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Sample records for quality perinatal care

  1. Mozambican midwives' views on barriers to quality perinatal care.

    Pettersson, Karen Odberg; Johansson, Eva; Pelembe, Maria de Fatima M; Dgedge, Clemencia; Christensson, Kyllike

    2006-02-01

    Our purpose in this study was to explore the midwives' perception of factors obstructing or facilitating their ability to provide quality perinatal care at a central labor ward in Maputo. In-depth interviews were undertaken with 16 midwives and were analyzed according to grounded theory technique. Barriers to provision of quality perinatal care were identified as follows: (i) the unsupportive environment, (ii) nonempowering and limited interaction with women in labor, (iii) a sense of professional inadequacy and inferiority, and (iv) nonappliance of best caring practices. A model based on the midwives' reflections on barriers to quality perinatal care and responses to these were developed. Actions aimed at overcoming the barriers were improvising and identifying areas in need of change. Identified evading actions were holding others accountable and yielding to dysfunction and structural control. In order to improve perinatal care, the midwives need to see themselves as change agents and not as victims of external and internal causal relationships over which they have no influence. It is moreover essential that the midwives chose actions aiming at overcoming barriers to quality perinatal care instead of choosing evading actions, which might jeopardize the health of the unborn and newborn infant. We suggest that local as well as national education programs need to correspond with existing reality, even if they provide knowledge that surpasses the present possibilities in practice. Quality of intrapartum and the immediate newborn care requires a supportive environment, however, which in the context of this study presented such serious obstacles that they need to be addressed on the national level. Structural and administrative changes are difficult to target as these depend on national organization of maternal health care (MHC) services and national health expenditures. PMID:16484159

  2. Construction of quality-assured infant feeding process of care data repositories: Construction of the perinatal repository (Part 2).

    García-de-León-Chocano, Ricardo; Muñoz-Soler, Verónica; Sáez, Carlos; García-de-León-González, Ricardo; García-Gómez, Juan M

    2016-04-01

    This is the second in a series of two papers regarding the construction of data quality (DQ) assured repositories, based on population data from Electronic Health Records (EHR), for the reuse of information on infant feeding from birth until the age of two. This second paper describes the application of the computational process of constructing the first quality-assured repository for the reuse of information on infant feeding in the perinatal period, with the aim of studying relevant questions from the Baby Friendly Hospital Initiative (BFHI) and monitoring its deployment in our hospital. The construction of the repository was carried out using 13 semi-automated procedures to assess, recover or discard clinical data. The initial information consisted of perinatal forms from EHR related to 2048 births (Facts of Study, FoS) between 2009 and 2011, with a total of 433,308 observations of 223 variables. DQ was measured before and after the procedures using metrics related to eight quality dimensions: predictive value, correctness, duplication, consistency, completeness, contextualization, temporal-stability, and spatial-stability. Once the predictive variables were selected and DQ was assured, the final repository consisted of 1925 births, 107,529 observations and 73 quality-assured variables. The amount of discarded observations mainly corresponds to observations of non-predictive variables (52.90%) and the impact of the de-duplication process (20.58%) with respect to the total input data. Seven out of thirteen procedures achieved 100% of valid births, observations and variables. Moreover, 89% of births and ~98% of observations were consistent according to the experts׳ criteria. A multidisciplinary approach along with the quantification of DQ has allowed us to construct the first repository about infant feeding in the perinatal period based on EHR population data. PMID:26950399

  3. Perinatal Health Statistics as the Basis for Perinatal Quality Assessment in Croatia

    Urelija Rodin

    2015-01-01

    Full Text Available Context. Perinatal mortality indicators are considered the most important measures of perinatal outcome. The indicators reliability depends on births and deaths reporting and recording. Many publications focus on perinatal deaths underreporting and misclassification, disabling proper international comparisons. Objective. Description of perinatal health care quality assessment key indicators in Croatia. Methods. Retrospective review of reports from all maternities from 2001 to 2014. Results. According to reporting criteria for birth weight ≥500 g, perinatal mortality (PNM was reduced by 31%, fetal mortality (FM by 32%, and early neonatal mortality (ENM by 29%. According to reporting criteria for ≥1000 g, PNM was reduced by 43%, FM by 36%, and ENM by 54%. PNM in ≥22 weeks’ (wks gestational age (GA was reduced by 28%, FM by 30%, and ENM by 26%. The proportion of FM at 32–36 wks GA and at term was the highest between all GA subgroups, as opposed to ENM with the highest proportion in 22–27 wks GA. Through the period, the maternal mortality ratio varied from 2.4 to 14.3/100,000 live births. The process indicators have been increased in number by more than half since 2001, the caesarean deliveries from 11.9% in 2001 to 19.6% in 2014. Conclusions. The comprehensive perinatal health monitoring represents the basis for the perinatal quality assessment.

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

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

    1999-01-01

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

  5. Episode-Based Payment for Perinatal Care in Medicaid: Implications for Practice and Policy.

    Jarlenski, Marian; Borrero, Sonya; La Charité, Trey; Zite, Nikki B

    2016-06-01

    Medicaid is an important source of health insurance coverage for low-income pregnant women and covers nearly half of all deliveries in the United States. In the face of budgetary pressures, several state Medicaid programs have implemented or are considering implementing episode-based payments for perinatal care. Under the episode-based payment model, Medicaid programs make a single payment for all pregnancy-related medical services provided to women with low- and medium-risk pregnancies from 40 weeks before delivery through 60 days postpartum. The health care provider who delivers a live birth is assigned responsibility for all care and must meet certain quality metrics and stay within delineated cost-per-episode parameters. Implementation of cost- and quality-dependent episode-based payments for perinatal care is notable because there is no published evidence about the effects of such initiatives on pregnancy or birth outcomes. In this article, we highlight challenges and potential adverse consequences related to defining the perinatal episode and assigning a responsible health care provider. We also describe concerns that perinatal care quality metrics may not address the most pressing health care issues that are likely to improve health outcomes and reduce costs. In their current incarnations, Medicaid programs' episode-based payments for perinatal care may not improve perinatal care delivery and subsequent health outcomes. Rigorous evaluation of the new episode-based payment initiatives is critically needed to inform policymakers about the intended and unintended consequences of implementing episode-based payments for perinatal care. PMID:27159762

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

    Sunita Mor; Daya Sirohiwal; Reetu Hooda

    2015-01-01

    Background: Eclampsia is a life threatening emergency that continues to be a major cause of maternal and perinatal mortality. The purpose of our study was to analyse the trend of eclampsia in a tertiary care teaching institute and to find out maternal and perinatal outcomes of eclampsia. Methods: A prospective study was undertaken in a tertiary care teaching institute over a period of one year. Patients of eclampsia were followed up with regard to the management and maternal and fetal morb...

  7. A 10-year history of perinatal care at the Brockington Mother and Baby Unit Stafford.

    Green, Debra J; Hofberg, Kristina; Carr, Caroline; Fanneran, Tina; Sumathipala, Athula

    2016-06-01

    Perinatal mother and baby units are an essential service for women suffering from perinatal mental illness by allowing the baby to stay with the mother whilst receiving inpatient mental health care. Such units enable the mother to develop a relationship with her baby in a safe and supportive environment whilst caring for her mental health needs and allow her to gain confidence in her role as a mother. This article presents the development of the Brockington Mother and Baby unit and its progressive advancement towards an exemplary service for women suffering from perinatal mental illness. The Brockington Mother and Baby unit (MBU) at South Staffordshire and Shropshire Healthcare Foundation Trust (SSSFT) is celebrating its 10th anniversary and is one of six MBUs accredited as excellent by the Royal College of Psychiatry (RCPsych). The unit is a member of the Royal College of Psychiatrists' Quality Care Network and thereby adheres to their national standard of care. This article describes the journey from a single lone worker in perinatal mental health to an exemplary service caring for women with perinatal mental illness during the first 12 months following the birth of their child. PMID:26439484

  8. Substandard factors in perinatal care in The Netherlands : a regional audit of perinatal deaths

    Wolleswinkel-van den Bosch, JH; Vredevoogd, CB; Borkent-Polet, M; van Eyck, J; Fetter, WPF; Lagro-Janssen, TLM; Rosink, IH; Treffers, PE; Amelink, M; Richardus, JH; Verloove-Vanhorick, P; Mackenbach, JP

    2002-01-01

    Background. To determine: 1) whether substandard factors were present in cases of perinatal death, and to what extent another course of action might have resulted in a better outcome, and 2) whether there were differences in the frequency of substandard factors by level of care, particularly between

  9. Care of the newborn in perinatal units in New Brunswick

    Stephen, David L.

    1986-01-01

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

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

    Neena Shah More

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

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

    Sunita Mor

    2015-06-01

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

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

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

    2009-01-01

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

  13. Improvement in perinatal care for extremely premature infants in Denmark from 1994 to 2011

    Hasselager, Asbjørn Børch; Børch, Klaus; Pryds, Ole Axel

    2016-01-01

    gestational age and administration of surfactant. CONCLUSIONS: Centralisation of treatment of extremely premature infants has been implemented because more children are being born at highly specialised perinatal centres. Care improved as more infants received evidence-based treatment. IVH 3-4 rates declined......INTRODUCTION: Major advances in perinatal care over the latest decades have increased the survival rate of extremely premature infants. Centralisation of perinatal care was implemented in Denmark from 1995. This study evaluates the effect of organisational changes of perinatal care on survival and...

  14. Who Receives Home-Based Perinatal Palliative Care: Experience from Poland

    Aleksandra Korzeniewska-Eksterowicz

    2013-01-01

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

  15. Identification of peripartum near-miss for perinatal audit

    Kerkhofs, C; De Bruyn, C.; Mesens, T.; Theyskens, C.; Vanhoestenberghe, M.; E. Bruneel; Van Holsbeke, C; Bonnaerens, A.; Gyselaers, W.

    2014-01-01

    Introduction: Today, perinatal audit focuses basically on cases of perinatal mortality. In most centres in Western Europe, perinatal mortality is low. Identification of metabolic acidosis at birth may increase index cases eligible for evaluation of perinatal care, and this might improve quality of perinatal audit. The aim of this study is to assess the incidence of metabolic acidosis at birth in order to estimate its impact on perinatal audit. Patients and Methods: Cord blood was analysed for...

  16. Perinatal Obstetric Office Depression Screening and Treatment: Implementation in a Health Care System.

    Flanagan, Tracy; Avalos, Lyndsay A

    2016-05-01

    Perinatal depression affects between 12% and 20% of pregnant and postpartum women and is underdiagnosed. The American College of Obstetricians and Gynecologists and the U.S. Preventive Services Task Force recently recommended universal perinatal depression screening. We discuss challenges to instituting universal screening, describe the development and implementation between 2007 and 2014 of Kaiser Permanente Northern California's successful program, and highlight key measures of success. A quality improvement system approach with four steps guided development: 1) identify and use best practices, 2) identify champions and educate clinicians, 3) use data that drive performance, and 4) streamline office workflow. Clinical success was determined by at least 50% improvement in depression care metrics from diagnosis to 120 days afterward. Depression diagnoses, Patient Health Questionnaire-9 scores, medication dispensation, and treatment for all births in 2014 (N=37,660) were extracted from electronic health records. Ninety-six percent of pregnant and postpartum women were screened at least once. Fourteen percent screened positive for depression (Patient Health Questionnaire-9 score of 10 or greater). Approximately 6% of pregnant and postpartum women had severe depression with a Patient Health Questionnaire-9 of 15 or greater and a depression diagnosis, and 80% of these women received treatment. Forty percent of women with a depression diagnosis demonstrated improved symptoms. Kaiser Permanente Northern California's universal perinatal depression screening program can serve as a model for the feasibility and clinical effectiveness of universal depression screening in obstetric care. PMID:27054937

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

    Manandhar Dharma

    2005-03-01

    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.

  18. Marketing and Quality of Life: A Model for Improving Perinatal Health Status

    Dever, G. E. Alan; Smith, Leah T.; Stamps, Bunnie V.

    2005-01-01

    Introduction: A marketing/business model using non-traditional Quality of Life measures was developed to assess perinatal health status on a micro-geographic level. This perinatal health status needs assessment study for Georgia South Central Region was conducted for the years 1994-1999. The model may be applied to any geographic unit in the…

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

    Pervin Jesmin

    2012-10-01

    and after the MNCH program initiation (Sobel test of mediation P Conclusions ANC visits are associated with increased uptake of facility-based delivery and improved perinatal survival in the icddr,b SA. Further testing of the icddr,b approach to simultaneously improving quality of ANC and facility delivery care is needed in the existing health system in Bangladesh and in other low-income countries to maximize health benefits to mothers and newborns.

  20. Bridging between professionals in perinatal care: towards shared care in the Netherlands.

    Posthumus, A G; Schölmerich, V L N; Waelput, A J M; Vos, A A; De Jong-Potjer, L C; Bakker, R; Bonsel, G J; Groenewegen, P; Steegers, E A P; Denktaş, S

    2013-12-01

    Relatively high perinatal mortality rates in the Netherlands have required a critical assessment of the national obstetric system. Policy evaluations emphasized the need for organizational improvement, in particular closer collaboration between community midwives and obstetric caregivers in hospitals. The leveled care system that is currently in place, in which professionals in midwifery and obstetrics work autonomously, does not fully meet the needs of pregnant women, especially women with an accumulation of non-medical risk factors. This article provides an overview of the advantages of greater interdisciplinary collaboration and the current policy developments in obstetric care in the Netherlands. In line with these developments we present a model for shared care embedded in local 'obstetric collaborations'. These collaborations are formed by obstetric caregivers of a single hospital and all surrounding community midwives. Through a broad literature search, practical elements from shared care approaches in other fields of medicine that would suit the Dutch obstetric system were selected. These elements, focusing on continuity of care, patient centeredness and interprofessional teamwork form a comprehensive model for a shared care approach. By means of this overview paper and the presented model, we add direction to the current policy debate on the development of obstetrics in the Netherlands. This model will be used as a starting point for the pilot-implementation of a shared care approach in the 'obstetric collaborations', using feedback from the field to further improve it. PMID:23229171

  1. Interprofessional Collaboration in Perinatal Care: The Future of Midwifery.

    Smith, Denise C

    2016-01-01

    Healthcare delivered by teams is becoming more common, and an estimated 50% of obstetricians in the United States (US) work with or employ nurse practitioners or nurse-midwives. The number of midwife-attended births in the United States is also growing. Interprofessional collaboration between midwives and physicians can increase access to safe, quality maternity care for women in the United States. A review of the literature indicates that successful collaborative practice includes effective communication, trust, and respect between providers. A review of concepts and theoretical frameworks offers a foundation for scholarly inquiry, suggests a research agenda for future study, and provides suggestions for organizational leaders to translate current knowledge into the clinical setting. Midwifery, through increasing collaborative practices, has the potential to change care delivery in the years to come. PMID:27465442

  2. A community based surveillance system for perinatal and neonatal care.

    Dyal Chand, A; Khale, M

    1989-11-01

    The impact of maternal health services on perinatal and neonatal mortality depends on both the quantitative and qualitative coverage of pregnant women with obstetric services. In rural areas this becomes all the more difficult because of the requirement of a large decentralized infrastructure extending from village based health workers and subcentres to the Primary Health Centre and tertiary levels of referral. An effective introduction of socio-cultural, biomedical and managerial interventions is required to reduce perinatal and neonatal mortality. A community based surveillance and monitoring system is central to and facilitates the introduction of all other interventions. Finally, the system operated by grass-root level workers is a motivational tool for achieving expected levels of performance. PMID:2630471

  3. Screening of Substance Abuse Among Women in Perinatal Care

    Tazanu Fossung, Joakem; Cudjoe, Kwame

    2013-01-01

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

  4. Barriers to Emergency Obstetric Care Services in Perinatal Deaths in Rural Gambia: A Qualitative In-Depth Interview Study

    Siri Vangen; Johanne Sundby; Abdou Jammeh

    2011-01-01

    Objective. The Gambia has one of the world's highest perinatal mortality rates. We explored barriers of timely access to emergency obstetric care services resulting in perinatal deaths and in survivors of severe obstetric complications in rural Gambia. Method. We applied the “three delays” model as a framework for assessing contributing factors to perinatal deaths and obstetric complications. Qualitative in-depth interviews were conducted with 20 survivors of severe obstetric complications at...

  5. Primary care obstetrics and perinatal health in the Netherlands.

    Hingstman, L.

    1994-01-01

    The Netherlands is the only industrialized country in which a large percentage of obstetric care takes place at home. Almost 31% of all deliveries are home confinements under supervision of a midwife or a general practitioner, and 84% of all postnatal care is given at home by maternity care assistants. To gain a better understanding of this unique situation, the structure of Dutch obstetric care is examined with special attention to the four pillars on which the system rests: the special prot...

  6. MANAGEMENT OF ECLAMPSIA IN A TERTIARY CARE CENTRE-MATERNAL AND PERINATAL OUTCOME

    Usha Rani

    2015-11-01

    Full Text Available AIM: Management of 240 cases of eclampsia during a period of 1yr 6 months. MATERIALS AND METHODS : A study of 240 cases of eclampsia over a period of 1yr 6months at a tertiary level referral centre.They were analyzed regarding age, parity, socio economic status, period of gestation, antenatal care, No.of convulsions, condition at the time of admission.Management of eclampsia ,maternal and perinatal outcome analyzed. RESULTS: Out of 240 cases of eclampsia most of them were primigravida belonging to low socio economic stata 73% had antenatal care but not regularly. 215 cases were given Mg So4 and the remaining patients Lorazepam and Phenytoin were added. The total perinatal mortality in our study was 28.3%.The perinatal mortality decreases with increasing gestational age and birth weight.Maternal Complications we encountered were Encephalopathy, Pyrexia, RTI, Retained Placenta. 6/240 Maternal deaths, in this two undelivered,CVA was the major cause of death. CONCLUSIONS: Eclampsia is a life endangering obstetric emergency still prevails in developing countries due to inadequate antenatal care, low socio economic stata and lack of transport facility, more common in primis. Good antenatal care helps in preventing ecampsia. Attentive nursing and individualized treatment algorithms, include prompt fluid replacement, anticonvulsant therapy (Mg So4 aggressive antihypertensive therapy and prompt delivery, availability of CT scan with good neonatal unit will improve the maternal and fetal outcome

  7. Comparison of Perinatal Outcome of Preterm Births Starting in Primary Care versus Secondary Care in Netherlands: A Retrospective Analysis of Nationwide Collected Data

    van der Ven, A. J.; Schaaf, J. M.; van Os, M. A.; de Groot, C. J. M.; Haak, M. C.; Pajkrt, E.; Mol, B. W. J.

    2014-01-01

    Introduction. In Netherlands, the obstetric care system is divided into primary and secondary care by risk level of the pregnancy. We assessed the incidence of preterm birth according to level of care and the association between level of care at time of labor onset and delivery and adverse perinatal outcome. Methods. Singleton pregnancies recorded in Netherlands Perinatal Registry between 1999 and 2007, with spontaneous birth between 25+0 and 36+6 weeks, were included. Three groups were compared: (1) labor onset and delivery in primary care; (2) labor onset in primary care and delivery in secondary care; (3) labor onset and delivery in secondary care. Multivariable logistic regression analyses were performed to calculate the risk of perinatal mortality and Apgar score ≤4. Results. Of all preterm deliveries, 42% had labor onset and 7.9% had also delivery in primary care. Women with labor onset between 34+0 and 36+6 weeks who were referred before delivery to secondary care had the lowest risk of perinatal mortality (aOR 0.49 (0.30–0.79)). Risk of perinatal mortality (aOR 1.65; 95% CI 1.20–2.27) and low Apgar score (aOR 1.95; 95% CI 1.53–2.48) were significantly increased in preterm home delivery. Conclusion. Referral before delivery is associated with improved perinatal outcome in the occurrence of preterm labor onset in primary care. PMID:25610468

  8. Comparison of Perinatal Outcome of Preterm Births Starting in Primary Care versus Secondary Care in Netherlands: A Retrospective Analysis of Nationwide Collected Data

    A. J. van der Ven

    2014-01-01

    Full Text Available Introduction. In Netherlands, the obstetric care system is divided into primary and secondary care by risk level of the pregnancy. We assessed the incidence of preterm birth according to level of care and the association between level of care at time of labor onset and delivery and adverse perinatal outcome. Methods. Singleton pregnancies recorded in Netherlands Perinatal Registry between 1999 and 2007, with spontaneous birth between 25+0 and 36+6 weeks, were included. Three groups were compared: (1 labor onset and delivery in primary care; (2 labor onset in primary care and delivery in secondary care; (3 labor onset and delivery in secondary care. Multivariable logistic regression analyses were performed to calculate the risk of perinatal mortality and Apgar score ≤4. Results. Of all preterm deliveries, 42% had labor onset and 7.9% had also delivery in primary care. Women with labor onset between 34+0 and 36+6 weeks who were referred before delivery to secondary care had the lowest risk of perinatal mortality (aOR 0.49 (0.30–0.79. Risk of perinatal mortality (aOR 1.65; 95% CI 1.20–2.27 and low Apgar score (aOR 1.95; 95% CI 1.53–2.48 were significantly increased in preterm home delivery. Conclusion. Referral before delivery is associated with improved perinatal outcome in the occurrence of preterm labor onset in primary care.

  9. [Quality of health care].

    Medina, J L; De Melo, P C

    2000-01-01

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

  10. Providing Perinatal Mental Health Services in Pediatric Primary Care

    Talmi, Ayelet; Stafford, Brian; Buchholz, Melissa

    2009-01-01

    After birth, newborns and their caregivers are seen routinely and frequently in pediatric primary care settings. The close succession of visits in the first few months of life puts pediatric primary care professionals in a unique position to enhance infant mental health by developing strong relationships with caregivers, supporting babies and…

  11. Envisioning Outcomes from Choosing the Midwifery Model of Perinatal Care

    Goldberg, Casey

    2005-01-01

    This birth story illustrates one woman's view of the importance of the type of birthing care she received and the involvement of her existing child in a second birth. The value of the mother's vision and her ability to participate in fully informed choices are emphasized.

  12. Eclampsia: maternal and perinatal outcome among tribal population of Bastar, Chhattisgarh, India in a tertiary care centre

    Indu Sharma; Alpana Bansal

    2016-01-01

    Background: Eclampsia is one of the major causes of maternal and perinatal morbidity and mortality in India and other developing countries. This problem is continued in spite of challenging efforts to reviev each and every pregnant woman with eclampsia and to analyse the factors affecting the outcome. The aim of the research is to study the demographic profile, maternal as well as perinatal outcome of patients with eclampsia and factor affecting it in tertiary care centre of tribal population...

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

    Valéria Saraceni

    2005-08-01

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

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

    Barnes Hayley

    2010-03-01

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

  15. Illness severity measured by CRIB score: a product of changes in perinatal care?

    Baumer, J; Wright, D.; Mill, T

    1997-01-01

    AIM—To determine the perinatal factors associated with initial illness severity (measured by the CRIB (clinical risk index for babies) score) and its relation to survival to discharge.
METHODS—A retrospective study was made of intensive care nursing records on 380 inborn babies, of less than 31 weeks gestation or 1501 g birthweight, admitted to one unit between 1984-6 and 1991-4.
RESULTS—Between the two time periods mean initial illness severity score increased significantly from 2.8 to 3.9. ...

  16. MANAGEMENT OF ECLAMPSIA IN A TERTIARY CARE CENTRE-MATERNAL AND PERINATAL OUTCOME

    Usha Rani; Vijaya

    2015-01-01

    AIM: Management of 240 cases of eclampsia during a period of 1yr 6 months. MATERIALS AND METHODS : A study of 240 cases of eclampsia over a period of 1yr 6months at a tertiary level referral centre.They were analyzed regarding age, parity, socio economic status, period of gestation, antenatal care, No.of convulsions, condition at the time of admission.Management of eclampsia ,maternal and perinatal outcome analyzed. RESULTS: Out of 240 cases of eclampsia most of them were prim...

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

    Wender-Ozegowska, Ewa; Bomba-Opoń, Dorota; Brazert, Jacek; Celewicz, Zbigniew; Czajkowski, Krzysztof; Karowicz-Bilińska, Agata; Malinowska-Polubiec, Aneta; Meczekalski, Błazej; Zawiejska, Agnieszka

    2012-10-01

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

  18. Perinatal staff perceptions of safety and quality in their service

    Sinni, Suzanne V; Wallace, Euan M; Cross, Wendy M

    2014-01-01

    Background Ensuring safe and appropriate service delivery is central to a high quality maternity service. With this in mind, over recent years much attention has been given to the development of evidence-based clinical guidelines, staff education and risk reporting systems. Less attention has been given to assessing staff perceptions of a service’s safety and quality and what factors may influence that. In this study we set out to assess staff perceptions of safety and quality of a maternity ...

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

    Kimiyo Kikuchi

    Full Text Available Continuum of care has the potential to improve maternal, newborn, and child health (MNCH by ensuring care for mothers and children. Continuum of care in MNCH is widely accepted as comprising sequential time (from pre-pregnancy to motherhood and childhood and space dimensions (from community-family care to clinical care. However, it is unclear which linkages of care could have a greater effect on MNCH outcomes. The objective of the present study is to assess the effectiveness of different continuum of care linkages for reducing neonatal, perinatal, and maternal mortality in low- and middle-income countries.We searched for randomized and quasi-randomized controlled trials that addressed two or more linkages of continuum of care and attempted to increase mothers' uptake of antenatal care, skilled birth attendance, and postnatal care. The outcome variables were neonatal, perinatal, and maternal mortality.Out of the 7,142 retrieved articles, we selected 19 as eligible for the final analysis. Of these studies, 13 used packages of intervention that linked antenatal care, skilled birth attendance, and postnatal care. One study each used packages that linked antenatal care and skilled birth attendance or skilled birth attendance and postnatal care. Four studies used an intervention package that linked antenatal care and postnatal care. Among the packages that linked antenatal care, skilled birth attendance, and postnatal care, a significant reduction was observed in combined neonatal, perinatal, and maternal mortality risks (RR 0.83; 95% CI 0.77 to 0.89, I2 79%. Furthermore, this linkage reduced combined neonatal, perinatal, and maternal mortality when integrating the continuum of care space dimension (RR 0.85; 95% CI 0.77 to 0.93, I2 81%.Our review suggests that continuous uptake of antenatal care, skilled birth attendance, and postnatal care is necessary to improve MNCH outcomes in low- and middle-income countries. The review was conclusive for the

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

    Bharti

    2013-04-01

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

  1. Eclampsia: maternal and perinatal outcome among tribal population of Bastar, Chhattisgarh, India in a tertiary care centre

    Indu Sharma

    2016-06-01

    Conclusions: The incidence of eclampsia in our institute was very high with corresponding very high maternal and perinatal morbidity and mortality which emphasizes the need of education, improvement in health care services and universal antenatal checkup and enhancement in timely referral with improvement in transport facilities. [Int J Reprod Contracept Obstet Gynecol 2016; 5(6.000: 1887-1891

  2. Potentially avoidable perinatal deaths in Denmark and Sweden 1991

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

    1996-01-01

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

  3. Maternal and perinatal outcome of eclampsia in a tertiary care centre

    Sasmita Swain

    2016-02-01

    Results: In this study 218 eclampsia cases were studied. The incidence of eclampsia in S.C.B.MCH during study period was 1.39%. Most of the patients were primigravida accounting 83.48% out of which 74.31% were antepartum, 14.22% were intrapartum and 11.47% were postpartum. 44.04% of cases had no ANC and 40.36 irregular ANC. Occurrence of onset of eclampsia at 38 weeks 29.35%. Most of patients were from rural area (97.50% and having low socioeconomic status (83.94% and illiterate. Out of 218 cases 46.33% patients had vaginal delivery, 3.21% patients had vaginal delivery with instrumentation. Conclusions: There is a need of proper antenatal care to prevent eclampsia and the need for intensive monitoring of women with eclampsia throughout hospitalization to improve both the maternal and perinatal outcome. [Int J Reprod Contracept Obstet Gynecol 2016; 5(2.000: 384-390

  4. Quality in Child Care Centers.

    ERS Spectrum, 1998

    1998-01-01

    A significant correlation exists between quality child care and outcomes. Quality-related outcomes include cooperative play, sociability, creativity, ability to solve social conflicts, self-control, and language and cognitive development. Legislatures and agencies should strengthen standards; require initial and ongoing staff training; recruit,…

  5. Measuring quality of maternity care.

    Collins, Katherine J; Draycott, Timothy

    2015-11-01

    Health-care organisations are required to monitor and measure the quality of their maternity services, but measuring quality is complex, and no universal consensus exists on how best to measure it. Clinical outcomes and process measures that are important to stakeholders should be measured, ideally in standardised sets for benchmarking. Furthermore, a holistic interpretation of quality should also reflect patient experience, ideally integrated with outcome and process measures, into a balanced suite of quality indicators. Dashboards enable reporting of trends in adverse outcomes to stakeholders, staff and patients, and they facilitate targeted quality improvement initiatives. The value of such dashboards is dependent upon high-quality, routinely collected data, subject to robust statistical analysis. Moving forward, we could and should collect a standard, relevant set of quality indicators, from routinely collected data, and present these in a manner that facilitates ongoing quality improvement, both locally and at regional/national levels. PMID:25913563

  6. Primary health care quality and diabetes care

    Marcelo Rodrigues Gonçalves

    2013-09-01

    Full Text Available Objective: To investigate the association between primary health care (PHC quality and diabetes mellitus (DM management in adult patients living within the catchment area of PHC services in Porto Alegre, Brazil. Methods: Cross-sectional, population-based study of adults reporting known diabetes. Quality of PHC was assessed through the Primary Care Assesment Tool (PCATool-Brazil. Statistical analyses were performed with Poisson regression with robust variance. Results: Of the 3,014 adults interviewed, 205 (6.8% reported having diabetes; of these, 64.4% were women and 68.3% were white. Regarding PHC score of the health service attended, people with diabetes that were classified with a high PHC score, presented longer duration of disease (10.9 vs 8.4 anos, p=0.03 and greater frequency of diabetes-related complications (75.3% vs 58.8%, p=0.02. Regarding the proportion of respondents with good glycemic control, no significant difference between groups was found (31.7% vs 38%, p=0.3. In the multivariate analysis, services with a high PHC score presented a better profile of care for the prevention of the main comorbidities – greater blood pressure assessment (PR=1.07; CI95% 1.01-1.14, lipid profile request (PR=1.23; CI95% 1.09-1.39, counseling for physical activity (PR=1.50; CI95% 1.21-1.86, foot examination (PR=2.08; CI95% 1.54-2,81, and counseling for foot care (PR=1.37; CI95% 1.18-1.59. Conclusion: High PHC score services showed better performance in the management of diabetes and care for more complicated patients, but they did not differ significantly from lower PHC score services in terms of patients’ glycemic control.

  7. "Can I Ask That?": Perspectives on Perinatal Care After Resettlement Among Karen Refugee Women, Medical Providers, and Community-Based Doulas.

    LaMancuso, Kate; Goldman, Roberta E; Nothnagle, Melissa

    2016-04-01

    This study characterized the perspectives of Karen refugee women in Buffalo, NY, their medical providers, and Karen interpreters/doulas on perinatal care for Karen women in resettlement. In-depth qualitative interviews with Karen women (14), Karen doulas/interpreters and key informants (8), and medical providers (6) were informed by the social contextual model and focused on women's questions about and opinions of perinatal care in Buffalo and on providers' experiences caring for Karen patients. Karen women expressed gratitude for and understanding of perinatal care in Buffalo, and providers described Karen patients as agreeable but shy. Karen doulas offered an alternative view that exposed women's many questions and concerns, and described how doula training empowered them as patients' advocates. Low self-efficacy, trauma histories, and cultural expectations may contribute to Karen women's seeming agreeability. Doulas/interpreters possess insider knowledge of women's concerns and facilitate communication between patients and the care team. PMID:25724151

  8. Iatrogenic scald injuries in Nigerian babies with perinatal asphyxia: A re-awakening call to strengthen primary health care services

    Kuti Bankole Peter

    2015-01-01

    Full Text Available Birth asphyxia is a major cause of neonatal morbidity and mortality in developing countries. Majority of pregnant women in Nigeria still deliver their babies in places where there are no personnel skilled in essential obstetric care and neonatal resuscitation. Consequently newborns are poorly handled at delivery with resultant poor outcome. We report two cases of iatrogenic burns injuries from hot water formentation in an attempt to resuscitate two neonates at peripheral health care facilities in Ilesa, Nigeria. These babies needlessly sustained burns injuries coupled with hypoxic-ischaemic injuries and poor perinatal outcome. These unfortunate cases of "insults upon injuries" underscore the need to strengthen the primary health care system in Nigeria by training and retraining health workers at these facilities. Proper antenatal care, adequate screening of high risk pregnancy for delivery at adequately equipped centres and making efficient referral system available will go a long way in reducing these needless injuries and morbidities.

  9. Perinatal depression

    Alhusen, Jeanne L.; Alvarez, Carmen

    2016-01-01

    Abstract: Perinatal depression is a common condition with significant adverse maternal, fetal, neonatal, and early childhood outcomes. The perinatal period is an opportune time to screen, diagnose, and treat depression. Improved recognition of perinatal depression, particularly among low-income women, can lead to improved perinatal health outcomes.

  10. What is Good Quality of Health Care?

    Magne Nylenna

    2015-03-01

    Full Text Available A diversity of definitions of quality exists, that frequently contain aspects of complexity, relativity and subjectivity. This paper provides an overview of key components in the quality debate within health care, including different perspectives and dimensions of the quality of care. Definitions of the quality of health care reflect the characteristics of health services, and are useful for measurements and quality improvement. Over time the patient perspective of quality has gotten increasing weight, and in quality improvement there has been a shift from individual responsibility for doctors and health care personnel to systems thinking. We argue that the quality approach in health care should be more standardized and that health care-specific definitions of quality should be used when the relationship between physician professionalism and quality is investigated.Keywords: quality, health care, systems thinking, patient perspective, outcome, indicator, measurement, improvement.

  11. Financial Health of Child Care Facilities Affects Quality of Care.

    Brower, Mary R.; Sull, Theresa M.

