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1

Early seizures indicate quality of perinatal care.  

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An analysis of antepartum, intrapartum, and postpartum variables was performed in a retrospective controlled study of 34 normally formed term infants who had perinatal asphyxia and subsequently displayed generalised seizures within 48 hours of birth. The aim was to identify any association, firstly between these variables and seizures, and secondly between these variables and subsequent morbidity and mortality among the seizure group. Maternal age greater than 35 years, duration of labour, me...

Derham, R. J.; Matthews, T. G.; Clarke, T. A.

1985-01-01

2

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

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

Kidanto, Hussein L.

2009-01-01

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A literature review on integrated perinatal care  

Directory of Open Access Journals (Sweden)

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

Rivières-Pigeon, Catherine des

2007-01-01

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A literature review on integrated perinatal care  

Directory of Open Access Journals (Sweden)

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

Charo Rodríguez

2007-07-01

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Comparing hospital perinatal mortality rates: a quality improvement instrument.  

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This article describes the development of a reliable measurement instrument for the quality of perinatal care. The Hospital Perinatal Mortality Comparison (HPMC) predicts the expected perinatal mortality for individual hospitals, based on the perinatal mortality experienced in a group of similar newborns in a large reference population. Out of the 76 hospitals analyzed in 1990, 2 performed significantly better and 5 performed significantly worse than expected according to the logistic regression model. These results may lead to the identification of opportunities for improving the process of medical care in these hospitals. PMID:8366682

Holthof, B; Prins, P

1993-09-01

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

Scientific Electronic Library Online (English)

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

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

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

Directory of Open Access Journals (Sweden)

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

Maria Albertina Santiago Rego

2009-09-01

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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.

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

9

Enhancing regional perinatal care: a clinical traineeship for perinatal nurses in a predominantly rural area.  

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This article describes the objectives, content, teaching strategies, and evaluation methods for the Rural Perinatal Traineeship Program (RPTP). The RPTP is a five-day outreach education program sponsored by The Children's Hospital, Denver for perinatal RNs in the Rocky Mountain, western Great Plains region. The program emphasizes nursing assessment, recognition, stabilization, and transport of the high-risk pregnant woman and sick newborn. The goal is to enhance the nursing care of pregnant women and newborns provided by community hospital RNs by increasing knowledge, reviewing equipment, and updating care practices/skills. To assess effectiveness of the RPTP, participants took a pre, post, and follow-up test. Additionally, follow-up questionnaires, which identified changes in care practices and equipment acquisition, were sent at three different intervals to 299 nurses who participated from 1980-89 and their nursing directors. Overall, 105 participants (36 percent) and 110 of the 127 nursing directors (86 percent) responded to the questionnaire. Results from 86 participants who took all three tests indicated an increase in pre- to post-test scores from 76 percent to 89 percent (p care practices, with 77 percent implemented; and 68 pieces of equipment of which 90 percent were acquired. Suggestions from past participants and nursing directors continue to influence the RPTP in the 1990s. PMID:8433701

Clarke, S B

1993-02-01

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

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

Manandhar Dharma

2005-03-01

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

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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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Quality of care: assessment  

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

Sridhar Gumpeny

2007-04-01

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A template for defining the perinatal care of monochorionic twins: the Istanbul international ad hoc committee.  

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This template was produced by the Working Group on Multiple Pregnancy and was endorsed by the International Board of the World Association of Perinatal Medicine. The purpose of this document is to expand the 2007 Istanbul international consensus statement on the perinatal care of multiple pregnancy and to focus on the care of monochorionic (MC) twins. The document represents the view and opinion of individuals who composed this ad hoc committee and discusses various aspects that are specific and relevant to the care of MC twin gestations. PMID:20156008

Blickstein, Isaac; Arabin, Birgit; Lewi, Liesbeth; Matias, Alexandra; Kavak, Zehra Nese; Basgul, Alin; Kalish, Robin; Vladareanu, Radu; Valderanu, Radu; Ville, Yves

2010-03-01

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

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

Saastad, Eli

2006-01-01

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Why and How Was Regionalization of Perinatal Care Accomplished in Portugal?  

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Portuguese health care system was created in 1979. It is universal and for free. Expenses are supported by the State through taxes. The modern perinatal care system started by the end of 1970. The first neonatal intensive care units were created in 1980, the Portuguese Neonatal Society in 1985 and the National Neonatal Transport System in 1987. Until the seventies of twentieth century and even during eighties there were more than 200 hospitals with deliveries, a great part without ob...

Neto, Mt

2011-01-01

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Care seeking at time of childbirth, and maternal and perinatal mortality in Matlab, Bangladesh  

Science.gov (United States)

Abstract Objective To examine the nature of the relationship between the use of skilled attendance around the time of delivery and maternal and perinatal mortality. Methods We analysed health and demographic surveillance system data collected between 1987 and 2005 by the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B) in Matlab, Bangladesh. Findings The study recorded 59 165 pregnancies, 173 maternal deaths, 1661 stillbirths and 1418 early neonatal deaths in its service area over the study period. During that time, the use of skilled attendance during childbirth increased from 5.2% to 52.6%. More than half (57.8%) of the women who died and one-third (33.7%) of those who experienced a perinatal death (i.e. a stillbirth or early neonatal death) had sought skilled attendance. Maternal mortality was low among women who did not seek skilled care (160 per 100 000 pregnancies) and was nearly 32 times higher (adjusted odds ratio, OR: 31.66; 95% confidence interval, CI: 22.03–45.48) among women who came into contact with comprehensive emergency obstetric care. Over time, the strength of the association between skilled obstetric care and maternal mortality declined as more women sought such care. Perinatal death rates were also higher for those who sought skilled care than for those who did not, although the strength of association was much weaker. Conclusion Given the high maternal mortality ratio and perinatal mortality rate among women who sought obstetric care, more work is needed to ensure that women and their neonates receive timely and effective obstetric care. Reductions in perinatal mortality will require strategies such as early detection and management of health problems during pregnancy.

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

2010-01-01

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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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Crossing the quality chasm in neonatal-perinatal medicine.  

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

Ellsbury, Dan L

2010-03-01

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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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Clinical and scientific results in perinatal care of pregnancy complicated by insulin dependent diabetes mellitus in Croatia.  

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At the Department of Obstetrics and Gynecology, Perinatal Unit for Diabetes and Fetal Growth, School of Medicine, Zagreb, perinatal care of pregnancies complicated with insulin dependent diabetes melitus (IDDM), has been performed for more than 36 years. The intention of this review is to show our own results in the management of IDDM pregnancies and the latest clinical advances in perinatal care of such pregnancies. Pregnancy complicated with IDDM is at risk because of numerous maternal, fetal and neonatal complications. Recent advances in medicine, especially in diabetology and perinatology, helps clinician avoid or lessen antenatal or perinatal complications in IDDM pregnancies. The main result of improved perinatal care is that today fetal and neonatal mortality in IDDM pregnancy is almost equal to that of healthy pregnant population. Intensive preconceptual care and optimal regulation of IDDM have resulted not only in decreased perinatal mortality but also in a decreased rate of congenital malformation. Tight glycemia control during pregnancy has a beneficial effect on fetal growth. Intensive control of fetal growth, verification of lung maturation at term by amniocenthesis, and control of fetal oxygenation will result in delivery of a mature eutrophic newborn with the lowest rate of neonatal complications possible. Perinatal mortality of less than 2% in IDDM pregnancy can be obtained by planned delivery between 38 and 39 weeks of gestation by either vaginal route or cesarean section, depending on indications. After delivery, intensive care of the newborn is necessary. PMID:9818436

Djelmis, J

1998-01-01

 
 
 
 
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Safety promotion and error reduction in perinatal care: lessons from industry.  

Science.gov (United States)

Medical error has been revealed as a significant cause of morbidity and mortality in the United States. Accordingly, patient safety and error reduction are the current focus of health care risk management. Prevalent cultures of blame and fear relative to error are counterproductive and professional cultures that focus on best practices and patient safety must be developed. Industries outside of health care offer valuable resources for error identification and reduction. In perinatal care, lessons from industry and business include application of human factors research, teambuilding, standardization, and use of electronic medical records. PMID:12822700

Miller, Lisa A

2003-01-01

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

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

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

2014-02-12

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

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

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

2003-01-01

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

Directory of Open Access Journals (Sweden)

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

Parrotta C

2012-11-01

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A successful decade of regionalized perinatal care in Tennessee: the neonatal experience.  

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We hypothesized that successful implementation of regionalized perinatal care would result in early identification and antenatal referral of high-risk neonates, and also improved stabilization before and during transport of those transferred postnatally. We conducted a retrospective study of demographic characteristics and transport outcome in two defined groups of neonates transported to regional perinatal centers in Tennessee, one group (n = 218) from the first year of regionalization (1975), and a second group (n = 261) from the 12th year (1986). The percentage of outborn infants decreased, from 50% of all admissions in 1975 to 22% in 1986 (P = .005). Likewise, the percentage of low-birthweight neonates transported after birth decreased, from 59% of all transports to 32% (P = .002). The frequency of stabilization measures performed before and during transport increased between study years (intravenous line placement: 12% to 58%, P = .0001; assisted ventilation: 10% to 33%, P = .001). The incidence of complications during transport decreased between study years (cyanosis: 25% to 8%, P = .0001; hypothermia: 30% to 3%, P = .0001; acidemia: 33% to 13%, P = .011). Both transport-related mortality and neonatal mortality decreased between study years (2.8% to 0.8%, P = .043; 17% to 7%, P = .0001, respectively). We conclude that regionalization during its first decade has been successful in improving perinatal care in Tennessee as indicated by favorable changes in referral patterns and improved outcome of transported neonates. PMID:1890472

Shenai, J P; Major, C W; Gaylord, M S; Blake, W W; Simmons, A; Oliver, S; DeArmond, D

1991-06-01

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Effect of Social Service Prenatal Care Utilization on Perinatal Outcomes among Women with Socioeconomic Problems in the Tokyo Metropolitan Area  

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Background. To investigate the effect of social service prenatal care (PNC) utilization on perinatal outcomes among women with socioeconomic problems in the Tokyo metropolitan area. Methods. Retrospective study. The study enrolled all women at our hospital who either attended PNC utilizing social services (attenders) or who did not attend PNC (nonattenders) between January 1, 2007, and December 31, 2010. We compared the maternal characteristics and perinatal outcome of attenders with those of...

Kakogawa, Jun; Sadatsuki, Miyuki; Ogaki, Yoko; Nakanishi, Misao; Minoura, Shigeki

2011-01-01

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Embrace: addressing anticipatory grief and bereavement in the perinatal population: a palliative care case study.  

Science.gov (United States)

Anticipatory grief is experienced by families who are informed that their unborn child may not survive in utero or during or after delivery. The child who survives delivery, but is critically ill, brings a combination of emotions to the family: joy in welcoming a new life and fear for the future. The healthcare team members caring for the patient and family often witness this grief and are impacted. In the perinatal setting, the care continuum for these patients begins at diagnosis, typically in the prenatal setting, and continued support extends beyond the presumed life expectancy of the child. This case study is provided to demonstrate the utilization of a palliative care interdisciplinary approach to meeting the complex bereavement needs of a family who was expecting a child with a life-impacting congenital condition. PMID:21311273

Bennett, Joann; Dutcher, Janet; Snyders, Michele

2011-01-01

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

Digital Repository Infrastructure Vision for European Research (DRIVER)

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 i...

Tromp, M.; Eskes, M.; Reitsma, J. B.; Erwich, J. J. H. M.; Brouwers, H. A.; Rijninks-van Driel, G. C.; Bonsel, G. J.; Ravelli, A. C.

2009-01-01

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[Quality management in palliative care].  

Science.gov (United States)

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

Cottier, Christoph

2012-02-01

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Perceived quality health care  

Directory of Open Access Journals (Sweden)

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

GALLARDO JIMÉNEZ NURIA.

2009-09-01

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The quality of caring relationships  

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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 ca...

2009-01-01

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The quality of caring relationships  

Digital Repository Infrastructure Vision for European Research (DRIVER)

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 negoti...

2009-01-01

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

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

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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 wo...

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

2006-01-01

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

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

2012-01-01

36

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

Directory of Open Access Journals (Sweden)

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

Manandhar Madan

2003-08-01

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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

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Causes of perinatal death at a tertiary care hospital in Northern Tanzania 2000–2010: a registry based study  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Background Perinatal mortality reflects maternal health as well as antenatal, intrapartum and newborn care, and is an important health indicator. This study aimed at classifying causes of perinatal death in order to identify categories of potentially preventable deaths. Methods We studied a total of 1958 stillbirths and early neonatal deaths above 500 g between July 2000 and October 2010 registered in the Medical Birth Registry and neonatal registry at Kilimanjaro Christian Medical Centre (KCMC in Northern Tanzania. The deaths were classified according to the Neonatal and Intrauterine deaths Classification according to Etiology (NICE. Results Overall perinatal mortality was 57.7/1000 (1958 out of 33 929, of which 1219 (35.9/1000 were stillbirths and 739 (21.8/1000 were early neonatal deaths. Major causes of perinatal mortality were unexplained asphyxia (n=425, 12.5/1000, obstetric complications (n=303, 8.9/1000, maternal disease (n=287, 8.5/1000, unexplained antepartum stillbirths after 37 weeks of gestation (n= 219, 6.5/1000, and unexplained antepartum stillbirths before 37 weeks of gestation (n=184, 5.4/1000. Obstructed/prolonged labour was the leading condition (251/303, 82.8% among the obstetric complications. Preeclampsia/eclampsia was the leading cause (253/287, 88.2% among the maternal conditions. When we excluded women who were referred for delivery at KCMC due to medical reasons (19.1% of all births and 36.0% of all deaths, perinatal mortality was reduced to 45.6/1000. This reduction was mainly due to fewer deaths from obstetric complications (from 8.9 to 2.1/1000 and maternal conditions (from 8.5 to 5.5/1000. Conclusion The distribution of causes of death in this population suggests a great potential for prevention. Early identification of mothers at risk of pregnancy complications through antenatal care screening, teaching pregnant women to recognize signs of pregnancy complications, timely access to obstetric care, monitoring of labour for fetal distress, and proper newborn resuscitation may reduce some of the categories of deaths.

Mmbaga Blandina T

2012-12-01

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Potentially avoidable perinatal deaths in Denmark and Sweden 1991.  

DEFF Research Database (Denmark)

BACKGROUND: Since 1950 the perinatal mortality has been significantly higher in Denmark than in Sweden. In 1991 the rate in Denmark was 8.0/1000 deliveries compared to 6.5/1000 in Sweden. An international audit was designed to investigate whether the perinatal death rates in the two countries to some extent could reflect differences in the quality of care, indicated by the numbers of perinatal deaths in categories of potentially avoidable deaths. MATERIAL AND METHODS: Medical records of 97% of all perinatal deaths in 1991 in the two countries were analyzed. A new classification focusing on potential avoidability from a health services perspective was elaborated at a Nordic-Baltic workshop, using the variables: time of death in relation to admission and delivery, fetal malformation, gestational age, growth-retardation and Apgar score at 5 min. RESULTS: Rates of perinatal deaths of malformed infants (0.00195 and 0.00145) and intrapartum deaths of non-malformed infants (0.00042 and 0.00019) was significantly higher in Denmark than in Sweden. CONCLUSION: Application of the Nordic-Baltic Perinatal Death Classification on perinatal deaths in Denmark and Sweden in 1991 raises the questions as to why the rate of perinatal death of malformed infants is higher in Denmark than in Sweden and whether intrapartum care in Denmark could be improved.

Langhoff-Roos, J; Borch-Christensen, H

1996-01-01

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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

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

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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

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

Digital Repository Infrastructure Vision for European Research (DRIVER)

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

Tzoumaka-bakoula, C.; Lekea-karanika, V.; Matsaniotis, N. S.; Shenton, T.; Golding, J.

1989-01-01

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The SATELLITE Sexual Violence Assessment and Care Guide for Perinatal Patients  

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Sexual violence (SV) is a prevalent public health problem affecting millions of women across the lifespan. Poor pregnancy outcomes have been shown to be related to SV experiences; therefore, the perinatal period is an important time for healthcare practitioners (HCPs) to intervene. Various healthcare organizations suggest or even mandate screening for SV. Although SV screening tools are available, many practitioners do not routinely screen their patients. Barriers to screening include lack of...

Ross, Ratchneewan; Roller, Cyndi; Rusk, Tom; Martsolf, Donna; Draucker, Claire

2009-01-01

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African primary care research: quality improvement cycles  

Directory of Open Access Journals (Sweden)

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

Claire Van Deventer

2014-04-01

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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

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The perinatal self-care index: development of an evidence-based assessment tool for use with child sexual abuse survivors.  

Science.gov (United States)

Every ninth woman presenting for prenatal care reports having experienced childhood sexual abuse. Many develop mental health disorders, including posttraumatic stress disorder (PTSD). In response to PTSD, pregnant women survivors of childhood sexual abuse engage in negative perinatal self-care behaviors that can lead to adverse perinatal outcomes. Currently, promotion of perinatal self-care does not consider childhood sexual abuse or PTSD. This study aimed to develop a Perinatal Self-Care Index, determine sensitivity of the index to differences in behaviors of childhood sexual abuse survivors (PTSD-affected and PTSD-resilient), and validate usefulness in relation to birth weight. Secondary analysis was conducted using data from a prospective cohort study of the effects of PTSD on pregnancy outcomes. The index explained 6.5% of variance in birth weight. Prediction improved to 9.4% once PTSD and socioeconomic status were considered. The index is sensitive to differences in PTSD-affected versus PTSD-resilient survivors of childhood sexual abuse and a useful predictor of birth weight in this analysis. PMID:23111720

Roller, Cyndi Gale

2012-01-01

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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

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Organisational culture and quality of health care  

Digital Repository Infrastructure Vision for European Research (DRIVER)

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

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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

50

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.

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Eliminating Perinatal HIV Transmission  

Centers for Disease Control (CDC) Podcasts

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

2012-11-26

52

Applicability of the ISO Reference Terminology Model for Nursing to the Detailed Clinical Models of Perinatal Care Nursing Assessments  

Science.gov (United States)

Objectives The purpose of this study was to examine the applicability of the International Organization for Standardization (ISO) reference terminology model for nursing to describe the terminological value domain content regarding the entities and attributes of the detailed clinical models (DCMs) used for nursing assessments. Methods The first author mapped 52 DCM entities and 45 DCM attributes used for perinatal care nursing assessments to semantic domains and their qualifiers to the ISO model. The mapping results of the entity and attribute concepts were classified into four categories: mapped to a semantic domain qualifier, mapped to a semantic domain, mapped to a broader semantic domain concept, and not mapped. The DCM mapping results were classified into three categories: fully mapped, partially mapped, and not mapped. The second author verified the mapping. Results All of the entities and 53.3% of the attribute concepts of the DCMs were mapped to semantic domains or semantic domain qualifiers of the ISO model, 37.8% of the attributes were mapped to the broader semantic domain concept, and 8.9% of the attributes were not mapped. At the model level, 48.1% of the DCMs were fully mapped to semantic domains or semantic domain qualifiers of the ISO model, and 51.9% of the DCMs were partially mapped. Conclusions The findings of this study demonstrate that the ISO reference terminology model for nursing is applicable in representing the DCM structure for perinatal care nursing assessment. However, more qualifiers of the Judgment semantic domain are required in order to clearly and fully represent all of the entities and attributes of the DCMs used for nursing assessment.

Min, Yul Ha

2011-01-01

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Case report of fetal lingual tumor - perinatal care and neonatal surgical intervention.  

