WorldWideScience
1

Perinatal Care in Canada  

OpenAIRE

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 am...

Chalmers Beverley; Wen Shi

2004-01-01

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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  

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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

2012-11-01

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A literature review on integrated perinatal care  

OpenAIRE

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 peri...

Rivia?¨res-pigeon, Catherine Des; Rodra?­guez, Charo

2007-01-01

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A literature review on integrated perinatal care  

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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.

Charo Rodríguez

2007-07-01

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A literature review on integrated perinatal care  

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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.

Rivières-Pigeon, Catherine des

2007-01-01

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Perinatal Care for Women Who Are Addicted: Implications for Empowerment.  

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This article explores societal responses to perinatal drug abuse, including stigmatic attitudes and behaviors of health care workers. Empowering strategies are suggested by which social workers and clients can potentially redefine perinatal drug abuse as a health problem rather than a legal issue and improve the environment in which perinatal care

Carter, Carolyn S.

2002-01-01

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New uses of legacy systems: examples in perinatal care.  

OpenAIRE

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

Margolis, A.; Va?¡zquez, R.; Mendoza, G.; Zignago, A.; La?³pez, A.; Lucia?¡n, H.

1999-01-01

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

Scientific Electronic Library Online (English)

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

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

2012-07-01

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Midwifery care: a perinatal mental health case scenario.  

Science.gov (United States)

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. PMID:24080179

Marnes, Joanne; Hall, Pauline

2013-12-01

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Care of the newborn in perinatal units in New Brunswick.  

OpenAIRE

A survey of 23 perinatal units in New Brunswick hospitals was conducted by means of a mailed questionnaire to determine the type of care provided to newborns. The results showed various degrees of conformity with published guidelines for the care of newborns. Deficiencies were noted in several areas of care: failing to give or improperly giving vitamin K1 prophylaxis (in 7 of the units), flushing the eyes after silver nitrate prophylaxis (in 10), using hexachlorophene to bathe newborns (in 11...

Stephen, David L.

1986-01-01

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

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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

2005-08-01

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

OpenAIRE

Background: Making perinatal care accessible to women in marginalized periurban areas poses a public health problem. Many women do not utilize institutional care in spite of physical accessibility. Home-based care by traditional birth attendants (TBA) is hazardous. Inappropriate early neonatal feeding practices are common. Many barriers to perinatal care can be overcome by social mobilization and capacity building at the community level. Objectives: To determine the existing perinatal prac...

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

2009-01-01

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

Scientific Electronic Library Online (English)

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

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

OpenAIRE

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

Pieters, A. J. H. M.

2013-01-01

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The Community Perinatal Care Study: Home Visiting and Nursing Support for Pregnant Women  

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This article describes The Community Perinatal Care Study, a community-based study of pregnancy support that was conducted in Calgary, Alberta, Canada, between 2001 and 2004. The study was conducted to learn how to improve community-based pregnancy care and to improve prenatal care and healthy births, particularly for women with increased…

Johnston, David; Tough, Suzanne; Siever, Jodi

2006-01-01

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Value and quality of perinatal and infant postmortem examinations: cohort analysis of 400 consecutive deaths.  

OpenAIRE

OBJECTIVES--To evaluate the contribution that perinatal and infant necropsy makes to clinical practice and to see how this might be influenced by the quality of the investigation. DESIGN--Cohort analysis, with data from the all Wales perinatal survey, of perinatal and infant deaths during 1993 of babies born to mothers usually resident in Wales. The clinicopathological classification of death based on clinical details was compared with the classification after necropsy. Similarly, cases in wh...

Cartlidge, P. H.; Dawson, A. T.; Stewart, J. H.; Vujanic, G. M.

1995-01-01

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Quality of care: assessment  

OpenAIRE

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.

Sridhar Gumpeny; Rao Allam

2007-01-01

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Regional perinatal mortality differences in the Netherlands; care is the question  

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Full Text Available Abstract Background Perinatal mortality is an important indicator of health. European comparisons of perinatal mortality show an unfavourable position for the Netherlands. Our objective was to study regional variation in perinatal mortality within the Netherlands and to identify possible explanatory factors for the found differences. Methods Our study population comprised of all singleton births (904,003 derived from the Netherlands Perinatal Registry for the period 2000–2004. Perinatal mortality including stillbirth from 22+0 weeks gestation and early neonatal death (0–6 days was our main outcome measure. Differences in perinatal mortality were calculated between 4 distinct geographical regions North-East-South-West. We tried to explain regional differences by adjustment for the demographic factors maternal age, parity and ethnicity and by socio-economic status and urbanisation degree using logistic modelling. In addition, regional differences in mode of delivery and risk selection were analysed as health care factors. Finally, perinatal mortality was analysed among five distinct clinical risk groups based on the mediating risk factors gestational age and congenital anomalies. Results Overall perinatal mortality was 10.1 per 1,000 total births over the period 2000–2004. Perinatal mortality was elevated in the northern region (11.2 per 1,000 total births. Perinatal mortality in the eastern, western and southern region was 10.2, 10.1 and 9.6 per 1,000 total births respectively. Adjustment for demographic factors increased the perinatal mortality risk in the northern region (odds ratio 1.20, 95% CI 1.12–1.28, compared to reference western region, subsequent adjustment for socio-economic status and urbanisation explained a small part of the elevated risk (odds ratio 1.11, 95% CI 1.03–1.20. Risk group analysis showed that regional differences were absent among very preterm births (22+0 – 25+6 weeks gestation and most prominent among births from 32+0 gestation weeks onwards and among children with severe congenital anomalies. Among term births (? 37+0 weeks regional mortality differences were largest for births in women transferred from low to high risk during delivery. Conclusion Regional differences in perinatal mortality exist in the Netherlands. These differences could not be explained by demographic or socio-economic factors, however clinical risk group analysis showed indications for a role of health care factors.

Rijninks-van Driel Greta C

2009-04-01

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

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

Khan Zulfia

2009-01-01

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

OpenAIRE

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.

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

2012-01-01

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Quality of Cancer Care  

Science.gov (United States)

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

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

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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

2012-11-01

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Validity of a questionnaire measuring the world health organization concept of health system responsiveness with respect to perinatal services in the dutch obstetric care system.  

Science.gov (United States)

BackgroundThe concept of responsiveness, introduced by the World Health Organization (WHO), addresses non-clinical aspects of health service quality that are relevant regardless of provider, country, health system or health condition. Responsiveness refers to ¿aspects related to the way individuals are treated and the environment in which they are treated¿ during health system interactions. This paper assesses the psychometric properties of a newly developed responsiveness questionnaire dedicated to evaluating maternal experiences of perinatal care services, called the Responsiveness in Perinatal and Obstetric Health Care Questionnaire (ReproQ), using the eight-domain WHO concept.MethodsThe ReproQ was developed between October 2009 and February 2010 by adapting the WHO Responsiveness Questionnaire items to the perinatal care context. The psychometric properties of feasibility, construct validity, and discriminative validity were empirically assessed in a sample of Dutch women two weeks post partum.ResultsA total of 171 women consented to participation. Feasibility: the interviews lasted between 20 and 40 minutes and the overall missing rate was 8%. Construct validity: mean Cronbach¿s alphas for the antenatal, birth and postpartum phase were: 0.73 (range 0.57-0.82), 0.84 (range 0.66-0.92), and 0.87 (range 0.62-0.95) respectively. The item-own scale correlations within all phases were considerably higher than most of the item-other scale correlations. Within the antenatal care, birth care and post partum phases, the eight factors explained 69%, 69%, and 76% of variance respectively. Discriminative validity: overall responsiveness mean sum scores were higher for women whose children were not admitted. This confirmed the hypothesis that dissatisfaction with health outcomes is transferred to their judgement on responsiveness of the perinatal services.ConclusionsThe ReproQ interview-based questionnaire demonstrated satisfactory psychometric properties to describe the quality of perinatal care in the Netherlands, with the potential to discriminate between different levels of quality of care. In view of the relatively small sample, further testing and research is recommended. PMID:25465053

van der Kooy, Jacoba; Valentine, Nicole B; Birnie, Erwin; Vujkovic, Marijana; de Graaf, Johanna P; Denkta, Semiha; Steegers, Eric A P; Bonsel, Gouke J

2014-12-01

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Training traditional birth attendants on the WHO Essential Newborn Care reduces perinatal mortality  

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Objectives To evaluate the impact of birth attendant training using the World Health Organization Essential Newborn Care (ENC) course among traditional birth attendants, with a particular emphasis on the effect of acquisition of skills on perinatal outcomes. Design Population-based, prospective, interventional pre-post design study. Setting 11 rural clusters in Chimaltenango, Guatemala. Population Health care providers. Methods This study analyzed the effect of training and implementation of the ENC health care provider training course between September 2005 and December 2006. Outcome measures The primary outcome measure was the rate of death from all causes in the first seven days after birth in fetuses/infants ?1500g. Secondary outcome measures were overall rate of stillbirth, rate of perinatal death, which included stillbirths plus neonatal deaths in the first seven days in fetuses/infants ?1500g. Results Perinatal mortality decreased from 39.5/1000 pre-ENC to 26.4 post-ENC (RR 0.72; 95%CI 0.54–0.97). This reduction was attributable almost entirely to a decrease in the stillbirth rate of 21.4/1000 pre-Essential Newborn Care to 7.9/1000 post-ENC (RR 0.40; 95%CI 0.25–0.64). Seven-day neonatal mortality did not decrease (18.3/1000 to 18.6/1000; RR 1.05; 95%CI 0.70–1.57). Conclusion Essential Newborn Care training reduced stillbirths in a population-based controlled study with deliveries conducted almost exclusively by traditional birth attendants. Scale-up of this intervention in other settings might help assess reproducibility and sustainability. PMID:22324644

GARCÉS, ANA; MCCLURE, ELIZABETH M.; HAMBIDGE, MICHAEL; KREBS, NANCY F.; MAZARIEGOS, MANOLO; WRIGHT, LINDA L.; MOORE, JANET; CARLO, WALDEMAR A

2015-01-01

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

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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.

Barnes Hayley

2010-03-01

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Regional perinatal mortality differences in the Netherlands; care is the question  

OpenAIRE

Abstract Background Perinatal mortality is an important indicator of health. European comparisons of perinatal mortality show an unfavourable position for the Netherlands. Our objective was to study regional variation in perinatal mortality within the Netherlands and to identify possible explanatory factors for the found differences. Methods Our study population comprised of all singleton births (904,003) derived from the Netherlands Perinatal Registry for the period 2000–2004. Perinatal mo...

Rijninks-van Driel Greta C; Aa, Brouwers Hens; Hm, Erwich Jan Jaap; Reitsma Johannes B; Eskes Martine; Tromp Miranda; Bonsel Gouke J; Cj, Ravelli Anita

2009-01-01

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Supporting bereaved parents: practical steps in providing compassionate perinatal and neonatal end-of-life care. A North American perspective.  

Science.gov (United States)

Providing compassionate bereavement support challenges care-givers in perinatal medicine. A practical and consistent approach tailored to individual families may increase the care-giver's ability to relieve parental grief. This approach includes: (1) clear and consistent communication compassionately delivered; (2) shared decision-making; (3) physical and emotional support; and (4) follow-up medical, psychological and social care. Challenges to providing comprehensive end-of-life care include care-giver comfort, consistency of care, cultural and legal barriers, and lack of adequate training. PMID:18472317

Williams, Constance; Munson, David; Zupancic, John; Kirpalani, Haresh

2008-10-01

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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 ... articles about the US health care system. MEASURING QUALITY FOR MORE INFORMATION • Agency for Healthcare Research and ...

29

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

OpenAIRE

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 need...

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

2008-01-01

30

Impact of Changes in Perinatal Care on Neonatal Respiratory Outcome and Survival of Preterm Newborns: An Overview of 15 Years  

OpenAIRE

Survival and outcomes for preterm infants with respiratory distress syndrome (RDS) have improved over the past 30 years. We conducted a study to assess the changes in perinatal care and delivery room management and their impact on respiratory outcome of very low birth weight newborns, over the last 15 years. A comparison between two epochs was performed, the periods before and after 2005, when early nasal continuous positive airway pressure (NCPAP) and Intubation-SURfactant-Extubation (INSURE...

Filipa Flor-de-Lima; Gustavo Rocha; Hercília Guimarães

2012-01-01

31

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

OpenAIRE

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 particula...

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

2006-01-01

32

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

OpenAIRE

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 PC...

Santos, Daniel Vi?tor V.; Souza, Maria Margarida R.; Gonc?alves, Se?rgio Henrique L.; Cotta, Ana Cristina S.; Melo, Lorenza A. O.; Andrade, Gla?ucia M. Q.; Brasileiro-filho, Geraldo

2000-01-01

33

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

2009-03-01

34

Stroke care: how do we measure quality?  

OpenAIRE

The purpose of this paper is to review the methods used to measure quality of stroke care. Relevant articles were searched for on Medline using the following key words: stroke, quality, outcome of care, process of care, structure of care. Articles that examined how to measure the quality of stroke care and that examined difficulties in the measurement of care outcomes, processes, and structures were selected. Selected articles were reviewed to summarise methods used to measure quality of stro...

Walsh, K.; Gompertz, P.; Rudd, A.

2002-01-01

35

Knowledge translation and evidence-based perinatal/neonatal health care.  

Science.gov (United States)

Knowledge translation is the process of bridging the gap between the overwhelming amount of research data/information/evidence and its critical appraisal, synthesis, dissemination, and application as knowledge by influential role models. Knowledge translation includes ongoing surveillance of the results of the implementation of new knowledge. By conducting research that is driven by relevant, well-defined questions and by using the most powerful study designs available, researchers generate valid new information that can later be translated into knowledge and applied in the clinical setting. Systematic reviews of the literature serve as good examples of knowledge management, when defined as "making proper use of the sum of what is known." Such reviews may identify that an intervention is effective without any harmful side effects, that it is noneffective, or that further research is warranted. Consumers of perinatal/neonatal health care or their ombudsmen should be encouraged to take part in setting the agenda and defining important outcomes for such research. PMID:12240460

Ohlsson, Arne

2002-08-01

36

The quality of caring relationships.  

Science.gov (United States)

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. PMID:22110320

Abma, Tineke A; Oeseburg, Barth; Widdershoven, Guy Am; Verkerk, Marian

2009-01-01

37

CMS emphasizes quality patient care.  

Science.gov (United States)

The Inpatient Prospective Payment System proposed rule for fiscal 2015 continues the Centers for Medicare & Medicaid Services' move toward basing reimbursement on quality of care, not quantity. The rule also asks for public input on the two-midnight rule and a policy to address short-stay patients. CMS is implementing the Hospital-Acquired Condition Reduction Program, which penalizes hospitals that perform poorly. The agency proposes to add two safety measures to value-based purchasing in the future. PMID:24946382

2014-07-01

38

Defining Quality Child Care: Multiple Stakeholder Perspectives  

Science.gov (United States)

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

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

2007-01-01

39

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

Directory of Open Access Journals (Sweden)

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

Ruy Laurenti

1985-06-01

40

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

Directory of Open Access Journals (Sweden)

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

Maria da Consolação Magalhães

2003-09-01

41

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.

Thomas Angela N

2009-09-01

42

Does Audit Improve the Quality of Care?  

OpenAIRE

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 searche...

Areti Tsaloglidou

2009-01-01

43

Effective Marketing of Quality Child Care.  

Science.gov (United States)

Identifies negative public and professional attitudes that lie beneath the contemporary negative image of quality child care. Argues that concepts and principles of marketing are appropriate for influencing parents to choose high quality services and helping ensure that supplementary care is of sufficient quality to enhance, not inhibit, the…

Caldwell, Bettye M.; Boyd, Harper W., Jr.

1984-01-01

44

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.

2000-01-01

45

Violence-related coping, help-seeking and health care-based intervention preferences among perinatal women in Mumbai, India.  

Science.gov (United States)

Domestic violence is a significant public health issue. India is uniquely affected with an estimated 1 in 3 women facing abuse at the hands of a partner. The current mixed-methods study describes violence-related coping and help-seeking, and preferences for health care-based intervention, among perinatal women residing in low-income communities in Mumbai, India. In-depth interviews were conducted with women who had recently given birth and self-reported recent violence from husbands (n = 32), followed by survey data collection (n = 1,038) from mothers seeking immunization for their infants ages 6 months or younger at 3 large urban health centers in Mumbai, India. Participants described fears and other barriers to abuse disclosure, and there was a low level of awareness of formal support services related to violence. Qualitative and quantitative findings indicated that formal help-seeking is uncommon and that informal help sources are most frequently sought. Quantitative results revealed that, while few (violence in the health care setting, most (67%) would be willing to disclose abuse if asked. When presented with a list of possible clinic-based violence support interventions, participants endorsed crisis counseling and safety planning as most helpful (90.9%). Findings provide direction for violence-related intervention services for perinatal women. A multipronged approach that includes strengthening the informal support system, for example, neighbors and family members, as well as facilitating access to formal services building on the health care system, warrants exploration in this context. PMID:23295374

Decker, Michele R; Nair, Saritha; Saggurti, Niranjan; Sabri, Bushra; Jethva, Meghna; Raj, Anita; Donta, Balaiah; Silverman, Jay G

2013-06-01

46

Leadership and the quality of care  

OpenAIRE

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

Firth-cozens, J.; Mowbray, D.

2001-01-01

47

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

OpenAIRE

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

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

2010-01-01

48

Caesarean section and neonatal outcomes in private hospitals in Brazil: comparative study of two different perinatal models of care.  

Science.gov (United States)

This study aims at comparing caesarean section rates and neonatal outcomes of two perinatal models of care provided in private hospitals in Brazil. Birth in Brazil data, a national hospital-based cohort conducted in the years 2011/2012 was used. We analysed 1,664 postpartum women and their offspring attended at 13 hospitals located in the South-east region of Brazil, divided into a "typical"--standard care model and "atypical"--Baby-Friendly hospital with collaborative practices between nurse-midwives and obstetricians on duty to attend deliveries in an alternative labour ward. The Robson's classification system was used to compare caesarean sections, which was lower in the atypical hospital (47.8% vs. 90.8%, prooming-in care, and discharge in exclusive breastfeeding were more frequent in the atypical hospital. Neonatal adverse outcome did not differ significantly between hospitals. The atypical hospital's intervention should be further evaluated since it might reduce caesarean section prevalence and increase good practices in neonatal care. PMID:25167181

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

2014-08-01

49

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

Scientific Electronic Library Online (English)

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

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

2014-12-01

50

[Quality of care in inflammatory bowel disease].  

Science.gov (United States)

Since inflammatory bowel disease (IBD) is a chronic and relapsing disorder, maintaining high quality of care plays an important role in the management of patients with IBD. To develop process-based quality indicator set to improve quality of care, the indicator should be based directly on evidence and consensus. Initially, ImproveCareNow group demonstrated quality improvement by learning how to apply quality improvement methods to improve the care of pediatric patients with IBD. The American Gastroenterological Association has developed adult IBD physician performance measures set and Crohn's and Colitis Foundation of America (CCFA) has developed a set of ten most highly rated process and outcome measures. Recently, The Emerging Practice in IBD Collaborative (EPIC) group generated defining quality indicators for best-practice management of IBD in Canada. Quality of Care through the Patient's Eyes (QUOTE-IBD) was developed as a questionnaire to measure quality of care through the eyes of patients with IBD, and it is widely used in European countries. The current concept of quality of care as well as quality indicator will be discussed in this article. (Korean J Gastroenterol 2015;65:139-144). PMID:25797376

Seo, Geom Seog

2015-03-25

51

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

52

Organisational culture and quality of health care  

OpenAIRE

concerned with assessing and improving the quality of health care. The USA, in particular, has identified specific concerns over quality issues1 2 and a recent report from the Institute of Medicine pointed to the considerable toll of medical errors.3 In the UK a series of scandals has propelled quality issues to centre stage4 5 and made quality improvement a key policy area.6 But how are quality improvements to be wrought in such a complex system as health care? A recent issue of Quality in H...

Nutley, S. M.; Davies, H. T. O.; Mannion, R.

2000-01-01

53

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

2013-04-01

54

Quality of Cancer Care - Applied Research  

Science.gov (United States)

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

55

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

OpenAIRE

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

Hoogenboom, G.

2010-01-01

56

A Conceptual Framework for Quality of Care  

OpenAIRE

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 ...

Mosadeghrad, Ali Mohammad

2012-01-01

57

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

Directory of Open Access Journals (Sweden)

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

Guillermo Hernández G

2000-11-01

58

[Quality of health care and its evaluation].  

Science.gov (United States)

The focus on quality improvement of health care has been emerging in last decade, due to rapidly increasing competition, cost containment by governmental and private health financing corporations (including health insurance), and high costs structure of health care providing institutions. Accordingly, necessity of evaluation on results of care/outcome (discharge and discontinuation) of care has been drawn prompt attention of decision makers and administrators in health care institutions. However, since, original motive of quality care has been generated from the aspect of care providers' oriented (in US: Market and costs oriented, in Europe: Legislation oriented) bases and directions, in terms of cost performance, downsizing operation, improvement of competing capability and creating new profit making opportunity, evaluation approach, prioritization, itemization, setting goal, and standards were forced to set as forth to meet the providers' objective, in stead of patient's benefit and maximization of patient's satisfaction. Therefore, effective evaluation structure of quality balance management in operation must be built and consisted of four major 1)-4) cores to maintain patient oriented quality and optimal level of quality obligation to community. 1) In process 2) In Services 3) In Inhabitant Benefits 4) In Producing Assured Results. Through the efforts, it is proposed to urge "Evaluation Effectiveness Initiative (EEI) by Japan's leadership" to achieve sustainable safety and effective quality in balance of process through whole operations. PMID:9423195

Tsubo, T

1997-10-01

59

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

OpenAIRE

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, on...

Parrotta C; Riley W; Meredith L

2012-01-01

60

The Experience of Perinatal Care at a Birthing Center: A Qualitative Pilot Study  

OpenAIRE

The purpose of this qualitative descriptive pilot study was to describe women's experiences of care and satisfaction at a freestanding birth center. Data were collected through semistructured interviews with seven women who had given birth within 12 months of participant selection. Using qualitative content analysis, three themes emerged: (1) Empowerment, (2) Sense of Motherhood, and (3) Establishing and Strengthening Relationships. Data revealed that women value caring providers, that caring...

Pewitt, Amber T.

2008-01-01

61

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

Directory of Open Access Journals (Sweden)

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

Gülmezoglu A Metin

2011-07-01

62

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

63

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

Directory of Open Access Journals (Sweden)

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

Karuga Robinson N

2010-10-01

64

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

Scientific Electronic Library Online (English)

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

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

1283-12-01

65

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

OpenAIRE

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

So?derba?ck, Maja; Erlandsson, Kerstin

2012-01-01

66

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

OpenAIRE

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

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

2000-01-01

67

Reviewing the quality of care: Priorities for improvement  

OpenAIRE

Rapid and substantial change in our health care system has prompted careful analysis of the quality of health care and the effectiveness of the methods used to review and improve quality. Although welcome, those applying this scrutiny must recognize that improvement in the quality of health care will take the concerted and cooperative efforts of health policymakers, health care practitioners, health care organizations, consumers of care, purchasers of care, and those organizations that define...

Roberts, James S.

1987-01-01

68

[Quality of care: from theory to practice].  

Science.gov (United States)

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

Guillain, H; Raetzo, M A

1997-03-29

69

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

70

Reinventing VA health care: systematizing quality improvement and quality innovation.  