    2003-01-01

    Contends that child care facility owners, boards of directors, staff, and parents need to focus on financial management, as poor financial health compromises the quality of care for children. Specifically addresses the issues of: (1) concern for providing high quality child care; (2) the connection between quality and money; and (3) strengthening…

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

    Filipa Flor-de-Lima

    2012-01-01

    Full Text Available Survival and outcomes for preterm infants with respiratory distress syndrome (RDS have improved over the past 30 years. We conducted a study to assess the changes in perinatal care and delivery room management and their impact on respiratory outcome of very low birth weight newborns, over the last 15 years. A comparison between two epochs was performed, the periods before and after 2005, when early nasal continuous positive airway pressure (NCPAP and Intubation-SURfactant-Extubation (INSURE were introduced in our center. Three hundred ninety-five clinical records were assessed, 198 (50.1% females, gestational age 29.1 weeks (22–36, and birth weight 1130 g (360–1498. RDS was diagnosed in 247 (62.5% newborns and exogenous surfactant was administered to 217 (54.9%. Thirty-three (8.4% developed bronchopulmonary dysplasia (BPD, and 92 (23% were deceased. With the introduction of early NCPAP and INSURE, there was a decrease on the endotracheal intubation need and invasive ventilation (P<0.0001, oxygen therapy (P=0.002, and mortality (P<0.0001. The multivariate model revealed a nonsignificant reduction in BPD between the two epochs (OR=0.86; 95% CI 0.074–9.95; P=0.9. The changes in perinatal care over the last 15 years were associated to an improvement of respiratory outcome and survival, despite a nonsignificant decrease in BPD rate.

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

    Thomas Angela N

    2009-09-01

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

  14. Defining Quality Child Care: Multiple Stakeholder Perspectives

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

    2007-01-01

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

  15. The SATELLITE Sexual Violence Assessment and Care Guide for Perinatal Patients

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

    2009-01-01

    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...

  16. Interpretative views on Hispanics' perinatal problems of low birth weight and prenatal care.

    Balcazar, H.; Aoyama, C; X. Cai

    1991-01-01

    From a public health perspective, there is a need to recognize that Hispanics, and in particular Mexican Americans, are a very heterogeneous group. They represent all shades of acculturation, education, income, and citizenship status. As this minority group continues to increase in numbers, pertinent information about their perinatal health problems in the context of their sociocultural characteristics will be required. This review examines critically the recent literature related to low birt...

  17. Primary care quality management in Uzbekistan.

    Boerma, W.G.W.; Kringos, D.S.; Verschuuren, M.; Pellny, M.; Baymirova, L.

    2008-01-01

    The Uzbek government has a central role in primary care quality management. On paper, many quality management structures and procedures exist. Now, primary care practice should follow, as NIVEL research – done on the initiative of the World Health Organisation (WHO) – has shown. The results have been published in a WHO report. With donor support, quality improvement in primary care is a national priority. Many laws, decrees and orders deal with the improvement of (primary) health care service...

  18. Eliminating Perinatal HIV Transmission

    2012-11-26

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

  19. Quality assurance in the ambulatory care setting.

    Tyler, R D

    1989-01-01

    One of the most utilitarian developments in the field of quality assurance in health care has been the introduction of industrial concepts of quality management. These concepts, coupled with buyer demand for accountability, are bringing new perspectives to health care quality assurance. These perspectives provide a new view of quality assurance as a major responsibility and strategic opportunity for management; a competitive and marketable commodity; and a method of improving safety, effectiveness, and satisfaction with medical care. PMID:10313405

  20. Deficiencies in the Quality of Diabetes Care

    Shah, Baiju R.; Hux, Janet E.; Laupacis, Andreas; Zinman, Bernard; Zwarenstein, Merrick

    2007-01-01

    The quality of diabetes care delivered to patients falls below the expectations of practice guidelines and clinical trial evidence. Studies in many jurisdictions with varying health care systems have shown that recommended processes of care occur less often than they should; hence, outcomes of care are inadequate. Many studies comparing care between specialists and generalists have found that specialists are more likely to implement processes of care. However, this provides little insight int...

  1. 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

    Ruy Laurenti

    1985-06-01

    Full Text Available Analisa-se a influência de variáveis como peso ao nascer, idade materna, assistência pré-natal e tabagismo materno. Do estudo dos 12.999 nascimentos (vivos e mortos ocorridos em nove maternidades no período de um ano, verificou-se que a mortalidade perinatal é muito maior para os recém-nascidos de baixo peso (665,3 ‰ para peso até 1.500 g, diminuindo à medida que aumenta o peso ao nascer. Também nos casos de mães jovens (menores de 15 anos ou mães com idade superior a 35 anos esse coeficiente foi mais elevado (45,5 ‰ para mães com menos de 15 anos e 47,0 ‰ para mães entre 35 a 39 anos. A faixa imediatamente superior - 40 a 44 anos - apresentou a mais alta mortalidade perinatal: 61,3 ‰ nascidos vivos e nascidos mortos. O número de consultas realizadas no pré-natal tem importância para a diminuição da gestação de alto risco. Mães que fizeram 7 ou mais consultas no pré-natal tiveram a menor mortalidade no período (17,7‰ nascidos vivos e nascidos mortos. Já o hábito materno de fumar influencia a mortalidade quando a quantidade é de mais de 10 cigarros por dia. A mortalidade perinatal dos produtos de mães que fumavam menos de 10 cigarros por dia não diferiu das taxas de mortalidade para as mães não-fumantes.The influence of birth weight, maternal age, prenatal care and smoking during pregnancy are analysed. Of 12,999 births (live and stillbirths ocurring in nine maternity hospitals during one year, the greatest perinatal mortality rate (PM was that of low birth weight babies (665.3 ‰ for those weighing less than 1,500 g. The PM decreases with increasing weight. Young mothers (less than 15 years of age and women aged 35 or more also had higher Perinatal Mortality rates - 45.5 ‰ for the former and 47.0 ‰ for the latter. Prenatal care is important for the decrease of high risk in pregnancy. Mothers who had made 7 or more consultations during pregnancy had the lowest PM (17.7 ‰ live and stillbirths

  2. [Quality management in intensive care medicine].

    Martin, J; Braun, J-P

    2014-02-01

    Treatment of critical ill patients in the intensive care unit is tantamount to well-designed risk or quality management. Several tools of quality management and quality assurance have been developed in intensive care medicine. In addition to external quality assurance by benchmarking with regard to the intensive care medicine, peer review procedures have been established for external quality assurance in recent years. In the process of peer review of an intensive care unit (ICU), external physicians and nurses visit the ICU, evaluate on-site proceedings, and discuss with the managing team of the ICU possibilities for optimization. Furthermore, internal quality management in the ICU is possible based on the 10 quality indicators of the German Interdisciplinary Society for Intensive Care Medicine (DIVI, "Deutschen Interdisziplinären Vereinigung für Intensiv- und Notfallmedizin"). Thereby every ICU has numerous possibilities to improve their quality management system. PMID:24493011

  3. Effective Marketing of Quality Child Care.

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

    1984-01-01

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

  4. Does Audit Improve the Quality of Care?

    Areti Tsaloglidou

    2009-01-01

    BACKGROUND: The quality of health care and quality assurance are concepts which have been established for many years. Audit nowadays is adopted as a means of developing high quality care.AIM: This study aims to identify the perspectives of audit in practice and its relationship to quality assessment and assurance, quality improvement, and clinical effectiveness.METHODS: There were used the databases Medline and Cinahl to identify studies related to clinical audit. These databases were searche...

  5. Medicaid Adult Health Care Quality Measures

    U.S. Department of Health & Human Services — The Affordable Care Act (Section 1139B) requires the Secretary of HHS to identify and publish a core set of health care quality measures for adult Medicaid...

  6. Analysing Maternal Employment and Child Care Quality

    Akgündüz, Yusuf

    2014-01-01

    The contributions in this thesis revolve around mothers' employment and child care quality. The first topic of interest is how mothers' employment is affected by modern child care services and parental leave entitlements. There is already an extensive literature on the effects of modern social policies such as child care services and parental leave entitlements. A related second topic is how child care quality is produced and influenced by policy measures. Positive findings from the UK and US...

  7. Quality systems in Dutch health care institutions.

    Casparie, Anton; Sluijs, Emmy; Wagner, Cordula; de Bakker, Dinny

    1997-01-01

    The implementation of quality systems in Dutch health care was supervised by a national committee during 1990-1995. To monitor the progress of implementation a large survey was conducted in the beginning of 1995. The survey enclosed all subsectors in health care. A postal questionnaire-derived from the European Quality Award-was sent to 1594 health care institutions; the response was 74%. The results showed that in 13% of the institutions a coherent quality system had been implemented. These ...

  8. Health Care Quality and Economic Inequality

    Jappelli, Tullio; Pistaferri, Luigi; Weber, Guglielmo

    2004-01-01

    We argue that health care quality has an important impact on economic inequality and on saving behaviour. We exploit district-wide variability in health care quality provided by the Italian universal public health system to identify the effect of quality on income inequality, health inequality and precautionary saving. We find that in lower quality districts there is greater income and health dispersion and higher precautionary saving. The analysis carries important insights for the ongoing d...

  9. Quality Assessment in the Primary care

    Muharrem Ak

    2013-04-01

    Full Text Available -Quality Assessment in the Primary care Dear Editor; I have read the article titled as “Implementation of Rogi Kalyan Samiti (RKS at Primary Health Centre Durvesh” with great interest. Shrivastava et all concluded that assessment mechanism for the achievement of objectives for the suggested RKS model was not successful (1. Hereby I would like to emphasize the importance of quality assessment (QA especially in the era of newly established primary care implementations in our country. Promotion of quality has been fundamental part of primary care health services. Nevertheless variations in quality of care exist even in the developed countries. Accomplishment of quality in the primary care has some barriers like administration and directorial factors, absence of evidence-based medicine practice lack of continuous medical education. Quality of health care is no doubt multifaceted model that covers all components of health structures and processes of care. Quality in the primary care set up includes patient physician relationship, immunization, maternal, adolescent, adult and geriatric health care, referral, non-communicable disease management and prescribing (2. Most countries are recently beginning the implementation of quality assessments in all walks of healthcare. Organizations like European society for quality and safety in family practice (EQuiP endeavor to accomplish quality by collaboration. There are reported developments and experiments related to the methodology, processes and outcomes of quality assessments of health care. Quality assessments will not only contribute the accomplishment of the program / project but also detect the areas where obstacles also exist. In order to speed up the adoption of QA and to circumvent the occurrence of mistakes, health policy makers and family physicians from different parts of the world should share their experiences. Consensus on quality in preventive medicine implementations can help to yield

  10. Quality of diabetes care in general practice

    van Bruggen, J.A.R.

    2009-01-01

    In the Netherlands, a quality incentive is expected to ensue from improved collaboration between healthcare professionals. Whether this view is supported by sufficient evidence is, however, questionable. Therefore, the first study included in this thesis is a systematic review of studies on the effects of sharing and delegating diabetes care tasks. It became apparent that sharing and delegating care tasks can improve the process of care and glycaemic control. Sharing or delegating care, howev...

  11. Nationwide quality improvement in lung cancer care

    Jakobsen, Erik Winther; Green, Anders; Oesterlind, Kell;

    2013-01-01

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

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

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

    2012-01-01

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

  13. 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

    Gülmezoglu A Metin

    2011-07-01

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

  14. Assuring quality care: measuring and monitoring the caring process.

    Ammentorp, W; Bock, W; Irrgang, S; Gossett, K

    1988-01-01

    Everyone interested in the quality of the human services agrees that it should be largely determined by the interaction between the client and their caregivers. Unfortunately, this exchange has proven to be very difficult to measure in an accurate and timely manner. The resulting uncertainty has prevented smooth adaptation of the caring process to client needs; it has also made it virtually impossible for managers to devise workable quality control systems. This paper describes the use of miniaturized barcode technology for collection of real-time data at the point of care. With the addition of laptop computers, this technology provides for immediate feedback of information to address quality issues in care planning and management. The data bases produced by this system are sources of documentation for quality assurance as well as a dynamic foundation for quality control. PMID:10291607

  15. Scaling up the Quality of Care Approach

    XieZhenming

    2005-01-01

    Like the pilot project, the scaling up of the quality of care approach is also new in China and requires continued research anct explorauon, in July 2003, the National Population and Family Planning Commission (NPFPC) drew on the experience of scaling up the quality of care project and decided to launch a campaign to select and commend model counties (cities/districts) in implementing the project in order to set an example for different regions with different economies and ensure the quality of care approach is adequately applied.

  16. Leadership: improving the quality of patient care.

    Clegg, A

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

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

    Aleksandra Korzeniewska-Eksterowicz

    2013-01-01

    Full Text Available Objective. To identify barriers and personnel attitudes towards realization of palliative care principles in neonatological units. Study Design. An anonymous questionnaire was posted to all heads of departments and head nurses of all the 27 neonatological units in the Lodz area. Results. We received 46 (85% questionnaires. Final analysis comprised 42 properly filled-in questionnaires (by 22 doctors and 20 nurses. In case of prenatal diagnosis of a lethal defect, 77.27% of doctors and 65% of nurses opted for informing the mother also about the possibility of pregnancy continuation and organization of palliative care after delivery. Most of respondents accepted conditions for abortion pointed by the Polish law. The most common barriers pointed out by both groups were insufficient knowledge of the personnel on palliative medicine and family preference for life sustaining treatment. Conclusions. Understanding attitudes of personnel towards palliative care and identification of barriers are a starting point for future efforts to improve the system of neonatological care.

  18. [Experience of extracorporeal membrane oxygenation in critical care of respiratory failure in newborn with congenital diaphragmatic hernia in perinatal center].

    Burov, A A; Nikiforov, D V; Podurovskaia, Iu L; Dorofeeva, E I; Abramian, M A; Makhalin, M V; Shatalov, K V; Nikiforov, V S; Degtiarev, D N

    2013-01-01

    The article deals with an experience of veno-arterial extracorporeal membrane oxygenation use in preterm infants with congenital diaphragmatic hernia during postoperative period in the perinatal center. PMID:24749262

  19. Quality of newborn care at birth

    Becker, AJ; Marchant, T

    2014-01-01

    Quality of care can be measured by seeing if skilled birth attendants use simple approaches to save lives. Skilled birth attendants range from trained community health workers to nurses, doctors and midwives. Findings from three low-income settings show quality of care for the newborn is low even when a skilled birth attendant is at the mother’s side during birth. Source: 2012 Baseline survey data, the IDEAS project, based at the London School of Hygiene & Tropical Medicine. Funded by the...

  20. Quality Assessment in the Primary care

    Muharrem Ak

    2013-01-01

    -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 coun...

  1. Analysing Maternal Employment and Child Care Quality

    Akgündüz, Yusuf

    2014-01-01

    The contributions in this thesis revolve around mothers' employment and child care quality. The first topic of interest is how mothers' employment is affected by modern child care services and parental leave entitlements. There is already an extensive literature on the effects of modern social polic

  2. Primary care quality management in Slovenia.

    Boerma, W.G.W.; Kringos, D.S.; Verschuuren, M.; Pellny, M.; Bulc, M.

    2008-01-01

    Of all GPs in Slovenia 86% are not interested in activities to systematically improve care. A clear national quality policy, further education for care managers and financial incentives for GPs could change the picture, as NIVEL research – done on the initiative of the World Health Organisation (WHO

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

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

    1991-01-01

    Access to obstetrical services has deteriorated in recent years, as large numbers of physicians have discontinued or restricted obstetrical practice. In Washington State, one response to this access crisis has been the establishment of the Access to Maternity Care Committee (AMCC), an ad hoc group composed primarily of private sector obstetrical providers and representatives of State government responsible for the delivery of health care to women and children. The major objectives of the AMCC...

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

    Mohammad Kazem

    2008-06-01

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

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

    Ying Dong

    2012-09-01

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

  6. Does Audit Improve the Quality of Care?

    Areti Tsaloglidou

    2009-01-01

    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.

  7. The Meaning of Food and Multicultural Implications for Perinatal Palliative Care.

    Chichester, Melanie; Wool, Charlotte

    2015-01-01

    Feeding an infant is a bonding experience for parents, particularly for women from cultures in which breastfeeding is the norm. When an infant is unexpectedly ill, or his or her life is expected to be brief, challenges surrounding infant feeding can occur. Regardless of ethnicity or culture, parents facing the death of their infant have difficult decisions to make and need time to process those decisions. Given the social, cultural and spiritual nature of food and water, withdrawing or withholding nutrition and/or hydration for infants can be one of the most difficult decisions for parents. This article considers the clinical and cultural ramifications of infant feeding decisions when a shift occurs from curative interventions to palliative care. PMID:26058905

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

    Valerie E. Whiteman

    2014-01-01

    Full Text Available Objective. To identify factors associated with opioid use during pregnancy and to compare perinatal morbidity, mortality, and healthcare costs between opioid users and nonusers. Methods. We conducted a cross-sectional analysis of pregnancy-related discharges from 1998 to 2009 using the largest publicly available all-payer inpatient database in the United States. We scanned ICD-9-CM codes for opioid use and perinatal outcomes. Costs of care were estimated from hospital charges. Survey logistic regression was used to assess the association between maternal opioid use and each outcome; generalized linear modeling was used to compare hospitalization costs by opioid use status. Results. Women who used opioids during pregnancy experienced higher rates of depression, anxiety, and chronic medical conditions. After adjusting for confounders, opioid use was associated with increased odds of threatened preterm labor, early onset delivery, poor fetal growth, and stillbirth. Users were four times as likely to have a prolonged hospital stay and were almost four times more likely to die before discharge. The mean per-hospitalization cost of a woman who used opioids during pregnancy was $5,616 (95% CI: $5,166–$6,067, compared to $4,084 (95% CI: $4,002–$4,166 for nonusers. Conclusion. Opioid use during pregnancy is associated with adverse perinatal outcomes and increased healthcare costs.

  9. Quality of care indicators in rectal cancer.

    Demetter, P; Ceelen, W; Danse, E; Haustermans, K; Jouret-Mourin, A; Kartheuser, A; Laurent, S; Mollet, G; Nagy, N; Scalliet, P; Van Cutsem, E; Van Den Eynde, M; Van de Stadt, J; Van Eycken, E; Van Laethem, J L; Vindevoghel, K; Penninckx, F

    2011-09-01

    Quality of health care is a hot topic, especially with regard to cancer. Although rectal cancer is, in many aspects, a model oncologic entity, there seem to be substantial differences in quality of care between countries, hospitals and physicians. PROCARE, a Belgian multidisciplinary national project to improve outcome in all patients with rectum cancer, identified a set of quality of care indicators covering all aspects of the management of rectal cancer. This set should permit national and international benchmarking, i.e. comparing results from individual hospitals or teams with national and international performances with feedback to participating teams. Such comparison could indicate whether further improvement is possible and/or warranted. PMID:22103052

  10. Measuring quality of care for colorectal cancer care: comprehensive feedback driving quality improvement

    Kolfschoten, Nicoline Elisabeth

    2015-01-01

    Data from clinical audits such as the Dutch Surgical Colorectal Audit, can be used for valid and meaningful feedback information, which may support improvement of quality of care. First, we showed that the continuous feedback cycle of clinical auditing has an autonomous, positive effect on the quality of surgical care. Second, we describe how data from clinical audits can be used to monitor and improve national practice and performance in colorectal cancer care, especially for high-risk patie...

  11. Assessing the Quality of Diabetic Patients Care

    Belkis Vicente Sánchez

    2012-12-01

    Full Text Available Background: to improve the efficiency and effectiveness of the actions of family doctors and nurses in this area is an indispensable requisite in order to achieve a comprehensive health care. Objective: to assess the quality of health care provided to diabetic patients by the family doctor in Abreus health area. Methods: a descriptive and observational study based on the application of tools to assess the performance of family doctors in the treatment of diabetes mellitus in the five family doctors consultation in Abreus health area from January to July 2011 was conducted. The five doctors working in these consultations, as well as the 172 diabetic patients were included in the study. At the same time, 172 randomly selected medical records were also revised. Through observation, the existence of some necessary material resources and the quality of their performance as well as the quality of medical records were evaluated. Patient criteria served to assess the quality of the health care provided. Results: scientific and technical training on diabetes mellitus has been insufficient; the necessary equipment for the appropriate care and monitoring of patients with diabetes is available; in 2.9% of medical records reviewed, interrogation appears in its complete form including the complete physical examination in 12 of them and the complete medical indications in 26. Conclusions: the quality of comprehensive medical care to diabetic patients included in the study is compromised. Doctors interviewed recognized the need to be trained in the diagnosis and treatment of diabetes in order to improve their professional performance and enhance the quality of the health care provided to these patients.

  12. Adherence and quality of care in IBD

    Bager, Palle; Julsgaard, Mette; Vestergaard, Thea;

    2016-01-01

    different aspects of adherence and to identify predictors of non-adherence, including the quality of care, for outpatients with IBD. MATERIALS AND METHODS: An anonymous electronic questionnaire was used to investigate different aspects of adherence, the quality of care, patient involvement and shared...... decision making among 377 IBD outpatients. RESULTS: Three hundred (80%) filled in the questionnaire. The overall adherence rate was 93%. Young age (< 35 years old) and smoking were significantly associated with non-adherence (prevalence odds ratio (POR) 2.98, 95% CI 1.04-8.52, p < 0.05 and POR 3.88, 95% CI...

  13. Countrywide analysis of perinatal outcome.

    Stembera, Z; Kravka, A; Mandys, F

    1988-01-01

    The computer laboratory of the Research Institute for the Care of Mother and Child in Prague performs annually a countrywide analysis of perinatal outcome in order to obtain a background for the preparation of the optimal strategy for improving perinatal care in CSR in the future. The total as well as weight specific perinatal mortality rate further sub-divided into early neonatal death rate and late fetal death rate and differentiated according to the birthweight, was correlated with the incidence of different factors influencing the perinatal mortality rate both countrywide and for each of the eight provinces of CSR. This way a correlation was found between some of the mentioned perinatal outcomes and e.g. instrumental equipment of obstetrical departments and neonatal intensive care units, frequency of caesarean sections, or transport of LBW newborns in incubators or "in utero" etc. The results of this analysis have proved that there still remain in some provinces opportunity for further decrease in perinatal mortality due to the incomplete observance of the two intervention strategies "Risk approach" and "New technology" which were introduced in the whole country during the last 10 years. PMID:3221298

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

    Adair Timothy

    2011-03-01

    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

  15. 孕产妇系统保健与围产儿死亡分析%Analysison maternal health care system and perinatal infants death

    刘玉洁

    2012-01-01

    OBJECTIVE To analyze maternal health care system and perinatal infants death in the county. METHODS Health information reports about maternity and children in the county during 2008-2011 were retrospectively analyzed, and management rates of permanent residence (local census register and temporary more than one year non-census register) and mobile pregnant women and perinatal infants death. RESULTS (1) In the same year, management rate of permanent system of pregnant residence of women was significantly higher than the floating population system, with significant difference (P < 0.05) ; (2) on the same year, death rate of perinatal infants of permanent residence of women was significantly lower than the floating-women, with significant difference (P< 0.05); (3) the sequence of death causes in perinatal infants in each year were not I-dentical, but the birth defects, fetal factors and mother's factors were the main causes of death; (4) management of pregnant women system would strengthened with the decrease of death rate of perinatal infants, there was a negative correlation between management rate of pregnant women system and death rate of perinatal infants (r =-1.121, P < 0.05). CONCLUSION Improving management level of maternal system, focusing on systematic health care of floating pregnant women are the keys to further reduce death rate of perinatal infants.%目的 分析迁西县孕产妇系统保健与围产儿死亡情况.方法 对2008~2011年迁西县妇幼卫生信息报表进行回顾性分析,重点分析常住(户籍本地及暂住一年以上非户籍)及流动孕产妇系统管理率及围产儿死亡情况.结果 (1)在同一年度内常住孕产妇系统管理率明显高于流动人口孕产妇系统管理率,差异有统计学意义(P< 0.05); (2)在同一年度内常住孕产妇围产儿死亡率明显低于流动孕产妇围产儿死亡率,差异有统计学意义(P<0.05); (3)围产儿死亡原因在各年度顺位顺序各不相同,但

  16. Integrating Comprehensive Reform with Quality of Care

    2005-01-01

    Xianyang City is located in the center of northwest China's Shaanxi Province. In 2001, it was designated as one of the pilot cities for comprehensive reform of family planning work initiated by the National Population and Family Planning Commission. This has provided a good opportunity for the city to better implement the quality of care approach.

  17. Quality Reforms in Danish Home Care

    Rostgaard, Tine

    2012-01-01

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

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

    Jensen, Hanne Irene; Gerritsen, Rik T; Koopmans, Matty;

    2015-01-01

    PURPOSE: The purpose of the study is to adapt and provide preliminary validation for questionnaires evaluating families' experiences of quality of care for critically ill patients in the intensive care unit (ICU). MATERIALS AND METHODS: This study took place in 2 European ICUs. Based on literature...... and qualitative interviews, we adapted 2 previously validated North American questionnaires: "Family Satisfaction with the ICU" and "Quality of Dying and Death." Family members were asked to assess relevance and understandability of each question. Validation also included test-retest reliability and construct...... validity. RESULTS: A total of 110 family members participated. Response rate was 87%. For all questions, a median of 97% (94%-99%) was assessed as relevant, and a median of 98% (97%-100%), as understandable. Median ceiling effect was 41% (30%-47%). There was a median of 0% missing data (0%-1%). Test...

  19. Long-Term Effects of Maternal Medication on Global Quality of Life Measured with SEQOL. Results from the Copenhagen Perinatal Birth Cohort 1959�61

    Soren Ventegodt

    2003-01-01

    Full Text Available The Copenhagen Perinatal Birth Cohort 1959�61 is a prospective longitudinal perinatal study that included all deliveries (over 20 weeks gestation, birthweight over 250 g that took place at the University Hospital (Rigshospitalet in Copenhagen, Denmark during the period of September 21, 1959 to December 21, 1961 and used in this follow-up study to investigate the connection between maternal medication during pregnancy and the quality of life of the child 31 to 33 years later. The latest follow-up study from the cohort was performed in 1993 and 7,222 of the surviving children were identified (now aged between 31 and 33 years and contacted with a nonanonymous questionnaire on several aspects of quality of life issues.There were 4,626 usable responses (f = 2,489, m = 2,131 corresponding to a response rate of 64.1%. Of the 12 groups of medication taking during pregnancy we found, before controlling (using multiple linear regression, that analgesics, chemotherapy, and psychopharmacologica showed links with the quality of life in the child 31 to 33 years later. Barbiturate use (95% was phenemal showed significant connection to quality of life. After controlling for social and pregnancy factors there was no correlation between quality of life and medication taken by the mother during pregnancy. From this study it is concluded the fetal exposure to the drugs examined showed no measurable long-term effects on quality of life.

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

    Beena Javaregowda Parvathy

    2014-01-01

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

  1. Efficacy of Perinatal Health Education in Quality of Life and Depression Symptoms of Maternal%围生期健康教育对孕产妇生活质量及抑郁症状的影响

    王会民; 张雅丽; 邢恩鸿; 邵雪斋; 郭艳巍; 袁晓明; 曾德会

    2015-01-01

    Objective To study the efficacy of perinatal health education in quality of life and depression symptoms of maternal.Methods From October 2014 to April 2015,100 cases of maternal as a research object,were randomly divided into two groups,control group and observation group of 50 cases in each group,control group maternal in the perinatal period given routine care,while the observation group maternal on the basis of conventional nursing, auxiliary comprehensive health education intervention path,and then looked at two groups of patients quality of life scores and SDS scores.Results After health education,the quality of life of maternal and SDS scores observation group was obviously better than that of control group (P<0.05). Conclusion The perinatal period health education can effectively improve the quality of life of maternal,control of postpartum depression symptoms.%目的:研究围生期健康教育对孕产妇生活质量及抑郁症状的影响。方法选取我院2014年10月~2015年4月收治的100例孕产妇作为研究对象,随机分为对照组和观察组两组,每组50例。对照组孕产妇在围生期给予常规护理,而观察组孕产妇在常规护理的基础上,辅助综合健康教育路径干预,观察两组患者的生活质量评分和SDS评分。结果健康教育之后,观察组孕产妇的生活质量和SDS评分优于对照组(P<0.05)。结论围生期的健康教育可以有效改善孕产妇的生活质量,控制产后的抑郁症状。

  2. Approaching the millennium: perinatal problems and software solutions.

    Sokol, R J; Chik, L; Zador, I

    1992-01-01

    Strategic planning for rational development of perinatal computing capabilities for the year 2000 should be driven by anticipated trends in (1) the health care business, (2) computer technology and (3) medicine, as well as (4) the needs of perinatal practitioners. In the USA, health care is the fastest growing segment of the economy. This will produce increasing attention from hardware and software developers, and vendors, and will lead to a proliferation of computing platforms, operating systems and specific medical application software. Desktop computers, already capable of 20 million instructions per second (MIPS) with massive storage capacities, will continue to evolve and fall in price. Increasingly, perinatologists will develop software packages to facilitate patient care in their own environments. All of these trends will lead to severe fragmentation in medical computing. Simultaneously, however, the need for integrated institutional computer-based data access for quality assurance and fiscal and operations management will increase. Perinatal care will be more regionalized, complex and rigorous with new clinical trial- and effectiveness research-based interventions, as well as molecular diagnosis and therapy. To practice appropriately, clinicians will need to be familiar with computer capabilities. Having been exposed to computer-aided instruction (CAI) at the undergraduate and postgraduate levels, they will except on-line access to detailed and accurate patient information with linkage to laboratory, radiology and other medical databases, as well as to reference databases, such as Medlines and the Oxford Database of Perinatal Trials. Artificial intelligence (AI) software may support perinatal decision making; computerized professional and facility billing will be available. PMID:1396279

  3. Factors related to main preventable perinatal injuries of public hospital in the Brazilian Federal District.

    Pamella Padilha BRITO

    2015-02-01

    Full Text Available Introduction: The quality of prenatal care, childbirth and newborn are determinants of perinatal morbidity and mortality. The realization of a adequate prenatal care and skilled birth assistance would reduce the incidence of injuries and perinatal deaths that are largely preventable. Method: Descriptive and exploratory study of quantitative and qualitative nature.  Interview and review of medical records of thirty mothers and newborns were made. The results were chart using the SPSS software, version 20.0, for processing and statistical analysis. We performed thematic analysis of interviews, and tabulated according to their frequencies, identifying the differences and similarities between data. Results: The most frequent perinatal injuries were prematurity (74.2%, Respiratory Distress (71%, Underweight (51.6%, Infection or Sepsis (41.9%, Perinatal Asphyxia (19.4%  and Oligohydramnio (19.4%. These injuries were related to several factors such as inadequate prenatal care, with fewer than six prenatal consultations (70% and late onset (50%, and presence of maternal health problems such as: changes in amniotic fluid (50% and preterm labor (50%. The interviewees added other factors such as failures in the care professional (43%, failures in care and service (33%, difficulty of access (19% and breast self-care failures (16.6%. Conclusion: Stood out in this study the occurrence of perinatal injuries in children of mothers with stable socio-demographic profile and in term newborns as also the percentage of deaths (16.1%. The perinatal injuries and deaths could have been avoided with qualified prenatal care, childbirth and newborn care.

  4. From Perspectives of the Elderly: Quality of care in Germany

    Dorian R. Woods

    2014-06-01

    Full Text Available This article reviews state-of-the-art findings on care and quality from published research from 2003-2014 in Germany, specifically from the perspective of the elderly. It is based on a larger project on care and quality in Germany that was funded by the Hans Böckler Foundation. The study provides a much needed overview of current issues on quality and care in light of increased pressure to address care and changes in German social policy. Although quality also encompasses conditions for professional care work and informal carers, this article focuses on the elderly as recipients of care, their perspectives and the ways in which they are involved in their care. Research on care quality from the perspective of the elderly is highlighted in the following themes: 1 the rights of the elderly to quality care 2 elderly perception of satisfaction and quality of outcomes of care, 3 documentation of care as quality control and time, 4 active aging and 5 equality of access. Results show that long-term care rights are more clearly defined and expanded, but enforcement problems are present. Satisfaction with care is traced to good communication with carers, but time for care is scarce. Active aging has become a central focus of care and more research on equal access is needed. The article outlines strengths and weaknesses in German quality care provision as well as learning effects for other countries.

  5. Influence of structural features on portuguese toddler child care quality

    Manuela Pessanha; Cecília Aguiar; Joaquim Bairrão

    2007-01-01

    Whereas child care quality has been extensively studied in the U.S., there is much less information about the quality of child care in other countries.With one of the highest maternal employment rates in Europe, it is important to examine child care in Portugal. Thirty toddler classrooms in child care centers were observed. The purpose of this studywas to determine whether structural features account for overall toddler child care quality. Results showed younger and better-paid teach...

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

    Griffith, Deloris G.

    1986-01-01

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

  7. Helping You Choose Quality Hospice Care

    ... Accreditation Accreditation Ambulatory Health Care Behavioral Health Care Critical Access Hospitals Home Care (+ Pharmacy) Hospital Laboratory Nursing Care Center International Accreditation Accreditation Top Spots What ...

  8. Impact of a nationwide study for surveillance of maternal near-miss on the quality of care provided by participating centers: a quantitative and qualitative approach

    Luz, Adriana Gomes; Osis, Maria José Duarte; Ribeiro, Meire; Cecatti, José Guilherme; Amaral, Eliana

    2014-01-01

    Background The Brazilian Network for Surveillance of Severe Maternal Morbidity was established in 27 centers in different regions of Brazil to investigate the frequency of severe maternal morbidity (near-miss and potentially life-threatening conditions) and associated factors, and to create a collaborative network for studies on perinatal health. It also allowed interventions aimed at improving the quality of care in the participating institutions. The objective of this study was to evaluate ...

  9. Quality indicators for international benchmarking of mental health care

    Hermann, Richard C; Mattke, Soeren; Somekh, David;

    2006-01-01

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

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

    Kwedza Ru K

    2011-03-01

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

  11. Predictors of Perinatal Hemorrhagic Stroke

    J Gordon Millichap

    2009-04-01

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

  12. Predictors of Perinatal Hemorrhagic Stroke

    J Gordon Millichap

    2009-01-01

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

  13. Carepaths: a framework for quality patient care

    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

  14. New health care law may spell opportunity for quality managers.

    2010-06-01

    New health care law emphasizes quality, safety, and efficiency. Pay-for-performance emphasis requires attention of quality managers. Many quality provisions will not kick in for several years. PMID:20491197

  15. Caring for quality of care: symbolic violence and the bureaucracies of audit

    Emmerich, Nathan; Swinglehurst, Deborah; Maybin, Jo; Park, Sophie; Quilligan, Sally

    2015-01-01

    Background This article considers the moral notion of care in the context of Quality of Care discourses. Whilst care has clear normative implications for the delivery of health care it is less clear how Quality of Care, something that is centrally involved in the governance of UK health care, relates to practice. Discussion This paper presents a social and ethical analysis of Quality of Care in the light of the moral notion of care and Bourdieu’s conception of symbolic violence. We argue that...