Science.gov (United States)

Fetal tumors are rare and can be difficult to diagnose in utero. In this presentation, we report an infantile hemangiopericytoma of the tongue, and also review the clinical characteristics, imaging appearances, perinatal differential diagnosis, and potential treatments of this tumors. Prenatal diagnosis of lingual fetal tumors with two-dimensional (2D) ultrasound presents a challenge to sonographers and perinatologists because these lesions are rare, usually develop in the third trimester of pregnancy and need a multidisciplinary approach. We describe an lingual tumor and moderate polyhydramnios which were prenatally detected at 31 weeks of gestation with two- dimensional ultrasound. The application of the surface mode of three-dimensional ultrasound improved the visualization of this tumor. Fetal Magnetic resonance imaging was performed to help in prenatal differential diagnostic. The option of prenatal cytology gained by amniocentesis should also be considered. To our knowledge there are no prenatal reports of similar cases. However, in our experience every information provided during the pregnancy, a correct and early diagnose of fetal condition helps to cope with the demands of perinatal management and to explain to the parents and neonatologists the findings of the case. PMID:23865586

Suciu, N; Serban, A; Toader, O; Oprescu, D; Spataru, R I

2014-02-01

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

Digital Repository Infrastructure Vision for European Research (DRIVER)

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 perin...

2010-01-01

55

Improving quality of tuberculosis care in India.  

Science.gov (United States)

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

Pai, Madhukar; Satyanarayana, Srinath; Hopewell, Phil

2014-01-01

56

Improving the quality of diabetes care in primary care practice.  

Science.gov (United States)

The quality of care delivered to patients with diabetes has an impact on long-term outcomes. The purpose of this quality improvement project was to examine the effect of a Diabetes Disease Management Program (DDMP) on compliance with recommended process measures of care in primary care practice settings. Certified diabetes nurse educators visited five participating primary care practices biweekly for 1 year providing education to physicians and office staff on standards for diabetes management and to patients regarding self-management. Among 208 participants, 85.5% had >2 HbA1cs, 93.6% had lipid profiles, and 100% had foot examinations. Improvements in HbA1c (9.0% to 7.7%) were observed. Implementation of DDMP effectively promotes compliance with care standards in primary care practices. PMID:15352340

Zgibor, Janice C; Rao, Harsha; Wesche-Thobaben, Jacqueline; Gallagher, Nancie; McWilliams, Janis; Korytkowski, Mary T

2004-01-01

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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  

Digital Repository Infrastructure Vision for European Research (DRIVER)

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...

2010-01-01

58

Providing high-quality care in primary care settings  

Science.gov (United States)

Abstract Objective To gain a deeper understanding of how primary care (PC) practices belonging to different models manage resources to provide high-quality care. Design Multiple-case study embedded in a cross-sectional study of a random sample of 37 practices. Setting Three regions of Quebec. Participants Health care professionals and staff of 5 PC practices. Methods Five cases showing above-average results on quality-of-care indicators were purposefully selected to contrast on region, practice size, and PC model. Data were collected using an organizational questionnaire; the Team Climate Inventory, which was completed by health care professionals and staff; and 33 individual interviews. Detailed case histories were written and thematic analysis was performed. Main findings The core common feature of these practices was their ongoing effort to make trade-offs to deliver services that met their vision of high-quality care. These compromises involved the same 3 areas, but to varying degrees depending on clinic characteristics: developing a shared vision of high-quality care; aligning resource use with that vision; and balancing professional aspirations and population needs. The leadership of the physician lead was crucial. The external environment was perceived as a source of pressure and dilemmas rather than as a source of support in these matters. Conclusion Irrespective of their models, PC practices’ pursuit of high-quality care is based on a vision in which accessibility is a key component, balanced by appropriate management of available resources and of external environment expectations. Current PC reforms often create tensions rather than support PC practices in their pursuit of high-quality care.

Beaulieu, Marie-Dominique; Geneau, Robert; Grande, Claudio Del; Denis, Jean-Louis; Hudon, Eveline; Haggerty, Jeannie L.; Bonin, Lucie; Duplain, Rejean; Goudreau, Johanne; Hogg, William

2014-01-01

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

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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

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

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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

 
 
 
 
61

Perinatal Death: Epidemiology and Etiology  

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

Neto, Mt

2011-01-01

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Quality Nursing Care Celebrates Diversity  

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

Leonard, B

2001-05-01

63

Living with diabetes: quality of care and quality of life  

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

Pilar Isla Pera

2011-01-01

64

Measuring health care process quality with software quality measures.  

Science.gov (United States)

Existing quality models focus on some specific diseases, clinics or clinical areas. Although they contain structure, process, or output type measures, there is no model which measures quality of health care processes comprehensively. In addition, due to the not measured overall process quality, hospitals cannot compare quality of processes internally and externally. To bring a solution to above problems, a new model is developed from software quality measures. We have adopted the ISO/IEC 9126 software quality standard for health care processes. Then, JCIAS (Joint Commission International Accreditation Standards for Hospitals) measurable elements were added to model scope for unifying functional requirements. Assessment (diagnosing) process measurement results are provided in this paper. After the application, it was concluded that the model determines weak and strong aspects of the processes, gives a more detailed picture for the process quality, and provides quantifiable information to hospitals to compare their processes with multiple organizations. PMID:22874345

Yildiz, Ozkan; Demirörs, Onur

2012-01-01

65

Software quality assessment for health care systems.  

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The problem of defining a quality model to be used in the evaluation of the software components of a Health Care System (HCS) is addressed. The model, based on the ISO/IEC 9126 standard, has been interpreted to fit the requirements of some classes of applications representative of Health Care Systems, on the basis of the experience gained both in the field of medical Informatics and assessment of software products. The values resulting from weighing the quality characteristics according to their criticality outline a set of quality profiles that can be used both for evaluation and certification. PMID:10179767

Braccini, G; Fabbrini, F; Fusani, M

1997-01-01

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

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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 ...

2000-01-01

67

Does Audit Improve the Quality of Care?  

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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

68

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

Science.gov (United States)

The project will create resources for States regarding the evaluation of child care quality rating systems (QRSs), systems that have been put in place to measure, monitor, and promote high-quality child care. The project has five goals: (1) to provide des...

2010-01-01

69

Perinatal asphyxia  

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Estimates of the incidence of perinatal asphyxia vary. In resource-rich countries, severe perinatal asphyxia (causing death or severe neurological impairment) is 1/1000 live births; in resource-poor countries, studies suggest an incidence of 5–10/1000 live births.

2007-01-01

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Trend Analysis of Primary Midwife-led Delivery Care at a Japanese Perinatal Center  

Science.gov (United States)

Objective: To perform trend analysis of primary midwife-led delivery care for 'low risk' pregnant women at our hospital. Methods: A retrospective cohort study was performed to examine trends and outcomes of labor under primary midwife-led delivery care at the Japanese Red Cross Katsushika Maternity Hospital between 2008 and 2012. Results: During the study period, the rate of deliveries initially considered 'low risk' decreased from 25 to 22% (p < 0.01). This change was associated with increased cases of previous Cesarean deliveries and preterm delivery. There were no significant changes in the neonatal outcomes; however, the rate of Cesarean delivery and incidence of severe perineal laceration in primary midwife-led delivery care were decreased from 2.1 and 3.3% to 0.3 (p = 0.02) and 1.1% (p = 0.04), respectively due to the close cooperation between midwives and obstetricians. Conclusion: The rate of deliveries initially considered 'low risk' decreased over the last 5-year period. Closer cooperation between midwives and obstetricians is important in primary midwife-led delivery care.

Suzuki, Shunji

2014-01-01

71

Computers and Quality of Care Review  

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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

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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.

73

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

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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 <1000 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 predictive model 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

74

Perinatal depression: implications for child mental health  

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

Muzik, Maria; Borovska, Stefana

2010-01-01

75

Prospective study on quality of newborn care  

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

N Khanam

2013-12-01

76

Structure quality management in pediatric diabetes care.  

Science.gov (United States)

The aim of all diabetes treatment in childhood and adolescence is to counteract the development of complications (acute as well as late), to achieve normal growth and development, and to provide the patients with as good as possible a quality of life. Many studies have confirmed the benefits of intensified medical management regarding the prevalence and/or the progression of diabetic microvascular complications. Intensified medical management means of course much more than intensified insulin substitution; diabetes care includes diet, physical exercise, diabetes education, continuous monitoring, and psychosocial support. To improve the outcome of patients with diabetes mellitus, optimizing structure quality is one of the goals. A number of prerequisites (regarding the social-socioeconomic-health care system) are not yet fulfilled everywhere; structures necessary to provide qualified diabetes care (e.g. pediatric diabetes center, team of experts, outpatient care) are not yet sufficiently available in some areas. According to both the declarations of St. Vincent and of Kos, every effort should be made to enhance structure quality in an attempt to improve the situation and the outcome of our young patients with diabetes. PMID:9676998

Borkenstein, M H; Limbert, C; Reiterer, E; Stalzer, C; Zinggl, E

1998-01-01

77

Audit of cases with uterine rupture: a process indicator of quality of obstetric care in Angola.  

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Audit of uterine rupture (UR) used as a process indicator, can identify factors considered avoidable to improve future quality of obstetric care. Records of UR cases at a referral maternity in Luanda were studied retrospectively (n=43) and prospectively (n=67) including basic obstetric information, maternal and foetal outcome, duration of labour, time interval between diagnosis and intervention, drugs used, type of delivery and intervention, surgical procedures and complications. A clinical estimation of avoidability was based on this information. Prevalence of UR was 4.9%. Maternal case fatality rate was 14% and early perinatal mortality 71%. Women with previous Caesarean Section (CS) constituted 28%, grand multiparous women 44% and primiparous women 6%. Uterotonic treatment was given in 36%. Avoidability was estimated to 65%. Regular morbidity-oriented audits with analysis of clinical management reveal weaknesses in obstetric care and may serve as an instrument for future improvement. PMID:21243919

Strand, R T; Tumba, P; Niekowal, J; Bergström, S

2010-06-01

78

Utility of local health registers in measuring perinatal mortality: A case study in rural Indonesia  

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Full Text Available Abstract Background Perinatal mortality is an important indicator of obstetric and newborn care services. Although the vast majority of global perinatal mortality is estimated to occur in developing countries, there is a critical paucity of reliable data at the local level to inform health policy, plan health care services, and monitor their impact. This paper explores the utility of information from village health registers to measure perinatal mortality at the sub district level in a rural area of Indonesia. Methods A retrospective pregnancy cohort for 2007 was constructed by triangulating data from antenatal care, birth, and newborn care registers in a sample of villages in three rural sub districts in Central Java, Indonesia. For each pregnancy, birth outcome and first week survival were traced and recorded from the different registers, as available. Additional local death records were consulted to verify perinatal mortality, or identify deaths not recorded in the health registers. Analyses were performed to assess data quality from registers, and measure perinatal mortality rates. Qualitative research was conducted to explore knowledge and practices of village midwives in register maintenance and reporting of perinatal mortality. Results Field activities were conducted in 23 villages, covering a total of 1759 deliveries that occurred in 2007. Perinatal mortality outcomes were 23 stillbirths and 15 early neonatal deaths, resulting in a perinatal mortality rate of 21.6 per 1000 live births in 2007. Stillbirth rates for the study population were about four times the rates reported in the routine Maternal and Child Health program information system. Inadequate awareness and supervision, and alternate workload were cited by local midwives as factors resulting in inconsistent data reporting. Conclusions Local maternal and child health registers are a useful source of information on perinatal mortality in rural Indonesia. Suitable training, supervision, and quality control, in conjunction with computerisation to strengthen register maintenance can provide routine local area measures of perinatal mortality for health policy, and monitoring of newborn care interventions. Similar efforts are required to strengthen routine health data in all developing countries, to guide planned progress towards reduction in the local, national and international burden from perinatal mortality.

Adair Timothy

2011-03-01

79

Regionalization of Maternity and Newborn Care in Massachusetts. (Condensed Version).  

Science.gov (United States)

The activities and outcomes of a project aimed at improving the quality and organization of maternity and newborn care in Massachusetts and at developing organized regional perinatal systems throughout the Commonwealth are documented in a condensed versio...

1976-01-01

80

Carepaths: a framework for quality patient care  

International Nuclear Information System (INIS)

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

1997-01-01

 
 
 
 
81

Minimal Brain Dysfunction: Associations with Perinatal Complications.  

Science.gov (United States)

Examined with over 28,000 7-year-old children whose mothers registered for prenatal care was the relationship between perinatal complications and such characteristics as poor school achievement, hyperactivity, and neurological soft signs associated with the diagnosis of minimal brain dysfunction (MBD). Ten perinatal antecedents were studied:…

Nichols, Paul L.

82

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

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

Julie Kiguli

2009-03-01

83

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

Scientific Electronic Library Online (English)

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

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

84

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

Directory of Open Access Journals (Sweden)

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

Eduardo Malvino

2005-03-01

85

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

86

Quality of care: how good is good enough?  

Digital Repository Infrastructure Vision for European Research (DRIVER)

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

2012-01-01

87

Is Health Care Ready for Six Sigma Quality?  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Serious, widespread problems exist in the quality of U.S. health care: too many patients are exposed to the risks of unnecessary services; opportunities to use effective care are missed; and preventable errors lead to injuries. Advanced practitioners of industrial quality management, like Motorola and General Electric, have committed themselves to reducing the frequency of defects in their business processes to fewer than 3.4 per million, a strategy known as Six Sigma Quality. In health care,...

1998-01-01

88

HCFA's health care quality improvement program: the medical informatics challenge.  

Digital Repository Infrastructure Vision for European Research (DRIVER)

The peer-review organizations (PROs) were created by Congress in 1984 to monitor the cost and quality of care received by Medicare beneficiaries. In order to do this, the Health Care Financing Administration (HCFA) contracted with the PROs through a series of contracts referred to as "Scopes of Work." Under the Fourth Scope of Work, the HCFA initiated the Health Care Quality Improvement Program (HCQIP) in 1990, as an application of the principles of continuous quality improvement. Sin...

1996-01-01

89

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

90

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

91

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

92

Incorporating health care quality into health antitrust law  

Digital Repository Infrastructure Vision for European Research (DRIVER)

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

Schneider Helen

2008-01-01

93

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

Directory of Open Access Journals (Sweden)

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

Gaurav Sharma

2012-01-01

94

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

Scientific Electronic Library Online (English)

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

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

95

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

96

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

Scientific Electronic Library Online (English)

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

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

97

Assessing Child-Care Quality with a Telephone Interview.  

Science.gov (United States)

Examined whether data on child care quality obtained from a telephone interview with the provider could serve as an adequate proxy for data obtained from direct observation of 89 child care homes and 92 centers. Found that a 25-item interview predicted accurately the quality classification of 92 percent of homes and 89 percent of centers.…

Holloway, Susan D.; Kagan, Sharon L.; Fuller, Bruce; Tsou, Lynna; Carroll, Jude

2001-01-01

98

High-quality chronic care delivery improves experiences of chronically ill patients receiving care  

Science.gov (United States)

Objective Investigate whether high-quality chronic care delivery improved the experiences of patients. Design This study had a longitudinal design. Setting and Participants We surveyed professionals and patients in 17 disease management programs targeting patients with cardiovascular diseases, chronic obstructive pulmonary disease, heart failure, stroke, comorbidity and eating disorders. Main Outcome Measures Patients completed questionnaires including the Patient Assessment of Chronic Illness Care (PACIC) [T1 (2010), 2637/4576 (58%); T2 (2011), 2314/4330 (53%)]. Professionals' Assessment of Chronic Illness Care (ACIC) scores [T1, 150/274 (55%); T2, 225/325 (68%)] were used as a context variable for care delivery. We used two-tailed, paired t-tests to investigate improvements in chronic illness care quality and patients' experiences with chronic care delivery. We employed multilevel analyses to investigate the predictive role of chronic care delivery quality in improving patients' experiences with care delivery. Results Overall, care quality and patients' experiences with chronic illness care delivery significantly improved. PACIC scores improved significantly from 2.89 at T1 to 2.96 at T2 and ACIC-S scores improved significantly from 6.83 at T1 to 7.18 at T2. After adjusting for patients' experiences with care delivery at T1, age, educational level, marital status, gender and mental and physical quality of life, analyses showed that the quality of chronic care delivery at T1 (P < 0.001) and changes in care delivery quality (P < 0.001) predicted patients' experiences with chronic care delivery at T2. Conclusion This research showed that care quality and changes therein predict more positive experiences of patients with various chronic conditions over time.

Cramm, Jane Murray; Nieboer, Anna Petra

2013-01-01

99

Improving quality of cancer care through surgical audit  

Digital Repository Infrastructure Vision for European Research (DRIVER)

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

2010-01-01

100

Improving Quality of Care in Acute Cardiology  

Digital Repository Infrastructure Vision for European Research (DRIVER)

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

 
 
 
 
101

OBRA 1987 and the quality of nursing home care.  

Science.gov (United States)

Because minimum government standards for quality regulate only part of the market failure, they may have unintended effects. We present a general theory of how government regulation of quality of care may affect different market segments, and test the hypotheses for the nursing home market. OBRA 1987 was a sweeping government reform to improve the quality of nursing home care. We study how the effect of OBRA on the quality of nursing home care, measured by resident outcomes, varied with nursing home profitability. Using a semi-parametric method to control for the endogenous effects of regulation, we found that this landmark legislation had a negative effect on the quality of care in less profitable nursing homes, but improved the quality in more profitable nursing homes during the initial period after OBRA. But, this legislation had no statistically significant effect in the later period when the regulation was weakly enforced. PMID:16612571

Kumar, Virender; Norton, Edward C; Encinosa, William E

2006-03-01

102

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.

103

Improving regional variation using quality of care measures  

Digital Repository Infrastructure Vision for European Research (DRIVER)

There is significant regional variability in the quality of care provided in the United States. This article compares regional performance for three measures that focus on transitions in care, and the care of patients with multiple conditions. Admissions for people with ambulatory care-sensitive conditions, hospital readmissions within 30 days of discharge, and compliance with practice guidelines for people with three chronic conditions (congestive heart failure, chronic obstructive pulmonary...

Berkowitz, Scott A.; Gerstenblith, Gary; Herbert, Robert; Anderson, Gerard

2009-01-01

104

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

Digital Repository Infrastructure Vision for European Research (DRIVER)

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

Gerberding, J. L.

2001-01-01

105

Measuring quality in social care services: theory and practice  

Digital Repository Infrastructure Vision for European Research (DRIVER)

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

106

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

Scientific Electronic Library Online (English)

Full Text Available SciELO Public Health | Language: Portuguese Abstract in portuguese 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. Abstract in english 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 informat [...] ion 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; Elizabeth, França; Maria do Carmo, Leal.

107

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

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: Portuguese Abstract in portuguese 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. Abstract in english 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 informat [...] ion 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; Elizabeth, França; Maria do Carmo, Leal.

108

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

109

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

Digital Repository Infrastructure Vision for European Research (DRIVER)

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 perina...

Kidanto, Hussein L.; Mogren, Ingrid; Roosmalen, Jos; Thomas, Angela N.; Massawe, Siriel N.; Nystro?m, Lennarth; Lindmark, Gunilla

2009-01-01

110

Quality Matters in Early Childhood Education and Care: Slovak Republic  

Science.gov (United States)

Early childhood education and care (ECEC) is a topic of increased policy interest in the Slovak Republic where improving quality in the ECEC sector is a subject of growing importance. The OECD has identified five effective policy levers to encourage quality in the sector: 1) quality goals and regulations; 2) curriculum and guidelines; 3)…

Taguma, Miho; Litjens, Ineke; Makowiecki, Kelly

2012-01-01

111

Mapping the processes and qualities of spiritual nursing care.  