Science.gov (United States)

The Veterans Health Administration (VHA) in the US Department of Veterans Affairs (VA) manages the largest fully integrated health care system in the United States. In 1995, the VHA initiated a reinvention effort that included the most radical redesign of VA health care to occur since the veterans health care system was formally established in 1946. The 2 paramount goals of this reinvention effort were to ensure the predictable and consistent provision of high-quality care everywhere in the system and to optimize the value of VA health care. Although still a work in progress, dramatic results have been achieved toward these ends during the past 5 years. This article provides an overview of the veterans health care system, and it highlights selected aspects of the system's reengineering. It also describes various steps that have been taken to better manage performance and to systematize quality improvement and quality innovation. This information provides a global context that should facilitate understanding of the genesis and purposes of the Quality Enhancement Research Initiative that is described in other articles in this issue of Medical Care. PMID:10843266

Kizer, K W; Demakis, J G; Feussner, J R

2000-06-01

71

Empathy and quality of care.  

OpenAIRE

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

Mercer, Stewart W.; Reynolds, William J.

2002-01-01

72

Dengue perinatal / Perinatal dengue  

Scientific Electronic Library Online (English)

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

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

2013-09-01

73

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

Science.gov (United States)

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

Ivory, Catherine H

2015-03-01

74

Perinatal and Pediatric Issues in Palliative and End-of-Life Care from the 2011 Summit on Compassionate Care  

Science.gov (United States)

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

Youngblut, JoAnne M.; Brooten, Dorothy

2012-01-01

75

Computers and Quality of Care Review  

OpenAIRE

This paper reports on the use of computer systems in psychiatric care settings in conjunction with the performance of four quality assurance functions (utilization review, patient care audit, individual case review, and medical records review for completeness). Thirty-two centers that treat psychiatric patients and 22 standards setting agencies were surveyed concerning: 1) the general use of computer systems by the facilities surveyed; 2) the computer applications used in conjunction with qua...

Murtaugh, Chris; Siegel, Carole; Fischer, Susan; Alexander, Mary Jane; Craig, Thomas J.

1982-01-01

76

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

Directory of Open Access Journals (Sweden)

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

Ying Dong

2012-09-01

77

Total quality management issues in managed care.  

Science.gov (United States)

The implementation of total quality management (TQM) in health care has gone on in parallel with the growth of managed care. What is the interaction between the two? Key issues are the ascendance of cost control over quality in many areas, erosion of employee commitment and loyalty, and a short-run orientation. Associated with this is an emphasis on organizational learning rather than learning by autonomous professionals. Both TQM and managed care acknowledge the dynamic nature of clinical processes and the ability and responsibility of both institutions and clinicians to improve their processes. Both are consistent with efforts to identify and implement best practices. However, these similarities should not mask fundamental differences. Continuous improvement must shift its focus from avoiding unnecessary variation to facilitating rapid organizational learning and institutionalizing mass customization into the delivery of health services. PMID:9327355

McLaughlin, C P; Kaluzny, A D

1997-01-01

78

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

Science.gov (United States)

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. PMID:23913619

Si, Jiliang; Li, Peng; Xin, Quanbing; Li, Xuewen; An, Lihong; Li, Jie

2015-01-01

79

Perinatal safety: from concept to nursing practice.  

Science.gov (United States)

Communication and teamwork problems are leading causes of documented preventable adverse outcomes in perinatal care. An essential component of perinatal safety is the organizational culture in which clinicians work. Clinicians' individual and collective authority to question the plan of care and take action to change the direction of a clinical situation in the patient's best interest can be viewed as their "agency for safety." However, collective agency for safety and commitment to support nurses in their role of advocacy is missing in many perinatal care settings. This article draws from Organizational Accident Theory, High Reliability Theory, and Symbolic Interactionism to describe the nurse's role in maintaining safety during labor and birth in acute care settings and suggests actions for supporting the perinatal nurse at individual, group, and systems levels to achieve maximum safety in perinatal care. PMID:20147827

Lyndon, Audrey; Kennedy, Holly Powell

2010-01-01

80

Validation of alternative indicators of social support in perinatal outcomes research using quality of the partner relationship  

Science.gov (United States)

Aim This paper suggests and tests alternatives to the current research and clinical practice of assuming that married or partnered status is a proxy for positive social support. Background Having a partner is assumed to relate to better health status via the intermediary process of social support. However, women’s health research indicates that having a partner is not always associated with positive social support. Design An exploratory post hoc analysis focused on posttraumatic stress and childbearing was conducted using a large perinatal database from 2005–2009. Methods To operationalize partner relationship, four variables were analyzed: partner (‘yes’ or ‘no’), intimate partner violence (‘yes’ or ‘no’), the combination of those two factors, and the woman’s appraisal of the quality of her partner relationship via a single item. Construct validity of these four alternative variables was assessed in relation to appraisal of the partner’s social support in labor and the postpartum using linear regression standardized betas and adjusted R-squares. Predictive validity was assessed using unadjusted and adjusted linear regression modeling. Results Four groups were compared. Married abused women differed most from married, not abused women in relation to the social support and depression outcomes used for validity checks. The variable representing the women’s appraisal of their partner relationship explains the most variance in predicting depression scores. Conclusions Our results support the validity of operationalizing the impact of the partner relationship on outcomes by using a combination of partnered status and abuse status or using a subjective rating of quality of the partner relationship. PMID:23009056

Kruse, Julie A.; Seng, Julia S.; Low, Lisa Kane

2015-01-01

81

Legal issues of perinatal oral health.  

Science.gov (United States)

Every dental health care provider will inevitably be faced with perinatal oral health issues involving patients or staff members. The legal issues involving perinatal dental care are reviewed including the laws of malpractice claims by patients, employment claims involving staff, and Dental Board of California investigations involving patient care, and the administration of the business of dentistry. Recommendations are made for record keeping. PMID:20961027

Curley, Arthur W

2010-09-01

82

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

Science.gov (United States)

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

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

2014-07-01

83

Quality Aspects of Maternal Health Care in Tanzania  

OpenAIRE

This thesis assesses some indicators of quality for maternity care in Tanzania, using antenatal management of anaemia and hypertension and emergency obstetric care as focal points. The care of pregnant women consecutively enrolled in antenatal care (n=379) was observed and compared with quality standard criteria. From a tertiary level labour ward 741 cases of eclampsia were identified and their antenatal care analyzed. A health systems analysis was performed for 205 cases of pregnancy complic...

Urassa, David Paradiso

2004-01-01

84

Quality of intensive care chest imaging  

International Nuclear Information System (INIS)

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

85

Carepaths: a framework for quality patient care  

International Nuclear Information System (INIS)

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

86

Evaluating health care quality: the moderating role of outcomes.  

Science.gov (United States)

An integrative model of health care quality is presented. "Health care quality" is defined as provider conformance to patient requirements at three benefit levels: core, intangible, and tangible. The model is operationalized and tested in a clinical setting, a large center for fertility studies with more than 5000 patients. Health care "process variables" such as physician and patient interactions were not as important in patients' evaluations of health care quality when successful outcomes occurred (pregnancy). However, when patients experienced unsuccessful outcomes (no pregnancy), health care "process variables" were important and had a significant influence on patient perceptions of health care quality. Hence, service outcomes can significantly affect the measurement and interpretation of health care quality. Implications for health care management and research are discussed. PMID:10116754

Lytle, R S; Mokwa, M P

1992-03-01

87

Evaluating perinatal mortality rates: effects of referral and case mix.  

OpenAIRE

OBJECTIVE--To evaluate perinatal mortality rates as a method of auditing obstetric and neonatal care after account had been taken of transfer between hospitals during pregnancy and case mix. DESIGN--Case-control study of perinatal deaths. SETTING--Leicestershire health district. SUBJECTS--1179 singleton perinatal deaths and their selected live born controls among 114,362 singleton births to women whose place of residence was Leicestershire during 1978-87. MAIN OUTCOME MEASURE--Crude perinatal...

Clarke, M.; Mason, E. S.; Macvicar, J.; Clayton, D. G.

1993-01-01

88

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

2000-06-01

89

42 CFR 483.25 - Quality of care.  

Science.gov (United States)

...2010-10-01 2010-10-01 false Quality of care. 483.25 Section 483.25...Long Term Care Facilities § 483.25 Quality of care. Each resident must receive...nutritional status, such as body weight and protein levels, unless the resident's...

2010-10-01

90

Molecular imaging in quality health care  

International Nuclear Information System (INIS)

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

91

The Impact of Financial Incentives on Quality of Health Care  

OpenAIRE

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

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

1998-01-01

92

Evaluating the Quality of the Child Care in Finland  

Science.gov (United States)

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

Hujala, Eeva; Fonsen, Elina; Elo, Janniina

2012-01-01

93

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

94

Quality assurance in health care: past, present and future.  

Science.gov (United States)

Quality of health care delivery is a growing concern globally given current budget restraints and increasing demands on health care providers. The variety of quality assurance and quality management activities equals the numerous ways health care practitioners of all genres provide health care. Dental hygienists around the world must be knowledgeable about quality assurance and management in health care as it is a significant factor in the evolution of the dental hygiene profession and the quality of oral health care provided by dental hygienists. The objective of this research was to conduct a literature review on quality assurance and quality management. A MEDLINE search from 1966 to 2002 was conducted. The search resulted in approximately 145 articles. Additional references from works generated by the search were also obtained. The literature revealed information on the background and history of quality assurance and quality management. Much of the literature was devoted to discussions of the validity, reliability and effectiveness of most prominent quality management activities being utilised in health care today. The investigation revealed numerous issues and barriers surrounding quality management. This article concludes with suggestions for future directions of quality assurance and quality management. PMID:16451516

Bilawka, E; Craig, B J

2003-08-01

95

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

96

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

97

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.

Silvânia Maria Mendes Vasconcelos

2009-09-01

98

Perinatal Safety: From Concept to Nursing Practice  

OpenAIRE

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

Lyndon, Audrey; Kennedy, Holly Powell

2010-01-01

99

Quality indicators for primary care mental health services  

OpenAIRE

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

Shield, T.; Campbell, S.; Rogers, A.; Worrall, A.; Chew-graham, C.; Gask, L.

2003-01-01

100

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

Directory of Open Access Journals (Sweden)

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

Isabel Río

2010-04-01

101

Quality of Life and Patient Satisfaction: ESRD Managed Care Demonstration  

OpenAIRE

To study the effects of managed care on dialysis patients, we compared the quality of life and patient satisfaction of patients in a managed care demonstration with three comparison samples: fee-for-service (FFS) patients, managed care patients outside the demonstration, and patients in a separate national study. Managed care patients were less satisfied than FFS patients about access to health care providers, but more satisfied with the financial benefits (copayment coverage, prescription dr...

Pifer, Trinh B.; Bragg-gresham, Jennifer L.; Dykstra, Dawn M.; Shapiro, Jennifer R.; Oppenheimer, Caitlin Carroll; Gaylin, Daniel S.; Beronja, Nancy; Rubin, Robert J.; Held, Philip J.

2003-01-01

102

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

Science.gov (United States)

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

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

2014-09-01

103

Molecular imaging in quality health care  

International Nuclear Information System (INIS)

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

104

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

Science.gov (United States)

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

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

2011-01-01

105

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

OpenAIRE

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

Parand, Anam

2013-01-01

106

38 CFR 51.120 - Quality of care.  

Science.gov (United States)

...2010-07-01 2010-07-01 false Quality of care. 51.120 Section 51.120...STATE HOMES Standards § 51.120 Quality of care. Each resident must receive...nutritional status, such as body weight and protein levels, unless the resident's...

2010-07-01

107

38 CFR 52.120 - Quality of care.  

Science.gov (United States)

...2010-07-01 2010-07-01 false Quality of care. 52.120 Section 52.120...STATE HOMES Standards § 52.120 Quality of care. Each participant must...nutritional status, such as body weight and protein levels, unless the participant's...

2010-07-01

108

Researcher's and Parents' Perspectives on Quality of Care and Education  

Science.gov (United States)

Based on arguments according to which the concept of quality is multifaceted, difficult to be defined and defined differently by various stakeholders, it has been suggested that the quality of care and education be evaluated from different perspectives if one aims to create a global picture of the early childhood education and care programmes. The…

Rentzou, Konstantina; Sakellariou, Maria

2013-01-01

109

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

Directory of Open Access Journals (Sweden)

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

Sônia Lansky

2002-12-01

110

Dengue perinatal / Perinatal dengue infection  

Scientific Electronic Library Online (English)

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

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

2011-06-01

111

Using Quality Experts from Manufacturing to Transform Primary Care  

Science.gov (United States)

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

Steiner, Rose M.; Walsworth, David T.

2010-01-01

112

Marketing quality and value to the managed care market.  

Science.gov (United States)

Quantifying quality and marketing care delivery have been long-term challenges in the health care market. Insurers, employers, other purchasers of care, and providers face a constant challenge in positioning their organizations in a proactive, competitive niche. Tools that measure patient's self-reported perception of health care needs and expectations have increased the ability to quantify quality of care delivery. When integrated with case management and disease management strategies, outcomes reporting and variance analysis tracking can be packaged to position a provider in a competitive niche. PMID:10338715

Kazmirski, G

1998-11-01

113

Association between education and quality of diabetes care in Switzerland  

Science.gov (United States)

Purpose Low socioeconomic status is associated with higher prevalence of diabetes, worse outcomes, and worse quality of care. We explored the relationship between education, as a measure of socioeconomic status, and quality of care in the Swiss context. Patients and methods Data were drawn from a population-based survey of 519 adults with diabetes during fall 2011 and summer 2012 in a canton of Switzerland. We assessed patients and diabetes characteristics. Eleven indicators of quality of care were considered (six of process and five of outcomes of care). After bivariate analyses, regression analyses adjusted for age, sex, and diabetic complications were performed to assess the relationship between education and quality of care. Results Of 11 quality-of-care indicators, three were significantly associated with education: funduscopy (patients with tertiary versus primary education were more likely to get the exam: odds ratio, 1.8; 95% confidence interval [CI], 1.004–3.3) and two indicators of health-related quality of life (patients with tertiary versus primary education reported better health-related quality of life: Audit of Diabetes-Dependent Quality of Life: ?=0.6 [95% CI, 0.2–0.97]; SF-12 mean physical component summary score: ?=3.6 [95% CI, 0.9–6.4]). Conclusion Our results suggest the presence of educational inequalities in quality of diabetes care. These findings may help health professionals focus on individuals with increased needs to decrease health inequalities. PMID:25759596

Flatz, Aline; Casillas, Alejandra; Stringhini, Silvia; Zuercher, Emilie; Burnand, Bernard; Peytremann-Bridevaux, Isabelle

2015-01-01

114

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

OpenAIRE

Analisa-se a influência de variáveis como peso ao nascer, idade materna, assistência pré-natal e tabagismo materno. Do estudo dos 12.999 nascimentos (vivos e mortos) ocorridos em nove maternidades no período de um ano, verificou-se que a mortalidade perinatal é muito maior para os recém-nascidos de baixo peso (665,3 ‰ para peso até 1.500 g), diminuindo à medida que aumenta o peso ao nascer. Também nos casos de mães jovens (menores de 15 anos) ou mães com idade superior a 35 anos...

Ruy Laurenti; Cássia Maria Buchalla

1985-01-01

115

Quality of ambulatory care for the elderly: Formulating evaluation criteria  

OpenAIRE

Efforts to assess the quality of ambulatory care services provided to Medicare beneficiaries cannot meaningfully proceed unless a concerted effort is made to develop criteria and standards for ambulatory care quality assessment that reflect the specific characteristics and needs of the elderly. In this article, we describe some of those characteristics and needs—such as physical and mental impairments and multiple coexisting conditions—and we show how they affect the care provided to the ...

Ferris, Ann K.; Wyszewianski, Leon

1990-01-01

116

Systems and processes that ensure high quality care.  

Science.gov (United States)

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

Bassett, Sally; Westmore, Kathryn

2012-10-01

117

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

Science.gov (United States)

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

Albright, Jamie N; Fair, Cynthia D

2014-11-01

118

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

Science.gov (United States)

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. PMID:23702898

Nagington, Maurice; Luker, Karen; Walshe, Catherine

2013-12-01

119

Improving Quality of Care in Acute Cardiology  

OpenAIRE

Acute cardiac care has changed dramatically over the past decennia. In coronary care and general intensive care units, information technology was introduced for arrhythmia monitoring and other signal processing. More recently, information technology has been applied to assist clinical decision making. Chapter 1 provides a definition for clinical decision support systems (CDSS) in critical care and describes factors for successful implementation of such systems. Subsequent chapters present ...

Lipton, J. A.

2010-01-01

120

Measuring Quality of Care Under Medicare and Medicaid  

OpenAIRE

The Health Care Financing Administration's (HCFA) approach to measuring quality of care uses an accepted definition of quality, explicit domains of measurement, and a formal validation procedure that includes face validity, construct validity, reliability, clinical validation, and tests for usefulness. The indicators of quality for Medicare and Medicaid patients span the range of service types, medical conditions, and payment systems and rest on a variety of data systems. Some have already be...

Jencks, Stephen F.

1995-01-01

121

Measuring quality in social care services: theory and practice  

OpenAIRE

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

Malley, Juliette; Ferna?ndez, Jose?-luis

2010-01-01

122

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.

Kisanga Felix

2010-06-01

123

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

2011-01-01

124

Assessing the Quality of Portuguese Child Care Programs for Toddlers  

Science.gov (United States)

The purpose of this study was to describe the quality of toddler child care classrooms in the district of Porto, in the north of Portugal. One hundred and sixty classrooms for children between 1 and 3 years of age participated in this study. Results suggested the existence of poor average quality and absence of good-quality classrooms. Child-adult…

Barros, Silvia; Aguiar, Cecilia

2010-01-01

125

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

OpenAIRE

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.; Brown, Richard; Levine, Richard; Cartwright, Thomas; Abesada-terk, Guillermo; Kim, George; Alemany, Carlos; Faig, Douglas; Sharp, Philip

2012-01-01

126

What is the cost of quality for diabetes care?  

Science.gov (United States)

Increasing the quality of care and reducing cost growth are core objectives of numerous private- and public-sector performance improvement initiatives. Using a unique panel data set for a commercially insured population and multivariate regression analysis, this study examines the relationship between medical care spending and diabetes-related quality measures, including provider-initiated processes of care and patient-dependent quality activities. Empirical evidence generated from this analysis of the relationship between a comprehensive set of diabetes quality measures and diabetes-related spending does not lend support for the assumption that high-quality preventive and primary care combined with effective patient self-management can lead to lower costs in the near term. Finally, we find no relationship between adjusted spending and intermediate clinical outcomes (e.g., HbA1c level) measured at the clinic level. PMID:25380606

Abraham, Jean M; Crespin, Daniel J; McCullough, Jeffrey S; Christianson, Jon B

2014-12-01

127

Protecting and Improving Quality of Care for Children under Health Care Reform: Workshop Highlights.  

Science.gov (United States)

This report discusses the quality of health care for children in light of national health care reform proposals put forth in 1994, and is based on presentations and discussions at an invitational workshop on maternal and child health. The report examines issues related to: (1) the differences between health care provision for children and adults;…

Durch, Jane S., Ed.

128

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

Science.gov (United States)

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

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

2012-01-01

129

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

OpenAIRE

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

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

2002-01-01

130

Patients' experiences with quality of hospital care: the Consumer Quality Index Cataract Questionnaire  

OpenAIRE

Abstract Background Patients' feedback is of great importance in health care policy decisions. The Consumer Quality Index Cataract Questionnaire (CQI Cataract) was used to measure patients' experiences with quality of care after a cataract operation. This study aims to evaluate the reliability and the dimensional structure of this questionnaire and assesses its ability to measure differences between hospitals in patients' experiences with quality of care. Methods Survey data of 4,635 responde...

Brouwer W; Jh, Stubbe; Dmj, Delnoij

2007-01-01

131

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

OpenAIRE

Background: Infectious disease and malnutrition are common in children. Primary health care came into being to decrease the morbidity. Quality assessment is neither clinical research nor technology assessment. It is primarily an administrative device used to monitor performance to determine whether it continues to remain within acceptable bounds. Aims and Objectives: To assess the quality of service in the delivery of child health care in a primary health care setting. To evaluate client s...

Rashmi,; Vijaykumar B

2010-01-01

132

Measuring adherence rate to quality indicators for diabetes care identified by primary health care in Bahrain  

OpenAIRE

Objectives: To measure the quality of care for patients with diabetes mellitus at the outpatient clinics from 12 general practitioners clinics (GPC) and one diabetes care clinic (DCC). Methods: A cross-sectional study was conducted at the Al-Razi Health Center, Manama, Bahrain, and health records from January to December 2012 were reviewed. The study consisted of 120 patients from GPC, and 80 patients from DCC. Information regarding quality indicators on the management of diabetic care was ga...

Al-ubaidi, Basem A.; Al-khadraji, Mohammed A.; Badriya Al-Hermi

2014-01-01

133

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

OpenAIRE

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 adhere...

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

2006-01-01

134

Analytical quality control of INR measurements in primary care  

OpenAIRE

In Norway, most patients on oral anticoagulation with warfarin are treated in primary care. The treatment is monitored with the laboratory method prothrombin time, expressed as International normalized Ratio (INR). It is important that the INR methods have good analytical quality because the treatment (medical dose) depends on the INR result. Overdosing can cause severe bleedings and under dosing can lead to thrombosis. The laboratories in primary care control the analytical quality of ...

Stavelin, Anne

2013-01-01

135

Leadership, staffing and quality of care in nursing homes  

OpenAIRE

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 ...

Havig Anders; Skogstad Anders; Kjekshus Lars; Romøren Tor

2011-01-01

136

Total quality management in health care: taking stock.  

Science.gov (United States)

Total quality management (TQM) is gaining momentum in health care. The experiences of pioneering organizations provide insights into the hurdles that many organizations face in implementing TQM. Based on their observations of these pioneers, the authors conclude that there are six key success factors for TQM in health care. This article reviews the success factors, considers the common obstacles to achieving them, and looks at some of the future directions for TQM in health care. PMID:10131012

Melum, M M; Sinioris, M E

1993-01-01

137

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

2012-08-01

138

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

Science.gov (United States)

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

Ndoro, Samuel

139

Helping You Choose Quality Hospice Care  

Science.gov (United States)

... Quality Measures CLABSI Toolkit Topics Topics Ebola Preparedness Emergency Management High Reliability Infection Prevention and HAI Portal Monographs & Papers Pain Management Patient Safety Sentinel Event - Sentinel Event Alert ...

140

Helping You Choose Quality Hospital Care  

Science.gov (United States)

... Quality Measures CLABSI Toolkit Topics Topics Ebola Preparedness Emergency Management High Reliability Infection Prevention and HAI Portal Monographs & Papers Pain Management Patient Safety Sentinel Event - Sentinel Event Alert ...

141

Helping You Choose Quality Ambulatory Care  

Science.gov (United States)

... Quality Measures CLABSI Toolkit Topics Topics Ebola Preparedness Emergency Management High Reliability Infection Prevention and HAI Portal Monographs & Papers Pain Management Patient Safety Sentinel Event - Sentinel Event Alert ...

142

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

OpenAIRE

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

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

2013-01-01

143

Patient satisfaction surveys and quality of care: an information paper.  

Science.gov (United States)

With passage of the Patient Protection and Affordable Care Act of 2010, payment incentives were created to improve the "value" of health care delivery. Because physicians and physician practices aim to deliver care that is both clinically effective and patient centered, it is important to understand the association between the patient experience and quality health outcomes. Surveys have become a tool with which to quantify the consumer experience. In addition, results of these surveys are playing an increasingly important role in determining hospital payment. Given that the patient experience is being used as a surrogate marker for quality and value of health care delivery, we will review the patient experience-related pay-for-performance programs and effect on emergency medicine, discuss the literature describing the association between quality and the patient-reported experience, and discuss future opportunities for emergency medicine. PMID:24656761

Farley, Heather; Enguidanos, Enrique R; Coletti, Christian M; Honigman, Leah; Mazzeo, Anthony; Pinson, Thomas B; Reed, Kevin; Wiler, Jennifer L

2014-10-01

144

Quality of care delivered to hospitalized inflammatory bowel disease patients  

Directory of Open Access Journals (Sweden)

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

Geoffrey C Nguyen

2013-01-01

145

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

DEFF Research Database (Denmark)

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

Peters, Michele; Jenkinson, Crispin

2012-01-01

146

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

147

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.)