  16. Perinatal care at the limit of viability between 22 and 26 completed weeks of gestation in Switzerland. 2011 revision of the Swiss recommendations.

    Berger, Thomas M; Bernet, Vera; El Alama, Susanna; Fauchère, Jean-Claude; Hösli, Irène; Irion, Olivier; Kind, Christian; Latal, Bea; Nelle, Mathias; Pfister, Riccardo E; Surbek, Daniel; Truttmann, Anita C; Wisser, Joseph; Zimmermann, Roland

    2011-01-01

    Perinatal care of pregnant women at high risk for preterm delivery and of preterm infants born at the limit of viability (22-26 completed weeks of gestation) requires a multidisciplinary approach by an experienced perinatal team. Limited precision in the determination of both gestational age and foetal weight, as well as biological variability may significantly affect the course of action chosen in individual cases. The decisions that must be taken with the pregnant women and on behalf of the preterm infant in this context are complex and have far-reaching consequences. When counselling pregnant women and their partners, neonatologists and obstetricians should provide them with comprehensive information in a sensitive and supportive way to build a basis of trust. The decisions are developed in a continuing dialogue between all parties involved (physicians, midwives, nursing staff and parents) with the principal aim to find solutions that are in the infant's and pregnant woman's best interest. Knowledge of current gestational age-specific mortality and morbidity rates and how they are modified by prenatally known prognostic factors (estimated foetal weight, sex, exposure or nonexposure to antenatal corticosteroids, single or multiple births) as well as the application of accepted ethical principles form the basis for responsible decision-making. Communication between all parties involved plays a central role. The members of the interdisciplinary working group suggest that the care of preterm infants with a gestational age between 22 0/7 and 23 6/7 weeks should generally be limited to palliative care. Obstetric interventions for foetal indications such as Caesarean section delivery are usually not indicated. In selected cases, for example, after 23 weeks of pregnancy have been completed and several of the above mentioned prenatally known prognostic factors are favourable or well informed parents insist on the initiation of life-sustaining therapies, active obstetric

  17. Quality indicators in breast cancer care.

    Del Turco, M Rosselli; Ponti, A; Bick, U; Biganzoli, L; Cserni, G; Cutuli, B; Decker, T; Dietel, M; Gentilini, O; Kuehn, T; Mano, M P; Mantellini, P; Marotti, L; Poortmans, P; Rank, F; Roe, H; Scaffidi, E; van der Hage, J A; Viale, G; Wells, C; Welnicka-Jaskiewicz, M; Wengstöm, Y; Cataliotti, L

    2010-09-01

    To define a set of quality indicators that should be routinely measured and evaluated to confirm that the clinical outcome reaches the requested standards, Eusoma has organised a workshop during which twenty four experts from different disciplines have reviewed the international literature and selected the main process and outcome indicators available for quality assurance of breast cancer care. A review of the literature for evidence-based recommendations have been performed by the steering committee. The experts have identified the quality indicators also taking into account the usability and feasibility. For each of them it has been reported: definition, minimum and target standard, motivation for selection and level of evidence (graded according to AHRO). In overall 17 main quality indicators have been identified, respectively, 7 on diagnosis, 4 on surgery and loco-regional treatment, 2 on systemic treatment and 4 on staging, counselling, follow-up and rehabilitation. Breast Units in Europe are invited to comply with these indicators and monitor them during their periodic audit meetings. PMID:20675120

  18. Quality Aspects of Maternal Health Care in Tanzania

    Urassa, David Paradiso

    2004-01-01

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

  19. Linkages among reproductive health, maternal health, and perinatal outcomes.

    Bhutta, Zulfiqar A; Lassi, Zohra S; Blanc, Ann; Donnay, France

    2010-12-01

    Some interventions in women before and during pregnancy may reduce perinatal and neonatal deaths, and recent research has established linkages of reproductive health with maternal, perinatal, and early neonatal health outcomes. In this review, we attempted to analyze the impact of biological, clinical, and epidemiologic aspects of reproductive and maternal health interventions on perinatal and neonatal outcomes through an elucidation of a biological framework for linking reproductive, maternal and newborn health (RHMNH); care strategies and interventions for improved perinatal and neonatal health outcomes; public health implications of these linkages and implementation strategies; and evidence gaps for scaling up such strategies. Approximately 1000 studies (up to June 15, 2010) were reviewed that have addressed an impact of reproductive and maternal health interventions on perinatal and neonatal outcomes. These include systematic reviews, meta-analyses, and stand-alone experimental and observational studies. Evidences were also drawn from recent work undertaken by the Child Health Epidemiology Reference Group (CHERG), the interconnections between maternal and newborn health reviews identified by the Global Alliance for Prevention of Prematurity and Stillbirth (GAPPS), as well as relevant work by the Partnership for Maternal, Newborn and Child Health. Our review amply demonstrates that opportunities for assessing outcomes for both mothers and newborns have been poorly realized and documented. Most of the interventions reviewed will require more greater-quality evidence before solid programmatic recommendations can be made. However, on the basis of our review, birth spacing, prevention of indoor air pollution, prevention of intimate partner violence before and during pregnancy, antenatal care during pregnancy, Doppler ultrasound monitoring during pregnancy, insecticide-treated mosquito nets, birth and newborn care preparedness via community-based intervention

  20. Quality of care of nurse-led and allied health personnel-led primary care clinics

    Chin, WY; Lam, CLK; Lo, SV

    2011-01-01

    Objectives To review the literature regarding quality of care of nurse-led and allied health personnel-led primary care clinics with specific attention to the quality indicators for fall prevention, continence care, pulmonary rehabilitation, mental health, pharmaceutical care, and wound care services. Data sources Literature search from 1990 to 2010 including Ovid Medline, Cochrane Database, RAND (Research and Development) Corporation Health Database, the ACOVE (Assessing the Care of Vulnerab...

  1. Perinatal Safety: From Concept to Nursing Practice

    Lyndon, Audrey; Kennedy, Holly Powell

    2010-01-01

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

  2. Diabetes quality management in care groups and outpatient clinics

    Campmans-Kuijpers, M.J.E.

    2015-01-01

    This research project relates to diabetes quality management in Dutch care groups (40-200 GP practices) and outpatient clinics. Improvement of quality management at an organisational level on top of the existing quality management in separate general practices is expected to be associated with better outcomes in diabetes care. Quality management was measured with newly developed questionnaires about organisation of care, multidisciplinary teamwork, patient centeredness, performance results, q...

  3. Molecular imaging in quality health care

    Full text: Quality Health Care results from applying fundamental basic science and preclinical concepts as well as novel technologies to patient care within specific socio-economic frameworks. Cancer mortality has improved recently but outcomes of cancer patients are still unacceptably poor. Molecular Imaging has the potential to improve the outcome of cancer patients in several ways. In the preclinical setting, high resolution molecular imaging devices designed for small animal research have developed into valuable tools for drug evaluation and imaging probe design. These have enabled us to study drug effects in vivo by monitoring longitudinally their effects on tumor cell metabolism or proliferation. The success of Imatinib in treating chronic myeloid leukemia (CML) and gastrointestinal stromal tumors (GIST) has demonstrated that targeted drugs can induce remarkable tumor responses and may even cure cancer patients. Targeted drugs have been used for treating various common solid human tumors, including breast cancer, colorectal cancer, and non-small cell lung cancer. However, diverse signaling pathways are involved in the development and progression of these genetically heterogeneous diseases. Consequently, inhibition of one specific pathway is likely to be efficacious in only in small subsets of patients with specific histological tumor types. It is unlikely that a single 'blockbuster' drug can be effective for all patients with a 'common' tumor. Rather, it will be necessary to develop multiple targeted drugs even for patients that share a single histologically defined tumor type. The inevitable consequence is a decreased revenue/cost ratio for the industry and increasing costs for patients and health care systems. It is therefore of paramount importance to identify drug failure as early as possible in preclinical and clinical trials. Human studies with positron emission tomography (PET) with molecular imaging probes targeting physiological processes such as

  4. [Toward a high quality glaucoma care].

    Kashiwagi, Kenji

    2012-03-01

    The following studies were performed to solve current problems in glaucoma care and to pursue quality glaucoma care. Using a scanning peripheral anterior chamber depth analyzer that we developed, we: 1) conducted cross-sectional screening for eyes with angle closure; 2) examined longitudinal changes in anterior chamber depth and occurrence rates of primary angle closure in local senior residents; 3) investigated the significance of the anterior chamber and the angle of eyes with open angle glaucoma; and 4) looked into possible applications of anterior chamber depth and the angle in routine examinations. We investigated the effects of retinal glial cells and optic nerve astrocytes on retinal ganglion cell (RGC) survival and neurite growth using a culture system. We also identified candidate genies of retinal glial cells and optic nerve astrocytes affecting RGC survival and neurite growth using microarray and siRNA systems. SRC, a membrane-associated 60-kDa tyrosine kinase, is reported to be involved in neuron death and neurite growth. We developed two types of gene-targeted mice in which we modified the status of SRC phosphorylation. We compared RGC survival and neurite growth by conducting in vivo and in vitro experiments. Adherence is currently a very important issue in the field of glaucoma. We developed a nm thick and composed of 21.5 chitosan-sodium alginate pairs. IOP reduction and its duration, as well as adverse effects, were investigated. In addition, we established and evaluated a support system for glaucoma care in an effort to promote participation of glaucoma patients in glaucoma care using information and communication technology. This system improved the literacy of glaucoma patients as well as glaucoma medical therapy. At the same time, in order to ably provide glaucoma care given the increase in the number of glaucoma patients and the shortage of glaucoma specialists, a tele-medicine system for ophthalmology was developed, in which ophthalmologists

  5. Perinatal mortality--an analysis of causes and strategies.

    Gupta, Neeru

    2011-04-01

    Perinatal mortality is the most sensitive index while imparting healthcare to mother during pregnancy and delivery and also to the baby in perinatal period. Perinatal mortality is higher in rural areas than in urban areas. Worldover perinatal or infant mortality rate is on decline. Developed countries are ahead of developing nations in giving good antenatal, intrapartal as well as neonatal care. Factors responsible for perinatal mortality in Indian context lie in sociodemographic, maternal and foetal aspects. Regional differences also are there in India while assessing perinatal mortality and delivery practices. The lacunae are to be identified while recommending strategies to be taken to lower the perinatal mortality. A community based data system should be developed so that the information should flow from down to above, from village to subcentre to primary health centre and further from district to state. Some newborns need special care. Since newborns need early recognition of danger signs and prompt treatment measures. PMID:22187796

  6. Measuring the Multifaceted Nature of Infant and Toddler Care Quality

    Mangione, Peter L.; Kriener-Althen, Kerry; Marcella, Jennifer

    2016-01-01

    Research Findings: The quality of group care infants and toddlers experience relates to their concurrent and later development. Recent quality improvement initiatives point to the need for ecologically valid measures that assess the multifaceted nature of child care quality. In this article, we present the psychometric properties of an infant and…

  7. Quality Indicators for Hospital Care: Reliability and validity

    Fischer, Claudia

    2015-01-01

    markdownabstractAbstract Hospital quality indicators are widely implemented for purposes such as accountability, transparency and the overarching aim of quality improvement. However, it is not clear whether currently used hospital quality indicators actually reflect quality of care. The aim of this thesis was to expand our knowledge on how to measure quality of hospital care with the focus on external comparison. I specifically investigated reliability and validity as these are key aspects of...

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

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

    1998-01-01

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

  9. Evaluating the Quality of the Child Care in Finland

    Hujala, Eeva; Fonsen, Elina; Elo, Janniina

    2012-01-01

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

  10. Data quality review during prenatal care

    Silvânia Maria Mendes Vasconcelos

    2009-09-01

    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.

  11. 38 CFR 51.120 - Quality of care.

    2010-07-01

    ... FOR NURSING HOME CARE OF VETERANS IN STATE HOMES Standards § 51.120 Quality of care. Each resident...) The resident environment remains as free of accident hazards as is possible; and (2) Each...

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

    Abrahamsen Grøndahl, Vigdis

    2012-01-01

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

  13. Quantification of EUGR as a Measure of the Quality of Nutritional Care of Premature Infants.

    Zhenlang Lin

    Full Text Available To develop an index of the quality of nutritional care of premature infants based on the change in weight Z score from birth to discharge and to illustrate the use of this index in comparing the performance of different NICUs.Retrospective data analysis was performed to compare the growth of premature infants born in three perinatal centers. Infants with gestational age ≤ 32 weeks who survived to discharge from 2006 to 2010 were included. Weight Z scores at birth and discharge were calculated by the method of Fenton. Using data from one NICU as the reference, a multivariable linear regression model of change in weight Z score from birth to discharge was developed. Employing this model, a benchmark value of change in weight Z score was calculated for each baby. The difference between this calculated benchmark value and the baby's observed change in weight Z score was defined as the performance gap for that infant. The average value of the performance gaps in a NICU serves as its quality care index.1,714 infants were included for analysis. Change in weight Z score is influenced by birth weight Z score and completed weeks of gestation; thus the model for calculating the benchmark change in weight Z score was adjusted for these two variables. We found statistically significant differences in the average performance gaps for the three units.A quality care index was developed based on change in weight Z score from birth to discharge adjusted for two initial risk factors. This objective, easily calculated index may be used as a measurement of the quality of nutritional care to rank the performance of different NICUs.

  14. System Change: Quality Assessment and Improvement for Medicaid Managed Care

    Smith, Wally R.; Cotter, J. James; Louis F Rossiter

    1996-01-01

    Rising Medicaid health expenditures have hastened the development of State managed care programs. Methods to monitor and improve health care under Medicaid are changing. Under fee-for-service (FFS), the primary concern was to avoid overutilization. Under managed care, it is to avoid underutilization. Quality enhancement thus moves from addressing inefficiency to addressing insufficiency of care. This article presents a case study of Virginia's redesign of Quality Assessment and Improvement (Q...

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

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

    2011-01-01

    In 2008, the federal government allotted $7 billion in child care subsidies to low-income families through the state-administered Child Care and Development Fund (CCDF), now the government's largest child care program (US DHHS, 2008). Although subsidies reduce costs for families and facilitate parental employment, it is unclear how they impact the quality of care families purchase. This study investigates the impact of government subsidization on parents' selection of child care quality using multivariate regression and propensity score matching approaches to account for differential selection into subsidy receipt and care arrangements. Data were drawn from the Child Care Supplement to the Fragile Families and Child Wellbeing Study (CCS-FFCWS), conducted in 2002 and 2003 in 14 of the 20 FFCWS cities when focal children were 3 years old (N = 456). Our results indicate that families who used subsidies chose higher quality care than comparable mothers who did not use subsidies, but only because subsidy recipients were more likely to use center-based care. Subgroup analyses revealed that families using subsidies purchased higher-quality home-based care but lower-quality center-based care than comparable non-recipients. Findings suggest that child care subsidies may serve as more than a work support for low-income families by enhancing the quality of nonmaternal care children experience but that this effect is largely attributable to recipients' using formal child care arrangements (versus kith and kin care) more often than non-recipients. PMID:21874092

  16. Improving the quality of cardiovascular preventive care in general practice

    Lobo, Claudia

    2002-01-01

    textabstractIn this thesis we target cardiovascular preventive care from a continuous quality improvement point of view in a project called CARPE (CArdiovascular Risk reduction in Primary carE). We created a multifaceted intervention based on a ·quality cycle· and used outreach visitors for its implementation, since this approach has proven successful in modifying professional behavior. 13 In addressing prevention we considered Donebedian's model 14 to assess quality of care: i.e. we distingu...

  17. Is Health Care Ready for Six Sigma Quality?

    Chassin, Mark R.

    1998-01-01

    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,...

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

    Child Trends, 2010

    2010-01-01

    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)…

  19. How health policy influences quality of care in pediatrics.

    Simpson, Lisa A; Fairbrother, Gerry

    2009-08-01

    The primary focus of child health policy for the last twenty years has been on improving health care coverage and access. More recently, the focus has shifted to include not only coverage, but also the quality of the care received. This article describes some "voltage drops" in health care that impede delivery of high quality health care. The growing emphasis on quality is reflected in provisions of the new Child Health Program Reauthorization Act of 2009 (CHIPRA) legislation. In addition to providing funding for health coverage for over four million more children, it also includes the most significant federal investment in pediatric quality to date. PMID:19660643

  20. The perinatal loss and parental reflection

    Kamile Kukulu

    2010-12-01

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

  1. Adverse obstetrical and perinatal outcome in adolescent mothers associated with first birth: a hospital-based case-control study in a tertiary care hospital in North-East India

    Medhi R

    2016-04-01

    Full Text Available Robin Medhi, Banani Das, Arpana Das, Mansur Ahmed, Sonika Bawri, Suditi Rai Department of Obstetrics and Gynaecology, Silchar Medical College and Hospital, Silchar, Assam, India Purpose: To analyze the adverse obstetrical and perinatal outcome of adolescent mothers associated with first birth. Patients and methods: This prospective case-control study was conducted in a tertiary care teaching hospital of North-East India between January 2014 and December 2014. All adolescent primigravidae completing 28 weeks of gestation with singleton pregnancy and delivered at our institution were included in the study group. Primigravidae aged between 20 and 25 years were taken as a control group. Mothers having pregnancy complicated with diabetes mellitus, renal disorder, thyroid disorders, and cardiac diseases were excluded from the study. Demographic data, maternal complications like severe anemia, pre-eclampsia, eclampsia, gestational age at delivery, mode of delivery, and postpartum complications were compared. Among fetal complications, low-birth weight, preterm birth, neonatal intensive care unit admission, still birth, and early neonatal death were compared. All the patients were interviewed regarding contraceptive knowledge and its use preceding the pregnancy. Results: Quality antenatal care was received by 80.6% of adolescent mothers. The adolescent mothers had a higher incidence of pre-eclampsia (odds ratio [OR] 2.017 95% confidence interval [CI]: 1.045–3.894, P=0.03, preterm deliveries (OR: 1.655, 95% CI: 1.039–2.636, P=0.03. Among fetal outcomes, the low- birth weight babies (OR: 1.59, 95% CI: 1.016–2.478, low mean birth weight (2,544.4±622.09 g versus 2,701.6±582.51 g, and higher admission to neonatal intensive care unit (OR: 1.957, 95% CI: 1.120–3.417 were significantly associated with adolescent mothers. There was no significant difference found regarding the mode of delivery, still birth, and early neonatal death. Moreover

  2. Quality indicators for primary care mental health services

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

    2003-01-01

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

  3. Concordance between nurse-reported quality of care and quality of care as publicly reported by nurse-sensitive indicators

    Stalpers, Dewi; Kieft, Renate A. M. M.; Linden, Dimitri; Kaljouw, Marian J.; Schuurmans, Marieke J.

    2016-01-01

    Background Nurse-sensitive indicators and nurses’ satisfaction with the quality of care are two commonly used ways to measure quality of nursing care. However, little is known about the relationship between these kinds of measures. This study aimed to examine concordance between nurse-sensitive screening indicators and nurse-perceived quality of care. Methods To calculate a composite performance score for each of six Dutch non-university teaching hospitals, the percentage scores of the public...

  4. Adverse obstetrical and perinatal outcome in adolescent mothers associated with first birth: a hospital-based case-control study in a tertiary care hospital in North-East India

    Medhi R; Das B; Das A; Ahmed M; Bawri S; Rai S

    2016-01-01

    Robin Medhi, Banani Das, Arpana Das, Mansur Ahmed, Sonika Bawri, Suditi Rai Department of Obstetrics and Gynaecology, Silchar Medical College and Hospital, Silchar, Assam, India Purpose: To analyze the adverse obstetrical and perinatal outcome of adolescent mothers associated with first birth. Patients and methods: This prospective case-control study was conducted in a tertiary care teaching hospital of North-East India between January 2014 and December 2014. All adolescent primigravidae com...

  5. Health Care Quality, Economic Inequality, and Precautionary Saving

    Tullio Jappelli; Luigi Pistaferri; Guglielmo Weber

    2006-01-01

    We argue that health care quality has an important impact on economic inequality and on saving behaviour. We exploit district-wide variability in health care quality provided by the Italian universal public health system to identify the effect of quality on income inequality, health inequality and precautionary saving. We find that in lower quality districts there is greater income and health dispersion and higher precautionary saving. The analysis carries important insights for the ongoing d...

  6. The meaning of quality of care in home care settings: older lesbian and bisexual women's perspectives.

    Grigorovich, Alisa

    2016-03-01

    Research suggests that the experience of being a lesbian or bisexual woman influences women's interactions with health care providers, and their perception of the quality of care. Limited research to date, however, has examined how ageing and sexuality mediates women's experiences of quality, when accessing health care in the community. To fill a gap in the literature, this study investigated older lesbian and bisexual women's perspectives on the meaning of quality of care in the context of receiving home care services. This was a qualitative single case study. Sixteen participants, aged 55-72 from Ontario, Canada, participated in semi-structured interviews between 2011 and 2012. The interviews were recorded and transcribed. The interview data were analysed using iterative thematic analysis and guided by a feminist ethic of care perspective. Participants described quality of care in ways that were in line with a feminist ethic of care; that is, they wanted care providers to be responsive and attentive to their needs, to involve them in the caring process and to demonstrate respect and caring. Participants also indicated that providers' comfort with, and knowledge of, sexual diversity was important for enabling quality of care. These findings deepen our understanding of how to support quality of care for this population through changes to provider education and training, and health policy. PMID:25919504

  7. Quality Indicators for Hospital Care : Reliability and validity

    C. Fischer (Claudia)

    2015-01-01

    markdownabstractAbstract Hospital quality indicators are widely implemented for purposes such as accountability, transparency and the overarching aim of quality improvement. However, it is not clear whether currently used hospital quality indicators actually reflect quality of care. The aim of

  8. Molecular imaging in quality health care

    Full text: Quality health care results from translating fundamental bench discoveries and making them available to patients. During the past decade, 'molecular imaging' has emerged both as a new tool/technology and as a research and clinical discipline. Molecular imaging is an interdisciplinary approach involving biologists, physicists, physicians, mathematicians, conventional chemists, radiochemists and other specialists who have joined forces for better understanding and visualizing of both normal physiological processes and the molecular processes preceding the morphological manifestations of disease in vivo. Molecular imaging has been defined as 'non-invasive, quantitative, and repetitive imaging of targeted macromolecules and biological processes in living organisms' or as 'the visual representation, characterization, and quantification of biological processes at the cellular and sub-cellular levels within intact living organisms'. Weissleder defined molecular imaging in the most simple terms as 'studying diseases non-invasively at the molecular level'. Regardless of these semantic differences molecular imaging can contribute significantly to the preclinical and clinical drug and disease evaluation process. It is interesting to note, that despite major advances in imaging technology, cancer mortality has remained largely unchanged over the last three decades. Imaging has thus far enabled us to look through a magnifying glass at disease processes but has failed to dramatically influence disease outcomes. Emerging data suggest that molecular PET imaging is about to change this situation. High resolution molecular imaging devices designed for small animal research have developed into valuable tools for drug evaluation and imaging probe design. These include microPET, microCT, microMRI and optical imaging devices. These have enabled us to study drug effects in vivo by monitoring longitudinally their effects on tumour cell metabolism or proliferation. The only

  9. Knowledge sharing behaviour and intensive care nurse innovation: the moderating role of control of care quality

    Li-Ying, Jason; Paunova, Minna; Egerod, Ingrid

    2016-01-01

    of the questionnaire were used – one designed for nurse employees and the other for the managing nurse(s). An ordinary least squares regression analysis was used to test the hypotheses. Results Different aspects of knowledge sharing affect innovation differently, depending on the strength of the control of care......Aims This study investigates the influence of intensive care unit nurses’ knowledge sharing behaviour on nurse innovation, given different conditions of care quality control. Background Health-care organisations face an increasing pressure to innovate while controlling care quality. We have little...... insight on how the control of care quality interacts with the knowledge sharing behaviour of intensive care nurses to affect their innovative behaviours. Methods We developed a multi-source survey study of more than 200 intensive care nurses at 22 intensive care units of 17 Danish hospitals. Two versions...

  10. Racial/Ethnic Discrimination in Health Care: Impact on Perceived Quality of Care

    Sorkin, Dara H.; Ngo-Metzger, Quyen; Alba, Israel

    2010-01-01

    Background Racial/ethnic minorities are more likely to report receipt of lower quality of health care; however, the mediators of such patient reports are not known. Objectives To determine (1) whether racial disparities in perceptions of quality of health care are mediated by perceptions of being discriminated against while receiving medical care and (2) whether this association is further mediated by patient sociodemographic characteristics, access to care, and patient satisfaction across ra...

  11. Racial/Ethnic Discrimination in Health Care: Impact on Perceived Quality of Care

    Sorkin, Dara H.; Ngo-Metzger, Quyen; Alba, Israel

    2010-01-01

    Racial/ethnic minorities are more likely to report receipt of lower quality of health care; however, the mediators of such patient reports are not known. To determine (1) whether racial disparities in perceptions of quality of health care are mediated by perceptions of being discriminated against while receiving medical care and (2) whether this association is further mediated by patient sociodemographic characteristics, access to care, and patient satisfaction across racial/ethnic groups....

  12. Improving the Quality of Behavioral Health Care for Medicaid Beneficiaries

    Allison Siegwarth

    2015-01-01

    This brief highlights Mathematica’s work to find opportunities for quality improvement in Medicaid’s behavioral health services, develop measures that can help monitor the quality of care, and to identify innovative strategies to better coordinate behavioral and physical health care.

  13. Effects of Quality Improvement System for Child Care Centers

    Ma, Xin; Shen, Jianping; Kavanaugh, Amy; Lu, Xuejin; Brandi, Karen; Goodman, Jeff; Till, Lance; Watson, Grace

    2011-01-01

    Using multiple years of data collected from about 100 child care centers in Palm Beach County, Florida, the authors studied whether the Quality Improvement System (QIS) made a significant impact on quality of child care centers. Based on a pre- and postresearch design spanning a period of 13 months, QIS appeared to be effective in improving…

  14. Parent-Caregiver Communication and Quality of Care.

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

    1994-01-01

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

  15. Agency for quality and accreditation of the health care facilities

    Zisovska, Elizabeta

    2014-01-01

    The Agency ensures quality and safety in health care through the process of accreditation and re-accreditation of the health care facilities. The Agency develops, revise and improves the standards of the health care in HC facilities, monitors the implementation of the standards and facilitates the preparedness of the HC facility for successful external assessment.

  16. Marketing quality and value to the managed care market.

    Kazmirski, G

    1998-11-01

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

  17. LONG-TERM CARE OF DEPENDENT ELDERLY AND QUALITY

    Macková Marie

    2013-01-01

    This article focuses on the issue of long-term care of dependent elderly and quality of life of their carers. Elderly care has an impact on the quality of life of family members. The research was carried out through a questionnaire and interview. The quality of life was measured using the WHOQOL instrument. The research aimed to identify the current levels of family members’ quality of life and the factors influencing the quality of life thereof. The research findings showed a lower quality o...

  18. How can clinicians measure safety and quality in acute care?

    Pronovost, Peter J; Nolan, Thomas; Zeger, Scott; Miller, Marlene; Rubin, Haya

    2011-03-01

    The demand for high quality care is increasing and warranted. Evidence suggests that the quality of care in hospitals can be improved. The greatest opportunity to improve outcomes for patients over the next quarter century will probably come not from discovering new treatments but from learning how to deliver existing effective therapies. To improve, caregivers need to know what to do, how they are doing, and be able to improve the processes of care. The ability to monitor performance, though challenging in healthcare, is essential to improving quality of care. We present a practical method to assess and learn from routine practice. Methods to evaluate performance from industrial engineering can be broadly applied to efforts to improve the quality of healthcare. One method that may help to provide caregivers frequent feedback is time series data--ie, results are graphically correlated with time. Broad use of these tools might lead to the necessary improvements in quality of care. PMID:23451357

  19. Is the nursing process part of quality care?

    Abaunza de González, Myriam

    2010-01-01

    The main purpose of this article is to answer the question: Is the nursing process part of quality care? In order to back the answer, it starts by mentioning several authors that have performed studies on the use of scientific methods, problem solving methods and the attention to care -innursing method and its relationship to the quality of service and the nursing care, while at the same time it introduces related experiences associated with NIPE research projects and related Groups with Dx, ...

  20. The Quality of Cancer Care Initiative in the Netherlands

    Wouters, Michel W. J. M.; Jansen-Landheer, Marlies L. E. A.; van de Velde, Cornelis J. H.

    2010-01-01

    Abstract Background In 2007 the Dutch Cancer Society formed a `Quality of Cancer Care? taskforce comprising medical specialists, from all disciplines involved in the care for cancer patients. This taskforce was charged with the evaluation of quality of cancer care in the Netherlands and the development of strategies for improvement. Objective The experts first focused on the relation between procedural volume and patient outcome and later aimed to i...

  1. Who Provides Good Quality Prenatal Care in the Philippines?

    Lavado, Rouselle F; Lagrada, Leizel P.; Ulep, Valerie Gilbert T.; Tan, Lester M.

    2010-01-01

    This paper attempts to illustrate the quality of prenatal care services provided by different health care providers. Section I presents the introduction and overview of the study. Section II discusses important information gathered during literature review which was organized into prenatal care and its benefits, recommended practice and discussion of quality of prenatal services. Sections III and IV present the detailed objectives and methodology adapted in the study. Section V discusses the ...

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

    Mainz, Jan; Kristensen, Solvejg; Bartels, Paul

    2015-12-01

    Denmark has unique opportunities for quality measurement and benchmarking since Denmark has well-developed health registries and unique patient identifier that allow all registries to include patient-level data and combine data into sophisticated quality performance monitoring. Over decades, Denmark has developed and implemented national quality and patient safety initiatives in the healthcare system in terms of national clinical guidelines, performance and outcome measurement integrated in clinical databases for important diseases and clinical conditions, measurement of patient experiences, reporting of adverse events, national handling of patient complaints, national accreditation and public disclosure of all data on the quality of care. Over the years, Denmark has worked up a progressive and transparent just culture in quality management; the different actors at the different levels of the healthcare system are mutually attentive and responsive in a coordinated effort for quality of the healthcare services. At national, regional, local and hospital level, it is mandatory to participate in the quality initiatives and to use data and results for quality management, quality improvement, transparency in health care and accountability. To further develop the Danish governance model, it is important to expand the model to the primary care sector. Furthermore, a national quality health programme 2015-18 recently launched by the government supports a new development in health care focusing upon delivering high-quality health care-high quality is defined by results of value to the patients. PMID:26443814

  3. Systems and processes that ensure high quality care.

    Bassett, Sally; Westmore, Kathryn

    2012-10-01

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

  4. Is health care ready for Six Sigma quality?

    Chassin, M R

    1998-01-01

    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, quality problems frequently occur at rates of 20 to 50 percent, or 200,000 to 500,000 per million. In order to approach Six Sigma levels of quality, the health care sector must address the underlying causes of error and make important changes: adopting new educational models; devising strategies to increase consumer awareness; and encouraging public and private investment in quality improvement. PMID:9879303

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

    Gerberding, J. L.

    2001-01-01

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

  6. Indicators for quality of hospital care: Beyond the numbers

    Dishoeck, Anne-Margreet

    2015-01-01

    markdownabstractAbstract This thesis addresses two major topics in measuring, comparing and improving quality of care. We found considerable influence of random variation and case-mix in comparing hospitals using performance indicators. Although we found a significant relation between outcome and care processes, chance variation is the major limitation for the interpretability of indicators used for quality measurement or quality improvement. Like a one hand clock, we roughly know what time i...

  7. Measuring Quality of Care Under Medicare and Medicaid

    Jencks, Stephen F.

    1995-01-01

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

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

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

    2013-01-01

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

  9. "Who Says What Is Quality?": Setting Quality Standards for Family Child Care

    Modigliani, Kathy

    2011-01-01

    This article tells the story of the 4-year consensus-building process to design quality standards for the field of family child care. Working with the National Association for Family Child Care, the Family Child Care Project at Wheelock College was funded to create an accreditation system for home-based child care programs using innovative methods…

  10. Maternal and perinatal mortality.

    Krishna Menon, M K

    1972-01-01

    A brief analysis of data from the records of the Government Hospital for Women and Children in Madras for a 36-year period (1929-1964) is presented. India with a population of over 550 million has only 1 doctor for each 6000 population. For the 80% of the population which is rural, the doctor ratio is only 88/1 million. There is also a shortage of paramedical personnel. During the earlier years of this study period, abortions, puerperal infections; hemorrhage, and toxemia accounted for nearly 75% of all meternal deaths, while in later years deaths from these causes were 40%. Among associated factors in maternal mortality, anemia was the most frequent, it still accounts for 20% and is a contributory factor in another 20%. The mortality from postpartum hemorrhage was 9.3% but has now decreased to 2.8%. Eclampsia is a preventable disease and a marked reduction in maternal and perinatal mortality from this cause has been achieved. Maternal deaths from puerperal infections have dropped from 25% of all maternal deaths to 7%. Uterine rupture has been reduced from 75% to 9.3% due to modern facilities. Operative deliveries still have an incidence of 2.1% and a mortality rate of 1.4% of all deliveries. These rates would be further reduced by more efficient antenatal and intranatal care. Reported perinatal mortality of infants has been reduced from 182/1000 births to an average of 78/1000 in all areas, but is 60.6/1000 in the city of Madras. Socioeconomic standards play an important role in perinatal mortality, 70% of such deaths occurring in the lowest economic groups. Improvement has been noted in the past 25 years but in rural areas little progress has been made. Prematurity and low birth weights are still larger factors in India than in other countries, with acute infectious diseases, anemia, and general malnutrition among mothers the frequent causes. Problems requiring further efforts to reduce maternal and infant mortality are correct vital statistics, improved

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

    Cormick Gabriela

    2012-08-01

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

  12. Quality in the provision of headache care. 1

    Peters, Michele; Perera, Suraj; Loder, Elizabeth;

    2012-01-01

    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......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...

