 2.29), assessment of dyspnea using the Medical Research Council (MRC) scale (RR 2.25, 95% CI, 2.20; 2.31), registration of smoking status (RR2.41, 95% CI, 2.35; 2.47), smoking cessation recommendation (RR 3.40, 95% CI, 3.18; 3.64) and offering of pulmonary rehabilitation (RR 2.78, 95% CI, 2.65; 2.90). Moderate variation in quality of care fulfillment between regions and hospital clinics still existed in 2011. The proportion of patients with mild- to moderate COPD increased during the study period (p<0.0001). CONCLUSION: Based on increased registration practice of important processes of care, the present study indicates a substantial improvement in the quality of care of COPD in Danish hospitals following the initiation of a national multidisciplinary quality improvement program in 2008. In the forthcoming years, it will be interesting to observe if this will translate into a better prognosis of Danish patients with COPD.

  2. Physician incentives in managed care organizations: Medical practice norms and the quality of care

    OpenAIRE

    Cooper, David J.; Rebitzer, James B.

    2002-01-01

    This brief considers the interaction between physician incentive systems and product market competition in the delivery of medical services via managed care organizations. At the center of the analysis is the process by which health maintenance organizations (HMOs) assemble physician networks and the role these networks play in the competition for customers. The authors find that although physician practice styles respond to financial incentives, there is little evidence that HMO cost-contain...

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

    OpenAIRE

    Adhikari S; Amini R; La, Stolz; Blaivas M

    2014-01-01

    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 h...

  4. Improving the quality of mental health care in primary care settings: a view from the United Kingdom

    Scientific Electronic Library Online (English)

    Linda, Gask.

    2007-03-01

    Full Text Available Background and objectives: In the forty years since 'general practice' became a focus for research in psychiatry the UK there have been considerable developments in policy, practice and research. The aim of this paper is to review recent research and policy developments concerned with improving qual [...] ity of mental health in primary care settings. Methods: Narrative review of the literature. Results: Disappointing results from large scales trials in the last decade have led to a move towards more exploratory studies and attempts to understand more about contextual factors. Policy initiatives such as the NICE (National Institute of Health and Clinical Excellence) guidelines have set clear standards for the delivery of care, but considerable variation in quality of care persists in primary care settings. The Medical Research Council of the UK has suggested a sequential model for future randomised trials of complex interventions. Conclusion: Major outstanding challenges are the difficulties in recruiting GPs (General Practitioners) into research studies who are not particularly interested in mental health and linking research and policy such that the findings of such studies are effectively implemented in everyday practice.

  5. Effect of Using Continuous Care Model on Sleep Quality of Chemical Warfare Victims with Bronchiolitis Obliterans

    Directory of Open Access Journals (Sweden)

    S Mehdizadeh

    2010-11-01

    Full Text Available Background & Objective: Poor physical and psychological health status in chemical warfare victims could result in decreasing quality of sleep. This study was conducted in order to evaluate the effect of using Continuous Care Model on sleep quality in chemical warfare victims with bronchiolitis obliterans. Methods & Materials: A total of 62 chemical warfare victims with bronchiolitis obliterans were recruited to the study. The participants were randomly allocated to experimental and control groups. The Continuous Care Model was used to experimental group for a period of two months. The quality of sleep was measured using Pittsburgh Sleep Quality Index (PSQI before and after the intervention in both study groups. Data were analyzed using independent sample t-test, and paired t-test in the SPSS-version 15. Results: There were significant differences between experimental and control groups in the means of Subjective Sleep Quality, Sleep Disturbances, Use of Medications, and global scores after the intervention (P<0.05. Conclusion: Using Continuous Care Model had positive effect on sleep quality in chemical warfare victims suffering from bronchiolitis obliterans.

  6. 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.

  7. Impacts of Evidence-Based Quality Improvement on Depression in Primary Care: A Randomized Experiment

    Science.gov (United States)

    Rubenstein, Lisa V; Meredith, Lisa S; Parker, Louise E; Gordon, Nancy P; Hickey, Scot C; Oken, Carole; Lee, Martin L

    2006-01-01

    CONTEXT Previous studies testing continuous quality improvement (CQI) for depression showed no effects. Methods for practices to self-improve depression care performance are needed. We assessed the impacts of evidence-based quality improvement (EBQI), a modification of CQI, as carried out by 2 different health care systems, and collected qualitative data on the design and implementation process. OBJECTIVE Evaluate impacts of EBQI on practice-wide depression care and outcomes. DESIGN Practice-level randomized experiment comparing EBQI with usual care. SETTING Six Kaiser Permanente of Northern California and 3 Veterans Administration primary care practices randomly assigned to EBQI teams (6 practices) or usual care (3 practices). Practices included 245 primary care clinicians and 250,000 patients. INTERVENTION Researchers assisted system senior leaders to identify priorities for EBQI teams; initiated the manual-based EBQI process; and provided references and tools. EVALUATION PARTICIPANTS Five hundred and sixty-seven representative patients with major depression. MAIN OUTCOME MEASURES Appropriate treatment, depression, functional status, and satisfaction. RESULTS Depressed patients in EBQI practices showed a trend toward more appropriate treatment compared with those in usual care (46.0% vs 39.9% at 6 months, P = .07), but no significant improvement in 12-month depression symptom outcomes (27.0% vs 36.1% poor depression outcome, P = .18). Social functioning improved significantly (mean score 65.0 vs 56.8 at 12 months, P = .02); physical functioning did not. CONCLUSION Evidence-based quality improvement had perceptible, but modest, effects on practice performance for patients with depression. The modest improvements, along with qualitative data, identify potential future directions for improving CQI research and practice. PMID:16836631

  8. Association between quality management and performance indicators in Dutch diabetes care groups: a cross-sectional study

    Science.gov (United States)

    Campmans-Kuijpers, Marjo J E; Baan, Caroline A; Lemmens, Lidwien C; Klomp, Maarten L H; Romeijnders, Arnold C M; Rutten, Guy E H M

    2015-01-01

    Objectives To enhance the quality of diabetes care in the Netherlands, so-called care groups with three to 250 general practitioners emerged to organise and coordinate diabetes care. This introduced a new quality management level in addition to the quality management of separate general practices. We hypothesised that this new level of quality management might be associated with the aggregate performance indicators on the patient level. Therefore, we aimed to explore the association between quality management at the care group level and its aggregate performance indicators. Design A cross-sectional study. Setting All Dutch care groups (n=97). Participants 23 care groups provided aggregate register-based performance indicators of all their practices as well as data on quality management measured with a questionnaire filled out by 1 or 2 of their quality managers. Primary outcomes The association between quality management, overall and in 6 domains (‘organisation of care’, ‘multidisciplinary teamwork’, ‘patient centredness’, ‘performance management’, ‘quality improvement policy’ and ‘management strategies’) on the one hand and 3 process indicators (the percentages of patients with at least 1 measurement of glycated haemoglobin, lipid profile and systolic blood pressure), and 3 intermediate outcome indicators (the percentages of patients with glycated haemoglobin below 53?mmol/mol (7%); low-density lipoprotein cholesterol below 2.5?mmol/L; and systolic blood pressure below 140?mm?Hg) by weighted univariable linear regression. Results The domain ‘management strategies’ was significantly associated with the percentage of patients with a glycated haemoglobin <53?mmol/mol (? 0.28 (0.09; 0.46) p=0.01) after correction for multiple testing. The other domains as well as overall quality management were not associated with aggregate process or outcome indicators. Conclusions This first exploratory study on quality management showed weak or no associations between quality management of diabetes care groups and their performance. It remains uncertain whether this second layer on quality management adds to better quality of care. PMID:25968001

  9. Focus on clinical practice: improving the quality of care.

    Science.gov (United States)

    Bowman, Marjorie A; Neale, Anne Victoria

    2012-01-01

    In this diverse issue, we have a report on the high cost of diabetes quality improvement programs. Two studies using health information technology, including one that embedded a questionnaire and tool for bipolar disorder into an electronic health record to improve diagnosis, and another that collected information about anxiety and depression for adolescents with a personal digital assistant. Other articles considered sources of disparities in screening for colorectal cancer in rural Georgia, and the characteristics of sepsis in HIV patients. Clinicians will likely find interesting how patients interpret and report provider reactions to interpersonal violence situations. We also have a review of the symptoms patients report in a community practice sample; breast cancer survivors' perspectives on acupuncture for treating hot flashes; clinical reviews about Alzheimer disease and prasugrel; and several interesting brief case reports. PMID:22570385

  10. 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

  11. [The clinical guidelines as a potential tool to improving health care quality].

    Science.gov (United States)

    Constantino-Casas, Patricia; Viniegra-Osorio, Arturo; Medécigo-Micete, Consuelo; del Pilar Torres-Arreola, Laura; Valenzuela-Flores, Adriana

    2009-01-01

    There is an increasing demand to ensure quality in the providing and receiving health care. Health care services face different challenges, such as: a growing aging population, increasing care costs, variations in clinical practice, and a fasting increase in the generation of information on diagnostic methods and therapies. In this context, a wave of development and use of clinical guidelines (CGL) based on scientific evidence has emerged worldwide, with the aim to creating tools to promote clinical excellence in practice. Our country and the Instituto Mexicano del Seguro Social (IMSS), with its experience in developing CGL has joined this trend as a main project. It is beneficial for IMSS health professionals and their patients. The aim of this paper is to present general information on definitions, structure, quality standards, development proceedings, updating, and potential advantages and disadvantages by using CGL. To achieve the expectations of a positive impact on quality and the health care budget distribution, health care personnel must be open to and receptive to the CGL recommendations and be flexible in changing their clinical practice. PMID:19624976

  12. The Quality of Care and Support (QOCS) for People with Disability Scale: Development and Psychometric Properties

    Science.gov (United States)

    Lucas-Carrasco, Ramona; Eser, Erhan; Hao, Yuantao; McPherson, Kathryn M.; Green, Ann; Kullmann, Lajos

    2011-01-01

    This paper describes the development of a Quality of Care and Support (QOCS) scale for use with adult persons with physical and intellectual disabilities. In the pilot phase of the study, 12 centers from around the world carried out focus groups with people with physical and disabilities, their carers, and with professionals in order to identify…

  13. A Correlational Analysis: Electronic Health Records (EHR) and Quality of Care in Critical Access Hospitals

    Science.gov (United States)

    Khan, Arshia A.