148

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

149

Improving Perinatal Care in the Rural Regions Worldwide by Wireless Enabled Antepartum Fetal Monitoring: A Demonstration Project  

Science.gov (United States)

Background. Fetal and neonatal morbidity and mortality are significant problems in developing countries; remote maternal-fetal monitoring offers promise in addressing this challenge. The Gary and Mary West Health Institute and the Instituto Carlos Slim de la Salud conducted a demonstration project of wirelessly enabled antepartum maternal-fetal monitoring in the state of Yucatán, Mexico, to assess whether there were any fundamental barriers preventing deployment and use. Methods. Following informed consent, high-risk pregnant women at 27–29 weeks of gestation at the Chemax primary clinic participated in remote maternal-fetal monitoring. Study participants were randomized to receive either prototype wireless monitoring or standard-of-care. Feasibility was evaluated by assessing technical aspects of performance, adherence to monitoring appointments, and response to recommendations. Results. Data were collected from 153 high-risk pregnant indigenous Mayan women receiving either remote monitoring (n = 74) or usual standard-of-care (n = 79). Remote monitoring resulted in markedly increased adherence (94.3% versus 45.1%). Health outcomes were not statistically different in the two groups. Conclusions. Remote maternal-fetal monitoring is feasible in resource-constrained environments and can improve maternal compliance for monitoring sessions. Improvement in maternal-fetal health outcomes requires integration of such technology into sociocultural context and addressing logistical challenges of access to appropriate emergency services. PMID:25691900

Tapia-Conyer, Roberto; Lyford, Shelley; Saucedo, Rodrigo; Casale, Michael; Gallardo, Hector; Becerra, Karen; Mack, Jonathan; Mujica, Ricardo; Estrada, Daniel; Sanchez, Antonio; Sabido, Ramon; Meier, Carlos; Smith, Joseph

2015-01-01

150

Reliability of medical audit in quality assessment of medical care  

OpenAIRE

Medical audit of hospital records has been a major component of quality of care assessment, although physician judgment is known to have low reliability. We estimated interrater agreement of quality assessment in a sample of patients with cardiac conditions admitted to an American teaching hospital. Physician-reviewers used structured review methods designed to improve quality assessment based on judgment. Chance-corrected agreement for the items considered more relevant to process and outcom...

Camacho Luiz Antonio Bastos; Rubin Haya Rahel

1996-01-01

151

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

152

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

OpenAIRE

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

Peters, M.; Jenkinson, C.; Perera, S.; Loder, E.; Jensen, R.; Katsarava, Z.; Gouveia, Rg; Broner, S.; Steiner, T.

2012-01-01

153

The Organization of Multidisciplinary Care Teams: Modeling Internal and External Influences on Cancer Care Quality  

OpenAIRE

Quality cancer treatment depends upon careful coordination between multiple treatments and treatment providers, the exchange of technical information, and regular communication between all providers and physician disciplines involved in treatment. This article will examine a particular type of organizational structure purported to regularize and streamline the communication between multiple specialists and support services involved in cancer treatment: the multidisciplinary treatment care (MD...

Fennell, Mary L.; Prabhu Das, Irene; Clauser, Steven; Petrelli, Nicholas; Salner, Andrew

2010-01-01

154

[Diabetes, psychosocial distress and quality of care].  

Science.gov (United States)

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

Fatati, Giuseppe

2014-10-01

155

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

156

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

157

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

158

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

159

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

160

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

161

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

162

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

163

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

164

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

165

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

Directory of Open Access Journals (Sweden)

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

Soleimani F

2009-09-01

166

Quality in obstetric care: measuring what matters.  

Science.gov (United States)

Quality measures allow providers, payers, and patients to assess and compare the performance of medical teams. The ideal quality measure is easy to define and observe, important to patients and physicians, and identifies areas ripe for improvement. There are several challenges unique to obstetrics that complicate quality measurement. Nationally available data are flawed and limited. Adverse outcomes are rare and difficult to compare between groups. An appropriate emphasis on teamwork makes assigning outcomes to individuals improper and impractical. We suggest some strategies that address these challenges and may improve obstetric measures: applying measures to teams rather than individuals, using sentinel events for internal root cause analysis rather than comparisons between groups, devising measures that account for alternatives, and developing data-collection fields that address important quality metrics directly. We highlight four measures that meet these criteria: 1) elective delivery before 39 weeks of gestation, 2) prophylactic antibiotic use for cesarean delivery, 3) the Adverse Outcome Index, and 4) the nulliparous term singleton vertex cesarean delivery rate. We suggest that each institution evaluate local priorities, select a measure, then continue to refine measures based on feedback from frontline clinicians. PMID:20733459

Janakiraman, Vanitha; Ecker, Jeffrey

2010-09-01

167

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

2004-07-01

168

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

Science.gov (United States)

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

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

2012-01-01

169

What is adequate health care and how can quality of care be improved?  

Science.gov (United States)

Attempts to improve patient care, its increasing cost and the aggressive malpractice environment have highlighted the need for standards of professional accountability. However, current measures of quality of care have mostly been met with skepticism by the medical community. These measures have been criticized for their uncertain validity and for focusing on secondary aspects of service that measure what is minimally acceptable. The objective of this essay is to review quality improvement methods that have been reported to be feasible, effective and acceptable by practicing physicians. The successful implementation of these methods seems to be related to their being nonintrusive, nonthreatening, and based on agreed upon standards of care. We believe that these three features are essential for a continuous quality improvement process in health care. PMID:10185317

Benbassat, J; Taragin, M

1998-01-01

170

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

Science.gov (United States)

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

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

2013-01-01

171

Health Literacy and Communication Quality in Health Care Organizations  

OpenAIRE

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

Wynia, Matthew K.; Osborn, Chandra Y.

2010-01-01

172

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

OpenAIRE

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

Duan, Xia; Shi, Yan

2014-01-01

173

The quality of nursing home care in Taiwan.  

Science.gov (United States)

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

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

2002-08-01

174

Variation in Patient-Reported Quality Among Health Care Organizations  

OpenAIRE

Health care quality measurement initiatives often use health plans as the unit of analysis, but plans often contract with provider organizations that are managed independently. There is interest in understanding whether there is substantial variability in quality among such units. We evaluated the extent to which scores on the Consumer Assessment of Health Plans Study (CAHPS®) survey vary across: health plans, regional service organizations (RSOs) (similar to independent practice association...

Solomon, Loel S.; Zaslavsky, Alan M.; Landon, Bruce E.; Cleary, Paul D.

2002-01-01

175

Hospital competition, resource allocation and quality of care  

OpenAIRE

Abstract Background A variety of approaches have been used to contain escalating hospital costs. One approach is intensifying price competition. The increase in price based competition, which changes the incentives hospitals face, coupled with the fact that consumers can more easily evaluate the quality of hotel services compared with the quality of clinical care, may lead hospitals to allocate more resources into hotel rather than clinical services. Methods To test this hypothesis we studied...

Zwanziger Jack; Mukamel Dana B; Bamezai Anil

2002-01-01

176

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

177

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

Science.gov (United States)

The objective of this study was to define "quality" of headache care, and develop indicators that are applicable in different settings and cultures and to all types of headache. No definition of quality of headache care has been formulated. Two sets of quality indicators, proposed in the US and UK, are limited to their localities and/or specific to migraine and their development received no input from people with headache. We first undertook a literature review. Then we conducted a series of focus-group consultations with key stakeholders (doctors, nurses and patients) in headache care. From the findings we proposed a large number of putative quality indicators, and refined these and reduced their number in consultations with larger international groups of stakeholder representatives. We formulated a definition of quality from the quality indicators. Five main themes were identified: (1) headache services; (2) health professionals; (3) patients; (4) financial resources; (5) political agenda and legislation. An initial list of 160 putative quality indicators in 14 domains was reduced to 30 indicators in 9 domains. These gave rise to the following multidimensional definition of quality of headache care: "Good-quality headache care achieves accurate diagnosis and individualized management, has appropriate referral pathways, educates patients about their headaches and their management, is convenient and comfortable, satisfies patients, is efficient and equitable, assesses outcomes and is safe." Quality in headache care is multidimensional and resides in nine essential domains that are of equal importance. The indicators are currently being tested for feasibility of use in clinical settings. PMID:22733141

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

2012-08-01

178

Imaging of perinatal stroke.  

Science.gov (United States)

The main neonatal stroke syndromes discussed in this article are: arterial ischemic stroke (AIS), including perinatal AIS, and "presumed" perinatal AIS; cerebral venous thrombosis, including cortical vein and venous sinus thrombosis and germinal matrix hemorrhage/periventricular hemorrhagic infarction; and intraparenchymal hemorrhage. This review discusses general pathophysiological mechanisms and the role of imaging in these conditions. PMID:22118590

Gunny, Roxana S; Lin, Doris

2012-02-01

179

Quality Nursing Care for Hospitalized Patients with Advanced Illness: Concept Development  

OpenAIRE

The quality of nursing care as perceived by hospitalized patients with advanced illness has not been examined. A concept of quality nursing care for this population was developed by integrating the literature on constructs defining quality nursing care with empirical findings from interviews of 16 patients with advanced illness. Quality nursing care was characterized as competence and personal caring supported by professionalism and delivered with an appropriate demeanor. Although the attribu...

Izumi, Shigeko; Baggs, Judith G.; Knafl, Kathleen A.

2010-01-01

180

Reliability of medical audit in quality assessment of medical care  

Directory of Open Access Journals (Sweden)

Full Text Available Medical audit of hospital records has been a major component of quality of care assessment, although physician judgment is known to have low reliability. We estimated interrater agreement of quality assessment in a sample of patients with cardiac conditions admitted to an American teaching hospital. Physician-reviewers used structured review methods designed to improve quality assessment based on judgment. Chance-corrected agreement for the items considered more relevant to process and outcome of care ranged from low to moderate (0.2 to 0.6, depending on the review item and the principal diagnoses and procedures the patients underwent. Results from several studies seem to converge on this point. Comparisons among different settings should be made with caution, given the sensitivity of agreement measurements to prevalence rates. Reliability of review methods in their current stage could be improved by combining the assessment of two or more reviewers, and by emphasizing outcome-oriented events.

Camacho Luiz Antonio Bastos

1996-01-01

181

Using empowerment to make quality work in health care.  

Science.gov (United States)

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

Byham, W C; Nelson, G D

1994-01-01

182

Process Dimensions of Child Care Quality and Academic Achievement: An Instrumental Variables Analysis  

Science.gov (United States)

Child care quality is usually measured along two dimensions--structural and process. In this paper the authors focus on process quality--the quality of child care center instructional practices and teacher interactions with students. They use an instrumental variables technique to estimate the effect of child care center process quality on…

Auger, Anamarie; Farkas, George; Duncan, Greg; Burchinal, Peg; Vandell, Deborah Lowe

2012-01-01

183

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

1999-08-01

184

[Quality in nursing care--action research in "Hamburger Behindertenhilfe"/Hamburg to disabled care].  

Science.gov (United States)

A two year action research program with the title "Quality in Nursing Care" was carried out by a large institute for disabled care in Hamburg. Presently, the importance of quality in nursing as a profession is seen to be secondary to that of pedagogy in the area of disabled care. A major explanation for this could be the fact that 150 years ago the treatment and care of disabled people lay predominately in the field of theology and only later in that of medicine. In the second half of the 20th century, in the 60ies and 70ies to be precise, starting with an investigative commission "Psychiatryenquete "pedagogical science began to focus on the education of disabled people and their integration within society. At this point in time, seen from the pedagogical point of view, the care of disabled people in theory and practice freed itself from being a medicine concentrated profession and from the dominance of nursing care. However in today's society due to the increasing number of disabled people requiring expert nursing care there is a necessity to examine care related needs of assistance. With the research project "Quality in Nursing Care" an institute for disabled care has looked at different nursing care interventions and methods that our society may require for the changing situation we are presently being confronted with. An analysis of the requirements, the content and evaluation of the three chosen project related interventions, (the individual consulting of inhabitants with regard to the broadening of the competence skills, the development of expert nursing competence through further and continuous education of multipliers, and the development of codes and guidelines for activities) will be introduced. Beginning with the basic and primary principle of the action research, the researchers have developed, with the participating members of the institutions, the specific aims of the work undertaken and the interventions studied and executed. The most important discovery made during the project work undertaken is that the assessment of the extensively nursing linked problems experienced by the inhabitants in disabled care at this point in time is either simply not receiving enough attention or not being taken sufficiently into consideration by the predominately pedagogically trained staff. Taking this into account it is quite clear that professional nursing support in the long term has an important role to play in a successful disabled people orientated care concept. PMID:16128174

Jahncke-Latteck, Anne-Dorte; Weber, Petra

2005-08-01

185

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

Directory of Open Access Journals (Sweden)

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

Sônia Lansky

2002-10-01

186

Quality of neurological care. Balancing cost control and ethics.  

Science.gov (United States)

As the quality of neurological care becomes a mutual objective of physicians, patients, and health planners, increased demands on cost savings will create conflicts that could threaten the ethical basis of medical practice. Physicians will see increasing ethical conflicts between their fiduciary duties to make treatment decisions in the best interest of their patients and their justice-based duties to conserve societal resources. These conflicts can be best mitigated if physicians maintain their orientation as patient advocates but practice cost-conscious clinical behaviors that consider the cost-effectiveness of tests and treatments and do not squander society's finite resources by ordering medical tests and treatments of zero or marginal utility. Health system planners should resolve their conflicting objectives of quality and cost control by rigorously defining and measuring quality through physician leadership and by implementing cost-control measures that enhance the quality of medical care. Managed care organizations voluntarily should forsake financially successful but blatantly unethical cost-saving schemes, such as gag clauses and end-of-year kickback payments to physicians, because these schemes diminish patients' trust in physicians and degrade the integrity of the patient-physician relationship. State and federal laws should prudently regulate these unethical cost-saving schemes to the same extent as they have for the harmful conflicts in fee-for-service medicine. PMID:9362979

Bernat, J L

1997-11-01

187

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

Science.gov (United States)

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

Hearn, Lydia; Miller, Margaret; Lester, Leanne

2014-01-01

188

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

Science.gov (United States)

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

Molenat, Françoise

2015-01-01

189

Effects of an Integrated Care System on quality of care and satisfaction for children with special health care needs.  

Science.gov (United States)

To assess the effects of an Integrated Care System (ICS) on parent-reported quality of care and satisfaction for Children with Special Health Care Needs (CSHCN). In 2006 Florida reformed its Medicaid program in Broward and Duval counties. Children's Medical Services Network (CMSN) chose to participate in the reform and developed an ICS for CSHCN. The ICS ushered in several changes such as more prior approval requirements and closing of the provider network. Telephone surveys were conducted with CMSN parents whose children reside in the reform counties and parents whose children reside outside of the reform counties in 2006 and 2007 (n = 1,727). Results from multivariate quasi-experimental models show that one component of parent-report quality of care, customer service, increased. Following implementation of the ICS, customer service increased by 0.22 points. After implementation of the ICS, parent-reported quality and satisfaction were generally unaffected. Although significant increases were not seen in the majority of the quality and satisfaction domains, it is nonetheless encouraging that parents did not report negative experiences with the ICS. It is important to present these interim findings so that progress can be monitored and decision-makers can begin to consider if the program should be expanded statewide. PMID:21509433

Knapp, Caprice; Madden, Vanessa; Sloyer, Phyllis; Shenkman, Elizabeth

2012-04-01

190

Situação de saúde materna e perinatal no Estado de São Paulo, Brasil Maternal and perinatal health position in the State of S. Paulo, Brazil  

Directory of Open Access Journals (Sweden)

Full Text Available Pelos dados oficiais disponíveis, para o Estado de São Paulo (Brasil analisou-se a assistência oferecida na gestação, no parto e ao recém-nascido e suas relações com a mortalidade materna e perinatal. Com referência ao pré-natal, houve indícios de quantidade de consultas por gestação, numericamente suficiente, porém de qualidade discutível. Quanto ao parto observou-se uma alta percentagem de cesarianas (46,2%. A mortalidade materna foi de 4,86 por dez mil n.v., valor este subestimado. A primeira causa de óbitos maternos foram as toxemias, seguidas das hemorragias e do aborto, causas estas evitáveis em sua maioria, com uma boa qualidade de assistência pré-natal e ao parto. Quanto aos óbitos do período perinatal, o coeficiente foi de 29,2 por mil nascimentos em 1984, valor este também elevado. A análise das causas de óbitos mostrou que as afecções de origem perinatal ocorreram em cerca de 90% dos óbitos, tendo como principais causas as hipóxias intra-uterinas, asfixias, síndromes de angústia respiratória e aspiração maciça. Esses dados revelam a má qualidade de assistência recebida por este grupo. Sugere-se que a nova política de Sistema Unificado e Descentralizado de Saúde deveria levar em conta tanto a qualidade de assistência como a integração dos serviços para poder-se fazer frente à situação precária de saúde materna e perinatal do Estado.The assistance offered during pregnancy and labour as also to the newborn child, and its relationship to maternal and perinatal mortality in the State of S. Paulo in 1984, is analysed on the basis of official available data. With respect to prenatal care the number of visits per woman was considered to be "sufficient" though of doubtful quality. The proportion of cesarean sections was very high (46.2%. Maternal mortality was found to be 4.86 deaths per 10,000 live births, but despite its being high, this figure is certainly too low and the correct figure is probably twice as high. The principal cause of maternal deaths is toxemia in pregnancy, followed by hemorrhage and abortion. Most of these deaths could have been avoided with care during pregnancy and labour. The rate of perinatal mortality was found to be 29.2 deaths per thousand births in 1984. This figure is also very high. The analysis of the causes of death for this period showed that the disorders which arose during the perinatal period were responsible for 90 per cent of the total number of deaths. The main causes of death in this group were the intra-uterine hypoxias and anoxias, asphyxia, respiratory distress syndrome and massive aspiration syndrome. These data bring to light the poor quality of the care offered to this group. The authors trust that the new policy of the Decentralized and Unified System of Health will take the quality of care as much as the integration of services into consideration with a view to overcoming the precarious maternal and perinatal health situation in S. Paulo.

Ana Cristina d'Andretta Tanaka

1989-02-01

191

Situação de saúde materna e perinatal no Estado de São Paulo, Brasil / Maternal and perinatal health position in the State of S. Paulo, Brazil  

Scientific Electronic Library Online (English)

Full Text Available Pelos dados oficiais disponíveis, para o Estado de São Paulo (Brasil) analisou-se a assistência oferecida na gestação, no parto e ao recém-nascido e suas relações com a mortalidade materna e perinatal. Com referência ao pré-natal, houve indícios de quantidade de consultas por gestação, numericamente [...] suficiente, porém de qualidade discutível. Quanto ao parto observou-se uma alta percentagem de cesarianas (46,2%). A mortalidade materna foi de 4,86 por dez mil n.v., valor este subestimado. A primeira causa de óbitos maternos foram as toxemias, seguidas das hemorragias e do aborto, causas estas evitáveis em sua maioria, com uma boa qualidade de assistência pré-natal e ao parto. Quanto aos óbitos do período perinatal, o coeficiente foi de 29,2 por mil nascimentos em 1984, valor este também elevado. A análise das causas de óbitos mostrou que as afecções de origem perinatal ocorreram em cerca de 90% dos óbitos, tendo como principais causas as hipóxias intra-uterinas, asfixias, síndromes de angústia respiratória e aspiração maciça. Esses dados revelam a má qualidade de assistência recebida por este grupo. Sugere-se que a nova política de Sistema Unificado e Descentralizado de Saúde deveria levar em conta tanto a qualidade de assistência como a integração dos serviços para poder-se fazer frente à situação precária de saúde materna e perinatal do Estado. Abstract in english The assistance offered during pregnancy and labour as also to the newborn child, and its relationship to maternal and perinatal mortality in the State of S. Paulo in 1984, is analysed on the basis of official available data. With respect to prenatal care the number of visits per woman was considered [...] to be "sufficient" though of doubtful quality. The proportion of cesarean sections was very high (46.2%). Maternal mortality was found to be 4.86 deaths per 10,000 live births, but despite its being high, this figure is certainly too low and the correct figure is probably twice as high. The principal cause of maternal deaths is toxemia in pregnancy, followed by hemorrhage and abortion. Most of these deaths could have been avoided with care during pregnancy and labour. The rate of perinatal mortality was found to be 29.2 deaths per thousand births in 1984. This figure is also very high. The analysis of the causes of death for this period showed that the disorders which arose during the perinatal period were responsible for 90 per cent of the total number of deaths. The main causes of death in this group were the intra-uterine hypoxias and anoxias, asphyxia, respiratory distress syndrome and massive aspiration syndrome. These data bring to light the poor quality of the care offered to this group. The authors trust that the new policy of the Decentralized and Unified System of Health will take the quality of care as much as the integration of services into consideration with a view to overcoming the precarious maternal and perinatal health situation in S. Paulo.

192

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

193

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

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

Rashmi

2010-01-01

194

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

Directory of Open Access Journals (Sweden)

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

Adriana Isabel Delgado Bravo

2010-07-01

195

Risk adjustment methods for Home Care Quality Indicators (HCQIs) based on the minimum data set for home care  

OpenAIRE

Abstract Background There has been increasing interest in enhancing accountability in health care. As such, several methods have been developed to compare the quality of home care services. These comparisons can be problematic if client populations vary across providers and no adjustment is made to account for these differences. The current paper explores the effects of risk adjustment for a set of home care quality indicators (HCQIs) based on the Minimum Data Set for Home Care (MDS-HC). Meth...

Hirdes John P; Dalby Dawn M; Fries Brant E

2005-01-01

196

Quality in public services: the challenges of Primary Care  

Directory of Open Access Journals (Sweden)

Full Text Available The Brazilian Ministry of Health has signaled a policy of evaluating the quality of primary care through the 1654 decree of 19.07.2011. Any organizational change interferes with the culture of any institution, especially when this change is directed toward the issue of quality. It involves processes, internal resources and people, and cannot be artificially produced by the power of the pen. In the health sector, management based on quality involves changes in business focus and technology, supported the rescue of professional-patient relationship, in the form of compensation of physicians and teams, in the qualification and training of professional, in qualifications in their own management, and in active participation of health professionals in the Agreement on these goals and quality parameters. Other instruments of quality assessment have been established within the Primary Care in public health sub-system, and its follow-up was interrupted. Qualifying the Primary is not just about evaluation, but also the selection of qualified professionals, qualification of services, monitoring results and valuation of health professionals involved with the new culture.

Leonardo Cançado Monteiro Savassi

2012-04-01

197

Meeting patients' needs: quality care in a changing environment.  

Science.gov (United States)

Recent surveys of patients in New York and Cleveland, among other cities, indicate that there is substantial room for improvement in meeting patients' needs and preferences, particularly in the areas of emotional support, coordination of care, discharge preparation, and the involvement of family and friends. Hospitals are using a variety of techniques to improve patient care and organizational efficiency in this challenging environment. One prominent approach, reengineering, offers a means by which hospitals can integrate highly specialized departmental structures and functions by focusing on interdisciplinary teamwork and organizing the delivery of care around patients. Key elements of successful hospital reengineering efforts have included: - the involvement and commitment of senior management and other key stakeholders, particularly physicians, nurses, and union representatives; - investment in staff training and retraining, and the redesign of staff evaluation and compensation systems; - timely, unit-specific measures of patient satisfaction and the clinical quality of care; - consistent and frequent internal communication between staff and leadership; and - treatment that emphasizes communication among caregivers, patients, and their family members. Several basic issues need to be addressed if hospitals are to offer technically sophisticated medical care that is also responsive to their patients' personal needs, including: - variations among patients regarding the amount of information they want and need, and the amount of involvement they want in their care; - the means by which patients will get information about their medical care, and who will provide any additional support that may be needed by non-English-speaking or socioeconomically disadvantaged patients; and - the specific changes in medical practice and hospital processes that will promote the involvement of patients in their care. PMID:10164376

Rogut, L; Hudson, A

1995-11-01

198

Improving quality and reducing inequities: a challenge in achieving best care  

OpenAIRE

The health care quality chasm is better described as a gulf for certain segments of the population, such as racial and ethnic minority groups, given the gap between actual care received and ideal or best care quality. The landmark Institute of Medicine report Crossing the Quality Chasm: A New Health System for the 21st Century challenges all health care organizations to pursue six major aims of health care improvement: safety, timeliness, effectiveness, efficiency, equity, and patient-centere...

