WorldWideScience
 
 
1

A perinatal care quality and safety initiative: are there financial rewards for improved quality?  

UK PubMed Central (United Kingdom)

BACKGROUND: Although costs of providing care may decrease with hospital initiatives to improve obstetric and neonatal outcomes, the accompanying reduced adverse outcomes may negatively affect hospital revenues. METHODS: In 2008 a Minnesota-based hospital system (Fairview Health Services) launched the Zero Birth Injury (ZBI) initiative, which used evidence-based care bundles to guide management of obstetric services. A pre-post analysis of financial impacts of ZBI was conducted by using hospital administrative records to measure costs and revenues associated with changes in maternal and neonatal birth injuries before (2008) and after (2009-2011) the initiative. RESULTS: For the Fairview Health Services hospitals, after adjusting for relevant covariates, implementation of ZBI was associated with a mean 11% decrease in the rate of maternal and neonatal adverse outcomes between 2008 and 2011 (adjusted odds ratio [AOR] = 0.89, p = .076). As a result of the adverse events avoided, the hospital system saved $284,985 in costs but earned $324,333 less revenue, which produced a net financial decrease of $39,348 (or a $305 net financial loss per adverse event avoided) in 2011, compared with 2008. CONCLUSIONS: Adoption of a perinatal quality and safety initiative that reduced birth injuries had little net financial impact on the hospital. ZBI produced better clinical results at a lower cost, which represents potential savings for payers, but the hospital system offering improved quality reaped no clear financial rewards. These results highlight the important role for shared-savings collaborations (among patients, providers, government and third-party payers, and employers) to incentivize QI. Widespread adoption of perinatal safety initiatives combined with innovative payment models may contribute to better health at reduced cost.

Kozhimannil KB; Sommerness SA; Rauk P; Gams R; Hirt C; Davis S; Miller KK; Landers DV

2013-08-01

2

Perinatal Care in Canada  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Health Issue Canada's standard of perinatal care ranks among the highest in the world, but there is still room for improvement, both in terms of regional differences in care and global comparisons of approaches to care in Canada and elsewhere. Data from the Canadian Perinatal Surveillance System (CPSS) was used to evaluate morbidity and mortality among mothers and infants. Key Findings Maternal mortality rates in Canada dropped to 4.4 per 100,000 live births in 1993–1997 and are among the lowest in the world. Rates of Caesarean section increased from 15.3 per 100 deliveries in 1994 to 19.1 in 1997. Although the infant mortality rate in Canada is among the lowest in the world (5.3–8.8 per 1,000 live births 1990–2000), there are unacceptable disparities between subpopulations. In Aboriginal populations, rates of stillbirth and perinatal mortality are 2–2.5 times the Canadian average. There has been a steady increase in the proportion of births among older women who have the highest risk of preterm births and pregnancy complications. The increasing rate of multiple births has accelerated recently and is of concern as these carry a higher risk of complications and are associated with an increased risk of preterm birth. The costs to the health care system are likely to be high. Data Gaps and Recommendations CPSS data, including economic indicators, needs to be collected in a more timely and uniform manner across Canada. The CPSS should provide an evaluation of how well Canada fares in relation to international standards of perinatal care.

Chalmers Beverley; Wen Shi

2004-01-01

3

Do Malawian women critically assess the quality of care? A qualitative study on women’s perceptions of perinatal care at a district hospital in Malawi  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Background Malawi has a high perinatal mortality rate of 40 deaths per 1,000 births. To promote neonatal health, the Government of Malawi has identified essential health care packages for improving maternal and neonatal health in health care facilities. However, regardless of the availability of health services, women’s perceptions of the care is important as it influences whether the women will or will not use the services. In Malawi 95% of pregnant women receive antenatal care from skilled attendants, but the number is reduced to 71% deliveries being conducted by skilled attendants. The objective of this study was to describe women’s perceptions on perinatal care among the women delivered at a district hospital. Methods A descriptive study design with qualitative data collection and analysis methods. Data were collected through face-to-face in-depth interviews using semi-structured interview guides collecting information on women’s perceptions on perinatal care. A total of 14 in depth interviews were conducted with women delivering at Chiradzulu District Hospital from February to March 2011. The women were asked how they perceived the care they received from health workers during antepartum, intrapartum and postpartum. They were also asked about the information they received during provision of care. Data were manually analyzed using thematic analysis. Results Two themes from the study were good care and unsatisfactory care. Subthemes under good care were: respect, confidentiality, privacy and normal delivery. Providers’ attitude, delay in providing care, inadequate care, and unavailability of delivery attendants were subthemes under unsatisfactory care. Conclusions Although the results show that women wanted to be well received at health facilities, respected, treated with kindness, dignity and not shouted at, they were not critical of the care they received. The women did not know the quality of care to expect because they were not well informed. The women were not critical of the care they received because they were not aware of the standard of care. Instead they had low expectations. Health workers have a responsibility to inform women and their families about the care that women should expect. There is also a need for standardization of the antenatal information that is provided.

Kumbani Lily C; Chirwa Ellen; Malata Address; Odland Jon Øyvind; Bjune Gunnar

2012-01-01

4

Do Malawian women critically assess the quality of care? A qualitative study on women's perceptions of perinatal care at a district hospital in Malawi.  

UK PubMed Central (United Kingdom)

BACKGROUND: Malawi has a high perinatal mortality rate of 40 deaths per 1,000 births. To promote neonatal health, the Government of Malawi has identified essential health care packages for improving maternal and neonatal health in health care facilities. However, regardless of the availability of health services, women's perceptions of the care is important as it influences whether the women will or will not use the services. In Malawi 95% of pregnant women receive antenatal care from skilled attendants, but the number is reduced to 71% deliveries being conducted by skilled attendants. The objective of this study was to describe women's perceptions on perinatal care among the women delivered at a district hospital. METHODS: A descriptive study design with qualitative data collection and analysis methods. Data were collected through face-to-face in-depth interviews using semi-structured interview guides collecting information on women's perceptions on perinatal care. A total of 14 in depth interviews were conducted with women delivering at Chiradzulu District Hospital from February to March 2011. The women were asked how they perceived the care they received from health workers during antepartum, intrapartum and postpartum. They were also asked about the information they received during provision of care. Data were manually analyzed using thematic analysis. RESULTS: Two themes from the study were good care and unsatisfactory care. Subthemes under good care were: respect, confidentiality, privacy and normal delivery. Providers' attitude, delay in providing care, inadequate care, and unavailability of delivery attendants were subthemes under unsatisfactory care. CONCLUSIONS: Although the results show that women wanted to be well received at health facilities, respected, treated with kindness, dignity and not shouted at, they were not critical of the care they received. The women did not know the quality of care to expect because they were not well informed. The women were not critical of the care they received because they were not aware of the standard of care. Instead they had low expectations. Health workers have a responsibility to inform women and their families about the care that women should expect. There is also a need for standardization of the antenatal information that is provided.

Kumbani LC; Chirwa E; Malata A; Odland JØ; Bjune G

2012-01-01

5

Provider continuity and quality of medical care. A retrospective analysis of prenatal and perinatal outcome.  

UK PubMed Central (United Kingdom)

It is often assumed that family physicians are able to provide a higher quality of medical care because of the greater degree of continuity inherent in their practices. The authors attempted to measure the association between continuity and quality of medical care using pregnancy as a tracer condition. Using a retrospective cohort study design, two groups of pregnant women were identified--those cared for in the family practice (FP) centers and those cared for in the obstetric (OB) clinics. Process and outcome of medical care were measured along with patient satisfaction. Provider continuity, as measured by the SECON value, was much higher in the FP group, and was highly correlated with the presence of an "attitudinal contract" between patient and physician. Although not statistically significant, four times as many newborns from the OB group were admitted to the neonatal intensive care unit. FP group newborn weight averaged 220 grams more than the OB group (P less than 0.05). This difference remained after control for covariates. While not reaching statistical significance, patient satisfaction scores tended to be higher for the FP group in two of three categories measured. The results suggest that continuity of care was associated with better patient outcome and satisfaction. Directions for causal interpretation and future research are discussed.

Shear CL; Gipe BT; Mattheis JK; Levy MR

1983-12-01

6

Parents' perceptions of the quality of pediatric and perinatal end-of-life care.  

UK PubMed Central (United Kingdom)

OBJECTIVE: The purpose of this study was to describe the quality of care provided before, at the time of, and following the death of an infant, child, or adolescent from the perspective of the parent, using a newly developed survey. SAMPLE AND METHODS: Parents were asked to participate in this study if they experienced a stillbirth or death of an infant/child/youth between 12 and 24 months prior to the beginning of the study. Thirty-eight families completed the survey with one of the researchers over the telephone or in person. Survey questions asked parents to report on the care received rather than rate how satisfied they were with care. RESULTS: Parents were reluctant to report negative occurrences in care they received, yet, when questioned further, nearly every parent could relate a particular event or person who had a negative impact on their experience. Parents identified communication between health professionals, relationships with health professionals, care at the time of death, and bereavement follow-up as problematic areas. CONCLUSION: There is room for improvement in the end-of-life care provided to infants, children and youth, and their families.

Widger K; Picot C

2008-01-01

7

A literature review on integrated perinatal care  

Directory of Open Access Journals (Sweden)

Full Text Available Context: The perinatal period is one during which health care services are in high demand. Like other health care sub-sectors, perinatal health care delivery has undergone significant changes in recent years, such as the integrative wave that has swept through the health care industry since the early 1990s. Purpose: The present study aims at reviewing scholarly work on integrated perinatal care to provide support for policy decision-making. Results: Researchers interested in integrated perinatal care have, by assessing the effectiveness of individual clinical practices and intervention programs, mainly addressed issues of continuity of care and clinical and professional integration. Conclusions: Improvements in perinatal health care delivery appear related not to structurally integrated health care delivery systems, but to organizing modalities that aim to support woman-centred care and cooperative clinical practice.

Rodríguez, Charo; Rivières-Pigeon, Catherine des

2007-01-01

8

Infusion techniques for perinatal home care.  

UK PubMed Central (United Kingdom)

Perinatal home infusion therapy is one service component of a comprehensive maternity care program. Physicians can prescribe perinatal home infusion therapies for various conditions, as an alternative to treatment in acute care settings. Maternal and fetal assessment is an integral part of the management of these therapies.

Eaton DG

1995-05-01

9

Do Malawian women critically assess the quality of care? A qualitative study on women’s perceptions of perinatal care at a district hospital in Malawi  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Abstract Background Malawi has a high perinatal mortality rate of 40 deaths per 1,000 births. To promote neonatal health, the Government of Malawi has identified essential health care packages for improving maternal and neonatal health in health care facilities. However, regardless ...

Kumbani Lily C; Chirwa Ellen; Malata Address; Odland Jon Øyvind; Bjune Gunnar

10

A subsidized perinatal care program in a rural Colorado county.  

Science.gov (United States)

A large number of medically indigent women in rural areas currently receive little or no prenatal care, raising major concerns regarding perinatal health. In Colorado, subsidized prenatal and labor/delivery programs have been instituted to address this problem. This article describes the implementation of two programs in one rural county. In these rural programs, private physicians, health department personnel, and social work staff at the local hospital collaborate to provide financial assistance, comprehensive health education, and quality medical care for eligible pregnant women. The identified benefits and barriers unique to the provision of quality perinatal care in rural settings are discussed. PMID:10296595

Main, D S; Tressler, C J; Calonge, N; Joffe, L; Robichaux, A

1989-10-01

11

A subsidized perinatal care program in a rural Colorado county.  

UK PubMed Central (United Kingdom)

A large number of medically indigent women in rural areas currently receive little or no prenatal care, raising major concerns regarding perinatal health. In Colorado, subsidized prenatal and labor/delivery programs have been instituted to address this problem. This article describes the implementation of two programs in one rural county. In these rural programs, private physicians, health department personnel, and social work staff at the local hospital collaborate to provide financial assistance, comprehensive health education, and quality medical care for eligible pregnant women. The identified benefits and barriers unique to the provision of quality perinatal care in rural settings are discussed.

Main DS; Tressler CJ; Calonge N; Joffe L; Robichaux A

1989-10-01

12

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  

Directory of Open Access Journals (Sweden)

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 2004. 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.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 hospitals 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.

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

2009-01-01

13

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)

Full Text Available Abstract in portuguese 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 2004. Uma subamostra de 20% foi utilizada para avaliação da confiabilidade do banco de dados eletrônico do programa. Foram calculadas proporções de completude ante (more) s 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 hospitals 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 re (more) covery 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.

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

2009-09-01

14

[Psychosocial factors influencing the perinatal health care satisfaction of parturients].  

UK PubMed Central (United Kingdom)

OBJECTIVE: To give an overview of the main psychosocial factors influencing the perinatal health care satisfaction of parturients and present recommendations for good practice. DESIGN: Original study. SETTING: Department of Psychology, Faculty of Philosophy, Charles University, Prague. METHODS: Qualitative methodology--content analysis of 189 childbirth narratives written by parturients and demi-structured interviews with 44 parturients. RESULTS: Seven dimensions of perinatal health care satisfaction of parturients were identified: 1. staff attitude and behavior; 2. staff communication; 3. parturient's participation in decision-making; 4. support of early mother-baby contact; 5. breastfeeding support; 6. mother-baby friendliness of maternity unit operation rules; 7. clarity of maternity unit operation rules. The most important dimensions include empathy and psychological support, respect for privacy and feelings of shame, relational symmetry/asymmetry and quality of provided information. CONCLUSION: Psychosocial aspects are a decisive criterion of perinatal health care satisfaction of parturients. Psychological competences of health care providers and staff make an inseparable part of their competence, with communication skills development and prevention and therapy of the burn-out syndrome deserving special attention.

Takács L; Kodysová E

2011-06-01

15

[Perinatal drug abuse. Collaborative perinatal care for drug abusers and their infants].  

UK PubMed Central (United Kingdom)

Pregnant drug abusers are a group with very high risk of perinatal morbidity. Intensive prenatal care, with substitution maintenance programs, by a medico-psycho-social team working in concert with ambulatory health and social workers, may prevent perinatal complications and mother-infant separation. The results of such a perinatal program, in a suburban low-socioeconomic population, are described. In comparison with reports in the literature, this approach appears to provide significant perinatal medical and social prognosis for pregnant abusers and their neonates.

Lejeune C; Floch-Tudal C; Crenn-Hebert C; Simonpoli AM

2004-02-01

16

High-tech, high-touch perinatal home care.  

UK PubMed Central (United Kingdom)

Perinatal home care for women experiencing a high-risk pregnancy often requires the use of technologies for safe home management. Home care professionals need to integrate high technology with high touch to ensure the best results.

Dahlberg NL; Blazek D; Wikoff B; Tuckwell BL; Koloroutis M

1995-05-01

17

Midwifery care: A perinatal mental health case scenario.  

UK PubMed Central (United Kingdom)

The establishment of the National Perinatal Depression Initiative (NPDI, 2008-2013) has brought a focus across Australia for the need to identify women at risk of perinatal mental health disorders, suggesting that routine screening by relevant health professionals may aid earlier detection, better care and improved outcomes. Midwives are frequently the primary point of contact in the perinatal period and thus ideally placed to identify, interpret and manage complex situations, including screening for perinatal mental health disorders. This paper offers strategies that could be implemented into daily midwifery practice in order to achieve the goals consistent with the National Perinatal Depression Initiative. A case study (Jen) and discussion, guided by recommendations from the Australian Nursing and Midwifery Competency standards and beyondblue Clinical Practice Guidelines, are used to demonstrate how midwifery care can be provided. In accordance with her legal obligations, the midwife should act within her scope of practice to undertake a series of psychosocial and medical assessments in order to best determine how midwifery care and support can be of benefit to Jen, her infant and her family. Suggestions described include administration of validated screening questionnaires, clinical interview, physical assessment, discussion with partner, awareness of the mother-infant interactions and questioning around baby's sleep and feeding. Based on evaluation of the information gained from a bio-psycho-social assessment, suggestions are made as to the midwifery care options that could be applied.

Marnes J; Hall P

2013-09-01

18

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)

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.

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

2005-01-01

19

Community mobilization in Mumbai slums to improve perinatal care and outcomes: a cluster randomized controlled trial.  

UK PubMed Central (United Kingdom)

INTRODUCTION: 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. METHODS AND FINDINGS: A cluster randomized controlled trial in 24 intervention and 24 control settlements covered a population of 283,000. In each intervention cluster, a facilitator supported women's groups through an action learning cycle in which they discussed perinatal experiences, improved their knowledge, and took local action. We monitored births, stillbirths, and neonatal deaths, and interviewed mothers at 6 weeks postpartum. The primary outcomes described perinatal care, maternal morbidity, and extended perinatal mortality. The analysis included 18,197 births over 3 years from 2006 to 2009. We found no differences between trial arms in uptake of antenatal care, reported work, rest, and diet in later pregnancy, institutional delivery, early and exclusive breastfeeding, or care-seeking. The stillbirth rate was non-significantly lower in the intervention arm (odds ratio 0.86, 95% CI 0.60-1.22), and the neonatal mortality rate higher (1.48, 1.06-2.08). The extended perinatal mortality rate did not differ between arms (1.19, 0.90-1.57). We have no evidence that these differences could be explained by the intervention. CONCLUSIONS: Facilitating urban community groups was feasible, and there was evidence of behaviour change, but we did not see population-level effects on health care or mortality. In cities with multiple sources of health care, but inequitable access to services, community mobilization should be integrated with attempts to deliver services for the poorest and most vulnerable, and with initiatives to improve quality of care in both public and private sectors. TRIAL REGISTRATION: Current Controlled Trials ISRCTN96256793

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

2012-01-01

20

Perinatal deaths in a Norwegian county 1986-96 classified by the Nordic-Baltic perinatal classification: geographical contrasts as a basis for quality assessment.  

UK PubMed Central (United Kingdom)

BACKGROUND: Quality assessment of perinatal care can be carried out by classifying perinatal deaths. In the following we have analyzed the geographical contrasts in perinatal deaths according to the Nordic-Baltic perinatal death classification in a sparsely populated Norwegian county. MATERIAL AND METHODS: All stillbirths (> or =28 weeks of gestation) and neonatal deaths (gestational age > or =22 weeks; death < or =28 days) in 1986-96 from Nordland county (240,000 inhabitants) were classified. For comparison the county was geographically divided into six general local hospital areas and one central hospital area. RESULTS: The classification showed a well acceptable inter and intra observer variation. One hundred and seventy-one stillbirths and 155 neonatal deaths were analyzed. The death rate (pr 1,000 births) for single, non-malformed, antenatal stillbirths was higher in the central hospital area than in the local hospital areas (3.22 vs. 2.02). The death rate for extreme preterm infants (22-27 weeks of gestation) was on the other hand higher in the local hospital areas (2.45 vs. 1.05). One of the general local hospital areas was singled out with an especially high neonatal death rate among extreme preterm infants. This was to some extent explained by the death of extreme preterm twins and triplets. CONCLUSION: The Nordic-Baltic perinatal death classification system is a consistent and reproducible tool also for studying perinatal death in restricted geographical areas. The observed contrasts in perinatal deaths were used as basis for programs aimed at improving perinatal care. The observation of an unexplained increased number of antenatal stillbirths in the central hospital area resulted in a program for prospective recording and better characterization of the placenta and umbilical cord. Proposals for a better antenatal program preventing extreme preterm birth of twins for the whole county has been launched. In utero transfer to a hospital with a neonatal intensive care unit seems crucial in improving the prognosis for these infants.

Holt J; Vold IN; Odland JO; Førde OH

2000-02-01

 
 
 
 
21

Perinatal outcome and antenatal care in a black South African population.  

Digital Repository Infrastructure Vision for European Research (DRIVER)

The relationship between perinatal outcome and antenatal care was investigated at King Edward VIII Hospital, Durban, by a case control retrospective study of pregnancy records in 165 perinatal deaths and 156 infants surviving the perinatal period. 82% of the mothers of live infants had booked for an...

Menown, I. B.; Archbold, J. A.; Wills, C.

22

Antenatal care and perinatal outcomes in Kwale district, Kenya  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Background The importance of antenatal care (ANC) for improving perinatal outcomes is well established. However access to ANC in Kenya has hardly changed in the past 20 years. This study aims to identify the determinants of attending ANC and the association between attendance and behavioural and perinatal outcomes (live births and healthy birthweight) for women in the Kwale region of Kenya. Method A Cohort survey of 1,562 perinatal outcomes (response rate 100%) during 2004–05 in the catchment areas for five Ministry of Health dispensaries in two divisions of the Kwale region. The associations between background and behavioural decisions on ANC attendance and perinatal outcomes were explored using univariate analysis and multivariate logistic regression models with backwards-stepwise elimination. The outputs from these analyses were reported as odds ratios (OR) with 95% confidence intervals (CI). Results Only 32% (506/1,562) of women reported having any ANC. Women with secondary education or above (adjusted OR 1.83; 95% CI 1.06–3.15) were more likely to attend for ANC, while those living further than 5 km from a dispensary were less likely to attend (OR 0.29; 95% CI 0.22–0.39). Paradoxically, however, the number of ANC visits increased with distance from the dispensary (OR 1.46; 95% CI 1.33–1.60). Women attending ANC at least twice were more likely to have a live birth (vs. stillbirth) in both multivariate models. Women attending for two ANC visits (but not more than two) were more likely to have a healthy weight baby (OR 4.39; 95% CI 1.36–14.15). Conclusion The low attendance for ANC, combined with a positive relationship between attendance and perinatal outcomes for the women in the Kwale region highlight the need for further research to understand reasons for attendance and non-attendance and also for strategies to be put in place to improve attendance for ANC.

Brown Celia A; Sohani Salim B; Khan Khalid; Lilford Richard; Mukhwana Walter

2008-01-01

23

Who receives home-based perinatal palliative care: experience from poland.  

UK PubMed Central (United Kingdom)

Context. The current literature suggests that perinatal palliative care (PPC) programs should be comprehensive, initiated early, and integrative. So far there have been very few publications on the subject of home-based PC of newborns and neonates. Most publications focus on hospital-based care, mainly in the neonatal intensive care units. Objective. To describe the neonates and infants who received home-based palliative care in Lodz Region between 2005 and 2011. Methods. A retrospective review of medical records. Results. 53 neonates and infants were admitted to a home hospice in Lodz Region between 2005 and 2011. In general, they are a growing group of patients referred to palliative care. Congenital diseases (41%) were the primary diagnoses; out of 53 patients 16 died, 20 were discharged home, and 17 stayed under hospice care until 2011. The most common cause of death (56%) was cardiac insufficiency. Neurological symptoms (72%) and dysphagia (58%) were the most common clinical problems. The majority of children (45%) had a feeding tube inserted and were oxygen dependent (45%); 39 families received psychological care and 31 social supports. Conclusions. For terminally ill neonates and infants, perinatal palliative care is an option which improves the quality of their lives and provides the family with an opportunity to say goodbye.

Korzeniewska-Eksterowicz A; Przys?o L; K?dzierska B; Stolarska M; M?ynarski W

2013-01-01

24

Goals in maternal and perinatal care in Latin America and the Caribbean.  

UK PubMed Central (United Kingdom)

Ten goals have been developed to guide perinatal caregivers by the Latin American Centre for Perinatology (CLAP), a PAHO/WHO unit dedicated to improving perinatal care in Latin America and The Caribbean. The goals were inspired by the current troubled perinatal care situation, the need to make significant changes, principles of evidence-based medicine, and reviews of many sources from other regions or countries.

Belizán JM; Cafferata ML; Belizán M; Tomasso G; Chalmers B

2005-09-01

25

Goals in maternal and perinatal care in Latin America and the Caribbean.  

Science.gov (United States)

Ten goals have been developed to guide perinatal caregivers by the Latin American Centre for Perinatology (CLAP), a PAHO/WHO unit dedicated to improving perinatal care in Latin America and The Caribbean. The goals were inspired by the current troubled perinatal care situation, the need to make significant changes, principles of evidence-based medicine, and reviews of many sources from other regions or countries. PMID:16128976

Belizán, José M; Cafferata, María L; Belizán, María; Tomasso, Giselle; Chalmers, Beverley

2005-09-01

26

Antenatal care packages with reduced visits and perinatal mortality: a secondary analysis of the WHO Antenatal Care Trial.  

UK PubMed Central (United Kingdom)

BACKGROUND: In 2001, the WHO Antenatal Care Trial (WHOACT) concluded that an antenatal care package of evidence-based screening, therapeutic interventions and education across four antenatal visits for low-risk women was not inferior to standard antenatal care and may reduce cost. However, an updated Cochrane review in 2010 identified an increased risk of perinatal mortality of borderline statistical significance in three cluster-randomized trials (including the WHOACT) in developing countries. We conducted a secondary analysis of the WHOACT data to determine the relationship between the reduced visits, goal-oriented antenatal care package and perinatal mortality. METHODS: Exploratory analyses were conducted to assess the effect of baseline risk and timing of perinatal death. Women were stratified by baseline risk to assess differences between intervention and control groups. We used linear modeling and Poisson regression to determine the relative risk of fetal death, neonatal death and perinatal mortality by gestational age. RESULTS: 12,568 women attended the 27 intervention clinics and 11,958 women attended the 26 control clinics. 6,160 women were high risk and 18,365 women were low risk. There were 161 fetal deaths (1.4%) in the intervention group compared to 119 fetal deaths in the control group (1.1%) with an increased overall adjusted relative risk of fetal death (Adjusted RR 1.27; 95% CI 1.03, 1.58). This was attributable to an increased relative risk of fetal death between 32 and 36 weeks of gestation (Adjusted RR 2.24; 95% CI 1.42, 3.53) which was statistically significant for high and low risk groups. CONCLUSION: It is plausible the increased risk of fetal death between 32 and 36 weeks gestation could be due to reduced number of visits, however heterogeneity in study populations or differences in quality of care and timing of visits could also be playing a role. Monitoring maternal, fetal and neonatal outcomes when implementing antenatal care protocols is essential. Implementing reduced visit antenatal care packages demands careful monitoring of maternal and perinatal outcomes, especially fetal death.

Vogel JP; Ndema HA; Souza JP; Gülmezoglu MA; Dowswell T; Carroli G; Baaqeel HS; Lumbiganon P; Piaggio G; Oladapo OT

2013-04-01

27

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

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Background Neonatal mortality rates are high in rural Nepal where more than 90% of deliveries are in the home. Evidence suggests that death rates can be reduced by interventions at community level. We describe an intervention which aimed to harness the power of community planning and decision making to improve maternal and newborn care in rural Nepal. Methods The development of 111 women's groups in a population of 86 704 in Makwanpur district, Nepal is described. The groups, facilitated by local women, were the intervention component of a randomized controlled trial to reduce perinatal and neonatal mortality rates. Through participant observation and analysis of reports, we describe the implementation of this intervention: the community entry process, the facilitation of monthly meetings through a participatory action cycle of problem identification, community planning, and implementation and evaluation of strategies to tackle the identified problems. Results In response to the needs of the group, participatory health education was added to the intervention and the women's groups developed varied strategies to tackle problems of maternal and newborn care: establishing mother and child health funds, producing clean home delivery kits and operating stretcher schemes. Close linkages with community leaders and community health workers improved strategy implementation. There were also indications of positive effects on group members and health services, and most groups remained active after 30 months. Conclusion A large scale and potentially sustainable participatory intervention with women's groups, which focused on pregnancy, childbirth and the newborn period, resulted in innovative strategies identified by local communities to tackle perinatal care problems.

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

2005-01-01

28

Opinions of UK perinatal health care professionals on home birth.  

UK PubMed Central (United Kingdom)

OBJECTIVE: to evaluate the opinions of UK perinatal health care professionals on home birthing. DESIGN: cross-sectional survey. SETTING: four hospitals and three Primary Care Trusts in the East of England. POPULATION: hospital and community midwives, GPs, consultant obstetricians and gynaecologists, consultant paediatricians and neonatologists. METHODS: postal questionnaire between December 2010 and June 2011 using Likert scales (range 0-10) and freetext questions. Data were analysed using the Kruskal-Wallis test and qualitative methods. MAIN OUTCOME MEASURES: opinions, support and enthusiasm for home birthing. FINDINGS: 432/831 (52%) professionals responded: 224/418 (54%) midwives, 148/321 (46%) GPs, 32/52 (62%) obstetricians/gynaecologists and 28/41 (68%) paediatricians/neonatologists. Midwives were more enthusiastic about home birthing than any other professionals (median Likert scale rating: 9 [IQR 8-10], p<0.0001) and more supportive of the UK government's plan to increase home birth rates (median 8.5 [IQR 7-10], p<0.0001). GPs and obstetricians/gynaecologists tended to hold neutral opinions about home birthing (median of GPs 5 [IQR 3-7.5] and of obstetrician/gynaecologists 5 [IQR 2-7]) and regarding support for the government's plan (GP median 5 [IQR 2-6]; obstetrician/gynaecologists median 5 [IQR 2-5]). Paediatricians/neonatologists were generally negative about home birthing (median 4 [IQR 3-5]) and opposed to the government's plan (median 3 [IQR 2-5]). CONCLUSIONS: significant differences of opinion exist between UK perinatal health care professional groups about home birthing. Negative and neutral opinions should be further explored and addressed as they may impact on the uptake of home birth by women.

McNutt A; Thornton T; Sizer P; Curley A; Clarke P

2013-08-01

29

Comparison of outcomes of perinatal care in Slovakia and the UK.  

UK PubMed Central (United Kingdom)

OBJECTIVE: To investigate whether there are differences in maternal and perinatal outcomes between Slovakia and the UK, and whether any observed variations can be attributed to differences in perinatal care. METHODS: Data on outcomes of perinatal care in Slovakia and the UK between 2006 and 2010 were compared. Perinatal mortality figures included stillbirths weighing 1000g or more and early neonatal deaths. RESULTS: In Slovakia, the perinatal mortality rate was significantly higher than that in the UK (RR 1.12; 95% CI, 1.06-1.18). Cesarean delivery was significantly more frequent in Slovakia (RR 1.05; 95% CI, 1.05-1.06); instrumental vaginal delivery was less frequent (ventouse delivery, RR 0.20; 95% CI, 0.19-0.21; forceps delivery, RR 0.09; 95% CI, 0.09-0.10). Episiotomy and peripartum hysterectomy were performed more often in Slovakia (episiotomy, RR 4.10; 95% CI, 4.07-4.12; peripartum hysterectomy, RR 2.02; 95% CI 1.65-2.47). The incidence of eclampsia was significantly higher in Slovakia (RR 1.60; 95% CI, 1.26-2.04). There were no significant differences in the rates of maternal death. CONCLUSION: Perinatal care outcomes and intervention rates differ between Slovakia and UK. This may be explained by differences in outcome definitions, perinatal care, and official encouragement of medical complaints.

Kristufkova A; Korbel M; Borovsky M; Knight M

2013-07-01

30

Quality of care: assessment  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract To translate science into clinical practice we must first assess the quality of care that is being delivered. The resulting information about qualitative and quantitative parameters can then be assessed. Ultimately insights can be obtained into improving the quality of care in diabetes mellitus. The Diabetes Quality Improvement Programme in USA has shown such an exercise is feasible. A similar exercise in India is necessary to improve the quality of diabetes care.

Rao Allam; Sridhar Gumpeny

2007-01-01

31

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

Directory of Open Access Journals (Sweden)

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.

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

32

Experiences of Women With Physical Disabilities During the Perinatal Period: A Review of the Literature and Recommendations to Improve Care.  

UK PubMed Central (United Kingdom)

Although pregnancy and childbirth have significant identity and health implications for all women, perinatal research has focused primarily on nondisabled women. In this article, I provide a review of literature regarding the perinatal care experiences of women with physical disabilities. I found that many women with physical disabilities encounter attitudinal, informational, physical, and financial barriers during the perinatal period that contribute to poor care experiences and may subsequently affect health outcomes. In an effort to improve perinatal care experiences and outcomes, I offer recommendations to address the barriers identified in the literature, including increased disability content in medical school curricula.

Tarasoff LA

2013-07-01

33

Crossing the quality chasm in neonatal-perinatal medicine.  

UK PubMed Central (United Kingdom)

The "Quality Chasm" exists in neonatal intensive care. Despite years of clinical research in neonatology, therapies continue to be underused, overused, or misused. A key concept in crossing the quality chasm is system redesign. The unpredictability of human factors and the dynamic complexity of the neonatal ICU are not amenable to rigid reductionist control and redesign. Change is best accomplished in this complex adaptive system by use of simple rules: (1) general direction pointing, (2) prohibitions, (3) resource or permission providing. These rules create conditions for purposeful self-organizing behavior, allowing widespread natural experimentation, all focused on generating the desired outcome.

Ellsbury DL

2010-03-01

34

Crossing the quality chasm in neonatal-perinatal medicine.  

Science.gov (United States)

The "Quality Chasm" exists in neonatal intensive care. Despite years of clinical research in neonatology, therapies continue to be underused, overused, or misused. A key concept in crossing the quality chasm is system redesign. The unpredictability of human factors and the dynamic complexity of the neonatal ICU are not amenable to rigid reductionist control and redesign. Change is best accomplished in this complex adaptive system by use of simple rules: (1) general direction pointing, (2) prohibitions, (3) resource or permission providing. These rules create conditions for purposeful self-organizing behavior, allowing widespread natural experimentation, all focused on generating the desired outcome. PMID:20363444

Ellsbury, Dan L

2010-03-01

35

Global and cultural perinatal nursing research: improving clinical practice.  

UK PubMed Central (United Kingdom)

High-quality perinatal nursing care should be based on the best evidence including research findings, clinical expertise, and the preferences of women and their families. Principles of perinatal research initiatives are defined, with suggested research priorities designed to close current gaps in the micro and macro environments of perinatal nursing throughout the world. Nearly a decade ago, the following question was asked, "Where is the 'E' (evidence) in maternal child health?" Improving the quality and safety of perinatal nursing care for culturally diverse women globally is the primary goal of nurse researchers leading the future of perinatal healthcare.

Callister LC

2011-04-01

36

[Regionalised perinatal care in cases of cervical incompetence and imminent premature birth].  

UK PubMed Central (United Kingdom)

INTRODUCTION: Premature birth due to cervical incompetence is a major obstacle of perinatal medicine. While measures of prevention have been investigated, the mother should be transferred to a perinatal centre when delivery < 34 + 0 weeks is imminent. Delivery in the state of Hessein the large majority of case is performed by medically indicated CS: We evaluated the potential prolongation of gestation in relation to the level of the institute.Methods: In order to evaluate the influence of the level of the obstetrical institute on the prolongation of pregnancy we used the data set of the Hesse perinatal survey (HEPE) of the years 1990 ? 2009 (n = 449 933). A multivariate analysis excluding the confounders prematurity, IUGR,and maternal disease was performed to evaluate the relation of prolongation of gestation to the level of care.Results: Admissions with imminent premature birth due to cervical incompetence were identified in 6 892 cases. Overall prolongation until birth was 9.6 days. When the cervical incompetence was < 3 cm the difference between hospitals was not significant (12.7 vs. 13.1 d) days. With the cervix ? 3 cm the period after admission was merly 0.6 day in level I hospitals ? thus significantly lower than in perinatal centres (6.5 days).Conclusion: In order to achieve optimal conditions at birth for very premature newborns the organisation of perinatal care should aim at intrauterine transfer to a specialised perinatal unit.A precondition is a health system with an adequate structure of perinatal centres within 30 k min the case of obstetrical emergencies

Schmidt S; Misselwitz B

2011-08-01

37

The model of Palliative Care in the perinatal setting: a review of the literature.  

UK PubMed Central (United Kingdom)

BACKGROUND: The notion of Palliative Care (PC) in neonatal and perinatal medicine has largely developed in recent decades. Our aim was to systematically review the literature on this topic, summarise the evolution of care and, based on the available data, suggest a current standard for this type of care. METHODS: Data sources included Medline, the Cochrane Library, CINAHL, and the bibliographies of the papers retrieved. Articles focusing on neonatal/perinatal hospices or PC were included. A qualitative analysis of the content was performed, and data on the lead author, country, year, type of article or design, and direct and indirect subjects were obtained. RESULTS: Among the 1558 articles retrieved, we did not find a single quantitative empirical study. To study the evolution of the model of care, we ultimately included 101 studies, most of which were from the USA. Fifty of these were comments/reflections, and only 30 were classifiable as clinical studies (half of these were case reports). The analysis revealed a gradual conceptual evolution of the model, which includes the notions of family-centered care, comprehensive care (including bereavement) and early and integrative care (also including the antenatal period). A subset of 27 articles that made special mention of antenatal aspects showed a similar distribution. In this subset, the results of the four descriptive clinical studies showed that, in the context of specific programmes, a significant number of couples (between 37 and 87%) opted for PC and to continue with the pregnancy when the foetus has been diagnosed with a lethal illness. CONCLUSIONS: Despite the interest that PC has aroused in perinatal medicine, there are no evidence-based empirical studies to indicate the best model of care for this clinical setting. The very notion of PC has evolved to encompass perinatal PC, which includes, among other things, the idea of comprehensive care, and early and integrative care initiated antenatally.