    2012-01-01

    Driven by the compulsion to improve the evident paucity in quality of care, especially in critical access hospitals in the United States, policy makers, healthcare providers, and administrators have taken the advise of researchers suggesting the integration of technology in healthcare. The Electronic Health Record (EHR) System composed of multiple…

  14. Quality in Family Child Care: A Focus Group Study with Canadian Providers

    Science.gov (United States)

    Doherty, Gillian

    2015-01-01

    A substantial proportion of American, Canadian and English preschoolers regularly participate in family child care making its quality of vital importance for the children concerned, their parents, the school system and the society in which they live. This article discusses the seven key caregiver behaviors and physical space characteristics…

  15. Detection of defects of information reliability for medical economic expertise and quality control of medical care

    Directory of Open Access Journals (Sweden)

    Kamakina Anastasia Andreevna

    2013-08-01

    Full Text Available The methods of information filtration for medical economic expertise and quality control of medical care within the mandatory health insurance system are considered. A set of semantic and pragmatic rules is described; according to them the typical defects of the primary information reliability from medical institutions are formalized.

  16. Top Management Leadership Style and Quality of Care in Nursing Homes

    Science.gov (United States)

    Castle, Nicholas G.; Decker, Frederic H.

    2011-01-01

    Purpose: The purpose of this study was to examine the association of Nursing Home Administrator (NHA) leadership style and Director of Nursing (DON) leadership style with quality of care. Design and Methods: Leaders were categorized into 4 groups: consensus managers, consultative autocrats, shareholder managers, or autocrats. This leadership style…

  17. Minnesota's Nursing Facility Performance-Based Incentive Payment Program: An Innovative Model for Promoting Care Quality

    Science.gov (United States)

    Cooke, Valerie; Arling, Greg; Lewis, Teresa; Abrahamson, Kathleen A.; Mueller, Christine; Edstrom, Lisa

    2010-01-01

    Purpose: Minnesota's Nursing Facility Performance-Based Incentive Payment Program (PIPP) supports provider-initiated projects aimed at improving care quality and efficiency. PIPP moves beyond conventional pay for performance. It seeks to promote implementation of evidence-based practices, encourage innovation and risk taking, foster collaboration…

  18. Registered Nurse Staffing Mix and Quality of Care in Nursing Homes: A Longitudinal Analysis

    Science.gov (United States)

    Kim, Hongsoo; Harrington, Charlene; Greene, William H.

    2009-01-01

    Purpose: To examine the relationship between registered nurse (RN) staffing mix and quality of nursing home care measured by regulatory violations. Design and Methods: A retrospective panel data study (1999-2003) of 2 groups of California freestanding nursing homes. One group was 201 nursing homes that consistently met the state's minimum standard…

  19. Integrating Education into Primary Care Quality and Cost Improvement at an Academic Medical Center

    Science.gov (United States)

    Harrison, R. Van; Standiford, Connie J.; Green, Lee A.; Bernstein, Steven J.

    2006-01-01

    Introduction: In 1996 the University of Michigan Health System created the Guidelines Utilization, Implementation, Development, and Evaluation Studies (GUIDES) unit to improve the quality and cost-effectiveness of primary care for common medical problems. GUIDES's primary functions are to oversee the development of evidence-based, practical…

  20. Transformation Education: A Vehicle for Structuring Group Care Organizations to Increase Service Quality and Effectiveness

    Science.gov (United States)

    Ross, Andrew L.

    2007-01-01

    Transformation Education, an organizational philosophy and operating system, is designed to increase service quality and effectiveness of group care through aligning its organizational structure with its purpose. This alignment is achieved through creating a culture designed to dispense transformation rather than treatment. The author presents how…

  1. Residents' self-reported quality of life in long-term care facilities in Canada.

    Science.gov (United States)

    Kehyayan, Vahe; Hirdes, John P; Tyas, Suzanne L; Stolee, Paul

    2015-06-01

    Quality of life (QoL) of long-term care (LTC) facility residents is an important outcome of care. This cross-sectional, descriptive study examined the self-reported QoL of LTC facility residents in Canada using the interRAI Self-Report Nursing Home Quality of Life Survey instrument. A secondary purpose was to test the instrument's psychometric properties. Psychometric testing of the instrument supported its reliability and its convergent and content validity for assessing the residents' QoL. Findings showed that residents rated positively several aspects of their life, such as having privacy during visits (76.9%) and staff's being honest with them (73.6%). Residents gave lower ratings to other aspects such as autonomy, staff-resident bonding, and personal relationships. The findings point to gaps between facility philosophies of care and their translation into a care environment where care is truly resident-directed. Moreover, the findings have potential implications for resident care planning, facility programming, social policy development, and future research. PMID:25752798

  2. How can we deliver high-quality cancer care in a healthcare system in crisis?

    Science.gov (United States)

    Mayer, Deborah K

    2014-08-01

    This provocative question was addressed in a report from the Institute of Medicine ([IOM], 2013), Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis. An interdisciplinary committee synthesized many of the changes that are occurring in our society and health care that will challenge our existing cancer care system. These changes are familiar to many of us: an aging population along with the resulting increase in the number of cancer survivors, an inadequate number of and increased demand for trained healthcare providers, and rising healthcare costs. The IOM report recommended a framework of six interconnected components for improving the quality of cancer care (see Figures 1 and 2). Each of these components is worthy of an editorial and more. I would like to focus, however, on one of them: an adequately staffed, trained, and coordinated workforce. And, for good reason, as I want to retire someday and know that others will be taking my place in caring for cancer survivors across the care continuum. So let's explore this one component in more detail. PMID:25095288

  3. Measuring health care quality. How do you know your care has improved?

    Science.gov (United States)

    Carey, R G

    2000-03-01

    Statistical process control (SPC) was developed in the 1920s as a way of detecting defects in manufacturing processes. During the past decade, SPC has been adopted by service industries and is increasingly being employed by health care organizations. The methodology involves the construction of a control chart to detect variation within processes. Variation is neither good nor bad in itself; therefore, the impact of variation must be interpreted within the context of expected outcomes, acceptable limits, and the process itself. In this article, the concept of statistical process control is explained, and examples are provided to illustrate how SPC can be applied in a clinical setting. PMID:10787949

  4. Quality assurance in the surgical intensive care unit. Where it came from and where it's going.

    Science.gov (United States)

    Osler, T; Horne, L

    1991-08-01

    The early history of QA is one of stunning achievements. Men and women led by a vision of what hospital health care should be brought about fundamental changes in the structure of hospitals and medical schools. These successes required lifetimes of work and enormous capital (Flexner's war chest would have amounted to billions of 1990 dollars). A second wave of reform included the creation of credentialing committees, tissue committees, and infection control efforts. Although less dramatic in their impact, these efforts have had measurable influence on the outcome of health care and, under the joint administration of local hospitals and the JCAHO, continue to guarantee excellence in health care. The most recent attempts at quality assurance, driven at least in part by a federal mandate to control costs, have been much more modest in their success. Committed groups working within a sound theoretical framework have had great difficulty monitoring and evaluating centrally a process as decentralized as health care. The regularity with which new fashions in QA have appeared underscores the frustration felt with this approach. If the quality of health care is to be monitored centrally, reliable measures of quality will be required. No one knows if such measures actually exist. The absence of objective evidence that quality has been improved by these efforts suggests that little has been accomplished, perhaps because all easily attainable improvements had already been implemented. The basic concept of a centrally monitored hospital structure within which provision is made for ongoing observation and innovation by those actually involved in the care of patients retains the advantages of central monitoring and local invention. It is a model that will be hard to improve on. We should persist in our efforts, but fundamental advances are unlikely. In the end, quality is only doing everything the best it can be done. The best quality assurance requires an excellent hospital in which a well-trained and committed staff has a central mandate and local purview to do the best possible job. Two thousand years after Hammurabi's minions busied themselves determining the appropriate punishment for various medical misadventures, the Greek Hippocrates advocated a less complex approach to the same problem. He suggested that the quality of health care could be best guaranteed by administering an oath to physicians, exhorting them simply to do what was best for their fellow men. This approach has seen us through two millennia and, however variable its results, may not be easily improved on. PMID:1907408

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

    DEFF Research Database (Denmark)

    Kjer Kaltoft, Mette; Cunich, Michelle

    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 quality to be regarded as both preference-sensitive across multiple relevant criteria and generic across all conditions and decisions. MyDecisionQuality is grounded in prescriptive multi criteria decision analysis and employs a simple expected value algorithm to calculate a score for the quality of a decision that combines, in the clinical case, the patient's individual preferences for eight quality criteria (expressed as importance weights) and their ratings of the decision just taken on each of these criteria (expressed asperformance rates). It thus provides an index of decision quality that encompasses both these aspects. It also provides patients with help in prioritizing quality criteria for future decision making by calculating, for each criterion, the Incremental Value of Perfect Rating, that is, the increase in their decision quality score that would result if their performance rating on the criterion had been 100%, weightings unchanged. MyDecisionQuality, which is a web-based generic and preference-sensitive instrument, can constitute a key patient-reported measure of the quality of the decision-making process. It can provide the basis for future decision improvement, especially when the clinician (or other stakeholders) completes the equivalent instrument and the extent and nature of concordance and discordance can be established. Apart from its role in decision preparation and evaluation, it can also provide real time and relevant documentation for the patient's record.