Mayberry, Robert M.; Nicewander, David A.; Qin, Huanying; Ballard, David J.

2006-01-01

199

Quality of life after stay in surgical intensive care unit  

OpenAIRE

Abstract Background In addition to mortality, Health Related Quality of Life (HRQOL) has increasingly been claimed as an important outcome variable. The aim of this study was to assess HRQOL and independence in activities of daily living (ADL) six months after discharge from an Intensive Care Unit (ICU), and to study its determinants. Methods All post-operative adult patients admitted to a surgical ICU between October 2004 and July 2005, were eligible for the study. The following variables we...

Castro Maria A; Maia Paula C; Santos Cristina C; Abelha Fernando J; Barros Henrique

2007-01-01

200

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

201

Quality of Tuberculosis Care in Private Health Facilities of Addis Ababa, Ethiopia  

OpenAIRE

Ensuring provision of good quality tuberculosis (TB) care, especially in private for profit health facilities, is an important component of TB control strategy to reduce poor medical practice which results in multidrug resistant TB (MDR-TB). The aim of this study was to investigate quality of TB care in private health facilities of Addis Ababa. A facility based cross-sectional study was conducted based on Donabedian's structure-process-outcome model of health care quality. Quality of care was...

Gezahegn Gebrekidan; Gezahegn Tesfaye; Mitiku Teshome Hambisa; Negussie Deyessa

2014-01-01

202

Barriers to quality patient care in rural district hospitals.  

Science.gov (United States)

Currently barriers exist in delivering quality health care. This study aimed to investigate such barriers in the eight rural district hospitals of the West Coast Winelands Region, three type A and five type B hospitals. A quantitative descriptive design was applied which included the total population of nursing staff (n = 340) working at the time of data collection. A self-administered questionnaire was distributed with a response rate of 82%.Reliability of the instrument was verified using the Cronbach alpha coefficient and a pilot study. The validity, specifically construct and content validity, were assured by means of an extensive literature review, pilot study and use of experts. Ethics approval was obtained from the relevant stakeholders.Results showed that 272 participants (97%) disagreed that provision of staff was adequate, with staff above 40 years of age more likely to disagree (p = nurses more likely to disagree (?² test, p = 0.02). Participants in both hospital types A (n = 131; 82%) and B (n = 108; 91%) also disagreed that provision of equipment and consumables was adequate.The research showed that inadequacies relating to human resources, professional development, consumables and equipment influenced the quality of patient care. Urgent attention should be given to the problems identified to ensure quality of patient care in rural hospitals. PMID:23327761

Eygelaar, Johanna E; Stellenberg, Ethelwynn L

2012-01-01

203

Barriers to quality patient care in rural district hospitals  

Directory of Open Access Journals (Sweden)

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

Ethelwynn L. Stellenberg

2012-05-01

204

Child Care under Pressure: The Quality of Dutch Centers in 1995 and in 2001  

Science.gov (United States)

In 2001, the authors assessed the quality of care provided to children in 51 care groups from 39 child-care centers in The Netherlands using the Infant/Toddler Environment Rating Scale (T. Harms, D. Cryer, & R. M. Clifford, 1990) and compared the results with the quality of child care assessed in 1995 (M. H. van IJzendoorn, L. W. C. Tavecchio, G.…

Deynoot-Schaub, Mirjam J. J. M. Gevers; Riksen-Walraven, J. Marianne

2005-01-01

205

Electronic Medical Records and Diabetes Quality of Care: Results From a Sample of Family Medicine Practices  

OpenAIRE

PURPOSE Care of patients with diabetes requires management of complex clinical information, which may be improved by the use of an electronic medical record (EMR); however, the actual relationship between EMR usage and diabetes care quality in primary care settings is not well understood. We assessed the relationship between EMR usage and diabetes care quality in a sample of family medicine practices.

Crosson, Jesse C.; Ohman-strickland, Pamela A.; Hahn, Karissa A.; Dicicco-bloom, Barbara; Shaw, Eric; Orzano, A. John; Crabtree, Benjamin F.

2007-01-01

206

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

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

Nissanholtz-Gannot Rachel

2012-06-01

207

Care seeking and management of common childhood illnesses in Tanzania:Questioning the quality of primary care services  

OpenAIRE

Mild cases of malaria, pneumonia and diarrhea can be effectively treated with cheap and widely available first-line drugs at the primary care level if care is sought at an early disease stage and the infection is correctly diagnosed and managed by the attending care provider. Tanzania has an extensive network of primary health care (PHC) facilities and substantial child survival gains might result if these facilities could provide quality care and are properly utilized by the populations they...

Kahabuka, Catherine

2013-01-01

208

Global quality indicators for primary care Electronic Patient Records.  

Science.gov (United States)

Electronic Patient Records can be interfaced with medical decision support systems and quality of care assessment tools. An easy way of measuring the quality of EPR data is therefore essential. This study identified a number of global quality indicators (tracers) that could be easily calculated and validated them by correlating them with the Sensitivity and Positive Predictive Value (PPV) of data extracted from the EPR. Sensitivity and PPV of automatically extracted data were calculated using a gold standard constructed using answers to questions GPs were asked at the end of each contact with a patient. These properties were measured for extracted diagnoses, drug prescriptions, and certain parameters. Tracers were defined as drug-disease pairs (e.g. insulin-diabetes) with the assumption that if the patient is taking the drug, then the patient is suffering from the disease. Four tracers were identified that could be used for the ResoPrim primary care research database, which includes data from 43 practices, 10,307 patients, and 13,372 contacts. Moderately positive correlations were found between the 4 tracers and between the tracers and the sensitivity of automatically extracted diagnoses. For some purposes, these results may support the potential use of tracers for monitoring the quality of information systems such as EPRs. PMID:23542969

De Clercq, Etienne; Moreels, Sarah; Van Casteren, Viviane; Bossuyt, Nathalie; Goderis, Geert

2013-01-01

209

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.)

210

Quality of asthma care: Western Cape Province, South Africa  

Scientific Electronic Library Online (English)

Full Text Available SciELO South Africa | Language: English 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 targeted all primary care facilities that managed adult patients with chronic asthma within all six districts of the Western Cape province. The usual steps in the quality improvement cycle were followed. RESULTS: Data were obtained from 957 patients from 46 primary care facilities. Only 80% of patients had a consistent diagnosis of asthma, 11.5% of visits assessed control and 23.2% recorded a peak expiratory flow (PEF), 14% of patients had their inhaler technique assessed and 11.2% were given a self-management plan; 81% of medication was in stock, and the controller/reliever dispensing ratio was 0.6. Only 31.5% of patients were well controlled, 16.3% of all visits were for exacerbations, and 17.6% of all patients had been hospitalised in the previous year. CONCLUSION: The availability of medication and prescription of inhaled steroids is reasonable, yet control is poor. Health workers do not adequately distinguish asthma from chronic obstructive pulmonary disease, do not assess control by questions or PEF, do not adequately demonstrate or assess the inhaler technique, and have no systematic approach to or resources for patient education. Ten recommendations are made to improve asthma care.

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

2009-12-01

211

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

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

Simone R de Bruin

2013-12-01

212

Relationship between maternal hemoglobin and perinatal outcome  

International Nuclear Information System (INIS)

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

213

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

OpenAIRE

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

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

2003-01-01

214

Quality of Care Attributions to Employed Versus Stay-at-Home Mothers  

Science.gov (United States)

The present study was designed to find whether evaluations of maternal competence are linked to mothers' employment status and the quality of maternal care. Participants rated videotaped vignettes, depicting either high-quality or low-quality mother-infant interactions, on various dimensions of care quality. The videotaped mothers were described…

Shpancer, Noam; Melick, Katherine M.; Sayre, Pamela S.; Spivey, Aria T.

2006-01-01

215

Availability and quality of prehospital care on pakistani interurban roads.  

Science.gov (United States)

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

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

2013-01-01

216

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

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

Hercília Guimarães

2015-03-01

217

Perinatal asphyxia in the term newborn  

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Full Text Available Despite the important advances in perinatal care in the past decades, asphyxia remains a severe condition leading to significant mortality and morbidity. Perinatal asphyxia has an incidence of 1 to 6 per 1,000 live full-term births, and represents the third most common cause of neonatal death (23% after preterm birth (28% and severe infections (26%. Many preconceptional, antepartum and intrapartum risk factors have been shown to be associated with perinatal asphyxia. The standard for defining an intrapartum hypoxic-ischemic event as sufficient to produce moderate to severe neonatal encephalopathy which subsequently leads to cerebral palsy has been established in 3 Consensus statements. The cornerstone of all three statements is the presence of severe metabolic acidosis (pH < 7 and base deficit ? 12 mmol/L at birth in a newborn exhibiting early signs of moderate or severe encephalopathy. Perinatal asphyxia may affect virtually any organ, but hypoxic-ischemic encephalopathy (HIE is the most studied clinical condition and that is burdened with the most severe sequelae. The feasibility of providing neuroprotection after HIE has been proven by hypothermia therapy, which is able to reduce the risk of death or major neurodevelopmental disability. Many promising neuroprotective agents might contribute to reduce hypoxic-ischemic brain injury through different mechanisms of action, but further studies are required to confirm their efficacy. The prognosis is dependent on the severity of the perinatal asphyxia. Only a minority of infants with severe HIE survive without handicap. Proceedings of the International Course on Perinatal Pathology (part of the 10th International Workshop on Neonatology · October 22nd-25th, 2014 · Cagliari (Italy · October 25th, 2014 · The role of the clinical pathological dialogue in problem solving Guest Editors: Gavino Faa, Vassilios Fanos, Peter Van Eyken

Roberto Antonucci

2014-06-01

218

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

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

van Diem Mariet Th

2012-07-01

219

The Quality Assurance Project: introducing quality improvement to primary health care in less developed countries.  

Science.gov (United States)

Persistently excessive morbidity and mortality rates in less developed countries (LDCs) served by primary health care systems suggest that the quality of services is inadequate. The PRICOR project, sponsored by the United States Agency for International Development, has designed and implemented methods for quality assessment and problem solving in LDC health systems. After developing comprehensive lists of essential activities and tasks, similar to practice parameters, for seven child survival interventions, PRICOR supported comprehensive quality assessment studies in twelve LDC countries. The studies, yielding over 6000 observations of health worker-client encounters, indicated highly prevalent, serious program deficiencies in areas including diagnosis, treatment, patient education and supervision. To facilitate corrective action, PRICOR assisted managers in conducting operations research to resolve priority problems revealed by the assessments. The recently initiated Quality Assurance Project is building on PRICOR techniques in designing and implementing sustainable continuous quality improvement programs for LDC health systems. PMID:1782383

Nicholas, D D; Heiby, J R; Hatzell, T A

1991-01-01

220

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

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

Gerdien Franx

2009-06-01

221

Quality of care and health-related quality of life of climacteric stage women cared for in family medicine clinics in Mexico  

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Full Text Available Abstract Objectives 1 To design and validate indicators to measure the quality of the process of care that climacteric stage women receive in family medicine clinics (FMC. 2 To assess the quality of care that climacteric stage women receive in FMC. 3 To determine the association between quality of care and health-related quality of life (HR-QoL among climacteric stage women. Methods The study had two phases: I. Design and validation of indicators to measure the quality of care process by using the RAND/UCLA Appropriateness Method. II. Evaluation of the quality of care and its association with HR-QoL through a cross-sectional study conducted in two FMC located in Mexico City that included 410 climacteric stage women. The quality of care was measured by estimating the percentage of recommended care received (PRCR by climacteric stage women in three process components: health promotion, screening, and treatment. The HR-QoL was measured using the Cervantes scale (0-155. The association between quality of care and HR-QoL was estimated through multiple linear regression analysis. Results The lowest mean of PRCR was for the health promotion component (24.1% and the highest for the treatment component (86.6%. The mean of HR-QoL was 50.1 points. The regression analysis showed that in the treatment component, for every 10 additional points of the PRCR, the global HR-QoL improved 2.8 points on the Cervantes scale (coefficient -0.28, P Conclusion The indicators to measure quality of care for climacteric stage women are applicable and feasible in family medicine settings. There is a positive association between the quality of the treatment component and HR-QoL; this would encourage interventions to improve quality of care for climacteric stage women.

Pérez-Cuevas Ricardo

2010-02-01

222

Intensive-care unit lungs - possibilities to improve the quality  

International Nuclear Information System (INIS)

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

223

Management of perinatal lung malformations.  

Science.gov (United States)

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

Macardle, C A; Kunisaki, S M

2015-02-01

224

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

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

Adhikari S

2014-09-01

225

Beyond ethical dilemmas: improving the quality of end-of-life care in the intensive care unit  

OpenAIRE

Consensus guidelines on providing optimal end-of-life care in the intensive care unit (ICU) are important tools. However, despite 30 years of ethical discourse and consensus on many of the principles that guide end-of-life care in the ICU, care remains inadequate. Although consensus on the most challenging ethical aspects of some cases will remain elusive, this need not deter clinicians from engaging in practical quality improvement, best practice, and educational interventions to provide com...

Rubenfeld, Gordon D.; Curtis, J. Randall

2002-01-01

226

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

Science.gov (United States)

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

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

2013-01-01

227

Money Matters for Early Education: The Relationships among Child Care Quality, Teacher Characteristics, and Subsidy Status  

Science.gov (United States)

Child care is the first out-of-home learning opportunity for many children. For low-income children, a high-quality child care placement can provide many of the experiences and skills that help build a foundation for later school success. Among the many measures of child care quality, some closely linked to later success in school are those…

St.Clair-Christman, JeanMarie; Buell, Martha; Gamel-McCormick, Michael

2011-01-01

228

Improving the Quality of Nursing Home Care and Medical-Record Accuracy with Direct Observational Technologies  

Science.gov (United States)

Nursing home medical-record documentation of daily-care occurrence may be inaccurate, and information is not documented about important quality-of-life domains. The inadequacy of medical record data creates a barrier to improving care quality, because it supports an illusion of care consistent with regulations, which reduces the motivation and…

Schnelle, John F.; Osterweil, Dan; Simmons, Sandra F.

2005-01-01

229

Quality improvement in radiography in a neonatal intensive care unit  

International Nuclear Information System (INIS)

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

230

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

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

Klomp Helena

2010-08-01

231

Quality of life in cancer patients receiving palliative care  

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Full Text Available Background: The main focus of palliative care services is to improve the patient?s quality of life (QOL, which is defined as the subjective evaluation of life as a whole or the patient?s appraisal and satisfaction with their current level of functioning compared with what they perceive to be possible or ideal. Aims: In this prospective study we attempt to validate the Hindi version of a questionnaire designed by the functional assessment of chronic illness therapy (FACIT measurement system; to measure the subjective QOL of cancer patients receiving home-based palliative care, determine ease of use of the questionnaire and correlate the QOL of these patients with the objective assessment of their Karnofsky?s performance status and their numerical pain score. Settings and Design: One hundred cancer patients receiving free home-based palliative care in New Delhi, India. Materials and Methods: A multidisciplinary palliative home care team using the Functional Assessment of Cancer Therapy-General (FACT-G© questionnaire in Hindi. Statistical Analysis Used: Microsoft Excel Correlation. Results: The FACT-G© questionnaire in Hindi is a useful tool in measuring QOL and can be used to monitor the patient?s progress and symptom control during the course of the disease. It is simple to use and does not take too much time to complete. The results are tabulated in English and can be used for comparison purposes globally; the scoring process is very simple. Conclusions: Increasing QOL and KPS showed a positive correlation whereas increasing pain and better QOL show negative correlation, as do better performance status and increasing pain score.

Singh Divya

2010-01-01

232

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

OpenAIRE

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 th...

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

1999-01-01

233

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

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: Spanish Abstract in spanish OBJETIVOS: comparar la calidad de los servicios de salud materno perinatales (SMP) de los establecimientos participantes en un programa de mejora de calidad (PMC) y compararlos con un grupo control; evaluar comparativamente los conocimientos y actitudes de usuarias de servicios de salud materna; y d [...] eterminar la contribución del PMC en los niveles de calidad. MÉTODOS: fue implementado un PMC en 74 establecimientos de salud seleccionados para mejorar la calidad. Se desarrolló un cuasiexperimento controlado en 74 hospitales, centros de salud y establecimientos periféricos. El análisis de la calidad de los SMP se realizó mediante comparación de promedios de escalas centesimales; los conocimientos y actitudes de las usuarias mediante análisis bivariado; y la predicción del nivel de calidad a través de análisis multivariado. RESULTADOS: al final de la intervención, la puntuación de los establecimientos con PMC tuvo un promedio de 61,8 puntos y de 37,5 en el grupo de comparación, (p Abstract in english OBJECTIVES: to compare the quality of the maternal-perinatal health services (MPHS) between health facilities with a continuos quality improvement (CQI) and those without such program; to evaluate the knowledge and attitudes of the users of maternal health services; to determine the contribution of [...] the CQI on the level of quality. METHODS: it was conducted a CQI program in 74 selected health facilities from Perú (1996-2000) for improved the quality of MPHS. A controlled, quasiexperimental study in facilities health (hospital, health centers and peripheral facilities) was conducted. The quality of care was measured by scores of the MPHS by comparing averages; the knowledge and attitudes of users by bivariate analysis, and the prediction of the quality level was studied through multivariate analysis. RESULTS: at the end of the intervention, CQI facilities score was 61,8 points and of 37,5 in the comparison group, (p

Juan A., Seclen-Palacín; Enrique, Jacoby M; Bruno, Benavides C; Joaquín, Novara V; Anibal, Velásquez V; Enrique, Watanabe V; César, Arroyo V.

2003-12-01

234

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

Science.gov (United States)

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

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

2004-01-01

235

The Nonprofit Advantage: Producing Quality in Thick and Thin Child Care Markets  

Science.gov (United States)

Nonprofit child care centers are frequently observed to produce child care which is, on average, of higher quality than care provided in commercial child care centers. In part, this nonprofit advantage is due to different input choices made by nonprofit centers--lower child--staff ratios, better-educated staff and directors, higher rates of…

Cleveland, Gordon; Krashinsky, Michael

2009-01-01

236

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

OpenAIRE

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

Mcnamara, P.

2006-01-01

237

Quality of Care for Myocardial Infarction in Rural and Urban Hospitals  

Science.gov (United States)

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

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

2010-01-01

238

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

Science.gov (United States)

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

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

2014-12-01

239

Hospital competition, resource allocation and quality of care  

Directory of Open Access Journals (Sweden)

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

Zwanziger Jack

2002-05-01

240

Assessment of quality of care in acute postoperative pain management  

Directory of Open Access Journals (Sweden)

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

Milutinovi? Dragana

2009-01-01

241

Mortality stastistics as indicators of quality of hospital care.  

Science.gov (United States)

Death rates have always been important information for hospitals to provide a solid base for the evaluation of the quality of their medical care. This study was carried out to find out the gross death rate (GDR) as well as net death rate (NDR) in King Fahad hospital, Jeddah, Kingdom of Saudi Arabia (KSA) in the period from 1994-2000 and also to find out demographic characteristics of deaths in the year 2000 according to ICD-10 as indicators of quality of hospital care. Medical records of discharged patients including deaths during the year 2000 were reviewed (13386). Complete data about deaths were obtained. Results of the studied hospital showed gradual decrease in GDR from 5.8% to 4.5% (1994-1998) then slight increase from 4.9% to 5.0% (1999-2000) but still below the year 1994 (5.8%) and also there is gradual decrease in NDR from 4.6% to 3.6% in the studied period. GDR in different departments of the hospital during the year 2000 showed that Medical ICU was the highest (24.5%) followed by Surgical ICU (17.9%) followed by Cardiac ICU (14.3%) while GDR in the Medical department was found to be (12.9 %) of the discharged subjects. According to nationality; proportional mortality rate (PMR) of Saudis represented 62% of total deaths followed by Yemenis (8.2%) meanwhile Egyptians represented 3.7% of total deaths in the studied year. As concerned to age groups; the highest PMR was found among those aged 65-74 years (21.9%) while the lowest PMR was found among those aged 13-24 years (4.2%). The highest PMR of deaths during the studied year was reported in March (10.4%) followed by April (9.7%) then February (9.4%) which are the months of pilgrimage season while the lowest frequency was found in December (6.9%). Also PMR was found to be higher among females (57%) compared to males (43%). According to International Classification of Diseases (ICD-10); diseases of the circulatory system were found to be the commonest underlying cause of death in the studied year. It represented 35.5% of all deaths followed by neoplasms (11.2%) while the lowest cause reported was mental and behavioral disorders (0.1%). In conclusion, combination of the previous indicators and comparing the results with other hospitals in different countries indicates good quality of medical care in the studied hospital. PMID:17219895

Gabal, Mohamed Salah; Salem, Khadiga Ahmed

2002-01-01

242

PERINATAL LEUKODYSTROPHY CLINICAL CASE  

OpenAIRE

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

Dana Mihut; Aniko Manea; Daniela Iacob; Botiu, V.; Es, Boia; Marioara Boia

2004-01-01

243

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

OpenAIRE

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

Muntlin, A?sa

2009-01-01

244

Optimizing the stake holder’s perspective on enhancing the service quality in health care  

OpenAIRE

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 man...

Nakkeeran, Senthil Kumar; G, Thiagarajan

2010-01-01

245

Errors in survey based quality evaluation variables in efficiency models of primary care physicians  

OpenAIRE

Efficiency analyses in the health care sector are often criticised for not incorporating quality variables. The definition of quality of primary health care has many aspects, and it is inevitably also a question of the patients? perception of the services received. This paper uses variables derived from patient evaluation surveys as measures of the quality of the production of health care services. It uses statistical tests to judge if such measures have a significant impact on the use ...

Kittelsen, Sverre A. C.; Kjæserud, Guri Galtung; Kvamme, Odd Jarle

2001-01-01

246

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

OpenAIRE

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

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

2010-01-01

247

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

Science.gov (United States)

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

Le Rouge, Cynthia; De Leo, Gianluca

2008-01-01

248

Optimizing care in osteoporosis: The Canadian quality circle project  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Background While the Osteoporosis Canada 2002 Canadian guidelines provided evidence based strategies in preventing, diagnosing, and managing this condition, publication and distribution of guidelines have not, in and of themselves, been shown to alter physicians clinical approaches. We hypothesize that primary care physicians enrolled in the Quality Circle project would change their patient management of osteoporosis in terms of awareness of osteoporosis risk factors and bone mineral density testing in accordance with the guidelines. Methods The project consisted of five Quality Circle phases that included: 1 Training & Baseline Data Collection, 2 First Educational Intervention & First Follow-Up Data Collection 3 First Strategy Implementation Session, 4 Final Educational Intervention & Final Follow-up Data Collection, and 5 Final Strategy Implementation Session. A total of 340 circle members formed 34 quality circles and participated in the study. The generalized estimating equations approach was used to model physician awareness of risk factors for osteoporosis and appropriate utilization of bone mineral density testing pre and post educational intervention (first year of the study. Odds ratios (OR and 95% confidence intervals (95% CI were calculated. Results After the 1st year of the study, physicians' certainty of their patients' risk factor status increased. Certainty varied from an OR of 1.4 (95% CI: 1.1, 1.8 for prior vertebral fracture status to 6.3 (95% CI: 2.3, 17.9 for prior hip fracture status. Furthermore, bone mineral density testing increased in high risk as compared with low risk patients (OR: 1.4; 95% CI: 1.2, 1.7. Conclusion Quality Circle methodology was successful in increasing both physicians' awareness of osteoporosis risk factors and appropriate bone mineral density testing in accordance with the 2002 Canadian guidelines.