Balaguer A; Martín-Ancel A; Ortigoza-Escobar D; Escribano J; Argemi J

2012-01-01

38

Identifying health care quality attributes.  

Science.gov (United States)

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

Ramsaran-Fowdar, Roshnee R

2005-01-01

39

Identifying health care quality attributes.  

UK PubMed Central (United Kingdom)

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

Ramsaran-Fowdar RR

2005-01-01

40

What factors predict differences in infant and perinatal mortality in primary care trusts in England? A prognostic model.  

UK PubMed Central (United Kingdom)

OBJECTIVE: To identify predictors of perinatal and infant mortality variations between primary care trusts (PCTs) and identify outlier trusts where outcomes were worse than expected. DESIGN: Prognostic multivariable mixed models attempting to explain observed variability between PCTs in perinatal and infant mortality. We used these predictive models to identify PCTs with higher than expected rates of either outcome. SETTING: All primary care trusts in England. Population For each PCT, data on the number of infant and perinatal deaths, ethnicity, deprivation, maternal age, PCT spending on maternal services, and "Spearhead" status. MAIN OUTCOME MEASURES: Rates of perinatal and infant mortality across PCTs. RESULTS: The final models for infant mortality and perinatal mortality included measures of deprivation, ethnicity, and maternal age. The final model for infant mortality explained 70% of the observed heterogeneity in outcome between PCTs. The final model for perinatal mortality explained 80.5% of the between-PCT heterogeneity. PCT spending on maternal services did not explain differences in observed events. Two PCTs had higher than expected rates of perinatal mortality. CONCLUSIONS: Social deprivation, ethnicity, and maternal age are important predictors of infant and perinatal mortality. Spearhead PCTs are performing in line with expectations given their levels of deprivation, ethnicity, and maternal age. Higher spending on maternity services using the current configuration of services may not reduce rates of infant and perinatal mortality.

Freemantle N; Wood J; Griffin C; Gill P; Calvert MJ; Shankar A; Chambers J; MacArthur C

2009-01-01

 
 
 
 
41

Perinatal assessment.  

UK PubMed Central (United Kingdom)

The role of the nurse in early recognition of risk factors in the perinatal period is very important. The author suggests that obstetrical units use a perinatal nursing team whose role would include the careful assessment of mother and infant for risk factors during the prenatal, intrapartal, and immediate neonatal periods. The perinatal assessment guide accompanying the text offers a comprehensive compilation of data to assist in the identification of perinatal risk factors. This guide will be useful for nurses working in obstetrical units and for nursing instructors teaching student nurses maternal-newborn nursing assessment.

Brodish MS

1981-01-01

42

Eliciting individual preferences for health care: a case study of perinatal care.  

UK PubMed Central (United Kingdom)

OBJECTIVE: To demonstrate how a discrete choice experiment (DCE) can be used to elicit individuals' preferences for health care and how these preferences can be incorporated into a cost-benefit analysis. METHODS: A DCE which elicited preferences for three perinatal services: specialist nurse appointments; home visits from a trained lay visitor; and home-help. Cost was included to obtain a monetary measure of the value that individuals place on the services. In total, 292 women who had previously participated in a randomized trial of alternative forms of pre-natal care were interviewed. RESULTS: The most preferred service configuration consisted of three nurse appointments and two home visits before birth and 4 h of home-help per week for the first 4 weeks after birth. On average, women are willing to pay $371 for this package. A package that excluded home-help was valued at $122 whilst provision of three nurse appointments only was valued at $97. The predicted uptake of the services ranged from 37% to 93% depending on the woman's experience with the service, whether or not it was her first child and her level of education. CONCLUSION: The willingness to pay values were much higher than the costs for nurse appointments, suggesting this service produces a net social benefit. The willingness to pay for the package including both the nurse appointments and home visits only just exceeded the costs of the package, suggesting there is a relatively high chance that this package produces a net social loss.

van der Pol M; Shiell A; Au F; Jonhston D; Tough S

2010-03-01

43

[Palliative care birth plan: a field of perinatal medicine to build].  

UK PubMed Central (United Kingdom)

Some couples may choose to continue the pregnancy unable to decide for termination of pregnancy. Such situations recently occurred in neonatology units and may lead to neonatal palliative care. Faced with all uncertainties inherent to medicine and the future of the baby, medical teams must inform parents of different possible outcome step by step. Consistency in the reflection and intentionality of the care is essential among all different stakeholders within the same health team to facilitate support of parents up to a possible fatal outcome. This issue in perinatal medicine seems to be to explore how caregivers can contribute in the construction of parenthood in a context of a palliative care birth plan.

Tosello B; Le Coz P; Payot A; Gire C; Einaudi MA

2013-04-01

44

Utilizing leadership to achieve high reliability in the delivery of perinatal care  

Directory of Open Access Journals (Sweden)

Full Text Available Carmen Parrotta,1 William Riley,1 Les Meredith21School of Public Health, University of Minnesota, Minneapolis, MN, 2Premier Insurance Management Services Inc, Charlotte, NC, USAAbstract: Highly reliable care requires standardization of clinical practices and is a prerequisite for patient safety. However, standardization in complex hospital settings is extremely difficult to attain and health care leaders are challenged to create care delivery processes that ensure patient safety. Moreover, once high reliability is achieved in a hospital unit, it must be maintained to avoid process deterioration. This case study examines an intervention to implement care bundles (a collection of evidence-based practices) in four hospitals to achieve standardized care in perinatal units. The results show different patterns in the rate and magnitude of change within the hospitals to achieve high reliability. The study is part of a larger nationwide study of 16 hospitals to improve perinatal safety. Based on the findings, we discuss the role of leadership for implementing and sustaining high reliability to ensure freedom from unintended injury.Keywords: care bundles, evidence-based practice, standardized care, process improvement

Parrotta C; Riley W; Meredith L

2012-01-01

45

An education program for nurses from referring hospitals in a perinatal regionalization system.  

UK PubMed Central (United Kingdom)

Administering high-quality perinatal care at a regional center involves more than providing in-center service. An outreach education program was developed for nurses in referring hospitals. The authors believe that through the carefully phased development of an outreach education program, quality perinatal care on all levels can be realized.

Ellenberger D; Kennedy AH; Chase C

1979-05-01

46

[Perinatal audit: the most important legal aspects].  

Science.gov (United States)

In The Netherlands a perinatal audit system is being prepared. Perinatal audit is seen as a powerful means of identifying substandard factors in perinatal care and of increasing the quality of care with better grounding. The proposed system does not raise insurmountable legal problems. However, certain legal aspects should be given specific attention. These aspects include the rights of patients with respect to privacy and information and the protection of health professionals against use of information from the audit system for reasons other than quality purposes. Legislation from other countries may inspire legislative developments in The Netherlands in this area. PMID:19192588

de Roode, R P; Legemaate, J

2008-12-13

47

[Polish Gynecologic Society guidelines on perinatal care and delivery management].  

UK PubMed Central (United Kingdom)

Recommendations concerning antenatal care and the management of labour were worked out in order to straighten basic standards of care in pregnancies near term. Problems with recognition of labour, indications for hospitalization and necessary procedures as well as principles of fetal monitoring during labour were discussed. In addition basic principles of induction and preinduction of labour, amniotomy and stimulation of uterine contractions and the management of different stages of labour were presented. The diagnostic criteria of prolonged, obstructed labour and intrauterine infection were shown. The necessity of adequate documentation of labour was emphasized.

Krzysztof C

2009-07-01

48

Specifying quality in health care.  

UK PubMed Central (United Kingdom)

Quality should be a central issue in the commissioning and provision of health care. This requires a systematic approach to defining and monitoring quality. Such an approach should address: quality characteristics such as efficiency, accessibility, effectiveness (which may conflict with each other); the several levels at which quality may be specified, from general (across all health care) to specific (particular conditions or patient groups); and the methods of quality monitoring which include documented policies, clinical audit, inspection visits/patient surveys, and routine information returns. Shows how a matrix for quality surveillance can be devised which provides a framework for purchasers and providers to work together in developing quality in health care.

Bull A

1994-01-01

49

The role of a community-based satellite clinic in the perinatal care of non-English-speaking immigrants.  

UK PubMed Central (United Kingdom)

In the provision of health care to non-English-speaking immigrants, cultural and linguistic barriers often deter both access to and use of needed services. This is especially true of the preventive health interventions such as perinatal care and family planning that contribute significantly to reproductive health. Alternative approaches to overcoming barriers to care are being taken in an urban health department clinic serving as a satellite perinatal resource to a group of low-income Chinese-speaking immigrants. The clinic, with service linkages to San Francisco General Hospital Medical Center and the Health Department of San Francisco City and County, is an example of culturally appropriate comprehensive perinatal care. Such an institution has helped recent immigrants adapt to their new environment and learn to use health services effectively.

Minkler DH

1983-12-01

50

Evidence for perinatal and child health care guidelines in crisis settings: can Cochrane help?  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Background It is important that healthcare provided in crisis settings is based on the best available research evidence. We reviewed guidelines for child and perinatal health care in crisis situations to determine whether they were based on research evidence, whether Cochrane systematic reviews were available in the clinical areas addressed by these guidelines and whether summaries of these reviews were provided in Evidence Aid. Methods Broad internet searches were undertaken to identify relevant guidelines. Guidelines were appraised using AGREE and the clinical areas that were relevant to perinatal or child health were extracted. We searched The Cochrane Database of Systematic Reviews to identify potentially relevant reviews. For each review we determined how many trials were included, and how many were conducted in resource-limited settings. Results Six guidelines met selection criteria. None of the included guidelines were clearly based on research evidence. 198 Cochrane reviews were potentially relevant to the guidelines. These reviews predominantly addressed nutrient supplementation, breastfeeding, malaria, maternal hypertension, premature labour and prevention of HIV transmission. Most reviews included studies from developing settings. However for large portions of the guidelines, particularly health services delivery, there were no relevant reviews. Only 18 (9.1%) reviews have summaries in Evidence Aid. Conclusions We did not identify any evidence-based guidelines for perinatal and child health care in disaster settings. We found many Cochrane reviews that could contribute to the evidence-base supporting future guidelines. However there are important issues to be addressed in terms of the relevance of the available reviews and increasing the number of reviews addressing health care delivery.

Turner Tari J; Barnes Hayley; Reid Jane; Garrubba Marie

2010-01-01

51

Stepped care for maternal mental health: a case study of the perinatal mental health project in South Africa.  

UK PubMed Central (United Kingdom)

As one article in a series on Global Mental Health Practice, Simone Honikman and colleagues from South Africa provide a case study of the Perinatal Mental Health Project, which delivered mental health care to pregnant women in a collaborative, step-wise manner, making use of existing resources in primary care.

Honikman S; van Heyningen T; Field S; Baron E; Tomlinson M

2012-01-01

52

The Role of a Community-Based Satellite Clinic in the Perinatal Care of Non-English-Speaking Immigrants  

Digital Repository Infrastructure Vision for European Research (DRIVER)

In the provision of health care to non-English-speaking immigrants, cultural and linguistic barriers often deter both access to and use of needed services. This is especially true of the preventive health interventions such as perinatal care and family planning that contribute significantly to repro...

Minkler, Donald H.

53

JAMA Patient Page: Quality of Care  

Science.gov (United States)

... of the American Medical Association JAMA PATIENT PAGE Quality of Care H ealth care quality means that patients receive ... prevent wound infections after surgery. IMPROVE YOUR OWN QUALITY OF CARE Improving communication in health care means that patients ...

54

[Recommendations of Polish Gynecological Society concerning perinatal care in obese pregnant women].  

UK PubMed Central (United Kingdom)

Maternal obesity (defined as prepregnancy maternal BMI> or = 30 kg/m2) is a risk factor strongly associated with serious perinatal complications and its prevalence has increased rapidly in a general population during the last decades. Therefore, following international approach to regulate perinatal care in this population, Group of Experts of Polish Gynecological Society developed these new guidelines concerning perinatal care in obese pregnant women, including women after bariatric surgery. The recommendations cover detailed information on specific needs and risks associated with obesity in women of reproductive age, pregnancy planning, antenatal care, screening, prophylaxis and treatment for other pregnancy complications characteristic for maternal obesity fetal surveillance, intrapartum care and post-partum follow-up. Pregnancy planning in these patients should involve dietary recommendations aiming at well balanced diet and daily caloric uptake below 2000 kcal and modest but regular physical activity with sessions every two days starting from 15 min and increased gradually to 40 min. Laboratory work-up should include tests recommended in general population plus fasting glycemia and oral glucose tolerance if necessary thyroid function, lipidprofile, blood pressure and ECG. Patients after bariatric surgery should allow at least one year before they conceive and have their diet fortified with iron, folic acid, calcium and vit. B12. Antenatal care should include monitoring body weight gain with a target increase in body weight less than 7 kg, thromboprophylaxis, strict monitoring of blood pressure and diagnostic for gestational diabetes in early pregnancy. Fetal ultrasonic scans should be arranged following protocols recommended by US section of Polish Gynaecological Society with additional scan assessing fetal growth performed within 7 days before delivery and aiming at assessing a risk for shoulder dystocia in a patient. Intrapartum care should be delivered in referral centers where fetal and maternal intrapartum complications can be addressed, preferably equipped with a proper medical equipment necessary to deal safely with extremely heavy individuals. Medical staff taking intrapartum care for obese parturient should be also aware of reduced reliability of methods used for intrapartum fetal surveillance, increased risk for intrapartum fetal death, maternal injuries, postpartum haemorrhage, shoulder dystocia, thrombophlebitis and infection. Pediatrician should be also available due to increased neonatal morbidity mainly due to meconium aspiration syndrome, hypoglycemia, and respiratory distress syndrome. In puerperium, medical staff should be prepared to deal with breastfeeding disturbances and increased maternal mortality.

Wender-Ozegowska E; Bomba-Opo? D; Brazert J; Celewicz Z; Czajkowski K; Karowicz-Bili?ska A; Malinowska-Polubiec A; Meczekalski B; Zawiejska A

2012-10-01

55

[Recommendations of Polish Gynecological Society concerning perinatal care in obese pregnant women].  

Science.gov (United States)

Maternal obesity (defined as prepregnancy maternal BMI> or = 30 kg/m2) is a risk factor strongly associated with serious perinatal complications and its prevalence has increased rapidly in a general population during the last decades. Therefore, following international approach to regulate perinatal care in this population, Group of Experts of Polish Gynecological Society developed these new guidelines concerning perinatal care in obese pregnant women, including women after bariatric surgery. The recommendations cover detailed information on specific needs and risks associated with obesity in women of reproductive age, pregnancy planning, antenatal care, screening, prophylaxis and treatment for other pregnancy complications characteristic for maternal obesity fetal surveillance, intrapartum care and post-partum follow-up. Pregnancy planning in these patients should involve dietary recommendations aiming at well balanced diet and daily caloric uptake below 2000 kcal and modest but regular physical activity with sessions every two days starting from 15 min and increased gradually to 40 min. Laboratory work-up should include tests recommended in general population plus fasting glycemia and oral glucose tolerance if necessary thyroid function, lipidprofile, blood pressure and ECG. Patients after bariatric surgery should allow at least one year before they conceive and have their diet fortified with iron, folic acid, calcium and vit. B12. Antenatal care should include monitoring body weight gain with a target increase in body weight less than 7 kg, thromboprophylaxis, strict monitoring of blood pressure and diagnostic for gestational diabetes in early pregnancy. Fetal ultrasonic scans should be arranged following protocols recommended by US section of Polish Gynaecological Society with additional scan assessing fetal growth performed within 7 days before delivery and aiming at assessing a risk for shoulder dystocia in a patient. Intrapartum care should be delivered in referral centers where fetal and maternal intrapartum complications can be addressed, preferably equipped with a proper medical equipment necessary to deal safely with extremely heavy individuals. Medical staff taking intrapartum care for obese parturient should be also aware of reduced reliability of methods used for intrapartum fetal surveillance, increased risk for intrapartum fetal death, maternal injuries, postpartum haemorrhage, shoulder dystocia, thrombophlebitis and infection. Pediatrician should be also available due to increased neonatal morbidity mainly due to meconium aspiration syndrome, hypoglycemia, and respiratory distress syndrome. In puerperium, medical staff should be prepared to deal with breastfeeding disturbances and increased maternal mortality. PMID:23383569

Wender-Ozegowska, Ewa; Bomba-Opo?, Dorota; Brazert, Jacek; Celewicz, Zbigniew; Czajkowski, Krzysztof; Karowicz-Bili?ska, Agata; Malinowska-Polubiec, Aneta; Meczekalski, B?azej; Zawiejska, Agnieszka

2012-10-01

56

Perinatal risk factors and neonatal complications in discordant twins admitted to the neonatal intensive care unit.  

UK PubMed Central (United Kingdom)

BACKGROUND: Many studies have shown a relationship between birth weight discordance and adverse perinatal outcomes. This study aimed to investigate the perinatal risk factors and neonatal complications of discordant twins who are admitted to the neonatal intensive care unit. METHODS: A total of 87 sets of twins were enrolled in this retrospective study, of which 22 sets were discordant twins and 65 sets were concordant twins. Binary Logistic regression analysis was used to identify the risk factors associated with the occurrence of discordant twins. The common neonatal complications of discordant twins were also investigated. RESULTS: Multivariate analysis showed that the use of assisted reproductive techniques, pregnancy-induced hypertension, and unequal placental sharing were risk factors for the occurrence of discordant twins. The incidence of small for gestational age infants and very low birth weight infants of discordant twins was significantly higher, while the birth weight of discordant twins was significantly lower than those of concordant twins. The duration of hospitalization of discordant twins was longer than that of concordant twins. The incidence of several neonatal complications, such as neonatal respiratory distress syndrome and intracranial hemorrhage, was higher in discordant twins than that in concordant twins. The percentage of those requiring pulmonary surfactant and mechanical ventilation was significantly higher in discordant twins than that in concordant twins. CONCLUSIONS: Use of assisted reproductive techniques, pregnancy-induced hypertension, and unequal placental sharing are perinatal risk factors of discordant twins who are admitted to the neonatal intensive care unit. These infants are also much more likely to suffer from various neonatal complications, especially respiratory and central nervous system diseases. It is important to prevent the occurrence of discordant twins by decreasing these risk factors and timely treatment should be given to discordant twins.

Zhang XR; Liu J; Zeng CM

2013-03-01

57

[Quality management in palliative care].  

UK PubMed Central (United Kingdom)

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

Cottier C

2012-02-01

58

[Quality management in palliative care].  

Science.gov (United States)

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

Cottier, Christoph

2012-02-01

59

Perinatal outcomes of low-risk planned home and hospital births under midwife-led care in Japan.  

UK PubMed Central (United Kingdom)

AIM: It has not been extensively studied whether planned home and planned hospital births under primary midwife-led care increase risk of adverse events among low-risk women in Japan. METHODS: A retrospective cohort study was performed to compare perinatal outcome between 291 women who were given primary midwife-led care during labor and 217 women who were given standard obstetric shared care. Among 291 women with primary midwife-led care, 168 and 123 chose home deliver and hospital delivery, respectively. Perinatal outcomes included length of labor of 24?h or more, augmentation of labor pains, delivery mode, severe perineal laceration, postpartum hemorrhage of 1000?mL or more, maternal fever of 38°C or more and neonatal asphyxia (Apgar score, <7). Analysis was by intention to treat. RESULTS: The incidence of transfer from primary midwife-led care to obstetric shared care was 27% (77 women) mainly due to failure of labor progress (21%, 16 women), postpartum hemorrhage (19%, 15 women) and non-reassuring fetal status (19%, 15 women). Significantly higher incidence of transfer to obstetric shared care from primary midwife-led care was seen among women who chose hospital delivery compared with women who chose home delivery (34 vs 21%, P?=?0.011). There were no significant differences in the incidence of adverse perinatal outcomes between women with obstetric shared care and women with primary midwife-led care (regardless of being hospital delivery or home delivery). CONCLUSION: Approximately one-quarter of low-risk women with primary midwife-led care required obstetric care during labor or postpartum. However, primary midwife-led care during labor at home and hospital for low-risk pregnant women was not associated with adverse perinatal outcomes in Japan.

Hiraizumi Y; Suzuki S

2013-07-01

60

Exploring the perceptions and the role of genetic counselors in the emerging field of perinatal palliative care.  

UK PubMed Central (United Kingdom)

Perinatal palliative care is a collaborative model of providing care to fetuses diagnosed with life-limiting conditions along with supportive care to parents. The study explored perceptions and current practice trends of genetic counselors related to this care. An ethics framework was used to structure the study. This cross-sectional, mixed method study was conducted to illuminate perceptions, practice barriers, familiarity with perinatal palliative care, clinician comfort, and referral comfort. The Perinatal Palliative Care Perceptions and Barriers Scale was self-administered online to 212 genetic counselors. Hierarchical multiple regression, used to test the hypothesis that perceptions, barriers to PPC, years of experience, personal comfort and prior familiarity with PPC explain variation in comfort of referral to PPC, yielded a significant overall R (2) of .51. These findings are the first data describing genetic counselors' perspectives and some of the factors contributing to referral comfort. Genetic counselors broadly endorsed the importance of palliative care concepts. They varied in their comfort with referral practices in ways that may be mitigated by increasing their familiarity with this evolving model of care.

Wool C; Dudek M

2013-08-01

 
 
 
 
61

Exploring the perceptions and the role of genetic counselors in the emerging field of perinatal palliative care.  

Science.gov (United States)

Perinatal palliative care is a collaborative model of providing care to fetuses diagnosed with life-limiting conditions along with supportive care to parents. The study explored perceptions and current practice trends of genetic counselors related to this care. An ethics framework was used to structure the study. This cross-sectional, mixed method study was conducted to illuminate perceptions, practice barriers, familiarity with perinatal palliative care, clinician comfort, and referral comfort. The Perinatal Palliative Care Perceptions and Barriers Scale was self-administered online to 212 genetic counselors. Hierarchical multiple regression, used to test the hypothesis that perceptions, barriers to PPC, years of experience, personal comfort and prior familiarity with PPC explain variation in comfort of referral to PPC, yielded a significant overall R (2) of .51. These findings are the first data describing genetic counselors' perspectives and some of the factors contributing to referral comfort. Genetic counselors broadly endorsed the importance of palliative care concepts. They varied in their comfort with referral practices in ways that may be mitigated by increasing their familiarity with this evolving model of care. PMID:23595167

Wool, Charlotte; Dudek, Martha

2013-04-18

62

Stepped Care for Maternal Mental Health: A Case Study of the Perinatal Mental Health Project in South Africa  

Digital Repository Infrastructure Vision for European Research (DRIVER)

As one article in a series on Global Mental Health Practice, Simone Honikman and colleagues from South Africa provide a case study of the Perinatal Mental Health Project, which delivered mental health care to pregnant women in a collaborative, step-wise manner, making use of existing resources in pr...

Honikman, Simone; van Heyningen, Thandi; Field, Sally; Baron, Emily; Tomlinson, Mark

63

Perceived quality health care  

Directory of Open Access Journals (Sweden)

Full Text Available Placement in an intensive care unit (ICU), means asituation of stress-anxiety, fear and insecurity, boththe patient and his family. At admission prioritizeshealth care, neglecting the care of relatives, relativeshaving anxiety and disruption of family processes.This aspect is worsening, with the architecturalstructure of the units and the restriction of visitinghours, which allows to maintain some physicalcontact, emotional and communication betweenpatients and health professionals with family, needspecial attention when planning interventionsNursing the promotion of communication (NIC4976) and encouraging the involvement /participation of the family (NIC 7110) in order tooptimize the perception / user involvement / familyin the process, through improved communication(NOC 0902).

GALLARDO JIMÉNEZ NURIA.; NAJARRO INFANTE FRANCISCO-ROMÁN.; DULCE GARCÍA MIGUEL ANGEL.; PÉREZ FERNÁNDEZ M.CARMEN.; FERNÁNDEZ FERNÁNDEZ ADELA.

2009-01-01

64

Helping You Choose Quality Behavioral Health Care  

Science.gov (United States)

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

65

Quality management in managed care.  

UK PubMed Central (United Kingdom)

Managed care creates a corporate environment in which competitiveness demands close attention to quality. Although the health care sector may benefit from solutions derived in other industries, it attaches unique importance to noneconomic, intangible factors. Adequate cost-utility analysis must take such factors into account instead of relying on artificial numerical values.

Reinke WA

1995-10-01

66

The quality of caring relationships  

Directory of Open Access Journals (Sweden)

Full Text Available Tineke A Abma, Barth Oeseburg, Guy AM Widdershoven, Marian VerkerkMedical Humanities/EMGO Institute, VU Medical Center, Amsterdam, The NetherlandsAbstract: In health care, relationships between patients or disabled persons and professionals are at least co-constitutive for the quality of care. Many patients complain about the contacts and communication with caregivers and other professionals. From a care-ethical perspective a good patient-professional relationship requires a process of negotiation and shared understanding about mutual normative expectations. Mismatches between these expectations will lead to misunderstandings or conflicts. If caregivers listen to the narratives of identity of patients, and engage in a deliberative dialogue, they will better be able to attune their care to the needs of patients. We will illustrate this with the stories of three women with multiple sclerosis. Their narratives of identity differ from the narratives that caregivers and others use to understand and identify them. Since identities give rise to normative expectations in all three cases there is a conflict between what the women expect of their caregivers and vice-versa. These stories show that the quality of care, defined as doing the right thing, at the right time, in the right way, for the right person, is dependent on the quality of caring relationships.Keywords: ethics of care, dialogue, responsibilities, narratives, relationships

Tineke A Abma; Barth Oeseburg; Guy AM Widdershoven; Marian Verkerk

2009-01-01

67

Development and Validation of Detailed Clinical Models for Nursing Problems in Perinatal care.  

UK PubMed Central (United Kingdom)

OBJECTIVES: The aims of this study were to develop detailed clinical models (DCMs) for nursing problems related to perinatal care and to test the applicability of these detailed clinical models. METHODS: First, we extracted entities of nursing problems by analyzing nursing-problem statements from nursing records, reviewing the literature, and interviewing nurse experts. Second, we extracted attributes and possible values needed to describe the entities in more detail by again analyzing nursing statements, reviewing the literature, and consulting nurse experts. Third, DCMs were modeled by linking each entity with possible attributes with value sets and optionalities. Fourth, entities, attributes and value sets in the DCMs were mapped to the International Classification for Nursing Practice (ICNP) version 2. Finally, DCMs were validated by consulting a group of experts and by applying them to real clinical data and nursing care scenarios published in the literature. The adequacy of the entities, attributes, value sets, and optionalities of the attributes were validated. RESULTS: Fifty-eight entities were identified, 41 entities from nursing records, 12 entities from literature review and 5 entities from nurse experts. Sixty-five attributes with values were identified, 25 attributes from nursing records, 34 attributes from literature review, and 6 attributes from nurse experts. In total 58 DCMs were developed and validated. CONCLUSIONS: The DCMs developed in this study can ensure that electronic health records contain meaningful and valid information, and support the semantic interoperability of nursing information.

Kim Y; Park HA

2011-01-01

68

Monitoring Quality of Nursing Care  

Digital Repository Infrastructure Vision for European Research (DRIVER)

The first phase of a cooperative project to develop and pilot-test an improved system for monitoring the quality of nursing care is described. Evaluation criteria from existing methodologies were grouped in a comprehensive framework of nursing objectives and subobjectives, and both the framework and...

Haussmann, R. K. Dieter; Hegyvary, Sue Thomas; Newman, John F.; Bishop, Annelle C.

69

Utility of qualitative methods in a clinical setting: perinatal care in the Western Province.  

UK PubMed Central (United Kingdom)

OBJECTIVE: A peculiar paradox that has been observed in previous studies of antenatal care is where patients are satisfied with the services despite obvious lack of basic facilities. Qualitative methods were used to describe the experience of perinatal care in the Western province with the objective of demonstrating application of this method in a clinical setting. METHODS: This paper used a 'naturalistic' approach of qualitative methods. In-depth interviews conducted with 20 postnatal mothers delivering in tertiary care institutions in the Western province was tape recorded, transcribed and content analysed. To ensure objectivity and validity of results, the principle investigator received only the anonymised data to prevent any prejudices or pre-conceptions affecting the results. RESULTS: The main themes emerging from the text demonstrated 'naïve trust' in the carer and a state of 'hero worship' where patients were distanced and therefore unable and unwilling to query the decisions made by the carers. This is similar to a state of patient-carer relationship described in a published model known as guarded alliance, where the relationship develops though four phases based on the level of trust and confidence in the relationship. This state explains not only why patients fail to recognise and report any deficiencies in the services but also the need for them to justify the behaviour of caregivers even when it amounts to incompetence and negligence. CONCLUSIONS: Qualitative methods allow the researcher to capture experiences in its 'natural' form rather than based on pre-determined protocols or plans, which may be limited to our own understanding and expectations and therefore unable to explain many idiosyncrasies of the programmes. This paper argues favourably for the use of qualitative methods in other clinical settings.

Jayasuriya V

2012-03-01

70

Systematic reviews and health policy: the influence of a project on perinatal care since 1988.  

UK PubMed Central (United Kingdom)

CONTEXT: Interrelated publications between 1988 and 1992 have influenced health policy and clinical practice: The Oxford Database of Perinatal Trials (ODPT), Effective Care in Pregnancy and Childbirth (ECPC), A Guide to Effective Care in Pregnancy and Childbirth (GECPC), and Effective Care of the Newborn Infant (ECNI). These publications applied and advanced methods that had a substantial history in the medical, biological, physical, and social sciences. Their unique contribution was to demonstrate the feasibility of organizing and sustaining programs to conduct systematic reviews across an entire field of health care. The publications also influenced subsequent advances in the methodology of systematic reviews and contributed to their proliferation; in large measure, but not entirely, because their editors and many of the authors participated in organizing and developing the Cochrane Collaboration. This article describes how and why these publications attracted favorable attention and resources from policymakers in numerous countries. METHODS: This article applies historical methods to the analysis of primary sources that help explain the influence of systematic reviews, mainly on health policy. These methods guide an analysis of the rhetoric of the two volumes of ECPC and of primary sources generated as systematic reviews influenced health policy. The analysis of rhetoric employs the methods of intellectual history and social studies of science. The analysis of policymaking uses the methods of political and policy history, political science, and public administration. Because the focus of this article is how science influenced policy it alludes to but does not describe in detail the literature on the methods, production, and publication of systematic reviews. FINDINGS: The influence of the four publications on policy was mainly a result of (1) their powerful blending of the rhetoric of scientific and polemical discourse, especially but not exclusively in ECPC; (2) a growing constituency for systematic reviews as a source of "evidence-based" health care among clinicians, journalists, and consumers in many countries; and (3) recognition by significant policymakers who allocate resources to and within the health sector that systematic reviews could contribute to making health care more effective and to containing the growth of costs. CONCLUSIONS: Analysis of this aspect of the history of producing and applying systematic reviews informs understanding of how knowledge derived from research informs policy.

Fox DM

2011-09-01

71

Behaviour change in perinatal care practices among rural women exposed to a women's group intervention in Nepal [ISRCTN31137309  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Background A randomised controlled trial of participatory women's groups in rural Nepal previously showed reductions in maternal and newborn mortality. In addition to the outcome data we also collected previously unreported information from the subgroup of women who had been pregnant prior to study commencement and conceived during the trial period. To determine the mechanisms via which the intervention worked we here examine the changes in perinatal care of these women. In particular we use the information to study factors affecting positive behaviour change in pregnancy, childbirth and newborn care. Methods Women's groups focusing on perinatal care were introduced into 12 of 24 study clusters (average cluster population 7000). A total of 5400 women of reproductive age enrolled in the trial had previously been pregnant and conceived during the trial period. For each of four outcomes (attendance at antenatal care; use of a boiled blade to cut the cord; appropriate dressing of the cord; not discarding colostrum) each of these women was classified as BETTER, GOOD, BAD or WORSE to describe whether and how she changed her pre-trial practice. Multilevel multinomial models were used to identify women most responsive to intervention. Results Among those not initially following good practice, women in intervention areas were significantly more likely to do so later for all four outcomes (OR 1.92 to 3.13). Within intervention clusters, women who attended groups were more likely to show a positive change than non-group members with regard to antenatal care utilisation and not discarding colostrum, but non-group members also benefited. Conclusion Women's groups promoted significant behaviour change for perinatal care amongst women not previously following good practice. Positive changes attributable to intervention were not restricted to specific demographic subgroups.

Wade Angie; Osrin David; Shrestha Bhim; Sen Aman; Morrison Joanna; Tumbahangphe Kirti; Manandhar Dharma S; de L Costello Anthony M

2006-01-01

72

Correlation of neonatal intensive care unit performance across multiple measures of quality of care.  

UK PubMed Central (United Kingdom)

OBJECTIVES: To examine whether high performance on one measure of quality is associated with high performance on others and to develop a data-driven explanatory model of neonatal intensive care unit (NICU) performance. DESIGN: We conducted a cross-sectional data analysis of a statewide perinatal care database. Risk-adjusted NICU ranks were computed for each of 8 measures of quality selected based on expert input. Correlations across measures were tested using the Pearson correlation coefficient. Exploratory factor analysis was used to determine whether underlying factors were driving the correlations. SETTING: Twenty-two regional NICUs in California. PATIENTS: In total, 5445 very low-birth-weight infants cared for between January 1, 2004, and December 31, 2007. MAIN OUTCOMES MEASURES: Pneumothorax, growth velocity, health care-associated infection, antenatal corticosteroid use, hypothermia during the first hour of life, chronic lung disease, mortality in the NICU, and discharge on any human breast milk. RESULTS: The NICUs varied substantially in their clinical performance across measures of quality. Of 28 unit-level correlations, 6 were significant (? < .05). Correlations between pairs of measures of quality of care were strong (? ? .5) for 1 pair, moderate (range, ? ? .3 to ? < .5) for 8 pairs, weak (range, ? ? .1 to ? < .3) for 5 pairs, and negligible (? < .1) for 14 pairs. Exploratory factor analysis revealed 4 underlying factors of quality in this sample. Pneumothorax, mortality in the NICU, and antenatal corticosteroid use loaded on factor 1; growth velocity and health care-associated infection loaded on factor 2; chronic lung disease loaded on factor 3; and discharge on any human breast milk loaded on factor 4. CONCLUSION: In this sample, the ability of individual measures of quality to explain overall quality of neonatal intensive care was modest.

Profit J; Zupancic JA; Gould JB; Pietz K; Kowalkowski MA; Draper D; Hysong SJ; Petersen LA

2013-01-01

73

Quality assurance in the health care industry.  

Science.gov (United States)

The purpose of this article is to explore the quality assurance methods commonly used in the health care industry. Factors that influence the delivery of quality patient care is explored as well as factors that affect implementation of quality control measures. The importance of quality patient care to the economic success of the health care industry is described. Quality improvement efforts that are utilized by health care institutions are described including: independent performance audits, internal audits, outcomes analysis, consumer reports, industry guidelines, and consumer satisfaction surveys. Highly effective hospital managers exhibit management roles, behaviors, and a range of activities that correlate strongly to institutional commitment to quality and improved patient care outcomes. By reinforcing their involvement in quality improvement efforts, hospital managers were able to enhance their effectiveness in promoting and sustaining quality care. PMID:16080413

Guth, Kim Ann; Kleiner, Brian

2005-01-01

74

Quality assurance in the health care industry.  

UK PubMed Central (United Kingdom)

The purpose of this article is to explore the quality assurance methods commonly used in the health care industry. Factors that influence the delivery of quality patient care is explored as well as factors that affect implementation of quality control measures. The importance of quality patient care to the economic success of the health care industry is described. Quality improvement efforts that are utilized by health care institutions are described including: independent performance audits, internal audits, outcomes analysis, consumer reports, industry guidelines, and consumer satisfaction surveys. Highly effective hospital managers exhibit management roles, behaviors, and a range of activities that correlate strongly to institutional commitment to quality and improved patient care outcomes. By reinforcing their involvement in quality improvement efforts, hospital managers were able to enhance their effectiveness in promoting and sustaining quality care.

Guth KA; Kleiner B

2005-01-01

75

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

Directory of Open Access Journals (Sweden)

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.