  6. Person-Centered Care in the Home Setting for Parkinson's Disease: Operation House Call Quality of Care Pilot Study.

    Science.gov (United States)

    Hack, Nawaz; Akbar, Umer; Monari, Erin H; Eilers, Amanda; Thompson-Avila, Amanda; Hwynn, Nelson H; Sriram, Ashok; Haq, Ihtsham; Hardwick, Angela; Malaty, Irene A; Okun, Michael S

    2015-01-01

    Objective. (1) To evaluate the feasibility of implementing and evaluating a home visit program for persons with Parkinson's disease (PD) in a rural setting. (2) To have movement disorders fellows coordinate and manage health care delivery. Background. The University of Florida, Center for Movement Disorders and Neurorestoration established Operation House Call to serve patients with PD who could not otherwise afford to travel to an expert center or to pay for medical care. PD is known to lead to significant disability, frequent hospitalization, early nursing home placement, and morbidity. Methods. This was designed as a quality improvement project. Movement disorders fellows travelled to the home(s) of underserved PD patients and coordinated their clinical care. The diagnosis of Parkinson's disease was confirmed using standardized criteria, and the Unified Parkinson's Disease Rating Scale was performed and best treatment practices were delivered. Results. All seven patients have been followed up longitudinally every 3 to 6 months in the home setting, and they remain functional and independent. None of the patients have been hospitalized for PD related complications. Each patient has a new updatable electronic medical record. All Operation House Call cases are presented during video rounds for the interdisciplinary PD team to make recommendations for care (neurology, neurosurgery, neuropsychology, psychiatry, physical therapy, occupational therapy, speech therapy, and social work). One Operation House Call patient has successfully received deep brain stimulation (DBS). Conclusion. This program is a pilot program that has demonstrated that it is possible to provide person-centered care in the home setting for PD patients. This program could provide a proof of concept for the construction of a larger visiting physician or nurse program. PMID:26078912

  7. Seeking value in pharmaceutical care: balancing quality, access and efficiency.

    Science.gov (United States)

    Montague, Terrence; Cavanaugh, Siobhan

    2004-01-01

    Healthcare remains a dominant issue for Canadians. Central to the debate is the dynamic tension among the value, accessibility and affordability of drugs. Simply put, innovative drugs improve health and economic outcomes for individuals and populations. As a result, providers and patients increasingly demand, and expect, these benefits; utilization and expenditures increase. The management challenge is finding the best balance of quality, access and costs. Supply-side strategies, such as restricting access with the intention of controlling isolated costs of drug budgets, are not optimal from a population health view because they have the adverse impact of limiting the system benefits of innovative drugs. Management strategies emphasizing the demand side of the market are more empowering to providers and patients and, given the increasing knowledge and accountability of these stakeholders, are increasingly feasible. Population health outcomes and efficient resource use may be better served by a combination of strategies. The partnership-measurement model of disease management is a practical example of this approach at the community level; timely and repeated feedback of real-world practices, as well as provider and patient education, drive accountable, cost-efficient and continuously improved outcomes. As we seek the optimal societal strategy for innovative drug therapy, resource allocation decisions have to be made. Widening the debate and informing the debaters will enhance the chances of making choices that achieve the best health for the most people at the best cost. PMID:15114070

  8. The relationship between general practice characteristics and quality of care: a national survey of quality indicators used in the UK Quality and Outcomes Framework, 2004–5

    Directory of Open Access Journals (Sweden)

    Armstrong David

    2006-11-01

    Full Text Available Abstract Background The descriptive information now available for primary care in the UK is unique in international terms. Under the 'Quality and Outcomes Framework' (QOF, data for 147 performance indicators are available for each general practice. We aimed to determine the relationship between the quality of primary care, as judged by the total QOF score, social deprivation and practice characteristics. Methods We obtained QOF data for each practice in England and linked these with census derived data (deprivation indices and proportion of patients born in a developing country. Characteristics of practices were also obtained. QOF and census data were available for 8480 practices. Results The median QOF score was 999.7 out of a possible maximum of 1050 points. Three characteristics were independently associated with higher QOF scores: training practices, group practices and practices in less socially deprived areas. In a regression model, these three factors explained 14.6% of the variation in QOF score. Higher list sizes per GP, turnover of registered patients, chronic disease prevalence, proportions of elderly patients or patients born in a developing country did not contribute to lower QOF scores in the final model. Conclusion Socially deprived areas experience a lower quality of primary care, as judged by QOF scores. Social deprivation itself is an independent predictor of lower quality. Training and group practices are independent predictors of higher quality but these types of practices are less well represented in socially deprived areas.

  9. Seguridad y Calidad en Medicina Intensiva Safety and quality in intensive care medicine

    Directory of Open Access Journals (Sweden)

    C.M. Romero

    2009-10-01

    Full Text Available La seguridad y la calidad de la atención son 2 atributos del sistema de salud que se encuentran estrechamente entrelazados. La calidad es una característica del sistema en que se entrega la atención de salud; por ende, para mejorarla, se necesita una adecuada reorganización del trabajo en equipo. Las mediciones de calidad tienen como objetivo evaluar si el proceso completo de atención de salud alcanza los objetivos deseados mientras evita los procesos que predisponen al daño del paciente. Los enfermos críticos se encuentran vulnerables frente a errores clínicos, y pueden experimentar efectos adversos prevenibles, frecuentemente asociados a medicamentos, a ventilación mecánica y a dispositivos intravasculares. La evidencia disponible actualmente indica que la seguridad y la calidad de la atención pueden ser mejoradas. En el presente artículo se exponen algunas de las estrategias e intervenciones desarrolladas para optimizar los procesos de cuidado en los pacientes críticos y mejorar la cultura de la seguridad en la unidad de cuidados intensivos.The safety and quality care are two attributes of the health care that are closely intertwined. Quality is a feature of the system that delivers health care, thereby improving it, we need a proper reorganization teamwork. Measurements of quality are intended to assess whether the process of health care reaches the desired objectives, while avoiding the processes that predispose to harm the patient. The critically ill patients are vulnerable to medical errors, and may experience side effects preventable, often associated with: medications, mechanical ventilation, and intravascular devices. The evidence currently available suggest that the safety and quality of care can be improved. In this article presents some of the strategies and interventions developed to optimize the processes of care in critically ill patients, and improve the safety culture in the ICU.

  10. Quality of life and persisting symptoms in intensive care unit survivors: implications for care after discharge

    OpenAIRE

    Dorsett Joanna; Hinge Denise; Baldwin Fiona J; Boyd Owen F

    2009-01-01

    Abstract Background We assessed the quality of life of ICU survivors using SF-36 at 4 months after ICU discharge and investigated any correlation of PCS and MCS with age, illness severity and hospital or ICU length of stay. We examined the relationship between these variables, persisting physical and psychological symptoms and the perceived benefit of individual patients of follow-up. Findings For one year, adult patients admitted for multiple organ or advanced respiratory support for greater...

  11. Discourses on Quality Care: The "Investigating "Quality"" Project and the Canadian Experience

    Science.gov (United States)

    Pence, Alan; Pacini-Ketchabaw, Veronica

    2008-01-01

    This article contextualizes the authors' work on a project entitled "Investigating Quality in Early Learning Environments (IQ)," conducted in British Columbia (BC), Canada, within national and international contexts. One of the project's primary objectives has been to engage in discussions that situate British Columbia's promotion of "quality" in…

  12. Palliative home care intervention to improve the quality of life of women with advanced breast cancer

    International Nuclear Information System (INIS)

    The quality of life is affected frequently observed in women with advanced breast cancer and is considered a leading indicator of effectiveness of palliative care. A descriptive, quasi-experimental study is presented ex-ante / ex-post, by applying open-ended interviews to explore the effects on the processes of adaptation of each patient and a self-administrable scale identified specific dimensions of quality of life, satisfaction with care and overall quality of life. The intervention was performed palliative home care to 52 women, according to the damages identified in the baseline diagnosis. The overall strategy included four steps: clinical and socio-demographic characterization of women; identification of the effects on the processes of adaptation by the theoretical model of Roy and dimensions of quality of life frequently affected, to design individually oriented actions on the drive shaft of Nursing Interventions Classification and evaluation of results intervention. The dimensions achieved higher frequency of involvement were: behavior, physical symptoms, pain interference and leisure activities, social life and family. Data were analyzed with qualitative methodologies and uni and multivariate statistical processing. After the intervention favorable changes in adaptive processes and dimensions of quality of life were observed; well as in the assessment of overall satisfaction with life. It was interesting that the dimensions of satisfaction assessed at the end of the intervention obtained an unfavorable assessment, outcome associated with sociodemographic variables. (author)

  13. Mortalidad perinatal en el Hospital Nacional Edgardo Rebagliati Martins

    Scientific Electronic Library Online (English)

    Lizeth, Diaz Ledesma; Moisés, Huaman Guerrero; Ingrid Úrsula, Necochea Villafuerte; Jorge Humberto, Davila Acosta; Emery Dirck, Aliaga San Miguel.