Kvern Brent

2008-10-01

249

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

Science.gov (United States)

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

Hickox, Benjamin C

2015-01-01

250

Barriers to quality patient care in rural district hospitals  

Scientific Electronic Library Online (English)

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

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

2012-01-01

251

[Content validation of quality indicators for nursing care evaluation].  

Science.gov (United States)

The objective of this study is to perform the content validation often Nursing Care Quality Indicators in Adverse Event Prevention. Nine experts took part in this study and answered three forms. The results appointed the validity of the indicators, but with reformulations. The process yielded twelve indicators: identification of the patient's bed; identification of the risk of falling out of bed; Identification of peripheral venous accesses; Verification of skin lesions after infiltrations; Identification of venous infusion equipment; Identification of serum bottles and infusion speed control; Identification of peptic probes; Fixation of vesical delay probe and positioning of the urine collection bag; Checking of Procedures in Nursing Prescription; Control of Vital Signs; Checking of Nursing Procedures in Medical Prescription and Nursing elaboration of daily and complete prescription. The results confirm that the content validation procedure is indispensable for the development of evaluative measures. PMID:19655686

Vituri, Dagmar Willamowius; Matsuda, Laura Misue

2009-06-01

252

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

Directory of Open Access Journals (Sweden)

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

Tajmohammad Arazi Ghojegh

2012-08-01

253

Quality of care in the management of major obstetric haemorrhage.  

LENUS (Irish Health Repository)

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

Johnson, S N

2012-02-01

254

Structured chronic primary care and health-related quality of life in chronic heart failure  

OpenAIRE

Abstract Background Structured care is proposed as a lever for improving care for patients with chronic conditions. The purpose of this study was to explore the associations of structured care characteristics, derived from the Chronic Care Model, with health-related quality of life (HRQOL) and optimal clinical management in chronic heart failure (CHF) patients in primary care, as well as the association between optimal management and HRQOL. Methods Cross-sectional observational study using mu...

Schers Henk; Akkermans Reinier; Grol Richard; van der Weijden Trudy; Bosch Marije; Niessen Louis; Wensing Michel

2009-01-01

255

Congenital cytomegalovirus infection in a neonatal intensive care unit in Brazil evaluated by PCR and association with perinatal aspects Infecção congênita pelo citomegalovírus em unidade neonatal de alto risco de um hospital universitário no Brasil: prevalência avaliada pela PCR e associação com alguns aspectos perinatais  

OpenAIRE

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 PC...

Santos, Daniel Vi?tor V.; Souza, Maria Margarida R.; Gonc?alves, Se?rgio Henrique L.; Cotta, Ana Cristina S.; Melo, Lorenza A. O.; Andrade, Gla?ucia M. Q.; Brasileiro-filho, Geraldo

2000-01-01

256

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

Science.gov (United States)

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

Youngblut, Jonne M; Brooten, Dorothy

2012-01-01

257

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

DEFF Research Database (Denmark)

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

Peters, Michele; Perera, Suraj

2012-01-01

258

Do hospitals without physicians on the board deliver lower quality of care?  

Science.gov (United States)

This study examines whether hospitals without physician participation on their boards of directors deliver lower quality of care. Using data from California nonprofit hospitals from 2004 to 2008, the authors document that the absence of physicians on the board is associated with a decrease of 3 to 5 percentage points in 3 of 4 measures of care quality. This result was obtained using regression analysis, which controls for various hospital characteristics. The authors also identify factors that influence quality of care in hospitals. Specifically, hospital size, church affiliation, urban location, and system affiliation are positively associated with quality of care; proportion of Medicaid patient revenue and poverty level of the county in which the hospital is located are negatively associated with quality of care. These results highlight the importance of physician participation in hospital governance and indicate areas for hospitals and policy makers to focus on to enhance medical quality management. PMID:24413657

Bai, Ge; Krishnan, Ranjani

2015-01-01

259

Audit of perinatal mortality at SSMCHRC-(Rural teaching hospital a retrospective study  

Directory of Open Access Journals (Sweden)

Full Text Available Objective: To estimate magnitude, determinants of perinatal mortality and suggest remedial measures for its reduction. Background: Perinatal mortality is mirror reflection of maternal and child health and socioeconomic environment of community. It is influenced by various medicosocial preventable causes. It can be reduced by improving maternal and child health services and by health education. Methods: A retrospective hospital based study of perinatal deaths among 2333 deliveries was conducted from June 2008 to June 2010 in our hospital. Fetomaternal factors like maternal age, religion, residence, parity, mode of delivery, booking status, antenatal complications, baby’s sex, birth weight, congenital anomalies, neonatal complications influencing perinatal mortality rate were tabulated and analyzed. Cause of perinatal death was assessed. Results: perinatal mortality rate was 127.4/1000 total births. Maternal factors like age more than 35 years, muslim religion, inadequate antenatal care, primiparity, grand multiparity, induced deliveries and neonatal factors like low birth weight, prematurity were associated with increased perinatal mortality. The leading cause of stillbirth was antepartum hemorrhage and prematurity for neonatal mortality. Conclusion: Apart from clinical causes high perinatal mortality was due to poverty, illiteracy, lack of health awareness, inadequate antenatal care and delayed referral. Health education, identification of high risk mothers, timely referral, advanced life support of preterm neonates should significantly help to reduce perinatal deaths.

M.S. Kokila

2013-04-01

260

Quality assurance of radiotherapy in cancer treatment: toward improvement of patient safety and quality of care.  

Science.gov (United States)

The process of radiotherapy (RT) is complex and involves understanding of the principles of medical physics, radiobiology, radiation safety, dosimetry, radiation treatment planning, simulation and interaction of radiation with other treatment modalities. Each step in the integrated process of RT needs quality control and quality assurance (QA) to prevent errors and to give high confidence that patients will receive the prescribed treatment correctly. Recent advances in RT, including intensity-modulated and image-guided RT, focus on the need for a systematic RTQA program that balances patient safety and quality with available resources. It is necessary to develop more formal error mitigation and process analysis methods, such as failure mode and effect analysis, to focus available QA resources optimally on process components. External audit programs are also effective. The International Atomic Energy Agency has operated both an on-site and off-site postal dosimetry audit to improve practice and to assure the dose from RT equipment. Several countries have adopted a similar approach for national clinical auditing. In addition, clinical trial QA has a significant role in enhancing the quality of care. The Advanced Technology Consortium has pioneered the development of an infrastructure and QA method for advanced technology clinical trials, including credentialing and individual case review. These activities have an impact not only on the treatment received by patients enrolled in clinical trials, but also on the quality of treatment administered to all patients treated in each institution, and have been adopted globally; by the USA, Europe and Japan also. PMID:18952706

Ishikura, Satoshi

2008-11-01

261

Board oversight of quality: any differences in process of care and mortality?  

Science.gov (United States)

In response to legal and accreditation mandates as well as pressures from purchasers and consumers for quality improvement, hospital governing boards seek to improve their oversight of quality of care by adopting various practices. Based on a previous survey of hospital presidents/chief executive officers, this study examines differences in hospital quality performance associated with the adoption of particular practices in board oversight of quality. Quality was measured by performance in process of care and risk-adjusted mortality, using the Hospital Compare data from the Centers for Medicare & Medicaid Services and the Healthcare Cost and Utilization Project inpatient databases of the Agency for Healthcare Research and Quality. Board practices found to be associated with better performance in both process of care and mortality include (1) having a board quality committee; (2) establishing strategic goals for quality improvement; (3) being involved in setting the quality agenda for the hospital; (4) including a specific item on quality in board meetings; (5) using a dashboard with national benchmarks that includes indicators for clinical quality, patient safety, and patient satisfaction; and (6) linking senior executives' performance evaluation to quality and patient safety indicators. Involvement of physician leadership in the board quality committee further enhanced the hospital's quality performance. Taken together, these findings seem to support the will-execution-constancy of purpose framework on improving the effectiveness of hospital boards in overseeing quality. Future study should examine how specific board practices influence the culture and operations of the hospital that lead to better quality of care. PMID:19227851

Jiang, H Joanna; Lockee, Carlin; Bass, Karma; Fraser, Irene

2009-01-01

262

Unpacking the relationship between operational efficiency and quality of care in Ontario long-term care homes.  

Science.gov (United States)

In this multiple-case study, we engaged directors of care of Ontario long-term care (LTC) homes in semi-structured interviews designed to increase our understanding of the influence exerted by organizational and extra-organizational factors on two key aspects of organizational performance: operational efficiency and quality of care. We also examined the influence of these factors on the relationship between efficiency and quality. Through a review of the health services and organization and management literatures, four broad factors identified a priori as influential for one or both performance outcomes were used to guide our data collection: staff characteristics, facility characteristics, extra-organizational influences, and the function of volunteers. Our findings suggest that while both high efficiency and high quality of care are achievable, there are aspects of a home's operations and realities associated with the LTC sector in Ontario that can make achieving both, simultaneously, exceedingly challenging. PMID:21134304

Berta, Whitney; Laporte, Audrey; Kachan, Natasha

2010-12-01

263

Perinatal tuberculosis: a diagnostic challenge  

OpenAIRE

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

Souza, Edna Lu?cia S.; Moreira, Li?cia Maria O.; Márcio Fernando Silva

2006-01-01

264

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

OpenAIRE

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

Fournier Pierre; Dogba Maman

2009-01-01

265

Developing a Quality Measure for Clinical Inertia in Diabetes Care  

Science.gov (United States)

Objective To develop a valid quality measure that captures clinical inertia, the failure to initiate or intensify therapy in response to medical need, in diabetes care and to link this process measure with outcomes of glycemic control. Data Sources Existing databases from 13 Department of Veterans Affairs hospitals between 1997 and 1999. Study Design Laboratory results, medications, and diagnoses were collected on 23,291 patients with diabetes. We modeled the decision to increase antiglycemic medications at individual visits. We then aggregated all visits for individual patients and calculated a treatment intensity score by comparing the observed number of increases to that expected based on our model. The association between treatment intensity and two measures of glycemic control, change in HbA1c during the observation period, and whether the outcome glycosylated hemoglobin (HbA1c) was greater than 8 percent, was then examined. Principal Findings Increases in antiglycemic medications occured at only 9.8percent of visits despite 39percent of patients having an initial HbA1c level greater than 8 percent. A clinically credible model predicting increase in therapy was developed with the principal predictor being a recent HbA1c greater than 8 percent. There were considerable differences in the intensity of therapy received by patients. Those patients receiving more intensive therapy had greater improvements in control (p<.001). Conclusions Clinical inertia can be measured in diabetes care and this process measure is linked to patient outcomes of glycemic control. This measure may be useful in efforts to improve clinicians management of patients with diabetes. PMID:16336551

Berlowitz, Dan R; Ash, Arlene S; Glickman, Mark; Friedman, Robert H; Pogach, Leonard M; Nelson, Audrey L; Wong, Ashley T

2005-01-01

266

OncoQUAL: a Clinical Instrument Panel for Quality Assessment in Cancer Care  

OpenAIRE

We present OncoQUAL, a clinical instrument panel for quality assessment in cancer care. OncoQUAL is fully integrated in an oncological electronic patient record (OEPR) and it enables oncologists to interactively retrieve clinical data for performing process and outcome-based measures of quality of care.

Tonazzolli, Giorgia; Galligioni, Enzo; Berloffa, Flavio; Forti, Stefano

2005-01-01

267

How Does Your Community Grow? Planting Seeds for Quality Day Care. A Citizen Action Manual.  

Science.gov (United States)

This manual, which presents the principles and steps involved in the two-year Citizen Involvement for Day Care Quality Project in Massachusetts, serves as a guide for developing a citizen network to address the need for quality day care. The Project was housed by the Office for Children (OFC), the state agency which licenses and monitors all day…

Fried, Mindy; O'Reilly, Elaine

268

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

Science.gov (United States)

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

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

1998-01-01

269

Vermont STep Ahead Recognition System: QRS Profile. The Child Care Quality Rating System (QRS) Assessment  

Science.gov (United States)

This paper presents a profile of Vermont's STep Ahead Recognition System (STARS) 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 All Child Care Programs;…

Child Trends, 2010

2010-01-01

270

A Study Identifying the Components of a Quality Child Care Center.  

Science.gov (United States)

Specific characteristics of a quality day care center are identified through a survey of parents, teachers, and directors utilizing or working in day care centers. The introduction to this descriptive research study offers background information on the history of the child care movement in America and a review of related research projects. A…

Panetta, Sandra J.

271

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

Science.gov (United States)

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

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

2010-01-01

272

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

LENUS (Irish Health Repository)

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

Walsh, T

2012-01-31

273

As our population ages, demand for social care is growing. But the government’s immigration policies may well restrict the quality and quantity of social care professionals.  

OpenAIRE

The UK’s ageing population has brought issues of long-term care to the fore, but the care workforce and the vital role that immigrants play in it are seldom discussed. Shereen Hussein argues that limiting non-EU care workers entry to the UK may reduce both the quantity and quality of care professionals needed to fill vital care posts.

Hussein, Shereen

2011-01-01

274

Maternal nutrition and perinatal outcomes.  

Science.gov (United States)

Diet and patterns of eating during pregnancy can affect perinatal outcomes through direct physiologic effects or by stressing the fetus in ways that permanently affect phenotype. Supplements are not a magic nutritional remedy, and evidence of profound benefit for most supplements remains inconclusive. However, research supports calcium supplements to decrease preeclampsia. Following a low glycemic, Mediterranean-type diet appears to improve ovulatory infertility, decrease preterm birth, and decrease the risk of gestational diabetes. Although women in the United States have adequate levels of most nutrients, subpopulations are low in vitamin D, folate, and iodine. Vitamin D has increasingly been shown to be important not only for bone health, but also for glucose regulation, immune function, and good uterine contractility in labor. To ensure adequate vitamin and micronutrient intake, especially of folate before conception, all reproductive age women should take a multivitamin daily. In pregnancy, health care providers need to assess women's diets, give them weight gain recommendations based on their body mass index measurement, and advise them to eat a Mediterranean diet rich in omega-3 fatty acids (ingested as low-mercury risk fatty fish or supplements), ingest adequate calcium, and achieve adequate vitamin D levels through sun exposure or supplements. Health care providers should continue to spend time on nutrition assessment and counseling. PMID:20974412

Barger, Mary K

2010-01-01

275

Reconciling Practice and Theory: Challenges in Monitoring Medicaid Managed-Care Quality  

OpenAIRE

The massive shift to managed care in many State Medicaid programs heightens the importance of identifying effective approaches to promote and oversee quality in plans serving Medicaid enrollees. This article reviews operational issues and lessons from the ongoing evaluation of a three-State demonstration of the Health Care Financing Administration's (HCFA) Quality Assurance Reform Initiative (QARI) for Medicaid managed care. The QARI experience to date shows the potential utility of the syste...

Gold, Marsha; Felt, Suzanne

1995-01-01

276

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

Science.gov (United States)

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

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

2001-01-01

277

Corioamnionitis: Repercusión perinatal  

Directory of Open Access Journals (Sweden)

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

Pedro Faneite

2010-12-01

278

Working with practitioners to develop training in peri-natal loss and bereavement: Evaluating three workshops.  

Science.gov (United States)

Peri-natal loss is as profound as any other bereavement [Chambers, H.M., Chan, F.J., 2000. Support for women/families after peri-natal death. (Cochrane Review). Issue 1. The Cochrane Library, Oxford, Update Software], is commonplace, and its traumatic potential has long been overlooked by clinicians and researchers [Spechard, 1997. Traumatic death in pregnancy: the significance of meaning and attachment. In: Figley, C.R., Bride, B., Mazza, N., (Eds.), Death and Trauma: The Traumatology of Grieving. Taylor and Francis, London, 1997, pp. 67-98]. Previous miscarriage, stillbirth or neonatal death is implicated in post-natal depression and behaviour management difficulties after the birth of subsequent children. The involvement of the health visitor in supporting grieving parents may be crucial to medium and long-term family health [Hill, C., 1997. Evaluating the quality of after death care. Nursing Standard 12(8), 38-39]. However, service provision for such families appears to be inconsistent and depends on the skills, confidence and time constraints of individual practitioners, with little in the way of guidance and support in this sensitive area of care [Dent, A., Condon, L., Blair, P., Flemming, P., 1996. A study of bereavement care after a sudden and unexpected death. Archives of disease in childhood, 74, 552-526]. This paper outlines the development and evaluation of a series of workshops around peri-natal loss initially offered to health visitors in North Staffordshire (UK), and then expanded to incorporate midwives. The authors formally evaluated the three workshops (and their impact) retrospectively, and implemented the findings to further develop the workshops, thus ensuring relevance to professional practice. The rationale behind the introduction of the workshops and the contents are introduced; approaches to the evaluation process described; presentation of the findings offered; followed by a discussion of the key issues. PMID:19040832

Cartwright, Pat; Read, Sue

2005-09-01

279

eHealth, care and quality of life  

CERN Document Server

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

Capello, Fabio; Manca, Marco

2014-01-01

280

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

DEFF Research Database (Denmark)

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

Kjaer, Monica Linda; Mainz, Jan

2004-01-01

281

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

Directory of Open Access Journals (Sweden)

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

Dorsett Joanna

2009-08-01

282

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

OpenAIRE

Abstract Background Despite decades of efforts to improve quality of health care, poor performance persists in many aspects of care. Less than 1% of the enormous national investment in medical research is focused on improving health care delivery. Furthermore, when effective innovations in clinical care are discovered, uptake of these innovations is often delayed and incomplete. In this paper, we build on the established principle of 'positive deviance' to propose an approach to identifying p...

Nembhard Ingrid M; Rowe Laura; Ramanadhan Shoba; Curry Leslie A; Bradley Elizabeth H; Krumholz Harlan M

2009-01-01

283

Local day-care quality and maternal employment: Evidence from East and West Germany  

OpenAIRE

By investigating how locally available early childhood education and care quality relates to maternal employment choices, this study extended the literature which has mostly focused on the importance of day-care availability or costs. We provided differentiated analyses by the youngest child's age and for West and East Germany to examine moderating influences of varying day-care supply and work-care cultures. The empirical analysis linked the Socio-Economic Panel and the 'Families in Germany'...

Schober, Pia S.; Spieß, C. Katharina

2014-01-01

284

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

Directory of Open Access Journals (Sweden)

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

Restuccia Joseph D

2012-09-01

285

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

International Nuclear Information System (INIS)

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

286

A comparison of palliative care outcome measures used to assess the quality of palliative care provided in long-term care facilities: a systematic review.  

Science.gov (United States)

Provision of palliative care in long-term care (LTC) facilities is important, but limited research has been undertaken to investigate the most appropriate outcome measure for use in this setting. In this systematic review we aimed to measure the psychometric properties (reliability/validity) and feasibility of palliative outcome measures used to assess the quality of palliative care provided in LTC. For identification of outcome measures we undertook systematic searches of electronic databases from 1 January 2000 to 12 September 2008. Included studies were assessed by two independent reviewers for methodological quality prior to inclusion in the review using an appraisal checklist developed for the review to evaluate validity, reliability and feasibility. Ten articles were included in the final review and these provided specific information on the psychometric properties of 10 outcome measures. Four of these measures reported data specifically for residents in LTC facilities, while the remaining six measures reported a sub-set of data for residents in LTC facilities. The Family Perceptions of Care Scale is considered by the authors as the most suitable outcome measure for use in LTC facilities. Of the remaining nine measures, a further two were also considered suitable for measuring the quality of palliative care in residential aged care facilities. These are the Quality of Dying in Long-term Care scale and the Toolkit Interview. PMID:20817748

Parker, Deborah; Hodgkinson, Brent

2011-01-01

287

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

Directory of Open Access Journals (Sweden)

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

Juan A. Seclen-Palacín

2003-12-01

288

Perinatal Risk Factors for Strabismus  

OpenAIRE

Abstract Background: Little is known about the etiologic factors underlying strabismus. We undertook a large cohort study to investigate perinatal risk factors for strabismus, overall and by subtype. Methods: Orthoptists reviewed ophthalmologic records for Danish National Birth Cohort children examined for strabismus in hospital ophthalmology departments or by ophthalmologists in private practice. Information on perinatal characteristics was obtained from national registers. We ...

Torp-pedersen, Tobias Emil; Boyd, Heather Allison; Poulsen, Gry; Haargaard, Birgitte; Wohlfahrt, J.; Melbye, M.; Holmes, Jonathan M.

2010-01-01

289

Use of the balanced scorecard to improve the quality of behavioral health care.  

Science.gov (United States)

As the debate over managed care continues, measuring quality has increasingly become a focus in health care. One approach to measuring quality is the use of a scorecard, which summarizes a critical set of indicators that measure the quality of care. The author describes the Balanced Scorecard (BSC), a tool developed for use in businesses to implement strategic plans for meeting an organization's objectives, and shows how the BSC can be adapted for use in behavioral health care. The scorecard addresses quality of care at five levels: financial, customer, outcomes, internal processes, and learning and growth. No more than four or five realistic objectives are chosen at each level, and an indicator for the achievement of each objective is designed. The BSC integrates indicators at the five levels to help organizations guide implementation of strategic planning, report on critical outcomes, and offer a report card for payers and consumers to make informed choices. PMID:10577875

Santiago, J M

1999-12-01

290

The quality of family relationships and use of maternal health-care services in India.  

Science.gov (United States)

Marital quality is well established as a determinant of health in Western contexts, yet the importance of relationship quality to health in non-Western contexts is largely limited to a focus on domestic violence. Using the Women's Reproductive Histories Survey, this study examines whether women with higher-quality family relationships are more likely than others to use maternal health-care services in Madhya Pradesh, India. Results show that among nuclear families, women with better marital relationships are more likely than others to use antenatal care services and to deliver in a health-care facility. Among joint families, women who have better relationships with their in-laws are more likely to use antenatal care services. The results further suggest that women's agency mediates some, but not all, of the effect of relationship quality on use of maternal health-care services. PMID:21465727

Allendorf, Keera

2010-12-01

291

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

Directory of Open Access Journals (Sweden)

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

van der Eijk Ingrid

2005-02-01

292

Enfermedad hemolítica perinatal Perinatal hemolytic disease  

Directory of Open Access Journals (Sweden)

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

María del Rosario López de Roux

2000-12-01

293

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

OpenAIRE

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

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

2008-01-01

294

Risk adjustment methods for Home Care Quality Indicators (HCQIs based on the minimum data set for home care  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Background There has been increasing interest in enhancing accountability in health care. As such, several methods have been developed to compare the quality of home care services. These comparisons can be problematic if client populations vary across providers and no adjustment is made to account for these differences. The current paper explores the effects of risk adjustment for a set of home care quality indicators (HCQIs based on the Minimum Data Set for Home Care (MDS-HC. Methods A total of 22 home care providers in Ontario and the Winnipeg Regional Health Authority (WRHA in Manitoba, Canada, gathered data on their clients using the MDS-HC. These assessment data were used to generate HCQIs for each agency and for the two regions. Three types of risk adjustment methods were contrasted: a client covariates only; b client covariates plus an "Agency Intake Profile" (AIP to adjust for ascertainment and selection bias by the agency; and c client covariates plus the intake Case Mix Index (CMI. Results The mean age and gender distribution in the two populations was very similar. Across the 19 risk-adjusted HCQIs, Ontario CCACs had a significantly higher AIP adjustment value for eight HCQIs, indicating a greater propensity to trigger on these quality issues on admission. On average, Ontario had unadjusted rates that were 0.3% higher than the WRHA. Following risk adjustment with the AIP covariate, Ontario rates were, on average, 1.5% lower than the WRHA. In the WRHA, individual agencies were likely to experience a decline in their standing, whereby they were more likely to be ranked among the worst performers following risk adjustment. The opposite was true for sites in Ontario. Conclusions Risk adjustment is essential when comparing quality of care across providers when home care agencies provide services to populations with different characteristics. While such adjustment had a relatively small effect for the two regions, it did substantially affect the ranking of many individual home care providers.