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

    Goodson, Justin; Jang, Wooseung; Rantz, Marilyn

    2008-01-01

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

  14. Multimorbidity and quality of preventive care in Swiss university primary care cohorts.

    Sven Streit

    Full Text Available BACKGROUND: Caring for patients with multimorbidity is common for generalists, although such patients are often excluded from clinical trials, and thus such trials lack of generalizability. Data on the association between multimorbidity and preventive care are limited. We aimed to assess whether comorbidity number, severity and type were associated with preventive care among patients receiving care in Swiss University primary care settings. METHODS: We examined a retrospective cohort composed of a random sample of 1,002 patients aged 50-80 years attending four Swiss university primary care settings. Multimorbidity was defined according to the literature and the Charlson index. We assessed the quality of preventive care and cardiovascular preventive care with RAND's Quality Assessment Tool indicators. Aggregate scores of quality of provided care were calculated by taking into account the number of eligible patients for each indicator. RESULTS: Participants (mean age 63.5 years, 44% women had a mean of 2.6 (SD 1.9 comorbidities and 67.5% had 2 or more comorbidities. The mean Charlson index was 1.8 (SD 1.9. Overall, participants received 69% of recommended preventive care and 84% of cardiovascular preventive care. Quality of care was not associated with higher numbers of comorbidities, both for preventive care and for cardiovascular preventive care. Results were similar in analyses using the Charlson index and after adjusting for age, gender, occupation, center and number of visits. Some patients may receive less preventive care including those with dementia (47% and those with schizophrenia (35%. CONCLUSIONS: In Swiss university primary care settings, two thirds of patients had 2 or more comorbidities. The receipt of preventive and cardiovascular preventive care was not affected by comorbidity count or severity, although patients with certain comorbidities may receive lower levels of preventive care.

  15. Assessing Quality in Mental Health Care

    Ian Shaw

    1997-01-01

    Quality assessment in mental health services is undergoing change in the United Kingdom following the introduction of market reforms. Traditionally, service quality was monitored by professional practitioners with reference to user satisfaction. This became formalized, and the two main forms of quality assurance currently used are outlined. However, the government is concerned that this may be inadequate for the monitoring of quality standards, specified in contracts between service purchaser...

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

    Havig Anders

    2011-11-01

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

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

    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

    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.

  18. Racial/Ethnic Discrimination in Health Care: Impact on Perceived Quality of Care

    Ngo-Metzger, Quyen; De Alba, Israel

    2010-01-01

    Background Racial/ethnic minorities are more likely to report receipt of lower quality of health care; however, the mediators of such patient reports are not known. Objectives To determine (1) whether racial disparities in perceptions of quality of health care are mediated by perceptions of being discriminated against while receiving medical care and (2) whether this association is further mediated by patient sociodemographic characteristics, access to care, and patient satisfaction across racial/ethnic groups. Research Design A cross-sectional analysis of a population-based sample of California adults responding to the 2003 California Health Interview Survey. Multivariable logistic regression was used to examine the relationship between perceived discrimination and perceived quality of health care after adjusting for patient characteristics and reports of access to care. Main Results A total of 36,831 respondents were included. African Americans (68.7%) and Asian/Pacific Islanders (64.5%) were less likely than non-Hispanic whites (72.8%) and Hispanics (74.9%) to rate their health care quality highly. African Americans (13.1%) and Hispanics (13.4%) were the most likely to report discrimination, followed by Asian/Pacific Islanders (7.3%) and non-Hispanic whites (2.6%). Racial/ethnic discrimination in health care was negatively associated with ratings of health care quality within each racial/ethnic group, even after adjusting for sociodemographic variables and other indicators of access and satisfaction. Feeling discriminated against fully accounted for the difference in low ratings of quality care between African Americans and whites, but not for other racial/ethnic minorities. Conclusions Patient perceptions of discrimination may play an important, yet variable role in ratings of health care quality across racial/ethnic minority groups. Health care institutions should consider how to address this patient concern as a part of routine quality improvement. PMID

  19. Improving perinatal care in the rural regions worldwide by wireless enabled antepartum fetal monitoring: a demonstration project.

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

    2015-01-01

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

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

    Roberto Tapia-Conyer

    2015-01-01

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

  1. Quality in the provision of headache care. 2

    Peters, Michele; Jenkinson, Crispin; Perera, Suraj;

    2012-01-01

    The objective of this study was to define "quality" of headache care, and develop indicators that are applicable in different settings and cultures and to all types of headache. No definition of quality of headache care has been formulated. Two sets of quality indicators, proposed in the US and U......." 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.......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...

  2. Measuring the quality of long-term care in England

    Malley, Juliette

    2010-01-01

    Improving the quality of long-term care has been central to the agenda of successive UK Governments since the late 1980s and a number of mechanisms have been introduced to achieve this end. The quality assurance framework that exists in England is comprehensive and supported by legislation. It is also supported by a number of national quality measures, including performance indicators from administrative systems to user surveys and composite measures of quality. There is close interaction ...

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

    Blum, Torsten G; Rich, Anna; Baldwin, David;

    2014-01-01

    Lung cancer is the commonest cause of cancer-related death worldwide and poses a significant respiratory disease burden. Little is known about the provision of lung cancer care across Europe. The overall aim of the Task Force was to investigate current practice in lung cancer care across Europe....... The Task Force undertook four projects: 1) a narrative literature search on quality management of lung cancer; 2) a survey of national and local infrastructure for lung cancer care in Europe; 3) a benchmarking project on the quality of (inter)national lung cancer guidelines in Europe; and 4) a...... feasibility study of prospective data collection in a pan-European setting. There is little peer-reviewed literature on quality management in lung cancer care. The survey revealed important differences in the infrastructure of lung cancer care in Europe. The European guidelines that were assessed displayed...

  4. Building a national perinatal database without the use of unique personal identifiers

    Schnell, R.; Borgs, C

    2015-01-01

    To assess the quality of hospital care, national databases of standard medical procedures are common. A widely known example are national databases of births. If unique personal identification numbers are available (as in Scandinavian countries), the construction of such databases is trivial from a computational point of view. However, due to privacy legislation, such identifiers are not available in all countries. Given such constraints, the construction of a national perinatal database has ...

  5. Disparities in Health Care Quality among Minority Women

    ... us at: https://info.ahrq.gov . Let us know the nature of the problem, the Web address of what you want, and your ... Store Disparities in Health Care Quality Among Minority Women Selected Findings From the 2011 ...

  6. Racial and Ethnic Disparities in the Quality of Health Care.

    Fiscella, Kevin; Sanders, Mechelle R

    2016-01-01

    The annual National Healthcare Quality and Disparities Reports document widespread and persistent racial and ethnic disparities. These disparities result from complex interactions between patient factors related to social disadvantage, clinicians, and organizational and health care system factors. Separate and unequal systems of health care between states, between health care systems, and between clinicians constrain the resources that are available to meet the needs of disadvantaged groups, contribute to unequal outcomes, and reinforce implicit bias. Recent data suggest slow progress in many areas but have documented a few notable successes in eliminating these disparities. To eliminate these disparities, continued progress will require a collective national will to ensure health care equity through expanded health insurance coverage, support for primary care, and public accountability based on progress toward defined, time-limited objectives using evidence-based, sufficiently resourced, multilevel quality improvement strategies that engage patients, clinicians, health care organizations, and communities. PMID:26789384

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

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

    2006-01-01

    Abstract Background Breast cancer in women is increasingly frequent, and care is complex, onerous and expensive, all of which lend urgency to improvements in care. Quality measurement is essential to monitor effectiveness and to guide improvements in healthcare. Methods Ten databases, including Medline, were searched electronically to identify measures assessing the quality of breast cancer care in women (diagnosis, treatment, followup, documentation of care). Eligible studies measured adhere...

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

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

    1982-01-01

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

  9. Quality Adjusted Cost Functions for Child Care Centers

    H. Naci Mocan

    1995-01-01

    Using a newly compiled data set, this paper estimates multi- product translog cost functions for 399 child care centers from California, Colorado, Connecticut, and North Carolina. Quality of child care is controlled by a quality index, which has been shown to be positively related to child outcomes by previous research. Nonprofit centers that receive public money, either from the state or federal government, (which is tied to higher standards), have total variable costs that are 18 percent hi...

  10. Management practices and the quality of care in cardiac units

    McConnell, K. John; Lindrooth, Richard C; Wholey, Douglas R; Maddox, Thomas M.; Bloom, Nicholas

    2013-01-01

    Importance:- To improve the quality of health care, many researchers have suggested that health care institutions adopt management approaches that have been successful in the manufacturing and technology sectors. However, relatively little information exists about how these practices are disseminated in hospitals and whether they are associated with better performance. Objectives:- To describe the variation in management practices among a large sample of hospital cardiac care units; asses...

  11. Quality of life before admission to the intensive care unit

    Tereran, Nathalia Perazzo; Zanei, Suely Sueko Viski; Whitaker, Iveth Yamaguchi

    2012-01-01

    Objective To examine the reliability of the SF-36 general health questionnaire when used to evaluate the health status of critically ill patients before admission to intensive care and to measure their health-related quality of life prior to admission and its relation to severity of illness and length of stay in the intensive care unit. Methods Prospective cohort study conducted in the intensive care unit of a public teaching hospital. Over three months, communicative and oriented patients we...

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

    Soleimani F

    2009-09-01

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

  13. Shared Care Contributions to Self-Care and Quality of Life in Chronic Cardiac Patients.

    Sebern, Margaret; Brown, Roger; Flatley-Brennan, Patricia

    2016-07-01

    Shared care is an interpersonal interaction system composed of communication, decision making, and reciprocity; it is used by patients and family caregivers (care dyads) to exchange social support. This study's purpose was to describe the contributions of shared care to outcomes for individuals with cardiac disease. A secondary data analysis was used to answer the following questions. What is the association between elements of shared care and patient outcomes? Do dyad perceptions of shared care differentially contribute to patient outcomes? Participants in this study were 93 individuals with a cardiac disease and 93 family caregivers. Composite index structured equation modeling was the analytic tool. Caregiver communication and reciprocity were related to patient mental quality of life. Patient communication and reciprocity were related to their own mental and physical quality of life and self-care confidence. Findings from this study contribute a better understanding of how care dyads are integral to patient outcomes. PMID:26864996

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

    Gilbert, Jaesook Lee; Harte, Helene Arbouet

    2013-01-01

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

  15. Patient's experiences with quality of hospital care: the Dutch Consumer Quality Index Cataract Questionnaire.

    Stubbe, J.H.; Brouwer, W.; Delnoij, D.M.J.

    2007-01-01

    BACKGROUND: Patients' feedback is of great importance in health care policy decisions. The Consumer Quality Index Cataract Questionnaire (CQI Cataract) was used to measure patients' experiences with quality of care after a cataract operation. This study aims to evaluate the reliability and the dimen

  16. Quality Control in Child Care Staff Selection

    Crow, Merwin R.

    1975-01-01

    This paper focuses on the process of staff selection of child care staff at a residential treatment center for children, ages 8-16. Phases of candidate selection, an "open-door" interview procedure, the orientation of hired candidates and the agency's philosophy, procedures and practices are discussed. (GO)

  17. The emerging EU quality of care policy

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

    2013-01-01

    Despite the fact that Member States and many citizens of the EU like to keep healthcare a foremost national competence and the EU treaties state that Member States remain primarily responsible for the organization and delivery of health care services, the European Union (EU) has expanded its...

  18. Evidence of improved quality of life with pediatric palliative care.

    O'Quinn, Lucy P; Giambra, Barbara K

    2014-01-01

    Pediatric nurses provide holistic family-centered care for children with life-limiting illnesses while being sensitive to children's growth and developmental needs. To learn how pediatric palliative care programs benefit children and their families, the following clinical question was asked: Among children with a life-limiting illness, does the use of a palliative care program compared with not using a palliative care program improve quality of life for patients and their families? Evidence from two studies found that palliative care services improve quality of life for children with life-limiting illness and their families in the areas of the child's emotional well-being and parental perception of preparation for the child's end of life, resulting in a low grade for the body of evidence. Future research should include high quality studies with larger sample sizes and control groups, and include children's perspectives--from both patients and siblings--to give a more complete picture of how best to improve their quality of life. A reliable tool is needed that includes a spiritual component and sensitive indicators specific to children with a life-limiting illness. Future research using this tool will more fully answer how palliative care services improve children's quality of life. PMID:25929123

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

    N. V. Tretyakova

    2013-01-01

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

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

    N. V. Tretyakova

    2015-03-01

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

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

    Rajshree Dayanand Katke

    2014-08-01

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

  2. Criteria-based audit of quality of care to women with severe pre-eclampsia and eclampsia in a referral hospital in Accra, Ghana.

    Joyce L Browne

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

  3. Quality in public services: the challenges of Primary Care

    Leonardo Cançado Monteiro Savassi

    2012-01-01

    The Brazilian Ministry of Health has signaled a policy of evaluating the quality of primary care through the 1654 decree of 19.07.2011. Any organizational change interferes with the culture of any institution, especially when this change is directed toward the issue of quality. It involves processes, internal resources and people, and cannot be artificially produced by the power of the pen. In the health sector, management based on quality involves changes in business focus and technology, su...

  4. Comparative Quality Indicators for Hospital Choice: Do General Practitioners Care?

    Ferrua, Marie; Sicotte, Claude; Lalloué, Benoît; Minvielle, Etienne

    2016-01-01

    Context The strategy of publicly reporting quality indicators is being widely promoted through public policies as a way to make health care delivery more efficient. Objective To assess general practitioners’ (GPs) use of the comparative hospital quality indicators made available by public services and the media, as well as GPs’ perceptions of their qualities and usefulness. Method A telephone survey of a random sample representing all self-employed GPs in private practice in France. Results A...

  5. Quality of diabetes care in general practice

    van Bruggen, J.A.R.

    2009-01-01

    In the Netherlands, a quality incentive is expected to ensue from improved collaboration between healthcare professionals. Whether this view is supported by sufficient evidence is, however, questionable. Therefore, the first study included in this thesis is a systematic review of studies on the effe

  6. 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

    Gülmezoglu A Metin; Calles Dinorah L; Hogue Carol J; Souza João-Paulo; Say Lale; Karlsen Saffron; Raine Rosalind

    2011-01-01

    Abstract Background Approximately one-third of a million women die each year from pregnancy-related conditions. Three-quarters of these deaths are considered avoidable. Millennium Development Goal five calls for a reduction in maternal mortality and the establishment of universal access to high quality reproductive health care. There is evidence of a relationship between lower levels of maternal education and higher maternal mortality. This study examines the relationship between maternal edu...

  7. Quality of care in Crohn’s disease

    Govind; K; Makharia

    2014-01-01

    Crohn’s disease(CD) is a chronic and progressive inflammatory disease of the intestine. Overall, healthcare delivery for patients with CD is not optimal at the present time and therefore needs improvement. There are evidences which suggest that there is a variation in the care provided to patients with CD by the inflammatory bowel disease(IBD) experts and community care providers. The delivery of healthcare for patients with CD is often complex and requires coordination between gastroenterologists/IBD specialist, gastrointestinal surgeon, radiologists and IBD nurses. In order to improve the quality of health care for patients with CD, there is need that we focus on large-scale, system-wide changes including creation of IBD comprehensive care units, provision to provide continuous care, efforts to standardize care, and education of the community practitioners.

  8. Health System Quality Improvement: Impact of Prompt Nutrition Care on Patient Outcomes and Health Care Costs.

    Meehan, Anita; Loose, Claire; Bell, Jvawnna; Partridge, Jamie; Nelson, Jeffrey; Goates, Scott

    2016-01-01

    Among hospitalized patients, malnutrition is prevalent yet often overlooked and undertreated. We implemented a quality improvement program that positioned early nutritional care into the nursing workflow. Nurses screened for malnutrition risk at patient admission and then immediately ordered oral nutritional supplements for those at risk. Supplements were given as regular medications, guided and monitored by medication administration records. Post-quality improvement program, pressure ulcer incidence, length of stay, 30-day readmissions, and costs of care were reduced. PMID:26910129

  9. Improving care quality and preventing maltreatment in institutional care – a feasibility study with caregivers

    Hermenau, Katharin; Kaltenbach, Elisa; Mkinga, Getrude; Hecker, Tobias

    2015-01-01

    Institutionalized children in low-income countries often face maltreatment and inadequate caregiving. In addition to prior traumatization and other childhood adversities in the family of origin, abuse and neglect in institutional care are linked to various mental health problems. By providing a manualized training workshop for caregivers, we aimed at improving care quality and preventing maltreatment in institutional care. In Study 1, 29 participating caregivers rated feasibility and efficacy...

  10. Quality and Safety in Health Care, Part II: Three Early Reports on Quality.

    Harolds, Jay A

    2015-09-01

    The 1990 Institute of Medicine report Medicare: A Strategy for Quality Assurance offered a definition of quality in health care and recommendations on how to achieve it. The forces for change would include different activities by the federal government, informed consumers, professionalism, and private initiatives. Eight years later, the National Roundtable report Statement on Quality of Care indicated that there were major problems of underuse, overuse, and misuse of health care services. In the same year, the President's Advisory Commission report Quality First: Better Health Care for All Americans discussed major problems with health care and proposed many initiatives to correct them, and also recommended a Bill of Rights and Responsibilities for the patients. PMID:26244402

  11. Reforming primary care in England--again. Plans for improving the quality of care.

    Baker, R

    2000-06-01

    An extensive programme of health service reform has begun in England. Improvement in the quality of care is a key objective of the reforms, and several initiatives are being introduced in response. These include systems to provide national guidance about appropriate treatment and services, a local system to support quality improvement and arrangements to monitor performance, including a new performance framework, an inspection agency and an annual survey of patients. The local quality improvement system has features of particular interest. These include arrangements for setting objectives for quality improvement, the use of various quality improvement methods tailored to local needs and a new system to provide accountability to both the health service and the public. The introduction of clinical governance and all the other reforms presents primary care practitioners with a major challenge. However, if sufficient time is allowed and adequate resources are made available, the reforms do have the potential to improve health care in England. PMID:10944059

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

    Dancet, E.A.; D'Hooghe, T.M.; Spiessens, C.; Sermeus, W.; Neubourg, D. De; Karel, N.; Kremer, J.A.M.; Nelen, W.L.D.M.

    2013-01-01

    STUDY QUESTION: What is the relative importance of the six dimensions of quality of care according to different stakeholders and can a quality indicator set address all six quality dimensions and incorporate the views from professionals working in different disciplines and from patients? SUMMARY ANS

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

    Hsieh, Chang-Ming

    2009-01-01

    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…

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

    Child Trends, 2010

    2010-01-01

    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…

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

    Child Trends, 2010

    2010-01-01

    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…

  16. Improving the quality of EHR recording in primary care: a data quality feedback tool.

    Bij, S. van der; Khan, N.; Veen, P. ten; Bakker, D.H. de; Verheij, R.A.

    2016-01-01

    Objective Electronic health record (EHR) data are used to exchange information among health care providers. For this purpose, the quality of the data is essential. We developed a data quality feedback tool that evaluates differences in EHR data quality among practices and software packages as part o

  17. Health care and the quality of life: a review.

    Holmes, C A

    1989-10-01

    The increasing requirement for evaluation of health care, either for purposes of quality assurance or deciding resource distribution issues, has brought into question a number of ideas concerning the aims of the health care enterprise. This article suggests that the ultimate aim is to improve the quality of life, and examines the feasibility of adopting this as an evaluation criterion. Difficulties concerning the concept and definition of the quality of life are outlined, and a plea made for the adoption of the broadest possible therapeutic aims. Social indicators and subjective evaluations are considered in turn as measures of the quality of life, and their inadequacies and strengths exposed. Relationships between the measures are discussed, and their uses outlined. It is finally suggested that nurses should participate in the formulation of quality of life concepts and evaluations which reflect the values which underpin their own practice. PMID:2681314

  18. Incorporating health care quality into health antitrust law

    Schneider Helen

    2008-04-01

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

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

    Ed Kelley

    2004-07-01

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

  20. China's Experience of Quality Care in Family Planning

    Er-sheng GAO; Wei YUAN; Ning LIU

    2006-01-01

    Objective To evaluate and overview the experience of quality care of family planning of China.Methods The framework of quality care of China was summarized and analyzed, that was clients, technology and management triangle program system.Results The 8 fundamental elements of quality care in China were presented:1) policy environment of QoC, 2) comprehensive services, 3) choice of method, 4) IEC to policy-makers and providers, 5) technical competence, 6) interpersonal communications, 7) institutional guideline and regulation, 8) appropriate constellation of service.Conclusion FP sectors should prepare different constellations of service to meet their individual reproductive health need for different clients and develop institutional guideline and regulation for FP service to follow up in practice. QoC should be a kind of standardized service process.

  1. Dimensions of Quality of Antenatal Care Sservice at Suez, Egypt

    Rahman El Gammal, Hanan Abbas Abdo Abdel

    2014-01-01

    Introduction: The 5th millennium development goal aims at reducing maternal mortality by 75% by the year 2015. According to the World Health Organization, there was an estimated 358,000 maternal deaths globally in 2008. Developing countries accounted for 99% of these deaths of which three-fifths occurred in Sub-Saharan Africa. In primary health care (PHC), quality of antenatal care is fundamental and critically affects service continuity. Nevertheless, medical research ignores the issue and i...

  2. Health Literacy and Communication Quality in Health Care Organizations

    Wynia, Matthew K; Osborn, Chandra Y.

    2010-01-01

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

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

    N. V. Tretyakova; Fedorov, V.A.

    2015-01-01

    The paper deals with one of the priority tasks of Russian educational system – developing the health responsibility. The recent health deterioration trend among children and adolescents calls for the complex health care measures, equally affecting the learning outcomes. The authors argue that there is a need for proper definition and specification of the key term of health care quality. However, the analysis of the available scientific and documentary recourses demonstrates the absence of suc...

  4. 锦州市围生期妇女保健需求的调查分析%Survey of perinatal health care demand in Jinzhou

    王怡涵; 王红霞; 侯晓瑛; 卢静; 宫建美

    2016-01-01

    Objective To understand perinatal health care and demand status, and explore the influence factors of perinatal health in Jinzhou area. Methods Randomly investigate 996 mothers from three hospital in Jinzhou. Results Seeking pregnancy health service demand rate: general hospital of obstetrics and gynecology accounted for 52.2%(520/996), maternity hospitals accounted for 39.5%(393/996), family planning services accounted for 8.3% (83/996). Good crowd in pregnancy cognition, > 30 65.3% (297/455), 30 years old or less accounted for 34.7% (158/455). Medical personnel in maternal knowledge acquirement accounted for 33.2% (331/996), pregnant women school training accounted for 23.9% (238/996), network way accounted for 16.2% (161/996), the relatives and friends accounted for 10.7% (107/996), books accounted for 10.8% (108/996), the other way accounted for 5.1% (51/996).The related factors of postpartum depression are marital status, antenatal education, the way of breastfeeding. Conclusions The family planning service has not fully played its efficiency. Women under t he age of 30 need to enhance conciousness about health care before pregnancy. The network platform still has space to play education function. It′s necessary that puerperal nursing routine should add postnatal depression questionnaire in the future.%目的:了解锦州地区妇女围生期保健需求,并探讨影响妇女围生期健康的相关因素。方法随机选取996例产后复查的产妇,对其一般情况、孕前保健认知和信息获取途径情况、孕产期知识获取途径情况和产后抑郁情况进行问卷调查。结果寻求孕前保健服务的需求率:综合性医院妇产科占52.2%(520/996),妇产科专科医院占39.5%(393/996),计划生育服务所占8.3%(83/996)。在围孕期认知良好的人群中,>30岁占65.3%(297/455),≤30岁占34.7%(158/455)。在孕产期知识获取途径中医务人员占33.2%(331/996

  5. Integrated Care for Older Adults Improves Perceived Quality of Care : Results of a Randomized Controlled Trial of Embrace

    Uittenbroek, Ronald J; Kremer, Hubertus P H; Spoorenberg, Sophie L W; Reijneveld, Sijmen A; Wynia, Klaske

    2016-01-01

    BACKGROUND: All community-living older adults might benefit from integrated care, but evidence is lacking on the effectiveness of such services for perceived quality of care. OBJECTIVE: To examine the impact of Embrace, a community-based integrated primary care service, on perceived quality of care.

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

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

    2013-03-01

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

  7. The management of health care service quality. A physician perspective.

    Bobocea, L; Gheorghe, I R; Spiridon, St; Gheorghe, C M; Purcarea, V L

    2016-01-01

    Applying marketing in health care services is presently an essential element for every manager or policy maker. In order to be successful, a health care organization has to identify an accurate measurement scale for defining service quality due to competitive pressure and cost values. The most widely employed scale in the services sector is SERVQUAL scale. In spite of being successfully adopted in fields such as brokerage and banking, experts concluded that the SERVQUAL scale should be modified depending on the specific context. Moreover, the SERVQUAL scale focused on the consumer's perspective regarding service quality. While service quality was measured with the help of SERVQUAL scale, other experts identified a structure-process-outcome design, which, they thought, would be more suitable for health care services. This approach highlights a different perspective on investigating the service quality, namely, the physician's perspective. Further, we believe that the Seven Prong Model for Improving Service Quality has been adopted in order to effectively measure the health care service in a Romanian context from a physician's perspective. PMID:27453745

  8. Choosing quality of care measures based on the expected impact of improved care on health.

    Siu, A L; McGlynn, E A; Morgenstern, H; Beers, M H; Carlisle, D M; Keeler, E B; Beloff, J.; Curtin, K; Leaning, J; Perry, B C

    1992-01-01

    Consumers, payers, and policymakers are demanding to know more about the quality of the services they are purchasing or might purchase. The information provided, however, is often driven by data availability rather than by epidemiologic and clinical considerations. In this article, we present an approach for selecting topics for measuring technical quality of care, based on the expected impact on health of improved quality. This approach employs data or estimates on disease burden, efficacy o...

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

    Sônia Lansky

    2002-12-01

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

  10. The quality of COPD care in general practice

    Rasmussen, F.V.; Borgeskov, H.; Dollerup, J.; Jensen, M.S.; Roslind, K.; Nielsen, L.M.; Lange, Peter

    2008-01-01

    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...... programme can improve the quality of COPD care in general practice Udgivelsesdato: 2008/8/25...

  11. PSYCHOSOCIAL FACTORS CONSUMER PERCEPTION OF QUALITY DENTAL CARE

    Надежда Алексеевна Кудинова

    2013-01-01

    Purpose to examine the motivational space, values and health-social and psychological portrait of patients who rated the quality of dental care.Methodology historical, sociological, statistical. Results: In a market economy, patients’ satisfaction is of one of the most important regulators of demand.  Estimate of the quality of dental services (QDS) depends on the patients having stable socio-psychological status being in a certain system of values, in space of some motives and needs. Got dat...

  12. The Child Care Industry: Cost Functions, Efficiency, and Quality

    H. Naci Mocan

    1995-01-01

    Using a newly compiled data set, this paper provides insights into the characteristics of the child care industry. First, there is no difference in average quality of the services produced between nonprofit and for-profit centers. This indicates that nonprofit status cannot be taken as a signal of higher quality. Second, the hypothesis of relative inefficiency of nonprofit centers with respect to for-profits is unfounded. On the other hand, centers that receive public money, either from the s...

  13. Quality systems in health care: A sociotechnical approach

    Harteloh, Peter

    2003-01-01

    textabstractIn this paper, we explore a sociotechnical approach to construct quality systems as an alternative to the traditional, ISO orientated approach. A sociotechnical approach is characterised as bottom-up, incremental, information technology facilitated and indicator driven. Its purpose is to ground quality assurance in medical practice and to provide meaning to those directly involved (patients, health care providers and medical professionals). Meaning depends on information. Accordin...

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

    Duan, Xia; Shi, Yan

    2014-01-01

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

  15. Perinatal outcomes among migrant mothers in the United Kingdom: Is it a matter of biology, behaviour, policy, social determinants or access to health care?

    Puthussery, Shuby

    2016-04-01

    This paper examines trends in perinatal outcomes among migrant mothers in the UK, and it explores potential contributors to disparities focusing on pregnancy, birth and the first year of life. Trends in perinatal outcomes indicate that ethnic minority grouping, regardless of migrant status, is a significant risk factor for unfavourable outcomes. It is unclear whether migrant status per se adds to this risk as within-group comparisons between UK-born and foreign-born women show variable findings. The role of biological and behavioural factors in producing excess unfavourable outcomes among ethnic minority mothers, although indicated, is yet to be fully understood. UK policies have salient aspects that address ethnic inequalities, but their wide focus obscures provisions for migrant mothers. Direct associations between socio-economic factors, ethnicity and adverse infant outcomes are evident. Evidence is consistent about differential access to and utilisation of health services among ethnic minority mothers, in particular recently arrived migrants, refugees and asylum seekers. PMID:26527304

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

    2009-01-01

    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 th...

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

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

    2015-01-01

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

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

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

    2015-01-01

    Objectives To examine the effectiveness of the quality management programme—European Practice Assessment—in primary care in Switzerland. Design Longitudinal study with three points of measurement. Setting Primary care practices in Switzerland. Participants In total, 45 of 91 primary care practices completed European Practice Assessment three times. Outcomes The interval between each assessment was around 36 months. A variance analyses for repeated measurements were performed for all 129 quali...

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

    Hearn, Lydia; Miller, Margaret; Lester, Leanne

    2014-01-01

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

  20. Reaching Perinatal Women Online: The Healthy You, Healthy Baby Website and App

    Lydia Hearn

    2014-01-01

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

  1. Compassion: the missing link in quality of care.

    van der Cingel, Margreet

    2014-09-01

    This article discusses the impact of selected findings from a PhD-study that focuses on compassion as a guiding principle for contemporary nursing education and practice. The study, of which the literature review and empirical findings have already been published, looked at compassion as perceived within the relationship of nurses and older persons with a chronic disease. The patient group was chosen because daily life for them is characterized by long-term dependency on care. The literature review resulted in a theoretical framework of compassion that also explores other closely related concepts such as suffering and empathy. The empirical part of the study, in which 61 in-depth interviews and 6 group interviews with patients and nurses took place, showed that compassion is a mirroring process in response to grief. Compassion consists of seven dimensions such as attentiveness and presence, in which saliency, so as to anticipate patients' needs, is of major importance. Compassion is perceived by participants as an indispensable aspect of care, which helps to reveal relevant information in order to establish appropriate outcomes of care. This article focuses on the aspects of the PhD-study in which an analysis of compassion in the context of both modern as well as the history of nursing took place. Currently evidence based practice is regarded as the standard for good quality care. Nevertheless there is an on-going debate about what constitutes good quality care. Within this debate two opposing views are apparent. One view defines good care as care supported by the best scientific evidence. The other view states that good care takes place within the nurse-patient relationship in which the nurse performs professional care based on intuitive knowing. It is suggested that compassion is the (missing) link between these views. PMID:24856582

  2. Evaluating the Effect of Software Quality Characteristics on Health Care Quality Indicators

    Sakineh Aghazadeh

    2015-07-01

    Full Text Available Introduction: Various types of software are used in health care organizations to manage information and care processes. The quality of software has been an important concern for both health authorities and designers of Health Information Technology. Thus, assessing the effect of software quality on the performance quality of healthcare institutions is essential. Method: The most important health care quality indicators in relation to software quality characteristics are provided via an already performed literature review. ISO 9126 standard model is used for definition and integration of various characteristics of software quality. The effects of software quality characteristics and sub-characteristics on the healthcare indicators are evaluated through expert opinion analyses. A questionnaire comprising of 126 questions of 10-point Likert scale was used to gather opinions of experts in the field of Medical/Health Informatics. The data was analyzed using Structural Equation Modeling. Results: Our findings showed that software Maintainability was rated as the most effective factor on user satisfaction (R2 =0.89 and Functionality as the most important and independent variable affecting patient care quality (R2 =0.98. Efficiency was considered as the most effective factor on workflow (R2 =0.97, and Maintainability as the most important factor that affects healthcare communication (R2 =0.95. Usability and Efficiency were rated as the most effectual factor affecting patient satisfaction (R2 =0.80, 0.81. Reliability, Maintainability, and Efficiency were considered as the main factors affecting care costs (R2 =0.87, 0.74, 0.87. Conclusion: We presented a new model based on ISO standards. The model demonstrates and weighs the relations between software quality characteristics and healthcare quality indicators. The clear relationships between variables and the type of the metrics and measurement methods used in the model make it a reliable method to assess

  3. Indicators for quality of hospital care : Beyond the numbers

    A.M. van Dishoeck (Anne-Margreet)

    2015-01-01

    markdownabstractAbstract This thesis addresses two major topics in measuring, comparing and improving quality of care. We found considerable influence of random variation and case-mix in comparing hospitals using performance indicators. Although we found a significant relation between outcome

  4. The quality of COPD care in general practice in Denmark

    Lange, Peter; Rasmussen, Finn Vejlø; Borgeskov, Hanne;

    2007-01-01

    We studied the quality of care for COPD patients in a large sample of general practices in Denmark. We focussed on whether participation by general practitioners (GPs) in an educational programme could enhance the use of spirometry in the diagnosis and staging of the disease and improve adherence...

  5. Training in data definitions improves quality of intensive care data

    Arts, DGT; Bosman, RJ; de Jonge, E; Joore, JCA; de Keizer, NF

    2003-01-01

    Background Our aim was to assess the contribution of training in data definitions and data extraction guidelines to improving quality of data for use in intensive care scoring systems such as the Acute Physiology and Chronic Health Evaluation (APACHE) II and Simplified Acute Physiology Score (SAPS)

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

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

    2011-01-01

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

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

    Hewes, Dorothy

    1994-01-01

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

  8. Enhancing Child Care Quality by Director Training and Collegial Mentoring

    Doherty, Gillian; Ferguson, Tammy McCormick; Ressler, Glory; Lomotey, Jonathan

    2015-01-01

    Although considerable evidence confirms that a director with good leadership and administrative skills is vital for developing and sustaining a high quality child care program, many directors assume the role with little management experience or training. This paper reports on a training program in Canada that combined a formal curriculum to…

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

    Chassin, Mark R

    2013-10-01

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

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

    Villadsen, Sarah Fredsted; Negussie, Dereje; GebreMariam, Abebe;

    2015-01-01

    in the evaluation. Improved content of care (physical examinations, laboratory testing, tetanus toxoid (TT)-immunization, health education, conduct of health professionals, and waiting time) were defined as proximal project outcomes and increased quality of care (better identification of health problems......BACKGROUND: Interventions for curing most diseases and save lives of pregnant and delivering women exist, yet the power of health systems to deliver them to those in most need is not sufficient. The aims of this study were to design a participatory antenatal care (ANC) strengthening intervention....... The effect of the intervention was assessed by comparing the change in quality of care from before to after the intervention period at intervention sites, relative to control sites, using logistic mixed effect regression. RESULTS: The continued attention to the ANC provision during implementation stimulated...