    2003-07-01

    Full Text Available Objetivo: Conocer la tasa de mortalidad perinatal en el Hospital Nacional Edgardo Rebagliati Martins y sus características. Materiales y Métodos: El estudio comprendió la revisión de todas las historias clínicas de gestantes portadoras de óbito fetal (mayor de 28 semanas de gestación o mayor de 1000 [...] gramos), de recién nacidos que fallecieron dentro de los primeros 7 días de vida y de sus madres durante el año 2000. Resultados: La tasa de mortalidad perinatal fue de 10.5 por mil nacidos vivos. La edad promedio materna fue de 31.6 años, + 5.9 y un rango entre 14 y 44 años. El 30.1% de partos correspondió a nulíparas, el 61.6% a multíparas y el 8.3% a gran multíparas. El promedio de visitas al control prenatal fue de 4.8 + 2.7. El 53.4% de las madres tuvo algún antecedente relacionado a mala historia obstétrica, siendo los más frecuentes historia de aborto previo (27.4%), cesárea anterior (13.7%) y pre eclampsia (12.3%). Las causas asociadas a mortalidad perinatal fueron madres con pre eclampsia severa (38.4%) y hemorragia en el tercer trimestre (15.1%) y fetos con malformaciones congénitas severas (27.4%). La vía de parto fue abdominal en 68.5% y vaginal en 31.5%. Se tuvo 83.6% de gestaciones únicas y 16.4% de gestaciones múltiples. El peso de los productos fue 1985.2 + 945.8 gramos. El 61.6% de muertes perinatales correspondieron a prematuros. Conclusiones:La tasa de mortalidad neonatal en el HNERM durante el año 2000 fue de 10.5 por mil nacidos vivos y los factores relacionados a mortalidad perinatal fueron pre-eclampsia severa, malformaciones congénitas severas y hemorragias del tercer trimestre. ( Rev Med Hered 2003; 14: 117-121). Abstract in english Objective: To know the perinatal mortality rate at the Hospital Nacional Edgardo Rebagliati Martins and its characteristics. Material and Methods: We reviewed clinical files from stillbirths (> 1000 grams or >28 weeks), infants deaths ([...] curred during 2000. Results:: The perinatal mortality rate was 10.5 per 1000 live births. The age average was 31.6 + 5.9 years old with a range between 14 and 44 years old. From the deliveries, 30.1% was in nuliparas, 61.6% was in multiparas and 8.3% grand multiparas. The average of prenatal care visits was 4.8 + 2.7. 53.4% of the mothers had antecedents for bad obstetric history, the more frequent antecedents were previous abort (27.4%), anterior cesarean delivery (13.7%) and preeclampsia (12.3%). The associated causes to perinatal mortality were mothers who suffered severe preeclampsia (38.4%) and third trimester bleeding (15.1%) and fetus with severe congenital malformations (27.4%). From the deliveries, 68.5% were Cesarean deliveries and 31.5% vaginal deliveries. We have 83.6% of single gestations and 16.4% multiple gestations. The average weight of the products were 1985.2 + 945.8 grams. The 61.6% of perinatal deaths were in preterm deliveries. Conclusions:s: The perinatal mortality rate in HNERM was 10.5 per 1000 live births and the related factors to perinatal mortality were severe preeclampsia, severe congenital malformations, and third trimester bleeding. ( Rev Med Hered 2003; 14: 117-121).

  14. Otitis Media, the Quality of Child Care, and the Social/Communicative Behavior of Toddlers: A Replication and Extension

    Science.gov (United States)

    Vernon-Feagans, Lynne; Manlove, Elizabeth E.

    2005-01-01

    The purpose of this study was to examine the effects of otitis media (OM) and the quality of child care on the social and communicative behaviors of toddlers, using a cumulative risk framework that included moderation. The study followed 72 children who began child care in infancy. Both process and structural aspects of the quality of 11 child…

  15. The "Palliative Care Quality of Life Instrument (PQLI" in terminal cancer patients

    Directory of Open Access Journals (Sweden)

    Kouvaris John

    2004-02-01

    Full Text Available Abstract Background This paper describes the development of a new quality of life instrument in advanced cancer patients receiving palliative care. Methods The Palliative Care Quality of Life Instrument incorporates six multi-item and one single-item scale. The questionnaire was completed at baseline and one-week after. The final sample consisted of 120 patients. Results The average time required to complete the questionnaire, in both time points, was approximately 8 minutes. All multi-item scales met the minimal standards for reliability (Cronbach's alpha coefficient ?.70 either before or during palliative treatment. Test-retest reliability in terms of Spearman-rho coefficient was also satisfactory (p Conclusion The PQLI is a reliable and valid measure for the assessment of quality of life in patients with advanced stage cancer.

  16. Emergency medical services for children: thirty years of advancing high-quality emergency care for children.

    Science.gov (United States)

    Adirim, Terry A

    2015-02-01

    The purpose of this article is to commemorate the 30th anniversary of the Emergency Medical Services for Children (EMSC) program. For the last 30 years, the EMSC has had a significant impact on transforming emergency care for children. The program has contributed to the creation of pediatric emergency medicine as a subspecialty and, importantly, has institutionalized pediatrics into the nation's emergency medical services systems.This article describes the history of the program, its components, and the return on investment over the years. The EMSC has undergone many changes since its inception, and now, because the health care system is rapidly changing, the EMSC must continue to ensure that children and their families receive the best emergency care possible. The EMSC community is poised to envision and adapt its mission to leverage opportunities in this rapidly changing environment to ensure that children receive and continue to receive high-quality emergency care services. PMID:25651387

  17. Quality of Recipient-Caregiver Relationship and Psychological Distress are Correlates of Self-Care Agency after Lung Transplantation

    Science.gov (United States)

    Dabbs, Annette DeVito; Terhorst, Lauren; Song, Mi-Kyung; Shellmer, Diana A.; Aubrecht, Jill; Connolly, Mary; Dew, Mary Amanda

    2012-01-01

    Self-care behaviors are crucial for following the complex regimen after lung transplantation, yet little is known about recipients’ levels of self-care agency (the capability and willingness to engage in self-care behaviors) and its correlates. We examined levels of self-care agency and recipient characteristics (socio-demographics, psychological distress, quality of relationship with primary lay caregiver, and health locus of control) in 111 recipients. Based on Perceived Self-Care Agency scores, recipients were assigned to either the low or high self-care agency comparison group. Characteristics were compared between groups to identify characteristics likely to be associated with lower self-care agency. Mean (S.D.) score for self-care agency (scale range 53–265) was 223.02 (22.46). Recipients with lowest self-care agency scores reported significantly poorer quality of caregiver relationships (p < .001) and greater psychological distress (p < .001). After controlling for psychological distress, the quality of the recipient-caregiver relationship remained significantly associated with self-care agency. Every one-point decrease in the quality of caregiver relationship increased the risk of low self-care agency by 12%. Recipients with poorer caregiver relationships and greater psychological distress may need additional support to perform the self-care behaviors expected after lung transplantation. PMID:23004565

  18. Duelo perinatal: un secreto dentro de un misterio / Perinatal grief: a secret within a mistery

    Scientific Electronic Library Online (English)

    Ana Pía, López García de Madinabeitia.

    2011-03-01

    Full Text Available La muerte del feto durante el embarazo, en el parto o pocos días después del nacimiento constituye un tema delicado, condicionado por numerosos factores. Esta pérdida puede desencadenar reacciones de duelo en los progenitores y situaciones de difícil manejo para los profesionales sanitarios. Son due [...] los que reciben escasa consideración y que pueden complicarse dando lugar a trastornos psiquiátricos. Es necesario conocer el significado de la pérdida perinatal desde la perspectiva de los progenitores para no caer en posturas paternalistas o en protocolos dogmáticos que consideran iguales a todos los progenitores ante pérdidas a las que ellos atribuyen significados diferentes. Abstract in english Fetal death in pregnancy, during delivery or in the days after birth is a sensible topic, influenced by several factors. The loss can trigger grief reactions in parents as well as situations difficult to manage by health care workers. This grief, which receives scant consideration, can complicate an [...] d give rise to psychiatric disorders. It is necessary to know the significance of perinatal loss from the parents' perspective not to make the mistake of displaying paternalist attitudes or relying on dogmatic guidelines that consider all parents equal in the face of losses to which they attach different meanings.

  19. Improving health care quality through culturally competent physicians: leadership and organizational diversity training

    Directory of Open Access Journals (Sweden)

    Irwin B Horwitz

    2011-02-01

    Full Text Available Irwin B Horwitz1, Marilyn Sonilal2, Sujin K Horwitz31Cameron School of Business, University of St. Thomas, Houston, TX, USA; 2School of Public Health, University of Texas, Houston, TX, USAAbstract: The growing diversity of the population has resulted in substantial challenges for the US health care system. A substantial body of evidence has identified significant disparities in health care among culturally and ethnically diverse patients, irrespective of income, that negatively affects such factors as diagnostic precision, quality of care, adherence to healing protocols, and overall treatment outcomes. Diversity has also been shown to compromise the functionality of health care teams that are increasingly comprised of members with culturally different backgrounds, in which diversity produces misunderstanding and conflict. Many of the problems stem from a lack of cultural competence among both physicians and teams under their supervision. To reduce the numerous problems resulting from inadequate cultural competence among health care professionals, this article examines ways in which the issues of diversity can be effectively addressed in health care institutions. It is advocated that physicians adopt a proactive transformational leadership style to manage diversity because of its emphasis on understanding and aligning follower values which lie at the heart of diversity-related misunderstandings. It is also held that for leadership training among physicians to be fully effective, it should be integrated with organizational-wide diversity programs. By doing so, the complimentary effect could result in comprehensive change, resulting in substantial improvements in the quality of health care for all patients.Keywords: leadership, diversity, health care, disparities, medical education

  20. An assessment of routine primary care health information system data quality in Sofala Province, Mozambique

    Directory of Open Access Journals (Sweden)

    Cuembelo Fatima

    2011-05-01

    Full Text Available 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 sample of primary health care HIS data from nine health facilities across three districts in Sofala Province, Mozambique. HIS data were also compared with results from large community-based surveys. Methodology We used a methodology similar to the Global Fund to Fight AIDS, Tuberculosis and Malaria data verification bottom-up audit to assess primary health care HIS data availability and reliability. The quality of HIS data was validated by comparing three key indicators (antenatal care, institutional birth, and third diptheria, pertussis, and tetanus [DPT] immunization with population-level surveys over time. Results and discussion The data concordance from facility clinical registries to monthly facility reports on five key indicators--the number of first antenatal care visits, institutional births, third DPT immunization, HIV testing, and outpatient consults--was good (80%. When two sites were excluded from the analysis, the concordance was markedly better (92%. Of monthly facility reports for immunization and maternity services, 98% were available in paper form at district health departments and 98% of immunization and maternity services monthly facility reports matched the Ministry of Health electronic database. Population-level health survey and HIS data were strongly correlated (R = 0.73, for institutional birth, first antenatal care visit, and third DPT immunization. Conclusions Our results suggest that in this setting, HIS data are both reliable and consistent, supporting their use in primary health care program monitoring and evaluation. Simple, rapid tools can be used to evaluate routine data and facilitate the rapid identification of problem areas.