Hirdes John P

2005-01-01

295

Empowering women to obtain high quality care: evidence from an evaluation of Mexico's conditional cash transfer programme  

OpenAIRE

Objectives To evaluate the impact of Mexico's conditional cash transfer programme on the quality of health care received by poor women. Quality is measured by maternal reports of prenatal care procedures received that correspond with clinical guidelines.

Barber, Sarah L.; Gertler, Paul J.

2008-01-01

296

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

OpenAIRE

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

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

2008-01-01

297

Utilization of Maternal and Child Health Care Services by Primigravida Females in Urban and Rural Areas of India  

OpenAIRE

Maternal complications and poor perinatal outcome are highly associated with nonutilisation of antenatal and delivery care services and poor socioeconomic conditions of the patient. It is essential that all pregnant women have access to high quality obstetric care throughout their pregnancies. Present longitudinal study was carried out to compare utilization of maternal and child health care services by urban and rural primigravida females. A total of 240 study participants were enrolled in t...

Mahajan, Hemant; Sharma, Bhuwan

2014-01-01

298

[Questioning of relatives--potentials for the internal quality management in institutions caring for the elderly].  

Science.gov (United States)

The German care quality assurance law ("Pflege-Qualitätssicherungs-Gesetz", PQsG) calls for internal quality management in residential care facilities. Empirical surveys with residents, their relatives and employees are essential to get transparency and to assess the quality of service. Within the scope of the present study more than 1400 relatives of residents of 31 residential care institutions were surveyed. Therefore in preliminary studies a questionnaire for the relatives was developed, which collects data concerning quality aspects on various aspects (for example care, staff, medical care, cooperation with relatives). On the average, relatives judged the quality of the institutions as good. The overall mean of 2.2 (scale values between 1.8 ["administration/management"] and 2.5 ["care"]) reveals a positive aspect, but there is substantial variation between institutions. Empirical surveys are important tools for internal quality management. Among other things, their results can be used as input for specific quality circle work and thus for continuous improvement. Used continually in the sense of a routine-monitoring system, surveys can also serve to evaluate quality management procedures. PMID:15206041

Nübling, R; Kriz, D; Kress, G; Schremmp, C; Löschmann, C; Schmidt, J

2004-06-01

299

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

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

Jafar S. Tabrizi

2014-12-01

300

A Conceptual Model for Assessing Quality of Care for Patients Boarding in the Emergency Department: Structure-Process-Outcome  

OpenAIRE

Many believe that the “boarding” of emergency department (ED) patients awaiting inpatient beds compromises quality of care. To better study the quality of care of boarded patients, one should identify and understand the mechanisms accounting for any potential differences in care. This paper present a conceptual boarding “structure-process-outcome” model to help assess quality of care provided to boarded patients, and to aid in recognizing potential solutions to improve that quality, i...

Liu, Shan W.; Singer, Sara J.; Sun, Benjamin C.; Camargo, Carlos A.

2011-01-01

301

High-Quality Asthma Care: It's Not Just About Drugs  

OpenAIRE

Asthma care is based on three simple, basic concepts: reduce triggers, use controller medicine, and take early action in flare-ups. Implementing these concepts is difficult, however, and nonadherence is common. The patient, family, and health care system tend to focus their attention on crisis care instead of on control, and long-standing behaviors are hard to change. Adherence to asthma control regimens can be improved if clinicians and their patients focus more attention on communication sk...

Farber, Harold J.

2005-01-01

302

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

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

Wilhelmina Mijntje Looman

2014-12-01

303

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

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

Hammouche Salah

2011-11-01

304

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

Science.gov (United States)

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

Hoyt, David B; Schneidman, Diane S

2015-03-01

305

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

Energy Technology Data Exchange (ETDEWEB)

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

Hanucharurnkul, S.

1988-01-01

306

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

DEFF Research Database (Denmark)

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

NØrgaard, Birgitte; Kofoed, Poul-Erik

2012-01-01

307

The experience of the implementation of perinatal audit in Moldova.  

Science.gov (United States)

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

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

2014-09-01

308

Communicating for Quality in School Age Care Services  

Science.gov (United States)

School Age Care (SAC) services have existed in Australia for over 100 years but they have tended to take a back seat when compared with provision for school-aged children and those under school age using early childhood education and care (ECEC) services. Many SAC services are housed in shared premises and many children attending preparatory or…

Cartmel, Jennifer; Grieshaber, Susan

2014-01-01

309

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

Science.gov (United States)

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

Sewell, N

1997-01-01

310

Low perinatal autopsy rate in Malaysia: time for a change.  

Science.gov (United States)

Our objectives were to determine the perinatal autopsy rate in a tertiary hospital in Malaysia and to quantify the value of the perinatal autopsy. All stillbirths, miscarriages, therapeutic abortions, and neonatal deaths between January 1, 2004, and August 31, 2009, were identified from the archives. The autopsy findings were compared with the clinical diagnoses. The autopsy reports were also reviewed to determine if it would be possible to improve the quality of the autopsies. There were 807 perinatal deaths, of which 36 (4.5%) included an autopsy. There were ethnic differences in the rate of autopsy, with the lowest rate among the Malays. The autopsy provided the diagnosis, changed the clinical diagnosis, or revealed additional findings in 58.3% of cases. Ancillary testing, such as microbiology, chromosomal analysis, and biochemistry, could improve the quality of the autopsy. This study provides further data on the perinatal autopsy rate from an emerging and developing country. It reaffirms the value of the perinatal autopsy. Attempts must be made to improve on the low autopsy rate while recognizing that the performance of autopsies can be enhanced through the use of ancillary testing. PMID:20367214

Tan, Geok Chin; Hayati, Abdul Rahman; Khong, Teck Yee

2010-01-01

311

A timely referral to palliative care team improves quality of life  

Directory of Open Access Journals (Sweden)

Full Text Available In the trajectory of disease progress and treatment plan, patients and the family members are confronted with challenging situations like unsurmountable physical distress, inadequate coping patterns,unanswered spiritual issues in the background of serious threat to very existence of life leads to a debilitating Quality of life.The Palliative Care team approach addresses all the issues and also sees the patient to go through the protocols of Palliative care management as well as Oncological treatment plan. Further, this fecilitates a smooth transition from the hospital to home and hospice care. Various studies conducted globally revealed that patients received palliative care intervention along with oncological treatments had higher scores of Quality of life compared to patients received onlyoncology care alone.This article discusses the various factors contributing to late referrals to palliative care team and also care giver?s views pertaining to need for early referral. Timely referral to palliative care minimises the patient?s and care giver?s distress,ensures modest Quality of life and appropriate measures at the end of life care.

Devi P

2011-01-01

312

How has hospital consolidation affected the price and quality of hospital care?  

Science.gov (United States)

During the 1990s, the hospital industry was transformed by mergers and acquisitions. This synthesis looks at why this rapid consolidation occurred and what impact it had on the price and quality for patients, and the cost of care for hospitals. Key findings include: Managed care was not a main driver of consolidation, but fear of managed care may have played a part. Other factors, including technological advances that reduced inpatient demand, and an antitrust environment that was receptive to consolidation contributed to consolidation. Research suggests hospital prices increased by 5 percent or more as a result of consolidation. When two hospitals merge, not only does the surviving hospital raise prices but so do its competitors. Evidence of the impact of consolidation on quality of care is limited and mixed, but the strongest studies show a reduction in quality. Hospital consolidation does modestly reduce the cost to hospitals of providing care. PMID:22051574

Vogt, William B; Town, Robert; Williams, Claudia H

2006-02-01

313

Framework for assessing quality of care for inflammatory bowel disease in Sweden  

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Full Text Available AIM: To create and apply a framework for quality assessment and improvement in care for inflammatory bowel disease (IBD patients. METHODS A framework for quality assessment and improvement was created for IBD based on two generally acknowledged quality models. The model of Donabedian (Df offers a logistical and productive perspective and the Clinical Value Compass (CVC model adds a management and service perspective. The framework creates a pedagogical tool to understand the balance between the dimensions of clinical care (CVC and the components of clinical outcome (Df. The merged models create a framework of the care process dimensions as a whole, reflecting important parts of the IBD care delivery system in a local setting. Clinical and organizational quality measures were adopted from clinical experience and the literature and were integrated into the framework. Data were collected at the yearly check-up for 481 IBD patients during 2008. The application of the quality assessment framework was tested and evaluated in a local clinical IBD care setting in Jönköping County, Sweden. RESULTS: The main outcome was the presentation of how locally-selected clinical quality measures, integrated into two complementary models to develop a framework, could be instrumental in assessing the quality of care delivered to patients with IBD. The selected quality measures of the framework noted less anemia in the population than previously reported, provided information about hospitalization rates and the few surgical procedures reported, and noted good access to the clinic. CONCLUSION: The applied local quality framework was feasible and useful for assessing the quality of care delivered to IBD patients in a local setting.

Martin Rejler

2012-01-01

314

Ensuring health care quality: JCAHO's perspective. Joint Commission on Accreditation of Healthcare Organizations.  

Science.gov (United States)

In recent years, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has expanded its traditional role as a leading evaluator of health care organizations to incorporate new attitudes and strategies in the areas of quality and performance improvement. This paper outlines plans for modifying the current accreditation process, and includes a proposition that accredited organizations actively participate in a quality measurement system and become involved in the process of selecting appropriate measures. The paper presents current and proposed methods for measuring performance standards, compares major accreditation systems, and explores the public's expectations for health care quality and the JCAHO's role in quality improvement and cost containment. PMID:9444459

Flanagan, A

1997-01-01

315

Corioamnionitis: Repercusión perinatal  

Scientific Electronic Library Online (English)

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

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

2010-12-01

316

Choosing High-Quality Child Care for a Child with Special Needs  

Science.gov (United States)

... as positive learning experiences. 1-800-221-6827 • easter-seals.org Why is high-quality child care ... Contact other national/state/local organizations such as Easter Seals (www.easterseals.com), whose members provide services ...

317

Early career RNs' perceptions of quality care in the hospital setting.  

Science.gov (United States)

The purpose of this study was to explore early-career registered nurses' perceptions of high-quality nursing care in hospitals. The study findings contribute to ongoing work intended to explore and define what quality nursing care is and how it ultimately impacts patients. The final sample analyzed for this article consisted of 171 narrative responses from hospital-based registered nurses. We used Krippendorff's technique for qualitative content analysis to identify themes. Three themes emerged as integral to high quality nursing care: registered nurse presence, developing relationships, and facilitating the flow of knowledge and information. Development of nursing quality indicators should focus on nursing processes in addition to patient outcomes. Such a focus would better capture the complexity of hospital nursing care. PMID:21216983

Cline, Daniel D; Rosenberg, Marie-Claire; Kovner, Christine T; Brewer, Carol

2011-05-01

318

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

OpenAIRE

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

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

2003-01-01

319

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

OpenAIRE

Abstract Background The descriptive information now available for primary care in the UK is unique in international terms. Under the 'Quality and Outcomes Framework' (QOF), data for 147 performance indicators are available for each general practice. We aimed to determine the relationship between the quality of primary care, as judged by the total QOF score, social deprivation and practice characteristics. Methods We obtained QOF data for each practice in England and linked these with census d...

Armstrong David; Ashworth Mark

2006-01-01

320

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

OpenAIRE

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

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

2014-01-01

321

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

OpenAIRE

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

Lewittes, L. R.; Marshall, V. W.

1989-01-01

322

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

Directory of Open Access Journals (Sweden)

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

Emamzadeh Ghasemi

2007-10-01

323

Involving deprived communities in improving the quality of primary care services: does participatory action research work?  

OpenAIRE

Abstract Background Participation by communities in improving the quality of health services has become a feature of government policy in the United Kingdom. The aim of the study was to involve a deprived community in the UK in shaping quality improvements of local primary care services. The specific objectives were firstly to create participation by local people in evaluating the primary care services available in the area and secondly to bring about change as a result of this process. Metho...

Mercer Stewart W; Cawston Peter G; Barbour Rosaline S

2007-01-01

324

Maternal near miss and quality of maternal health care in Baghdad, Iraq  

OpenAIRE

Abstract Background The maternal near-miss concept has been developed as an instrument for assisting health systems to evaluate and improve their quality of care. Our study aimed at studying the characteristics and quality of care provided to women with severe complications in Baghdad through the use of the World Health Organization (WHO) near-miss approach for maternal health. Methods This is a facility-based, cross-sectional study conducted in 6 public hospitals in Baghdad between March 1, ...

Jabir Maysoon; Abdul-Salam Imad; Suheil Dhikra M; Al-Hilli Wafa; Abul-Hassan Sana; Al-Zuheiri Amal; Al-Ba'aj Rasha; Dekan Abeer; Tunçalp Özge; Souza Joao Paulo

2013-01-01

325

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

OpenAIRE

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

Kebriaei, A.; Akbari, F.

2006-01-01

326

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

OpenAIRE

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

Forder, Julien; Allan, Stephen

2014-01-01

327

A conceptual model for assessing quality of care for patients boarding in the emergency department: structure-process-outcome.  

Science.gov (United States)

Many believe that the "boarding" of emergency department (ED) patients awaiting inpatient beds compromises quality of care. To better study the quality of care of boarded patients, one should identify and understand the mechanisms accounting for any potential differences in care. This paper presents a conceptual boarding "structure-process-outcome" model to help assess quality of care provided to boarded patients and to aid in recognizing potential solutions to improve that quality, if it is deficient. The goal of the conceptual model is to create a practical framework on which a research and policy agenda can be based to measure and improve quality of care for boarded patients. PMID:21496148

Liu, Shan W; Singer, Sara J; Sun, Benjamin C; Camargo, Carlos A

2011-04-01

328

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

OpenAIRE

Abstract Background Attributes of teams could affect the quality of care delivered in primary care. The aim of this study was to systematically review studies conducted within the UK NHS primary care that have measured team climate using the Team Climate Inventory (TCI), and to describe, if reported, the relationship between the TCI and measures of quality of care. Findings The databases MEDLINE, EMBASE, and CINAHL were searched. The reference lists of included article were checked and one re...

Goh Teik T; Eccles Martin P

2009-01-01

329

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

Science.gov (United States)

New Zealand has one of the best value health care systems in the world, but as a proportion of GDP our spending on health care has increased every year since 1999. Further, there are issues of quality and safety in our system we must address, including rates of adverse events. The Health Quality and Safety Commission was formed in 2010 as a crown agent to influence, encourage, guide and support improvement in health care practice in New Zealand. The New Zealand Triple Aim has been defined as: improved quality, safety and experience of care; improved health and equity for all populations; and best value for public health system resources. The Commission is pursuing the Triple Aim via two fundamental objectives: doing the right thing by providing care supported by the best evidence available, focused on what matters to each individual patient, and doing the right thing right, first time, by making sure health care is safe and of the highest quality possible. Improvement efforts must be supported by robust but economical measurements. New Zealand has a strong culture of quality, so the Commission's role is to work with our colleagues to make good health care better. PMID:25662383

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

2015-01-30

330

Grantee Research Highlight: Taking Account of the Patient's Perspective when Examining the Quality of Cancer Care  

Science.gov (United States)

Optimizing patient experiences with care is especially important in cancer because cancer care is often complex and involves communication with and coordination across providers of multiple specialties and across multiple institutional settings. Unsatisfactory interactions with the health care system pose an additional burden on patients when they are already ill and vulnerable. More importantly, less-than-optimal patient experiences can have a significant negative impact on patients’ health-related quality of life.

331

Measuring quality of care with routine data: avoiding confusion between performance indicators and health outcomes  

OpenAIRE

Objective To investigate the impact of factors outside the control of primary care on performance indicators proposed as measures of the quality of primary care. Design Multiple regression analysis relating admission rates standardised for age and sex for asthma, diabetes, and epilepsy to socioeconomic population characteristics and to the supply of secondary care resources. Setting 90 family health services authorities in England, 1989-90 to 1994-5. Results At health authority level socioeco...

Giuffrida, A.; Gravelle, H.; Roland, M.

1999-01-01

332

Longitudinal Pediatric Palliative Care: Quality of Life & Spiritual Struggle (FACE): Design and Methods  

OpenAIRE

As life expectancy increases for adolescents ever diagnosed with AIDS due to treatment advances, the optimum timing of advance care planning is unclear. Left unprepared for end-of-life (EOL) decisions, families may encounter miscommunication and disagreements, resulting in families being charged with neglect, court battles and even legislative intervention. Advanced care planning (ACP) is a valuable tool rarely used with adolescents. The Longitudinal Pediatric Palliative Care: Quality of Life...

Dallas, Ronald H.; Wilkins, Megan L.; Wang, Jichuan; Garcia, Ana; Lyon, Maureen E.

2012-01-01

333

Satisfaction with pregnancy and delivery services: The quality of maternity care services as experienced by women  

OpenAIRE

Objective: The objective of this study was to investigate the opinions of women regarding the satisfaction about the quality of maternity care received. We hope to establish whether health care technology increases satisfaction or whether it actually interferes with the construction of personal satisfaction in the process of care. Design and setting: Information was gathered using the focus group technique. The area of study comprised the post-natal groups run as part of the Sexual and Reprod...

Goberna Tricas, Josefina; Banu?s Gime?nez, Ma Rosa; Palacio Tauste, Alicia; Linares Sancho, Sara

2011-01-01

334

Impacts of pay for performance on the quality of primary care  

OpenAIRE

T Allen, T Mason, W WhittakerManchester Centre for Health Economics, University of Manchester, Manchester, United KingdomAbstract: Increasingly, financial incentives are being used in health care as a result of increasing demand for health care coupled with fiscal pressures. Financial incentive schemes are one approach by which the system may incentivize providers of health care to improve productivity and/or adapt to better quality provision. Pay for performance (P4P) is an example of a fina...

Allen T; Mason T; Whittaker W

2014-01-01

335

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

Science.gov (United States)

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

Viney, Linda L.; And Others

1994-01-01

336

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

Science.gov (United States)

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

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

2014-01-01

337

Preschool Center Care Quality Effects on Academic Achievement: An Instrumental Variables Analysis  

Science.gov (United States)

Much of child care research has focused on the effects of the quality of care in early childhood settings on children's school readiness skills. Although researchers increased the statistical rigor of their approaches over the past 15 years, researchers' ability to draw causal inferences has been limited because the studies are based on…

Auger, Anamarie; Farkas, George; Burchinal, Margaret R.; Duncan, Greg J.; Vandell, Deborah Lowe

2014-01-01

338

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

Science.gov (United States)

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

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

2015-01-01

339

Quality and safety: Precision, accuracy and compliance with accepted standards of care  

Directory of Open Access Journals (Sweden)

Full Text Available How to cite this article: Oosthuizen SJ, Van Deventer C. Quality and safety: Precision, accuracy and compliance with accepted standards of care. Afr J Prm Health Care Fam Med. 2010;2(1, Art. #245, 2 pages. DOI: 10.4102/ phcfm.v2i1.245

Susara J. Oosthuizen

2010-03-01

340

Quality and safety: Precision, accuracy and compliance with accepted standards of care  

OpenAIRE

How to cite this article: Oosthuizen SJ, Van Deventer C. Quality and safety: Precision, accuracy and compliance with accepted standards of care. Afr J Prm Health Care Fam Med. 2010;2(1), Art. #245, 2 pages. DOI: 10.4102/ phcfm.v2i1.245

Oosthuizen, Susara J.; Claire Van Deventer

2010-01-01

341

Quality-of-care initiative in patients treated surgically for perforated peptic ulcer  

DEFF Research Database (Denmark)

Mortality and morbidity are considerable after treatment for perforated peptic ulcer (PPU). Since 2003, a Danish nationwide quality-of-care (QOC) improvement initiative has focused on reducing preoperative delay, and improving perioperative monitoring and care for patients with PPU. The present study reports the results of this initiative.

MØller, M H; Larsson, Heidi Jeanet

2013-01-01

342

Assessing quality of Interdisciplinairy rounds in the intensive care unit  

OpenAIRE

Het meten van de kwaliteit van het multidisciplinair overleg op de intensive care De technische mogelijkheden om patiënten te bewaken en te behandelen op een intensive care (IC) zijn de afgelopen decennia sterk toegenomen. Naast deze technologische ontwikkelingen is goede samenwerking evenzo belangrijk voor optimale patiëntenzorg, om het risico op fouten en complicaties te verminderen. Samenwerking in teams is niet alleen zichtbaar in de directe zorg maar ook in regulier overleg: he...

Have, Elisabeth Cornelia Maria Ten

2014-01-01

343

Quality of life of the nursing caregiver and its relationship with care  

Directory of Open Access Journals (Sweden)

Full Text Available Objective: To identify aspects that affect the quality of life of nursing caregivers and their relationship with care in an Intensive Care Unit for Adults (A-ICU. Methods: This was a descriptive study with qualitative approach, taking as subjects 21 professionals who constitute the nursing staff of the A-ICU of a school hospital in Maringá-PR. Unstructured interview was used as a strategy to collect data, conducted between May and June 2009. Data analysis was based on the method of content analysis. The categories identified were: overlooking improvement in quality of life related to the resources in an A-ICU; the quality of life influencing the form of care; interpersonal relationships into the health team reflecting on the quality of life and care. Results: The analysis of caregivers’ speech and the results of the observation showed that there is correlation between the aspects they consider influential in their quality of life and the way of caring for patients in an A-ICU. Conclusion: The findings indicate that, among the influential aspects, the stressful factors overlap the enhancing ones. From this perspective, dealing with caregiver’s suffering might be the starting point for the improvement in quality of care in an A-ICU.

Everton Fernando Alves

2013-08-01

344

Traveling abroad for medical care: U.S. medical tourists' expectations and perceptions of service quality.  

Science.gov (United States)

The SERVQUAL scale has been widely used to measure service quality in the health care industry. This research is the first study that used SERVQUAL to assess U.S. medical tourists' expectations and perceptions of the service quality of health care facilities located outside the United States. Based on a sample of U.S. consumers, who had traveled abroad for medical care, the results indicated that there were significant differences between U.S. medical tourists' perceived level of service provided and their expectations of the service that should be provided for four of the five dimensions of service quality. Reliability had the largest service quality gap followed by assurance, tangibles, and empathy. Responsiveness was the only dimension without a significantly different gap score. The study establishes a foundation for future research on service quality in the rapidly growing medical tourism industry. PMID:21815742

Guiry, Michael; Vequist, David G

2011-01-01

345

Transfer of training: the missing link in training and the quality of adult social care.  

Science.gov (United States)

Recent UK social care reforms characterised by a policy of increasing personalisation and choice in adult social care have been accompanied by major reorganisation and investment in workforce training and development. There is an assumed link between training and the quality of care received. This assumption has a long pedigree in social care, but rarely does it receive the scrutiny necessary for us to understand better the nature of this relationship. This paper focuses on the potential for in-service training to contribute to the transformation in social care as expected by policy-makers. Reviewing recent findings from the evaluation of training in social care shows that problems continue to persist in demonstrating that training results in changes in practitioner behaviour back on the job. Findings within the social care literature mirror those found more widely in suggesting learner characteristics, intervention design, and delivery and the workplace environment combine to influence whether training transfers to use on the job. The argument advanced here is that without a focus on the transfer of training, the contribution of training to quality of care outcomes will remain illusory. A shift is required in policy-makers' mindsets away from training, to a focus on training transfer in directing workforce development strategies. It might then be possible to begin to identify how and in what configurations training may be associated with quality of care outcomes. PMID:22804952

Clarke, Nicholas

2013-01-01

346

Progress report: Chile's primary health care quality assessment and improvement program.  