Science.gov (United States)

Although the importance of spiritual care is widely recognized in nursing theory, recent research suggests that it is rarely attended to in nursing practice. One explanation for this contradiction is the conceptual confusion that exists regarding the meaning of spiritual nursing care. To help unravel this confusion, in-depth open-ended interviews were conducted in an oncology care setting with 29 individuals representing the multiple perspectives of nurses, patients, family, and others. Phenomenological analysis of these interviews reveals that spiritual nursing care involves a complexity of social processes, of which developing caring relationships is core. For these social processes to work and for spiritual nursing care to be realized, the nurse must embody four essential human qualities: receptivity, humanity, competency, and positivity. Participants' descriptions of these processes and qualities not only offer clarity and understanding but also capture the diffuse and amorphous nature of spiritual nursing care. PMID:18227195

Carr, Tracy

2008-05-01

112

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

Digital Repository Infrastructure Vision for European Research (DRIVER)

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

Siegel, Erin M.; Jacobsen, Paul B.; Malafa, Mokenge; Fulp, William; Fletcher, Michelle; Lee, Ji-hyun; Smith, Jesusa Corazon R.; Brown, Richard; Levine, Richard; Cartwright, Thomas; Abesada-terk, Guillermo; Kim, George; Alemany, Carlos; Faig, Douglas; Sharp, Philip

2012-01-01

113

Leadership, staffing and quality of care in nursing homes  

Directory of Open Access Journals (Sweden)

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

Havig Anders

2011-11-01

114

Quality of maternal care: A comparison of preterm infants in Kangaroo mother care and full- term infants in regular care  

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The purpose of this study was to examine the potential impact of an intervention program (Kangaroo Mother Care, KMC) on maternal sensitivity in a sample of high-risk adolescent mothers. Two mother-infant groups were compared: adolescent mothers with their preterm baby in kangaroo care and adolescent mothers with their full-term baby in regular care. Naturalistic observations at the home environment were conducted to assess maternal quality of care. No significant differences were found betwee...

2010-01-01

115

Leadership, staffing and quality of care in nursing homes  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Abstract Background Leadership and staffing are recognised as important factors for quality of care. This study examines the effects of ward leaders' task- and relationship-oriented leadership styles, staffing levels, ratio of registered nurses and ratio of unlicensed staff on three 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 utilis...

Havig Anders; Skogstad Anders; Kjekshus Lars; Romøren Tor

2011-01-01

116

A Portable Computer System for Auditing Quality of Ambulatory Care  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Prior efforts to effectively and efficiently audit quality of ambulatory care based on comprehensive process criteria have been limited largely by the complexity and cost of data abstraction and management. Over the years, several demonstration projects have generated large sets of process criteria and mapping systems for evaluating quality of care, but these paper-based approaches have been impractical to implement on a routine basis. Recognizing that portable microcomputers could solve many...

Mccoy, J. Michael; Dunn, Earl V.; Borgiel, Alexander E.

1987-01-01

117

Gauging food and nutritional care quality in hospitals  

Directory of Open Access Journals (Sweden)

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

Diez-Garcia Rosa

2012-09-01

118

The European initiative for quality management in lung cancer care.  

Science.gov (United States)

Lung cancer is the commonest cause of cancer-related death worldwide and poses a significant respiratory disease burden. Little is known about the provision of lung cancer care across Europe. The overall aim of the Task Force was to investigate current practice in lung cancer care across Europe. The Task Force undertook four projects: 1) a narrative literature search on quality management of lung cancer; 2) a survey of national and local infrastructure for lung cancer care in Europe; 3) a benchmarking project on the quality of (inter)national lung cancer guidelines in Europe; and 4) a feasibility study of prospective data collection in a pan-European setting. There is little peer-reviewed literature on quality management in lung cancer care. The survey revealed important differences in the infrastructure of lung cancer care in Europe. The European guidelines that were assessed displayed wide variation in content and scope, as well as methodological quality but at the same time there was relevant duplication. The feasibility study demonstrated that it is, in principle, feasible to collect prospective demographic and clinical data on patients with lung cancer. Legal obligations vary among countries. The European Initiative for Quality Management in Lung Cancer Care has provided the first comprehensive snapshot of lung cancer care in Europe. PMID:24659546

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

2014-05-01

119

Improving regional variation using quality of care measures  

Digital Repository Infrastructure Vision for European Research (DRIVER)

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

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

2009-01-01

120

Quality of care delivered to hospitalized inflammatory bowel disease patients  

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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. Moreo...

Weizman, Adam V.; Nguyen, Geoffrey C.

2013-01-01

 
 
 
 
121

Is there an association between female circumcision and perinatal death?  

Directory of Open Access Journals (Sweden)

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

Essén Birgitta

2002-01-01

122

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

Science.gov (United States)

The project will create resources for States regarding the evaluation of child care quality rating systems (QRSs), systems that have been put in place to measure, monitor, and promote high-quality child care. The project has five goals: (1) to provide des...

2010-01-01

123

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

124

Assessing Quality of Care of Elderly Patients Using the ACOVE Quality Indicator Set: A Systematic Review  

Science.gov (United States)

Background Care of the elderly is recognized as an increasingly important segment of health care. The Assessing Care Of Vulnerable Elderly (ACOVE) quality indicators (QIs) were developed to assess and improve the care of elderly patients. Objectives The purpose of this review is to summarize studies that assess the quality of care using QIs from or based on ACOVE, in order to evaluate the state of quality of care for the reported conditions. Methods We systematically searched MEDLINE, EMBASE and CINAHL for English-language studies indexed by February 2010. Articles were included if they used any ACOVE QIs, or adaptations thereof, for assessing the quality of care. Included studies were analyzed and relevant information was extracted. We summarized the results of these studies, and when possible generated an overall conclusion about the quality of care as measured by ACOVE for each condition, in various settings, and for each QI. Results Seventeen studies were included with 278 QIs (original, adapted or newly developed). The quality scores showed large variation between and within conditions. Only a few conditions showed a stable pass rate range over multiple studies. Overall, pass rates for dementia (interquartile range (IQR): 11%–35%), depression (IQR: 27%–41%), osteoporosis (IQR: 34%–43%) and osteoarthritis (IQR: 29–41%) were notably low. Medication management and use (range: 81%–90%), hearing loss (77%–79%) and continuity of care (76%–80%) scored higher than other conditions. Out of the 278 QIs, 141 (50%) had mean pass rates below 50% and 121 QIs (44%) had pass rates above 50%. Twenty-three percent of the QIs scored above 75%, and 16% scored below 25%. Conclusions Quality of care per condition varies markedly across studies. Although there has been much effort in improving the care for elderly patients in the last years, the reported quality of care according to the ACOVE indicators is still relatively low.

Askari, Marjan; Wierenga, Peter C.; Eslami, Saied; Medlock, Stephanie; de Rooij, Sophia E.; Abu-Hanna, Ameen

2011-01-01

125

Quality of Care: Expanding the Social Work Dialogue  

Science.gov (United States)

For social work practitioners to engage fully in efforts designed to improve the quality of social services, they need to understand what is meant by quality of care, grapple with its complexity, and know how to identify and leverage the key factors most likely to influence it. This article introduces a conceptual model that articulates numerous…

Megivern, Deborah M.; McMillen, J. Curtis; Proctor, Enola K.; Striley, Catherine L. W.; Cabassa, Leopoldo J.; Munson, Michelle R.

2007-01-01

126

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

127

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

128

[Tuberculosis in perinatal stage. A challenge to the binomial care mother-son. Report of two cases].  

Science.gov (United States)

Case report of 18-year old female patient with clinical signs of pulmonary tuberculosis during pregnancy at beginning of fourth month into term, with airway impairment, as evidenced by dry cough, fever and night sweats, as well as a 6 kg. weightloss. Twenty-two days after giving birth, the patient was hospitalized with high fever and deteriorated health conditions, requiring treatment in the intensive care unit due to complications such as severe malnutrition, septic shock, pulmonary abscess, pachypleuritis, empyema and bronchopleural fistula. The tuberculosis diagnosis was established through ABF identification with Ziehl-Neelsen stain of the pleural fluid. The patient was hospitalized for 42 days, including eleven days on a mechanical ventilator, before being discharged. Her newborn daughter was admitted to the Pediatric Intensive Care Unit on the 19th day of life due to coughing, fever, difficulty in breathing, liquid stool and rejecting food. The newborn was hospitalized in the newborn intensive care unit for twenty-two days, developing major sepsis and multiple organ failure, which complications led to her death. An autopsy was conducted, revealing granulomatous lesions consistent with tuberculosis in lungs, liver, small intestine, large intestine and peritoneum; additionally the PCR of bronchial aspirate was positive to Mycobacterium tuberculosis DNA. PMID:24779276

Martínez-Verónica, Ricardo; López-Vargas, Laura; Avalos-Huizar, Luis Manuel; Aviz-Vinaña, Lizeth Dimelza; Gutiérrez-Padilla, Alfonso

2014-03-01

129

Increasing capacity for quality improvement in underresourced primary care settings.  

Science.gov (United States)

While hospitals have widely adopted quality improvement (QI) initiatives, primary care practices continue to face unique challenges to QI implementation. The purpose of this article is to outline a strategy for promoting QI in primary care practices by introducing specially trained nurses. Two case examples are described, one with a QI nurse external to the practice and one with a nurse internal to the practice. Lessons learned and barriers and facilitators to QI in primary care are presented. Barriers and facilitators are identified in the following categories: practice infrastructure, practice leadership, and practice organizational culture. Implications for primary care practitioners and avenues for future work are discussed. PMID:24978164

Hudson, Shannon M; Hiott, Deanna B; Cole, Jeff; Davis, Robert; Egan, Brent M; Laken, Marilyn A

2014-01-01

130

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

Scientific Electronic Library Online (English)

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

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

131

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

Scientific Electronic Library Online (English)

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

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

132

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

Directory of Open Access Journals (Sweden)

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

Isabel Marlúcia Lopes Moreira de Almeida

2013-03-01

133

Achievable benchmarks of care for primary care quality indicators in a practice-based research network.  

Science.gov (United States)

A number of sources publish health care quality reports in the United States, but there is limited information about achievable performance in primary care settings. The objective of this article is to report Achievable Benchmarks of Care (ABCs) for 54 quality indicators. Eighty-seven practices participating in a demonstration project in the Practice Partner Research Network (PPRNet), representing 35 US states and 711 969 patients, were included in the analyses. PPRNet practices use a common electronic medical record (Practice Partner, Seattle, Washington). ABCs ranged from 25% to 99%. High ABCs (> or =90%) were achieved for blood pressure screening, lipid screening, and avoiding antibiotics in upper respiratory infection. Some calculated ABCs may be lower than the actual ABCs due to incomplete data recording or abstracting. Primary care practices can achieve high performance across a number of quality indicators, and PPRNet ABCs can serve as benchmarks for primary care practitioners and payers. PMID:18187589

Wessell, Andrea M; Liszka, Heather A; Nietert, Paul J; Jenkins, Ruth G; Nemeth, Lynne S; Ornstein, Steven

2008-01-01

134

Case management in an acute-care hospital: collaborating for quality, cost-effective patient care.  

Science.gov (United States)

Case management has recently been advanced as a valuable component in achieving quality patient care that is also cost-effective. At St. Michael's Hospital, in Toronto, Ontario, case managers from a variety of professional backgrounds are central to a new care initiative--Rapid Assessment and Planning to Inform Disposition (RAPID)--in the General Internal Medicine (GIM) Unit that is designed to improve patient care and reconcile high emergency department volumes through "smart bed spacing." Involved in both planning and RAPID, GIM's case managers are the link between patient care and utilization management. These stewards of finite resources strive to make the best use of dollars spent while maintaining a commitment to quality care. Collaborating closely with physicians and others across the hospital, GIM's case managers have been instrumental in bringing about significant improvements in care coordination, utilization management and process redesign. PMID:24844723

Grootveld, Kim; Wen, Victoria; Bather, Michelle; Park, Joan

2014-01-01

135

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

Digital Repository Infrastructure Vision for European Research (DRIVER)

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

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

2005-01-01

136

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

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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

137

The nursing practice environment, staff retention, and quality of care.  

Science.gov (United States)

The effects of key factors in the nursing practice environment--management style, group cohesion, job stress, organizational job satisfaction, and professional job satisfaction--on staff nurse retention and process aspects of quality of care were examined. Hinshaw and Atwood's (1985) anticipated turnover model was modified and expanded to include relevant antecedent and outcome variables. The four-stage theoretical model was tested using data from 50 nursing units at four acute care hospitals in the southeast. The model explained 49% of the variance in staff nurse retention and 39% of the variance in process aspects of quality of nursing care. Study findings warrant careful consideration in light of recent practice environment changes: experience on the unit and professional job satisfaction were predictors of staff nurse retention; job stress and clinical service were predictors of quality of care. The variable contributing the most to indirect, and in turn, total model effects, was that of management style. These results substantiate the belief that aspects of the practice environment affect staff nurse retention, and most importantly, the quality of care delivered on hospital nursing units. PMID:8773556

Leveck, M L; Jones, C B

1996-08-01

138

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

139

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

140

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

 
 
 
 
141

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

142

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

143

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

144

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

145

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

146

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

147

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

148

Health, Quality of Care and Quality of Life: A Case of Frail Older Adults  

Science.gov (United States)

This study explores the relationship between health, quality of care of geriatric case management and quality of life for the purpose of furthering the understanding of the relationship between quality of life and geriatric case management. Using survey data from a group of frail older adults, this study assesses the relative merit of two…

Hsieh, Chang-Ming

2009-01-01

149

Using a summary measure for multiple quality indicators in primary care: the Summary QUality InDex (SQUID)  

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Abstract Background Assessing the quality of primary care is becoming a priority in national healthcare agendas. Audit and feedback on healthcare quality performance indicators can help improve the quality of care provided. In some instances, fewer numbers of more comprehensive indicators may be preferable. This paper describes the use of the Summary Quality Index (SQUID) in tracking quality of care among patients and primary care practices that use an electronic medical reco...

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

2007-01-01

150

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

Scientific Electronic Library Online (English)

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

Isabel, Río Sánchez; Susana, Bosch Sánchez; Adela, Castelló Pastor; Aurora, López-Maside; Carmen, García Senchermes; Oscar, Zurriaga Llorens; Sol, Juárez; Marisa, Rebagliato Ruso; Francisco, Bolúmar Montrull.

151

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

Scientific Electronic Library Online (English)

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

Isabel, Río Sánchez; Susana, Bosch Sánchez; Adela, Castelló Pastor; Aurora, López-Maside; Carmen, García Senchermes; Oscar, Zurriaga Llorens; Sol, Juárez; Marisa, Rebagliato Ruso; Francisco, Bolúmar Montrull.

152

A model program for perinatal palliative services.  

Science.gov (United States)

Despite the fact that parents of infants with lethal anomalies may not want "full-blown" medical care for their infants after birth, most such infants die in neonatal intensive care units. Although neonatal nurses are trained to administer life-saving treatments, they may suffer from moral distress when faced with caring for babies with incompatible-with-life conditions. This article describes a Perinatal Comfort Care program in which (a) care is provided at the time of diagnoses/antenatally and includes home visits by members of an interdisciplinary hospice team; (b) care is collaborative, community-based, and family-centered, and takes place in labor and delivery and on the mother baby unit; and (c) follow-up to the family continues for 1 year after the death. Neonatal nurses can become involved either by initiating efforts to form a perinatal comfort care program or by joining an existing team. PMID:22301541

Engelder, Suzanne; Davies, Kathryn; Zeilinger, Terry; Rutledge, Dana

2012-02-01

153

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

Digital Repository Infrastructure Vision for European Research (DRIVER)

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

Donaldson, L.

2001-01-01

154

Total quality management and the Army health care system.  

Science.gov (United States)

Total quality management (TQM) is the newest in a long line of magic formulas which have been touted as saviors for American industry and medicine. The author discusses the basic concepts of TQM and notes that much of it resembles philosophical beliefs long held by the medical community. TQM does offer many opportunities to refine old concepts and further those goals of quality care to which health care providers have always aspired. If, however, it becomes simply another codified bureaucracy, then a great deal of time and money will be invested for very little gain. PMID:1749501

Jeffer, E K

1991-10-01

155

Effectiveness of a quality management program in dental care practices  

Science.gov (United States)

Background Structured quality management is an important aspect for improving patient dental care outcomes, but reliable evidence to validate effects is lacking. We aimed to examine the effectiveness of a quality management program in primary dental care settings in Germany. Methods This was an exploratory study with a before-after-design. 45 dental care practices that had completed the European Practice Assessment (EPA) accreditation scheme twice (intervention group) were selected for the study. The mean interval between the before and after assessment was 36 months. The comparison group comprised of 56 dental practices that had undergone their first assessment simultaneously with follow-up assessment in the intervention group. Aggregated scores for five EPA domains: ‘infrastructure’, ‘information’, ‘finance’, ‘quality and safety’ and ‘people’ were calculated. Results In the intervention group, small non-significant improvements were found in the EPA domains. At follow-up, the intervention group had higher scores on EPA domains as compared with the comparison group (range of differences was 4.2 to 10.8 across domains). These differences were all significant in regression analyses, which controlled for relevant dental practice characteristics. Conclusions Dental care practices that implemented a quality management program had better organizational quality in contrast to a comparison group. This may reflect both improvements in the intervention group and a selection effect of dental practices volunteering for the first round of EPA practice assessment.

2014-01-01

156

Introducing quality management into primary health care services in Uganda.  

Digital Repository Infrastructure Vision for European Research (DRIVER)

In 1994, a national quality assurance programme was established in Uganda to strengthen district-level management of primary health care services. Within 18 months both objective and subjective improvements in the quality of services had been observed. In the examples documented here, there was a major reduction in maternal mortality among pregnant women referred to Jinja District Hospital, a reduction in waiting times and increased patient satisfaction at Masaka District Hospital, and a mark...

Omaswa, F.; Burnham, G.; Baingana, G.; Mwebesa, H.; Morrow, R.

1997-01-01

157

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  

Digital Repository Infrastructure Vision for European Research (DRIVER)

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 bet...

Karlsen Saffron; Say Lale; Souza João-Paulo; Hogue Carol J; Calles Dinorah L; Metin, Gu?lmezoglu A.; Raine Rosalind

2011-01-01

158

Quality of care and quality of life in coronary artery disease  

Digital Repository Infrastructure Vision for European Research (DRIVER)

The aim was to study the efficacy in primary care of Case method learning (CML) in secondary prevention of patients with coronary artery disease (CAD). A further aim was to explore the structure of health related quality of life (HRQL) in these patients and its relations to chest pain and ill health. 54 general practitioners and 255 consecutive patients with CAD participated in a randomised controlled educational trial with the intention to improve the quality of care in ...

Kiessling, Anna

2005-01-01

159

Quality  

Science.gov (United States)

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

160

Why America Needs High-Quality Early Care and Education  

Science.gov (United States)

Business Roundtable (BRT) and Corporate Voices for Working Families (CVWF) believe federal and state efforts to develop early care and education systems for children birth through age five must be based on a set of guiding Principles that define the components of a successful system and high-quality programs. These Principles draw on current early…

Business Roundtable, 2009

2009-01-01

 
 
 
 
161

The Critical Appraisal of Quality of Care Indicators  

Directory of Open Access Journals (Sweden)

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

Salmi L-R

2001-06-01

162

Improving regional variation using quality of care measures  

Directory of Open Access Journals (Sweden)

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

Scott A Berkowitz

2009-11-01

163

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

Directory of Open Access Journals (Sweden)

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

Ricardo Silva

2012-06-01

164

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

Scientific Electronic Library Online (English)

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

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

165

Gender perspectives and quality of care: towards appropriate and adequate health care for women.  

Science.gov (United States)

Gender inequalities in health are a consequence of the basic inequality between men and women in many societies. Despite the importance of socio-economic factors, women's health is also greatly affected by the extent and quality of health services available to them. Both non-governmental women's organizations and feminist health researchers have in recent years identified major gender inequalities in access to services and in the way men and women are treated by the health care system. Firstly, although women are major health care users as well as providers, they are under-represented in decision-making in health care. Secondly, no justice is done in general to existing differences in position and needs of women and men in defining quality of health care, i.e. gender aspects. Among women's organizations, there is general agreement that "gender sensitive health care should be available, accessible, affordable, appropriate and acceptable". In addition, health care for women should be adequate and not depart from a male model of health and illness. In this paper, we pay attention to inappropriate health care for women on the one hand, as illustrated by the increasing medicalization of women's reproductive life [menstruation, menopause, pregnancy and childbirth and (in)fertility]. On the other hand, we discuss gender bias in the management of serious, life-threatening diseases such as cardiovascular disease, lung cancer, and kidney failure, as a form of inadequate care. These examples are followed by a global vision on quality of care from a gender perspective, as formulated by the women's health care movement in the Netherlands and at the Fourth International Conference on Women in Beijing. If anything, the recommendations agreed upon in Beijing will have to ensure the consolidation and enhancement of good quality health care for women around the world. The final discussion, attempts to give some general recommendations for achieving more adequate (gender sensitive) and appropriate (non-medicalizing) health care for women. These recommendations pertain to health and health care research, policy, education, and organization from a women's perspective. PMID:8870135

Gijsbers van Wijk, C M; van Vliet, K P; Kolk, A M

1996-09-01

166

Measuring technical efficiency of output quality in intensive care units.  