  1. Pharmaceutical care – impact on quality of life in patients with type 2 diabetes: a review

    Directory of Open Access Journals (Sweden)

    Krass I

    2013-03-01

    Full Text Available Ines Krass,1 Teerapon Dhippayom2 1Faculty of Pharmacy, University of Sydney, Sydney, NSW, Australia; 2Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand Abstract: Type 2 diabetes mellitus (T2DM, a chronic disorder now reaching epidemic proportions, imposes a huge burden on individuals and health care systems. In recent years, pharmacists, highly trained health care professionals with expertise in medicines, have sought to develop an expanded role in diabetes care. Evidence suggests that pharmaceutical care produces improvements in glycemic control; however, little is known about its impact on humanistic outcomes such as health-related quality of life (HRQoL. This review aimed to address this gap. A systematic search was conducted of English language articles published from 1996 to January, 2013 in Cochrane databases of systematic reviews and clinical trials, CINAHL, Embase, MEDLINE, PubMed, International Pharmaceutical Abstracts, PsycINFO, and Web of Science databases to identify relevant original research articles and reviews linking pharmaceutical care, T2DM, and HRQoL. The quality of selected articles was assessed using a modified version of the Downs and Black checklist. Of a total of 122 articles addressing pharmaceutical care in T2DM, 17 articles were suitable for inclusion: 12 studies used generic HRQoL instruments, six used diabetes-specific HRQoL scales, and one study used both. Because of the different scales used and the level of detail, it is difficult to compare between studies. The results provide some preliminary evidence that pharmaceutical care in T2DM can have a positive impact on HRQoL, with the evidence pointing to a greater effect on mental rather than physical health; however, these findings are inconclusive. The mean quality score for the 13 studies included in the quality rating was 0.63 ± 0.11 (range 0.40–0.76, which is classified as only fair. Future studies should use robust research designs to bolster the evidence for the impact of pharmaceutical care on HRQoL using both generic and disease-specific measures. Keywords: health-related quality of life, pharmacist intervention, disease management, health outcomes, generic measures, disease-specific measures

  2. Measuring client experiences in long-term care in the Netherlands: a pilot study with the Consumer Quality Index Long-term Care

    Directory of Open Access Journals (Sweden)

    Kool Rudolf B

    2010-04-01

    Full Text Available Abstract Background This study aims to describe the development, testing and optimization of a new standard instrument, the Consumer Quality Index (CQ-index® Long-term Care, for measuring client experiences with long-term care in the Netherlands. Methods Three versions of the CQ-index questionnaires and protocols for study sampling and data collection were developed, designed for interviews with residents of nursing or residential care homes and postal surveys among representatives of psychogeriatric residents and homecare clients. From July to November 2006 a pilot study was conducted among 2,697 clients of 68 nursing or residential care homes, 2,164 representatives of clients in 57 psychogeriatric care institutions, and 1,462 clients of 19 homecare organizations. We performed psychometric analyses and descriptive analyses, and evaluated the pilot study. Results The pilot study showed the feasibility and usability of the instruments, supported the multidimensionality of the questionnaires and showed first findings on client experiences and possibilities for quality improvement. Nine scales applied to all care settings: shared decision making, attitude and courtesy, information, body care, competence and safety of care, activities, autonomy, mental well-being, and availability of personnel. The pilot resulted in three optimized questionnaires and recommendations for nationwide implementation. Conclusions The CQ-index® Long-term Care provides a good basis to investigate the quality of nursing homes, residential care homes and homecare from the clients' perspective. This standardized instrument enables a nationwide comparison of the quality of long-term care for the purpose of transparency and quality assurance.

  3. Quality of life assessment in advanced cancer patients treated at home, an inpatient unit, and a day care center

    OpenAIRE

    Leppert W; Majkowicz M; Forycka M; Mess E; Zdun-Ryzewska A

    2014-01-01

    Wojciech Leppert,1 Mikolaj Majkowicz,2 Maria Forycka,1 Eleonora Mess,3 Agata Zdun-Ryzewska2 1Department of Palliative Medicine, Poznan University of Medical Sciences, Poznan, Poland; 2Department of Quality of Life Research, Gdansk Medical University, Gdansk, Poland; 3Palliative Care Nursing Department, Wroclaw Medical University, Wroclaw, Poland Aim of the study: To assess quality of life (QoL) in cancer patients treated at home, at an in-patient palliative care unit (PCU), and at a day care...

  4. Quality of Obstetric Care in Public-sector Facilities and Constraints to Implementing Emergency Obstetric Care Services: Evidence from High- and Low-performing Districts of Bangladesh

    OpenAIRE

    Anwar, Iqbal; Kalim, Nahid; Koblinsky, Marge

    2009-01-01

    This study explored the quality of obstetric care in public-sector facilities and the constraints to programming comprehensive essential obstetric care (EOC) services in rural areas of Khulna and Sylhet divisions, relatively high- and low-performing areas of Bangladesh respectively. Quality was explored by physically inspecting all public-sector EOC facilities and the constraints through in-depth interviews with public-sector programme managers and service providers. Distribution of the funct...

  5. Measuring perinatal mental health risk

    OpenAIRE

    Johnson, M.; Schmeid, V.; Lupton, S. J.; Austin, M. -p; Matthey, S. M.; Kemp, L.; Meade, T.; Yeo, A. E.

    2012-01-01

    The purpose of this review was to critically analyse existing tools to measure perinatal mental health risk and report on the psychometric properties of the various approaches using defined criteria. An initial literature search revealed 379 papers, from which 21 papers relating to ten instruments were included in the final review. A further four papers were identified from experts (one excluded) in the field. The psychometric properties of six multidimensional tools and/or criteria were asse...

  6. Fourth goal of perinatal medicine

    OpenAIRE

    Ounsted, C.; Roberts, Jacquie C.

    1982-01-01

    Reduction in maternal mortality, infant mortality, and infant morbidity have been successively the goals of perinatal medicine. The fourth is to reduce bonding failure. In July 1978 a preventive service was started in the John Radcliffe Maternity Hospital. A twice-weekly round is made. Midwives refer families who cause them concern. In the first year the referral rate ws 20.5 per 1000 liveborn babies. The referred sample differed from the hospital population in terms of maternal psychiatric h...

  7. Importance of good teamwork in urgent care services.

    Science.gov (United States)

    Meier, Curtis

    2014-11-01

    High quality, safe care for patients depends on effective teamwork, and where multi-professional teams work together there is higher patient satisfaction, increased staff innovation, less stress and more communication ( West 2013 ). Conversely, lapses in teamwork and poor communication can result in adverse events ranging from retained foreign objects to perinatal events and medication errors ( Peter and Pronovost 2013 ), and even the death of patients ( Resuscitation Council UK 2011 ). Teamwork requires a set of skills and behaviours that, once learned by clinicians, can save lives ( Peter and Pronovost 2013 ). This article refers to a case study to explore the topic of teamwork in a tertiary care emergency setting. PMID:25369970

  8. Interdisciplinary teamwork and the power of a quality improvement collaborative in tertiary neonatal intensive care units.

    Science.gov (United States)

    Grover, Theresa R; Pallotto, Eugenia K; Brozanski, Beverly; Piazza, Anthony J; Chuo, John; Moran, Susan; McClead, Richard; Mingrone, Teresa; Morelli, Lorna; Smith, Joan R

    2015-01-01

    Significant gaps in healthcare quality and outcomes can be reduced via quality improvement collaboratives (QICs), which improve care by leveraging data and experience from multiple organizations.The Children's Hospital Neonatal Consortium Collaborative Initiatives for Quality Improvement team developed an infrastructure for neonatal QICs. We describe the structure and components of an effective multi-institutional neonatal QIC that implemented the "SLUG Bug" project designed to reduce central line-associated bloodstream infections (CLABSIs).The operational infrastructure of SLUG Bug involved 17 tertiary care neonatal intensive care units with a goal to reduce CLABSI in high-risk neonates. Clinical Practice Recommendations were produced, and the Institute of Healthcare Improvement Breakthrough Series provided the framework for the collaborative. Process measures studied the effectiveness of the collaborative structure.CLABSI rates decreased by 20% during a 12-month study period. Compliance bundle reporting exceeded 80%. A QIC score of 2.5 or more ("improvement") was achieved by 94% of centers and a score 4 or more ("significant improvement") was achieved by 35%.Frequent interactive project meetings, well-defined project metrics, continual shared learning opportunities, and individual team coaching were key QIC success components. Through a coordinated approach and committed leadership, QICs can effectively implement change and improve the care of neonates with complex diagnoses and rare diseases. PMID:25919608

  9. Day-care attendance and child development: : In how far does the quality matter?

    DEFF Research Database (Denmark)