Science.gov (United States)

A progress report on the primary health care quality assessment and improvement program in Chile is presented. In March 1991, the Quality Assurance Project (QAP) and the Primary Health Care Department of the Ministry of Health of Chile initiated a collaborative effort to improve the quality of primary health care services. During the first year of the project, significant progress has been made. Over 400 health professionals nationwide have received basic training in quality assurance, and over 30 quality improvement activities are underway. The project started by raising awareness among top-level managers. Next, reflecting the decentralized focus of Chile's health system, training and technical assistance were provided to managers and supervisors at the district level. Chilean health professionals trained by QAP are encouraged to meet with their clinic staffs to identify problems that affect the quality of their services, and determine the causes of these problems. While the project focuses on primary health care clinics in the public sector, QAP is also working with universities, professional associations, and nongovernmental organizations. Because of their expertise and influence in primary health care, these entities have been an integral part of the effort from the outset. Included in this paper are the three main components of the quality assurance (QA) effort in Chile: training, application of QA methods, and institutionalization. PMID:12295541

1992-05-01

347

Perinatal Oxygen in the Developing Lung  

Science.gov (United States)

Lung diseases, such as bronchopulmonary dysplasia (BPD), wheezing, and asthma, remain significant causes of morbidity and mortality in the pediatric population, particularly in the setting of premature birth. Pulmonary outcomes in these infants are highly influenced by perinatal exposures including prenatal inflammation, postnatal intensive care unit interventions, and environmental agents. Here, there is strong evidence that perinatal supplemental oxygen administration has significant effects on pulmonary development and health. This is of particular importance in the preterm lung, where premature exposure to room air represents a hyperoxic insult that may cause harm to a lung primed to develop in a hypoxic environment. Preterm infants are also subject to increased episodes of hypoxia, which may also result in pulmonary damage and disease. Here, we summarize current understanding of the effects of oxygen on the developing lung and how low vs. high oxygen may predispose to pulmonary disease that may extend even into adulthood. Better understanding of the underlying mechanisms will help lead to improved care and outcomes in this vulnerable population. PMID:25594569

Vogel, Elizabeth R.; Britt, Rodney D.; Trinidad, Mari Charisse; Faksh, Arij; Martin, Richard J.; MacFarlane, Peter M.; Pabelick, Christina M.; Prakash, Y.S.

2015-01-01

348

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

Scientific Electronic Library Online (English)

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

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

2012-12-01

349

The physician quality reporting initiative: what is it, will it increase health care quality, and should wide participation be encouraged?  

Science.gov (United States)

The physician quality reporting initiative (PQRI) is a voluntary program for reporting certain quality measures on Medicare patients in return for receiving a small bonus payment. However, the PQRI procedures are such that a large number of those who try to participate do not receive incentive payments. Also, many indicate that the small bonus for participation is not worth the effort and costs incurred. Furthermore, it has been found that many of the quality measures are not a good indicator of a favorable outcome, and do not clearly promote significant increases in the quality of patient care. However, penalties will be given from the year 2015 for not participating in PQRI. Also, it is expected that PQRI will be a precursor to Pay for Performance legislation, which will require mandatory participation by physicians. Therefore, participation in PQRI now is recommended by many experts, so that health care professionals can learn the procedures and make necessary adjustments in their practice procedures. PMID:21220973

Harolds, Jay A; Merrill, Janette K

2011-02-01

350

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

Science.gov (United States)

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

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

2011-01-01

351

Women's Reflections on Choosing Quality Long Day Care in a Regional Community  

Science.gov (United States)

This article qualitatively explores women's experiences of choosing quality long day care in a regional community. The study complements recent quantitative research on the quality implications of increased for-profit childcare provision. It also adds to our understanding of current childcare policy by focusing on the experiences of women in a…

Harris, Nonie

2008-01-01

352

The Quality of Early Childhood Educators: Children's Interaction in Greek Child Care Centers  

Science.gov (United States)

Though quality in early childhood education and care has attracted last decades enormous research interest there is still not a unanimous agreement about its definition. Yet, almost all definitions attempted include interaction, group size, adult:child ratio and early childhood educators' level of education, as important indices of quality.…

Rentzou, Konstantina; Sakellariou, Maria

2011-01-01

353

Delaware Stars for Early Success. QRS Profile. The Child Care Quality Rating System (QRS) Assessment  

Science.gov (United States)

This paper presents a profile of Delaware's Stars for Early Success 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

354

Kentucky STARS for KIDS NOW: QRS Profile. The Child Care Quality Rating System (QRS) Assessment  

Science.gov (United States)

This paper presents a profile of Kentucky's STARS for KIDS NOW 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

355

Pennsylvania Keystone STARS: QRS Profile. The Child Care Quality Rating System (QRS) Assessment  

Science.gov (United States)

This paper presents a profile of Pennsylvania's Keystone STARS 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

356

Colorado Qualistar. QRS Profile. The Child Care Quality Rating System (QRS) Assessment  

Science.gov (United States)

This paper presents a profile of Colorado's Qualistar 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

357

Minnesota Parent Aware: QRS Profile. The Child Care Quality Rating System (QRS) Assessment  

Science.gov (United States)

This paper presents a profile of Minnesota's Parent Aware 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

358

North Carolina Star Rated License System: QRS Profile. The Child Care Quality Rating System (QRS) Assessment  

Science.gov (United States)

This paper presents a profile of North Carolina's Star Rated License 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

359

Changes in the relationship between nursing home financial performance and quality of care under public reporting.  

Science.gov (United States)

The relationship between financial performance and quality of care in nursing homes is not well defined and prior work has been mixed. The recent focus on improving the quality of nursing homes through market-based incentives such as public reporting may have changed this relationship, as public reporting provides nursing homes with increased incentives to engage in quality-based competition. If quality improvement activities require substantial production costs, nursing home profitability may become a more important predictor of quality under public reporting. This study explores the relationship between financial performance and quality of care and test whether this relationship changes under public reporting. Using a 10-year (fiscal years 1997-2006) panel data set of 9444 skilled nursing facilities in the US, this study employs a facility fixed-effects with and without instrumental variables approach to test the effect of finances on quality improvement and correct for potential endogeneity. The results show that better financial performance, as reflected by the 1-year lagged total profit margin, is modestly associated with higher quality but only after public reporting is initiated. These findings have important policy implications as federal and state governments use market-based incentives to increase demand for high-quality care and induce providers to compete based on quality. PMID:20578255

Park, Jeongyoung; Werner, Rachel M

2011-07-01

360

Physician leadership: a health-care system's investment in the future of quality care.  

Science.gov (United States)

The current state of health care and its reform will require physician leaders to take on greater management responsibilities, which will require a set of organizational and leadership competencies that traditional medical education does not provide. Physician leaders can form a bridge between the clinical and administrative sides of a health-care organization, serving to further the organization's strategy for growth and success. Recognizing that the health-care industry is rapidly changing and physician leaders will play a key role in that transformation, Hartford HealthCare has established a Physician Leadership Development Institute that provides advanced leadership skills and management education to select physicians practicing within the health-care system. PMID:23248866

Orlando, Rocco; Haytaian, Marcia

2012-08-01

361

Can structured data fields accurately measure quality of care? The example of falls  

Directory of Open Access Journals (Sweden)

Full Text Available By automating collection of data elements, electronic health records may simplify the process of measuring the quality of medical care. Using data from a quality improvement initiative in primary care medical groups, we sought to determine whether the quality of care for falls and fear of falling in outpatients aged 75 and older could be accurately measured solely from codable (non-free-text data in a structured visit note. A traditional medical record review by trained abstractors served as the criterion standard. Among 215 patient records reviewed, we found a structured visit note in 54% of charts within 3 mo of the date patients had been identified as having falls or fear of falling. The reliability of an algorithm based on codable data was at least good (kappa of at least 0.61 compared with full medical record review for three care processes recommended for patients with two falls or one fall with injury in the past year: orthostatic vital signs, vision test/eye examination, and home safety evaluation. However, the automated algorithm routinely underestimated quality of care. Performance standards based on automated measurement of quality of care from electronic health records need to account for documentation occurring in nonstructured form.

David A. Ganz, MD, PhD

2012-12-01

362

Non-psychotic mental disorders in the perinatal period.  

Science.gov (United States)

Mental disorders are among the most common morbidities of pregnancy and the postnatal period, and can have adverse effects on the mother, her child, and family. This Series paper summarises the evidence about epidemiology, risk factors, identification, and interventions for non-psychotic mental disorders. Although the phenomenology and risk factors for perinatal mental disorders are largely similar to those for the disorders at other times, treatment considerations differ during pregnancy and breastfeeding. Most randomised controlled trials have examined psychosocial and psychological interventions for postnatal depression, with evidence for effectiveness in treating and preventing the disorder. Few high-quality studies exist on the effectiveness or safety of pharmacological treatments in the perinatal period, despite quite high prescription rates. General principles of prescribing of drugs in the perinatal period are provided, but individual risk-benefit analyses are needed for decisions about treatment. PMID:25455248

Howard, Louise M; Molyneaux, Emma; Dennis, Cindy-Lee; Rochat, Tamsen; Stein, Alan; Milgrom, Jeannette

2014-11-15

363

Quality assessment of mental health care by people with severe mental disorders: a participatory research project.  

Science.gov (United States)

This study assessed the perceived quality of care by consumers with severe mental disorders. A questionnaire investigating service quality was developed by a consumer focus group and filled by 204 consumers. In five areas the negative evaluations exceeded or closely approximated the positive ones: choice of professionals, waiting times, information about illness and medications. All five do not refer to the outcomes of care, but to the concept of responsiveness. The results confirmed that people with severe mental disorders can give value judgments on various aspects of care. However, even in a service strongly oriented towards community care, the consumers' needs in sensitive areas concerning choices, respect and autonomy are not met. The application of the concept of responsiveness to quality improvement may help services to meet consumers' expectations. PMID:24318768

Barbato, Angelo; Bajoni, Alessia; Rapisarda, Filippo; D'Anza, Vito; De Luca, Luigi Fabrizio; Inglese, Cristiana; Iapichino, Sonia; Mauriello, Fabrizio; D'Avanzo, Barbara

2014-05-01

364

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

Directory of Open Access Journals (Sweden)

Full Text Available Introduction: Elderly people aged over 75 years with multifaceted care needs are often in need of hospital treatment. Transfer across care levels for this patient group increases the risk of adverse events. The aim of this paper is to establish knowledge of quality in transitional care of the elderly in two Norwegian hospital regions by identifying issues affecting the quality of transitional care and based on these issues suggest improvement measures.Methodology: Included in the study were elderly patients (75+ receiving health care in the municipality admitted to hospital emergency department or discharged to community health care with hip fracture or with a general medical diagnosis. Participant observations of admission and discharge transitions (n = 41 were carried out by two researchers.Results: Six main challenges with belonging descriptions have been identified: (1 next of kin (bridging providers, advocacy, support, information brokering, (2 patient characteristics (level of satisfaction, level of insecurity, complex clinical conditions, (3 health care personnel's competence (professional, system, awareness of others’ roles, (4 information exchange (oral, written, electronic, (5 context (stability, variability, change incentives, number of patient handovers and (6 patient assessment (complex clinical picture, patient description, clinical assessment.Conclusion: Related to the six main challenges, several measures have been suggested to improve quality in transitional care, e.g. information to and involvement of patients and next of kin, staff training, standardisation of routines and inter-organisational staff meetings.

Marianne Storm

2014-05-01

365

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

OpenAIRE

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

Granja, C.; Lopes, A.; Moreira, S.; Dias, C.; Costa?pereira, A.; Carneiro, A.; JMIP STUDY GROUP

2005-01-01

366

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

Science.gov (United States)

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

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

2013-04-01

367

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

Science.gov (United States)

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

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

2013-12-01

368

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

Directory of Open Access Journals (Sweden)

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

Gholam Reza Mahmodi

2012-05-01

369

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

OpenAIRE

Objective This study examined the psychosocial predictors of poor sleep quality in parents caring for children with developmental disabilities. Methods Sixty-seven parents of children with developmental disabilities and 42 parents of typically developing children completed the Pittsburgh Sleep Quality Index, and measures of parental stress, child problem behaviors, and social support. Results Parents of children with developmental disabilities reported poorer sleep quality. Further, the major...

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

2010-01-01

370

Private Health Care and Drug Quality in Germany – A Game-Theoretical Approach  

OpenAIRE

Quality of medical treatment is a major goal of Germany's statutory health insurance system. According to our game theoretical approach, existing price-discrimination between statutory and private health insurance leads to a higher quality of innovative drugs. Hence, a move into the direction of a single payer health care (so-called citizens’ insurance) should result in a reduction of innovative drugs' quality. Moreover, and in the case of citizens insurance's implementation, innovative dru...

Tristan Nguyen; Karsten Rohlf

2012-01-01

371

The changing pattern of perinatal mortality and causes of death in central Anatolian region of Turkey.  

Science.gov (United States)

In this study, the perinatal mortality is presented in 2009 compared to 1998. Changing patterns of the perinatal mortality rate (PNMR), the stillbirth rate (SBR), early neonatal mortality rate (ENMR) and the causes of the perinatal mortality in Zekai Tahir Burak Women's Health Education and Research Hospital (ZTBH) were described. This is the largest maternity hospital of Ankara in the central Anatolian region of Turkey. The total deliveries were 22,777 and 18,567 in 1998 and 2009, respectively. PNMR was 27.7 per 1000, and SBR was 23.7 per 1000 total births. ENMR was 4 per 1000 in 1998. PNMR is 20.7 per 1000, and SBR was 16.3 per 1000 and ENMR was 4.6 per 1000 total births in 2009. It is important to know the causes of mortality. In this study, the causes of perinatal deaths were classified according to the Wigglesworth classification. Antepartum stillbirth (62.3%) was the most frequent cause in 1998. Perinatal asphyxia is the majority (46.6%) of the perinatal deaths in 2009. This study shows that even prenatal care is getting better, obstetric care as well as close follow-up throughout the intrapartum period and diminishing the preterm delivery rate is also important for preventing and reducing perinatal mortality. PMID:22339476

Ecevit, Ayse; Oguz, Suna Serife; Tarcan, Aylin; Yazici, Canan; Dilmen, Ugur

2012-09-01

372

Assessing organizational readiness for depression care quality improvement: relative commitment and implementation capability.  

Science.gov (United States)

BackgroundDepression is a major cause of morbidity and cost in primary care patient populations. Successful depression improvement models, however, are complex. Based on organizational readiness theory, a practice¿s commitment to change and its capability to carry out the change are both important predictors of initiating improvement. We empirically explored the links between relative commitment (i.e., the intention to move forward within the following year) and implementation capability.MethodsThe DIAMOND initiative administered organizational surveys to medical and quality improvement leaders from each of 83 primary care practices in Minnesota. Surveys preceded initiation of activities directed at implementation of a collaborative care model for improving depression care. To assess implementation capability, we developed composites of survey items for five types of organizational factors postulated to be collaborative care barriers and facilitators. To assess relative commitment for each practice, we averaged leader ratings on an identical survey question assessing practice priorities. We used multivariable regression analyses to assess the extent to which implementation capability predicted relative commitment. We explored whether relative commitment or implementation capability measures were associated with earlier initiation of DIAMOND improvements.ResultsAll five implementation capability measures independently predicted practice leaders¿ relative commitment to improving depression care in the following year. These included the following: quality improvement culture and attitudes (p =0.003), depression culture and attitudes (p commitment (p¿=¿0.002) and prior depression quality improvement activities appeared to be associated with earlier participation in the DIAMOND initiative.ConclusionsThe study supports the concept of organizational readiness to improve quality of care and the use of practice leader surveys to assess it. Practice leaders¿ relative commitment to depression care improvement may be a useful measure of the likelihood that a practice is ready to initiate evidence-based depression care changes. A comprehensive organizational assessment of implementation capability for depression care improvement may identify specific barriers or facilitators to readiness that requires targeted attention from implementers. PMID:25443652

Rubenstein, Lisa V; Danz, Marjorie S; Crain, A; Glasgow, Russell E; Whitebird, Robin R; Solberg, Leif I

2014-12-01

373

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

Directory of Open Access Journals (Sweden)

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

Nembhard Ingrid M

2009-05-01

374

Implementing collaborative care for depression treatment in primary care: A cluster randomized evaluation of a quality improvement practice redesign  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Background Meta-analyses show collaborative care models (CCMs with nurse care management are effective for improving primary care for depression. This study aimed to develop CCM approaches that could be sustained and spread within Veterans Affairs (VA. Evidence-based quality improvement (EBQI uses QI approaches within a research/clinical partnership to redesign care. The study used EBQI methods for CCM redesign, tested the effectiveness of the locally adapted model as implemented, and assessed the contextual factors shaping intervention effectiveness. Methods The study intervention is EBQI as applied to CCM implementation. The study uses a cluster randomized design as a formative evaluation tool to test and improve the effectiveness of the redesign process, with seven intervention and three non-intervention VA primary care practices in five different states. The primary study outcome is patient antidepressant use. The context evaluation is descriptive and uses subgroup analysis. The primary context evaluation measure is naturalistic primary care clinician (PCC predilection to adopt CCM. For the randomized evaluation, trained telephone research interviewers enrolled consecutive primary care patients with major depression in the evaluation, referred enrolled patients in intervention practices to the implemented CCM, and re-surveyed at seven months. Results Interviewers enrolled 288 CCM site and 258 non-CCM site patients. Enrolled intervention site patients were more likely to receive appropriate antidepressant care (66% versus 43%, p = 0.01, but showed no significant difference in symptom improvement compared to usual care. In terms of context, only 40% of enrolled patients received complete care management per protocol. PCC predilection to adopt CCM had substantial effects on patient participation, with patients belonging to early adopter clinicians completing adequate care manager follow-up significantly more often than patients of clinicians with low predilection to adopt CCM (74% versus 48%%, p = 0.003. Conclusions Depression CCM designed and implemented by primary care practices using EBQI improved antidepressant initiation. Combining QI methods with a randomized evaluation proved challenging, but enabled new insights into the process of translating research-based CCM into practice. Future research on the effects of PCC attitudes and skills on CCM results, as well as on enhancing the link between improved antidepressant use and symptom outcomes, is needed. Trial Registration ClinicalTrials.gov: NCT00105820

Lee Martin

2011-10-01

375

The effect of point of care technology on the quality of patient care.  

OpenAIRE

It is thought that new technologies like computers at the patient's bedside, or point of care technology (PCT) improve nursing productivity, documentation, patient satisfaction and decrease costs. Using the Health Care Technology Assessment (HCTA) framework, (safety, cost, effectiveness, social impact), a descriptive and quasi-experimental study was performed to test the effectiveness and explain the social impact of PCT. A sample of 90 patients from five nursing units in three hospitals were...

Happ, B. A.

1993-01-01

376

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

OpenAIRE

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 fi...

Kosloff, Thomas M.; Elton, David; Shulman, Stephanie A.; Clarke, Janice L.; Skoufalos, Alexis; Solis, Amanda

2013-01-01

377

[Access to quality primary care for LGBT people].  

Science.gov (United States)

This article offers a comprehensive approach to the health of lesbian, gay, bisexual and transgender (LGBT) people, where respect for diversity and non judgemental care play a central role. It calls for a health and medical vision that goes beyond HIV risk. For those who never had to question their own sexual orientation or gender identity, it is certainly difficult to understand how the discovery of one's identity trait in childhood or early adolescence can be transformed under social pressure into a burden which often remains invisible but is associated with considerable emotional and medical morbidity. This article raises the following question: How many LGBT patients go unnoticed every week, leaving the physician's office without an opportunity to receive appropriate listening, support and care? PMID:21987880

Bize, Raphaël; Volkmar, Erika; Berrut, Sylvie; Medico, Denise; Balthasar, Hugues; Bodenmann, Patrick; Makadon, Harvey J

2011-09-01

378

Quality assurance: standards of care and ethical practice  

OpenAIRE

In the past, standards of care in chiropractic were based upon the bias, empiricism and little if any scientific work by the author. This was due, in part, to history which fostered the belief that all that was needed was anecdotal testimony and in part to the isolation of chiropractic colleges from main stream science. Today, standards are being based upon the scientific evaluation of the clinical procedures used and formulated by consensus of experts within the profession. The chiropractic ...

Vear, Herbert J.

1991-01-01

379

Perinatal programming prevention measures.  

Science.gov (United States)

Over the past 10 years, there has been outstanding scientific progress related to perinatal programming and its epigenetic effects in health, and we can anticipate this trend will continue in the near future. We need to make use and apply these achievements to human neurodevelopment via prevention interventions. Based on the concept of the interaction between genome and ambiome, this chapter proposes low-cost easy-implementation preventive strategies for maternal and infant health institutions.Breastfeeding and human milk administration are the first preventive measures, as has been reviewed in the policy statement of the American Academy of Pediatrics. Another strategy is the Safe and Family-Centered Maternity Hospitals initiative that promotes and empowers the inclusion of the families and the respect for their rights, especially during pregnancy and birth. (This change of paradigm was approved and is recommended by both United Nations Children's Fund, UNICEF, and Pan American Health Organization, PAHO.) Then, there is also an important emphasis given to the sacred hour-which highlights the impact of bonding, attachment, and breastfeeding during the first hour of life-the pain prevention and treatment in newborns, the control of the "new morbidity" represented by late preterm infants, and finally, the importance of avoiding intrauterine and extrauterine growth restriction. (However, there are not yet clear recommendations about nutritional interventions in order to diminish the potential metabolic syndrome consequence in the adult.). PMID:25287552

Larguía, A Miguel; González, María Aurelia; Dinerstein, Néstor Alejandro; Soto Conti, Constanza

2015-01-01

380

Preschool center care quality effects on academic achievement: an instrumental variables analysis.  

Science.gov (United States)

Much of child care research has focused on the effects of the quality of care in early childhood settings on children's school readiness skills. Although researchers increased the statistical rigor of their approaches over the past 15 years, researchers' ability to draw causal inferences has been limited because the studies are based on nonexperimental designs. The purpose of the present study was to demonstrate how an instrumental variables approach can be used to estimate causal impacts of preschool center care quality on children's academic achievement when applied to a study in which preschool curricula were randomly assigned across multiple sites. We used data from the Preschool Curriculum Evaluation Research Initiative (PCER; n = 2,700), in which classrooms or preschools were randomly assigned to that grantee's treatment curriculum or "business as usual" conditions in 18 research sites. Using this method, we demonstrate how developmental researchers can exploit the random-assignment designs of multisite studies to investigate characteristics of programs, such as preschool center care quality, that cannot be randomly assigned and their impacts on children's development. We found that the quality of preschool care received by children has significant, albeit modest, effects on children's academic school readiness, with effect sizes of .03 to .14 standard deviation increases in academic achievement associated with a 1 standard deviation increase in quality. Applications and potential policy implications of this method are discussed. PMID:25437755

Auger, Anamarie; Farkas, George; Burchinal, Margaret R; Duncan, Greg J; Vandell, Deborah Lowe

2014-12-01

381

Birthing experience of adolescents at the Ottawa General Hospital Perinatal Centre.  

OpenAIRE

OBJECTIVE: To study the experiences of prenatal care, prenatal classes and birthing among adolescents. DESIGN: Anonymous self-report questionnaire survey. SETTING: Ottawa General Hospital Perinatal Centre. PATIENTS: A total of 100 adolescents (aged less than 20 years) and 100 control subjects (aged over 19 years) who gave birth at the Perinatal Centre from June 1989 to August 1990. MAIN OUTCOME MEASURES: Prenatal experiences, attendance at prenatal classes, experiences in labour and delivery,...

Lena, S. M.; Marko, E.; Nimrod, C.; Merritt, L.; Poirier, G.; Shein, E.

1993-01-01

382

Long-term effects of perinatal glucocorticoid treatment on the heart  

OpenAIRE

Long-term effects of perinatal glucocorticoid treatment on the heart Chronic lung disease in the extremely preterm baby is still a major complication in neonatal intensive care medicine. Perinatal (ante- and neonatal) glucocorticoids are widely used to prevent severe infant respiratory syndrome and to reduce chronic lung disease. The aim of this thesis was to describe the histopathological, functional and hemodynamic impact of antenatal and neonatal glucocorticoid treatment on the developing ...