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

2003-01-01

76

[Perinatal care in the Czech Republic in 1997 and prospects for the near future--I. Nationwide analysis  

UK PubMed Central (United Kingdom)

From an analysis of the four main components of perinatal mortality, participating in its gradual decline to the value of 5.1/1000 in 1997 ensued that the ratio of three of them, i.e. inborn defects incompatible with life, stillborn neonates with a birth weight of 2000 g or more and neonates with birth weight of 1000 g or more who die after delivery, declined in recent years only minimally despite the use of expensive diagnostic and therapeutic procedures, incl. the increased rate of Caesarean sections. A continual decline of morbidity was noted only in neonates weighing less than 1000 g due to the high percentage taken before delivery to perinatological centres and due to the marked decline of specific early neonatal mortality of these neonates in some of these centres. Improvement of this care in other centres is a reserve for a further decline of the perinatal mortality but only of the order of tenths pro mille. Therefore in future it will be necessary to change priorities and focus them on the effectiveness but also usefulness of expansive diagnostic and preventive and therapeutic procedures and on the long-term follow up of all risk neonates with the objective of early assessment and subsequent prevention of their perinatal morbidity.

Stembera Z; Velebil P

1999-06-01

77

Maternal anaemia and its impact on perinatal outcome in a tertiary care hospital in Pakistan.  

UK PubMed Central (United Kingdom)

Maternal anaemia is a common problem in pregnancy, particularly in developing countries. We investigated the relationship between maternal anaemia and perinatal outcome in a cohort of 629 pregnant women from October 2001 to 2002. Of these, 313 were anaemic (haemoglobin < 11 g/L). Perinatal outcomes included preterm delivery, low birth weight, intrauterine growth retardation, perinatal death, low Apgar scores and intrauterine fetal death. Univariate and multivariate analyses were performed. The risk of preterm delivery and low birth weight among the anaemic women was 4 and 1.9 times more respectively than the non-anaemic women. The neonates of anaemic women also had 1.8 times increased risk having low Apgar scores at 1 minute and there was a 3.7 greater risk of intrauterine fetal death among the anaemic women than the non-anaemic women.

Lone FW; Qureshi RN; Emmanuel F

2004-11-01

78

[Coverage and quality of the registration of perinatal deaths occurring in health institutions in the Federal District  

UK PubMed Central (United Kingdom)

"This paper presents the results of the first direct attempt at evaluating the coverage of the perinatal death registration in the Distrito Federal [of Mexico]; this study is based on the information gathered from 574 deaths which took place in 23 hospitals in the Distrito Federal during a three month period in 1984. Both the causes of the failure to register many of these deaths and the quality of the information presented in perinatal death certificates are pointed out and discussed here. According to the evidence analyzed, it is clear that underregistration in the Distrito Federal is extremely marked.... The paper suggests the possibility of establishing a hospital registration system which would keep a record of both deaths and births. It also stresses the need for establishing rules to detect fetal deaths plus the need for unifying criteria regarding the definition of 'live birth'." (SUMMARY IN ENG)

Bobadilla JL; Ceron P; Coria I

1987-05-01

79

[Quality management in intensive care medicine].  

Science.gov (United States)

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

Martin, J; Braun, J-P

2013-09-01

80

[Quality management in intensive care medicine].  

UK PubMed Central (United Kingdom)

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

Martin J; Braun JP

2013-09-01

 
 
 
 
81

[Quality management in intensive care medicine.  

UK PubMed Central (United Kingdom)

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

Martin J; Braun JP

2013-07-01

82

Commentary: Measuring Quality of Care in Osteoporosis.  

UK PubMed Central (United Kingdom)

We know improving the quality of care in osteoporosis is an important goal. We have made some strides toward measuring quality of osteoporosis care, focusing on process measures regarding care that is provided. Unfortunately, improving care as measured by these process measures does not always yield improved outcomes. We need to hold health care providers and health care systems responsible not only for health care production but for production of health and well-being. However, there is a multiplicity of factors that will need to be considered to make this next step.

Silverman SL; Curtis J

2013-10-01

83

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  

Scientific Electronic Library Online (English)

Full Text Available Abstract in portuguese 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 quin (more) to 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. Abstract in english 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 importan (more) t 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.

Magalhães, Maria da Consolação; Carvalho, Marilia Sá

2003-09-01

84

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

Directory of Open Access Journals (Sweden)

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

Kidanto Hussein L; Mogren Ingrid; van Roosmalen Jos; Thomas Angela N; Massawe Siriel N; Nystrom Lennarth; Lindmark Gunilla

2009-01-01

85

Quality in health care and ethical principles.  

Science.gov (United States)

Quality in health care and ethical principles The last three decades have seen rapid changes in the way United States of America (USA) health care has been delivered, financed and regulated. Four major stakeholders have emerged in the health care debate: patients, providers, payers and public regulatory agencies. These groups do not agree on a definition of quality health care. This paper suggests five ethical principles - autonomy, justice, beneficence, non-maleficence, and prudence - be included in the framework of quality health care. A framework that outlines possible relationships among these ethical attributes and four major stakeholders is presented. PMID:11012797

Huycke, L; All, A C

2000-09-01

86

Transforming quality of care in North Carolina.  

UK PubMed Central (United Kingdom)

North Carolina is entering a period of transformative change in health care, as health system consolidation, health care reform, and payment reform combine to dramatically reshape health care. In this turbulent time, maintaining focus on quality of care will be critical. North Carolina has been a national leader in efforts to improve quality of care, starting from classic research in the 1950s on the measurement of quality and culminating in major statewide efforts to improve care through the North Carolina Area Health Education Centers Program, Community Care of North Carolina, the North Carolina Hospital Association, Medicaid, Blue Cross and Blue Shield of North Carolina, academic centers, and many other partners. The purpose of this issue of the NCMJ is to highlight initiatives to improve quality across the continuum of care and across the state. This overview puts these initiatives in context and addresses 3 fundamental questions: Can quality of care be measured and improved? What does the landscape of quality in North Carolina look like now? What should North Carolina's priorities be for improving quality of care moving forward?

Newton W; Bradley D

2013-03-01

87

NCI Community Cancer Centers Program - Pilot Subcommittees - Quality of Care  

Science.gov (United States)

The issue of quality of care involves many different components, including what cancer care quality looks like, which patients are more likely to receive poor quality care, and ways to measure healthcare quality.

88

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

Science.gov (United States)

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

Child Trends, 2010

2010-01-01

89

Protecting Quality under Medicaid Managed Care  

Directory of Open Access Journals (Sweden)

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

Booth, Maureen

1997-01-01

90

[Prognosis of the level of perinatal care in the Czech Republic in near future II. From the World Health Organization point of view].  

UK PubMed Central (United Kingdom)

AIM OF THE STUDY: Evaluation of performance according to Goals of the WHO Project Health for All 21 in the Czech Republic. STUDY DESIGN: Comparative study of the WHO recommendations and the situation in the Czech Republic. SETTING: Institute for the Care of Mother and Child, Prague-Podoli. METHODS: Comparison of completion of 4 out of 21 Goals of the WHO Project Health for All 21 related to perinatal care in the Czech Republic. RESULTS: After experience with the WHO Project HFA 2000 for Europe (introduced in late 70s) consisting of 38 goals for particular fields of medicine to be achieved by the end of 2000 (adapted in 1992), the WHO Project HFA 21 with 21 Goals to be achieved by 2020 was introduced. While in relation to the Project HFA 2000 the Czech Republic analyzed the situation in 1993 without application of individual goals into the health care system, in 2003 the group of experts prepared "Recommendation for achievements of the Goals" of the WHO Project HFA 21. In 4 goals related to perinatal care, the recommendation postulated the ways and timeline and responsibilities in effort to accomplish these tasks. The evaluation of achievements by the year 2009 is attached. In the Goal 3, related to indicators of perinatal care, we have accomplish the decrease of perinatal mortality and the Czech Republic got among countries with the best results. On contrary, we have observed increase of low birth-weight rate and increase of frequency of cesarean delivery, and increase of drug abuse among pregnant women. The legislature in the field of long-term follow-up of handicapped children was not prepared. In the Goal 15 the Czech Republic accomplished the introduction of functional organizational system of care. In the Goal 17, the financing of high level of care was underestimated. In the Goal 20, the health care policy was not prepared to fulfill the requirements of this Goal. CONCLUSION: Comparison of recommendation of the 4 goals of the WHO Project Health for All 21 related to perinatal care in the Czech Republic and the national recommendations was confronted with the results. While the improvements of indicators of level of care and introduction of organization of perinatal care were achieved, the lack of health care policy was the main deficiency of the system.

Stembera Z; Velebil P

2011-02-01

91

Quality Assessment in the Primary care  

Directory of Open Access Journals (Sweden)

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

Muharrem Ak

2013-01-01

92

Adverse perinatal outcome in teenage pregnancies: is it all due to lack of prenatal care and ethnicity?  

UK PubMed Central (United Kingdom)

OBJECTIVE: To investigate teenage pregnancy outcomes controlling for lack of prenatal care (LOPC) and ethnicity. METHODS: A retrospective population-based cohort study comparing singleton deliveries of nulliparous women classified into two teenage groups: 15-17, 18-19, and a comparison group of 20-24 years was performed. Multiple logistic regressions were used to control for confounders. RESULTS: The study population consisted of 31,985 women, 1,482 15-17 years old, 5,876 18-19 years old and 24,627 20-24 years old. A significant linear association was found between maternal age and perinatal mortality, low birth weight (LBW) and preterm delivery (PTD). Using multivariable logistic regression models, controlling for LOPC and ethnicity, the association between maternal age and perinatal mortality was no longer statistically significant, but both LBW and PTD were significantly associated with young maternal age (>17 years). CONCLUSION: Teenage pregnancy is a risk factor for LBW and PTD especially for parturient younger than 17.

Liran D; Vardi IS; Sergienko R; Sheiner E

2013-03-01

93

Congenital cytomegalovirus infection in a neonatal intensive care unit in Brazil evaluated by PCR and association with perinatal aspects  

Directory of Open Access Journals (Sweden)

Full Text Available Cytomegalovirus (CMV) infection is the most common congenital infection, affecting 0.4% to 2.3% newborns. Most of them are asymptomatic at birth, but later 10% develop handicaps, mainly neurological disturbances. Our aim was to determine the prevalence of CMV shed in urine of newborns from a neonatal intensive care unit using the polymerase chain reaction (PCR) and correlate positive cases to some perinatal aspects. Urine samples obtained at first week of life were processed according to a PCR protocol. Perinatal data were collected retrospectively from medical records. Twenty of the 292 cases (6.8%) were CMV-DNA positive. There was no statistical difference between newborns with and without CMV congenital infection concerning birth weight (p=0.11), gestational age (p=0.11), Apgar scores in the first and fifth minutes of life (p=0.99 and 0.16), mother's age (p=0.67) and gestational history. Moreover, CMV congenital infection was neither related to gender (p=0.55) nor to low weight (<2,500g) at birth (p=0.13). This high prevalence of CMV congenital infection (6.8%) could be due to the high sensitivity of PCR technique, the low socioeconomic level of studied population or the severe clinical status of these newborns.

SANTOS Daniel Vítor V.; SOUZA Maria Margarida R.; GONÇALVES Sérgio Henrique L.; COTTA Ana Cristina S.; MELO Lorenza A. O.; ANDRADE Gláucia M. Q.; BRASILEIRO-FILHO Geraldo

2000-01-01

94

What is quality primary dental care?  

UK PubMed Central (United Kingdom)

In the first paper of a series exploring quality in primary dental care a definition for quality in dentistry is sought. There is a little agreement in academic literature as to what quality really means in primary dental care and without a true understanding it is difficult to measure and improve quality in a systematic way. 'Quality' of healthcare in dentistry will mean different things to practitioners, policy makers and patients but a framework could be modelled on other definitions within different healthcare sectors, with focus on access, equity and overall healthcare experience.

Campbell S; Tickle M

2013-08-01

95

Adoption of the who assessment tool on the quality of hospital care for mothers and newborns in Albania.  

UK PubMed Central (United Kingdom)

AIM: The aim of the adoption process of the "Quality of hospital care for mothers and newborns babies, assessment tool" (WHO, 2009) was to provide the Albanian health professionals of maternity hospitals with a tool that may help them assess the quality of perinatal care and identify key areas of pregnancy, childbirth and newborn care that need to be improved. METHODS: Four maternity hospitals (one university hospital and three regional hospitals) were selected for the assessment using this standard tool covering over 600 items grouped into 13 areas ranging from supportive services to case management. Sources of information consisted of site visits, hospital statistics, medical records, observation of cases and interviews with staff and patients. A score was assigned to each item (range 0-3) and area of care. The assessments were carried out in two rounds: in 2009 and in 2011. These assessments provided semi-quantitative data on the quality of hospital care for mothers and newborns. RESULTS: Data collected on the first round established a baseline assessment, whereas the second round monitored the subsequent changes. The findings of the second round revealed improvements encountered in all maternities, notwithstanding differences in the levels of improvement between maternities, not necessarily linked with extra financial inputs. CONCLUSIONS: The Albanian experience indicates a successful process of the adoption of the WHO tool on the quality of hospital care for mothers and newborn babies. The adopted tool can be used country-wide as a component of a quality improvement strategy in perinatal health care in Albania.

Mersini E; Novi S; Tushe E; Gjoni M; Burazeri G

2012-12-01

96

ADOPTION OF THE WHO ASSESSMENT TOOL ON THE QUALITY OF HOSPITAL CARE FOR MOTHERS AND NEWBORNS IN ALBANIA  

Science.gov (United States)

Aim: The aim of the adoption process of the “Quality of hospital care for mothers and newborns babies, assessment tool” (WHO, 2009) was to provide the Albanian health professionals of maternity hospitals with a tool that may help them assess the quality of perinatal care and identify key areas of pregnancy, childbirth and newborn care that need to be improved. Methods: Four maternity hospitals (one university hospital and three regional hospitals) were selected for the assessment using this standard tool covering over 600 items grouped into 13 areas ranging from supportive services to case management. Sources of information consisted of site visits, hospital statistics, medical records, observation of cases and interviews with staff and patients. A score was assigned to each item (range 0-3) and area of care. The assessments were carried out in two rounds: in 2009 and in 2011. These assessments provided semi-quantitative data on the quality of hospital care for mothers and newborns. Results: Data collected on the first round established a baseline assessment, whereas the second round monitored the subsequent changes. The findings of the second round revealed improvements encountered in all maternities, notwithstanding differences in the levels of improvement between maternities, not necessarily linked with extra financial inputs. Conclusions: The Albanian experience indicates a successful process of the adoption of the WHO tool on the quality of hospital care for mothers and newborn babies. The adopted tool can be used country-wide as a component of a quality improvement strategy in perinatal health care in Albania.

Mersini, Ehadu; Novi, Silvana; Tushe, Eduard; Gjoni, Maksim; Burazeri, Genc

2012-01-01

97

Severity of non-immune hydrops fetalis at birth continues to predict survival despite advances in perinatal care.  

UK PubMed Central (United Kingdom)

OBJECTIVES: To describe the aetiology and short-term outcome of live-born infants with non-immune hydrops fetalis (NIH), to identify predictors of mortality and to establish whether there has been any change in mortality over a 14-year period. METHODS: A retrospective case note review of all liveborn neonates with NIH. RESULTS: 30 infants were identified. Twenty (66%) had an identifiable aetiology. Ten (33%) survived to discharge. Survivors had significantly higher Apgar scores at 1 and 5 min (both p<0.001). Mortality did not differ between the time periods 1990-1999 and 2000-2004. CONCLUSIONS: NIH continues to be associated with a significant mortality despite advances in perinatal care. Poor condition at birth is a strong predictor of death.

Simpson JH; McDevitt H; Young D; Cameron AD

2006-01-01

98

A conceptual framework for quality of care.  

UK PubMed Central (United Kingdom)

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

Mosadeghrad AM

2012-01-01

99

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

UK PubMed Central (United Kingdom)

The practice and timing of routine antenatal visits for healthy pregnant women, introduced arbitrarily and without evidence of effectiveness, have become entrenched in obstetric practice over the last century. In 2001 the large, cluster randomized WHO Antenatal Care Trial concluded that a goal-orientated package of antenatal care with reduced visits seemed not to affect maternal and perinatal outcomes. The reduced visit package has been implemented in several countries. The current re-analysis finds that the significantly increased perinatal mortality which occurred in the reduced visit package persists after adjustment for potential confounding factors. The WHO Antenatal Care Trial provided the first evidence from a randomized trial that the traditional high frequency of routine visits in the third trimester may well reduce perinatal mortality.

Hofmeyr GJ; Hodnett ED

2013-01-01

100

Standards for perinatal education. Part 1.  

UK PubMed Central (United Kingdom)

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. To reach this goal, the study proceeded as follows: Development phase concepts were developed for perinatal education, the concepts were logically systematized and formulated in concept standards, the standards were presented for peer group review with the purpose of refinement and further development. Quantification phase the statistical validity of the standards was determined/calculated. After completion of the study the researcher reached the conclusion that quality perinatal education must adhere to the following standards: A philosophy for perinatal education must exist. The perinatal facilitator must be a well trained professional person, and must possess certain personal traits. The perinatal education style/method must adapt according to the client's socio-economic status, age, marital status and needs. The perinatal facilitator must make use of acknowledged teaching methods and techniques in order to facilitate learning. The perinatal education must comply with certain minimum requirements in order to make it accessible and acceptable to the client. The perinatal facilitator must complete a preparatory phase before she is allowed to give education. A perinatal education programme must have a curriculum that can be adapted to the client's circumstances. Perinatal education must be presented purposefully. The end result of perinatal education must focus on a healthy baby and a healthy, empowered mother, family and community.

Richter MS

2002-02-01

 
 
 
 
101

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

Science.gov (United States)

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)…

Child Trends, 2010

2010-01-01

102

Clinical benchmarking: implications for perinatal nursing.  

UK PubMed Central (United Kingdom)

Health care is a dynamic environment where expectations of quality must be balanced with appropriateness of treatment and cost of care. Managers often have inadequate information on which to base decisions, policy, and practice. Clinical benchmarking is a tool and a process of continuously comparing the practices and performances of one's operations against those of the best in the industry or the focused area of service and then using that information to enhance and improve performance and productivity. The article discusses the advantages and disadvantages of benchmarking as well as the factors influencing the need for such tools in health care and in perinatal nursing.

Fitzgerald K

1998-06-01

103

Sleep quality among health care workers.  

UK PubMed Central (United Kingdom)

BACKGROUND: Sleep problems are common complaints in health care workers that can affect quality of life and productivity, both in patients and healthy individuals. This study evaluates the prevalence of low sleep quality in health care workers with no health issues or complaints of sleep problems. METHODS: In this cross-sectional study was conducted on healthy employees of a health care organization in Tehran. The presence of physical and mental health issues and satisfaction from their sleep quality was assessed by means of a self-administered questionnaire. Sleep quality was evaluated by the Persian version of the Pittsburgh Sleep Quality Index (PSQI). PSQI scores of 5 or less were considered as good sleep quality. RESULTS: From 925 participants, 56.9% were good sleepers. There was a significant association between poor sleep quality and female sex, divorced, shift-working, and age; it was not associated with education level. Self-rated health (SRH) had a significant positive correlation with sleep quality. CONCLUSION: Poor sleep quality is common in our study population and associated with a lower SRH. The high prevalence of poor sleep quality in a group of healthy non-complaining employees can be an important early sign of underlying physical or mental health issues. Providing screening and monitoring programs to detect the underlying health conditions and their consequent treatment can promote health and productivity of employees and improve society's health, both directly and indirectly.

Ghalichi L; Pournik O; Ghaffari M; Vingard E

2013-02-01

104

Creating a total quality health care environment.  

UK PubMed Central (United Kingdom)

Until recently, health professionals lacked incentives to integrate internal management processes, depending instead on external quality assurance and regulatory standards. Competitive markets and increased regulatory pressures now encourage managers to reorient systems from a cost-driven reimbursement approach to the implementation of Total Quality Care as a management strategy.

Milakovich ME

1991-01-01

105

The continuity and quality of primary care.  

UK PubMed Central (United Kingdom)

Patients who have access to different health care systems, such as Medicare-eligible veterans, may obtain services in either or both health systems. We examined whether quality of diabetes care was associated with care continuity or veterans' usual source of primary care in a retrospective cohort study of 1,867 Medicare-eligible veterans with diabetes in 2001 to 2004. Underprovision of quality of diabetes care was more common than overprovision. In adjusted analyses, veterans who relied only on Medicare fee-for-service (FFS) for primary care were more likely to be underprovided HbA1c testing than veterans who relied only on Veteran Affairs (VA) for primary care. Dual users of VA and Medicare FFS primary care were significantly more likely to be overprovided HbA1c and microalbumin testing than VA-only users. VA and Medicare providers may need to coordinate more effectively to ensure appropriate diabetes care to Medicare-eligible veterans, because VA reliance was a stronger predictor than care continuity.

Maciejewski ML; Wang V; Burgess JF Jr; Bryson CL; Perkins M; Liu CF

2013-10-01

106

Managed care: quality management differentiates the product.  

UK PubMed Central (United Kingdom)

Comprehensive quality management is a goal that requires major corporate commitment to implement and maintain. The best results in a quality management program will be achieved when all components are tied together in a comprehensive program. To do that, a significant investment in personnel and equipment is required. As the benefits of having a program such as the one as described above become more widely known and accepted, more and more managed care insurers and providers will adopt these or similar standards. The question, "How do you know that patients are getting high-quality and sufficient care?" cannot be answered today by insurers who do not have such a program.

Dunn R

1990-09-01

107

[Coordination and quality of care].  

UK PubMed Central (United Kingdom)

The complexity of care situations, notably for the treatment of chronic pathologies or dependent elderly people, requires different disciplines to work together and makes healthcare professionals increasingly dependent on each other. However, in our daily practice, do we really know how to work together?

Puéblas F

2013-01-01

108

Slack resources and quality of primary care.  

UK PubMed Central (United Kingdom)

BACKGROUND: Research generally shows that greater resource utilization fails to translate into higher-quality healthcare. Organizational slack is defined as extra organizational resources needed to meet demand. Divergent views exist on organizational slack in healthcare. Some investigators view slack negatively because it is wasteful, inefficient, and costly, whereas others view slack positively because it allows flexibility in work practices, expanding available services, and protecting against environmental changes. OBJECTIVE: We tested a curvilinear relationship between organizational slack and care quality. METHODS: The study setting was primary care clinics (n=568) in the Veterans Health Administration. We examined organizational slack using the patient panel size per clinic capacity ratio and support staff per provider ratio staffing guidelines developed by the Veterans Health Administration. Patient-level measures were influenza vaccinations, continuity of care, and overall quality of care ratings. We obtained 2 independent patient samples with approximately 28,000 and 62,000 observations for the analysis. We used multilevel modeling and examined the linear and quadratic terms for both organizational slack measures. RESULTS: We found a significant curvilinear effect for panel size per clinic capacity for influenza vaccinations and overall quality of care. We also found support staff per provider exhibited a curvilinear effect for continuity of care and influenza vaccinations. Greater available resources led to better care, but at a certain point, additional resources provided minimal quality gains. CONCLUSIONS: Our findings highlight the importance of primary care clinic managers monitoring staffing levels. Healthcare systems managing a balanced provider workload and staff-mix may realize better patient care delivery and cost management.

Mohr DC; Young GJ

2012-03-01

109

Do patient characteristics, prenatal care setting, and method of payment matter when it comes to provider-patient conversations on perinatal mood?  

Science.gov (United States)

To examine factors associated with provider-patient conversations regarding prenatal and postpartum depressed mood. This study included 3,597 White, African American, Hispanic, and Asian/Pacific Islander NYC resident women who completed the Pregnancy Risk Assessment Monitoring System (PRAMS) survey from 2004-2007, a population-based assessment of patient and health care characteristics. Social determinants including race, nativity, maternal age, prenatal health care setting, and payment type were associated with patient report of having had a conversation about perinatal mood with their provider. Compared to Whites, Asian/Pacific Islanders were less likely to have this conversation (OR = 0.7, CI = 0.5-0.9). Older (OR = 0.6, CI = 0.4-0.9), non-US born (OR = 0.6, CI = 0.5-0.8), and women receiving care from a private doctor or HMO clinic (OR = 0.7, CI = 0.6-0.9) were less likely to have this conversation compared to their respective counterparts. Those who paid for their prenatal care primarily through personal income or through an expanded Medicaid program for prenatal care compared to those who did not were more likely to have had a conversation about mood with their providers. Health care providers and public health advocates should be aware that non-US born women were less likely to have conversations about mood than US born women. However, young mothers shown to be at risk for perinatal depression were more likely to have these conversations compared to older women. Protocols for assessing and educating patients about perinatal mood should be evaluated to improve conversation rates for those receiving care through private doctors and managed care organizations. Income and prenatal care assistance funds may play separate and important roles in provider-patient conversations. PMID:21681636

Liu, Cindy H; Tronick, Ed

2012-07-01

110

Do patient characteristics, prenatal care setting, and method of payment matter when it comes to provider-patient conversations on perinatal mood?  

UK PubMed Central (United Kingdom)

To examine factors associated with provider-patient conversations regarding prenatal and postpartum depressed mood. This study included 3,597 White, African American, Hispanic, and Asian/Pacific Islander NYC resident women who completed the Pregnancy Risk Assessment Monitoring System (PRAMS) survey from 2004-2007, a population-based assessment of patient and health care characteristics. Social determinants including race, nativity, maternal age, prenatal health care setting, and payment type were associated with patient report of having had a conversation about perinatal mood with their provider. Compared to Whites, Asian/Pacific Islanders were less likely to have this conversation (OR = 0.7, CI = 0.5-0.9). Older (OR = 0.6, CI = 0.4-0.9), non-US born (OR = 0.6, CI = 0.5-0.8), and women receiving care from a private doctor or HMO clinic (OR = 0.7, CI = 0.6-0.9) were less likely to have this conversation compared to their respective counterparts. Those who paid for their prenatal care primarily through personal income or through an expanded Medicaid program for prenatal care compared to those who did not were more likely to have had a conversation about mood with their providers. Health care providers and public health advocates should be aware that non-US born women were less likely to have conversations about mood than US born women. However, young mothers shown to be at risk for perinatal depression were more likely to have these conversations compared to older women. Protocols for assessing and educating patients about perinatal mood should be evaluated to improve conversation rates for those receiving care through private doctors and managed care organizations. Income and prenatal care assistance funds may play separate and important roles in provider-patient conversations.

Liu CH; Tronick E

2012-07-01

111

[Psychosocial climate in maternity hospitals from the perspective of parturients I. Results from a national survey on perinatal care satisfactionusing a representative sample of 1195 Czech parturients].  

UK PubMed Central (United Kingdom)

OBJECTIVE: To assess women's satisfaction with psychosocial aspects of perinatal care provided in Czech maternity hospitals, to identify areas that need improvement and to compare satisfaction with maternity care between selected subgroups of parturients. DESIGN: Original study. SETTING: Department of Psychology, Faculty of Philosophy, Charles University, Prague. METHODS: A survey on satisfaction with perinatal care was conducted with a sample of 1195 Czech parturients. The sample was representative of the Czech parturients population in terms of educational level, age, parity, and rate of vaginal and caesarean section delivery. The sample was proportionated as regards the number of births at small and large hospitals and at hospitals in different regions as well. All currently existing Czech maternity hospitals were included. For the data collection, the original Czech questionnaire KLI-P was used. The KLI-P measures psychosocial climate of maternity hospitals on following six scales: helpfulness and empathy of caregivers; control and involvement in decision-making; communication of information and availability of caregivers; dismissive attitude and lack of interest; physical comfort and services. In addition, differences in satisfaction rates between different subgroups of respondents were investigated: primiparas/multiparas, women with lower/higher educational status, women who gave birth at smaller/lager hospitals (< 800 / > 800 births per year), women who gave birth at university/other hospitals, women after vaginal delivery/caesarean section, women accommodated in high-standard rooms at after-birth unit, and women who filled the questionnaire within one year after/later than one year after delivery. RESULTS: The overall satisfaction with care provided at delivery unit (DU) and after-birth unit (ABU) was 70% and 61%, respectively. The best rated scale at DU was physical comfort and services (69%), the worst evaluation score received the scale control and involvement in decision-making (34%). At ABU, the best rated scale was control and involvement in decision-making (76%) while the lowest evaluation score was found for the scale dismissive attitude and lack of interest (48% - reverse-scored). The items with the best scores referred to the cleanliness at DU and mother-infant contact at ABU, the items with the lowest evaluation scores referred to emotional support provided by physicians at DU, involvement in decision-making concerning the position during the second stage of labour and quality of food. Significantly more satisfied with care provided at DU were multiparas, women who gave birth at non-university hospitals and women who gave birth vaginally. Significantly more satisfied with care at ABU were multiparas, women with lower educational status, women who gave birth at non-university and smaller hospitals (< 800 births per year) and women who evaluated a given hospital within one year after delivery. CONCLUSION: Despite its rather high quality, the Czech perinatal care suffers from several shortcomings as regards its psychosocial aspects. These shortcomings include lack of respect and empathy shown by caregivers, poor communication of information and low involvement of parturients in decision-making. Improving the quality of care at the Czech maternity hospitals requires empowerement of parturients in the system of perinatal care and development of psychological and psychosocial compteneces of health care providers.

Takács L; Seidlerová J

2013-04-01

112

Does Audit Improve the Quality of Care?  

Directory of Open Access Journals (Sweden)

Full Text Available BACKGROUND: The quality of health care and quality assurance are concepts which have been established for many years. Audit nowadays is adopted as a means of developing high quality care.AIM: This study aims to identify the perspectives of audit in practice and its relationship to quality assessment and assurance, quality improvement, and clinical effectiveness.METHODS: There were used the databases Medline and Cinahl to identify studies related to clinical audit. These databases were searched up to May 2009.DISCUSSION: Audit is used as a tool to assure and assess the quality of patient health care. It is also an educational tool as it creates a lot of opportunities for professionals to think about practice and to learn from the experience of others.CONCLUSIONS: Although that audit is a powerfull and useful tool to improve and evaluate the quality of health care, on the other hand there are many barriers that make its use difficult in everyday practice.

Areti Tsaloglidou

2009-01-01

113

[Validity and reliability of data and avoidability of the underlying cause of neonatal deaths in the intensive care unit of the North-Northeast Perinatal Care Network].  

UK PubMed Central (United Kingdom)

The aim of this study was to analyze the validity and reliability of data and the avoidability of neonatal deaths in the intensive care unit in the North-Northeast Perinatal Care Network (RENOSPE). The sample included 53 neonatal deaths recorded in the RENOSPE database that occurred in a maternity hospital in Teresina, Piauí State, Brazil. Validity was assessed by comparing causes recorded in the database with those from patient charts and calculating kappa index, sensitivity, and positive predictive value (PPV). Analysis of avoidability used the Brazilian List of Avoidable Deaths. When causes of death recorded in the RENOSPE database were compared with patient charts, kappa was 47.6% for maternal causes and 73.9% for congenital malformations, sensitivity was 95% and 83.3%, and PPV was 88.9% and 85.7%, respectively. The percentage of avoidable deaths in the RENOSPE database was high, attributable to lack of adequate prenatal care in 72% of cases. In conclusion, causes classified as congenital malformations were valid, and the high rate of avoidable deaths points to the need for improved prenatal care.

e Silva CM; Gomes KR; Rocha OA; de Almeida IM; Moita Neto JM

2013-03-01

114

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

Directory of Open Access Journals (Sweden)

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.

Aghlmand Siamak; Akbari Feizollah; Lameei Aboulfath; Mohammad Kazem; Small Rhonda; Arab Mohammad

2008-01-01

115

Health care utilisation in the first year of life among infants of mothers with perinatal depression or anxiety.  

UK PubMed Central (United Kingdom)

BACKGROUND: Limited information is available on associations between maternal depression and anxiety and infant health care utilisation. METHODS: We analysed data from 24 263 infants born between 1998 and 2007 who themselves and their mothers were continuously enrolled for the infant's first year in Kaiser Permanente Northwest. We used maternal depression and anxiety diagnoses during pregnancy and postpartum to categorise infants into two depression and anxiety groups and examined effect modification by timing of diagnosis (pregnancy only, postpartum only, pregnancy and postpartum). Using generalised estimating equations in multivariable log-linear regression, we estimated adjusted risk ratios (RR) between maternal depression and anxiety and well baby visits (<5 and ? 5), up to date immunisations (yes/no), sick/emergency visits (<6 and ? 6) and infant hospitalisation (any/none). RESULTS: Infants of mothers with perinatal depression or anxiety were as likely to attend well baby visits and receive immunisations as their counterparts (RR = 1.0 for all). Compared with no depression or anxiety, infants of mothers with prenatal and postpartum depression or anxiety, or postpartum depression or anxiety only were 1.1 to 1.2 times more likely to have ? 6 sick/emergency visits. Infants of mothers with postpartum depression only had marginally increased risk of hospitalisation (RR = 1.2 [95% confidence interval 1.0, 1.4]); 70% of diagnoses occurred after the infant's hospitalisation. CONCLUSIONS: An understanding of the temporality of the associations between maternal depression and anxiety and infant acute care is needed and will guide strategies to decrease maternal mental illness and improve infant care for this population.

Farr SL; Dietz PM; Rizzo JH; Vesco KK; Callaghan WM; Bruce FC; Bulkley JE; Hornbrook MC; Berg CJ

2013-01-01

116

Barriers to and enablers of evidence-based practice in perinatal care in the SEA-ORCHID project.  

UK PubMed Central (United Kingdom)

RATIONALE, AIMS AND OBJECTIVES: The South-East Asia Optimising Reproductive and Child Health in Developing Countries (SEA-ORCHID) project aimed to improve health outcomes for mothers and babies in nine hospitals in South-East Asia by supporting evidence-based perinatal health care. In this research, we aimed to identify and explore the factors that may have acted as barriers to or enablers of evidence-based practice change at each of the hospitals. METHODS: During the final 6 months of the intervention phase of the project, semi-structured, face-to-face interviews were undertaken with 179 nurses, midwives and doctors from the maternal and neonatal departments at each of the nine participating South-East Asian hospitals. RESULTS: The interviews identified several factors that participants believed had a substantial impact on the effectiveness of the SEA-ORCHID intervention. These included knowledge, skills, hierarchy, multidisciplinarity and leadership, beliefs about consequences, resources, and the nature of the behaviours. The success of the SEA-ORCHID intervention in improving practice may reflect the extent to which tailored strategies were effective in overcoming these barriers. CONCLUSION: Effective interventions to align practice with evidence rely on identifying and addressing barriers to practice change. The barriers identified in this study may be useful for those designing similar clinical practice improvement projects, as well as for continued efforts to improve practice in the SEA-ORCHID hospitals.

Turner T; Short J

2013-08-01

117

[Perinatal mortality at the Medical Care Units of the IMSS (Mexico Social Security Institute), National Medical Center of Torreon  

UK PubMed Central (United Kingdom)

To describe the situation of perinatal mortality during 1994 year in General Hospitals with Family Medicine number 16 and 18 of IMSS (Social Security Mexican Institut) National Medical Center in Torreón Coah. It was realized a retrospective study, were included 199 files of perinatal deaths occurred from January 1st to December 31 of 1994. The variables obtained were number of death for step, period, age, sex, weight and the cause of the cause of the death. Were eliminated the files without data of interest. For the analysis our utilized descriptive statistics. The rate of perinatal mortality was 20.17 per 1000 live birth, fetal death rate 9.58 by 1000 and the rate of neonatal death 12.97 per 1,000 live birth, fetal death rate 8.68 and neonatal death rate 12.30. The majority were in the perinatal period one with a rate of 16.71 by 1,000 live birth. Were most common in a male sex (53%) in pregnancies from 28 to 32 weeks (33.91%) and in babies with less of 1000 gr of weight (33.86%). The causes more frequents of deaths were the respiratory difficult syndrome (41.77%), the anomalies (19.62%) and hypoxia (9.49%). The perinatal mortality in our study was similar that in the rest of the country and is acorde with the literature. The perinatal mortality were in the perinatal period one. Is important to conduce a prospective studies.

Rodríguez y Enríquez de Rivera FC; Velázquez Trejo ML; Roís Hernández J

1998-07-01

118

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

Digital Repository Infrastructure Vision for European Research (DRIVER)

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 thei...

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

119

[The quality of chronic care in Germany].  

UK PubMed Central (United Kingdom)

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

Fullerton B; Nolte E; Erler A

2011-01-01

120

[The quality of chronic care in Germany].  