    Bauchmüller, Robert; GØrtz, Mette

    Earlier research suggests that children’s development is shaped in their early years of life. This paper examines whether differences in day-care experiences during pre-school age are important for children’s cognitive and language development at the age of 15. The analysis is based on class performance at the end of elementary schooling. We assess the effects of attended types and qualities of day-care institutions on various child outcomes as measured by school grades in mathematics, science, English and Danish for the whole Danish population as well as outcomes from the 2006 PISA Denmark survey and a 2007 PISA Copenhagen survey. We use administrative registries to generate indicators such as child-staff ratios, child-pedagogues ratios, and the share of male staff and of staff with non-Danish origins. Furthermore, we use information on the average levels of educational attainments, of total work experiences, ages and hourly wages of staff members. Those indicators show the expected correlations with children’s development outcomes, better day-care quality being linked to better child outcomes ten years later. We use rich administrative information about the children’s background as well as an instrumental variable approach based on wider geographic area aggregates to test whether those correlations reveal unbiased causal effects. The identification of truly effective quality characteristics of day-care centres enhances policymakers’ resource allocation to make all children getting ready for school

  10. Introduction of performance-based financing in burundi was associated with improvements in care and quality.

    Science.gov (United States)

    Bonfrer, Igna; Soeters, Robert; Van de Poel, Ellen; Basenya, Olivier; Longin, Gashubije; van de Looij, Frank; van Doorslaer, Eddy

    2014-12-01

    Several governments in low- and middle-income countries have adopted performance-based financing to increase health care use and improve the quality of health services. We evaluated the effects of performance-based financing in the central African nation of Burundi by exploiting the staggered rollout of this financing across provinces during 2006-10. We found that performance-based financing increased the share of women delivering their babies in an institution by 22 percentage points, which reflects a relative increase of 36 percent, and the share of women using modern family planning services by 5 percentage points, a relative change of 55 percent. The overall quality score for health care facilities increased by 45 percent during the study period, but performance-based financing was found to have no effect on the quality of care as reported by patients. We did not find strong evidence of differential effects of performance-based financing across socioeconomic groups. The performance-based financing effects on the probability of using care when ill were found to be even smaller for the poor. Our findings suggest that a supply-side intervention such as performance-based financing without accompanying access incentives for poor people is unlikely to improve equity. More research into the cost-effectiveness of performance-based financing and how best to target vulnerable populations is warranted. PMID:25489036

  11. Health-related quality of life after prolonged pediatric intensive care unit stay.

    LENUS (Irish Health Repository)

    Conlon, Niamh P

    2012-02-01

    OBJECTIVE: To investigate the long-term health-related quality of life (HRQOL) outcomes for patients requiring at least 28 days of pediatric intensive care. DESIGN: Retrospective cohort and prospective follow-up study. SETTING: A 21-bed pediatric intensive care unit (PICU) in a university-affiliated, tertiary referral pediatric hospital. PATIENTS: One hundred ninety-three patients who spent 28 days or longer in the PICU between January 1, 1997 and December 31, 2004. INTERVENTIONS: Quality of life was measured using the Pediatric Quality of Life Inventory (Peds QL 4.0) parent-proxy version at 2 to 10 yrs after discharge. The PedsQL 4.0 is a modular measure of HRQOL, which is reliable in children aged 2 to 18 yrs. It generates a total score and physical, emotional, social, school, and psychosocial subscores. MEASUREMENTS AND MAIN RESULTS: Of the 193 patients, 41 died during their PICU admission and 27 died between PICU discharge and follow-up. Quality of life questionnaires were posted to parents of 108 of the 125 survivors and 70 were returned completed. Forty children (57.1%) had scores indicating a normal quality of life, whereas 30 (42.9%) had scores indicating impaired HRQOL. Of these, 14 (20%) had scores indicating poor quality of life with ongoing disabling health problems requiring hospitalization or the equivalent. CONCLUSIONS: Our results indicate that, while long PICU stay is associated with significant mortality, the long-term HRQOL is normal for the majority of surviving children.

  12. Using risk contracting to reduce service use, improve quality, and strengthen primary care.

    Science.gov (United States)

    Lazaroff, Alan

    2013-10-01

    The high costs of American health care, the related problem of the uninsured, and the grim fiscal prognosis of Medicare and Medicaid are among the most pressing challenges facing the United States today. A solution to the cost problem that does not reduce access or quality is sought by those at all points on the political spectrum. This article discusses the experience of an independent practice association that has collaborated with a related business partner and a health plan to improve the quality of care of 16,000 Medicare Advantage beneficiaries while substantially reducing hospitalization rates and overall service use. The capacity to reduce service use frees funds that are used to support the infrastructure for high-value care and to reward those who provide it. Higher performing primary care, supported by changes in payment, has driven a sustainable business model that preserves the option of independent practice for physicians. We are now testing competencies developed for Medicare Advantage in the Pioneer Accountable Care Organization program, which preserves the broad patient choice that is an important feature of traditional Medicare. PMID:24081348

  13. Competition and quality as dynamic processes in the Balkans of American health care.

    Science.gov (United States)

    Hammer, Peter J

    2006-06-01

    The American health care system embodies a complex amalgamation of fractured and conflicting parts. As such, any call to enhance quality or competition necessarily presupposes some ability to introduce greater harmony and coordination. But how does one make a complicated system work well? Dynamic theories of economics stress the significance of section mechanisms, learning, and adaptive modes of behavior in directing markets toward more efficient outcomes under conditions of uncertainty. Unfortunately, the American health care sector suffers from intense factional divisions. Policy makers need a more self-conscious understanding of the interactive and often conflicting effects of regulation if the health care system is to be reshaped in a manner that will generate more desired social outcomes. Evolutionary theories of economics can provide the conceptual framework in which such a restructuring could take place. This article examines how health care quality and competition can be improved through a better understanding of dynamic economic processes and evaluates the Federal Trade Commission and Department of Justice 2004 report Improving Health Care: A Dose of Competition in light of these perspectives. PMID:16785293

  14. Referral letter: evaluation of quality of communication between Primary Health Care and Otolaryngology.

    Directory of Open Access Journals (Sweden)

    Pelegrín-Hernández JP, Hernández-Cervantes AE, Estevez-Monción A, Hellín-Meseguer D, Amorós-Rodriguez LM.

    2012-11-01

    Full Text Available The Referral letter, is a fundamental tool in the link between Primary Care and second care level. So the main objective of this study is to evaluate the quality of this document on Otolaryngology Department as a high demand specialty. For this purpose, we conducted a prospective, descriptive and observational study, which analyzed all referral letter sent it from Primary Health Care Centers for a month, and used quality criteria previously defined by Izabal et al.The study included 144 referral letters, which 40.3% were male and 59.7% women, mean age was 50 years. In reference to the quality level, we found that 77.1%, was acceptable, 13.9% good and 9% poor. Regarding compliance with quality criteria, we were found very different results, appearing as readability parameters and current condition in a high number of psychiatric liaison, against personal history and physical exam came barely reflected. In conclusion we can say, there are an improvement can be done, mainly in the sections on physical examination and medical history. To achieve this goal is important and appropriate to develop a referral guide, which clearly establishes the guidelines to follow in the referral patient process.

  15. Pregnancy and Perinatal Outcomes Associated with Acinetobacter baumannii Infection

    OpenAIRE

    He, Mai; Kostadinov, Stefan; Gundogan, Fusun; Struminsky, Judith; Pinar, Halit; Sung, C. James

    2013-01-01

    Objective?To determine perinatal and pregnancy outcomes of Acinetobacter baumannii infection using clinicopathologic material from pregnant women, neonates, and perinatal postmortem examinations with positive cultures.

  16. Nationwide quality improvement in lung cancer care : the role of the danish lung cancer group and registry

    DEFF Research Database (Denmark)

    Jakobsen, Erik; Green, Anders

    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 monitoring result and process indicators.

  17. Availability and Price of High Quality Day Care and Female Employment

    DEFF Research Database (Denmark)

    Simonsen, Marianne

    2005-01-01

    In this paper I analyse to what degree availability and price of high quality publicly subsidised childcare affects female employment for women living in couples following maternity leave. The results show that unrestricted access to day care has a significantly positive effct on female employment.The price effect is significantly negative: An increase in the price of child care of C=1 will decrease the female employment with 0.08% corresponding to a price elasticity of ?0.17. This effect prevails during the first 12 months after childbirth.

  18. The effect of information systems architecture on health care data quality.

    Science.gov (United States)

    Quinn, J F

    1994-11-01

    A rapidly increasing number of health care provider institutions is dealing with data architecture design issues that directly affect the quality of data within their heterogeneous information systems. These problems result from a failure to recognize that they are actually managing a loosely distributed yet integrated database among their many information system platforms. Understanding the issues surrounding data integration, the application available interface standards, and the tools available for implementation is critical to operating a successful distributed health care information systems environment today. PMID:10138525

  19. Improving patient care through student leadership in team quality improvement projects.

    Science.gov (United States)

    Tschannen, Dana; Aebersold, Michelle; Kocan, Mary Jo; Lundy, Francene; Potempa, Kathleen

    2015-01-01

    In partnership with a major medical center, senior-level nursing students completed a root cause analysis and implementation plan to address a unit-specific quality issue. To evaluate the project, unit leaders were asked their perceptions of the value of the projects and impact on patient care, as well as to provide exemplars depicting how the student root cause analysis work resulted in improved patient outcome and/or unit processes. Liaisons noted benefits of having an RCA team, with positive impact on patient outcomes and care processes. PMID:25098916

  20. The role of team climate in improving the quality of chronic care delivery: a longitudinal study among professionals working with chronically ill adolescents in transitional care programmes

    Science.gov (United States)