  11. Comparative Quality Indicators for Hospital Choice: Do General Practitioners Care?

    Ferrua, Marie; Sicotte, Claude; Lalloué, Benoît; Minvielle, Etienne

    2016-01-01

    Context The strategy of publicly reporting quality indicators is being widely promoted through public policies as a way to make health care delivery more efficient. Objective To assess general practitioners’ (GPs) use of the comparative hospital quality indicators made available by public services and the media, as well as GPs’ perceptions of their qualities and usefulness. Method A telephone survey of a random sample representing all self-employed GPs in private practice in France. Results A large majority (84.1%–88.5%) of respondents (n = 503; response rate of 56%) reported that they never used public comparative indicators, available in the mass media or on government and non-government Internet sites, to influence their patients’ hospital choices. The vast majority of GPs rely mostly on traditional sources of information when choosing a hospital. At the same time, this study highlights favourable opinions shared by a large proportion of GPs regarding several aspects of hospital quality indicators, such as their good qualities and usefulness for other purposes. In sum, the results show that GPs make very limited use of hospital quality indicators based on a consumer choice paradigm but, at the same time, see them as useful in ways corresponding more to the usual professional paradigms, including as a means to improve quality of care. PMID:26840429

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

    Junoy, J P

    1997-01-01

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

  13. Reliability of medical audit in quality assessment of medical care

    Camacho Luiz Antonio Bastos

    1996-01-01

    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.

  14. Maternal perinatal mental health and offspring academic achievement at age 16:the mediating role of childhood executive function

    Pearson, Rebecca M.; Bornstein, Marc H.; Cordero, Miguel; Scerif, Gaia; Mahedy, Liam; Evans, Jonathan; Abioye, Abu; Stein, Alan

    2016-01-01

    BACKGROUND: Elucidating risk pathways for under-achieving at school can inform strategies to reduce the number of adolescents leaving school without passing grades in core subjects. Maternal depression can compromise the quality of parental care and is associated with multiple negative child outcomes. However, only a few small studies have investigated the association between perinatal maternal depression and poor academic achievement in adolescence. The pathways to explain the risks are also...

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

    Sh. Salarilak

    1999-08-01

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

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

    Fumić, Nera; Marinović, Marin; Brajan, Dolores

    2014-10-01

    Health care and today's medical and technical achievements and approved standards of treatment provide comprehensive quality, safety and traceability of medical procedures respecting the principles of health protection. Continuous education improves the quality of nursing health care and increases the effectiveness of patient care, consequently maintaining and enhancing patient safety. Patient health problems impose the need of appropriate, planned and timely nursing care and treatment. In providing quality nursing care, attention is focused on the patient and his/her needs in order to maintain and increase their safety, satisfaction, independence and recovery or peaceful death, so the health and nursing practices must be systematized, planned and based on knowledge and experience. Health and nursing care of patients at risk of developing acute and chronic wounds or already suffering from some form of this imply preventive measures that are provided through patient education, motivation, monitoring, early recognition of risk factors and causes, and reducing or removing them through the prescribed necessary medical treatment which is safe depending on the patient health status. Except for preventive measures, nursing care of patients who already suffer from some form of acute or chronic wounds is focused on the care and treatment of damaged tissue by providing appropriate and timely diagnosis, timely and proper evaluation of the wound and patient general status, knowledge and understanding of the wide range of local, oral and parenteral therapy and treatment, aiming to increase patient safety by preventing progression of the patient general condition and local wound status and reducing the possibility of developing infection or other complications of the underlying disease. In the overall patient management, through nursing process, medical interventions are implemented and aimed to maintain and optimize health status, prevent complications of existing diseases and

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

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

    2004-01-01

    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...

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

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

    2010-01-01

    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...

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

    Conrad, Douglas A; Perry, Lisa

    2009-01-01

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

  20. Acute Myocardial Infarction Quality of Care: The Strong Heart Study

    Best, Lyle G.; Butt, Amir; Conroy, Britt; Devereux, Richard B.; Galloway, James M.; Jolly, Stacey; Lee, Elisa T.; Silverman, Angela; Yeh, Jeun-Liang; Welty, Thomas K.; Kedan, Ilan

    2014-01-01

    Objectives Evaluate the quality of care provided patients with acute myocardial infarction and compare with similar national and regional data. Design Case series. Setting The Strong Heart Study has extensive population-based data related to cardiovascular events among American Indians living in three rural regions of the United States. Participants Acute myocardial infarction cases (72) occurring between 1/1/2001 and 12/31/2006 were identified from a cohort of 4549 participants. Outcome measures The proportion of cases that were provided standard quality of care therapy, as defined by the Healthcare Financing Administration and other national organizations. Results The provision of quality services, such as administration of aspirin on admission and at discharge, reperfusion therapy within 24 hours, prescription of beta blocker medication at discharge, and smoking cessation counseling were found to be 94%, 91%, 92%, 86% and 71%, respectively. The unadjusted, 30 day mortality rate was 17%. Conclusion Despite considerable challenges posed by geographic isolation and small facilities, process measures of the quality of acute myocardial infarction care for participants in this American Indian cohort were comparable to that reported for Medicare beneficiaries nationally and within the resident states of this cohort. PMID:21942161

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

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

    2013-10-01

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

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

    Mark Lane

    2014-09-01

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

  3. What doctors think about the impact of managed care tools on quality of care, costs, autonomy, and relations with patients

    Bovier Patrick A; Agoritsas Thomas; Deom Marie; Perneger Thomas V

    2010-01-01

    Abstract Background How doctors perceive managed care tools and incentives is not well known. We assessed doctors' opinions about the expected impact of eight managed care tools on quality of care, control of health care costs, professional autonomy and relations with patients. Methods Mail survey of doctors (N = 1546) in Geneva, Switzerland. Respondents were asked to rate the impact of 8 managed care tools on 4 aspects of care on a 5-level scale (1 very negative, 2 rather negative, 3 neutral...

  4. The controversy over the restructuring of perinatal emergency services in Portugal and the importance of citizen participation in health care decision-making processes.

    Matos, Ana Raquel

    2015-01-01

    This article explores the controversial decision made by the Ministry of Health to restructure the perinatal emergency services in Portugal in 2006. Particular emphasis is given to the protests held across the country against, the actors involved, and the arguments put forward for and against the measure, in an attempt to understand the forms of knowledge and experiences brought to the discussion about the issues raised by the decision, and how different forms of knowledge are reconciled under a democratic process. In addition, this article explores the importance of citizen participation, including that which emerges from conflicting relations, in the formulation of health policies. PMID:26331640

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

    Maria L. G. Rosa

    2002-06-01

    of variables may have contributed to perinatal mortality: distribution of resources was insufficient to provide quality in health care, especially in private maternity hospitals; there was no formal or informal regional or hierarchical organization of obstetric care in the city; Ministry of Health guidelines were ignored in all four maternity hospitals, while in three of the hospitals there were no admissions procedures and delivery and fetal follow-up listed in their own rules; and the level of actual participation was low.

  6. CARE - curriculum quality analysis and impact review of European ECEC

    Jensen, Bente; Iannone, Rosa Lisa

    to child outcomes including cognitive, language, social and emotional and educational development, as well as more general indicators of leaning and well-being. Research, mostly from the US, suggests that life-chances and child development are dependent on the quality of educational opportunities...... it is possible to identify different ways for improving ECEC quality, both structurally and processually. We know from research, that processual quality, e.g. positive interactions between children and adults, is the most important factor to improving child outcomes in general and for socially...... disadvantaged children in particular. Results from this review showed that several initiatives have been taken to raise professionals' knowledge and skills, and overall competences to implement high quality interventions in day care. However findings also showed that resources and support at the policy or...

  7. Perinatal asphyxia in the term newborn

    Roberto Antonucci

    2014-06-01

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

  8. Quality and Safety in Health Care, Part VII: Lower Costs and Higher Quality.

    Harolds, Jay A

    2016-02-01

    The Institute of Medicine report entitled The Health Care Imperative: Lowering Costs and Improving Outcomes discussed numerous ways to decrease costs in the health care system without decreasing quality. The use of evidence-based medicine, eliminating wasteful spending such as needlessly high administrative costs, having more preventive services, having a better reimbursement system that emphasized quality, developing a less fragmented and more efficient medical delivery system, having more transparency for patients on the outcomes of different providers, having greater health care literacy for patients, and eliminating fraud were some of the recommendations. The total savings from eliminating unnecessary health care costs was estimated to be over 3 quarters of a trillion dollars each year. PMID:26545019

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

    Rashmi

    2010-01-01

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

  10. Issues of therapeutic communication relevant for improving quality of care

    Popa-Velea, O; Purcărea, VL

    2014-01-01

    Communication issues are extensively considered a topic of high interest for improving the efficacy of the therapeutic act. This article aimed to overview several issues of therapeutic communication relevant for improving quality of care. A number of 15 bibliographic resources on these topics published in peer-reviewed journals between 1975 and 2010, and indexed in PubMed, ProQuest and EBSCO databases were examined, to seek for evidence regarding these data. Results highlight a number of comm...

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

    Coltart Cordelia EM

    2011-10-01

    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

  12. Improving care at cystic fibrosis centers through quality improvement.

    Kraynack, Nathan C; McBride, John T

    2009-10-01

    Quality improvement (QI) using a clinical microsystems approach provides cystic fibrosis (CF) centers the opportunity to make a significant positive impact on the health of their patients. The availability of center-specific outcomes data and the support of the Cystic Fibrosis Foundation are important advantages for these quality improvement efforts. This article illustrates how the clinical microsystems methodology can improve care delivery and outcomes by describing the gradual application of quality improvement principles over the past 5 years by the CF team at the Lewis Walker Cystic Fibrosis Center at Akron Children's Hospital in Akron, Ohio. Using the example of a project to improve the pulmonary function of the pediatric patients at our center as a framework, we describe the QI process from the initial team-building phase, through the assessment of care processes, standardization of care, and developing a culture of continuous improvement. We outline how enthusiastic commitment from physician leadership, clinical managers and central administration, the availability of coaches, and an appreciation of the importance of measurement, patient involvement, communication, and standardization are critical components for successful process improvement. PMID:19760542

  13. How Health Care Organizations Are Using Data on Patients' Race and Ethnicity to Improve Quality of Care

    Thorlby, Ruth; Jorgensen, Selena; Siegel, Bruce; Ayanian, John Z.

    2011-01-01

    Context: Racial and ethnic disparities in the quality of health care are well documented in the U.S. health care system. Reducing these disparities requires action by health care organizations. Collecting accurate data from patients about their race and ethnicity is an essential first step for health care organizations to take such action, but these data are not systematically collected and used for quality improvement purposes in the United States. This study explores the challenges encounte...

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

    Olga Alicia Carbonell

    2010-02-01

    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.

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

    Mendoza Aldana, J.; Piechulek, H.; al-Sabir, A.

    2001-01-01

    OBJECTIVE: To assess user expectations and degree of client satisfaction and quality of health care provided in rural Bangladesh. METHODS: A total of 1913 persons chosen by systematic random sampling were successfully interviewed immediately after having received care in government health facilities. FINDINGS: The most powerful predictor for client satisfaction with the government services was provider behaviour, especially respect and politeness. For patients this aspect was much more important than the technical competence of the provider. Furthermore, a reduction in waiting time (on average to 30 min) was more important to clients than a prolongation of the quite short (from a medical standpoint) consultation time (on average 2 min, 22 sec), with 75% of clients being satisfied. Waiting time, which was about double at outreach services than that at fixed services, was the only element with which users of outreach services were dissatisfied. CONCLUSIONS: This study underscores that client satisfaction is determined by the cultural background of the people. It shows the dilemma that, though optimally care should be capable of meeting both medical and psychosocial needs, in reality care that meets all medical needs may fail to meet the client's emotional or social needs. Conversely, care that meets psychosocial needs may leave the clients medically at risk. It seems important that developing countries promoting client-oriented health services should carry out more in-depth research on the determinants of client satisfaction in the respective culture. PMID:11436472

  16. Improving the quality of care for patients with hypertension in Moshupa District, Botswana: Quality improvement cycle

    Cathy Kande

    2014-01-01

    Full Text Available Background: Although there are no prevalence studies on hypertension in Botswana, this condition is thought to be common and the quality of care to be poor.Aim: The aim of this project was to assess and improve the quality of primary care forhypertension.Setting: Moshupa clinic and catchment area, Botswana.Methods: Quality improvement cycle.Results: Two hundred participants were included in the audit. Sixty-eight per cent were women with a mean age of 55 years. In the baseline audit none of the target standards were met. During the re-audit six months later, six out of nine structural target standards, five out of 11 process target standards and one out of two outcome target standards were achieved. Statistically-significant improvement in performance (p < 0.05 was shown in 10 criteria although the target standard was not always met. In the re-audit, the target of achieving blood pressure control (< 140/90 in 70% of patients was achieved.Conclusion: The quality of care for hypertension was suboptimal in our setting. Simple interventions were designed and implemented to improve the quality of care. These interventions led to significant improvement in structural and process criteria. A corresponding significant improvement in the control of blood pressure was also seen.

  17. Overall quality of diabetes care in a defined geographic region: different sides of the same story

    Van Bruggen, R; Gorter, K.; Stolk, R.; Zuithoff, P.; Verhoeven, R.; Rutten, G.

    2008-01-01

    Background In diabetes care, knowledge about what is achievable in primary and secondary care is important. There is a need for an objective method to assess the quality of care in different settings. A quality-of-care summary score has been developed based on process and outcome measures. An adapted version of this score was used to evaluate diabetes management in different settings. Aim To evaluate the quality of diabetes management in primary and secondary care in a defined geographic regi...

  18. Improving quality of care through improved audit and feedback

    Hysong Sylvia J

    2012-05-01

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

  19. Does Nursing Leadership Affect the Quality of Care in the Community Setting?

    Haycock-Stuart, Elaine; Kean, Susanne

    2012-01-01

    Aim  To examine perceptions about how nursing leadership affects quality of care in the community setting.Background  Quality care is considered an essential component of nursing work and recent policy has emphasized the role of leadership in meeting the quality agenda. As shifting the balance of nursing care from the hospital to the community occurs in the UK, there is an imperative to confirm more effectively the quality of care that patients and families receive from nurses working in the ...

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

    Veerbeek, Laetitia

    2008-01-01

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

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

    Sônia Lansky

    2006-01-01

    with perinatal deaths. In the multiple regression analysis, lack of partograph use during labor and type of hospital were associated with perinatal deaths. These results indicate inadequate quality of care in maternity hospitals and show that health services structure and health care process are related to perinatal mortality due to preventable causes.

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

    Pieterse, Quirine Dionne

    2007-01-01

    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

  3. Quality registers in professional health care educations: knowledge gaps and proposed actions:

    Nordin Annika M. M.; Ernsäter Torie Palm; Bergman Bo

    2014-01-01

    Background and purpose: The use of quality registers has increased rapidly in Sweden and they are identified as beneficial for health care competitiveness. A quality register is a structured gathering of patient information, to improve health care. However, the introduction of quality registers in health care organisations presupposes that employees know how to use them in quality improvement. Disconnections, or knowledge gaps, concerning quality registers hamper the possibilities to take adv...

  4. How financial cutbacks affect job quality and care of the elderly

    Burns, D.; Hyde, P; Killett, A.

    2016-01-01

    Based on case studies in 12 nursing homes in the United Kingdom, the authors illustrate how financial cutbacks affect job quality and the quality of care. The dimensions of job quality that suffered most were those directly related to the ability of workers to provide care: reductions in staffing, longer working hours, and work intensification. Cuts to labor costs eroded the quality of workers’ jobs in all 12 homes but with two differential outcomes: in seven homes, care quality was maintaine...

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

    Huang, Yu-Chu; Lin, Chouh-Jiaun

    2009-08-01

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

  6. eHealth and quality in health care: implementation time.

    Ossebaard, Hans C; Van Gemert-Pijnen, Lisette

    2016-06-01

    The use of information and communication technologies in health and health care could improve healthcare quality in many ways. Today's evidence base demonstrates the (cost-)effectiveness of online education, self-management support and tele-monitoring in several domains of health and care. While new results gradually provide more evidence for eHealth's impact on quality issues, now is the time to come to grips with implementation issues. Documented drawbacks such as low acceptance, low adoption or low adherence need our attention today to make the most of eHealth' potential. Improvement science is beginning to deliver the tools to address these persistent behavioural and cultural issues. The ceHRes Roadmap, for instance, is a plural and pragmatic approach that includes users' needs. It is now imperative to improve our implementation strategies in order to scale up eHealth technologies. This will accelerate the much needed transformation of our healthcare systems and sustain access, affordability and quality for all in the near future. PMID:27029590

  7. Management of nursing care quality with ethical principles

    Cabarcas-Ortega Nirva del Socorro

    2011-06-01

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

  8. [Influence of registries on the quality of care].

    Stengel, D; Dreinhöfer, K; Kostuj, T

    2016-06-01

    Registries are a topic of lively debate amongst all stakeholders in healthcare, politics and economics. In general, registries are national or international (prospective) databases documenting the current state of diagnostic, therapeutic and long-term outcome variables of subjects with a distinct condition or health problem. The access to and handling of registry information is subject to strict legal, methodological and ethical principles and regulations before these data can be scientifically utilized and reentered into the routine daily practice. Because of the representativeness and reality of data, registries are widely regarded as the backbone of health systems and budgets.Currently there is only indirect evidence that registries influence outcomes and the quality of care. Recent statistical techniques may allow quasi-experimental modelling of observational information. In orthopedic and trauma surgery, current and upcoming registries should be wisely utilized to develop and evaluate innovations and to make informed decisions relevant to care. PMID:27164976

  9. Improving the quality of emergency medicine care by developing a quality requirement framework: a study from The Netherlands

    Ikkersheim, David E; van de Pas, Harm

    2012-01-01

    Background In The Netherlands, mainly inexperienced physicians work in the ED on all shifts, including the evening and night shifts, when no direct supervision is available. In 2004 a report of the Dutch Health Care Inspectorate revealed that quality of care at Emergency Departments (EDs) was highly variable. Based on this report and international studies showing significant potential for quality improvement, stakeholders felt the need to improve the quality of EM care. Based on the literatur...

  10. STUDY OF MATERNAL AND PERINATAL OUTCOME IN REFERRED OBSTETRICS CASES

    Umesh; Alka Murlidhar

    2015-01-01

    OBJECTIVE: To review the referred obstetric cases for reason of referral and to study the maternal and perinatal outcome. DESIGN: Prospective Observational study . STUDY POPULATION: 380 cases referred from periphery to tertiary care institute in one year duration. METHODS: INCLUSION C RITERIA : All referred ANC cases to our tertiary care i...

  11. Improving Quality of Care in Peptic Ulcer Bleeding

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

    2013-01-01

    OBJECTIVES:The treatment of peptic ulcer bleeding (PUB) is complex, and mortality remains high. We present results from a nationwide initiative to monitor and improve the quality of care (QOC) in PUB.METHODS:All Danish hospitals treating PUB patients between 2004 and 2011 prospectively registered...... demographic, clinical, and prognostic data. QOC was evaluated using eight process and outcome indicators, including time to initial endoscopy, hemostasis obtainment, proportion undergoing surgery, rebleeding risks, and 30-day mortality.RESULTS:A total of 13,498 PUB patients (median age 74 years) were included...

  12. Quality of Care in Family Planning Program in China

    Zhen-ming XIE; Hong-yan LIU

    2006-01-01

    Objective To sum up the theory of quality care according to the experience of F.P. program in China.Methods The author summarized the QOC theory and draw on its experiences and strength in family planning program in China.Results The theory facilitated the earnest program of the population and family planning program during the tenth five-year plan period, benefited the realization of the innovation of system and mechanism in population and family planning work, and the creation of a nice population environment for the healthy social and economic development in China.Conclusion The development of QOC has displayed a conspicuous theory in China's family planning program.

  13. Quality of Dental Care and Social Disparities in Health

    Mabriez JC; Chanut C; Herter G; Minguet-Fabbri J; Orgebin JY; Borgès Da Silva Ge

    2002-01-01

    Aims: To compare the quality of oro-dental preparation before prosthesis in patients affiliated with the general health care fund ( régime général ) and those covered by the universal health coverage program (CMU) including complementary insurance (CMUC). Method: The study sample was comprised by requests for prior approval collected between February 15, 2001 and May 18, 2001 in eight administrative regions participating in the study. Accordingly, 3 116 patients covered by the CMUC and 3 310...

  14. Psychosocial adjustment in perinatally human immunodeficiency virus infected or exposed children – a Retrospective Cohort Study

    Zalwango, Sarah K; Kizza, Florence N; Nkwata, Allan K; Sekandi, Juliet N; Kakaire, Robert; Kiwanuka, Noah; Whalen, Christopher C; Ezeamama, Amara E

    2016-01-01

    Objective To determine whether perinatal HIV infection and exposure adversely affected psychosocial adjustment (PA) between 6 and 18 years of life (i.e. during school-age and adolescence). Methods We enrolled 58 perinatally HIV-infected, 56 HIV-exposed uninfected and 54 unexposed controls from Kampala, Uganda. Perinatal HIV status was determined by 18 months of age using a DNA-polymerase chain-reaction test and was confirmed via HIV rapid diagnostic test at psychosocial testing when the children were 6 to 18 years old. Five indicators of PA (depressive symptoms, distress, hopelessness, positive future orientation and esteem) were measured using validated, culturally adapted and translated instruments. Multivariable linear regression analyses estimated HIV-status-related percent differences (β) in PA indicators and corresponding 95% confidence intervals (CIs). Results During school-age and adolescence, positive outlook (β=−3.8, 95% CI: −7.2, −0.1) and self-esteem (β=−4.3, 95% CI: −6.7, −1.8) scores were significantly lower, whereas depressive (β=11.4, 95% CI: 3.3, 19.5) and distress (β=12.3, 95% CI: 5.9, 18.7) symptoms were elevated for perinatally HIV-infected, compared to unexposed controls and exposed uninfected children. Similarly, positive outlook (β=−4.3, 95% CI: −7.3, −1.2) and self-esteem were lower for exposed controls versus HIV-unexposed children. Hopelessness was similar by perinatal HIV status. Likewise, the distress and depressive symptom levels were comparable for HIV-exposed uninfected and HIV-unexposed children. Conclusions Perinatal HIV infection predicted higher distress and depressive symptoms, while HIV-affected status (infection/exposure) predicted low self-esteem and diminished positive outlook in the long term. However, HIV-affected status had no impact on hopelessness, suggesting that psychosocial interventions as an integral component of HIV care for infected children or primary care exposed uninfected children may

  15. Psychosocial adjustment in perinatally human immunodeficiency virus infected or exposed children – a Retrospective Cohort Study

    Sarah K Zalwango

    2016-06-01

    Full Text Available Objective: To determine whether perinatal HIV infection and exposure adversely affected psychosocial adjustment (PA between 6 and 18 years of life (i.e. during school-age and adolescence. Methods: We enrolled 58 perinatally HIV-infected, 56 HIV-exposed uninfected and 54 unexposed controls from Kampala, Uganda. Perinatal HIV status was determined by 18 months of age using a DNA-polymerase chain-reaction test and was confirmed via HIV rapid diagnostic test at psychosocial testing when the children were 6 to 18 years old. Five indicators of PA (depressive symptoms, distress, hopelessness, positive future orientation and esteem were measured using validated, culturally adapted and translated instruments. Multivariable linear regression analyses estimated HIV-status-related percent differences (β in PA indicators and corresponding 95% confidence intervals (CIs. Results: During school-age and adolescence, positive outlook (β=−3.8, 95% CI: −7.2, −0.1 and self-esteem (β=−4.3, 95% CI: −6.7, −1.8 scores were significantly lower, whereas depressive (β=11.4, 95% CI: 3.3, 19.5 and distress (β=12.3, 95% CI: 5.9, 18.7 symptoms were elevated for perinatally HIV-infected, compared to unexposed controls and exposed uninfected children. Similarly, positive outlook (β=−4.3, 95% CI: −7.3, −1.2 and self-esteem were lower for exposed controls versus HIV-unexposed children. Hopelessness was similar by perinatal HIV status. Likewise, the distress and depressive symptom levels were comparable for HIV-exposed uninfected and HIV-unexposed children. Conclusions: Perinatal HIV infection predicted higher distress and depressive symptoms, while HIV-affected status (infection/exposure predicted low self-esteem and diminished positive outlook in the long term. However, HIV-affected status had no impact on hopelessness, suggesting that psychosocial interventions as an integral component of HIV care for infected children or primary care exposed uninfected

  16. Pediatric recertification and quality of care: the role of the American Board of Pediatrics in improving children's health care.

    Miles, Paul V

    2007-11-01

    American health care is in the middle of a second revolution in quality as profound as the Flexner revolution occurring almost 100 years ago. Although systems issues are the basis for most of the concern, physician quality and professional development are also pertinent. Specialty board certification and maintenance of certification are key drivers of professional development and improvement of care. PMID:17950317

  17. Carefree in child care ? : child wellbeing, caregiving quality, and intervention programs in center-based child care

    Werner, Claudia Denise

    2014-01-01

    The use of center child care in Western countries has increased over the last three decades and is nowadays the most frequently used type of non-parental care for children aged zero to four (OECD, 2013). The aim of the current dissertation is to shed more light on indicators of child care quality in

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

    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.)

  19. Carefree in child care ?: child wellbeing, caregiving quality, and intervention programs in center-based child care

    Werner, Claudia Denise

    2014-01-01

    The use of center child care in Western countries has increased over the last three decades and is nowadays the most frequently used type of non-parental care for children aged zero to four (OECD, 2013). The aim of the current dissertation is to shed more light on indicators of child care quality in center child care and to answer the question whether narrow-focused caregiver interventions are effective in improving child care quality. The reported meta-analysis shows that narrow-focus interv...

  20. Provider communication on perinatal depression: a population-based study.

    Farr, Sherry L; Ko, Jean Y; Burley, Kim; Gupta, Seema

    2016-02-01

    Women's lack of knowledge on symptoms of perinatal depression and treatment resources is a barrier to receiving care. We sought to estimate the prevalence and predictors of discussing depression with a prenatal care provider. We used the 2011 population-based data from 24 sites participating in the Pregnancy Risk Assessment Monitoring System (n = 32,827 women with recent live births) to examine associations between maternal characteristics and report that a prenatal care provider discussed with her what to do if feeling depressed during or after pregnancy. Overall, 71.9 % of women reported discussing perinatal depression with their prenatal care provider (range 60.7 % in New York City to 85.6 % in Maine). Women were more likely to report a discussion on perinatal depression with their provider if they they were 18-29 years of age than over 35 years of age compared to older (adjusted prevalence ratio [aPR] 18 to 19 y = 1.08, 20 to 24 y = 1.10, 25 to 29 y = 1.09), unmarried (aPR = 1.07) compared to married, had 12 years, and had no previous live births (aPR = 1.03) compared to ≥ 1 live births. Research is needed on effective ways to educate women about perinatal depression and whether increased knowledge on perinatal depression results in higher rates of treatment and shorter duration of symptoms. PMID:25578631

  1. Spirometry in Primary Care: An Analysis of Spirometry Test Quality in a Regional Primary Care Asthma Program

    Licskai, Christopher J; Todd W Sands; Lisa Paolatto; Ivan Nicoletti; Madonna Ferrone

    2012-01-01

    BACKGROUND: Primary care office spirometry can improve access to testing and concordance between clinical practice and asthma guidelines. Compliance with test quality standards is essential to implementation.OBJECTIVE: To evaluate the quality of spirometry performed onsite in a regional primary care asthma program (RAP) by health care professionals with limited training.METHODS: Asthma educators were trained to perform spirometry during two 2 h workshops and supervised during up to six patien...

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

    Busari, Jamiu O

    2012-01-01

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

  3. Health-care Worker Engagement in HIV-related Quality Improvement in Dar es Salaam, Tanzania.

    Garcia, Maria E; Li, Michelle S.; Siril, Hellen; Hawkins, Claudia; Kaaya, Sylvia; Ismail, Shabbir; Chalamilla, Guerino; Mdingi, Sarah Geoffrey; Hirschhorn, Lisa R.

    2011-01-01

    To assess health-care worker (HCW) awareness, interest and engagement in quality improvement (QI) in HIV care sites in Tanzania. Cross-sectional survey distributed in May 2009. Sixteen urban HIV care sites in Dar es Salaam, Tanzania, 1 year after the introduction of a quality management program. Two hundred seventy-nine HCWs (direct care, clinical support staff and management). HCW perceptions of care delivered, rates of engagement, knowledge and interest in QI. HCW-identified barriers to and...

  4. Quality Assurance and Quality Control in Point-of-Care Testing.

    Newman, Ashleigh W; Behling-Kelly, Erica

    2016-03-01

    With advancements in the standard of care in veterinary medicine and instrument technology, performing in-house laboratory work on a variety of point-of-care instruments, ranging from glucometers to benchtop chemistry analyzers, has become increasingly commonplace. However, the ability of an instrument to perform a test does not guarantee that those results are accurate. Ensuring that your in-clinic laboratory is providing reliable data requires a comprehensive plan that encompasses both common sense practices aimed at preventing errors at each stage of the testing process, as well as standard operating procedures to validate and monitor analyzer performance. These 2 arms of the plan are known as quality assurance and quality control. Although these concepts are typically out of the comfort zone for veterinarians, just as the thought of business management may deter some veterinarians from practice ownership, it is not beyond the capabilities of veterinarians to learn, understand, and incorporate them into their practice. The objectives of this article are to convey the importance of quality assurance and quality control, walk you through the American Society for Veterinary Clinical Pathology guidelines on this topic, and provide direction to additional resources for further education on this topic, all with the focus on point-of-care testing in the in-clinic laboratory. PMID:27451043

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

    Green Michael E

    2012-07-01

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

  6. A systematic review of the effectiveness of training in emergency obstetric care in low-resource environments

    van Lonkhuijzen, L.; Dijkman, A.; van Roosmalen, J.; Zeeman, G.; Scherpbier, A.

    2010-01-01

    Background Training of healthcare workers can play an important role in improving quality of care, and reducing maternal and perinatal mortality and morbidity. Objectives To assess the effectiveness of training programmes aimed at improving emergency obstetric care in low-resource environments. Sear

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

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

    2014-01-01

    Objective To evaluate the role of quality indicators and adverse events registering in the quality assessment of intensive care physiotherapy and to evaluate the impact of implementing protocolized care and professional training in the quality improvement process. Methods A prospective before-after study was designed to assess 15 indicators of the quality of care. Baseline compliance and adverse events were collected before and after the implementation of treatment protocols and staff trainin...

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

    Loovere, L.; Boyle, E.M. [Dept. of Pediatrics, McMaster Univ., Hamilton, Ontario (Canada); Blatz, S. [Dept. of Pediactrics, McMaster Children' s Hospital, Hamilton Health Sciences, Hamilton, Ontario (Canada); Bowslaugh, M.; Kereliuk, M. [Dept. of Radiology, Diagnostic Imaging, Hamilton Health Sciences, Hamilton, Ontario (Canada); Paes, B. [Dept. of Pediatrics, McMaster Univ., Hamilton, Ontario (Canada)], E-mail: paes@mcmaster.ca

    2008-10-15

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

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

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

  10. Quality of Type II Diabetes Care in Primary Health Care Centers in Kuwait: Employment of a Diabetes Quality Indicator Set (DQIS)

    Dalia Badawi; Shadi Saleh; Nabil Natafgi; Yara Mourad; Kazem Behbehani

    2015-01-01

    Diabetes Mellitus is one of the major public health challenges, affecting more than 347 million adults worldwide. The impact of diabetes necessitates assessing the quality of care received by people with diabetes, especially in countries with a significant diabetes burden such as Kuwait. This paper aimed at piloting an approach for measuring Type II diabetes care performance through the use of a diabetes quality indicator set (DQIS) in primary health care. The DQIS for Kuwait was adapted from...

  11. Primary Health Care Consumers’ Perception of Quality of Care and Its Determinants in North-Central Nigeria

    Oluwole Adeyemi Babatunde; Emmanuel Aiyenigba; Olugbenga Ademola Awoyemi; Tanimola Makanjuola Akande; Omotosho Ibrahim Musa; Adekunle Ganiyu Salaudeen; Olubukola Oluwakemi Babatunde; Oladele Ademola Atoyebi

    2013-01-01

    Background: The importance of incorporating the perspective of the patient when evaluating and designing health care programs is now widely recognized. The objective of this study was to assess consumers’ perception of quality of care and its determinants among Primary Health Care Consumers in Ilorin, Nigeria.Methodology: It was a descriptive cross-sectional study carried out among consumers of Primary Health Care in Ilorin South Local Government Area of Kwara State. Sample size of 250 was de...