Science.gov (United States)

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

Junoy, J P

1997-01-01

167

Complicated deliveries, critical care and quality in emergency obstetric care in Northern Tanzania.  

Science.gov (United States)

Our objective was to determine the availability and quality of obstetric care to improve resource allocation in northern Tanzania. We surveyed all facilities providing delivery services (n=129) in six districts in northern Tanzania using the UN Guidelines for monitoring emergency obstetric care (EmOC). The three last questions in this audit outline are examined: Are the right women (those with obstetric complications) using emergency obstetric care facilities (Met Need)? Are sufficient quantities of critical services being provided (cesarean section rate (CSR))? Is the quality of the services adequate (case fatality rate (CFR))? Complications are calculated using Plan 3 of the UN Guidelines to assess the value of routine data for EmOC indicator monitoring. Nearly 60% of the expected complicated deliveries in the study population were conducted at EmOC qualified health facilities. 81.2% of the expected complicated deliveries are conducted in any facility (including facilities not qualifying as EmOC facilities). There is an inadequate level of critical services provided (CSR 4.6). Voluntary agencies provide most of these services in rural settings. All indicators show large variations with the setting (urban/rural location, level and ownership of facilities). Finally, there is large variation in the CFR with only one facility meeting the minimum accepted level. Utilization and quality of critical obstetric services at lower levels and in rural districts must be improved. The potential for improving the resource allocation within lower levels of the health care system is discussed. Given the small number of qualified facilities yet relatively high Met Need, we argue that it is neither the mothers' ignorance nor their lack of ability to get to a facility that is the main barrier to receiving quality care when needed, but rather the lack of quality care at the facility. Little can be concluded using the CFR to describe the quality of services provided. PMID:15464791

Olsen, Ø E; Ndeki, S; Norheim, O F

2004-10-01

168

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

169

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

Digital Repository Infrastructure Vision for European Research (DRIVER)

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

170

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

Digital Repository Infrastructure Vision for European Research (DRIVER)

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

2010-01-01

171

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

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

Julie Ratcliffe

2013-06-01

172

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

Science.gov (United States)

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

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

2013-09-01

173

Satisfaction of patients from provided quality of care  

Directory of Open Access Journals (Sweden)

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

Ifigenia Kotsagiorgi

2010-04-01

174

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

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

Fridawaty, Rivai; Tjahjono, Koentjoro; Adi, Utarini

2013-01-01

175

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

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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...

2004-01-01

176

[Quality of care in diabetic patients receiving pharmacologic treatment].  

Science.gov (United States)

Diabetes mellitus is a chronic disease with an increasing prevalence. Appropriate treatment of the disease and prevention of chronic complications reduce morbidity and mortality in a cost-effective manner. These actions should be measured through the use of validated indicators for quality of care. The goal of this study was to assess the quality of care in diabetic patients under pharmacologic treatment in a private university hospital. A retrospective study was conducted in adult patients who bought insulin or oral hypoglycemic agents during a 3 month period; demographic and clinical data were obtained for 12 consecutive months following the buying period. The study included 305 adult patients; most were males (60%), with type 2 diabetes (95%), and using oral hipoglycemic agents (86%). Control of blood pressure was registered in 80%, foot exam in 5%, eye exam in 27%, HbA1C blood level in 85%, complete lipid profile in 82%, microalbuminuria in 27% and creatinine clearance in 22% of patients, respectively. Mean values were HbA1C 7.1(+/- 1.6)%, and < or = 7% in 66%, LDL 113 (+/- 33.6) mg/dl and <100 mg/dl in 30%, BP 136-79 mm Hg and < 130-80 mm Hg in 46% of patients, respectively. This study emphasizes the need for quality of care assessment through validated indicators and points out the aspects that should be improved within a health care system. PMID:18051222

Lombraña, María A; Capetta, María E; Ugarte, Alejandro; Correa, Viviana; Giganti, Jorge; Saubidet, Cristian Lopez; Stryjewski, Martin E

2007-01-01

177

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

Science.gov (United States)

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

Conrad, Douglas A; Perry, Lisa

2009-01-01

178

Quality of Care for Oncologic Conditions and HIV: A Review of the Literature and Quality Indicators  

Canada Institute for Scientific and Technical Information (Canada)

Developing and implementing a valid system of-quality assessment is essential for effective functioning of the health care system. Although a number of groups have produced quality assessment tools, these tools typically suffer from a variety of limitations. Information is obtained on only a few dimensions of quality, the tools rely exclusively on administrative data, they examine quality only for users of services rather than the population, or they fail to provide a scientific basis for the quality indicators. Under funding from public and private sponsors, including the Health Care Financing Administration (HCFA), the Agency for Healthcare Research and Quality (AHRQ), the California HealthCare Foundation, and the Robert Wood Johnson Foundation (RWJ), RAND has developed and tested a comprehensive, clinically based system for assessing quality of care for children and adults. We call this system QA Tools. In this introduction, we discuss how the clinical areas were selected, how the indicators were chosen, and what is included in the overall system. We then describe in detail how we developed the indicators for children and adolescents.

2000-01-01

179

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

180

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

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

Higginson Irene J

2011-06-01

 
 
 
 
181

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

Directory of Open Access Journals (Sweden)

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

Richard P.T. M. Grol

2008-06-01

182

Parent and family impact of raising a child with perinatal stroke  

Science.gov (United States)

Background Perinatal stroke is a leading cause of early brain injury, cerebral palsy, and lifelong neurological morbidity. No study to date has examined the impact of raising a child with perinatal stroke on parents and families. However, a large breadth of research suggests that parents, especially mothers, may be at increased risk for psychological concerns. The primary aim of this study was to examine the impact of raising a child with perinatal stroke on mothers’ wellbeing. A secondary aim was to examine how caring for a child with perinatal stroke differentially affects mothers and fathers. Methods In Study I, a matched case-control design was used to compare the wellbeing of mothers of children with perinatal stroke and mothers of children with typical development. In Study II, a matched case-control design was used to compare mother-father dyads. Participants completed validated measures of anxiety and depression, stress, quality of life and family functioning, marital satisfaction, and marital distress. Parents of children with perinatal stroke also completed a recently validated measure of the psychosocial impact of perinatal stroke including guilt and blame outcomes. Disease severity was categorized by parents, validated by the Pediatric Stroke Outcome Measure (PSOM), and compared across the above outcomes in Study I. Results A total of 112 mothers participated in Study I (n?=?56 per group; mean child age?=?7.42 years), and 56 parents participated in Study II (n?=?28 per group; mean child age?=?8.25 years). In Study I, parent assessment of disease severity was correlated with PSOM scores (??=?0.75, p?quality of life, and family functioning. In Study II, mothers and fathers had similar outcomes except mothers demonstrated a greater burden of guilt and higher levels of anxiety. Conclusions Although most mothers of children with perinatal stroke adapt well, mothers of children with moderate/severe conditions appear to be at higher risk for psychological concerns.

2014-01-01

183

Total quality in acute care hospitals: guidelines for hospital managers.  

Science.gov (United States)

Quality improvement can not focus exclusively on peer review and the scientific evaluation of medical care processes. These essential elements have to be complemented with a focus on individual patient needs and preferences. Only then will hospitals create the competitive advantage needed to survive in an increasingly market-driven hospital industry. Hospital managers can identify these patients' needs by 'living the patient experience' and should then set the hospital's quality objectives according to its target patients and their needs. Excellent quality program design, however, is not sufficient. Successful implementation of a quality improvement program further requires fundamental changes in pivotal jobholders' behavior and mindset and in the supporting organizational design elements. PMID:10114504

Holthof, B

1991-08-01

184

Total Quality Management in Health Care - A Study on TQM Implementation and its Application to the Army Health Care System.  

Science.gov (United States)

Total Quality Management (TQM) is the new management philosophy of the Army health care system. TQM consists of principles and tools which can be applied in this health care setting. TQM represents a tremendous departure from the previous traditional mana...

T. H. Auer

1993-01-01

185

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

186

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

187

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

188

EMR Competency: Supporting Quality, Safe and Efficient Care  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Training clinical users to effectively and efficiently use and integrate the EMR into their workflow is one of the most important aspects of a successful implementation. Appropriate training and use facilitates achieving the benefits of quality, safety and efficiency in providing care. In their absence, these benefits are likely to suffer. Here we discuss the challenges, learning and innovative approaches in training a large academic medical center to use an integrated EMR.

Kamath, Janine; Storlie, Debbie; Ferguson, Jennifer

2006-01-01

189

Quality of plasma cholesterol measurements in primary care.  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Three surveys were made of the quality of plasma cholesterol measurements performed with a commercial desktop analyser (BCL Reflotron) in primary care. Each survey included three specimens, and results were received from 37, 61, and 69 participants. Although many participants obtained satisfactory results, 8.6% of the results differed by 1.0 mmol/l or more from the target values, and the overall between instrument dispersion of results was 1.3 times that between hospital laboratories. It was ...

Broughton, P. M.; Bullock, D. G.; Cramb, R.

1989-01-01

190

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

191

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

Digital Repository Infrastructure Vision for European Research (DRIVER)

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...

2006-01-01

192

Quality of maternal care: A comparison of preterm infants in Kangaroo mother care and full- term infants in regular care  

Directory of Open Access Journals (Sweden)

Full Text Available The purpose of this study was to examine the potential impact of an intervention program (Kangaroo Mother Care, KMC on maternal sensitivity in a sample of high-risk adolescent mothers. Two mother-infant groups were compared: adolescent mothers with their preterm baby in kangaroo care and adolescent mothers with their full-term baby in regular care. Naturalistic observations at the home environment were conducted to assess maternal quality of care. No significant differences were found between both groups of dyads. Results are in line with the notion that KMC seems to play a protective role for adolescent mothers and their premature babies, given the additional risk factor of prematurity when compared to the full term group. These preliminary findings are stimulating and support further inquiry into the effects of KMC on maternal sensitivity particularly in high-risk populations.

Olga Alicia Carbonell

2010-02-01

193

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

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Background & Aim: Quality of health care services shows the degree of achievement of health outcomes. From ethical and legal perspectives, nurses should be responsible for quality of presented care. Retired nurses can help to elaborate real and valuable concepts related to effective factors on quality of nursing care due to their experiences. The aim of this study was to explore the perspectives of retired nurses on factors that affect quality of nursing care in Semnan. Methods & Mate...

Ahmadi, F.; Nobahar, M.; Alhani, F.; Falahi Khoshknab, M.

2011-01-01

194

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

Digital Repository Infrastructure Vision for European Research (DRIVER)

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 th...

Reza Negarandeh; Sepideh Mohammadi; Soheyla Zabolypour; Tajmohammad Arazi Ghojegh

2012-01-01

195

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

Scientific Electronic Library Online (English)

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

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

196

Improving quality of care through improved audit and feedback  

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

Hysong Sylvia J

2012-05-01

197

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

198

Effects of hospital delivery during off-hours on perinatal outcome in several subgroups: a retrospective cohort study  

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Abstract Background Studies have demonstrated a higher risk of adverse outcomes among infants born or admitted during off-hours, as compared to office hours, leading to questions about quality of care provide during off-hours (weekend, evening or night). We aim to determine the relationship between off-hours delivery and adverse perinatal outcomes for subgroups of hospital births. Methods This retrospective cohort study was based on data from the Netherlands Per...

2012-01-01

199

The quality of COPD care in general practice  

DEFF Research Database (Denmark)

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

Rasmussen, F.V.; Borgeskov, H.

2008-01-01

200

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

Digital Repository Infrastructure Vision for European Research (DRIVER)

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

Oscanoa, Mery; Bergdahl, Roger

2008-01-01

 
 
 
 
201

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.

202

Effects of hospital delivery during off-hours on perinatal outcome in several subgroups: a retrospective cohort study  

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Full Text Available Abstract Background Studies have demonstrated a higher risk of adverse outcomes among infants born or admitted during off-hours, as compared to office hours, leading to questions about quality of care provide during off-hours (weekend, evening or night. We aim to determine the relationship between off-hours delivery and adverse perinatal outcomes for subgroups of hospital births. Methods This retrospective cohort study was based on data from the Netherlands Perinatal Registry, a countrywide registry that covers 99% of all hospital births in the Netherlands. Data of 449,714 infants, born at 28 completed weeks or later, in the period 2003 through 2007 were used. Infants with a high a priori risk of morbidity or mortality were excluded. Outcome measures were intrapartum and early neonatal mortality, a low Apgar score (5?minute score of 0–6, and a composite adverse perinatal outcome measure (mortality, low Apgar score, severe birth trauma, admission to a neonatal intensive care unit. Results Evening and night-time deliveries that involved induction or augmentation of labour, or an emergency caesarean section, were associated with an increased risk of an adverse perinatal outcome when compared to similar daytime deliveries. Weekend deliveries were not associated with an increased risk when compared to weekday deliveries. It was estimated that each year, between 126 and 141 cases with an adverse perinatal outcomes could be attributed to this evening and night effect. Of these, 21 (15-16% are intrapartum or early neonatal death. Among the 3100 infants in the study population who experience an adverse outcome each year, death accounted for only 5% (165 of these outcomes. Conclusion This study shows that for infants whose mothers require obstetric interventions during labour and delivery, birth in the evening or at night, are at an increased risk of an adverse perinatal outcomes.

Gijsen Ronald

2012-09-01

203

OBRA '87: has it resulted in better quality of care?  

Science.gov (United States)

This study examines perspectives of a broad group of nursing home employees, regulators, advocates, and professional associations to describe progress made since the 1990 implementation of the Nursing Home Reform legislation (OBRA '87) and to determine whether the legislation is perceived as affecting positive change for nursing home residents. Interviews were conducted with 59 residents and 132 professional and non-professional staff in six states. Important quality of care issues of resident rights, resident dignity, restraint use, resident assessment, as well as perspectives of residents themselves are explored. In general, OBRA '87 is viewed as positive, with all groups of respondents indicating that residents have benefited from it. They identify the focus on resident rights as the most important accomplishment. Empowerment of residents through involvement in care decisions is noted by many as an important achievement. Many conclude that quality of care has improved and restraint use has decreased. The MDS is a useful tool from the standpoint of nursing home staff and regulators. This appraisal sharply contrasts their opinions about the Preadmission Screening and Resident Review (PASARR) screening tool. We believe that PASARR should be reexamined and that changes should be made in the process and/or implementation of the tool. PMID:8954382

Marek, K D; Rantz, M J; Fagin, C M; Krejci, J W

1996-10-01

204

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

Scientific Electronic Library Online (English)

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

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

205

Quality of antenatal care in Zambia: a national assessment  

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

Kyei Nicholas N A

2012-12-01

206

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

Directory of Open Access Journals (Sweden)

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

207

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

Digital Repository Infrastructure Vision for European Research (DRIVER)

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 Ca...

Dalby Dawn M; Hirdes John P; Fries Brant E

2005-01-01

208

Church sponsored child care: Association of regulatory level with quality for young children  

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Multiple types of child care are exempt from state licensure or regulation yet research has shown that stricter adherence to standards for a child care program predicts higher quality programs. This study compares three groups of church-sponsored child care centers operating at different regulatory levels and the global child care quality and teacher-child interactions in these child care centers within one state. The hypothesis was supported that centers that follow more strict regulation ha...

2013-01-01

209

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

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

Busari, Jamiu O.

2012-01-01

210

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

Digital Repository Infrastructure Vision for European Research (DRIVER)

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

From, Ingrid

2011-01-01

211

Health and quality of care from older peoples’ and formal caregivers’ perspective  

Digital Repository Infrastructure Vision for European Research (DRIVER)

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

From, Ingrid

2011-01-01

212

QUALICOPC, a multi-country study evaluating quality, costs and equity in primary care  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Background: The QUALICOPC (Quality and Costs of Primary Care in Europe) study aims to evaluate the performance of primary care systems in Europe in terms of quality, equity and costs. The study will provide an answer to the question what strong primary care systems entail and which effects primary care systems have on the performance of health care systems. QUALICOPC is funded by the European Commission under the “Seventh Framework Programme”. In this article the background and design of ...

2011-01-01

213

QUALICOPC, a multi-country study evaluating quality, costs and equity in primary care  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Background: The QUALICOPC (Quality and Costs of Primary Care in Europe) study aims to evaluate the performance of primary care systems in Europe in terms of quality, equity and costs. The study will provide an answer to the question what strong primary care systems entail and which effects primary care systems have on the performance of health care systems. QUALICOPC is funded by the European Commission under the "Seventh Framework Programme". In this article the background and design...

2011-01-01

214

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.)

1984-06-01

215

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

Directory of Open Access Journals (Sweden)

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

216

The quality of care for adults with epilepsy: an initial glimpse using the QUIET measure  

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Abstract Background We examined the quality of adult epilepsy care using the Quality Indicators in Epilepsy Treatment (QUIET) measure, and variations in quality based on the source of epilepsy care. Methods We identified 311 individuals with epilepsy diagnosis between 2004 and 2007 in a tertiary medical center in New England. We abstracted medical charts to identify the extent to which participants received quality indicator (QI) concordant care for ind...

2011-01-01

217

Prioritizing WHO normative work on maternal and perinatal health: a multicountry survey  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Background WHO develops evidence-based guidelines for setting global standards and providing technical support to its Member States and the international community, as a whole. There is a clear need to ensure that WHO guidance is relevant, rigorous and up-to date. A key activity is to ascertain the guidance needs of the countries. This study provides an international comparison of priority guidance needs for maternal and perinatal health. It incorporates data from those who inform policy and implementation strategies at a national level, in addition to targeting those who use and most need the guidance at grassroot level. Methods An online multi-country survey was used to identify WHO guidance priorities for the next five years in the field of maternal and perinatal health. WHO regional and country offices were requested to respond the survey and obtain responses from Ministries of Health around the world. In addition, the survey was disseminated through other networks and relevant electronic forums. Results A total of 393 responses were received, including 56 from Ministries of Health and 54 from WHO/UN country offices. 75% of responses were from developing countries and 25% from developed countries. Guidance on strategies focusing on 'quality of care' issues to reduce all-cause maternal/perinatal mortality was considered the most important domain to target, which includes for instance guidance to improve access, dissemination, implementation of effective practices and health professionals' education. Conclusions This study provides a panorama of international priority guidance needs for maternal and perinatal health. Although clinical guidance remains a priority, there are other areas related to health systems guidance, which seem to be even more important. Overall, the domain ranked highest in terms of greatest need for guidance was around quality of care, which included questions related to educational needs, access to and implementation of guidance.

Coltart Cordelia EM

2011-10-01

218

Perinatal mortality and neonatal survival in Avon: 1976-9.  

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A study of perinatal and neonatal mortality figures for all 36 810 infants born to Avon residents during 1976-9 reported by year of birth and in relation to birth weight, gestational age, and th presence of lethal malformation showed the need for reporting mortality data for normally formed infants weighing 1000 g or more at birth and for assessing perinatal morbidity as well as mortality when attempting to evaluate the standard of perinatal care and the resources required to provide for it.

Mutch, L. M.; Brown, N. J.; Speidel, B. D.; Dunn, P. M.