    Cramm, Jane M; Strating, Mathilde M H; Nieboer, Anna P

    2014-01-01

    Objectives This study aimed to (1) evaluate the effectiveness of implementing transition programmes in improving the quality of chronic care delivery and (2) identify the predictive role of (changes in) team climate on the quality of chronic care delivery over time. Settings This longitudinal study was undertaken with professionals working in hospitals and rehabilitation units that participated in the transition programme ‘On Your Own Feet Ahead!’ in the Netherlands. Participantss A total of 145/180 respondents (80.6%) filled in the questionnaire at the beginning of the programme (T1), and 101/173 respondents (58.4%) did so 1?year later at the end of the programme (T2). A total of 90 (52%) respondents filled in the questionnaire at both time points. Two-tailed, paired t tests were used to investigate improvements over time and multilevel analyses to investigate the predictive role of (changes in) team climate on the quality of chronic care delivery. Interventions Transition programme. Primary outcome measures Quality of chronic care delivery measured with the Assessment of Chronic Illness Care Short version (ACIC-S). Results The overall ACIC-S score at T1 was 5.90, indicating basic or intermediate support for chronic care delivery. The mean ACIC-S score at T2 significantly improved to 6.70, indicating advanced support for chronic care. After adjusting for the quality of chronic care delivery at T1 and significant respondents’ characteristics, multilevel regression analyses showed that team climate at T1 (pchanges in team climate (pclimate to enhance the quality of chronic care delivery to chronically ill adolescents. PMID:24852302

  1. Globalization and perinatal medicine--how do we respond?

    Science.gov (United States)

    Kurjak, Asim; Di Renzo, Gian Carlo; Stanojevic, Milan

    2010-04-01

    Globalization is both inevitable and usually desirable and contains advantageous and disadvantageous issues. It is a source of both hope and of apprehension and is an accelerating process in flow of information, technology, goods and services, and production means. Globalization has a complex influence on perinatal health. The bonds that link perinatologists together transcend geographic, political, religious, and lingual differences, resulting in a globalization that optimizes perinatal care. In this review, we will discuss some of the global problems facing modern perinatologists. Close to 1.5 billion people in the world, live in extreme poverty, a situation which is particularly stark in the developing world, where 80% of them live. Poor people have little or no access to qualified health services and education, and do not participate in the decisions critical to their day-to-day lives. Poverty cannot be defined solely in terms of lack of income. A person, a family, even a nation is not deemed poor only because of low economic resources. Little or no access to health services, lack of access to safe water and adequate nutrition, illiteracy or low educational level, and a distorted perception of rights and needs are also essential components of poverty. Expression of poverty in perinatal health care in developing countries are high maternal death and morbidity rates, huge perinatal and childhood losses, and high birth rates. There are good reasons to define it as a global tragedy in our time. Although the mankind has come quite far because the development of civilization and more advances in the health care were made during the past 100 years than in all previous human history, some inhabitants of our planet are not able to experience it. According to some data, every 3 s a newborn dies, and every minute a pregnant woman dies in the globalized world. All together over 10 million deaths every year, which indicates that health security is not strong enough. It is essential for improvement of these discouraging data to be aware that global health security is only as strong as its weakest link. The situation in perinatal health affected by the global crisis could be solved if the world community can agree on and enact comprehensive reforms in both economic and social areas, and on the national and international level. PMID:19895359

  2. A systematic review of perinatal depression interventions for adolescent mothers.

    Science.gov (United States)

    Lieberman, Kate; Le, Huynh-Nhu; Perry, Deborah F

    2014-12-01

    Poor, adolescent, racial/ethnic minority women are at great risk for developing perinatal depression. However, little research has been conducted evaluating interventions for this population. We conducted a systematic review of preventive and treatment interventions for perinatal depression tested with adolescents, with a focus on low income, minority populations. Nine research-based articles (including one that reported on two studies) were reviewed systematically, and quality ratings were assigned based on a validated measure assessing randomization, double-blinding, and reporting of participant withdrawals. Two treatment studies were identified, both of which were successful in reducing depression. Eight prevention studies were located, of which four were more efficacious than control conditions in preventing depression. Studies sampled mostly minority, low socioeconomic status adolescents. No consistent characteristics across efficacious interventions could be identified. This review underscores the need for researchers to further investigate and build an evidence base. PMID:25238209

  3. Transforming communication and safety culture in intrapartum care: a multi-organization blueprint.

    Science.gov (United States)

    Lyndon, Audrey; Johnson, M Christina; Bingham, Debra; Napolitano, Peter G; Joseph, Gerald; Maxfield, David G; O?Keeffe, Daniel F

    2015-05-01

    Effective, patient-centered communication facilitates interception and correction of potentially harmful conditions and errors. All team members, including women, their families, physicians, midwives, nurses, and support staff, have a role in identifying the potential for harm during labor and birth. However, the results of collaborative research studies conducted by organizations that represent professionals who care for women during labor and birth indicate that health care providers may frequently witness, but may not always report, problems with safety or clinical performance. Some of these health care providers felt resigned to the continuation of such problems and fearful of retribution if they tried to address them. Speaking up to address safety and quality concerns is a dynamic social process. Every team member must feel empowered to speak up about concerns without fear of put-downs, retribution, or receiving poor-quality care. Patient safety requires mutual accountability: individuals, teams, health care facilities, and professional associations have a shared responsibility for creating and sustaining environments of mutual respect and engaging in highly reliable perinatal care. Defects in human factors, communication, and leadership have been the leading contributors to sentinel events in perinatal care for more than a decade. Organizational commitment and executive leadership are essential to creating an environment that proactively supports safety and quality. The problem is well-known; the time for action is now. PMID:25932832

  4. Transforming communication and safety culture in intrapartum care: a multi-organization blueprint.

    Science.gov (United States)

    Lyndon, Audrey; Johnson, M Christina; Bingham, Debra; Napolitano, Peter G; Joseph, Gerald; Maxfield, David G; O'Keeffe, Daniel F

    2015-05-01

    Effective, patient-centered communication facilitates interception and correction of potentially harmful conditions and errors. All team members, including women, their families, physicians, midwives, nurses, and support staff, have a role in identifying the potential for harm during labor and birth. However, the results of collaborative research studies conducted by organizations that represent professionals who care for women during labor and birth indicate that health care providers may frequently witness, but may not always report, problems with safety or clinical performance. Some of these health care providers felt resigned to the continuation of such problems and fearful of retribution if they tried to address them. Speaking up to address safety and quality concerns is a dynamic social process. Every team member must feel empowered to speak up about concerns without fear of put-downs, retribution, or receiving poor-quality care. Patient safety requires mutual accountability: individuals, teams, health care facilities, and professional associations have a shared responsibility for creating and sustaining environments of mutual respect and engaging in highly reliable perinatal care. Defects in human factors, communication, and leadership have been the leading contributors to sentinel events in perinatal care for more than a decade. Organizational commitment and executive leadership are essential to creating an environment that proactively supports safety and quality. The problem is well-known; the time for action is now. PMID:25857371

  5. Transforming communication and safety culture in intrapartum care: a multi-organization blueprint.

    Science.gov (United States)

    Lyndon, Audrey; Johnson, M Christina; Bingham, Debra; Napolitano, Peter G; Joseph, Gerald; Maxfield, David G; O'Keeffe, Daniel F

    2015-05-01

    Effective, patient-centered communication facilitates interception and correction of potentially harmful conditions and errors. All team members, including women, their families, physicians, midwives, nurses, and support staff, have roles in identifying the potential for harm during labor and birth. However, the results of collaborative research studies conducted by organizations that represent professionals who care for women during labor and birth indicate that health care providers may frequently witness, but may not always report, problems with safety or clinical performance. Some of these health care providers felt resigned to the continuation of such problems and fearful of retribution if they tried to address them. Speaking up to address safety and quality concerns is a dynamic social process. Every team member must feel empowered to speak up about concerns without fear of put-downs, retribution, or receiving poor-quality care. Patient safety requires mutual accountability: individuals, teams, health care facilities, and professional associations have a shared responsibility for creating and sustaining environments of mutual respect and engaging in highly reliable perinatal care. Defects in human factors, communication, and leadership have been the leading contributors to sentinel events in perinatal care for more than a decade. Organizational commitment and executive leadership are essential to creating an environment that proactively supports safety and quality. The problem is well-known; the time for action is now. PMID:25851413

  6. Rural/Urban and Socioeconomic Differentials in Quality of Antenatal Care in Ghana

    Science.gov (United States)

    Afulani, Patience A.

    2015-01-01

    Background Approximately 800 women die of pregnancy-related complications every day. Over half of these deaths occur in sub-Saharan Africa (SSA). Most maternal deaths can be prevented with high quality maternal health services. It is well established that use of maternal health services vary by place of residence and socioeconomic status (SES), but few studies have examined the determinants of quality of maternal health services in SSA. The purpose of this study is to examine the determinants of antenatal care (ANC) quality in Ghana–focusing on the role of place of residence and SES (education and wealth). The analysis also examines the interactions of these variables and the mediating role of ANC timing, frequency, facility type, and provider type. Methods The data are from the Ghana Maternal Health Survey (N = 4,868). Analytic techniques include multilevel linear regression with mediation and moderation analysis. Results Urban residence and higher SES are positively associated with higher ANC quality, but the urban effect is completely explained by sociodemographic factors. Specifically, about half of the urban effect is explained by education and wealth alone, with other variables accounting for the remainder. The effects of education are conditional on wealth and are strongest for poor women. Starting ANC visits early and attending the recommended four visits as well as receiving ANC from a higher level facility and from a skilled provider are associated with higher quality ANC. These factors partially explain the SES differentials. Implications Ghanaian women experience significant disparities in quality of ANC, with poor illiterate women receiving the worst care. Targeted efforts to increase quality of ANC may significantly reduce maternal health disparities in Ghana and SSA. A particularly crucial step is to improve ANC quality in the lower level health facilities, where the most vulnerable women are more likely to seek ANC. PMID:25695737

  7. Insurance, racial/ethnic, SES-related disparities in quality of care among US adults with diabetes.

    Science.gov (United States)

    Hu, Ruwei; Shi, Leiyu; Rane, Sarika; Zhu, Jinsheng; Chen, Chien-Chou

    2014-08-01

    Diabetes-related quality improvement initiatives are typically aimed at improving outcomes and reducing complications. Studies have found that disparities in quality persist for certain racial/ethnic and socioeconomically disadvantaged groups; however, results are mixed with regard to insurance-based differences. The purpose of this study is to investigate the independent associations between type of health insurance coverage, race/ethnicity, and socioeconomic status (SES), and quality of care, as measured by benchmark indicators of diabetes-related primary care. This study used the Diabetes Care Survey of the 2010 Medical Expenditure Panel Survey. Bivariate and multivariate logistic regressions were used to examine the association between quality of diabetes care and type of insurance coverage, race/ethnicity, and SES. Multivariate analyses also controlled for additional demographic and health status characteristics. Respondents with insurance coverage (particularly those with private insurance or with Medicare and Medicaid coverage) were more likely to receive quality diabetes care than uninsured individuals. Few significant disparities based on race/ethnicity or SES persisted in subsequent multivariate analyses. Findings suggest that insurance coverage may make the greatest impact in ensuring equitable distribution of quality diabetes care, regardless of race/ethnicity or socioeconomic status. With the implementation of Affordable Care Act under which more people could potentially gain access to insurance, policymakers should next track insurance-based diabetes care disparities. PMID:24363118

  8. How patient reactions to hospital care attributes affect the evaluation of overall quality of care, willingness to recommend, and willingness to return.