  12. 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

    Eduardo Malvino

    2005-03-01

    Full Text Available Se analizaron en forma retrospectiva las características clínicas, complicaciones, gravedad, y sobrevivencia materna y fetal, en un grupo de gestantes con síndrome HELLP ( Hemolysis , Elevated Liver enzyme levels, Low Platelet count que requirieron admisión en cuatro unidades de cuidados intensivos del área metropolitana Buenos Aires, Argentina. Durante el período comprendido entre marzo de 1997 y marzo de 2003 se evaluaron 62 pacientes en la segunda mitad del embarazo o el puerperio inmediato que cumplían criterios diagnósticos de hipertensión inducida por el embarazo, asociado a plaquetopenia 70 UI/l, láctico deshidrogenasa >600 UI/l, bilirrubina total >1.2 mg / dl , y/o frotis de sangre periférica con signos de hemólisis. La edad promedio fue 28 ± 8 años; número de gestas promedio 2.7 ± 2.3; edad gestacional media 33 ± 4 semanas. Según el grado de plaquetopenia, 23 casos pertenecieron a la clase 1, 29 a la clase 2 y el resto a la clase 3 de la clasificación de Martin . Hubo 16 formas eclámpticas. El recuento plaquetario promedio fue 67 604 ± 31 535/ mm3 ; TGO 271 ± 297 UI/l; TGP 209 ± 178 UI/l; LDH 1 444 ± 1 295 UI/l; creatininemia 1.1 ± 0.8 mg / dl. Cuarenta y una pacientes cursaron con diverso grado de deterioro del filtrado glomerular, con requerimiento de tratamiento hemodialítico y plasmaféresis en un caso. Se presentó insuficiencia respiratoria vinculada a síndrome de distrés respiratorio del adulto en cuatro enfermas. Todas las puérperas sobrevivieron y se comprobaron cuatro muertes perinatales. En la población estudiada, se observó baja prevalencia de complicaciones graves, óptima sobrevivencia materna y baja mortalidad perinatal.We analized the clinical characteristics, complications, severity, and maternal and fetal survival of patients suffering from HELLP syndrome ( Hemolysis , Elevated Liver enzymes level, Low Platelet count requiring admission to the intensive care unit in four hospitals from

  13. STUDY OF MATERNAL AND PERINATAL OUTCOME IN REFERRED OBSTETRICS CASES

    Umesh

    2015-03-01

    Full Text Available OBJECTIVE: To review the referred obstetric cases for reason of referral and to study the maternal and perinatal outcome. DESIGN: Prospective Observational study . STUDY POPULATION: 380 cases referred from periphery to tertiary care institute in one year duration. METHODS: INCLUSION C RITERIA : All referred ANC cases to our tertiary care institute >20 weeks gestation. The total number of deliveries during this period were 11106. The total number of referred cases in above study period was 1980. Out of these 1520 met the inclusion criteria & according to the sample size calculated 380 cases were selected for the study. Selection of cases were done by systematic sampling technique. RESULTS: The proportion of referral cases to the tertiary care institute is 17.83%. Majority (42.37% of referred cases were from district level hospitals showing lacunae in the emergency obstetric care given at the district level hospitals. In present study, there was unavailability of ambulance in 65.26% of cases for transport. Most (92.89% of the patients were not accompanied by any medical assistance during transport. Major complication during immediate postpartum period was postpartum hemorrhage (19.99%. In our study, 31.84% of the patients required blood/blood products transfusion. There were 3(0.79% maternal mortalities in present study & behind these there were total 70(18.42% near miss cases which provide valuable information on the quality of antenatal care at the periphery. 54.87% of all neonates had low birth weight in this study. In present study, 45.90% babies were p reterm. Total NICU admission rate was 14.36%. Neonatal mortality documented in present study was 5.38%. CONCLUSION: The present study has shown that improper antenatal & intranatal care at the periphery level is responsible for poor maternal & perinatal outcome. Rural women have very poor access to MCH services. There is lack of Transportation facilities for referral patients & they have to

  14. Assessment of the Quality of Delivered Care for Iranian patients with Rheumatoid Arthritis by Using Comprehensive Quality Measurement Model in Health Care (CQMH

    Saeed Karimi

    2015-12-01

    Full Text Available Introduction: Quality of care has become increasingly critical in the evaluation of healthcare and healthcare services. The aim of this study was to assess quality of delivered care among patients with rheumatoid arthritis using a model of Comprehensive Quality Measurement in Health Care (CQMH. Methods: This cross-sectional study was conducted on 172 patients with rheumatoid arthritis (RA who were received care from private clinics of Isfahan University of medical sciences in 2013. CQMH questionnaires were used for assessing the quality of care. Data were analyzed using SPSS for Windows. Results: The mean scores of Quality Index, Service Quality (SQ, Technical Quality (TQ, and Costumer Quality (CQ were 72.70, 79.09, 68.54 and 70.25 out of 100, respectively. For CQ only 19.8% of participations staying the course of action even under stress and financial constraints, there is a significant gap between what RA care they received with what was recommended in the guideline for TQ. Scores of service quality was low in majority of aspects especially in "availability of support group" section. Conclusion: Study shows paradoxical findings and expresses that quality scores of service delivery for patients with arthritis rheumatoid from patient's perspective is relatively low. Therefore, for fixing this paradoxical problem, improving the participation of patients and their family and empowering them for self-management and decision should be regarded by health systems.

  15. Under-reporting of maternal and perinatal adverse events in New Zealand

    Farquhar, Cynthia; Armstrong, Sarah; Kim, Boa; Masson, Vicki; Sadler, Lynn

    2015-01-01

    Objectives To determine the proportion of maternal and perinatal mortality and morbidity cases, identified by the Perinatal and Maternal Mortality Review Committee (PMMRC), that are also reported within the annual serious adverse events (SAEs) reports published by the Health Quality and Safety Commission (HQSC). Setting Nationally collated data from the PMMRC and HQSC, New Zealand. Participants Analysis of maternal and perinatal mortality and morbidity data 2009–2012. Interventions Every SAE ...

  16. Burnout and Self-Reported Quality of Care in Community Mental Health

    Salyers, Michelle P.; Fukui, Sadaaki; Rollins, Angela L.; Firmin, Ruth; Gearhart, Timothy; Noll, James P.; Williams, Stacy; Davis, C.J.

    2014-01-01

    Staff burnout is widely believed to be problematic in mental healthcare, but few studies have linked burnout directly with quality of care. The purpose of this study was to examine the relationship between burnout and a newly developed scale for quality of care in a sample of community mental health workers (N=113). The Self-Reported Quality of Care scale had three distinct factors (Client-Centered Care, General Work Conscientiousness, and Low Errors), with good internal consistency. Burnout, particularly personal accomplishment, and to a lesser extent depersonalization, were predictive of overall self-reported Quality of Care, over and above background variables. PMID:24659446

  17. Maternal haemoglobin and perinatal outcome

    Bharathi Anjanappa

    2015-10-01

    Full Text Available Background: Maternal anaemia is common medical disorder in developing countries. WHO defines anaemia as haemoglobin concentration of and #8804;11 g/dl. However, in developing countries like India, the lower limit is accepted as 10 g/dl. Results: Of 218 women, 69 had anaemia. The prevalence of anaemia was 31.65%; of which 84% had mild anaemia, 14.6% had moderate and only 1.4% had severe anaemia. Mean Hb levels were 12.04% among non-anaemic mothers and mean birth weight was 2.89 Kg whereas 9.14%, 2.18 kg in anaemic mothers respectively. In our study, 21% in anaemic group has birth weight <2.5 kg and only 0.06% in non-anaemic mothers (p<0.0012 3.6 times higher. The risk of IUGR was 3.77 times higher, low APGAR score at 1 min was 3.8 times higher (p<0.0001, meconium stained liquor was 2.3 times higher and NICU admissions 2.96 times higher in anaemic mothers than non-anaemic mothers. Conclusions: Anaemia in pregnancy is one of the causes of poor perinatal outcome. Maternal anaemia is associated with the high risk of low birth weight, IUGR babies, low APGAR scores and NICU admissions and overall increase in perinatal morbidity. Hence proper antenatal care and counseling can reduce occurrence of anaemia in pregnancy. [Int J Reprod Contracept Obstet Gynecol 2015; 4(5.000: 1335-1338

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

    Harolds, Jay

    2015-08-01

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

  19. Perinatal tuberculosis: a diagnostic challenge

    Edna Lúcia S. de Souza

    2006-06-01

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

  20. Perinatal Hypoxic-Ischemic Encephalopathy

    Ming-Chi Lai; San-Nan Yang

    2010-01-01

    Perinatal hypoxic-ischemic encephalopathy (HIE) is an important cause of brain injury in the newborn and can result in long-term devastating consequences. Perinatal hypoxia is a vital cause of long-term neurologic complications varying from mild behavioural deficits to severe seizure, mental retardation, and/or cerebral palsy in the newborn. In the mammalian developing brain, ongoing research into pathophysiological mechanism of neuronal injury and therapeutic strategy after perinatal hypoxia...

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

    Schafer, W.L.; Boerma, W.G.; Kringos, D.S.; Maeseneer, J. De; Gress, S.; Heinemann, S.; Rotar-Pavlic, D.; Seghieri, C.; Svab, I.; Berg, M.J. van den; Vainieri, M.; Westert, G.P.; Willems, S.; Groenewegen, P.P.

    2011-01-01

    ABSTRACT: BACKGROUND: The QUALICOPC (Quality and Costs of Primary Care in Europe) study aims to evaluate the performance of primary care systems in Europe in terms of quality, equity and costs. The study will provide an answer to the question what strong primary care systems entail and which effects

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

    Schäfer, W.L.A.; Boerma, W.G.W.; Kringos, D.S.; Maeseneer, J. de; Gress, S.; Heinemann, S.; Rotar-Pavlic, D.; Seghieri, C.; Svab, I.; Berg, M.J. van den; Vainieri, M.; Westert, G.P.; Willems, S.; Groenewegen, P.P.

    2011-01-01

    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 c

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

    Jensen, Anne Nakano; Johnsen, Søren Paaske; Frederiksen, Birgitte Lidegaard;

    2013-01-01

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

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

    AM Mosadegh Rad

    2005-10-01

    Full Text Available Background: Total quality management (TQM is a managerial practice to improve the effectiveness, efficiency, flexibility, and competitiveness of a business as a whole. However, in practice, these TQM benefits are not easy to achieve. Despite its theoretical promise and the enthusiastic response to TQM, recent evidence suggests that attempts to implement it are often unsuccessful. Many of these TQM programmes have been cancelled, or are in the process of being cancelled, as a result of the negative impact on profits. Therefore, there is a pressing need for a clinical approach to establishing TQM. Method: The aim of this article is therefore: “To identify the strengths and weakness of TQM, the logical steps towards TQM, and to develop a model so that health care organizations aiming at using TQM to achieve excellence can follow through easily”. Based on the research questions proposed in this study, the research strategies of a literature review, a questionnaire survey, semi-structured interviews, and a participatory action research were adopted in this study. For determining the success and barriers of TQM in health care organizations, a questionnaire survey has done in 90 health acre organizations in Isfahan Province, which implement TQM. The results of this survey were used for introducing a new model of TQM. This model will be developed via a semi-structured interview with at minimum 10 health care and quality managers. Then, through a participatory action research, this model will be implemented in 3 sites. At this time, the questionnaire survey has done and the model is introduced. Therefore, developing the model and its implementation will be done later. Results: In this survey, the mean score of TQM success was 3.48±0.68 (medium from 5 credits. Implementation of TQM was very low, low, medium, high and very high successful respectively in 3.6, 10.9, 21.8, 56.4 and 7.3 percent of health care organizations. TQM had the most effect on

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

    Nørgaard, Birgitte; Kofoed, Poul-Erik; Ohm Kyvik, Kirsten;

    2012-01-01

    Scand J Caring Sci; 2012; Communication skills training for health care professionals improves the adult orthopaedic patient's experience of quality of care Rationale:  Despite the fact that communication has become a core topic in health care, patients still experience the information provided as...... insufficient or incorrect and a lack of involvement. Objective:  To investigate whether adult orthopaedic patients' evaluation of the quality of care had improved after a communication skills training course for healthcare professionals. Design and methods:  The study was designed as an intervention study...... limitation. Response rates were comparable to those of other studies. Conclusion:  Patients show increased satisfaction with the quality of health care after professionals have attended a communication skills training course, even when implemented in an entire department. Practice implications:  We recommend...

  6. Toward a 21st Century Quality-Measurement System for Managed-Care Organizations

    Armstead, Rodney C.; Elstein, Paul; Gorman, John

    1995-01-01

    As the Nation's largest managed-care purchaser, the Health Care Financing Administration (HCFA) is working to develop a uniform data and performance-measurement system for all enrollees in managed-care plans. This effort will ultimately hold managed-care plans accountable for continuous improvement in the quality of care they provide and will provide information to consumers and purchasers to make responsible managed-care choices. The effort entails overhauling peer review organization (PRO) ...

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

    M.S. Kokila

    2013-04-01

    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.

  8. Hospital competition, resource allocation and quality of care

    Zwanziger Jack

    2002-05-01

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

  9. 围产期孕妇焦虑抑郁状况与生活质量的相关性研究%Association study of depression,anxiety status and quality of life in perinatal gravida

    合浩; 杨菊琼; 邬劲; 杨婷; 李晓霞; 杨蜀云

    2015-01-01

    Objective To explore the association among depression ,anxiety sta‐tus and quality of life in perinatal gravida .Methods Assessments were carried out with the Edinburgh Postnatal Depression Scale (EPDS) ,Self‐rating Anxiety Scale (SAS) and MOS 12‐item Short Form Health Survey (SF‐12) in 968 perinatal pregnant women within the 28th week of preg‐nancy and 1 month after delivery .Results Within the 28th week of pregnancy and 1 month after delivery mental and physical component score of the SF‐12 were negatively related to the EPDS and SAS score ;the EPDS score was positively related to the SAS score significantly (P<0 .01) .Conclusion Anxious emotion of perinatal pregnant woman is positively related to depressive emotion ,depressive and anxious emotion are negatively related to quality of life .%目的:探讨围产期孕妇焦虑抑郁状况与生活质量的相关性。方法对968名围产期孕妇于孕28周及产后1个月采用焦虑自评量表、爱丁堡产后抑郁量表、生活质量量表进行测评分析。结果孕28周及产后1个月孕妇生活质量量表的精神成分及躯体成分维度分与爱丁堡产后抑郁量表、焦虑自评量表评分呈负相关;爱丁堡产后抑郁量表评分与焦虑自评量表评分呈显著正相关(P<0.01)。结论围产期孕妇焦虑情绪与抑郁情绪呈正相关,焦虑抑郁情绪与生活质量呈负相关。

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

    Milutinović Dragana

    2009-01-01

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

  11. The relation between quality of co-ordination of nursing care and quality of life in Dutch nursing homes.

    Holtkamp, C.C.M.; Kerkstra, A.; Ribbe, M.W.; Campen, C. van; Ooms, M.E.

    2000-01-01

    Quality of life of nursing home residents is a critical consideration in international health care policies and health care decisions. Yet, there is little relevant research to support decisions about client-tailored and effective nursing care for this population. Because of the permanency of their

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

    Coxon, Ian Robert; Bremner, Craig; Jensen, Jesper;

    a convincing and interesting story on it" (Glanville, 2014). In doing this we also recognise and appreciate that some readers may find the text less than accessible at times because of what might be viewed as philosophical or esoteric language. Using this language and writing style is not intentionally done...... to make the reading and understanding process heavy going. It is quite the opposite, in fact. At times it has been necessary to delve sufficiently deeply into some of the topics discussed using the language of the thinkers who have paved the way. This may be off-putting to some who are not familiar...... of the acknowledged complexity of such a holistic notion such as Care. Its role is to simplify Care, as we formulate it, to a point where its complexity can begin to be understood in ways that might be practically useful. After all, Care derives much of its meaning through the actions taken in its name, but more...

  13. Health insurance and quality of care: Comparing perceptions of quality between insured and uninsured patients in Ghana’s hospitals

    Abuosi, Aaron A.; Domfeh, Kwame Ameyaw; Abor, Joshua Yindenaba; Nketiah-Amponsah, Edward

    2016-01-01

    Background The introduction of health insurance in Ghana in 2003 has resulted in a tremendous increase in utilization of health services. However, concerns are being raised about the quality of patient care. Some of the concerns include long waiting times, verbal abuse of patients by health care providers, inadequate physical examination by doctors and discrimination of insured patients. The study compares perceptions of quality of care between insured and uninsured out-patients in selected h...

  14. 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

    Isabel Río

    2010-04-01

    Full Text Available Objetivos: Evaluar la calidad de los datos sobre nacimientos recogidos en el Movimiento Natural de la Población (MNP y en los registros de metabolopatías para el cálculo de indicadores de salud reproductiva y perinatal. Métodos: Comparación entre registros acerca de 1 número total de nacimientos de madre residente en Cataluña y Comunitat Valenciana registrados durante 2005-2006, 2 grado de cumplimentación de los datos sobre origen geográfico de la madre, y 3 grado de cumplimentación de la edad materna, peso al nacer y edad gestacional según el origen de la madre. Resultados: Los registros de metabolopatías recogen de forma exhaustiva los nacimientos registrados en el MNP. El grado de cumplimentación de los datos sobre el origen y la edad materna fue algo menor en los registros de metabolopatías, aunque la proporción de nacimientos según el origen de la madre fue muy similar a la del MNP, así como la media de edad materna según el origen. El grado de cumplimentación de los datos sobre peso al nacer y edad gestacional según el origen materno fue muy inferior en el MNP, especialmente entre los nacimientos de madre inmigrante registrados en Cataluña. Conclusiones: Nuestros resultados sugieren una limitación en la calidad de los datos sobre edad gestacional y peso al nacer del MNP, sobre todo de cara al cálculo y la comparación de indicadores de prematuridad y bajo peso al nacer en población autóctona e inmigrante. A la vez, apoyan la utilidad de los registros de metabolopatías como fuente para el cálculo diferencial de tales indicadores.Objective: To assess the quality of data on births in the Natural Population Movement (NPM and congenital metabolic disorders registers with regard to calculation of reproductive and perinatal health indicators. Methods: The following comparisons between registers were made: (1 the total number of births to mothers living in Catalonia and Valencia from 2005 to 2006, (2 the percentage of

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

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

    2010-01-01

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

  16. Which Combination of High Quality Infant-Toddler and Preschool Care Best Promotes School Readiness?

    Li, Weilin; Farkas, George; Duncan, Greg J.; Burchinal, Margaret R.; Vandell, Deborah L.; Ruzek, Erik A.; Dang, Tran T.

    2011-01-01

    This paper aims to test the following hypotheses: Hypothesis 1 (H1): Everything else the same, high quality infant-toddler care will increase children's cognitive scores immediately (i.e. at 24 months of age). However, without subsequent high quality preschool, children with high quality infant-toddler care will not have higher cognitive and…

  17. The quality of maternity care services as experienced by women in the Netherlands

    Wiegers Therese A

    2009-05-01

    Full Text Available Abstract Background Maternity care is all care in relation to pregnancy, childbirth and the postpartum period. In the Netherlands maternity care is provided by midwives and general practitioners (GPs in primary care and midwives and gynecologists in secondary care. To be able to interpret women's experience with the quality of maternity care, it is necessary to take into account their 'care path', that is: their route through the care system. In the Netherlands a new tool is being developed to evaluate the quality of care from the perspective of clients. The tool is called: 'Consumer Quality Index' or CQI and is, within a standardized and systematic framework, tailored to specific health care issues. Within the framework of developing a CQI Maternity Care, data were gathered about the care women in the Netherlands received during pregnancy, childbirth, and the postpartum period. In this paper the quality of maternity care in the Netherlands is presented, as experienced by women at different stages of their care path. Methods A sample of 1,248 pregnant clients of four insurance companies, with their due date in early April 2007, received a postal survey in the third trimester of pregnancy (response 793. Responders to the first questionnaire received a second questionnaire twelve weeks later, on average four weeks after delivery (response 632. Based on care provider and place of birth the 'care path' of the women is described. With factor analysis and reliability analysis five composite measures indicating the quality of treatment by the care provider at different stages of the care path have been constructed. Overall ratings relate to eight different aspects of care, varying from antenatal care by a midwife or GP to care related to neonatal screening. Results 41.5 percent of respondents remained in primary care throughout pregnancy, labor, birth and the postpartum period, receiving care from a midwife or general practitioner, 31.3% of respondents

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

    Johnson, S N

    2012-02-01

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

  19. Treatment of severe perinatal mood disorders on a specialized perinatal psychiatry inpatient unit.

    Kimmel, Mary C; Lara-Cinisomo, S; Melvin, K; Di Florio, A; Brandon, A; Meltzer-Brody, S

    2016-08-01

    Perinatal patients with bipolar and psychotic mood disorder exacerbations are challenging to treat and often receive suboptimal care. We sought to examine the treatment patterns and outcomes on one of the only US-based Perinatal Psychiatry Inpatient Units (PPIU). Perinatal patients admitted to the PPIU completed self-report measures at admission and before discharge. Retrospective chart reviews extracted history, diagnoses (current and past), and medication treatment. Patients who had discharge diagnoses of bipolar disorder, major depression with psychotic features, or postpartum psychosis were included. Forty-seven met the diagnostic inclusion criteria. Over an average length of stay (ALOS) of 9.96 days, there was significant improvement in depressive and anxiety symptoms and daily functioning (Work and Social Adjustment Scale). Psychiatric comorbidity was common. Polypharmacy was utilized in 87 %. The most common medications prescribed at discharge were antipsychotics, alone or in combination with mood stabilizers or antidepressants. ECT was performed in 10 % of cases. The complexity of patients with severe mood disorders or psychosis admitted to the PPIU supports individualized treatment plans that address both primary diagnosis and psychiatric comorbidities. Our results provide important information that can be disseminated to others to improve clinical outcomes for severe perinatal mood disorders. PMID:26802019

  20. The health and social situation of the mother during pregnancy and global quality of life of the child as an adult. Results from the prospective Copenhagen Perinatal Cohort 1959-1961

    Søren Ventegodt

    2005-01-01

    Full Text Available A prospective cohort study (Copenhagen Perinatal Birth Cohort 1959-61 of 7,222 persons was used in order to explore the association between the social and health situation during pregnancy and the global quality of life (QOL of the adult child 31-33 years later. Two sets of questionnaires were used with one filled out by physicians during pregnancy and one filled out by the adult children 31-33 years later. The questionnaires included mother's situation during pregnancy and global QOL of the child at follow-up: Well-being, life satisfaction, happiness, fulfilment of needs, experience of life’s temporal and spatial domains, expression of life’s potentials and objective measures. The only indicators to have clear connections with a reduced quality of life were the cases of mother's with syphilis (8.5%, mother's congenital malformations (8.8%, low social group (6.9% and failing contraception (3.8%. The results obtained repudiate the common notion and hypothesis that the mother's situation during pregnancy is highly important for the quality of life that the child experience as an adult. This suggest that the aspects important for quality of life later on are not found solely in early conditions, but instead more dependent on later attitude towards life of that specific person.

  1. A comprehensive model of cooperation between caregivers related to quality of care.

    Meijer, W.J.; Vermeij, D.J.B.

    1997-01-01

    Background: The system and delivery of health care tend to suffer from fragmentation, resulting in discontinuous and costly care. Local cooperation between caregivers is essential to achieve appropriate, timely, continuous and efficient care. The article develops a general comprehensive patient-centered model of quality of care related to local cooperation between caregivers. The model can be used in quality improvement and research. The proposed model: Within the framework of Donabedian's tr...

  2. What are the effective ways to translate clinical leadership into health care quality improvement?

    McSherry, Robert

    2016-01-01

    Robert McSherry,1 Paddy Pearce2 1School of Health and Social Care, University of Teesside, Middlesbrough, 2PKP Consulting, Yarm, United Kingdom Abstract: The presence and/or absence of effective leaders in health care can have a stark consequence on the quality and outcomes of care. The delivery of safe, quality, compassionate health care is dependent on having effective clinical leaders at the frontline. In light of the Kirkup and Francis reports, this article explores some ways of translat...

  3. Benchmarking Is Associated With Improved Quality of Care in Type 2 Diabetes

    Hermans, Michel; Elisaf, Moses; Michel, Georges; Muls, Erik; Nobels, Frank; Vandenberghe, Hans; Brotons, Carlos; OPTIMISE International Steering Committee

    2013-01-01

    OBJECTIVE: To assess prospectively the effect of benchmarking on quality of primary care for patients with type 2 diabetes by using three major modifiable cardiovascular risk factors as critical quality indicators. RESEARCH DESIGN AND METHODS: Primary care physicians treating patients with type 2 diabetes in six European countries were randomized to give standard care (control group) or standard care with feedback benchmarked against other centers in each country (benchmarking group). In both...

  4. Assessing the Overall Quality of Health Care in Persons Living with HIV in an Urban Environment

    KELLER, Sara C.; Yehia, Baligh R.; Momplaisir, Florence O.; Eberhart, Michael G.; Share, Amanda; Brady, Kathleen A.

    2014-01-01

    Ensuring high quality primary care for people living with HIV (PLWH) is important. We studied factors associated with meeting Health Resources and Services Administration-identified HIV performance measures, among a population-based sample of 376 PLWH in care at 24 Philadelphia clinics. Quality of care was assessed by a patient-level composite of 15 performance measures, focusing on HIV-specific care, vaccinations, and co-morbid condition screening. Adjusted incidence rate ratios (IRR) demons...

  5. Improving care quality and preventing maltreatment in institutional care - a feasibility study with caregivers.

    Hermenau, Katharin; Kaltenbach, Elisa; Mkinga, Getrude; Hecker, Tobias

    2015-01-01

    Institutionalized children in low-income countries often face maltreatment and inadequate caregiving. In addition to prior traumatization and other childhood adversities in the family of origin, abuse and neglect in institutional care are linked to various mental health problems. By providing a manualized training workshop for caregivers, we aimed at improving care quality and preventing maltreatment in institutional care. In Study 1, 29 participating caregivers rated feasibility and efficacy of the training immediately before, directly after, and 3 months following the training workshop. The results showed high demand, good feasibility, high motivation, and acceptance of caregivers. They reported improvements in caregiver-child relationships, as well as in the children's behavior. Study 2 assessed exposure to maltreatment and the mental health of 28 orphans living in one institution in which all caregivers had been trained. The children were interviewed 20 months before, 1 month before, and 3 months after the training. Children reported a decrease in physical maltreatment and assessments showed a decrease in mental health problems. Our approach seems feasible under challenging circumstances and provides first hints for its efficacy. These promising findings call for further studies testing the efficacy and sustainability of this maltreatment prevention approach. PMID:26236248

  6. Improving care quality and preventing maltreatment in institutional care – a feasibility study with caregivers

    Katharin eHermenau

    2015-07-01

    Full Text Available Institutionalized children in low-income countries often face maltreatment and inadequate caregiving. In addition to prior traumatization and other childhood adversities in the family of origin, abuse and neglect in institutional care are linked to various mental health problems. By providing a manualized training workshop for caregivers, we aimed at improving care quality and preventing maltreatment in institutional care. In Study 1, 29 participating caregivers rated feasibility and efficacy of the training immediately before, directly after, and three months following the training workshop. The results showed high demand, good feasibility, high motivation and acceptance of caregivers. They reported improvements in caregiver-child relationships, as well as in the children’s behavior. Study 2 assessed exposure to maltreatment and the mental health of 28 orphans living in one institution in which all caregivers had been trained. The children were interviewed 20 months before, one month before, and three months after the training. Children reported a decrease in physical maltreatment and assessments showed a decrease in mental health problems. Our approach seems feasible under challenging circumstances and provides first hints for its efficacy. These promising findings call for further studies testing the efficacy and sustainability of this maltreatment prevention approach.

  7. Instruments to measure patient experience of health care quality in hospitals: a systematic review protocol

    Beattie, Michelle; Lauder, William; Atherton, Iain; Murphy, Douglas J.

    2014-01-01

    Background Improving and sustaining the quality of care in hospitals is an intractable and persistent challenge. The patients’ experience of the quality of hospital care can provide insightful feedback to enable clinical teams to direct quality improvement efforts in areas where they are most needed. Yet, patient experience is often marginalised in favour of aspects of care that are easier to quantify (for example, waiting time). Attempts to measure patient experience have been hindered by a ...

  8. The quality of childbirth care in China: women’s voices: a qualitative study

    Raven, Joanna; van den Broek, Nynke; TAO, FANGBIAO; Kun, Huang; Tolhurst, Rachel

    2015-01-01

    Background In the context of improved utilisation of health care and outcomes, rapid socio-economic development and health system reform in China, it is timely to consider the quality of services. Data on quality of maternal health care as experienced by women is limited. This study explores women’s expectations and experiences of the quality of childbirth care in rural China. Methods Thirty five semi-structured interviews and five focus group discussions were conducted with 69 women who had ...

  9. Quality of care for patients with sexually transmitted diseases in Zambia

    Faxelid, Elisabeth

    1997-01-01

    QUALITY OF CARE FOR PATIENTS WITH SEXUALLY TRANSMITTED DISEASESIN ZAMBIA Elisabeth Faxelid Factors which have implications for STD care in Zambia have been described andanalysed in order to find strategies for quality improvements. A total of 684 patients with STD were interviewed about health seeking behaviour,sex partners, and satisfaction with quality of care. The male patients had had moresex partners than the female patients, but both groups knew the identity pa...

  10. Improving palliative care in selected settings in England using quality indicators: a realist evaluation

    Iliffe, S.; Davies, N; Manthorpe, J; Crome, P; Ahmedzai, S.; Vernooij-Dassen, M; Engels, Y.

    2016-01-01

    Background: There is a gap between readily available evidence of best practice and its use in everyday palliative care. The IMPACT study evaluated the potential of facilitated use of Quality Indicators as tools to improve palliative care in different settings in England. / Methods: 1) Modelling palliative care services and selecting a set of Quality Indicators to form the core of an intervention, 2) Case studies of intervention using the Quality Indicator set supported by an expert in service...

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

    Le Rouge, Cynthia; De Leo, Gianluca

    2008-01-01

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

  12. Quality of Primary Care in Low-Income Countries: Facts and Economics

    Jishnu Das; Jeffrey Hammer

    2014-01-01

    New research on the quality of care in public and private primary care facilities has significantly enriched our understanding of how health care is delivered in low- and middle-income countries. First, this article summarizes recent advances in the measurement of quality, distinguishing between measurements of provider knowledge and provider effort. Second, it looks at the determinants of practice quality variation in low-income settings, highlighting the limited role of structural constrain...

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

    Eccles Martin P; Goh Teik T; Steen Nick

    2009-01-01

    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 relatio...

  14. Improving palliative care in selected settings in England using quality indicators: a realist evaluation

    Iliffe, Steve; Davies, Nathan; Manthorpe, Jill; Crome, Peter; Ahmedzai, Sam H; Vernooij-Dassen, Myrra; Engels, Yvonne

    2016-01-01

    Background: There is a gap between readily available evidence of best practice and its use in everyday palliative care. The IMPACT study evaluated the potential of facilitated use of Quality Indicators as tools to improve palliative care in different settings in England.Methods: 1) Modelling palliative care services and selecting a set of Quality Indicators to form the core of an intervention, 2) Case studies of intervention using the Quality Indicator set supported by an expert in service ch...

  15. Perinatal risk factors for strabismus

    Torp-Pedersen, Tobias; Boyd, Heather A; Poulsen, Gry; Haargaard, Birgitte; Wohlfahrt, Jan; Holmes, Jonathan M; Melbye, Mads

    2010-01-01

    Little is known about the aetiological factors underlying strabismus. We undertook a large cohort study to investigate perinatal risk factors for strabismus, overall and by subtype.......Little is known about the aetiological factors underlying strabismus. We undertook a large cohort study to investigate perinatal risk factors for strabismus, overall and by subtype....

  16. Respect in the Perinatal Experience

    DeLellis, Anthony J.

    2000-01-01

    Perinatal educators wish to respect all parties in the perinatal experience. To accomplish this, some may need to learn and practice ways to express feelings of respect. Respect can be written into policy or procedure and is implicit in personal interaction. While all the possible ways to demonstrate respect cannot be listed and passed along, principles of respect can be offered for guidance.

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

    Ana Cristina d'Andretta Tanaka

    1989-02-01

    Full Text Available Pelos dados oficiais disponíveis, para o Estado de São Paulo (Brasil analisou-se a assistência oferecida na gestação, no parto e ao recém-nascido e suas relações com a mortalidade materna e perinatal. Com referência ao pré-natal, houve indícios de quantidade de consultas por gestação, numericamente suficiente, porém de qualidade discutível. Quanto ao parto observou-se uma alta percentagem de cesarianas (46,2%. A mortalidade materna foi de 4,86 por dez mil n.v., valor este subestimado. A primeira causa de óbitos maternos foram as toxemias, seguidas das hemorragias e do aborto, causas estas evitáveis em sua maioria, com uma boa qualidade de assistência pré-natal e ao parto. Quanto aos óbitos do período perinatal, o coeficiente foi de 29,2 por mil nascimentos em 1984, valor este também elevado. A análise das causas de óbitos mostrou que as afecções de origem perinatal ocorreram em cerca de 90% dos óbitos, tendo como principais causas as hipóxias intra-uterinas, asfixias, síndromes de angústia respiratória e aspiração maciça. Esses dados revelam a má qualidade de assistência recebida por este grupo. Sugere-se que a nova política de Sistema Unificado e Descentralizado de Saúde deveria levar em conta tanto a qualidade de assistência como a integração dos serviços para poder-se fazer frente à situação precária de saúde materna e perinatal do Estado.The assistance offered during pregnancy and labour as also to the newborn child, and its relationship to maternal and perinatal mortality in the State of S. Paulo in 1984, is analysed on the basis of official available data. With respect to prenatal care the number of visits per woman was considered to be "sufficient" though of doubtful quality. The proportion of cesarean sections was very high (46.2%. Maternal mortality was found to be 4.86 deaths per 10,000 live births, but despite its being high, this figure is certainly too low and the correct figure is

  18. Serotonin reuptake inhibitor-induced perinatal complications.

    Gentile, Salvatore

    2007-01-01

    There are a growing number of concerns about the utilization of serotonin reuptake inhibitors (SRIs) in late pregnancy and the onset of perinatal complications. This review aimed to analyze and summarize the studies evaluating the risk of perinatal complications (such as low birth weight, preterm delivery, withdrawal or toxic phenomena, and other detrimental events/poor neonatal outcomes) related to maternal SRI use in late pregnancy. A computerized search of MEDLINE (1966-January 2007) and PsycINFO (1974-January 2007) databases was performed. Articles describing perinatal complications after late in utero exposure to SRIs were selected and also reviewed for additional references. Fifty studies met the inclusion criteria. Exposure to SRIs late in pregnancy is clearly associated with an increased risk of infants developing a constellation of symptoms, including CNS and respiratory effects, often requiring close infant observation and supportive or specific treatment in intensive care units. Such symptoms are not always due to toxic or withdrawal reactions. Indeed, some evidence suggests that SRIs may interfere with the physiology of the respiratory system and parasympathetic activity in neonates. Of the most methodologically relevant studies reviewed, 50% have been published in the last 3 years. Hence, it is possible that further concerning data will become available in the future. For these reasons, the opportunity of tapering and discontinuing SRIs in late pregnancy should be taken into consideration, although to date the evidence to support such a clinical decision is preliminary. PMID:17407365

  19. National healthcare information system in Croatian primary care: the foundation for improvement of quality and efficiency in patient care

    Darko Gvozdanovi_; Miroslav Kon_ar; Vinko Kojund_i_; Hrvoje Jezid_i_

    2007-01-01

    In order to improve the quality of patient care, while at the same time keeping up with the pace of increased needs of the population for healthcare services that directly impacts on the cost of care delivery processes, the Republic of Croatia, under the leadership of the Ministry of Health and Social Welfare, has formed a strategy and campaign for national public healthcare system reform. The strategy is very comprehensive and addresses all niches of care delivery processes; it is founded on...

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

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

  1. Physician attitude toward depression care interventions: Implications for implementation of quality improvement initiatives

    Chanin Johann C; Chou Ann F; Henke Rachel; Zides Amanda B; Scholle Sarah

    2008-01-01

    Abstract Background Few individuals with depression treated in the primary care setting receive care consistent with clinical treatment guidelines. Interventions based on the chronic care model (CCM) have been promoted to address barriers and improve the quality of care. A current understanding of barriers to depression care and an awareness of whether physicians believe interventions effectively address those barriers is needed to enhance the success of future implementation. Methods We cond...