Science.gov (United States)

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

Fullerton, Birgit; Nolte, Ellen; Erler, Antje

2011-01-22

 
 
 
 
121

Why some women fail to give birth at health facilities: a qualitative study of women’s perceptions of perinatal care from rural Southern Malawi  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Background Despite Malawi government’s policy to support women to deliver in health facilities with the assistance of skilled attendants, some women do not access this care. Objective The study explores the reasons why women delivered at home without skilled attendance despite receiving antenatal care at a health centre and their perceptions of perinatal care. Methods A descriptive study design with qualitative data collection and analysis methods. Data were collected through face-to-face in-depth interviews using a semi- structured interview guide that collected information on women’s perception on perinatal care. A total of 12 in- depth interviews were conducted with women that had delivered at home in the period December 2010 to March 2011. The women were asked how they perceived the care they received from health workers before, during, and after delivery. Data were manually analyzed using thematic analysis. Results Onset of labor at night, rainy season, rapid labor, socio-cultural factors and health workers’ attitudes were related to the women delivering at home. The participants were assisted in the delivery by traditional birth attendants, relatives or neighbors. Two women delivered alone. Most women went to the health facility the same day after delivery. Conclusions This study reveals beliefs about labor and delivery that need to be addressed through provision of appropriate perinatal information to raise community awareness. Even though, it is not easy to change cultural beliefs to convince women to use health facilities for deliveries. There is a need for further exploration of barriers that prevent women from accessing health care for better understanding and subsequently identification of optimal solutions with involvement of the communities themselves.

Kumbani Lily; Bjune Gunnar; Chirwa Ellen; Malata Address; Odland Jon Øyvind

2013-01-01

122

Perinatal exposure to low doses of tributyltin chloride reduces sperm count and quality in mice.  

UK PubMed Central (United Kingdom)

Exposure to endocrine disruptors (EDs) during early development might lead to adverse health outcomes later in life. Tributyltin (TBT), a proven ED, is widely used in consumer goods and industrial products. Herein we demonstrate the effects of low doses of tributyltin chloride (TBTCl) on reproduction of male KM mice. Pregnant mice were administered by gavage with 0, 1, 10, or 100 ?g TBTCl/kg body weight/day from day 6 of pregnancy through the period of lactation. TBTCl dramatically decreased sperm counts and motility on postnatal days (PNDs) 49 and 152. Meanwhile, a significant increase in sperm abnormality was observed in exposed mice on PND 49, but comparable to that in the control on PND 152. The histopathological analysis of testes of treated animals showed a dose-dependent increase in sloughing of germ cells in seminiferous tubules. Mice treated with 10 ?g TBTCl/kg exhibited decreased intratesticular 17?-estradiol (E2) levels on PND 49, and then followed by an obvious recovery on PND 152. While, no significant differences in serum E2, testosterone (T) levels and intratesticular T levels were detectable between control and TBTCl-exposed offspring at the sacrifice. These results suggest that perinatal TBTCl exposure is implicated in causing long lasting alterations in male reproductive system and these changes may persist far into adulthood. © 2013 Wiley Periodicals, Inc. Environ Toxicol, 2013.

Si J; Li P; Xin Q; Li X; An L; Li J

2013-08-01

123

Organizationwide quality improvement in health care.  

UK PubMed Central (United Kingdom)

Organizationwide quality improvement has offered many organizations in many different industries a new approach to work and leadership. The lessons learned can be applied to the health care setting. QA professionals can play an important role in this change by leading through example--first in their own departments and the work they currently perform and then throughout the entire organization.

Batalden PB

1991-03-01

124

Methodology for Monitoring Quality of Nursing Care.  

Science.gov (United States)

The results of the first phase of a study sponsored by the Division of Nursing, Public Health Service, DHEW to provide a methodology for monitoring the quality of nursing care are reported. The project was a joint undertaking by the Rush-Presbyterian-St. ...

R. C. Jelinek J. F. Newman S. T. Hegyvary R. K. Haussmann

1975-01-01

125

Neurodevelopmental outcome in extremely preterm infants at 2.5 years after active perinatal care in Sweden.  

UK PubMed Central (United Kingdom)

IMPORTANCE: Active perinatal care increases survival of extremely preterm infants; however, improved survival might be associated with increased disability among survivors. OBJECTIVE: To determine neurodevelopmental outcome in extremely preterm children at 2.5 years (corrected age). DESIGN, SETTING, AND PARTICIPANTS: Population-based prospective cohort of consecutive extremely preterm infants born before 27 weeks of gestation in Sweden between 2004 and 2007. Of 707 live-born infants, 491 (69%) survived to 2.5 years. Survivors were assessed and compared with singleton control infants who were born at term and matched by sex, ethnicity, and municipality. Assessments ended in February 2010 and comparison estimates were adjusted for demographic differences. MAIN OUTCOMES AND MEASURES: Cognitive, language, and motor development was assessed with Bayley Scales of Infant and Toddler Development (3rd edition; Bayley-lll), which are standardized to mean (SD) scores of 100 (15). Clinical examination and parental questionnaires were used for diagnosis of cerebral palsy and visual and hearing impairments. Assessments were made by week of gestational age. RESULTS: At a median age of 30.5 months (corrected), 456 of 491 (94%) extremely preterm children were evaluated (41 by chart review only). For controls, 701 had information on health status and 366 had Bayley-lll assessments. Mean (SD) composite Bayley-III scores (cognition, 94 [12.3]; language, 98 [16.5]; motor, 94 [15.9]) were lower than the corresponding mean scores for controls (cognition, 104 [10.6]; P < .001; adjusted difference in mean scores, 9.2 [99% CI, 6.9-11.5]; language, 109 [12.3]; P < .001; adjusted difference in mean scores, 9.3 [99% Cl, 6.4-12.3]; and motor, 107 [13.7]; P < .001; adjusted difference in mean scores, 12.6 [99% Cl, 9.5-15.6]). Cognitive disability was moderate in 5% of the extremely preterm group vs 0.3% in controls (P < .001) and it was severe in 6.3% of the extremely preterm group vs 0.3% in controls (P < .001). Language disability was moderate in 9.4% of the extremely preterm group vs 2.5% in controls (P < .001) and severe in 6.6% of the extremely preterm group vs 0% in controls (P < .001). Other comparisons between the extremely preterm group vs controls were for cerebral palsy (7.0% vs 0.1%; P < .001), for blindness (0.9% vs 0%; P = .02), and for hearing impairment (moderate and severe, 0.9% vs 0%; P = .02, respectively). Overall, 42% (99% CI, 36%-48%) of extremely preterm children had no disability, 31% (99% CI, 25%-36%) had mild disability, 16% (99% CI, 12%-21%) had moderate disability, and 11% (99% CI, 7.2%-15%) had severe disability. Moderate or severe overall disability decreased with gestational age at birth (22 weeks, 60%; 23 weeks, 51%; 24 weeks, 34%; 25 weeks, 27%; and 26 weeks, 17%; P for trend < .001). CONCLUSIONS AND RELEVANCE: Of children born extremely preterm and receiving active perinatal care, 73% had mild or no disability and neurodevelopmental outcome improved with each week of gestational age. These results are relevant for clinicians counseling families facing extremely preterm birth.

Serenius F; Källén K; Blennow M; Ewald U; Fellman V; Holmström G; Lindberg E; Lundqvist P; Maršál K; Norman M; Olhager E; Stigson L; Stjernqvist K; Vollmer B; Strömberg B

2013-05-01

126

Use of Care, Outcomes and Costs of a Culturally-based Perinatal Program for Asian American and Pacific Islander Women in Hawaii.  

Science.gov (United States)

PURPOSE. This study examines whether psychosocial perinatal care services developed through community partnerships and cultural deference with attention to individual women's health issues, had an assocaited impact on use of prenatal care, birth outcomes and perinatal care costs for the three participating Asian Pacific Islander American ethinc groups. METHODS. The use of prenatal care visits and birth outcomes for women in the Malama program were compared to those for women of the same etnic groups in the community prior to the introduction of the program. Data on program participants from 1992 to 1994 were compared to birth certificate data on Hawaiian, Filipino and Japanese women from 1988 to 1991. Costs of providing Malama prenatal services were determined from data provided by cost accounting and encounter data systems for the program. SUMMARY OF IMPORTANT FINDINGS. The use of prenatal care visits and birth outcomes were significantly lower for Malama program participants than for women of the same ethnic groups prior to the introduction of the program. The costs of the prenatal program services were $846 to $920 per woman. The expected savings in medical costs per infant with the improved preterm birth rates were $680 per infant. Thus 75% to 80% of the costs of the services were likely to be saved in lower medical costs of the infants. MAJOR CONCLUSIONS. Programs that use community approaches and caring servies delivered in a cultural context, like the Malama model, have a potential for improving the use of prenatal care and birth outcomes at reasonable costs. RELEVANCE TO ASIAN PACIFIC ISLANDER AMERICAN POPULATIONS. The Malama approach to ascertaining cultural preferences for the content and delivery of care should prove useful in addressing public health goals of improved pregnancy outcomes for diverse groups of Asian Americans and Pacific Islanders. KEY WORDS. Asian Americans/Pacific Islanders, pregnancy, prenatal care, low birthweight, preterm birth, cultural competency, community partnerships, costs, cost effectiveness. PMID:11567478

Affonso, Dyanne D.; Korenbrot, Carol C.; De, Anindya K.; Mayberry, Linda J.

1999-01-01

127

Remote midwifery in Nunavik, Quebec, Canada: outcomes of perinatal care for the Inuulitsivik health centre, 2000-2007.  

UK PubMed Central (United Kingdom)

BACKGROUND: The Inuulitsivik midwifery service is a community-based, Inuit-led initiative serving the Hudson coast of the Nunavik region of northern Québec. This study of outcomes for the Inuulitsivik birth centers, aims to improve understanding of maternity services in remote communities. METHODS: We used a retrospective review of perinatal outcome data collected at each birth at the Inuulitsivik birth centers to examine outcomes for 1,372 labors and 1,382 babies from 2000 to 2007. Data were incomplete for some indicators, particularly for transfers to Montreal. RESULTS: Findings revealed low rates of intervention with safe outcomes in this young, largely multiparous "all risk" Inuit population. Ninety-seven percent of births were documented as spontaneous vaginal deliveries, and 85 percent of births were attended by midwives. Eighty-six percent of the labors occurred in Nunavik, whereas 13.7 percent occurred outside Nunavik. The preterm birth rate was found to be 10.6 percent. Postpartum hemorrhage was documented in 15.4 percent of women; of these cases, 6.9 percent had blood loss greater than 1,000 mL. Four fetal deaths (2.9 per 1,000) and five neonatal deaths (< 3.6 per 1,000) were documented. Nine percent (9%) of births involved urgent transfers of mother or baby. The most common reasons for medical evacuation were preterm labor and preeclampsia, and preterm birth was the most common reason for urgent neonatal transfer. CONCLUSIONS: The success of the Innulitsivik midwifery service rests on the knowledge and skills of the Inuit midwives, and support of an interprofessional health team. Our study points to the potential for safe, culturally competent local care in remote communities without cesarean section capacity. Our findings support recommendations for integration of midwifery services and Aboriginal midwifery education programs in remote communities.

Van Wagner V; Osepchook C; Harney E; Crosbie C; Tulugak M

2012-09-01

128

Addressing barriers to perinatal care: a case study of the Access to Maternity Care Committee in Washington State.  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Access to obstetrical services has deteriorated in recent years, as large numbers of physicians have discontinued or restricted obstetrical practice. In Washington State, one response to this access crisis has been the establishment of the Access to Maternity Care Committee (AMCC), an ad hoc group c...

Schleuning, D; Rice, G; Rosenblatt, R A

129

The NC Quality Center: empowering excellence in health care.  

UK PubMed Central (United Kingdom)

The NC Quality Center is transforming health care quality and patient safety in North Carolina by providing leadership, direction, and a vision to ensure that North Carolina delivers the best health care possible.

Koeble C; Campione J

2013-03-01

130

Measuring quality in end-of-life care.  

UK PubMed Central (United Kingdom)

Scrutiny of the quality of medical care near the end of life is increasing. Experts have begun to define and conceptualize quality of care for dying patients and are developing measurement tools to assess quality of care in this population. Definitions and conceptual models of quality of care at the end of life are reviewed. Approaches for measuring the processes and outcomes of end-of-life care are discussed. Approaches for initiating quality assessment of end-of-life care among geriatric patients are suggested.

Rosenfeld K; Wenger NS

2000-05-01

131

Health Care Quality Improvement Publication Trends.  

UK PubMed Central (United Kingdom)

To analyze the extent of academic interest in quality improvement (QI) initiatives in medical practice, annual publication trends for the most well-known QI methodologies being used in health care settings were analyzed. A total of 10 key medical- and business-oriented library databases were examined: PubMed, Ovid MEDLINE, EMBASE, CINAHL, PsycINFO, ISI Web of Science, Scopus, the Cochrane Central Register of Controlled Trials, ABI/INFORM, and Business Source Complete. A total of 13 057 articles were identified that discuss at least 1 of 10 well-known QI concepts used in health care contexts, 8645 (66.2%) of which were classified as original research. "Total quality management" was the only methodology to demonstrate a significant decline in publication over time. "Continuous quality improvement" was the most common topic of study across all publication years, whereas articles discussing Lean methodology demonstrated the largest growth in publication volume over the past 2 decades. Health care QI publication volume increased substantially beginning in 1991.

Sun GH; Maceachern MP; Perla RJ; Gaines JM; Davis MM; Shrank WH

2013-10-01

132

Can payment incentives improve quality and efficiency of care?  

UK PubMed Central (United Kingdom)

Faced with increasing health care costs, America's major corporations are beginning to explore a variety of mechanisms to assure that health care providers are delivering high quality care. The General Motors Corporation (GM), with approximately two million employees, retirees and family members, and annual health care expenditures of approximately $3 billion, has developed a quality review system and a hospital payment mechanism that includes incentives to enhance the quality of care provided to GM beneficiaries. The following article describes this project.

Steinberg EP; Gertman P

1989-11-01

133

[Care quality in intensive care evaluated by the patients using a service quality scale (SERVQUAL)].  

UK PubMed Central (United Kingdom)

INTRODUCTION: The evaluation made by the patients on the quality of service received is important to introduce improvement strategies in the care quality. OBJECTIVES: 1. To evaluate the care quality through the analysis of the differences obtained between expectations and perceptions, that the patients have of the service received in the ICU. 2. To analyze if there is any relationship between care quality evaluated by the patients and the sociodemographic variables. METHOD: A total of 86 patients who were conscious and oriented during their stay in the ICU were studied prospectively. At 24h of the discharge from the ICU, the SERVQUAL (Service Quality) scale, adapted for the hospital setting by Babakus and Mangold (1992), was applied. This scale measures the care quality based on the difference in scores obtained between expectations and perceptions of the patients. The positive scores indicate that the perceptions of the patients exceed their expectations. The scale has 5 dimensions: Tangibility, Reliability, Responsiveness, Assurances and Empathy. It includes 15 items for perceptions and the same for expectations, with 5 grades of response (1 totally disagree - 5 totally agree). RESULTS: The mean score of perceptions 66.92) exceeded that of the expectations (62.30). The mean score of the difference between perceptions and expectations for the total of the SERVQUAL scale was 4.62. It was also positive for each one of the dimensions: Tangibility=1.44, Reliability=0.53, Responsiveness=0.95, Assurances=0.99, Empathy=0.71. No statistically significant associations were found between care quality evaluated by the patients and the sociodemographic variables. CONCLUSION: The care quality perceived by the patients in the ICU exceeds their expectations, and had no relationship with the sociodemographic characteristics.

Regaira Martínez E; Sola Iriarte M; Goñi Viguria R; Del Barrio Linares M; Margall Coscojuela MA; Asiain Erro MC

2010-01-01

134

Ethnicity and mental health encounters in primary care: help-seeking and help-giving for perinatal depression among Black Caribbean women in the UK.  

UK PubMed Central (United Kingdom)

BACKGROUND: Perinatal depression among Black Caribbean women in the UK remains an intriguingly under-researched topic. Despite high levels of known psychosocial risks, Black Caribbeans remain relatively invisible among those seeking/receiving help for depression during and after pregnancy. METHODS: In-depth interviews were undertaken with a purposive sample of twelve Black Caribbean women selected from a larger sample (n=101) to examine prevalence and psychosocial risks for perinatal depression among this ethnic group. The study also sought to explore women's models of help-seeking. During analysis, the context in which help-seeking/giving is mediated emerged as a key issue. We explore the nature of these encounters thereby opening up the possibility of finding common ground between service users and providers for enabling women to receive the care and support they need. FINDINGS: Whether or not women configure depressive feelings as 'symptoms' requiring external validation and intervention is a reflection both of the social embeddedness of those individuals and of how 'help-givers' perceive them and their particular needs. We suggest that the ways in which help-seeking/giving are commonly conceptualised might offer at least a partial explanation for apparently low levels of diagnosed perinatal depression among Black Caribbean women. CONCLUSIONS: Popular approaches to health seeking behaviours within health promotion and practice focus on individuals as the fulcrum for change, tending to overlook their embeddedness within 'reflexive communities'. This might serve to reinforce the invisibility of Black Caribbean women both in mainstream mental health services and associated research. Alternative approaches may be required to achieve government targets to reduce inequalities in access, care, and treatment and to deliver more responsive and culturally-appropriate mental health services.

Edge D; MacKian SC

2010-01-01

135

A computerized perinatal data system.  

UK PubMed Central (United Kingdom)

A computerized perinatal data system has been proposed and is under implementation at St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA. The concept encompasses all phases of perinatal care from pre-natal consultation through transferral of infant care to the family paediatrician. A complete record system was designed and computerized to serve both in-house and regional institutions with an on-line data system. Extensions into labour-delivery and nursery are under way and will provide augmentation of health care delivery as well as serving educational, audit, and research needs.

Warford HS; Jennett RJ; Gall DA

1979-07-01

136

Diabetes Care Quality Improvement: A Workbook for State Action.  

Science.gov (United States)

Diabetes Care Quality Improvement: A Resource Guide for State Action and its accompanying Workbook were developed by the Agency for Healthcare Research and Quality (AHRQ) as learning tools for all State officials who want to improve the quality of health ...

B. Kass

2004-01-01

137

Diabetes Care Quality Improvement: A Resource Guide for State Action.  

Science.gov (United States)

Diabetes Care Quality Improvement: A Resource Guide for State Action and its accompanying Workbook were developed by the Agency for Healthcare Research and Quality (AHRQ) as learning tools for all State officials who want to improve the quality of health ...

R. M. Coffey T. L. Matthews K. McDermott

2004-01-01

138

Carepaths: a framework for quality patient care  

International Nuclear Information System (INIS)

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

1997-01-01

139

Health care quality in NHS hospitals.  

UK PubMed Central (United Kingdom)

Hospitals provide the same type of service, but they do not all provide the same quality of service. No one knows this better than patients. Reports the results of a market research exercise initiated to ascertain the different factors which patients of health care identify as being necessary to provide error-free service quality in the NHS hospitals. To measure patients' satisfaction with NHS hospitals, the internationally-used market research technique called SERVQUAL was used in order to measure patients' expectations before admission, record their perceptions after discharge from the hospital, and then to close the gap between them. This technique compares expectations with perceptions of service received across five broad dimensions of service quality, namely: tangibility; reliability; responsiveness; assurance; and empathy. This analysis covered 174 patients who had completed the SERVQUAL questionnaire, including patients who had had treatment in surgical, orthopaedic, spinal injury, medicinal, dental and other specialties in the West Midlands region. Recorded the average weighted NHS service quality score overall for the five dimensions as significantly negative.

Youssef FN; Nel D; Bovaird T

1996-01-01

140

[Psychopharmaceuticals in primary care: prescription quality  

UK PubMed Central (United Kingdom)

OBJECTIVE: Using criteria based on the bibliography, to assess drugs prescription in a Health Centre, in order to put forward corrective measures in line with the defects identified. DESIGN: Descriptive and retrospective study. SETTING: Santa Maria de Benquerancia Health Centre (Toledo). PARTICIPANTS: A sample of 40% of the clinical records of patients over 14 produced records of patients treated with drugs for psychic disorders between October 1990 and October 1991. MEASUREMENTS AND MAIN RESULTS: 248 prescriptions for these drugs were found. The most common diagnoses were: neurotic depression (33.1%), anxiety (25.8%) and insomnia (10.1%). Benzodiazepines made up 78.2% of the prescriptions. Of 8 quality criteria assessed, the compliance level was acceptable by WHO standards except in the recording in the notes of the diagnosis or problem for which the drug was prescribed (74.2% non-compliance); Alprazolam and Triazolam were not considered first-choice benzodiazepines (31.3% non-compliance); and there was 44.5% non-compliance by Primary Care physicians with the non-prescription of anti-psychotic or stimulant MAO inhibitor antidepressants. CONCLUSIONS: Quality-control studies, such as this one, in order to identify problems, to take corrective measures and subsequently assess them, are useful in improving care procedures.

Torres Martínez C; Orgaz Gallego P; Lozano Alvarez F; Sánchez Gómez MH; Pinnel Muñoz MF; Tojeiro Lorente S; Laín Terres N

1993-05-01

 
 
 
 
141

Surgical quality of care in esophageal malignancies.  

UK PubMed Central (United Kingdom)

AIM: Esophagectomy is the primary surgical treatment for localized malignant neoplasms of the esophagus, and while outcomes have shown that substantial improvement has been made, the ceiling for improvement is still high. METHODS: A total of 2506 publications published from January 2002 to March 2012 were identified from PubMed, MEDLINE and the Cochrane Library using the keywords: 'esophagectomy', 'esophagus', 'neoplasm' and 'cancer' to identify quality key surgical articles in esophagectomy that were broken down into three groups: preoperative, intraoperative and postoperative care. DISCUSSION: There have been limited preoperative surgical trials, mostly in preoperative antibiotic use, which have led to changes in surgical management. Key and substantial changes have occurred in the intraoperative management for esophageal malignancies around surgical anastomosis technique and anesthesia. Nutritional outcomes still remain a key challenge, and currently there is no established standard of care in the postoperative management of esophagectomy patients. CONCLUSION: We established quality parameters for leak rates, overall morbidity and mortality, and these form the foundation from which all esophageal surgeons should rank their results. We then utilized the techniques described above to maintain those rates or, better yet, to significantly improve those rates in each surgeons' practice.

Lee TJ; Martin RC 2nd

2013-04-01

142

[Analysis of perinatal indicators of the Olomouc region in the period 1994-2008].  

UK PubMed Central (United Kingdom)

OBJECTIVE: The aim of this study was to examine the evolution of the main perinatology outcomes in the last fifteen years and their comparison to the Czech Republic. Analysis belong to the control system of quality of care. DESIGN: Retrospective epidemiological study. SETTING: Gynaecology and Obstetrics Clinic Medical Faculty Palacky University and Faculty Hospital in Olomouc. METHODS: For analysis in this study were used results of perinatal databases of the Committee for Perinatal Medicine of the Czech Republic (10 million population) and all hospitals in Olomouc region (600,000 population). RESULTS: Since mid-90th years there is a significant improvement of perinatal indicators and very good results have been achieved since 2000, when the perinatal mortality rate dropped to 2 per mille (in 2008). The downward trend in perinatal mortality rate and early neonatal mortality rate was statistically significant (P for trend = 0.008). Comparison of major perinatal outcomes confirms that perinatal mortality rate exceeds in five years the national average in the reference interval.. Statistically significant worse results were in early neonatal mortality rate without congenital malformations in the year 1994 (P = 0.005) and the year 2001 (P = 0.0008). Stillbirth rate without congenital malformation fluctuated from 1.1 to 3.1 per mile and exceeded republic mean in the year 1998. Since 1994 increased in the Czech Republic frequency of preterm births of children of low birth weight (LBW--less than 2.5 kg) from 5.47% to 7.37%. In recent years, there was a problem with the lack of beds in the neonatology intensive care unists. CONCLUSION: Analysis of the main perinatology data of the last fifteen years acknowledges, that monitored indices of the Olomouc region were more often better than the national average. A major problem of this region, as well as the Czech Republic, is increased frequency of premature labour and associated insufficient capacity of neonatal intensive care unit in perinatal center.

Vetr M

2009-12-01

143

Establishing a quality measurement system for cancer care in Japan.  

UK PubMed Central (United Kingdom)

Ensuring the quality of care is a major objective of cancer control policy. The Cancer Control Act 2006 placed responsibility on the Japanese government to maintain the quality of cancer care nationwide. To function as centers providing high-quality care, designated cancer care hospitals (397 hospitals as of April 2012) were instituted nationwide. Although they meet the structural standards, such as the presence of radiation equipment and palliative care teams, it remains unclear whether the designation has led to appropriate provision of care and optimal patient outcomes. A national system to examine the processes and outcomes of cancer care is under development. In 2007 and 2008, the Japanese Association of Clinical Cancer Centers publicly disclosed the 5-year survival of their member facilities with strict data quality standards, including sufficient follow-up of patients' vital status. The network of designated cancer care hospitals will follow this lead to provide a national outcome monitoring system. The processes of care have also been addressed by a government-funded research project. With the collaboration of clinical experts, 206 quality indicators have been developed for five major cancers in Japan (breast, colorectal, liver, lung and stomach) and palliative care. Each indicator described the target patients and standards of care for the patients, the provision of which was considered an aspect of quality. In 2012, the Cancer Registry Chapter of the Association of Prefectural Designated Cancer Care Hospitals instituted quality measurement using these indicators. These activities will soon lead to effective quality monitoring and improvement in Japan.

Higashi T; Nakamura F; Saruki N; Sobue T

2013-03-01

144

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

Directory of Open Access Journals (Sweden)

Full Text Available Julie Kiguli1, Elizabeth Ekirapa-Kiracho1, Olico Okui1, Aloysius Mutebi1, Hayley MacGregor2, George William Pariyo11Makerere University School of Public Health, Kampala, Uganda; 2Institute of Development Studies, Sussex, UKAbstract: This paper examines the community’s perspectives and perceptions on quality of health care delivery in two Uganda districts. The paper addresses community concerns on service quality. It focuses on the poor because they are a vulnerable group and often bear a huge burden of disease. Community views were solicited and obtained using eight focus group discussions, six in-depth and 12 key informant interviews. User perceptions and definitions of the quality of health services depended on a number of variables related to technical competence, accessibility to services, interpersonal relations and presence of adequate drugs, supplies, staff, and facility amenities. Results indicate that service delivery to the poor in the general population is perceived to be of low quality. The factors that were mentioned as affecting the quality of services delivered were inadequate trained health workers, shortage of essential drugs, poor attitude of the health workers, and long distances to health facilities. This paper argues that there should be an improvement in the quality of health services with particular attention being paid to the poor. Despite wide focus on improvement of the existing infrastructure and donor funding, there is still low satisfaction with health services and poor perceived accessibility.Keywords: quality, health care, poor, community, perceptions, utilization

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

2009-01-01

145

Molecular imaging in quality health care  

International Nuclear Information System (INIS)

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

2007-01-01

146

Perinatal Asphyxia  

Directory of Open Access Journals (Sweden)

Full Text Available Asphyxia before, during or after delivery is an important cause of perinatal mortality and neurologic morbidity. The fetus and newborn are equipped with a wide range of adaptive mechanisms to survive an Asphyxia episode, and when these fail, injury can occur. The American academy or pediatrics (AAP) and the American college of obstetrics and gynecology (AcoG) committees on maternal-fetal medicine and fetus and newborn have recently defined certain criteria that must be present: Profound umbilical artery metabolic or mixed academia (PH<700), persistence of an apgar score of 0 to 3 for longer than 5 minutes, neonatal neurologic sequelae (E.g., seizures, coma, hypotonia), and multiorgan system dysfunction (E.g., cardiovascular, gastrointestinal, hematologic, pulmonary or renal). In cases in which such evidence is laking, we cannot conclude that perinatal Asphyxia exists. The staging of the encephalopathy is useful for determination of prognosis. Those with mild encephalopathy do well, those with severe encephalopathy have a poor prognosis. The outcome of these with moderate (Stage II) hypoxic-ischemic encephalopathy is less certain, however, these children are at risk for neurologic disability and future academic failure. Overall tests used to evaluate subtle changes that may relate to perinatal hypoxic-ischemic injury have been inadequate, future studies should include tests of acquisition of new learning, memory, problem solving, and reasoning.

H Shajari

2000-01-01

147

Quality measures in neurology consult care for epileptic patients.  

UK PubMed Central (United Kingdom)

CONCLUSIONS: The care we provide is appropriate according to many of the quality measures, but we must deliver more counselling and information necessary for the care of epileptic patients in different stages of life.

de la Morena Vicente MA; Ballesteros Plaza L; Martín García H; Vidal Díaz B; Anaya Caravaca B; Pérez Martínez DA

2013-09-01

148

Quality indicators for international benchmarking of mental health care  

DEFF Research Database (Denmark)

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

Hermann, Richard C; Mattke, Soeren

2006-01-01

149

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)

Full Text Available Abstract in spanish 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 Investigación de Enfermedades Diarreicas de Bangladesh en Matlab, Bangladesh. RESULTADOS: El estudio registró 59 165 embarazos, 173 muertes maternas, 1661 defunciones prenatales y 1 (more) 418 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 de (more) aths 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.

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

2010-04-01

150

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

Science.gov (United States)

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

Child Trends, 2010

2010-01-01

151

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

Science.gov (United States)

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

Child Trends, 2010

2010-01-01

152

Providing high-quality end-of-life care universally.  

UK PubMed Central (United Kingdom)

The National End of Life Care Programme was launched in November 2004, and has been instrumental in delivering the Department of Health's (2008) End-of-Life Care Strategy and the National Institute of Health and Clinical Excellence's (2011) Quality Standard for End of Life Care for Adults. End-of-life care now sits within NHS Improving Quality. In this article we discuss an overview of the programme's successes, challenges and priorities for the future.

Henry C; Hayes A

2013-08-01

153

Data quality review during prenatal care  

Directory of Open Access Journals (Sweden)

Full Text Available Aim: To review the quality of prenatal care data registered by the professionals from the Family Health Strategy (ESF) in Jericoacoara city – Ceara State – Brazil. Methods: This was a quantitative and documental study, in which were analyzed 71 obstetric records of pregnant women who underwent prenatal care in 2006. The studied variables comprised those obtained by data quality review of standard obstetric records regarding to socioeconomic aspects, family history, personal and obstetric and the data related to current pregnancy. Results: Among the 71 obstetric records reviewed, in 70 of them (98.6%), the socioeconomic data were completed satisfactorily. The data concerning the history of familiar and personal morbidity, besides obstetric and gynecological history of the pregnant women were 100% (71) complete. Referring to the data of current pregnancy collected during the anamnesis of the first medical appointment, it was detected that 47 (66.2%) were filled in properly, while in 24 (33.8%) of them there were missing important data, such as height and weight of the pregnant women. From all obstetric records, in only 60 (84.5%) there were the registers of all laboratory tests compulsory for the first trimester of pregnancy and it’s highlighted that only 43 (60.6%) of the records were filled in properly regarding the lab tests of the third trimester. It was yet verified that in only 6 (8.5%) of the records there was information related to the curve of uterine height/gestational age. Conclusion: In this study, the adequate filling of obstetric records was observed, although we found a great number of lack or of incomplete registers in the topic related to the graphs of height/weight and the curve of uterine height/ gestational age.

Alison Alves de Farias; Rita Neuma Dantas Cavalcante de Abreu; Eliane Magalhães de Brito; Thereza Maria Magalhães Moreira; Lucilane Maria Sales da Silva; Silvânia Maria Mendes Vasconcelos

2009-01-01

154

Quality of diabetes mellitus care by rural primary care physicians.  

UK PubMed Central (United Kingdom)

PURPOSE: To explore the relationship between degree of rurality and glucose (hemoglobin A1c), blood pressure (BP), and lipid (LDL) control among patients with diabetes. METHODS: Descriptive study; 1,649 patients in 205 rural practices in the United States. Patients' residence ZIP codes defined degree of rurality (Rural-Urban Commuting Areas codes). Outcomes were measures of acceptable control (A1c < = 9%, BP < 140/90 mmHg, LDL < 130 mg/dL) and optimal control (A1c < 7%, BP < 130/80 mmHg, LDL < 100 mg/dL). Statistical significance was set at P < .008 (Bonferroni's correction). FINDINGS: Although the proportion of patients with reasonable A1c control worsened by increasing degree of rurality, the differences were not statistically significant (urban 90%, large rural 88%, small rural 85%, isolated rural 83%; P = .10); mean A1c values also increased by degree of rurality, although not statistically significant (urban 7.2 [SD 1.6], large rural 7.3 [SD 1.7], small rural 7.5 [SD 1.8], isolated rural 7.5 [SD 1.9]; P = .16). We observed no differences between degree of rural and reasonable BP or LDL control (P = .42, P = .23, respectively) or optimal A1c or BP control (P = .52, P = .65, respectively). Optimal and mean LDL values worsened as rurality increased (P = .08, P = .029, respectively). CONCLUSIONS: In patients with diabetes who seek care in the rural Southern United States, we observed no relationship between degree of rurality of patients' residence and traditional measures of quality of care. Further examination of the trends and explanatory factors for relative worsening of metabolic control by increasing degree of rurality is warranted.

Tonks SA; Makwana S; Salanitro AH; Safford MM; Houston TK; Allison JJ; Curry W; Estrada CA

2012-01-01

155

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)

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.

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

2005-01-01

156

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)

Full Text Available Abstract in spanish 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 emb (more) arazo 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, 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, (more) 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.

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

2005-03-01

157

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)

Full Text Available Abstract in spanish 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) (more) 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 dat (more) a 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.

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

2010-04-01

158

International approaches to measuring the quality of mental health care.  

UK PubMed Central (United Kingdom)

The importance of measuring the quality of mental health care is widely recognized. A number of factors should be considered when constructing mental health quality indicators including the aspects of care to be measured; translation of quality measurement concepts into indicators that can be measured; pilot-testing, analysis and display of measures; and maintaining effectiveness of performance measures and policies over time. The impetus to measure quality in mental health care may be dampened by the innumerable challenges inherent in this worthwhile endeavour. In particular, many countries lack adequate quality measurement infrastructure. Challenges may be overcome to a certain extent by international collaboration. While cross-country co-operation can also introduce additional complexities; its benefits usually outweigh the costs. Quality indicators can have many uses but of utmost importance is that quality measurement in mental health care subsequently results in quality improvements.

Moran V; O'Connor S; Borowitz M

2013-03-01

159

Different Perspectives on Health Care Quality: Is the Consensus Possible?  

Directory of Open Access Journals (Sweden)

Full Text Available For the success of health care organizations, accurate measurement of health care service quality is as important as understanding the nature of the service delivery system. Without a valid measure, it would be difficult to establish and implement appropriate tactics or strategies for service quality management.Experts have struggled for decades to formulate a concise, meaningful and generally applicable definition of the quality of health care. However, the complexity and variability of many definitions are very confusing even to experts. Patients, service providers and other parties involved in the process of health care service delivery, understand and describe service quality in different ways. Different perspectives on health care quality lead to different expectations and different methods of quality measurement.Patients tend to evaluate health care quality according to the responsiveness to their specific needs. Medicine has made remarkable advances over the past century and patients expect to get modern medical help, which would solve their health problems; medications that can cure a number of physical and psychological problems; surgery that can undo the inborn deficiencies and damage caused by accidents or diseases that until recently meant death or disability. Most patients define quality as efforts of physicians to do everything possible for a patient. Patients’ expectations about the health care system may differ from those of health care professionals and managers. For example, shorter visit lengths, which reduce the cost of providing ambulatory care, may have a negative effect on patients’ ability to participate in making choices about their care. On the other hand, patients cannot evaluate many technical aspects of health care quality. Physicians can provide a high level technical quality but still be rated low by patients because of the lack of humanity, responsiveness or satisfaction.For physicians and other health care providers measurement of quality has typically been driven by medical outcomes. However, outcomes indicative of quality may differ for a patient and physician. For example, although an oncologist may consider radiographically documented shrinkage of tumor size a desirable outcome, the patient may not care about tumor size and may rather consider improvement in health-related quality of life as the most desirable outcome. Health care administrators often use managerial input measures such as the average number of nursing hours required for an outpatient surgery.Considering all above mentioned, this article aims to reveal the similarities and differences between three competing perspectives on health care quality and to provide a way of integrating perceptions and needs of every group involved into one coherent approach to health care quality and its measurement.

Žaneta Piligrimien?; Ilona Bu?i?nien?

2008-01-01

160

Molecular imaging in quality health care  

International Nuclear Information System (INIS)

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

2006-01-01

 
 
 
 
161

Using management information systems to enhance health care quality assurance.  