1981-01-01

219

The quality of care for adults with epilepsy: an initial glimpse using the QUIET measure  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Background We examined the quality of adult epilepsy care using the Quality Indicators in Epilepsy Treatment (QUIET measure, and variations in quality based on the source of epilepsy care. Methods We identified 311 individuals with epilepsy diagnosis between 2004 and 2007 in a tertiary medical center in New England. We abstracted medical charts to identify the extent to which participants received quality indicator (QI concordant care for individual QI's and the proportion of recommended care processes completed for different aspects of epilepsy care over a two year period. Finally, we compared the proportion of recommended care processes completed for those receiving care only in primary care, neurology clinics, or care shared between primary care and neurology providers. Results The mean proportion of concordant care by indicator was 55.6 (standard deviation = 31.5. Of the 1985 possible care processes, 877 (44.2% were performed; care specific to women had the lowest concordance (37% vs. 42% [first seizure evaluation], 44% [initial epilepsy treatment], 45% [chronic care]. Individuals receiving shared care had more aspects of QI concordant care performed than did those receiving neurology care for initial treatment (53% vs. 43%; X2 = 9.0; p = 0.01 and chronic epilepsy care (55% vs. 42%; X2 = 30.2; p Conclusions Similar to most other chronic diseases, less than half of recommended care processes were performed. Further investigation is needed to understand whether a shared-care model enhances quality of care, and if so, how it leads to improvements in quality.

Avetisyan Ruzan

2011-01-01

220

Quality of the Care Process for Children with Intellectual Disabilities: A Delphi Study. Short Reports  

Science.gov (United States)

This short report explores the quality of the care process for children with intellectual disabilities. A Delphi procedure was used to identify a set of indicators for the quality of the care process reflecting the perspectives of the care providers, the parents and the experts. The sample consisted of 59 individuals involved in different ways in…

Swennenhuis, Petra; Vermeer, Adri; Rispens, Jan; Teunissen, Joop; Wensing, Michel

2004-01-01

 
 
 
 
221

Care quality commission compliance and frequently asked questions.  

Science.gov (United States)

As part of the Department of Health initiative - £30 million funding for children's palliative care in 2010/11, Children's Hospices UK successfully submitted a proposal with Help the Hospices relating to Care Quality Commission (CQC) registration and compliance with the statutory Essential Standards of Quality and Safety. The project ran between December 2010 and March 2011 developing guidance and best practice examples for hospice services in England. The project assisted children's and adult hospice services by providing information to:? Inform future development and planning of services to ensure best practice ? Identify current services and gaps in current compliance ? Work with our partner 'Help the Hospices' to share project outputs and support the transition agenda between children's and adult services. The project required a mixed methodology to ensure effective delivery of the project objectives. Methodologies employed included an online questionnaire, stakeholder visits and interviews, delivery of three educational workshops, academic review of compliance techniques and partnership working with stakeholders to complete exemplar compliance assessments. The project enabled a number of outputs and analysis and these were shared with member organisations via the extranet services of both Children's Hospices UK and Help the Hospices. Outputs included:? Establishment of information relating to registered activities across hospice services ? Provision of educational workshops led by the CQC in relation to compliance, inspection and the Judgement Framework ? The development of a 'Compliance Toolkit' providing information and advice relating to meeting the Essential Standards including exemplar compliance assessments ? Partnership with 'Help the Hospices' to further improve transition for life limited young people by understanding the population of children and young people with palliative care needs who will be moving to adult services. The presentation will focus on some of the learning from this joint venture and consider next steps. PMID:24653238

Ruthven, Tracy; Blackburn, Maddie; Ellis, Jonathan

2011-09-01

222

Quality of life in cancer patients receiving palliative care  

Directory of Open Access Journals (Sweden)

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

223

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

Directory of Open Access Journals (Sweden)

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

James X Zhang

2011-01-01

224

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

Digital Repository Infrastructure Vision for European Research (DRIVER)

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

225

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

226

Agreement and disagreement on health care quality concepts among academic health professionals: the Saudi case.  

Science.gov (United States)

A systematic and rigorous implementation of quality improvement processes is likely to improve the well-being of staff members and heighten their job satisfaction. Assessing professionals' perceptions of health care quality should lead to the betterment of health care services. In Saudi Arabia, no previous studies examine how university health professionals view health care quality concepts. A cross-sectional analytical study employing a self-administered questionnaire with 43 statements assessing quality perceptions of academic health care professionals was used. Despite the agreement of health professionals on numerous quality concepts addressed in this study, there was insufficient agreement on 10 core quality concepts, 3 of which were the following: "quality focuses on customers" (50%), "quality is tangible and therefore measurable" (29.3%), and "quality is data-driven" (62%). Hence, providing health professionals with relevant training likely will generate a better understanding of quality concepts and optimize their performance. PMID:23897553

Mahrous, Mohamed Saad

2014-01-01

227

Early stage cervical cancer : quality of cancer care and quality of life  

Digital Repository Infrastructure Vision for European Research (DRIVER)

To improve quality of cancer care treatment-related information is needed. This could be acquired by registries. Since January 1984, the Leiden University Medical Center (LUMC) collects prospectively more than 200 relevant clinical and pathological parameters of women with cervical cancer treated in the LUMC. The purpose of this thesis was to use the treatment-related information of this database, to get inside information and to become aware of possibilities for improvement in the current tr...

Pieterse, Quirine Dionne

2007-01-01

228

Developing a Total Quality Management Model for Health Care Systems  

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

AM Mosadegh Rad

2005-10-01

229

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

230

Preconception care for diabetic women for improving maternal and fetal outcomes: a systematic review and meta-analysis  

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Abstract Background Preexisting diabetes mellitus is associated with increased risk for maternal and fetal adverse outcomes. Despite improvement in the access and quality of antenatal care recent population based studies demonstrating increased congenital abnormalities and perinatal mortality in diabetic mothers as compared to the background population. This systematic review was carried out to evaluate the effectiveness and safety of preconception care in improving maternal ...

Wahabi Hayfaa A; Alzeidan Rasmeia A; Bawazeer Ghada A; Alansari Lubna A; Esmaeil Samia A

2010-01-01

231

Quality of Care and Cancer Survivorship: The Challenge of Implementing the Institute of Medicine Recommendations  

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As the population ages, maintaining the quality of care for new patients with cancer will be challenged by an anticipated shortage of health professionals to care for the increased number of newly diagnosed and surviving patients with cancer.

2009-01-01

232

Quality of Care Indicators, Health Behaviors, and Physical Functioning in Adults with Diabetes*  

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Purpose: Physical functioning is an important and often neglected outcome in patients with diabetes. Identification of quality of care indicators and health behaviors associated with higher physical functioning may lead to improved care and outcomes for adult diabetic patients.

Krousel-wood, Marie; Radosevich, David M.; Erikson, Clese; Blonde, Lawrence; Sanderson-austin, Julie

2007-01-01

233

Grantee Research Highlight: Using Health Systems to Study and Improve the Quality of Cancer Care  

Science.gov (United States)

The NIH Roadmap and National Cancer Institute strategic plans repeatedly emphasize the importance of involving health care systems in research. Integrated care delivery systems can address key research questions that cannot be answered in other types of settings. Research in this setting can lead to essential insights about the quality of care, including the quality of cancer care and how best to improve patient outcomes.

234

The lower quality of preventive care among forced migrants in a country with universal healthcare coverage  

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OBJECTIVE: To assess the association between socio-demographic factors and the quality of preventive care and chronic care of cardiovascular (CV) risk factors in a country with universal health care coverage. METHODS: Our retrospective cohort assessed a random sample of 966 patients aged 50-80years followed over 2years (2005-2006) in 4 Swiss university primary care settings (Basel/Geneva/Lausanne/Zürich). We used RAND's Quality Assessment Tools indicators and examined recommended preventive ...

Martin, Yonas; Collet, Tinh-hai; Bodenmann, Patrick; Blum, Manuel R.; Zimmerli, Lukas; Gaspoz, Jean-michel; Battegay, Edouard; Cornuz, Jacques; Rodondi, Nicolas

2014-01-01

235

The K index: a proxy measure of health care quality.  

Science.gov (United States)

An index of health care quality is described that requires data on "sentinel health events"--unnecessary death and disability caused by specific ICDA-coded conditions on which medical agreement can be reached about avoidability of negative outcomes. The proposed index combines measures of incidence, severity, and concentration of sentinel health events in communities and compares the measures with mean values for a group of normative communities, to arrive at index values that are distributed as X2 for a group of communities with regard to the mean health conditions experienced by the normative communities. Calculation of the index is illustrated with hypothetical data, and problems of selecting normative communities are discussed. PMID:1030698

Chen, M K

1976-01-01

236

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

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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...

2010-01-01

237

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

238

Palliative Care: Increasing the quality of life for patients and families | NIH MedlinePlus the Magazine  

Science.gov (United States)

... of this page please turn JavaScript on. Feature: Palliative Care Palliative Care: Increasing the quality of life for patients and families… Spring 2014 Table of Contents Palliative Care: Conversations Matter™ for Sick Children "Palliative Care: Conversations ...

239

PERINATAL LEUKODYSTROPHY CLINICAL CASE  

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

Dana Mihut

2004-01-01

240

Perinatal unilateral hydrocephalus  

International Nuclear Information System (INIS)

Unilateral hydrocephalus is rare, and is usually associated with a neuplasm or inflammatory response at the foramen of Monro. It is even more uncommon with congenital atresia of one foramen of Monro. We report the fifth such case documented in the perinatal period, and the second case of unilateral hydrocephalus diagnosed by prenatal ultrasound. (orig.)

1989-01-01

 
 
 
 
241

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

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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 achievem...

Hammouche Salah; Holland Richard; Steel Nicholas

2011-01-01

242

Quality of Care in the Psychiatric Setting : Perspectives of the Patient, Next of Kin and Care staff  

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The overall aim of this thesis was to describe quality of care from different perspectives in the psychiatric setting, to develop an instrument for measuring quality of care from the in-patient perspective and to use this instrument empirically. A qualitative descriptive design involving a phenomenographic analysis was used in Studies I, III and IV, and a descriptive and comparative design with statistical analysis in Study II. In Study I, 20 patients were interviewed. The results showed that...

Schro?der, Agneta

2006-01-01

243

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

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

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

Monjurul Hoque; Shahnaz Hoque

2010-01-01

244

Quality of health care in inflammatory bowel disease and its assessment  

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Full Text Available SUMMARY Patients with inflammatory bowel disease (IBD are consistently high users of health care services. They need continuous medication, frequent follow up visits, while their life expectancy is normal. One major parameter, which creeps into the assessment of quality of care, is organization of health care system. However, relatively little research exists on the characteristics and the organization of an ideal health care system which will effectively satisfy the needs of the chronically ill patient. Regarding money spent on chronic illnesses in terms of societal costs, IBD is less costly than, for example, coronary diseases, since loss of work hours, disability, or early death are less common. In terms of pure economic costs, IBD patients can be more costly than other chronic patients depending on age of disease onset and severity of illness. Crohn?s disease patients consider cost aspects as an important element of quality more than ulcerative colitis patients do. Standard framework for the assessment of quality of care remains Donabedian?s approach according to the Structure-Process-Outcome characterization. Lack of information is associated with more disease related worries and concerns of patients and, accordingly, with decreased quality of life. Finally, the patient ?s perception about high quality health care and his/ her satisfaction as a ?consumer? of health care services are extremely important issues for assessing quality of health care. Key words: Inflammatory bowel disease, Ulcerative colitis, Crohn?s disease, care, quality of care, health services, health system, patient?s satisfaction

I.A. Mouzas A.G. Pallis,

2007-03-01

245

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

246

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

247

The case for using industrial quality management science in health care organizations.  

Science.gov (United States)

In an effort to provide health care of optimal quality, providers traditionally assess or measure performance and then assure that it conforms to standards. In cases where performance fails to conform, providers attempt to modify or improve physician behavior. The analytic scope of this traditional paradigm may not be broad enough to allow modern health care organizations to provide optimal care. At a theoretical and practical level, many conceptual limitations inherent in the traditional approach are addressed in modern industrial quality science. A fundamental principle of industrial quality control is the recognition, analysis, and elimination of variation. Based on rigorous analysis of variation in outcomes and processes, industrial quality experts have developed principles and techniques for quality improvement. Health care organizations may well make important advances in the quality of care and service through the application of these principles and techniques. PMID:2810623

Laffel, G; Blumenthal, D

1989-11-24

248

Eclampsia: Repercusión materna y perinatal  

Scientific Electronic Library Online (English)

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

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

249

Eclampsia: Repercusión materna y perinatal  

Directory of Open Access Journals (Sweden)

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

Marianela Rivas

2012-03-01

250

Current efforts in chiropractic quality assurance and standards of care  

Digital Repository Infrastructure Vision for European Research (DRIVER)

The chiropractic profession has recently begun to proactively address the problems identified by the health care industry. Prompted by rising health care costs, careful analysis revealed that the major culprit was the variance in the delivery of health care. Concerned with outside regulation, health professionals, both in the USA and Canada, are generating clinical guidelines that will serve as templates for the development of standards of care. More specifically, the chiropractic profession ...

1991-01-01

251

Using a summary measure for multiple quality indicators in primary care: the Summary QUality InDex (SQUID  

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Full Text Available Abstract Background Assessing the quality of primary care is becoming a priority in national healthcare agendas. Audit and feedback on healthcare quality performance indicators can help improve the quality of care provided. In some instances, fewer numbers of more comprehensive indicators may be preferable. This paper describes the use of the Summary Quality Index (SQUID in tracking quality of care among patients and primary care practices that use an electronic medical record (EMR. All practices are part of the Practice Partner Research Network, representing over 100 ambulatory care practices throughout the United States. Methods The SQUID is comprised of 36 process and outcome measures, all of which are obtained from the EMR. This paper describes algorithms for the SQUID calculations, various statistical properties, and use of the SQUID within the context of a multi-practice quality improvement (QI project. Results At any given time point, the patient-level SQUID reflects the proportion of recommended care received, while the practice-level SQUID reflects the average proportion of recommended care received by that practice's patients. Using quarterly reports, practice- and patient-level SQUIDs are provided routinely to practices within the network. The SQUID is responsive, exhibiting highly significant (p Conclusion The SQUID algorithm is feasible and straightforward, and provides a useful QI tool. Its statistical properties and clear interpretation make it appealing to providers, health plans, and researchers.

Nemeth Lynne S

2007-04-01

252

Short and long term improvements in quality of chronic care delivery predict program sustainability.  

Science.gov (United States)

Empirical evidence on sustainability of programs that improve the quality of care delivery over time is lacking. Therefore, this study aims to identify the predictive role of short and long term improvements in quality of chronic care delivery on program sustainability. In this longitudinal study, professionals [2010 (T0): n=218, 55% response rate; 2011 (T1): n=300, 68% response rate; 2012 (T2): n=265, 63% response rate] from 22 Dutch disease-management programs completed surveys assessing quality of care and program sustainability. Our study findings indicated that quality of chronic care delivery improved significantly in the first 2 years after implementation of the disease-management programs. At T1, overall quality, self-management support, delivery system design, and integration of chronic care components, as well as health care delivery and clinical information systems and decision support, had improved. At T2, overall quality again improved significantly, as did community linkages, delivery system design, clinical information systems, decision support and integration of chronic care components, and self-management support. Multilevel regression analysis revealed that quality of chronic care delivery at T0 (p<0.001) and quality changes in the first (p<0.001) and second (p<0.01) years predicted program sustainability. In conclusion this study showed that disease-management programs based on the chronic care model improved the quality of chronic care delivery over time and that short and long term changes in the quality of chronic care delivery predicted the sustainability of the projects. PMID:24560235

Cramm, Jane Murray; Nieboer, Anna Petra

2014-01-01

253

Age and gender as predictors of allied health quality stroke care  

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

Luker JA

2011-07-01

254

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  

Digital Repository Infrastructure Vision for European Research (DRIVER)

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

255

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

256

Child Care Quality Rating System (QRS) Assessment. Oklahoma Reaching for the Stars. QRS Profile.  

Science.gov (United States)

The project will create resources for States regarding the evaluation of child care quality rating systems (QRSs), systems that have been put in place to measure, monitor, and promote high-quality child care. The project has five goals: (1) to provide des...

2010-01-01

257

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

Science.gov (United States)

The project will create resources for States regarding the evaluation of child care quality rating systems (QRSs), systems that have been put in place to measure, monitor, and promote high-quality child care. The project has five goals: (1) to provide des...

2010-01-01

258

The role of clinical governance as a strategy for quality improvement in primary care.  

Science.gov (United States)

This power considers the process of implementing clinical governance in primary care and its impact on quality improvement. It discuss how clinical governance is being implemented both at the level of Primary Care Organisations and general practices, and the challenges to implementing clinical governance. It also suggests a model for promoting the factors that will help clinical governance improve quality of care. The experience of implementing clinical governance is broadly positive to date. However, the government needs to match its commitment to a ten-year programme of change with realistic timetables to secure the cultural and organisational changes needed to improve quality of care. PMID:12389764

Campbell, Stephen M; Sweeney, Grace M

2002-10-01

259

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

Science.gov (United States)

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

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

1998-01-01

260

ICU 2020: five interventions to revolutionize quality of care in the ICU.  

Science.gov (United States)

Intensive care units (ICUs) are an essential and unique component of modern medicine. The number of critically ill individuals, complexity of illness, and cost of care continue to increase with time. In order to meet future demands, maintain quality, and minimize medical errors, intensivists will need to look beyond traditional medical practice, seeking lessons on quality assurance from industry and aviation. Intensivists will be challenged to keep pace with rapidly advancing information technology and its diverse roles in ICU care delivery. Modern ICU quality improvement initiatives include ensuring evidence-based best practice, participation in multicenter ICU collaborations, employing state-of-the-art information technology, providing point-of-care diagnostic testing, and efficient organization of ICU care delivery. This article demonstrates that each of these initiatives has the potential to revolutionize the quality of future ICU care in the United States. PMID:22328598

Bauman, Kristy A; Hyzy, Robert C

2014-01-01

 
 
 
 
261

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

262

eHealth, care and quality of life  

CERN Multimedia

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

263

The relationship of bedside nurses' emotional intelligence with quality of care.  

Science.gov (United States)

Emotional intelligence, a predictor of productivity and success, may impact behaviors responsible for quality of care. This study examined if emotional intelligence of units' bedside nurses is related to the quality of care delivered to the patients. In this study, emotional intelligence was found to be correlated to the number of Clostridium difficile infections, MRSA infections, patient falls with injury, and pressure ulcer screenings (P < .001) in the inpatient acute care setting. PMID:24356579

Adams, Kelly L; Iseler, Jackeline I

2014-01-01

264

The role of clinical governance as a strategy for quality improvement in primary care.  

Digital Repository Infrastructure Vision for European Research (DRIVER)

This power considers the process of implementing clinical governance in primary care and its impact on quality improvement. It discuss how clinical governance is being implemented both at the level of Primary Care Organisations and general practices, and the challenges to implementing clinical governance. It also suggests a model for promoting the factors that will help clinical governance improve quality of care. The experience of implementing clinical governance is broadly positive to date....

2002-01-01

265

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

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

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

2008-01-01

266

Integrating “Best of Care” Protocols into Clinicians' Workflow via Care Provider Order Entry: Impact on Quality-of-Care Indicators for Acute Myocardial Infarction  

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Objective: In the context of an inpatient care provider order entry (CPOE) system, to evaluate the impact of a decision support tool on integration of cardiology “best of care” order sets into clinicians' admission workflow, and on quality measures for the management of acute myocardial infarction (AMI) patients.

Ozdas, Asli; Speroff, Theodore; Waitman, L. Russell; Ozbolt, Judy; Butler, Javed; Miller, Randolph A.

2006-01-01

267

Monitoring quality in Medicaid managed care: Accomplishments and challenges at the year 2000  

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This paper reviews the major developments during the late 1990s in quality monitoring for Medicaid managed care and offers an assessment of major challenges faced at the year 2000. We highlight the dramatic increase in activities to ensure and improve quality in Medicaid managed care. Prior to these developments, little was known about the actual level of quality of care. Thus, a major accomplishment of the late 1990s is that we now know more about quality, through some key indicators, and th...

Felt-lisk, Suzanne

2000-01-01

268

Quality Health Care in the European Union Thanks to Competition Law  

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

Diego Fornaciari

2009-12-01

269

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

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

Waydhas, Christian

2010-01-01

270

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

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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

271

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

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

Reid, Colin R.