  2. Feasibility study and methodology to create a quality-evaluated database of primary care data

    Alison Bourke

    2004-11-01

    Conclusions In the group of practices studied, levels of recording were generally assessed to be of sufficient quality to enable a database of quality-evaluated, anonymised primary care records to be created.

  3. Mobile phone intervention reduces perinatal mortality in Zanzibar

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

    2014-01-01

    BACKGROUND: Mobile phones are increasingly used in health systems in developing countries and innovative technical solutions have great potential to overcome barriers of access to reproductive and child health care. However, despite widespread support for the use of mobile health technologies......, evidence for its role in health care is sparse. OBJECTIVE: We aimed to evaluate the association between a mobile phone intervention and perinatal mortality in a resource-limited setting. METHODS: This study was a pragmatic, cluster-randomized, controlled trial with primary health care facilities in...... care facilities in six districts were randomized to either mobile phone intervention or standard care. The intervention consisted of a mobile phone text message and voucher component. Secondary outcome measures included stillbirth, perinatal mortality, and death of a child within 42 days after birth as...

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

    Heidari Gorji, Ali Morad; Farooquie, Jamal A

    2011-01-01

    Background Total quality management (TQM) has a great potential to address quality problems in a wide range of industries and improve the organizational performance. The growing need to take initiatives by hospitals in countries like India and Iran to improve the service quality and reduce wastage of resources has inspired the authors to develop a survey instrument to measure health care quality and performance in the two countries. Methods Based on the Baldrige health care criteria for perfo...

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

    Heidari Gorji Ali; Farooquie Jamal A

    2011-01-01

    Abstract Background Total quality management (TQM) has a great potential to address quality problems in a wide range of industries and improve the organizational performance. The growing need to take initiatives by hospitals in countries like India and Iran to improve the service quality and reduce wastage of resources has inspired the authors to develop a survey instrument to measure health care quality and performance in the two countries. Methods Based on the Baldrige health care criteria ...

  6. Defining Access to Health Care: Evidence on the Importance of Quality and Distance in Rural Tanzania

    Klemick, Heather; Leonard, Kenneth L; Masatu, Melkiory C.

    2008-01-01

    We examine the implications of health seeking behavior on access to quality health care using a unique dataset that combines a household survey from rural Tanzania with the location and quality of all health facilities available to households. Patients do not always visit the nearest facility, but choose from among multiple facilities, improving the quality of care they receive by bypassing low quality facilities. Recognizing this behavior alters the projected benefits to health interventions...

  7. Quality Assurance Policies and Indicators for Long-Term Care in the European Union

    Fermon, Béatrice; Joël, Marie-Eve

    2012-01-01

    Quality assurance policies for long-term care in France are founded on a law passed in 2002, but the organisation of the system is still underway. It is principally based on a legal framework that sets out requirements for quality monitoring and quality improvement. Quality assessment is related to outcomes, indicators and guidelines. It pertains to formal care and is related to administrative authorisation and financial conditions. In the public sector, the aim is to develop continuous quali...

  8. Quality Assurance Policies and Indicators for Long-Term Care in the European Union.

    Fermon, Béatrice; Joël, Marie-Eve

    2012-01-01

    Quality assurance policies for long-term care in France are founded on a law passed in 2002, but the organisation of the system is still underway. It is principally based on a legal framework that sets out requirements for quality monitoring and quality improvement. Quality assessment is related to outcomes, indicators and guidelines. It pertains to formal care and is related to administrative authorisation and financial conditions. In the public sector, the aim is to develop continuous quali...

  9. A cross-national comparison of the quality of clinical care using vignettes.

    Peabody, John W; Liu, Anli

    2007-09-01

    In studies comparing clinical practice to evidence-based standards, researchers have found that quality of care is inconsistently provided to different segments of the population in both developing and developed countries. To test the hypothesis that quality of care varies widely within different countries, we conducted a prospectively designed evaluation of quality for three common clinical conditions: diarrhoea, tuberculosis and prenatal care. Five countries participated in the study: China, the Philippines, Mexico, El Salvador and India. Within each country, physicians were randomly selected from tertiary care hospitals, district level hospitals, and public and private outpatient clinics. A total of 488 previously validated case vignettes were administered to 300 participating physicians. Vignettes were scored according to evidence and expert based quality criteria. We used a random effects model to estimate the associations between quality scores by case, physician characteristics, study site, and country. We found that average quality of care was low (61.0%), but there exists a wide variation in overall quality (30-93%). While there was little difference in average quality scores between countries (60.2 to 62.6%), variation within countries was broad. The wide variation was consistent across facility type, medical condition and domain of care. We also found that younger, female, tertiary care and specialist physicians performed better than their counterparts. We conclude that some physicians provide exceptional care even in the setting of limited resources. Furthermore, poor quality can be addressed by health policy planners by directing remediation toward the lowest performers. PMID:17660225

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

    Phillips, Louise

    2015-11-01

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

  11. Maternal and perinatal outcome in severe preeclampsia and eclampsia

    Neha Saxena

    2016-07-01

    Conclusions: Maternal and perinatal complications are more in patients with eclampsia. The incidence of eclampsia can be reduced by better antenatal care, early recognition and prompt treatment of severe pre-eclampsia. [Int J Reprod Contracept Obstet Gynecol 2016; 5(7.000: 2171-2176

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

    Michael Gregory

    2015-05-01

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

  13. Preventing Workplace Injuries Among Perinatal Nurses.

    Harolds, Laura; Hurst, Helen

    2016-01-01

    Many aspects of perinatal nursing put nurses at risk for injuries, including frequent repetitive bending, lifting of clients, and exposure to potentially large amounts of body fluids such as blood and amniotic fluid. Violence is also a potential risk with stressful family situations that may arise around childbirth. Workplace injuries put a health care facility at risk for staff turnover, decreases in the number of skilled nurses, client dissatisfaction, workers' compensation payouts, and employee lawsuits. Through the use of safety equipment, improved safety and violence training programs, "no manual lift" policies, reinforcement of personal protective equipment usage, and diligent staff training to improve awareness, these risks can be minimized. PMID:26902445

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

    Juan A. Seclen-Palacín

    2003-12-01

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

  15. Relationship Between Patients' Perceptions of Care Quality and Health Care Errors in 11 Countries: A Secondary Data Analysis.

    Hincapie, Ana L; Slack, Marion; Malone, Daniel C; MacKinnon, Neil J; Warholak, Terri L

    2016-01-01

    Patients may be the most reliable reporters of some aspects of the health care process; their perspectives should be considered when pursuing changes to improve patient safety. The authors evaluated the association between patients' perceived health care quality and self-reported medical, medication, and laboratory errors in a multinational sample. The analysis was conducted using the 2010 Commonwealth Fund International Health Policy Survey, a multinational consumer survey conducted in 11 countries. Quality of care was measured by a multifaceted construct developed using Rasch techniques. After adjusting for potentially important confounding variables, an increase in respondents' perceptions of care coordination decreased the odds of self-reporting medical errors, medication errors, and laboratory errors (P integrated care. PMID:26783863

  16. eHealth, care and quality of life

    Capello, Fabio; Manca, Marco

    2014-01-01

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

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

    Luker JA

    2011-07-01

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

  18. Relation Between Quality-of-Care Indicators for Diabetes and Patient Outcomes : A Systematic Literature Review

    Sidorenkov, Grigory; Haaijer-Ruskamp, Flora M.; de Zeeuw, Dick; Bilo, Henk; Denig, Petra

    2011-01-01

    The authors conducted a systematic literature review to assess whether quality indicators for diabetes care are related to patient outcomes. Twenty-four studies were included that formally tested this relationship. Quality indicators focusing on structure or processes of care were included. Descript

  19. A Nursing Interaction Approach to Consumer Internet Training on Quality Health Care

    Lesley, Marsha L.; Oermann, Marilyn H.; Vander Wal, Jillon S.

    2004-01-01

    This study examined the effectiveness of using the Internet to teach consumers about quality health care, compared consumer definitions of quality health care prior to and following completion of the Internet experience, and compared ratings of learning, satisfaction and value of the Internet instruction between consumers who completed the…

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

    Child Trends, 2010

    2010-01-01

    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;…

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

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

    2008-01-01

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

  2. 45 CFR 98.51 - Activities to improve the quality of child care.

    2010-10-01

    ... health and safety, nutrition, first aid, the recognition of communicable diseases, child abuse detection... 45 Public Welfare 1 2010-10-01 2010-10-01 false Activities to improve the quality of child care... CHILD CARE AND DEVELOPMENT FUND Use of Child Care and Development Funds § 98.51 Activities to...

  3. 产前综合性心理干预对围产期抑郁患者情绪及生活质量的影响%Effects of antenatal comprehensive psychological interventions on emotions and quality of life of perinatal depression patients

    杨蜀云; 合浩; 阮冶; 苏虹; 邬劲; 杨婷

    2016-01-01

    目的:探讨产前综合性心理干预对围产期抑郁患者情绪及生活质量的影响。方法将497例围产期抑郁患者按产检号随机分为两组,研究组251例,对照组246例。两组均接受常规孕期保健宣教,研究组在此基础上联合综合性心理干预,于孕28周、36周及产后1个月采用焦虑自评量表、爱丁堡产后抑郁量表、生活质量量表进行测评分析。结果孕28周两组各量表评分比较差异无显著性( P>0.05)。孕36周及产后1个月两组焦虑自评量表、爱丁堡产后抑郁量表总分均较孕28周显著降低( P<0.05或0.01),研究组显著低于对照组( P<0.05或0.01);研究组生活质量量表的精神成分及躯体成分维度分较孕28周显著升高( P<0.05或0.01),对照组仅躯体成分维度分较孕28周显著升高( P<0.01),研究组显著高于对照组( P<0.05或0.01)。结论综合性心理干预能显著改善围产期抑郁患者的焦虑抑郁情绪,提高患者的生活质量。%Objective To explore the effect of antenatal comprehensive psychological interventions on emo‐tions and quality of life of perinatal depression patients .Methods A total of 497 perinatal depression pa‐tients were assigned to research (n=251) and control group (n=246) according to obstetric examination number .Both groups received routine antenatal care education ,on this basis research group was plus com‐prehensive psychological interventions , and assessments conducted with the Self‐rating Anxiey Scale (SAS) ,Edinburgh Postnatal Depression Scale (EPDS) and MOS 12‐item Short Form Health Survey (SF‐12) within the week 28 and 36 of pregnancy as well as within 1 month after delivery .Results There were no significant group differences in all scales scores within Scores of EPDS and SAS significantly were sig‐nificantly lower in week 28 of pregnancy (P>0 .05) .The total scores of the SAS and EPDS

  4. Long-term care of dependent elderly and quality of life their carers

    Macková, Marie

    2013-01-01

    This article focuses on the issue of long-term care of dependent elderly and quality of life of their carers. Elderly care has an impact on the quality of life of family members. The research was carried out through a questionnaire and interview. The quality of life was measured using the WHOQOL instrument. The research aimed to identify the current levels of family members’ quality of life and the factors influencing the quality of life thereof. The research findings showed a lower quality o...

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

    Walsh, T

    2012-01-31

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

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

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

    2010-01-01

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

  7. Quality of antenatal care in primary health care centers of bangladesh.

    Ahmed M S A Mansur

    2014-12-01

    Full Text Available To find out the quality of ANC in the Upazila Health Complexes (PHC centres of Bangladesh.This cross sectional study was done in purposively selected three upazilas among the clients receiving antenatal care (ANC. Data were collected with questionnaire cum checklist in the context of two aspects of quality issues, namely assessment of physical arrangements for ANC (input and services rendered by the providers (process.The mean age of respondents was 24.6±4.5 years. Majority of the respondents were with primary level education (60.3%. About half (52.8% of the families had monthly income ranging from 3000-5000 taka (38-64 US$. Nearly half (48.9% had no child, little more than one third (42.3% were primigravida and 528 (57.7% were multigravida. Out of 528 multigravid respondents 360 (68.2% took ANC in their previous pregnancy whereas 168 (31.8% did not take ANC Pregnancy outcome was found to be associated with receiving ANC (χ(2=73.599; p=0.000. Respondents receiving ANC had more good pregnancy outcome. The mean waiting time for receiving ANC was 0.77±.49 hours. Out of the 13 centers, only 3 (23.1% have sufficient instruments to render ANC services. Findings showed that where the modes of ANC service delivery in the ANC centers are fairly satisfactory. Though some of the points of standard operation procedures (SOPs on ANC are not covered by some ANC centers, those were not considered necessary. But, regarding the physical facilities available for rendering ANC services, it is seen that facilities are not quite satisfactory. Number of doctors and nurses are not very satisfactory. One of the centers under this study has no doctor, where ANC services are given by nurses.It can be concluded that the ANC services at the primary health care level is not adequate in Bangladesh. To ensure further improvement of the quality of ANC services, instruments used in logistics and supplies should be enhanced.

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

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

    2015-03-01

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

  9. Quality of HIV Care and Mortality Rates in HIV-Infected Patients

    Korthuis, PT; McGinnis, KA; Kraemer, KL; Gordon, AJ; Skanderson, M; Justice, AC; Crystal, S; Goetz, MB; Gibert, CL; Rimland, D.; Fiellin, LE; Gaither, JR; Wang, K; Asch, SM; McInnes, DK

    2016-01-01

    The Patient Protection and Affordable Care Act encourages healthcare systems to track quality-of-care measures; little is known about their impact on mortality rates. The objective of this study was to assess associations between HIV quality of care and mortality rates.A longitudinal survival analysis of the Veterans Aging Cohort Study included 3038 human immunodeficiency virus (HIV)-infected patients enrolled between June 2002 and July 2008. The independent variable was receipt of ≥80% of 9 ...

  10. Quality of care and patient satisfaction: a review of measuring instruments.

    Campen, C. van; Sixma, H; Friele, R.D.; Kerssens, J. J.; L. Peters

    1995-01-01

    Surveying the literature on the assessment of quality of care from the patient's perspective, the concept has often been operationalized as patient satisfaction. Patient satisfaction has been a widely investigated subject in health care research, and dozens of measuring instruments were developed during the past decade. Quality of care from the patient's perspective, however, has been investigated only very recently, and only a few measuring instruments have explicitly been developed for the ...

  11. Quality Adjusted Cost Function in Japanese Child Care Market: Evidence from Micro-level Data

    Shimizutani, Satoshi; NOGUCHI Haruko

    2003-01-01

    This is the first study that uses facility-level data to evaluate the cost efficiency of the child care market in Japan after controlling for quality of services. Japanese households in urban areas suffer from a severe undersupply of child care, and inefficient operation in public centers is allegedly responsible for the bottleneck. We take advantage of our unique and unusually rich data set on Japan's child care centers collected in summer 2002. We estimate quality-adjusted cost functions to...

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

    Gold, Marsha; Felt, Suzanne

    1995-01-01

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

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

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

    2012-01-01

    The Referral letter, is a fundamental tool in the link between Primary Care and second care level. So the main objective of this study is to evaluate the quality of this document on Otolaryngology Department as a high demand specialty. For this purpose, we conducted a prospective, descriptive and observational study, which analyzed all referral letter sent it from Primary Health Care Centers for a month, and used quality criteria previously defined by Izabal et al.The study included 144 refe...

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

    Dorsett Joanna

    2009-08-01

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

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

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

    2001-01-01

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

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

    Patten, Peggy; Ricks, Omar Benton

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

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

    Felt-Lisk, Suzanne

    2000-01-01

    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...

  18. Understanding organizational and cultural premises for quality of care in nursing homes: an ethnographic study

    Nakrem, Sigrid

    2015-01-01

    Background Internationally, there are concerns about the quality of care in nursing homes. The concept of ‘corporate culture’ as an internal variable could be seen as the means to improve quality of care and quality of life for the residents. The aim of this article was to describe the nursing home culture from the staff’s perspective and to include how the residents describe quality of care. Methods An ethnographic design was employed. A purposive sample of four municipal public nursing home...

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

    Busari JO

    2012-12-01

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

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

    Pia S. Schober; Spieß, C. Katharina

    2014-01-01

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

  1. Influence of national culture on the social construction of health care quality

    Aldousari, Abdulrahman

    2015-01-01

    The purpose of this study is to examine how national culture influences the social constructions of health care quality in the Kuwaiti primary care. Kuwait has a well- developed primary care system, offering a wide range of services in practices distributed throughout the nation, throughout the day, and on a walk-in basis. Despite its extended hours, relative comprehensiveness and affordability, the primary care service in Kuwait appears to be poorly received by the public. This study employe...

  2. Study of Access and Quality of Care in For-Profit PACE

    David Jones; Nancy Duda; Bob Schmitz; Sandi Nelson; Chelsea Swete; Alex Bryce; Jared Coopersmith; Karen CyBulski

    2013-01-01

    This report summarizes a study to address quality of and access to care for participants of for-profit Programs of All-Inclusive Care for the Elderly (PACE) organizations. The PACE model allows people who otherwise need a nursing home-level of care to remain in the community by providing health care and related support services, such as social supports, meals and chore services, and transportation.

  3. Surveying Consumer Satisfaction to Assess Managed-Care Quality: Current Practices

    Gold, Marsha; Wooldridge, Judith

    1995-01-01

    Growing interest in using consumer satisfaction information to enhance quality of care and promote informed consumer choice has accompanied recent expansions in managed care. This article synthesizes information about consumer satisfaction surveys conducted by managed-care plans, government and other agencies, community groups, and purchasers of care. We discuss survey content, methods, and use of consumer survey information. Differences in the use of consumer surveys preclude one instrument ...

  4. What Do We know About Competition and Quality in Health Care Markets?

    Martin Gaynor

    2006-01-01

    The goal of this paper is to identify key issues concerning the nature of competition in health care markets and its impacts on quality and social welfare and to identify pertinent findings from the theoretical and empirical literature on this topic. The theoretical literature in economics on competition and quality, the theoretical literature in health economics on this topic, and the empirical findings on competition and quality in health care markets are surveyed and their findings assesse...

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

    Diego Fornaciari

    2009-01-01

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

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

    Restuccia Joseph D

    2012-09-01

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

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

    Chirkov Vitaliy Anatolievich; Breusov Aleksey Vasilievich

    2013-01-01

    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...

  8. Quality of care from the perspective of the cataract patient: QUOTE Cataract Questionnaire.

    Nijkamp, M D; Sixma, H.J.; Afman, H.; Hiddema, F; Koopmans, S.A.; Borne, B. van den; Hendrikse, F.; Nuijts, R M M A

    2002-01-01

    PURPOSE: To examine the potential of a questionnaire (QUOTE Cataract) to measure quality of care from the perspective of cataract patients in quality-assurance or improvement programs. SETTING: Department of Ophthalmology, University Hospital Maastricht, Maastricht, University Hospital Groningen, Groningen, and Rotterdam Eye Hospital, Rotterdam, The Netherlands. METHODS: Cataract patients (N = 540) who had cataract surgery 2 to 8 months previously rated 31 quality-of-care aspects in terms of ...

  9. [Quality of life and supportive care in head and neck cancers].

    Babin, Emmanuel; Heutte, Natacha; Grandazzi, Guillaume; Prévost, Virginie; Robard, Laetitia

    2014-05-01

    The quality of life of patients treated for head and neck cancers and their carers is part of the current concerns of health care teams. Assessment tools were created and helped to highlight the severe physical effects (pain, mucositis…) and chronic (mutilation, post-radiation complications…) related to the disease or to different treatments but also to consider the psychosocial impact of this disease. Improving the quality of life through a thoughtful and comprehensive support that must be associated with somatic care, mental health care, rehabilitation and inclusion of social difficulties and suffering relatives. Supportive care shall ensure a good quality of life for patients treated and their families but also reduce the physical effects associated with the disease and treatment. They rely on coordination of care including the cancer networks established in the cancer plan to ensure comprehensive and continuous care for these patients. PMID:24886902

  10. Quality of care in psychosis and bipolar disorder from the service user perspective.

    Skelly, Niamh; Schnittger, Rebecca I; Butterly, Lisa; Frorath, Charlotte; Morgan, Craig; McLoughlin, Declan M; Fearon, Paul

    2013-12-01

    According to the recovery model of mental health care, service development should incorporate the expert knowledge of service users. To date, there has been limited research into conceptualizations of mental health care quality among services users diagnosed with bipolar disorder or psychosis. To investigate service user perspectives on quality of care, we conducted six focus groups (N = 29) with inpatients and outpatients of an independent Irish mental health service. We undertook an inductive thematic analysis of the data. Participants identified proactive staff, meaningful and warm staff-patient interactions, and safety and sociability in the inpatient environment as components of good quality mental health care. Participants also discussed how the implementation of best practice guidelines does not necessarily improve quality of care from the service user perspective. This and similar qualitative research should be used to inform service development and the creation of evaluation instruments compatible with the recovery model. PMID:24163347

  11. Implementation and quality monitoring of e-communication across health care sectors

    Nicolaisen, Anne; Qvist, Peter

    quality monitoring of specified quality standards. Objective: To monitor the implementation and quality of the Sam:Bo e-communication Method: An explicit audit performed in all local municipalities and at selected hospital departments from all hospital units in the Region of Southern Denmark. The audit......: Results from this audit will identify challenges in e-communication across health care sectors and provide knowledge of the implementation and quality of the Sam:Bo e-communication. Points for discussion: How to improve quality of care using e-communication in general practice in the handover of patients...

  12. Enablers and barriers for implementing high-quality hypertension care in a rural primary care setting in Nigeria: perspectives of primary care staff and health insurance managers

    Aina O. Odusola

    2016-02-01

    Full Text Available Background: Hypertension is a highly prevalent risk factor for cardiovascular diseases in sub-Saharan Africa (SSA that can be modified through timely and long-term treatment in primary care. Objective: We explored perspectives of primary care staff and health insurance managers on enablers and barriers for implementing high-quality hypertension care, in the context of a community-based health insurance programme in rural Nigeria. Design: Qualitative study using semi-structured individual interviews with primary care staff (n = 11 and health insurance managers (n=4. Data were analysed using standard qualitative techniques. Results: Both stakeholder groups perceived health insurance as an important facilitator for implementing high-quality hypertension care because it covered costs of care for patients and provided essential resources and incentives to clinics: guidelines, staff training, medications, and diagnostic equipment. Perceived inhibitors included the following: high staff workload; administrative challenges at facilities; discordance between healthcare provider and insurer on how health insurance and provider payment methods work; and insufficient fit between some guideline recommendations and tools for patient education and characteristics/needs of the local patient population. Perceived strategies to address inhibitors included the following: task-shifting; adequate provider payment benchmarking; good provider–insurer relationships; automated administration systems; and tailoring guidelines/patient education. Conclusions: By providing insights into perspectives of primary care providers and health insurance managers, this study offers information on potential strategies for implementing high-quality hypertension care for insured patients in SSA.

  13. Overall satisfaction of health care users with the quality of and access to health care services: a cross-sectional study in six Central and Eastern European countries

    Stepurko, Tetiana; Pavlova, Milena; Groot, Wim

    2016-01-01

    Background: The measurement of consumer satisfaction is an essential part of the assessment of health care services in terms of service quality and health care system responsiveness. Studies across Europe have described various strategies health care users employ to secure services with good quality and quick access. In Central and Eastern European countries, such strategies also include informal payments to health care providers. This paper analyzes the satisfaction of health care users with...

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

    Silva Antônio Augusto M. da

    2001-01-01

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

  15. Measurement of Perceived and Technical Quality of Care for Depression in Racially and Ethnically Diverse Groups.

    Leff, H Stephen; Chow, Clifton; Wieman, Dow A; Ostrow, Laysha; Cortés, Dharma E; Harris, Treniece

    2016-08-01

    Measurement of patient satisfaction is now considered essential for providing patient centered care and is an important tool for addressing health care disparities. However, little is known about how ethnically and racially diverse (ERD) groups differ in how they perceive quality, and widely used instruments for measuring perceived quality give little attention to cultural elements of care. This study examined the relationship between the culturally determined beliefs and expectations of four ERD groups (African Americans, Latinos, Portuguese-speakers, and Haitians, total N = 160) and the technical quality of treatment for depression provided in four "culturally-specific" primary care clinics. Using data from the Experiences of Care and Health Outcomes survey, chart reviews and focus groups, the study addressed a set of questions related to the psychometric properties of perceived care measures and the technical quality of care. The groups differed in preferred cultural elements except all preferred inclusion of religion. They did not differ in overall perceived quality. Technical quality was higher for Portuguese and Haitians than for African Americans and Latinos. Implications of group differences for measuring quality are discussed. PMID:26748509

  16. Quality of Child Care Using the Environment Rating Scales: A Meta-Analysis of International Studies

    Vermeer, Harriet J.; van IJzendoorn, Marinus H.; Cárcamo, Rodrigo A.; Harrison, Linda J.

    2016-01-01

    The current study provides a systematic examination of child care quality around the globe, using the Environment Rating Scales (ERS). Additional goals of this study are to examine associations between ERS process quality and structural features (group size, caregiver-child ratio) that underpin quality and between ERS and more proximal aspects of…

  17. Thin Blue Lines and Red Crosses: Signposts to Quality in Family Day Care?

    White, Jayne

    2005-01-01

    This paper explores some of the findings of a study focussing on constructions of family day care from the perspectives of caregivers/educators and coordinators as they engaged in a quality review process using a recently developed resource--The Quality Journey/He haerenga whai hua (2000). The paper positions quality review as a part of a…

  18. Communicating for Quality in School Age Care Services

    Cartmel, Jennifer; Grieshaber, Susan

    2014-01-01

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

  19. Structure and quality of outpatient care for people living with an HIV infection.

    Engelhard, Esther A N; Smit, Colette; Nieuwkerk, Pythia T; Reiss, Peter; Kroon, Frank P; Brinkman, Kees; Geerlings, Suzanne E

    2016-08-01

    Policy-makers and clinicians are faced with a gap of evidence to guide policy on standards for HIV outpatient care. Ongoing debates include which settings of care improve health outcomes, and how many HIV-infected patients a health-care provider should treat to gain and maintain expertise. In this article, we evaluate the studies that link health-care facility and care provider characteristics (i.e., structural factors) to health outcomes in HIV-infected patients. We searched the electronic databases MEDLINE, PUBMED, and EMBASE from inception until 1 January 2015. We included a total of 28 observational studies that were conducted after the introduction of combination antiretroviral therapy in 1996. Three aspects of the available research linking the structure to quality of HIV outpatient care were evaluated: (1) assessed structural characteristics (i.e., health-care facility and care provider characteristics); (2) measures of quality of HIV outpatient care; and (3) reported associations between structural characteristics and quality of care. Rather than scarcity of data, it is the diversity in methodology in the identified studies and the inconsistency of their results that led us to the conclusion that the scientific evidence is too weak to guide policy in HIV outpatient care. We provide recommendations on how to address this heterogeneity in future studies and offer specific suggestions for further reading that could be of interest for clinicians and researchers. PMID:26971587

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

    Mahajan, Hemant; Sharma, Bhuwan

    2014-01-01

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

  1. Perceived quality of health care services among people with osteoarthritis – results from a nationwide survey

    Grønhaug G

    2015-09-01

    Full Text Available Gudmund Grønhaug,1 Jon Hagfors,2 Ingebjørg Borch,2 Nina Østerås,1 Kåre Birger Hagen11National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital, 2Norwegian Rheumatism Association, Oslo, NorwayObjective: To assess the perceived quality of care received by people with osteoarthritis (OA in Norway and explore factors associated with the quality of care.Methods: A national survey in which members of the Norwegian Rheumatism Association with OA registered as their main diagnosis completed a questionnaire. The perceived quality of care was reported on a 17-item OsteoArthritis Quality Indicator questionnaire, covering both pharmacological and non-pharmacological aspects of OA care. In addition, the four-page questionnaire covered areas related to demographic characteristics, the location and impact of the OA, and utilization and satisfaction with health care services. The quality of care is calculated as pass rates, where the numerator represents the number of indicators passed and the denominator represents the number of eligible persons.Results: In total, 1,247 participants (response rate 57% completed the questionnaire. Mean age was 68 years (standard deviation 32 and 1,142 (92% were women. Respondents reported OA in hand only (12.4%, hip only (7.3%, knee only (10.4%, in two locations (42% or all three locations (27%. The overall OsteoArthritis Quality Indicator pass rate was 47% (95% confidence interval [CI] 46%–48%, and it was higher for pharmacological aspects (53% [51%–54%] than for non-pharmacological aspects of care (44% [43%–46%]. The pass rate for the individual quality indicators ranged from 8% for “referral for weight reduction” to 81% for “receiving advice about exercises”. Satisfaction with care was strongly associated with perceived quality. The pass rate for those who were “very satisfied” was 33% (25%–40% higher than those who were “very unsatisfied” with care.Conclusion: While the OA

  2. Organizational Fragmentation and Care Quality in the U.S. Health Care System

    Randall D. Cebul; James B. Rebitzer; Taylor, Lowell J.; Mark Votruba

    2008-01-01

    Many goods and services can be readily provided through a series of unconnected transactions, but in health care close coordination over time and within care episodes improves both health outcomes and efficiency. Close coordination is problematic in the US health care system because the financing and delivery of care is distributed across a variety of distinct and often competing entities, each with its own objectives, obligations and capabilities. These fragmented organizational structures l...

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

    Reid, Colin R.

    2008-01-01

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

  4. The activities of hospital nursing unit managers and quality of patient care in South African hospitals: a paradox?

    Armstrong, Susan J; Laetitia C. Rispel; Loveday Penn-Kekana

    2015-01-01

    Background: Improving the quality of health care is central to the proposed health care reforms in South Africa. Nursing unit managers play a key role in coordinating patient care activities and in ensuring quality care in hospitals. Objective: This paper examines whether the activities of nursing unit managers facilitate the provision of quality patient care in South African hospitals. Methods: During 2011, a cross-sectional, descriptive study was conducted in nine randomly selected hospital...

  5. The activities of hospital nursing unit managers and quality of patient care in South African hospitals: a paradox?

    Armstrong, Susan J; Laetitia C. Rispel; Penn-Kekana, Loveday

    2015-01-01

    Background: Improving the quality of health care is central to the proposed health care reforms in South Africa. Nursing unit managers play a key role in coordinating patient care activities and in ensuring quality care in hospitals.Objective: This paper examines whether the activities of nursing unit managers facilitate the provision of quality patient care in South African hospitals.Methods: During 2011, a cross-sectional, descriptive study was conducted in nine randomly selected hospitals ...

  6. Comparison of Healthcare Quality Outcomes Between Accountable Care Organizations and Physician Group Practices.

    Singh, Sukhchain; Khosla, Sandeep; Sethi, Ankur

    2015-01-01

    Accountable Care Organizations (ACOs) were created under the Affordable Care Act to deliver better quality of care at reduced cost compare with the traditional fee-for-service model. But their effectiveness in achieving healthcare quality metrics is unclear. We analyzed ACO and physician group practice (PGP) performance rates for the single coronary artery disease measure and four diabetes mellitus measures now publicly reported on the Medicare Physician Compare Web site for program year 2012. There was no statistically significant difference in reported quality measures between ACOs and PGPs. Our study shows that PGPs can achieve outcomes at par with ACOs. PMID:26223106

  7. First, do no harm: less training ≠ quality care.

    Baumann, Michael H; Simpson, Steven Q; Stahl, Mary; Raoof, Suhail; Marciniuk, Darcy D; Gutterman, David D

    2012-07-01

    In an attempt to transform the health care system in the United States to improve upon the inadequacies and deficiencies of our current model, the Robert Wood Johnson Foundation and the Institute of Medicine created a collaborative partnership to spell out what aspects of our health care system need to be remodeled. They envisioned that "interprofessional collaboration and coordination would be the 'norm,'"(1) because no discipline functions in isolation of others, certainly not in our intensive care units. In this spirit of interdisciplinary collaboration, the American College of Chest Physicians (ACCP) and the American Association of Critical-Care Nurses (AACN)-physician and nursing societies, respectively, with combined memberships totaling more than 110 000 practicing critical care practitioners-have spoken with one voice in the editorial that follows about how and how not to address the shortage of critical care physicians. Because our critical care nurses work side by side with our intensivists, shouldn't they have a say in how intensivists are trained? The ACCP and AACN think so, and we agree. Richard S. Irwin, MD, Master FCCP Editor in Chief, CHEST. PMID:22721978

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

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

    2013-01-01

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

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

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

  10. Supporting employees' work-family needs improves health care quality: Longitudinal evidence from long-term care.

    Okechukwu, Cassandra A; Kelly, Erin L; Bacic, Janine; DePasquale, Nicole; Hurtado, David; Kossek, Ellen; Sembajwe, Grace

    2016-05-01

    We analyzed qualitative and quantitative data from U.S.-based employees in 30 long-term care facilities. Analysis of semi-structured interviews from 154 managers informed quantitative analyses. Quantitative data include 1214 employees' scoring of their supervisors and their organizations on family supportiveness (individual scores and aggregated to facility level), and three outcomes: (1), care quality indicators assessed at facility level (n = 30) and collected monthly for six months after employees' data collection; (2), employees' dichotomous survey response on having additional off-site jobs; and (3), proportion of employees with additional jobs at each facility. Thematic analyses revealed that managers operate within the constraints of an industry that simultaneously: (a) employs low-wage employees with multiple work-family challenges, and (b) has firmly institutionalized goals of prioritizing quality of care and minimizing labor costs. Managers universally described providing work-family support and prioritizing care quality as antithetical to each other. Concerns surfaced that family-supportiveness encouraged employees to work additional jobs off-site, compromising care quality. Multivariable linear regression analysis of facility-level data revealed that higher family-supportive supervision was associated with significant decreases in residents' incidence of all pressure ulcers (-2.62%) and other injuries (-9.79%). Higher family-supportive organizational climate was associated with significant decreases in all falls (-17.94%) and falls with injuries (-7.57%). Managers' concerns about additional jobs were not entirely unwarranted: multivariable logistic regression of employee-level data revealed that among employees with children, having family-supportive supervision was associated with significantly higher likelihood of additional off-site jobs (RR 1.46, 95%CI 1.08-1.99), but family-supportive organizational climate was associated with lower likelihood

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

    Rehn, Marius; Krüger, Andreas J

    2014-01-01

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

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

    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

    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

  13. Physicians' Psychosocial Work Conditions and Quality of Care: A Literature Review

    Peter Angerer

    2015-05-01

    Full Text Available Background: Physician jobs are associated with adverse psychosocial work conditions. We summarize research on the relationship of physicians' psychosocial work conditions and quality of care. Method: A systematic literature search was conducted in MEDLINE and PsycINFO. All studies were classified into three categories of care quality outcomes: Associations between physicians' psychosocial work conditions and (1 the physician-patient-relationship, or (2 the care process and outcomes, or (3 medical errors were examined. Results: 12 publications met the inclusion criteria. Most studies relied on observational cross-sectional and controlled intervention designs. All studies provide at least partial support for physicians’ psychosocial work conditions being related to quality of care. Conclusions: This review found preliminary evidence that detrimental physicians’ psychosocial work conditions adversely influence patient care quality. Future research needs to apply strong designs to disentangle the indirect and direct effects of adverse psychosocial work conditions on physicians as well as on quality of care.Keywords: psychosocial work conditions, physicians, quality of care, physician-patient-relationship, hospital, errors, review, work stress, clinicians

  14. Perinatal programming prevention measures.

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

    2015-01-01

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

  15. Quality along the continuum: a health facility assessment of intrapartum and postnatal care in Ghana.

    Robin C Nesbitt

    Full Text Available To evaluate quality of routine and emergency intrapartum and postnatal care using a health facility assessment, and to estimate "effective coverage" of skilled attendance in Brong Ahafo, Ghana.We conducted an assessment of all 86 health facilities in seven districts in Brong Ahafo. Using performance of key signal functions and the availability of relevant drugs, equipment and trained health professionals, we created composite quality categories in four dimensions: routine delivery care, emergency obstetric care (EmOC, emergency newborn care (EmNC and non-medical quality. Linking the health facility assessment to surveillance data we estimated "effective coverage" of skilled attendance as the proportion of births in facilities of high quality.Delivery care was offered in 64/86 facilities; only 3-13% fulfilled our requirements for the highest quality category in any dimension. Quality was lowest in the emergency care dimensions, with 63% and 58% of facilities categorized as "low" or "substandard" for EmOC and EmNC, respectively. This implies performing less than four EmOC or three EmNC signal functions, and/or employing less than two skilled health professionals, and/or that no health professionals were present during our visit. Routine delivery care was "low" or "substandard" in 39% of facilities, meaning 25/64 facilities performed less than six routine signal functions and/or had less than two skilled health professionals and/or less than one midwife. While 68% of births were in health facilities, only 18% were in facilities with "high" or "highest" quality in all dimensions.Our comprehensive facility assessment showed that quality of routine and emergency intrapartum and postnatal care was generally low in the study region. While coverage with facility delivery was 68%, we estimated "effective coverage" of skilled attendance at 18%, thus revealing a large "quality gap." Effective coverage could be a meaningful indicator of progress towards

  16. Surgical Precision in Clinical Documentation Connects Patient Safety, Quality of Care, and Reimbursement.

    Kittinger, Benjamin J; Matejicka, Anthony; Mahabir, Raman C

    2016-01-01

    Emphasis on quality of care has become a major focus for healthcare providers and institutions. The Centers for Medicare and Medicaid Services has multiple quality-of-care performance programs and initiatives aimed at providing transparency to the public, which provide the ability to directly compare services provided by hospitals and individual physicians. These quality-of-care programs highlight the transition to pay for performance, rewarding physicians and hospitals for high quality of care. To improve the use of pay for performance and analyze quality-of-care outcome measures, the Division of Plastic Surgery at Scott & White Memorial Hospital participated in an inpatient clinical documentation accuracy project (CDAP). Performance and improvement on metrics such as case mix index, severity of illness, risk of mortality, and geometric mean length of stay were assessed after implementation. After implementation of the CDAP, the division of plastic surgery showed increases in case mix index, calculated severity of illness, and calculated risk of mortality and a decrease in length of stay. For academic plastic surgeons, quality of care demands precise documentation of each patient. The CDAP provides one avenue to hone clinical documentation and performance on quality measures. PMID:26903784

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

    Jafar S Tabrizi; Samira Askari; Zahra Fardiazar; Hossein Koshavar; Kamal Gholipour

    2014-01-01

    Background: Our aim was to determine the service quality of delivered care for people with Caesarean Section and Normal Delivery. Methods: A cross-sectional study was conducted among 200 people who had caesarean section and normal delivery in Al-Zahra Teaching Hospital in Tabriz, north western Iran. Service quality was calculated using: Service Quality = 10 – (Importance × Performance) based on importance and performance of service quality aspects from the postpartum women‟s...