UK PubMed Central (United Kingdom)

Examines how computers and quality assurance are being used to improve the quality of health care delivery. Traditional quality assurance methods have been limited in their ability to effectively manage the high volume of data generated by the health care process. Computers on the other hand are able to handle large volumes of data as well as monitor patient care activities in both the acute care and ambulatory care settings. Discusses the use of computers to collect and analyse patient data so that changes and problems can be identified. In addition, computer models for reminding physicians to order appropriate preventive health measures for their patients are presented. Concludes that the use of computers to augment quality improvement is essential if the quality of patient care and health promotion are to be improved.

Rosser LH Jr; Kleiner BH

1995-01-01

162

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

Directory of Open Access Journals (Sweden)

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.

Gaurav Sharma

2012-01-01

163

Mortality in perinatally HIV-infected young people in England following transition to adult care: an HIV Young Persons Network (HYPNet) audit.  

UK PubMed Central (United Kingdom)

OBJECTIVES: Mortality in young people with perinatally acquired HIV infection (PHIV) following transfer to adult care has not been characterized in the UK. We conducted a multicentre audit to establish the number of deaths and associated factors. METHODS: Fourteen adult clinics caring for infected young people reported deaths to 30 September 2011 on a proforma. Deaths were matched to the Collaborative HIV Paediatric Study, a clinical database of HIV-infected children in the UK/Ireland, to describe clinical characteristics in paediatric care of those who died post-transition. RESULTS: Eleven deaths were reported from 14 clinics which cared for 248 adults with PHIV. For the 11 deaths, the median age at transfer to adult care was 17 years (range 15-21 years), and at death was 21 years (range 17-24 years). Causes of death were suicide (two patients), advanced HIV disease (seven patients) and bronchiectasis (one patient), with one cause missing. At death, the median CD4 count was 27 cells/?L (range 0-630 cells/?L); five patients were on antiretroviral therapy (ART) but only two had a viral load care, continuing into adult care despite multidisciplinary support. Eight had ART resistance, although all had potentially suppressive regimens available. Nine had mental health diagnoses. CONCLUSIONS: Our findings highlight the complex medical and psychosocial issues faced by some adults with PHIV, with nine of the 11 deaths in our study being associated with poor adherence and advanced HIV disease. Novel adherence interventions and mental health support are required for this vulnerable cohort.

Fish R; Judd A; Jungmann E; O'Leary C; Foster C

2013-09-01

164

Measures for Improving the Quality of Health Care  

Directory of Open Access Journals (Sweden)

Full Text Available Quality and safety in the health sector go “hand in hand”, which means that both components are inseparably linked - quality improvement will often affect more security. Good quality services will be successfully implemented in organizations that already have a "quality culture", i.e., where the value system of employees is consistent with their commitment to providing high quality health services. The organization must have a clear strategic commitment to providing quality services at all levels of an organization. Quality and safety are not "an extra element in providing services, but make its ground. As such, the quality and safety must be built into the organization. Patient satisfaction, quality service and efficient management of resources become “holy trinity” of modern health care, strictly oriented towards the patient, aimed at reducing costs while increasing quality. Healthcare system worldwide try to develop new strategies, the implementation of which would lead to the end result -improvement of health care quality.

Aleksandar Višnji?; Vladica Veli?kovi?; Sla?ana Jovi?

2012-01-01

165

Methodological processes in validating and analysing the quality of population-based data: a case study using the Victorian Perinatal Data Collection.  

UK PubMed Central (United Kingdom)

This paper describes methods used and results obtained from a study that measured the accuracy of a routinely collected population-based data set. Data on a random sample of births were extracted from the 2003 Victorian Perinatal Data Collection (VPDC) and compared with information in the original medical record. Accuracy was calculated for 111 items related to diverse aspects of maternity and neonatal health and care. Sensitivity, specificity, positive predictive value and negative predictive value were calculated for dichotomous items. Seventynine items were accurate in at least 97% of cases, 45 of them in at least 99% of cases, and accuracy was below 90% for five items. Very high specificities demonstrate that conditions were rarely reported in error. Lower sensitivities indicate that some events that occurred went unreported on the perinatal form. The excellent results for specifi city indicated that the dataset is appropriate for a conservative analysis of relationships between factors. The lower sensitivities could result in true relationships between factors remaining unidentified. Reasons for discrepancies between the VPDC and the original medical record are described.

Davey MA; Sloan ML; Palma S; Riley M; King J

2013-01-01

166

Quality measures for primary care of complex pediatric patients.  

UK PubMed Central (United Kingdom)

OBJECTIVES: A well-recognized gap exists in assessing and improving the quality of care for medically complex patients. Our objective was to examine evidence for primary care based on the patient-centered medical home model and to identify valid and meaningful quality measures for use in complex pediatric patients. METHODS: We conducted literature searches on Medline and the National Quality Measures Clearinghouse for existing measures, as well as evidence to inform the development of new quality measures. We used a 3-step process to select relevant sources from published literature: (1) the titles were screened by 2 independent reviewers; (2) the abstracts were reviewed for quality-of-care contents or constructs; and (3) full-text articles were obtained and reviewed for measure specification. All materials were reviewed for the Oxford Centre For Evidence-Based Medicine level of evidence and for relevance to primary care of complex pediatric patients. A national expert panel was convened to evaluate and rate the measures by using the Rand/University of California Los Angeles Appropriateness Method. RESULTS: We presented 74 quality measures to the expert panel for review and discussion. The panel rated and accepted 35 measures as valid and feasible for assessing primary care quality in complex pediatric patients. The final set of quality measures was grouped in the following domains: primary care-general (14), patient/family-centered care (8), chronic care (2), coordination of care (9), and transition of care (2). CONCLUSIONS: By using the patient-centered medical home framework of accessible, continuous, family-centered, coordinated, and culturally effective care, a national expert panel selected 35 primary care quality measures for complex pediatric patients.

Chen AY; Schrager SM; Mangione-Smith R

2012-03-01

167

Quality end-of-life care: A global perspective  

Directory of Open Access Journals (Sweden)

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.

Singer Peter A; Bowman Kerry W

2002-01-01

168

Parent-Caregiver Communication and Quality of Care.  

Science.gov (United States)

Investigated the relationship between parent-caregiver communication and child care quality in 12 child care centers representing different types of sponsorship. Compared to parents, caregivers rated all forms of parent-caregiver communication as more frequent and as more important. Frequency of parent-caregiver communication and quality of child…

Ghazvini, Alisa S.; Readdick, Christine, A.

1994-01-01

169

Quality end-of-life care: A global perspective  

Digital Repository Infrastructure Vision for European Research (DRIVER)

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...

Singer Peter A; Bowman Kerry W

170

The role of health plans in improving quality of care.  

UK PubMed Central (United Kingdom)

Regulations and accrediting bodies have charged health plans with assuring and improving the quality of care delivered to plan members. Now, health plans also have an opportunity to promote payment reform designed to align incentives so that plans, providers, employers, and patients can all focus on achieving high-quality care.

Barco D; Chauncey P

2013-03-01

171

Overview of issues in improving quality of care for children.  

Digital Repository Infrastructure Vision for European Research (DRIVER)

OBJECTIVE: To provide a framework for a research agenda-setting conference on quality of care for children. DATA SOURCES/STUDY SETTING: Literature review. CONCLUSIONS: Research on quality of care for children has lagged behind its counterpart for adults. Defining key issues and questions in seven to...

McGlynn, E A; Halfon, N

172

Provider workload and quality of care in primary care settings: moderating role of relational climate.  

UK PubMed Central (United Kingdom)

Primary care providers are increasingly under pressure to do more with fewer resources. We examined the effect of workload on patients' experiences of quality of care, measured through approximately 44,000 patient experience surveys in a sample of 222 primary care clinics in the Veterans Health Administration. We tested the extent to which relational climate, a measure of teamwork, moderated the relationship between workload and patient ratings of quality of care. Our outcome measures included patient complaints, time spent with provider, and overall visit quality. Workload was negatively associated with patients' quality of care ratings and relational climate moderated the relation between workload and quality of care ratings. Patients seen in clinics with higher workload and greater relational climate reported better care compared with patients in clinics with higher workload but lower relational climate. Findings highlight the importance of relational climate as an important teamwork factor when managing and developing clinic policies, practices, and procedures in resource-constrained settings.

Mohr DC; Benzer JK; Young GJ

2013-01-01

173

Inter-regional competition and quality in hospital care.  

UK PubMed Central (United Kingdom)

This study analyzes the effect of episode-of-care payment and patient choice on waiting time and the comprehensive quality of hospital care. The study assumes that two hospitals are located in two cities with different population sizes and compete with each other. We find that the comprehensive quality of hospital care as well as waiting time of both hospitals improve with an increase in payment per episode of care. However, we also find that the extent of these improvements differs according to the population size of the cities where the hospitals are located. Under the realistic assumptions that hospitals involve significant labor-intensive work, we find the improvements in comprehensive quality and waiting time in a hospital located in a small city to be greater than those in a hospital located in a large city. The result implies that regional disparity in the quality of hospital care decreases with an increase in payment per episode of care.

Aiura H

2013-06-01

174

How can clinicians measure safety and quality in acute care?  

UK PubMed Central (United Kingdom)

The demand for high quality care is increasing and warranted. Evidence suggests that the quality of care in hospitals can be improved. The greatest opportunity to improve outcomes for patients over the next quarter century will probably come not from discovering new treatments but from learning how to deliver existing effective therapies. To improve, caregivers need to know what to do, how they are doing, and be able to improve the processes of care. The ability to monitor performance, though challenging in healthcare, is essential to improving quality of care. We present a practical method to assess and learn from routine practice. Methods to evaluate performance from industrial engineering can be broadly applied to efforts to improve the quality of healthcare. One method that may help to provide caregivers frequent feedback is time series data--ie, results are graphically correlated with time. Broad use of these tools might lead to the necessary improvements in quality of care.

Pronovost PJ; Nolan T; Zeger S; Miller M; Rubin H

2004-03-01

175

How can clinicians measure safety and quality in acute care?  

UK PubMed Central (United Kingdom)

The demand for high quality care is increasing and warranted. Evidence suggests that the quality of care in hospitals can be improved. The greatest opportunity to improve outcomes for patients over the next quarter century will probably come not from discovering new treatments but from learning how to deliver existing effective therapies. To improve, caregivers need to know what to do, how they are doing, and be able to improve the processes of care. The ability to monitor performance, though challenging in healthcare, is essential to improving quality of care. We present a practical method to assess and learn from routine practice. Methods to evaluate performance from industrial engineering can be broadly applied to efforts to improve the quality of healthcare. One method that may help to provide caregivers frequent feedback is time series data--ie, results are graphically correlated with time. Broad use of these tools might lead to the necessary improvements in quality of care.

Pronovost PJ; Nolan T; Zeger S; Miller M; Rubin H

2011-03-01

176

Quality, costs and the role of primary health care  

Digital Repository Infrastructure Vision for European Research (DRIVER)

The general aim of this thesis is to describe and analyse the role of primary care in health care systems in terms of health, health care utilisation and costs, and to study the feasibility of retrieval of data from computerised medical records to monitor medical quality. The thesis includes five st...

Engström, Sven

177

[Psychosocial climate in maternity hospitals from the perspective of parturients II. Predictors of womens satisfaction with perinatal care in the Czech Republic].  

UK PubMed Central (United Kingdom)

OBJECTIVE: To identify the key determinants of parturients satisfaction with care provided in the Czech maternity hospitals and to draw up recommendation for good practice. DESIGN: Original study. SETTING: Department of Psychology, Faculty of Philosophy, Charles University, Prague. METHODS: Statistical analysis of data from the representative sample of Czech parturients (n = 1195) who gave birth from 2005 to 2012 in Czech maternity hospitals was conducted. Ordinal logistical regression (cumulative logit model) was used to identify predictors of womens satisfaction with intrapartum and postpartum care and their willingness to return and give birth in the same hospital as well as to recommend the hospital to others. The independent variables were the individual items of the KLI-P questionnaire measuring psychosocial climate in maternity hospitals and socio-demographic and anamnestic characteristics of parturients. RESULTS: Among the most important determinants of parturients satisfaction with care at delivery unit were well-timed provision of information concerning a treatment plan (OR = 2,79; p < 0,0001), privacy during the first stage of labour (OR = 2,81; p < 0,0001), kind and helpful attitude of physicians (OR = 2,67; p < 0,0001) and confidence in physicians (OR = 2,68; p = 0,0001). Among the most important determinants of satisfaction with care at after-birth unit were well-timed provision of information concerning a treatment plan (OR = 2,25; p < 0,0001), active breastfeeding support (OR = 2,19;p < 0,0001), availability of caregivers (OR = 2,16;p < 0,0001), multiparity (OR = 1,52; p = 0,0001), respect shownby staff employed in mother care (OR = 2,02; p = 0,0004) and kind and helpful attitude of staff employed in newborn care (OR = 1,86; p = 0,0005). When considering the future place of birth and recommendation of the hospital to others, women predominantly take into account the care provided at delivery unit. Intrapartal care evaluation was affected to a lesser degree by satisfaction with midwives as compared to satisfaction with physicians. CONCLUSION: Analyses of the most important predictors of satisfaction with perinatal care indicate the need for practice to focus on enhancing psychosocial competences (particularly communication skills) of health care providers, more active breastfeeding support and communication of consistent information (especially concerning newborn care) by caregivers at after-birth unit.

Takács L; Seidlerová J

2013-06-01

178

[Medical care organization in analgesia, anaesthesia and intensive care in maternity units: results from the National Perinatal Surveys in 2003 and 2010].  

UK PubMed Central (United Kingdom)

OBJECTIVE: The equipment and practices in obstetric analgesia, anaesthesia and intensive care, as well as their evolution between 2003 and 2010 in metropolitan France, were described. POPULATION AND METHODS: Data were derived from two representative samples of births in 2003 and 2010, based on all births in France during one week. The sample included 534 maternity units and 14,903 births in 2010 and 618 maternity units and 14,737 births in 2003. RESULTS: The caesarean operating room was adjacent or inside the labour ward in 66% of maternity units in 2010 vs 56% in 2003. An anaesthetist was appointed permanently to the labour ward in 38.9% of maternity units in 2010 vs 21.5% in 2003. Locoregional analgesia or anaesthesia rate increased significantly: 81.5% in 2010 compared to 74.9% in 2003. Almost all operative vaginal deliveries were performed under epidural anesthesia in 2010. Patient controlled epidural analgesia (PCEA) was available in 58% of the units in 2010 but only 34.2% of women had PCEA. Newborn's resuscitations were performed mainly by paediatricians in 2010, but 11.4% of children were resuscitated by an anaesthetist in level 1 maternity units. CONCLUSION: The conditions required to ensure anaesthetic care safety in maternity units has improved since 2003. Improvements in quality of care are still possible.

Ducloy-Bouthors AS; Prunet C; Tourrès J; Chassard D; Benhamou D; Blondel B

2013-01-01

179

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

UK PubMed Central (United Kingdom)

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.

Boorsma M; Frijters DH; Knol DL; Ribbe ME; Nijpels G; van Hout HP

2011-08-01

180

Constructing a framework for quality activity in primary care.  

UK PubMed Central (United Kingdom)

INTRODUCTION: In 2009, the Royal New Zealand College of General Practitioners commissioned the development of a framework to facilitate quality-improvement activity in primary care settings. This paper outlines the development of the framework, which integrates concepts of quality with the reality of practice-based clinical care, and discusses its value for primary care quality improvement. METHOD: Framework development involved: (1) literature review of theoretical approaches to healthcare quality; (2) field work utilising a mixed methods approach to obtain empirical data; and (3) model design. RESULTS: Primary care practitioners are juggling competing priorities. Models and tools that promote quality-related activity at practice level need to take into account, and incorporate by design, day-to-day clinical and practice functions. CONCLUSIONS: The quality framework identifies the components of primary care practice and locates this model within the concepts and activities necessary for quality improvement. It may be used by primary care organisations and practices to facilitate focussed quality-improvement activity and self-directed process review. The framework was developed for, and within a New Zealand primary care setting, and is applicable internationally and within other healthcare settings.

Perera GA; Dowell AC; Morris CJ

2013-02-01

 
 
 
 
181

'Busyness' and the preclusion of quality palliative district nursing care.  

UK PubMed Central (United Kingdom)

Ethical care is beginning to be recognised as care that accounts for the views of those at the receiving end of care. However, in the context of palliative and supportive district nursing care, the patients' and their carers' views are seldom heard. This qualitative research study explores these views. Data were collected through semi-structured interviews with 26 patients with palliative and supportive care needs receiving district nursing care, and 13 of their carers. Participants were recruited via community nurses and hospices between September 2010 and October 2011. Post-structural discourse analysis is used to examine how discourses operate on a moral level. One discourse, 'busyness', is argued to preclude a moral form of nursing care. The discourse of friendship is presented to contrast this. Discussion explores Gallagher's 'slow ethics' and challenges the currently accepted ways of measuring to improve quality of care concluding that quality cannot be measured.

Nagington M; Luker K; Walshe C

2013-05-01

182

Cardiac care quality indicators: a new hospital-level quality improvement initiative for cardiac care in Canada.  

UK PubMed Central (United Kingdom)

Health system stakeholders at different levels are focused more than ever on improvements to quality of care. With heart disease continuing to be a top health issue for Canadians, quality improvement initiatives aimed at improving cardiac care are increasingly important. The Cardiac Care Quality Indicators are one such initiative, with the goal of supporting cardiac care centres in their quality improvement efforts by providing comparable facility-level information on a number of cardiac quality outcome indicators. Working together, the Canadian Institute for Health Information and the Cardiac Care Network of Ontario completed the pilot project for this initiative in Ontario and British Columbia in 2010. Based on the success of the pilot, a national expansion of the initiative is currently under way. This article details some of the processes that led to the success of the project and presents some high-level, de-identified results.

Gorzkiewicz V; Lacroix J; Kingsbury K

2012-01-01

183

Quality management in dental health care: Present and future development  

Directory of Open Access Journals (Sweden)

Full Text Available The standards ISO 9000 series, brought in 1987, were the driving force for the development and application of quality management (QM) in various areas, including health care. Currently, there are over one million certificates for quality management (QMC), and they were main initiators of quality improvement. In addition to the model for quality management of products/services, other models are also in use. The aim of this study was to present methods and techniques for quality improvement of health services, with special emphasis on dental health care services (DHS), and possibility for enhancement.

Teki? Jasmina; Majstorovi? Vidosav D.; Markovi? Dejan; Nikodijevi? Angelina; Stamenkovi? Dragoslav

2011-01-01

184

Nursing Home Care Quality: Insights from a Bayesian Network Approach  

Science.gov (United States)

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…

Goodson, Justin; Jang, Wooseung; Rantz, Marilyn

2008-01-01

185

Number of sites of perinatal Candida colonization and neutropenia are associated with nosocomial candidemia in the neonatal intensive care unit patient.  

UK PubMed Central (United Kingdom)

OBJECTIVES: To determine the role of perinatally acquired Candida colonization to invasive Candida infection (candidemia) and to assess risk factors associated with Candida colonization and candidemia in neonatal intensive care unit patients. DESIGN: Retrospective case-control study. SETTING: Neonatal intensive care unit of a teaching hospital. PATIENTS: A total of 39 of 3219 (1.2%) who were positive for Candida colonization at birth were compared with 117 noncolonized controls. INTERVENTIONS: Routine surveillance cultures for Candida of skin and meconium were performed at admission. All neonates with Candida colonization at birth during a 10-yr period were identified. Each case was matched to place of birth and date of admission with three noncolonized controls. MEASUREMENTS AND MAIN RESULTS: Perinatal and neonatal variables were collected. Blood or skin culture was obtained when signs of sepsis or dermatitis were present. Patients with Candida colonization were compared with their noncolonized controls, whereas in this cohort, patients with candidemia were compared with those without by multivariate analysis. Vaginal candidiasis (odds ratio [OR] 15.8, 95% confidence interval [CI] 2.63, 94.77), birth weight below 1000 g (OR 8.1, 95% CI 1.22, 52.26), and vaginal delivery (OR 7.08, 95% CI 1.17, 42.70) were associated with Candida colonization. An increased risk for nosocomial candidemia was independently associated with the number of sites of Candida colonization (OR 24.02, 95% CI 1.89, 304), early neonatal neutropenia (OR 7.15, 95% CI 0.98, 80.95) and illness severity (clinical risk index for babies [CRIB]) score at day 1 (OR 1.38, 95%CI 1.065, 1.811). CONCLUSIONS: Maternal vaginal candidiasis and vaginal birth are risk factors for neonatal colonization. When controlling for illness severity, the number of sites colonized with Candida at birth contributes to neonatal nosocomial candidemia. Early neutropenia increases the risk further. These findings offer opportunities for prevention of Candida infection in neonatal intensive care unit patients.

Mahieu LM; Van Gasse N; Wildemeersch D; Jansens H; Ieven M

2010-03-01

186

Use of quality indicators in patient care: a senior primary care physician trying to take good care of his patients.  

UK PubMed Central (United Kingdom)

Dr A is a senior primary care physician who recently moved from a small private practice to a larger group-model practice. He believes he was able to provide higher-quality and more individualized care for his patients in his small practice. As Dr A has discovered, quality measurement and improvement activities in primary care have evolved from a focus on an individual patient in an examination room to a systems approach that incorporates population management. Although many frustrations remain with physicians' ability to measure and influence the quality of care received by populations of patients, quality measures and monitoring have improved and should continue to improve. However, the perspective of patients and experienced physicians like Dr A also should be incorporated into quality measurement and management systems. Dr A clearly has the welfare of his patients at heart, and his experience and perspective could help improve his organization's systems of care and identify resources to deliver the best care.

Landon BE

2012-03-01

187

A matched pair cluster randomized implementation trail to measure the effectiveness of an intervention package aiming to decrease perinatal mortality and increase institution-based obstetric care among indigenous women in Guatemala: study protocol.  

UK PubMed Central (United Kingdom)

BACKGROUND: Maternal and perinatal mortality continue to be a high priority problem on the health agendas of less developed countries. Despite the progress made in the last decade to quantify the magnitude of maternal mortality, few interventions have been implemented with the intent to measure impact directly on maternal or perinatal deaths. The success of interventions implemented in less developed countries to reduce mortality has been questioned, in terms of the tendency to maintain a clinical perspective with a focus on purely medical care separate from community-based approaches that take cultural and social aspects of maternal and perinatal deaths into account. Our innovative approach utilizes both the clinical and community perspectives; moreover, our study will report the weight that each of these components may have had on reducing perinatal mortality and increasing institution-based deliveries. METHODS/DESIGN: A matched pair cluster-randomized trial will be conducted in clinics in four rural indigenous districts with the highest maternal mortality ratios in Guatemala. The individual clinic will serve as the unit of randomization, with 15 matched pairs of control and intervention clinics composing the final sample. Three interventions will be implemented in indigenous, rural and poor populations: a simulation training program for emergency obstetric and perinatal care, increased participation of the professional midwife in strengthening the link between traditional birth attendants (TBA) and the formal health care system, and a social marketing campaign to promote institution-based deliveries. No external intervention is planned for control clinics, although enhanced monitoring, surveillance and data collection will occur throughout the study in all clinics throughout the four districts. All obstetric events occurring in any of the participating health facilities and districts during the 18 months implementation period will be included in the analysis, controlling for the cluster design. Our main outcome measures will be the change in perinatal mortality and in the proportion of institution-based deliveries. DISCUSSION: A unique feature of this protocol is that we are not proposing an individual intervention, but rather a package of interventions, which is designed to address the complexities and realities of maternal and perinatal mortality in developing countries. To date, many other countries, has focused its efforts to decrease maternal mortality indirectly by improving infrastructure and data collection systems rather than on implementing specific interventions to directly improve outcomes. TRIAL REGISTRATION: ClinicalTrial.gov,http://NCT01653626.

Kestler E; Walker D; Bonvecchio A; de Tejada SS; Donner A

2013-01-01

188

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

UK PubMed Central (United Kingdom)

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

Barba BE; Hu J; Efird J

2012-03-01

189

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

UK PubMed Central (United Kingdom)

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.

Sword W; Heaman MI; Brooks S; Tough S; Janssen PA; Young D; Kingston D; Helewa ME; Akhtar-Danesh N; Hutton E

2012-01-01

190

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

Directory of Open Access Journals (Sweden)

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.

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

191

Evaluating the Quality of Colorectal Cancer Care in the State of Florida: Results From the Florida Initiative for Quality Cancer Care  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Although the quality of care delivered within the Florida Initiative for Quality Cancer Care practices seems to be high, several components of care were identified that warrant further scrutiny on a systemic level and at individual centers.

Siegel, Erin M.; Jacobsen, Paul B.; Malafa, Mokenge; Fulp, William; Fletcher, Michelle; Lee, Ji-Hyun; Smith, Jesusa Corazon R.

192

Leadership, staffing and quality of care in nursing homes  

Directory of Open Access Journals (Sweden)

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.

Havig Anders; Skogstad Anders; Kjekshus Lars; Romøren Tor

2011-01-01

193

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)

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.

Schachter Howard M; Mamaladze Vasil; Lewin Gabriela; Graham Ian D; Brouwers Melissa; Sampson Margaret; Morrison Andra; Zhang Li; O'Blenis Peter; Garritty Chantelle

2006-01-01

194

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

Digital Repository Infrastructure Vision for European Research (DRIVER)

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...

Abrahamsen Grøndahl, Vigdis

195

Quality of care of patients with chronic lymphoedema in Germany.  

UK PubMed Central (United Kingdom)

BACKGROUND: The management of lymphoedema is complex and should be based on guidelines. To date, no data assessing quality of care in lymphoedema in Germany are available. OBJECTIVE: We aimed at evaluating the quality of care of lymphoedema in the metropolitan area of Hamburg using guideline-based indicators. METHODS: Cross-sectional, community-based study including patients with lymphoedema. Assessment included a structured interview, clinical examination and patient-reported outcomes. Quality indicators derived from guidelines by a Delphi consensus were applied. RESULTS: 348 patients (median age 60.5 years) with lymphoedema (66.4%), lipoedema (9.5%) or combined oedema (24.1%) were included. 86.4% performed compression therapy, 85.6% received lymphatic drainage. On average 55.0% of the quality of care criteria were met; 64.8% were satisfied with care. The distribution curve of the health care index was almost normal. Treatment by specialists led to a higher quality of care index. CONCLUSION: Although overall quality of care in lymphoedema is fair, many patients are not treated properly according to guidelines.

Herberger K; Blome C; Sandner A; Altheide F; Heyer K; Münter KC; Gottlieb WR; Augustin M

2013-01-01

196

Improving the quality of care for Medicaid patients with chronic diseases: Community Care of North Carolina.  

UK PubMed Central (United Kingdom)

Community Care of North Carolina's provider-driven approach to quality improvement has benefitted tens of thousands of North Carolinians with diabetes, asthma, hypertension, heart failure, and cardiovascular disease, and it has achieved better results than commercial Medicaid managed care nationally. Substantial opportunities remain, however, particularly for patients with complex care needs.

DuBard CA

2013-03-01

197

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

Digital Repository Infrastructure Vision for European Research (DRIVER)

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 the...

Ygge, Britt Marie

198

Professional commitment, patient safety, and patient-perceived care quality.  

UK PubMed Central (United Kingdom)

PURPOSE: To examine how professional commitment influences patient safety and patient-perceived care quality. DESIGN: Investigators for this study used a cross-sectional design with questionnaires. A total of 348 pairs of nurses and inpatients were contacted at two medical centers in Taiwan during the period from August 2007 to January 2008, yielding 284 pairs of completed questionnaires. METHODS: Frequencies of six adverse patient events were used to measure patient safety; and the Service Quality Scale was used to measure patient-perceived care quality. Four items of the Professional Commitment Questionnaire were used to measure professional commitment. Regressions were used for the analyses. FINDINGS: Professional commitment positively influenced overall patient safety (ss=.19, p=.00) and overall patient-perceived care quality (ss=.13, p=.03). Furthermore, professional commitment positively influenced all patient safety indicators (ss>or=.12, pcare quality in terms of responsiveness (ss=.16, p=.01) and empathy (ss=.14, p=.03). CONCLUSIONS: Professional commitment may enhance patient safety and patient-perceived care quality. CLINICAL RELEVANCE: This study indicates that nurse professional commitment can enhance patient safety and patient-perceived care quality.

Teng CI; Dai YT; Shyu YI; Wong MK; Chu TL; Tsai YH

2009-01-01

199

Privatization of social services: quality differences in Swedish elderly care.  

Science.gov (United States)

One of the major policy trends in recent decades has been the privatization of social services. This trend has also reached Sweden, a welfare state with health care and social service sectors that previously had almost no private providers. One of the most affected areas is elderly care, i.e. home-help services and residential care provided to citizens older than 65 years, where the proportion of private providers increased from 1% in 1990 to 16% in 2010. The ongoing privatization in Sweden and many other countries has raised important questions regarding the consequences of this policy transformation. In this paper, we present a cross-sectional study comparing the quality of services in private and public elderly care. Using statistics from 2007 displaying a variety of quality dimensions covering over 99% of all elderly care residents in Sweden, we were able to show that privatization is indeed associated with significant quality differences. Structural quality factors such as the number of employees per resident was significantly smaller (-9%) in private elderly care. On the other hand, the proportion of residents participating in the formulation of their care plan (+7%), the proportion of elderly with a reasonable duration between evening meal and breakfast (+15%), and the proportion of elderly offered different food alternatives (+26%) were significantly in favour of private contractors. Our conclusion is that private care providers seem to emphasize service aspects rather than structural prerequisites for good care. PMID:21167627

Stolt, Ragnar; Blomqvist, Paula; Winblad, Ulrika

2010-11-24

200

Inpatient palliative care consultation: enhancing quality of care for surgical patients by collaboration.  

UK PubMed Central (United Kingdom)

Hospital-based surgeons will likely encounter palliative care service colleagues more frequently, given the growth of approved fellowships and hospital palliative care programs. Surgeons may consult with palliative care colleagues to help patients and families manage pain and other symptoms, cope with the distress of acute and chronic illness, manage complex decisions at end-of-life, and negotiate through a critical illness (or combinations thereof). Inpatient palliative care consultation has been shown to improve quality of care, including quality of life and satisfaction of patients, families, and referring clinicians.

Adolph MD

2011-04-01

 
 
 
 
201

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

Directory of Open Access Journals (Sweden)

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.

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

2010-01-01

202

The Wormerveer study; perinatal mortality and non-optimal management in a practice of independent midwives.  

UK PubMed Central (United Kingdom)

In a prospective study in a group of 7980 pregnant women who booked in an independent midwife practice perinatal mortality was studied with the aim to assess non-optimal management. An internally generated audit proved not to be successful because of emotional involvement. A panel of independent experts seemed to be a better instrument to assess the quality of care. In 66 (75%) of all 89 cases complete consensus or near consensus was reached. In this group preventable factors were noticed in 29 cases (44%). In 30 cases (45%) the mortality was judged as inevitable. In 7 cases the information was insufficient. In the 29 cases with preventable factors, 12 cases concerned the skill of the obstetrician, seven cases the skill of the pediatrician, seven cases the skill of the midwife. In two cases the behaviour of the patient and in one case the skill of the general practitioner were blamed. Preventable factors are mainly present in decisions made during the prenatal period by the midwife (or general practitioner) and the obstetrician, and in care during labour and delivery and the postnatal period by the obstetrician and pediatrician. The care of the midwife during labour and delivery had little influence on preventable perinatal mortality. A further decrease of perinatal mortality may be achieved by analysis of the cases and continued education of all workers in perinatal care.

Eskes M; van Alten D; Treffers PE

1993-10-01

203

The Wormerveer study; perinatal mortality and non-optimal management in a practice of independent midwives.  

Science.gov (United States)

In a prospective study in a group of 7980 pregnant women who booked in an independent midwife practice perinatal mortality was studied with the aim to assess non-optimal management. An internally generated audit proved not to be successful because of emotional involvement. A panel of independent experts seemed to be a better instrument to assess the quality of care. In 66 (75%) of all 89 cases complete consensus or near consensus was reached. In this group preventable factors were noticed in 29 cases (44%). In 30 cases (45%) the mortality was judged as inevitable. In 7 cases the information was insufficient. In the 29 cases with preventable factors, 12 cases concerned the skill of the obstetrician, seven cases the skill of the pediatrician, seven cases the skill of the midwife. In two cases the behaviour of the patient and in one case the skill of the general practitioner were blamed. Preventable factors are mainly present in decisions made during the prenatal period by the midwife (or general practitioner) and the obstetrician, and in care during labour and delivery and the postnatal period by the obstetrician and pediatrician. The care of the midwife during labour and delivery had little influence on preventable perinatal mortality. A further decrease of perinatal mortality may be achieved by analysis of the cases and continued education of all workers in perinatal care. PMID:8119466

Eskes, M; van Alten, D; Treffers, P E

1993-10-01

204

The perinatal loss and parental reflection  

Directory of Open Access Journals (Sweden)

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

Öznur Körükcü; Kamile Kukulu

2010-01-01

205

Implementing total quality management (TQM) in health-care laboratories.  

UK PubMed Central (United Kingdom)

Health-care organizations are beginning to apply the principles of total quality management (TQM). Implementing TQM in a health-care laboratory requires incorporating quality improvement (QI) and quality planning (QP) with quality laboratory practices (QLP), quality control (QC), and quality assurance (QA) to provide a complete quality management system. QI and QP can be initiated by developing a strategic plan as a pilot QI project. QI project teams are then introduced to accomplish the highest priority goals. This implementation approach improves strategic planning by using group problem-solving tools and techniques, such as process flow charts, brainstorming, nominal group, fishbone diagrams, consensus decision making, and Pareto analysis. The approach also improves the success of project teams by providing a clear management agenda and a commitment to project-by-project QI.

Westgard JO; Barry PL; Tomar RH

1991-09-01

206

Implementing total quality management (TQM) in health-care laboratories.  

Science.gov (United States)

Health-care organizations are beginning to apply the principles of total quality management (TQM). Implementing TQM in a health-care laboratory requires incorporating quality improvement (QI) and quality planning (QP) with quality laboratory practices (QLP), quality control (QC), and quality assurance (QA) to provide a complete quality management system. QI and QP can be initiated by developing a strategic plan as a pilot QI project. QI project teams are then introduced to accomplish the highest priority goals. This implementation approach improves strategic planning by using group problem-solving tools and techniques, such as process flow charts, brainstorming, nominal group, fishbone diagrams, consensus decision making, and Pareto analysis. The approach also improves the success of project teams by providing a clear management agenda and a commitment to project-by-project QI. PMID:10113715

Westgard, J O; Barry, P L; Tomar, R H

207

LONG-TERM CARE OF DEPENDENT ELDERLY AND QUALITY  

Directory of Open Access Journals (Sweden)

Full Text Available This article focuses on the issue of long-term care of dependent elderly and quality of life of their carers. Elderly care has an impact on the quality of life of family members. The research was carried out through a questionnaire and interview. The quality of life was measured using the WHOQOL instrument. The research aimed to identify the current levels of family members’ quality of life and the factors influencing the quality of life thereof. The research findings showed a lower quality of life for family caregivers as compared to non-caregivers in the Czech Republic. The main factor effecting the quality of life was a degree of elderly dependency. This research represents a contribution to descriptions of life situation and position of family carers of their dependent elderly.

Macková Marie

2013-01-01

208

The quality of district nursing care for dying patients.  

UK PubMed Central (United Kingdom)

During a project to explore the quality of district nursing care provided to patients with and without cancer, six district nurses in one community trust were interviewed. They acknowledged that the quality of their terminal care was dependent on whether patients were dying from cancer or from non-cancer diseases. This article describes how the project was undertaken, the methods, the results and the implications for district nursing.

Law R

1997-11-01

209

Outcomes Management Conference: Quality of Cancer Care.  

Science.gov (United States)

This was the third Evanston Northwestern Healthcare/Northwestern Universitysponsored conference on outcomes management. The conference was built around two interconnected themes that focused on activities essential for improving cancer care: expanding and...

C. Nowinski D. Cella S. Becker C. Caprini K. Cook

2004-01-01

210

Gauging food and nutritional care quality in hospitals  

Directory of Open Access Journals (Sweden)

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.

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

2012-01-01

211

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

UK PubMed Central (United Kingdom)

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

Hunter MA; Larrabee JH

1998-12-01

212

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

Science.gov (United States)

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

Hunter, M A; Larrabee, J H

1998-12-01

213

Economics and quality of care: are they in competition?  