2008-01-01

272

[Congenital and perinatal infections  

Science.gov (United States)

OBJECTIVE: To review current information about congenital and perinatal infections, mainly related to their epidemiology in Brazil, mother-to-infant transmission, diagnosis, treatment and prevention. Particular aspects related to the agents T. pallidum, hepatitis B virus, human immunodeficiency virus, cytomegalovirus and T. gondii were considered. METHODS: The main published papers from the last 10 years were selected from a Medline database electronic search. RESULTS: Congenital or perinatal infections can occur in up to 10% of newborns. Although there are few Brazilian studies, available data suggest their relevance, mainly related to the occurrence of infection due to T. pallidum, HIV and CMV. At least 50% of the infected newborns are asymptomatic. However, because these infections may lead to long term sequelae, it is necessary to early identify infected pregnant women in order to implement specific preventive measures. Presently, laboratory methods for early diagnosis of fetal or neonatal infections are available. They are predominantly based on assays for detection of IgA or IgM specific antibodies and fragments of the microorganism nucleic acids by polymerase chain reaction. The available treatments had only limited success, because they often have failed to substantially modify the prognosis for infected infants. New treatments and outcome studies are needed. CONCLUSIONS: Congenital and perinatal infections are a relevant problem whose main current advances are related to prevention and laboratory diagnostic methods applicable to pregnant women, fetus or infants. PMID:14685480

Mussi-Pinhata, M M; Yamamoto, A Y

1999-07-01

273

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

274

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

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

Busari JO

2012-12-01

275

[Effects of functional differentiation within home care on the quality of care--from the client's viewpoint].  

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In home care nursing work is redesigned by differentiated practice (= skill mix) and specialization. The aim of this redesign is efficient use of staff, and maintenance or improvement of quality of care. In this article the effects of differentiated practice and specialization are studied in respect of quality of care. The perspective of the client was taken as the starting point. Quality of care was defined as the discrepancy between clients' expectations and perceptions of several aspects of care. The effects of work redesign were determined on the basis of a comparison between an experimental (n = 103) and a control group (n = 108). Data-analysis showed hardly any differences. Possible explanations are the premature status of the projects and the fact that clients are usually (very) satisfied. The margin in which differences between the experimental and the control group should occur is therefore very small. However, by means of this approach a detailed picture can be obtained of the subjective standard clients use to judge the quality of care. PMID:9376931

Jansen, P G; Kerkstra, A; van der Zee, J; Huijer Abu-Saad, H; Abrahamse, H

1997-05-01

276

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

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

Verheggen, F W; Harteloh, P P

1993-01-01

277

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

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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...

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

2009-01-01

278

Nursing Staff Competence, Psychosocial Work Environment and Quality of Elderly Care: Impact of an Educational Intervention  

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Insufficient competence among nursing staff is a major concern in elderly care worldwide as the healthcare needs of the elderly become increasingly complex. In previous research, insufficient competence has been associated with work dissatisfaction and stress among elderly care nurses, and with lower quality of care. This thesis describes the development, implementation and evaluation of an educational intervention for nursing staff in elderly care. In a prospective, controlled study, evaluat...

Hasson, Henna

2006-01-01

279

The Missing Link: Improving Quality With a Chronic Disease Management Intervention for the Primary Care Office  

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Bold steps are necessary to improve quality of care for patients with chronic diseases and increase satisfaction of both primary care physicians and patients. Office-based chronic disease management (CDM) workers can achieve these objectives by offering self-management support, maintaining disease registries, and monitoring compliance from the point of care. CDM workers can provide the missing link by connecting patients, primary care physicans, and CDM services sponsored by health plans or i...

Zweifler, John

2007-01-01

280

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

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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 me...

2013-01-01

 
 
 
 
281

Interventions and targets aimed at improving quality in inflammatory bowel disease ambulatory care  

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Over the past decade, there has been increasing focus on improving the quality of healthcare delivered to patients with chronic diseases, including inflammatory bowel disease. Inflammatory bowel disease is a complex, chronic condition with associated morbidity, health care costs, and reductions in quality of life. The condition is managed primarily in the outpatient setting. The delivery of high quality of care is suboptimal in several ambulatory inflammatory bowel disease domains including o...

Weizman, Adam V.; Nguyen, Geoffrey C.

2013-01-01

282

Improving quality of reproductive health care in Senegal through formative supervision: results from four districts  

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Abstract Background In Senegal, traditional supervision often focuses more on collection of service statistics than on evaluation of service quality. This approach yields limited information on quality of care and does little to improve providers' competence. In response to this challenge, Management Sciences for Health (MSH) has implemented a program of formative supervision. This multifaceted, problem-solving approach collects data on quality of care, improves technical com...

2007-01-01

283

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

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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

284

Quality Health Care in the European Union Thanks to Competition Law  

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There are many biases concerning the application of competition law in health care. Quality concerns can however be integrated into competition law analysis. The aim of this paper is to identify the links between the application of competition law in the European Union and the right to quality health care and to point out the problems that arise when integrating quality concerns in competition law analysis. Guidelines must be issued and competition authorities must work together with institut...

Fornaciari, Diego

2010-01-01

285

Quality Health Care in the European Union Thanks to Competition Law  

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There are many biases concerning the application of competition law in health care. Quality concerns can however be integrated into competition law analysis. The aim of this paper is to identify the links between the application of competition law in the European Union and the right to quality health care and to point out the problems that arise when integrating quality concerns in competition law analysis. Guidelines must be issued and competition authorities must work together with institut...

Diego Fornaciari

2009-01-01

286

Assessment of users’ expectations, perceived quality and satisfaction with primary care in Greece  

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Full Text Available Aim: To explore users’ expectations, their perceived quality and their satisfaction with primary care services an anonymous questionnaire has been administered to a sample of 212 users.Background: Patient satisfaction with quality of primary care is a dominant concept in quality assurance and quality improvement programs.Methods: It has been used the Expectations-Perceived Quality-Satisfaction with Primary Care Services Scale (E-PQ-SPCSS that was developed and validated in this study. Data were analysed using SPSS, version 18.Results: The overall satisfaction with the primary care services was 97.2%, with the medical care provided was 95.3% and with nursing care was 92.5%. Nursing care was provided to 126 (59.4% users. These users were more satisfied (p<0.0001 with global nursing care provided (4.52±0.70 than those who were not provided a nursing care intervention (3.53±1.73. Age correlated with global satisfaction with primary care (r=0.315, p<0.001 with medical (r=0.194, p<0.001 and nursing care (r=0.183, p<0.001 as well as with expectations totalscore (r=0.295, p<0.001, perceived quality of care total score (r=0.366, p<0.001 and satisfaction with care total score (r=0.207, p=0.002. Based on Cattell’s visual scree plot, four factors accounting for 64.34% of the item covariance were extracted and rotated through factor analysis (nurse’s technical and interpersonal competence, physician’s interpersonal competence, physician’s technical competence and structure characteristics.Conclusions: The psychometric properties of the E-PQ-SPCSS were good enough indicating that the scales are reliable and adequate for group comparisons.

Vasilios Raftopoulos

2010-01-01

287

PERINATAL INFECTIONS - The GBS successful practices in prevention  

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Updated information on the most common infectious diseases that the mother may transmit to her infant during pregnancy, at birth or by breast feeding the infant. Most of the emphasis is directed to preventive measures, screening when interventions are available, and the detailed analysis of interventions during the preconceptional period, antenatal care, perinatal care and maternal and neonatal care after birth. The strategic approach for prevention is illustrated with the group B streptococc...

Melin, Pierrette

2012-01-01

288

Corioamnionitis: Repercusión perinatal  

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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

289

Quality standards for child and adolescent mental health in primary care  

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

Sayal Kapil

2012-06-01

290

Too complicated for the field? Measuring quality of care in humanitarian aid settings  

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Full Text Available While quality of care is a major concern in the western world, not many studies investigate this topic in low-income countries. Even less is known about the quality of care in humanitarian aid settings, where additional challenges from natural or manmade disasters contribute to additional challenges. This study tried to address this gap by introducing a new approach to systematically measure quality of care in a project of Médecins Sans Frontières (MSF in Agok area, between South Sudan and Sudan. Our objective was to obtain a valid snapshot of quality of care for a MSF project in three weeks that has the potential to serve as a baseline for quality improvement strategies. The evaluation followed a cross-sectional study design to assess structural, process and outcome quality according to Donabedian's criteria of quality of care. A bundle of well-established methods for collection of quantitative and qualitative data was used to assess the project by following a triangulated mixed-methods approach. Mean structural quality scored 73% of expected performance level and mean process quality 59%. The overall mortality rate for the hospital was 3.6%. On average, less complicated cases got a better level of care than patients who were seriously ill. Significant motivational issues were discovered in staff interviews potentially affecting quality of care. The tool appeared to be quick, feasible and effective in judging quality of care in the selected project. To tap the whole potential of the approach a re-evaluation should be carried out to assess the effectiveness of implemented improvement strategies in Agok. To confirm the usefulness of the approach, more studies are needed covering the variety of different humanitarian aid settings.

Roland Kersten

2013-05-01

291

Too complicated for the field? Measuring quality of care in humanitarian aid settings.  

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While quality of care is a major concern in the western world, not many studies investigate this topic in low-income countries. Even less is known about the quality of care in humanitarian aid settings, where additional challenges from natural or manmade disasters contribute to additional challenges. This study tried to address this gap by introducing a new approach to systematically measure quality of care in a project of Médecins Sans Frontières (MSF) in Agok area, between South Sudan and Sudan. Our objective was to obtain a valid snapshot of quality of care for a MSF project in three weeks that has the potential to serve as a baseline for quality improvement strategies. The evaluation followed a cross-sectional study design to assess structural, process and outcome quality according to Donabedian's criteria of quality of care. A bundle of well-established methods for collection of quantitative and qualitative data was used to assess the project by following a triangulated mixed-methods approach. Mean structural quality scored 73% of expected performance level and mean process quality 59%. The overall mortality rate for the hospital was 3.6%. On average, less complicated cases got a better level of care than patients who were seriously ill. Significant motivational issues were discovered in staff interviews potentially affecting quality of care. The tool appeared to be quick, feasible and effective in judging quality of care in the selected project. To tap the whole potential of the approach a re-evaluation should be carried out to assess the effectiveness of implemented improvement strategies in Agok. To confirm the usefulness of the approach, more studies are needed covering the variety of different humanitarian aid settings. PMID:23683715

Kersten, Roland; Bosse, Götz; Dörner, Frank; Slavuckij, Andrej; Fernandez, Gustavo; Marx, Michael

2013-01-01

292

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

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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

293

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

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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

294

Quality of Care in the Social Services: Research Agenda and Methods  

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In an era of heightened accountability, remarkably little is known empirically about the quality of social work services. This article applies insights from health services research to propose a research agenda on the quality of care in the social services. The agenda calls for studies that address the definition of quality service, variations in…

McMillen, J. Curtis; Proctor, Enola K.; Megivern, Deborah; Striley, Catherine Woodstock; Cabassa, Leopoldo J.; Munson, Michelle R.; Dickey, Barbara

2005-01-01

295

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

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

Ingeman Annette

2009-10-01

296

Factors predicting team climate, and its relationship with quality of care in general practice  

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Full Text Available Abstract Background Quality of care in general practice may be affected by the team climate perceived by its health and non-health professionals. Better team working is thought to lead to higher effectiveness and quality of care. However, there is limited evidence available on what affects team functioning and its relationship with quality of care in general practice. This study aimed to explore individual and practice factors that were associated with team climate, and to explore the relationship between team climate and quality of care. Methods Cross sectional survey of a convenience sample of 14 general practices and their staff in South Tyneside in the northeast of England. Team climate was measured using the short version of Team Climate Inventory (TCI questionnaire. Practice characteristics were collected during a structured interview with practice managers. Quality was measured using the practice Quality and Outcome Framework (QOF scores. Results General Practitioners (GP had a higher team climate scores compared to other professionals. Individual's gender and tenure, and number of GPs in the practice were significantly predictors of a higher team climate. There was no significant correlation between mean practice team climate scores (or subscales with QOF scores. Conclusion The absence of a relationship between a measure of team climate and quality of care in this exploratory study may be due to a number of methodological problems. Further research is required to explore how to best measure team functioning and its relationship with quality of care.

Eccles Martin P

2009-08-01

297

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

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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

298

Electronic Health Record Clinical Decision Support Systems and National Ambulatory Care Quality  

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Context Electronic health records (EHRs) are increasingly used by U.S. outpatient physicians. EHRs could improve clinical care via clinical decision support (CDS), electronic guideline-based reminders and alerts. Objective Using nationally representative data, we assessed the relationship of EHR and CDS use to ambulatory care quality, hypothesizing that higher quality of care would be associated with EHRs and CDS. Design Retrospective, cross-sectional analysis of physician survey data on patient visits. Setting Ambulatory care physician practices in non-federal offices and hospitals. Participants National estimates were based on 190,314 patient visits from the 2005–07 National Ambulatory Medical Care Survey and 2005–06 National Hospital Ambulatory Medical Care Survey. Main Outcome Measures We used a previously developed set of 20 visit-based quality indicators to assess the provision of guideline recommended care with a focus on appropriate pharmacotherapy and preventive counseling. Results EHRs were connected with 28% of an estimated 1.0 billion annual U.S. patient visits. CDS was present in 57% of the visits where an EHR was used (16% of all visits). Use of EHR and CDS varied with provider and patient characteristics, including significantly increased use in the West and in multi-physician settings compared with solo practices. For 19 of 20 quality indicators, visits associated with EHRs had similar quality compared with visits conducted without EHR. Higher quality was noted only for diet counseling in high risk adults (p=0.002). Among the EHR visits, 19 of the 20 quality indicators showed no significant difference in quality between visits with and without CDS. CDS was associated with significantly better performance for only one indicator, lack of routine ECG ordering in low risk patients (p=0.001). Conclusions Our finding of no consistent association between EHR and CDS use and better quality raises concern about the ability of EHR, in isolation, to fundamentally alter outpatient care quality.

Romano, Max J.; Stafford, Randall S.

2014-01-01

299

Impact of provider coordination on nurse and physician perceptions of patient care quality.  

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The objective of this study was to assess the role of provider coordination on nurse manager and physician perceptions of care quality, while controlling for organizational factors. Findings indicated that nurse-nurse coordination was positively associated with nurse manager perceptions of care quality; neither physician-physician nor physician-nurse coordination was associated with physician perceptions. Organizational factors associated with positive perceptions of care quality included facility support of education for nurses and physicians, and the use of multidisciplinary rounding. PMID:24509244

McIntosh, Nathalie; Burgess, James F; Meterko, Mark; Restuccia, Joseph D; Alt-White, Anna C; Kaboli, Peter; Charns, Martin

2014-01-01

300

Predicting Desire for Institutional Placement among Racially Diverse Dementia Family Caregivers: The Role of Quality of Care  

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Purpose: Literature on institutionalization of patients with dementia has not considered the role of caregivers' quality of care, which encompasses caregivers' exemplary care (EC) behaviors and caregivers' potentially harmful behaviors (PHBs) toward care recipients. This study sought to understand the role of quality of care in mediating between…

Sun, Fei; Durkin, Daniel W.; Hilgeman, Michelle M.; Harris, Grant; Gaugler, Joseph E.; Wardian, Jana; Allen, Rebecca S.; Burgio, Louis D.

2013-01-01

 
 
 
 
301

Enfermedad hemolítica perinatal Perinatal hemolytic disease  

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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

302

Economic Development Strategies to Promote Quality Child Care.  

Science.gov (United States)

Across the country as state and local teams have conducted economic analyses of the child care sector, they have faced the challenge of how to take the next step and build linkages between economic development and child care policy. The intent of this doc...

B. Markeson J. Hallas M. Warner N. Barai S. Adriance

2004-01-01

303

Perinatal lethal osteogenesis imperfecta.  

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Perinatal lethal osteogenesis imperfecta is the result of heterozygous mutations of the COL1A1 and COL1A2 genes that encode the alpha 1(I) and alpha 2(I) chains of type I collagen, respectively. Point mutations resulting in the substitution of Gly residues in Gly-X-Y amino acid triplets of the triple helical domain of the alpha 1(I) or alpha 2(I) chains are the most frequent mutations. They interrupt the repetitive Gly-X-Y structure that is mandatory for the formation of a stable triple helix...

Cole, W. G.; Dalgleish, R.

1995-01-01

304

[Perinatal dengue infection].  

Science.gov (United States)

Dengue is a mosquito-borne viral disease, with worldwide distribution in tropical and subtropical areas. Argentina was certified free of Aedes aegypti in the sixties, however the vector reappered in 1984. In the nineties, small dengue outbreaks occurred with autocthonus diseases at first limited to the 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. PMID:21660390

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

2011-06-01

305

Patient perceptions of electronic medical records use and ratings of care quality  

Science.gov (United States)

Purpose Despite considerable potential for improving health care quality, adoption of new technologies, such as electronic medical records (EMRs), requires prudence, to ensure that such tools are designed, implemented, and used meaningfully to facilitate patient-centered communication and care processes, and better health outcomes. The association between patients’ perceptions of health care provider use of EMRs and health care quality ratings was assessed. Method Data from two iterations of the Health Information National Trends Survey, fielded in 2011 and 2012, were pooled for these analyses. The data were collected via mailed questionnaire, using a nationally representative listing of home addresses as the sampling frame (n=7,390). All data were weighted to provide representative estimates of quality of care ratings and physician use of EMR, in the adult US population. Descriptive statistics, t-tests, and multivariable linear regression analyses were conducted. Results EMR use was reported significantly more frequently by females, younger age groups, non-Hispanic whites, and those with higher education, higher incomes, health insurance, and a usual source of health care. Respondents who reported physician use of EMRs had significantly higher ratings of care quality (Beta=4.83, standard error [SE]=1.7, PEMR use are associated with their perceptions of the quality of the health care they receive.

Finney Rutten, Lila J; Vieux, Sana N; St Sauver, Jennifer L; Arora, Neeraj K; Moser, Richard P; Beckjord, Ellen Burke; Hesse, Bradford W

2014-01-01

306

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

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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

307

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

International Nuclear Information System (INIS)

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

1988-01-01

308

Impacts of pay for performance on the quality of primary care  

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

Allen T

2014-07-01

309

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

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Scand J Caring Sci; 2012; Communication skills training for health care professionals improves the adult orthopaedic patient's experience of quality of care Rationale:â?? 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:â?? 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:â?? 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:â?? 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:â?? 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:â?? 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:â?? 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

310

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

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Pre-hospital critical care is considered to be a complex intervention with a weak evidence base. In quality improvement literature, the value equation has been used to depict the inevitable relationship between resources expenditure and quality. Increased value of pre-hospital critical care involves moving a system from quality assurance to quality improvement. Agreed quality indicators can be integrated in existing quality improvement and complex intervention methodology. A QI system for pre-hospital critical care includes leadership involvement, multi-disciplinary buy-in, data collection infrastructure and long-term commitment. Further, integrating process control with governance systems allows evidence-based change of practice and publishing of results. PMID:24887186

Rehn, Marius; Krüger, Andreas J

2014-01-01

311

Perinatal transmission of Hepatitis B  

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Full Text Available There is a high global prevalence of hepatitis B. Perinatal transmission of hepatitis B is the predominant mode of transmission in high prevalence areas. The risk of progression to chronic liver disease and development of hepatocellular carcinoma in individuals who acquire the infection at birth is high. Perinatal transmission of hepatitis B can be reduced by early identification of hepatitis B virus (HBV carrier mothers. High maternal viral loads and maternal serum HBeAg positivity increase the risk of perinatal transmission of hepatitis B. Passive and active immunoprophylaxis at birth reduces the risk of perinatal transmission of hepatitis B in approximately 95%. Failure of immunoprophylaxis has been related to possible in utero transmission of HBV. Reducing maternal HBV DNA levels by treatment with lamivudine in the last trimester of pregnancy in high viremic mothers may help reduce the risk of perinatal transmission of hepatitis B.