  18. A pragmatic approach for measuring data quality in primary care databases

    Dungey, Sheena; Beloff, Natalia; Puri, Shivani; Boggon, Rachael; Williams, Tim; Tate, A Rosemary

    2014-01-01

    There is currently no widely recognised methodology for undertaking data quality assessment in electronic health records used for research. In an attempt to address this, we have developed a protocol for measuring and monitoring data quality in primary care research databases, whereby practice-based data quality measures are tailored to the intended use of the data. Our approach was informed by an in-depth investigation of aspects of data quality in the Clinical Practice Research Datalink Gol...

  19. QUALITY MANAGEMENT IN HEALTH CARE - CONTRIBUTING TO PATIENT SAFETY AND EFFICIENCY OF BUSINESS OPERATION

    Nevenka Kovac

    2014-01-01

    In order to ensure efficient and effective health care, of equal high quality and accessibility, at all the levels of healthcare and across the entire Croatian territory, all operators in health services are required to establish, develop and maintain a system for assuring and improving the quality in healthcare. Legal requirement to introduce quality management systems into healthcare institutions notwithstanding, a quality management system is equally important in regard to the provision of...

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

    Lima, Camila S P; Barbosa, Sayonara F F

    2015-01-01

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

  1. Localized intestinal perforations as a potential complication of brain hypothermic therapy for perinatal asphyxia.

    Nishizaki, Naoto; Maiguma, Atsuko; Obinata, Kaoru; Okazaki, Tadaharu; Shimizu, Toshiaki

    2016-08-01

    Brain hypothermic therapy (BHT) is becoming a frequently used standard of care for perinatal asphyxia. Although cardiovascular side effects, coagulation disorders, renal impairment, electrolyte abnormalities, impaired liver function, opportunistic infections, and skin lesions are well-known adverse effects of BHT in newborns, little information is available on the clinical features of intestinal perforation-related BHT. We herein report a case of therapeutic brain cooling for perinatal asphyxia complicated by localized intestinal perforation. In practice, the neonatologist should be aware that intestinal perforation in an infant with perinatal asphyxia is possible, particularly following BHT. PMID:26445344

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

    Martin Rejler; J(o)rgen Tholstrup; Mattias Elg; Anna Sp(a)ngéus; Boel Andersson G(a)re

    2012-01-01

    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 J(o)nk(o)ping 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.

  3. Patient safety and quality of care: how may clinical simulation contribute?

    Jensen, Sanne

    2015-01-01

    The usability of health information technology (IT) is increasingly recognized as critically important to the development of systems that ensure patient safety and quality of care. The substantial complexity of organizations, work practice and physical environments within the healthcare sector...

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

    Blenkiron, P.; Hammill, C

    2003-01-01

    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.

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

    Lange, P.; Andersen, Klaus Kaae; Munch, E.;

    2009-01-01

    Background: We studied the quality of care for COPD patients in 22 hospital-based outpatient clinics in Denmark and evaluated if participation by the staff in an educational programme could improve the quality of care and adherence to the COPD guidelines. Methods: We performed two audits of the...... hospital records one year apart before and after the educational programme for the participating doctors and nurses. A total of 941 patient records were included in the first audit and 927 in the second. The indicators of quality of care comprised amongst others referral to pulmonary rehabilitation......, smoking cessation advice, nutritional advice, instruction in inhalation technique and assessment of BMI, smoking status, pack years, lung function parameters, dyspnoea oxygen saturation and comorbidities. Results. In general, the quality of care for COPD patients in Denmark was suboptimal and not in...

  6. Antenatal umbilical cord parameters and perinatal outcome

    Athira Narayanan

    2016-04-01

    Conclusions: No association between antenatal umbilical cord characteristics and perinatal outcome was found in pregnancies at high risk for poor perinatal outcome. [Int J Reprod Contracept Obstet Gynecol 2016; 5(4.000: 1211-1215

  7. Do We Care More about Our Cars than about Our Children? High-Quality Child Care: Luxury Option or Standard Equipment?

    Koshansky, Deborah

    1997-01-01

    Reviews research showing that there is a level of quality below which children's development is compromised. Uses analogies of options available to consumers when buying cars to designate features of quality child care. Argues that high-quality care should be available to all children. (AMC)

  8. Setting up a health care quality management system in a multidisciplinary clinical research center

    L. V. Laktionova

    2014-07-01

    Full Text Available The paper discusses the issues of setting up a quality management system in a multidisciplinary specialized clinical research center. It describes the experience with information technologies used in a prophylactic facility to set up effective out- and inpatient health care control. Measures to optimize work under present-day conditions to upgrade the quality of health care are given using the federal health facility as an example.

  9. Assessment of health care quality among penitentiary employees with hypertension in the Saratov region

    Balashov S.V.; Balashova M.E.; Popova Yu.V.

    2015-01-01

    The aim of the study is to assess the quality of health care among penitentiary employees with hypertension in the Saratov region from 2003 to 2013. Material and Methods. The data from 62 employees with hypertension (43 men and 19 women) who followed up in the dispensary of Branch of Center of Medical and Social Rehabilitation of Medical Unit no.64 of Russian Federal Penitentiary Service in 2013 were evaluated. We analyzed retrospectively the quality of health care in every calendar year from...

  10. The Impact of Health Service Provider Agreeableness on Care Quality Variation

    Ching-I Teng; Wen-Hsin Hsu

    2012-01-01

    Variation of customer-perceived care quality may trigger customer complaints, negative word of mouth, and reduced revisit behavior; for health services especially, this area warrants additional research. This study investigates whether health service provider agreeableness is related to the variation of customer-perceived care quality. Questionnaires were sent to health service providers and customers in two medical centers. In total, 411 sets of responses were collected, with each one compri...

  11. Quality and correlates of medical record documentation in the ambulatory care setting

    Simon Steven R; Kleinman Kenneth P; Soto Carlos M

    2002-01-01

    Abstract Background Documentation in the medical record facilitates the diagnosis and treatment of patients. Few studies have assessed the quality of outpatient medical record documentation, and to the authors' knowledge, none has conclusively determined the correlates of chart documentation. We therefore undertook the present study to measure the rates of documentation of quality of care measures in an outpatient primary care practice setting that utilizes an electronic medical record. Metho...

  12. Quality Adjustment for Health Care Spending on Chronic Disease: Evidence from Diabetes Treatment, 1999-2009

    Eggleston, Karen N.; Shah, Nilay D.; Smith, Steven A; Berndt, Ernst R.; Newhouse, Joseph P.

    2011-01-01

    Although US health care expenditures reached 17.6 percent of GDP in 2009, quality measurement in this important service sector remains limited. Studying quality changes associated with 11 years of health care for patients with diabetes, we find that the value of reduced mortality and avoided treatment spending, net of the increase in annual spending, was $9,094 for the average patient. These results suggest that the unit cost of diabetes treatment, adjusting for the value of health outcomes, ...

  13. Real teams and their effect on the quality of care in nursing homes

    Havig, Anders Kvale; SKOGSTAD, Anders; Veenstra, Marijke; Romøren, Tor Inge

    2013-01-01

    Background: Use of teams has shown to be an important factor for organizational performance. However, research has shown that a team has to meet certain criteria and operate in a certain way to realize the potential benefits of team organizing. There are few studies that have examined how teams operate in the nursing home sector and their effect on quality of care. This study investigates the relationship between teams that meet an academic definition of the team concept and quality of care i...

  14. Events, Public Discourses and Responsive Government: Quality Assurance in Health Care in England, Sweden and Japan

    Kodate, Naonori

    2010-01-01

    One would expect the common agenda of improving the quality of care in hospital sectors across nations to bring about a convergence of their quality assurance systems. However, one finds great variations in the ways in which such schemes are constructed and communicated to the general public in different countries. This paper examines three universal health care systems (England, Sweden and Japan) and explores the degree to which political institutions and public opinions af...

  15. Improving Quality of Care in Renal Replacement Therapy Using a Collaborative Approach

    Azri Mohamed Nache

    2012-01-01

    AbstractImproving Quality of Care in Renal Replacement Therapy Using a Collaborative ApproachAzri Mohamed Nache, MB ChB MRCPUnder direction of Professor Ruth BoadenMaster of Philosophy Business and Management, University of ManchesterOctober 2012Introduction:In the past few decades, there have been rapid advances in knowledge of best practice in all areas within healthcare. Despite this, a large gap remains between what is best practice and the care that actually received by patients. Quality...

  16. Improving quality of care in renal replacement therapy using collaborative approach

    Nache, Azri

    2012-01-01

    Improving Quality of Care in Renal Replacement Therapy Using a Collaborative ApproachAzri Mohamed Nache, MB ChB MRCPUnder direction of Professor Ruth BoadenMaster of Philosophy Business and Management, University of ManchesterOctober 2012Introduction:In the past few decades, there have been rapid advances in knowledge of best practice in all areas within healthcare. Despite this, a large gap remains between what is best practice and the care that actually received by patients.Quality improvem...

  17. Application of evidence-based urology in improving quality of care

    Panda, Arabind; Dorairajan, L. N.; Kumar, Santosh

    2007-01-01

    Evidence-based medicine requires use of the best available evidence for optimal patient care. Increasingly scarce resources and escalating demands on time have led to emphasis on effective treatment. Opinion is slowly yielding to high-quality existent evidence. It is important that urologists adapt to these changes for them to deliver optimum care to the patients. This article discusses the levels of evidence, the nature of desirable evidence, means of assessing quality of clinical trials and...

  18. 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

    Isabel Río Sánchez

    2009-10-01

    Full Text Available Objetivo: Realizar un análisis comparativo de la exhaustividad de los datos sobre mortalidad perinatal en la Comunitat Valenciana recogidos en el Instituto Nacional de Estadística (INE y en el Registro de Mortalidad Perinatal (RMPCV. Posteriormente, calcular y comparar la tasa de mortalidad perinatal (TMP y sus componentes en gestantes autóctonas e inmigrantes, tomando como referencia los casos notificados a ambos registros durante 2005 y 2006. Métodos: Se definieron los distintos tipos de mortalidad de acuerdo con los criterios establecidos por la OMS. La magnitud de la infradeclaración se analizó calculando las frecuencias y porcentajes de muertes infradeclaradas para el período 2005-2006. Se calcularon y compararon las diversas tasas entre mujeres autóctonas e inmigrantes de los cuatro grupos mayoritarios a partir de ambos registros, así como los intervalos de confianza del 95% para dichas tasas. Resultados: En el INE existe un importante subregistro de muertes fetales y neonatales. Además, constan neonatos fallecidos de madre extranjera con nacionalidad española asignada. Ambos factores distorsionan la proporción de muertes fetales y neonatales en inmigrantes, y provocan una infraestimación de la TMP y sus componentes en estos colectivos, pues las obtenidas a partir del RMPCV son muy superiores en las mujeres inmigrantes, en particular en las de Europa del Este y las subsaharianas, en comparación con las autóctonas. Conclusiones: En definitiva, nuestros resultados indican que ambos registros son complementarios, pero el RMPCV presenta una mayor exhaustividad y fiabilidad para el cálculo de tasas. Además, sugieren la necesidad de monitorizar la evolución de la TMP en la población inmigrante en España.Objective: To analyze the exhaustiveness and reliability of the data on perinatal mortality in two Spanish registries, namely, the National Statistics Institute and the Perinatal Mortality Registry of the Valencian Community

  19. Effect of an Educational Toolkit on Quality of Care: A Pragmatic Cluster Randomized Trial

    Shah, Baiju R; Onil Bhattacharyya; Catherine H Y Yu; Mamdani, Muhammad M.; Parsons, Janet A; Straus, Sharon E; Merrick Zwarenstein

    2014-01-01

    Editors' Summary Background Clinical practice guidelines help health care providers deliver the best care to patients by combining all the evidence on disease management into specific recommendations for care. However, the implementation of evidence-based guidelines is often far from perfect. Take the example of diabetes. This common chronic disease, which is characterized by high levels of sugar (glucose) in the blood, impairs the quality of life of patients and shortens life expectancy by i...

  20. Quality of care in one Italian nursing home measured by ACOVE process indicators.

    Claudia Pileggi

    Full Text Available 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.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.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.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.

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

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

    2011-01-01

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

  2. An audit of the quality of inpatient care for adults with learning disability in the UK

    Sheehan, Rory; Gandesha, Aarti; Hassiotis, Angela; Gallagher, Pamela; Burnell, Matthew; Jones, Glyn; Kerr, Michael; Hall, Ian; Chaplin, Robert; Crawford, Michael J.

    2016-01-01

    Objectives To audit patient hospital records to evaluate the performance of acute general and mental health services in delivering inpatient care to people with learning disability and explore the influence of organisational factors on the quality of care they deliver. Setting Nine acute general hospital Trusts and six mental health services. Participants Adults with learning disability who received inpatient hospital care between May 2013 and April 2014. Primary and secondary outcome measure...

  3. Assessment of patient satisfaction with acute pain management service: Monitoring quality of care in clinical setting

    Farooq, Fizzah; Khan, Robyna; Ahmed, Aliya

    2016-01-01

    Background and Aims: Assessment of patient satisfaction is an important tool for monitoring the quality of care in hospitals. The aim of this survey was to develop a reliable tool to assess patient satisfaction with acute pain management service (APMS) and identify variables affecting this so that care can be improved. Methods: A questionnaire was developed and administered to patients after being discharged from APMS care by an unbiased person. Data collected from record included patient dem...

  4. Assessment of patient satisfaction with acute pain management service: Monitoring quality of care in clinical setting

    Fizzah Farooq; Robyna Khan; Aliya Ahmed

    2016-01-01

    Background and Aims: Assessment of patient satisfaction is an important tool for monitoring the quality of care in hospitals. The aim of this survey was to develop a reliable tool to assess patient satisfaction with acute pain management service (APMS) and identify variables affecting this so that care can be improved. Methods: A questionnaire was developed and administered to  patients after being discharged from APMS care by an unbiased person. Data collected from record included patient de...

  5. Quality of weight-loss counseling by Dutch practice nurses in primary care: an observational study.

    Dillen, S.M.E. van; Noordman, J.; Dulmen, S. van; Hiddink, G.J.

    2015-01-01

    Background/objective: To assess the quality of weight-loss counseling provided by Dutch primary care practice nurses (PNs) to overweight and obese patients including both PNs’ compliance with the Five A’s Model for behavioral counseling in primary care, and the use of different communication styles.

  6. Quality of weight-loss counseling by Dutch practice nurses in primary care: an observational study

    Dillen, S.M. van; Noordman, J.; Dulmen, S. van; Hiddink, G.J.

    2015-01-01

    BACKGROUND/OBJECTIVE: To assess the quality of weight-loss counseling provided by Dutch primary care practice nurses (PNs) to overweight and obese patients including both PNs' compliance with the Five A's Model for behavioral counseling in primary care, and the use of different communication styles.

  7. A quality management model for integrated care : results of a Delphi and Concept Mapping study

    Minkman, Mirella; Ahaus, Kees; Fabbricotti, Isabelle; Nabitz, Udo; Huijsman, Robbert

    2009-01-01

    The objective of this study is to identify the elements and clusters of a quality management model for integrated care. In order to develop the model a combination of three methods were applied. A literature study was conducted to identify elements of integrated care. In a Delphi study experts comme

  8. A quality management model for integrated care: results of a Delphi and Concept Mapping study

    M. Minkman; K. Ahaus; I. Fabbricotti; U. Nabitz; R. Huijsman

    2009-01-01

    The objective of this study is to identify the elements and clusters of a quality management model for integrated care. In order to develop the model a combination of three methods were applied. A literature study was conducted to identify elements of integrated care. In a Delphi study experts comme

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

    Schyve, Paul M.

    2007-01-01

    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.

  10. Quality of Care for Acute Myocardial Infarction in Rural and Urban US Hospitals

    Baldwin, Laura-Mae; MacLehose, Richard F.; Hart, L. Gary; Beaver, Shelli K.; Every,Nathan; Chan,Leighton

    2004-01-01

    Context: Acute myocardial infarction (AMI) is a common and important cause of admission to US rural hospitals, as transport of patients with AMI to urban settings can result in unacceptable delays in care. Purpose: To examine the quality of care for patients with AMI in rural hospitals with differing degrees of remoteness from urban centers.…

  11. Child care quality in The Netherlands over the years: a closer look

    K.O.W. Helmerhorst; J.M.A. Riksen - Walraven; M.J.J.M. Gever Deynoot-Schaub; L.W.C. Tavecchio; R.G. Fukkink

    2014-01-01

    Research Findings: We assessed the quality of child care in a nationally representative sample of 200 Dutch child care centers using the Infant/Toddler Environment Rating Scale-Revised and/or Early Childhood Environment Rating Scale-Revised and compared it with a previous assessment in 2005. The Car

  12. Child care quality in the Netherlands over the years: A closer look

    Helmerhorst, K.O.W.; Riksen-Walraven, J.M.A.; Gevers Deynoot-Schaub, M.J.J.M.; Tavecchio, L.W.C.; Fukkink, R.G.

    2015-01-01

    Research Findings: We assessed the quality of child care in a nationally representative sample of 200 Dutch child care centers using the Infant/Toddler Environment Rating Scale–Revised and/or Early Childhood Environment Rating Scale–Revised and compared it with a previous assessment in 2005. The Car

  13. Predictors of quality of life of people receiving intensive community-based care

    Emmerink, P.M.J.; Roeg, Diana

    2015-01-01

    Purpose Intensive community-based care (ICBC) is a home-treatment approach aiming to support people ‘living in the community’ with severe psychiatric and addiction problems. Although subjective quality of life (SQOL) is an increasingly important outcome measure in health care, little is known on ICB

  14. Quality and safety in transitional care of the elderly: The study protocol of a case study research design (Phase 1)

    Aase, Karina; Laugaland, Kristin A; Dyrstad, Dagrunn Nåden; Storm, Marianne

    2013-01-01

    Introduction: Although international studies have documented that patients ’ transitions between care providers are associated with the risk of adverse events and uncoordinated care, research directed towards the quality and safety of transitional care between primary and secondary health and care services, especially for the elderly receiving care from multiple healthcare providers due to complex health problems, is lacking. This study investigates how differ...

  15. 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

    Gaye Alioune

    2009-09-01

    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

  16. 推进优质护理提升护理质量%Promoting High Quality Care to Enhance the Quality of Care

    郭燕红

    2012-01-01

    Nurse care reform is a microcosm of the reform of public hospitals, which is an important benchmark of public hospital reform. The paper discussed the importance of nurse care in hospital, clarified the connotation of high quality care , and described the implementation of high quality care for the importance of reform of public hospitals, summed up the achievements and problems of high quality care at this stage and pointed out the direction for next step.%护理改革是公立医院改革的一个缩影,是评价公立医院改革的重要标尺.概述了医院护理工作的重要性,阐明了优质护理的内涵,阐述了推行优质护理对于公立医院改革的重要意义,总结了现阶段已经取得的成效和存在的问题,指出了优质护理的下一步发展方向.

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

    von dem Knesebeck Olaf

    2011-05-01

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

  18. Neonatal seizures triple the risk of a remote seizure after perinatal ischemic stroke.

    Fox, CK; Glass, HC; Sidney, S; Smith, SE; Fullerton, HJ

    2016-01-01

    To determine incidence rates and risk factors of remote seizure after perinatal arterial ischemic stroke.We retrospectively identified a population-based cohort of children with perinatal arterial ischemic stroke (presenting acutely or in a delayed fashion) from a large Northern Californian integrated health care system. We determined incidence and predictors of a remote seizure (unprovoked seizure after neonatal period, defined as 28 days of life) by survival analyses, and measured epilepsy ...

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

    Guiry, Michael; Vequist, David G

    2011-01-01

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

  20. Quality of death: a dimensional analysis of palliative care in the nursing home.

    Trotta, Rebecca L

    2007-10-01

    Palliative care in nursing homes is increasingly discussed, investigated, and implemented, yet the term lacks conceptual clarity and definition. Furthermore, the components, process, and outcomes of palliative care as it is delivered in the nursing home have not been clearly articulated. This paper provides a dimensional analysis of palliative care in the nursing home to elucidate the concept and its context and consequences, as portrayed through available literature. As a method, dimensional analysis is rooted in symbolic interaction and grounded theory. As such, it provides a useful tool with which to analyze existing literature on palliative care in the nursing home. In this dimensional analysis, communication is the dominant perspective of palliative care in the nursing home. This analysis demonstrates that the consequences of palliative care in the nursing home are personhood and identity, and quality of death rather than quality of life. These consequences suggest that the focus of palliative care should be on the nursing home resident and the dying experience, rather than quality of life and issues around living that exclude the dying experience and do not acknowledge the personhood and identity of the resident. These elements represent a shift in focus away from one that does not include death, toward the dying experience, and that such a change in focus is necessary to achieve palliative care in the nursing home. Finally, the analysis elucidates potential outcome measures for the study of palliative care in nursing homes and outlines possibilities for further research. PMID:17985968

  1. Perinatal mortality in Indonesia: an unfinished agenda

    Riawati Jahja

    2011-10-01

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

  2. Conditions of Caregiving, Provider Nurturance, and Quality Care

    Austin, Ann Marie Berghout; Lindauer, Shelley L. Knudsen; Rodriquez, Ariel; Nortion, Maria L.; Nelson, Farol A. Groutage

    1997-01-01

    Participants included 36 licensed family day care providers from six rural counties who had been providing care for a mean of 8.3 years (SO = 6.8 years). Fourteen of the providers had earned high school diplomas; twenty‐two had some post high school education. At least one child from an economically strained home (as measured by AFDC receipt) was present in 44.4% of the FDC homes. Dependent measures included: The Caregiver Interaction Scale (Arnett, 1989); Elaboration Scale from The Family Da...

  3. FACTORS CONTRIBUTING TO PERINATAL MORTALITY : OPTIMIZING OUTCOME

    Lakshmi; Menon Nalini; Aravind

    2015-01-01

    OBJECTIVE: To evaluate the various causes of perinatal deaths and adopt strategies to improve perinatal outcome at a referral teaching hospital in North Kerala. METHODS: A prospective observational study conducted at Institute of Maternal and Child Health, Government Medical College, Kozhikode. All perinatal deaths during the period January 2013 to December 2014 were analysed and from this factors responsible for ...

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

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

    2011-04-01

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

  5. The effectiveness of an aged care specific leadership and management program on workforce, work environment, and care quality outcomes: design of a cluster randomised controlled trial

    Jeon, Yun-Hee; Simpson, Judy M; Chenoweth, Lynn; Cunich, Michelle; Kendig, Hal

    2013-01-01

    Background A plethora of observational evidence exists concerning the impact of management and leadership on workforce, work environment, and care quality. Yet, no randomised controlled trial has been conducted to test the effectiveness of leadership and management interventions in aged care. An innovative aged care clinical leadership program (Clinical Leadership in Aged Care − CLiAC) was developed to improve managers’ leadership capacities to support the delivery of quality care in Australi...

  6. Deconstructing Quality: A Conceptual Framework for the New Paradigm in Day Care Provision for the Under Eights.

    Munton, Anthony G.; And Others

    1995-01-01

    Argues that the issue of quality in day care provision for children is relative, but that the best alternative to a universally accepted definition of quality is a conceptual framework within which different definitions of quality can be constructed. Describes and develops six dimensions of quality in day care: effectiveness, acceptability,…

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

    Orlando, Rocco; Haytaian, Marcia

    2012-08-01

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

  8. Socioeconomic inequalities in the access to and quality of health care services

    Bruno Pereira Nunes

    2014-12-01

    Full Text Available OBJECTIVE To assess the inequalities in access, utilization, and quality of health care services according to the socioeconomic status. METHODS This population-based cross-sectional study evaluated 2,927 individuals aged ≥ 20 years living in Pelotas, RS, Southern Brazil, in 2012. The associations between socioeconomic indicators and the following outcomes were evaluated: lack of access to health services, utilization of services, waiting period (in days for assistance, and waiting time (in hours in lines. We used Poisson regression for the crude and adjusted analyses. RESULTS The lack of access to health services was reported by 6.5% of the individuals who sought health care. The prevalence of use of health care services in the 30 days prior to the interview was 29.3%. Of these, 26.4% waited five days or more to receive care and 32.1% waited at least an hour in lines. Approximately 50.0% of the health care services were funded through the Unified Health System. The use of health care services was similar across socioeconomic groups. The lack of access to health care services and waiting time in lines were higher among individuals of lower economic status, even after adjusting for health care needs. The waiting period to receive care was higher among those with higher socioeconomic status. CONCLUSIONS Although no differences were observed in the use of health care services across socioeconomic groups, inequalities were evident in the access to and quality of these services.

  9. Psychosocial impact of perinatal loss among Muslim women

    Sutan Rosnah

    2012-06-01

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

  10. Cancer rehabilitation and palliative care: critical components in the delivery of high-quality oncology services.

    Silver, Julie K; Raj, Vishwa S; Fu, Jack B; Wisotzky, Eric M; Smith, Sean Robinson; Kirch, Rebecca A

    2015-12-01

    Palliative care and rehabilitation practitioners are important collaborative referral sources for each other who can work together to improve the lives of cancer patients, survivors, and caregivers by improving both quality of care and quality of life. Cancer rehabilitation and palliative care involve the delivery of important but underutilized medical services to oncology patients by interdisciplinary teams. These subspecialties are similar in many respects, including their focus on improving cancer-related symptoms or cancer treatment-related side effects, improving health-related quality of life, lessening caregiver burden, and valuing patient-centered care and shared decision-making. They also aim to improve healthcare efficiencies and minimize costs by means such as reducing hospital lengths of stay and unanticipated readmissions. Although their goals are often aligned, different specialized skills and approaches are used in the delivery of care. For example, while each specialty prioritizes goal-concordant care through identification of patient and family preferences and values, palliative care teams typically focus extensively on using patient and family communication to determine their goals of care, while also tending to comfort issues such as symptom management and spiritual concerns. Rehabilitation clinicians may tend to focus more specifically on functional issues such as identifying and treating deficits in physical, psychological, or cognitive impairments and any resulting disability and negative impact on quality of life. Additionally, although palliative care and rehabilitation practitioners are trained to diagnose and treat medically complex patients, rehabilitation clinicians also treat many patients with a single impairment and a low symptom burden. In these cases, the goal is often cure of the underlying neurologic or musculoskeletal condition. This report defines and describes cancer rehabilitation and palliative care, delineates their

  11. Identifying resident care areas for a quality improvement intervention in long-term care: a collaborative approach

    Cranley Lisa A

    2012-09-01

    Full Text Available Abstract Background In Canada, healthcare aides (also referred to as nurse aides, personal support workers, nursing assistants are unregulated personnel who provide 70-80% of direct care to residents living in nursing homes. Although they are an integral part of the care team their contributions to the resident care planning process are not always acknowledged in the organization. The purpose of the Safer Care for Older Persons [in residential] Environments (SCOPE project was to evaluate the feasibility of engaging front line staff (primarily healthcare aides to use quality improvement methods to integrate best practices into resident care. This paper describes the process used by teams participating in the SCOPE project to select clinical improvement areas. Methods The study employed a collaborative approach to identify clinical areas and through consensus, teams selected one of three areas. To select the clinical areas we recruited two nursing homes not involved in the SCOPE project and sampled healthcare providers and decision-makers within them. A vote counting method was used to determine the top five ranked clinical areas for improvement. Results Responses received from stakeholder groups included gerontology experts, decision-makers, registered nurses, managers, and healthcare aides. The top ranked areas from highest to lowest were pain/discomfort management, behaviour management, depression, skin integrity, and assistance with eating. Conclusions Involving staff in selecting areas that they perceive as needing improvement may facilitate staff engagement in the quality improvement process.

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

    Rentzou, Konstantina; Sakellariou, Maria

    2011-01-01

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

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

    Child Trends, 2010

    2010-01-01

    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…

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

    Child Trends, 2010

    2010-01-01

    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…

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

    Child Trends, 2010

    2010-01-01

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

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

    Child Trends, 2010

    2010-01-01

    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…

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

    David A. Ganz, MD, PhD

    2012-12-01

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

  18. Reforming Cardiovascular Care in the United States towards High-Quality Care at Lower Cost with Examples from Model Programs in the State of Michigan

    Daniel Alyeshmerni

    2014-07-01

    Full Text Available Despite its status as a world leader in treatment innovation and medical education, a quality chasm exists in American health care. Care fragmentation and poor coordination contribute to expensive care with highly variable quality in the United States. The rising costs of health care since 1990 have had a huge impact on individuals, families, businesses, the federal and state governments, and the national budget deficit. The passage of the Affordable Care Act represents a large shift in how health care is financed and delivered in the United States. The objective of this review is to describe some of the economic and social forces driving health care reform, provide an overview of the Patient Protection and Affordable Care Act (ACA, and review model cardiovascular quality improvement programs underway in the state of Michigan. As health care reorganization occurs at the federal level, local and regional efforts can serve as models to accelerate improvement toward achieving better population health and better care at lower cost. Model programs in Michigan have achieved this goal in cardiovascular care through the systematic application of evidence-based care, the utilization of regional quality improvement collaboratives, community-based childhood wellness promotion, and medical device-based competitive bidding strategies. These efforts are examples of the direction cardiovascular care delivery will need to move in this era of the Affordable Care Act.

  19. Quality of care for patients with non-communicable diseases in the Dedza District, Malawi

    Rachel Wood

    2015-02-01

    Full Text Available Introduction: In Malawi, non-communicable diseases (NCDs are thought to cause 28% of deaths in adults. The aim of this study was to establish the extent of primary care morbidity related to NCDs, as well as to audit the quality of care, in the primary care setting of Dedza District, central Malawi.Methods: This study was a baseline audit using clinic registers and a questionnaire survey of senior health workers at 5 clinics, focusing on care for hypertension, diabetes, asthma and epilepsy.Results: A total of 82 581 consultations were recorded, of which 2489 (3.0% were for the selected NCDs. Only 5 out of 32 structural criteria were met at all 5 clinics and 9 out of 29process criteria were never performed at any clinic. The only process criteria performed at all five clinics was measurement of blood pressure. The staff’s knowledge on NCDs was basic and the main barriers to providing quality care were lack of medication and essential equipment, inadequate knowledge and guidelines, fee-for-service at two clinics, geographic inaccessibility and lack of confidence in the primary health care system by patients.Conclusion: Primary care morbidity from NCDs is currently low, although other studies suggest a significant burden of disease. This most likely represents a lack of utilisation, recognition, diagnosis and ability to manage patients with NCDs. Quality of care is poor due to a lack of essential resources, guidelines, and training.

  20. [Access to quality primary care for LGBT people].

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

    2011-09-01

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