Science.gov (United States)

I propose that high quality health care -- including innovation and state-of-the-art technology -- can and must co-exist with society's desire to reduce costs. One need not threaten the other. In fact, they should be mutually supportive. In this paper I talk about how we assess value in health care and some of the principles that should inform sound economic decisions about quality care. First, I'd like to consider why consumers define quality differently in health care than they do in other markets, and why lower costs and improved quality can -- and must -- move together. I review examples of how we currently use less costly alternatives for delivering care and at the same time maintain or improve our performance in meeting quality health care goals. I discuss how mechanisms in our current system support continued cost and quality improvements. Finally, I'll conclude with thoughts on how we can facilitate this trend with information and continued innovation.

Simmons, Joan

1995-10-01

214

Quality of care: how good is good enough?  

Digital Repository Infrastructure Vision for European Research (DRIVER)

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...

Chassin Mark R

215

Older people's views of quality of care: a randomised controlled study of continuum of care.  

UK PubMed Central (United Kingdom)

AIMS AND OBJECTIVES: To analyse frail older people's views of quality of care when receiving a comprehensive continuum of care intervention, compared with those of people receiving the usual care (control group). The intervention included early geriatric assessment, case management, interprofessional collaboration, support for relatives and organising of care-planning meetings in older people's own homes. BACKGROUND: Prior studies indicate that tailored/individualised care planning conducted by a case manager/coordinator often led to greater satisfaction with care planning among older people. However, there is no obvious evidence of any effects of continuum of care interventions on older people's views of quality of care. DESIGN: Randomised controlled study. METHODS: Items based on a validated questionnaire were used in face-to-face interviews to assess older people's views of quality of care at three, six and 12 months after baseline. RESULTS: Older people receiving a comprehensive continuum of care intervention perceived higher quality of care on items about care planning (p ? 0·005), compared with those receiving the usual care. In addition, they had increased knowledge of whom to contact about care/service, after three and 12 months (p < 0·03). CONCLUSIONS: The study gives evidence of the advantages of a combination of components such as organising care-planning meetings in older people's own homes, case management and interprofessional teamwork. RELEVANCE TO CLINICAL PRACTICE: The results have implications for policymakers, managers and professionals in the area of health and social care for older people to meet individual needs of frail older people.

Berglund H; Wilhelmson K; Blomberg S; Dunér A; Kjellgren K; Hasson H

2013-10-01

216

Quality of Care for Diabetics among Health Plans  

Directory of Open Access Journals (Sweden)

Full Text Available This reseach examines the performance rates of management care organizations as stakeholders andthe implication for public health. D ata on core measures of diabetes care - hemoglobin A1C, serum cholesterollevel, eye exam and kidney disease were used. The results show that variations exist in diabetes managementwithin and between managed cares. Realizing the causes of variability w ithin all stakeholders in diabetes careis the key to developing and implementing targeted quality improvement strategies and programs.

Matilda Steiner_Asiedu

2009-01-01

217

Quality improvement in chronic illness care: a collaborative approach.  

UK PubMed Central (United Kingdom)

BACKGROUND: Despite rapid advances in the clinical and psycho-educational management of diabetes, the quality of care received by the average patient with diabetes remains lackluster. The "collaborative" approach--the Breakthrough Series (BTS; Institute for Healthcare Improvement [IHI]; Boston)--coupled with a Chronic Care Model was used in an effort to improve clinical care of diabetes in 26 health care organizations. METHODS: Descriptive and pre-post data are presented from 23 health care organizations participating in the 13-month (August 1998-September 1999) BTS to improve diabetes care. The BTS combined the system changes suggested by the chronic care model, rapid cycle improvement, and evidence-based clinical content to assist teams with change efforts. The characteristics of organizations participating in the diabetes BTS, the collaborative process and content, and results of system-level changes are described. RESULTS: Twenty-three of 26 teams completed participation. Both chart review and self-report data on care processes and clinical outcomes suggested improvement based on changes teams made in the collaborative. Many of the organizations evidencing the largest improvements were community health centers, which had the fewest resources and the most challenged populations. DISCUSSION: The initial Chronic Illness BTS was sufficiently encouraging that replication and evaluation of the BTS collaborative model is being conducted in more than 50 health care systems for diabetes, congestive heart failure, depression, and asthma. This model represents a feasible method of improving the quality of care across different health care organizations and across multiple chronic illnesses.

Wagner EH; Glasgow RE; Davis C; Bonomi AE; Provost L; McCulloch D; Carver P; Sixta C

2001-02-01

218

Care pathways to improve care co-ordination and quality between primary and hospital care for patients with radical prostatectomy: a quality improvement project.  

UK PubMed Central (United Kingdom)

BACKGROUND: Care pathways are widely used in hospitals to improve quality. There is a growing interest in extending care pathways into primary care. There is little evidence on the relationship between care pathways across the primary-hospital care continuum and improvement in quality of care. Members of primary and hospital care services in the region of Bruges (Belgium) developed a care pathway for radical prostatectomy patients. An evaluation of this care pathway encountered some problems. AIM: To assess if a revision of the care pathway would improve quality of care enhancing patient outcomes. METHODS: An exploratory trial was performed to test the feasibility of quality measurement, the possible intervention effect and recruitment. A pre-post-intervention postal survey was used. Quality of care was translated into process and outcome indicators. These indicators were measured in two groups receiving a postal questionnaire: one group before (pre-intervention) and another group after implementation (post-intervention). A Fisher's exact test was used to compare differences for dichotomous variables, and a Mann-Whitney U-test to compare ordinal and continuous variables. RESULTS: Observed improvements in process and outcome indicators were not statistically significant after correcting for multiple testing: 95.1% of patients received the information pack during the pre-operative consultation (versus 81.0% in the pre-intervention), 86.0% of the patients consulted a physiotherapist who specialised in pelvic floor muscle exercise treatment (versus 56.0% in the pre-intervention) and no patients experienced pain (versus 13.6% in the pre-intervention). No changes were observed for communication and co-ordination between caregivers. CONCLUSION: Given the background of scarce evidence on the quality improvement effect of care pathways between primary and hospital care, this exploratory trial provides information about the quality measurement, the possible intervention effect and recruitment. The quality improvement process is continuing as the hospital takes further initiatives to improve well-being.

Van Houdt S; Heyrman J; Vanhaecht K; Sermeus W; De Lepeleire J

2013-01-01

219

Is there an association between female circumcision and perinatal death?  

Directory of Open Access Journals (Sweden)

Full Text Available OBJECTIVE: In Sweden, a country with high standards of obstetric care, the high rate of perinatal mortality among children of immigrant women from the Horn of Africa raises the question of whether there is an association between female circumcision and perinatal death. METHOD: To investigate this, we examined a cohort of 63 perinatal deaths of infants born in Sweden over the period 1990-96 to circumcised women. FINDINGS: We found no evidence that female circumcision was related to perinatal death. Obstructed or prolonged labour, caused by scar tissue from circumcision, was not found to have any impact on the number of perinatal deaths. CONCLUSION: The results do not support previous conclusions that genital circumcision is related to perinatal death, regardless of other circumstances, and suggest that other, suboptimal factors contribute to perinatal death among circumcised migrant women.

Essén Birgitta; Bödker Birgit; Sjöberg N-O.; Gudmundsson Saemundur; Östergren P-O.; Langhoff-Roos Jens

2002-01-01

220

Pediatric Health Care Quality Measures: Considerations for Pharmacotherapy.  

UK PubMed Central (United Kingdom)

Measuring the quality use of medicines can be conceptualized as a mechanism for understanding appropriate use, underuse, overuse, or misuse. For pediatric pharmacotherapy, measuring the quality use of medicines requires awareness of the differences in health care between children and adults and the differences in the quality and quantity of science that supports evidence-based practice in pediatric health care compared with adult health care. Here we use the Pediatric Quality Measures Program that arose from the Children's Health Insurance Program Reauthorization Act in the United States to illustrate the challenges in developing quality measures of pediatric pharmacotherapy. The challenges are primarily twofold: (i) weak evidence base for the specific pharmacotherapy in children and (ii) limited data to calculate the measure. A weak evidence base must often be weighed against the importance of the topic if the quality measure is intended to address a known quality of care or public health problem. Limited data because of insufficient amount or inappropriate type will affect implementation of the measure and its eventual usefulness. Methods to meet these challenges often depend on the priorities of and the tools available to end users. Health information technology is emerging as a tool to improve quality measurement but presents additional challenges.

Lomotan EA; Dougherty D

2013-08-01

 
 
 
 
221

Quality improvement in a primary care case management program.  

UK PubMed Central (United Kingdom)

In this article we describe and evaluate quality monitoring and improvement activities conducted by Massachusetts Medicaid for its primary care case management program, the primary care clinician plan (PCC). Emulating managed care organization (MCO) practices, the State uses claims to analyze and report service delivery rates on the practice level and then works directly with individual medical practices on quality improvement (QI) activities. We discuss the value and limitations of claims-based data for profiling, report provider perspectives, and identify challenges in evaluating the impact of these activities. We also provide lessons learned that may be useful to other States considering implementing similar activities.

Walsh EG; Osber DS; Nason CA; Porell MA; Asciutto AJ

2002-01-01

222

Quality indicators in rheumatoid arthritis care: using measurement to promote quality improvement.  

UK PubMed Central (United Kingdom)

Quality of care improvement has become a priority for decision-makers. Important variations in the quality and cost of care are being documented often without evidence of improved outcomes. Therapeutic advances are not consistently applied to practice despite efforts from professional organisations to create guidelines. The quality movement emerged following increasing evidence that the creation and measurement of quality indicators can improve quality of care and health outcomes. Quality indicators can measure healthcare system performance across providers, system levels and regions. In rheumatology, early efforts to develop quality measures have focused on examining all aspects of care while more recent efforts have focused on disease course monitoring. The American College Rheumatology has recently endorsed seven quality indicators for rheumatoid arthritis (RA) that are evidence based and measurable for use in routine rheumatology practices. This review provides an overview on quality indicators in rheumatology with a focus on RA, and discusses the application of quality measures into routine rheumatology practices to improve quality of care for RA.

Bombardier C; Mian S

2013-04-01

223

How do we improve quality in primary dental care?  

UK PubMed Central (United Kingdom)

Quality improvement differs from quality assurance (which is retrospective in nature) in that it attempts to use a quality assessment cycle and focuses on the organisation or system of production as a whole. In this paper, the third in a series of three published in this Journal, we discuss the concept and evidence base of quality improvement, the main approaches that have been used in other healthcare settings and the importance of a multi-faceted strategy to address this issue. These topics are then related to the context of primary dental care and the way dentistry currently addresses quality improvement. Finally, we set out an agenda and provide recommendations for a system-based quality improvement strategy for primary dental care and identify the likely barriers and facilitators for this approach.

Campbell S; Tickle M

2013-09-01

224

How do we measure quality in primary dental care?  

UK PubMed Central (United Kingdom)

In the second paper of a series exploring quality in primary dental care a way to measure quality in dentistry is considered. Unless there are valid and reliable tools to measure quality then quality can never be improved. Measurement tools need to be acceptable to patients if they are to be employed, as well as to busy practices in terms of practicality and costs. Examples such as the General Medical Practitioner's Quality Outcome Framework need to be understood to see if they can be translated to dentistry.

Tickle M; Campbell S

2013-08-01

225

[Criteria used in the health care quality assurance systems].  

UK PubMed Central (United Kingdom)

The author presents the criteria used in the health care quality assurance systems with special attention paid to the following issues: Quality management system ISO 9000:2000. European Foundation Quality Management. Hospital accreditation. Quality assurance system in occupational health services in Norway "Good OHS". Quality management criteria are regarded as guidelines for functioning of organizations. All presented evaluation systems are based on a common set of criteria, which include: client-patient orientation; advancement of stuff skills; information management; services and management improvement.

Wdówik P

2003-01-01

226

Service quality perceptions in primary health care centres in Greece.  

Science.gov (United States)

Context? The paper refers to the increased competition between health care providers and the need for patient-centred services in Greece. Using service quality methodology, this paper investigates service quality perceptions of patients in Greek public primary health centres. Objective? To test the internal consistency and applicability of SERVQUAL in primary health care centres in Greece. Strategy? SERVQUAL was used to examine whether patients have different expectations from health care providers and whether different groups of patients may consider some dimensions of care more important than others. Results? The analysis showed that there were gaps in all dimensions measured by SERVQUAL. The largest gap was detected in empathy. Further analysis showed that there were also differences depending on gender, age and education levels. A separate analysis of expectations and perceptions revealed that this gap was because of differences in patients' perceptions rather than expectations. Discussion and conclusions? This paper raises a number of issues that concern the applicability of SERVQUAL in health care services and could enhance current discussions about SERVQUAL improvement. Quality of health care needs to be redefined by encompassing multiple dimensions. Beyond a simple expectations-perceptions gap, people may hold different understandings of health care that, in turn, influence their perception of the quality of services. PMID:22296402

Papanikolaou, Vicky; Zygiaris, Sotiris

2012-02-01

227

Service quality perceptions in primary health care centres in Greece.  

UK PubMed Central (United Kingdom)

Context? The paper refers to the increased competition between health care providers and the need for patient-centred services in Greece. Using service quality methodology, this paper investigates service quality perceptions of patients in Greek public primary health centres. Objective? To test the internal consistency and applicability of SERVQUAL in primary health care centres in Greece. Strategy? SERVQUAL was used to examine whether patients have different expectations from health care providers and whether different groups of patients may consider some dimensions of care more important than others. Results? The analysis showed that there were gaps in all dimensions measured by SERVQUAL. The largest gap was detected in empathy. Further analysis showed that there were also differences depending on gender, age and education levels. A separate analysis of expectations and perceptions revealed that this gap was because of differences in patients' perceptions rather than expectations. Discussion and conclusions? This paper raises a number of issues that concern the applicability of SERVQUAL in health care services and could enhance current discussions about SERVQUAL improvement. Quality of health care needs to be redefined by encompassing multiple dimensions. Beyond a simple expectations-perceptions gap, people may hold different understandings of health care that, in turn, influence their perception of the quality of services.

Papanikolaou V; Zygiaris S

2012-02-01

228

Alternative perspectives of quality of prenatal care in Chihuahua, Mexico  

Directory of Open Access Journals (Sweden)

Full Text Available Objective: this article describes the process and results of a research on the quality of prenatal care from the perspective of pregnant women who use the principal subsystems of the Mexican healthcare system in the city of Chihuahua, Mexico. Methodology: the ?eld of cognitive anthropology was adopted using techniques that reveal the organization of concepts of quality in prenatal care based on pregnant women’s knowledge and experience, in terms of where they decided to seek care. Results: aspects of care quality assumed as satis?ers that are important to women when they seek prenatal care in different healthcare institutions are presented. These women prefer to obtain full information from their healthcare providers about how to take care of themselves during their pregnancy, and, additionally, they also wish to be treated in a kind way showing respect and interest in their emotions and feelings on the part of the physicians. They also criticize the condition of the hospitals and the lack of medicines that were supposed to be provided. The methods that were utilized are considered to contribute to the improvement of quality in prenatal service and, furthermore, to optimizing the continuity of care for pregnant women.

Lourdes Camarena O; Christine von Glascoe

2007-01-01

229

Quality of care delivered to hospitalized inflammatory bowel disease patients  

Science.gov (United States)

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.

Weizman, Adam V; Nguyen, Geoffrey C

2013-01-01

230

Reflections on total quality management and health care supervisors.  

UK PubMed Central (United Kingdom)

Total quality management (TQM) has become an integral process in service delivery for many health care organizations. This article reviews the fundamental concepts underlying TQM and how TQM is relevant to health care supervisors. In many respects TQM represents a contemporary approach to supervising innovation and change, to analytically solving customer problems, and to implementing continuous quality improvement. Several strategies are examined that health care supervisors can adopt for improving service quality, including cultivating a climate for innovation, motivating by example, leading staff to do what is right and to tolerate no service delivery errors, retraining staff, developing control systems, and creating barrier-free organizations. These strategies are examined from the perspective of achieving continuous improvement in health care settings.

Smith HL; Discenza R; Piland NF

1993-12-01

231

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

UK PubMed Central (United Kingdom)

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 instead of care in health facilities to treat maternal and newborn conditions. This study also looked at community support structures, transportation and care-seeking behaviour for maternal and newborn problems which create access barriers. Sociocultural barriers to better maternal-newborn health include shame about utilisation of maternal and neonatal services, women's inability to seek care without being accompanied by a male relative, and care-seeking from mullahs for serious health concerns. This study also found a high level of post-partum depression. Targeted and more effective behaviour-change communication programmes are needed. This study presents a set of behaviour-change messages to reduce maternal and newborn mortality associated with births occurring at home in rural communities. This study recommends using religious leaders, trained health workers, family health action groups and radio to disseminate these messages.

Newbrander W; Natiq K; Shahim S; Hamid N; Skena NB

2013-09-01

232

Quality of care emerges as a determinant of creditworthiness.  

UK PubMed Central (United Kingdom)

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.

Oszustowicz RJ

1992-03-01

233

Quality of care emerges as a determinant of creditworthiness.  

Science.gov (United States)

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

Oszustowicz, R J

1992-03-01

234

Is the quality of health care changing? GPs' views.  

UK PubMed Central (United Kingdom)

Examines the debate on quality in health care in light of GP fundholding and the Patients' charter. Focuses on the development of quality issues in General Practice by carrying out research based on two stages: first, an exploratory stage aimed at the understanding of key issues; and second, a questionnaire made up primarily of attitude elements drawn from stage one. Concludes that, in the changing political and public environment, GPs are facing the challenges of managing service quality.

Hogarth-Scott S; Wright G

1997-01-01

235

Improving the quality of telephone-delivered health care: a national quality improvement transformation initiative.  

UK PubMed Central (United Kingdom)

BACKGROUND: Many Veterans Affairs (VA) primary care (PC) patients prefer telephone-delivered care to other health care delivery modalities. OBJECTIVE: To evaluate PC patients' telephone experiences and outcomes before and after a national telephone transformation quality improvement (QI) collaborative. METHODS: Cross-sectional surveys were conducted pre- and post-collaborative. We used bivariate analyses to assess differences in pre/post outcomes and multivariate regression to identify variables associated with patients' perceptions of poor quality care. RESULTS: Patients from 13 VA facilities participated (n = 730; pre-intervention = 314, post-intervention = 416); most of them were males (90%) with a mean age of 62 years. After the collaborative (versus pre-collaborative), few experienced transfers (52% versus 62%, P = 0.0006) and most reported timely call answer (88% versus 80%, P = 0.003). Improvements in staff understanding why patients were calling and providing needed medical information were also found. There were measurable improvements in patient satisfaction (87% versus 82% very/mostly satisfied, P = 0.04) and perceived quality of telephone care (85% versus 78% excellent/good quality, P = 0.01) post- collaborative. The proportion of veterans who reported delayed care due to telephone access issues decreased from 41% to 15% after the collaborative, P < 0.0001. Perceptions of poor quality care were higher when calls were for urgent care needs did not result in receipt of needed information and included a transfer or untimely answer. CONCLUSIONS: The QI collaborative led to improvements in timeliness of answering calls, patient satisfaction and perceptions of high-quality telephone care and fewer reports of health care delays. Barriers to optimal telephone care 'quality' include untimely answer, transfers, non-receipt of needed information and urgent care needs.

Lavela SL; Gering J; Schectman G; Locatelli SM; Weaver FM; Davies M

2013-10-01

236

Does the 'Liverpool Care Pathway' facilitate an improvement in quality of care for dying cancer patients?  

UK PubMed Central (United Kingdom)

BACKGROUND: The Liverpool Care Pathway for the Dying Patient (LCP) aims to transfer hospice principles of care for dying patients to other health-care sectors. This post-bereavement survey explored the LCP's effectiveness in improving quality of care for cancer patients. METHODS: Postal self-completion questionnaires were sent to 778 next-of-kin to consecutive deceased patients who had died an 'expected' cancer death in a hospice and acute tertiary hospital. RESULTS: Following exclusions (n=53), 255 of the 725 next-of-kin agreed to participate (35.2% response rate). Overall hospice participants reported the best quality of care, and hospital participants, for whom care was not supported by the LCP, reported the worst quality of care. Multivariate analysis showed the hospice was an independent predictor for patients being treated with dignity (OR 8.46) and receiving adequate family support (OR 7.18) (P<0.0001). Care supported by the LCP and the hospital specialist palliative care team were both associated with good family support, but neither was an independent predictor. CONCLUSIONS: From the bereaved relatives' perspective, within the hospital, the LCP is effective in improving specific aspects of care, such as symptom control for dying patients. Further improvement is required, however, to attain the hospice standard of care.

Mayland CR; Williams EM; Addington-Hall J; Cox TF; Ellershaw JE

2013-05-01

237

Mississippi Quality Step System: QRS Profile. The Child Care Quality Rating System (QRS)Assessment  

Science.gov (United States)

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

Child Trends, 2010

2010-01-01

238

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

Science.gov (United States)

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

Child Trends, 2010

2010-01-01

239

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

Science.gov (United States)

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

Child Trends, 2010

2010-01-01

240

Ohio Step Up to Quality: QRS Profile. The Child Care Quality Rating System (QRS) Assessment  

Science.gov (United States)

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

Child Trends, 2010

2010-01-01

 
 
 
 
241

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

Science.gov (United States)

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

Child Trends, 2010

2010-01-01

242

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

Science.gov (United States)

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

Child Trends, 2010

2010-01-01

243

Virginia Star Quality Initiative: QRS Profile. The Child Care Quality Rating System (QRS) Assessment  

Science.gov (United States)

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

Child Trends, 2010

2010-01-01

244

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

Science.gov (United States)

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

Child Trends, 2010

2010-01-01

245

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

Science.gov (United States)

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

Child Trends, 2010

2010-01-01

246

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

Science.gov (United States)

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

Child Trends, 2010

2010-01-01

247

Companion animals in palliative care: a hidden quality option?  

UK PubMed Central (United Kingdom)

In the light of the unprecedented demographic changes in many countries it is important to review and adapt existing strategies for giving old and incurable patients the adequate health care. Based on available data the importance of companion animals needs to be considered as part of individual care planning. Despite intensive research in other areas of health care, there is limited data concerning the use of companion animals in palliative care. The field demands much more recognition. For many people companion animals can be a chance for better quality of life.

Tanneberger S; Köhler U

2013-01-01

248

International comparisons of patients' views on quality of care.  

UK PubMed Central (United Kingdom)

PURPOSE: To compare patients' views on quality of care in different countries using a theory-based instrument, while at the same time controlling for the following potential confounders: type of care system (private vs public), type of care (kind of health problem), gender, age, and subjective wellbeing. DESIGN/METHODOLOGY/APPROACH: Patients capable of communicating in wards (medical and surgical departments) and day surgery departments in England, France, Norway, and Sweden were recruited consecutively, to participate in a programme run by the health-care company Capio. Ward patients: England (n=1236), France (n=1051), Norway (n=226), and Sweden (n=428). Day surgery patients: England (n=887), France (n=544), Norway (n=101), and Sweden (n=742). Average response rate across settings: approximately 75 per cent. Patients evaluated the quality of the care they actually received and the subjective importance they ascribed to different aspects of care. The questionnaire "Quality from the patient's perspective" (QPP) was used (modified short version). FINDINGS: Cross-national comparisons were made within each of the two care contexts (wards and day surgery) separately for men and women. Quality of care evaluations were adjusted for age and subjective wellbeing. English and French patients scored significantly higher than Norwegian and Swedish on both kinds of ratings (perceived reality and subjective importance), in both kinds of care contexts, and in both sexes. ORIGINALITY/VALUE: Cross-national comparisons of patients' views on care can give meaningful guidance for practitioners only if they are context-specific and if well-known confounders are controlled for.

Larsson BW; Larsson G; Chantereau MW; von Holstein KS

2005-01-01

249

Afghanistan's national strategy for improving quality in health care.  

UK PubMed Central (United Kingdom)

UNLABELLED: QUALITY PROBLEM OR ISSUE: When the Ministry of Public Health (MoPH) of the Islamic Republic of Afghanistan began reconstructing the health system in 2003, it faced serious challenges. Decades of war had severely damaged the health infrastructure and the country's ability to deliver health services. INITIAL ASSESSMENT: A national health resources assessment in 2002 revealed huge structural and resource disparities fundamental to improving health care. For example, only 9% of the population was able to access basic health services, and about 40% of health facilities had no female health providers, severely constraining access of women to health care. Multiple donor programs and the MoPH had some success in improving quality, but questions about sustainability, as well as fragmentation and poor coordination, existed. PLAN OF ACTION: In 2009, MoPH resolved to align and accelerate quality improvement efforts as well as build structural and skill capacity. IMPLEMENTATION: The MoPH established a new quality unit within the ministry and undertook a year-long consultative process that drew on international evidence and inputs from all levels of the health system to developed a National Strategy for Improving Quality in Health Care consisting of a strategy implementation framework and a five-year operational plan. LESSONS LEARNED: Even in resource-restrained countries, under the most adverse circumstances, quality of health care can be improved at the front-lines and a consensual and coherent national quality strategy developed and implemented.

Rahimzai M; Amiri M; Burhani NH; Leatherman S; Hiltebeitel S; Rahmanzai AJ

2013-07-01

250

Quality indicators for all dimensions of infertility care quality: consensus between professionals and patients.  

UK PubMed Central (United Kingdom)

STUDY QUESTION: What is the relative importance of the six dimensions of quality of care according to different stakeholders and can a quality indicator set address all six quality dimensions and incorporate the views from professionals working in different disciplines and from patients? SUMMARY ANSWER: Safety, effectiveness and patient centeredness were the most important quality dimensions. All six quality dimensions can be assessed with a set of 24 quality indicators, which is face valid and acceptable according to both professionals from different disciplines and patients. WHAT IS KNOWN ALREADY: To our knowledge, no study has weighted the relative importance of all quality dimensions to infertility care. Additionally, there are very few infertility care-specific quality indicators and no quality indicator set covers all six quality dimensions and incorporated the views of professionals and patients. STUDY DESIGN, SIZE AND DURATION: A three-round iterative Delphi survey including patients and professionals from four different fields, conducted in two European countries over the course of 2011 and 2012. PARTICIPANTS/MATERIALS, SETTINGS AND METHODS: Dutch and Belgian gynaecologists, embryologists, counsellors, nurses/midwifes and patients took part (n = 43 in round 1 and finally 30 in round 3). Respondents ranked the six quality dimensions twice for importance and their agreement was evaluated. Furthermore, in round 1, respondents gave suggestions, which were subsequently uniformly formulated as quality indicators. In rounds 2 and 3, respondents rated the quality indicators for preparedness to measure and for importance (relation to quality and prioritization for benchmarking). Providing feedback allowed selecting indicators based on consensus between stakeholder groups. Measurable indicators, important to all stakeholder groups, were selected for each quality dimension. MAIN RESULTS: All stakeholder groups and most individuals agreed that safety, effectiveness and patient centeredness were the most important quality dimensions. A total of 498 suggestions led to the development of 298 indicators. Professionals were sufficiently prepared to measure 204 of these indicators. Based on importance, 52 (7-15 per dimension; round 2) and finally 24 (4 per dimension; round 3) quality indicators were selected. LIMITATIONS, REASONS FOR CAUTION: The final quality indicator set does not cover the entire care process, but rather takes a 'sample' of each quality dimension. Although the quality indicators are face valid and acceptable, their psychometric characteristics need to be tested by further research. WIDER IMPLICATIONS OF THE FINDINGS: Quality management should focus on safety, effectiveness and patient centeredness of care. Clinics can use the quality indicator set to assess all quality dimensions of their care.

Dancet EA; D'Hooghe TM; Spiessens C; Sermeus W; De Neubourg D; Karel N; Kremer JA; Nelen WL

2013-06-01

251

Quality  

Science.gov (United States)

... User Administration Sign Up Sign In Sign out Quality Americans' health care should be safe, coordinated, evidence- ... Affordable Care Act established the National Strategy for Quality Improvement in Health Care (the National Quality Strategy ) ...

252

The senses in practice: enhancing the quality of care for residents with dementia in care homes.  

UK PubMed Central (United Kingdom)

AIM: The study aimed to develop, deliver, and evaluate a training programme in care homes to enhance the quality of care for people living with dementia based on the principles of relationship-centred care expressed through the Senses Framework. BACKGROUND: There are increasing numbers of people living with dementia worldwide with a growing proportion requiring residential long-term care. This makes the quest for enhancing the quality of care and quality of life for people with dementia ever more pressing. DESIGN: A mixed-methods design was used adopting a Practice Development approach. The findings from one care home in the North West of England are reported. METHODS: Eight facilitated workshops based on the principles of relationship-centred care were completed and evaluated in 2010, using pre- and postintervention design. A focus group was undertaken with staff on completion of the study to gain a more comprehensive understanding of the practice/training context, augmented by case examples of changes in practice identified from the study workshops. RESULTS: Structured questionnaires were used to profile the care home before and after the training. Following the workshops, staff felt more able to collect and use biographical information. In particular, staff reported how this information supported them to initiate meaningful conversations with the person with dementia as part of everyday care routines, thus improving overall feelings of well-being. CONCLUSION: Using a biographical approach to care planning structured through the Senses Framework helped staff to develop a greater understanding of the person with dementia.

Brown Wilson C; Swarbrick C; Pilling M; Keady J

2013-01-01

253

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

UK PubMed Central (United Kingdom)

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

Wang WL; Chang HJ; Liu AC; Chen YW

2007-12-01

254

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

Science.gov (United States)

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

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

2007-12-01

255

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

Directory of Open Access Journals (Sweden)

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

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

2012-01-01

256

Board oversight of patient care quality in community health systems.  

UK PubMed Central (United Kingdom)

In hospitals and health systems, ensuring that standards for the quality of patient care are established and continuous improvement processes are in place are among the board's most fundamental responsibilities. A recent survey has examined governance oversight of patient care quality at 123 nonprofit community health systems and compared their practices with current benchmarks of good governance. The findings show that 88% of the boards have established standing committees on patient quality and safety, nearly all chief executive officers' performance expectations now include targets related to patient quality and safety, and 96% of the boards regularly receive formal written reports regarding their organizations' performance in relation to quality measures and standards. However, there continue to be gaps between present reality and current benchmarks of good governance in several areas. These gaps are somewhat greater for independent systems than for those affiliated with a larger parent organization.

Prybil LD; Peterson R; Brezinski P; Zamba G; Roach W Jr; Fillmore A

2010-01-01

257

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

Directory of Open Access Journals (Sweden)

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.

Ed Kelley; Ernie Moy; Beth Kosiak; Dwight McNeill; Chunliu Zhan; Dan Stryer; Carolyn Clancy

2004-01-01

258

Impact of clinical complexity on the quality of diabetes care.  

UK PubMed Central (United Kingdom)

OBJECTIVES: To assess the impact of clinical complexity on 3 dimensions of diabetes care. STUDY DESIGN: We identified 35,872 diabetic patients receiving care at 7 Veterans Affairs facilities between July 2007 and June 2008 using administrative and clinical data. We examined control at index and appropriate care (among uncontrolled patients) within 90 days, for blood pressure (<130/80 mm Hg), glycated hemoglobin (<7%), and low-density lipoprotein cholesterol (<100 mg/dL). We used ordered logistic regression to examine the impact of complexity, defined by comorbidities count and illness burden, on control at index and a combined measure of quality (control at index or appropriate follow-up care) for all 3 measures. RESULTS: There were 6260 (17.5%) patients controlled at index for all 3 quality indicators. Patients with >3 comorbidities (odds ratio [OR], 1.94; 95% confidence interval [CI], 1.67-2.26) and illness burden >2.00 (OR, 1.22; 95% CI, 1.13-1.32) were more likely than the least complex patients to be controlled for all 3 measures. Patients with >3 comorbidities (OR, 2.30; 95% CI, 2.07-2.54) and illness burden >2.00 (OR, 1.25; 95% CI, 1.18-1.33) were also more likely than the least complex patients to meet the combined quality indicator for all 3 measures. CONCLUSIONS: Patients with greatest complexity received higher quality diabetes care compared with less complex patients, regardless of the definition of complexity chosen. Although providers may appropriately target complex patients for aggressive control, deficits in guideline achievement among all diabetic patients highlight the challenges of caring for chronically ill patients and the importance of structuring primary care to promote higher-quality, patient-centered care.

Woodard LD; Landrum CR; Urech TH; Wang D; Virani SS; Petersen LA

2012-09-01

259

Guidelines-based indicators to measure quality of antenatal care.  

UK PubMed Central (United Kingdom)

RATIONALE, AIMS AND OBJECTIVES: No comprehensive measurement of quality of antenatal care is available. Late booking or low number of checks are often used as surrogate for poor quality, leaving uncertainty on the actual content of the care received. In order to fill this gap, we have reviewed two sets of clinical guidelines and developed corresponding indicators of quality. METHOD: A group of clinicians and methodologists reviewed the National Institute for Clinical Excellency Clinical Guidelines on antenatal care, and the list of prenatal care interventions recommended by the Research and Development Group, both based on evidence of effectiveness of specific interventions. We identified single aspects in three domains: (1) services utilization; (2) screening; and (3) interventions. For each indicator, we defined: (1) eligibility, that is the characteristics of the women to whom the indicator applies; (2) standard, that is the situation when the target is met; and (3) moderators, that is all conditions which legitimately hamper the fulfilment of the standard. RESULTS: We developed four indicators of service utilization, 25 of screening and 17 of intervention. The respective eligibility, standard and moderators criteria were described for each indicator. While many indicators could be retrospectively evaluated from medical charts, quality of communication with provider, screening for sensible issues and counselling on behaviours to be avoided could only be obtained with a prospective data collection. CONCLUSIONS: The indicators of quality of antenatal care, complemented by measures of social position, social support and immigrant/ethnic status, allow for a careful description of the gaps in quality of care for specific groups of women.

Bollini P; Quack-Lötscher K

2013-03-01

260

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

Scientific Electronic Library Online (English)

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

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

2013-03-01

 
 
 
 
261

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

Directory of Open Access Journals (Sweden)

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

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

2013-01-01

262

Characteristics of primary care practices associated with high quality of care.  

UK PubMed Central (United Kingdom)

BACKGROUND: No primary practice care model has been shown to be superior in achieving high-quality primary care. We aimed to identify the organizational characteristics of primary care practices that provide high-quality primary care. METHODS: We performed a cross-sectional observational study involving a stratified random sample of 37 primary care practices from 3 regions of Quebec. We recruited 1457 patients who had 1 of 2 chronic care conditions or 1 of 6 episodic care conditions. The main outcome was the overall technical quality score. We measured organizational characteristics by use of a validated questionnaire and the Team Climate Inventory. Statistical analyses were based on multilevel regression modelling. RESULTS: The following characteristics were strongly associated with overall technical quality of care score: physician remuneration method (27.0; 95% confidence interval [CI] 19.0-35.0), extent of sharing of administrative resources (7.6; 95% CI 0.8-14.4), presence of allied health professionals (15.3; 95% CI 5.4-25.2) and/or specialist physicians (19.6; 95% CI 8.3-30.9), the presence of mechanisms for maintaining or evaluating competence (7.7; 95% CI 3.0-12.4) and average organizational access to the practice (4.9; 95% CI 2.6-7.2). The number of physicians (1.2; 95% CI 0.6-1.8) and the average Team Climate Inventory score (1.3; 95% CI 0.1-2.5) were modestly associated with high-quality care. INTERPRETATION: We identified a common set of organizational characteristics associated with high-quality primary care. Many of these characteristics are amenable to change through practice-level organizational changes.

Beaulieu MD; Haggerty J; Tousignant P; Barnsley J; Hogg W; Geneau R; Hudon E; Duplain R; Denis JL; Bonin L; Del Grande C; Dragieva N

2013-09-01

263

Characteristics of primary care practices associated with high quality of care  

Science.gov (United States)

Background: No primary practice care model has been shown to be superior in achieving high-quality primary care. We aimed to identify the organizational characteristics of primary care practices that provide high-quality primary care. Methods: We performed a cross-sectional observational study involving a stratified random sample of 37 primary care practices from 3 regions of Quebec. We recruited 1457 patients who had 1 of 2 chronic care conditions or 1 of 6 episodic care conditions. The main outcome was the overall technical quality score. We measured organizational characteristics by use of a validated questionnaire and the Team Climate Inventory. Statistical analyses were based on multilevel regression modelling. Results: The following characteristics were strongly associated with overall technical quality of care score: physician remuneration method (27.0; 95% confidence interval [CI] 19.0–35.0), extent of sharing of administrative resources (7.6; 95% CI 0.8–14.4), presence of allied health professionals (15.3; 95% CI 5.4–25.2) and/or specialist physicians (19.6; 95% CI 8.3–30.9), the presence of mechanisms for maintaining or evaluating competence (7.7; 95% CI 3.0–12.4) and average organizational access to the practice (4.9; 95% CI 2.6–7.2). The number of physicians (1.2; 95% CI 0.6–1.8) and the average Team Climate Inventory score (1.3; 95% CI 0.1–2.5) were modestly associated with high-quality care. Interpretation: We identified a common set of organizational characteristics associated with high-quality primary care. Many of these characteristics are amenable to change through practice-level organizational changes.