Vries, W. B.

2006-01-01

383

Organizational factors associated with quality of care in US teaching hospitals.  

Science.gov (United States)

This study is unique because it uses multiple regression and data envelopment analysis (DEA) to evaluate teaching hospital quality. The results support the premise that teaching hospital leadership through the effective allocation of resources can improve the quality of care. This study has managerial implications by demonstrating the positive correlation between HMO market penetration and improved clinical quality outcomes. This would suggest that improved efficiency caused by limited HMO reimbursement and tight utilization controls encourage hospitals to cut waste as well as improve their clinical care processes. Additionally, our research found that teaching hospitals with higher levels of long-term debt also had improved quality. This shows that increased investments in facilities and advanced technology at teaching hospitals can lead to enhanced quality. PMID:22329326

Harrison, Jeffrey P; Lambiase, Louis R; Zhao, Mei

2010-01-01

384

Factors associated with and causes of perinatal mortality in northeastern Tanzania  

DEFF Research Database (Denmark)

Objective. To identify factors associated with perinatal mortality in northeastern Tanzania. Design. Prospective cohort study. Setting. Northeastern Tanzania. Population. 872 mothers and their newborns. Methods. Pregnant women were screened for factors possibly associated with perinatal mortality, including preeclampsia, small-for-gestational age, preterm delivery, anemia, and health-seeking behavior. Fetal growth was monitored using ultrasound. Finally, the specific causes of the perinatal deaths were evaluated. Main outcome measure. Perinatal mortality. Results. Forty-six deaths occurred. Key factors associated with perinatal mortality were preterm delivery (adjusted odds ratio (OR) 14.47, 95% confidence interval (CI) 3.23-64.86, p <0.001), small-for-gestational age (adjusted OR 3.54, 95%CI 1.18-10.61, p = 0.02), and maternal anemia (adjusted OR 10.34, 95%CI 1.89-56.52, p = 0.007). Adherence to the antenatal care program (adjusted OR 0.027, 95%CI 0.003-0.26, p = 0.002) protected against perinatal mortality.The cause of death in 43% of cases was attributed to complications related to labor and specifically to intrapartum asphyxia (30%) and neonatal infection (13%). Among the remaining deaths, 27% (7/26) were attributed to preeclampsia and 23% (6/26) to small-for-gestational age. Of these, 54% (14/26) were preterm. Conclusions. Preeclampsia, small-for-gestational age and preterm delivery were key risk factors and causes of perinatal mortality in this area of Tanzania. Maternal anemia was also strongly associated with perinatal mortality. Furthermore, asphyxia accounted for a large proportion of the perinatal deaths. Interventions should target the prevention and handling of these conditions in order to reduce perinatal mortality.

Schmiegelow, Christentze; Minja, Daniel

2012-01-01

385

The Human Side of Quality: Employee Care and Empowerment.  

Science.gov (United States)

Frequently, educational institutions seeking to implement Total Quality Management (TQM) as a means to improve institutional effectiveness, overemphasize training in the application of TQM tools and fail to fully address human needs and concerns, such as the critical issue of employee empowerment. Four principal barriers exist to adequately…

Thor, Linda M.

386

Centre-Based Child Care Quality in Urban Australia  

Science.gov (United States)

This study investigates the quality of childcare centres in urban Australian communities designated according to different bands of Centre Location Demographics (CLD). Childcare centres were assessed using the Early Childhood Environment Rating Scale- Revised Edition (ECERS-R) and the Early Childhood Environment Rating Scale-Extension (ECERS-E).…

Ishimine, Karin; Wilson, Rachel

2009-01-01

387

Disparities in Health Care Quality among Minority Women  

Science.gov (United States)

... Library of Resources Resources Education & Training Continuing Education Curriculum Tools Hospitals & Health Systems Hospital Resources Long-Term ... Children's Health Insurance Program Reauthorization Act (CHIPRA) National Evaluation of the Quality Demonstration Grant ... Research Tools & Data Data Resources Data Sources Available from ...

388

Mothers on the margins: implications for eradicating perinatal HIV.  

Science.gov (United States)

Tactics aimed at reducing perinatal transmission of HIV are proving ineffective at accomplishing complete eradication: a group of women with HIV remain at very high risk for transmitting the virus to their newborns. This study engaged a uniquely high-risk group of HIV-infected mothers as expert informants on childbearing with HIV to inform strategies to eradicate perinatal HIV transmission. The sample draws from an Illinois Department of Children and Family Services (DCFS) database of 1104 HIV-seropositive women with children in protective services between 1989 and 2001. Of these, 32 women knew their HIV-positive status and gave birth to at least two children after 1997 (zidovudine widely implemented as standard of care). Twelve were accessible and consented to participate. Three others, currently pregnant, also participated. Fifteen interviews were completed. The 15 women had given birth to 78 children (9 HIV-infected), fathered by 62 men. Respondents were severely socioeconomically marginalized. They were aware of their HIV status and the benefits of prophylaxis, most desired healthy babies to parent, and most delivered their babies in hospitals equipped to provide adequate prophylaxis. Yet most received inadequate or no prenatal care and did not disclose their HIV status at delivery. Women indicated that denial and substance use were the primary intrinsic barriers and disrespectful treatment was the primary extrinsic barrier to disclosure and care. Women's recommendations about eradication of perinatal HIV transmission emphasized the problem of substance use, the need for private and thorough communication with medical and DCFS personnel, and the need for positive social relationships to enable HIV positive mothers to engage in care. Attention to potent social and institutional barriers that impair the ability of the most marginalized women to disclose their HIV status and accept care is essential to realize eradication of perinatal transmission. PMID:15992982

Lindau, Stacy Tessler; Jerome, Jessica; Miller, Kate; Monk, Elizabeth; Garcia, Patricia; Cohen, Mardge

2006-01-01

389

The Versatility of the Perinatal Educator  

OpenAIRE

Perinatal educators can expand their role beyond that of childbirth preparation. One such role is the perinatal bereavement counselor. Having the courage to balance one's skills with one's intuitive impulses may greatly enrich carrying out this or any role.

Humenick, Sharron S.

1999-01-01

390

Exploring the relationship between inpatient hospital costs and quality of care.  

Science.gov (United States)

This research explores the potential benefit of improving the clinical quality and reducing the cost of inpatient care using administrative data to inform or restrict provider choice. Cost and quality measures derived from this source are already available to purchasers, payers, and consumers in support of insurance products designed to provide financial incentives for consumers to seek high-quality, low-cost care. It will be important to further refine the clinical and cost data to take into account measurable differences in the severity of illness of patients, and to acknowledge that some of the differences in cost or quality variation among hospitals may not be captured despite such refinements. Medicare cost report data is merged with Uniform Hospital Discharge Abstracts to identify the additional direct cost of patients experiencing 1 of 6 poor clinical outcomes, or admissions for ambulatory care sensitive conditions, or selected surgical procedures at low volume hospitals. Variability in case mix-adjusted cost per case among community and teaching hospital groups is also quantified; measurable quality differences between low cost and other hospitals in each group is described. Our results suggest that, despite implementation challenges, purchaser and payer initiatives that encourage consumers to seek lower cost inpatient care without sacrificing clinical quality are worth pursuing. PMID:12817615

Siegrist, Richard B; Kane, Nancy M

2003-06-01

391

Michigan's Fee-For-Value Physician Incentive Program Reduces Spending And Improves Quality In Primary Care.  

Science.gov (United States)

As policy makers and others seek to reduce health care cost growth while improving health care quality, one approach gaining momentum is fee-for-value reimbursement. This payment strategy maintains the traditional fee-for-service arrangement but includes quality and spending incentives. We examined Blue Cross Blue Shield of Michigan's Physician Group Incentive Program, which uses a fee-for-value approach focused on primary care physicians. We analyzed the program's impact on quality and spending from 2008 to 2011 for over three million beneficiaries in over 11,000 physician practices. Participation in the incentive program was associated with approximately 1.1 percent lower total spending for adults (5.1 percent lower for children) and the same or improved performance on eleven of fourteen quality measures over time. Our findings contribute to the growing body of evidence about the potential effectiveness of models that align payment with cost and quality performance, and they demonstrate that it is possible to transform reimbursement within a fee-for-service framework to encourage and incentivize physicians to provide high-quality care, while also reducing costs. PMID:25847648

Lemak, Christy Harris; Nahra, Tammie A; Cohen, Genna R; Erb, Natalie D; Paustian, Michael L; Share, David; Hirth, Richard A

2015-04-01

392

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

Science.gov (United States)

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

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

2015-04-01

393

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

OpenAIRE

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

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

2005-01-01

394

Perinatal mortality in Indonesia: an unfinished agenda  

Directory of Open Access Journals (Sweden)

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

Riawati Jahja

2011-11-01

395

Improving Social Work in Intensive Care Unit Palliative Care: Results of a Quality Improvement Intervention  

Science.gov (United States)

Abstract Objective The intensive care unit (ICU) is a focal point for decision making in end-of-life care. Social workers are involved in providing this care for patients and families. Our goal was to examine the social worker component of an intervention to improve interdisciplinary palliative care in the ICU. Methods The study took place at a 350-bed hospital with 65 ICU beds. We surveyed family members and social workers caring for patients who died in the ICU or within 30 hours of transfer from ICU. Clustered regression was used to assess the effect of the intervention on three outcomes: (1) families' satisfaction with social work, (2) social workers' reported palliative and supportive activities, and (3) social workers' satisfaction with meeting family needs. Results Of 590 eligible patients, 275 families completed surveys (response rate, 47%). Thirty-five social workers received 353 questionnaires concerning 353 unique patients and completed 283 (response rate, 80%). Social workers reported significant increase in the total number of activities for family members after the intervention. Some of the activities included addressing spiritual or religious needs, discussing disagreement among the family, and assuring family the patient would be kept comfortable. Neither social workers' satisfaction with meeting families' needs nor family ratings of social workers were higher after the intervention. Increased social worker experience and smaller social worker caseload were both associated with increased family satisfaction with social work. Discussion The increase in social worker-reported activities supports the value of the interdisciplinary intervention, but we did not demonstrate improvements in other outcomes. Increased social-worker experience and decreased social worker caseload were independently associated with better family ratings of social workers suggesting future directions for interventions to improve care by social workers. Future studies will need more powerful interventions or more sensitive outcome measures to document improvements in family-assessed outcomes. PMID:20078245

McCormick, Andrew J.; Stowell-Weiss, Patti; Toms, Carol; Engelberg, Ruth

2010-01-01

396

Quality Reforms in Danish Home Care : Balancing between Standardisation and Individualisation  

DEFF Research Database (Denmark)

Despite relatively generous coverage of the over-65 population, Danish home help services receive regular criticism in the media and public opinion polls. Perhaps as a consequence, reforms of Danish home care policy for senior citizens have placed strong emphasis on quality since the 1990s. This reform strategy represents a shift from the welfare state modernisation program of the 1980s, which built mainly on economic strategies of cost-efficiency and New Public Management (NPM) princi-ples, including contract management and performance management. Recent reforms have instead attempted to increase the overall quality of care by increasing the transparency at the political, administrative and user levels. However, reforms have revolved around conflicting principles of standardisation and the individualisation of care provision and primarily succeeded in increasing the political and ad-ministrative control over home help at the expense of the control by users, care workers and case managers.

Rostgaard, Tine

2012-01-01

397

Quality of care and mortality among patients with stroke - A nationwide follow-up study  

DEFF Research Database (Denmark)

Background: The relationship between process and outcome measures among patients with stroke is unclear. Objectives: To examine the association between quality of care and mortality among patients with stroke in a nationwide population-based follow-up study. Methods: Using data from The Danish National Indicator Project, a quality improvement initiative with participation of all Danish hospital departments caring for patients with stroke, we identified 29,573 patients hospitalized with stroke between January 13, 2003 and October 31, 2005. Quality of care was measured in terms of 7 specific criteria: early admission to a stroke unit, early initiation of antiplatelet or oral anticoagulant therapy, early examination with computed tomography/magnetic resonance imaging scan, and early assessment by a physiotherapist, an occupational therapist, and of nutritional risk. Data on 30- and 90-day mortality rates were obtained through the Danish Civil Registration System. Results: Six of 7 of these criteria were associated with lower 30- and 90-day mortality rates. Adjusted mortality rate ratios corrected for clustering by department ranged from 0.41 to 0.83. We found indication of an inverse dose-response relationship between the number of quality of care criteria met and mortality; the lowest mortality rate was found among patients whose care met all criteria compared with patients whose care failed to meet any criteria (ie, adjusted 30-day mortality rate ratios: 0.45, 95% confidence interval: 0.24-0.66). When analyses were stratified by age and sex, the dose-response relationship was found in all subgroups. Conclusions: Higher quality of care during the early phase of stroke was associated with substantially lower mortality rates Udgivelsesdato: 2008/1

Ingeman, A.; Pedersen, Lars

2008-01-01

398

Use of a customer satisfaction survey by health care regulators: a tool for total quality management.  

OpenAIRE

OBJECTIVES: To conduct a survey of health care providers to determine the quality of service provided by the staff of a regulatory agency; to collect information on provider needs and expectations; to identify perceived and potential problems that need improvement; and to make changes to improve regulatory services. METHODS: The authors surveyed health care providers using a customer satisfaction questionnaire developed in collaboration with a group of providers and a research consultant. The...

Andrzejewski, N.; Lagua, R. T.

1997-01-01

399

Assessment of medical care by elderly people: general satisfaction and physician quality.  

OpenAIRE

OBJECTIVE: To identify personal characteristics and factors related to health and patterns of healthcare utilization associated with the elderly people's satisfaction with medical care. DATA SOURCES/STUDY SETTING: Data from the 1991 Medicare Current Beneficiary Survey (MCBS) on 8,859 persons age 65 and over living in the community. STUDY DESIGN: Items reflecting general satisfaction with care and views of physician quality are examined and, based on factor analysis, grouped in dimensions of t...

Lee, Y.; Kasper, J. D.

1998-01-01

400

An evaluation of the quality of care midwives provide during the postpartum period in northern Botswana  

OpenAIRE

Objective: To assess the quality of care midwives provide to clients during the postpartum period. Design: A cross sectional descriptive qualitative and quantitative survey among 65 practising registered nurse midwives. They were interviewed and observed in health institutions while examining the mother and baby prior to discharge. A convenient non-probability sampling was used to identify and select respondents from 14 primary health care facilities in northern Botswana, who were actively in...

Kebalepile, Tapiwa Mavis

2001-01-01

401

Patient assessment of physician performance of epilepsy quality-of-care measures  

OpenAIRE

To identify gaps in physician practice of epilepsy care, an online survey was sent to members of a Web-based epilepsy community to ascertain whether their physician performed 8 quality measures for epilepsy care. A total of 221 of 348 recently active epilepsy patients (64%) completed the survey. More than 80% of patients agreed they knew their seizure type, epilepsy syndrome, current seizure frequency, and had an EEG and neuroimaging. Fewer (60%) recalled being asked about medication side eff...

Wicks, Paul; Fountain, Nathan B.

2012-01-01

402

Quality improvement in the care of patients with inflammatory bowel disease  

OpenAIRE

A range of studies have supported the existence of a gap between what medicine could possibly deliver and what it actually does deliver. This is also true for the delivery of care to patients with inflammatory bowel disease (IBD) and several international stakeholders have called for action. The aim of this thesis was to describe, study and evaluate a quality improvement intervention (QII) in the care for patients with IBD in a population-based setting, with special reference to clinical rede...

Rejler, Martin

2012-01-01

403

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

OpenAIRE

Abstract Background Primary health care is recognized as a main driver of equitable health service delivery. For it to function optimally, routine health information systems (HIS) are necessary to ensure adequate provision of health care and the development of appropriate health policies. Concerns about the quality of routine administrative data have undermined their use in resource-limited settings. This evaluation was designed to describe the availability, reliability, and validity of a sam...

Cuembelo Fatima; Karagianis Marina; Lara Joseph; Lambdin Barrot; Micek Mark; Gimbel Sarah; Gloyd Stephen S; Pfeiffer James; Sherr Kenneth

2011-01-01

404

Developing a Total Quality Management Model for Health Care Systems  

OpenAIRE

Background: Total quality management (TQM) is a managerial practice to improve the effectiveness, efficiency, flexibility, and competitiveness of a business as a whole. However, in practice, these TQM benefits are not easy to achieve. Despite its theoretical promise and the enthusiastic response to TQM, recent evidence suggests that attempts to implement it are often unsuccessful. Many of these TQM programmes have been cancelled, or are in the process of being cancelled, as a result of the ne...

Am, Mosadegh Rad; Ansarian, M.

2005-01-01

405

Goals of care in advanced dementia: quality of life, dignity and comfort.  

Science.gov (United States)

Prolongation of human lifespan is increasing the number of individuals suffering from Alzheimer's disease and other progressive dementia worldwide. There are about 5 million of these individuals in both United States and European Union and many more in other countries of the world (1). Because there is no curative treatment for these diseases, most individuals with dementia survive to an advanced stage of dementia at which time many of them require institutional care. Home care for individuals with advanced dementia and especially institutional care are very expensive and are becoming major public health problems. The cost of care for advanced dementia is often increased by the use of aggressive medical interventions that may not be in the best interest of the patient. Because advanced dementia is currently incurable, it should be considered a terminal illness, similar to terminal cancer. Therefore, palliative care may be the most appropriate strategy for management of advanced dementia (2). The goals of palliative care are maintenance of quality of life, dignity and comfort and the four articles in this special issue are addressing these goals. Enhancement of quality of life in dementia requires attention to three main domains: provision of meaningful activities, appropriate medical care, and treatment of behavioral symptoms (3). Individuals with advanced dementia may not be able to participate in many activity programs but they still may maintain some quality of life if they are provided care in a pleasant environment with constant presence of a caregiver. Simard describes a program, Namaste Care, which is specifically tailored for individuals with advanced dementia. This program requires neither major expenditure nor increased staffing and should be instituted in all facilities that care for individuals with advanced dementia. Maintaining functional status of individuals with advanced dementia is important because it improves their self esteem and facilitates provision of care. Van der Steen et al. present evidence that lower respiratory tract infection leads frequently but not always to functional decline. However, it is significant that the Dutch participants in this study were never hospitalized and always treated in a nursing home. Hospitalization leads to functional deterioration even in cognitively intact elderly individuals (4). In addition, treatment of lower respiratory infection is more effective when provided in a nursing home than when the resident is transferred to an acute care setting (5). It should also be considered that antibiotic treatment of lower respiratory tract infections in individuals with terminal dementia does not increase their comfort and lifespan (6). Dignity is an often invoked goal of care in dementia but it is often poorly defined and characterized. Holmerova et al. provide a detailed description of the concept of dignity and its application in dementia care. They also present two specific examples of problems encountered when individuals with advanced dementia are treated insensitively in an acute care setting. Dignity oriented care should treat everybody as an individual and provide care according to the goals of care determined before any crisis situation (7). Namaste Care is an example of care setting that respects individual's dignity until death; respecting "the spirit within". Tube feeding in individuals with advanced progressive dementia does not promote quality of life, dignity or comfort. Tube feeding deprives individuals from contact with the caregiver during hand feeding and from enjoyment of the taste of food. Tube feeding often requires use of restraints that decreases an individual's dignity and comfort. Despite the lack of beneficial effects and the burdens that the tube feeding imposes (8), it is still widely used in individuals with advanced dementia. Pang et al. compare the use of tube feeding in two different settings of dementia care, one in which tube feeding is not used and one in which everybody dies with some form of artificial feeding. She documents

Volicer, L

2007-01-01

406

Psychosocial impact of perinatal loss among Muslim women  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Background Women of reproductive age are vulnerable to psychosocial problems, but these have remained largely unexplored in Muslim women in developing countries. The aim of this study was to explore and describe psychosocial impact and social support following perinatal loss among Muslim women. Methods A qualitative study was conducted in a specialist centre among Muslim mothers who had experienced perinatal loss. Purposive sampling to achieve maximum variation among Muslims in relation to age, parity and previous perinatal death was used. Data was collected by focus group discussion and in-depth unstructured interview until the saturation point met. Sixteen mothers who had recent perinatal loss of wanted pregnancy, had received antenatal follow up from public or private health clinics, and had delivery in our centre participated for the study. All of them had experienced psychological difficulties including feelings of confusion, emptiness and anxiety over facing another pregnancy. Results Two out of sixteen showed anger and one felt guilt. They reported experiencing a lack of communication and privacy in the hospital during the period of grief. Family members and friends play an important role in providing support. The majority agreed that the decision makers were husbands and families instead of themselves. The respondents felt that repetitive reminder of whatever happened was a test from God improved their sense of self-worth. They appreciated this reminder especially when it came from husband, family or friends closed to them. Conclusion Muslim mothers who had experienced perinatal loss showed some level of adverse psychosocial impact which affected their feelings. Husbands and family members were the main decision makers for Muslim women. Health care providers should provide psychosocial support during antenatal, delivery and postnatal care. On-going support involving husband should be available where needed.

Sutan Rosnah

2012-06-01

407

LEVEL OF WAGES OF THE STAFF AND THE QUALITY OF PATIENT CARE: A COMPARATIVE CHARACTERISTIC  

Directory of Open Access Journals (Sweden)

Full Text Available In work are presented the main results received during social and hygienic research, directed on studying and comparison of level of a salary of the medical personnel of a number of treatment-and-prophylactic establishments of the Moscow region and quality of the medical care rendered to patients are presented. Estimating results of examination of quality of medical care in the studied medical institutions from medical insurance companies, it should be noted that improvements of quality of medical care rendered to the population on its main indicators it is noted. Practically on all establishments the return tendency to what growth of number of defects in its rendering because of the medical organizations testifies is noted. By comparison of the data obtained during research to results questioning of working citizens in one of regions of theMoscowregion in 2012, it is established that satisfied quality of medical care appeared in policlinic – 30%, and in a hospital – only 25% of respondents.Thus, it is possible to draw a conclusion that quality of medical care doesn't grow in direct ratio to increase in financing of treatment-and-prophylactic establishments and growth of a salary of employees. The organization and personnel work incentives need treatment-and-prophylactic establishments further and systematic improvement. Quality achievement of medical care rendered to patients is impossible without creation of accurate system of motivation of the personnel and basic change of system of the organization and management of the medical organizations.DOI: http://dx.doi.org/10.12731/2218-7405-2013-6-27

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2013-09-01

408

Perinatal sources of stem cells.  

Science.gov (United States)

Recently, stem cell biology has become an interesting topic. Several varieties of human stem cells have been isolated and identified in vivo and in vitro. Successful application of hematopoietic stem cells in hematology has led to the search for other sources of stem cells and expanding the scale of their application. Perinatal stem cells are a versatile cell population, and they are interesting for both scientific and practical objectives. Stem cells from perinatal tissue may be particularly useful in the clinic for autologous transplantation for fetuses and newborns, and after banking in later stages of life, as well as for in utero transplantation in the case of genetic disorders. In this review paper we focus on the extraction and therapeutic potential of stem cells derived from perinatal tissues such as the placenta, the amnion, amniotic fluid, umbilical cord blood and Wharton's jelly. PMID:25748624

Piskorska-Jasiulewicz, Magdalena Maria; Witkowska-Zimny, Ma?gorzata

2015-01-01

409

Doing the right thing for women and babies: policy initiatives to improve maternity care quality and value.  

Science.gov (United States)

When defined within the context of maternity care, the Institute of Medicine's six aims for health-care quality improvement provide a framework for Childbirth Connection's Maternity Quality Matters Initiative, a multipronged program agenda intended to foster a maternity care system that delivers care of the highest quality and value in order to achieve optimal health outcomes and experiences for mothers and babies. These aims also provide childbirth educators and others in the maternity care community with an ethical framework for efforts to serve childbearing women and families and ensure the best outcomes for women, babies, and families. PMID:19436596

Corry, Maureen P; Jolivet, Rima

2009-01-01