Chowdhury Sudipta

2009-01-01

312

Blueprint for action: steps toward a high-quality, high-value maternity care system.  

Science.gov (United States)

Childbirth Connection hosted a 90th Anniversary national policy symposium, Transforming Maternity Care: A High Value Proposition, on April 3, 2009, in Washington, DC. Over 100 leaders from across the range of stakeholder perspectives were actively engaged in the symposium work to improve the quality and value of U.S. maternity care through broad system improvement. A multi-disciplinary symposium steering committee guided the strategy from its inception and contributed to every phase of the project. The "Blueprint for Action: Steps Toward a High Quality, High Value Maternity Care System", issued by the Transforming Maternity Care Symposium Steering Committee, answers the fundamental question, "Who needs to do what, to, for, and with whom to improve the quality of maternity care over the next five years?" Five stakeholder workgroups collaborated to propose actionable strategies in 11 critical focus areas for moving expeditiously toward the realization of the long term "2020 Vision for a High Quality, High Value Maternity Care System", also published in this issue. Following the symposium these workgroup reports and recommendations were synthesized into the current blueprint. For each critical focus area, the "Blueprint for Action" presents a brief problem statement, a set of system goals for improvement in that area, and major recommendations with proposed action steps to achieve them. This process created a clear sightline to action that if enacted could improve the structure, process, experiences of care, and outcomes of the maternity care system in ways that when anchored in the culture can indeed transform maternity care. PMID:20123180

Angood, Peter B; Armstrong, Elizabeth Mitchell; Ashton, Diane; Burstin, Helen; Corry, Maureen P; Delbanco, Suzanne F; Fildes, Barbara; Fox, Daniel M; Gluck, Paul A; Gullo, Sue Leavitt; Howes, Joanne; Jolivet, R Rima; Laube, Douglas W; Lynne, Donna; Main, Elliott; Markus, Anne Rossier; Mayberry, Linda; Mitchell, Lynn V; Ness, Debra L; Nuzum, Rachel; Quinlan, Jeffrey D; Sakala, Carol; Salganicoff, Alina

2010-01-01

313

Using a summary measure for multiple quality indicators in primary care: the Summary QUality InDex (SQUID)  

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Background Assessing the quality of primary care is becoming a priority in national healthcare agendas. Audit and feedback on healthcare quality performance indicators can help improve the quality of care provided. In some instances, fewer numbers of more comprehensive indicators may be preferable. This paper describes the use of the Summary Quality Index (SQUID) in tracking quality of care among patients and primary care practices that use an electronic medical record (EMR). All practices are part of the Practice Partner Research Network, representing over 100 ambulatory care practices throughout the United States. Methods The SQUID is comprised of 36 process and outcome measures, all of which are obtained from the EMR. This paper describes algorithms for the SQUID calculations, various statistical properties, and use of the SQUID within the context of a multi-practice quality improvement (QI) project. Results At any given time point, the patient-level SQUID reflects the proportion of recommended care received, while the practice-level SQUID reflects the average proportion of recommended care received by that practice's patients. Using quarterly reports, practice- and patient-level SQUIDs are provided routinely to practices within the network. The SQUID is responsive, exhibiting highly significant (p < 0.0001) increases during a major QI initiative, and its internal consistency is excellent (Cronbach's alpha = 0.93). Feedback from physicians has been extremely positive, providing a high degree of face validity. Conclusion The SQUID algorithm is feasible and straightforward, and provides a useful QI tool. Its statistical properties and clear interpretation make it appealing to providers, health plans, and researchers.

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

2007-01-01

314

Quality of life after stay in surgical intensive care unit  

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Full Text Available 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 were recorded on admission: age, gender, American Society of Anesthesiologists physical status (ASA-PS, type and magnitude of surgical procedure, ICU and hospital length of stay (LOS, mortality and Simplified Acute Physiology Score II (SAPS II. Six months after discharge, a Short Form-36 questionnaire (SF-36 and a questionnaire to assess dependency in ADL were sent to all survivors. Descriptive statistics was used to summarize data. Patient groups were compared using non-parametric tests. A logistic regression analysis was performed to identify covariate effects of each variable on dependency in personal and instrumental ADL, and for the change-in-health question of SF-36. Results Out of 333 hospital survivors, 226 completed the questionnaires. Fifty-nine percent reported that their general level of health was better on the day they answered the questionnaire than 12 months earlier. Patients with greater co-morbidities (ASA-PS III/IV, had lower SF-36 scores in all domains and were more frequently dependent in instrumental and personal ADL. Logistic regression showed that SAPS II was associated with changes in general level of health (OR 1.06, 95%CI, 1.01 – 1.11, p = 0,016. Six months after ICU discharge, 60% and 34% of patients, respectively, were dependent in at least one activity in instrumental ADL (ADLI and personal ADL (ADLP. ASA-PS (OR 3.00, 95%CI 1.31 – 6.87, p = 0.009 and age (OR 2.36, 95%CI, 1.04 – 5.34, p = 0.04 were associated with dependency in ADLI. For ADLP, only ASA-PS (OR 4.58, 95%CI, 1.68–12.46, p = 0.003 was associated with higher dependency. Conclusion ASA-PS, age, type of surgery, ICU LOS and SAPS II could be seen as determinants of HRQOL.

Castro Maria A

2007-07-01

315

Nurse qualifications and perceptions of patient safety and quality of care in South Africa.  

Science.gov (United States)

A plethora of research links professional nurses' qualifications to patient outcomes. Also, research has shown that reports by nurses on the quality of care correspond with process or outcome measures of quality in a hospital. New to the debate is whether professional nurses' qualifications impact on their perceptions of patient safety and quality of care. This research aims to investigate professional nurses' perceptions of patient safety and quality of care in South Africa, and the relationship between these perceptions and professional nurses' qualifications. A cross-sectional survey of 1117 professional nurses from medical and surgical units of 55 private and 7 public hospitals was conducted. Significant problems with regard to nurse-perceived patient safety and quality of care were identified, while adverse incidents in patients and professional nurses were underreported. Qualifications had no correlation with perceptions of patient safety and quality of care, although perceptions may serve as a valid indicator of patient outcomes. Creating an organizational culture that is committed to patient safety and encourages the sharing of adverse incidents will contribute to patient safety and quality of care in hospitals. PMID:24102916

Blignaut, Alwiena J; Coetzee, Siedine K; Klopper, Hester C

2014-06-01

316

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

317

Measuring Process of Arthritis Care. A Proposed Set of Quality Measures for the Process of Care in Juvenile Idiopathic Arthritis  

Science.gov (United States)

Objectives The ability to assess quality of care is a necessary component of continuous quality improvement. The assessment typically is accomplished by determination of compliance with a defined set of quality measures (QMs). The objective of this effort was to establish a set of QM for the assessment of the process of care in JIA. Methods A 12 member working group (WG) composed of representatives from the ACR, AAP, ABP, and ARHP was assembled to guide the project. Delphi questionnaires were sent to 237 health professionals involved in the care of children with juvenile idiopathic arthritis (JIA). A total of 471 items in 27 domains were identified. The WG met via four live e-meetings during which results from the Delphi’s were distilled to a reduced draft set. Each WG member selected a proposed QM to investigate and present evidence from the literature as to its attributes and appropriateness for inclusion into the set. Nominal group technique was used to come to consensus on a proposed set of QMs. Results The proposed set contains 12 QMs within four health care domains. Each QM consists of a statement of (i) the assessment to be completed, (ii) when the first assessment should be completed and a suggested frequency of assessment during follow-up, (iii) recommendations of appropriate tools or methods of assessment, and (iv) initial performance goals. Conclusions Implementation of the proposed QM set will improve the process of care, facilitate continuous QI, and eventuate in improved health outcomes of children with JIA.

Lovell, Daniel J.; Passo, Murray H.; Beukelman, Timothy; Bowyer, Suzanne L.; Gottlieb, Beth S.; Henrickson, Michael; Ilowite, Norman T.; Kimura, Yukiko; DeWitt, Esi Morgan; Segerman, Jill; Stein, Leonard D.; Taylor, Janalee; Vehe, Richard K.; Giannini, Edward H.

2010-01-01

318

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

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

Frimpong Jemima A

2013-01-01

319

What determines patients' satisfaction with their mental health care and quality of life?  

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Objectives: This study investigated whether patients' satisfaction with their mental health care and quality of life is related to their age, gender, psychiatric diagnosis, and duration of mental disorder.

Blenkiron, P.; Hammill, C.

2003-01-01

320

Patient and nurse assessment of quality of care in postoperative pain management  

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Objective: To describe and compare patient and nurse assessments of the quality of care in postoperative pain management, to investigate differences between subgroups of patients, and to compare patient assessments in different departments.

Idvall, E.; Hamrin, E.; Sjostrom, B.; Unosson, M.

2002-01-01

 
 
 
 
321

Evaluation of a Quality Assessment Tool for Health Care Administrators at Brooke Army Medical Center.  

Science.gov (United States)

The intent of this study was to examine the feasibility of a tracking mechanism and patient survey as a means of directly and indirectly assessing specific administrative functions in the health care delivery process. Keywords: TQM; Management; Quality; H...

M. S. Lopez

1986-01-01

322

Medical Care Appraisal and Quality Assurance in the Office Practice of Internal Medicine.  

Science.gov (United States)

The specific objectives of this study were: (1) develop a method for assessing quality in office practice on internists; (a) select a number of categories of care representative of the practice of internal medicine; (b) develop objective criteria of quali...

R. L. Hare S. Barnoon

1973-01-01

323

Theoretical Model Testing -- Patients', Nurses' and Physicians' Perceptions of Quality Nursing Care.  

Science.gov (United States)

In order to determine what constitutes quality nursing care, a research project was designed and carried out using quantitative methods. The theoretical framework was derived from previous research on conflict from role strain. It was assumed that patient...

A. S. Hinshaw D. L. Oakes

1977-01-01

324

Effectiveness of palliative day care in improving pain, symptom control, and quality of life.  

Science.gov (United States)

To evaluate the effectiveness of palliative day care in improving pain, symptom control, and quality of life (QOL), 120 consecutive new referrals to five specialist palliative day care centers were recruited into a prospective comparative study. Fifty-three comparison patients were identified as those patients receiving usual palliative care services (home care, inpatient care), but did not attend day care. Patients were assessed at 3 interviews (baseline, 6-8 weeks, and 12-15 weeks) using measures of health-related quality of life: McGill Quality of Life Questionnaire (MQOL) and Palliative Care Outcome Scale (POS). There were two main analyses: 1) patient demographic data were analyzed using chi-square (chi(2)), and 2) QOL data were compared, based on distribution of scores, using the Mann-Whitney test (MQOL and POS), and Wilcoxon Signed Rank for within group differences (POS data only); P palliative day care in the UK. At baseline, the day care group were (non-significantly) worse than the comparison group in the MQOL support domain (P = 0.065). The comparison group had marginally more severe pain at baseline (P = 0.053) and more severe symptoms at second assessment (P = 0.025). Both patient groups maintained overall health-related quality of life during the three months of the study. Palliative day care was not found to improve overall health-related quality of life. The limitations of the QOL measures in identifying the effects (patient outcomes) of palliative day care and the differences between the two patient groups (age, employment, unequal sample sizes) were limitations of the study and indicate the need for further research in this area. PMID:12614955

Goodwin, Danielle M; Higginson, Irene J; Myers, Kathy; Douglas, Hannah-Rose; Normand, Charles E

2003-03-01

325

Measuring quality of care in nursing home - what matters?  

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Residential care in nursing homes continues to be necessary for those individuals who are no longer able to live safely and comfortably at home. The demographic change with increasing number of persons over 65 years in the next 20 years also means that the percentage of those who will require care in a nursing home some time before the end of their lives will increase. Therefore, anticipating this pressure to expand nursing home availability, it is critical that these services are developed f...

Nakrem, Sigrid

2011-01-01

326

The Impact of Continuing Education on the Quality of Patient Care  

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We randomly allocated family physicians meeting explicit entry criteria to experimental and control groups to determine whether CME affects the quality of patient care. The experimental group received educational packages, the control group did not. These educational packages were closely matched with explicit criteria used in the indicator condition—our method of measuring the quality of care. The indicator conditions were divided into elective, mandatory and hidden categories. We compared...

Rudnick, K. V.; Fraser, W. P.; Sibley, J. C.; Neufeld, V. R.; Sackett, D. L.; Gerrard, B. A.

1983-01-01

327

Quality Measures for Hospice and Palliative Care: Piloting the PEACE Measures.  

Science.gov (United States)

Abstract Background: The Carolinas Center for Medical Excellence launched the PEACE project in 2006, under contract with the Centers for Medicare & Medicaid Services (CMS), to identify, develop, and pilot test quality measures for hospice and palliative care programs. Objectives: The project collected pilot data to test the usability and feasibility of potential quality measures and data collection processes for hospice and palliative care programs. Settings/subjects: Twenty-two hospices participating in a national Quality Improvement Collaborative (QIC) submitted data from 367 chart reviews for pain care and 45 chart reviews for nausea care. Fourteen additional hospices completed a one-time data submission of 126 chart reviews on 60 potential patient-level quality measures across eight domains of care and an organizational assessment evaluating structure and processes of care. Design: Usability was assessed by examining the range, variability and size of the populations targeted by each quality measure. Feasibility was assessed during the second pilot study by surveying data abstractors about the abstraction process and examining the rates of missing data. The impact of data collection processes was assessed by comparing results obtained using different processes. Results: Measures shown to be both usable and feasible included: screening for physical symptoms on admission and documentation of treatment preferences. Methods of data collection and measure construction appear to influence observed rates of quality of care. Conclusions: We successfully identified quality measures with potential for use in hospices and palliative care programs. Future research is needed to understand whether these measures are sensitive to quality improvement interventions. PMID:24921162

Schenck, Anna P; Rokoske, Franziska S; Durham, Danielle; Cagle, John G; Hanson, Laura C

2014-07-01

328

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

Digital Repository Infrastructure Vision for European Research (DRIVER)

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 affil...

Emamzadeh Ghasemi;  Vanaky Z;  Dehghan nayeri N;  Salehi T;  Salsali M; Faghihzadeh s

2007-01-01

329

A hybrid course for the RN-to-baccalaureate curriculum: patient-centered care and quality.  

Science.gov (United States)

Teaching RN-to-baccalaureate nursing students to incorporate patient-centered care and quality concepts into the practice environment presents challenges and opportunities for nurse educators. The authors describe development, deployment, and evaluation of an RN-to-baccalaureate hybrid course focused on patient-centered care and quality improvement. Course teaching strategies and evaluation of student learning and the efficacy of using a hybrid instructional design are discussed. PMID:21670632

Johnson, Linda; Smith, Charlene M

2011-01-01

330

An evaluation of quality control activity for near patient testing in primary care.  

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Near patient activity is now increasing within the United Kingdom and can be a valuable activity within primary care, but only within the confines of safe practice that incorporates quality control procedures. This study identified widespread use of near patient testing (NPT) within primary care but that there is a haphazard approach to specific test performance. Results showed a poor understanding of quality control issues and provide a clear indication of future training and educational pri...

Murray, E. T.; Fitzmaurice, D. A.

1998-01-01

331

Exploring the quality of life of younger residents living in residential care facilities  

Digital Repository Infrastructure Vision for European Research (DRIVER)

The purpose of this qualitative study is to explore the characteristics of the quality of life of younger residents in residential care facilities, and to gain an understanding of the important factors that contribute to their quality of life. Multiple methods were employed to collect data, including younger resident in-depth interviews, focus groups with staff members, and interviews with a member from the management team at two residential care facilities in British Columbia, Canada. The da...

Hay, Kara Noelle

2010-01-01

332

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

Digital Repository Infrastructure Vision for European Research (DRIVER)

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 hospita...

2013-01-01

333

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

Digital Repository Infrastructure Vision for European Research (DRIVER)

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

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

2013-01-01

334

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

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

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

2004-01-01

335

THE SYSTEM APPROACH TO THE ESTIMATION OF MEDICAL CARE QUALITY IN DAY HOSPITAL IN PEDIATRICS  

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In the paper the system of criteria for estimation of medical care quality in pediatric hospital is suggested. Itcontains objective and subjective criteria (some of them were used in Russian practice first time), quantitative and qualitative, direct and indirectcriteria. The system was approved for compare five analysis of day and twenty-four-hour hospitals of gastroenterology profile atthe Saratov State Regional Children’s Clinical Hospital. Itwas shown that high quality of medical care to...

Shigaev, N. N.

2008-01-01

336

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

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

2009-01-01

337

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

Digital Repository Infrastructure Vision for European Research (DRIVER)

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

338

Quality of Care in One Italian Nursing Home Measured by ACOVE Process Indicators  

Science.gov (United States)

Objectives To adapt the Assessing Care of Vulnerable Elders Quality Indicators (ACOVE QIs) for use in Italy, to assess the adherence to these indicators as reported in the medical records of residents in a nursing home (NH), to compare this adherence for general medical and geriatric conditions, and eventually, to identify the relationships between patients' characteristics and reported processes of care. Methods Two physicians collected the data by reviewing medical records of all NH residents in the previous 5 years, for a period of one year. Patients aged <65 years were excluded. A total of 245 patients were reviewed during the study period. The ACOVE QIs set, developed for NH processes of care, was used to assess the quality of care. Multivariate analysis was performed to identify and to assess the role of patients' characteristics on quality of processes of care by several domains of care in general medical and geriatric conditions. Results With the exception of diabetes management, quality of processes of care for general medical conditions approached adequate adherence. Care falls substantially short of acceptable levels for geriatric conditions (pressure ulcers, falls, dementia). On the contrary, the recommended interventions for urinary incontinence were commonly performed. Adherence to indicators varied for the different domains of care and was proven worse for the screening and prevention indicators both for geriatric and general medical conditions. Statistical analysis showed disparities in provision of appropriate processes of care associated with gender, age, co-morbidities, level of function and mobility, length of stay and modality of discharge by NHs. Conclusions Adherence to recommended processes of care delivered in NH is inadequate. Substantial work lies ahead for the improvement of care. Efforts should focus particularly on management of geriatric conditions and on preventive healthcare.

Pileggi, Claudia; Manuti, Benedetto; Costantino, Rosa; Bianco, Aida; Nobile, Carmelo G. A.; Pavia, Maria

2014-01-01

339

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

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

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

1999-01-01

340

Do the ward notes reflect the quality of end-of-life care?  

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OBJECTIVES: To study the accuracy of reviewing ward notes (chart review) as a measure of the quality of care rendered to patients with "Do Not Resuscitate" (DNR) orders. DESIGN: We reviewed the charts of 19 consecutive, competent inpatients with DNR orders for evidence that the staff addressed a broad range of patient care needs called Concurrent Care Concerns (CCCs), such as withholding treatments other than resuscitation itself, and attention to patient comfort needs. We then interviewed th...

Sulmasy, D. P.; Dwyer, M.; Marx, E.

1996-01-01

 
 
 
 
341

Patient satisfaction with quality of primary health care in Benghazi, Libya  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Introduction: The Libyan National Health System (LNHS) is debated for the paradox of its performance versus impact. It has poor performance, but the national health statistics are good and competitive. There are concerted efforts to manage health care services and to regain the lost trust. A primary health care (PHC) system that focuses on preventive and promotive care is the core focus of LNHS efforts. Objectives: To assess patient satisfaction with quality of PHC assessed in terms of (a) cu...

Asharaf Abdul Salam; Amina Abdulla Alshekteria; Hana Abd Alhadi; Mariam Ahmed; Anees Mohammed

2010-01-01

342

Adult Obesity and Office-based Quality of Care in the U.S  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Nationally representative data are limited on the quality of care for obese patients in U.S. ambulatory care settings. We conducted a cross-sectional analysis of the 2005 and 2006 National Ambulatory Medical Care Survey, which for the first time, collected patient weights and heights during a representative sample of visits to U.S. private physician practices. We examined obesity screening, diagnosis and counseling during adult visits and associations with patient and provider characteristics...