Beaulieu, Marie-Dominique; Haggerty, Jeannie; Tousignant, Pierre; Barnsley, Janet; Hogg, William; Geneau, Robert; Hudon, Eveline; Duplain, Rejean; Denis, Jean-Louis; Bonin, Lucie; Del Grande, Claudio; Dragieva, Natalyia

2013-01-01

264

[Quality improvement in primary care. Financial incentives related to quality indicators in Europe].  

UK PubMed Central (United Kingdom)

Quality improvement in primary care has been an important issue worldwide for decades. Quality indicators are increasingly used quantitative tools for quality measurement. One of the possible motivational methods for doctors to provide better medical care is the implementation of financial incentives, however, there is no sufficient evidence to support or contradict their effect in quality improvement. Quality indicators and financial incentives are used in the primary care in more and more European countries. The authors provide a brief update on the primary care quality indicator systems of the United Kingdom, Hungary and other European countries, where financial incentives and quality indicators were introduced. There are eight countries where quality indicators linked to financial incentives are used which can influence the finances/salary of family physicians with a bonus of 1-25%. Reliable data are essential for quality indicators, although such data are lacking in primary care of most countries. Further, improvement of indicator systems should be based on broad professional consensus.

Kolozsvári LR; Rurik I

2013-07-01

265

[Quality improvement in primary care. Financial incentives related to quality indicators in Europe].  

Science.gov (United States)

Quality improvement in primary care has been an important issue worldwide for decades. Quality indicators are increasingly used quantitative tools for quality measurement. One of the possible motivational methods for doctors to provide better medical care is the implementation of financial incentives, however, there is no sufficient evidence to support or contradict their effect in quality improvement. Quality indicators and financial incentives are used in the primary care in more and more European countries. The authors provide a brief update on the primary care quality indicator systems of the United Kingdom, Hungary and other European countries, where financial incentives and quality indicators were introduced. There are eight countries where quality indicators linked to financial incentives are used which can influence the finances/salary of family physicians with a bonus of 1-25%. Reliable data are essential for quality indicators, although such data are lacking in primary care of most countries. Further, improvement of indicator systems should be based on broad professional consensus. PMID:23835354

Kolozsvári, László Róbert; Rurik, Imre

2013-07-14

266

Benchmarking urban acute care hospitals: efficiency and quality perspectives.  

UK PubMed Central (United Kingdom)

BACKGROUND: Over the last couple of decades, hospitals in the United States are facing pressures to maximize performance in terms of production efficiency and quality. An increasing emphasis on value-based purchasing on the part of third-party payers as well as the prevalence of pay for performance initiatives create an imperative for more accurate assessments of health care provider performance. PURPOSES: The objectives of this study were to measure hospital performance in terms of both technical efficiency and quality using data envelopment analysis (DEA) models in urban acute care hospitals. METHODOLOGY/APPROACH: In this observational cross-sectional study of a nationally representative sample of 371 urban acute care hospitals, hospital performance was assessed using slack-based additive DEA models. The technical inputs included in the DEA models were total number of beds setup and staffed, nonphysician full-time equivalent staffing, and nonpayroll operating expenses. The technical outputs were adjusted patient days, total number of outpatient visits, and training full-time equivalent, obtained from the American Hospital Association 2008 database. The quality measures used for the quality of care dimension of performance were survival rates for acute myocardial infarction, congestive heart failure, and pneumonia obtained from the Nationwide Inpatient Sample 2008 data. FINDINGS: Less than 20% of the sample hospitals were optimally performing for both quality and efficiency. Tobit regression analysis of the DEA scores found that public, small, teaching hospitals had higher DEA efficiency and quality scores. PRACTICE IMPLICATIONS: DEA is a promising tool for benchmarking both aspects of performance: efficiency and quality of hospitals. Because quality is a multidimensional construct, the choice of an appropriate composite quality measure has to be addressed in future research. However, incorporating quality into the DEA models would be a better reflection of the hospital product.

Nayar P; Ozcan YA; Yu F; Nguyen AT

2013-04-01

267

Perinatal depression: implications for child mental health  

Digital Repository Infrastructure Vision for European Research (DRIVER)

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...

Muzik, Maria; Borovska, Stefana

268

Perinatal risk.  

UK PubMed Central (United Kingdom)

Genetic inheritance, the embryonic-fetal environment, and the family and social milieu are factors that may place the fetus-newborn at an increased risk for premature birth, congenital malformations, or neonatal illness. Knowledge of these factors is crucial to providing optimum nursing care to newborns. These factors are discussed in detail, and appropriate nursing assessments and interventions are reviewed.

Cranley MS

1983-05-01

269

Perinatal risk.  

Science.gov (United States)

Genetic inheritance, the embryonic-fetal environment, and the family and social milieu are factors that may place the fetus-newborn at an increased risk for premature birth, congenital malformations, or neonatal illness. Knowledge of these factors is crucial to providing optimum nursing care to newborns. These factors are discussed in detail, and appropriate nursing assessments and interventions are reviewed. PMID:6553111

Cranley, M S

270

MRI of perinatal brain injury  

Energy Technology Data Exchange (ETDEWEB)

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

Rutherford, Mary; Allsop, Joanna [Imperial College, Robert Steiner MR Unit, Perinatal Imaging, MRC Clinical Sciences Centre, Hammersmith Hospital, London (United Kingdom); Martinez Biarge, Miriam [La Paz University Hospital, Dept of Neonatology, Madrid (Spain); Counsell, Serena [Imperial College, Robert Steiner MR Unit, Neonatal Medicine, MRC Clinical Sciences Centre, Hammersmith Hospital, London (United Kingdom); Cowan, Frances [Imperial College, Dept of Paediatrics, Hammersmith Hospital, London (United Kingdom)

2010-06-15

271

MRI of perinatal brain injury  

International Nuclear Information System (INIS)

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

2010-01-01

272

Nursery epidemic due to multiply-resistant Klebsiella pneumoniae: epidemiologic setting and impact on perinatal health care delivery.  

UK PubMed Central (United Kingdom)

Gram-negative bacilli frequently cause epidemics in high-risk newborn intensive care units. Recently, an epidemic caused by a multiply-resistant K. pneumoniae, serotype 21, occurred in the Vanderbilt University intensive care nursery. The background of this outbreak included an increasing endemic nosocomial sepsis rate, operation of the facility in excess of rated capacity, and increasingly inadequate nurse-to-patient staffing ratios. The epidemic lasted 11 weeks; 26 (12%) of the 232 infants at risk in the unit became colonized. Five infants developed systemic illness and one died. Cohorting, reinforcement of strict handwashing and isolation procedures, and closure of the unit to outborn admissions resulted in rapid termination of the outbreak. Followup studies performed on infants colonized with the epidemic bacterium demonstrated persistent fecal shedding up to 13 months following discharge from the hospital. This epidemic had a detrimental influence on high-risk newborn and obstetric health care delivery in an area encompassing portions of three states. Under a system of progressively more sophisticated referral units, nosocomial infections occurring at a tertiary center can have an impact on other hospitals within the network.

McKee KT Jr; Cotton RB; Stratton CW; Lavely GB; Wright PF; Shenai JP; Evans ME; Melly MA; Farmer JJ; Karzon DT; Schaffner W

1982-03-01

273

Physician-targeted financial incentives and primary care physicians' self-reported ability to provide high-quality primary care.  

UK PubMed Central (United Kingdom)

OBJECTIVE: High-quality primary care is envisaged as the centerpiece of the emerging health care delivery system under the Affordable Care Act. Reengineering the US health care system into a primary care-driven model will require widespread, rapid changes in the management and organization of primary care physicians (PCPs). Financial incentives to influence physician behavior have been attempted with various approaches, without empirical evidence of their effectiveness in improving care quality. This study examines the above research question adjusting for the patient-centeredness of the practice climate, a major contextual factor affecting PCPs' ability to provide high-quality care. METHODS: Secondary data on a sample of salaried PCPs (n = 1733) from the nation-wide Community Tracking Study Physician Survey 2004-2005 were subject to generalized multinomial logit modeling to examine associations between financial incentives and PCPs' self-reported ability to provide quality care. RESULTS: After adjusting for patient-centered medical home (PCMH)-consistent practice environment, financial incentive aligned with care quality/care content is positively associated with PCPs' ability to provide high-quality care. An encouraging finding was that financial incentives aligned with clinic productivity/profitability do not to impede high-quality care in a PCMH practice environment. CONCLUSION: Financial incentives targeted to care quality or content indicators may facilitate rapid transformation of the health system to a primary care-driven system. The study provides empirical evidence of the utility of practically deployable financial incentives to facilitate high-quality primary care.

Baek JD; Xirasagar S; Stoskopf CH; Seidman RL

2013-07-01

274

[Quality of care in psychiatric hospitals: literature review and perspectives].  

UK PubMed Central (United Kingdom)

Within hospitals, a plan for quality improvement consists of numerous steps to be taken by an inclusive management team, implicating all of the actors involved. The establishment of an instrument panel of indicators is the outcome of such a participatory process. The existence of best practice referentials allows for the construction of a coherent plan to improve the quality of care. A query of the francophone bibliographic databases reveals very few publications from internal audits on the relevance of care. Nevertheless, external audits demonstrate the significance of evaluation of the quality of care in psychiatric hospitals. The authors are therefore surprised to note the existing hiatus between the wealth of references and their lack of being used in the publications of the professionals concerned. The analysis of the relevance of the medical decision is not widely accepted. Clinical practice is still considered as an art form even though it has become a technique which now calls on the collective experience of peers.

Da Silva GB

2003-06-01

275

How much does quality mental health care profit employers?  

UK PubMed Central (United Kingdom)

OBJECTIVE: Employers provide most American mental health benefits and are increasingly cost conscious. However, commonplace anxiety and depressive disorders have enormous economic and workplace performance costs. METHODS: We performed multiple literature searches on several areas of pertinent research (and on key articles) covering the past 5 years. RESULTS: Substantial research exists about anxiety and depression costs, such as performance and productivity, absenteeism, presenteeism, disability, physical disability exacerbation, mental health treatment, increased medical care costs, exacerbating of physical illness, and studies of mental health care limitations and cost-offset. Research addressing the potential value of higher quality mental health care is limited. CONCLUSIONS: Commonplace anxiety and depressive disorders are costly in the workplace. Employers and researchers remain largely unaware of the value of quality care and psychiatric skills. Effective solutions involve the increased use of psychiatric skills and appropriate treatment.

Langlieb AM; Kahn JP

2005-11-01

276

[The MobiQual program, tools for quality of care].  

UK PubMed Central (United Kingdom)

The MobiQual programme aims to improve the quality of care through the use of pedagogical tools focused on public health issues. Developed by the French society of geriatrics and gerontology, and initially aimed at institutions, in 2009 the programme was opened up to those who provide home care. The "Pain, Well Treatment, Home" tool was the first to be specifically aimed at this sector

Doutreligne S; Ruault G

2013-05-01

277

The business case for health-care quality improvement.  

UK PubMed Central (United Kingdom)

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

Swensen SJ; Dilling JA; Mc Carty PM; Bolton JW; Harper CM Jr

2013-03-01

278

Assessing the quality of health care: a consumerist approach.  

UK PubMed Central (United Kingdom)

Recent investigations show that nontechnical interventions influence patients' ratings of the quality of health care, and that these aspects of the medical encounter are as important to the patient as the technical aspects; perhaps more important. This paper adopts a consumerist approach and measures patients' perceptions of health care quality using a scale adapted from the consumer behavior literature (SERVQUAL). The study measures health care quality as well as five of its individual dimensions. The findings indicate that, for the whole sample, patients' ratings of overall quality as well as the ratings of four of the five dimensions of care are negative. Further analysis indicates that many individual aspects (scale items) are rated negatively by each of two age groups (25-65 and over 65 years old), but the gap between perceptions of the younger group and their expectations is greater than that of the senior group. The two dimensions of "assurance" and "empathy" are found to be the most discriminating dimensions between the two groups. Other analyses indicate that age, annual household income, and work status significantly relate to overall quality rating. Marketing and strategic planning implications of the results are discussed.

Soliman AA

1992-01-01

279

Helping primary care teams emerge through a quality improvement program.  

UK PubMed Central (United Kingdom)

BACKGROUND: Approaches to improving the quality of health care recognize the need for systems and cultures that facilitate optimal care. Interpersonal relationships and dynamics are a key factor in transforming a system to one that can achieve quality. The Quality in Family Practice (QIFP) program encompasses clinical and practice management using a comprehensive tool of family practice indicators. OBJECTIVE: The objective of this study was to explore and describe the views of staff regarding changes in the clinical practice environment at two affiliated academic primary care clinics (comprising one Family Health Team, FHT) who participated in QIFP. METHODS: An FHT in Hamilton, Canada, worked through the quality tool in 2008/2009. A qualitative exploratory case study approach was employed to examine staff perceptions of the process of participating. Semi-structured interviews were conducted in early 2010 with 43 FHT staff with representation from physicians, nurses, allied health professionals, support staff and managers. Interviews were audio-taped and transcribed verbatim. A modified template approach was used for coding, with a complexity theory perspective of analysis. RESULTS: Themes included importance of leadership, changes to practice environment, changes to communication, an increased understanding of team roles and relationships, strengthened teamwork, flattening of hierarchy through empowerment, changes in clinical care and clinical impacts, challenges and rewards and sustainability. CONCLUSION: The program resulted in perceived changes to relationships, teamwork and morale. Addressing issues of leadership, role clarity, empowerment, flattening of hierarchy and teamwork may go a long way in establishing and maintaining a quality culture.

Hilts L; Howard M; Price D; Risdon C; Agarwal G; Childs A

2013-04-01

280

Are Physician Productivity and Quality of Care Related?  

UK PubMed Central (United Kingdom)

This study examines the relationship between clinical quality of care and physician productivity in the public sector clinical setting. This longitudinal study takes place in Jefferson County, Alabama using data from six public sector clinics. Data representing 21 physicians across 13 consecutive quarters representing 44,765 person observations were analyzed. Four variables were selected to represent quality of care for this pediatric patient population; two of which pertained to antibiotic use and two pertained to asthma care. Findings from multivariate analyses examining each quality of care measure and controlling for other visit and practice characteristics indicate that three of the four quality measures were significantly related to productivity. Specifically, the percent of asthma patients with documented asthma severity classification was negatively related to physician productivity (ß = -.24, p = .04), although the magnitude of this relationship was small. The percent of asthma patients prescribed an inhaled corticosteroid who also had a severity classification was negatively related to physician productivity (ß = -.23, p = .03) and the percent of patients prescribed oral antibiotics was marginally negatively related to physician productivity (ß = -.09, p = .09). In general, findings suggest that a relationship exists between quality of healthcare and physician productivity. Future research should continue to examine this relationship across other disciplines and healthcare settings.

Menachemi N; Yeager VA; Welty E; Manzella B

2013-08-01

 
 
 
 
281

Improving the Quality of Care for Older Adults Using Evidence-Informed Clinical Care Pathways  

Science.gov (United States)

Background There has been an intensified focus on quality initiatives within health care. Clinical Networks have been established in Alberta as a structure to improve care within and across settings. One method used by Clinical Networks to improve care is clinical care pathways. The objective of this study was to evaluate an evidence-informed hip fracture acute care pathway before broad implementation. Methods The pathway was developed by a provincial Clinical Network and implemented at four of 14 hospitals across the province. Within four months of implementing the pathway, experienced interviewers conducted focus groups with end-users at the four sites. Domains of inquiry focused on indentifying barriers and facilitators to use of the pathway. Results Fifteen physicians and 29 other health-care providers participated in eight focus groups. Common themes identified around the pathway order sets included issues with format, workflow and workload, and dissemination. The patient/family educational materials were deemed to be beneficial. Health-care provider education required better support. Overall the pathway was seen to be comprehensive. However, communication about the pathway could have been improved. Conclusions This care model is novel in that it combines the concepts of clinical networks, care pathways, and knowledge translation in an effort to provide high-quality, evidence-informed care in a standardized equitable manner across a diverse geographic area.

Holroyd-Leduc, Jayna M.; Steinke, Vanessa; Elliott, Debbie; Mullin, Katherine; Elder, Kevin; Callender, Stella; Hildebrand, Kevin A.

2013-01-01

282

Standards of care: integrating nursing care plans and quality assurance activities.  

UK PubMed Central (United Kingdom)

Traditionally, standards are used to define the level of care that a patient can expect to receive in a given institution or on a given nursing unit. These standards are the foundation of quality assurance programs. Unfortunately, with the increased emphasis on monitoring care, many standards are being written after the quality assurance activities have been developed and are in place. Often, standards are placed neatly in a book that is dusted off and brought out when the Joint Commission for Accreditation of Healthcare Organizations representative (JCAHO) visits. The nursing staff at the unit level has no real knowledge or understanding of the standards. This may result in a nonfunctioning quality assurance program.

Mize CP; Bentley G; Hubbard S

1991-02-01

283

Comparing public and private hospital care service quality.  

UK PubMed Central (United Kingdom)

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.

Camilleri D; O'Callaghan M

1998-01-01

284

Comparing public and private hospital care service quality.  

Science.gov (United States)

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

Camilleri, D; O'Callaghan, M

1998-01-01

285

[Application of subjective quality indicators in intensive care].  

Science.gov (United States)

Our aim is to describe the clients'perception related to to the admission in the Intensive Care. We have developed a descriptive study based on a qualitative approach in the intensive care in a university hospital in RJ, from May, 2003 to May, 2004. Thirty-two clients participated in this study just after hospital discharge. Data collection was possible through a questionaire. We consider that the clients showed some kind of satisfaction related to nursing intensive care, and the problem that really annoys them is the physical and ambiental stressors. The study shows questions that need a continuous discussion considering the stress, once it is a part of the activities and the atmosphere of intensive care and it also detaches the relavence of a work using indicatives of subjective quality in the intensive care. PMID:17051891

de Souza, Sônia Regina Oliveira e Silva; da Silva, Cláudia Aparecida; de Mello, Ursula Magliano; Ferreira, Carolina Neris

286

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

UK PubMed Central (United Kingdom)

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

Groman RF; Rubin KY

2013-01-01

287

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

UK PubMed Central (United Kingdom)

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

Ng CW; Ng KP

2013-09-01

288

The quality of advanced dementia care in the nursing home: the role of special care units.  

UK PubMed Central (United Kingdom)

BACKGROUND: The quality of nursing home care for residents with advanced dementia has been described as suboptimal. One relatively understudied factor is the impact of special care units (SCUs) for dementia for residents at the end stage of this disease. OBJECTIVE: To examine the association between residence in an SCU and the quality of end-of-life care for nursing home residents with advanced dementia. RESEARCH DESIGN: This study used longitudinal data on 323 nursing home residents with advanced dementia living in 22 Boston-area facilities. Using multivariate methods, we analyzed the association between residence in an SCU and measures of quality of end-of-life care including: treatment of pain and dyspnea, prevalence of pressure ulcers, hospitalization, tube feeding, antipsychotic drug use, advance care planning, and health care proxy (HCP) satisfaction with care. RESULTS: A total of 43.7% residents were cared for in an SCU. After multivariate adjustment, residents in SCUs were more likely to receive treatment for dyspnea, had fewer hospitalizations, were less likely to be tube fed, and more likely to have a do-not-hospitalize order, compared with non-SCU residents. However, non-SCU residents were more likely to be treated for pain, had fewer pressure ulcers, and less frequent use of antipsychotic drugs than SCU residents. HCPs of SCU residents reported greater satisfaction with care than HCPs of non-SCU residents. CONCLUSIONS: Residence in an SCU is associated with some, but not all, markers of better quality end-of-life care among nursing home residents with advanced dementia.

Cadigan RO; Grabowski DC; Givens JL; Mitchell SL

2012-10-01

289

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

UK PubMed Central (United Kingdom)

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.

Grace SC; Elliott MN; Giordano LA; Burroughs JN; Malinoff RL

2013-01-01

290

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

Digital Repository Infrastructure Vision for European Research (DRIVER)

To determine the coverage rate, timeliness and quality of ante-natal care in rural areas under the coverage of Health Houses in West Azerbaijan province, 30 Health Houses (HH) were randomly selected out of 731 HH in the province. In each HH, using the method of Lot Quality Assurance Sampling (LQAS) ...

Sh. Salarilak; A. Gashtasb I; A. Nadim

291

Muscle-invasive bladder cancer: Quality of Care and Quality of Life in the Netherlands  

Digital Repository Infrastructure Vision for European Research (DRIVER)

The aim of this thesis was to get insight in the quality of care delivered to the Dutch patient with muscle-invasive bladder cancer. Furthermore, for the patients undergoing radical cystectomy, the gold standard therapy, the patient reported outcome quality of life was measured, before and after the...

Goossens-Laan, C.A.

292

Challenges in the perinatal clinical nurse specialist role.  

Science.gov (United States)

Evolving changes in health care trends and national directives, including recommendations from the Institute of Medicine (1985), are shaping priorities in perinatal nursing care. This paper addresses considerations for expanding the scope of practice of perinatal clinical nurse specialists (PCNS). The role of the PCNS in the participation of healthy policy implementation is one area to activate. Legislative action involving perinatal nurses influences the scope of practice. Expansion of the clinical nurse specialist roles in consultation/education and practice/research is necessary to emphasize preventative health care, program development, and community liaison activities. PMID:2736470

Affonso, D; Mayberry, L

1989-01-01

293

[In-service training to improve quality of health care].  

UK PubMed Central (United Kingdom)

UNLABELLED: Argentine's neonatal mortality rate represents 60% of infant mortality; implementation of strategies that improve quality of neonatal care is a priority. Traditionally, the training of health professionals is accomplished through scientific meetings with little capacity for exchange; in-service training incorporates the identification and resolution of problems joining the daily patient care. OBJECTIVE: To describe the in-service training program (ISTP), to identify its strengths as strategies for quality of care improvement and to evaluate its impact in four different Argentine maternity services. METHOD: Design: health services research intervention study, not controlled, before and after evaluation. INTERVENTION: This program is a multidimensional strategy consisting in regular visits by a neonatologist and a nurse to health professionals in their own settings. Program stages: 1) service assessment and design of the action plan according to the priorities, 2) implementation, 3) consolidation and analysis through indicators. RESULTS: Greatest impact was found over equipment and human resources improvement; we also observed an improvement in management related aspects like organization and coordination of care. The reduction of preventable deaths varied between centers. CONCLUSIONS: The in-service training program is an effective tool with measurable quantitative and qualitative results with positive impact on the quality of care. Conjunctural factors and political will were determinant on the program's success, as it is commonly seen in the implementation of strategies that involve changing established structures.

Fariña D; Rodríguez S; Erpen N

2012-01-01

294

The Critical Appraisal of Quality of Care Indicators  

Directory of Open Access Journals (Sweden)

Full Text Available Aim: To elaborate criteria for the critical appraisal of quality of care indicators. Methods: We based our critical appraisal on the essential elements for describing and assessing quality of care indicators found in the published literature. The resulting grid was tested by methodology specialists and health-care professionals with respect to its implicit and explicit convenience. Results: The grid contains seven sections. The first three sections analyse the characteristics needed to describe the indicators. The title should explain the indicator’s overall content and describe its type. The numerator contains the parameters measured while the denominator quantifies the population studied. In addition, inclusion and exclusion criteria, data lists and sources, the codification used and the modalities of quality of care control need to be clearly defined. The last four sections concern the performance of the indicators and include whether the measurements are reproducible and acceptable (do they fulfil professionals’ needs?, use an indicator emanating from a recognised and accepted reference source?, is the work-load acceptable?). At the same time, they should describe the conditions under which the interpretations were made (threshold, need for risk stratification or other adjustments, the sample size) and the expected impact (magnitude of the quality parameters identified, detection of avoidable problems, measurement of identifiable corrective measures, impact of actions taken for improvement). Conclusion: The metric properties of the grid remain to be determined.

Michel P; Amouretti M; Juge C; Mathloulin-Pelissier S; Mazou H; Phely-Peyronnaud C; Rossignol C; Salmi L-R

2001-01-01

295

Adolescent Substance Abuse Treatment: Organizational Change and Quality of Care  

Science.gov (United States)

|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…

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

2011-01-01

296

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

UK PubMed Central (United Kingdom)

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.

Rieckmann T; Fussell H; Doyle K; Ford J; Riley K; Henderson S

2011-04-01

297

Adolescent Substance Abuse Treatment: Organizational Change and Quality of Care  

Science.gov (United States)

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…

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

2011-01-01

298

Leadership, staffing and quality of care in nursing homes  

Digital Repository Infrastructure Vision for European Research (DRIVER)

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...

Havig Anders; Skogstad Anders; Kjekshus Lars; Romøren Tor

299

The quality of care for patients receiving an outpatient PCI  

Digital Repository Infrastructure Vision for European Research (DRIVER)

The objective of this registry is to survey data about the situation and quality of medical care for patients receiving an outpatient percutaneous coronary intervention (PCI) in the state of Hessia. The so called "MAIN-Registry" (M anagement of a mbulatory percutaneous coronary in terventions in Hes...

Foerster, A; Kurt, B; Hahmann, M; Sattler, A; Leussler, D; Schaefer, JR

300

[The perceived quality of hospital care  

UK PubMed Central (United Kingdom)

INTRODUCTION: SERVQUAL has been introduced in the healthcare sector as an alternative to the patient satisfaction measures. SERVQUAL is one of the most used questionnaires to measure the customers' perceived quality. It is based on the disconfirmation paradigm (expectations-minus-perceptions). However, the structure, validity and reliability of this questionnaire have not been assessed in the Spanish hospital context. METHODS: Three main targets defined in this study: 1) analyze the SERVQUAL's factorial solution, 2) determine which of its scales (perceptions, expectations, and expectations-minus-perceptions) has higher predictive efficiency, and 3) develop a new version for hospital setting (which was called SERVQHOS). A descriptive study based on surveys with multivariate analysis of data was conducted. Eight-hundred-twenty-six subjects were interviewed. All were attended in the Alicante's, Elche's, or Elda's hospital. RESULTS: A five-factor solution of the SERVQUAL was not corroborated. The perceptions scale obtained a higher predictive efficiency than expectations and expectations-minus-perceptions scales. Four factors were identified using SERVQHOS (56% explained variance). Perceptions-SERVQHOS gathered a greater predictive capacity that the scores derived from the difference among expectations and perceptions. This result was obtained in both criteria: patient satisfaction (55% explained variance) and whether the respondents would recommend the hospital (76.36% right classifications with respect to response levels of the criterion). CONCLUSIONS: Before using SERVQUAL is highly recommended to realize a validation procedure of this questionnaire. SERVQHOS has shown adequate reliability and validity. However, there were some methodological problems using it. The most important inconvenience was that perceptions' scores showed greater predictive capacity than expectations-minus-perceptions.

Mira Solves JJ; Buil Aina JA; Rodríguez-Marín J; Aranaz Andrés J

1997-07-01

 
 
 
 
301

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

Directory of Open Access Journals (Sweden)

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

Sh. Salarilak; A. Gashtasb I; A. Nadim

1999-01-01

302

[The quality of care in shoulder pain. A medical audit].  

UK PubMed Central (United Kingdom)

BACKGROUND: To evaluate the quality of hospital ambulatory care in non-surgical painful shoulder by auditing medical records using quality indicators. MATERIAL AND METHODS: We reviewed 245 medical records of non-surgical patients assisted for pain shoulder in 1999-2000 in two public hospitals. Quality of care indicators for antecedents, physic exploration, diagnosis and treatment were developed based in systematic reviews of clinical trials, guidelines and expert criteria. Medical records review was carried out by two rehabilitative doctors. Fulfilling of quality criteria and differences between hospitals was analyzed. RESULTS: 76.3% of the medical records did not fulfill > or = 4 of 10 quality criteria for antecedents, 61.6% did not fulfill > or = 3 of 10 criteria for physical exploration, and 7.7% did not have any diagnosis registered. 96.9% of the 98 patients with impingement syndrome did not complete the criteria of anti-inflammatory treatment or infiltration in the pre-established time, and up to 15.3% had not been proposed physiotherapy or programmed exercise in the 4 weeks after the diagnosis; 95.8% of the 24 patients with rotators cuff tears were not proposed for early surgical evaluation, and 86.7% of the 15 cases of adhesive capsulitis did not receive instructions to carry out programmed exercise in the proposed times. CONCLUSIONS: The audit revealed significant deficiencies in adherence to quality indicators in non-surgical pain shoulder. Part of these problems can be due to low medical records quality.

Marín-Gómez M; Navarro-Collado MJ; Peiró S; Trenor-Gomis C; Payá-Rubio A; Bernal-Delgado E; Hernández-Royo A

2006-03-01

303

Improving regional variation using quality of care measures  

Directory of Open Access Journals (Sweden)

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

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

2009-01-01

304

Ensuring quality care: what do you get for your money?  

Science.gov (United States)

In the rush to produce balanced scorecards and outcomes measures, managed care organizations must recognize the need to better assess the clinical competencies of their contracted skilled nursing facilities. Health plan quality management staffs, although composed of gifted professionals, generally do not have sufficient skilled nursing facility (SNF)-related experience or knowledge to support evaluation and qualification of these providers. The successfully implemented Altman-Conrad (A-C) SNF quality management process objectively measures and monitors managed care contracted services provided by SNFs. The A-C process requires a health plan's quality management/utilization management staff to engage in a team-based educational endeavor. This effort is designed to generate measurable outcomes specific to the health plan's needs. The proven benefits of the process include improved member services, greater member satisfaction, more productive days for SNFs, more effective discharges, and the generation of a win-win relationship between the health plan and its contract providers. PMID:10185717

Altman, S; Conrad, S

305

Ensuring quality care: what do you get for your money?  

UK PubMed Central (United Kingdom)

In the rush to produce balanced scorecards and outcomes measures, managed care organizations must recognize the need to better assess the clinical competencies of their contracted skilled nursing facilities. Health plan quality management staffs, although composed of gifted professionals, generally do not have sufficient skilled nursing facility (SNF)-related experience or knowledge to support evaluation and qualification of these providers. The successfully implemented Altman-Conrad (A-C) SNF quality management process objectively measures and monitors managed care contracted services provided by SNFs. The A-C process requires a health plan's quality management/utilization management staff to engage in a team-based educational endeavor. This effort is designed to generate measurable outcomes specific to the health plan's needs. The proven benefits of the process include improved member services, greater member satisfaction, more productive days for SNFs, more effective discharges, and the generation of a win-win relationship between the health plan and its contract providers.

Altman S; Conrad S

1998-09-01

306

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

UK PubMed Central (United Kingdom)

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.

Braun JP; Bause H; Bloos F; Geldner G; Kastrup M; Kuhlen R; Markewitz A; Martin J; Mende H; Quintel M; Steinmeier-Bauer K; Waydhas C; Spies C

2010-01-01

307

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

Science.gov (United States)

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

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

2010-10-08

308

Medicare managed care and primary care quality: examining racial/ethnic effects across states.  

UK PubMed Central (United Kingdom)

The study assesses the role of Medicare Advantage (MA) plans in providing quality primary care in comparison to FFS Medicare in three states, New York, California, Florida, across three racial ethnic groups. The performance is measured in terms of providing better quality primary care, as defined by lowering the risks of preventable hospital admissions. Using 2004 hospital discharge data (HCUP-SID) of Agency for Healthcare Research and Quality for three states, a multivariate cross sectional design is used with individual admission as the unit of analysis. The study found that MA plans were associated with lower preventable hospitalizations relative to marker admissions. The benefit also spilled over to different racial and ethnic subgroups and in some states, e.g. CA and FL, MA enrollment was associated with significantly lower odds of minority admissions than of white admissions. These results may indicate a potentially favorable role of MA plans in attenuating racial/ethnic inequalities in primary care in some states.

Basu J

2012-03-01

309

Good care in ongoing dialogue. Improving the quality of care through moral deliberation and responsive evaluation.  

UK PubMed Central (United Kingdom)

Recently, moral deliberation within care institutions is gaining more attention in medical ethics. Ongoing dialogues about ethical issues are considered as a vehicle for quality improvement of health care practices. The rise of ethical conversation methods can be understood against the broader development within medical ethics in which interaction and dialogue are seen as alternatives for both theoretical or individual reflection on ethical questions. In other disciplines, intersubjectivity is also seen as a way to handle practical problems, and methodologies have emerged to deal with dynamic processes of practice improvement. An example is responsive evaluation. In this article we investigate the relationship between moral deliberation and responsive evaluation, describe their common basis in dialogical ethics and pragmatic hermeneutics, and explore the relevance of both for improving the quality of care. The synergy between the approaches is illustrated by a case example in which both play a distinct and complementary role. It concerns the implementation of quality criteria for coercion in Dutch psychiatry.

Abma TA; Molewijk B; Widdershoven GA

2009-09-01

310

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

UK PubMed Central (United Kingdom)

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

Gruffydd-Jones K; Small I; Fletcher M; Bryant T

2013-09-01

311

Quality indicators for evaluating trauma care: a scoping review.  

UK PubMed Central (United Kingdom)

OBJECTIVES: To systematically review the literature on quality indicators (QIs) for evaluating trauma care, identify QIs, map their definitions, and examine the evidence base in support of the QIs. DATA SOURCES: We searched MEDLINE, EMBASE, CINAHL, Cochrane Database of Systematic Reviews, Cochrane Database of Abstracts of Reviews of Effects, and Cochrane Central Register of Controlled Trials from the earliest available date through January 14, 2009. To increase the sensitivity of the search, we also searched the grey literature and select journals by hand, reviewed reference lists to identify additional studies, and contacted experts in the field. Study Selection and DATA EXTRACTION: We selected all articles that identified or proposed 1 or more QIs to evaluate the quality of care delivered to patients with major traumatic injuries. Minimum inclusion criteria were a description of 1 or more QIs designed to evaluate patients with major traumatic injuries (defined as multisystem injuries resulting in hospitalization or death) and focused on prehospital care, hospital care, posthospital care, or secondary injury prevention. DATA SYNTHESIS: The literature search identified 6869 citations. Review of abstracts led to the retrieval of 538 full-text articles for assessment, of which 192 articles were selected for review. Of these, 128 (66.7%) articles were original research, predominantly trauma database case series (57 [29.7%]) and cohort studies (55 [28.6%]), whereas 37 (19.3%) were narrative reviews and 8 (4.2%) were guidelines. A total of 1572 QIs in trauma care were identified and classified into 8 categories: non-American College of Surgeons Committee on Trauma (ACS-COT) audit filters (42.0%), ACS-COT audit filters (19.1%), patient safety indicators (13.2%), trauma center/system criteria (10.2%), indicators measuring or benchmarking outcomes of care (7.4%), peer review (5.5%), general audit measures (1.8%), and guideline availability or adherence (0.8%). Measures of prehospital and hospital processes (60.4%) and outcomes (22.8%) were the most common QIs identified. Posthospital and secondary injury prevention QIs accounted for less than 5% of QIs. CONCLUSIONS: Many QIs for evaluating the quality of trauma care have been proposed, but the evidence to support these indicators is not strong. Practical recommendations to select QIs to measure the quality of trauma care will require systematic reviews of identified candidate indicators and empirical studies to fill the knowledge gaps for postacute QIs.

Stelfox HT; Bobranska-Artiuch B; Nathens A; Straus SE

2010-03-01

312

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

Directory of Open Access Journals (Sweden)

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

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

2012-01-01

313

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

Scientific Electronic Library Online (English)

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

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

2012-06-01

314

Health Information Technology in Urologic Care: Current Status and Implications for Quality of Care.  

UK PubMed Central (United Kingdom)

Health information technology (HIT) is expected to transform the delivery of health care in the United States, but implementation and adoption vary widely across settings, specialties, and geographies. Significant barriers to high-level adoption persist despite federal incentives to hospitals and health-care providers. This article will review the current status and future impact of HIT in the specialty of urology, with emphasis on the intersection of HIT and quality measurement.

Dowling RA

2013-07-01

315

COMPETITION AND QUALITY IN HOME HEALTH CARE MARKETS.  