    Science.gov (United States)

    Otani, Koichiro; Waterman, Brian; Faulkner, Kelly M; Boslaugh, Sarah; Dunagan, W Claiborne

    2010-01-01

    Patient satisfaction is a critical part of the quality outcomes of healthcare. Every industry is interested in customer satisfaction because satisfied customers are loyal customers. Healthcare is no exception. Many research studies assume that satisfied patients are more likely to recommend their providers to their friends and to return when they need care again. Although this assumption sounds logical, we argue that three dependent variables-the Evaluation of Overall Quality of Care, Willingness to Recommend, and Willingness to Return-are unique constructs. Thus, we examine how patient reactions (experiences) to different hospital care attributes (factors or dimensions) influence these dependent variables. Our study analyzed a comprehensive patient satisfaction data set collected by BJC HealthCare. We used a multiple linear regression model with a scatter term to analyze 14,432 cases. In Evaluation of Overall Quality of Care model, we found that the nursing care attribute showed the strongest influence, followed by staff care. In assessing the other two models-Willingness to Recommend and Willingness to Return-we found that staff care showed the strongest influence, followed by nursing care. Patients put a different emphasis or a different priority on their reactions to hospital care attributes, depending on which outcome they arrive at. In addition, we found that patients are disproportionately influenced by a weak or poor attribute reaction, which is a conjunctive strategy (risk averse). In general, nursing care and staff care should be the first priority for improvement. This may be good news because these areas are under the control of hospital managers. PMID:20210071

  9. Quality and Investment Decisions in Hospital Care when Physicians are Devoted Workers

    OpenAIRE

    Moretto, Michele; Levaggi, Rosella; Rebba, Vincenzo

    2005-01-01

    This paper analyses the decision to invest in quality by a hospital in an environment where doctors are devoted workers, i.e. they care for specific aspects of the output they produce. We assume that quality is the result of both an investment in new technology and the effort of the medical staff. Hospital services are paid on the basis of their marginal cost of production while the number of patients treated depends on a purchasing rule which discriminates for the level and timing of the inv...

  10. Service quality in the health care industry: how are hospitals evaluated by the general public?

    Science.gov (United States)

    Elliott, K M; Hall, M C; Stiles, G W

    1992-01-01

    This paper investigates the "expectations" aspect of service quality in the health care industry. Specifically, an examination is made of the importance of various hospital characteristics to consumers, the dimensionality of service quality, and the relative importance of these dimensions across demographic groups. The results suggest that the competency and the behavior of physicians are the most important characteristics in the minds of consumers. Moreover, it was found that hospitals are evaluated along: (1) interpersonal, (2) amenities, (3) capabilities, and (4) accessibility dimensions. These findings are consistent with previous research in this regard. Additionally, significant differences in the importance of these factors were found across respondent gender, age, income, and education. PMID:10125829

  11. Improving benchmarking by using an explicit framework for the development of composite indicators: an example using pediatric quality of care

    OpenAIRE

    Hysong Sylvia J; Typpo Katri V; Profit Jochen; Woodard LeChauncy D; Kallen Michael A; Petersen Laura A

    2010-01-01

    Abstract Background The measurement of healthcare provider performance is becoming more widespread. Physicians have been guarded about performance measurement, in part because the methodology for comparative measurement of care quality is underdeveloped. Comprehensive quality improvement will require comprehensive measurement, implying the aggregation of multiple quality metrics into composite indicators. Objective To present a conceptual framework to develop comprehensive, robust, and transp...

  12. Perspectives on quality mental health care from Brazilian and Cape Verdean outpatients: implications for effective patient-centered policies and models of care.

    Science.gov (United States)

    De Jesus, Maria; Earl, Tara R

    2014-01-01

    Mental health providers are increasingly coming into contact with large and growing multi-racial/ethnic and immigrant patient populations in the United States. Knowledge of patient perspectives on what constitutes quality mental health care is necessary for these providers. The aim of this study was to identify indicators of quality of mental health care that matter most to two underrepresented immigrant patient groups of Portuguese background: Brazilians and Cape Verdeans. A qualitative design was adopted using focus group discussions. Six focus groups of patients (n=24 Brazilians; n=24 Cape Verdeans) who received outpatient mental health treatment through public safety net clinics in the northeast region of the United States were conducted. The Consensual Qualitative Research analytic method allowed us to identify three quality of care domains: provider performance, aspects of mental health care environment, and effectiveness of mental health care treatment. Provider performance was associated with five categories: relational, communication, linguistic, cultural, and technical competencies. Aspects of mental health care environment were linked to two categories: psychosocial and physical environment. Effectiveness of mental health care treatment was related to two categories: therapeutic relationship and treatment outcomes. Study findings provide useful data for the development of more culturally appropriate and effective patient-centered models and policies in mental health care. PMID:24461570

  13. European Cystic Fibrosis Society Standards of Care : Quality Management in cystic fibrosis

    DEFF Research Database (Denmark)

    Stern, Martin; Bertrand, Dominique Pougheon

    2014-01-01

    Since the earliest days of cystic fibrosis (CF) treatment, patient data have been recorded and reviewed in order to identify the factors that lead to more favourable outcomes. Large data repositories, such as the US Cystic Fibrosis Registry, which was established in the 1960s, enabled successful treatments and patient outcomes to be recognized and improvement programmes to be implemented in specialist CF centres. Over the past decades, the greater volumes of data becoming available through Centre databases and patient registries led to the possibility of making comparisons between different therapies, approaches to care and indeed data recording. The quality of care for individuals with CF has become a focus at several levels: patient, centre, regional, national and international. This paper reviews the quality management and improvement issues at each of these levels with particular reference to indicators of health, the role of CF Centres, regional networks, national health policy, and international data registration and comparisons.

  14. Quality of life, happiness and satisfaction with life of individuals 75 years old or older cared for by a home health care program

    OpenAIRE

    Puig Llobet, Montserrat; Rodri?guez A?vila, Nu?ria; Farra?s I Farra?s, Jaume; Lluch Canut, Ma Teresa

    2011-01-01

    This case study identifies the elements that compose the Quality of Life (QofL) of individuals who were 75 years old or older and receive care at home. The study's sample was composed of individuals 75 years or older cared for by a home health care service in the primary health care unit in Vilafranca del Penedès, Spain (n=26). The variables included: a) socio-demographic data; b) concept of QofL; c) perception of QofL; d) reasons for their perception; d) satisfaction with life and related a...

  15. A study on coverage utilization and quality of maternal care services

    Directory of Open Access Journals (Sweden)

    Neeraj Agarwal, Abhiruchi Galhotra, H M Swami

    2011-01-01

    Full Text Available The objectives of the study were yo assess the utilization of various maternal services and to compare the quality of services provided by doctors and health workers in terms of components and advice received by pregnant women during antenatal period. It was a Cross-sectional Study conducted in a village on the border of Chandigarh (U.T. and Mohali (Punjab. All the women who had delivered in the past three years in the village Palsora were included in the study. 92.4% of the pregnancies were registered, 53.2% of which received antenatal care by a Doctor and 46.8% by a health worker. The measuring of blood pressure was significantly higher by the doctor than the health workers who recorded weight more significantly. The advice provided by doctors was significantly higher than health workers regarding diet, danger signs, newborn care, family planning and natal care.

  16. The challenges of success: adolescents with perinatal HIV infection

    Directory of Open Access Journals (Sweden)

    Lynne M Mofenson

    2013-06-01

    Full Text Available The great success in the prevention and treatment of pediatric HIV in high resource countries, and now in low resource countries, has changed the face of the HIV epidemic in children from one of near certain mortality to that of a chronic disease. However, these successes pose new challenges as perinatally HIV-infected youth survive into adulthood. Increased survival of HIV-infected children is associated with challenges in maintaining adherence to what is likely life-long therapy, and in selecting successive antiretroviral drug regimens, given the limited availability of pediatric formulations, limitations in pharmacokinetic and safety data of drugs in children, and the development of extensive drug resistance in multi-drug-experienced children. Pediatric HIV care must now focus on morbidity related to long-term HIV infection and its treatment. Survival into adulthood of perinatally HIV-infected youth in high resource countries provides important lessons about how the epidemic will change with increasing access to antiretroviral therapy for children in low resource countries. This series of papers will focus on issues related to management of perinatally infected youth and young adults.

  17. Hospital-Based Outcomes Management: Enhancing Quality of Care with Coordinated Data Systems

    OpenAIRE

    Lansky, David

    1989-01-01

    A hospital based outcomes management system permits physicians, patients, administrators, and purchasers of care to evaluate treatm