Ma, Jun; Xiao, Lan; Stafford, Randall S.

2009-01-01

343

Connecting Child Care Quality to Child Outcomes: Drawing Policy Lessons from Nonexperimental Data  

Science.gov (United States)

Effective early childhood intervention and child care policies should be based on an understanding of the effects of child care quality and type on child well-being. This article describes methods for securing unbiased estimates of these effects from nonexperimental data. It focuses on longitudinal studies like the one developed by the National…

Duncan, Greg J.; Gibson-Davis, Christina M.

2006-01-01

344

Language Differences as a Barrier to Quality and Safety in Health Care: The Joint Commission Perspective  

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Effective communication with patients is critical to the safety and quality of care. Barriers to this communication include differences in language, cultural differences, and low health literacy. Evidence-based practices that reduce these barriers must be integrated into, rather than just added to, health care work processes.

Schyve, Paul M.

2007-01-01

345

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

346

Psychosocial stress at work and perceived quality of care among clinicians in surgery  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Background Little is known about the association between job stress and job performance among surgeons, although physicians' well-being could be regarded as an important quality indicator. This paper examines associations between psychosocial job stress and perceived health care quality among German clinicians in surgery. Methods Survey data of 1,311 surgeons from 489 hospitals were analysed. Psychosocial stress at work was measured by the effort-reward imbalance model (ERI and the demand-control model (job strain. The quality of health care was evaluated by physicians' self-assessed performance, service quality and error frequency. Data were collected in a nationwide standardised mail survey. 53% of the contacted hospitals sent back the questionnaire; the response rate of the clinicians in the participating hospitals was about 65%. To estimate the association between job stress and quality of care multiple logistic regression analyses were conducted. Results Clinicians exposed to job stress have an increased risk of reporting suboptimal quality of care. Magnitude of the association varies depending on the respective job stress model and the indicator of health care quality used. Odds ratios, adjusted for gender, occupational position and job experience vary between 1.04 (CI 0.70-1.57 and 3.21 (CI 2.23-4.61. Conclusion Findings indicate that theoretical models of psychosocial stress at work can enrich the analysis of effects of working conditions on health care quality. Moreover, results suggest interventions for job related health promotion measures to improve the clinicians' working conditions, their quality of care and their patients' health.

von dem Knesebeck Olaf

2011-05-01

347

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

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

Pirkle Catherine M

2012-10-01

348

Corioamnionitis: Repercusión perinatal  

Scientific Electronic Library Online (English)

Full Text Available SciELO Venezuela | Language: Spanish Abstract in spanish 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

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

349

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

Directory of Open Access Journals (Sweden)

Full Text Available Objective: To describe consumer assessment of the perceived-quality of antenatal care services in a tertiary health care institution in Osun State.Material and Methods: In a descriptive cross-sectional study, information was obtained (utilizing a semi-structured questionnaire from 289 pregnant women randomly selected from the Antenatal Clinic (ANC of Obafemi Awolowo University Teaching Hospital. Chi-square statistic test was used to explore associations. Level of significance was p<0.05.Results: Mean age of respondents was 30.93 + 9.109 years, the modal age group was 26-30 years, 6.2% were single while 93.8% were ever-married, 3.5% had no formal education, while 39.1%, 53.3% had secondary and tertiary education respectively. Rate of adolescent pregnancy in this study was 4.2%. About a third each of respondents had parity of one and two respectively. Age, occupation, husband’s payment of booking fees, and previous ANC attendance were all significantly related to place of previous delivery (p<0.05. More than 90% of respondents assessed health personnel’s attitudes positively; however, an assessment of poor quality of care in terms of time spent in clinic (too long/too short was given by 66.5% of respondents, whilst almost one quarter (22.5% were not satisfied with the over-all perceived quality of care received. The most frequently mentioned reason for non-satisfaction with quality of care received was wasting of time in the clinic.Conclusion: Although the majority of respondents assessed the overall quality of care received as satisfactory, a major point of dissatisfaction in many respondents is the length of time spent in the ANC. To achieve the MDG of reduction in maternal mortality especially in Nigeria, the quality of ANC care needs to be improved, which will, in turn, lead to increased utilization of ANC services and an ultimate reduction in maternal mortality rate.

Esther Olufunmilayo Asekun-olarinmoye

2009-06-01

350

Quality of Care for Incident Lupus Nephritis Among Medicaid Beneficiaries in the United States  

Science.gov (United States)

OBJECTIVE We investigated the quality of care and factors associated with variations in care among a national cohort of Medicaid enrollees with incident lupus nephritis. METHODS Using Medicaid Analytic eXtract (MAX) files from 47 U.S. states and D.C. for 2000–2006, we identified a cohort of individuals with incident lupus nephritis. We assessed performance on three measures of health care quality: receipt of immunosuppressive, renal-protective anti-hypertensive, and anti-malarial medications. We examined performance on these measures over one year, and applied multivariable logistic regression models to understand whether sociodemographic, geographic or health care access factors were associated with higher performance on quality measures. RESULTS We identified 1711 Medicaid enrollees with incident lupus nephritis. Performance on quality measures was low at 90 days (21.9% for immunosuppressive therapy, 44.0% for renal protection and 36.4% for anti-malarials), but increased by one year (33.7%, 56.4%, and 45.8%, respectively). Younger individuals, Blacks and Hispanics were more likely to receive immunosuppressive therapy and hydroxychloroquine. Younger individuals were less likely to receive renal-protective anti-hypertensive medications. We found significant geographic variation in performance, with patients in the Northeast receiving higher quality of care compared to other regions. Poor access to health care, as assessed by having a greater number of treat-and-release emergency departments visits compared to ambulatory encounters, was associated with lower receipt of recommended treatment. CONCLUSION These nationwide data suggest low overall quality of care and potential delays in care for Medicaid enrollees with incident lupus nephritis. Significant regional differences also suggest room for quality improvement.

Yazdany, Jinoos; Feldman, Candace H.; Liu, Jun; Ward, Michael M.; Fischer, Michael A.; Costenbader, Karen H.

2014-01-01

351

Psychological treatments for perinatal depression.  

Science.gov (United States)

Perinatal depression is prevalent and greatly affects the mother and infant. Fortunately, empirically validated psychological treatments are available for postpartum depression and depression during pregnancy. Primary among these are interpersonal psychotherapy and cognitive-behavioural therapy, which have been shown to be effective for perinatal women across the spectrum from mild to severe depression. At present, interpersonal psychotherapy is better validated than antidepressant medication for perinatal depression, and should be considered as a first-line treatment option, especially for pregnant and breast-feeding women who are depressed. More studies are needed to evaluate further the relative efficacy of psychotherapy and medication, and more thoroughly test other psychological treatments. PMID:24269903

Stuart, Scott; Koleva, Hristina

2014-01-01

352

Perinatal Grief in Latino Parents  

Science.gov (United States)

Extensive research exists that describes the meaning of perinatal loss to some parents, but the experience of loss from the perspective of Latino parents is not clearly understood. Additionally, current perinatal bereavement practices used often to facilitate memory-making for parents (such as viewing or holding the baby, taking photographs, or collecting mementos) are based upon research done primarily with non-Latino families. Are these common practices appropriate for this population? Because there is a paucity of research on this topic, this article describes what has been written over the past 30 years on the topic of grief and perinatal loss in Latino culture.

Whitaker, Claudia; Kavanaugh, Karen; Klima, Carrie

2013-01-01

353

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  

Directory of Open Access Journals (Sweden)

Full Text Available 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 were established to evaluate the intervention programme from September 2000 to December 2004 in primary care as a part of the Prevention of Allergy among Children in Trondheim study (PACT. The primary outcome variables were self reported smoking behaviour at inclusion and six weeks postnatal. Data from the Medical Birth Registry of Norway (MBR were used to describe smoking cessation during pregnancy in Trondheim, Bergen and Norway 1999–2004. Results Maternal smoking prevalence at inclusion during pregnancy were 5% (CI 95% 4–6 in the intervention cohort compared to 7% (CI 95% 6–9, p = 0.03, in the control cohort. Of the pre-pregnancy maternal smokers 25% (CI 95% 20–31 and 32% (CI 95% 26–38, p = 0.17, were still smoking at inclusion in the intervention and control cohorts, respectively. Six weeks postnatal 72% (CI 95% 59–83 and 68% (CI 95% 57–77, p = 0.34 of the maternal smokers at inclusion still smoked. No significant difference in paternal smoking between the cohorts was found after the intervention period. Data from the MBR showed a significantly higher proportion of women who stopped smoking during pregnancy in Trondheim than in Bergen in 2003 and 2004, p = 0.03 and Conclusion No impact on parental smoking behaviour between the cohorts was observed after the smoking intervention programme. Of the women who stopped smoking during pregnancy most of them stopped smoking before the intervention. However, we observed a significantly higher quitting rate in Trondheim than in Bergen in 2003 and 2004 which may have been facilitated by the supplemental attention on smoking behaviour the PACT study initiated.

Jenssen Jon A

2008-09-01

354

Moving equilibria in the public health care sector: A low-quality trap and a resolution  

Directory of Open Access Journals (Sweden)

Full Text Available This paper demonstrates the existence, in a particular subset of the Turkish public health care sector, of equilibria moving towards a low-quality trap over time. The dynamics of the movement in question hinges, in part, on the socially necessary but demographically asymmetric burden, on some public health care institutions, of providing affordable health care to certain sections of the population. The paper formulates a policy option that could help the sector to escape the trap, moving the sector towards high quality-high welfare equilibria.

Ahmet Kara

2006-09-01

355

The quality of nursing care of the frail aged in selected institutions in Eastern Cape and Natal  

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An investigation was undertaken to establish standards for the care of the frail aged and to develop an instrument to measure this care. In this process the care in 12 institutions was monitored. In general, the care was found to be o f good quality, with an average o f 74,3%, but there are residences where the percentage is up to 10% lower. The influence o f some internal and external factors on the quality o f care were investigated.

Hunt, Noelle B.; Uys, Leana R.

1990-01-01

356

A common problem for neonatal intensive care units: late preterm infants, a prospective study with term controls in a large perinatal center.  

Science.gov (United States)

Compared with term infants, late preterm infants are immature physiologically and metabolically, and have higher risks for medical complications such as respiratory distress, hypoglycemia, hyperbilirubinemia, sepsis, feeding difficulty and poor neurodevelopmental outcomes. The incidence of late preterm birth is increasing. We evaluated the clinical and demographic characteristics, short-term outcomes and clinical courses of late preterm infants admitted to our neonatal intensive care unit (NICU). Data from NICU admissions of 605 late preterm and 1477 term infants in the 1-year period between June 2010 and May 2011 were analyzed. There were 2004 late preterm deliveries and 18,854 total deliveries. Of late preterm infants, 30% were admitted to the NICU. The mean gestational age and birth weight were 35(1/7) weeks and 2352?g, respectively. The admission diagnoses were respiratory distress (46.5%), low birth weight (17.5%), jaundice (13.7%), feeding difficulty (13.1%), polycythemia (8.1%) and hypoglycemia (4%); these morbidity rates were higher than those in term infants (p < 0.001). The overall mean hospitalization period was 7.5?±?9.1 days. The respective mortality and rehospitalization rates were 2.1% and 4.4%, which were higher than those for term infants (p < 0.001). In conclusion, late preterm infants should be followed closely for the complications just after birth, and preventive strategies should be developed. PMID:23106478

Celik, Istemi Han; Demirel, Gamze; Canpolat, Fuat Emre; Dilmen, Ugur

2013-03-01

357

‘TOP HEAVY’ SYSTEMS AND QUALITY OF HEALTH CARE  

Digital Repository Infrastructure Vision for European Research (DRIVER)

The paper is based on a primary survey of 1095 patients from the Medicine, General Surgery and Cardiac departments in R.G. Kar Medical College and Hospital (a major public sector health care institution in the metropolitan city of Kolkata, India). The results show that public health care institutions remain a vital life support system of the poorer sections of the population. However, this is not a matter of choice, but necessity. The breakdown of the three tiered referral system in the regio...

Zakir Husain; Saswata Ghosh; Bijoya Roy

2009-01-01

358

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

359

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

360

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

 
 
 
 
361

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

362

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

363

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

364

A model of service quality perceptions and health care consumer behavior.  

Science.gov (United States)

Analysis of covariance structures (LISREL) was used to examine the influence of consumer held perceptions of service quality on consumer satisfaction and intentions to return. Results indicate that service quality is a significant predictor of consumer satisfaction which, in turn, predicts intention to return. Health care marketing implications are discussed. PMID:10116639

O'Connor, S J; Shewchuk, R M; Bowers, M R

1991-01-01

365

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

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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

366

QUARITE (quality of care, risk management and technology in obstetrics: a cluster-randomized trial of a multifaceted intervention to improve emergency obstetric care in Senegal and Mali  

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Full Text Available Abstract Background Maternal and perinatal mortality are major problems for which progress in sub-Saharan Africa has been inadequate, even though childbirth services are available, even in the poorest countries. Reducing them is the aim of two of the main Millennium Development Goals. Many initiatives have been undertaken to remedy this situation, such as the Advances in Labour and Risk Management (ALARM International Program, whose purpose is to improve the quality of obstetric services in low-income countries. However, few interventions have been evaluated, in this context, using rigorous methods for analyzing effectiveness in terms of health outcomes. The objective of this trial is to evaluate the effectiveness of the ALARM International Program (AIP in reducing maternal mortality in referral hospitals in Senegal and Mali. Secondary goals include evaluation of the relationships between effectiveness and resource availability, service organization, medical practices, and satisfaction among health personnel. Methods/Design This is an international, multi-centre, controlled cluster-randomized trial of a complex intervention. The intervention is based on the concept of evidence-based practice and on a combination of two approaches aimed at improving the performance of health personnel: 1 Educational outreach visits; and 2 the implementation of facility-based maternal death reviews. The unit of intervention is the public health facility equipped with a functional operating room. On the basis of consent provided by hospital authorities, 46 centres out of 49 eligible were selected in Mali and Senegal. Using randomization stratified by country and by level of care, 23 centres will be allocated to the intervention group and 23 to the control group. The intervention will last two years. It will be preceded by a pre-intervention one-year period for baseline data collection. A continuous clinical data collection system has been set up in all participating centres. This, along with the inventory of resources and the satisfaction surveys administered to the health personnel, will allow us to measure results before, during, and after the intervention. The overall rate of maternal mortality measured in hospitals during the post-intervention period (Year 4 is the primary outcome. The evaluation will also include cost-effectiveness. Trial Registration The QUARITE trial is registered on the Current Controlled Trials website under the number ISRCTN46950658 http://www.controlled-trials.com/.

Gaye Alioune

2009-09-01

367

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

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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

368

Factors affecting the quality of antenatal care provided to remote dwelling Aboriginal women in northern Australia.  

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Objective: there is a significant gap in pregnancy and birth outcomes for Australian Aboriginal and Torres Strait Islander women compared with other Australian women. The provision of appropriate and high quality antenatal care is one way of reducing these disparities. The aim of this study was to assess adherence to antenatal guidelines by clinicians and identify factors affecting the quality of antenatal care delivery to remote dwelling Aboriginal women. Setting and design: a mixed method study drew data from 27 semi-structured interviews with clinicians and a retrospective cohort study of Aboriginal women from two remote communities in Northern Australia, who gave birth from 2004-2006 (n=412). Medical records from remote health centres and the regional hospital were audited. Measurements and findings: the majority of women attended antenatal care and adherence to some routine antenatal screening guidelines was high. There was poor adherence to local guidelines for follow-up of highly prevalent problems including anaemia, smoking, urinary tract infections and sexually transmitted infections. Multiple factors influenced the quality of antenatal care. Key conclusions and implications for practice: the resourcing and organisation of health services and the beliefs, attitudes and practices of clinicians were the major factors affecting the quality of care. There is an urgent need to address the identified issues in order to achieve equity in women's access to high quality antenatal care with the aim of closing the gap in maternal and neonatal health outcomes. PMID:23809580

Bar-Zeev, Sarah; Barclay, Lesley; Kruske, Sue; Kildea, Sue

2014-03-01

369

Quality management in German health care--the EFQM Excellence Model.  

Science.gov (United States)

A brief insight into the issues affecting German health care is given. Namely, upward pressure on costs leads to increasing expenditure within health care and downward pressure from economic recession and political unwillingness to increase taxes and budget spending. In the case of competing key stakeholder perspectives, a quality management framework is seen as a potential approach for addressing these issues. The framework is the European Foundation for Quality Management (EFQM) Excellence Model. The article briefly explains the pilot phase for utilising the EFQM Excellence Model within German health care organisations and the various implementation approaches recommended by EFQM. Specific details of an approach used by a health care organisation within Germany (providing social medicine, geriatric and elderly services) are described in detail. The benefits achieved from using the Model are a clear picture of where the gaps are in the organisation and a clear vision for concentrating future efforts towards total quality management. PMID:11484642

Moeller, J; Breinlinger-O'Reilly, J; Elser, J

2000-01-01

370

THE RELATIONSHIP BETWEEN QUALITY OF LIFE AND SELF-CARE AGENCY IN PREGNANT  

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Full Text Available The purpose of this research was to evaluate the self-care agency in pregnant, to investigate the effects of socio-demographical features and quality of life, self-care agency of pregnants. The research was conducted between 1 May- 30 May 2005 as descriptive field study. The population of the study consisted of 269 pregnant, in 10 Numbered Health Centre and 5 Numbered Health Centre in Manisa. In the statistical evaluating of the data were used percentage, Kruskall Wallis, One-way ANOWA, Independent samples T test, pearson corelation analysis. In the results of this study the life of quality level and self-care agency was determined too high who have high income family and have social insurance and nucleus family and have more education. In addition to, result of the study is the quality of life, the increasingly self care agency. [TAF Prev Med Bull 2006; 5(6.000: 416-423

Saliha ALTIPARMAK

2006-12-01

371

Measuring the productive efficiency and clinical quality of institutional long-term care for the elderly.  

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The authors consider the association between productive efficiency and clinical quality in institutional long-term care for the elderly. Cross-sectional data were collected from 122 wards in health-centre hospitals and residential homes in Finland in 2001. Productive efficiency was measured in terms of technical efficiency, which was defined as the unit's distance from the (best practice) production frontier. The analysis employed stochastic production frontier estimation, where technical inefficiency in the production function was specified to be a function of ward characteristics and clinical quality of care. Several quality indicators based on the Resident Assessment Instrument, such as prevalence of pressure ulcers and depression with no treatment, were used in the analysis. The results did not reveal systematic association between technical efficiency and clinical quality of care. However, the prevalence of pressure ulcers, indicating poor quality of care was associated with technical efficiency, a fact which highlights the importance of including quality measures in the assessment of efficiency in long-term care. PMID:15386654

Laine, Juha; Linna, Miika; Häkkinen, Unto; Noro, Anja

2005-03-01

372

Nursing practice environment, quality of care, and morale of hospital nurses in Japan.  

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The purpose of this study was to describe Japanese hospital nurses' perceptions of the nursing practice environment and examine its association with nurse-reported ability to provide quality nursing care, quality of patient care, and ward morale. A cross-sectional survey design was used including 223 nurses working in 12 acute inpatient wards in a large Japanese teaching hospital. Nurses rated their work environment favorably overall using the Japanese version of the Practice Environment Scale of the Nursing Work Index. Subscale scores indicated high perceptions of physician relations and quality of nursing management, but lower scores for staffing and resources. Ward nurse managers generally rated the practice environment more positively than staff nurses except for staffing and resources. Regression analyses found the practice environment was a significant predictor of quality of patient care and ward morale, whereas perceived ability to provide quality nursing care was most strongly associated with years of clinical experience. These findings support interventions to improve the nursing practice environment, particularly staffing and resource adequacy, to enhance quality of care and ward morale in Japan. PMID:23855754

Anzai, Eriko; Douglas, Clint; Bonner, Ann

2014-06-01

373

Impacts of pay for performance on the quality of primary care  

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Increasingly, financial incentives are being used in health care as a result of increasing demand for health care coupled with fiscal press