UK PubMed Central (United Kingdom)

Market-based solutions are often proposed to improve health care quality; yet evidence on the role of competition in quality in non-hospital settings is sparse. We examine the relationship between competition and quality in home health care. This market is different from other markets in that service delivery takes place in patients' homes, which implies low costs of market entry and exit for agencies. We use 6?years of panel data for Medicare beneficiaries during the early 2000s. We identify the competition effect from within-market variation in competition over time. We analyze three quality measures: functional improvements, the number of home health visits, and discharges without hospitalization. We find that the relationship between competition and home health quality is nonlinear and its pattern differs by quality measure. Competition has positive effects on functional improvements and the number of visits in most ranges, but in the most competitive markets, functional outcomes and the number of visits slightly drop. Competition has a negative effect on discharges without hospitalization that is strongest in the most competitive markets. This finding is different from prior research on hospital markets and suggests that market-specific environments should be considered in developing polices to promote competition. Copyright © 2013 John Wiley & Sons, Ltd.

Jung K; Polsky D

2013-05-01

316

Satisfaction of patients from provided quality of care  

Directory of Open Access Journals (Sweden)

Full Text Available During recent years, the interest of health professionals has turned more and more towards to satisfaction of patients by the provided care of health. Aim: The aim of the present study was to review the literature about the satisfaction of patients by the the provided care of health. The method ?f this study included bibliography research from both the review and the research literature, mainly in the pubmed data base which referred to the satisfaction of patients by the provided care of health. Results: According to the literature, satisfaction of patients’ needs consists a complex issue. As implementation of patients’ needs is defined the level of satisfaction of patients’ expectations related to personal experience and to the meet of internal needs. The results of recent studies indicate that the expectation of patients and the health professionals should coincide having as ultimate goal the reassurance of co-operation. It is widely accepted that the meet of needs is related to better clinical outcome since satisfied patients are more likely to accept medical treatment, to have active participation in their care and maintain trust of services of health care. Furthermore, assessment of satisfaction of patients’ needs contributes to the improvement of health care services and to better management of cost for health. Finally, it is widely accepted that the meet of needs consists a credible index of quality of care. Conclusions: Though the satisfaction of patients’ needs is a subjective issue, however, it should consist an integral part of the treatment.

Ifigenia Kotsagiorgi; Kalliroi Gkeka

2010-01-01

317

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

UK PubMed Central (United Kingdom)

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

Ball JE; Murrells T; Rafferty AM; Morrow E; Griffiths P

2013-07-01

318

Improving breast cancer care through a regional quality collaborative.  

UK PubMed Central (United Kingdom)

BACKGROUND: Regional collaborative organizations provide an effective structure for improving the quality of surgical care. With low complication rates and a long latency between surgical care and outcomes such as survival and local recurrence, quality measurement in breast cancer surgery is ideally suited to process measures. Diagnostic biopsy technique for breast cancer diagnosis is measurable and amenable to change at the provider level. We present initial results from our analysis of institutional variation in surgical and core needle biopsy use within a regional breast cancer quality collaborative. METHODS: Established in 2006, the Michigan Breast Oncology Quality Initiative (MiBOQI) consists of 18 hospitals collecting data on breast cancer care using the National Comprehensive Cancer Centers Network (NCCN) Oncology Outcomes Database Project platform to analyze and compare breast cancer practices and outcomes amongst member institutions. Institutional review board approval is obtained at each site. Data are submitted electronically to the NCCN and analyzed for concordance with practice guidelines. Aggregate and blinded data are shared with project directors and institutions at collaborative meetings, and ongoing practice patterns are observed for change. We analyzed variation in breast biopsy technique for initial cancer diagnosis over time and between institutions. Diagnostic biopsies were categorized as core needle, surgical excisional, surgical incisional, and other surgical biopsy. RESULTS: Procedural data for 8,066 patients treated for breast cancer between November 1, 2006 and December 31, 2009 were analyzed. The mean patient age was 59.5 years (range, 25.4-90.0 years). Within MiBOQI, 21% of patients underwent surgical biopsy for initial diagnosis. The percentage of patients undergoing surgical biopsy ranged from 8% to 37%, and the majority of surgical biopsies were classified as excisional biopsies. Patients with ductal carcinoma in situ were more likely to undergo surgical biopsy compared to those with invasive cancer (30.4% vs 17.8%; P < .001). There was no association between biopsy type and patient age, race, or comorbidity. Data on biopsy technique were shared with site project directors and a target surgical biopsy rate of <15% was chosen by consensus. Site project directors disseminated the data to their institutions and developed action plans for provider and patient education. Over the study period, the percentage of cases undergoing surgical biopsy for the entire MiBOQI collaborative decreased from 21% to 15% (P < .001). CONCLUSION: The regional quality collaborative model can be used to collect, analyze, and disseminate surgical breast care quality data to organizations and treating physicians. These data can be used to describe patterns of care and make comparisons over time and between organizations. These data can also be used to set regional quality standards and provide an avenue for physician-led quality improvement.

Breslin TM; Caughran J; Pettinga J; Wesen C; Mehringer A; Yin H; Share D; Silver SM

2011-10-01

319

Maternal age ?45 years and maternal and perinatal outcomes: a review of the evidence.  

UK PubMed Central (United Kingdom)

OBJECTIVE: to examine the evidence in relation to very advanced maternal age (?45 years) and maternal and perinatal outcomes in high-income countries. BACKGROUND: this review was conducted against a background of increasing fertility options for women aged ?=45 years and rising birth rates among this group of women. METHODS: established health databases including SCOPUS, MEDLINE, CINAHL, EMBASE and Maternity and Infant Care were searched for journal papers, published 2001-2011, that examined very advanced maternal age (VAMA) and maternal and perinatal outcomes. Further searches were based on references found in located articles. Keywords included a search term for maternal age ?45 years (very advanced maternal age, pregnancy aged 45 years and older) and a search term for maternal complications (caesarian section, hypertension, pre-eclampsia, gestational diabetes) and/or adverse perinatal outcome (preterm birth, low birth weight, small for gestational age, stillbirth, perinatal death). Of 164 retrieved publications, 10 met inclusion criteria. DATA EXTRACTION: data were extracted and organised under the following headings: maternal age ?45 years; maternal characteristics such as parity and use of artificial reproductive technology (ART); and pre-existing maternal conditions, such as diabetes and hypertension. Additional headings included: gestational conditions, such as pre-eclampsia and gestational diabetes (GDM); and perinatal outcomes, including fetal/infant demise; gestational age and weight. Study quality was assessed by using the Critical Appraisal Skills Programme (CASP) guidelines. FINDINGS: this review produced three main findings: (1) increased rates of stillbirth, perinatal death, preterm birth and low birth weight among women ?45 years; (2) increased rates of pre-existing hypertension and pregnancy complications such as GDM, gestational hypertension (GH), pre-eclampsia and interventions such as caesarian section; and (3) a trend of favourable outcomes, even at extremely advanced maternal age (50-65 years), for healthy women who had been screened to exclude pre-existing disease. KEY CONCLUSIONS: although there is strong evidence of an association between very advanced maternal age and adverse maternal and perinatal outcomes, the absolute rate of stillbirth/perinatal death remains low, at less than 10 per 1000 births in most high-income countries. Therefore, although women in this age group encounter greater pregnancy risk, most will achieve a successful pregnancy outcome. Best outcomes appear to be linked to pre-existing maternal health, and pregnancy care at tertiary centres may also contribute. This information should be used to counsel women aged ?45 years who are contemplating pregnancy.

Carolan M

2013-05-01

320

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

Directory of Open Access Journals (Sweden)

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.

Leah Couzner; Maria Crotty; Ruth Walker; Julie Ratcliffe

2013-01-01

 
 
 
 
321

Quality-of-care standards for early arthritis clinics.  

UK PubMed Central (United Kingdom)

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.

Ivorra JA; Martínez JA; Lázaro P; Navarro F; Fernandez-Nebro A; de Miguel E; Loza E; Carmona L

2013-10-01

322

Quality-of-care standards for early arthritis clinics.  

Science.gov (United States)

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

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

2013-04-09

323

Management of nursing care quality with ethical principles  

Directory of Open Access Journals (Sweden)

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

Cabarcas-Ortega Nirva del Socorro

2011-01-01

324

Comparing public and private hospital care service quality in Turkey.  

UK PubMed Central (United Kingdom)

PURPOSE: The aim of this article is to examine the differences in service quality between public and private hospitals in Turkey. DESIGN/METHODOLOGY/APPROACH: This study applies the principles behind the SERVQUAL model and compares Turkey's public and private hospital care service quality. The study sample contains a total of 200 outpatients. Through the identification of 40 service quality indicators and the use of a Likert-type scale, two questionnaires containing 80-items was developed. The former measured patients' expectations prior to admission to public and private hospital service quality. The latter measured patient perceptions of provided service quality. FINDINGS: The results indicate that inpatients in the private hospitals were more satisfied with service quality than those in the public hospitals. The results also suggest that inpatients in the private hospitals were more satisfied with doctors, nurses and supportive services than their counterparts in the public hospitals. Finally, the results show that satisfaction with doctors and reasonable costs is the biggest determinants of service quality in the public hospitals. ORIGINALITY/VALUE: Consequently, SERVQUAL, as a standard instrument for measuring functional service quality, is reliable and valid in a hospital environment.

Taner T; Antony J

2006-01-01

325

The malpractice controversy and the quality of patient care.  

UK PubMed Central (United Kingdom)

The widespread doctor strikes of 1975 stimulated belated attention to a crisis in malpractice insurance. Most state legislatures responded only to a shadow crisis in insurance as they rallied to the defense of health care providers. The smouldering substantive crisis--the reality of malpractice--is now galvanizing institutions and professions into aggressive activities for quality assurance and renewal of trust between patient and doctor. New procedural experiments offer prospects for preserving economy and equity by containing the causes of malpractice suits within the health care system itself.

Somers HM

1977-01-01

326

Conservative Spine Care: Opportunities to Improve the Quality and Value of Care.  

UK PubMed Central (United Kingdom)

Abstract Low back pain (LBP) has received considerable attention from researchers and health care systems because of its substantial personal, social, work-related, and economic consequences. A narrative review was conducted summarizing data about the epidemiology, care seeking, and utilization patterns for LBP in the adult US population. Recommendations from a consensus of clinical practice guidelines were compared to findings about the current state of clinical practice for LBP. The impact of the first provider consulted on the quality and value of care was analyzed longitudinally across the continuum of episodes of care. The review concludes with a description of recently published evidence that has demonstrated that favorable health and economic outcomes can be achieved by incorporating evidence-informed decision criteria and guidance about entry into conservative low back care pathways. (Population Health Management 2013;16:xxx-xxx).

Kosloff TM; Elton D; Shulman SA; Clarke JL; Skoufalos A; Solis A

2013-08-01

327

Do Patients "Like" Good Care? Measuring Hospital Quality via Facebook.  

UK PubMed Central (United Kingdom)

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

Timian A; Rupcic S; Kachnowski S; Luisi P

2013-09-01

328

Do Patients "Like" Good Care? Measuring Hospital Quality via Facebook.  

Science.gov (United States)

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

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

2013-02-01

329

Congenital syphilis: a sentinel event in antenatal care quality.  

UK PubMed Central (United Kingdom)

OBJECTIVE: To evaluate antenatal care in reducing the vertical transmission of syphilis. METHODS: A cross-sectional study was designed to be representative of low-risk pregnancies in women cared for at the Brazilian Unified Health System (SUS) network in the city of Rio de Janeiro, from November 2007 to July 2008. Pregnant women diagnosed with syphilis were identified through interviews, checking their antenatal care card and searching for reported cases in the public health information systems. Cases of congenital syphilis were sought at the disease reporting system (Sinan), the Mortality Information System (SIM) and the SUS's Hospital Information System (SIH). RESULTS: Syphilis was identified in 46 of the pregnancies, and 16 cases of congenital syphilis were identified, resulting in a prevalence of 1.9% (95%CI 1.3;2.6) of syphilis in pregnancy and an incidence of 6/1,000 (95%CI 3;12/1,000) of congenital syphilis. The vertical transmission rate was 34.8% with three cases resulting in death (1 abortion, 1 stillborn and 1 neonatal death) and high proportions of prematurity and low birth weight. The healthcare pathway of those women revealed flaws in the care they received, such as late entry to antenatal care, syphilis remaining undiagnosed during pregnancy and lack of treatment for the partner. CONCLUSIONS: Innovative strategies are needed to improve the outcomes of syphilis in pregnancy, including improving the laboratory network, the quality of care delivered to the pregnant women and their sexual partners and, most important of all, investigating every case of congenital syphilis as a sentinel event in the quality of antenatal care.

Domingues RM; Saracen V; Hartz ZM; Leal Mdo C

2013-02-01

330

Improving quality of chronic care by integrating the primary care setting.  

UK PubMed Central (United Kingdom)

PurposeOne of the main barriers for further improving the quality of chronic care was the absence of performance-based financing. With the introduction of a Diagnosis-Based Costing method (DBC) within primary care, a new organisational model is implemented in the region Maastricht. This integrated care model includes all relevant stakeholders, such as GPs, district nurses, dieticians, nurse practitioners, practice assistants, physiotherapists and hospital-based specialists. Aim is to optimise the quality of fragmented primary care for chronically ill within the existing budget restraints or, if even possible, to diminish the present costs for chronic care.Context and data sourcesIncreasing prevalence of chronic illnesses, an ageing society and the observation that existing care systems approach mostly insufficiently to specific health problems and patients' needs asked for redesigning the existing healthcare system. We started by focussing on primary diabetes and COPD care. For the delivery of diabetes and COPD care within the entire primary care setting health care insurance companies contract with GPs only. GPs act as gatekeepers and coordinate the delivery of care within the primary care setting. Evidence-based medical guidelines and evidence about the organisation of respectively integrated diabetes and COPD care were used to outline care in multidisciplinary protocols. Referral criteria for secondary care are formulated as well. Within this protocol hospital-based specialists deliver specialized care while working in the GPs electronic patient file.Case descriptionIn 2007 and 2008, respectively 6390 and 6700 diabetes patients, derived form 87 GPs, have been included in the DBC-cohorts. The DBC COPD has been implemented in October last year, until now 2253 patients are registered. DBCs for cardiovascular diseases and for depression and anxiety are under construction and will be implemented by the end of this year. All healthcare givers register their delivered care into the same electronic patient file.Preliminary conclusions/discussionBased on the preliminary data it can be concluded that the integrated care model has been adopted by professionals in the primary care setting, patients and the health care insurance companies. Moreover, agreement has been reached in the process of care delivery, the indicators for performance-based costing and the collection of data for care and research purposes.Matches and gaps between the actual delivered care and the protocol are explained by the Chronic Care Model and the Management Control Theory (an article is accepted for international publication). Patient outcomes, cost-effectiveness and benefits of these programmes are now subject of investigation. The main challenge for the future is to answer the question whether such disease-specific driven approaches remain suitable for patients suffering from more than one chronic disease (multi-morbidity).

Duimel-Peeters IGP; Schaper NC; Wesseling G; Vrijhoef HJM

2009-01-01

331

Electronic health records and ambulatory quality of care.  

UK PubMed Central (United Kingdom)

CONTEXT: The US Federal Government is investing up to $29 billion in incentives for meaningful use of electronic health records (EHRs). However, the effect of EHRs on ambulatory quality is unclear, with several large studies finding no effect. OBJECTIVE: To determine the effect of EHRs on ambulatory quality in a community-based setting. DESIGN: Cross-sectional study, using data from 2008. SETTING: Ambulatory practices in the Hudson Valley of New York, with a median practice size of four physicians. PARTICIPANTS: We included all general internists, pediatricians and family medicine physicians who: were members of the Taconic Independent Practice Association, had patients in a data set of claims aggregated across five health plans, and had at least 30 patients per measure for at least one of nine quality measures selected by the health plans. INTERVENTION: Adoption of an EHR. MAIN OUTCOME MEASURES: We compared physicians using EHRs to physicians using paper on performance for each of the nine quality measures, using t-tests. We also created a composite quality score by standardizing performance against a national benchmark and averaging standardized performance across measures. We used generalized estimation equations, adjusting for nine physician characteristics. KEY RESULTS: We included 466 physicians and 74,618 unique patients. Of the physicians, 204 (44 %) had adopted EHRs and 262 (56 %) were using paper. Electronic health record use was associated with significantly higher quality of care for four of the measures: hemoglobin A1c testing in diabetes, breast cancer screening, chlamydia screening, and colorectal cancer screening. Effect sizes ranged from 3 to 13 percentage points per measure. When all nine measures were combined into a composite, EHR use was associated with higher quality of care (sd 0.4, p?=?0.008). CONCLUSIONS: This is one of the first studies to find a positive association between EHRs and ambulatory quality in a community-based setting.

Kern LM; Barrón Y; Dhopeshwarkar RV; Edwards A; Kaushal R

2013-04-01

332

Advance care planning and the quality of end-of-life care in older adults.  

UK PubMed Central (United Kingdom)

OBJECTIVES: To determine whether advance care planning influences quality of end-of-life care. DESIGN: In this observational cohort study, Medicare data and survey data from the Health and Retirement Study (HRS) were combined to determine whether advance care planning was associated with quality metrics. SETTING: The nationally representative HRS. PARTICIPANTS: Four thousand three hundred ninety-nine decedent subjects (mean age 82.6 at death, 55% women). MEASUREMENTS: Advance care planning (ACP) was defined as having an advance directive (AD), durable power of attorney (DPOA) or having discussed preferences for end-of-life care with a next of kin. Outcomes included previously reported quality metrics observed during the last month of life (rates of hospital admission, in-hospital death, >14 days in the hospital, intensive care unit admission, >1 emergency department visit, hospice admission, and length of hospice ? 3 days). RESULTS: Seventy-six percent of subjects engaged in ACP. Ninety-two percent of ADs stated a preference to prioritize comfort. After adjustment, subjects who engaged in ACP were less likely to die in a hospital (adjusted relative risk (aRR) = 0.87, 95% confidence interval (CI) = 0.80-0.94), more likely to be enrolled in hospice (aRR = 1.68, 95% CI = 1.43-1.97), and less likely to receive hospice for 3 days or less before death (aRR = 0.88, 95% CI = 0.85-0.91). Having an AD, a DPOA or an ACP discussion were each independently associated with a significant increase in hospice use (P < .01 for all). CONCLUSION: ACP was associated with improved quality of care at the end of life, including less in-hospital death and increased use of hospice. Having an AD, assigning a DPOA and conducting ACP discussions are all important elements of ACP.

Bischoff KE; Sudore R; Miao Y; Boscardin WJ; Smith AK

2013-02-01

333

Improving quality of care among COPD outpatients in Denmark 2008-2011  

DEFF Research Database (Denmark)

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.

TØttenborg, Sandra SØgaard; Thomsen, Reimar Wernich

2013-01-01

334

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 (

2007-01-01

335

Caring for the carers: quality of life in Huntington's disease.  

UK PubMed Central (United Kingdom)

Huntington's disease (HD) is a dementia that is genetically inherited as an autosomal-dominant trait with a complete lifetime penetrance. For individuals who develop HD, it is generally the immediate family that take on the responsibility of caring. However, there is a paucity of research into the impact of HD on the quality of life (QoL) of the spousal carer and the possible benefits of quantifying the HD carer's experience. Therefore, the purpose of this article is to describe the experiences of family carers of HD patients, specifically in relation to their QoL and to introduce the Huntington's Disease Quality of Life Battery for Carers (HDQoL-C). This is a valid and reliable QoL measure that has been developed to quantify the care-giving experience in HD in order to implement and assess therapeutic interventions.

Aubeeluck A

2005-04-01

336

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

Directory of Open Access Journals (Sweden)

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

Liesbeth A.D. Borgermans; Geert Goderis; Marielle Ouwens; Johan Wens; Jan Heyrman; Richard P.T. M. Grol

2008-01-01

337

Quality-of-care indicators for pelvic organ prolapse: development of an infrastructure for quality assessment.  

UK PubMed Central (United Kingdom)

INTRODUCTION AND HYPOTHESIS: A paucity of data exists addressing the quality of care provided to women with pelvic organ prolapse (POP). We sought to develop a means of measuring this quality through the development of quality-of-care indicators (QIs). METHODS: QIs were modeled after those previously described in the Assessing the Care of Vulnerable Elders (ACOVE) project. The indicators were then presented to a panel of nine experts. Using the RAND Appropriateness Method, we analyzed each indicator's preliminary rankings. A forum was then held in which each indicator was thoroughly discussed by the panelists as a group, after which panelists individually re-rated the indicators. QIs with median scores of at least 7 were considered valid. RESULTS: QIs were developed that addressed screening, diagnosis, work-up, and both nonsurgical and surgical management. Areas of controversy included whether screening should be performed to identify prolapse, whether pessary users should undergo a vaginal examination by a health professional every 6 months versus annually, and whether a colpocleisis should be offered to older women planning to undergo surgery for POP. Fourteen out of 21 potential indicators were rated as valid for pelvic organ prolapse (median score ?7). CONCLUSION: We developed and rated 14 potential quality indicators for the care of women with POP. Once these QIs are tested for feasibility they can be used on a larger scale to measure and compare the care provided to women with prolapse in different clinical settings.

Anger JT; Scott VC; Kiyosaki K; Khan AA; Sevilla C; Connor SE; Roth CP; Litwin MS; Wenger NS; Shekelle PG

2013-05-01

338

Quality of Medical Care in Diabetic Women Undergoing Fertility Treatment  

Science.gov (United States)

OBJECTIVE Diabetic women are at increased risk for adverse pregnancy outcomes that can be improved by preconception care. Our goal was to evaluate the quality of medical care in diabetic women who undergo fertility treatment and compare it with the quality of medical care in diabetic women with spontaneous pregnancies. RESEARCH DESIGN AND METHODS This retrospective study on reproductive-age women undergoing fertility treatment in Clalit Health Services (CHS) used data on fertility treatments, prescription fillings, HbA1c levels, and demographics extracted from CHS computerized systems. The control group comprised women with spontaneous pregnancy. Three quality measures in the periconception period were evaluated: folic acid prescription fillings, evaluation and level of HbA1c, and use of potentially hazardous drugs. RESULTS There were 230 fertility treatment cycles in 83 diabetic women, and 30 diabetic women had spontaneous pregnancy. Women in the fertility group were older and had fewer children. There were no significant differences in marital status or ethnicity. Regular folic acid use, HbA1c recording, and the percentage of women with HbA1c <7% was similar between women in fertility treatment and those with spontaneous pregnancy (23.9, 57.8, and 31.3% vs. 20.0, 73.3, and 40.0%, respectively). Several women in both groups continued the use of potentially hazardous medication. CONCLUSIONS The periconception medical care of diabetic women who undergo fertility treatment is suboptimal and no better than that of diabetic women with spontaneous pregnancies. More intensive and targeted counseling regarding the importance of folic acid and glycemic control is needed to optimize periconception care of these diabetic patients.

Riskin-Mashiah, Shlomit; Auslander, Ron

2011-01-01

339

Neonatal-perinatal medicine in a transitional period in China.  

Science.gov (United States)

With an annual birth rate of 12‰, or 16 millions, of all population (1.34 billions), and an implementation of universal healthcare policy for all rural residents in recent years, China is undergoing a dramatic and profound transition in perinatal and neonatal healthcare as a part of the global campaign for reduction in mortality of children under 5 years old. This review describes recent development in neonatal-perinatal medicine, with special emphasis on general neonatal-perinatal care, respiratory and intensive care, neurological and infectious diseases, for a comprehensive view of the trend and challenge in relation with problems and solutions of the field. PMID:23759518

Sun, Bo; Shao, Xiaomei; Cao, Yun; Xia, Shiwen; Yue, Hongni

2013-06-12

340

Quality of care for incident lupus nephritis among medicaid beneficiaries in the united states.  

UK PubMed Central (United Kingdom)

CONCLUSION: These nationwide data suggest low overall quality of care and potential delays in care for Medicaid enrollees with incident lupus nephritis. Significant regional differences also suggest room for quality improvement. © 2013 American College of Rheumatology.

Yazdany J; Feldman CH; Liu J; Ward MM; Fischer MA; Costenbader KH

2013-10-01

 
 
 
 
341

Perinatal death pattern in the four districts of Thailand: findings from the Prospective Cohort Study of Thai Children (PCTC).  

UK PubMed Central (United Kingdom)

OBJECTIVE: To determine the magnitude and investigate causes of perinatal deaths of a cohort of the Prospective Cohort Study of Thai Children. MATERIAL AND METHOD: A semi-structured verbal autopsy questionnaire and review of medical records were used to ascertain the causes of deaths during the perinatal period in four districts of Thailand. RESULTS: The total numbers of 3,522 babies (with 28 pairs of twins) were born from 3,494 pregnant women. The perinatal mortality rate was 10.69 per 1,000 total births, the stillbirth rate was 6.75 per 1,000 births, and the early neonatal mortality rate was 3.97 per 1,000 live-births. About 37.8% of the perinatal deaths were agreed to by two pediatricians and a neonatologist as preventable. About 90% of the preventable stillbirths occurred in the antepartum period. CONCLUSION: Findings from the present study indicates that to further reduce the perinatal death rate, attention should be focused on reducing the stillbirths by a quality antenatal care.

Mo-suwan L; Isaranurug S; Chanvitan P; Techasena W; Sutra S; Supakunpinyo C; Choprapawon C

2009-05-01

342

Racial/ethnic perspectives on the quality of hospice care.  

UK PubMed Central (United Kingdom)

Diversity in the US population is increasing, and evaluating the quality of culturally sensitive hospice care is important. A survey design was used to collect data from 743 patients enrolled in hospice or their family members or caregivers. Race/ethnicity was not significantly associated with any of the hospice interventions or outcomes. Patients were less likely to be satisfied with the overall hospice care (OR = 0.23, 95% CI = 0.065-0.796, P = .021) compared to other type of respondents.  Satisfaction with emotional support was substantially associated with the increased likelihood of satisfaction with pain management (OR = 3.82, 95% CI = 1.66-8.83, P = .002), satisfaction with other symptom management (OR = 6.17, 95% CI = 2.80-13.64, P < .001), and of overall satisfaction with hospice care (OR = 20.22, 95% CI = 8.64-47.35, P < .001).

Campbell CL; Baernholdt M; Yan G; Hinton ID; Lewis E

2013-06-01

343

Quality of care: how good is good enough?  

UK PubMed Central (United Kingdom)

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/

Chassin MR

2012-01-01

344

Quality of care: how good is good enough?  

Directory of Open Access Journals (Sweden)

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/

Chassin Mark R

2012-01-01

345

[Evaluation of the quality of care for normal delivery].  

UK PubMed Central (United Kingdom)

PURPOSE: To evaluate the quality of health care assistance during childbirth in the hospitals of Goiânia, in Brazil. METHODS: Thirteen hospitals were appraised from April to December 2007, and a random sample of 404 normal births was studied. Data were obtained from interviews with mothers after delivery and by consulting their medical records. The quality of assistance at birth was evaluated by using the Bologna score and by comparing the procedures used in those hospitals to standard recommended practices. RESULTS: The Bologna score presented an average value of 1.04 (95%CI=0.9-1.1). The elective caesarian rate was 30%, the emergency caesarian rate was 10%, and the rate of induced childbirth was 1.6% The percentage of childbirths attended by health care professionals was 100%, but pediatricians in the delivery room were present only in 30% of the time. During labor, half of the women had no evaluation of the uterine dynamics and 29% had no auscultation fetal monitoring. The partogram was used for only 28.5% of the women, whereas the use of oxytocin was 45.8%. CONCLUSIONS: The results indicate a poor quality of childbirth care with low values of the Bologna score, high elective and emergency caesarians rates, a high number of unnecessary and potentially harmful interventions, and an insufficient frequency of beneficial interventions.

Giglio MR; França E; Lamounier JA

2011-10-01

346

Quality care for older adults: the NLN Advancing Care Excellence for Seniors (ACES) project.  

UK PubMed Central (United Kingdom)

There is a significant need to improve the amount and quality of gerontological nursing content in pre-licensure nursing programs in the United States.The National League for Nursing's Advancing Care Excellence for Seniors (ACES) project is designed to enhance gerontological nursing content in all pre-licensure nursing programs. Nurse educators can use the ACES framework to engage nursing students in studying the care of older adults through innovative and unique teaching/learning strategies, such as unfolding cases and simulation.The ACES framework, which includes the ACES Essential Knowledge Domains and Nursing Actions, is designed to enhance gerontological nursing content in pre-licensure nursing programs without adding additional content to curricula. Use of the ACES framework in pre-licensure nursing programs will help promote quality care of older adults in a variety of settings.

Tagliareni ME; Cline DD; Mengel A; McLaughlin B; King E

2012-05-01

347

Improving quality of cancer care through surgical audit  

DEFF Research Database (Denmark)

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.

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

2010-01-01

348

Management practices and the quality of care in cardiac units.  

UK PubMed Central (United Kingdom)

IMPORTANCE: To improve the quality of health care, many researchers have suggested that health care institutions adopt management approaches that have been successful in the manufacturing and technology sectors. However, relatively little information exists about how these practices are disseminated in hospitals and whether they are associated with better performance. OBJECTIVES: To describe the variation in management practices among a large sample of hospital cardiac care units; assess association of these practices with processes of care, readmissions, and mortality for patients with acute myocardial infarction (AMI); and suggest specific directions for the testing and dissemination of health care management approaches. DESIGN: We adapted an approach used to measure management and organizational practices in manufacturing to collect management data on cardiac units. We scored performance in 18 practices using the following 4 dimensions: standardizing care, tracking of key performance indicators, setting targets, and incentivizing employees. We used multivariate analyses to assess the relationship of management practices with process-of-care measures, 30-day risk-adjusted mortality, and 30-day readmissions for acute myocardial infarction (AMI). SETTING: Cardiac units in US hospitals. PARTICIPANTS: Five hundred ninety-seven cardiac units, representing 51.5% of hospitals with interventional cardiac catheterization laboratories and at least 25 annual AMI discharges. MAIN OUTCOME MEASURES: Process-of-care measures, 30-day risk-adjusted mortality, and 30-day readmissions for AMI. RESULTS: We found a wide distribution in management practices, with fewer than 20% of hospitals scoring a 4 or a 5 (best practice) on more than 9 measures. In multivariate analyses, management practices were significantly correlated with mortality (P = .01) and 6 of 6 process measures (P < .05). No statistically significant association was found between management and 30-day readmissions. CONCLUSIONS AND RELEVANCE: The use of management practices adopted from manufacturing sectors is associated with higher process-of-care measures and lower 30-day AMI mortality. Given the wide differences in management practices across hospitals, dissemination of these practices may be beneficial in achieving high-quality outcomes.

McConnell KJ; Lindrooth RC; Wholey DR; Maddox TM; Bloom N

2013-04-01

349

Standards of care: integrating nursing care plans and quality assurance activities.  

Science.gov (United States)

Traditionally, standards are used to define the level of care that a patient can expect to receive in a given institution or on a given nursing unit. These standards are the foundation of quality assurance programs. Unfortunately, with the increased emphasis on monitoring care, many standards are being written after the quality assurance activities have been developed and are in place. Often, standards are placed neatly in a book that is dusted off and brought out when the Joint Commission for Accreditation of Healthcare Organizations representative (JCAHO) visits. The nursing staff at the unit level has no real knowledge or understanding of the standards. This may result in a nonfunctioning quality assurance program. PMID:1995020

Mize, C P; Bentley, G; Hubbard, S

1991-02-01

350

Measuring the quality of a childhood cancer care delivery system: quality indicator development.  

UK PubMed Central (United Kingdom)

OBJECTIVES: A set of indicators to assess the quality of a childhood cancer system has not been identified in any jurisdiction internationally, despite the movement toward increased accountability and provision of high-quality care with limited health care resources. This study was conducted to develop a set of quality indicators (QIs) of a childhood cancer control and health care delivery system in Ontario, Canada. METHODS: A systematic review and targeted gray literature search were conducted to identify potential childhood cancer QIs. A series of investigator focus group sessions followed to review all QIs identified in the literature, and to generate a provisional QI set for a childhood cancer system. QIs were evaluated by three content experts in a sequential selection process on the basis of a series of criteria to select a subset for presentation to stakeholders. Following an appraisal of the relevance of quality assessment frameworks, remaining QIs were mapped onto the Cancer System Quality Index framework. RESULTS: The systematic review yielded few relevant childhood cancer system QIs. Overall, 120 provisional QIs were developed by the investigator group. Based on median QI rating scores, representation across the childhood cancer continuum, and feasibility of data collection, a subset of 33 QIs was selected for stakeholder consideration. CONCLUSIONS: The subset of 33 QIs developed on the basis of a systematic literature review and consensus provides the basis for the selection of a set of QIs for ongoing, standardized monitoring of various dimensions of quality in a childhood cancer system.

Bradley NM; Robinson PD; Greenberg ML; Barr RD; Klassen AF; Chan YL; Greenberg CM

2013-06-01

351

Diagnostic image quality of mammograms in German outpatient medical care  

International Nuclear Information System (INIS)

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

2010-01-01

352

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

Digital Repository Infrastructure Vision for European Research (DRIVER)

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 ...

353

The quality of COPD care in general practice  

DEFF Research Database (Denmark)

We investigated whether the quality of management of COPD in general practice could be improved by the participation of general practitioners and their staff in a COPD-specific educational programme. One-hundred and fifty-four doctors participated in the study, and 2549 patient record forms were included in the first audit and 2394 in the second audit. We observed a significantly increased utilisation of spirometry from the first (52.7%) to the second audit (71.4%) (p < 0,001) and improvement in other parameters describing the quality of management. We conclude that participation in an educational programme can improve the quality of COPD care in general practice Udgivelsesdato: 2008/8/25

Rasmussen, F.V.; Borgeskov, H.

2008-01-01

354

An international environmental scan of quality indicators for cardiovascular care.  

UK PubMed Central (United Kingdom)

Quality indicators (QIs) are increasingly being used to measure and improve the quality of cardiac care. We conducted an international environmental scan to identify and critically appraise published QI development initiatives addressing cardiovascular disease (CVD). A review of the peer-reviewed and grey English-language literature was conducted to identify published CVD QI development initiatives. The quality of identified studies was assessed using a modified version of the Appraisal of Guidelines for Research and Evaluation (AGREE) II QI tool-an instrument originally developed for the assessment of the quality of clinical practice guidelines. An initial literature search identified 2314 potentially relevant abstracts of peer-reviewed articles. After a review of the abstracts, 120 full text articles were retrieved and reviewed. Of these, 20 articles and 1 peer-reviewed monograph were selected for critical appraisal (n = 21). Most of the initiatives were conducted in North America (76%) and were published after 2005 (62%). The majority (5 of 6) of the AGREE II QI domain scores were skewed toward higher values, including the median score for the 'overall quality' rating (83.3%). Of the CVD categories addressed within the 21 initiatives, heart failure was the most common (n = 10 QI indicator sets), followed by acute coronary syndromes (n = 8). Considerable variation was observed in the methods utilized and the degree of scientific rigour applied in the published international CVD QI development initiatives. Adoption of standardized methods could help improve the quality of QI development initiatives.

Abrahamyan L; Boom N; Donovan LR; Tu JV

2012-01-01

355

Client satisfaction and quality of health care in rural Bangladesh  

Directory of Open Access Journals (Sweden)

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

Aldana Jorge Mendoza; Piechulek Helga; Al-Sabir Ahmed

2001-01-01

356

75 FR 44971 - Medicaid Program; Request for Comments on Legislative Changes To Provide Quality of Care to Children  

Science.gov (United States)

...Legislative Changes To Provide Quality of Care to Children AGENCY: Centers for...legislative changes to improve the quality of care provided to children under Medicaid...legislative changes to improve the quality of care provided to children under...

2010-07-30

357

[Perinatal mortality in foreign workers (author's transl)  

UK PubMed Central (United Kingdom)

From 1970 to 1972, there were 216 perinatal deaths among 5595 newborns at the I. Frauenklinik der Universität München. 54 of these deaths were children of foreign workers (so-called "Gastarbeiter"). The data have been processed on punch cards and analysed by a computer. The differences noted underwent significance testing by the CHI-Quadrat test. Only statistical significant results are published. The perinatal mortality in the above period shows no difference between foreign and German ward patients. There is, however, a significant lower perinatal mortality in private patients. We feel that this difference is due to a significant lower rate of prematures in the private patient group. The cocial status as well as higher interest and motivation in health resulting in better prenatal care are discussed as causal reasons for this fact.

Höfling HJ; Jonas R; Brusis E; Lochmüller H; Selbmann HK; Holzmann K; Zander J

1975-03-01

358

Quality of asthma care: Western Cape Province, South Africa  

Scientific Electronic Library Online (English)

Full Text Available Abstract in english 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 targete (more) d all primary care